Alexandria Journal of Medicine RSS feed: Articles in Press. The Alexandria Journal of Medicine publishes concise, original articles and contributions in the broad field of medical sciences. The material is subject to editorial revision. Papers describing research involving human subjects and the procedures followed should be in accordance with the ethical standards. Articles containing promotional material (advertisements), whether implicit or explicit, are not allowed to be included in the Journal. http://www.ajme.org//inpress?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. Alexandria Journal of Medicine2090-50682012-05-17 © 2012 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.ajme.org/article/PIIS2090506812000310/abstract?rss=yesAbstract: Background: ICSI/ET in endometriosis patients has poor outcome by traditional protocols. The key enzyme in the biosynthesis of estradiol, aromatase, has been demonstrated within endometriosis. Combined administration of aromatase inhibitor and GnRH-agonist may efficiently suppress estrogen biosynthesis through a combined pituitary, ovarian and local factors in the implants.Objective: Evaluate the effect of using letrozole in improvement of the results of ICSI/ET in endometriosis women with long agonist protocol.Patients: Sixty infertile women with minimal and mild endometriosis according to the revised American Fertility Society classification were scheduled for ICSI/ET.Methods: Women were randomized into two groups. Group 1: using the traditional luteal long agonist protocol using triptorelin 0.1 and Group 2: using letrozole 5mg/day started 5days after the start of GnRH agonist for 5days. All patients were monitored with day 6 serum estradiol level and estradiol at day of HCG. The number of days of stimulation, number of retrieved oocytes, number of MII oocytes, cleavage rate, and pregnancy rate were studied in both groups.Results: Days of stimulation were significantly higher in the treated group (p=0.019). Oocytes number was not affected (10.57±6.14) and (11.21±6.41) (p=0.516) in groups 1 and 2 respectively also, the number of embryos was not affected (p=0.955). Nine (32.1%) pregnant cases of 28 were in the first group while 8 from 27 in the second group (29.6%).Conclusion: Letrozole significantly affected days of stimulation of ICSI cycle in endometriosis patients without affecting pregnancy rate.Effect of aromatase inhibitor (letrozole) with long agonist protocol on the results of ICSI/ET in females with minimal and mild endometriosis - Corrected ProofMohamed S. Abd Rabbo, Hassan A. Elmaghraby, Nagwa A. Mashali, Mohamed E. Abdel Moneim10.1016/j.ajme.2012.04.001Alexandria Journal of Medicine (2012)2012-05-17Alexandria Journal of Medicine2012-05-17http://www.ajme.org/article/PIIS2090506812000280/abstract?rss=yesAbstract: Background: The objective of the present work is to determine the prevalence of Cyclospora cayetanensis in symptomatic and asymptomatic immune-competent children less than five years in Alexandria, Egypt.Subjects and methods: This study was conducted on two groups: Group I: 100 children suffering from acute diarrhea for less than 14days. Group II: 100 apparently healthy children without diarrhea. All patients were subjected to history taking, physical examination and stool examination by: direct smear examination, concentration using formol ether sedimentation and Sheather’s sugar floatation technique and staining using modified Ziehl–Neelsen and modified trichrome stains.Results: There was a significant difference between Cyclospora infected children in symptomatic (17%) and asymptomatic (6%) groups. Cryptosporidium was detected in 10 diarrheic children (10%), five cases were combined with Cyclospora infection and not detected in any of the asymptomatic group. Microsporidia, Giardia lamblia and Hymenolepis nana were also detected in the symptomatic group. There was no significant difference as regards age and residency of Cyclospora positive and negative cases in both groups. In asymptomatic group, Cyclospora infected cases were males while in negative cases, 50% were males. This was statistically significant. There was no significant difference between the type of feeding and the Cyclospora infected cases in the two groups. As regards weight for height standard deviation (SD), there was no significant difference between the number of cases below normal in infected and noninfected diarrheic children. All asymptomatic cases were within the normal range without a significant difference. There was no significant difference between symptomatic Cyclospora infected and noninfected cases as regards the duration of diarrhea and clinical presentations.Conclusion: Cyclospora infection in immune-competent symptomatic and asymptomatic children in Alexandria is common. Physicians should request a routine fecal examination for this parasite in any case with diarrhea or gastrointestinal troubles.Prevalence of Cyclospora cayetanensis among symptomatic and asymptomatic immune-competent children less than five years of age in Alexandria, Egypt - Corrected ProofNaguib M. Massoud, Doaa E. Said, Ahmed R. El-Salamouny10.1016/j.ajme.2012.02.008Alexandria Journal of Medicine (2012)2012-04-26Alexandria Journal of Medicine2012-04-26ORIGINAL ARTICLEhttp://www.ajme.org/article/PIIS2090506812000255/abstract?rss=yesAbstract: Objective: To determine the cellular immune response in Bell’s palsy (BP) and its prognostic value in relation to clinical and electrophysiological findings.Methods: Twenty patients with BP were subjected to: Facial nerve paralysis assessment according to House–Brackmann (H&B) grading system, bilateral facial nerve conduction study with electroneurography (ENoG) quotient calculation, blink reflex, and needle electromyography (EMG) for the affected side; one week from the onset. Before the start of medical treatment, peripheral blood mononuclear cell subsets were analyzed to reveal the percentage of total T cells (CD3+), T helper/inducer cells (CD4+), T cytotoxic (CD8+) and B cells (CD19+). Patients were followed up by H&B, ENoG and needle EMG up to 3months from the onset (end point). Fifteen age and sex matched healthy control subjects for the electrophysiological study and laboratory tests were included.Results: The percentages of CD3+, CD4+ & CD8+ were significantly depressed in BP patients than in control. CD19+ percentage did not show significant difference between them. On follow up, H&B revealed significant improvement. Neither electrophysiological parameters nor ENoG showed significant difference between initial and follow up assessments. Initial CD4+ percentage correlated negatively with disease duration. While Initial CD8+ percentage correlated positively with follow up compound muscle action potential (CMAP) amplitude of orbicularis oris muscle and ENoG of orbicularis oculi and nasalis muscles. Initial CD19+ percentage correlated negatively with follow up H&B and R1 & R2 responses of follow up blink reflex. Initial CD3+ percentage did not correlate with any of the follow up measures.Conclusion: Decreased percentage of peripheral blood CD3+, CD4+ & CD8+ in BP patients emphasizes the role of cell mediated autoimmune pathogenesis in the acute stage of the disease. These cells have a prognostic significance for prediction of the disease duration and outcome. Analysis of T lymphocytes subsets may provide an additional parameter to differentiate patients with favorable from those with poor prognosis.Cellular immune response in prognosis of Bell’s palsy and its relation to clinical and electrophysiological findings - Corrected ProofNoha A. El Sawy, Enas M. Shahine, Abir S. Alhadidi, Ghada A. Achmawi, Nehal M. Alhabashy10.1016/j.ajme.2012.02.006Alexandria Journal of Medicine (2012)2012-03-30Alexandria Journal of Medicine2012-03-30ORIGINAL ARTICLEhttp://www.ajme.org/article/PIIS2090506812000231/abstract?rss=yesAbstract: Background: Mechanical ventilation offers essential ventilatory support, while the respiratory system recovers from acute respiratory failure. Yet, invasive mechanical ventilation is associated with risks and complications that prolong the duration of mechanical ventilation and increase the risk of death. Neuromuscular dysfunctions acquired during intensive care unit (ICU) stay are considered to be one of the important factors that impair the weaning process.The aim of this work: To evaluate the role of the neuromuscular factors responsible for difficult weaning from mechanical ventilation.Methods: The study included 19 patients with difficult weaning from mechanical ventilation from the Alexandria medical respiratory intensive care unit (ICU) during the period from May 2009 till May 2010. The selected patients included patients who need mechanical ventilation for medical reasons, Patient fulfilling the parameters for weaning, (59) with failed spontaneous breathing trial. In the present study EMG and sensory–motor nerve conduction study was done.Results: 26% show normal study, 63% showed moderate to severe axonal sensory–motor peripheral neuropathy and 11% showed a picture of myopathy. The study revealed that 33% of the patients with peripheral neuropathy failed weaning trials and finally died. It is also found that drugs taken during ICU stay as corticosteroids and electrolyte disturbances (hypocalcaemia, hypophosphatemia, and hypomagnesaemia) may be related to the occurrence of neuromuscular dysfunctions. The present work also revealed a significant relationship between hypoalbuminemia and neuromuscular dysfunction.Conclusions: The present study stresses on the importance of neuromuscular assessment in all cases with difficult weaning as this may be an important contributing factor for difficult weaning and prolonged mechanical ventilation (neuropathic or myopathic in origin). EMG and nerve conduction study may be of help for the detection of such disturbances. So, proper assessment of the neuromuscular apparatus and the management of any disorder may be a great step toward successful weaning.Neuromuscular dysfunction associated with delayed weaning from mechanical ventilation in patients with respiratory failure - Corrected ProofYehia Khalil, Emad El Din Mustafa, Ahmed Youssef, Mohamed Hassan Imam, Amni Fathy El Behiry10.1016/j.ajme.2012.02.004Alexandria Journal of Medicine (2012)2012-03-22Alexandria Journal of Medicine2012-03-22ORIGINAL ARTICLEhttp://www.ajme.org/article/PIIS2090506812000206/abstract?rss=yesAbstract: Background: Work stress is an important problem that affects physicians. Sources and expressions of stress among hospital physicians (HP) and primary health care (PHC) physicians (PHCP) differ due to the nature of clinical work duties.Objective: Was to compare sources and expressions of stress among HP and PHCP.Subjects and Methods: Data were collected from 247 HP working in a general hospital and 250 working in PHC centers in Kuwait using the Quick Stress Questionnaire (QSQ), in addition to sociodemographic and work characteristics of physicians.Results: Both HP and PHCP suffered from only few sources of stress. Also they had relatively low mean percent scores for the three studied domains of stress. HP tended to significantly suffer from more sources of stress than PHCP (2.33+1.88 compared with 1.91+1.956, P=0.003). Significantly higher proportions of HP suffered from work, financial, family, and social/personal relationship concerns than PHCP. Self-image and sex concerns were more likely encountered among PHCP than HP. The overall mean percent score of stress expression did not differ significantly between the two groups (25.7+16.9% compared with 25.1+18.9%). However, few somatic expressions were more significantly expressed among PHCP.Conclusion: HP were significantly more exposed to sources of stress than PHCP. Overall, both groups had similar level of stress expressions with some differences in the somatic expressions domain.Comparison of sources and expressions of stress among hospital and primary health care physicians - Corrected ProofAmna Al-Meerza, Safeya F.Y. Al-Sayegh, Laila M. Al-Sayrafy, Ebtisam M. Alkoot, Medhat K. El-Shazly, Mohammed Ibrahim Kamel10.1016/j.ajme.2012.02.001Alexandria Journal of Medicine (2012)2012-03-19Alexandria Journal of Medicine2012-03-19ORIGINAL ARTICLEhttp://www.ajme.org/article/PIIS2090506812000218/abstract?rss=yesAbstract: Background: Work stress is an important problem that affects physicians. Multiple sources can contribute to this problem. High rates of stress among physicians can be manifested in various expressions including cognitive, behavioral, and somatic expressions. Work performance and quality of medical care administered to the patients can be undermined by over stressed physicians.Objective: The aim of the study was to reveal sources and expressions of stress among hospital physicians and their relationship with socio-demographic and job factors.Subjects and methods: Two hundred and forty-seven physicians working in a general hospital in Kuwait were the candidates of this study. Quick Stress Questionnaire (QSQ) was used. It consisted mainly of two parts, the first dealt with the sources of stress while the second entailed cognitive, behavioral, and somatic expressions of stress. In addition, sociopage title demographic and work characteristics of physicians were studied and their association with stress domains was illustrated.Results: The most commonly encountered sources of work stress were work concerns (55.9%), followed by financial (51.0%), and family (45.7%) concerns. The most commonly encountered expressions are “sleeping disturbance, night awakening, and troublesome dreams” (27.5%) followed by “anxiety, fears, and worrying” (25.9%). The least commonly encountered ones are “acne, eczema, hives, breaking out, and skin blotching and skin blanching” (3.6%) followed by “tics, tremors, and muscle spasms” (4.0%).Conclusion: Work, financial, and family concerns were the main sources of stress among physicians. Cognitive expressions were the most common manifestations of stress followed by behavioral expressions, while the least expressed were the somatic manifestations.Sources and expressions of stress among physicians in a general hospital - Corrected ProofReem A. Makames, Ebtisam M. Alkoot, Bibi M. Al-Mazidi, Medhat K. El-Shazly, Mohamed I. Kamel10.1016/j.ajme.2012.02.002Alexandria Journal of Medicine (2012)2012-03-19Alexandria Journal of Medicine2012-03-19ORIGINAL ARTICLEhttp://www.ajme.org/article/PIIS209050681200022X/abstract?rss=yesAbstract: Background: Extracellular calcium is vital for the functioning of many metabolic processes and neuromuscular activities. Awareness and practice of patients with vitamin D deficiency are very important.Objective: To explore knowledge, attitude and practice of patients receiving vitamin D supplement and attending primary health care (PHC) in Kuwait.Subjects and methods: The study design is a simple descriptive cross-sectional one that was carried out in two PHC centers. Two hundred patients were selected randomly from a list of all registered patients in the selected centers. Criteria for inclusion included adult age ⩾18years, diagnosis with hypovitaminosis D within a year, and under vitamin D supplement.Results: Only 28.5% of participants were aware about their condition, 53.5% related pain to vitamin D deficiency, 33.5% knew the presence of relation between vitamin D deficiency and joint pain. One third of the participants received the loading dose of vitamin D, and, 17.5% had the maintenance dose. Only 21.0% believed that they feel better regarding musculoskeletal symptoms after taking treatment doses and 12.5% of the participants knew that the level of vitamin D dropped again after stopping medication. Only 29.5% knew the relation between vitamin D and other diseases. The majority of patients (85.5%) agreed about the importance of sunshine as a source of vitamin D and 60.0% thought that they can get vitamin D from the nutrients. Regarding the main sources of knowledge about vitamin D, 40.5 % of patients got knowledge from doctors, 12.5% from the media, 29.0% from relatives and friends, 8.5% from background information and 9.5% from journals and magazines.Conclusions: The majority of the study participants had limited knowledge, poor practices, and negative attitude toward vitamin D problems. Planning health education interventions for this group of patients are essential.Knowledge, attitude and practice of patients attending primary care centers toward vitamin D in Kuwait - Corrected ProofBassam A. Al Bathi, Khaled E. Al Zayed, Mohammad Al Qenai, Gamal Makboul, Medhat K. El-Shazly10.1016/j.ajme.2012.02.003Alexandria Journal of Medicine (2012)2012-03-19Alexandria Journal of Medicine2012-03-19ORIGINAL ARTICLEhttp://www.ajme.org/article/PIIS2090506812000267/abstract?rss=yesAbstract: Background: Autonomic nervous system (ANS) dysfunction is one of the suggested pathophysiological mechanisms of fibromyalgia (FM). Its dysfunction may contribute to enhanced pain and other clinical problems associated with FM. Previous studies showed conflicting results regarding ANS function in FM. Some studies showed increased while others showed decreased ANS activity in FM patients. Thus, the autonomic responses in FM patients need further elaboration.Aim of the work: The aim of this work was to evaluate the autonomic dysfunction in FM patients clinically and electrophysiologically.Subjects and methods: Twenty-five patients (23 females and 2 males) diagnosed as FM and 15 apparently healthy individuals served as a control group were included in this study. Patients were subjected to thorough clinical examination and assessment of 1 – pain by McGill pain questionnaire (MPQ), 2 – sleep by Visual Analogue Scale (VAS), 3 – depression by Hamilton Rating Scale for Depression (HRSD) and 4 – functional status by Fibromyalgia impact questionnaire (FIQ). Assessment of ANS function was carried out by tilt table test, measuring supine and standing blood pressure (BP) and heart rate (HR) and sympathetic skin response (SSR) of the hands.Results: Compared to controls, there was a statistically significant decrease of standing systolic BP standing, diastolic BP and standing HR as well as a statistically significant increase in latency and decrease in amplitude of SSR of the hands of the FM patients. HRSD was correlated positively with supine systolic BP and standing diastolic BP while McGill pain questionnaire was correlated positively with supine systolic BP. Moreover, VAS falling asleep was correlated positively with standing systolic BP.Conclusion: The studied FM patients showed ANS dysfunction in the form of abnormal responses to active and passive changes in posture as well as abnormal SSR.Autonomic changes in fibromyalgia: Clinical and electrophysiological study - Corrected ProofNoha El-Sawy, Gihan El-Tantawi, Ghada Abdel Hadi Achmawi, Hussein Sultan, Safaa Younis10.1016/j.ajme.2012.02.007Alexandria Journal of Medicine (2012)2012-03-15Alexandria Journal of Medicine2012-03-15ORIGINAL ARTICLE