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January-June 2014
Online since Tuesday, May 20, 2014
Immunohistochemical expression of topoisomerase II a and tissue inhibitor of metalloproteinases 1 in locally advanced breast carcinoma p. 1
Hala S El Rebey, Hayam A Aiad, Nancy Y Asaad, Moshira M Abd El-Wahed, Iman L Abulkheir, Fatma M Abulkasem, Shereen F Mahmoud
DOI:10.4103/1110-2098.132294
Objectives To evaluate immunohistochemical expression of topoisomerase II a (TOP2α) and tissue inhibitor of metalloproteinases 1 (TIMP-1) in an attempt to identify their prognostic roles in locally advanced breast cancer (LABC). Background LABC is a heterogeneous clinical entity that remains a clinical challenge. Efforts are still needed to identify new markers in an attempt to predict response to therapy and prognosis. Patients and methods This study included 84 pretreatment needle core biopsies of LABC cases subjected to TOP2α and TIMP-1 immunohistochemical staining and the expression was correlated with some prognostic clinicopathlogical parameters of the patients studied. Results Fifty-seven of 84 cases (67.9%) showed positive TOP2͍ expression, with the proportion of TOP2α immunopositive cells (%score) ranging from 0 to 95%, mean ± SD of 27.84 ± 26.16%, and the median was 25%. Positive TOP2α expression was significantly associated with the presence of necrosis (P = 0.03). There was also a near-significant association between positive TOP2α expression and high mitotic count (P = 0.08). Forty-eight of 84 cases (57.1%) showed positive TIMP-1 expression with proportion of TIMP-1 immunopositive cells (%score) ranged from 0 to 95%, mean ± SD of 35.59 ± 32.93%, and the median was 30%. Positive TIMP-1 expression was significantly associated with a low apoptotic count (P = 0.03). Conclusion TOP2α-positive expression in diagnostic samples of LABC patients is associated with poor prognostic features such as the presence of necrosis, whereas TIMP-1 is associated with a low apoptotic count.
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Immunohistochemical localization of β-catenin in medulloblastoma p. 10
Rehab M Samaka, Moshira M Abd El-Wahed, Mona A Kandil, Eman Abdelzaher, Mohamed I Shaaban, Rania Abd Allah
Objectives The aim of this study was to explore the relationship between immunohistochemical expression of β-catenin and the relevant clinicopathological features of medulloblastoma in Egyptian patients. Background Medulloblastoma is a small round blue cell malignancy of the cerebellum and is a major cause of morbidity and mortality in pediatric oncology. Identification of the signaling pathways involved in the pathogenesis of medulloblastoma represents a key challenge for medulloblastoma management. The wingless (WNT)-signaling pathway has been reported to be responsible for 15% of sporadic medulloblastoma. β-Catenin represents the downstream effector of the WNT pathway. Activation of the WNT-signaling pathway results in stabilization of β-catenin and its translocation from the cytoplasm to the nucleus where it regulates the related genes. Patients and methods This retrospective study was conducted on 49 tissue specimens of medulloblastoma patients for evaluation of immunohistochemical expression of β-catenin. Results None of the studied medulloblastoma patients showed nuclear localization of β-catenin. However, 29 patients exhibited cytoplasmic staining and 20 patients were absolutely negative. No statistically significant difference was found when comparing patients with cytoplasmic β-catenin expression and negative patients with the studied parameters. In addition, the H-score value of patients with cytoplasmic β-catenin did not show significant relationship with the studied clinicopathologic parameters. Conclusion In view of the absence of nuclear localization of β-catenin, we could conclude that β-catenin does not play a role in the pathogenesis in all evaluated medulloblastoma patients. However, a large-scale study is recommended to elicit the exact role of the WNT-signaling pathway through dysregulation of components other than β-catenin.
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Assessment of fibroproliferative healing after functional endoscopic sinus surgery p. 16
Ahmed Ragab, Abdel-Latif El-Rasheedy, Rehab M Samaka, Nanes S Hola, Ahmad Hamdan
Objective The aim of the present study was to assess fibroproliferative healing after endoscopic sinus surgery (ESS) by endoscopic, histopathological, and immunohistochemical (IHC) examination. The secondary objectives were to assess the correlation between fibroproliferative tissue formation and the evaluated clinical parameters. Background Fibrous tissue formation is an inevitable process during wound healing after ESS that results in the formation of sinus adhesions and synechia and is reflected on patient's comfort and recovery from sinus diseases. Materials and methods Twenty chronic rhinosinusitis patients (12 with and eight without nasal polyposis) subjected to ESS were enrolled in the study. Patients were subjected to computed tomography and preoperative endoscopic staging of sinus disease. Patients were assessed at 2, 4, and 12 weeks postoperatively through endoscopic and tissue (histopathological and IHC) evaluation. Results There is a significant increase in the degree of fibroproliferation along the three visits in the form of fibroblast and myofibroblast proliferation (H&E stain) (P = 0.001 and P < 0.001, respectively) and presence of collagen fibers (using Masson Trichrome stain) (P = 0.008), and there was a significant increase in the ͍-smooth muscle IHC score (P < 0.001). There were no associated increases in the rate of middle meatal synechia formation or middle meatal antrostomy closure during the three follow-up periods (P > 0.05). Conclusion Wound healing after functional ESS along 12 weeks is associated with microscopic fibroproliferative healing, not apparent at macroscopic levels, and is proportional to preoperative computed tomography and endoscopic and operative technique staging.
Urinary cotinine level in passive smoker nondiabetic children of diabetic families p. 23
Soheir S Abou El-Ella, Maha A Tawfik, Maha A El Bassuoni, Mohamed I Yahia
Objective The aim of the study was to measure urinary cotinine level as a biomarker of passive smoking in children. Background Children's exposure to passive smoking is associated with a number of health hazards such as prenatal damage to the fetus, poor growth, respiratory illness, atopy and asthma, coronary heart disease, and sudden infant death syndrome. Materials and methods This study was conducted on 54 nondiabetic children from attendance of Genetic and Endocrine Units of Pediatric Department, Menofiya Faculty of Medicine. They were divided into two groups: group A (34 children exposed to passive smoking) and group B (20 children not exposed to passive smoking). The studied groups were subjected to detailed history taking, clinical examination, investigations (measurement of cotinine level by competitive enzyme immunoassay for the specific detection of cotinine in urine samples), and family counseling. Results There is significantly higher urinary cotinine levels among children with history of exposure to passive tobacco smoke (152.06 ± 106.92) in comparison with children with no history of exposure (3095.0 ± 1160.09; P ≤ 0.001). The urinary cotinine levels were found to be dependent on daily exposure to tobacco smoke as indicated by the number of cigarettes consumed by the smoker in the presence of the child. Conclusion Passive smoking is a risk factor for many health hazards, and cotinine is a valuable biomarker for assessing exposure to passive tobacco smoking especially in children.
Study of risk factors of diabetic foot ulcers p. 28
Nabil Abd El Fatah Al Kafrawy, Ehab Ahmed Abd El-Atty Mustafa, Alaa El-Din Abd El-Salam Dawood, Osama Mohammed Ebaid, Omnia Mahmoud Ahmed Zidane
Objective To study the risk factors for diabetic foot ulcers (DFUs) in Menoufia University Hospitals. Background Problems associated with the diabetic foot are prevalent worldwide. DFUs contribute significantly toward the morbidity and mortality of patients with diabetes mellitus. This study was carried out to evaluate the risk factors for DFUs. Patients and methods One hundred patients with diabetic foot were enrolled and 50 patients had foot ulcers. All were subjected to the following: assessment of full history, physical examination including foot examination through peripheral pulses including Doppler examination of dorsalis pedis and posterior tibial arteries, sensations, reflexes and callus, and routine investigations including HbA1c, fasting, and 2 h postprandial blood glucose. Results DFUs occurred mostly in patients who had had diabetes for a long duration more than 10 years (94%), smokers (50%), those with diabetic retinopathy (92%), those with previous ulcers (74%), those who had a previous amputation (42%), those with peripheral neuropathy assessed by [lost monofilament (100%), lost vibration sensation (100%), lost pinprick sensation (100%)], peripheral vascular disease assessed by [ankle brachial index≤0.9 (84%), Doppler examination detected ischemia (84%)], foot fissures (12%), foot callus (24%), foot deformities (36%), limited joint mobility (26%), dyslipidemia on the basis of elevated total cholesterol greater than 200 mg/dl (40%), and poor glycemic control on the basis of (hemoglobin A1C>7.5%). The types of ulcers were neuropathic (16%) and neuroischemic (84%). Age, sex, diabetic nephropathy, obesity detected by BMI, abnormal ankle reflexes, and elevated serum creatinine were not risk factors for DFUs. Conclusion Peripheral neuropathy, duration of diabetes, peripheral vascular disease, and poor glycemic control were significant predictors of DFUs.
Calprotectin as a fecal marker for diagnosis and follow-up in patients with ulcerative colitis p. 35
Mohamed A.E. Nouh, Atef A.E. Ali, Emad F.A. El Halim, Hosam I. Mohamed, Ayman M.A. El Ghany, Amira M. Badawy
Objective This study is designed to evaluate the role of fecal calprotectin as a marker for the diagnosis of ulcerative colitis (UC) and its correlation with disease activity and remission. Background Inflammatory bowel diseases (IBD) are lifelong intestinal inflammatory conditions of unknown etiology, characterized by remissions and exacerbations. The diagnosis and classification of IBD is usually established by a combination of tests (laboratory, endoscopic, and/or radiologic) in the presence of clinical symptoms. Fecal calprotectin serves as a noninvasive biomarker of intestinal inflammation, and has been found to be useful in the diagnosis of IBD, assessment of response to medical therapy, and in prediction of clinical relapse. Materials and methods This study was carried out on 40 patients. Twenty of these patients had clinical, laboratory, colonoscopic, and histopathological findings of UC. Group I was subdivided as follows: GIa: 20 patients with active UC and GIb: the same patients as in GIa while on remission. Group II included 20 patients as controls, matched for age and sex without clinical, laboratory, colonoscopic, and histopathological findings of UC. Complete stool analysis, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) titer, complete blood count, colonoscopy and biopsy, histopathological examination of biopsy specimens, measurement of ulcerative colitis activity index (UCAI), and quantitative determination of calprotectin in stool sample were carried out for all patients. Results There was a highly significant increase in the mean value of fecal calprotectin in active UC patients in comparison with the inactive UC patients and controls. Also, there was a highly significant increase in the mean value of fecal calprotectin in the inactive UC patients in comparison with the controls. There was also a highly significant positive correlation between fecal calprotectin and UCAI, CRP, ESR, total leukocyte count, and platelets count. At the cut-off value of 131 μg/g, fecal calprotectin has 100% accuracy, sensitivity, specificity, positive predictive value, and negative predictive value in differentiating UC patients from other patients with lower gastrointestinal symptoms and at the cut-off value of 253 μg/g fecal calprotectin has 95% accuracy, sensitivity, specificity, positive predictive value, and negative predictive value in differentiating active from inactive UC patients. Conclusion Fecal calprotectin is a valuable, simple, easily performed, and cost-effective noninvasive marker for evaluation of patients with UC. It differentiated UC and other diseases causing colonic symptoms (cut-off value of 131 μg/g) and between active and inactive UC (cut-off value of 235 μg/g) with high accuracy, sensitivity, and specificity. It also correlates well with other markers for UC activity (UCAI, ESR, CRP, total leukocyte count, and platelets count) and could be a reliable surrogate marker for the severity of UC.
The influence of phototherapy for neonatal hyperbilirubinemia on tumour necrosis factor-α p. 44
Magdy A. Saber, Sameh A. Abd El Naby, Mohamed A. Helwa, Ramy N. Deghedy
Objective The aim of the study was to investigate the influence of phototherapy in treatment of neonatal hyperbilirubinemia on the serum level of tumour necrosis factor-α (TNF-α). Background Jaundice is the most common clinical diagnosis in neonatal medicine that requires medical attention. Phototherapy is the most commonly used intervention to treat and prevent severe hyperbilirubinemia. Some investigations have expressed concern about potential toxic effects of phototherapy; one possible harmful consequence is affection of cytokines production and lymphocyte subtypes, which can affect the function of the immune system of the newborn. Recent research has provided evidence that phototherapy is associated with some long-term side effects such as melanocytic nevi and skin cancer, allergic diseases, asthma, patent ductus arteriosus and retinal damage. Patients and methods A total of 30 term neonates with neonatal jaundice were included in this study who had indirect bilirubin levels higher than 14 mg/dl, and 15 healthy matched newborns were selected as controls. Blood samples were obtained from hyperbilirubinemic newborns before exposure and at 72 h of exposure to phototherapy and from controls at the time of examination. Serum TNF-α levels were measured in the samples using enzyme-linked immunosorbent assay kits. Results Serum TNF-α levels in both patients before phototherapy and the control group did not differ significantly. Serum TNF-͍ levels significantly increased after 72 h of exposure to phototherapy, indicating the strong effect of phototherapy on TNF-α serum level. Conclusion These results demonstrate that, in addition to the well-known positive effect of phototherapy on the neonatal serum bilirubin level, this therapeutic modality increased serum TNF-α that can affect the function of the immune system in newborns.
Study of DNA damage in asphyxiated newborns p. 50
Maha A. Tawfik, Sohier S. AboElella, Hany M. El-Boshy
Objective The present study was carried out to assess the presence of DNA damage in asphyxiated newborns. Background Perinatal asphyxia is one of the major causes of neonatal mortality. It results from lack of oxygen before, during, or after birth. Patients and methods Thirty asphyxiated and 20 nonasphyxiated neonates were included in this case-control study. Blood samples were collected from a peripheral vein into heparinized tubes and stored at 10°C away from light to prevent DNA damage and were processed within 24 h to avoid further DNA damage. Estimation of DNA damage in peripheral leukocytes by DNA fragmentation assay was carried out by DNA extraction and then gel electrophoresis. Results Significant DNA damage was found (56.7%) in asphyxiated newborns and positively correlated with severity and clinical complications of hypoxic-ischemic encephalopathy. Conclusion The study indicates the presence of DNA damage in asphyxiated newborns.
Study of fungal infections in pediatric intensive care unit in Menoufiya University Hospital p. 55
Fady M. ElGendy, Fahima M. Hassan, Ahmed A. Khatab, Ghada R. El-Hendawy, Nagwan Y. Saleh
Objective The aim of the study was to determine the incidence and risk factors of fungal infections in patients admitted to pediatric intensive care unit (PICU) in Menoufiya University Hospital. Background Critically ill patients are immunosuppressed, invasively monitored, and exposed to aggressive interventions that put them at increased risk for infectious complications while residing in PICU. Fungal pathogens are an increasing important cause of infection among patients in PICU. Patients and methods This study was conducted on 492 critically ill pediatric patients admitted to PICU from July 2010 to July 2011; each patient was examined and sampled on the day of admission and after 5 and 7 days of admission. Samples were taken from oropharyngeal, axillary, and rectal areas in addition to blood sample. All specimens were cultured on Sabouraud dextrose agar. The analysis of samples included a direct examination, culture, and susceptibility of isolates to antifungal drugs. Results Candida albicans was the most common colonizing organisms, as about 156 (31.7%) patients were colonized by it on the day of admission. The most commonly acquired fungi were: C. glabrata in 71 (25.7%) patients, C. tropicalis in 61 (22.1%) patients, C. albicans in 46 (16.7%) patients, C. krusei in 33 (11.9%) patients, Aspergillus flavus in 20 (7.3%) patients, and mixed infection in 45 (16.3%) patients. Patients on previous antibiotic therapy, parenteral nutrition, and central venous line had an increased risk of acquiring fungal organisms. Conclusion Monitoring for colonization with Candida spp. in children admitted to PICU and children undergoing treatment for severe sepsis or septic shock in PICU for more than 5 days may offer an opportunity for early intervention for prevention of candidemia.
Evaluation of serum cystatin C as an indicator of early renal function decline in type 2 diabetes p. 60
Nabil A. El-Kafrawy, Ahmed A. Shohaib, Samar M. Kamal El-Deen, Hani El Barbary, Ameer S. Seleem
Objectives This study was conducted to evaluate the clinical usefulness of cystatin C levels in the serum in predicting renal impairment in patients with type 2 diabetes. Background In clinical practice, the glomerular filtration rate is often estimated from plasma creatinine levels. Several studies have shown cystatin C to be a better marker for the diagnosis of impaired renal function. Materials and methods Plasma samples were obtained from 20 healthy individuals and 40 patients with diabetes mellitus type 2 for the determination of the levels of creatinine and cystatin. In addition, we classified all participants according to the urine albumin/creatinine ratio. Results Patients were categorized into the following groups depending on their urine albumin/creatinine ratio (mg/g creatinine): macroalbuminuric, microalbuminuric, and normoalbuminuric. There were no significant differences in age and sex between the three groups. However, the estimated glomerular filtration rate was significantly lower in the macroalbuminuric group compared with the microalbuminuric and normoalbuminuric groups, and cystatin C showed a highly significant difference in detecting early decline in diabetic patients. Conclusion From this study, we concluded that estimation of the serum cystatin C level is a useful, practical, and noninvasive tool for early detection of renal impairment in the course of diabetes.
Lipid profiles in β thalassemic children p. 66
Seham M. Ragab, Manal A. Safan, Asmaa S. Sherif
Objectives To study the pattern of serum lipids in β thalassemic children. Background β Thalassemia is a common chronic hemolytic anemia in Egypt. Iron overload is a common sequelae in these patients. Abnormal lipid profile patterns have been suggested to occur in thalassemic patients. Materials and methods Forty-two children with β thalassemia (22 thalassemia major and 20 thalassemia intermedia) were included in the present study with 30 matched controls. Complete blood count, kidney function tests (serum creatinine, blood urea), liver function tests (alanine aminotransferase, aspartate aminotransferase), serum ferritin, and 12-h overnight fasting Serum lipid profiles including total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) triglycerides were performed for patients and controls. Results The thalassemic children had significantly higher platelets count, WBCs count, serum ferritin, alanine aminotransferase, aspartate aminotransferase, and serum triglyceride levels, with significantly lower Hb level, RBCs count, total cholesterol, HDL-C, LDL-C levels, and LDL/HDL ratio compared with the control group. Conclusion β Thalassemic children are at risk of developing disturbed lipid profile patterns that could place them at risk for atherosclerosis and thromboembolic events.
Ventilator-associated pneumonia in the neonatal intensive care unit p. 73
Objective Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in the ICU. We studied the characteristics and risk factors of VAP in critically ill neonates. Background VAP, which was not present at the time of intubation, accounted for up to 30% of nosocomial infections in neonatal intensive care unit (NICU) patients. Patients and methods This study was carried out in the NICU in Benha Children's Hospital on 85 neonates with different diagnoses admitted from April to October 2012 who needed mechanical ventilation. All studied neonates were subjected to history taking, clinical examination, routine investigations (assessment of complete blood count, C-reactive protein levels, and arterial blood gas volumes, blood culture, and liver, serum albumin, and kidney function tests), and chest radiography daily, as well as to nonbronchoscopic alveolar lavage culture. Results Of 85 neonates who needed mechanical ventilation, 55.2% developed VAP. Prematurity, low birth weight, and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leukocyte count, C-reactive protein, and hypoalbuminemia were significantly present in the VAP group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO 2 , and PaO 2 . The microorganisms associated with bloodstream infection in the VAP-diagnosed group were Staphylococcus aureus (15%), Klebsiella spp.(8.5%), Candida spp.(6.5%), Pseudomonas spp. (4.2%), and Escherichia coli (4.2%); 61.7% of obtained blood cultures in VAP patients were sterile. The results of nonbronchoscopic bronchoalveolar lavage cultures revealed the presence of Klebsiella spp. (34%), Pseudomonas spp. (25.5%), S. aureus (17%), E. coli (17%), and Candida spp. (6.4%). K. pneumoniae was the most commonly isolated pathogen in nonbronchoscopic bronchoalveolar lavage. Conclusion The most important risk factors of VAP are prematurity, low birth weight, prolonged duration of mechanical ventilation, enteral nutrition, and umbilical catheterization.
Effect of experimental hyperthyroidism on the maximum acute exercise tolerance and neuromuscular performance in rats p. 78
Background Thyroid hormones regulate many physiologic functions such as energy and heat production, synthesis of proteins, and muscle contraction. Objective This study aims to demonstrate the mechanism by which hyperthyroidism affects neuromuscular performance and acute exercise tolerance and whether this effect is reversible or not after recovery in rats. Materials and methods Rats used in this study were divided into three groups, each containing 10 rats: (a) in the euthyroid group, rats were selected by measurement of serum FT3 (triiodothyronin), FT4 (tetraiodothyronine), and thyroid-stimulating hormone levels. (b) In the hyperthyroid group, hyperthyroidism was induced by Eltroxin in increasing doses, beginning from 50 μg to reach 200 μg/kg body weight daily by intragastric administration for 3 weeks. (c) In the recovery group, hyperthyroid rats are allowed to recover by exogenous thyroxine withdrawal for 25 days. After induction, body weight and the maximal swimming time were estimated, and then retro-orbital blood samples were collected for estimation of malondialdehyde and the total antioxidant capacity. Rats were then killed by cervical decapitation. Phrenic nerve diaphragm preparations were excised, connected to a four-channel oscillograph for measuring the strength of muscle contraction at the start of the experiment and after 30 min activity using both direct and indirect stimulation. Glucose uptake by the muscle during 30 min of activity and 30 min of recovery was estimated. Results The data show that hyperthyroidism induced by Eltroxin elevates serum malondialdehyde significantly when compared with the euthyroid group, whereas reduces total antioxidant capacity significantly. Hyperthyroidism was also associated with reduction of body weight, the maximal swimming time, the strength of skeletal muscle contraction induced by direct and indirect repetitive stimulation, and its glucose uptake. Conclusion Oxidative stress plays a critical role in the pathogenesis of hyperthyroidism, especially on skeletal muscle performance and exercise tolerance. This effect is reversible after restoration of the euthyroid state.
Additive effect of ozone therapy to insulin in the treatment of diabetic rats p. 85
Sohair Saleh, Mamdouh El-Ridi, Sherif Zalat, Safaa El-Kotb, Sally Donia
Background Chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the heart and blood vessels. Therapy in the past few decades was mainly aimed at reducing hyperglycemia. It became clear that ameliorating oxidative stress through treatment with antioxidants might be an effective strategy for reducing diabetic complications. Medical ozone treatment may be useful in the treatment of diabetes and its complications. Objective This study aims to show the additive effect of ozone to insulin in the treatment of diabetes in rats. Materials and methods Diabetes was induced by an intraperitoneal injection of streptozotocin (45 mg/kg) in 0.2 ml of 10 mmol/l citrate buffer. Rats were considered diabetic when fasting blood glucose was at least 113 mg/dl. Rats proved to be diabetic were isolated and subdivided into four subgroups: (a) diabetic nontreated rats (n = 8), (b) diabetic ozone-treated rats (n = 8), (c) diabetic insulin-treated rats (n = 8), and (d) diabetic insulin + ozone-treated rats (n = 8). After induction, all rats were fasted for 12 h. Systolic blood pressure (SBP) was measured. Retro-orbital blood samples were collected for estimation of fasting serum glucose, glycosylated hemoglobin, total antioxidant capacity (TAC), and malondialdehyde (MAD) level. Rats were then sacrificed; vascular reactivity to norepinephrine and acetylcholine with and without endothelial lining was estimated. Results The data showed that insulin reduced the elevated fasting serum glucose, glycosylated hemoglobin, MAD, and SBP significantly when compared with the diabetic nontreated group. Also, it significantly reduced TAC and vascular reactivity to norepinephrine with and without endothelium, but there was an increase in the percent of relaxation to acetylcholine. Ozone therapy potentiated the effects of insulin on SBP and vascular reactivity. Importantly, serum MAD and TAC and glycemic state were significantly improved. Conclusion This study shows that ozone therapy may have an additive effect in the treatment of diabetes by insulin; this may attribute to the multiprotective antioxidant effect of ozone.
In-vitro and in-vivo assessment of the effect of soybean extract on Fasciola gigantica infection in comparison with triclabendazole p. 93
Nashaat E. Nassef, Wafaa M. El-Kersh, Mona M El Sobky, Nancy M. Harba, Samar A El Refai Khalil
Objective The aim of this study was to assess the effect of genistein (soybean extract) on fascioliasis. Background Continued use of triclabendazole (TBZ) as the major antifascioliasis drug has resulted in resistance. Genistein, a major isoflavone in soybean extract, shows activity against different parasites. Materials and methods This was an in-vivo study that included 28 male New Zealand rabbits grouped as follows: GI, infected and nontreated; GII, infected and treated with TBZ; GIII, infected and treated with soybean extract; GIV, normal control group; GV1, not infected and treated with TBZ; and GV2, not infected and treated with soybean extract. Treatment started on the 80th day postinfection (d.p.i.) Stool examination by formol ether concentration and egg count per gram of feces were performed on day 0 of treatment, 3rd and 7th day post treatment (d.p.t.) Cure rate and fecal egg count reduction of TBZ and soybean extract were compared. Rabbits were killed on the 95th d.p.i. Liver sections were stained with hematoxylin & eosin (H&E) and with caspase-3 immunostain. The in-vitro study included 24 adult worms classified as follows: GI, control nondrug exposed; GII, TBZ exposed; GIII, soybean extract exposed; and GIV, incubated with DMSO (soybean solvent). Adult Fasciola DNA was extracted for electrophoresis. Results Fecal egg count reduction of soybean extract was 41.6% on the 3rd d.p.t. and 95.8% on the 7th d.p.t. compared with 100% of TBZ on the 3rd and 7th d.p.t. The cure rate of this extract was 0% on the 3rd d.p.t. and 83.3% on the 7th d.p.t compared with 100% of TBZ on the 3rd and 7th d.p.t. Soybean extract improved most hepatic lesions shown by H&E staining and decreased the apoptotic changes detected by caspase-3 immunostaining. It also induced apoptotic damage of Fasciola gigantica DNA. Conclusion Soybean extract can be used in the treatment of fascioliasis to decrease the emergence of TBZ resistance.
Parasitological, histopathological, and immunohistochemical assessment of nitric oxide synthase inhibitor: aminoguanidine versus albendazole in the treatment of experimental murine toxocariasis p. 103
Nashaat A. Nassef, Wafaa M. El-Kersh, Nadia S. El-Nahas, Salwa A. Shams El-Din, Salwa F. Oshiba, Mona M. Nosseir
Objectives The study was intended to evaluate the effect of aminoguanidine compared with that of albendazole on mice infected with eggs of Toxocara canis by parasitological, histopathological, and immunohistochemical studies. Background T. canis is a widely distributed parasite. The nematode can cause toxocariasis in man. The infection takes place after swallowing fully embryonated eggs with larvae inside. Materials and methods The study was conducted on 117 albino mice classified into four groups: GI (the control group with subgroups Ia, Ib, and Ic); GII (infected with T. canis eggs); GIII (infected with T. canis eggs and treated with albendazole); and GIV (infected with T. canis eggs and treated with aminoguanidine). Sera from different groups of mice were collected for nitrite assay. The lung and brain tissues were taken for larval recovery and histopathological and immunohistochemical [inducible nitric oxide synthase (iNOS)] studies. Results The mean larval count decreased significantly from 7th to 45th day post infection (d.p.i), with albendazole and aminoguanidine, which was more effective in decreasing larval count. Aminoguanidine treatment caused early improvement in histopathological lesions initiating from the second d.p.i.; however, albendazole improvement was observed on the seventh d.p.i. The grade of iNOs expression in GII and GIII was high as compared with that in GIV. There was significantly positive correlation between serum nitrite and the grade of iNOS expression, especially on early d.p.i only in groups II and III. Conclusion Both albendazole and aminoguanidine treatment for T. canis-infected mice caused decrease in larval count and improvement in histopathological lesions. Aminoguanidine was more effective with early response and decreased tissue damage.
Effect of 3-month treatment of obesity by low-calorie diet on anthropometric, health, and nutritional status for obese female individuals p. 115
Olfat M Ibrahim Nassar
Background In the majority of obese patients, adjustment of the diet will be required to reduce calorie intake. In general, diets containing 1000-1200 kcal/day should be selected for obese patients. Objective The objective was to study the effect of treatment by low-calorie diet on obese female individuals for 3 months. Participants Forty obese female individuals (BMI΃40 kg/m 2 ) with ages ranging from 27 to 30 years were divided into two main groups: the nontreated group (n = 20) in which obese female individuals did not follow any diet and the treated group (n = 20) in which obese female individuals consumed low-calorie diet (LCD) containing 1200 kcal as 60 g protein, 165 g carbohydrate, and 33 g fats for 3 months. Materials and methods Food intakes, anthropometric measurements, follow-up weights, and blood samples were studied. Results After weight-loss phase, the anthropometric measurements (weight, hips, waist circumference, and BMI) for the treated group (consumed LCD) were decreased significantly. The mean serum total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) in the treated group were decreased significantly (P < 0.001) at the end of weight-loss phase, whereas serum high-density lipoprotein (HDL) was increased but insignificantly when compared with the nontreated group. Serum red blood cell, hemoglobin, hematocrit, and platelet in the treated group were decreased significantly at the end of weight-loss phase (P < 0.001 and P < 0.05), whereas in the nontreated group after the same time they were slightly increased (P < 0.01 and P < 0.001) except WBC and platelet, which decreased. The mean values of serum aspartate aminotransferase, alanine aminotransferase, glucose, uric acid, creatinine, and blood urea nitrogen in the treated group were decreased significantly (P < 0.001) compared with that in the nontreated group with slightly increased values, but the differences were insignificant. All obese patients (n = 40) before weight-loss phase (3 months) consumed a diet rich in energy, protein, and micronutrients (calcium, iron, vitamin A, C, D, B6, and B12). However, the weight-loss phase treated group (n = 20) (consumed LCD) consumed a diet that had reduced requirements (DRI) for energy, calcium, iron, vitamin A, vitamin C, vitamin D, and vitamin B6 by 54.5, 22.58, 36, 48.31, 83.33, 64.0, and 12.5%, respectively, whereas they consumed a diet that had increased requirements for total protein and vitamin B12. Hence, consumed LCD has a positive role in controlling body weight, anthropometric measurements, and health status but has a negative impact on nutritional status because it lacks some of the nutrients. Conclusion Body weight reduction after LCD has a positive impact on anthropometric measurements and health status but has a negative impact on nutritional status because it lacks some of the nutrients.
A prospective study of some medicolegal aspects of physical and sexual family violence cases at Menoufia University hospital over 2 years p. 122
Samy M. Badawy, Naira F. Gergis, Amira M. El-Seidy, Fatma S. Kandeel
Objective To study some medicolegal aspects of family violence cases at Menoufia University hospital beginning from 1 June 2009 to 31 May 2011 in terms of sociodemographic pattern, injuries pattern, relation between family violence and substance abuse, and outcome of these cases. Background Family violence occurs in all socioeconomic groups, in every race, ethnic group, religion, and also in same-sex relationships and it can be perpetrated by both men and women. It may be called battery, child abuse, elder abuse, intimate partner violence, family violence or domestic violence, and other violent acts between family members. Patients and methods This was a prospective study including all family violence cases after obtaining their written valid consents, and clinical sheets were obtained including assessment of history and examination. Results A total of 472 cases were studied. Physical violence constituted 98.5% (465 cases) and sexual violence constituted 1.5% (seven cases) of cases. Most violence occurred indoor (84.7%) and in a repeated manner (80.7%). Social causes of violence (50.2%) outnumbered other causes, followed by economic causes (28.2%). The most common assailants in family violence were husbands (23%), followed by brothers (16%). Most of the assailants were men (89.2%), from rural areas (71.8%), of low socioeconomic standard (53.2%). Sexual violence was significantly associated with lower age of victims and assailants. Conclusion Family violence was mainly of the physical type. Most of the assailants were men. Social and economic causes were the main causes. Sexual violence was significantly associated with lower age of victims and assailants.
Effects of isolated obesity on left ventricular function: a longitudinal strain imaging study p. 130
Walaa F. Abdelazez, Rehab I. Yaseen, Ahmed M. Alkersh, Mohammad A.H. Ebada
Background Obesity is associated with heart failure, cardiovascular morbidity, and mortality. A direct effect of weight on left ventricular (LV) structure and myocardial function is not well established. Aim The aim of this study was to determine the effect of isolated obesity on LV morphology and systolic function using LV standard ECG indices and strain imaging indices. Patients and methods Sixty-five individuals were enrolled into this study: 45 with isolated obesity, defined as a BMI of 30 kg/m 2 or higher with no other cardiovascular comorbidities, and 20 nonobese age-adjusted and sex-adjusted controls. All participants underwent standard two-dimensional ECG and myocardial strain imaging. Results There was no significant difference between patients and controls as regards height (P > 0.05). In contrast, weight, BMI, and waist circumference were significantly higher in the patient group compared with the control group (P < 0.001). Obese participants had significantly increased left atrial diameter, aortic diameter, septal wall thickness, LV posterior wall thickness, and LV mass (P < 0.001). There was no significant difference between patients and controls as regards LV diastolic diameter, LV systolic diameter, ejection fraction, fractional shortening, LV mass index, E velocity, A velocity, and the E/A ratio (P > 0.05). Comparative analysis of LV two-dimensional longitudinal strain parameters between patients and controls shows a significant decrease in longitudinal strain in obese patients in the apical long-axis, apical four-chamber, and apical two-chamber views (P < 0.001). Conclusion Obesity is associated with morphologic alterations in the LV, in the form of increased LV mass, interventricular septum thickness, and LV posterior wall thickness, as well as subclinical changes in LV systolic function, which can be detected by strain imaging even without overt heart disease.
Assessment of right ventricular response to exercise using vector velocity imaging in hypertrophic cardiomyopathy p. 136
Hala M. Badran, Naglaa F. Ahmed, Waleed A. Ibrahim, Maged M. Khalifa
Objective The objective of this study was to assess right ventricular (RV) deformation response to exercise in hypertrophic cardiomyopathy (HCM) and its relationship with left ventricular (LV) function using vector velocity imaging (VVI). Background RV adaptive mechanisms to exercise in HCM are poorly understood. VVI is achieved through the combination of speckle tracking, mitral annulus motion, tissue-blood border detection, and the periodicity of the cardiac cycle using R-R intervals. It can measure different parameters of deformation and dyssynchrony of the regional myocardium. Patients and methods Resting and exercise echocardiography was performed in 40 HCM patients and 33 healthy control individuals. Longitudinal peak systolic strain (εsys ) and strain rate (SR sys , SR e , SR a ) of RV segments from the apical four-chamber view were used to evaluate RV functional reserve (stress-rest/rest). Similar parameters were quantified in LV wall segments. Intra-V dyssynchrony was defined as SD of TTP (measured from regional strain curves for each segment as time from the beginning of the Q wave to time to peak åsys ). Results In HCM and immediately after exertion, RV åsys and SR sys were significantly lower and RV dyssynchrony was greater compared with those in the control participants. A significant correlation was evident between exercise capacity and RV TTP-SD and RV SR sys . RV functional systolic reserve showed a direct relationship with LV systolic functional reserve. However, using multivariate regression analysis, LV SR sys , and LV, TTP-SD is the only predictor of exercise capacity, whereas the RV functional reserve did not alter the outcome. Exercise stress-induced RV dysfunction in HCM is associated with exercise intolerance and strongly related to LV deformation abnormalities as evaluated by VVI. Conclusion Although exercise-induced RV dysfunction assessed during stress was statistically associated with exercise capacity, it was found that the LV systolic SR and systolic dyssynchrony at rest are major determinants of exercise tolerance in HCM.
Atrial septal defects: clinical presentation and recent approach in its diagnosis and treatment p. 145
Hala M. Badran, Ghada M. Soltan, Mohammed A Alrefaey Atwa
Objective This study aimed to review the atrial septal defects (ASDs), describing their types, presentations, and different lines of management. Data summary ASDs are the second most common congenital lesion in adults (after bicuspid aortic valves). They represent ∼7% of all cardiac anomalies. Transcatheter closure of a secundum ASD is now widely accepted as an alternative to surgical closure. With currently available devices and techniques, ∼80-90% of secundum ASDs can be closed percutaneously. In this review, we summarize the literatures of ASD in terms of its closure. Conclusion Closure of secundum ASD percutaneously has become the standard of care in pediatric and adult patients. Patients of all ages experience reduction in pulmonary artery pressure and right ventricular size, and an improvement in functional capacity after percutaneous device closure of ASD, and these improvements appear to be greater if the defect is closed earlier.
Study of swine flu infection in Menoufia governorate in years 2009-2010 p. 152
Osama Fahim Mansour, Ramadan Mohamed Baker, Rabab Abd El Razek El Wahsh, Asrar Helal Mahrous
Objective The aim of this study was to evaluate the status of new H1N1 swine flu infection in Menoufia governorate during the years 2009 and 2010, with regard to the prevalence and mortality rates, and the most risky groups for infection and complications. Background Swine influenza is an infection caused by swine influenza virus that is endemic in pigs and was transmitted to humans. Patients and methods Data of H1N1-infected patients were collected from different hospitals (Chest, Fever and Menoufia University Hospital). Data were collected from Preventive Medicine Authorities in Menoufia governorate (2009-2010). A total of 400 patients were confirmed to be H1N1 infected using nasopharngeal swabs. Only files of 125 patients who were admitted to the hospital could be collected and studied regarding their name, age, sex, address, symptoms, signs, radiological findings, time of initiation of Tamiflu treatment, risk factors and outcome. All collected data were analysed to determine the prevalence of H1N1 infection in Menoufia governorate. Results The mean age of H1N1-infected patients was 30.9 ± 19.6 years. It was more common in urban areas than in rural areas. The presenting clinical features were tachycardia and fever. Radiograph was normal in 59.2% of the infected patients; 32.8% of the patients showed pneumonic patches on radiograph and 8% of the patients had a radiological picture of ARDS; 20% of the patients had chronic obstructive pulmonary diseases, 15% of the patients had cardiac diseases and 12% of the patients had diabetes mellitus; 96% of the patients improved and 4% died during the course of the illness. Only eight patients (6-4%) underwent mechanical ventilation. Conclusion Patients who received Tamiflu treatment within 48 h had better prognosis. Early suspicion of the infected cases is very important to decrease complications.
Role of three-dimensional multidetector computed tomography angiography of hepatic vessels in the evaluation of living donors p. 157
Mohamed R. Elkholy, Hazem M. Elshazly
Objectives To assess the role of multidetector computed tomography (MDCT) angiography in the preoperative mapping of hepatic vascular anatomy in potential living liver donors, identification of anatomical variants that influence the donor selection and surgical planning. Background Liver transplantation became the ultimate solution for decompensating liver diseases. Donor's safety and selection protocols are primary concerns. Thus, preoperative evaluation of the hepatic vascular anatomy is crucial to minimize mortality, morbidity, and post-transplant complications. Patients and methods Evaluation of 20 potential living donors was performed using 64-row MDCT scanners, obtaining hepatic arterial and portovenous phases. The arterial anatomy was classified according to the Michels classification. The portal venous anatomy was assessed and classified according to the Cheng classification. The hepatic venous anatomy was evaluated with special attention paid to the middle hepatic vein anatomy. Results In our study, out of 20 liver transplantation potential donors, 11 (55%) showed a classic arterial anatomy, whereas nine (45%) showed some type of anatomical variant. Replaced right hepatic artery from the superior mesenteric artery was the most common (three donors, 15%). The classic portal venous anatomy was found in 16 candidates (80%), whereas its variants were detected in four cases (20%). The standard hepatic venous anatomy was found in 14 candidates (70%). Six individuals (20%) had significant accessory hepatic veins. Middle hepatic vein confluence was late in four candidates (20%). An accessory inferior right hepatic vein was the most common accessory hepatic vein that was detected in five cases (25%). Conclusion 64-row MDCT is essential in the preoperative evaluation of potential liver donors. It is a noninvasive comprehensive evaluation tool that can show the hepatic vascular anatomic details with precise relationship to the liver parenchyma.
Varicocele repair outcome with respect to hormonal profile and spermogram pattern p. 164
Alaa Eldin M Almahdy, Ahmed A Gamal Eldin, Mohammed M. Abdullah, Mohammed I. Abuzaid
Objectives This study aims to evaluate the outcome of varicocelectomy on the hormonal and spermatogenic function of the testis. Background Varicocele of the testis is the most common male factor causing subfertility. The harmful effect of varicocele on the testis has been documented, and the value of varicocelectomy in improving spermatogenesis has also been confirmed. However, the effect of varicocele on steroidogenesis and the role of varicocelectomy in improving testicular testosterone production are still under evaluation. Patients and methods This prospective study included 46 patients with bilateral varicocele. Semen analysis was carried out and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone were obtained preoperatively. Bilateral inguinal varicocelectomy was performed in all 46 patients. All patients were followed up 3 months postoperatively by semen analysis and serum levels of FSH, LH, and testosterone. Only 32 patients were followed up 6 months postoperatively, also by semen analysis and serum levels of FSH, LH, and testosterone. Results There was no statistically significant change in the levels of FSH, LH, and testosterone postoperatively even after 6 months of follow-up. However, a significant increase in the testosterone level was found in patients with preoperative low testosterone level (≥3 ng/ml) both at 3 months (P = 0.005 ) and at 6 months (P = 0.004) from the operation. Both sperm concentration and progressive sperm motility showed statistically significant increases both at 3 months (P = 0.0003 and 0.0001, respectively) and 6 months (P = 0.0001 and 0.002, respectively) of follow-up. Normal morphology of sperm showed a statistically significant improvement only after 3 months of follow-up (P = 0.008). Conclusion Varicocelectomy improves the spermatogenic function of the testis. In addition, it has a favorable effect on testosterone production in patients with varicocele and low serum testosterone.
A comparative study on tracheal intubation using Airtraq laryngoscope versus Macintosh laryngoscope in morbidly obese patients p. 169
Osama El Sharkawy, Sabry Ibrahim
Background Airtraq laryngoscope was designed to facilitate tracheal intubation in patients with either normal or difficult airways to provide high quality view of the glottis without the need to align the oral, pharyngeal, and tracheal axes. This study evaluates the usefulness of this new device in morbidly obese patients who are deemed to be at high risk of difficult intubation. Methods Forty morbidly obese (BMI>35 kg/m 2 ) adult patients with American Society Of Anaesthiologist physical status I-II were randomly divided into two groups (20 patients each). All patients were preoxygenated for 4 min then anesthetized with fentanyl (1-1.5 μg/kg), propofol (2-3 mg/kg), and succinylcholine (1 mg/kg). Thereafter, they were manually ventilated before tracheal intubation using Macintosh laryngoscope 'Group I' or Airtraq laryngoscope (Prodol Meditec S.A., Vizcaya, Spain) 'Group II'. Results In the Macintosh group, two patients needed a stylet, one patient needed a bougie, and another four patients needed to switch to Airtraq, but in the Airtraq group only one patient needed to switch to Macintosh. In addition, the degree of difficulty of intubation in the two groups according to the sum of intubation difficulty score showed that four patients in the Macintosh group had high degree of difficulty against one patient in the Airtraq group. Hence, the visualization of the larynx and endotracheal intubation was better and easier with Airtraq laryngoscope than Macintosh laryngoscope. Conclusion The use of Airtraq laryngoscope is more suitable 'rapid, safe and successful' in tracheal intubation of high-risk morbidly obese patients.
Optical coherence tomography as a prognostic tool for visual improvement after management of diabetic macular edema p. 174
Faried M. Wagdy, Abdel Rahman E Sarhan, Osama A. Elmorsy, Marwa A Zaky Galal, Moustafa K. Nassar
Objectives The aim of the study was to evaluate the role of optical coherence tomography (OCT) as a prognostic tool for visual improvement after management of diabetic macular edema (DME). Background OCT provides an easy quantitative assessment of the relationship between DME and visual acuity. Patients and methods Fifty eyes affected with DME were treated and followed up for 6 months. The main outcome measures were best corrected visual acuity (BCVA) and central macular thickness (CMT) in addition to photoreceptor integrity changes, which were measured using OCT at 1 month and 6 months after treatment. Result After treatment of DME, follow-up at 1 month revealed that the mean CMT was significantly higher among patients in the panretinal photocoagulation (PRP) + intravitreal triamcinolone acetonide (IVTA) + grid group compared with the patients in the grid + PRP group (P = 0.001), focal + PRP group (P = 0.01), and focal management group (P = 0.008). The mean BCVA was significantly lower among patients in the grid + IVTA group compared with patients in the grid + PRP group (P = 0.03), focal + PRP group (P = 0.02), and focal treatment group (P = 0.008). After 6 months of treatment, there was no significant difference between the mean values of CMT (P = 0.46) or BCVA (P = 0.07) with respect to different ways of management. With respect to the photoreceptor integrity at 1 month follow-up, the mean CMT was significantly lower in the intact (P = 0.001) and disrupted (P = 0.01) groups compared with that in the absent photoreceptor integrity group, whereas the mean BCVA was significantly higher in the intact group than in the absent (P = 0.001) and disrupted (P = 0.001) photoreceptor integrity groups. At 6 months, the mean CMT of the absent photoreceptor integrity group was significantly higher than that of the intact group (P = 0.03), and the mean BCVA was significantly higher in the intact group than that in the disrupted photoreceptor integrity group (P = 0.01). Conclusion CMT measured using OCT and the status of photoreceptor layer significantly provide an objective guideline for predicting the visual improvement in eyes with DME after treatment.
Suprascapular nerve neurotization in obstetrical brachial plexus palsy using the spinal accessory nerve or the C5 root p. 178
Saeed E. Al-Emam, Sobhy A. Hewidi, Adel M. Hanafey, Essam Al-Din G Saleh, Ahmad F. Sheha
Objective To evaluate the value of distal spinal accessory nerve (SAN) or 5th cervical (C5) root neurotization to the suprascapular nerve (SSN) in infants with obstetrical brachial plexus birth palsy. Background Surgical treatment of obstetrical brachial plexus birth palsy in infants includes neurolysis, nerve repair directly, or the use of interposition nerve graft and neurotization procedures. Repair of SSN is the key to restoration of shoulder joint function. Materials and methods Over a 3-year period, 30 infants with brachial plexus injuries were subjected to SSN repair, 18 infants by neurotization to the SAN and 12 infants by interposition nerve grafting to the C5 root as part of the primary surgical reconstruction. Operative and postoperative outcomes were evaluated with a minimum follow-up of 18 months. Results Neurotization of the SSN was performed by intraplexal neurotization using a nerve graft to C5 in 12 patients (40%) or extraplexal neurotization using SAN directly in 18 patients (60%). Nineteen infants were subjected to surgical reconstruction at less than 6 months of age and 11 were subjected to surgical reconstruction, age range 3 to 16 months, mean 5 months. At the latest follow-up, active shoulder movements were measured confirmed by review of videos. The outcome of nerve injury was assessed using the peripheral nerve injury unit scale. The results of neurotization and the use of an interpositional nerve graft were analyzed. SSN neurotization outcome by SAN showed 94.4% good outcome and 5.6% fair outcome, which were better than outcome by C5 root neurotization (66.7% good and 33.3% fair). Five patients developed a postoperative superficial wound infection. Conclusion Although both SAN and C5 root neurotization to the SSN nerve are reliable options for shoulder reinnervation in infants with obstetrical brachial plexus palsy, direct neurotization without an interpositional nerve graft yields better results.
Safety and efficacy of endovascular treatment of ruptured cerebral aneurysms p. 184
Ahmed S. Mansour, Essam E. Gaber, Tamer Hassan, Hytham AlBeltagy, Waseem Hamed, Mohammed Shadad, Shawky S. Gad
Objectives The aim of this study was to study the safety and efficacy of endovascular treatment of ruptured cerebral aneurysms. Background Endovascular treatment has become a standard method for the treatment of intracranial aneurysms. Materials and methods A total of 12 patients were referred for endovascular treatment of ruptured aneurysms: six women and six men, with a mean age of 48.8 years. Patients were classified according to the Hunt and Hess grading system. There were one grade I patient (8.3%), five grade II (41.6%) patients, and six grade III (50%) patients. No patient belonged to grade IV (0%) or grade V (0%). Clinical follow-up was conducted at 6 months, and the results are classified according to the Glasgow Outcome Scale (GOS). Control angiograms were obtained immediately and at 6 months. Results Immediate angiographic results were satisfactory in seven patients (58.3%; complete obliteration), and five patients experienced some residual symptoms of their aneurysms (41.6%). The mortality and morbidity was low. At 6 months, the outcomes were as follows: GOS score of 1, two patients (16.6%); GOS score of 2, seven patients (58.3%); GOS score of 3, three patients (25%); and GOS score of 4 and 5, zero patients (0%). Six-month angiographic follow-up data were available for 10 patients (83.3%). The morphological results were satisfactory in most patients: complete occlusion in seven patients (58.3%) and residual or incomplete occlusion in three patients (25%); two patients (16.6%) underwent recoiling. Conclusion Endovascular treatment of ruptured aneurysms was attempted without clinically significant complications in 91.6% of patients. Morphological results were unsatisfactory in 16.6% of patients. Complete obliteration of the sac, with or without residual neck, is essential to prevent subsequent bleeding, which occurred in 66.6% of patients. The overall outcome at 6 months was satisfactory, despite a selected group of patients [three patients (25%)] having residual complications or residual aneurysms.
Posterolateral fusion versus posterior interbody fusion in adult lumbar isthmic spondylolisthesis p. 191
Hosam A.M. Habib
Objective The aim of this study is to assess and compare the outcomes of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in adult isthmic spondylolisthesis. Background Both PLIF and PLF have been used widely in the treatment of lumbar degenerative spinal diseases. Although PLIF has theoretical and demonstrable advantages over PLF, many authors did not observe this and report that outcomes of both surgical methods are comparable. Materials and methods Fifty patients with lumbar spondylolisthesis were operated for isthmic spondylolisthesis complaining of low back pain with or without sciatica and neurogenic claudication. The patients were allocated randomly to two groups according to the mode of bony fusion into PLIF and PLF groups. The two groups were statistically similar with respect to demographic and clinical data. Results No significant differences were found between PLIF and PLF in blood loss, short-term postoperative clinical result, or complications, but the operation time was longer with PLIF. Postoperative long-term visual analogue scale (VAS) for back pain, the Oswestry disability index, and fusion rates were significantly better in PLIF. Conclusion PLIF seems to be a better bone fusion technique than PLF in the management of isthmic spondylolisthesis.
Effect of atorvastatin and erythropoietin on renal fibrosis induced by partial unilateral ureteral obstruction in rats p. 197
El Sayed M Abd El Salam, Mahmoud H El Odemi, Adel H. Omar, Fatma A. El-Serafy, Tarek F Abd El Hakim, Rehab M. Samaka, Noha M. El-Kady
Objective This work aims at investigating the effects of atorvastatin and erythropoietin (EPO) on tubulointerstitial fibrosis induced by partial unilateral ureteral obstruction (PUUO) in rats. Background Renal fibrosis is the final manifestation of chronic kidney disease. It is one of the biggest problems in nephrology, indicating that patients inevitably reach end-stage renal disease. Atorvastatin has anti-inflammatory, antiproliferative, and immunomodulatory potential. EPO has been demonstrated to play an important cytoprotective role. Methods Fifty adult albino rats were divided into five equal groups: group 1 received saline intraperitoneally and methylcellulose orally for 14 days and served as the negative control; group 2 (sham-operated group) rats underwent the same surgical procedures as group 3 without ureteral obstruction; group 3 rats underwent PUUO without any medication; group 4 rats underwent PUUO and received atorvastatin at a dose of 50 mg/kg orally; group 5 rats underwent PUUO and received EPO at a dose of 3.000 IU/kg daily intraperitoneally. After 14 days, systolic blood pressure was measured. Blood and urine samples were also collected for measurement of serum transforming growth factor-β1, tumor necrosis factor-͍, urea and creatinine, and urinary protein and albumin levels. Renal tissue samples were collected for determination of malondialdehyde and ͍-smooth muscle actin levels, as well as for histopathological and immuonohistochemical examination. Results Our results showed that systolic blood pressure; serum levels of transforming growth factor-β1, tumor necrosis factor-α, and malondialdehyde; and biochemical parameters were significantly elevated. Histopathological examination of kidney tissue revealed marked degenerative changes and increased expression of α-smooth muscle actin in group 3 compared with groups 1 and 2. In contrast, biochemical, histological, and immuonohistochemical features in groups 4 and 5 showed significant improvement compared with group 3. Conclusion It is concluded that both atorvastatin and EPO have renoprotective effects against renal fibrosis, shown by improvement in kidney functions and using fibrosis markers.
Evaluation of total thyroidectomy in benign thyroid diseases p. 205
Hatem Mahmoud Sultan, Hossam Abd El-Kader Ahmed, Hany Ibrahim Sedhom
Objectives The aim of the study was to evaluate the role of total thyroidectomy in benign thyroid diseases such as simple multinodular goiter, secondary toxic goiter, diffuse toxic goiter relapsing after full medical treatment, and selected cases of thyroiditis (Hashimoto's thyroiditis). Background The extent of thyroidectomy in benign thyroid enlargement remains a matter of debate and shows a large spectrum of management strategies. Patients and methods We conducted a prospective observational study by collecting data from 40 patients in Menoufia university hospital between April 2010 and October 2011. All patient groups were subjected to investigations such as complete blood count, T3, T4, TSH, and calcium level. Results Of the 40 patients operated upon by total thyroidectomy in our study, eight patients (20%) suffered from complications: six patients (15%) suffered from transient hypoparathyroidism, one patient (2.5%) suffered from unilateral partial recurrent laryngeal nerve injury, and one patient (2.5%) suffered from difficult intubation. Conclusion The study showed that total thyroidectomy is recommended as a routine procedure of choice in benign thyroid diseases because it avoids leaving residual unhealthy thyroid tissue liable for recurrence with or without superimposed malignancy.
Fixation of subtrochanteric fracture femur using a proximal femoral nail p. 208
Hesham M. El-Mowafi, Taher A. Eid, Amro S. El-Sayed, Soliman H. Zalalo
Objectives The aim of this work was to evaluate the results of management of 20 adult patients with subtrochanteric femoral fractures using a proximal femoral nail (PFN). Background Fractures of the proximal femur are a big challenge in traumatology. Rapid strides in implant and instrumentations in quest of ideal fixation of subtrochanteric femoral fractures have made various options available. The present study aims to study the role of standard PFN in the management of these fractures. Materials and methods We reviewed the results of 20 consecutive patients who had undergone intramedullary fixation with PFN for traumatic subtrochanteric fractures in our hospital from May 2011 to June 2013, including the follow-up. The average age of the patients was 45 years. Clinical and radiographic analyses were performed during follow-up at 6, 12 weeks, 6 months, and 1 year. Results All patients were clinically assessed according to the Merle d'Aubigné hip scoring system. Our final results were excellent in 25%, good in 40%, fair in 20%, and poor in 15% of patients. Poor results were seen in three cases. Radiologic assessment included union, malunion, failure of fixation, and implant failure. There was only one case of delayed union and two nonunited cases, with a union rate of 85% at final follow-up. Shortening and varus deformity occurred in two cases but had no effect on the clinical and functional outcome. Failure of fixation occurred in only one case but there were no implant failures. Also there were no intraoperative or postoperative shaft fractures. Conclusion The current study shows that PFN is an evolving safe and successful approach in the treatment of subtrochanteric femoral fractures and can be carried out in a minimally invasive manner.


1:30pm – 2:00pm The future skills that employers are looking for – thank you to Leeds City Region for standing in due to the snow. Their presentation can be viewed here.
Learn about who ITV are and the kind of roles that exist within the TV industry – there are some you won't even have thought of! Hear what ITV look for in their entry level talent and how to get your students ready for that winning interview.
Having just been through an Ofsted inspection, a Matrix reaccreditation plus completing the Level 6 in Career Guidance and Development and now working towards the Quality in Careers Standard, Kate Molloy provides some thoughts on how to use these processes for the benefit of your clients and how not to get bogged down in the sense of being 'monitored' and checked.
Discover how Teesside University's BSc (Hons) Criminology and Sociology students enhance their studies through an innovative module involving collaboration with prison inmates. The module, Inside Out, is based on an American model. It allows students and prisoners to gain from one another's views and experiences. This is a great example of how Teesside University's courses provide students with valuable employability skills to prepare them for the working world.
This fast growing sector has a breadth of opportunities for students who are looking for interesting places to use their STEM skills. Every one of us uses space every day often in ways we're not even aware of – come and hear about it.
RateMyApprenticeship will share their knowledge and experience of the school and college leaver market, as well as insights from the 11,000 peer to peer reviews featured on RateMyApprenticeship.co.uk.
Statistics about young people show a rise in alcohol and substance misuse, unemployment, mental health, poverty and family breakdown. Tackling these issues head-on benefits young people, their families and wider society. Find out how 'I am Resilient' Project from Prospects is nurturing resilience to help young people engage in education, employment and training.


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Posted on March 31, 2016 by Kelly Melsted, One of Thousands of Career Coaches on Noomii.
But do I really believe this stuff I preach?
Which brings me to my beef with bucket lists. This also seems to be something like bucket lists. I kinda sorta know that the chances that I will die before tomorrow are rare. We don't plan on dying anytime soon. That's why bucket list don't really work! I can put the bucket list on hold- just call Mom tomorrow- make the phone call to that woman I would love to coach- go the whopping 15 minutes out of my way to say 'hi' to my brother and sissy or tell that person how amazing they truly are.
This had the wheels turning upstairs. What if I asked myself every night this question of Champagne- worthiness, what would change?
So what ever happened with the golden bubbles? I told my sweetheart this highly dramatic dilemma that was having me question life, my authenticity & gumption- to name a few.
Do you also have Macklemores gold song in your head?


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text:
Q: How to intent to Location Mode Settings in Android? I know that I can use the following code to go to the Location Settings and then to Location Mode:
Intent viewIntent = new Intent(Settings.ACTION_LOCATION_SOURCE_SETTINGS);
startActivity(viewIntent);

But is it possible to go to Location Mode/Locating Method directly
Locating Method image

redpajama_set_name: RedPajamaStackExchange


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Jeb Bush, icky and awkward: Jokes that Supergirl "looks pretty hot"
Who is your favorite Marvel superhero, Jeb?
Jeb just wants you to like him.
Unfortunately, he has an odd, and somewhat creepy way of going about persuading voters that he has a likable personality.
Who is your favorite Marvel superhero, the former Florida governor was asked during a Libre Institute forum in Las Vegas last night. Apparently voters care because Jeb said this was the second time he had been asked that question recently before revealing that he was no fan of the Ant-Man sequel but was interested in the Supergirl television show because the actress "looks pretty hot."
"I like watching the movies," Jeb told the Koch-funded Hispanic business group. "I wish I owned Marvel, as someone that believes in capitalism," he awkwardly added.
"I don't know, I'm kinda old school," he continued. "I like the old school guys like Batman, a little dark these days."
Ignore that Jeb clearly cannot denote between Marvel and DC Comics because one second later he dives into even more awkward territory.
"I saw that 'Supergirl' is on TV," he began to joke, "I saw it when I was working out this morning. There's an ad promoting 'Supergirl.' She looked kind of -- she looked pretty hot."
Displaying some semblance of self awareness, Jeb then paused before adding, "that'll make news."


Consultant: Have you met with appropriate internal and/or external resources (legal, accounting, HR, shareholder relations, consultant, other) to prepare the proxy?
Save time, empower your teams and effectively upgrade your processes with access to this practical Consultant Toolkit and guide. Address common challenges with best-practice templates, step-by-step work plans and maturity diagnostics for any Consultant related project.
The latest quick edition of the Consultant Self Assessment book in PDF containing 49 requirements to perform a quickscan, get an overview and share with stakeholders.
Featuring new and updated case-based questions, organized into seven core areas of process design, this Self-Assessment will help you identify areas in which Consultant improvements can be made.
Review the clients bonus/incentive compensation plan to ensure that objective, performance-based criteria were established, communicated to staff, and used in determining bonus amounts?
Impact of upgrade projects on the service desk and it department in general; will you need to employ expensive consultants or re-train your it staff?
If any data will be released to the public, consultants, researchers or other third parties, will it be aggregated or otherwise de-identified (i.e. anonymized)?
Review the clients bonus/incentive compensation plan to determine if any portion of the bonus paid was a constructive dividend or other distribution of profits?
How will you train employees to apply lean and knowledge management practices so they can accomplish the streamlining and institution of new practices tasks?
Have you met with appropriate internal and/or external resources (legal, accounting, HR, shareholder relations, consultant, other) to prepare the proxy?
While you can hire consultants to help alleviate the resource crunch for the project, who gets to run them after the consultants leave?
Will you be working with professional consultants such as accountants, financial counselors, or small business development professionals?
Procurement Management Plan: What areas does the group agree are the biggest success on the Consultant project?
Schedule Management Plan: Will the Consultant project sponsor be involved in preliminary schedule reviews?
Scope Management Plan: Given the scope of the Consultant project, which criterion should be optimised?
Planning Process Group: When developing the estimates for Consultant project phases, you choose to add the individual estimates for the activities that comprise each phase. What type of estimation method are you using?
Step-by-step and complete Consultant Project Management Forms and Templates including check box criteria and templates.
With this Three Step process you will have all the tools you need for any Consultant project with this in-depth Consultant Toolkit.
This Toolkit empowers people to do just that – whether their title is entrepreneur, manager, consultant, (Vice-)President, CxO etc… – they are the people who rule the future. They are the person who asks the right questions to make Consultant investments work better.
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President of Grupo MindValue and Academic Manager of B-Talent. Thinker and speaker, he is considered one of the greatest contemporary experts in the Government of private individuals and organisations. He is a Senior Management coach, a member of Top Ten Management Spain and Top Ten Speakers Spain.
Vice president of Keiretsu Forum. Board Member of the Spanish Confederation of Managers and Executives and former director of institutional relations of La Caixa, as well as lecturer at prestigious business schools.
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Explanation from Javier Fernández Aguado on the difference between a manager and a leader.
Research on Human Capital trends in relation to leadership.
The difference between the leader and the boss.
Leadership styles according to the contingency model.
The role of a leader.
Benefits of being a good leader.
Keys to being a good leader.
The 8 golden rules of leadership from Jack Welch.
Successful behaviour of a good leader according to B-Talent.
Jack Zenger's view on leadership.
The features of a leader who knows how to lead teams.
Key behaviours for leading teams according to B-Talent.
Key behaviours for promoting change according to B-Talent.
Barriers to team success in achieving goals.
Key behaviours for achieving results according to B-Talent.
Key behaviours for inspiring the team according to B-Talent.
Role of the emotions in involvement and communication (self-assessment).
Keys for improving descending communication.
Examples of communication from a leader.
Key behaviours for communicating with and influencing the team according to B-Talent behaviour.
Process for promoting the growth of collaborators.
Key behaviours for becoming a leader-coach according to B-Talent.


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