STUDY OF THE IMPACT OF MICROALBUMINURIA ON THE MORBIDITY AND MORTALITY OF THE ACUTE CORONARY SYNDROME IN DIABETIC PATIENTS DURING ICU ADDMISSION
M.
Kamar
Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.
author
M.
Assy
Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.
author
Hatem
Salem
Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
author
Mohamed
Saad
Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
author
Nermin
Raafat
Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Egypt
author
text
article
2013
eng
Background: Microalbuminuria (MA) is a well- known risk factor for coronary artery disease (CAD) in diabetics and non diabetics. It is associated with higher cardiovascular mortality. However, the impact of MA on the morbidity and mortality of the acute coronary syndrome (ACS) in diabetic patients is not definitively known and the relationship between the degree of albuminuria and outcome of ACS is unclear. Aim of the Work: To Study the morbidity and mortality of diabetic patients presenting with acute coronary symptoms in relation to presence of MA during ICU admission. Patient and Methods: This study was planned to evaluate the impact of MA on outcome of ACS in diabetics patients admitted to ICU in internal medicine department Zagazig University. The study included 80 patients with acute coronary syndrome 60 diabetics and 20 non diabetics. Patients were classified into four groups: Group (A): 20 ACS non diabetic patients with no albuminuria. Group (B): 20 ACS type 2 diabetic patients without albuminuria. Group (C): 20 ACS type 2 diabetic patients with MA. Group (D): 20 ACS type 2 diabetic patients with macroalbuminuria. Urinary albumin excretion rate was performed to all patients with ACS. They were followed up during their staying in the ICU for the occurrence of heart failure, pulmonary embolism, shock, arrithymia or death. Serum lipid profile and HbA1c were performed also for all patients. Results: Complications occurred more significantly in albuminuric patients with MA (70%) and with macroalbuminuria (65%) than non albuminuric patients (20%);(P<0.001). Complications also occurred more significantly in patients with HbA1c>7%(69.7%) than those with HbA1c<7%(30.3%);(P<0.001). Also complications occurred more significantly in patients with serum triglyceride>150 mg/dl(78.4%) than those with serum triglyceride<150 mg/dl(14%);(P<0.001) and LDL>100mg/dl(82.4) than those with LDL<100mg/dl(15.3%);(P<0.001). Conclusions: There is a significant prevalence of albuminuria in diabetic patients in comparison with non diabetic patients. Complications including life threatening disorder as arrhythmia, heart failure, shock and cardiac arrest occurred more significantly in diabetic albuminuric patients with ACS during admission to ICU. Complications occurred more significantly in patients with abnormal lipid profile especially patients with hypertriglyceridemia or LDL > 100mg/dl.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
11
https://zumj.journals.ekb.eg/article_4316_c89fa68889275afa7550a4c710ec45be.pdf
dx.doi.org/10.21608/zumj.2013.4316
STUDY OF SOME BIOMARKERS IN FRAIL ELDERLY
Abdallah
Abdel-Rahman
Internal Medicine Department, Faculty of Medicine, Zagazig University
author
Nabila
Hussein
Internal Medicine Department, Faculty of Medicine, Zagazig University
author
Hamed
Deraz
Internal Medicine Department, Faculty of Medicine, Zagazig University
author
Emam
Esmayel
Internal Medicine Department, Faculty of Medicine, Zagazig University
author
Waseem
Seleem
Internal Medicine Department, Faculty of Medicine, Zagazig University
author
Marawan
Atiyah
Internal Medicine Department, Faculty of Medicine, Zagazig University
author
Emad
Hamed
Internal Medicine Department, Faculty of Medicine, Zagazig University
author
Ayman
N.
Internal Medicine Department, Faculty of Medicine, Zagazig University
author
Reda
Salem
Internal Medicine Department, Faculty of Medicine, Zagazig University
author
text
article
2013
eng
Background: Frailty recognized as a common clinical syndrome associated wih a high rate of morbidity and mortality.Aim of the Study: This study aimed at assessing the value of determination of some biomarkers in identification and recruitment of frail elderly. The association between these biomarkers and stages of frailty were also assessedSubjects and Methods : A total number of 100 elderly subjects (above 65 years old) were included in the work divided into three groups : Group 1 (non-frail) included 34 subjects (19 males and 15 females), their ages ranged from 66.3 to 72.9 with mean 67.6 + 3.3 year; Group 2 (pre-frail) included 26 subjects (1 males and 15 females), their ages ranged from 65.5 to 73.1 with mean age of 69.3 + 3.8 year and Group 3 (frail) included 40 subjects (25 males and 15 females), their ages ranged from 67.9+ to 78.3 with mean age of 73.1+5.2 year.All subjects of this study were subjected to : thorough clinical examination, Anthropometric measures (including mid upper arm circumference, mid calf circumference, body mass index), Timed get-up-and-go test, hand grip strengh test and laboratory investigations (including complete blood picture, serum albumin, serum alanine transferase, INR. Prothrombin time and partial thromboplastin time, Cholesterol and C-reactive protein.Results: In our study; frailty recorded higher prevalence than most of epidemiological studies. Regarding CRP, there was significant increase in CRP level in frail group (27.4 + 8.1 mg/l) compared to both pre-frail (14.3 + 4.5 pg/ml) and non-frail groups (7.5 + 5.5 pg/ml). Regarding cholesterol, there was significant decrease in cholesterol level in frail group (125.7 + 54.9) compared to both pre-frail (168.1 + 17.2) and non-frail (165.3 + 29.7) groups. Regarding TGUGT, it was prolonged in frail group compared to both pre-frail and non-frail groups.Conclusions: There is high prevalence of frailty among studied elderly population, the causes of which need further studies to unravel. The changes in biomarkers noticed in our frail elderly may suggest its use in diagnosis and follow up of frailty, a suggestion that still in its infancy and needs further more studies to verify.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
11
https://zumj.journals.ekb.eg/article_4317_e7a0a959d926144fb994bea743f9f838.pdf
dx.doi.org/10.21608/zumj.2013.4317
EFFECT OF PREGNANCY ON THE LIPID PROFILE IN EGYPTIAN WOMEN
Ghada
Ibrahim
Cardiology Department, Faculty of Medicine, Zagazig University
author
text
article
2013
eng
Background:Blood lipid concentration increase significantly during pregnancy. The increased progesterone in the 2nd half of pregnancy may act to reset the lipostat in the hypothalamus. There is conflicting evidence for an association between parity and the risk of cardiovascular disease in women. Previous studies have reported a decline in HDL cholesterol up to 10 years after the first pregnancy.Objective: To detect the effect of pregnancy on the lipid profile during normal pregnancy in the different trimesters.Patients andMethods: This study included 100 cases; 80 pregnant women and 20 healthy non-pregnant women matched for age as control. All patients subjected to: Compete history taking and clinical examination, twelve leads resting surface ECG, echocardiography and total Lipid Profile (at the middle of each trimester and 6-12 weeks post-partum) In general, the test performed following 12 hours overnight fast.Results:The total cholesterol and triglycerides were significantly increased from the 1stto the 2ndtrimester with further significant increase in the 3rdtrimesterand after delivery there were highly significant decrease in both. (TC changed from 196+18 mg/dl to 216 +19.3 mg /dl to 243+13.5 mg/dl with P<0.05 then to 187.1+19.3 mg/dl with P<0.001, respectively). The LDL cholesterol, HDL cholesterol and VLDL cholesterol were non-significantly changed from the 1sttrimester to the 2ndtrimester with significant increase in the 3rd trimester and after delivery it was highly significant decreased to the below or near the 1sttrimester level(LDLchanged from 119+ 9 mg/dl to 111.9+11.5 mg /dl to 123.5+11.9 mg/dl with P>0.05 then to 112.6+13.8 mg/dl with P<0.001, respectively) (HDL changed from 41.9+ 14 mg/dl to 42.8+15.4 mg /dl, with P<0.05 then to 57.9+23.1 mg/dl to 48.6+25 mg/dl with P<0.001, respectively) Conclusions:We have demonstrated that normal pregnancy is associated with raised triglycerides and cholesterol. By the third trimester most women have a lipid profile which would be considered highly atherogenic in the non-pregnant state. However this represents a transient disturbance which reverts to normal after delivery. Further studies are needed to determine the risk and cardiovascular effects of disturbed lipid profile during pregnancy especially in multipara women with repeated pregnancy.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
6
https://zumj.journals.ekb.eg/article_4318_0b1defd8dce164811f2f414c684408a9.pdf
dx.doi.org/10.21608/zumj.2013.4318
THYROTOXIC PERIODIC PARALYSIS: DIAGNOSIS, MANAGEMENT AND ROLE OF PROPRANOLOL IN TREATMENT
Jehan
Saeed
Department of Internal Medicine
author
Ayman
Fathy
Department of Internal Medicine
author
Ayman
N.
Department of Internal Medicine
author
Osama
Al Azoni
Department of Neurology, Zagazig University
author
text
article
2013
eng
Background: Hypokalemia is commonly encountered during paralysis in patients with thyrotoxic periodic paralysis (TPP) and may contribute to neuromuscular manifestations. This condition mainly affects male patients of Asian descent. With increasing population mobility and admixture, TPP as the presenting feature of hyperthyroidism is more common in Western countries and Gulf area. TPP is an alarming and potentially lethal complication of hyperthyroidism characterized by muscle paralysis and hypokalemia due to a massive intracellular shift of potassium. A potassium supplement has been recommended to hasten recovery and prevent cardiopulmonary complications. However, this recommendation has not yet proven efficacious. Hyperadrenergic activity has been implicated in the pathogenesis of TPP. We tested whether nonselective β-blockers could terminate neuromuscular symptoms rapidly while reducing an intracellular shift of potassium. Methods: We describe 7 patients who had an acute attack of TPP with characteristic hypokalemia. Results: After oral propranolol, 3 mg/kg, serum potassium concentrations increased promptly in all patients, and there was complete amelioration of paralysis. Only 3 patient needed short term K supplement for their sever hypokalemia and sever symptoms. No rebound hyperkalemia was detected. Conclusion: Given propranolol efficacy in this study, propranolol should be considered as a first-line therapy for TPP.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
6
https://zumj.journals.ekb.eg/article_4319_af2644cabdb89e2acd907fe7804b52f3.pdf
dx.doi.org/10.21608/zumj.2013.4319
AN INTERVENTIONAL STUDY TO DECREASE CENTRAL VENOUS CATHETER RELATED BLOOD STREAM INFECTION IN INTENSIVE CARE UNITS AT ZAGAZIG UNIVERSITY HOSPITAL
Wafaa
El Nemr
Faculty of Medicine, Zagazig University
author
Hoida
Fahmy
Faculty of Medicine, Zagazig University
author
Ghada
Abed El Razek
Faculty of Medicine, Zagazig University
author
Noha
Abed El Salam
Departments of Public Health and Ansethiology & Intensive Care
author
text
article
2013
eng
Background: Catheter related blood stream infection (CRBSI) is a complication of central venous catheter (CVC) use. This Infection particularly in the ICU population results in higher levels of morbidity and mortality coupled with greater costs in terms of care and increased duration of hospital stay. Aim & Objectives: The aim of this study is to improve the safety of patients with CVC via decreasing the incidence of CRBSI in ICUs patients at Zagazig University Hospital through the following objectives: 1- Calculation the incidences of CRBSI in ICUs patients over six months before and after intervention through active surveillance. 2- Assessment the level of the knowledge and adherence of health care providers in ICUs to evidence based guidelines recommended by CDC to decrease the incidences of CRBSI in ICUs patients before and after intervention. 3- Implementation of health education program on ICUs health care providers i.e. providing them by information about evidence based guidelines recommended by CDC to decrease the incidence of CRBSI in ICUs patients.Subjects & Methods: An interventional study was conducted in surgical and emergency ICUs at Zagazig University Hospital during the academic year between 2011 and 2012. All patients with CVC in the studied ICUs were consecutively enrolled in the study and all health care providers working in the studied units and involved in insertion, maintenance and care of CVC during the period of study were included in the study. The study was carried out through 3 phases. Results: Statistically, there is a significant improvement in physician practice in both ICUs after intervention. The incidence of CRBSI decreased after intervention in surgical ICU but in comparison with that before intervention it was found no significant difference. In emergency ICU, the incidence of CRBSI after intervention is 0% and in comparison with that before intervention it was found a significant difference. Incidence of CRBSI decreased from 6.01/1000 catheter-days to 3.9/1000 catheter-days after intervention in surgical ICU. In emergency ICU, the incidence of CRBSI was 0% after intervention. Conclusion: This study revealed that, implementation of simple education program increased adequacy of knowledge, improved the practice of healthcare providers and reduced CVC blood stream infection rates in ICUs by almost 50%, during the intervention period.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
16
https://zumj.journals.ekb.eg/article_4320_e3a7576e7ee2b3c13f769a37995a48ec.pdf
dx.doi.org/10.21608/zumj.2013.4320
MANAGEMENT OPTIONS FOR CEREBRAL GLIOMAS
Wael
El-Mesallamy
Neurosurgery Department, Faculty of Medicine, Zagazig University
author
Hamdy
Farahat
Neurosurgery Department, Faculty of Medicine, Zagazig University
author
Tarek
Abdel Bary
Neurosurgery Department, Faculty of Medicine, Zagazig University
author
Magdy
Rashed
Neurosurgery Department, Faculty of Medicine, Zagazig University
author
text
article
2013
eng
Background: Cerebral gliomas are the most prevalent primary brain tumors in adult patients. Objectives: The purpose of this prospective study was evaluation of various management strategies including surgery facilitated by intraoperative ultrasonography, radiotherapy and chemotherapy with addressing impact of various factors on the outcome. Patients and methods: In a prospective evaluation, we studied 55 adult patients with primary cerebral gliomas who were operated upon at our department between January 2009 and January 2011 with follow up at least one year for survived patients. Radiotherapy was received postoperatively by 48 patients of whom 34 patients received chemotherapies. All clinical, radiological, imaging, pathological and management modality records were evaluated as prognostic factors. Results: The mean survival time was 13.7 months. We confirmed that the patient age, preoperative functional status (by Karnofesky scale), location of cerebral gliomas, size of gliomas, extent of resection, intraoperative ultrasonography use, grades of glioma and postoperative functional status as decisive prognostic factors and had an impact on outcome. Conclusion: We could show that young ages (≥ 16-40 years), high preoperative Karnofesky scores (≥ 80%), single-lobe involvement by glioma, small tumor size (≤ 5 cm), gross total resection, intraoperative ultrasonography use, low-grade gliomas and high postoperative Karnofesky scores (≥ 80%) were predictors for better outcome.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
11
https://zumj.journals.ekb.eg/article_4321_3d20c82f6d8f718a336bee4728d86017.pdf
dx.doi.org/10.21608/zumj.2013.4321
ROLE OF DIFFUSION – WEIGHTED MAGNETIC RESONANCE IMAGING IN CHARACTERIZATION OF VERTEBRAL BONE MARROW PATHOLOGICAL LESIONS
Khaled
Lakouz
(Radiodiagnosis departments, Faculty of Medicine, Zagazig University
author
Hesham
Radwan
(Radiodiagnosis departments, Faculty of Medicine, Zagazig University
author
A.
Sarhan
Neurology departments, Faculty of Medicine, Zagazig University
author
Rania
Elmolla
Radiodiagnosis departments, Faculty of Medicine, Zagazig University
author
text
article
2013
eng
AIM: To evaluate the role of diffusion weighted magnetic resonance imaging in characterization of vertebral bone marrow pathological lesions. MATERIALS AND METHODS: Forty patients with bone marrow abnormal MRI signal intensity were enrolled in the study and upon MRI finding they wear grouped into four groups. DWI was performed with b values of 0and 500 s/ mm2. Results of the histo-pathological evaluation or MRI follow up or isotope were compared with the DWI results. Apparent diffusion coefficient (ADC) values were calculated. RESULTS: All cases of malignant collapse (4 cases 10%) were hyper intense on DWIs and hypo intense on ADC map with mean ADC (0.8 ± 0.33 x 10−3 mm2/s). All benign osteoporotic collapse cases (7 cases 17.5%) were hypo intense (3 cases) or iso to hypo intense (4 cases) on DWIs and all wear hyper intense on ADC with mean ADC (1.64 ± 0.33 x 10−3 mm2/s). Twelve cases with endplate changes, the eight infectious spondylitis recorded mean ADC value (1.03 ±0.33× 10−3mm2/s). The remaining, 4 cases (10 %) with degenerative Modic I end plate changes recorded ADC value (1.76 ±0.33× 10−3mm2/s). Also (3 cases) malignant bone marrow infiltration without collapse were hyperintense on DWIs and hypointense on ADC map with mean ADC (0.8 ± 0.33 x 10−3 mm2/s). The mean ADC in hemangioma was (1.9 ± 0.33 x 10−3 mm2/s) and in ABC (1.93 ± 0.33 x 10−3 mm2/s). DW study of 4 cases respond to therapy recorded mean ADC value (1.64 ±0.33× 10−3mm2/s), however, the 2 cases with residual viable tumor tissue record (0.79 ±0.33× 10−3mm2/s). DWI and ADC values have high sensitivity and specificity in differentiating benign from malignant lesions and in post therapy follow up.CONCLUSIONS: DWI with quantitative ADC measurements Using b value (b=500 s / mm2) can be useful in differentiating benign from malignant bone marrow lesions, differentiated between causes of end plate changes and be used in post therapy follow up.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
12
https://zumj.journals.ekb.eg/article_4322_d8366de6eb108faf098975194fcac93e.pdf
dx.doi.org/10.21608/zumj.2013.4322
MANAGEMENT AND REHABILITATION OF TRAUMATIC BRAIN INJURY IN CHILDREN
Khaled
Abd El-Twab
Professor of Pediatrics, Faculty of Medicine Cairo University
author
Hala
Foaud
Professor of Pediatrics, Faculty of Medicine Cairo University
author
John
youssef
Lecturer of Pediatrics, Faculty of Medicine Cairo University
author
Hala
Metwally
Professor of Clinical Pathology, Faculty of Medicine Cairo University
author
text
article
2013
eng
Traumatic brain injury is described as a blow to the head or a penetrating head damage which disturb the normal function of the brain. Traumatic brain injuries, in children are common and sometimes are powerful in threatening the life and are leading causes of acquired disability and death. Traumatic brain injury is responsible for nearly 1.4 million injuries and 52 000 deaths annually in the United States. Therefore, in this paper we reviewed the new and recent advances about the management and neuromonitoring in pediatric traumatic brain injury. And to provide a summary of the empirical research on management and rehabilitation in pediatric traumatic brain injury (TBI). Studies of the effectiveness of interventions with children with TBI are hampered by difficulty with combining subjects with various levels of TBI, problems with random assignment to treatment groups, and varying age levels at injury. While these are areas of concern, there are emerging studies that indicate both applied behavioral analysis (ABA) and positive behavioral interventions are helpful to many children. For some children, ABA is not successful, and a shift to positive behavioral interventions has been found to be helpful. Transitions to home and school can be difficult particularly if there are family issues that predated the injury. This review provides additional information for the pediatric neuropsychologist to assist with transition to school and home. Studies utilizing the Internet for family interventions have revealed promising results.Conclusion: Neuromonitoring technology is still at an early stage in pediatric TBI. These improvements have provided the possibility of true multimodal monitoring for useful treatments. But, using clinical functional neuromonitoring would help clinicians to evaluate the managements in hospitals. Studies have indicated that children with severe TBI show significant difficulties with emotional and behavioral adjustment that pose more challenges for intervention and reentry to home and school compared with cognitive and physical issues.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
13
https://zumj.journals.ekb.eg/article_4323_2939642f293f9e5862c533141ce3e24e.pdf
dx.doi.org/10.21608/zumj.2013.4323
THE ROLE OF PLASMA D – DIMER AS PROGNOSTIC MARKER IN CHILDREN WITH TRAUMATIC BRAIN INJURY
Khaled
Abd El-Twab
Professor of Pediatrics, Faculty of Medicine Cairo University
author
Hala
Foaud
Professor of Pediatrics, Faculty of Medicine Cairo University
author
John
youssef
Lecturer of Pediatrics, Faculty of Medicine Cairo University
author
Hala
Metwally
Professor of Clinical Pathology, Faculty of Medicine Cairo University
author
text
article
2013
eng
Objectives: To investigate the value of plasma D-dimer as a prognostic marker in severe traumatic brain injury in children and to compare the results of plasma D- dimer level in plasma and the clinical condition of the case and the results of its routine laboratory investigations.Methods: The study was carried out on 64 head trauma children 46 cases and 20 controls of both sexes, who admitted to pediatric intensive care unit in Alharam hospital in Giza.All children patients had full history, vital sign, general examination, complete neurological examination, GCS or PGCS, cranial CT scan, abdominal ultrasonography, full radiological studies, plasma D-dimer on admission, the 3rd day and at 14th day, INR, PT, APTT. on admission, the 3rd day and at 14th day, routine laboratory investigations on admission as CBC, CRP, Liver function test, Urea, Creatinine, Blood glucose, Na, K and Arterial blood gas analysis.Results: GCS improved significantly in the favorable group but not in the unfavorable group. D-dimer mean values were significantly higher in the unfavorable group more than the favorable group. D-dimer is correlated with mortality and can predict poor patient outcome. D-dimer have inverse relation with GCS and. PT, aPTT, INR, and Concentration mean values were significantly higher in the unfavorable group than in the favorable group.Conclusion: GCS or PGCS has evident role in evaluation and assessment of TBI especially in acute stage and gives excellent idea about the prognoses of TBI. D-dimer is a good marker to predict outcome in TBI & it has an inverse correlation with GCS or PGCS. PT, aPTT, INR and Concentration have some role in TBI and their values increase in the acute stage of TBI.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
12
https://zumj.journals.ekb.eg/article_4324_173c71389d6ffb5c029fcb79df4af8f2.pdf
dx.doi.org/10.21608/zumj.2013.4324
DETECTION OF HUMAN INTESTINAL PROTOZOA BY USING MULTIPLEX ALLELE SPECIFIC POLYMERASE CHAIN REACTION (MAS-PCR) In New Damietta City
Khaled
Mohammad
Department of Parasitology, Faculty of medicine (Damietta), Al-Azhar University, New Damietta City, Egypt
author
text
article
2013
eng
Enteric protozoa continue to be the most commonly encountered parasitic diseases causing significant morbidity and mortality in developing regions of the world affecting millions of people. This study assessed the use of Multiplex Allele Specific Polymerase Chain Reaction (MAS-PCR) assay and microscopy for detection and identification of common pathogenic protozoan parasites in New Damietta city of North Delta region, Egypt. During Jun 2013 until Sept 2013, fresh stool samples were obtained from 249 patients up to 65 years of age attending the internal clinic of the Damietta University Hospital and those visiting their general practitioner (GP) of outpatient clinics because of gastrointestinal symptoms. Stool samples collected was preserved at -200C for DNA extraction whilst the remaining was preserved in sodium acetate-acetic acid formalin and concentrated using the formol-ether technique for microscopic examination. DNA extracts were analyzed with the multiplex allele specific Polymerase Chain Reaction (MAS-PCR) for pathogenic protozoan parasites. The diagnostic results obtained using a multiplex allele specific PCR for the detection of E. histolytica/dispar, G. lamblia and C. parvum/C. hominis were compared with these obtained by routine microscopy of faecal samples from patients. 69 samples were positive by MAS-PCR assays, 9 cases of G. intestinalis infection, 34 cases of D. fragilis infection, 3 cases of E. histolytica infection, 17 cases E.dispar and 6 cases of Cryptosporidium infection in the clinical samples. By microscopy, only 32 samples were positive for one or more of the enteric protozoa, 5cases of G. intestinalis infection, 9cases of D. fragilis infection, 13 cases of E. histolytica infection, and 1 cases of Cryptosporidium infection in the clinical samples. However, there are no cases of E.dispar observed. Mixed infections were detected in 4 samples. The sensitivities varied from 58% for D. fragilis to 47% for E. histolytica, 35% for Giardia, and 30% for Cryptosporidium, while the specificities also varied from 97% for E. histolytica to 99% for D. fragilis and 100% for E.dispar . No cross-reactivity was detected in stools samples containing various bacterial, viral, and other protozoan species. This present study showed relatively high rates of protozoa infections in the study patients. The study has also demonstrated that the multiplex real time PCR assay was more sensitive compared to microscopy in the diagnosis of the intestinal protozoa parasites and thus, molecular methods must be considered the diagnostic methods of choice for enteric protozoan parasites.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
13
https://zumj.journals.ekb.eg/article_4325_fcf3f8842e47a04285279dea16d31c0d.pdf
dx.doi.org/10.21608/zumj.2013.4325
DETECTION AND DIFFERENTIATION OF HUMAN PROTOZOAN PARASITES IN STOOL SPECIMENS BY USING MULTIPLEX ALLELE SPECIFIC POLYMERASE CHAIN REACTION (MAS-PCR) In New Damietta City, Egypt
Khaled
Mohammad
Department of Parasitology, Faculty of medicine (Damietta), Al-Azhar University, New Damietta City, Egypt.
author
text
article
2013
eng
Enteric protozoa continue to be the most commonly encountered parasitic diseases causing significant morbidity and mortality in developing regions of the world affecting millions of people. This study assessed the use of Multiplex Allele Specific Polymerase Chain Reaction (MAS-PCR) assay and microscopy for detection and identification of common pathogenic protozoan parasites in New Damietta city of North Delta region, Egypt. Between Jun 2013 until Sept 2013, fresh stool samples were obtained from 249 patients up to 65 years of age attending the internal clinic of the Damietta University Hospital and those visiting their general practitioner (GP) of outpatient clinics because of gastrointestinal symptoms. Stool samples collected was preserved at -200C for DNA extraction whilst the remaining was preserved in sodium acetate-acetic acid formalin and concentrated using the formol-ether technique for microscopic examination. DNA extracts were analyzed with the multiplex allele specific Polymerase Chain Reaction (MAS-PCR) for pathogenic protozoan parasites. The diagnostic results obtained using a multiplex allele specific PCR for the detection of E. histolytica/dispar, G. lamblia and C. parvum/C. hominis were compared with these obtained by routine microscopy of faecal samples from patients. 69 samples were positive by MAS-PCR assays , 9 cases of G. intestinalis infection, 34 cases of D. fragilis infection, 3 cases of E. histolytica infection, 17 cases E.dispar and 6 cases of Cryptosporidium infection in the clinical samples. By microscopy, only 32 samples were positive for one or more of the enteric protozoa, 5cases of G. intestinalis infection, 9cases of D. fragilis infection, 13 cases of E. histolytica infection, and 1 cases of Cryptosporidium infection in the clinical samples. However, there are no cases of E.dispar observed. Mixed infections were detected in 4 samples. The sensitivities varied from 58% for D. fragilis to 47% for E. histolytica, 35% for Giardia, and 30% for Cryptosporidium, while the specificities also varied from 97% for E. histolytica to 99% for D. fragilis and 100% for E.dispar . No cross-reactivity was detected in stool samples containing various other bacterial, viral, and protozoan species. This present study showed relatively high rates of protozoa infections in the study patients. The study has also demonstrated that the multiplex real time PCR assay was more sensitive compared to microscopy in the diagnosis of the intestinal protozoa parasites and thus, molecular methods must be considered the diagnostic methods of choice for enteric protozoan parasites.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
14
https://zumj.journals.ekb.eg/article_4326_e8b5a6347881999df32bb53ed61e0110.pdf
dx.doi.org/10.21608/zumj.2013.4326
BED UTILIZATION PATTERN AT ZAGAZIG UNIVERSITY HOSPITALS
Wassif
M
Community Medicine Department, Faculty of Medicine, Zagazig University
author
Ali
AS
Community Medicine Department, Faculty of Medicine, Zagazig University
author
Elsharkawy
GF
Community Medicine Department, Faculty of Medicine, Zagazig University
author
Elwan
A
Community Medicine Department, Faculty of Medicine, Zagazig University
author
text
article
2013
eng
Hospital beds are an important and costly resource for all health systems. Objectives: to assess the appropriateness of hospitalization days and identify risk factors associated with extra length of hospital stay. Methods: Record analysis and indepth interview with hospital managers were conducted to review hospital rates and bed management policy for different departments of Zagazig university hospitals in 2012. Then, non emergency settings in 4 selected departments were studied in a cross sectional study involved 200 patients and 108 physicians. Patients were interviewed and their bed days were assessed by using appropriateness evaluation protocol(AEP). Physicians were asked to complete a questionnaire on bed cycle and their recommendations were recorded. Results: Record analysis and indepth interview revealed considerable variability in bed occupancy pattern among various departments with overall bed occupancy rate of 67.9%. In the 4 detailed studied departments, percentages of inappropriate hospital admission and stay were 19% and 59 % respectively. Elective admission and being admitted for first time were the significant predictors of inappropriate admission on logistic regression. The main causes of inappropriate stay were waiting for operating room diagnostic or therapeutic procedures in patients in medical departments and persistence of symptoms or occurrence of complications in surgical departments . Poor records and lack of application of clinical guidelines are the main causes of extra length of stay from physicians, prospective. Conclusion: Optimal use of hospital beds remains a challenge at Zagazig university hospitals .So, application of standardized electronic patients records, proper inter departmental communications, proper discharge planning, in addition to planning for rehabilitative and social services are recommended.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
12
https://zumj.journals.ekb.eg/article_4327_1ed6df5c4cda2d338f5be99e0897bdf4.pdf
dx.doi.org/10.21608/zumj.2013.4327
PREVALENCE AND PSYCHIATRIC COMORBIDITIESOF NOCTURNAL ENURESIS IN A SAMPLE OF BASIC EDUCATION STUDENTS IN SHARKIA GOVERNORATE
Hayam
lgohary
Psychiatry Department, Zagzazig University, Zagazig, Egypt
author
Asaad
Shalanda
Psychiatry Department, Zagzazig University, Zagazig, Egypt
author
Saed
lethy
Psychiatry Department, Zagzazig University, Zagazig, Egypt
author
text
article
2013
eng
Background: Nocturnal enuresis and its psychiatric comorbidities are important psychosocial problem. Aim of the work: The aim is to study the prevalence and psychiatric comorbidities of nocturnal enuresis in 11 to13 years’ old children in Sharkia governorate.Subject and Method:A random sample of school students aged 11 to 13 years old in Sharkia Governorate (N. 603) applied a strucured questionair searching for nocturnal enuresis. The cases having nocturnal enuresis (N.50) and non enuretic control group (51) applied Children's Manifest Anxiety Scale, Children Depression Inventory, Abuse and neglect scale for children. Results: The overall prevalence was 8.29% (50/603), depression, anxiety and child abuse are significantly associated with nocturnal enuresis. Conclusion: Our results with enuresis prevalence was comparable to other epidemiologic studies from various countries. Depression, anxiety and child abuse are more prevalent in enurtic child.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
9
https://zumj.journals.ekb.eg/article_4328_38f4c8ce3842d062cc6258e52848ed73.pdf
dx.doi.org/10.21608/zumj.2013.4328
PSYCHOSOCIAL BURDEN AMONG CAREGIVERS OF PATIENTS WITH SCHIZOPHRENIA IN EGYPT
Amira
Fouad
Department of Psychiatry, Faculty of Medicine, Zagazig University, Sharkia, Egypt
author
Mohab
Fawzi
Department of Psychiatry, Faculty of Medicine, Zagazig University, Sharkia, Egypt
author
El Masry
N.
Department of Psychiatry, Faculty of Medicine, Zagazig University, Sharkia, Egypt
author
text
article
2013
eng
Most studies of family burden have been conducted in developed countries, thus it is important to conduct studies in developing countries, namely Egypt.Aim of the study: To evaluate the psychosocial burden among caregivers of schizophrenic patients.Subjects and Methods: A total of 120 schizophrenic patients attending the outpatient Clinic of Zagazig University Hospital with their primary caregivers, using Caregiver Strain Index (CSI), Caregiver Self Assessment Questionnaire (CSAQ), Hamilton Anxiety Scale, Hamilton Scale of Depression.Results: High level of burden was found mainly among caregivers of disorganized type followed by catatonic type, also high levels of anxiety and depression in disorganized type followed by catatonic type.Conclusion: Schizophrenia is associated with high level of burden on caregiver. So effort should be made to alleviate the burden for better outcome in both patients and caregivers.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
8
https://zumj.journals.ekb.eg/article_4329_af1ea12a12082bee8fc837f2a290dd20.pdf
dx.doi.org/10.21608/zumj.2013.4329
EFFECT OF DIABETES AND SCHIZOPHRENIA ON COGNITIVE FUNCTION IN EGYPTIANS
Khaled
Hadhoud
Departments of Internal Medicine ,Faculty of Medicine, Zagazig University
author
Amira
Fouad
Departments of Psychiatry, Faculty of Medicine, Zagazig University
author
text
article
2013
eng
Background: Cognitive impairment occurs in both schizophrenia (SZ) and diabetes mellitus, in addition, people with SZ are more likely to develop diabetes than those without SZ. Objective: This study was planned to determine whether SZ patients with diabetes have an increased risk of cognitive impairment than SZ without diabetes or diabetes only. Subjects & Methods: The study included 120 subjects, 30 of them were known patients with SZ (Group I), 30 with type 2 diabetes mellitus (T2DM) (group II), 30 of them had SZ with diabetes (Group III) as well as 30 healthy subjects served as control group (Group IV). All subjects were subjected to complete clinical examination, including body mass index [BMI] and waist circumference, in addition to investigations including fasting blood glucose, lipid profile and routine laboratory investigations and assessment of cognitive functions using RBANS [Repeatable Battery for the Assessment of Neuropsychological Status]. Results: SZ with diabetes showed higher fasting blood glucose and triglyceride levels than SZ without diabetes (both P < 0.05). No significant differences between SZ with and without diabetes in duration of illness, antipsychotic types, duration of current antipsychotic treatment (all P > 0.05). Compared to healthy controls, all patients groups had significantly decreased total and five index RBANS scores [the repeatable pattery for assessment of neuropsychological status] (all P < 0.01 – P < 0.001), except for the visuospatial/ constructional index. SZ with diabetes performed worse than SZ without diabetes in immediate memory (P > 0.01) and total RBANS scores (P < 0.05) and showed a trend for decreased attention (P = 0.052) and visuospatial/constructional capacity (P = 0.63). SZ with diabetes performed worse than diabetes only in immediate memory (P < 0.001) and attention (P < 0.05) and showed a trend for decreased total RBANS scores (P = 0.069). Conclusion and Recommendations: SZ with Co-morbid diabetes showed more impairment than SZ without diabetes or diabetes only especially in immediate memory & attention. Thus, diabetes prevention and control should be targeted in patients with SZ.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
9
https://zumj.journals.ekb.eg/article_4330_5bf05df79cdcc5d774860ba113327e17.pdf
dx.doi.org/10.21608/zumj.2013.4330
SIGNIFICANCE OF FLAT EPITHELIAL LESIONS OF THE URINARY BLADDER IN EARLY DETECTION OF BLADDER CANCER: HISTOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY
Mohamed
Ramadan
Pathology Department, Faculty of Medicine, Zagazig University
author
Masoud
Omar
Pathology Department, Faculty of Medicine, Zagazig University
author
Mona
Abdel-Wahed
Pathology Department, Faculty of Medicine, Zagazig University
author
Shimaa
Ahmed
Pathology Department, Faculty of Medicine, Zagazig University
author
text
article
2013
eng
Background: Urothelial carcinoma of the urinary bladder is the second most common malignancy of the genitourinary system, after prostate cancer. The flat lesions are classified into flat lesions without cytological atypia (Flat hyperplasia) and flat lesions with cytological atypia; reactive atypia, atypia of unknown significance, urothelial dysplasia and urothelial carcinoma in situ). The immunohistochemical markers such as cytokeratin 20,CD 44 and Ki 67 may be useful in differentiating CIS from reactive changes in difficult biopsy cases.Aim: This study was conducted to determine the role of cytokeratin 20, CD 44 and Ki 67 in the diagnosis of dysplasia and other flat lesions of the urinary bladder.Methods: Sixty representative cases for flat urothelial lesions of urinary bladder were examined immunohistochemically using antibodies against CD44, cytokeratin 20 and Ki-67.Results: CD 44 were positive in 100%of cases of reactive urothelial atypia, but flat Hyperplasia and CIS cases were negative. However CD 44 were positive in 42.9% of atypia of unknown significance and 14.3% of Dysplasia. CK 20 were positive in (95.5%) of Dysplasia. Non of Flat Hyperplasia were positive for CK 20. However CK 20 was positive in 88.2% of CIS, 57.1 % of atypia of unknown significance and 7.1% of reactive urothelial atypia. ki 67 index were high in 82.4% of cases of CIS, non of flat hyperplasia expressed high ki 67 index. However ki 67 index were high in 57.1% of atypia of unknown significance, 52.4% of dysplasia and 14.3% of reactive urothelial atypia.Conclusion. CD 44 is the most constant marker in the reactive urothelium. CK20 is the most commonly detected marker in the dysplastic urothelium. Nevertheless, the most accurate is application of an immunohistochemical panel composed of the three antibodies (standard CD 44, CK20 and Ki-67) together with correlation with morphology. This is very useful for confirming the presence of dysplastic changes in the urothelium and differentiating reactive urothelium from dysplastic urothelium (dysplasia/CIS).
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
14
https://zumj.journals.ekb.eg/article_4331_1513e5b16b709df26fe1ae3b4146fb08.pdf
dx.doi.org/10.21608/zumj.2013.4331
WHAT ARE THE RESULTS OF ANATOMIC RECONSTRUCTION FOR UNSTABLE ACROMIOCLAVICULAR JOINT BY USING AN AUTOGENOUS SEMITENDINOSUS GRAFT?
Mohamed
Elzohairy
Lecturer of orthopedic surgery, faculty of medicine Zagazig University
author
text
article
2013
eng
Acromioclavicular injury is considered as a common athletic shoulder injury. Many of these injuries can be treated nonoperatively but high-grade injuries can result in pain and loss of shoulder function. A numerous operative techniques have been proposed with recent renewed focus on the anatomy of the coracoclavicular ligaments which has led to anatomic reconstructive techniques that show promised results in biomechanical comparisons. These techniques involve reconstruction of the conoid and trapezoid ligaments through anatomically-based tunnels in the clavicle, with preservation of the distal clavicle that improves the biomechanical stability of this construct. The purpose of this study was to evaluate the results of anatomic reconstruction of unstable acromioclavicular joint by using an autogenous semitendinosus graft. All the patients gave the informed consent prior to being included into this study; the study was authorized by the local ethical committee and was performed in accordance with the Ethical standards of the 1964 Declaration of Helsinki as revised in 2000.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
7
https://zumj.journals.ekb.eg/article_4332_14220695347e63e2161202695ef81014.pdf
dx.doi.org/10.21608/zumj.2013.4332
DIFFERENT MODALITIES OF RECONSTRUCTION IN FOURNIER GANGRENE
Moustafa
El Saady
General Surgery department, Faculty of Medicine, Zagazig University
author
Samy
Ahmed
General Surgery department, Faculty of Medicine, Zagazig University
author
Raafat
Mansour
General Surgery department, Faculty of Medicine, Zagazig University
author
Fady
Salamh
General Surgery department, Faculty of Medicine, Zagazig University
author
text
article
2013
eng
Background: Fournier gangrene is an acute and potentially lethal necrotising fasciitis that involves the scrotum and perineum. This disease can result in the loss of skin and soft tissue. Multiple options for reconstruction of the scrotum are available. To repair the scrotal and perineal defects remains a surgical challenge. Objective: The aim of this work is to compare different modalities of reconstruction in Fournier gangrene and to verify the indications of efficacy of each modality. Patients and methods: The present study includes 20 patients with diagnosis of Fournier gangrene from the General Surgery Departments, Faculty of Medicine, Zagazig University Hospitals from 2010 to 2012. Following admission, correction of the fluid and electrolyte imbalance, and estimation of the extension and depth of the gangrenous area were done. After stabilization of the patients, all patients underwent surgical debridement with frequent dressing, and then the patients were divided randomally into four groups according to the reconstructive procedure. Results: A total of 20 cases with Fournier gangrene were included in this study. All patients included in this study were males. Their age ranged from 20–70 years old with a mean age of 50 years. The most common comorbid condition was diabetes mellitus in 50% of cases. The infection was polymicrobial in 70% of cases. Wound healing with secondary repair was performed in 5 patients. Wound healing with primary closure was performed in 5 patients. Wound healing with split-thickness skin graft was performed in 5 patients. Wound healing with gracilis muscle flap followed by split-thickness skin graft was performed in 5 patients. No surgical mortality was recorded. Conclusion: Gracilis muscle flap plus split-thickness skin graft covered the deep perineal defects very well. It is a reliable procedure, which provides excellent cover for the exposed testes and gives satisfactory protection and aesthetic outcome.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
8
https://zumj.journals.ekb.eg/article_4333_8854ae49fcb4214f19c530a75947eec2.pdf
dx.doi.org/10.21608/zumj.2013.4333
EFFECT OF APELIN-13 ADMINISTRATION ON GASTRIC SECRETION IN NORMAL AND DIABETIC RATS
Akmal
Diab
Physiology Department, faculty of medicine, Zagazig University
author
Soad
Ahmed
Physiology Department, faculty of medicine, Zagazig University
author
Abeer
Khalefa
Physiology Department, faculty of medicine, Zagazig University
author
Reham
Ibrahim
Physiology Department, faculty of medicine, Zagazig University
author
text
article
2013
eng
Background: Apelin is a recently discovered peptide, identified as an endogenous ligand of receptor APJ, apelin has beneficial effect in diabetic conditions as it increase glucose uptake and improve insulin sensitivity, diabetic patients have impaired gastric secretion and apelin is expressed in parietal, chief and mucous cells and this raise the possibility of involvement of apelin in gastric physiology. Objective: The present study was carried out to demonstrate the effect of acute and chronic administration of apelin 13 on gastric secretion in normal and diabetic rats. Design: 98 adult wistar male albino rats were used, animals were divided into three main groups group A (normal rats), group B (high fat diet induced diabetic rats) and group C (streptozotocin induced diabetic rats), each group is subdivided into control subgroup (1), acute apelin-13 injected subgroup (2), chronic apelin-13 injected subgroup for 21 days (3): In all studied groups, different parameters of gastric secretion, gastric mucosal pH and mucin content were measured. Results: acute administration of apelin-13 decreased gastric acid secretion in all groups proved by significant increase in pH accompanied by significant decrease in total and free acidity, the percentage in decrease of gastric acid secretion in normal rats is more than that of high fat diet induced diabetic rats and streptozotocin induced diabetic rats. Ghrelin level, volume of gastric secretion, blood glucose and HOMA- IR significantly decreased in all groups. pepsin, mucin content of gastric mucosa and insulin level had no significant change in all groups, while, pH of gastric mucosal surface significantly increased .In addition, there was negative correlation between ghrelin level and pH, positive correlation between ghrelin and both total and free acidity in normal rats, positive correlation between ghrelin and volume of gastric secretion in all studied groups. Chronic administration of apelin-13 caused no change in gastric acidity in normal rats. and increase gastric acidity in high fat diet induced diabetic rats and streptozotocin induced diabetic rats, proved by significant decrease in pH accompanied by significant increase in total and free acidity, the percentage of increase in gastric acid secretion in high fat diet induced diabetic rats is more than that of streptozotocin induced diabetic rats, moreover, chronic administration of apelin-13decreased ghrelin level, pepsin level, volume of gastric secretion, blood glucose, insulin level and HOMA- IR and increase pH of gastric mucosal surface and mucin level in all studied groups. In addition, there is positive correlation between ghrelin and volume of gastric secretion in all studied groups. Conclusion: While apelin-13 injection on chronic run caused no change in gastric acidity in normal rats, it improved gastric acidity in diabetic rats and can act as a promising target for type 2 diabetes treatment. In addition apelin-13 can be considered as gastro protective agent as it increased pH of gastric mucosal surface and mucin level in normal and diabetic rats.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
13
https://zumj.journals.ekb.eg/article_4334_6421a0f00735f14552b2b566278f881c.pdf
dx.doi.org/10.21608/zumj.2013.4334
TOTAL VERSUS COMPLETION THYROIDECTOMY IN MANAGEMENT OF SUSPECTED THYROID CARCINOMA
Hatem
Gaafar
General Surgery department, Faculty of Medicine, Zagazig University
author
Mohamed
Hefny
General Surgery department, Faculty of Medicine, Zagazig University
author
Doaa
Refaat
General Surgery department, Faculty of Medicine, Zagazig University
author
Abd Elrahman
Metwalli
General Surgery department, Faculty of Medicine, Zagazig University
author
text
article
2013
eng
Background: When results of the FNA are reported as indeterminate, a hemi- or total thyroidectomy may be performed, depending on the suspicion of cancer. Objective: This work was designed is to compare the incidence of complications and surgical outcome of total and completion thyroidectomy in management of suspected thyroid carcinoma Patients and methods: The study included 50 patients with STN and results of the FNA are reported as (indeterminate or a follicular lesion). They divided into 2 groups. (Group I) include 20 patients (40%) were subjected to Completion thyroidectomy and (Group II) include 30 patients (60 %) were subjected to total thyroidectomy. All cases were operated upon in the department of General Surgery department, Zagazig University Hospitals during the period of the research from May 2010 to July 2013.Statistical analysis: SPSS version 19.Results: In the present study there was 38 (76%) were males and 12 (24%) were female and the pathology of residual tissue in (Group I) showed 8 case (40%) had residual malignancy and 12 cases (60.0%) are free from malignancy. From this study the hospital stay in (Group I) ranges from 5 to 8 days with The mean stay was ( 5.9 ± 1.0 days ) which is longer than (group II) ranges from 3 to 5 days with The mean stay was(3.7 ± 0.75 days).From this study the development of hypoparathyroidism was greater in (Group I) (20%) than (group II) (10%) and recurrent laryngeal nerve injury was greater in (Group I) (4%) than (Group II) (2%).Conclusion: The frequency of complications was greater in (Group I) than (Group II) so total thyroidectomy is considered as the treatment of choice for both malignant and benign thyroid disease requiring surgical treatment when performed by experienced surgeons Moreover, it eliminates the requirement of completion thyroidectomy for incidentally diagnosed thyroid carcinoma.
Zagazig University Medical Journal
Zagazig University, Faculty of Medicine
1110-1431
19
v.
6
no.
2013
1
8
https://zumj.journals.ekb.eg/article_4335_0a3ab792264e6444eac6becada2761e2.pdf
dx.doi.org/10.21608/zumj.2013.4335