| Fetal imaging and diagnosis services in developing countries – A call to action JA Akinmoladun, D OC Anumba Tropical Journal of Obstetrics and Gynaecology 2019 36(1):1-7 Fetal congenital anomalies are among the leading causes of perinatal death or survival with disability worldwide. Their accurate antenatal detection employing a range of fetal imaging techniques enables parental choices to be made and for postnatal care of affected babies to be planned. While such prenatal care is well developed in developed countries of the world, it remains poor in many low- and middle-income countries (LMICs). This review article examines the scope of the problem and proffers strategies for service organization and fetal imaging that will improve care in LMIC settings. |
| A 35-year standardized prediction estimates for gynecological lesions in oil and gas exploration and production city in the Niger Delta M Onyije Felix, A Ngokere Ajuluchukwu, E Ligha Aloysius, O Mgbere Osaro, O Avwioro Godwin Tropical Journal of Obstetrics and Gynaecology 2019 36(1):8-14 Background: The impact of constant emission of hydrocarbons and contaminated water level through oil spillage in the oil and gas exploration and production areas of Niger Delta on women's health cannot be underestimated. We developed a 35-year standardized prediction estimates for gynecological lesions using data obtained from an integrated specialist hospital serving the residence of the oil and gas exploration and production City of Port Harcourt and the surrounding areas of Niger Delta, Nigeria. Methods: The study participants comprised of 697 females who received medical care at the Braithwaite Memorial Specialist Hospital (BMSH), Port Harcourt, Rivers State, Nigeria, between 2010 and 2014. Predictive modeling of the diseases was performed using JMP statistical discovery™ software, version 12.0 (SAS Institute, Cary, NC, USA). Results: The distribution of the gynecological lesions (n = 697) differed significantly (P < 0.001) by year of diagnosis, developmental stage, age category, and types of lesion. The mean age of study participants was 39.1 ± 12.8 years, and most of the lesions (61.8%) occurred among females who were 30- to 49-year old. Leiomyoma recorded the highest 5-year standardized prevalence rate of 0.508, and with no intervention, it is estimated that the number of cases diagnosed will rise from 235 in 2015 to 1883 by the year 2050. This was followed by ovarian cyst with a prevalence rate of 0.124 and projected increase from 57 in 2015 to 461 by the year 2050. Similarly, the product of conception is also estimated to increase from 34 to 277 by the year 2050. Conclusion: The over 700% increased prediction of gynecological lesions by 2050 calls for urgent attention by both governmental and private agencies to fund awareness campaigns and screenings for women, especially for those residing in the oil- and gas-producing areas of Niger Delta. |
| Maternal and neonatal outcomes in premature rupture of membranes at University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria A Idrisa, S Pius, M Bukar Tropical Journal of Obstetrics and Gynaecology 2019 36(1):15-20 Background: Premature rupture of membrane (PROM) is linked to significant adverse events in the prenatal, peripartum and neonatal period. Both, PROM and PPROM are associated with maternal and neonatal morbidities and mortalities. Severe oligohydramnios after PROM is associated with foetal abnormalities, pulmonary hypoplasia, respiratory distress syndromes, intrauterine growth restriction, intrauterine foetal death, foetal/neonatal sepsis, presence of meconium and an Apgar score lower than seven at five minutes. Objective: To determine the factors that influenced maternal and neonatal outcomes following a premature rupture of membranes. Subjects and Methods: This retrospective cross-sectional study was conducted over five years between 1st January 2012 and 31st December 2016 on mother neonate pair delivered at the University of Maiduguri Teaching Hospital Maiduguri. Results: During the period of the study there were 7200 deliveries at the labour ward of (UMTH), out of which 91 (1.3%) had PROM. Seventy three ( 80.2%) of the case files were retrieved and analysed. Thirty six women (49.3%) were delivered by emergency caesarean section (EMCS), while 37 (50.7%) were delivered vaginally (SVD). In the bivariate (crude) analysis, Apgar score < 7 at 5 minutes (P = 0.008, OR 95 % CL: 0.092 (0.011, 0.742), birth weight ≥ 2500g (P = 0.006, 8.944 (1.892, 42.284), and absence of APH (P = 0.007, 4.83 (1.440, 16.196) were factors modifying neonatal outcome. When adjusted regression with only factors with P value < 0.2 in crude analysis were done, only birth weight ≥ 2500 g (P = 0.024, 6.677 [1.286, 34.664]) and absence of APH (P = 0.038, 4.406 [1.085, 17.883]) were independent predictors of neonatal outcome. Thus, neonates with birth weight ≥ 2500 g were about 6.7 times more like to show favourable outcome than those with birth weight < 2500g while those without APH showed 4.4 times more likelihood for a favourable neonatal outcome. Antenatal corticosteroids use also was associated with favourable outcome as it had significantly improved preterm neonatal survival. Conclusion: Intervention with steroids, antibiotics in labour and delivery within 24 hours of PROM will greatly reduce maternal complications and enhances favourable neonatal outcome. |
| Disrespect and abuse during facility based childbirth: The experience of mothers in Kano, Northern Nigeria TG Amole, MJ Tukur, SL Farouk, AO Ashimi Tropical Journal of Obstetrics and Gynaecology 2019 36(1):21-27 Context: An important but little understood concept that retards the goal to reduce maternal mortality and increase universal access to reproductive health is disrespect and abuse (D&A) during childbirth. Aim: This study aims to determine the prevalence, pattern, perpetrators, and determinants of D&A during childbirth among recently parturient women in Kano, north western Nigeria. Settings and Design: Using a cross-sectional design, 332 women accessing child immunization and postnatal services at Murtala Muhammad Specialist Hospital, Kano, were selected. Subjects and Methods: Respondents were selected using systematic sampling technique and data collected using an adapted, interviewer administered tool. Statistical Analysis: Data was analysed using IBM SPSS version 21.0 and level of significance set at 0.05. Results: Respondents (n = 306) had a mean age of 27.7 ± 6.3 years and more than half (55.9%; n = 171) had experienced at least one form of D&A during childbirth. Commonest forms of abuse were abandonment and nonconfidential care (84.5%, n = 142; 67.9%, n = 114, respectively). Main perpetrators were nurses/midwives (83.0%, n = 142). The experience during the last childbirth was significantly higher among respondents of non-Hausa/Fulani ethnic group (χ2 = 6.10; P = 0.014), of the Christian faith (χ2 = 8.62; P = 0.003), and with formal education (χ2 = 19.94; P = 0.0001). After controlling for confounders, formal education remained a predictor for experiencing abuse at childbirth (AOR = 2.43; 95% confidence interval = 1.11--5.32). Conclusions: D&A during childbirth is prevalent in our setting. Educating healthcare providers and women about their responsibilities and rights will enhance provision and utilization of quality maternal health services. |
| The effect of hyoscine butyl bromide in shortening the duration of first stage of labor: A single-blind randomized control study R Ibrahim, EI Nwobodo, KA Tunau, AT Burodo, B Sulaiman, JA Garba, AD Saidu Tropical Journal of Obstetrics and Gynaecology 2019 36(1):28-32 Background: Active management of labor reduces the number of prolonged labor and the duration of labor without having any adverse effects on the mother and the fetus. Intervention with drugs is among the options used for active management of labor. This includes use of analgesics, oxytocics, prostaglandins derivatives, and smooth muscle relaxants. The objectives of the study were to determine whether hyoscine N butyl bromide (HNBB) shortens the first stage of labor in term pregnancies, to compare the mean duration of labor between primigravidae and multigravidae in HBB group, to compare the maternal and fetal outcome between HBB and control group, and also to determine the side effects of HBB in parturients. Materials and Methods: The study was a single-blind randomized control study carried out in Usmanu Danfodiyo University Teaching Hospital (UDUTH) over 4-month period. A total of 204 pregnant women at term in spontaneous labor who presented in active phase of labor at UDUTH and have met the inclusion criteria were recruited and randomized into 102 women as case group and 102 women as control. The women in the case group received 40 mg (2 mls) of HBB, while those in the control group received 2 mls of normal saline. Data entry and analysis was done with IBM SPSS version 20. The duration and outcome was monitored. Results: The mean duration of labor in the first stage among the case group was 5:44 ± 2:11, while it was 6:52 ± 2:11 among the control group representing a decrease of 16.5%. This was statistically significant (P < 0.05). There was no difference in the duration of the second and third stages of labor among the two groups. There was no difference in the maternal and neonatal outcome among the two groups. Vomiting was the only maternal side effect that was statistically significant among the HBB group. Conclusion: HBB reduced the duration of first stage of labor in both primigravid and multigravid women without adverse maternal and neonatal complications. It is recommended that HBB to be given to women in active phase of labor to reduce the incidence of prolonged labor. |
| Awareness and attitude of female undergraduates toward human papillomavirus vaccine in Ibadan T AO Oluwasola, OO Bello, AA Odukogbe Tropical Journal of Obstetrics and Gynaecology 2019 36(1):33-38 Introduction: The human papillomavirus (HPV) has significant public health importance because of its high prevalence, mode of transmission, major causative role in cervical cancer, and having effective vaccines. The main thrust of this study was to ascertain the level of awareness of HPV and its vaccines among students as well as their attitudes toward receiving the vaccines. Materials and Methods: A descriptive cross-sectional survey conducted among female undergraduates of the University of Ibadan using structured self-administered questionnaires. The questionnaires sought to obtain information about their awareness of HPV, their sexual behavior, previous vaccination, and willingness to access HPV vaccination. Results: A total of 489 students, with a mean age of 19.7 ± 3.2 years, satisfactorily responded to the survey. Overall, 411 (84%) had an overall good knowledge about vaccines, 218 (44.6%) recalled that they had been previously vaccinated in childhood, and 147 (30.1%) were aware of HPV. Only 66 (13.5%) were aware of HPV vaccines, and 10 (2%) had ever been vaccinated against HPV. A majority were willing to get vaccinated if the current price is further reduced. Conclusion: There is a low level of awareness of HPV and its vaccines among female undergraduates. When available, uptake is restricted by cost. There is an urgent need to support public health programs that increase awareness through adequate information dissemination on mechanisms of cancer prevention and also to strengthen policy efforts that address the barriers of HPV vaccination. |
| Intrauterine adhesions in the University of Uyo Teaching Hospital, Uyo, South-South, Nigeria: A ten year review N Utuk, AM Abasiattai, O Asuquo Tropical Journal of Obstetrics and Gynaecology 2019 36(1):39-43 Background: Asherman's syndrome is a clinical entity that can cause menstrual abnormalities and infertility. Objectives: This study was done to determine the risk factors, and management outcome of intrauterine adhesions in our hospital. Subjects and Methods: We carried out a retrospective study of the patients who were treated for intrauterine adhesions at the University of Uyo Teaching Hospital over a 10 years period-from January 1st 2006 to December 2016. Results: During the study period, a total of 1977 gynecological surgeries were performed of which 83 were for intrauterine adhesions, giving a rate of 4.2%. However, only 52 folders were retrieved, giving a retrieval rate of 62.5%. Analyses, using ratios and percentages, was based on these. Most patients belonged to the 30-34 age group (28.9%) followed by the 20-24 age group (25.0%). The majority of the patients were nulliparous (58.9%), married (65.4%) and had a tertiary education (50.0%). Dilatation and curettage for induced abortion (42.3%), open myomectomy (26.9%), and caesarean section (19.2%) were the common risk factors. Amenorrhoea (65.4%), and hypomenorrhoea (30.8%) were the commonest modes of presentation. All the patients were managed by blind adhesiolysis, done overwhelmingly by the resident doctors, under anaesthesia with a significant percentage (65.3%) showing that there is no change in menstrual condition. Conclusion: Ashermans syndrome is a relatively common condition, and it is necessary to train doctors in the use of, and acquire, a hysteroscope, for the proper management of this condition. Meanwhile, more senior personnel should be involved in the blind adhesiolysis, and Foley catheter that appears superior as a uterine splint to the intrauterine contraceptive device. |
| Co morbidities associated with vesico vaginal fistula in patients managed in Maryam Abacha Fistula Hospital Sokoto, Northwestern Nigeria M Hassan, S Nasir Tropical Journal of Obstetrics and Gynaecology 2019 36(1):44-48 Background: Prolong obstructed labor is a preventable obstetric complication in the developing countries with devastating consequences and comorbidities. This study aimed to determine the frequencies of the common comorbidities in patients managed for obstetrics fistula at Maryam Abacha Women and Children Hospital, Sokoto, and also to identify the association of age and parity on the occurrence of some of the comorbidities observed. Materials and Methods: This was a cross-sectional study involving 179 patients with obstetric vesicovaginal fistula seen at Maryam Abacha women and Children VVF center, Sokoto, from January to December 2017. A proforma was used to assess the sociodemograhic features and also to record comorbidities during preoperative evaluation. Results: Foot drop was the commonest comorbidity seen in 106 (59.2%), followed by depression in 104 (58.1%). There was statistically significant association between age, parity, and foot drop P = 0.025. Depression was found to be higher in the primipara P = <0.001.Urinary dermatitis occurred more frequently in the older age group and multipara 62.7% and 80%, respectively. Amenorrhea was commoner among age group 30 years and above 62.7%. Out of 179 patients analyzed, 36 (20.1%) had eclampsia whereas gynaetresia was present in 29 (16.2%). Conclusion: Significant comorbid conditions accompany obstetrics trauma and vesicovaginal fistula. Foot drop had statistically significant association with age. Depression was common in all age groups. There was significant association between depression and parity. Urinary dermatitis occurred more frequently in the older age group and multiparae. |
| Effectiveness of mobile phone text message reminder on birth preparedness in a rural community in Kenya Cheptum Joyce, Omoni Grace, Mirie Waithira Tropical Journal of Obstetrics and Gynaecology 2019 36(1):49-53 Background: Birth preparedness is a strategy that has been found effective in preventing obstetric delays. Use of mobile technology can enable access and efficiency of health messages delivered during antenatal care. The mobile technology can be more effective in conveying health messages owing to its accessibility and enables follow up. Materials and Methods: This was a randomized control trial carried out among pregnant women attending public health antenatal clinics in Migori County. Four health facilities were randomized. Two facilities each were randomly picked for the study and control groups respectively. A total of 379 participants were recruited into the study. The study group participants received a verbal message on birth preparedness and a mobile phone text message reminder one month to their expected date of delivery. Follow up was done to both groups through their mobile phone contacts. Data was collected using an interviewer-administered questionnaire and analyzed using Stata version 11. Proportion tests were done to compare the groups. Results: The success rate of the study was 90.5% (n = 343). Most of the participants (73%) were aged between 20 and 34 years. Majority of them were married (79.2%) and most of them had primary level of education. Protestant was the predominant religion (55.2%). Housewives and businesswomen constituted 34.2% and 27%, respectively. The respondents in the study group who were birth prepared were 74.3% (n = 136) while those in the control group were 48.1% (n = 77). Conclusion: The use of mobile phone text message reminder in addition to verbal messages is more effective. |
| Can hsCRP be the sole investigation for predicting the severity and outcome in women with pre-eclampsia presenting late in pregnancy? N Mishra, K Pradhan, GD Sahoo, M Rohilla, M Meena Tropical Journal of Obstetrics and Gynaecology 2019 36(1):54-60 Context: Healthcare facilities in developing countries are over burdened and proper triage of patients requiring attention more than others is needed in every sub speciality of medical sciences in them. Patients with pre-eclampsia require attention to prevent any associated complication. Aims: The aim of this study was to evaluate whether hsCRP alone or in combination could be used as an indicator of severity and predictor of outcome in women with PE presenting to a healthcare facility late in the third trimester. Settings and Design: Prospective observational study conducted at a teaching medical college and referral hospital catering primarily to rural, semi urban and tribal population. Methods and Material: 85 women with PE who reported to the hospital after completed 36 weeks of gestation were included. Patients were divided in three groups. hsCRP, biochemical and hematological investigations were performed for each patient. Results were expressed as median. Independent samples Kruskall Wallis one way ANOVA and Mann Whitney U tests were performed and correlation of hsCRP with other parameters and fetal outcome was examined. Statistical Analysis Used: Kruskall Wallis one way ANOVA and Mann Whitney U tests. Results: hsCRP was significantly elevated in severe PE as compared to PE without severe features and normal patients. Higher requirement of labour induction and caesarean section was seen in severe PE patients along with higher still births and low baby weight babies. hsCRP had positive correlation with other markers of severity of PE and negative correlation with still births and fetal weight in severe PE patients. However, although raised in every case of severe PE, a wide variation was noted in hsCRP values. Conclusions: hsCRP alone cannot be recommended as a marker of severity or a predictor of outcome in women presenting late in the third trimester of pregnancy. However, in combination with serum uric acid it can be used for that purpose. |
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ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ ΑΤΟΚΕΣ ΔΟΣΕΙΣ
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Τετάρτη, 17 Απριλίου 2019
Obstetrics and Gynaecology
Oral and Maxillofacial Pathology
| Extracellular matrix in invasion and metastasis of oral squamous cell carcinoma K Vinod Kumar, KN Hema Journal of Oral and Maxillofacial Pathology 2019 23(1):10-16 Oral squamous cell carcinoma is a common cancer in developing countries with highly invasive and metastasis credentials. The Lymphnode metastasis in oral squamous cell carcinoma is regarded as the factor that decides on disease survival of patients. Steps have been made towards research in the field of Oral squamous cell carcinoma for better understanding of the molecular events involved in invasion and metastasis. Recently, the role of Extracellular matrix (ECM) of oral squamous cell carcinoma in invasion and metastasis has gained interest, as ECM is known to actively contribute in events that regulate transcriptional controls and cell signalling mechanisms involved in invasion and metastasis. Understanding such contributing role of ECM may pave way for newer methodologies in early detection, prevention and therapeutic strategies for oral squamous cell carcinoma. |
| Kamino bodies Deepak Venkatesh, T Smitha Journal of Oral and Maxillofacial Pathology 2019 23(1):17-18 |
| Oral epithelial dysplasia: Classifications and clinical relevance in risk assessment of oral potentially malignant disorders Kannan Ranganathan, Loganathan Kavitha Journal of Oral and Maxillofacial Pathology 2019 23(1):19-27 After more than a decade, the World Health Organization (WHO) published the revised grading system for oral epithelial dysplasia in 2017. The revised classification has changes reflecting our evolution of understanding of the dysplastic process. Although the WHO 2017 three-tier grading system is the gold standard for histological diagnosis of oral potentially malignant disorders, it has certain limitations. Suggestions to overcome these limitations include the use of clinical determinants and molecular markers to supplement the grading system. It has also been suggested that a two-tier system may be more reproducible and clinically translatable for better management. These advances in the understanding of epithelial dysplasia are very important globally and for us in the Indian subcontinent, given the prevalence of habits (tobacco/areca nut) and burden of oral cancer in this part of the world. The following review traces the evolution of the grading system of dysplasia, its relevance and clinical utility. |
| Identification of Candida albicans using different culture media and its association in leukoplakia and oral squamous cell carcinoma Vivek Gupta, Khare Abhisheik, Shreedhar Balasundari, Niranjan K Devendra, Kalim Shadab, Mahendra Anupama Journal of Oral and Maxillofacial Pathology 2019 23(1):28-35 Context: Candida, leukoplakia and oral squamous cell carcinoma. Aims: The aim of the present study has assessed the association of Candida albicans with normal control group, leukoplakia and oral squamous cell carcinoma lesions of the oral cavity by using cornmeal broth +5% milk and milk serum liquid culture media. Settings and Design: Thepresent study comprised of total 80 patients,which included, 30 patients of Leukoplakia, 30 patients of oral squamous cell carcinoma and normal control group comprised of 20 healthy individuals who were not having any relevant medical, dental and habit history. Subjects and Methods: Saliva and Biopsy was taken from clinically suspected leukoplakia and oral squamous cell carcinoma lesions for the confirmation of histopathological diagnosis. Saliva samples were inoculated for fungal growth in Sabouraud Dextrose Agar, and culture-positive samples had undergone for the germ tube test. Germ tube-positive samples were further taken for chlamydospore production in milk serum and cornmeal broth +5% milk media separately at 8 and 16 h. Statistical Analysis Used: Chi-square test, Fischer extract test. Results: In the normal control group, no fungus growth was found; however, leukoplakia and oral squamous cell carcinoma showed fungus growth with positive germ tube test and chlamydospore formation; the result also showed rapid and quantitatively more chlamydospore formation in cornmeal broth +5% milk in comparison to serum milk culture media. There was no growth of Candida in mild and moderate form of leukoplakia. Whereas in a severe form of leukoplakia, there was more quantitative chlamydospore growth in cornmeal broth +5% milk liquid media. Conclusions: In this study, we have tried to compare the efficacy of cornmeal broth +5% milk and milk serum for the identification of C. albicans. Both the culture media were able to promote the growth of chlamydospore in C. albicans. Among different grades of leukoplakia, the growth of C. albicans was seen in severe dysplastic patient only while mild and moderate dysplasia showed no Candidal growth. |
| From the Editor's Desk T Smitha Journal of Oral and Maxillofacial Pathology 2019 23(1):1-1 |
| President's Message B Veerendra Kumar Journal of Oral and Maxillofacial Pathology 2019 23(1):2-2 |
| Hon. Secretary's Message Nadeem Jeddy Journal of Oral and Maxillofacial Pathology 2019 23(1):3-3 |
| Hon. Treasurer's Message S Ratheesh Kumar Nandan Journal of Oral and Maxillofacial Pathology 2019 23(1):4-4 |
| Delineating the scope of oral pathology and microbiology: Present scenario and future prospects Bhuvan Nagpal Journal of Oral and Maxillofacial Pathology 2019 23(1):5-7 |
| Prof. (Dr.) R R Paul Mousumi Pal Journal of Oral and Maxillofacial Pathology 2019 23(1):8-9 |
Rheumatology and Rehabilitation
| Carotid artery atherosclerosis and ECG changes in patients with systemic lupus erythematosus: relation to disease activity and severity Samia M Abdel-Monem, Sahar S Ganeb, Rasha M Fawzy, Ahmed M Bendary, Zeinab N Elhawary Egyptian Rheumatology and Rehabilitation 2019 46(2):71-77 Aim This study aimed to detect atherosclerotic changes in the carotid arteries of systemic lupus erythematous (SLE) patients as an indicator of cardiovascular risk factors and to correlate the findings with disease severity and activity parameters as well as to study specific ECG changes in these patients to elucidate possible associations between these variables. Patients and methods This study included 30 SLE patients who met the Systemic Lupus International Collaborating Clinics (SLICC) criteria (group I), 30 rheumatoid arthritis (RA) patients diagnosed according to the American College of Rheumatology/European league against rheumatism (EULAR) 2010 criteria (group II), and 30 apparently healthy volunteers age and sex matched to the SLE patients’ group (group III). All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using the Systemic Lupus Erythematous Disease Activity Index (2 K) score and assessment of damage by the SLICC/American College of Rheumatology Damage Index (SDI). Laboratory investigations included: complete blood count, erythrocyte sedimentation rate, lipid profile, immunological profile (antinuclear antibodies, anti-double-stranded DNA antibody, anticardiolipin antibody, and complements C3 and C4). The right common carotid artery was scanned by ultrasound and the average of carotid intima media thickness (CIMT) was calculated (mean of four readings) for all participants participating in the study. ECG was also done for all participants. Results The mean CIMT was higher in RA patients (0.71±0.194 mm) with a nonsignificant difference compared with SLE patients (0.68±0.197 mm) and a high statistically significant difference (P<0.001) compared with healthy controls (0.34±0.09 mm). There was no statistically significant correlation of the mean CIMT (mm) with SLICC damage index (P=0.09) and disease activity score (P>0.05). Abnormal ECG findings were observed in 3/30 SLE patients (10%), 10/30 RA patients (33.3%), and one/30 healthy control (3.3%), with statistically significant difference (P<0.03) among groups. The presence or absence of abnormal ECG findings showed statistically insignificant differences regarding patients’ disease activity and mean CIMT. Conclusion Although ECG changes were present in 10% of our SLE patients, association of specific ECG changes could not be confirmed. A greater prevalence of increased CIMT was observed in SLE patients, emphasizing the important role of this disease in the development of premature atherosclerosis which did not correlate with disease activity or severity parameters. |
| Outcome of intensive rehabilitation following single-event multilevel surgery for crouch gait in children with cerebral palsy John F.H Amen, Dalia M.E El-Mikkawy, Ahmed H Yosry, Mohamed A El-Gebely, Mostafa H.A El-Sherbini Egyptian Rheumatology and Rehabilitation 2019 46(2):78-84 Background Crouch gait is one of the most common gait patterns in ambulatory children with cerebral palsy (CP) and is contributed by several factors. The literature reports wide variations in surgical practice and rehabilitation programs following single-event multilevel surgeries. Objective To evaluate the outcome of rehabilitation after single-event multilevel orthopedic surgery for crouch gait in children with CP. Patients and methods A total of 20 children with bilateral spastic CP and walked with a crouch gait, with gross motor function classification system levels II, III, and IV, were subjected to single-event multilevel surgery. Ten (20 limbs) patients were men and eight (14 limbs) were women. Their age ranged from 5.5 to 19 years. To assess the outcome of our rehabilitation program, we used clinical couch examination parameters, functional mobility scale, and instrumented three-dimensional gait analysis. Rehabilitation program included preoperative and postoperative rehabilitation at 1-year postoperatively. Results Highly statistically significant improvements in clinical parameters, which include hip abduction, femoral anteversion, fixed flexion deformity, popliteal angle, and extension lag, were demonstrated (P<0.01), whereas tibial torsion showed a statistically significant improvement (P<0.05). Functional mobility scale at 5, 50, and 500 m improved in 10 (55.6%) cases, 13 (72.2%) cases, and 11 (61.1%) cases, respectively. Instrumented gait laboratory parameters, namely, stride length, crouch angle at initial stance, and peak knee flexion in mid-swing, showed improvement but did not reach statistical significance. Conclusion The rehabilitation program we offered improves clinical and functional mobility of children with CP with crouch gait. Thus, it is viewed as an important contributor to the overall outcome together with multilevel orthopedic surgery. |
| Premature ovarian failure in systemic lupus erythematosus patients: is it related to cyclophosphamide treatment? Rasha M Ghaleb, Khaled A Fahmy Egyptian Rheumatology and Rehabilitation 2019 46(2):85-91 Introduction Systemic lupus erythematosus (SLE) is a chronic autoimmune systemic disease that mainly affects women during the childbearing period. Cyclophosphamide (CYC) is the drug of choice for severe SLE manifestations. However, many side effects had been reported. Premature ovarian failure (POF) is one of the serious complications that can occur in SLE patients. Aim The aim was to evaluate the prevalence of POF in female patients with SLE and whether it is related to CYC treatment or not. Patients and methods One hundred women with SLE satisfying the updated revised criteria for the classification of SLE were studied. The patients were allocated into two groups: CYC-treated group (n=55) and non-CYC-treated group (n=45). Patients were interviewed and demographic characteristics, clinical and serologic profiles, and menstrual histories were recorded. Disease activity was measured by the SLE disease activity index. Serum anti-Müllerian hormone was measured as a marker for ovarian reserve assessment in the two study groups. Results Ovarian failure occurred in 15 (27.3%) patients out of the 55 SLE patients treated with CYC. The cumulative CYC dose was significantly higher in patients with ovarian failure than in those without this condition (11.7 vs. 9.5 g; P=0.001). The cumulative dose of CYC and the older age at initiation were found to be associated more with POF. Conclusion In our population of female SLE patients, CYC-induced ovarian failure is a significant problem occurring in 27.3% of SLE patients receiving CYC. So, for SLE patients in whom the use of CYC is mandatory, a lower dosage and a shorter course of this agent should be considered. Co-treatment with gonadotropin-releasing hormone agonists might persevere the future fertility and ovarian function in young women. Ovarian banking before administration of CYC could be a possible solution in certain cases. |
| Neuromuscular ultrasound in ulnar neuropathy at the elbow: correlation with electrodiagnostic studies Esraa Muhammad Bastawy, Naglaa Ali Gad Allah, Ola Abd El Nasser, Eman Ahmed Tawfik Egyptian Rheumatology and Rehabilitation 2019 46(2):92-100 Introduction Ulnar nerve entrapment is the second most common entrapment neuropathy in the upper limb after carpal tunnel syndrome, and, if left untreated, it may lead to significant functional impairment and disability. Objective The aim of this study was to perform clinical, electrodiagnostic (EDX), and neuromuscular ultrasound assessment for patients with ulnar neuropathy at the elbow, to determine the possible roles of neuromuscular ultrasound in the localization of the neuropathy, in the detection of its possible etiologies and in the determination of its severity. Patients and methods A sample of 15 (22 elbows) patients was recruited and subjected to full medical history, neurological assessment, EDX studies, and neuromuscular ultrasound examination. Ten (20 elbows) age-matched and sex-matched healthy volunteers were also recruited and served as a control group. Results This study revealed significantly enlarged ulnar nerve cross-sectional area (CSA) at the ulnar groove and below the elbow and supracondylar sites in patients compared with the control group. receiver-operating characteristic curve analysis revealed high diagnostic accuracy of the absolute CSA at the ulnar groove, and below the elbow and supracondylar sites, with an area under the curve of 0.8, 0.8, and 0.9, respectively, and the cutoff values were >9, >8, and >8, respectively. The area under the curve for the ‘maximum CSA/midforearm CSA ratio’ was 0.9, with a cutoff value of more than 1.3. Conclusion Our study data suggest that neuromuscular ultrasound (NMUS) examination may play a potentially important role in the assessment of ulnar neuropathy at the elbow. It can localize the lesion and disease severity, and it can differentiate between patients and controls, given its high diagnostic ability. Abnormalities in ultrasonographic features of ulnar nerve entrapment with regard to CSA and ratio between ‘maximum CSA and midforearm CSA’ at the elbow was correlated with EDX findings. |
| Clinical significance of interleukin 27 serum concentration in patients with systemic sclerosis: relation to clinical, laboratory and radiological parameters Waleed A Hassan, Gamal A Hamaad, Emtethal A Sayed, Mona M El Behisy, Manal K Gomaa Egyptian Rheumatology and Rehabilitation 2019 46(2):101-107 Background Interleukin 27 (IL27) is a cytokine that belongs to IL12 family and it is mainly produced by antigen presenting cells. IL27 binding to its receptor leads to activation of many intracellular signaling pathways that can exhibit a wide variety of immunomodulatory actions. Aim of the work The current study aimed to determine IL27 concentrations in the sera of SSc patients and to assess the relation between these concentrations and the various clinical, laboratory and radiological disease parameters. Methods We measured serum IL27 concentrations in 31 SSc patients and 20 controls. The patients were subjected to detailed history and clinical evaluation. In SSc patients, modified Rodnan skin score (MRSS) was used to assess the skin thickness and pulmonary involvement was assessed by high resolution computerized tomography (HRCT) and forced vital capacity (FVC) assessment. Results IL27 serum concentrations in diffuse (median, 302.8; 101.6-1034.4 ng/L) and limited (median, 385; 109-826.3 ng/L) subtypes of SSc showed a significant elevation (P < 0.001) compared to its concentrations in the controls (median, 104.2; 51-184.2 ng/L). SSc patients with elevated IL27 serum concentrations had significantly lower forced vital capacity (FVC) than those with normal IL27 serum concentrations (p=0.04). Also, serum level of sCD163 significantly correlated with MRSS (r=0.48, p=0.0064) and FVC (r=-0.6, p=0.0005). Conclusion Patients with systemic sclerosis have significantly increased serum IL27 concentrations that remarkably associated with significant cutaneous and pulmonary involvement signifying that it could be a beneficial biomarker that reflects disease severity and implies a possible pathogenic role in SSc. |
| Relation of ischemia-modified albumin to disease manifestations and activity in Egyptian patients with Behҫet's disease Nermeen A Fouad, Tarek I Ahmed, Olfat G Shaker, Omayma O Abdelaleem Egyptian Rheumatology and Rehabilitation 2019 46(2):108-112 Aim of work To determine level of ischemia-modified albumin (IMA) in patients with Behçet’s disease (BD) and to assess its role in disease manifestations and activity. Patients and methods The study included 48 patients with BD and 38 matched controls. Disease activity was estimated by the BD current activity form. Serum IMA was measured. Results Mean age of the patients was 33.8±7.9 years. There were 42 males and six females, and the disease duration was 52.9±48.8 months. The serum IMA level was significantly increased in the patients with BD (50.9±12.9 U/ml) compared with the control (7.76±1.6 U/ml) (P<0.001). There was a statistically significant association between IMA level and disease activity, with high mean IMA level among active cases (P=0.01). There was no statistically significant association between IMA level and any of other clinical characteristics in patients with BD. Sensitivity and specificity test for IMA level in detection of cases illustrated accuracy of 98.5% with sensitivity 95.8% and specificity 78.9% at cutoff value of 9.4 U/ml. Conclusion There is growing evidence indicating the role of oxidative stress in BD. IMA is accepted as an essential marker of oxidative stress in patients with BD. It has a potential diagnostic value for the detection of the disease. Furthermore, it correlates with the disease activity. |
| Ultrasonographic features of tibialis posterior tendon in rheumatoid arthritis patients with pes planovalgus Hamdy Khamis Koraym, Wafaa S El-Emary, Sherine M Elsherif, Ahmed H Afifi, Samar A.S.M Olibah Egyptian Rheumatology and Rehabilitation 2019 46(2):113-120 Aim The aim of this study was to assess the relationship between ultrasonographic features of tibialis posterior (TP) tendon in rheumatoid arthritis (RA) patients and associated pes planovalgus (PPV) foot deformity. Patients and methods This study included 20 (40 feet) RA patients with PPV and ultrasound-proven TP tenosynovitis. The following variables were recorded for patients: the number of tender and swollen foot joints count, foot posture index (FPI), Health Assessment Questionnaire, and Disease Activity Score 28 (DAS28). FPI is a clinical tool used to quantify the degree to which a foot is pronated, neutral, or supinated using the set criteria. Patients underwent high-resolution ultrasound of the TP tendon. Measurement of tendon diameter was recorded in the retromalleolar region. The presence of fluid around the TP tendon and levels of power Doppler signal (PDS) were assessed. Results High disease activity was detected in patients (mean DAS28 of 5.89). Eighteen (45%) feet had thickened transverse diameter and 15 (37.5%) feet had thickened longitudinal diameter. Twenty-three feet showed PDS. Nineteen feet had fluid around the tendon, detected only in the retromalleolar region. Regarding FPI, 14 feet were mild to moderate pronated feet and 26 feet were highly pronated feet. There were direct correlation between FPI and both DAS28 (p=0.05) and transverse diameter thickness (p=0.01). Highly pronated feet had higher DAS28 (p=0.03), increased transverse diameter thickness (p=0.04), more detection of fluid around the TP tendon (p=0.005) as well as higher incidence of PDS around the TP tendon (p=0.002). Conclusion Higher degree of pronation in RA feet with PPV is associated with ultrasonographic increased tendon thickness, PDS, and fluid around TP tendon. Early diagnosis and intervention for TP tenosynovitis may prevent progressive PPV foot deformity. |
| Patellar tendon ultrasonographic properties and lower limb function in rheumatoid arthritis patients Samia Abd El Hamid Abd El Megid, Salwa Saeid El Gendy, Hussein Abd El Aziz Yassin, Marwa Mohamed Mohamed Ali Abd El Rahim, Mai Abd El Halim Abd El Razik Moussa Egyptian Rheumatology and Rehabilitation 2019 46(2):121-131 Aim of work The aim of this work was to investigate patellar tendon (PT) biomechanical properties in rheumatoid arthritis (RA) patients through changes in ultrasonographic tendon properties and its effect on lower limb function. Patients and methods Forty RA patients and 20 healthy participants were included in this study. The physical function was assessed by Health Assessment Questionnaire, the activity of RA by disease activity score 28 and range of motion for all knees by a manual goniometer. RA patients were divided into the following groups: group I comprised patients with low disease activity score 28, who were further subdivided according to the presence of knee flexion deformity into two subgroups (GIA and GIB) and group II patients in the remission stage. Ultrasonography was used for measuring PT elongation and cross-sectional area and quadriceps’ muscle strength was measured. The lower limb function was assessed clinically by 50-foot walk test and smart balance master system through unilateral stance test, step up and over and sit to stand tests. Results There was an increased elongation of PT of all RA groups relative to the control group (P=0.001); no significant difference was found in the PT (cross-sectional area). RA patients showed quadriceps’ muscle strength reduction (P=0.001) and delayed walking time of the 50-foot walk test (P=0.05). Unilateral stance test showed increased center of gravity sway velocity during either eye open or eye closed conditions in RA groups and deterioration in all parameters of step up and over and sit to stand tests (P=0.05–0.001). All physical function evaluation of RA patients showed impairment associated with a reduction of PT stiffness and quadriceps’ strength. Conclusion Inflammation of the PT and peritendinous tissues in RA alters its biomechanical properties; this impairs RA patients’ physical and lower limb functions. |
| Combined (physical and medical treatment) therapy versus physical treatment alone and medical treatment alone in the management of chronic pelvic inflammatory disease Dalia S Saif, Dina S Fotoh, Reem M EL Kholy, Dalia I Morsi, Heba M Farag Egyptian Rheumatology and Rehabilitation 2019 46(2):132-139 Context Pelvic inflammatory disease (PID) is the inflammation of the upper genital tract involving the fallopian tubes as well as the ovaries. Symptoms of PID are fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, uterine and adnexal tenderness, and irregular menstruation. Aim The aim was to determine the therapeutic efficacy of combined shortwave diathermy and medical treatment in the management of chronic PID in comparison to either therapy alone. Materials and methods Sixty participants were recruited and diagnosed as chronic PID for more than 6 months by history, clinical examination, cervical swab, and ultrasonography. They were divided into three groups: Statistical analysis Descriptive and analytic study by SPSS version 16 on IBM compatible computer. Results There was a statistically highly significant clinical improvement regarding itching, discharge and pain relief, laboratory improvement regarding the number of pus cells in cervical swab, and radiological improvement regarding US parameters in the first group of patients with PID compared with the baseline and compared with other groups. Conclusion The greatest therapeutic efficacy can be obtained from combined physical and medical treatment compared with each line alone in the treatment of chronic PID. |
Movement Disorders
| The chronicles of modern movement disorders in India Prashanth L Kukkle, Hee Kyung Park, Mona T Obaid, Shinshuki Fujioka Annals of Movement Disorders 2019 2(1):1-8 Movement Disorders are currently growing to be one of the major subspecialties of neurology worldwide, primarily by developments of research and therapeutics in this field. As any specialty grows, it leads to the formation of its society and the publication of journal to disseminate the knowledge. The International Parkinson’s Disease and Movement Disorders Society (IPMDS, formerly known as Movement Disorders Society) played its role with inception since 1980s. Further development of Movement Disorders subspecialty leads each region and country to have their own national societies and publications. Similarly, the seeds of Movement Disorders were sown in India in mid-1980s but it took a major stride in last few years with the formation of Movement Disorders Society of India (MDSI) in 2014 and following this, it is now at the crux of starting its journal—Annals of Movement Disorders (AOMD). This would be a right time to look back into the history of Indian Neurology with specific reference to the Movement Disorders and pen down these chronicles since the inception of modern neurology in India. The current chronicles of Indian Movement Disorders is penned based on personal interviews with various senior Movement Disorder specialists of India. However, it should also be remembered that many of the chronicles are limited by the memories of people and their biases with whom the interviews are conducted. |
| Sleep disturbances in patients with Huntington's disease: A questionnaire-based study Menka Jha, Nitish Kamble, Abhishek Lenka, Ravi Yadav, Meera Purushottam, Sanjeev Jain, Pramod Kumar Pal Annals of Movement Disorders 2019 2(1):9-14 OBJECTIVES: To compare the sleep profiles of genetically proven cases of Huntington’s disease (HD) with healthy controls and to correlate the results of various sleep-related parameters with disease severity, duration, and length of cytosine–adenine–guanosine repeats.METHODS: This prospective study was conducted at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India, which included 31 genetically confirmed patients with HD and 50 controls. All the subjects were evaluated for sleep disturbances using standardized sleep questionnaires (Pittsburgh Sleep Quality Index [PSQI] and Epworth Sleepiness Scale [ESS]).RESULTS: The mean age of the patients during the first consultation was 46.0±12.7 years (range: 28–80). The mean age at onset of symptoms was 40.5±13.8 years. Nineteen patients (61.2%) gave history of sleep disturbances. Symptom suggestive of rapid eye movement sleep behavior disorder was present in 8 patients (25.8%). Difficulty in falling asleep was the most common sleep-related disturbance reported by 16 patients (51.6%). The mean ESS score of the patients was 6.22±2.89 and that of the control population was 3.00±2.8 (P value < 0.001). The mean PSQI score of the patients was 8.90±3.50 and that of the control population was 3.3±2.9 (P value < 0.001).CONCLUSIONS: This study demonstrates sleep disturbances in patients with HD compared to healthy controls and the sleep disturbances correlated significantly with the disease duration, severity, and coexistent anxiety and depression. |
| Clinical outcomes of step-synchronized vibration training in patients of Parkinson's disease with freezing of gait Rajeev Aggarwal, Ingrid Pretzer-Aboff, Kyle N Winfree, Sunil K Agrawal, Madhuri Behari Annals of Movement Disorders 2019 2(1):15-20 OBJECTIVE: To elucidate the effect of step-synchronized vibration training using PDShoe on balance, gait, and quality of life in patients of Parkinson’s disease (PD) with freezing of gait (FOG).MATERIALS AND METHODS: In a pilot study, 17 patients of PD with FOG were recruited for step-synchronized vibration training. The training involved 10 sessions of gait training over 2 weeks. Each session included three 6-min bouts of walking with step-synchronized vibration applied to the second metatarsal head and medial surface of calcaneus. Participants were assessed with the Unified Parkinson’s Disease Rating Scale-III (UPDRS III), Timed Up and Go (TUG) test, Berg Balance Scale (BBS), Timed 10-Meter Walk Test, Freezing of Gait Questionnaire (FOG-Q), Falls Efficacy Scale-International (FES-I), and Parkinson’s Disease Questionnaire-39 (PDQ-39). Measurements were collected pre-intervention, post-intervention, and at a 2-week follow-up. Friedman test followed by Wilcoxon signed-rank test were used for statistical analysis.RESULTS: All participants completed the intervention without any adverse effects. Fifteen participants reported for a follow-up evaluation 2 weeks after intervention. There was statistically significant improvement in UPDRS III (P = 0.044) and significant improvement in TUG test (P = 0.005), BBS (P = 0.026), FES-I (P = 0.041), and PDQ-39 (P = 0.021) scores between pre and follow-up evaluations. No significant changes were seen in FOG-Q and Timed 10-Meter Walk Test.CONCLUSION: Step-synchronized vibration is a novel intervention to improve balance, gait, motor features, and quality of life in patients of PD with FOG. Further research is warranted to confirm the results found in this pilot study. |
| Analysis of gait in Parkinson's disease reflecting the effect of l-DOPA Banashree Mondal, Supriyo Choudhury, Rebecca Banerjee, Koustav Chatterjee, Sayam Ghosal, Sidharth S Anand, Hrishikesh Kumar Annals of Movement Disorders 2019 2(1):21-27 BACKGROUND: Gait instability is one of the disabling clinical features of majority of patients suffering from Parkinson’s disease (PD). It is partially responsive to dopamine replacement therapy. Precise evaluation of distinct l-DOPA-sensitive and l-DOPA-resistant gait profiles might help in planning therapy of PD patients with gait disorder.METHOD: In this cross-sectional analytical study, we measured the gait parameters of 70 patients and 37 healthy participants using a 6.1-m long electronic walkway containing thousands of pressure sensors embedded in a carpet. The patients were evaluated in their OFF and ON phases of l-DOPA medication, and the data were compared with age- and gender-matched healthy controls.RESULTS: Except for the cadence, most gait parameters including velocity, stride length, and step length were deranged in PD patients. The mean velocity was significantly higher among healthy volunteers (99.19cm/s) compared to PD patients (73.90cm/s, P value 0.0001). However, the mean cadence was comparable between healthy and patient groups (103.29 vs. 103.39, P value 0.966). Certain temporal parameters (cadence, cycle time, and swing time) were nonresponsive to the dopaminergic therapy.CONCLUSION: On the basis of the findings, we propose that l-DOPA treatment improves most of the spatiotemporal gait parameters but cannot completely eliminate the risk of fall. |
| Poststroke dystonia: A video-based case series Gurusidheshwar M Wali Annals of Movement Disorders 2019 2(1):28-31 Insidious-onset progressive dystonias are rarely described as a sequelae of stroke. Their pathological basis consists of axonal degeneration and neuronal plasticity secondary to the initial vascular damage. This case series describes four cases of poststroke dystonias. Although clinical and radiological findings suggest their cause–effect relationship, we have performed genetic testing using clinical exome sequencing to rule out incidental co-occurrence of genetic dystonic syndrome in a patient with stroke. We have documented the clinical evolution of the dystonic features and attempted clinico-radiological correlations using magnetic resonance imaging. A video document of all the cases is provided, highlighting the clinical distribution of the dystonic features and unusual findings. Treatment aspects are briefly discussed. |
| Abstracts of Award Papers, MDSICON 2019, New Delhi Annals of Movement Disorders 2019 2(1):32-35 |
Menoufia Medical Journal
| Platelet-derived growth factor in patients with liver fibrosis Enas S Essa, Fikry G Eskander, Amira Z Badawy Menoufia Medical Journal 2019 32(1):1-7 Objective To asses the changes in platelet-derived growth factor (PDGF) in liver fibrosis. Data sources The data were sourced from the PubMed database from the start of the database to 2017 and from all materials available in the Internet. Study selection The initial search presented 423 articles of which 39 met the inclusion criteria. The articles studied the relation between PDGF and liver fibrosis. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included when ethical approval was obtained, eligibility criteria defined, sufficient information, convenient controls, and known assessment measures. Data synthesis Comparisons were made through structured review with the results tabulated. Findings In total, 39 potentially relevant publications were included. The studies indicate an association between PDGF and liver fibrosis as PDGF increases in patients with hepatic fibrosis and correlates well with the grade of fibrosis. The majority of studies were performed on the effect of PDGF antagonists on liver fibrosis and they found that interference of PDGF pathway leads to reduction of liver fibrosis. Conclusion We found that PDGF levels increase in patients with liver fibrosis and its level correlates well with the stage of fibrosis; thus, PDGF can be used as a potential noninvasive marker for liver fibrosis either alone or in association with other fibrosis markers. Further, antagonizing the pathway of PDGF may offer a promising strategy for the treatment of liver fibrosis. |
| Immunotherapy for advanced bladder cancer: a new era Eman Abd ElRazek, Suzan Alhassanin, Hagar Al Agizy, Alshimaa M Alhanafy, Eman Helmy Desoky Menoufia Medical Journal 2019 32(1):8-13 Objectives The aim of this study was to analyze data and current trends in immune checkpoint targeting therapy for bladder cancer. Data sources A systematic literature search was performed for clinical trials in the Medline databases (Google Scholar, ClinicalTrials.gov, Cochrane, http://www.ekb.eg) and all materials available in the Internet from 2014 up to 2017 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Study selection The initial search yielded 35 articles, of which 30 fulfilled the inclusion criteria. The articles studied the role of Immune checkpoint targeting therapy in bladder cancer. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was obtained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Data synthesis Comparisons were made by structured review, with the results tabulated. Findings Humanized monoclonal antibodies that block CTLA-4 (ipilimumab, tremelimumab), PD-1 (nivolumab, pembrolizumab), or PD-L1 (atezolizumab, durvalumab, avelumab) have all shown antitumor activity in patients with urothelial carcinoma (UC). Atezolizumab and nivolumab are approved by the Food and Drug Administration for second-line therapy for advanced UC and a number of other checkpoint inhibitors are in clinical trials. Conclusion Immunotherapy for UC remains a promising and active area of research; intravesical Bacillus Calmette-Guerin has been used as a form of immunotherapy in nonmuscle invasive disease. Also, numerous agents, particularly the monoclonal antibodies targeting checkpoint inhibition pathways, are showing encouraging signs of clinical activity. |
| Aortic stiffness is increased with premature coronary artery disease: a tissue Doppler imaging study Ahmed M Emara, Wessam E. H. El Shafey, Nader Nabil Menoufia Medical Journal 2019 32(1):14-17 Objective The objective of this study was to review the relationship of the aortic wall structure velocities evaluated by tissue Doppler imaging echocardiography in coronary artery disease (CAD). Materials and methods Data resources included Medline directories (PubMed, Medscape, Research Direct) and all material available in the internet from 1985 to 2017. The original search offered 104 articles, of which 47 fulfilled the inclusion standards. The articles analyzed aortic rigidity in patients with early CAD. Studies that did not fulfill the inclusion criteria were excluded. Research quality evaluation included determining whether honest authorization was gained, eligibility conditions were specified, appropriate settings were used, enough information was present, and whether assessment measures were described. Evaluations were created by organized review with the results tabulated. Results Altogether, 47 possibly relevant magazines were included. The studies suggested that aortic rigidity is increased in patients with early CAD. Conclusion Increased aortic rigidity has been named a predictor of cardiovascular incidents. Our conclusions verify this finding. Pulse-wave tissue Doppler imaging of the ascending aorta is an easily available way for estimating aortic flexible properties, and early aortic velocities are correlated with recently defined variables of aortic rigidity. Thus, early aortic velocities may show increased aortic rigidity in patients with early CAD. The medical use of the parameter needs further investigation. |
| Relationship of coronary artery disease with testosterone level in young men undergoing coronary angiography Hala M Badran, Mahmoud A Soliman, Ibrahim Elmadbouh, Waleed A Ibrahim, Sameh F El Masry Menoufia Medical Journal 2019 32(1):18-24 Objective This study aimed to investigate the relation of testosterone level with the extent of coronary artery disease (CAD) in young adult male undergoing coronary angiography. Materials and methods Medline databases (PubMed, Journal of Clinical Endocrinology and Metabolism, British Medical Journal, Journal of American College of Cardiology and European Heart Journal) and also materials available in the internet were searched. The search was performed in the electronic databases from 2014 to 2017. The initial search presented 127 articles of which 61 met the inclusion criteria. The articles studied premature CAD, relation of testosterone level to CAD, and testosterone replacement therapy. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Comparisons were made by structured review with the results tabulated. Findings In total, 61 potentially relevant publications were included. The studies indicate that the serum levels of both total and free testosterone were significantly lower in young males with CAD, and both were significantly correlated with the severity of CAD as assessed by Gensini score. Conclusion The low testosterone level is associated with both the incidence and severity of premature CAD in young adult males. |
| Theory of mind: its development and its relation to communication disorders: a systematic review Mohammed Baraka, Hossam M El-Dessouky, Eman E Abd El-Wahed, Shimaa S Allam Amer Menoufia Medical Journal 2019 32(1):25-30 Objective To define theory of mind (TOM), its development, its significance, its assessment, its deficits and intervention. Data sources Medline databases (PubMed, Medscape and Science Direct) and all materials available in the Internet from 1990 to 2016. Study selection The initial search presented 250 articles of which 47 met the inclusion criteria. The articles studied the development, assessment, deficits and intervention of TOM. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information and defined assessment measures. Data synthesis Significant data were collected. It was heterogeneous. Thus, a structured review was performed with the results tabulated. Conclusion TOM is the ability to infer the mental states such as (beliefs, thoughts, intentions) to one-self and to the others. Joint attention is an early precursor of TOM development. Theoretical accounts of TOM mechanism are, the Theory Theory, Simulation Theory and Modularity Theory. Many tools used in its assessment as false belief tasks (e.g., Sally and Anne task) and TOM test. It is impaired in autism, attention deficits hyperactivity disorder, hearing impairment, schizophrenia and dementia. Intervention solutions for the deficit are undertaken. Phoniatritions should be aware of TOM as a cognitive capacity that plays a big role in our communication. They should initiate appropriate assessment and interventions for disorders having TOM deficits. |
| The role of growth factors in the treatment of voice disorders: systematic review Mohamed K. M. El-Sharnoby, Mohamed A. S. Baraka, Hossam M El-Dessouky, Eman E Abd El-Wahed, Amina G Abd El-Aleem Menoufia Medical Journal 2019 32(1):31-37 Objective The aim of this study was to present a review about the role of growth factors (GFs) in the treatment of some voice disorders. Materials and methods The data sources consisted of Medline databases (PubMed, Elsevier, and Wily Library) and all materials available in the internet from 1990 to 2017. The initial search presented 150 articles, of which 57 met the inclusion criteria, with level II-2 as the level of evidence. The articles studied the function, uses and the efficacy of basic fibroblast growth factor (bFGF) on vocal outcomes of patients with vocal fold (VF) lesions. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria were specified, appropriate controls were used, adequate information was given and whether the studies defined assessment measures. Significant data were collected. It was heterogeneous. Thus, a structured review was performed with the results tabulated. Conclusion VF lesions and paralysis induced severe dysphonia, and the fundamental therapy for these diseases is voice therapy; however, this approach is ineffective for severe dysphonia. Surgical approaches have been attempted, but the outcome varies. The aim of surgical treatment has recently changed to stimulate the regeneration of VF structures. GF therapy is considered to be a 'trigger' for jumpstarting biological processes. One promising GF is bFGF. Cases of severe dysphonia that were treated by the single, transoral bFGF injection method showed significant improvements in the vocal functions after injection. The single injection method is easy to perform as an office procedure. The use of bFGF injection to treat severe VF lesions and VF paralysis is still controversial. |
| Language processing in a bilingual child Mohamed Baraka, Hossam El-Dessouky, Eman Ezzat, Fatima M Al-Sharif Menoufia Medical Journal 2019 32(1):38-44 Objectives To review the language processing, 'central and linguistic processing,' in bilingual children. The age of second language acquisition, a factor which may impact language processing, was also reviewed. Data sources Medline databases (PubMed, Medscape, and Science Direct) using the terms 'bilingual' or 'bilingualism' with the word 'children' as the search criteria. The resulting materials available in the internet from 1980 to 2017 were further screened for the terms 'processing,' 'cognition,' or 'age of acquisition.' Study selection Our refined search included 124 articles and book's chapters out of which 83 met our selection criteria. Those data related to late bilingualism were excluded. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, adequate information, and defined assessment measures were made. Data synthesis Significant data were collected. It was heterogeneous. Thus, a structured review was performed with the results tabulated. Conclusion An unresolved issue in bilingualism is how different languages are represented in the brain and which cognitive mechanisms are required to regulate their use. In learning a second language, the brain has to build on a neural network that enables the segregation of the new language from the native one. A bilingual child can create languages' activation and inhibitory links at the lexical and the morphological level and also can develop the ability to select a word and its syntactic characters correctly. |
| Assessment of phonological awareness in children with delayed language development Mohamed Baraka, Hossam El-Dessouky, Eman Ezzat, Eman F El-Domiaty Menoufia Medical Journal 2019 32(1):45-53 Objective To study the relationship between language disorders in children and phonological awareness (PA) to identify children with reading difficulties as early as possible. Background PA is an important determiner of success in learning to read and spell. Early speech and early language difficulties are considered to be risk factors associated with future reading difficulties. Children with language difficulties are particularly at risk for poor literacy outcomes. Patients and methods Fifty cases (aged from 5 to 8 years) with delayed language development of average intelligence quotient participated in our study at Phoniatrics unit outpatient clinic in Menoufia University Hospital, from March 2015 to March 2016. They were divided into three groups (A, B, and C) and assessed by Arabic Phonological Awareness Test and Standardized Arabic Language Test. The results of cases were compared with the results of 50 controls matched for age and sex. Moreover, the results of the PA test were correlated with the results of standardized Arabic language test. Results By comparing the performance of PA skills for cases and control in the three age groups, there were significant differences in all skills (P < 0.05), except in segmenting words into syllables (P = 0.06) and blending syllables (P = 0.1) in group A. By studying the correlation between PA age and total language age, receptive language age, expressive language age, and semantics age, there were highly significant positive correlations (P = 0.000). Significant positive correlation was found between PA age and articulation (P = 0.029). Moreover, there was a significant negative correlation between PA score and the gap between language age and chronological age (P = 0.045). Conclusion Children with specific language impairments require specific therapy that includes explicit focus on PA and letter identification. |
| Laryngeal assessment of patients with rheumatoid arthritis using laryngeal photodocumentation Mohamed Baraka, Hossam El-Dessouky, Alaa Labeeb, Eman Ezzat, Asmaa El-Dessouky Menoufia Medical Journal 2019 32(1):54-61 Objective The aim was to assess the prevalence of dysphonia and laryngeal changes upon videolaryngoscopic examination of patients with rheumatoid arthritis (RA). Background RA effects on larynx vary from mild asymptomatic effect to life-threatening conditions. Many authors have emphasized the need of studies in different communities on its effect. In Egypt, the knowledge regarding its manifestations on the larynx, as well as its laryngeal alterations, is limited. Patients and methods A total of 79 patients diagnosed as having RA in Menoufia University Hospitals from March 2015 to March 2017 were assessed by taking history and asking about different laryngeal complaints followed by telescopic videolaryngeal examination. Results The estimated prevalence of laryngeal complaints in patients with RA was 57%. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Dysphonia prevalence was 25.3%. Regarding videolaryngoscopic findings, the prevalence of changes was present in 86.15% of the patients. Most common finding has been posterior laryngitis, which was found in 78.5% of patients, followed by glottic gap in 34.2% and vocal folds rheumatoid nodules in 26.6% of them. Conclusion Laryngeal complaints and videolaryngoscopic morphological findings are prevalent among patients with RA, with a prevalence rate of 57 and 86.15%, respectively. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Most common videolaryngoscopic findings have been posterior laryngitis, which was found in 78.5% of our patients, followed by glottic gaps in 34.2%. |
| Study of peripheral neuropathy in patients with type 2 diabetes mellitus Wafik M El-Sheikh, Ibrahim E Alahmar, Gelan M Mohamed, Mohamed A El-Sheikh Menoufia Medical Journal 2019 32(1):62-66 Objectives To compare serum levels of tumor necrosis factor-alpha (TNF-α) in patients with peripheral neuropathy and patients without neuropathy in type 2 diabetes mellitus (T2DM) and study the relation between nerve conduction studies of motor and sensory nerves and the serum level of TNF-α in T2DM. Background TNF-α presence in the serum of diabetic patients can be used as an indicator for the development of neuropathy with nerve conduction studies. Patients and methods This cross-sectional study was conducted in diagnosed T2DM patients. They were divided into two groups: group I (n = 40) with clinically detectable diabetic peripheral neuropathy (DPN) of shorter duration and group II (n = 40) with clinically detectable DPN of longer duration. They were compared with patients without clinical neuropathy (n = 40); clinical diagnosis was based on Neurologic Severity Score (NSS) and National Disability Services (NDS) for signs. Blood samples were collected for the estimation of serum TNF-α. Nerve conduction velocity was measured in the upper and lower limbs. Median, ulnar, common peroneal, and posterior tibial nerves were selected for motor nerve conduction study and median and sural nerves were selected for sensory nerve conduction study. Results The serum level of TNF-α in type 2 diabetic patients with peripheral neuropathy is higher than those without neuropathy. The serum level of TNF-α shows statistically significant negative correlation with nerve conduction velocities which is higher in type 2 diabetic patients (5–10 years duration) with peripheral neuropathy. Conclusion A high level of TNF-α in the serum of T2DM patients with neuropathy shows possible contribution in the development of neuropathy. This cytokine might be used as a biomarker for DPN. |
Medicine
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