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M.Ss.; Samir A. El Gazar Fatma M. Mahmoud, Ph.D.; Maha F.M. Shehata Fatma Aboelmagd
The Medical Journal of Cairo University, Volume 88, pp 2111-2115; doi:10.21608/mjcu.2020.125156

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Ph.D.; Asmaa M. Elbandrawy Mohamed A. Awad, M.D.; Aya H. Abd El Hamid Amir A. Gabr
The Medical Journal of Cairo University, Volume 88, pp 2165-2175; doi:10.21608/mjcu.2020.125293

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M.D.; Salwa M. Ouis Dorreia A.M. Zaghlol, M.D.; Safaa M. El-Mahdy Wail M. Gad El-Rab
The Medical Journal of Cairo University, Volume 88, pp 2329-2336; doi:10.21608/mjcu.2020.125467

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M.D.; Ehab A. Abdelsalam Hesham A. Elshitany, M.D. Mohamed I. Refaat
The Medical Journal of Cairo University, Volume 88, pp 2411-2415; doi:10.21608/mjcu.2020.125478

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M.D. Ahlam Nasir Aboud Al Hayani
The Medical Journal of Cairo University, Volume 88, pp 2139-2145; doi:10.21608/mjcu.2020.125164

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M.D.; Mohammed A.A. Elhawary Walaa Mahmoud, M.D.; Mohamed A. Borg Ahmed G. Sadek, M.D. Mohamed F.M. Mostafa
The Medical Journal of Cairo University, Volume 88, pp 2381-2389; doi:10.21608/mjcu.2020.125475

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M.D.; Abdel Moniem El-Khateeb Mahmoud F. Sherif, M.D.; Ragai Hanna Gamal A. Makhlouf, M.Sc. Emad M. Nassif
The Medical Journal of Cairo University, Volume 88, pp 2229-2235; doi:10.21608/mjcu.2020.125306

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M.Sc.; Osama Shieha Ahmed Esmail, M.D.; Dalia Bayoumi Ahmed Galal
The Medical Journal of Cairo University, Volume 88, pp 2355-2366; doi:10.21608/mjcu.2020.125470

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M.Sc.; Nahed A. Abdulatife Amina I.E. Elkhouly, M.D. Heba M. Galal
The Medical Journal of Cairo University, Volume 88, pp 2399-2409; doi:10.21608/mjcu.2020.125477

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M.Sc.; Hesham M.A. Mansour Nehal E.A. Elshebl, M.D. Mena E. Youseef
The Medical Journal of Cairo University, Volume 88, pp 2015-2021; doi:10.21608/mjcu.2020.125141

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M.D.; Ayman M.A. Osman Dalia K. Serour
The Medical Journal of Cairo University, Volume 88, pp 2131-2138; doi:10.21608/mjcu.2020.125163

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M.Sc.; Marwa A. El-Sayed Norhan A. Helmy, M.D. Naglaa Shebrya
The Medical Journal of Cairo University, Volume 88, pp 2311-2319; doi:10.21608/mjcu.2020.125463

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M.Sc.; Hala S. El-Ozairy Amr M. Abou El-Kheir, M.D. Noha M. Elsharnouby
The Medical Journal of Cairo University, Volume 88, pp 2007-2013; doi:10.21608/mjcu.2020.125140

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M.D.; Eman A.F. Darwish Amany M.R. Abdel-Aziz, M.Sc. Sara M.M. Mahmoud
The Medical Journal of Cairo University, Volume 88, pp 2205-2215; doi:10.21608/mjcu.2020.125303

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M.D.; Doaa A. Abdel Moety Alaa I. Ali, M.D.; Mahmoud M.A. Abulmeaty Ebtesam M. Ibrahim
The Medical Journal of Cairo University, Volume 88, pp 2081-2089; doi:10.21608/mjcu.2020.125153

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M.Sc.; Salwa F. Abd El-Majied Aya S.M. Khattab, Ph.D.; Maha M. Mohammed Naser M. Alotaibi
The Medical Journal of Cairo University, Volume 88, pp 2037-2043; doi:10.21608/mjcu.2020.125145

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M.D.; Hassan S. El Sayed Ali Marwa O. Abdl El All, M.D.; Ayman M. Helal Heba H. Rohym, M.D.; Mohamed M. Khamiss Abd El Guaad Radwa M. Ahmed
The Medical Journal of Cairo University, Volume 88, pp 2337-2353; doi:10.21608/mjcu.2020.125469

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Ph.D. Hadi A. Al-Najjar
The Medical Journal of Cairo University, Volume 88, pp 2417-2420; doi:10.21608/mjcu.2020.125479

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M.Sc.; Enas F. Youssef Mohamed N.H. Abdelhamid, M.D.; Maha M. Mohammed Ahmad H. Azzam
The Medical Journal of Cairo University, Volume 88, pp 2073-2079; doi:10.21608/mjcu.2020.125152

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M.D. Alshaymaa Zakaria Mahmoud
The Medical Journal of Cairo University, Volume 88, pp 2431-2437; doi:10.21608/mjcu.2020.125481

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M.D.; Mohammed H. Elmelegy Ahmed S. Elgammal, M.Sc. Mahmoud A. Badawy
The Medical Journal of Cairo University, Volume 88, pp 2023-2029; doi:10.21608/mjcu.2020.125142

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Ph.D.; Hanan F. Abd-El Rasoul Nahla A. Mohammed
The Medical Journal of Cairo University, Volume 88, pp 2147-2155; doi:10.21608/mjcu.2020.125165

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M.Sc.; Eman S. Fayez Dina A. Abd El Salam, M.D.; Heba A. Khalifa Sandra M. Ahmed
The Medical Journal of Cairo University, Volume 88, pp 2045-2050; doi:10.21608/mjcu.2020.125148

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M.Sc.; Awatef M. Labib Fatma Alzahraa M. Ali, Ph.D.; Shimaa T. Abu El-Kasem Magda G. Sedhom
The Medical Journal of Cairo University, Volume 88, pp 2051-2057; doi:10.21608/mjcu.2020.125150

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M.D.; Hanan Farouk Mervat Abo Gabal, M.D.; Maryam A. Abdulrahman Noran O. El Azizi, M.Sc.; Neama M. Lotfy Dalia Gamal
The Medical Journal of Cairo University, Volume 88, pp 2421-2429; doi:10.21608/mjcu.2020.125480

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M.D.; Ahmed Shehta Ahmed Farouk, M.D.; Mohamed Elshobary Ahmad Mohamed Sultan, M.D. Rami Said
The Medical Journal of Cairo University, Volume 88, pp 2261-2268; doi:10.21608/mjcu.2020.125315

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M.D.; Hider Al-Shami Mohammed F.A. Ali, M.D. Hussein Soffar
The Medical Journal of Cairo University, Volume 88, pp 2249-2254; doi:10.21608/mjcu.2020.125311

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M.Sc.; Awny F. Rahmy Esraa N. Said, M.D.; Mohamed Shendy Khaled Halema
The Medical Journal of Cairo University, Volume 88, pp 2295-2301; doi:10.21608/mjcu.2020.125459

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M.Sc.; Gamal Al-Adl Amr Galal, M.D. Wael Al-Adl
The Medical Journal of Cairo University, Volume 88, pp 2217-2221; doi:10.21608/mjcu.2020.125304

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M.Sc.; Abeer A. Elwishy Mustafa I. Ahmed, Ph.D.; Nevin M. Shalaby Mahmoud Y. Elzanaty
The Medical Journal of Cairo University, Volume 88, pp 2277-2288; doi:10.21608/mjcu.2020.125455

The publisher has not yet granted permission to display this abstract.
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.; 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:
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
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.
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