Alexandria Journal of Medicine <p>The <em>Alexandria Journal of Medicine</em> is concerned with providing a venue for publication of research, with a particular focus on diseases of high prevalence in MENA (Middle East and North Africa) and its comparison to their profile worldwide. Manuscripts from the international scientific community are also welcome to cater to the interests of our broad readership, both regional and worldwide, and to increase the opportunities for fruitful interregional scientific collaboration. <br /> <br /> The journal publishes original research articles, review articles and clinical trials in an open access format. It is highly recommended to follow the reporting guidelines described on the <a href="">Equator Network</a> home page.</p><p>For a detailed description of the different types of manuscripts, the readers can consult the online instructions for authors (<a href=";page=instructions">;page=instructions</a>). The material is subject to the highest standards of editorial revision and peer review. Papers describing research involving human subjects and the procedures followed should conform to ethical standards. Articles containing promotional material (advertisements), whether implicit or explicit will not be included in the Journal.</p><p><br /><strong>Please Note:</strong> This journal is now produced and hosted by Taylor &amp; Francis on behalf of the Alexandria University Faculty of Medicine.</p><p class="TableContents" align="left">Current issue is available on:</p><p class="TableContents" align="left"><a href=""></a></p><p>Previous issues of the journal (2011 – 2018) are available on : <a href=""></a></p><p class="TableContents" align="left">The journal is indexed in DOAJ and E-SCI</p><p class="TableContents" align="left">Scimago journal rank:<br /> <a title="SCImago Journal &amp; Country Rank" href=";tip=sid&amp;exact=no"><img src="" alt="SCImago Journal &amp; Country Rank" border="0" /></a> </p><p> </p> en-US <div dir="ltr"><span class="u-margin-bottom-xs text-s u-display-block js-copyright" data-reactid="334">Copyright © 2017 Alexandria University Faculty of Medicine. Production and hosting by Elsevier B.V. All rights reserved</span></div><div dir="ltr"> </div> (Prof. Seddik Abdel-Salam) (Salah-Eldin Abdelmoneim) Tue, 22 Jan 2019 14:57:46 +0000 OJS 60 First line defence antioxidants-superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX): Their fundamental role in the entire antioxidant defence grid <p>The body encloses a complex antioxidant defence grid that relies on endogenous enzymatic and nonenzymatic antioxidants. These molecules collectively act against free radicals to resist their damaging effects to vital biomolecules and ultimately body tissues. Based on their response to general free radical invasion, they can be categorized into first, second, third and even fourth line defense antioxidants. The role and effectiveness of the first line defense antioxidants which basically include superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX) is important and indispensable in the entire defense strategy of antioxidants, especially in reference to super oxide anion radical (*O<sub>2</sub>) which is perpetually generated in normal body metabolism, particularly through the mitochondrial energy production pathway (MEPP). A lot has been published concerning antioxidants and their significance in preventing oxidative stress and the attendant cellular damage, howbeit with paucity of awareness on the fundamental role of SOD, CAT and GPX. The present review tends to articulate important information on SOD, CAT and GPX as first line defense antioxidant enzymes.</p><p><strong>Keywords:</strong> Antioxidants, Superoxide dismutase, Catalase, Glutathione peroxidase</p> O.M. Ighodaro, O.A. Akinloye Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 The possible protective effect of lactoferrin on lipopolysaccharideinduced memory impairment in albino rats No Abstract Nermin M. Madi, Mervat H. El-Saka Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Association of <i>IL-23R</i> gene single nucleotide polymorphism; rs 11209026 with incidence and severity of ankylosing spondylitis in a cohort of Egyptian patients <p>The aim of the present study was to investigate the possible association between incidence and severity of ankylosing spondylitis (AS) in a cohort of Egyptians and Interleukin-23Receptor (<em>IL23R</em>) genesingle nucleotide polymorphism(rs11209026).</p><p><strong>Methods:</strong> The study included thirty-two AS patients and forty volunteers who serves as a control group. The studied polymorphismwas genotyped using 50 Nuclease assay.</p><p><strong>Results:</strong> A statistically significant difference was detected between both studied groups as regards different <em>IL23R</em> genesingle nucleotide polymorphism (rs11209026) genotypes. Heterozygous genotype was the most prevailing among both cases and controls. At a cutoff level of 110 pg/mL, a statically significant difference was observed between cases and controls as regards serum IL23 level.</p><p><strong>Conclusions:</strong> In Egyptians, <em>IL-23R</em> single nucleotide polymorphism (rs11209026) appears to be associated with ankylosing spondylitis occurrence not severity, while higher levels of IL-23 might be associated with disease severity.</p><p><strong>Keywords:</strong> Interleukin 23 receptor, Polymorphism, rs 11209026, Ankylosing spondylitis</p> Mohamed I. Sayed, Doaa I. Hashad, Eman A. Soliman, Maha M. Talaaba Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Parathormone (PTH) is strongly related to left ventricular mass index (LVMI) in hypertensives, obese, and normal control No Abstract Samir Naim Assaad, Aliaa Ali El-Aghoury, Eman M. El-Sharkawy, Tamer Mohamed Elsherbiny, Ahmed Abdelhameed Osman Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Salt intake in a group of Tunisian obeses <p><strong>Background:</strong> Salt is directly related to hypertension and cardiovascular disease associated with it. As obesity facilitates the effect of salt, a quantification of obese salt intake is necessary.</p><p><strong>Methods:</strong> Our patients numbering 56 have been recruited in the consultation of the obesity unit. Patients were given a questionnaire about their knowledge concerning salt. Natriuresis of 24 h was quantified. The average amount of sodium consumed per day from foods was determined (SAL), the average amount of sodium consumed per day from table salt added to cooking and seasoning (SAC) and the average total amount of sodium consumed per day (STOQ).</p><p><strong>Results:</strong> The mean age of our patients was 44.31 ± 12.8 years. The average BMI of our patients was 37.12 ± 5.9 kg/m<sup>2</sup>. The average systolic blood pressure was 123.8 ± 14 mmHg and mean diastolic blood pressure was 76.45 ± 10.7 mmHg. The average amount of sodium consumed per day from food (SAL) was 1 915 ± 1038 mg. The average amount of sodium consumed per day from cooking salt (SAC) was 2487 ± 1663 mg. The total amount of sodium consumed per day (STOQ) was 4402 ± 1831 mg. This addition is equivalent to 11 ± 4.6 g of salt per day. The total sodium intake exceeded 2000 mg/day in 89.2% of patients. More than half (57%) of spontaneous sodium intake comes from salt added. The average natriuresis in our population is 158 ± 68 mmol/24 h, higher than the norm in 18% of cases. The majority (85%) of our patients have claimed that excess salt is bad to very bad for health.</p><p><strong>Conclusion:</strong> Our study showed the importance of salt consumption in obeses and especially table salt and yet the majority of our patients consider it to be harmful to health.</p><p>It will be necessary to take into account the sodium intake when prescribing the diet.</p><p><strong>Keywords:</strong> Obesity, Salt, Sodium intake, Natriuresis 24 h</p> Chiraz Amrouche, Olfa Berriche, Rym Ben Othman, Feten Mahjoub, Khouloud Halloumi, Fahim Chaima, Sabeh Bhouri, Amel Gammoudi, Henda Jamoussi Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Upgrading patients with pacemakers to resynchronization pacing: Predictors of success <p><strong>Background:</strong> The investigations of predictors of success or failure of cardiac resynchronization therapy were studied previously. Assessment of success in patients already on dual or single pacemakers and upgraded to cardiac resynchronization therapy (CRT) were not extensively studied before. How to select<br />patients in whom this may be the most optimal strategy is unclear. We sought to determine factors associated with success or failure in this group of patients who were already paced for heart block.</p><p><strong>Methods:</strong> 81 pts were subjected to upgrade to CRT implantation after being on pacemaker. The study was conducted in Germany. Data was presented as Median (Min.–Max.) for abnormally distributed data or Mean ± SD. for normally distributed data. Parameters that revealed no statistical significance in response: Age, sex, EF, diabetes, renal disease, GFR, MR, QRS duration (all above 150 ms), history of ablation, AF recurrence, previous pacemaker, optimization. The following parameters revealed significant influence on response to CRT: Less responders with: Higher C reactive protein (CRP), presence of tricuspid incompetence (TR), presence of pulmonary hypertension (PHN), presence of previous MI, being ischemic vs nonischemic cardiomyopathy (CM) (less responders with ischemic CM).</p><p><strong>Conclusions:</strong> The findings through light on specific parameters that predict response to upgrade to CRT after usual pacemaker.</p><p><strong>Keywords:</strong> Heart failure, Resynchronization therapy, CPR, Ischemic vs non-ischemic cardiomyopathy</p> Samir Rafla, Aly Aboelhoda, Mostafa Nawar, J.Ch. Geller, Mohamed Lotfi Copyright (c) Sun, 21 Jan 2018 00:00:00 +0000 Knowledge and practice of breast self-examination among sample of women in Shatra/Dhi-Qar/Iraq <p><strong>Objectives:</strong> The knowledge and practice of breast self-examination (BSE) and breast cancer (BC) warning signs for the prevention purpose among females in Technical Institute of Shatra, Dhi-Qar Province, Iraq were investigated.</p><p><strong>Methods:</strong> A cross-sectional survey by self-administered questionnaire prepared and 200 participants surveyed from January to March 2017 included 122 students, 45 teaching staff, and 33 employees.</p><p><strong>Results:</strong> The results showed that 73% of students, 88% teaching staff, and 85% employees heard of BSE.</p><p>About 55.7% of students, 44% teaching staff, and 45.4% employees know how to do BSE.</p><p>Only 25.4% students, 24.4% teaching staff, and 21.2% employees actually practiced BSE.</p><p>Fifty-four percent of students, 42% teaching staff, and 37% employees know that a mammography is a tool for screening of BC. Most of the participants had knowledge about warning signs of BC but only half of all the participants know that the best time for BSE is 5th to 7th day after menstrual cycle and only 31% know that the correct age to do BSE is &gt;18 year age.</p><p>TV and internet were the main sources of knowledge about SBE for 47% of all participants. There was a low awareness of BC and BSE among the participants and there are a need for continuing medical education programs by TV and the internet about BC warn signs, BSE and risk factors.</p><p><strong>Keywords:</strong> Knowledge, Breast cancer, Self-examination, Iraq</p> Salam Hussein Ewaid, Ali Muzahem Shanjar, Raghed Hadi Mahdi Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Study of risk factors for erectile dysfunction in patients with type 2 diabetes mellitus: Correlation to serum testosterone level <p><strong>Background:</strong> Diabetes mellitus (DM) is one of the most frequent etiologies of erectile dysfunction (ED). Risk factors of ED in type 2 diabetes mellitus (T2 DM) include patient age, disease duration, sedentary life and glycemic control. Subnormal testosterone concentrations contribute to ED as testosterone regulates<br />nearly every component of erectile function.</p><p>The aim of the work was to study the age of the patient, duration of diabetes mellitus, body mass index (BMI), glycosylated hemoglobin (HbAIc) and urinary albumin creatinine ratio (uACR) in type 2 male diabetic patients as risk factors for erectile dysfunction and their relation to serum testosterone level.</p><p><strong>Patients and methods: </strong>This study was conducted on 100 male type 2 diabetics selected from inpatient department and out patient clinics of the Internal Medicine Department in Menoufia University Hospital. The patients were divided into two groups: Group 1: 50 patients with type 2 DM with erectile dysfunction and Group 2: 50 patientswith type 2 DMwithout erectile dysfunction. The study groups were subjected to thorough history with special emphasis on age of the patients, disease duration and investigations including testosterone level, glycosylated hemoglobin, and uACR. The patients answered the abridged 5-item version of the International Index of Eectile Function (IIEF-5) questionnaire.</p><p><strong>Results:</strong> Total serum testosterone was significantly lower in diabetics with ED compared to those without ED. HbAIc, diabetes duration and uACR were independently negatively correlated with testosterone level.</p><p><strong>Conclusion:</strong> The diabetes duration, glycemic control and uACR contribute to erectile dysfunction in type 2 diabetics, and they were independently and negatively correlated with total serum testosterone level.</p><p><strong>Keywords:</strong> Type 2 diabetes mellitus, Erectile dysfunction, Serum testosterone</p> Mohamed Abdelraouf Korani, Ahmed Sonbol Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Omentin-1 and diabetic retinopathy in type 2 diabetic patients <p><strong>Background:</strong> Diabetic retinopathy (DR) is one of the most common and serious micro vascular complication affecting type 2 diabetic patients.</p><p>The literature on adipokines as a possible mechanism in the pathogenesis of DR is contradictory.</p><p>We are in need for more explanation about the pathogenesis of DR and also in need for reliable biomarker for early diagnosis of such complication.</p><p>The aim of this work was to study the serum level of omentin-1 and its relation to diabetic retinopathy in type 2 diabetes mellitus (type 2 DM).</p><p><strong>Patients and methods:</strong> This study was conducted on 75 type 2 DM patients; 20 healthy subjects served as a control group. All participants were classified into 4 groups:</p><ul><li>Group 1: Included 25 type 2 diabetics without retinopathy.</li><li>Group 2: Included 25 type 2 diabetics with non proliferative diabetic retinopathy (NDPR).</li><li>Group 3: Included 25 type 2 diabetics with proliferative diabetic retinopathy (PDR). </li><li>Group 4: Included 20 healthy subjects as a control group.</li></ul><p>Thorough history taking and physical examination with calculation of body mass index (BMI), investigations were done including serum creatinine, lipid profile, glycosylated haemoglobin (HbAIc), C-reactive protein (CRP), urine albumin creatinine ratio (UACR) and serum omentin-1. Fundus examination was carried out by an expert ophthalmologist.</p><p><strong>Results:</strong> Serum omentin-1 level was significantly lower in diabetic patients compared with the control, and in DR compared with diabetics without DR and in PDR compared with NPDR.</p><p>There was a negative significant correlation between serum omentin-1 level and BMI, HbA1c, CRP, total cholesterol, low density lipoprotein (LDL) and Serum triglycerides (TG) and positive significant correlation with high density lipoprotein (HDL).</p><p><strong>Conclusions:</strong> From this study we can conclude that serum omentin-1 is significantly lower in patients with DR compared with diabetics without retinopathy and in PDR patients compared with NPDR patients.</p><p>Also, there is a negative significant correlation between serum omentin-1 and HbAIc, BMI, CRP and some lipid parameters.</p><p><strong>Keywords:</strong> Omentin-1, Diabetic retinopathy</p> Mohamed Abdelraouf Korany, Ahmed Sonbol, Sameh Mohamed Elgouhary Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Identification of colorblindness among selected primary school children in Hararghe Region, Eastern Ethiopia <p><strong>Background:</strong> Color vision deficiency or colorblindness, is the inability or reduced ability to distinguish different color spectra, particularly, red &amp; green under normal lighting conditions with unaided eye. Redgreen colorblindness is heritable genetic disorder and most prevalent type of color vision deficiency and its incidence varies between different ethnicity and sex and shows disparity in different parts/regions of the world.</p><p><strong>Objectives:</strong> This study was conducted to find out the prevalence of colorblindness in Eastern part of Ethiopia and identify its distribution among Harari, Oromo and Ethio-Somali ethnic groups.</p><p><strong>Methods:</strong> A total of 2103 (1043 male &amp; 1060 female) students belonging to the three ethnic groups were randomly selected from nine selected primary schools and were screened for color vision deficiency by using Ishihara’s tests for color vision deficiency and the data analysis was carried out with SPSS version 16.0.</p><p><strong>Results:</strong> Among those screened for color vision deficiency, 33 of them (1.6%) were diagnosed with colorblindness out of which 31 were male and 2 were female. Out of this; 15, 7 and 11 were from Harari, Oromo and Somali ethnicity respectively. The highest incidence was observed among Harari males (4.2%) and no color vision deficiency was recorded among Oromo females. Deuteronomally was the most frequent color vision defect detected (16, 48.5%) and protanopia was the least detected color vision deficiency with 4 cases (12.1%).</p><p><strong>Conclusion:</strong> Results from this study show similar prevalence rate with previously reported study in Ethiopia for Harari ethnic group but lower prevalence rates for Somali and Oromo ethnic groups. Early detection of colorblindness is important for children to select their future profession and take necessary precautions in their everyday activities. Families and other concerned bodies should also take the case of children with colorblindness into consideration while dealing with them.</p><p><strong>Keywords:</strong> Color vision deficiency, Red-green, Ishihara test, Eastern Ethiopia</p> Temesgen Tola Geletu, Manikandan Muthuswamy, Tamiru Oljira Raga Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Factors affecting seeking health-related information through the internet among patients in Kuwait <p><strong>Background:</strong> The internet is a powerful worldwide communication medium that provides its users with immediate information irrespective of their location, culture, language and time. E-health service will have a great impact in reducing the costs of health care, increasing satisfaction of patients and health professionals, and minimizing the burden on health facilities.</p><p><strong>Objective:</strong> This study aims to determine the proportion of patients who obtain health-related information through the internet as well as factors that could affect using the internet for seeking health information.</p><p><strong>Subjects and methods:</strong> This study was conducted in six general hospitals in Kuwait. A cross-sectional study was adopted to determine the proportion of patients who obtain health-related information through the internet. It was followed by a case-control study to determine factors that could be associated with online search of health information. A questionnaire was used which included data related to sociodemographic characteristics, clinical history and computer experience. The final analysis included 220 participants.</p><p><strong>Results:</strong> The majority of participants (93.2%) mentioned that they have used the internet for one or more purposes. Only 129 participants (62.9%) used the internet for obtaining health related information. All studied socio-demographic factors, except age and marital state, and computer skills variables had significant effect on on-line search for health information. After adjustment for confounding, only gender, nationality, level of education, and using computer at work were proved to be significant determinants of the outcome of interest.</p><p><strong>Conclusion:</strong> It is important to close the gap in health literacy and increase the use of health information technology to support patient self-management. The creation of an eHealth-literate population should be a priority in Kuwaiti public health policy.</p><p><strong>Keywords:</strong> Health information, Seeking, Internet</p> Haya M. Alkhatlan, Khan F. Rahman, Badriyah H. Aljazzaf Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Prevalence of depression and anxiety among college students living in a disaster-prone region <p>The present study examined the prevalence rate of depression and anxiety among college students living in a disaster-prone area of Aceh, Indonesia. College students enrolled in two public Universities in Banda Aceh were randomly selected to participate in the self-administered standardized questionnaires for depression and anxiety. The prevalence rates of depression and anxiety were 18.8% and 27.4%, respectively. Depression was associated with gender and BMI while anxiety was only associated with gender. Depression is also positively correlated to anxiety. Depression and anxiety are prevalent among college students living in a disaster prone area. Early detection and timely treatment of mental disorders should be beneficial to the students living in this circumference.</p><p><strong>Keywords:</strong> Depression, Anxiety, College students, Disaster</p> Marthoenis Marthoenis, Inong Meutia, Liza Fathiariani, Hizir Sofyan Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Serum cobalamin and red cell folate levels of anti-psychotic treatment and treatment naïve psychiatic patients in a tertiary hospital in Nigeria <p><strong>Background:</strong> Psychiatric disorders contribute significantly to the global burden of diseases. There is an urgent need to curtail the morbidity and mortality associated with psychiatric disorders. Deficiencies of cobalamin and folate have been linked with psychiatric disorders.</p><p><strong>Materials and method:</strong> Sixty-six each of antipsychotic treatment, treatment naïve psychiatric patients and control were recruited for the study. Red cell folate and serum cobalamin were determined with Enzyme Linked Immunosorbent Assay kits and the haemogram using Sysmex XT2000i.</p><p><strong>Result:</strong> Folate deficiency was present in 13.6% of newly diagnosed anti-psychotic naive psychiatric patients with few of them having neutrophil hypersegmentation (7.6%) and macrocytosis (4.5%). Mean red cell folate levels for anti-psychotic naïve, patients on anti-psychotic and controls were 350.23 ± 0.54 nmol/l, 370 ± 0.70 nmol/l and 370 ± 0.51 nmol/l respectively, with p-values of 0.0001 and 0.3500 respectively when compared with control, while serum cobalamin levels were within the normal reference range in all patients and controls.</p><p>Reticulocyte count had 8 times and 3 times likelihood of influencing low serum folate and low serum cobalamin respectively.</p><p><strong>Conclusion:</strong> All patients had Serum cobalamin levels within the reference interval, the same can be said of the RBC folate levels of the greater percentage (95.5%) of psychiatric patients on psychotropic drugs.</p><p><strong>Keywords:</strong> Red cell folate, Serum cobalamin, Anti-psychotic treatment, Treatment naïve psychiatric patients</p> A.O. Shittu, A.O. Adewoye, H.O. Olawumi Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Utility of diffusion weighted imaging (DWI) in assessment of liver fibrosis <p><strong>Objectives:</strong> hepatic fibrosis occurs due to chronic liver injury. Early fibrosis can be reversed by treatment with specific antifibrotic therapy in addition to removal of the cause if possible, that is why, identification of the early liver fibrosis is important. MRI DWI is a non-invasive non-contrast imaging technique which help in diagnosis of different stages of hepatic fibrosis.</p><p><strong>Aim of the work:</strong> was to study the predictive value of diffusion weighted MRI for assessing liver fibrosis in comparison to liver biopsy in chronic hepatitis C virus patients.</p><p><strong>Methods:</strong> all the studied cases were subjected to the followings: (1) History and laboratory examination (PCR for HCV and liver function tests). (2) MRI DWI and post processing ADC map. (3) Percutaneous liver biopsy in cases with HCV for histopathological examination to assess the stage of fibrosis.</p><p><strong>Results:</strong> this study was carried out on 75 subjects, divided into two group, 50 cases and 25 controls, the mean age in the two studied groups was 36.5 ± 9.32 and 35.8 ± 6.75 respectively in patients and control. ADC of both liver and spleen showed a highly significant increase in the control than in the cases with mean liver ADC in the control group = 2.3 ± 0.25. There was a significant negative correlation between the mean ADC of the liver, spleen and the stage of liver fibrosis.</p> Doaa M. Emara, Marwa M. Reda, Doaa A. Elwazzan Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Role of magnetic resonance imaging in the evaluation of the popliteus musclotendinous injuries as a part of the posterolateral corner injuries of the knee <p><strong>Introduction:</strong> The popliteus musclotendinous complex is considered to be one of the main stabilizers of the posterolateral corner of the knee having different attachments and variable sites of injuries, the use of MRI helps the radiologists to depict such injuries consistently.</p><p><strong>Purpose of the study:</strong> To study the role of MRI in evaluating the popliteus musclotendinous injuries as a part of the PLCof the knee.</p><p><strong>Patients and methods:</strong> Our study included 15 patients with trauma to the knee undergoing MRI using 1.5 T magnet using the following sequence: Axial, Coronal, sagittal proton density fat sat, T1, T2 and T2 gradient and conventional X-ray/CT [All patients did conventional X-ray Knee (AP and Lateral views), two patients did CT study of the knee].</p><p><strong>Results:</strong> Out of 15 studied patients with PLC injuries, eight (53.33%) patients had popliteus complex injuries, 7 (87.5%) patients showed combined injuries with other posterolateral structures while one (12.5) patient had isolated popliteus musclotendinous complex injury.</p><p><strong>Conclusion:</strong> MRI imaging is crucial in the evaluation of the different sites and patterns of injuries of the popliteus musclotendinous complex when suspecting PLC injury.</p><p><strong>Keywords:</strong> Popliteus muscle, Popliteus tendon, Posterolateral corner, Popliteofibular ligament, MRI</p> Aly A. Abdel-Kerim Farahat, Abd ElAziz Elnekeidy, Mohamed Abdel Motaleb Abdelgelil Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Results of arthroscopic treatment of femroacetabular impingement (FAI) <p><strong>Introduction:</strong> Femoroacetabular impingement (FAI) has been suggested as an important etiology of pain in the groin region in young adults especially athletes and there are theories connecting it to early onset osteoarthritis.</p><p><strong>Aim:</strong> To assess the results of arthroscopic treatment of FAI.</p><p><strong>Patients:</strong> Forty patients had been managed arthroscopically for their FAI in both El-Hadra university hospital and William Harvey Hospital.</p><p><strong>Methods:</strong> Results of arthroscopic treatment of FAI in 40 consecutive patients had been evaluated using patients reported outcomes (modified Harris Hip Score and international Hip Outcome Tool-12) and clinical measures of improvement of range of motion in both flexion and internal rotation in 90<sup>o</sup> of hip flexion.</p><p><strong>Results:</strong> The average of the outcome scores showed statistically significant improvement following the arthroscopic intervention.</p><p><strong>Conclusion:</strong> Femroacetabular impingement is an important etiology of groin pain in young adults, nevertheless the athletes. Diagnosis of this condition is primarily a clinical one to be supported with relevant imaging. Hip arthroscopy is an effective approach to treat and correct the underlying bony abnormalities of FAI. Younger age of patients predicts better improvement in i-HOT-12 score.</p><p><strong>Keywords:</strong> Hip, Arthroscopy, FAI, Labral tear, Cam lesion, Labral repair, MRA</p> Raafat Ragab, Tarek Elkhadrawe, Philip Housden, Ahmed Abotaleb Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Adjustment disorder after botulinum toxin injection in an adolescent palatal myoclonus case: The importance of informed consent in the treatment of neuropsychiatric disorders in children and adolescents No Abstract Yusuf Öztürk, Zehra Topal, Nuran Demir, Ali Evren Tufan Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Nodular hidradenoma of the breast: A case report <p>Nodular hidradenoma is a rare benign skin adnexial lesion of the breast. It is often located in the nipple areolar region and presents as a slow growing painless lesion.</p><p>We report a case in a 62 yr old male who had a slowly growing left breast lesion of 10 yrs duration. Physical examination revealed an 8 cm superficial, spherical, mobile non tender lump in the nipple areolar region. Excision biopsy with clear margins was performed and histologic examination was nodular hidradenoma after wide consultations.</p><p>Nodular hidradenoma of the breast is a differential diagnosis of sub areolar masses that must be considered by both pathologist and surgeons to avoid misdiagnosis and overtreatment.</p><p><strong>Keywords:</strong> Nodular hidradenoma, Male breast, Nipple areolar region</p> G.H. Ano-Edward, I.O. Amole, S.A. Adesina, O.A. Ajiboye, M.E. Lasisi, R.K. Jooda Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 An unusual case of peritonitis following a caesarean delivery <p>Postoperative fluid accumulation is a very rare complication of caesarean delivery. We present an unusual case of peritonitis of unknown origin following a caesarean delivery. Emergency surgery was performed. On exploration there was a large amount of clear fluid which was removed. No signs of iatrogenic injury or any abnormality was detected. Fluid cultures of fluid drained from the abdomen did not grow any organisms. The working diagnosis was reactive peritonitis. Post exploratory laparotomy sepsis developed which was managed conservatively. The patient was discharged after full recovery.</p><p><strong>Keywords:</strong> Caesarean delivery, Complications, Peritonitis</p> Ahmed Gado, Hesham Badawi, Ahmed Karim Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Effect of metformin on Sirtuin-1 disorders associated with diabetes in male rats <p><strong>Background:</strong> Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, hyperinsulinaemia and hyperglycaemia. Increased glucose production through abnormally elevated hepatic gluconeogenesis is central to the manifestation of hyperglycaemia in T2DM. Metformin corrects hyperglycaemia mainly through inhibition of gluconeogenesis. Sirtuin 1 (SIRT1) has been identified as regulator of gluconeogenic gene expression. The present study aimed to evaluate the effect of metformin on SIRT1 level and activity in liver and pancreas of diabetic rats. Further, the possible role of SIRT1 on metabolic disorders associated with diabetes mellitus, including serum levels of glucose, insulin, triglyceride (TG) and high density lipoprotiens (HDL), will be explored.</p><p><strong>Methods:</strong> Thirty-two male albino rats were divided into control group (GpI), diabetic (DM) group (GpII), (metformin + DM) group (GpIII) administered 120 mg/kg metformin daily for 1 month before induction of diabetes, (DM + metformin) group (GpIV) administered 250 mg/kg metformin daily for 1 month after induction of diabetes. At the end of the study, BMI%, serum levels of glucose, insulin, TG and HDL, HOMA, SIRT1 level and activity in liver and pancreas and pancreatic DNA ladder were assessed.</p><p><strong>Results:</strong> Our results showed significant decrease in serum glucose, insulin and TG levels and HOMA; significant increase in HDL level and SIRT1 level and activity in liver and pancreas beside the marked disappearance of pancreatic apoptosis in GpIII &amp; IV relative to GpII. Regarding BMI%, it showed no significant changes in GpIV relative to GpII. No significant change was recorded between GpIII and GpIV regarding all studied parameters except on serum TG.</p><p><strong>Conclusion:</strong> Lowered SIRT1 in diabetes was improved by the administration of Metformin. Consequently, the pathophysiological disorders associated with T2DM were improved.</p><p><strong>Keywords:</strong> DM, Metformin, SIRT1, Pancreatic apoptosis</p> Effat A. Khowailed, Hanan Ahmed Seddiek, Manal Moustafa Mahmoud, Laila A. Rashed, Fatma Elsayed Ibrahim Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Metabolomics-based studies in the field of <i>Leishmania</i>/leishmaniasis <p><em>Leishmania</em> is a neglected protozoan parasite which creates some problems for public health with different clinical infections in different countries around. Due to the lack of an effective drug without side effects and the emergence drug resistance, there is an urgent need to introduce the novel drug targets and new drugs and vaccines to control leishmaniasis during recent years, metabolomics and other ‘‘Omics” platforms has become an important approach to comprehensive knowledge of the<em> Leishmania </em> parasites biology. The study of metabolite profiles can open the insights for discovering novel therapeutic targets in this infection in both of the parasites and human host. In addition, specifying the metabolomics profile changes among promastigotes, amastigotes and during metacyclogenesis can pay the way for achieving parasite survival parameters and the host-parasite interaction. The previous studies in this field have been extracted from the databases, literature and their detailed major concepts. The present review highlights the role of metabolomics approach in the field of <em>Leishmania</em> research. Also, several important metabolite signatures introduced in various aspect of <em>leishmania</em> parasite such as drug resistance and parasite biology which would be useful in the field of biomarker and drug discovery process. Finally, metabolomics plays a potential role in introducing metabolic pathways related to <em>Leishmania</em> parasite and its treatment design.</p><p><strong>Keywords: </strong> Omics, System biology, Metabolomics, <em>Leishmania</em>, Parasite, Leishmaniasis, Biomarker</p> Nasrin Amiri Dash Atan, Mehdi Koushki, Nayeb Ali Ahmadi, Mostafa Rezaei-Tavirani Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Traditional practices and childhood cryptosporidiosis in Nigeria: A review <p><em>Cryptosporidium</em> infection is known worldwide as an important aetiology of chronic diarrhoea that can become fatal in children (below 5 years of age) and immunocompromised individuals. This review was aimed at identifying some traditional practices that may be risk factors for childhood diseases like cryptosporidiosis in a country like Nigeria with different tribes and cultures. Information gathered from literature search and informal sources identified some indigenous practices like birth rituals, special childhood menus, traditional nanny practice, local management of childhood diarrhoea and some myths among others, as factors that may negatively impact childhood health in a multi-cultural population like Nigeria. A proper understanding of these traditional practices will enable the prevention and control of childhood disease like cryptosporidiosis in a multi-ethnic setting.</p><p><strong>Keywords:</strong> Traditional practices, Childhood, Cryptosporidiosis, Nigeria</p> Adekunle B. Ayinmode, Oluwasola O. Obebe Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Zoonotic fungal diseases and animal ownership in Nigeria <p><strong>Background:</strong> The growing interest in keeping animals as pets in Nigeria and other resource-poor countries highlights the possibility of transmission of zoonotic infections to humans. These zoonoses which are usually caused by viruses, bacteria, parasites and fungi, are naturally transmitted to humans, causing various degrees of morbidity and mortality with attendant economic and or public health consequences.</p><p><strong>Materials and method:</strong> In the present review, a computerized search of existing literature was conducted using the Google search engine and PubMed electronic database to identify and download relevant publications on zoonotic fungal infections in Nigeria. The key words used were zoonotic fungal disease and Nigeria while the Boolean operator ‘AND’ was used to combine and narrow the searches. Additional information was obtained by searching the medical and veterinary libraries for journals not listed in the database. The available publications were thereafter reviewed and findings qualitatively described.</p><p><strong>Results:</strong> Our findings revealed that fungal diseases with zoonotic potential lack sufficient attention in Nigeria. This suggests that fungi are yet to be considered as major causes of morbidity and mortality in animals and humans in Nigeria, and may account for the few reports available on zoonotic fungal diseases in the country.</p><p><strong>Conclusion:</strong> There is a need to raise awareness of the extent of health problems caused by zoonotic fungal diseases in Nigeria in order to better appreciate their burden and public health consequences, and also provide an integrated platform for development of effective prevention and control strategies.</p><p><strong>Keywords:</strong> Zoonoses, Fungal disease, Humans, Animals, Nigeria</p> Adebowale I. Adebiyi, Daniel O. Oluwayelu Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Risk factors associated with paediatric tuberculosis in an endemic setting <p><strong>Background:</strong> The success of any tuberculosis (TB) control/intervention programme hinges on the understanding of transmission dynamics of TB within that setting. However, there is paucity of data in high disease burdened countries like Nigeria on the associated risk factors of childhood TB and this supports the need for this research.</p><p><strong>Objective:</strong> This study was undertaken to determine the prevalent associated risk factors of childhood pulmonary TB in a high diseased burdened setting.</p><p><strong>Subjects and method:</strong> We carried out a cross sectional study among children aged 18 months to 15 years in six selected health facilities in Nasarawa State, Nigeria. The subjects were screened for pulmonary TB using chest X-ray, sputum or gastric aspirate acid-fast bacilli microscopy and mycobacterium culture. They were also screened for HIV infection. Detailed information was taken regarding history of contact with adult TB source case, house-hold contact, duration of contact, house-hold size, number of people sleeping in a room, cross ventilation, BCG immunization, socio-economic, educational and HIV status of parents, and ingestion of unpasteurized milk and chronic illness other than TB. The subjects had physical examination for BCG scar and nutritional status.</p><p><strong>Results:</strong> A total of 150 subjects were selected for the study with mean age of 9.12 ± 4.66 years and median age of 10.0 years. The prevalence of definite TB cases found among them was 32% which is 5.5 times higher than the reported national average. The risk factors associated with pulmonary TB include lower socioeconomic status (79.2%), history of contact with an adult TB case source (72.9%), overcrowding (72.9%), absence of cross ventilation (68.8%), ingestion of unpasteurized milk (45.8%) and severe malnutrition among children under five using MUAC parameter (12.5%). The most significant independent predictors of TB in children were absence of cross ventilation (OR = 3.27), contact with adult source case (OR = 2.91) and overcrowding (OR = 2.30).</p><p><strong>Conclusion:</strong> Absent of cross ventilation, contact with adult source case and overcrowding are the most significant predictors of pulmonary TB in children. Although ingestion of unpasteurized milk is a significant predictor and important source of TB, it is not a major source of TB transmission when compared to contact with adult source case (Open TB).</p> Caleb Joseph Attah, Stephen Oguche, Daniel Egah, Tokkit Nandi Ishaya, Mathilda Banwat, Adgidzi Godwin Adgidzi Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Additive manufacturing applications in medical cases: A literature based review <p><strong>Background:</strong> A significant number of the research paper on Medical cases using Additive manufacturing studied. Different applications of additive manufacturing technologies in the medical area analysed for providing the state of the art and direction of the development.</p><p><strong>The aim of work:</strong> To illustrate the Additive Manufacturing technology as being used in medical and its benefits along-with contemporary and future applications.</p><p><strong>Materials and methods:</strong> Literature Review based study on Additive Manufacturing that are helpful in various ways to address medical problems along with bibliometric analysis been done.</p><p><strong>Result:</strong> Briefly described the review of forty primary applications of AM as used for medical purposes along with their significant achievement. Process chain development in the application of AM is identified and tabulated for every process chain member, its achievement and limitations for various references. There are five criteria which one can achieve through medical model when made through AM technology. To support the achievements and limitations of every criterion proper references are provided. The ongoing research is also classified according to the application of AM in medical with criteria, achievement and references. Eight major medical areas where AM is implemented have been identified along with primary references, objectives and advantages.</p><p><strong>Conclusion:</strong> Paper deals with the literature review of the Medical application of Additive Manufacturing and its future. Medical models which are customised and sourced from data of an individual patient, which vary from patient to patient can well be modified and printed. Medical AM involves resources of human from the field of reverse engineering, medicine and biomaterial, design and manufacturing of bones, implants, etc. Additive Manufacturing can help solve medical problems with extensive benefit to humanity.</p><p><strong>Keywords:</strong> 3D scanning, 3D printing, Additive Manufacturing (AM), Medical, Applications, Medical model, Rapid Prototyping (RP)</p> Mohd. Javaid, Abid Haleem Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 Synthetic biology-based portable <i>in vitro</i> diagnostic platforms <p>Early diagnosis of infectious diseases represents powerful means to increase patient survival rate, avoid disease spreading, and decrease healthcare costs. Current Polymerase Chain Reaction (PCR)- and antibody-based diagnostic methods for detecting pathogens offer rapid analysis with highly accurate and specific results. However, those methods are still hampered by the need of sophisticated infrastructures and highly-skilled technicians, which limit the deployment in developing area. Synthetic biology with its rational and short design-to-production cycles has the potential to overcome those limitations. Here, we discuss two promising efforts for pathogen nucleic acids detection using synthetic biology approaches: Synthetic RNA-based and Clustered Regularly Interspaced Short Palindromic Repeats/ CRISPR-associated (CRISPR/Cas)-based biosensors. The two systems were reported to show remarkable specificity and sensitivity on detecting and reporting the presence of pathogen via pathogen nucleic acid recognition with lower development and operational costs when compared to current PCR- and antibody-based diagnostic tools. Moreover, both systems can be applied to paper-based platforms which simplify the distribution and utilization in low resource-settings.</p><p><strong>Keywords:</strong><em> In vitro </em>diagnostics, Synthetic biology, RNA-based biosensors, Toehold switch, CRISPR/Cas system</p> Almando Geraldi, Ernawati Arifin Giri-Rachman Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Exercise as a treatment modality for depression: A narrative review <p>Depression is a major health burden associated with poor quality of life and impaired functioning. Depression is a leading cause of disability worldwide and is associated with profound economic costs. Depression is usually treated with antidepressant medications and psychological therapy or combination of both. However, there are lot of limitations associated with these therapies and as a result, a number of alternative or adjunctive therapies have been sought for. Exercise is one such option with a lot of substantial supportive research. The objective of the article was to review the beneficial effects of exercise in depression. An electronic search of literature from inception till 06/2017 highlighting the effects of exercise on depression and the possible mechanistic pathways involved was conducted using PubMed/ Medline, Google scholar and Scopus and relevant articles were utilized for this review. The results of this review confirmed the beneficial role of exercise in depression as evidenced by the improvement in the outcomes and the various psychobiological parameters measured. Thus exercise can be considered as a treatment option for the management of depression.</p><p><strong>Keywords:</strong> Depression, Exercise, Physical activity, Mechanistic pathways, BDNF</p> Awad Mohammed Al-Qahtani, Mohammed Ashique K. Shaikh, Ibrahim Ahmed Shaikh Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Carpal tunnel syndrome in patients with and without diabetes mellitus in Upper Egypt: The impact of electrophysiological and ultrasonographical studies <p><strong>Background:</strong> Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Nerve conduction studies (NCS) is the most valid way of diagnosing CTS in combination of these clinical symptoms together with positive signs by physical examination. Ultrasonography is a useful non-invasive diagnostic method for CTS and there is considerable correlation between the electrophysiological tests and the measurements of cross-sectional area (CSA) by ultrasonography. Many studies have shown that the carpal tunnel syndrome seems to occur more frequently in patients with diabetes mellitus and might be associated with the duration of diabetes mellitus, microvascular complications and degree of glycemic control. Although diabetes mellitus is a risk factor for CTS, reports about median nerve CSA measurements between CTS patients with and without DM are scant. This prospective study aimed to evaluate whether or not ultrasonographic findings of the median nerve is different between DM and non-DM-CTS patients. To correlate the diagnostic results in both DM and non-DMCTS patients.</p><p><strong>Patients and methods:</strong> Thirty six non-diabetic patients and twenty five diabetic patients with CTS were assessed. All patients were subjected to thorough history taking, full clinical examination, electrophysiological assessment of wrists and gray scale ultrasonography (US).</p><p><strong>Results:</strong> High mean cross sectional area of median nerve (CSA) on ultrasonographical studies was detected with non-significant difference between both groups. Additionally, a non-significant difference for flattening ratio was found between two groups. Moreover, there was a highly significant positive correlation between electro diagnostic and ultrasonographic results in diabetic patients.</p><p><strong>Conclusion:</strong> The CSA of median nerve is larger in CTS hands in both DM and non-DM patients. Mean electro-diagnostic parameters were not significant predictors of CTS in patients with diabetes. The combination of electrophysiological and ultrasonography provides diagnostic effective tools across the entire spectrum of CTS in diabetic and non-diabetic patients. Nevertheless, screening for DM in patients with CTS is not recommended.</p><p><strong>Keywords:</strong> Carpal tunnel syndrome (CTS), Diabetes mellitus (DM), Diabetic polyneuropathy (DPN), Electrophysiological and ultrasonography (US)</p> Abeer A. Tony, Effat A.E. Tony, Yasser A.R.M. Selim, Ehab Saad Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Chronic kidney disease in type 2 diabetes mellitus patients: Comparison of KDIGO and KDOQI guidelines <p><strong>Background:</strong> Chronic kidney disease (CKD), has become a public health concern as it has been reported to cause adverse outcomes such as kidney failure and premature death. This cross sectional study compared the Kidney Disease: Improving Global Outcomes (KDIGO) and Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines in assessing the prevalence of CKD in Type 2 diabetes Mellitus (T2DM) patients.</p><p><strong>Methods:</strong> We consecutively sampled a cross-section of 202 T2DM patients from the Ho municipality in the Volta region (Ghana). Structured pre-tested questionnaires were administered to obtain information on gender, age, body mass index (BMI), systolic and diastolic blood pressure, medication used, duration on medication, and duration of diabetes. Serum creatinine and urine protein were estimated using standard protocols and CKD was classified according to KDIGO and KDOQI guidelines.</p><p><strong>Results:</strong> The prevalence of CKD was 63.4% and 58.4% using the KDIGO and KDOQI guidelines respectively. The prevalence of mildly decreased renal function or worse (eGFR &lt; 60/ml/min/1.73 m<sup>2</sup>) was 10.4% for KDIGO guideline and 7.9% for KDOQI guidelines with an excellent agreement between both definitions showing bias = -0.129, 95%CI = (-0.17 to -0.08) on Bland-Altman analysis. Participants older than 70 years were more likely to have CKD when KDIGO criteria was used (P = 0.018). The prevalence of albuminuria was 47.0% with 21.9% presenting with 1+ and 2+ grades.</p><p><strong>Conclusion:</strong> KDIGO guideline estimates higher prevalence of CKD than KDOQI guidelines in the same study population. KDIGO guideline might help in early detection and proper classification of CKD which will illicit stage-specific treatment.</p><p><strong>Keywords:</strong> Type 2 diabetes mellitus, Chronic kidney disease, Estimated glomerular filtration rate, Albuminuria</p> Richard K.D. Ephraim, Richard Mantey, Stephen Atombo, Samuel A. Sakyi, Linda A. Fondjo, Worlanyo Tashie, Hope Agbodzakey, Felix A. Botchway, Bright Amankwaa Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Predictors of conversion from prediabetic state to type 2 diabetes mellitus in Jordan No Abstract Khawla Al-dajah, Anwar Al-Kassar, Amjad Al-shdaifat Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Characterization of abnormal sleep patterns in patients with obesity, type 2 diabetes, or combined <p><strong>Introduction:</strong> Obesity and type 2 diabetes mellitus have reached epidemic proportions worldwide. Abnormal sleep has been linked to both incident and prevalent obesity and type 2 diabetes. We aimed to characterize abnormal sleep patterns [ASP’s] in patients with obesity, type 2 diabetes, or both.</p><p><strong>Subjects:</strong> The study included 92 subjects divided into four groups: Group 1, 23 obese patients (BMI &gt; 30) with type 2 diabetes mellitus; Group 2, 23 non-obese diabetic patients; group 3, 23 obese subjects without diabetes; group 4, 23 matched healthy control subjects.</p><p><strong>Methods:</strong> Waist circumference and BMI [body mass index] estimation, fasting and post challenge plasma glucose ‘‘groups 2 &amp; 4”, HOMAIR [Homeostatic model assessment- Insulin resistance] estimation, and finally evaluation for ASP’s using a CDC [Centers for Disease Control and prevention] validated questionnaire.</p><p><strong>Results:</strong> Post-prandial glucose and BMI significantly predicted Sleep latency and sleep hours at night respectively. Both group 1 and 3 compared to group 4 showed higher prevalence of: Insomnia [p &lt; .01], snoring [p &lt; .01], fragmented sleep [p &lt; .05], excessive day time sleepiness [p &lt; .001], and daytime dysfunction [p &lt; .001]. Group 2 compared to group 4 showed higher prevalence of: Insomnia, snoring, fragmented sleep, and finally, daytime dysfunction [All p &lt; .01]. Group 1 compared to groups 3 and 4 had significantly less hours of sleep at night [p &lt; .01]. Group 1 compared to group 2 showed higher prevalence of: Insomnia, fragmented sleep, excessive day time sleepiness, and daytime dysfunction [All p &lt; .05]. Finally, group 3 compared to group 2 showed higher prevalence of: Excessive day time sleepiness, and daytime dysfunction [p &lt; .01].</p><p><strong>Conclusion:</strong> The combination of obesity and diabetes mellitus is associated with poor quality and quantity of sleep with resultant significant daytime dysfunction. Glycemic, and adiposity measures predicted sleep latency and hours.</p><p><strong>Keywords:</strong> Type 2 diabetes, Obesity, Abnormal sleep patterns, Insulin resistance Latency period, Impaired daily activities</p> Aliaa Ali El-Aghoury, Tamer Mohamed Elsherbiny, Neveen Lewis, Tarek Mohamed Salem, Nesma Osman Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Prevalence of obesity among adults in Issele-Uku, Delta State Nigeria <p><strong>Background:</strong> Obesity is gradually assuming an epidemic dimension among adults in Nigeria. Unfortunately, this has led to the increase in the prevalence of chronic diseases.</p><p><strong>Objective:</strong> The study was designed to assess the prevalence of obesity among adults in Issele-uku, Aniocha North Local Government Area of Delta State, Nigeria.</p><p><strong>Materials and Methods:</strong> The study employed a cross-sectional study design conducted among 201 respondents utilizing a simple random sampling technique. A validated semi-structured questionnaire was administered to obtain information from respondents; while descriptive and inferential statistics was used to analyze the data.</p><p><strong>Results:</strong> The results show that more of the respondents were between the ages of 18–40 years, while about half 101 (50.50%) were females and 104 (52.0%) were married. Furthermore, only 46 (23.0%) were overweight while 17.50% and 5.50% were pre-obese and obese respectively. The mean Body Mass Index of the respondents was 23.02 ± 4.42 while the respondents demonstrated positive attitude towards prevention of obesity. In addition, only eating akpu/fufu significantly predicted obesity (R<sup>2</sup> = 0.034) while both sex (P = .350) and educational status (P = 0.165) did not significantly influence obesity and some of the respondents’ 82(41.0%) exercises once in a while.</p><p><strong>Conclusion:</strong> The study recommended more awareness campaign on the dangers of obesity across communities in Nigeria.</p><p><strong>Keywords:</strong> Obesity, Adults, Body Mass Index, Nigeria, Prevalence</p> Otovwe Agofure Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Interplay of adipokines in the pathogenesis of essential hypertension: A comparative cross-sectional in Ghana <p><strong>Background:</strong> The renin-angiotensin-system (RAS), endothelial dysfunction and sympathetic nervous system are mechanistic risk factors of hypertension. The study sought to elucidate the interplay of adipokines in the pathogenesis of essential hypertension.</p><p><strong>Methodology:</strong> This comparative cross-sectional study recruited 200 confirmed hypertensive patients from the KATH and 50 age-matched normotensives. Participants’ blood pressures, anthropometric and socio-demographic information were voluntarily obtained. Serum levels of adiponectin, leptin and resistin of the participants were quantified using the ELISA. Renal function, lipid profile and glycemic status of all subjects were also analyzed.</p><p><strong>Results:</strong> Hypertensive patients showed a significantly higher anthropometric indices of adiposity compared to normotensives, CI (p &lt; 0.0001), BAI (p &lt; 0.0001) and AVI (p = 0.002). Adiponectin levels (p &lt; 0.0001) were significantly lower in the hypertensive relative to the normotensives. Furthermore, significantly higher concentrations of serum leptin (p = 0.016) and the leptin-adiponectin ratio (p = 0.001) were observed among the hypertensive compared to the normotensives. The study further observed a direct association between serum leptin and weight (r = 0.111, p = 0.022), BMI (r = 0.129, p = 0.009) and WHtR (r = 0.098, p = 0.045) but inverse relationship with height (r = -0.134, p = 0.006) among the hypertensive. Serum leptin has a significant negative correlation with HDL-C among the hypertensive (r = -0.174, p = 0.013). The fully aOR for hypertension as predicted by resistin and adiponectin were 1.12 (95% Cl, 1.02–1.25); p = 0.019) and 0.93 (95% Cl, 0.91–0.95); p = 0.0001) respectively.</p><p><strong>Conclusion:</strong> We found that elevations in serum levels of leptin and resistin, and low levels of adiponectin may play a role in the pathogenesis of essential hypertension. Therefore, adipokines may offer themselves as potential indices for early and accurate detection of high blood pressure. At the same time our present<br />results also confirm the conclusions with respect to correlation of leptin and obesity. Further longitudinal studies in a larger population are warranted to investigate the physiological and pathological functions of adipokines in hypertension.</p><p><strong>Keywords:</strong> Adipokines, Hypertension, Leptin, Adiponectin, Resistin</p> Osei Asibey, Francis Agyemang Yeboah, W.K.B.A. Owiredu, Emmanuel Acheampong, Enoch Odame Anto, Isaac K. Owusu Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Prevalence of pre-hypertension and hypertension and its related risk factors among undergraduate students in a Tertiary institution, Ghana <p><strong>Objectives:</strong> This study sought to provide information about pre-hypertension and hypertension status among undergraduate students at the Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.</p><p><strong>Methods:</strong> This cross-sectional study was conducted among a total of 540 students. Participants were interviewed using questionnaires and their blood pressures (BP), height, weight were measured and Body Mass Index ‘BMI’ and Waist-to-Height Ratio (WHtR) were calculated. Repeated measurements were obtained on two successive times in students with persistently elevated BP. Data obtained was entered and analyzed using SPSS version 23. Final prevalence was adjusted for loss-to- follow up on participants with first elevated BP from the reading and logistic regression used to evaluate risk factors. P-value less than .05 was considered statistically significant.</p><p><strong>Results:</strong> Twelve (2.2%) of the students were hypertensive, whilst pre-hypertension was prevalent in 26.1% of the student. Family history of hypertension [OR = 1.68(0.73–1.68)], kidney failure [OR = 1.38(0.34– 5.60)], stroke [OR = 1.10(0.64–1.91)] and heart failure [OR = 1.03(0.27–3.94)] were associated with increased risk of developing pre-hypertension; however no significant association was observed (p &gt; .05). WHtR and BMI were independent positively correlated with blood pressure status after controlling for gender and age (p &lt; .05). Further analysis revealed that, obesity detected by WHtR [OR = 3.67 (1.13–11.94), p = .031] and BMI [OR = 6.89(0.71–66.48), p = .0005] were significant predictors of hypertension using logistic regression analysis.</p><p><strong>Conclusion:</strong> The study revealed considerable prevalence rates of pre-hypertension and hypertension among undergraduate students, with significant risk factors such as obesity detected by BMI and WHtR. Gender as male was also significant for pre-hypertension and hypertension. Sound prevention and control programmes of hypertension should be devised among students, to improve their knowledge and lifestyle practices early in life.</p><p><strong>Keywords:</strong> Hypertension, Pre-hypertension, Obesity, Tertiary students, Ghana</p> Daniel Gyamfi, Christian Obirikorang, Emmanuel Acheampong, Kwabena Owusu Danquah, Evans Adu Asamoah, Fatima Zarah Liman, Emmanuella Nsenbah Batu Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Low cost detection of hepatitis C virus RNA in HCV infected patients by SYBR Green I real-time PCR <p>The prevalence of hepatitis C virus (HCV) is highest in Egypt compared to other countries. Nucleic acid amplification test (NAT) allows detection of HCV early during the course of infection. Unfortunately, NAT is more expensive than ELISA, thus its routine use as a screening tool for blood products or in clinical practice is quite limited. The aim of this study was to compare two common RT-PCR methods, TaqMan probe technique and SYBR Green method in quantitative detection of HCV RNA for diagnosis and follow up of HCV patients. Among the recruited 220 HCV patients, 154 (70%) were HCV-RNA positive by both the techniques, while 24 (10.9%) were negative by both techniques. On the other hand, 40 (18.2%) cases were HCV RNA positive only by SYBR Green technique, and 2 (0.9%) only by TaqMan probe technique. Forty (20.4%) of the 196 chronic HCV cases were HCV-RNA positive by SYBR Green but negative by TaqMan probe technique.</p><p><strong>Conclusion:</strong> This method is useful for rapid qualitative detection of HCV infection and particularly suitable for routine diagnostic applications.</p><p><strong>Keywords:</strong> HCV, PCR, SYBR Green 1, TaqMan probe, Viral load</p> Dalia Elsayed Metawlly, Ahmed Noby Amer, Hanan Mostafa Mostafa, Gamal El Din Elsawaf, Ola Abd El Kader Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Hepatitis E virus isolated from chronic hepatitis B patients in Malaysia: Sequences analysis and genetic diversity suggest zoonotic origin <p><strong>Background:</strong> Zoonotically acquired HEV has been described as one of the most successful zoonotic viral infections in human history.</p><p><strong>Aim:</strong> In this study we characterized HEV comparative genomic analysis as it relates to swine HEV.</p><p><strong>Materials and methods:</strong> A total of 82 chronic hepatitis B patients were recruited from May 2015 to May 2016 for this study. We conducted a serological and molecular investigation of HEV among these patients. The detected HEV were sequenced and the genomes and deduced amino acids were characterized using molecular evolutionary genetic analysis software version 7.</p><p><strong>Results:</strong> Of the 82 chronic hepatitis B patients that were tested, 9.8% (8/82) were found to be HEV positive. Phylogenetic analysis of the HEV RNA sequences showed they are of genotype 4 and demonstrated high sequence identity with a swine isolate from China, with variation in amino acids at position 22, where leucine was present in the Malaysian human isolate while phenylalanine was present in the China swine isolate.</p><p><strong>Conclusion:</strong> Comparative analysis of the human HEV ORF-2 nucleotide sequence suggest zoonotic origin.</p><p><strong>Keywords:</strong> Co-infection, Chronic hepatitis B, Hepatitis E virus, Zoonotic HEV, Malaysian HEV isolate</p> Shuaibu Abdullahi Hudu, Mohd Taib Niazlin, Syafinaz Amin Nordin, Nabil Saad Harmal, Soek Siam Tan, Haniza Omar, Hamiza Shahar, Noor Aliza Mutalib, Zamberi Sekawi Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Comparing the efficiency of four diagnostic concentration techniques performed on the same group of intestinal parasites <p><strong>Background:</strong> Intestinal parasites are a major public health problem, and their accurate diagnosis is important. The purpose of this study was to evaluate and compare the efficiency of four concentration techniques for the detection of intestinal parasites under laboratory conditions.</p><p><strong>Methods:</strong> A total of 800 suspension specimens including 200 samples for each technique were simultaneously and parallel processed for comparing the diagnostic efficiency of the formalin-tween (FTC), formalin-ether (FEC), formalin-acetone (FAC), and formalin-gasoline concentration (FGC) techniques.</p><p><strong>Results:</strong> Sensitivity of FTC, FEC, FAC, and FGC techniques for diagnosis of intestinal parasites was 71.7%, 55.8%, 70.0% and 56.7%; and their negative predictive values (NPV) were 70.2%, 60.2%, 69.0% and 60.6%, respectively. FTC and FAC techniques with equivalent recovery rates were significantly more sensitive than FEC and FGC techniques for diagnosing helminth ova, but for diagnosis of protozoan cysts they were reversed. Overall diagnostic <span>k</span> agreement for FTC and FAC techniques was substantial, while for FEC and FGC techniques it was moderate. The <span>k </span>statistic indicated low to moderate agreement for diagnosis of helminths and moderate to substantial agreement for protozoa.</p><p><strong>Conclusion:</strong> Tween, acetone and gasoline reagents are more stable, safer, less flammable and of lower cost than that of ether; and promise to be a useful alternative to ether- concentration. Our results demonstrated that the combined use of parasitological techniques is important for the diagnosis of all intestinal parasites. FTC and FGC techniques are superior for the diagnosis of helminth ova and protozoan cysts in stool, respectively. Additional studies are suggested, using a larger sample size and different parasites in the field.</p><p><strong>Keywords:</strong> Concentration technique, Diagnosis, Intestinal parasite, Sensitivity, NPV, FAC, FTC, FEC, FGC</p> Kamran Pakdad, Seyed Dawood Mousavi Nasab, Fatemeh-Alsadat Damraj, Nayeb Ali Ahmadi Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Comparison of immunogenical potency of <i>Leishmania major</i> (MRHO/IR/ 75/ER) antigens prepared by 3 different methods in conjunction with Alum-Naltrexone adjuvant in BALB/c mice <p><strong>Objectives:</strong> To evaluate the immunization ability of three <em>Leishmania major</em> antigens including formaline killed promastigotes (FKP), autoclaved <em>Leishmania major</em> (ALM) and soluble <em>Leishmania</em> antigen (SLA), they were used to immunize BALB/c mice in association with a mixture of alum and naltrexone (Alum-Nalt) as adjuvant.</p><p><strong>Methods:</strong> Each mouse from any of three groups received FKP, ALM or SLA antigens. Three additional groups were injected with same antigenes plus Alum-Nalt. One more group was injected with PBS to be the control group. Booster injections were given at 14th and 28th days. Two weeks after the last immunization, seven mice from each group were exposed to live promastigotes subcutaneously, and skin lesion formation among each mouse was monitored and recorded for 60 days. One week later, cellular and humoral immune responses of other immunized mice were evaluated by measuring the serum levels of anti-ALM-specific IgG1, IgG2a and total IgG antibodies, splenic anti-ALM-specific IFN-<span>γ</span> and IL-5 production and splenic lymphocyte proliferation after adding ALM.</p><p><strong>Results:</strong> In the challenge test, all mice immunized with ALM antigen and Alum-Nalt were prevented from formation of skin ulcer. Also, the mice from the same group showed higher IFN-<span>γ</span> production and splenic lymphocyte proliferation and higher anti-ALM-specific IgG2a production.</p><p><strong>Keywords:</strong><em> Leishmania major</em>, Immunization, Alum, Naltrexone, Opioid-receptor</p> Peyman Khezri, Shahram Shahabi, Esmaeil Abasi, Habib Mohammadzadeh Hajipirloo Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 <i>Toxoplasma gondii</i>: Prolonged <i>in-vitro</i> maintenance of virulent tachyzoites in fluid media at low temperatures <p><strong>Background:</strong> Prolonged maintenance of infective <em>Toxoplasma gondii</em> tachyzoites (<em>T</em>.g.T.) is an important subject for research purposes. This study aimed to evaluate four serum free fluid media for prolonged<em> in vitro</em> maintenance of <em>T</em>.g.T.</p><p><strong>Methods:</strong> The four fluid media Phosphate buffered saline (PBS) pH 7.2 and <em>Roswell Park Memorial Institute</em> (<em>RPMI</em>-1640) with or without 3% fetal bovine serum (FBS) were evaluated for maintenance of virulent <em>T</em>.g.T. The four media were tested after incubation at three different temperature degrees in the darkness.</p><p><strong>Results:</strong> Prolonged maintenance period for infective <em>T</em>.g.T. was recorded especially in the absence of FBS supplement. RPMI without FBS was able to maintain infective <em>T</em>.g.T. for 16 days post incubation (dpi) at refrigerator temperature. This period decreased to 10 dpi and 6 dpi after incubation in the same media at 18–22 <sup>o</sup>C and 37 <sup>o</sup>C, respectively. Cultivation of <em>T</em>.g.T. in RPMI supplemented with 3% FBS and in PBS proved to maintain infective <em>T</em>.g.T. for 14 dpi at refrigerator temperature, and for 9 and 5 dpi when the two media were incubated at 18–22 <sup>o</sup>C and 37 <sup>o</sup>C, respectively. Shorter periods for keeping the <em>T</em>.g.T. infectivity were recorded using PBS supplemented with 3% FBS under all tested temperature conditions.</p><p><strong>Conclusion:</strong> This method allows economic long-lasting maintenance of tachyzoites for 16th dpi in RBMI that can be reactivated by reinoculation in mice.</p><p><strong>Keywords: </strong> <em>Toxoplasma gondii</em>, Tachyzoites, Fluid media, Temperature</p> Mohamed M. El-Bahy, Marwa M. Khalifa, Eman M.H. Méabed Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Candidemia after cardiac surgery in Tehran, Iran: A retrospective analysis of 424 cases at two medical centers <p><strong>Background:</strong> Candidaemia is an emerging problem and one of the most important nosocomial infections in many hospitals. The aim of this study was to characterize the epidemiology and patient outcomes of candidemia after cardiac surgery at two medical centers in Iran over a nine-year period.</p><p><strong>Methods:</strong> A retrospective analysis was conducted reviewing the medical records of all patients who underwent surgical treatment of cardiac disease at two medical centers. Demographic data, comorbidities, surgical procedure, length of hospital stay, odds ratio and annual trend for candidemia in cardiosurgical cases were collected and analyzed.</p><p><strong>Results:</strong> Candidemia was responsible for 1.78% cases of total cardiac surgeries (23,849) in two hospitals. Data showed an overall declining trend for the incidence of candidemia during the study period, so that decreased from 3.81% in 2003–2004 to 0.52% in 2011–2012 (P &lt; .01). The odds ratio was significantly downward (from 1 to 0.14, P &lt; .01). Candidemia had a direct relationship with patiant age, and the mean age was 64.2 years. A remarkable gender difference skewed towards males was observed, and the male/female ratio among candidemia cases &lt;60 and <span>≥</span>65 years old was 0.82 and 1.79, respectively. Housewives had the highest rate of infection (34.91%). Coronary Artery Bypass Graft was the most common type of surgical intervention. Majority of candidemia patients (89.2%) had risk factor and the most common comorbidities were diabetes. Mean total hospital stay was 17.34 ± 4.69 days.</p><p><strong>Conclusions:</strong> This study expands the knowledge of the epidemiology and trend of incidence of candidemia in cardiosurgical cases. The survey provides preliminary baseline data for the future monitoring of candidemia, and effective programs for controlling and preventive strategies against the disease in hospitals.</p><p><strong>Keywords:</strong> Candidemia, <em>Candida</em>, Cardiac surgery, Epidemiology, Predisposing factor, Iran</p> Nayeb Ali Ahmadi, Leila Davodi Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Microbiological monitoring of ultrapure dialysis fluid in a hemodialysis center in Alexandria, Egypt No Abstract Aleya A. Abbass, Ahmed F. El-Koraie, Walaa A. Hazzah, Eman A. Omran, Mohammed A. Mahgoub Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Diagnostic performance of GeneXpert and Ziehl-Neelson microscopy in the detection of tuberculosis in Benue State, Nigeria <p><strong>Background:</strong> Accurate and timely diagnosis of tuberculosis (TB) is key to effective treatment and management. This study was designed to compare the diagnostic performance of GeneXpert and Ziehl-Neelson (ZN) microscopy test using culture as the reference.</p><p><strong>Methods:</strong> Cross-sectional study was conducted in a tertiary hospital to compare the performance of GeneXpert and ZN test among HIV and non-HIV patients. Sputum samples were collected from 261 suspected TB patients and analyzed in the laboratory using GeneXpert, ZN test and culture. Statistical analysis included calculation of sensitivity, specificity, positive predictive value and negative predictive value. X<sup>2</sup> was used to compare the outcome of diagnostic test and demographic variables. p-value &lt; 0.05 was considered significant.</p><p><strong>Results:</strong> Comparison of TB prevalence among urban versus rural areas using the three diagnostic tests are: ZN test: 32 (12.3%) vs 16 (6.1%; X<sup>2</sup> 7.63, P = 0.007); GeneXpert: 63 (16.1%) vs 20 (7.7%, X<sup>2</sup> 9.01, P = 0.003) and culture: 22 (8.4%) vs 10 (3.8% X<sup>2</sup> 4.44, P = 0.05). Also, prevalence of TB was significantly (P &lt; 0.05) higher among HIV negative 25 (9.6%) than HIV positive 23 (8.8%) patients. The overall prevalence of rifampicin resistance was 12 (4.60%). Out of 261 sputum samples examined for TB, 48 (18.38%) tested positive by ZN test, 62 (23.76%) by GeneXpert and 32 (12.26%) by culture. Two out of 32 samples that tested positive by culture were negative by GeneXpert. GeneXpert had higher sensitivity (93.75%) than ZN test (50.00%). However, they had equal specificity (86.03%). The sensitivity and specificity of ZN and GeneXpert among HIV patients was 58.33% (95% CI = 29.66–84.83) and 79.31% (95% CI; 69.24–87.26) and 91.67% (95% CI 61.51–99.79) and 80.67 (95% CI; 70.58–88.17) while among HIV negative patients; ZN test and GeneXpert assay had 45.00% (23.05–68.45) and 90.14% (84.04–94.50) and 95.00% (75.13–99.87) and 89.44% (83.13–93.96), respectively.</p><p><strong>Conclusion:</strong> GeneXpert demonstrated higher level of performance than ZN microscopy. We recommend the use of GeneXpert for diagnosis of TB in Benue State and Nigeria in general for effective treatment and management of tuberculosis.</p><p><strong>Keywords:</strong> Diagnostic performance, GeneXpert MTB/Rif, Ziehl-Neelson, Tuberculosis, HIV</p> Enenche Francis Ejeh, Ann Undiandeye, Victor O. Akinseye, Kenneth O. Okon, Haruna M. Kazeem, Caleb Ayuba Kudi, Simeon Idowu B. Cadmus Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Assessment of knowledge, attitude and behavior towards antibiotic use in primary health care patients in Fayoum Governorate, Egypt No Abstract Naglaa A. El Sherbiny, Eman H. Ibrahim, Mohamed Masoud Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Antibiotic prescribing practices in the presence of extended-spectrum β-lactamase (ESBL) positive organisms in an adult intensive care unit in South Africa – A pilot study <p><strong>Introduction:</strong> Antimicrobial resistance is one of the most severe health threats globally. Extended spectrum β-lactamases (ESBLs) are enzymes produced by a variety of gram-negative bacteria, which lead to an increase in resistance to commonly used antibiotics and are associated with higher morbidity and mortality.</p><p><strong>Objectives:</strong> Assess the prescribing practices prior to, and after, positive ESBL producing microbiology cultures in an adult ICU setting, according to sensitivity reports obtained from the clinical laboratories from January 2013 until January 2014. Subsequently use the findings to guide future practice.</p><p><strong>Method:</strong> Retrospective study at a private hospital in Pretoria, Gauteng Province. All adult patients older than 18 years of age that were admitted to either the MICU (multi-intensive care unit) or the TICU (trauma intensive care unit) with a positive producing ESBL culture during their hospitalised stay were assessed.</p><p><strong>Results:</strong> During the study period, 39 patients in the MICU and TICU had positive ESBL microbiology results. The majority of positive ESBL results were due to <em>Klebsiella pneumonia</em> isolates. Antibiotics prescribed post ESBL positive culture were appropriate according to the sensitivity report in 64% of patients. 22 patients survived and 17 patients died. All the patients that died were on invasive ventilatory support.</p><p><strong>Conclusion:</strong> Clinically it appears as if patients who received appropriate therapy according to the microbiology results showed a better clinical outcome than those with inappropriate therapy. This underlines the importance of appropriate prescribing practices in combination with co-morbid conditions. Invasive ventilatory support can be identified as a clear risk for contracting an infection due to an ESBL producing organism.</p><p><strong>Keywords:</strong> Antimicrobial, Extended spectrum β-lactamase, Prescribing practices Initial antimicrobial use, Antimicrobial stewardship, South Africa</p> T Fourie, N Schellack, E Bronkhorst, J Coetzee, B Godman Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Prevalence of depressive symptoms among Turkish women experiencing premenstrual symptoms and correlated factors <p><strong>Objective:</strong> The aim of this study was to investigate prevalence of depressive symptoms among Turkish women experiencing premenstrual symptoms and correlated factors.</p><p><strong>Method:</strong> This descriptive and cross-sectional study. The data were collected with Beck Depression Inventory (BDI) and Premenstruel Syndrome Scale (PMSS), and questionnaire form. A total of 121 married and literate women who agreed to participate were included in the study.</p><p><strong>Results:</strong> The proportions depressive symptoms among women with severe premenstrual symptoms and without severe premenstrual symptoms were 51% and 13.5% respectively. Statistically significant positive correlations were found between the BDI score; the total PMSS score (r = 0.403) and its subscales scores including depressive feelings (r = 0.439); anxiety (r = 0.412); fatigue (r = 0.280); irritability (r = 0.253); depressive thoughts (r = 0.456); pain (r = 0.204); and the changes in appetite (r = 0.418). A negative correlation was found in the swelling subscale score of PMSS (r = -0.079), but there was no correlation with the changes in the sleeping habits subscale score (r = 0.024). There was correlation between BDI scores and occupation, education, perception of outcome, domicile, and a history of psychiatric disorders of the women. There was correlation between PMSS scores a history of psychiatric disorders and complaint of dysmenorrhea in the women.</p><p><strong>Conclusions:</strong> In conclusion, women who experienced premenstrual syndrome had higher depressive symptoms than women without premenstrual syndrome. Women with premenstrual syndrom should be assessed for depression by health professionals.</p><p><strong>Keywords:</strong> Premenstrual syndrome, Depressive symptom, Women, Correlated factors</p> Nülüfer Erbil Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Knowledge of basic life support among the students of Jazan University, Saudi Arabia: Is it adequate to save a life? <p><strong>Background:</strong> Basic Life Support [BLS; including cardiopulmonary resuscitation (CPR)] is a part of medical skills utilized in case of an emergency medical care to save human lives. It is well established that the young students can become major healthcare supportive workforce for a community including the cases of emergency. Therefore, adequate knowledge of BLS is necessary for all the university attending students. This study evaluated the awareness of BLS knowledge and attitude towards BLS training among the students of Jazan University, Saudi Arabia.</p><p><strong>Methods:</strong> A self-administered survey questionnaire using cross-sectional design was employed.</p><p><strong>Results:</strong> Out of 360 participants, the majority were male students (84.2%). The participants have mediocre knowledge of BLS, and their mean score was 7.83 out of 14. The knowledge score, i.e., correct response of male and female students was almost similar. Not a single student answered all the questions correctly. About 28% participants had received BLS training previously during their study course and showed better BLS knowledge (mean score 10.41) in comparison with the other participants. In contrast with the students of health science related courses, the highest mean knowledge score (11.5) was opted by the students of emergency medical services, whereas the lowest score (6.58) was opted by the students of nursing background.</p><p><strong>Conclusions:</strong> Overall, a majority of the students of Jazan University did not have complete knowledge of BLS (CPR). The outcomes of this study will be helpful for education and healthcare service providers of the Saudi kingdom as a whole and for Jazan region.</p><p><strong>Keywords:</strong> Basic life support, Health occupations, Students’ knowledge, Medical education, Saudi Arabia</p> Awais Ahmad, Naseem Akhter, Raju K. Mandal, Mohammed Y. Areeshi, Mohtashim Lohani, Mohammad Irshad, Mohsen Alwadaani, Shafiul Haque Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Early prediction of iron deficiency in females in child bearing age in central Saudi Arabia No Abstract Mysara M. Mogahed, Shereen Mohamed Abdelwahab Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Plasma soluble CD 163 level as a marker of oesophageal varices in cirrhotic patients <p><strong>Background:</strong> Variceal bleeding (VB), the most common lethal complication of cirrhosis, associated with high mortality. Timely prediction of esophageal varices (EV) represents a real challenge for the medical team. This study evaluated the level of plasma soluble CD 163 as a marker of the presence of EVs and to compare it with other noninvasive clinical, laboratory and ultrasonographic parameters as well as endoscopy.</p><p><strong>Methods:</strong> This prospective controlled study was conducted on 80 adults. Gp I had no oesophageal varices, gp II had small varices, gp IIIa had large varices, gp IIIb are the same patients of gp IIIa but after eradication of varices and gp IV as healthy controls. Serum samples were assayed for soluble CD 163.</p><p><strong>Results:</strong> soluble CD163 was statistically significant different between controls and all liver cirrhosis. it showed a statistically significant difference between group I and II (p = 0.009) and between group I and IIIa (p &lt; 0.001) and between group II and IIIa (p &lt; 0.001) but, no difference between group IIIa and IIIb (p = 0.179).</p><p><strong>Conclusion:</strong> Serum soluble CD163 is a good noninvasive predictor for the presence of EVs and it may be used for grading of EVs. Its level does not change after esophageal varices eradication.</p><p><strong>Trial registration:</strong> IRB No: 00007589 FWA No: 00015712 The Ethics Committee of the faculty of medicine Alexandria University.</p><p><strong>Keywords:</strong> Hepatic, Cirrhosis, Varices, CD163, Endoscopy, Ultrasonography</p> Alaa El Din Mohamed Abdo, Khaled Mahmoud Mohy El Din, Essam El Din Saeed Bedewy, Reham Abdel Haleem Abo Elwafa, Mohamed Adel Abdel Aziz Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Childhood accidental poisoning in western Iraq: Pattern and risk factors No Abstract Zaid R. Al-Ani, Sahar J. Al-Hiali, Riyadh H. Al-Janabi Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Toxicities of selected medicinal plants and floras of lower phyla <p>The aim of this study was to evaluate the toxic effects associated with the administration of aqueous extracts (AE) of <em>Calliandra portoricensis</em> (CP), D<em>racaena arborea</em> (DA),<em> Duranta repens</em> (DR), <em>Polytrichum juniperinum</em> (PJ), <em>Parmelia caperata</em> (PC), and <em>Nostartium officinale</em> (NO) on Wistar rats. LD<sub>50</sub> for each plant was obtained prior to administration. Seven groups of six rats each were orally gavaged for 28 days as follows; group 1–7 received normal rat pellets and saline, in addition, group 2 received 20 mg/kg b.w CP, group 3 &amp; 4 respectively received 8 mg/kg b.w DA and DR, group 5 &amp; 6 respectively received 4 mg/ kg b.w PJ and PC, and group 7 received 100 mg/kg b.w NO. Liver enzymes; ALP, ALT, AST and GGT were significantly (p &lt; 0.05) elevated by CP, DR, PJ and PC extracts. All the extracts caused significant alterations of the total protein, albumin and globulin levels. The urea levels were deranged by all the extracts while CP, PJ, PC, and NO extracts caused no significant effects on the creatinine levels. Both DR and NO deranged the serum electrolytes; Na, K, Cl, and HCO<sub>3</sub>. Results for the lipid profile showed that all extracts significantly altered the phosphatidate phosphohydrolase and LDL levels while no significant effects were observed in the VLDL, TG, TC, HDL, cardiac risk ratio, arterogenic coefficients, and arterogenic index of plasma, of NO treated rats. For hematological parameters DR, PJ, and PC significantly deranged the RBC, HGB, MCHC, MCV, and MCH concentrations while the neutrophils, eosinophils and basophils were significantly altered on administration of all the extracts. No significant effects were observed on the platelets and plateletcrit level in rats gavaged with CP, whereas the MPV, PDW, and PCT concentrations were<br />deranged by DR extracts. CP and NO caused no alterations in the MDA, GSH, and GST levels whereas the SOD, GPx, and xanthine oxidase levels were significantly deranged by all the plant extracts. Only NO treatment produced catalase, glutathione reductase, and xanthine dehydrogenase levels equivalent to the control group. This study has shown various degrees of deleterious effects on biochemical parameters associated with the consumption of these plants, thus raising serious concerns over their continuous applications as local medicaments.</p><p><strong>Keywords: </strong> Toxicity,<em> Calliandra portoricensis</em>,<em> Dracaena arborea</em>,<em> Duranta repens </em><em>Polytrichum juniperinum</em>,<em> Parmelia caperata</em>, <em>Nostartium officinale</em>, Liver, Electrolytes, Phosphaditate phosphohyrolase, Platelets, Xanthine dehydrogenase</p> P.U. Amadi, E.N. Agomuo, A.I. Bob-Chile Agada, U.C. Njoku, M.O. Ifeanacho, J.C. Okereke, C.U. Iheka, J.O. Osuoha Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Analysis and reporting of adverse drug reactions at a tertiary care teaching hospital <p><strong>Objectives:</strong> To analyze and report adverse drug reactions (ADRs) in a tertiary care teaching hospital.</p><p><strong>Methods:</strong> This was an observational study, conducted to analyze and communicate the ADRs reported from July 2016 to June 2017 in a south Indian tertiary care teaching hospital. On daily basis, ADRs reported by healthcare professionals (HCPs) were analyzed and the reports that meet pharmacovigilance programme of India (PvPI) reporting criteria were communicated to PvPI through a specified updated Indian Pharmacopoeia Commission (IPC) suspected ADR reporting form. In this study, ADRs were summarised based on demographics, drug, incidence, type of reaction and its outcome. Causality, severity, seriousness, and predictability were assessed through WHO causality assessment scale, Hartwig and Siegel Severity Assessment Scale and PvPI criteria.</p><p><strong>Results:</strong> A total of 254 ADRs communicated to PvPI through specified, updated IPC suspected ADR reporting form. The incidence of ADRs in both males and females was identical. The occurrence of ADRs in adult patients (71.26%) was significantly higher than other age groups. Of total ADRs, most of them were with<br />Antibiotics (24.01%) followed by antipsychotics (11.42%). In causality assessment, a majority of ADRs (48.82%) were considered possibly related to the drug or treatment and 55.12% were mild in severity. Overall, 36.22% patients were recovered from ADRs. Most of the reported ADRs (54.33%) were probably preventable.</p><p><strong>Conclusions:</strong> The results provided an insight to the HCPs on the importance of monitoring and reporting of ADRs. High-quality data gathered through a reporting system, most of the reported ADRs were probably preventable; the proper review of patient history and monitoring by HCPs can reduce the incidence of ADR. Our study results emphasize a need for establishing a pharmacovigilance centre to ensure the safe use of drugs.</p><p><strong>Keywords:</strong> Adverse drug reaction, Pharmacovigilance, Reporting, Causality</p> Meda Venkatasubbaiah, P. Dwarakanadha Reddy, Suggala V. Satyanarayana Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Relationship between body mass index, waist circumference, waist hip ratio and erosive gastroesophageal reflux disease in a tertiary centre in Nigeria: A case control study <p><strong>Background:</strong> Gastro-oesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach content causes troublesome symptoms with or without mucosa damage and or complications. GERD is believed to be evolving among blacks.</p><p><strong>Objectives:</strong> The objective of this study was to look at the relationship of GERD to body mass index (BMI), waist circumference (WC), hip circumference (HC) and waist hip ratio (WHR) among patients with distal oesophageal erosive GERD and controls.</p><p><strong>Methods:</strong> A case control study among patients with dyspepsia that had diagnostic upper gastrointestinal endoscopy. Patients with erosive GERD were grouped into cases while those without GERD were controls. GERD was graded using the Los Angeles classification. BMI, WC, HC and WHR were measured among cases and controls. Obesity was defined as BMI <span>≥</span> 30 kg/m<sup>2</sup> or WC <span>≥</span> 88 cm or <span>≥</span>WHR 0.85 in females and BMI <span>≥</span> 30 kg/m<sup>2</sup> or WHR <span>≥</span> 0.9 or WC <span>≥</span>102 cm for males. Data were analysed using descriptive and inferential statistics.</p><p><strong>Results:</strong> A total of 160 subjects (80 cases and 80 controls) were analysed. Mean (SD) age for cases was 51.1 (±12.4) years and 50.1 (±13.7) years for controls. When cases with GERD were compared with controls; males were less likely to be obese, BMI &lt; 30 kg/m<sup>2</sup>, have normal WC, HC and WHR while females were more likely to be obese, BMI <span>≥</span> 30 kg/m<sup>2</sup> and have increased WC, and HC, (p &lt; 0.05).</p><p><strong>Conclusion:</strong> Central obesity is a risk factor for distal oesophageal erosive GERD among female Nigerians but not among males.</p><p><strong>Keywords:</strong> Gastro esophageal reflux, Central obesity, Dyspepsia, Nigeria</p> Olusegun Adekanle, Samuel Anu Olowookere, Oluwasegun Ijarotimi, Dennis Amajuoyi Ndububa, Akinwumi Oluwole Komolafe Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Anthropometric dimensions of hand and foot as predictors of stature: A study of two ethnic groups in Nigeria <p><strong>Background:</strong> Anthropometry as a science deals with the study of human measurements with a view towards the understanding of physical variations that exist in human population groups. Estimation of stature is very important in the investigation process of unknown and co-mingled human remains in mass casualties and natural disasters. Stature or height therefore is critically essential in human identification.</p><p><strong>Aim:</strong> This study was aimed at determining stature using the anthropometric measurements of hand and foot dimensions in two ethnic Nigerian populations.</p><p><strong>Methodology:</strong> A descriptive cross-sectional study involving 384 Nigerian students selected using random sampling technique was used. These subjects were male and female volunteers of two ethnic groups’ aged between18 and 30 years. Cochran method for sample size determination was used. All measurements of hand and foot dimensions were recorded to the nearest centimetre using standardized anthropometric measuring equipment and the mean actual and estimated stature obtained.</p><p><strong>Results:</strong> The study showed significant gender difference in mean right and left hand breadth but not the mean right and left hand length (P &lt; 0.05). Similarly, there was a statistically significant gender difference between the mean right and left foot breadth (P &lt; 0.05), but not between the mean right and left foot breadth and right foot lengths respectively (P &gt; 0.05). The study further showed that in both gender, that breadth parameters showed stronger correlations in hand and foot dimensions. There was also a significant association between the mean left hand length and right and left hand breadth (P &lt; 0.05) but not with the mean right hand length (P = 0.853). There was also significant association in the mean left foot length and the right and left foot breadths (P &lt; 0.05) but not in the right foot lengths (P = 0.294). The mean estimated value of stature using linear and multiple regression equations for all parameters ranged from 164.53 cm to 165.57 cm while the mean actual stature from the study was 165.30 cm for all the subjects, specifically, 165.90 cm for the Igbos and 164.79 cm for the Isokos respectively.</p><p><strong>Conclusion:</strong> Our study showed that stature can be accurately estimated using all hand and foot parameters and this is of medico-legal importance.</p><p><strong>Keywords:</strong> Anthropometric dimensions, Stature prediction, Ethnic groups, Nigerians</p> Patrick S. Igbigbi, Beryl S. Ominde, Chidinma F. Adibeli Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Lateral ankle anatomical variants predisposing to peroneal tendon impingement <p><strong>Purpose:</strong> To delineate the significant association between the peroneal tendons injury and the lateral ankle joint anatomical variants.</p><p><strong>Subjects:</strong> Retrospective revision of the last 600 ankle MRI examinations, with dividing such candidates into: <strong>Group A:</strong> Inclusion group including patients with pure Peroneal tendon injury &amp; lateral ankle anatomical variants. <strong>Group B:</strong> Control group including patients with Peroneal Tendonsinjury &amp; no anatomical variants. <strong>Group C:</strong> Exclusion group including patients with other different types of ankle injuries.</p><p><strong>Technique:</strong> Standard MRI ankle joint protocols.</p><p><strong>Results:</strong> Group A: 73 patients (40.3%) had PTT including: straight/convex RMG in 48 (26.5%) patients; 19 of them (39.6%) had PTT, PT hypertrophy in 39 (21.6%) patients; 14 (35.9%) of them had PTT. RCE hypertrophy in 33 (18.3%) patients; 12 of them (36.4%) had PTT. PQ muscle was seen in 15 (8.3%) patients; 7 (46.7%) of them had PTT. Low PB muscle belly was found in 29 (16%) patients; 13 (44.9%) of them had PTT. OP was found in 17 (9.3%) patients; 8 (47%) of them had PTT. Group B: 26 of them (18%) had PTT. Fisher exact test 0 P value.</p><p><strong>Conclusion:</strong> The lateral ankle joint anatomical variants facilitate peroneal tendons injury, ending in chronic lateral joint instability.</p> Mahmoud Agha, Mohamed Saied Abdelgawad, Nasser Gamal Aldeen Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Public and private surgeon attitude towards informed consent <p><strong>Background:</strong> Informed consent ranks as one of the most prominent issues in the recent bioethics literature due to increasing number of medico-legal cases and, the introduction of new national guidelines.</p><p><strong>Objectives:</strong> The aim of this study is to examine the attitude of surgeons working in public and private hospitals towards informed consent.</p><p><strong>Subjects and methods:</strong> This study is a cross-sectional survey that was conducted from January to June 2016 in all five governmental general hospitals, and two private hospitals in Kuwait. A selfadministered questionnaire was used to collect data from the surgeons working in the selected hospitals including six domains related to informed consent.</p><p><strong>Results:</strong> The majority of surgeons believed that informed consent routinely achieved in their current practice and that all doctors should receive formal training on informed consent, though only 35.7% of public surgeon received training compared to 76.7% of private surgeons. Although 82.7% of public surgeons believed that written information leaflets should be provided for patients, only 41.1% provide their patients with these type of leaflets. There was no significant difference between public and private surgeons regarding the purpose of informed consent except that higher proportion of private surgeons believed that informed consent improves the doctor-patient relationship. There was an agreement between public and private surgeons that junior doctors should not conduct the informed consent. Higher proportion of private than public surgeons stated that the content of informed consent was affected by patient’s age, gender, and social class whereas level of education was thought by public surgeons.</p><p><strong>Conclusion:</strong> Private surgeons differ from those in the public hospitals in that they tend to look at informed consent as not only an ethical and legal obligation, but also of benefit to patients. The introduction of formal training on informed consent in both types of hospitals are recommended.</p><p><strong>Keywords:</strong> Informed consent, Attitude, Surgeons, Public, Private</p> Saadoun Faris Alazmi Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Impact of methylenetetrahydrofolate reductase (MTHFR) A1298C gene polymorphism on the outcome of methotrexate treatment in a sample of Egyptian rheumatoid arthritis patients <p><strong>Background:</strong> Methotrexate is the most commonly used disease-modifying anti-rheumatic drug (DMARD) and it is considered the first-line treatment in the management of rheumatoid arthritis (RA). MTX treatment outcome regarding response to the drug and adverse effects in RA patients are not universal. Therefore, it would be beneficial if we could predict the response of patients to MTX before starting MTX treatment in order to determine the patient’s drug-treatment plan.</p><p><strong>Objectives:</strong> The present study aimed to evaluate the impact of <em>MTHFR</em> A1298C SNP (rs1801131) on the clinical outcome of MTX treatment as regards treatment efficacy and toxicity in a cohort of Egyptian rheumatoid arthritis patients.</p><p><strong>Patients and methods:</strong> Fifty rheumatoid arthritis patients were included in the present study. Data about patient related variables such as age and sex, disease related variables such as disease duration as well as treatment related variables such as treatment duration, dose of MTX, its route of administration and concomitant use of other drugs (NSAIDs) were obtained. DAS28 was calculated to all patients to assess drug response. <em>MTHFR</em> A1298C polymorphism was investigated using real time 50 nuclease allelic discrimination assay.</p><p><strong>Results:</strong> Multivariate regression analysis for factors predicting MTX drug response showed that <em>MTHFR</em> A1298C SNP and MTX dose were the most significant independent predictors for MTX treatment response (p = .016, OR = 39.113, 95% C.I = 1.970–776.558, p = .003, OR = 1.667, C.I = 1.184–2.348, respectively). Considering clinicopathological variables; longer disease duration, positive anti-CCP, NSAIDs users, higher MTX doses and longer treatment durations were significantly associated with nonresponse to MTX. Regarding MTX drug toxicity, <em>MTHFR</em> 1298 CC genotype, MTX dose and concomitant use of NSAIDs were significantly associated with MTX drug toxicity (<sup>MC</sup>p = .003, p = .031, p = .029, respectively).</p><p><strong>Conclusion:</strong> Our study proved that <em>MTHFR </em>A1298C SNP can predict clinical outcome of MTX treatment as regards treatment efficacy and toxicity in Egyptian rheumatoid arthritis patients.</p><p><strong>Keywords:</strong> Rheumatoid arthritis, Methotrexate, Pharmacogenetics, Methylenetetrahydrofolate reductase</p> Ola Atef Sharaki, Amira Hasan Elgerby, Eman Saad Nassar, Sara Salah Eldin Khalil Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Gene expression and six single nucleotide polymorphisms of interleukin-6 in rheumatoid arthritis: A case-control study in Iraqi patients <p><strong>Background:</strong> Interleukin-6 (IL-6) plays a significant role in pathogenesis of rheumatoid arthritis (RA), but its single nucleotide polymorphisms (SNPs), as well as therapy may modulate such role.</p><p><strong>Objectives:</strong> It was aimed to determine gene expression and six SNPs (rs1800796 C/G, rs7802307 A/C/T, rs7802308 A/T, rs36215814 A/G, rs184229712 A/G and rs867254801 C/G) of <em>IL6</em> in etanercept-treated Iraqi Arab RA patients.</p><p><strong>Materials and methods:</strong> Fifty-one RA patients and 45 controls were enrolled, and the determinations were carried out by reverse transcription quantitative polymerase chain reaction (RT-qPCR) and Sanger’s DNA sequencing. Disease activity and laboratory markers were considered in these evaluations, which were the first presentation in Iraqi patients.</p><p><strong>Results:</strong> The <span>△</span>Ct mean of <em>IL</em>6 mRNA showed a significant increase in RA patients compared to control (9.084 ± 0.964 vs. 6.780 ± 2.240; <em>p</em> = 0.0001). In terms of a relative expression, the 2<sup>-<span>△</span><span>△</span></sup>Ct means showed no significant variations between subgroups of patients distributed by clinical and laboratory findings, with the exception of C-reactive protein (CRP). CRP-positive patients showed a lower mean compared to CRP-negative patients (0.201 ± 0.109 vs. 0.312 ± 0.131; <em>p</em> = 0.001). Distributing patients by gender and duration of disease also revealed significant variations between male and female patients. With respect to SNPs, allele and genotype frequencies of four SNPs (rs1800796, rs7802307, rs184229712 and rs867254801) showed variations between patients and controls, while no differences were reported for rs7802308 and rs36215814 SNPs. In addition, <em>IL</em>6 gene expression was significantly influenced by two SNP genotypes (rs36215814 GA and rs184229712 AG) compared to the corresponding GG genotypes.</p><p><strong>Conclusion:</strong> Gene expression of <em>IL</em>6 was down-regulated in RA patients, especially CRP-negative patients. Moreover, four SNPs of such cytokine may have a role in RA risk.</p><p><strong>Keywords:</strong> Rheumatoid arthritis, Interleukin-6, Single nucleotide polymorphism, Gene expression, Etanercept</p> Ali H. Ad’hiah, Aseel S. Mahmood, Abdul-Kareem A. Al-kazaz, Khadier K. Mayouf Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Study of urinary interferon gamma-induced protein 10 (IP-10) and urinary soluble CD 25 (sCD25) as markers of lupus nephritis and their relation to histological class <p><strong>Objective:</strong> To study the role of urinary interferon gamma-induced protein 10 (IP-10) and urinary soluble CD 25 (sCD 25) as diagnostic and prognostic markers of lupus nephritis (LN) and their relation to the LN class in renal biopsy.</p><p><strong>Subjects and methods:</strong> This study included 45 lupus patients fulfilling the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria: 25 patients with active LN during activity and during follow up (3 months later) as [group A] and 20 patients without any signs of activity [group B]. (20) age and sex matched healthy subjects were enrolled as control group [group C]. Urine samples were collected at baseline and at follow up. Urinary IP-10 and sCD25 were measured by ELISA.</p><p><strong>Results:</strong> Urinary IP-10 and sCD25 levels were higher in group A compared to groups B and C (P &lt; 0.001 for both). In patients with active nephritis, urinary IP-10 and sCD25 correlated positively with serum creatinine (P &lt; 0.001 for both), proteinuria (p = 0.010; p = 0.007), anti ds-DNA (p = 0.002; p &lt; 0.001), SLEDAI<br />score (global) (P &lt; 0.001 for both), and renal SLEDAI score (p = 0.002; p &lt; 0.001) respectively. The urinary IP-10 and sCD25 levels were highest in patients with class (IV) LN and lowest in class (II) patients with a statistically significant difference. In patients achieving remission with treatment, both markers decreased significantly.</p><p><strong>Conclusion:</strong> Urinary IP-10 and sCD25 are potential biomarkers for early recognition and follow up of LN.</p><p><strong>Keywords:</strong> Lupus nephritis, Urinary, IP-10, CD25</p> Montasser Mohamed Hussein Zeid, Nahed Mohamed Baddour, Dalia Abd El-Moaty El-Neily, Heba Selim Elshair, Mohamed Mamdouh Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Assessment of the onset of radiation-induced cardiac damage after radiotherapy of breast cancer patients <p><strong>Objectives:</strong> The study aimed to evaluate the dose delivered to the heart during radiotherapy of left-sided and right-sided breast cancer (BC) patients, correlate the dose and laterality of radiotherapy to the possible cardiac damage and evaluate whether Left-ventricular Ejection Fraction (LVEF), Troponin-I (TnI), Creatinine Kinase (CK), Creatine Kinase-MB Relative Index (CK-MBRI) or Lactic Dehydrogenase (LDH) could be used to detect the possible onset of radiotherapy-related cardiotoxicity.</p><p><strong>Subjects and methods:</strong> 80 females were assigned as; 30 left-sided BC patients, 30 right-sided BC patients and 20 healthy females. Patients were treated by radical mastectomy followed by FAC-based chemotherapy and radiotherapy. CT-based 3D-planning was used to generate cardiac dose-volume histograms to assess mean dose received by the heart.</p><p>Echocardiography was done to all patients before and 1 year after completing radiotherapy. In serum, TnI and CK-MB concentration and CK and LDH activities were determined before and 1 year after radiotherapy.</p><p><strong>Results:</strong> In left-sided patients, mean dose delivered to the heart was significantly higher in left-sided patients with significant association with total radiotherapy dose in left- but not right-sided patients. LVEF before and after radiotherapy were statistically different only in left-sided patients. LVEF one year after radiotherapy dropped 20% or more (<span>△</span>LVEF) in 6 patients, all were left-sided. Using cut-off values 0.08 ng/mL for TnI and 1.4 for CK-MBRI; 11 left-sided patients had abnormal TnI and CK-MBRI vs 5 right-sided patients, the 6 patients identified with <span>△</span>LVEF <span>≥</span> 20 were all among them.</p><p><strong>Conclusion:</strong> the mean dose delivered to the heart is significantly higher in left-sided patients, and it was correlated to the total radiotherapy dose. One year after radiotherapy, <span>△</span>LVEF is possibly good marker of cardiotoxicity onset, however, the persistent elevation of both TnI and CK-MBRI could identify both patients with cardiotoxicity and patients that are thought to be in subclinical phase of cardiac damage.</p><p><strong>Keywords:</strong> Breast cancer, Radiation-induced cardiac damage, LVEF, Troponin I<br />CK-MB relative index, LDH</p> Ebtsam Zaher, Enayat Fahmy, Kamal Mahmoud, Yasser El Kerm, Mohammad Auf Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Role of magnetic resonance imaging in loco-regional evaluation of cancer rectum, pre and post neoadjuvant therapy <p>The high rate of local recurrence is considered the major concern and challenge regarding the surgical treatment of cancer rectum. The target of use of pre-operative neoadjuvant therapy is reducing tumour size and improving its resectability in order to reduce local recurrence risk and improve survival rates.</p><p>Plans for management and treatment of locally advanced rectal cancer showed clear changes after use of neoadjuvant therapy. This in turn necessitates accurate evaluation of the tumour parameters before and after use of combined chemotherapy and radiation therapy (CRT).</p><p>Aim of study is to assess the initial stage of cancer rectum then its response to neoadjuvant therapy using MRI, prior to operative interference. This is followed by post-operative histo-pathological data correlation.</p><p><strong>Methods:</strong> This study was conducted on 50 patients. All patients were examined by high-resolution T2- weighted images. Turbo-spin-echo sequences taken in sagittal plane, axial plane perpendicular to tumor axis and coronal plane parallel to tumor axis or anal canal. All are according to tumor height. Diffusion weighted images (DWI) performed in all cases.</p><p><strong>Results:</strong> Following neoadjuvant therapy, down-staging was detected in this study in more than 90% of patients regarding the T2 signal and apparent diffusion coefficient (ADC) value of the tumour, also status of depth of involvement of meso-rectal fascia (MRF), circumferential resection margin (CRM), extramural vascular invasion (EMVI) and nodal involvement.</p><p><strong>Conclusion:</strong> Pre-operative MRI in cancer rectum is irreplaceable to assess initial staging and postneoadjuvant therapy response thus improving surgical results.</p><p><strong>Keywords: </strong> MRI, CRT, DWI, ADC, MRF, CRM, EMVI</p> Enjy El-Kady, Mohamed Eid Ibrahim, Khaled Saied Abbas, Amal Sobhy El-Sedfy, M. Ahmed Mohallel Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Definitive salvage chemotherapy for the treatment of refractory/relapsed non-Hodgkin lymphoma, a single center experience <p><strong>Objective:</strong> Non Hodgkin Lymphomas (NHL)s are a group of malignancies which affect the lymphatic system. A significant proportion of NHL patients experience either relapse or failure of treatment which is called refractory disease. Relapsed or refractory NHL usually have poor prognosis due to shortage of randomized trials comparing efficacy of different treatment protocols to define the optimal salvage chemotherapy regimen in these cases. In this study, we are trying to define the best salvage chemotherapy regimen with low toxicity and better quality of life for patients by comparing outcome of 2 salvage chemotherapy regimens GDP &amp; DHAP.</p><p><strong>Patients and methods:</strong> 100 patients diagnosed as relapsed or refractory NHL were randomly assigned to receive either Gemcitabine, Dexamethasone and Cisplatin (GDP) or Dexamethasone, Cytarabine and Cysplatin (DHAP) for 4 to 6 cycles. Primary endpoints of the study were overall survival and progression free survival. Secondary endpoints were response to treatment, toxicity profile of each regimen, and quality of life assessment.</p><p><strong>Results:</strong> The overall response rate was 70% in GDP group &amp; 64% in DHAP group with no statistically significant difference between them (p-value 0.5). There was no significant difference between both groups regarding toxicity profile except in febrile neutropenia episodes which was much less in GDP group (p-value 0.04). Quality of life was better in GDP group than DHAP with significant difference (p-value &lt; 0.05). There was no statistical significant difference between both groups regarding OS or PFS.</p><p><strong>Conclusion:</strong> GDP is as effective as DHAP for relapsed or refractory lymphoma with less toxicity and better quality of life.</p><p><strong>Keywords:</strong> DHAP, GDP, NHL, Relapsed, Refractory lymphoma</p> Rania Hafez, Safinaz Hussein, Marwa Ismail Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 The Diagnostic accuracy of transvaginal ultrasonography, magnetic resonance imaging and diffusion weighted image in female patients with endometrial carcinoma <p><strong>Aim of work:</strong> To evaluate the efficacy of transvaginal ultrasonography (TVUS), magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) in presurgical staging of endometrial cancer.</p><p><strong>Methodology:</strong> This work included 35 female patients. Thirty patients were diagnosed to have endometrial carcinoma.</p><p><strong>Results:</strong> The sensitivity, specificity, predictive values, accuracy of transvaginal ultrasound in detection of invasion of myometrial cavity were 67.25%, 75.0%, 90.00%, 30.00% and in distant metastasis were 77.78%, 80.95%, 63.64%, 89.47% and %80. These variables for MRI were 88.89%, 100.0%, 100%, 66.67% and 91% in myometrial invasion and in distant metastasis were 100.0%, 100.0%, 100.0%, 100% and 100.0%. There was an inversely proportional relationship between ADC values and the tumor grading. Apparent diffusion coefficient (ADC) magnitude of 0.77 ± 0.21 x 10<sup>-3</sup> mm<sup>2</sup>/s was associated with endometrial cancer while normal endometrial cavity showed ADC value of 1.31 ± 0.11 x 10<sup>-3</sup> mm<sup>2</sup>/s).</p><p><strong>Conclusion:</strong> Conventional MRI, diffusion weighted imaging and contrast enhanced MR images are superior to TVUS in patients with endometrial cancer and ADC values help to differentiate between normal and endometrial cancer which may replace MR contrast enhanced images.</p><p><strong>Keywords:</strong> Transvaginal ultrasound, MRI, DWI, Endometrial carcinoma</p> Dina Moghazy Mohamed, Khaled Abd El-Wahab abo Dewan, Salwa Mahmoud Mera Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Osteocalcin, Azan and Toluidine blue staining in fibrous dysplasia and ossifying fibroma of the jaws <p><strong>Background:</strong> Fibrous dysplasia (FD) and ossifying fibroma (OF) are fibro-osseous lesions (FOLs) having several overlaps that may make final diagnosis difficult by hematoxylin and eosin (H/E) alone.</p><p><strong>Aim:</strong> This study seeks to detect any association between Azan and Toluidine blue staining as compared with osteocalcin in FD and OF diagnosis.</p><p><strong>Methods:</strong> Forty formalin fixed paraffin embedded (FFPE) blocks of FD and OF were prepared for Azan, Toluidine blue and osteocalcin staining. Brown staining of calcified structures was considered as positive for osteocalcin. Scoring for Azan and Toluidine blue was evaluated based on intensity and localization. Level of agreement of original and revised diagnosis was determined.</p><p><strong>Results:</strong> Six (40%) of 15 FD were corroborated by osteocalcin. Eight cases initially diagnosed as OF were revised to FD. There were 25 OF according to H/E, and 17 (68%) were validated by osteocalcin. Measure of agreement between histology and immunohistochemistry was 0.081; p = .608. Eleven (42.3%) OF expressed strong toluidine blue staining of the intervening fibrous connective tissue stroma while only 2 (14.2%) FD showed similar staining, this difference was statistically significant [p = .001].</p><p><strong>Conclusions:</strong> Histomorphometric analysis with Toluidine blue may reduce diagnostic errors of OF and FD.</p><p><strong>Keywords:</strong> Osteocalcin, Azan, Toluidine blue, Fibrous dysplasia, Ossifying fibroma</p> Samuel Ebele Udeabor, Akinyele Olumuyiwa Adisa, Anna Orlowska, Poju Chia, Robert A. Sader, Shahram Ghanaati Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Neuronal and glial regeneration after focal cerebral ischemia in rat, an immunohistochemical and electron microscopical study <p><strong>Objectives:</strong> Unilateral middle cerebral artery occlusion (MCAO) is an established rat model for stoke studies. It induces focal cerebral ischemia, prior to necrotic and apoptotic loss of tissue in a circumscribed cortical area, paralleled by temporary motor impairment.</p><p><strong>Methods:</strong> Here we examined tissue samples from the peri-infarct zone of rats that had survived unilateral MCAO for up to 90 min. With immunohistochemistry we stained sections for proliferation markers Ki 67 and PCNA and for intermediate filament protein nestin. Electron microscopy was employed to assess ultrastructural changes.</p><p><strong>Results:</strong> All MCAO animals developed pronounced lesions in the motor cortex. Numerous cells in the immediate peri-infarct area and scattered cells which seem to have migrated into the infarcted lesion stained positively for Ki 67 and PCNA. Electron microscopy revealed that cells in the lesion site proliferate along the blood vessels. Most of these cells had the ultrastructural features of fibrillary astrocytes while some of the cells were clearly neurons. Endothelia were in part fenestrated. Some of the surrounding cells showed immunostaining for PCNA, indicating proliferation. Oligodendroglia and myelination could not be seen in the lesion site. Single neuronal contacts exhibited the ultrastructural features of synapses. Reformation of cortical layers could not be observed.</p><p><strong>Conclusions:</strong> We concluded that in spite of extensive proliferation; neuronal and glial regeneration occurs after MCAO only to a small extent. Revascularization seems to be an important initial step. The observed functional recovery of experimental animals may be due to neuronal plasticity in young rats rather than structural regeneration.</p><p><strong>Keywords:</strong> Middle cerebral artery occlusion, Rat stroke model, Neuronal regeneration, Revascularization in brain, Electron microscopy, Proliferation markers</p> Abeer E. Dief, Passainte S. Hassan, Oehring Hartmut, Gustav F. Jirikowski Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Time course effects of 5,5-dihydroxyl pyrimidine-2,4,6-trione (alloxan) as a diabetogenic agent in animal model <p><strong>Objective:</strong> The use of alloxan as a diabetogenic agent at 150 mg/kg BW has been characterized by low percentage induction and instability of the hyperglycemia induced. The present study examined its time course effects with a view to suggesting the probable effective dose of the compound for animal studies.</p><p><strong>Methods:</strong> Forty adult Wistar rats were equally randomized into two groups (I and II) and were injected with single intraperitoneal dose of alloxan, 170 and 200 mg/kg BW respectively. Blood glucose concentration (BGC) was monitored in consecutive phases of hourly for 3 h, 3 h interval for 15 h, 6 h interval for 12 h and 9 h after. Changes with time in biomarkers of oxidative stress (SOD, CAT, GST and MDA) and pancreas histopathology were studied.</p><p><strong>Results:</strong> Alloxan at the evaluated doses produced a multiphasic blood glucose response. One hour post alloxan injection, 90% of group I and 85% of group II animals exhibited diabetic hyperglycemia (glucose level <span>≥</span> 200 mg/dL). Groups I and II respectively produced peak levels of hyperglycemia (586.8 and 575.9 mg/dL) at 9 and 12 h post alloxan administration. Hypoglycemia which is characteristic of experimental diabetes was noted between the 15th and 21st hour in both groups (I and II) and resulted in 5 and 10% mortality respectively. At 36th hour, hyperglycemia was restored and apparently sustained. Changes in biomarkers of oxidative stress showed patterns similar to that of blood glucose, and the histopathological examination of the pancreas mainly indicated focal area of a necrotic islet and multifocal area of mild infiltration in both groups.</p><p><strong>Conclusion:</strong> The data obtained shows that alloxan at the investigated doses produced sustained hyperglycemia at 21st and 24th hour post administration, and 170 mg dosage of the compound is apparently a better diabetogenic dose, particularly in terms of reduced animal mortality.</p><p><strong>Keywords:</strong> Alloxan, Diabetogenicity, Diabetes, Effective dose</p> Osasenaga M. Ighodaro, Abiola M. Adeosun, Folake O. Asejeje, Gabriel O. Soetan, Omolara O. Kassim Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 The role of eugenol in the prevention of chromium-induced acute kidney injury in male albino rats <p><strong>Background:</strong> Potassium dichromate induces nephrotoxicity mainly due to increased cellular oxidative stress.</p><p><strong>Objectives:</strong> To evaluate the possible renoprotective effects of eugenol on the damage induced by potassium dichromate poisoning in male rats.</p><p><strong>Methods:</strong> 30 male Wistar rats were divided into 3 groups, 10 rats in each group; Control group: given olive oil orally (5 mL/kg body weight) for 10 consecutive days. Potassium dichromate (PDC) group: received olive oil orally (5 mL/kg body weight) for 10 consecutive days, then a single <em>s.c.</em> injection of PDC (15 mg/kg) was given in the tenth day. And eugenol + PDC group: received eugenol orally (100 mg/kg body weight/day) for 10 consecutive days and a single s.c. injection of PDC (15 mg/kg) in the tenth day.</p><p>Then the animals were anaesthetized, blood samples were taken from the abdominal aorta, for measurement of serum urea and creatinine, and lactate dehydrogenase (LDH). Also reduced glutathione (GSH), malondialdehyde (MDA), superoxide dismutase (SOD) and tumor necrosis factor alpha (TNF-a) were monitored in renal tissue.</p><p><strong>Results:</strong> PDC caused significant increase in serum urea, creatinine and LDH levels; this was accompanied with significant decrease in renal GSH and SOD contents, and increase in renal MDA and TNF-a. Histopathological investigations provoked tubular necrosis associated with mononuclear cell infiltration. Pretreatment of rats with eugenol significantly change all previously mentioned PDC-induced effects.</p><p><strong>Conclusion:</strong> The findings of the current study revealed that eugenol protected the kidney against PDCinduced acute kidney injury in rats by its antioxidant and anti-inflammatory properties.</p><p><strong>Keywords:</strong> Eugenol, Potassium dichromate, Antioxidant, Acute kidney injury</p> Ramez A.E. Barhoma Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 Comparative study between multi-detector computed tomography and echocardiography in evaluation of congenital vascular rings <p>Vascular rings are unusual anomalies represent less than 1% of all cardiac anomalies, it is abnormal development of aortic arch complex leading to formation of a ring formed by vessels that encircle both the trachea and esophagus, echocardiography had limited acoustic window which leads to inadequate evaluation of great vessels, Multi-detector computed tomography (MDCT) is one of the most important non invasive diagnostic tool for detection the vascular ring anomalies.</p><p><strong>The Aim:</strong> To evaluate role of MDCT Scanning for diagnosis of congenital vascular rings anomalies compared to echocardiography.</p><p><strong>Methods:</strong> This is a prospective study of 21 children suspected to have vascular ring anomalies. All patients underwent chest radiography, echocardiography examinations and MDCT Scanning using a 128-row CT scanner with 3D reconstruction.</p><p><strong>Results:</strong> Twenty-one patients (11 male and 10 female), mean age (14 months) were diagnosed as vascular ring anomalies by MDCT then confirmed by surgical results MDCT diagnosed 14 patients with (double aortic arch), 4 patients (right sided aortic arch with aberrant left subclavian), 2 patients (left sided aortic arch with aberrant right subclavian artery) and one patient with pulmonary sling. MDCT also diagnosed seven patients with tracheobronchial stenosis. Echocardiography succeeded only in nine patients with DAA and failed in five and succeeded in diagnosis of two cases of (right aortic arch with aberrant left subclavian).</p><p><strong>Conclusion:</strong> MDCT is an excellent diagnostic tool for optimum detection of vascular ring anomalies and other extra cardiac lesions compared to echocardiography.</p><p><strong>Keywords:</strong> Vascular ring, MDCT, Double aortic arch, Congenital heart disease</p> Manal Hamisa, Fatma Elsharawy, Wafaa Elsherbeny, Suzan Bayoumy Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000 The supracerebellar infratentorial approach in pineal region tumors: Technique and outcome in an underprivileged setting <p><strong>Background:</strong> Pineal region tumors represent 1.5–8.5% of the pediatric brain tumors. Management includes endoscopic third ventriculostomy and biopsy in cases presenting with hydrocephalus. In addition, surgical resection provides survival advantage in selected cases. The supracerebellar infratentorial approach is a widely preferred approach for such region.</p><p><strong>Methods:</strong> After approval of the local ethics committee of Alexandria University and acquisition of the appropriate formal consents according to the committee’s standards, we have reviewed the records of fifteen cases presenting with pineal region tumors in Alexandria main university hospital from 2013 to 2016. The mean age at the diagnosis was 14 years (2–54 years). All cases had supracerebellar infratentorial approach for surgical resection. Follow up period was from 12 to 59 months.</p><p><strong>Results:</strong> All 15 cases presented with hydrocephalus and increased intracranial pressure manifestations. Out of the 15 cases, 3 cases were germ-cell tumors, 2 cases were pineoblastomas, one parenchymal tumor with intermediate differentiation (PPID), one pineocytoma, 2 cases were anaplastic ependymomas and 6 cases were astrocytomas. Gross total resection (GTR) was achieved in 4 cases, subtotal resection was achieved in 7 cases and partial resection in 4 cases. Major surgical complications included severe postoperative cerebellar edema in 2 cases that required further decompression and hemorrhage in one case that has been managed conservatively.</p><p><strong>Conclusion:</strong> In Alexandria university, the supracerebellar infratentorial approach is considered a safe approach with minimal morbidity and no surgery related mortality.</p><p><strong>Keywords:</strong> Pineal region tumors, Tectal tumors, Supracerebellar infratentorial approach</p> Mahmoud Abbassy, Khaled Aref, Ahmed Farhoud, Anwar Hekal Copyright (c) Mon, 21 Jan 2019 00:00:00 +0000 WITHDRAWN: Combined calcitonin gene-related peptide receptor antagonist, MK-8825, and caffeine as potential therapeutic target in the nitroglycerin-induced rat migraine model (MK-8825 and caffeine in migraine) <p>This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.</p><p>The full Elsevier Policy on Article Withdrawal can be found at <a href=""></a>.</p> Seddik Abdel-Salam Copyright (c) Tue, 22 Jan 2019 00:00:00 +0000