2024-03-29T14:02:57Z
https://zumj.journals.ekb.eg/?_action=export&rf=summon&issue=5283
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
EFFECT OF PERCUTANEOUS AND OPEN TENOTOMY ON CONTINUITY OF TENDOACHILLIS IN RELAPSED CLUBFOOT
Khairy
H.M
Elzohairy
M.M
El-aidy
S.M
Nusayr
A.N
Background: Tenotomy of tendon Achilles is one of the majorcomponents of Ponseti method and necessary to complete correction inabout 80 to 90 % of patients, it is safely procedure can be done inoutpatient office as percutaneous technique under local anesthesia or inoperative room under general anesthesia as mini-open technique. Thisstudy was designed to evaluate effect of tendoachillis tenotomy eitherpercutaneous or open on continuity of tendoachillis by open evaluation in relapsed club foot. Patient & method: This study was conducted on 18 individuals. Theywere divided into 2 equal groups: Group I: containing 9 patients both sexhad previously percutaneous tenotomy is done and Group II: 9 patientsboth sex had previously open tenotomy is done.Results: percutaneous technique found easy dissection in 6 patients(66.7%) and difficult dissection in 3 patients (33.3%) and continuityfound central and regular contour in 7 patients (77.8%) and fibrotic massin 2 patients (22.2%), open technique found easy dissection in 5 patients(55.6%) and difficult dissection in 4 patients (44.4%) and continuityfound central and regular contour in 5 patients (55.6%) and fibrotic massin 4 patients (44.4%), Conclusion: the techniques tenotomy of tendoachillis had no effect oncontinuity of tendoachillis either open or closed techniques inmanagement of club foot.
clubfoot
tenotomy
tendon Achilles
Ponseti method
2019
05
01
278
284
https://zumj.journals.ekb.eg/article_30723_9dcb66e077da4ab4d58b1a66114ed355.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
EVALUATION OF SERUM INTERLEUKIN-34, AS A MARKER OF DISEASE ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS AND RHEUMATOID ARTHRITIS PATIENTS
Mohammad
Hassan El-Gawish
Doaa
Mohamed Sharaf
Nermin
Raafat Abdel-Fattah
Salwa
Abdelaziz Rashed
Aim of the work: To evaluate the role of IL-34 in the pathogenesis of SLE and RA and to assess its role as a biomarker of disease activity. Subjects and methods: This study was carried out on 29 patients with SLE, 29 patients with RA, and 29 healthy control subjects. SLE disease activity was measured by systemic lupus erythematosus disease activity index (SLEDAI). RA disease activity was measured by 28-joint disease activity score (DAS-28). Serum IL-34 was measured by enzyme-linked immunosorbent assay (ELISA) . Results: There was highly significant elevation in IL-34 level in SLE and RA when compared to control group (p<0.001). IL34 level did not differ significantly between SLE and RA groups (p˃ 0.05). There was a significant positive correlation between IL-34 level and SLEDAI in SLE patients as well DAS 28 score in RA patients. The highest level was detected in patients with high disease activity. There was statistically significant correlation between IL-34 levels and ESR, CRP, and anti-ds DNA antibodies but inversely correlated with C3 in SLE patients. There was also statistically significant correlation between IL-34 levels and ESR, CRP RF, and anti CCP antibodies in RA patients. Conclusion: IL-34 could be useful marker for disease activity in SLE and RA.
2019
05
01
285
290
https://zumj.journals.ekb.eg/article_30725_c55c7f99b1567070d04b52e4bea1e4de.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
DECOMPRESSIVE CRANIECTOMY FOR SPONTANEOUS INTRACEREBRAL HEMATOMA, DOES IT ADD BENEFIT?
Hosni
H. Salama
Background: Many studies discussed the validity of hematoma evacuation versus conservative treatment, and little research discussed the role of decompressive craniectomy in the management of SICH. The purpose of the study is to discuss the role of decompressive craniectomy alone in selected cases of supratentorial SICH and comparing it with the reported results of best medical treatment in the literatures. Patients and methods; Fourteen patients harboring SICH with mass effect were operated in Zagazig University Hospitals by decompressive craniectomy from March 2015 to September 2017. Inclusion criteria were hypertensive supratentorial SICH with massive edema and midline shift and GCS score below 10. Wide decompressive craniotomy was performed together with duroplasty. Patients were followed for 6 months postoperatively using modified Rankin scale (mRS). Results: There was 14 patients, 9 males and 5 females with mean age 69.7 (range 56 to 81), 8 right and 6 left sided hematoma with mean GCS of 7 (range 4 to 10), preoperative midline shift ranged from 9 mm to 15 mm (mean 12.7). Early postoperative follow up showed improvement of GCS mean 11 (range 6 to 15) and midline shift mean 3 mm (range 1 to 9) in the first 24 hours. At 6 months, mortality rate was 2/14. GOS showed good outcome (mRS 0-4) in 10 patients and poor outcome (mRS 5-6) in 4 patients. Conclusion: Decompressive craniectomy with duroplasty is an effective method for management of supratentorial SICH and is better than the best medical treatment in selected cases.
Spontaneous intracerebral hematoma
Decompressive craniectomy
Outcome
2019
05
01
291
297
https://zumj.journals.ekb.eg/article_30727_dc0f589235c228ded234007f63342c36.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
EFFECT OF COMBINING EPIDURAL WITH GENERAL ANESTHESIA ON RECOVERY AFTER SPINE SURGERY: RANDOMIZED CONTROLLED STUDY
Ashraf
El sayed Ahmed El sayed
Abeer
Mohamed Abdelbaky Elnakera
Abeer
Hassan Mostafa Al sawy
Tarek
Yousef Gaafar
Background: Fast track techniques have been applied to reduce surgical stress response and to provide effective perioperative analgesia, thereby improving patient''''''''s recovery and reducing postoperative morbidity. The present study was undertaken to assess the effect of using combined general/epidural anesthesia (CGEA) on early recovery after lumbar spine surgeries. Subjects and Methods: The current prospective randomized clinical study had included a total of 40 patients who underwent elective one or two level laminectomy/discectomy. Patients were randomized and divided into two groups; general anesthesia (GA) group (group I) and combined general/epidural anesthesia group (CGEA) (group II). Patient characteristics, anesthesia time, surgical time, heart rate, mean arterial pressure (MAP), anesthetic / analgesic requirements, the occurrence of intraoperative bradycardia and/or hypotension, time to extubation, time to post anesthesia care unit (PACU) discharge and duration of PACU stay were recorded and considered for analysis. Results: It was observed that CGEA was significantly associated with reduction of intraoperative anesthetics / analgesic requirements, shorter time to extubation, time for PACU discharge and duration of PACU stay but on the expense of higher incidence of intraoperative hypotension. Conclusion: This study proved that CGEA seems to be an effective fast track anesthetic protocol in patients undergoing elective lumbar spine surgeries.
Combined epidural/general anesthesia
Lumbar spine surgeries
PACU
hypotension
2019
05
01
298
307
https://zumj.journals.ekb.eg/article_30729_24f61104b5818289e8ed2d8cf123f14d.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
IS INTRAVENOUS LONG-ACTING OPIOID (MORPHINE) ASSOCIATED WITH MORE POSTOPERATIVE HYPOXEMIA THAN SHORT-ACTING OPIOID (FENTANYL) AFTER NON-CARDIAC SURGERY?
ahmed
Abdulmonem
doaa
farid
lobna
dorgham
Alshaimaa
Abdel Fattah Kamel
Background: morphine is a potent analgesic in decreasing postoperative pain; however its use is accompanied by many complications especially respiratory one. On the other side, fentanyl titration may cause less postoperative respiratory complications. Objective: To compare between intravenous long-acting opioid (Morphine), and short-acting opioid (Fentanyl) regarding postoperative hypoxemia after non-cardiac surgery. Patients and methods: A prospective randomized clinical study done on 52 patients, they were divided equally into two groups: Group M (Morphine) received (0.1mg/kg), and Group F (Fentanyl) received (1ug/kg) on induction, and supplemented by effective rescue analgesia. When postoperative VAS score ≥4 , patients in Group M received 5mg morphine as bolus ,and re-assess pain every 5 min to give another bolus ( the total allowed dose was 15mg/3-4h).For Group F 50ug fentanyl was given as a bolus ,and could be repeated (total allowed dose was 100 ug/1-2h.). Result(s): There were no significant difference between two groups as regard respiratory rate (RR) nor peripheral O2 saturation (SPO2) (P value0.05). Conclusion: Intravenous morphine as effective rescue analgesic is not associated with more postoperative hypoxemia, or respiratory depression than fentanyl
Opioid
morphine
Fentanyl
and hypoxemia
2019
05
01
308
316
https://zumj.journals.ekb.eg/article_30730_31827ac7b20c818dd3a493191e5b87c0.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
SERUM AND ASCITIC FLUID HIGH SENSITIVE C REACTIVE PROTEIN AS PROGNOSTIC MARKER IN PATIENTS WITH SPONTANEOUS BACTERIAL PERITONITIS
Mahmoud
Ashour
Hanaa
Elsaid
Ahmed
Gomaa
Ahmed
Mahmoud
Background: Spontaneous Bacterial Peritonitis (SBP) is the most frequent bacterial infection in cirrhotic patients with ascites. The mortality rate in those patients ranges from 40-70%. Aim: to assess level of serum and ascetic fluid polymorph nuclear leucocytes (PMN), high sensitive C reactive protein (hs-CRP) in patients with SBP before and after treatment. Methods: A cohort study was done on 114 patients SBP admitted in the Internal Medicine, Faculty of Medicine, Zagazig University during the period from December 2017 to September 2018. All patients were subjected to full history taking, thorough clinical examination, routine laboratory investigation, ultrasonography and ascitic fluid sampling. They was followed up for 5 days from starting treatment by parenteral third generation cephalosporin and peripheral blood (PMN), serum (hs-CRP), ascitic fluid PMN and hs-CRP were measured again. Results: the largest percentage of the patients were male, had posthepatitic C cirrhosis and child C score. There was statistically non-significant difference between antibiotic responders and non-responders regarding peripheral blood PMN before or five days after antibiotic use. There was statistically non-significant difference in ascitic fluid PMN, serum and ascitic fluid hs-CRP before treatment while the difference is significant between both groups regarding them five days after treatment. Percent change in serum hs-CRP was equal to that of ascitic fluid PMN. Percent change in ascitic fluid hs-CRP was comparable to that of ascitic fluid PMN. Conclusion: Serum and ascitic fluid hs-CRP level can be considered as alternative prognostic markers in cirrhotic patients with SBP.
Spontaneous Bacterial Peritonitis
Ascitic fluid
hs-CRP
2019
05
01
317
325
https://zumj.journals.ekb.eg/article_30921_48757349be0d0ca84439ba167dc8e8cd.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
HISTOPATHOLOGICAL FINDINGS IN LESIONAL AND PERILESIONAL SKIN OF VITILIGO PATIENTS BEFORE AND AFTER NARROW BAND ULTRAVIOLET B PHOTOTHERAPY.
Hend
Gamil
Magda
Assaf
Mohamad
Khater
Manal
Fawzy
Background: Vitiligo is a skin disease with complex, multifactorial pathogenesis. Abnormalities in surrounding keratinocytes may cause melanocyte death due to deprivation of growth factors. Narrow band ultraviolet B (NB-UVB) is an effective therapeutic option especially in patients with generalized disease.
Objective: The aim of this study was to identify histopathological changes in lesional and perilesional skin of vitiligo patients and the effect of NB-UVB therapy on them.
Methods: Twenty patients were enrolled in this study. They received NB-UVB twice weekly on non-consecutive days for a total of 40 sessions. Skin biopsies from lesional and perilesional skin were obtained from each patient before and after therapy.
Results: After therapy, 10% of patients showed excellent clinical response, 10% showed good response, 40% showed moderate response, 35% showed poor response and 5% showed progressive disease. Before therapy, 50% of patients showed a basal lymphocytic infiltrate with a perivascular lymphocytic infiltrate in both lesional and perilesional skin. 40% of them showed additional hydropic degeneration of lower epidermis with apoptotic keratinocytes in 20% of them. After therapy, these inflammatory changes were significantly reduced (p=0.04).
Conclusion: NB-UVB is an effective method of treatment of vitiligo. This may be due to its immunosuppressive effects. Also, keratinocyte apoptosis may have a role in pathogenesis of vitiligo.
Vitiligo
NB-UVB
Keratinocytes
apoptosis
2019
05
01
326
334
https://zumj.journals.ekb.eg/article_30922_1292812d94510a42fe1ca9d403c3d103.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
CARVEDILOL AND NEBIVOLOL PROTECT THE KIDNEY AGAINST RENAL ISCHEMIA IN WISTAR RATS.
Amira
M Abdelhamid
Ali
A Moustafa
Amin
M Sekinah
Noha
A T Abbas
Hayam
E Rashed
Samia
Hussein
Background: Classical β-blockers usually reduce renal blood flow thus, worsening renal function in hypertensive patients with renal impairment. However, vasodilator b-blockers with biased agonist activity on b-arrestin, at least theoretically, could protect the kidney against ischemia. Objectives: To compare the effect of prophylactic administration of carvedilol, nebivolol, nadolol on the kidneys.
Materials & Methods: Rats were divided into five groups: Group1: sham-operated; Group2: Untreated hypertensive; Group3: Carvedilol pre-treated; Group4: Nebivolol pre-treated; Group5: Nadolol pre-treated. MABP, serum urea, creatinine, renal level of TNFα, BAX and pERK1/2 to non-pERK1/2 ratio were measured, besides renal histopathology and Bax immunohistochemistry. Results: In carvedilol and nebivolol groups, MABP, Bax, TNFα and pERK1/2 to non-pERK1/2 ratio were not only significantly (P<0.05) lower than that of the untreated group; but also, not significantly different from that of the sham; except significantly higher pERK1/2 to non-pERK1/2 ratio. In the nadolol pre-treated rats, MABP and the pERK1/2 to non-pERK1/2 ratio were significantly lower than that of the untreated hypertensive rats, however, they were significantly higher than that of the carvedilol, nebivolol pre-treated groups and the sham-operated group. Furthermore, Bax and TNFα were not significantly different from that of the untreated hypertensive group; in the meantime, they were significantly higher compared to sham, carvedilol and nebivolol pretreated groups. Serum urea& creatinine levels were significantly higher in nadolol pre-treated group compared to other groups. Conclusion: Carvedilol and nebivolol have renal protective effect which is nearly equal in contrast to the deterioration caused by nadolol.
Renal artery ligation
Hypertension
Carvedilol
nebivolol
nadolol
2019
05
01
335
343
https://zumj.journals.ekb.eg/article_30932_4f328bf4697461ad10c052d04319de8d.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
REVISION SURGERY IN LUMBAR DEGENERATIVE DISEASE
Hosni
H. Salama
Tarek
H. Abdelbary
Introduction: Lumbar degenerative disease is a common health problem all over the world and the need for revision surgery is still high with variable results. The aim of the work: Is to evaluate the clinical and radiologic outcome in cases of redo surgery for lumbar degenerative pathology and to specify which pathology is responding well to revision surgery. Patients and methods: Forty eight patients were operated upon for revision of previous failed back surgery in Zagazig University Hospitals from August 2014 to April 2017. Selection of patients for revision surgery depends on confirmed radiological and clinical compression or instability. All patients were operated and followed for at least 6 months after surgery. VAS score was used as a tool for evaluation of back and leg pain. Results: There were 48 patients; with a mean age of 46.7 years (range 22-78).There were 29 males and 19 females. The dominant symptoms were unilateral sciatica in 30, bilateral in 11, low back pain in 23 patients .Neurogenic claudication was present in 4 cases. Type of surgery was redo discectomy in 31 cases, revision decompression for spinal canal stenosis in 4 cases, and posterior lumbar interbody fusion in 13 cases, with success rate of 96.8%, 75% and 84.6% respectively regarding improvement after surgery. Conclusion: Revision surgery of lumbar degenerative diseases gives excellent results provided that the patients are properly selected.
Lumbar degenerative disease. Revision surgery. Outcome
2019
05
01
344
349
https://zumj.journals.ekb.eg/article_30933_31f112ebece44fe71983e569a971c610.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
ASSESSMENT OF THE PREDICTIVE VALUE OF T-REGULATORY CELLS FOR THE RESPONSE OF CHRONIC HEPATITIS C TO SOFOSBUVIR BASED THERAPY
Monkez
MoteihYousif
Mohammad
Mohammad Sakr
Seham
Mahrous Zaki
Ayman
Magd-eldin Sadek
Osama
Husseiny Mostafa
Background: In Chronic Hepatitis C (CHC) disease, the role of Treg is still controversial and most studies yielded conflicting reports. Our study aimed to assess the influence of baseline T-regulatory cells on Chronic Hepatitis C (CHC) disease progression and response to treatment with direct-acting antiviral drugs (DAA).Method: This prospective cohort study included 120 CHC patients who are eligible to receive DAA treatment in National Committee for Combating Viral Hepatitis (NCCVH) at Al-AHRAR hospital, were subjected to routine laboratory investigation, pre and post-treatment polymerase chain reaction (PCR) analysis and flow cytometry analysis to reveal ratio percentages of T-regulatory cells subsets. According to response to DAA into the sustained virological response (SVR) group and Non-response (NR) group included 112 and 8 patient respectively also divided into Non-Cirrhotic and Cirrhotic groups included 103 and 17 patients respectively. Result: Comparison SVR and NR groups resulted in a significant difference between both groups with higher FOX-p3 expression among NR populations (p= 0.002). Multivariate regression analysis resulted in FOX-p3 expression as an independent factor for non-response to DAA treatment, there is a positive correlation between T-regulatory cells and the severity of liver disease. ROC curve analysis had shown a cut-off for FOX-p3 expression percentage (≥6.92) that can differentiate between SVR and NR groups. CD25+CD4 (P =0.002) and Fox+ve Treg (P =0.018) were higher in Cirrhotic than Non Cirrhotic group. Conclusion: T-Regulatory cell level may predict the response to DAA treatment in CHC patients.
Direct-acting antiviral drugs
Chronic hepatitis C
T-regulatory
2019
05
01
350
358
https://zumj.journals.ekb.eg/article_30934_b73e9f546bc94c4268a2f78e8d6218d0.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
PREDICTORS OF LEFT VENTRICULAR REMODELING IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION TREATED BY PRIMARY PERCUTANEOUS INTERVENTION
Mahmoud
Hassan shah
Nader
talat kandil
Wael
ali ali
Alaa
Mohamed
Background: Outcomes in the treatment of STEMI have markedly improved in recent years. However, LV remodeling is still commonly present in MI patients. Early prediction of LV remodeling in MI patient is a matter of challenge.
Aim of the study: is to highlight the value of certain factors that may help in early prediction of LV remodeling after STEMI eg; ECG parameters, GLS, biomarker NT-pro BNP and angiographic factors like TIMI and MBG.
Patients and Methods: The study included 60 patients 1st acute STEMI directed , all patients were subjected to ECG analysis, admission time and GLS , NT-pro BNP, LV volume and EF, pulsed Doppler and TDI and 3 months follow up NT-pro BNP, LV volume and EF, pulsed Doppler and TDI , angiographic parameters were assessed TIMI and MBG
Results: there was a statistically significant difference between the study groups regarding, male sex, sum STR, incomplete STR, GLS, 3 months LVED and EF, three vessel disease, MBG, there was positive correlation between GLS and LV remodeling (r= 0.643, p< 0.001), there was strong negative correlation between sum STR and LV remodeling (r= - 0. 494 , p< 0.001) A ROC analysis was performed. The cut-off value of GLS that predict LV remodeling was -15.6% multivariate regression analysis showed that GLS was an independent predictor of LV remodeling.
Conclusions: Global Longitudinal strain can significantly predict adverse LV remodeling early after MI at a cut-off value - 15.6%.
LV remodeling
GLS
predictors
2019
05
01
359
368
https://zumj.journals.ekb.eg/article_30937_79a3e5b3c4388b7d3de22cf389826d46.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
OPEN SURGICAL REPAIR OF CONGENITAL ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA BY AZYGOS SPRING VERSUS CLASSIC REPAIR
Wesam
Mohamed Ali Amr
Osama
Hassan Ghareb
Wael
Mohamed Elshahat
Abdulsalam
Meftah Ali Elrabie
Background: The open EA/TEF repair is a test of surgical skills of a pediatric surgeon. In a baby with EA and a distal TEF, the lungs may be exposed to gastric secretions, air from the trachea can pass down the distal fistula when the baby cries, strains, or receives ventilation. This condition can lead to an acute gastric perforation, which is often lethal. The thoracoscopic approach to repair EA/TEF provides excellent view, allowing the most skillful surgeons to spare the azygos vein by performing the esophageal anastomosis over (on the right side) the azygos vein. Aim of the study was to compare a short-term outcome of open surgical repair of esophageal atresia and tracheoesophageal fistula (EA/TEF) by Azygos spring versus classic repair. Patients and Mehods: This prospective comparative study was carried out at the Pediatric Surgery Department, at Zagazig University Hospital during the period study year 2017 till the year 2019, 22 neonates diagnosed with EA/TEF were admitted to NICU undergoing azygos spring repair versus 22 NICU neonates diagnosed with EA/TEF undergoing classic repair operations. Results: Regarding short-outcome results, leakage, pneumonia, and overall complications were significantly in lower rate with Azygos repair and associated with classic group. Conclusion: Open surgical repair of EA/TEF with preservation of the azygous vein and if possible immediate or early extubation, leads to good results if performed by an experienced surgeon with respect to other perioperative factors.
Open Surgical Repair
Congenital Esophageal Atresia
Tracheoesophageal Fistula
Azygos Spring
2019
05
01
369
375
https://zumj.journals.ekb.eg/article_30941_2770953d82c713a296f35d8dbd70263f.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
FEASIBILITY OF LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS
Wessam
Mohamed Amr
Mohamed
Mahmoud Riyad
Mostafa
Mohamed Khairy
Zaineb
Abdellatif Almohlhel
Background: Gallstone disease is a global health problem. The incidence is 10–20% of the whole adult population. The most common infectious disease of the Gallbladder (GB) is the acute cholecystitis (AC). Objectives: evaluate the safe technique of surgery in patients with acute cholecystitis, to highlight the better method in which patient can be prevented from complications, to analyze the clinical features and surgical outcome of LC for AC, to develop a new criterion for the therapeutic strategy used for AC, especially for late AC. Patients & Methods: The present study shows that the operation time among the studied cases ranged from 90 to 120 min with mean 105.34 min. Out of 24 LC cases 5 patients (20.8%) were converted to open cholecystectomy. These patients had unclear anatomy during LC dissection, wherein 3 patients (12.5%) had bile duct injury and 2 patients (8.3%) had bleeding. Results: Observed that the mean total hospital stays as a result of repeated readmission and recurrent attacks biliary pain were higher for patient groups with significant distribution. Therefore, the overall patient’s satisfaction regarding surgical outcome, recurrent attacks biliary pain, repeated readmission, and the length of hospital stay was in favor of patients with early surgical intervention. Our results concerning patient’s preference and satisfaction came in concordance with other published results of the same interest. Conclusions: The conversion rate is related to operators’ surgical experience. Regarding the postoperative outcomes, financial costs and length of hospital stay, it is more helpful than LC beyond 72 hours.
Gallstone
LC
postoperative outcomes
2019
05
01
376
386
https://zumj.journals.ekb.eg/article_30942_a38a0ff1be283346da9dbe34d0b33efc.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
ENDOSCOPIC (TRANS-FORAMINAL AND INTERLAMINAR) DISCECTOMY VERSUS MICRODISCECTOMY IN MANAGEMENT OF HERNIATED LUMBAR DISC
Adel
Saad Ismaeil
Mahmoud
Mostafa Taha
Essam
Abd-Elhameed Dawood
Antar
Abo-mesallam Haggag
Mustafa
Abed Elsallam Elzohiery
Background: The standard goal of surgical options of lumbar disc herniations is adequate decompression with minimalizm which means tissue preservation, improving clinical outcome and minimizing harm to neural, muscular, ligamentous and peridural structures. In brief, doing only what is needed Objectives: The aim of this work is evaluation of the endoscopic lumbar discectomy in treatment of lumbar and lumbosacral disc herniation and to compare endoscopic and microscopic discectomy. Patients and Methods: A prospective study that was carried out in Zagazig University Hospital, Neurosurgery Department during the period from 2016 to 2018. The sample size was 30 patients with lumbar disc herniation attending the out-patient clinic of Neurosurgery Department. The sample was selected from the spine unit by systematic random sampling technique until the sample size was reached which took the duration from May 2016 till august 2018 (24 months). All participants were screened to determine the eligibility for participation in the study according to specific inclusion and exclusion criteria. They were treated surgically using neuroendoscopy and microscopic discectomy techniques. The two groups were evaluated clinically (VAS, ODI), radiologically (dynamic x-ray, CT and MRI), laboratory (Creatine phosphokinase level) and surgically (operative time, perioperative blood loss, complications, postoperative mobilization and hospital stay). Results: Endoscopic discectomy procedure , proved to be a technique with a high accuracy and reliability, with results comparable to those reported in studies with the classical microdiscectomy regarding the clinical condition (pain free status), but superior in regard to less muscle injuiry and damage. Conclusion: Endoscopic discectomy procedure is a valid, safe, and effective treatment for herniated lumbar disc.
Microdiscectomy
Transforaminal endoscopic discectomy
Interlaminar endoscopic discectomy
2019
05
01
387
395
https://zumj.journals.ekb.eg/article_30943_64628702d97abcc92ec4020a957b29b8.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
DETERMINANTS OF HEPATOCELLULAR CARCINOMA IN CLINICAL ONCOLOGY AND NUCLEAR MEDICINE DEPARTMENT IN ZAGAZIG UNIVERSITY HOSPITALS: A RETROSPECTIVE ANALYSIS OF 538 CASES
Nahla
Mokhtar Abdelmawla
Yousra
Taha Dorgham
Eman
Ismail Ibrahim
Lobna
Abdelaziz Abdelaziz.
Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world and it`s prevalence in Egypt has been rising in the last few years. The aim was to study determinants of HCC in Clinical Oncology and Nuclear Medicine Department in Zagazig University Hospitals.
Methods: This is a retrospective chart review of 538 patients with HCC conducted from 2012 to 2017. Analysis of data in files was done to study the determinants of HCC.
Results: The majority of cases (77%) were male, about 71.7% of patients were from urban areas. Age of majority of cases was in 50s (40%). (99.71%) of patients were of cirrhotic liver. HCV antibody was detected in serum of (89.92%) of studied cases while hepatitis B virus infection was detected in only (3.10%) of cases.
Conclusion: HCC is a major health problem in Zagazig and its incidence is increasing. The high prevalence of HCV infection makes screening programs and following up of HCV patients is a very important tool for early detection of mild HCCs cases.
HCC
Cirrhosis
HCV and HBV
2019
05
01
396
400
https://zumj.journals.ekb.eg/article_30944_a86ded4467b45183d0f2d3a6d6eaad2e.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
ASSESSMENT OF SUBCLINICAL INNER EAR DYSFUNCTION IN PSORIATIC ARTHRITIS PATIENTS
Hager
Nabil Bayoumi Ahmed
Omaima
Zakaria Shehata
Soha
Abd-el Raouf Mekki
Marwa
Hammad
Introduction: In patients with spondyloarthropathies, underlying autoimmune mechanisms and vasculitis may affect audiovestibular system. In previously presented studies, presence of sensory neural hearing loss (SNHL) was detected in some patients with PsA.
Aim: The aim of this study was early detection of subclinical inner ear affection in psoriatic arthritis patients.
Methods: a case-control study was carried out in Rheumatology and Rehabilitation Department and Audiovestibular unit, Faculty of Medicine, Zagazig University Hospitals. The sample size was calculated to be 32 divided into 2 groups: 16 psoriatic arthritis patients (Group 1) and 16 apparently healthy age and sex matched controls (Group 2). Psoriatic arthritis patients were gathered according to CASPAR classification criteria for psoriatic arthritis. All participants underwent an otoscopic examination & pure tone audiometry (PTA) with air conduction testing from 250 through 8000Hz delivered through headphone TDH39 and bone conduction testing from 500 through 4000Hz, bone conduction stimulus will be delivered via bone conduction vibrator model B71 on mastoid using ascending, descending techniques and speech audiometry.
Results: Significant differences in the pure-tone audiogram values at 8000 Hz and acoustic reflex at 4000 Hz detected in patients with PsA also tympanometric values were statistically different relative to control group indicating involvement of the functions of the inner ear. There is significant difference between PsA and control group regarding acoustic reflex in contralateral ear both right and left ear at 4000 Hz. No significant difference between PsA and control group regarding speech reception threshold and Speech discrimination in both right and left ear.
Conclusion: this study provides evidence suggesting the presence of subclinical SNHL in PsA patients denoting necessity of audiological assessment of PsA patients.
Psoriatic arthritis
Inner ear dysfunction
Audiometry
Speech audiometry
2019
05
01
401
408
https://zumj.journals.ekb.eg/article_30945_7092f2c7617404d59cfb63a2f89e6474.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
MYOCARDIAL DYSFUNCTION IN CHILDREN WITH NEPHROTIC SYNDROME, A TISSUE DOPPLER STUDY
Laila
Rasslan Abd Elaziz
Heba
Mohammed Abouzeid
Khalifa
Younes Abu Fares
Background: The prevalence of chronic kidney disease (CKD) has increased steadily. Mortality and morbidity are seen more frequently in CKD compared to in healthy subjects. Cardiovascular events are the most frequent cause of mortality and morbidity in this patient group.
Objectives: To assess the presence of fQRS in children with NS and to evaluate the relationship between fQRS and myocardial functions.
Patients & Methods: 30 children with nephrotic syndrome and 30 apparently healthy children were enrolled in the study. All patients in this study were subjected to:
Full history taking, full clinical examination and laboratory investigations; (BUN), creatinine, albumin, calcium, phosphorus, LDL, HDL, triglycerides and 24h urine collection for protein in urine. ECG and Echocardiography was performed to detect early pathological problems. Tissue doppler imaging was used to detect changes occurring in the heart with nephrotic syndrome.
Patient group was subdivided in to 2 groups according to presence of FQRS in ECG.
Results: fQRS was present in 56.7% of patient group. There was significant increase in systolic and diastolic blood pressure in patient with FQRS in ECG. There was no statistically significantdifferences between tissue doppler parameter and Tie index with FQRS except for Em wave. By univariate analysis for patient with FQRS and all parameter, FQRS was presented with increase in systolic and diastolic blood pressure, and in patient with systolic dysfunction (decrease FS%), and in patient with diastolic dysfunction (E`).
Conclusions: NS children generally have a high risk of cardiovascular complications. The present study revealed that fQRS determined using ECG, an economic and easily accessible technique, can be used as an early marker of myocardial function impairment in this patient group.
Myocardial dysfunction
A tissue doppler study
2019
05
01
409
418
https://zumj.journals.ekb.eg/article_30946_a6df6445225d040f4164a2f706ee2f2e.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
COMPARATIVE STUDY BETWEEN OPEN INGUINAL HERNIOPLASTY VERSUS TRANSPERITONEAL LAPAROSCOPY REPAIR
Ibrahem
Mohamed Mostafa
Wesam
Mohamed Amr
Mostafa
Mohamed Khairy
Ayman
Omar Abdulaziz Abu Ghamjah
Background: Successful hernia treatment should offer high patient satisfaction, low cost, low recurrence rate, and rapid return to work Objectives: To compare the effectiveness and safety of laparoscopic and conventional open repair in the treatment of inguinal hernia. To determine whether laparoscopic inguinal hernia repair offers a quicker return to duty over open repair.
Subjects & Methods: All of the patients were male, both in the group A and group B. Majority of the patients operated were having right inguinal hernia in both groups with right hernia making 80% in group A and 60% in group B.
Results: Our study showed that mean hospital stay in days for the group A was significantly lower than the group B (1±0.5versus 1.5±0.5). Hence the mean post-operative hospital stay was significantly higher in laparoscopic repair than open hernia repair which was extremely significant.
Conclusion: It can be concluded that laparoscopic hernia repair is associated with high postoperative hospital stay than open hernia repair.
Inguinal hernia
Laparoscopic repair
Open repair
2019
05
01
419
429
https://zumj.journals.ekb.eg/article_30947_915ca1c7ea6b35c7fe285a729287d122.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
ANATOMICAL VARIATIONS OF CONGENITAL DIAPHRAGMATIC HERNIA DURING THORACOSCOPIC REPAIR :A TWO EGYPTIAN CENTERS EXPERIENCE
Ahmed
Osama Hassan
Ahmed
Ezzat Mohamed Rozik
Ismail
Mohamed Ali Tantawy
Mohamed
Magdy El Barbary
Background: Congenital diaphragmatic hernia is a major problem in pediatric patients specially neonates with subsequent high morbidity and mortality. Thoracoscopic repair is now being considered the primary choice in management of such patients. The present work aims at evaluating the different anatomical characteristics and variations of congenital diaphragmatic defects during thoracoscopic repair.
Methods: Thirty patients with congenital diaphragmatic hernia were included in the study. Thoracoscopic inspection of the defect and its anatomical characters was followed by repair. Data were recorded regarding symptoms, radiological findings, anatomic landmarks and variations during the procedure itself.
Results: A higher incidence of congenital diaphragmatic hernia in infantile male population was documented with a higher incidence of left sided defect (96.7%). Postero-lateraldefects were common (86.7%) compared to lateral defect. Hernial sac was absent in 90% of cases. Most of cases had anterolateral muscular rim (86.7%). Liver herniation occurred in only two cases (6.7%). The majority of patients had moderate organ displacement (70%). Thoracoscopic repair was successful in 90% of cases. Primary repair was done in all cases with no need of synthetic patches.
Conclusion: The use of thoracoscope helps in creation of a strict phenotyping system that will enhance the ability to predict the clinical course of diaphragmatic defects and will aid in identifying developmental pathways responsible for the disease.
Congenital diaphragmatic hernia
Thoracoscope
Diaphragmatic defect
Hernial sac
Liver herniation
2019
05
01
430
438
https://zumj.journals.ekb.eg/article_30948_7b8c906537071bf885fa315c17636abe.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
ROLE OF ELECTROENCEPHALOGRAME IN DIAGNOSIS OF ATTENTION DEFICIT HYPER ACTIVITY DISORDER
Alaa
Zidan Ibrahim
Mohammed
Ahmed Talat
Usama
Mahmoud Yossef
Amr
Ibrahim Mohammed
Introduction: Attention deficit hyper activity disorder (ADHD), is the most prevalent neurodevelopmental disorder of childhood, which is characterized by the presence of inattention, hyperactivity, and/or impulsivity, EEG is the substrate of brain activity underlying cognition and behavior.
Objective: To detect the abnormalities in the electroencephalogram (EEG) in patients with ADHD also to find the relation between attention deficit hyperactivity disorder symptom severity and results of EEG.
Method: sixty patients of ADHD and 60 age and sex matched control were evaluated with EEG to detect abnormal waves.
Results: Patients with ADHD show abnormal EEG results in the form of background slowing in3 patients (5%) and epileptiform discharge in 19 patients (32%) frontal slowing in 13 patients(22%) normal EEG in 25 patients (42%) .
Conclusion: There is increased low frequency activity and decreased high frequency activity in children with ADHD, this may aid as an indicator in the diagnosis of ADHD
ADHD
Epilepsy
Electroencephalogram EEG
2019
05
01
439
446
https://zumj.journals.ekb.eg/article_30949_ecdb4bb9c0adac0949b01b9db851f687.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
THE ROLE OF DIFFUSION-WEIGHTED AND FLUID ATTENUATED INVERSION RRECOVERY MAGNETIC RESONANCE IMAGING IN DIAGNOSIS AND TIMING OF ACUTE ISCHEMIC STROKE
May
Selim Elgendy
Abdallah
Almamun Sarhan
Elhady
Ahmed Abd El Gawad
Alaa
Ali Abdelghani
Ahmed
Sabry Ragheb
Background: Ischemic stroke causes serious long-term disability and a great number of economic losses. Thrombolytic therapy is used only if the time of stroke onset was <4.5 hours. However, new categories such as wake-up and day un-witnessed strokes, patients unable to tell exact time of last seen well. The importance of study is to use diffusion weighted/Fluid attenuated inversion recovery (DWI/FLAIR) mismatch as a radiological marker which can help to identify patients with lacunar and non-lacunar stroke within 4.5 hours of onset and use it to determine whether patients with unknown onset stroke qualify for thrombolytic therapy or not.
Patients and methods: prospective cohort study was conducted on 72 patients with known time of symptoms onset, imaged within 24 hours from stroke onset. Patients underwent the admission Computed tomography CT and magnetic resonance scans (DWI and FLAIR only) with time gap was no longer than one hour. The presences of lesions in the neuroradiological modalities were assessed in correlation with the duration of the stroke.
Results: The time from stroke onsetto neuroimaging was significantly shorter with ischemic lesions visible in DWI/FLAIR mismatch group when compared to other modalities. The DWI/FLAIR was characterized by global specificity 100%, sensitivity 91.9%, PPV 100% and NPV 92.1%. It succeeded to diagnose 12 patients with lacunar stroke before 4.5 hours from the stroke onset.
Conclusion: The presence of acute ischemic lesions only in DWI/FLAIR mismatch group can help to identify both lacunar and non-lacunar stroke patients who are within 4.5 hours' time window for intravenous thrombolysis.
diffusion weighted/Fluid attenuated inversion recovery
stroke
2019
05
01
447
455
https://zumj.journals.ekb.eg/article_30950_c2cf835832ccb45f22aeb0c263500e5b.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
PREVALENCE AND FACTORS OF FUNCTIONAL DISABILITY IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS
Wafaa
Elsayed Mostafa
Amal
Bakry Abdul-sattar
Ghada
Abo elsaud Dawa
The aim of this study was to identify the prevalence of functional disability and the possible factors that may be associated with functional disability in children and adolescents with juvenile idiopathic arthritis (JIA) in Sharkia Governorate. Methods: This cross sectional study was carried out in Rheumatology and Rehabilitation department, Faculty of Medicine, Zagazig University Hospitals. Forty-eight consecutive patients of JIA aged from 7 to 17 years underwent assessment of socio-economic and demographic characteristics, functional ability using the childhood health assessment questionnaire (CHAQ), disease activity using the Juvenile Arthritis Disease Activity Score based on 27 joints (JADAS-27), psychological symptoms using the Children’s Depression Inventory (CDI) score. Results: Multivariate modeling was applied to determine the factors that associated with functional disability. A total of 80 % of the patients (39 of 48) had functional disability. In multiple regression analyses, high CDIscores (OR 20.78, 95 % CI 1.64 to 262.91, P =.019),JADAS-27 (OR 17.49% CI 2.16 to 141.62, P =.007), low socioeconomic status (OR 10.43, 95 % CI 1.24 to 87.57, P =.031) were strong predictors of functional disability in JIA patients. Conclusion: Our study on patients with JIA provides evidence suggesting that a total of 80 % of the patients had functional disability, that is associated with higher CDI scores, higher JADAS -27 and a low socioeconomic status.
Juvenile idiopathic arthritis• Functional disability• Determinants. CHAQ
2019
05
01
456
463
https://zumj.journals.ekb.eg/article_30951_dc03381c7be0280a20f76a09c849e578.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
COSMETIC OUTCOME OF HYPOFRACTIONATED WHOLE-BREAST IRRADIATION WITH CONCOMITANT BOOST IN BREAST CANCER
Rawda
Abdul Hakim Abdul Aziz Balata
Abbas
Sarhan
Seham
El. Hagrasy
Ahmad
Al.Hosainy
Background: Breast cancer is the most common cancer in women worldwide, second most common malignancy in Egypt.
Methods: 60 early-stage breast cancer patients who underwent breast-conserving surgery were clusterized into 2 groups: Arm A hypofractionation with concomitant boost and Arm B conventional fractionation, each compromising 30 early stage breast cancer patients. Assessment of cosmetic outcome after breast irradiation was recorded in both groups in 4 intervals to correlate cosmesis in relation to different irradiation schedules and boost dosage and timing. The study was conducted from April 2016 till December 2018, 32 months were obtained to assure that all patients completed their irradiation schedule and 12 months follow-up period.
Results: Lowest cosmetic outcome was recorded immediately after completion of breast irradiation with excellent/good in 66.7% and 73.3% of patients and fair/poor in 33.3% and 26.7% in Arm A and B, respectively. Improvement in cosmesis after 12 months of breast irradiation reaching excellent/good in 83.4% and fair/poor in 16.7% in both Arm A and B.
Conclusion: An abbreviated 4-week hypofractionated schedule with a concomitant boost is as effective as conventional irradiation with comparable cosmesis and may be a reasonable alternative following breast conserving surgery.
breast cancer
Hypofractionation
Boost
Cosmesis
2019
05
01
464
472
https://zumj.journals.ekb.eg/article_30952_6ba9561666fc8995809d9fccd852f95c.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
COLECTOMY IN PATIENTS WITH COLONIC CARCINOMA: LAPAROSCOPIC VERSUS OPEN METHODS
Bassam
Rabieh Mahmoud Mousa
Alaa
Mohamed Ibrahim Khalil
Wael
Elsayed Lotfy Mokhtar
Mohamed
Ibrahim Abdelhamid
Ramadan
Mahmoud Ali
Hassan
Rabieh Ashour
Background: colon cancer is one of the most common cancers all over the world. There are many methods for surgical removal of the cancer as open conventional colectomy and laparoscopic colectomy. The aim of this study is to compare between the two methods to establish the advantages and disadvantages of laparoscopic colectomy in comparison to open colectomy.
Methods: Patients were divided into 2 groups according to type of surgical interference. Group 1: included "15 patients" comprised those who had colonic carcinoma with laparoscopic intervention. Group 2: included "15 patients" comprised those who had colonic carcinoma with open surgical intervention. This study included patients with colonic carcinoma were admitted to Zagazig University Hospitals. Patients were collected in the period from December 2016 to December 2018.
Results: the results showed that there are no significant differences between laparoscopic colectomy and open colectomy. Laparoscopic colectomy showed advantages over open colectomy in terms of short hospital stay (P=0.02), rapid recovery, early return to work and good oncological outcomes.
Conclusion: Laparoscopic colectomy can be performed with good technical efficiency, quick recovery of bowel function, and mild disability, less operative blood loss, less operative trauma and shorter hospital stay. The short-term oncologic results of laparoscopic colectomy seem to be acceptable and comparable with conventional methods. We recommend using Laparoscopic colectomy in colonic carcinoma as a gold standard in our hospital to get the aforementioned advantages.
Laparoscopic Colectomy
Open colectomy
Cancer Colon
2019
05
01
473
480
https://zumj.journals.ekb.eg/article_30953_12628262b8512543dea8cb38c987e85d.pdf
Zagazig University Medical Journal
1110-1431
1110-1431
2019
25
3
EVALUATION OF PROTOCOL OF MANAGEMENT OF MORBIDLY ADHERENT PLACENTA IN MATERNITY ZAGAZIG UNIVERSITY HOSPITAL
Mahmoud
Ahmed Gharib
Walid
Mohamed El-Nagar
Mohamed
El-Bakry Lashin
Marehan
Mohammed Elaweel
Background: Morbidly adherent placenta (MAP) defines the abnormal adherence of the placenta to the underlying uterine wall. It has a rising incidence world-wide. The risk of placental abnormalities increases in the presence of uterine scars due to cesarean delivery or gynecologic procedures. It may lead to massive obstetric hemorrhage resulting in serious complications such as DIC, transfusion related complications.
Aim: Evaluation of protocol of management of patients with morbidly adherent placenta at Maternity Zagazig University Hospital and its effect on pregnancy outcome to find the best method of management to decrease associated morbidity and mortality.
Patients and methods: This cohort study conducted on 120 patients diagnosed as having morbidly adherent placenta and were admitted to Zagazig University Hospitals.
Results: In our study there were 48 cases (40%) managed by CS only and 72 cases (60%) managed by hysterectomy.
Conclusion: well-planned caesarean hysterectomy with placenta left in situ adopting multidisciplinary approach is the recommended management option for MAP.
accreta
Increta
Percreta
2019
05
01
481
489
https://zumj.journals.ekb.eg/article_30954_2a901e88befe81fa4cbe1ae266b80253.pdf