Alexandria Journal of Medicine

FM 3 - Editorial Board

2012-03-01

Tranexamic acid – A recipe for saving lives in traumatic bleeding

Ian Roberts — 2011-12-28

Using kitchen scales, carefully weight out 4kg of rice and pour it into a deep saucepan. Now put your hands into the rice and let the grains run between your fingers. Contemplate carefully each grain. The number of grains (about 140,000) is approximately the number of lives that could be saved each year world-wide if all hospitalized trauma patients with significant bleeding were treated with tranexamic acid (TXA) within 3h of injury. TXA is cheap and widely available. All that is needed to reap these human benefits is that doctors use it.

Effect of intravenous dexmedetomidine infusion on some proinflammatory cytokines, stress hormones and recovery profile in major abdominal surgery

2011-12-19

Abstract: Background: This study was designed to evaluate the effect of intravenous dexmedetomidine infusion in patients undergoing major abdominal surgery on stress response markers as plasma interleukin-6, cortisol and blood glucose level. It also assessed its effect on recovery profile and postoperative pain.Methods: Thirty adult ASA I–III patients admitted to the surgery department of the Alexandria Main University Hospital scheduled for elective major abdominal surgery under general anaesthesia were included. They were randomly classified into two equal groups of 15 patients each, dexmedetomidine group (Group D) received intravenous dexmedetomidine infusion and placebo group (Group P) received intravenous infusion of normal saline. Haemodynamic parameters were recorded intra- and postoperatively. Interleukin-6, cortisol and blood glucose levels were measured. Recovery profile, postoperative pain score and analgesic requirement postoperatively were assessed.Results: Heart rate and mean arterial pressure were significantly lower in group D relative to group P during most of the intra- and postoperative periods. Postoperatively, the levels of interleukin-6, cortisol and blood glucose were significantly lower in group D relative to group P. Recovery time was longer in group D than group P but with no significant difference. Postoperative pain score was significantly less in group D relative to group P during the early postoperative period with smaller amount of analgesic requirements in group D.Conclusion: Dexmedetomidine is safe and effective in blunting the postoperative rise of the proinflammatory cytokine interleukin-6 and resulted in lower levels of markers of stress response to surgery as cortisol and blood glucose. Dexmedetomidine also reduces the postoperative pain score without delaying recovery from anaesthesia.

Elderly versus young patients with appendicitis 3 years experience

Wagih Mommtaz Ghnnam — 2011-12-15

Abstract: Background: Appendicitis in the elderly continues to be a challenging surgical problem. Patients continued to present late with atypical presentations. Results might improve with earlier consideration of the diagnosis in elderly patients with abdominal pain, followed by prompt surgical operation. We aimed to present our experience with a series of elderly patients with acute appendicitis who were subjected to appendectomy to find out the difference in the course and outcome of acute appendicitis in elderly patients.Patients and methods: We reviewed medical records of elderly patients (aged>60years) who underwent appendectomy for acute appendicitis at our hospital. Variables selected for analysis included age, sex, presenting symptoms, operative approach, operative findings, duration of hospitalization. Patients were compared to a control group, less than 31years admitted during the same period.Results: Twenty-three patients’ records aged>60years with acute appendicitis were compared to a group of 40 patients aged<30years. There were significant differences between the two groups with regard to duration of symptoms preoperative hospital stay and total hospital stay. All young patients group had an uneventful postoperative recovery only two cases (5%) had wound infection. There was one death in the elderly group thus mortality rate was 4.3%. These two groups of patients showed significant differences in relation to the stage of disease at operation and postoperative complications. Elderly group of patients had perforated appendix in 16 cases (69.5%) while in group II patients eight cases (20%) had perforated appendix.Conclusion: Acute appendicitis in the elderly remains a challenge for practicing surgeons and continues to be associated with high morbidity and mortality. Results might improve with earlier consideration of the use of CT abdomen for diagnosis in elderly patients with abdominal pain, followed by prompt surgical operation.

Clinical trial comparing excision and primary closure with modified Limberg flap in the treatment of uncomplicated sacrococcygeal pilonidal disease

Walid Galal Elshazly, Kaled Said — 2011-12-14

Abstract: The aim of this study was to compare modified Limberg flap procedure with excision and primary closure in the treatment of uncomplicated pilonidal disease.Methods: This study was conducted on 120 patients with uncomplicated sacrococcygeal pilonidal disease that were randomly allocated into two groups: group I underwent excision and primary closure; group II underwent modified Limberg flap procedure. The duration of operation, postoperative pain, length of hospital stay, duration of incapacity for work, postoperative complications and postoperative recurrence were recorded.Results: Duration of operation was longer in group II than in group 1 (P<0.001). However, postoperative pain was less (P<0.001), duration of hospital stay shorter (P<0.001), time to resumption of work shorter (P<0.001) and postoperative complications were significantly fewer in group II. During follow-up period of 21.5±6.82 (months) for group I and 22±7.64 (months) for group II, single case of recurrence 1.67% was detected in patients in group II versus four patients (6.67% patients) in group I (P=0.032).Conclusion: Wide excision with a modified Limberg transposition flap reconstruction is a very effective operative procedure for uncomplicated pilonidal sinus, associated with a low complication rate, short hospitalization and disability, and a low recurrence rate.

Voice quality after laser cordectomy and vertical hemilaryngectomy

Hesham Abdelfattah, Manal El-Banna — 2011-12-29

Abstract: Introduction: Various surgical techniques have been adopted for management of glottic cancer with the aim of eradicating the disease and preserving the voice character.Aim: The aim of the study was to determine the voice quality for patient after various surgical interventions for treatment of cancer larynx, and to evaluate the effect of postoperative voice therapy.Subjects: 20 patients were subjected to surgical intervention for management of glottic cancer (seven had unilateral laser cordectomy-group A, and five had bilateral laser cordectomy-group B and eight had vertical hemilaryngectomy-group C). Thirteen age matched males were randomly selected for obtaining normal computer voice function parameters as the control group-group D.Methodology: The four groups were subjected to protocol of voice evaluation postoperatively. Patients were re-evaluated two months later and a comparison of voice outcome for patients receiving voice therapy and those who did not was conducted.Conclusion: Most acoustic and aerodynamic parameters are significant different between patients from control. Subharmonics parameters (NSH and DSH) and degree of voice breaks (DVB) in addition to phonatory resistance specifically differentiate the voice of laser cordectomized from that of vertical hemilaryngectomized patient, this may reflect occurrence of vocal fry related to supraglottic phonation. Improvement was recorded by all patients receiving voice therapy. Unilateral laser cordectomy gave better phonatory outcome due to less extension of surgical resection and development of glottic phonation. Bilateral laser cordectomy gave relatively worse prognosis highlighting the advantage of the experience of surgeon in creation of pseudoglottis in improving phonatory outcome in vertical hemilaryngectomy over extensive resection of bilaterally cordectomized patients.

Role of magnetic resonance venography in evaluation of cerebral veins and sinuses occlusion

2011-12-15

Abstract: Introduction: Cerebral venous occlusion (CVO) means intraluminal obstruction by cerebral venous thrombosis (CVT) or external compression. The differential diagnosis is broad including stroke, brain capillary telangiectasia, contusion, hypertensive hemorrhage, metastases and venous vascular malformations. MRI in conjunction with MRV is considered the modality of choice in diagnosis of CVO.Objective: To assess the role of magnetic resonance venography in the evaluation of cerebral veins and sinuses occlusion.Methods: The study was conducted on 15 patients with cerebral venous occlusion and subjected to MRI and MRV.Results: The study included 13 patients with cerebral venous occlusion due to thrombosis and two patients with occlusion by tumors (meningioma).Conclusion: MRI in conjunction with MRV is considered an accurate, safe, non-invasive, non-ionizing diagnostic modality in assessing CVO. It can assess parenchymal lesions and detect intraluminal small thrombi and its extension.

Ultrasound guided local steroid injection versus extracorporeal shockwave therapy in the treatment of plantar fasciitis

Nayera Saber, Hosam Diab, Wael Nassar, Hanaa A. Razaak — 2011-12-19

Abstract: Objective: This study was conducted to compare and evaluate the therapeutic effects of ultrasound guided local steroid injection versus medium frequency shock wave therapy in plantar fasciitis treatment among Egyptian population.Patients and methods: Between May 2009 and May 2010, 60 patients (27 males, 33 females), otherwise healthy individuals with the diagnosis of unilateral plantar fasciitis were included in this study. All patients underwent subjective assessment following The Mayo clinical scoring system and objective assessment through measuring plantar fascia thickness by US imaging. Patients were randomly classified into two equal groups; group A had ultrasound guided local steroid injection, and group B received high dose of extracorporeal shock wave therapy.Results: There was a statistically significant reduction in plantar fascia thickness after treatment in both groups, while no statistically significant difference between the study groups. According to assessment with Mayo clinic scoring system, despite the fact that both groups showed statistically significant improvement at the end of follow up period, there was no statistically significant difference between the study groups.Conclusion: Both treatment groups showed significant clinical and radiological improvement of plantar fasciitis after therapy with statistically non-significant superior results of the extracorporeal shock wave therapy group. However, we do recommend local steroid injection as our preferred method of treatment as it attains clinical improvement at a much better cost effective value.

Brown–Vialetto–Van Laere syndrome: Egyptian case report

Hayam Moustafa, Tarek Omar, Yaser Sami — 2011-12-14

Highlights: ► A five-year-old Egyptian girl with progressive hearing loss. ► Brainstem auditory evoked potentials (BAEP) are reported. ► No evidence of involvement of the upper motor neurons or spinal motor nerves. ► There is no similar case in the family.Abstract: We report an Egyptian case with Brown–Vialetto–Van Laere syndrome. A five-year-old girl with progressive hearing loss was documented by brainstem auditory evoked potentials (BAEP) as sensorineural deafness, bilateral facial palsy and bilateral partial vocal cord paralysis in the paramedian position. There was no evidence of involvement of the upper motor neurons or spinal motor nerves. There is no similar case in the family.

VEGF expression and microvascular density in relation to high-risk-HPV infection in cervical carcinoma – An immunohistochemical study

Bassma M. El Sabaa, Mahmoud Meleiss, Inass Zaki — 2012-01-16

Abstract: Background: The poor outlook of cervical carcinoma, a human papillomavirus (HPV)-related cancer mandates the search for new treatment modalities. Therapeutic targeting of tumor vasculature is a promising strategy. The aim was to study angiogenesis in cervical carcinoma in terms of VEGF expression and assessment of microvascular density (MVD) in relation to HPV antigen expression.Methods: Thirty paraffin blocks of cervical carcinoma were studied for the immune expression of VEGF and MVD utilizing CD34 monoclonal antibody. Statistical analysis of these immunophenotypes in relation to tumor type, grade and HPV antigen expression was performed.Results: This retrospective study comprised of 17 squamous cell carcinomas, 11 adenocarcinomas and two adenosquamous carcinomas. Eleven cases were low grade and 19 were high-grade cases. VEGF expression was detected in 100% of cases. The relation between carcinoma grade and VEGF expression and MVD was statistically significant. There was no relation between VEGF intensity and tumor type although more intense VEGF staining tended to occur in cervical adenocarcinomas. VEGF density was significantly lower in squamous cell carcinomas compared to adenocarcinomas. Mean MVD was 50.37±20.0. The relation between MVD and VEGF expression was statistically significant. HPV immune expression was detected in 93.33% of cases. The relation between HPV antigen expression and each of tumor histotype and grade was not statistically significant. There was a statistically significant relation between HPV antigen expression and each of MVD and VEGF intensity. Multivariate statistical analysis showed MVD as an independent predictor of carcinoma grade.Conclusion: VEGF was expressed in 100% of studied cervical carcinoma. There was a statistically significant relation between VEGF expression and MVD. Since HPV antigen expression was significantly correlated with MVD and VEGF staining intensity, we provide evidence that HPV infection may augment tumor angiogenesis in cervical carcinoma. MVD emerged as an independent predictor of cervical carcinoma grade and hence of progressive behavior.

Efficacy of Allium sativum (garlic) against experimental cryptosporidiosis

Maha Reda Gaafar — 2012-01-19

Abstract: Background: Due to increasing problems of inadequate and unreliable medical treatments for Cryptosporidium enteritis, alternative therapies are being sought.Objective: The current study was designed to evaluate the prophylactic and therapeutic efficacy of Allium sativum (garlic) against Cryptosporidium infection in experimentally infected immunocompetent and immunosuppressed mice.Methods: Forty eight male Swiss albino mice were divided equally into control and experimental groups. Each group was further subdivided into four equal subgroups; two immunosuppressed and two immunocompetent. Cryptosporidial oocysts were isolated from human stools, and were used to infect the mice. The experimental subgroups received garlic orally two days before infection or one day following infection, and continued daily till the end of the study. Two weeks following garlic administration, mice stools were examined for counting the cryptosporidial oocysts, then the animals were sacrificed; their small intestines were processed and were examined for detection of the pathological lesions and for counting of the parasites. Also, myeloperoxidase (MPO) activity was measured in jejunal sections.Results: The results showed that the infected immunosuppressed subgroups of mice; showed a statistically significant increase in the number of cryptosporidial oocysts in stool and ileal sections, as well as an increase in the MPO activity when compared to the corresponding immunocompetent subgroups. Garlic successfully eradicated the Cryptosporidium oocysts from stool and intestinal sections of the infected immunocompetent subgroup of mice receiving garlic two days before the infection. Besides, the oocysts were significantly reduced in all other infected experimental subgroups in comparison to the corresponding infected control subgroups. The intestinal sections of all subgroups received garlic before or after the infection, revealed a more or less normal architecture. Reduction in the level of MPO activity was also detected in all experimental subgroups.Conclusion: Our findings suggest that garlic is a convenient prophylactic and a promising therapeutic agent for cryptosporidial infection.

Predictors of physicians’ practices related to nutritional counseling and management in Riyadh City

May N. Al-Muammar — 2011-12-14

Abstract: Background: A growing interest has become increasing in the role of physicians as effective resources for the promotion of good nutritional practices, however, the factors that impede their nutritional counseling and management practice (NC&M) are not clearly understood in Saudi Arabia.Objectives: The objectives of the study were to investigate physicians’ practices concerning NC&M and to explore some determinants that predict such practices.Results: Data of 266 physicians working in big hospitals in Riyadh showed that only 7.9% of the respondents reported that they were practicing all aspects of NC&M; including nutritional assessment, therapy, and education. Those who practiced any one of these aspects ranged between 13.9–40.2%, meanwhile, 28% frankly reported that they did not practice NC&M. In the last year, the mean percentage of patients placed on nutrition therapy was 24.15±27.78% and the mean percentage of clinic time dedicated to NC&M was 21.49±20.54%. Most of the respondents (72.9%) had poor nutritional knowledge score. Overall, 19.2% previously attended CME in nutrition. Only 1.5% and 28.6% self-assessed themselves as “outstanding” and “good” in NC&M skills and the mean total self-efficacy in NC&M was moderate. The majority (77.8%) perceived NC&M as highly or moderately relevant to their specialties. Physicians attitude and perceived efficacy towards NC&M was moderately high as the mean scores were greater than their midpoint. Their perceived barriers of NC&M were considerably moderate; as the mean total score was found to be near the midpoint of that scale. Among the seven independent variables entered the binary logistic regression of physicians practice of NC&M, only the knowledge, attitude, and self-efficacy scores were significantly associated with their NC&M practice. These three predictors contributed by 23.5% of the variation of physician practice of NC&M.Conclusions: Physicians knowledge, self-efficacy, attitudes and other factors should be stressed in any intervention warranted to improve their nutritional practices.

Knowledge, awareness, and practices concerning breast cancer among Kuwaiti female school teachers

2011-12-19

Abstract: Background: Breast cancer is by far the most frequent cancer of women. However the preventive measures for such problem are probably less than expected.Objectives: The objectives of this study are to assess the breast cancer knowledge and awareness and factors associated with the practice of breast self examination (BSE) among female teachers.Methods: This study is a cross-sectional survey of teachers working in schools in Al-Jahra, governorate. A sample of twenty schools was selected randomly by the stratified sampling method from all schools of the selected governorate that included primary, intermediate and secondary schools. All ever married Kuwaiti female teachers working in the selected schools were asked to fill a self-administered questionnaire to investigate their knowledge about the risk factors of breast cancer, their awareness and screening behaviors. Data were collected from 421 female teachers with 87.5% response rate.Results: The results of the study showed that 67.5% of the participants declared that they had information about breast cancer and their sources of information were mainly health professionals/workers (98.2%), friends/neighbors (83.5%), TV/Radio (76.0%) and printed materials (60.2%). Of the participants, 18.5% reported positive family history of breast cancer, 49.9% did not know how to practice BSE, 29.0% knew the procedure but never applied it. Moreover, 81.9% has no breast examination by health professionals and 85.7% did not know what the mammography is. The factors that may have an impact on acquiring satisfactory level of knowledge were, women older than 40years, married, user of contraceptive pills, with a history of child death.Conclusions: The study points to the insufficient knowledge of female teachers about breast cancer and identified the negative influence of low knowledge on the practice of BSE.

Knowledge and perception of domestic violence among primary care physicians and nurses: A comparative study

2012-01-18

Abstract: Introduction: Domestic violence (DV) has a deteriorating influence on society by affecting victims, their children, families, and friends, as well as social and financial relationships. Primary care providers, including physicians and nurses, frequently are the first in the community to encounter the battered women.Objective: The aim of this work was to compare the knowledge and perception of primary care physicians and nurses about DV.Methods: This study was carried out in all primary health care centers in Kuwait. All physicians and nurses who were currently working in these centers during the study period were asked to complete a self-administered close-ended questionnaire that included personal and working conditions information. It included also knowledge about prevalence of DV, and four main aspects relevant to DV, namely deprivation, psychological, physical and sexual domains. A 5-point, Likert-scale was used to assess participant’s answers for each item.Results: The response rate was 62.8% for physicians and 61.1% for nurses. The study revealed that the overall knowledge score was higher in physicians than nurses. Also, the scores for the individual domains were significantly higher for physicians than nurses except for psychological one.Conclusion: Overall, primary care physicians and nurses had poor knowledge and many had negative perception regarding DV. Although physicians are somewhat more knowledgeable about DV, many more educational activities are needed.