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M.D.; Mohamed O. Yousif Ayman A. Gaafar, M.D.; Nardeen Adel Yacoub Bassem F. Aziz
The Medical Journal of Cairo University, Volume 88, pp 1761-1765; doi:10.21608/mjcu.2020.116823

Abstract:
Background: Dry eye is a “multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface”. Symptoms of dry eye, which include visual disturbances and pain/dysesthesias, have been found to negatively impact quality of life. Aim of Study: To assess the presence of ocular surface Matrix Metalloproteinase-9 (MMP-9) in dry eye by Infla-mmaDry® test. Patients and Methods: A prospective cross-sectional study included a total of 40 eyes with dryness. This study was involved patients visiting outpatient clinic in Qalawoon Hospital from December 2018 till May 2019. The tear film was analyzed for MMP-9 by InflammaDry®test, symptoms and signs of dry eye disease were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Tear Breakup Time (TBUT), corneal staining, Schirmer and Meibomian gland examination. Results: Mean age of the study population was 39.45 years ±9.06 SD (range 30-60), sixty five percent of study population were females. Mean of Ocular Surface Disease Index was 23.05±5.00 SD (14-33 range), Schirmer test mean was 4.60mm/5 minutes ± 2.11 SD (1-8mm/5min range), Tear Breakup Time mean was 5.40 seconds ±1.61 SD (3-9 range) and corneal staining mean was 2.45±0.68 SD (2-4 range). Seventy five percent of the study population had Meibomian glad dysfunction. There was a highly statistically significant correlation between InflammaDry® results and Meibomian glands dysfunction. There were statistically non-significant correlations between Ocular surface disease index, Schirmer test results, tear breakup time, corneal staining and positive results of InflammaDry®test. Conclusion: There is direct correlation between inflam-mation and dry eye disease. Also, Matrix metalloproteinase testing in dry eye disease is a valuable new diagnostic tool to identify the presence of ocular surface inflammation.
M.D.; Saher Ebrahim Taman Ahmad El-Morsy, M.D.; Mona Mahmoud Zaky Tamer M Belal
The Medical Journal of Cairo University, Volume 88, pp 1849-1856; doi:10.21608/mjcu.2020.118542

Abstract:
Background: Migraine is a predominant headache that features pulsating pain that is mostly unilaterally provoked by regular physical activity and is accompaniedby nausea and/or photophobia and phonophobia. A range of autonomic, cognitive, and emotional disturbances may accompany mi-graine. High prevalence and elevated socioeconomic and personal effect have been recorded by epidemiological studies. Migraine has an incidence of 14% in the overall population for one year. The Global Burden of Disease Survey ranked it as the sixth largest worldwide cause of disability. Aim of Study: The aim of this study is to assess the role of volumetric software tools using artificial intelligence in evaluation of regional gray and white matter volume changes in patients having migraine without aura. Patients and Methods: We enrolled in this prospective study 20 patients, age ranged from 13 to 52 years old (mean =33.65 years, SD=10.68), 1 male and 19 female patients (5% and 95% respectively). Ten patients (50%) suffering from right side migraine, 8 (40%) from left side and two patients (10%) suffering bilaterally. 3D T1-weighted MRI images with dedicated parameters were uploaded to NeuroQuant software which is FDA approved software for segmental brain volu-metric studies. Automated reports for volume changes were obtained. Results: Focal hypertrophy was observed in 14 (70%) patients for cerebellar white matter, 11 (55%) patients for cingulate gyrus, 10 (50%) patients for nucleus accumabens, 10 (50%) patients for Hippocampus, 8 (40%) patients for thalamus, 8 (40%) patients for isthmus cingulate, 7 (35%) patients for posterior superior temporal sulcus, anterior cin-gulate, para hippocampaleach & 6 (30%) patients for cerebral white matter and ventral diencephalon. Less percentage was noted for focal atrophy, 9 (45%) patients for medial orbitof-rontal gyrus, 7 (35%) patients for posterior superior temporal sulcus & 4 (20%) patients for ventricles. Conclusion: Patients having migraine without aura show gray and white matter volume changes in different cerebral and cerebellar areas that could be detected by MRI and improved by using artificial intelligence software programs for accurate, fast, automated volume changes detection.
M.Sc.; Ahmed A. Elshehawy Mohamed N.H. Ibrahim, M.D.; Mariam E. Mohamed Ahmed M. Bahaa El-Din
The Medical Journal of Cairo University, Volume 88, pp 1777-1782; doi:10.21608/mjcu.2020.116827

Abstract:
Background: Diabetic peripheral neuropathies are a het-erogeneous group of disorders caused by neuronal dysfunction in patients with diabetes. DPNs cause different pathological changes in sensory, Motor and Function levels in Diabetic patients. Aim of Study: Was to investigate the effect of Kinesio tape and resistive exercise on dorsiflexors' functional perform-ance in diabetic patients with peripheral neuropathy and compare between them. Subjects and Methods: Forty Type II diabetic patients-controlled-diagnosed by Physician and confirmed by Labora-tory investigations (HbA1c, FBG) with Mild DPNs, their ages from 50-60 years old were assigned to two equal Groups (Group A) was treated with resistive exercise for eight weeks, three times per week. And (Group B) who were treated with KinesioTM tape that was applied to dorsiflexors 24 hours a day and was replaced every 5 days for 8 weeks. For evaluation of the muscle strength Hand held Dynamometer were used (Lafayette Manual Muscle Tester, Model #01163), while the functional performance was evaluated using the 6 minutes walking test. Results: In Group A the mean value of muscle strength of the right dorsiflexors improved from (295.4±84.7) to (334.5 ±104.0) with the mean difference (39.2±63.2) which is a significant difference. The mean value of muscle strength of the left side improved from (296.2±115.2) to (310.8±111.1) with the mean difference (14.7±68.8) which is not a significant difference. The mean value of functional performance im-proved from (345.6±62.8) to (376.4±70.9) with the mean difference (30.7±31.8) which is a significant difference. In Group (B) the mean value of muscle strength of the right side improved from (296.1±66.8) to (385.5±102.5) with the mean difference (89.4±78.0) which is a significant difference, the mean value of muscle strength of the left side improved from (293.5±72.8) to (385.5±102.5) with the mean difference (89.4±78.0) which is a significant difference and the mean value of functional performance improved from (344.1±73.2) to (388.4±84.7) with the mean difference (44.3±38.8) which is a significant difference. In Conclusion: Both KinesioTM tape and resistive exercise improve the dorsiflexors and functional performance without significant difference between them on Dorsiflexors' strength and patients functional performance in diabetic polyneuropathy.
M.D.; Maiy Abdel-Raheim Alshahat Fatma Mohamed Sherif
The Medical Journal of Cairo University, Volume 88, pp 1893-1902; doi:10.21608/mjcu.2020.118546

Abstract:
Background: Tongue carcinoma is characterized by high recurrence rate. Thus, post-treatment follow-up imaging is critically important. Advanced Magnetic Resonance Imaging (MRI) techniques can be employed for this purpose due to the limited accuracy of conventional MRI. Aim of Study: Evaluation of the value of Diffusion Weight-ed (DW) and perfusion weighted MRI implementation in the post-treatment follow-up of tongue carcinoma. Patients and Methods: This study was conducted on 23 patients on post-treatment follow-up of tongue carcinoma. They underwent DW-MRI and Dynamic Contrast Enhanced (DCE) perfusion T1-weighted MRI to differentiate between recurrent tumor and post-treatment changes. Apparent Diffu-sion Coefficient (ADC) was estimated, perfusion MR quali-tative and semiquantitative assessment was performed. Re-sulting data were compared to histopathologic characterization (n=18) and further clinical and radiological follow-up (n=5) which were considered as the reference standards. Results: The mean ADC value of recurrent tongue carci-noma (1.029±0.207 X 10–3mm2/s) was significantly lower (p < 0.001) than the mean ADC value of post-treatment changes (1.425±0.238 X 10–3mm2/s). The ADC threshold used for differentiating recurrent tumor from post-treatment changes was 1.175 X 10–3mm2/s with Area Under the Curve (AUC) of 0.938 and diagnostic accuracy of 82.6%. Among the DCE perfusion weighted MR parameters, the wash in rate and Area Under Gadolinium Curve (AUGC) displayed the highest diagnostic accuracy (73.9%) with thresholds of 18.65a.u/s and 126826.7m.M.s respectively. The combined use of both DW-MRI and perfusion weighted MRI showed the highest diagnostic accuracy. Conclusion: The DW MRI is a non-invasive technique providing accurate post-treatment follow-up assessment of tongue carcinoma. The perfusion weighted MRI provides lower diagnostic accuracy than DWI. The combined use of both techniques provides superior differentiation of tumor recurrence from post-treatment changes.
M.D.; Naglaa A. Hussein Fatma A. ElSharawy
The Medical Journal of Cairo University, Volume 88, pp 1827-1837; doi:10.21608/mjcu.2020.118540

Abstract:
Background: Ovarian masses present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Magnetic Resonance Imaging (MRI) is currently used to evaluate ovarian tumors. Functional MRI techniques such as Diffusion Weighted MRI (DW-MRI), Dynamic Contrast-Enhanced MRI (DCE-MRI) are currently being evaluated as possible predictive and prognostic biomar-kers in the context of ovarian malignancy. Aim of Study: Differentiation between benign and malig-nant ovarian lesions by conventional MRI and assessing the role of functional MRI (f-MRI) as an advanced MRI technique for better differentiation. Patients and Methods: 30 patients with ovarian masses were included. Evaluation of functional Magnetic Resonance Imaging (f-MRI) in diagnosis of ovarian masses and differ-entiating the benign from malignant lesions in addition to conventional MRI sequences. Results: Our study included 30 patients with different ovarian lesions, 22 benign cases and 8 malignant cases proved by histopathology and laparoscopy, and the mean age was 40.37 years. Imaging all have increased the sensitivity, spe-cificity, positive and negative predictive values and accuracy from 72.7%, 66.7, 57.14%, 80%, 61.5% respectively for conventional MRI to 90.9%, 100%, 90.9%, 94.7%, 95% respectively for f-MRI. Conclusion: Combination of conventional MRI & f-MRI findings are problem-solving tool for confusing ovarian lesions, characterizing benign and malignant ovarian tumors.
M.D.; Mahmoud Wahdan Mohammed Adawi, M.D. Mohammed Mourad
The Medical Journal of Cairo University, Volume 88, pp 1649-1653; doi:10.21608/mjcu.2020.116258

Abstract:
Background: Caniopharyngiomas in spite of being benign tumors they have a high rate of recurrence of which cysts constitute major component. Ommaya Reservoir System (ORS) is a simple manoeuvre for percutaneous drainage of cysts. Aim of Study: To evaluate the efficacy of using C-arm as a guiding tool for placement of Ommaya reservoir tube in predominantly cystic recurrent craniopharyngiomas. Patients and Methods: This study included 8 patients with clinically symptomatic and radiologically confirmed recurrent craniopharyngioma with significant cystic part. These patients were treated by C-arm guided insertion of Ommaya reservoir tube. The technique is described in details. CT brain was obtained in the first post-operative night to assess the position of the tube. Post-operative clinical and radiological evaluations were compared to the pre-operative. Results: This study included 6 males and 2 females, ranging in age from 5 years to 38 years with mean age of 18.4 years. Headache was the most common presenting complaint, followed by visual impairment. All surgeries were performed with C-arm guidance and post-operative CT brain documented satisfactory position of the tube in 7 cases and only one case required second look surgery for repositioning of the tube with the same technique. Significant post-operative improve-ment of headache and visual symptoms were encountered in all cases due to decompression of the optic chiasm by cyst drainage. Conclusion: C-arm assisted insertion of Ommaya reservoir tube is a reliable method that can minimize the errors of free hand technique and of special value in low facility centers.
M.Sc.; Naglaa Shebreya Dawlat A. Abd El-Mageed, M.D. Nermeen N. Keriakos
The Medical Journal of Cairo University, Volume 88, pp 1699-1706; doi:10.21608/mjcu.2020.116376

Abstract:
Background: Determining whether a clinically diagnosed adnexal mass is benign or malignant is frequently not possible until surgical exploration and histologic examination are performed. Consequently, it may not be possible to decide pre-operatively whether conservative or radical surgery is appropriate. Areliable method with which to differentiate a benign from a malignant adnexal mass would provide a basis for optimal pre-operative planning. Aim of Study: To get judgment for the utilized MRI tools of assessment and to find out whether diffusion weighted imaging is a necessity or luxury in case we need to asses an adnexal mass. Patients and Methods: The current study is a prospective analysis that was conducted at Ain Shams University Hospital and Damnhour Scan Center from 2018 to 2019. The study was performed on 22 cases of ovarian tumors. 5 patients presented by abdominal enlargement, 5 were complaining of long standing abdominal pain, 7 came with other different complaints; 4 came complaining with frequency of micturition, dysuria, loss of weight and one case accidentally discovered during US examination. Results: DWI had shown 100% sensitivity in its individual performance; yet a low specificity which was 78.6%. Such low specificity value was attributed to the presence of benign masses that have mimicked malignancy on DWI; starting from their misleading signal intensities of restricted diffusion, down to their measured ADC values. These masses were: Mature teratomas and tubo-ovarian abscess. Conclusion: The solo performance of DWI is not an applicable way to discriminate benign from malignant adnexal masses due to its low specificity. According to us, DWI has sensitivity of (100%), but didn't improve the specificity (78.6%) or the accuracy (86.4%). DWI can help and increase confidence of MRI in assessment or exclude potential malig-nancy in complex adnexal masses; provided I) inclusion of the conventional MRI data, II) Combined analysis of DWI quantitative and qualitative criteria and iii) awareness of the possible sequence pitfalls.
M.Sc.; Nessrin G. El Nahass Mohamed A. Rabee, Ph.D.; Fatma Abd El Kader Heba A. Abdeen
The Medical Journal of Cairo University, Volume 88, pp 1507-1512; doi:10.21608/mjcu.2020.116241

Abstract:
Background: Vitamin D deficiency affects individuals in all age groups worldwide. Aim of Study: This study aimed to identify the efficacy of interval training combined with vitamin D supplementation on quality of life in women with vitamin deficiency. Subject and Methods: Forty women with vitamin D defi-ciency participated in this study. Their age ranged from 40 to 50 years. They were assigned randomly into 2 groups. The first group (A) included 20 patients who participated in an interval training exercise program with vitamin D supplemen-tation. The second group (B) included 20 patients who received vitamin D supplementation only. The interval training exercises were conducted for one hour, three times per week on a total period of 12 weeks. The quality of life was assessed by short form health survey (SF-12). Results: Before the study, there was no significant differ-ence in the mean values of all variables among the two groups. After study there was a significant improvement in both components of SF-12 in all groups with significant difference between 2 groups (p < 0.05). Conclusion: Combined interval training and vitamin D supplementation are effective for improving quality of life in women with vitamin D deficiency than either of them alone.
M.D.; Basma M.A. Alkalaawy Aya M.B.F. Hashem, M.D. Nour M.M. Kandil
The Medical Journal of Cairo University, Volume 88, pp 1589-1600; doi:10.21608/mjcu.2020.116252

Abstract:
Background: Juvenile Idiopathic Arthritis (JIA) is defined as arthritis of unknown etiology beginning before the age of 16 years and persisting for at least 6 weeks, while excluding other known conditions. Aim of Study: The purpose of this study is to highlight the beneficial role of MRI & US in the evaluation of knee joint affection in patients with juvenile idiopathic arthritis, especially in early cases. Patients and Methods: The study was carried out on fourty patients (26 females and 14 males), referred to the Radiology Department of Kasr El-Ainy Hospital from Abo El-Rish Pediatric Hospital. Their age ranged from 2.5 years up to 13 years. All patients underwent examination of the more symp-tomatic knee joint using MRI with intravenous contrast (Gadolinium) and Ultrasound (US) examinations. The results of the ultrasound were compared to those of MRI, with the MRI being the gold standard of diagnosis. Results: Among the studied cases ultrasound was able to detect joint effusion in all cases as a compressible anechoic area. It was able to detect synovitis as synovial thickening and increased vascularity on power Doppler in all cases which is evident mainly in the suprapatellar recess. The accuracy of US regarding both effusion and synovitis was 100%. Ultra-sound had great potential to identify the normal cartilage and allows for differentiation of the abnormal morphology such as loss of clarity, irregularity, and defects on the surface. In our study ultrasound was able to demonstrate most of the cases. The overall accuracy regarding cartilage changes was 90%. In this study six of the cases had bone erosions which were detected on MRI. US was able to detect four of these cases. The overall accuracy of US regarding erosions was 95%. Conclusion: Ultrasound has the ability to demonstrate knee joint pathology in early JIA which can help start early treatment or modify already existing one to prevent permanent joint damage. At this point in time, however, it is not possible to determine that ultrasound is superior to MRI, especially regarding bone erosions and the fact that it is operator depend-ent and needs experience.
M.D.; Amir Louis Louka Hana Hamdy Nassef, M.Sc. Amira Lotaif Abdullah
The Medical Journal of Cairo University, Volume 88, pp 1561-1569; doi:10.21608/mjcu.2020.116249

Abstract:
Backgroud: Microcalcificaitons constitute up to 31% of lesions detected at screening mammography. Ductal carcinoma in situ (DCIS) often presents with microcalcificaitons on mammography. Of all mammographically detected DCIS lesions, up to 79% manifest with microcalcifications only. However, not all microcalficications are associated with in situ or malignant disease. Aim of Study: To evaluate diagnostic value of contrast enhanced digital mammography in breast microcalcificaations. Methods: A retrospective study of 30 patients having mammographic suspicious breast calcifications under BIRADS 4, 5 and 6 categories. A high-energy and a low-energy digital mammograms were obtained and then images were subtracted, isolating the iodine signal in the region of angiogenesis. 1.5mg/kg of the contrast agent was injected by hand over a period of 1 minute at a rate of 3mL per second, followed by a saline solution flush. Breast compression was applied to reduce the thickness of the breast and images obtained exactly 2 min after contrast administration. Image acquisitions: Cranio-caudal and the medio-lateral oblique projections for the abnormal breast were obtained exactly 2 minutes after contrast injection followed by cranio-caudal and medio-lateral oblique projections of the normal breast. The lesions were analyzed by specialized radiologist for the presence, morphology, and pattern of enhancement. Finally, Correlation with histopatho-logical findings was done. Results: The sensitivity of CEDM in detecting malignant pathology with contrast uptake was 96%. Compared to sensi-tivity of 86.7% in FFDM. There were lesions of IDC in (69.2%), lesion of DCIS in (11.5%), lesion of IDCS & IDC in (11.5%) and lesions of ILC in (3.8%). Enhancement was also observed in 3/4 (75%) of the benign lesions. Conclusion: Dual-energy contrast-enhanced digital mam-mography is a useful technique in the diagnosis of underlying disease in mammographically detected breast microcalcifica-tions.
M.D.; Ehab M. Reyad Phebe L. Abdel-Messeih, M.D. Heba H. Mansour
The Medical Journal of Cairo University, Volume 88, pp 1655-1661; doi:10.21608/mjcu.2020.116259

Abstract:
Background: CXC chemokine ligand 16 (CXCL16) is both an oxidized low density lipoprotein receptor (ox-LDL) and a chemokine with a potential role in the pathogenesis of Diabetic Nephropathy (DN). Aim of Study: The aim of this work is to evaluate the relationship between serum CXCL16 levels and (DN) in type 2 Egyptian diabetic patients. Methods: This case-controlled study was conducted on 80 T2DM patients (group A1: 24 patients with normoalbu-minuria; group A2: 28 patients with microalbuminuria, and group A3: 28 patients with macroalbuminuria) and 20 age-and sex-matched healthy controls. All were subjected to a complete clinical evaluation and laboratory investigations which included quantitative measurements of urinary albu-min/creatinine ratio and serum CXCL16 levels by enzyme-linked immunosorbent assays. Results: Serum CXCL16 levels were significantly higher in all T2DM groups compared with healthy controls. There was a positive correlation between CXCL16, creatinine and ACR (r=0.48, p:0.039 and r=0.53, p:0.019, respectively), whereas it was significantly negatively associated to eGFR (r=–0.46, p:0.05). Regression analysis indicated that CXCL16 levels were continued significantly correlated with creatinine, eGFR and ACR (p:<0.05, for all). Conclusion: Egyptian type 2 DM patients are characterized by increased serum CXCL16 levels. There was a statistically significant correlation between CXCL16 levels and conven-tional renal markers reflecting disease progression.
M.Sc.; Nesreen G. Elnahas Soma A.G. Abd-ElGhany, Ph.D.; Youssef M.A. Soliman Zahra M.H. Serry
The Medical Journal of Cairo University, Volume 88, pp 1461-1468; doi:10.21608/mjcu.2020.115373

Abstract:
Background: Chronic Obstructive Pulmonary Disease (COPD) is a rising health problem. Dyspnea causes reduction of functional status and quality of life in it. Pursed Lips Breathing (PLB) and mouth mask use to reduce dyspnea and improve quality of life. Aim of Study: To compare the effect of mouth mask versus pursed lip breathing on ventilatory functions and dyspnea index in patient with chronic obstructive lung disease. Subjects and Methods: Forty men patient presented with chronic obstructive pulmonary disease (FEV1/FVC <0.70) were selected from outpatient clinic at Chest Department Kasr El-Ainy Hospital, age ranged from 50-65 years old. Ventilatory functions, Dyspnea index, oxygen saturation, CATscore ques-tionnaire, were measured pre and post training program. Patients were assigned in two groups. Group (A): Consisted of 20 patients were treated by expiratory breathing through Mouth Mask plus standard chest physiotherapy. Group (B) consisted of 20 patients were treated by pursed lip breathing plus standard chest physiotherapy Program was for five days per week for 8 weeks. Results: There was a significant increase in FVC, FEV1 and FEV1/FVC post-treatment compared with that pre-treatment with a percent of improvement 19.25%, 44.29%, 21.5% respectively in the group A and 8.7%, 18.37%, 8.9% respectively in group B (p < 0.001). There was a significant decrease in CAT post-treatment compared with that pre-treatment with apercent of improvement 61.07% and 46.07% respectively in the group A and B (p < 0.001). There was a significant increase in FEV1 with the mean difference between both groups was 0.28L and a significant decrease in CAT of the group A compared with that of the group B the mean difference between both groups was –5.1 (p < 0.05). There was a significant decrease in DI pre and post 3min step test post-treatment in the group A and B compared with that pre-treatment (p < 0.0001). Pre-treatment the median value of DI (pre 3min step test) of the group A was 2 and group B was 2 and that post-treatment was 0 for group A and 1 for group B. Pre-treatment the median value of DI (post 3min step test) of the group A was 3 and group B was 3 and post-treatment for group A was 1 and group B was 1.5. and comparison between the A and B post-treatment revealed a significant decrease in DI pre and post 3min step test of the group A compared with that of the group B. Conclusion: Mouth mask and pursed lip breathing are effective in improving ventilatory functions, improving of dyspnea, improving of health status and physical activity in patient with chronic obstructive lung disease. As there is improvement in CAT score questionnaire ventilatory param-eters and Dyspnea index in COPD.
M.Sc.; Mohamed Fayek Michael W. Shaker, M.D. Abd M. Ezzat
The Medical Journal of Cairo University, Volume 88, pp 1539-1552; doi:10.21608/mjcu.2020.116246

Abstract:
Background: Preventive strategies and safe surgery are of utmost importance to minimize BDI during cholecystectomy. The impor-tance of frank communication with the patient and accurate documentation cannot be overemphasized. Diagnosis requires a high index of suspicion with focused clinical, biochemical, and radiological examination. Aim of Study: Is to evaluate the best protocol in manage-ment of iatrogenic biliary injuries sustained during either laparoscopic or open cholecystectomy. Patients and Methods: 40 patients with iatrogenic bile duct injuries following cholecystectomy (open and Laparo-scopic) referred to the Department of Hepatobiliary Surgery at Sohag Teaching Hospital, Sohag Univeristy, Egypt from January 2016 to January 2018 and treated by multidisciplinary approach team including hepatobiliary surgeons, gastroenter-ologists, and interventional radiologists. Results: In this retrospective study there were 12 cases that detected intraoperatively; 2 cases of them with complete cut of CBD. 8 cases (66, 67%) with partial injury of CBD and the other 2 cases (16.67%) with partial injury of CHD; 9 cases were repaired by primary repair of CBD and 3 cases by repair over stent. There were 14 cases detected early postoperative 1 (7.14%) case with complete injury of CBD and 4 (28.57%) cases with with partial injury of CBD and 6 (42.86%) cases with ligation of CBD and one (7.14%) case with slipped cystic duct ligature and 2 cases with ligation of CHD. There were 14 cases were detected late postoperatively 3 cases of them were with slipped cystic duct ligature and 11 cases with stricture of CBD. Conclusion: Advanced laparoscopic fellowship training may decrease conversion rates of laparoscopic cholecystecto-my. This may translate into a slightly shorter duration of hospitalization for these patients, which for a high volume procedure could make a significant impact on hospital eco-nomics.
M.D.; Rania M. Sarhan Manal A. Moustafa, M.D.; Heba N.A.H. Abdel Menaem Abeer A. Abdel-Rahman, M.D.; Shimaa A. Elgohary Samia W. Abdel Sayed
The Medical Journal of Cairo University, Volume 88, pp 1487-1491; doi:10.21608/mjcu.2020.116238

Abstract:
Background: Schistosomiasis is a major health problem infecting about 7.2 million in Egypt. Praziquantel (PZQ) is the only drug effective against Schistosoma mansoni infection without effective available alternatives. VEGF was used to assess the associated schistosomal inflammatory and hepatic histopathological changes. Aim of Study: The aim of this work is to evaluate the expression of VEGF in hepatocytes and sinusoids of experi-mental infected mice with Schistosomiasis mansoni compar-ative to treated group with PZQ. Material and Methods: Swiss albino mice housed at the Animal House at Theodor Bilharz Research Institute (TBRI), Giza, Egypt were divided into three major categories: Group I (positive control); Group II (negative control); Group III (Infected mice treated with PZQ). They were infected by (60±10) S. mansoni cercariae. VEGF was measured. Results: VEGF expression was reduced in hepatocytes and sinusoids in treated group compared with positive control group with non expression in negative control group. Conclusions: VEGF is an important marker in reflection of infection and progression of treatment. It is a good marker of cure.
M.D.; Maha A. Nada Nahid S. Ahmed, M.D.; Abdi Hakim S. Mohammed Doaa A. Elaidy
The Medical Journal of Cairo University, Volume 88, pp 1477-1485; doi:10.21608/mjcu.2020.115624

Abstract:
Background: Epilepsy is a common chronic neurological condition in developing years that can negatively impact one's physical, social and emotional function. Aim of Study: The aim of this study was to assess the health-related quality of life (HRQOL) and its predictors in children with epilepsy in Egypt, comparing the relationship between different types of seizures and the HRQOL and increasing the awareness of the importance of assessing physical, psychosocial, and behavioral well-being of children with epilepsy in Egypt. Patients and Methods: To assess the health-related quality of life (HRQOL) and its predictors in children with epilepsy in Egypt during the period from August 2019 and December 2019. This cross-sectional study was conducted at Ain Shams Neurology Department and included 75 children with epilepsy of 11-18 years. The tools used to assess children's QOL were pediatric QOL questionnaires. Parents' QOL was assessed using SF36 inventory. Results: Children with epilepsy have an affected quality of life according to the PedQOL assessment tool with a mean PedQOL total score 64.4±6.9 and ranged from 56.1 to 83.6. Among the different domains of the PedQOL inventory, the results of our study showed that children with epilepsy have got higher scores in the physical and the school domains than in the emotional and social domains. Our sample was drawn from Ain Shams University Hospital. Patients attending this health facility are usually from low to intermediate socio-economic status which may explain this result. Conclusion: Epilepsy in children has a great impact on the quality of life of those children particularly on the emotional and social domains. Some antiepileptic drugs like valproic acid have a better effect on the quality of life than others. The higher the children's quality of life the higher is the parents' quality of life. The highly impacted domains of the parents quality of life according to the SF36 questionnaire were role limitation (physical or social), social functioning and mental health domain.
M.D.; Shaban M. Abdel Mageed Emad Eldin F. Ibrahim, M.D.; Amr Khedawy D. Mohammed Fawzy S. Fawzy
The Medical Journal of Cairo University, Volume 88, pp 1493-1502; doi:10.21608/mjcu.2020.116239

Abstract:
Background: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. In spite of the advantages of a distinctly faster recovery and better cosmetic results, the laparoscopic approach bears a higher risk for iatrogenic bile duct injury and injury of the right hepatic artery. Bile leak after laparoscopic cholecystec-tomy is uncommon but can occur in 0.3-2.7% of patients. A bile leak may result in a biliary fistula, a subhepatic/subphrenic collection and localised or generalised peritonitis. Despite the widespread notion that the risk of bile leak is higher after LC, there is a scarcity in the published literature that directly compared the risk of bile leak after LC versus open cholecys-tectomy. Aim of Study: To provide cumulative data about the outcome of biliary leakage after laparoscopic versus open cholecystectomy. Patients and Methods: In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from their inception till December 2018. The search retrieved 12157 unique records. We then retained 45 potentially eligible records for full-texts screening. Finally, 17 studies were included in the present systematic review and meta-analysis. Data Extrac-tion: If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Results: In terms of the primary outcomes of the present study, the overall effect estimates showed that LC significantly increased the risk of bile leak compared to OC (OR 2.01, 95% CI [1.3-3.09]; p=0.002); the pooled studies showed no signif-icant heterogeneity (p=0.74; I2=0%). Conclusion: Surgeons experienced a very low rate of postoperative bile leak following laparoscopic or open chole-cystectomy; however, the risk of bile leak appears to be higher with laparoscopic compared to open cholecystectomy. The present systematic review and meta-analysis showed that the laparoscopic cholecystectomy significantly increased the risk of bile leak compared to open cholecystectomy. These data draw attention to the importance of early identification of patients, at high risk of bile leak, as it may allow specific measures or conversion to open cholecystectomy.
M.Sc.; Ahmed M.I. Khalil Ahmed E.A. El Kordy, M.D. Mohammed M.M. Omar
The Medical Journal of Cairo University, Volume 88, pp 1641-1647; doi:10.21608/mjcu.2020.116257

Abstract:
Background: Type 2 diabetes mellitus has reached pan-demic levels with associated many co-morbidities and decrease in life expectancy. Bariatric surgery presented its value as a definitive solution for type 2 diabetes mellitus management especially with the laparoscopic surgery evolution which occurred since the 1990s. Bariatric surgery has a significant role in remission or alleviation of type 2 diabetes mellitus, weight loss, remission of comorbidities, and the improvement in the quality of life. Aim of Study: We attempt to illustrate, through the available researches, the role of laparoscopic ileal interposition associ-ated with sleeve gastrectomy in management of type 2 diabetes mellitus and the feasibility and efficacy of this procedure as an option in management of type 2 diabetes mellitus and assess the risk to benefit profiles. Material and Methods: The search is carried out using the electronic national library of medicine's PubMed database plus manual reference checks of articles published on lapar-oscopic ileal interposition associated with sleeve gastrectomy in management of type 2 diabetes mellitus in the period between February 2019 to February 2020. The jejuno-ileal interposition associated with sleeve gastrectomy can be an effective method used for management of type 2 diabetes mellitus in patients with BMI less than 35 kg/m2. Results: The results of this procedure are promising regarding its outcome in remission of T2DM and remission of its co-morbidity diseases. The operative time of the proce-dure along with its reasonable post-operative hospital stay and its results in type 2 diabetes mellitus remission may present the procedure as an alternative for other more complex bariatric procedures in management of type 2 diabetes mellitus. Conclusion: The duration time of T2DM, the drug used, the dose of the drug and the BMI of the patient affect the rate of complete remission of T2DM. The procedure can produce adequate control of hyperglycemic state in T2DM patients and satisfactory weight loss without signs of nutritional deficiencies. The procedure seems to be safe and an effective option in the management of type 2 diabetes patients with affordable risk comparing to its long term benefits.
M.Sc.; Marwa M. Serag El-Dien Gehad R.A. El-Gaphrawy, M.D.; Asmaa G. Abdou Shereen F. Mahmoud
The Medical Journal of Cairo University, Volume 88, pp 1441-1447; doi:10.21608/mjcu.2020.115260

Abstract:
Background: Bladder cancer in Egypt is the most prevalent malignancy among Egyptian males (16%), producing >7900 deaths annually, which is strikingly higher than most other parts of the world. The genesis and progression of urothelial bladder carcinoma (UBC) is known to involve alterations in several molecular pathways. Subtyping of bladder carcinoma patients based on the molecular alterations in their primary tumors may permit risk stratification and administration of more personalized therapies. Aim of Study: The aim of this study is to review the studies investigating the frequency of CK 5/6 expression and its value in the stratification of urothelial bladder carcinoma in English literature. Material and Methods: The data were retrieved from databases (PubMed, Medscape and Google scholar) and also material available on the Internet from 2001 till 2019. A structured systematic review was performed with the results tabulated. Results: The initial search presented 8 articles (2001- 2019). The frequency of CK 5/6 expression in UBC cases ranged between 19.7% and 62%. Positivity of CK 5/6 showed significant association with female gender, advanced tumor stage and pure SCC and UC with squamous differentiation. Positivity for CK 5/6 showed significant association with shorter overall survival in UC cases with squamous differen-tiation. CK5/6 expression alone was not associated with clinical outcome in any of the articles but showed significant association when combined with other markers. Conclusions: CK 5/6 as a basal marker could identify aggressive subtypes of urothelial carcinoma as those associated with squamous differentiation and advanced stage, however, it is not related to grading.
M.D.; Mohamed A. Abd Elhamid Abdelghany M. ElShamy, M.Sc. Ahmed I.A. Ibrahim
The Medical Journal of Cairo University, Volume 88, pp 1743-1751; doi:10.21608/mjcu.2020.116551

Abstract:
Background: Pancreatic Ductal Adenocarcinoma (PDAC) is one of the deadliest cancers presenting an increased mortality rate of about 3% of all cancers and about 7% of all cancer death in the United States and Europe. One of them, used for long as potential independent predictor of surgery is the Sialylated Lewis blood group carbohydrate antigen 19.9 (CA19.9). CA19.9 is detected in low levels in healthy indi-viduals (up to 37U/ml) and the level is elevated in several types of cancers including pancreatic, and also in benign conditions such as pancreatitis and choledocholithiasis. Aim of Study: To evaluate the diagnostic value of CA19.9 in predicting the resectability of pancreatic cancer. Patients and Methods: This is prospective and retrospec-tive study which was carried out on 25 patients diagnosed as patients with biopsy-proved adenocarcinoma of the pancreas. All patients were selected from Eldemerdash Hospital Uni-versity, Ain-Shams University Hospitals in the period from January 2016 to April 2019. Results: The majority of the patients have cancer head of pancreas (72%), while 20% were confined to the body and 8% were confined to the body and tail. The majority of patients (44%) underwent pancreaticoduodenectomy, 20% of patients underwent distal pancreatectomy, 4% of patients underwent total pancreatectomy, and 32% patients underwent only ex-ploratory laparotomy and biopsy. At present the best way for pre-operative staging of pancreatic cancer is bolous and tri-phase helical computed tomography, which have been showen to be almost 100% accurate in predicting unresectable disease. Serum CA19.9 level in patients with unresectable tumor was highly significantly higher compared with that in patients with resectable tumor. Positive significant correlation between CA19-9 with total bilirubin, ALT and AST. Conclusion: CA19.9 is one of the tumor markers for pancreatic adenocarcinoma. It can be used as marker to identify pancreatic adenocarcinoma with limited sensitivity and spe-cificity. The use of CA19.9 in conjunction with modern imaging techniques may improve the characterization of resectability and categorization of 'borderline-resectable' tumours, however this biomarker alone does not possess enough predictive value. Most likely, as suggested by many others, a combination of biomarkers is needed in order to achieve acceptable sensitivity and specificity in a disease with non-specific symptoms and low incidence.
M.Sc.; Ragheb A. Ragheb Ahmed A. Basiouny, M.D. Ashraf E. Elsharkawy
The Medical Journal of Cairo University, Volume 88, pp 1673-1678; doi:10.21608/mjcu.2020.116261

Abstract:
Background: Inguinal hernia repair is one of the most widely performed surgical procedure. Amongst the techniques used, the Open Lichtenstein Repair (OLR) is still the most widely performed. However, in the last decade there has been an increased interest in the laparoscopic approach for inguinal hernia repair, mainly represented as the Trans-Abdominal Pre-Peritoneal (TAPP) technique. As described in recent studies, TAPP approach entails the benefits of minimally invasive surgery, such as less pain and earlyrecovery. Aim of Study: This study aims to compare between lich-tenstein repair of inguinal hernia and transabdominal preperi-toneal repair of inguinal hernia (TAPP) as regard their hospital stay, post-operative complications and short-term recurrence. Patients and Methods: Our study was carried out on (40) male patients with inguinal hernia attendees Kobry El-Qobba Military and Alzahraa Hospital; Al-Azhar University between April 2019-Octoper 2019, 20 patients underwent laparoscopic Trans-Abdominal Pre-Peritoneal (TAPP) repair and 20 patients underwent open Lichtenstein repair. Results: In our study the mean operative time was (97.50 ±19.97) minute for TAPP, (70.30±19.55) minute for open Lichtenstein repair. None of our patients had intra-operative complications such as (vascular injury... etc). There was one patient with wound infection (5%) for TAPP repair versus two patients seroma (10%), one patient hematoma (5%) and one patient wound infection (5%) but the difference between both groups was statistically insignificant. There was no significant difference in terms of hernia recurrence. This study confirmed less post-operative pain day 0, day 1 and day 7 post-operatively. There was no significant difference in 1 and 6 month post-operatively. Conclusion: Our study showed that laparoscopic TAPP approach for inguinal hernia repair is safe and reduces early post-operative pain. Furthermore, it is related to less compli-cations. Significantly although it takes a longer operative time.
M.Sc.; Zienab A. Hussein Sara M.M. Kortam, Ph.D. Shimaa M. Refaat
The Medical Journal of Cairo University, Volume 88, pp 1725-1731; doi:10.21608/mjcu.2020.116549

Abstract:
Background: Rapid developments in technology have encouraged the use of smartphones in pediatric evaluation research and practice. Although many applications (apps) relating to physical activity are available from major smart-phone platforms, relatively few have been tested in research studies to determine their effectiveness in evaluation of children strength and muscle power. Aim of Study: The aim of the study to evaluate intra-rater reliability of smart phone application in measuring range of motion among normal children. Material and Methods: In this article, we summarize data on use of smartphone apps for estimating range of motion based upon bibliographic searches with relevant search terms in PubMed and Google scholar. Results: After screening the abstracts or full texts of articles, 20 eligible studies of the acceptability or efficacy of smartphone apps for increasing physical activity were identi-fied. Of the 20 included studies, 9 were comparative research studies, 8 were reliability studies and 2was across sectional studies. The results indicate that smartphone appscan be efficacious in pediatric evaluation although the magnitude of the intervention effectis modest. Participants of various ages and genders respond favorably to apps that automaticallytrack range of motion, track progress toward evaluation goals, and areuser-friendly and flexible enough for use with several types of range of motion. Conclusions: In conclusion, Dr Goniometer smart phone application can be used in clinical practice and research as an easy and convenient alternative to a digital and universal goniometer.
M.D.; Hider Al-Shami Mohammed F.A. Ali, M.D. Mohamed F. Alsawy
The Medical Journal of Cairo University, Volume 88, pp 1959-1966; doi:10.21608/mjcu.2020.118553

Abstract:
Background: Post-operative visual outcome in surgically treated suprasellar meningiomas is a great concern for surgeon, patient and of course for the health system. Certain reports were published before questioning about the aim of treating such tumors in which visual recovery cannot be guaranteed. It is important to classify the possible factors that may predict the prognosis thereafter. Aim of Study: Assessment of the visual function periop-eratively and to delineate the factors of visual recovery in surgically treated suprasellar meningioma. Patients and Methods: This was a retrospective analysis of 24 patients who were operated for suprasellar meningioma in Kasr Al-Ainy University Hospital from January 2018 to July 2020. The following predictive factors were tested: Age, duration of symptoms, pre-operative visual function damage, and radiological criteria of the tumor. Results: An overall improvement in visual function was seen in 14/24 patients (58.3%) in our study. The mean and standard deviation of symptoms' duration in months were 12.36±5.11 (3-23 months). Gross total resection was achieved in 19 cases (79.1%). Gross total resection achieved improve-ment of overall visual function in 73.7% of cases with statis-tically significant difference versus subtotal resection (p-value =0.03). It has been found that duration of symptoms (less than 12 months), mild pre-operative visual symptoms, tumor size less than 3cm, absence of optic nerve extension and gross total resection are related to post-operative improvement in visual outcome. Conclusion: Visual recovery of surgically treated supra-sellar meningiomas is greatly dependent on duration of symp-toms, pre-operative visual status, tumor size, adherence to strategic neurovascular structures and gross total resection.
M.D.; Wael A. Alzamil Essam Fatehy
The Medical Journal of Cairo University, Volume 88, pp 1753-1759; doi:10.21608/mjcu.2020.116821

Abstract:
Background: The discontinuity of ossicular chain most commonly affects the incudostapedial joint in 80% of patients an absent incus, or an absent incus and stapes superstructure. This discontinuity leads to a conductive hearing loss of different degrees. The goals of surgery for chronic ear disease are eradication of the disease and reconstruction of a sound transformer mechanism, but reconstructing this defect is a challenging procedure for the surgeon with different treatment options such as total ossicular chain prosthesis, a partial ossicular chain prosthesis, incus interposition, or bone cement utilization. Extrusion of the prosthesis is still a challenge in ossiculoplasty with alloplastic materials, especially in patients with poor eustachian tube function. Bone cement is cost effective, because it is cheaper than other ossiculoplasty materials, and this cost-effectiveness plays an important role in the decision the surgeon has to make, and bone cement has a promising role in this so, there is a rising interest in the otologic surgical field to use bone cement because of its biocompatible profile, its easy application, its suitable cost, and its low extrusion rate. Also, it may have a potentiality of neo-osteogenesis. Aim of Study: To evaluate the post-operative results and usefulness of bone cement application in repairing ossicular chain defects, to discuss surgical technique, and to compare pre-operative and post-operative ABG. Patients and Methods: This study was carried out in the ORL-HNS Department, Hearing and Speech Institute, from April 2015 to March 2018, on 30 patients with ossicular chain defect. Bridging of ossicular discontinuity was done by glass monomer bone cement in all patients. Results: In this study, successful hearing restoration could be achieved in 96% of the patients represented, as 52% of the patients had hearing improvement (dB gain) of more than or equal 10 dB, and 26% of patients had hearing im-provement (dB gain) more than 20 dB, and 18% of patients had hearing improvement (dB gain) of more than 40 dB, after 12 months.Conclusion: Incudostapedial joint rebridging ossiculo-plasty with ionomeric bone cement is a reliable method for ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.
M.Sc.; Mohamed A. Omar Moaaz Abd El-Monaem, M.D. Hany A. Soliman
The Medical Journal of Cairo University, Volume 88, pp 1839-1848; doi:10.21608/mjcu.2020.118541

Abstract:
Background: Intramedullary nailing of metaphyseal frac-tures may be associated with deformity as a result instability after fixation. Our aim was to evaluate the clinical use of Poller screws (blocking screws) as a supplement to stability after fixation with statically locked intramedullary nails of small diameter. Aim of Study: To evaluate the mechanical effect and clinical outcome of poller screw in metaphyseal fractures of tibia fixed by locking intramedullary nail. Patients and Methods: 15 men and 5 women (20 fractures) aged 19 to 60 (mean, 36.25) years underwent fixation of tibial metaphysis by locking intramedullary nail and poller screw. The mechanisms of injury included motor car accident in thirteen patients, fall from height in two patients, direct trauma in five patients. Radiological and clinical outcome was eval-uated. Results: Twenty patients were followed-up in the outpatient clinic for assessment of fracture healing or the establishment of a nonunion. Union was defined as the healing of at least 3 of 4 cortices on a biplanar radiograph. All the twenty patients (100%) achieved union at average time twenty weeks (ranging from 16 to 24 weeks). Conclusion: Poller (blocking) screws are an important adjunct for intramedullary nailing; aiding fracture reduction at the metaphysis, and offsetting deforming forces that cause malalignment.
M.D.; Mohammed Adawi Nasser Mosaad, M.D. Rami Teama
The Medical Journal of Cairo University, Volume 88, pp 1903-1908; doi:10.21608/mjcu.2020.118547

Abstract:
Background: The linear incision and its modifications are the most commonly used incisionsbecause of being simple and having good outcome. Linear incisions have the advantage of easier upward and downward extension. Layers of the scalp can be arranged as the mnemonic SCALP: S (Skin), C (Connective tissue), A (Aponeurosis), L (Loose areolar tissue), and P (Pericranium). Aim of Study: Is to evaluate thesufficiency of linear scalp incisions, and its resultant scar. Patients and Methods: This is a prospective study per-formed on 43 cases with different pathologies all of them were operated using linear scalp incision between January 2017 and December 2019 in Neurosurgery Department at Benha University Hospitals. Results: Forty three cases were operated using linear scalp incision in the period from January 2017 to December 2019 at Neurosurgery Department at Benha University Hospitals. The age of patients in this study ranged from 5 years to 66 years with a mean age of 29 years. The patients in this study were composed of 24 females and 19 males. The follow-up period ranged from 6 months to three years. Conclusion: Linear scalp incision has a very great safety and efficacy in different types of craniotomies. We found the disadvantages to be present in few cases and can also occur in other types of scars that may be worse than linear incisions and can be minimized by taking care of langers lines and vascular territories of the scalp and minimizing the use of artery forceps.
M.D. Ahlam Nasir Aboud Al Hayani
The Medical Journal of Cairo University, Volume 88, pp 1967-1974; doi:10.21608/mjcu.2020.118554

Abstract:
Background: GDM affects both mother and baby during pregnancy and in the long term. Metformin was associated with a lower risk of neonatal hypoglycemia; however, met-formin may slightly increase the risk of prematurity. Aim of Study: The aim of the present study was to compare the safety and efficacy of metformin as an oral anti-diabetic drug with insulin as oral hypoglycemic drugs for management of gestational diabetes mellitus. Patients and Methods: 120 pregnant women with gesta-tional diabetes mellitus were included in this randomized controlled trial. Patients were randomly allocated into 2 groups as follows: Group I: Insulin group (n=64) and Group M: Metformin group (n=56). Follow-up was done every week by measuring fasting and post prandial blood glucose level. Maternal outcomes and neonatal outcomes were recorded. Results: There were statistically significant differences as regard mean fasting and post prandial blood glucose level and mean birth weight in insulin and metformin group. Also, increased CS rate between insulin and metformin group. There were statistically significant differences between insulin group and metformin sub-groups patients as regards birth weight, Apgar score and serum glucose level. Conclusion: We concluded that metformin is an effective and safe treatment option for women with GDM. Metformin is comparable with insulin in glycemic control, providing additional evidence for the use of metformin in GDM.
M.D.; Mohamed A. Hegazy Talal A. Amer, M.Sc.; Fatma M. Sherif Ghada H. Abdelraouf
The Medical Journal of Cairo University, Volume 88, pp 1909-1916; doi:10.21608/mjcu.2020.118548

Abstract:
Background: This study aimed at assessment of the role of magnetic resonance imaging (MRI) in evaluating residual disease, and its ability to detect response after neoadjuvant chemotherapy (NAC) for locally advanced breast cancer cases. Aim of Study: The aim of this study was to assess the role of MRI in evaluating response to NAC for locally advanced breast cancer cases. Patients and Methods: This prospective study included 40 female patients with pathologically proven locally advanced breast cancer, with mean age of 43.1 years. They underwent dynamic MRI with diffusion study after neoadjuvant chemo-therapy (NAC) to assess the response after the NAC, results were compared to the histopathological results after surgery following NAC as the gold standard. The study was done at Radiology Department, Mansoura University, Egypt. This study was carried out in the period between February 2017, and September 2019. Results: MRI showed sensitivity of 91.2%, specificity 66.7%, PPV 93.9%, NPV 57.1%, and accuracy 87.5% in assessment of the response to NAC. In (17.5%) of cases MRI showed overestimation compared to the pathological results. In (5%) of cases MRI showed underestimation compared to the pathological results. Conclusion: MRI proved to be highly beneficial in assess-ment of response of locally advanced breast cancer to NAC. However, it may overestimate or underestimate residual disease in some patients. Further studies to improve the specificity of MRI may be of benefit.
M.D.; May F. Nassar Mohamed A. Abd El Wahed, M.Sc.; Heba E. El Kholy Ahmed K. Ahmed
The Medical Journal of Cairo University, Volume 88, pp 1767-1775; doi:10.21608/mjcu.2020.116826

Abstract:
Background: Malnutrition in children is common globally and may result in both short-and long-term irreversible negative health outcomes. Conventional indices fall short of portraying the full consequence of under-nutrition in the population. Screening Tool for Assessment of Malnutrition in Pediatric (STAMP) is another nutritional assessment tool which was created to solve this dilemma. Aims of Study: This study was designed to detect any deviation of nutritional status of children from 2-5 years in outpatient clinic of rural and urban areas using conventional indices (weight for age, height for age and BMI), and the newly developed STAMP. Patients and Methods: This cross-sectional study was conducted on 135 children aged 2-5 years attended the outpa-tient clinics in three hospitals, Bulaq El-Dakrur General Hospital (urban area), Al-Badrashin Central Hospital and Al-Wahat Al-Bahariya Hospital (rural areas), in Egypt. Weight and height measurements were obtained. Z-scores were cal-culated for weight-for-age (WAZ), height-for-age (HAZ) and BMI. World Health Organization growth charts were used to define underweight, stunted and obese patients and STAMP score was used to assess the risk for nutritional derangements. Dietary recall was also obtained and analyzed. Results: Children were classified as per the conventional indices and STAMP. The prevalence of normal weight, height and BMI were 80%, 59.2% and 37.7% respectively. The prevalence of marginal underweight, marginal stunting and overweight were 17%, 27.4%, and 34% respectively and the prevalence of underweight, stunting and obese were 2.9%, 11.8%, and 28.1% respectively. As per STAMP, 57% of children were at low risk, 17.7% were at intermediate risk and 25.1 % were at high risk of malnutrition. Concerning the difference between urban and rural areas, the prevalence of underweight and stunting in urban district were 0.00% and 6.7% respectively, and in rural district were 4.4% and 14.4% respectively. Conclusion: STAMP offers a valid screening tool for the detection of malnutrition and malnutrition risk in pediatric primary health care setting. It met the requirements of a nutrition screening tool in being quick and easy to use.
M.D.; Mahmoud M. Wahdan Mohammed M. Adawi, M.D. Ramy A. Teama
The Medical Journal of Cairo University, Volume 88, pp 1857-1865; doi:10.21608/mjcu.2020.118543

Abstract:
Background: Sphenoid wing meningioma en plaque is a unique subtype of intracranial meningiomas, known as intra osseous meningiomas that specifically grow at the base of the anterior and middle cranial fossa, extending to the sphenoid wing and orbit and associated with a significant hyperostosis. They result in neurosurgical complications by direct pressure of nearby cranial nerves, cavernous sinus and carotid artery. Aim of Study: Present our series of Sphenoid wing men-ingioma en plaque and to try to conclude the best surgical options and promising results. Patients and Methods: Retrospective analysis for our records regarding 22 patients with radiologically and patho-logically proven en plaque meningioma from Jan 2016 to Nov 2019. All patients underwent complete neurological examina-tion with detailed ophthalmic examination was performed. We adopted the pterional approach with its modification for all surgeries. Post operative CT scan was performed to asses degree of excision and possible recurrence. Results: Mean age was 42 years 21 were females and 1 male. The most common presenting symptom was proptosis in 20 (93%) patients and also 6 patients presented with visual affection (27%). 7 patients complained of peri-orbital pain. 5 patients observed solid swelling over the Temple region We could remove the tumors in most of cases totally Up to grade II on Simpson scale. In 5 out of 22 cases, the resection was subtotal. Improved Proptosis in 17 out of 22 patients post operative. Adjuvant radiation therapy was performed in 5 patients. After a mean follow-up of 24 monthes, 4 out of 22 patients presented by tumor recurrence (18,2%) the recurrences were mainly in the areas around the superior orbital fissure due to our inability to resect the tumor completely for fear of complications and exposed to another course of radiotherapy, No patient presented recurrence after radiation therapy. Conclusion: Early diagnosis, prompt surgical intervention with resection of all invaded bone as possible are key factors in improving outcome of spheno-orbital meningioma en plaque. Regular follow-up is mandatory as some cases may have unpredictable behavior.
M.D.; Hanan Abdelmonaem Mona Al Sayed Elkafrawy, M.D. Hala Maghraby Sherief
The Medical Journal of Cairo University, Volume 88, pp 1883-1892; doi:10.21608/mjcu.2020.118545

Abstract:
Background: Placenta accreta is serious pregnancy com-plication associated with various maternal morbidity and mortality and is currently the major cause of postpartum hysterectomy. Aim of Study: Evaluation of the value of the uterine artery color Doppler ultrasonography in the detection of placenta accrete in pregnant women with previous cesarean section. Patients and Methods: This study was a prospective observational (Cohort) study was done at Al-Zahraa University Hospital (in Obstetric and Gynecology Department) in the period from December 2017 to February 2019. All women were pregnant in a singleton fetus, their gestational age ranged from 28 to 36 weeks, with history of previous cesarean section and all patients presented with anterior low inserted placenta or placenta centralis. The study included sixty pregnant women without risk factors. Patients were recruited from the causality and the antenatal care clinic with suspected placenta previa (anterior low inserted or complete centralis) during the Third trimester of pregnancy which was confirmed by abdominal ultrasound. All the women in this study were subjected to Complete history taking, physical examination, and routine obstetric ultrasound study for detection of the location of the placenta after the 28th week of gestation and Color Doppler ultrasound study of the uterine artery. The intraoperative findings of each case were compared with the preoperative imaging findings. Results: Placenta accreta was found in 41.7% of the studied women. The study reported that the mean RI deter-mined by color Doppler ultrasonography of the uterine artery was significantly low in placenta previa with accreta. As it was 0.656±0.190 for placenta without accreta and 0.557±0.127 for placenta accreta (p < 0.001). The cutoff value of mean uterine artery Doppler PI for placenta accrete obtained from ROCK curve was £0.93, AUROC (0.636), SN (64%), SP (74.3%), PPV (64%), NPV (71.3%), accuracy (70%) and CI (95%). Conclusion: This study concluded that ultrasound and uterine artery Doppler had a role in detection of placenta accreta in cases with previous CS. The mean uterine artery RI was significantly lower in the placenta accreta compared to placenta previa without accreta.
M.Sc.; Ashraf A. Abdel Basset Amira R. Abass, M.D.; Mohamed M. Ali El Assmy Amany K. El-Hawary, M.D. Reham El-Farahaty
The Medical Journal of Cairo University, Volume 88, pp 1793-1805; doi:10.21608/mjcu.2020.116829

Abstract:
Background: To assess the serum level of sclerostin as a bone marker in children with different stages of Chronic Kidney Disease and its relation to bone status in children with CKD. Aime of Study: Is to assess the serum level of sclerostin in children with different stages of CKD and its relation to bone status in those children. Patients and Methods: The study was conducted on total of 90 children, 60 children of them were followed-up for diagnosis of CKD stages from II to V at Mansoura University Children Hospital (MUCH) Nephrology Unit. This study was done from March 2015 to March 2016. They were 34 (56.7%) males and 26 (43.3%) females with mean age SD of 11.06±3.4. Control group of 30 healthy children and were 18 male (60%) and 12 (40%) female with mean age SD of 9.6±2.3. Age ranges from three to seventeen years, complete blood picture, serum creatinine, parathyroid hormone, alkaline phosphatase, calcium, phosphorous and sclerostin serum level and also DEXA scan were measured in both groups. All patients were free from acute illness or symptoms suggestive of a urinary infection in the previous 3 months and none of them were receiving corticosteroids. Children with CKD who have diabetes, vascular calcifications or had undergone renal transplantation were excluded. Results: Elevated serum sclerostin in CKD & ESRD groups compared to control. Non-significant correlation between serum sclerostin level, biochemical bone markers and different anthropometeric measures. Conclusions: Serum sclerostin was elevated in CKD & ESRD suggesting as an indicator of bone mineral density in CKD patients but it is level didn't correlate as expected with observed BMD or bone turnover markers, suggesting presence of confounding variables that must be taken into account before routine clinical implementation. Non-significant cor-relation between serum sclerostin level and other biochemical bone markers as regard Calcium, phosphate, alkaline phos-phatase and patathemone hormone. Non-significant correlation was also detected between sclerostin, bone mineral density and body composition.
M.D. Hanan N. Gadallah
The Medical Journal of Cairo University, Volume 88, pp 1867-1882; doi:10.21608/mjcu.2020.118544

Abstract:
Background: Cyclophosphamide (CP) is commonly used as chemotherapy for many cancers as well as autoimmune disorders. However, upon treatment, it was found that it had side effect which was the cause of histological and biochemical changes due to its oxidative stress capability. Atorvastatin (ATV) at a therapeutic low dose has been found to have antioxidant and anti-inflammatory properties. Aim of Study: The present work was designed to evaluate the adverse effect of cyclophosphamide on the histology and oxidative markers of the kidneys and testes of adult male albino rats. Moreover, the study evaluated the role of Atorv-astatin in prevention and treatment of the possible renal and testicular histological and biochemical alterations induced by cyclophosphamide. Material and Methods: Twenty-four adult male albino rats were utilized in the present study, six in each group; Group I (control group), Group II receiving Cyclophosph-mideonly, Group III receiving Atorvastatin 10 days after-Cyclophosphmide, Group IV receiving Atorvastatin 5 days before and 5 days after Cyclophosphmide. The kidneys and testes of all rats were dissected and removed for investigation using light microscopic study, biochemical analysis, histomor-phometrical and statistical study. Results: Light microscopic examination of the renal cortex of the kidneys of group II showed shrunken renal glomeruli with subsequent widening of the Bowman's space, and inter-stitial inflammatory cellular infiltration. The proximal and distal convoluted tubules appeared dilated. Examination of the rat testes of group II displayed histological changes in theform of irregular distorted seminiferous tubules with marked degenerative changes of the spermatogenic epithelium. The interstitial spaces were wide containing pyknotic Leydig cells, dilated congested blood vessels and interstitial acidophilic exudate. The renal glomeruli and seminiferous tubules showed increased amount of collagen fibers deposition in the interstitial tissue in Masson's stained sections. Light microscopic exam-ination of the kidneys and testes of group III and IV showed recovery of the histological changes. Conclusion: Atorvastatin intake implicated outstanding structural recovery approaching the structural and biochemical parameters of the control group, but the improvement in group IVwas much better than in group III.
M.D.; Mohamed M. Mabrouk Fatma A. El-Sharawy
The Medical Journal of Cairo University, Volume 88, pp 1923-1931; doi:10.21608/mjcu.2020.118550

Abstract:
Background: Cirrhosis is often complicated by Esophageal Varices (EV) and portal hypertension. The use of upper GI endoscopy (GIE) as a screening method is limited regarding invasiveness, expensive, needs sedation as well as patient's poor acceptance of the procedure. In contrast; Multidetector Computed Tomography (MDCT) imaging is non-invasive, does not necessitate sedation, and allows accurate assessment of variceal site and size, also better tolerated by patients than upper GI Endoscopy (GIE). Aim of Study: To prove that MDCT is a non-invasive alternative diagnostic tool to EGD in grading of Esophageal Varices. Patients and Methods: 50 patients with liver cirrhosis were included. Evaluation of Multidetector Computed Tom-ography (MDCT) in the diagnosis of esophageal varices and its grading was done by comparing the grades of Esophageal Varices at Multidetector Computed Tomography (MDCT) and upper GI endoscopy independently. Extra-esophageal findings were also assessed by Multidetector Computed Tomography (MDCT) that cannot by (GIE). Results: At upper GI endoscopy, 3 patients had grade 0 Esophageal Varices, 25 patients had grade 1, 16 patients had grade 2 and 6 had grade 3. The sensitivity, specificity, positive and negative predictive values and accuracy of Multidetector Computed Tomography (MDCT) for defining Esophageal Varices in all grades were 99.5%, 99.6%, 99.4%, 99.5% and 99.5% respectively. Important extra-esophageal findings were determined by Multi-Detector Computed Tomography (MD-CT) only. The acceptance of patients for Multidetector Com-puted Tomography (MDCT) was significantly more than that for upper GI Endoscopy (GIE). Conclusion: Multi-Detector Computed Tomography (MD-CT) is a fast, non-invasive procedure for diagnosis and grading of Esophageal Varices.
M.D.; Ahmed El Shimy Sherine K. Amin, M.Sc. Mahmoud M.A. Abdul Salam
The Medical Journal of Cairo University, Volume 88, pp 1553-1559; doi:10.21608/mjcu.2020.116247

Abstract:
Background: Breast cancer is the most commonly occur-ring cancer in women and one of the most important causes of death. 1.67 million new cases of breast cancer were iden-tified worldwide, accounting for 25% of all cancers. The incidence and mortality rates of breast cancer is rising. Patient survival rates depend on both early diagnosis and improved treatment modalities including surgery, radiotherapy and chemotherapy. Aim of Study: To investigate the accuracy of dynamic contrast material-enhanced (DCE) breast MRI for determining residual tumor size after neoadjuvant chemotherapy (NAC) and detect the value of measuring residual size in delayed phase compared to early phase. Patients and Methods: The study started at December, 2019 and included twenty female patients who were newly diagnosed breast cancers after completion of NAC referred from surgical oncologists to Radiodiagnosis Departments of Ain Shams University and Nasser Institute Hospitals. Each patient was subjected to full history, reviewing medical sheet and dynamic contrast enhanced MRI using 1.5 T unit (GE). Results: DCE-MRI after NAC underestimation rate was found to be about 50% Vs 15% overestimation rate. 51% NPV Vs 93% PPV was reported. Delayed phase better correlated with postsurgical histopathological size than early phase. Conclusion: DCE-MRI has lower accuracy when per-formed after NAC. It tends to underestimate residual tumor size. Delayed phase is more accurate than early phase in evaluating residual tumor size.
M.D.; Mohamed G. Abdel Mutaleb Sherine K. Amin, M.Sc. Latifa E. Gad
The Medical Journal of Cairo University, Volume 88, pp 1715-1723; doi:10.21608/mjcu.2020.116379

Abstract:
Background: Automated Breast Ultrasound technology (ABUS) allows the radiologist to interpret ultrasonography images in a separate time after acquisition. Different interpre-tation times have been reported, ranging from 5 to 10min, probably according to differences in readers' experience and complexity of each case. Aim of Study: To detect the impact of ABUS technique's advantages, pearls and pitfalls combining with mammography compared with mammography alone, significantly improved detection of breast cancers in women with dense breast tissue without substantially affecting specificity. Patients and Methods: This cross-sectional study was conducted on of 20 women at Radiodiagnosis Department, Shoubra General Hospital referred from surgery clinic during a period of about one year. The study was limited to only females who were willingness to undergo additional investi-gations after being diagnosed as dense breast on mammo-graphy. Results: We found that cases with ABUS study shows sensitivity about (60%) which is more than that of mammogram (30%) but less than HHUS (80%); while ABUS (70%) was less specific than both mammogram (100%) and HHUS (90%). Accuracy of HHUS (85%) was more than that of both mam-mogram (65%) and ABUS (65%), with p-value (0.257) to both mammogram and ABUS, and (0.008) to HHUS. Conclusion: Adding automated breast ultrasound to mam-mography is of great value in detection of breast cancer in mammographically dense breasts. It increases the detection rate of breast lesions mostly cancer. It is important as screening tool to decrease doses of radiation that female exposed to while mammogram screening.
M.D.; Ayman A. Albaghdady Ayman A. Talaat, M.D.; Mohammad R. El-Shahawy Ahmed B. Arafa
The Medical Journal of Cairo University, Volume 88, pp 1503-1506; doi:10.21608/mjcu.2020.116240

Abstract:
Background: Pediatric chronic constipation and obstructed defecation is a challenging problem, with bad impact on quality of life affecting both the child and family. It is a complex disorder of multifactorial etiology and pathophysi-ology. Many symptoms-based systems have been instructed for clarifying definitions for chronic constipation and obstruct-ed defecation such as ROME IV criteria, PACCT criteria, NICE guideline. Most protocols of management of functional constipation usually include; disimpaction enemas, feeding regulations, bowel diaries and laxatives. Aim of Study: To evaluate the effectiveness of adding anal Botox injection to those already following management plan for pediatric age group suffering from chronic constipation and obstructed defecation. Patients and Methods: The current study included 40 children with functional constipation, and obstructed defeca-tion. The study started in April 2017 and completed the patients follow-up in November 2019. Bowel management program was applied with Botulinum toxin injection. Patients were followed-up at 2 months, and 6 months using Rintala Scores. Results: The study included 45% female members and 55% male ones, with age range between 3-12 years. Improve-ment was achieved in 22.5% of children after 2 months of the management, all patients were followed-up at least for 6 months period, with a mean follow-up of 11.35 months. Rintala scores at initial presentation, 2 months and 6 months follow-up showed improvement. Overall, across all the study subjects, females did better and showed more improvement. Conclusion: This study has confirmed that BT injection did not add any significant effect, to children with obstructed defecation and chronic FC.
M.Sc.; Mohammed A. Ali Maysa S. ElKerdawy, M.D. Nermeen N. Keriakos
The Medical Journal of Cairo University, Volume 88, pp 1523-1530; doi:10.21608/mjcu.2020.116243

Abstract:
Background: Investigation of the probable causes of female infertility is complex and in many instances a compli-cated process. Aim of Study: To discuss the role of ultrasound in detection of causes of female infertility (including those disorders of cervix, ovaries, fallopian tube and uterus) illustrated by few cases. Patients and Methods: This cross sectional study was conducted on thirty female patients seeking fertility at Itay scan private radiology center, Itay Elbaroud and Al Dlangat General Hospitals, during the period from January 2018 to January 2020. All patients were subjected to examination using (GE healthcare Voluson P8 and Toshiba Nemio 30 and Medison Sono Ace R3) Ultrasound Machines. Results: Uterine abnormalities represent about 60%, cervical abnormalities represent 3.3% and ovarian abnormal-ities represent 23.3%, while tubal abnormalities represent 13.3% of the study group. Mean age of uterine abnormalities is about 30.5 years old, cervical abnormalities about 26 years old, ovarian abnormalities about 26 years old while mean age of tubal abnormalities is 30.5 years old in the study group. In most cases of female infertility in our study, ultrasound has been of great value: e.g. uterine malformations (sub septate and bicornuate uterus), endometrial abnormalities (endometrial polyp and focal endometrial hyperplasia), myometrial diseases (fibroids and uterine adenomyosis), tubal abnormalities (in-cluding hydrosalpinx and endometriosis), ovarian functional abnormalities (polycystic ovary) and cervical abnormalities (cervical masses). Conclusion: Ultrasound is a reliable tool in the diagnosis of many anatomical causes of female infertility and is com-parable to gold standard investigations in many circumstances, so we recommend it as primary investigation modality that could be complemented by other tools e.g. MRI, HSG, and laparoscopy when needed.
M.Sc.; Yousuf M. Al-Balawy Fatimah I. Abdul-Shafy, Ph.D.; Ebtesam M. Fahmy Hoda M. Zakaria
The Medical Journal of Cairo University, Volume 88, pp 1601-1614; doi:10.21608/mjcu.2020.116253

Abstract:
Background: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Aim of Study: The aim of the study was to investigate the efficacy of sensory re-education paradigm on functional outcomes of patients with carpal tunnel syndrome. Subjects and Methods: Thirty participants was be randomly assigned to either the sensory re-education paradigm group or the traditional physical therapy group. First group (control group), the patients received standard physical therapy program including progressive active and resisted therapeutic exercises, median nerve gliding exercises and tendon gliding exercises. Second group (experimental study group), the patients received sensory re-education paradigm as the followings; Step 1: Splinting as a constant maintained touch for fifteen minutes, Step 2: Topical anesthesia for pain reduction by using 8% Lidocaine spray for 15 minutes, Step 3: Massage using different textures; graduating from the softest to rougher one with same speed and pressure, Step 4: Proprioceptive Neuromuscular Facilitation (PNF) technique using extension, adduction and internal rotation with extended elbow pattern. Sensory function was assessed by Semmes-Weinstein monofilament, pain intensity level was assessed by a Visual Analogue Scale (VAS), hand grip was assessed by using hand held dynamom-eter and functional outcomes were assessed by using Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Results: There was a statistically significant improvement in the measured parameters in both groups when comparing their pre and post-treatment mean values. However, significant difference was recorded between the two groups after treatment in favor of the study group. Conclusion: The obtained results suggest that the appli-cation of sensory re-education paradigm become a beneficial therapeutic technique in improving the functional outcomes as a whole in patients with CTS when adjunct to a physical therapy program.
M.D.; Usama M. Abdelwahab Mohamed A. Youssef
The Medical Journal of Cairo University, Volume 88, pp 1089-1095; doi:10.21608/mjcu.2020.110845

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M.Sc.; Abeer M. Abd Elhameed Maggie S. Abd Elgawad, M.D. Samar R. Ragheb
The Medical Journal of Cairo University, Volume 88, pp 1031-1039; doi:10.21608/mjcu.2020.110838

The publisher has not yet granted permission to display this abstract.
M.D.; Mohamed A.S. Kohla Mahmoud H. Allam, M.D. Wesam S. Morad
The Medical Journal of Cairo University, Volume 88, pp 1247-1255; doi:10.21608/mjcu.2020.110876

The publisher has not yet granted permission to display this abstract.
Ph.D.; Ahmad A. Mohammed Haidy N. Ashm, Ph.D.; Yassmin M. El-Tabakh Khadra M. Ali
The Medical Journal of Cairo University, Volume 88, pp 1393-1397; doi:10.21608/mjcu.2020.110950

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M.D.; Nader A. El Borey Mamdooh El Sharawy, M.Sc.; Ahmed M.A. Bakry Dina M. Osman
The Medical Journal of Cairo University, Volume 88, pp 1233-1237; doi:10.21608/mjcu.2020.110874

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M.D.; Mervat E. Behiry Basma M. Medhat, M.D. Naglaa Afifi
The Medical Journal of Cairo University, Volume 88, pp 1065-1071; doi:10.21608/mjcu.2020.110842

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M.D.; Mohamed Halawa Salah Shelbaya, M.D. Merhan Nasr
The Medical Journal of Cairo University, Volume 88, pp 1413-1421; doi:10.21608/mjcu.2020.110954

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M.D.; Hashem Aboul-Ela Mohammed F. Adel Ali, M.D.; Ahmed M. Salah Ahmed Ali Mohamed
The Medical Journal of Cairo University, Volume 88, pp 1357-1363; doi:10.21608/mjcu.2020.110944

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M.D.; Ahmed S. Abdelrahman Tougan T. Abdelaziz
The Medical Journal of Cairo University, Volume 88, pp 1007-1016; doi:10.21608/mjcu.2020.110835

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M.D.; Hussein Soffar Ahmed Ali
The Medical Journal of Cairo University, Volume 88, pp 1365-1371; doi:10.21608/mjcu.2020.110945

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M.D.; Nader E. Awad Amr F. Abo El Fotouh, M.D.; Asem Sh. Abd El Khalique Jane N.R. Aboulenein
The Medical Journal of Cairo University, Volume 88, pp 1239-1245; doi:10.21608/mjcu.2020.110875

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M.D.; Ahmed E. Abd El-Alim Ehab A. Abd Elatty, M.D.; Khaled M. Elsayed Reem M. Elkholy
The Medical Journal of Cairo University, Volume 88, pp 1203-1211; doi:10.21608/mjcu.2020.110870

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