Fwd: Current Medical Research and Practice

Current Medical Research and Practice

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Obesity: the major preventable risk factor of obstructive sleep apnea Hager M Nousseir Journal of Current Medical Research and Practice 2019 4(1):1-5 An incre asing prevalence of obesity has led to an increase in the incidence of sleep disordered breathing in the general population. Obesity is associated with anatomic alterations that predispose to upper airway obstruction during sleep, leading to complete or partial cessation of respiration called obstructive sleep apnea. The awareness of this global issue is rising, and health care systems are providing preventive measures, diagnostic, and treatment options for both conditions. To decrease obesity, lifestyle modification (eating behaviors, smoking, drinking alcohol, etc.) and understanding the importance of exercise are needed. If these lifestyle modifications are widely applied, then not only obesity and sleep apnea will be reduced but also the incidence of serious consequences such as cardiovascular disease and health care costs will decrease greatly.

Diagnostic role of cyclin D1 as a new marker for early diagnosis of breast cancer Hanan A Abdel-Azeem, Hesham M Mohamed, Mohamed I Seddik, Noha R Abd El-Hamid Journal of Current Medical Research and Practice 2019 4(1):6-10 Breast cancer is the most frequent cancer in women; in Egypt it affects 37.7% of all women and accounts for 29.1% of their cancer-related mortality. Cyclin D1 protein overexpression is found in up to 50% of breast cancers. The aim of this study is to study the correlations between cyclin D1 level and stages of breast cancer (TNM staging) and to study the correlations between cyclin D1 and routine markers used in breast cancer [cancer antigen 15-3 (CA15-3) and carcinoembryonic antigen (CEA)]. This study was performed on 80 female breast cancer patients. Ten healthy women served as controls. The patients were referred from the Assiut University Hospital and South Egypt Cancer Institute. None of the healthy women in the control group had elevated cyclin D1 level above the cutoff value. Elevated levels of cyclin D1 was detected in 80, 90, 95, and 100% of patients in groups II, III, IV, and V, respectively. There was a significant positive correlation between cyclin D1 positivity with CEA and CA15-3 concentrations. The combination of CA15-3, CEA, and cyclin D1 resulted in the highest sensitivity (95.2%), highest specificity (100%), and highest diagnostic accuracy (96%). The cyclin D1 level in samples obtained from Egyptian women with breast cancer is a good marker for the detection of breast cancer, and in the detection of metastasis as it correlates with the clinical staging of the disease. A combination of CA15-3, CEA, and cyclin D1 may be used as a panel for the diagnosis of metastasis among those patients.

Efficacy and safety of an interferon-free regimen for treatment of recurrent hepatitis C virus infection following liver transplant Ahlam M Ahmed, Abeer S. El-Din Abdel Rehim, Ahmed S. Abd El-Mohsen Moussa Journal of Current Medical Research and Practice 2019 4(1):11-17 Introduction Recurrent hepatitis C virus (HCV) infection after transplantation is aggressive, and its progression to cirrhosis is more rapid than in nontransplant settings. As pegylated interferon based therapies for HCV treatment after transplantation have poor tolerance, poor efficacy, and significant interactions with immunosuppression medications, and this developed the need for a new safe and effective oral regimen. Aim To evaluate the efficacy, safety, and tolerability of sofosbuvir (SOF) in combination with ribavirin (RBV) in treating recurrent hepatitis C after transplantation and also to detect any significant interaction with immunosuppressive therapy. Patients and methods Between August 2014 and January 2016, a single-center, prospective, nonrandomized, open-labeled study was conducted, in which the patients with post-transplant recurrent HCV infection were enrolled. All patients received 400 mg once-daily SOF for 24 weeks with variable dose of RBV. After treatment, patients underwent follow-up for 12 weeks. Results Sixty patients were enrolled, and their mean age was 57.67 years, with 78.3% were male. Overall, 70% had genotype 1 and 61.7% had received previous HCV treatment. At baseline, 21 patients had severe fibrosis. Median time interval from liver transplantation was 51 months, and immunosuppressive therapy was tacrolimus based in 78.3%. Median baseline HCV-RNA was 2.341.172 IU/ml. Among the patients, 12-week sustained virological response was achieved in 43 (71.7%) patients. There was no significant difference in dose and level of tacrolimus during course of therapy. Absence of hepatic encephalopathy, treatment-naive patients, nonsevere fibrosis, and low pretherapy Liver stiffness (LS) values were predictors for sustained virological response. Conclusion Interferon-free regimen containing SOF and RBV is generally safe, well tolerated, and reasonably effective in post-transplantation settings.

Post-laser in-situ keratomileuses effects on visual field in myopia and myopic astigmatism Dalia M. A. Tohamy, Kamel Abdelnaser Soliman, Hany Omar Elsedfy, Walid Saad Eldin Mohamed Journal of Current Medical Research and Practice 2019 4(1):18-24 Background The suction used during the laser insitu keratomileusis (LASIK) procedure necessary for cutting of the cornea by an oscillating blade induces an increase of intraocular pressure (IOP) to approximately 60 mm Hg or even more. This acute increase in IOP during LASIK may endanger the blood flow within the retinal vessels and induce visual field (VF) depression. Purpose To identify the effect of LASIK on the visual field parameters. Settings Prospective interventional case series study performed in ELNOOR ophthalmology center. From October 2015 to October 2016. Methods Prospective interventional case series study including patients with myopia and myopic astigmatism who were deemed candidates for LASIK correction. All recruited patients underwent visual field examination immediately before,1 week and 3 months post LASIK using Humphrey 750 Visual Field Analyzer (Zeiss Humphrey Systems, San Leandro, CA, USA), with a white-on-white Swedish Interactive Threshold (SITA). LASIK procedure was done using Allegretto device (wave light EX500, ALCON, Fort Worth, TX, USA) and Moria microkeratome (MM2). Results 60 eyes of 30 patients were included in our study. Mean age was 28 + 5.6 years (range20-41), mean spherical equivalent (S.E) was -6.1 + 3.2 D (Range -1.4 to -15.1D), mean axial length was 23.5 + 1.5mm (Range 21-26.3mm). Humphrey global indexes included MD and PSD. The MD index estimates the uniform part of VF deviation, while the PSD index estimates the non-uniform part of VF deviation, reflecting the amount of localized depression of the VF. We found that (MD) shows slight decrease 1-week postoperative which is statistically significant, then improved 3 months postoperative with no statistical significant difference between preoperative and 3 months postoperative values. As regards PSD we found that there is no statistical difference between preoperative,1 week and 3 months postoperative. Conclusion The surgery of LASIK is safe and efficient, but surgeons should choose effective and safe suction mode, shorten the suction time and exclude potential retinopathy and preexisting glaucoma before surgery to improve the safety and efficacy. We found that LASIK procedure has no significant effect on visual field parameters, except for diffuse depression that occurs in the first week postoperative.

Risk-stratified outcome of congenital heart surgery in Assiut University Hospital Khaled A Kassem, Mostafa A Abdelaziz, Ahmed I Ismael, Ahmed M Ghoneim Journal of Current Medical Research and Practice 2019 4(1):25-33 Context Assessment of surgical performance in the field of congenital heart surgery is very difficult, so many risk scoring systems have been developed. The most popular used systems nowadays are the risk adjustment for congenital heart surgery (RACHS-1) system, Aristotle basic complexity score (ABC score), and the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) mortality score and categories. Aims The aims of the study were the application of the three popular risk scoring systems to Assiut University Hospital for evaluation of the outcome results, determination of the correlations between the mortality and morbidity to the risk categories of these systems, comparison with other cardiac centers worldwide, and managing the factors that lead to different outcome in an attempt to improve our performance. Materials and methods A retrospective descriptive study including all pediatric patients (ages ranging from 0 to 16 years old, excluding preterm babies) who underwent cardiac surgery in Assiut University Hospital between January 2008 and December 2017 was conducted. Statistical analysis The receiver operating characteristic curve and univariate and multivariate analyses were performed with SPSS 16.0 for Windows. Results Postoperative in-hospital mortality was 5.8%, with increasing mortality rates at the higher levels of the RACHS-1 and the ABC. The mean ABC score was 5.57 ± 2.07, which represents a complexity between ABC levels 1 and 2. The mean STS-EACTS mortality score was 0.375 ± 0.376, which placed our complexity of procedures into categories 1–2. Conclusion The RACHS-1, ABC, and STS-EACTS mortality scoring systems are useful tools for assessing mortality discharge in a medium volume cardiac center in Egypt. These scores imply a procedural-based level of complexity in the institute, which would be useful information for a longitudinal study.

Left ventricular mass index as a prognostic factor in children with chronic kidney disease Salah-Eldin A Ahmad, Ahlam B Ali, Zeinab Abdallah Journal of Current Medical Research and Practice 2019 4(1):34-37 Objective The objective of this study was to evaluate the effect of decreasing renal function on left ventricular mass index (LVMI) in children with chronic kidney disease (CKD) on regular hemodialysis attending Assiut University Hospital for Children, and also to evaluate left ventricular mass changes as predictor of morbidity and mortality of uremic children by using echocardiography, aiming to use it in the future. Patients and methods Baseline clinical characteristics were collected by careful history and examination. Routine laboratory methods were used to measure biochemical parameters: hemoglobin, C-reactive protein, phosphorus, calcium, parathyroid hormone, and lipid profile after patients fasted for 8 h. Echocardiographic parameters were measured within 2–24 h after a dialysis session. Results In this study, we studied 36 children on regular hemodialysis. The age of our patients ranged from 3.5 to 16 years, and the number of male patients was similar to female patients. In our study. we found eccentric left ventricular hypertrophy was predominant (38.9%) compared with concentric left ventricular hypertrophy (13.9%). We found that 52.8% of patients had increased LVMI and 47.2% had normal LVMI. Regarding the fate of our cases, 39% died during the study period, whereas the other 61% survived. Mortality among patients with increased LVMI was higher (28%) than among patients with normal LVMI (11%). Conclusion Children with CKD are prone to development of cardiac dysfunctions, so early and regular echocardiographic studies of all children with CKD to detect early cardiac changes and institute interventions and follow-up are required.

Retrospective study in cases of pregnancy-induced hypertension admitted to the ICU at Women Health Teaching Hospital of Assiut University Golnar M Fathy, Sayed K Abd-Elshafy Mahmoud, Bahaa K AbdelNoor Journal of Current Medical Research and Practice 2019 4(1):38-43 Objective The aim of the study was a retrospective analysis of the causes and risk factors of ICU admission, postoperative management, and outcomes of patients with pregnancy-induced hypertensive disorders. Background Hypertensive disorders of pregnancy, including severe preeclampsia and eclampsia, complicate about 10% of pregnancies worldwide, constituting one of the chief causes of maternal and perinatal morbidity and mortality worldwide. Patients and methods Our retrospective study included 186 cases of antenatal and postpartum severe preeclampsia and eclampsia patients admitted to the ICU in Assiut Woman Health Hospital in 24 months. All patients showed manifestations of severe preeclampsia or eclampsia. The study obtained an institutional ethical approval. Results In this study, the most frequent complication was HELLP (hemolysis, elevated liver enzyme levels, and low platelet levels) syndrome that occurred in 25 (13.44%) women followed by renal impairment, cerebral hemorrhage, and pulmonary that occurred in 11 (5.91%), 10 (5.37%), and nine (4.83%) women, respectively. Unfortunately, permanent blindness affected three (1.61%) women in this study and 12 (6.45%) women encountered death. Improvement occurred in 160 (86%) women, whereas six (3.22%), five (2.28%), and five (2.68%) women were transferred to other departments namely neurological, nephrological, and cardiology wards, respectively. Conclusion Reducing maternal morbidity and mortality, pregnancy-induced hypertension patients require early admission and appropriate management in the ICU.

Clinical and laboratory outcomes of stem cell transplantation in patients with decompensated liver cirrhosis: single-arm pilot trial Saad Z Mahmoud, Ehab F Abdo, Shaaban R Helal, Heba Saad Eldien, Doaa Abdeltawab, Alaa Soliman Abd-Elkader Journal of Current Medical Research and Practice 2019 4(1):44-49 Introduction The high prevalence of hepatitis C virus-associated liver disease has led to increasing number of Egyptian patients having end-stage liver disease and requiring liver transplantation. Because of several limitations of liver transplantation, new alternative treatment modalities are required for patients with liver cirrhosis. Many study results encourage the use of autologous bone marrow-derived mesenchymal stem cells (MSCs) for liver diseases. Aim The aim of this study was to assess the efficacy of using bone marrow-derived MSC on clinical manifestations, liver function, Child–Pugh score, and Model for End-stage Liver Disease score in patients with decompensated liver cirrhosis. Patients and methods This is a pilot single-arm prospective trial that included 13 patients with hepatitis C virus-associated liver cirrhosis who received transdifferentiated MSC via ultrasound-guided percutaneous portal vein infusion plus regular conventional treatment for patients with cirrhosis. Patients were followed up weekly for the first month and monthly for 6 months. Results There was significant improvement in some clinical manifestations, including frequency of attacks of hematemesis, ascites, and lower limb edema after MSC infusion compared with baseline data. Moreover significant increase was detected in mean serum albumin level as it began with 24.62 ± 3.93 and became 27.81 ± 4.14 (P = 0.009) after 6 months of follow-up. Moreover, the results showed improvement in Child–Pugh, but no changes were detected in Model for End-stage Liver Disease score after MSC infusion compared with baseline. Conclusion Our data show that transdifferentiated MSC injection may improve some clinical manifestations and some indices of liver function in patients with decompensated liver cirrhosis with successful tolerability.

Safety of sildenafil citrate in the management of hypertensive disorders of pregnancy Hasan S Kamel, Hisham A Abou-Taleb, Fady N Abdallah Journal of Current Medical Research and Practice 2019 4(1):50-55 Objective This study investigated the safety of sildenafil citrate in managing hypertensive disorders of pregnancy. Patients and methods In a randomized, double-blind, placebo-controlled trial, 122 singleton pregnancies with mild pre-eclampsia between 28 and 36 weeks of gestation were randomized to either use oral sildenafil citrate tablets with antihypertensive or antihypertensive alone. The primary outcome was occurrence of maternal and/or neonatal complications. Results Headache was the most frequent adverse effect in the study and is significantly higher in the intervention group [22 (36.1%) vs. 12 (19.7%) in placebo group; P = 0.03]. In the intervention group, headache was dose related. The headache was tolerable in the majority of patients. The intervention group has an insignificant lower incidence of intrauterine growth restriction than the placebo group (1.7 vs. 6.7%, respectively, P = 0.31). The incidence of oligohydramnios was significantly higher in the placebo group than in the intervention group (16.7 vs. 8.5%, respectively, P = 0.03). No intrauterine fetal deaths have occurred in our study, and only one neonatal death occurred in the placebo group. Conclusion Using sildenafil citrate in addition to other antihypertensive drugs in the management of mild pre-eclampsia is safe and has a better maternal and neonatal outcome.

A descriptive study on the diagnosis and treatment of ventilator-associated pneumonia in the neonatal intensive care unit of Assiut University Children's Hospital Ahmed A Mohammed, Ahlam B Ali, Nafisa H Refaat Journal of Current Medical Research and Practice 2019 4(1):56-60 Background Neonatal ventilator-associated pneumonia (VAP) is a common nosocomial infection and a frequent reason for empirical antibiotic therapy in neonatal intensive care units. Patients and methods Reviewing data of diagnosis and management of neonates with VAP admitted to Assiut University Neonatal Intensive Care Unit was carried out during a period of 1 year. Results The current study was carried out at Assiut Children University Hospital during the period spanning between October 2016 and November 2017 to audit the clinical practice towards management of neonates with mechanical VAP. It included 50 neonates who were diagnosed to have mechanical VAP. Conclusion The incidence of suspected VAP and concomitant antibiotic use is much higher than for confirmed VAP; therefore, inclusion of suspected episodes should be considered for accurate evaluation. There is a high diagnostic inconsistency and a low reliability of interpretation of chest radiographs with regard to VAP. Implementation of combined antimicrobial stewardship and infection control measures may lead to an effective decrease in VAP incidence and antibiotic use.