Menoufia University Hospital Research Articles

Study of fatigue in hypothyroid patients

ObjectivesTo assess the association between the severity of chronic fatigue and hypothyroidism.BackgroundFatigue is often described as mainly physical and cognitive and emotional discomfort. Persistent tiredness and fatigue-related symptoms are common in many hypothyroidism individuals.Patients and methodsThis case–control study was carried out on overt hypothyroid and subclinical hypothyroid patients attending outpatient clinics and inpatient endocrinology clinics in Menoufia University Hospital. The participants were classified into two groups: group I (control): 48 patients with normal thyroid-function tests (euthyroid) and group II (cases): 45 patients with overt hypothyroid and subclinical hypothyroid patients (autoimmune hypothyroidism). Patients were subjected to full clinical examination such as weight, height, BMI, and waist and hip circumference, and laboratory investigations such as complete blood count, renal-function test, liver-function test, lipid profile, and thyroid profile. Their fatigue level was assessed by Fatigue Severity Scale (FSS) and Multidimensional Fatigue Inventory.ResultsThe cases had significantly higher body weight, BMI, and waist: hip ratio (P ≤ 0.001). There was a significant positive correlation between FSS and each of thyroglobulin antibodies and thyroid peroxidase (TPO) (P = 0.005, P < 0.001, and P < 0.001, respectively). The univariate linear-regression analysis showed that TPO, free thyroxin, and duration of illness were independently associated with the FSS.ConclusionFatigue is prominent in patients with hypothyroidism. However, TPO, free thyroxin, and duration of illness were independently associated with higher FSS.

Assessment of hepatic steatosis by computed tomography and its relation with coronary artery disease

ObjectivesTo assess the association between nonalcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) frequency and severity using multidetector computed tomography.BackgroundFatty liver disease is a common disorder with an increasing prevalence. It is considered to be an important association with several cardiovascular risk factors and to be a component of metabolic syndrome.Patients and methodsThis study was carried out on 175 patients presented to the Radiology Department at Menoufia University Hospital and some private centers from January 2020 to March 2021 and who were referred from cardiology and internal medicine outpatient clinics. Twenty nine patients were excluded according to the exclusion criteria. All patients were subjected to clinical assessment, coronary CT angiography, and CAD-reporting and data system was used to assess the CAD severity. Nonenhanced CT examination of the liver was used to assess hepatic steatosis.ResultsAmong 146 patients enrolled into our study, 54 (37%) patients were diagnosed with NAFLD; 39 (72.2%) of them showed CAD. There was positive significant association (P = 0.003) between NAFLD and CAD and positive strong association (P = 0.001) between NAFLD and CAD grades by CAD-reporting and data system.ConclusionNAFLD is significantly associated with CAD in a grade-dependent manner, and assessment of NAFLD may be helpful for cardiovascular risk stratification.

Intravitreal injection of ranibizumab for treatment of macular edema secondary to retinal vein occlusion

ObjectiveThis study aims to evaluate the effect of ranibizumab for treatment of macular edema (ME) secondary to retinal vein occlusion (RVO).Patients and methodsThis is a prospective case series study that included 35 eyes of patients with ME due to RVOs. This study was conducted in Menoufia University Hospital during the period study from March 2018 till February 2020. The study protocol was approved by the medical research ethics committee of Faculty of Medicine, Menoufia University.ResultsThere was a significant improvement in the best-corrected visual acuity (VA) value in the fourth month postoperatively than preoperatively, whereas there was no change in the sixth month postoperatively than preoperatively (P1 < 0.025, P2 < 0.17, and P3 < 0.025, respectively). There was a significantly improvement in the central macular thickness (CMT) at 4 and 6 months postoperatively than preoperatively (P1 < 0.001, P2 < 0.001, and P3 > 0.037, respectively). Moreover, there was a significant positive correlation between preoperative CMT and Snellen VA, CMT at fourth month postoperatively, and CMT at sixth month postoperatively (P < 0.05).ConclusionsCMT and best-corrected VA were significantly improvement at 4 and 6 months postoperatively compared with preoperatively. In the current study, during the follow-up, no patients showed any severe local adverse events such as retinal detachment, retinal tears, endophthalmitis, or uveitis, and none showed progression to ischemia or rubeosis iridis. No patients experienced any systemic adverse effects. Finally, evaluation of the short-term effect of intravitreal ranibizumab injection can be used to predict the outcome of the therapy at 1 week and 1 month after injection for the ME secondary to RVO.

Maternal serum vitamin D level in patients complicated by preeclampsia

ObjectivesTo evaluate the relationship between maternal serum vitamin D level and severity of preeclampsia.BackgroundPregnant women with preeclampsia are susceptible to pulmonary edema, coagulation defects, and renal failure. Vitamin D is thought to play a significant role in preeclampsia as an immune modulator. It may help in producing an appropriate maternal immune response to the placenta preventing the release of antiangiogenic factors into the bloodstream and modulating hypertension.Patients and methodsA case–control study was conducted at Department of the Obstetrics and Gynecology, Menoufia General Hospital and Menoufia University Hospital from June 2019 till October 2020. The study was approved by the Ethics Committee, Faculty of Medicine, Menoufia University. This study included 100 pregnant nulliparae divided into two groups: group A included 50 pregnant women with preeclampsia either mild or severe; their blood samples were drawn at the time of delivery to check maternal serum 25-hydroxyvitamin D levels. Group B included 50 women with normal pregnancy; their blood samples were drawn at the time of delivery to check maternal serum 25-hydroxyvitamin D levels. Full history taking, general examination, vital signs, obstetrical examination, ultrasonography, lab investigations, and maternal serum vitamin D level were done for all studied women.ResultsVitamin D level was significantly decreased among the preeclampsia group (10.40–31.00 ng/ml) than the control group (15.50–32.00 ng/ml). There were significant positive correlations between vitamin D deficiency level with systolic blood pressure (r = 0.420) and diastolic blood pressure (r = 0.492).ConclusionVitamin D deficiency has a significant role in the development of preeclampsia. Larger studies including a large sample size are needed to confirm our results about vitamin D deficiency and its relation to preeclampsia.

Management of nonunion of diaphyseal femoral fractures using exchange nailing versus plate augmentation

ObjectivesThe aim of this study was to compare the clinical and radiographic outcomes of exchange nailing versus plate augmentation for the management of patients with nonunion of diaphyseal femoral fractures.BackgroundDue to its superior biomechanical and biological properties, intramedullary nailing of the femur has enjoyed widespread acceptance in the management of femoral diaphyseal fractures. However, nonunion occasionally occurs secondary to malreduction, inaccurate implant placement, and unfavorable fracture pattern.Patients and methodsThis was an interventional prospective cohort study to evaluate the treatment options, which was conducted at the Department of Orthopedics and Traumatology, Menoufia University Hospital between May 2017 and July 2019.ResultsThere was no significant difference between the studied groups as regards postoperative blood loss, P value of 0.183. There was no significant difference as regards preoperative versus postoperative range of motion, P value of 0.561.ConclusionDiaphyseal femoral fracture nonunion can be successfully treated by either exchange nailing and bone grafting or by augmentation plating and bone grafting; however, the later has less operative time and lower reoperation rate.

Is bipolar superior to monopolar energy for transurethral resection of bladder tumors?

ObjectivesTo compare bipolar transurethral resection of bladder tumor (B-TURBT) and monopolar transurethral resection of bladder tumor (M-TURBT) in terms of its perioperative clinical and pathological outcomes.BackgroundBladder cancer is the seventh most diagnosed cancer in the male population worldwide. TURBT is considered the initial treatment and the only method to provide specimens for tumor staging and grading.Patients and methodsThis study was conducted at the Urology Department at Menoufia University Hospital during the period of study from April 2018 and April 2020. After consent, newly diagnosed bladder tumor patients who were planned for TURBT at Menoufia University were randomized into two equal groups: B-TURBT and M-TURBT. All patients were evaluated through careful history, physical examination, routine laboratory investigations, ultrasonography, and contrast-enhanced computed tomography. All specimens were examined by a uropathologist who was blinded to the type of energy used.ResultsThere were no statistically significant differences between both groups regarding patients' characteristics, obturator jerk, bladder perforation, completed resection of the tumor, and serum sodium drop. Bipolar resection group showed significantly shorter resection time (P = 0.009), less hemoglobin drop (P = 0.001), less catheterization time (P = 0.044), and less hospitalization time (P = 0.012). Grade 3 tissue artifact on histopathological examination was 16.6 and 23.5% in bipolar and monopolar groups, respectively, with no statistically significant difference.ConclusionBipolar energy in TURBT is a safe and effective modality as the monopolar one. Bipolar resection is superior to the monopolar one in shortening the resection time, hospital stay and catheterization time and less hemoglobin drop. Both techniques have comparable effects on tissue biopsy, other operative data, and perioperative complications.

Predictors of placental abruption during expectant management of premature preterm rupture of membranes

ObjectiveTo predict the risk factors of placental abruption during expectant management of preterm rupture of membranes.BackgroundA frequency of abruption of 4.0%–6.8% has been reported in patients with preterm premature rupture of membranes (PPROM). Antepartum vaginal bleeding occurs during the period of expectant management, the associated risk of developing placental abruption is high. It may be possible to approximate the risk for placental abruption based on these simple prepregnancy risk factors.Patients and methodsAn observational study was conducted on 100 pregnant women. The patients were randomly selected from those attending labor ward at Menoufia University Hospital and Shebin EL-Kom Teaching Hospital. All women included in this study are with PPROM, divided into group I that included 79 without placental abruption and group II included 21 with placental abruption. Full analysis of detailed history and examination and primarily samples are taken during the study period from January 2019 to December 2020.ResultsThere were statistically significant differences among patients with placental abruption than those without placental abruption regarding antepartum or intrapartum fetal distress requiring urgent cesarean section and gestational age. The majority of patients with placental abruption had gestational age more than 32 weeks (P < 0.05). Most of the patients with placental abruption had latency to its occurrence more than 48 h since the time of admission with PPROM with a percentage of 85.71%.ConclusionPlacental abruption is a complex disease. Although several risk factors are known, the etiopathogenesis is not fully understood and its occurrence often remained unpredictable or unpreventable. Placental abruption was absent in 79% of our patients.

Prevalence of ipsilateral knee ligament injuries associated with femoral shaft fractures in Menoufia University Hospitals

ObjectiveThis study was designed to estimate the prevalence of ipsilateral knee ligament injuries associated with fracture shaft femur in Menoufia University Hospitals.BackgroundIpsilateral knee ligament injuries associated with femoral shaft fractures are a common finding but can be easily missed during early management of initial trauma.Patients and methodsAfter femoral fixation with intramedullary rod placement, external fixation, or plate fixation, all patients underwent a thorough physical examination of the involved limb including varus and valgus stress tests, Lachman test, anterior drawer test, and posterior drawer test, under anesthesia. Clinical assessments were performed and compared with the contralateral knee.ResultsThe most common mechanism of injury observed was RTA. Of the 44 patients who were studied, 15 (34.1%) patients had a knee ligament injury. Of the 15 patients, 47% had a cruciate ligament injury. The ligament injury was not treated at the time of the osteosynthesis procedure.ConclusionWe highlight the difficulty of diagnosis of ipsilateral knee ligament injuries at the time of admission and the need for systemic physical examination after surgical treatment of femoral fractures.

Magnetic resonance brain imaging findings in epilepsy

ObjectivesThe aim was to evaluate the different findings of magnetic resonance brain imaging in epilepsy.BackgroundEpilepsy is a common brain disease that affects both pediatrics and adults. The main role of neuroimaging in epilepsy patients is to identify underlying structural abnormalities. MRI has a high spatial resolution, soft tissue contrast and multiplanar capabilities making it the modality of choice in investigating patients with epilepsy.Patients and methodsThis study was conducted at the MRI Unit, Radiodiagnosis Department at Menoufia University Hospital from October 2019 to September 2021 with the approval of the Menoufia Review Board and prospectively performed after obtaining consent from all patients or, in the cases of children, their parent or guardian. Patients were referred/recruited and subjected to brain MRI. The included patients were diagnosed as having epilepsy according to 2014 criteria of the International League Against Epilepsy.ResultsThe study included 100 patients (51% adults, 53% males, median age 23.87 years). The MRI was normal in 31 patients (31%) while abnormal in 69 patients (69%) with a wide diffuse range of abnormalities. The most common abnormalities were congenital/developmental lesions (27%) followed by brain tumors (26%). The abnormal MRIs were more common with increased age (median age 33 years, P < 0.001), in adults than pediatrics (P < 0.001) and in chronic/recurrent seizures than new-onset seizures (P < 0.001).ConclusionMRI brain assessment of patients with clinically diagnosed epilepsy showed a high prevalence of MRI abnormalities with a diffuse range of etiologies. MRI should be used as an essential tool for assessing patients with epilepsy.

The effect of topical nano vitamin-C iontophoresis versus the effect of trichloroacetic acid 20% peel in treatment of melasma

BackgroundMelasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies, including hydroquinone, tretinoin, corticosteroids, and triple-combination creams.ObjectiveThis study was designed to assess the efficacy of topical nano vitamin C enhanced with iontophoresis and to compare its effect with topically applied trichloroacetic acid 20% chemical peeling in the treatment of melasma.Patients and methodsA right–left comparative study included 30 female patients with their age ranging from 20 to 52 years, who participated for treatment of facial melasma, with melasma duration ranging from 1 to 12 years selected from the cosmetology outpatient clinic of Dermatology Department, Menoufia University Hospitals during the period from September 2020 to March 2021. History and clinical examinations were done for each patient.ResultsThere was a significant positive correlation between Melasma Area and Severity Index score in the sixth session on right sides and age, disease duration, number of pregnancies, and duration from the last pregnancy. There was a significant positive correlation between Melasma Area and Severity Index score in the sixth session on the left sides and the amount of pregnancy and mean percentage of improvement was more on the right than the left side, 58.9 ± 18.8 versus 51.2 ± 18.8, but did not reach the significance level (P > 0.05).ConclusionNanosomal vitamin C with iontophoresis is an easy, safe, effective, painless, and noninvasive method in the treatment of melasma and trichloroacetic acid 20% peel was found as effective in the treatment of melasma.

Onychomycosis: correlation between the dermoscopic patterns and fungal culture

ObjectiveThe aim was to correlate the results of fungal investigations (Direct KOH and fungal culture) with dermoscopic findings on clinically suspected cases of onychomycosis and to evaluate dermoscope as an alternative tool in diagnosis of such cases.BackgroundOnychomycosis is a fungal infection of the nail plate or nail bed. There are four clinical types of onychomycosis: distal and lateral subungual onychomycosis (DLSOM), proximal subungual onychomycosis (PSOM), white superficial onychomycosis (WSOM), and total dystrophic onychomycosis (TDOM).Patients and methodsThis study was conducted at Menoufia University Hospital on 44 patients with a clinical diagnosis of onychomycosis. Full history taking and complete general examination were performed to detect associated systemic diseases. Dermatological examination was done to exclude any associated dermatological diseases that can affect the nails, such as psoriasis, lichen planus, alopecia areata, eczema and/or melanomas. Photography of the nail using digital camera and dermoscopic examination of the nail also were done to our patients.ResultsJagged proximal edge, longitudinal white striae and chromonychia were more frequently observed in patients with DLSOM. Straight onycholytic area was observed in 4 cases of DLSOM. Subungual hyperkeratosis was significantly associated with TDOM. Leukonychia was significantly associated with PSOM. Our results reported that, all dermoscopic patterns were significantly associated with positive fungal growth cultures.ConclusionDermoscope may be considered quick, easy, helpful, effective, and inexpensive tool for confirmation the diagnosis of clinically suspected cases of onychomycosis.

Arthroscopic-assisted versus all-arthroscopic massive rotator-cuff repair: a cohort study of postoperative return to work

ObjectiveTo evaluate arthroscopic-assisted versus all-arthroscopic suture-anchor repair of massive rotator-cuff tears (RCTs), especially regarding postoperative patient's return to work.BackgroundMassive RCTs represent a challenging problem for shoulder surgeons. Management of RCT aims at pain relief, movement restoration, and improvement of the shoulder function.Patients and methodsA prospective study of 38 patients having massive RCT, conducted at Menoufia University Hospital and Neurosurgery Hospital between September 2019 and March 2021. Patients were divided into group A, which included 19 patients who were managed by arthroscopic-assisted technique. Group B included 19 patients who were managed by all-arthroscopic technique. Full history taking with complete clinical examination. All patients have completed 6-month postoperative follow-up.Primary outcomePostoperative patient's time to return to work.ResultsOur results found that postoperatively, there was statistically highly significant improvement in range of motion and University of California, Los Angles score in each group with a statistically nonsignificant difference between both groups. Comparison between both groups in time to return to work: postoperatively, there was a statistically nonsignificant difference between both groups in time to return to work, but in the all-arthroscopic group (group B), the patient returned to work slightly earlier.ConclusionBoth arthroscopic-assisted and all-arthroscopic procedures are effective in management of massive RCTs and result in significant improvement in clinical, functional outcomes, and patients' return to preinjury level of activity and work with a statistically nonsignificant difference between them, and both procedures could be used as an alternative repair method for massive RCTs.

Evaluation of PCR technique as a rapid screening method for detection of Group B streptococci colonization in pregnant women

BackgroundGroup-B streptococci (GBS) colonization in pregnant women could be a source of serious neonatal infections, such as meningitis and sepsis; therefore, a rapid and accurate method for detection is needed for early prophylaxis. Conventional culture is a common method used for the detection of GBS. However, polymerase-chain reaction (PCR)-based assay may be another method for detection of GBS colonization.ObjectiveTo evaluate the performance of the PCR as a method for detection of GBS (Strept. agalactiae) colonization in the urogenital tract of pregnant women and to detect its prevalence among these women.MethodsThe present study was done at the Department of Clinical Pathology and Department of Obstetrics/Gynecology, Menoufia University Hospitals, during the period from June 2020 to June 2021. In this study, vaginal and perianal swabs were collected from 250 pregnant women, between the 35th and 37th weeks of pregnancy, who attended the Department of Obstetrics and Gynecology for perinatal care. Their ages ranged from 20 to 40 years. GBS was detected by culture VITEK2 and PCR was done.ResultsThe prevalence of colonization in pregnant women with GBS was 20%. The sensitivity and specificity of PCR and culture were 99% and 98%, respectively.ConclusionsPCR technique is a rapid, specific, and sensitive diagnostic tool for GBS detection. So, PCR could be used as a rapid test for the detection of GBS colonization in pregnant women. The sensitivity and specificity of automated culture were 99.8% and 89.2%, respectively, so it is also a rapid and specific method for the detection of GBS colonization.

Thorax trauma severity score and trauma injury severity score evaluation as outcome predictors in chest trauma

Objective The aim was to evaluate the performance of thorax trauma severity score (TTSS) in predicting hospital mortality in thoracic trauma and comparing its performance with the trauma and injury severity score (TRISS).Background Because the great risk of thoracic trauma that may be life-threatening especially if uncontrolled, early management of it reduces mortality of polytraumatized patients. TTSS and TRISS were developed for the purpose of prediction of hospital mortality in thoracic trauma.Patients and methods This is a prospective comparative study done on 100 patients with chest trauma, either isolated chest trauma or as a part of polytrauma, who presented to the Emergency Department of Menoufia University Hospital during the period from April 2019 to April 2020. TTSS score was applied to assess its performance and comparing it with TRISS score.Results TTSS and TRISS scores were applied on 100 patients with trauma meeting inclusion criteria to predict the hospital mortality in thoracic trauma. The area under the receiver operating characteristics curve was 0.88 for TTSS score and 0.892 for TRISS score.Conclusion This study demonstrates that the TRISS, and the TTSS, can be used to predict hospital mortality in patients with thoracic trauma; hence, additional prospective studies are required. We believe that the study provides important information regarding validation of the TTSS, as it had a direct correlation with need for oxygenation, ventilator, duration of hospital stay, mortality, or outcome in patients with chest trauma.

Placenta accreta index as a predictor of placental invasion in cases of placenta previa

ObjectiveThis study aims to evaluate the role of the placenta accreta index in predicting placental invasion in patients with placenta previa.Patients and methodsThis study was carried on 60 pregnant women with placenta previa (after 30 weeks gestation). They were recruited from the Obstetrics and Gynecology clinic of Menoufia University hospitals and Shebin El Kom Teaching Hospital in the period from January 2019 to December 2020.ResultsPreterm labor was found in 15 (78.95%) patients in the accreta group and six (14.36%) patients in the nonaccreta group (P = 0.000). Hysterectomy was performed in 14 (73.68%) patients in the accreta group and four (9.76%) patients in the nonaccreta group (P = 0.000). Urological complications occurred in five (26.32%) patients in the accreta group and one (2.44%) patient in the nonaccreta group (P = 0.004). Blood transfusion was needed in 16 (84.21%) patients in the accreta group and seven (17.07%) patients in the nonaccreta group (P = 0.000). ICU transfer was needed in 10 (52.63%) patients in the accreta group and two (4.88%) patients in the nonaccreta group (P = 0.000).ConclusionsBoth grayscale and color Doppler ultrasound were very important in the prenatal diagnosis of placenta accreta to reduce maternal and perinatal mortality and morbidity, but color Doppler had higher sensitivity and specificity. Placenta accreta index score 4 can be used as a predictive cutoff value for prediction of placental invasion in patients with placenta previa. Placenta previa in current pregnancy, previous uterine scar, increased maternal age, number of dilation and curettage and number of pregnancies and labors, and the presence of previous history of placenta previa are all risk factors for placenta accreta, and placenta accreta is associated with increased postoperative morbidity. It is associated with increased blood loss, risk of blood transfusion, ICU admissions, wound sepsis, urological complications, and poor neonatal outcome.

Chitinase-3 protein-like-1 as inflammatory marker and disturbed lipid-profile risk in acne vulgaris

ObjectiveTo evaluate YKL-40 role in acne vulgaris (AV) patients and its potential link to the disturbed lipid profile in AV.BackgroundAV is a cutaneous chronic inflammatory disorder. YKL-40 is an inflammatory glycoprotein associated with metabolic syndrome.Patients and methodsThe study was done on 40 AV patients and 40 apparently healthy individuals attending the Outpatient Clinic of Dermatology Department of Menoufia University Hospitals in the period between March 2020 and January 2021. ELISA technique was used to detect YKL-40 level.ResultsIn the present study, patients and controls were not smokers (82.5 and 80%). About 90% of patients were married. The studied patients and all controls had no systemic treatment, topical treatment, or obesity (85, 90, and 82.5%). High-density lipoprotein was significantly lower in AV patients than in the control group. Cholesterol, triglyceride, very low-density lipoprotein, and low-density lipoprotein levels were not significantly different between both groups. YKL-40 level was significantly higher in AV patients than controls. There was a significant positive correlation between YKL-40 levels with cholesterol level (P = 0.0163), triglyceride (P = 0.001), and low-density lipoprotein (P = 0.045). YKL-40 level had significant negative correlation with high-density lipoprotein level of AV cases (P = 0.008). Receiver-operating characteristic curve analysis shows that more than 9.94 ng/ml was the best cutoff for YKL-40 level to predict the risk of AV patients under an area of 0.711 with sensitivity of 82.5% and specificity of 75.0% with a statistically significant association (95% confidence interval, 0.599–0.807, P = 0.001).ConclusionIt is concluded that higher YKL-40 level was considered as a predictor of AV susceptibility and higher severity.

Role of MRI in the prognosis of hypoxic–ischemic encephalopathy

BackgroundNeonatal encephalopathy is a heterogeneous syndrome characterized by signs of central nervous system dysfunction in newborn infants. The main cause of neonatal encephalopathy can be broadly divided into perinatal asphyxia [hypoxic–ischemic encephalopathy (HIE)], perinatal stroke, metabolic encephalopathy from inborn errors of metabolism, congenital neonatal central nervous system infections, and severe birth trauma.ObjectivesTo highlight the predictive value of MRI as a safe and superior neuroimaging technique in cases of HIE.Patients and methodsThis progressive study was conducted on 30 neonates with HIE referred to the Radiology Department at Menoufia University Hospitals for advanced magnetic resonance techniques assessment during the period from July 2019 to December 2020. The study received the approval of Ethics Committee of Faculty of Medicine, Menoufia University. A written informed consent was taken from the parents or caregivers and written informed consent was obtained from them.ResultsApparent diffusion coefficient (ADC) value was significantly increased with hypertonia (1.75 ± 1.21), hypotonia (1.52 ± 1.51), and MRI than flaccid (0.86 ± 0.67). There was no statistically significant relation between ADC value with time of birth, causes of admission, Apgar score, time of birth at 5 min, Tendon reflex, seizures, periventricular leukomalacia, and intraventricular hemorrhage.ConclusionMRI findings were significantly related with diffusion-weighted (DW) and ADC value. MRI findings indicated that periventricular leukomalacia and basal ganglia ischemia were significantly related with DW. Moreover, it was noted that MRI is a very efficient tool in evaluating morphometric HIE. It's noninvasiveness and no exposure to ionizing radiation is an added advantage. However, experience and understanding of the principles are essential for accurate diagnosis. Also, DW and ADC values may add value to routine MRI examination. However, there is limitation in our study as regards the small number of cases, lack of clinical data, and long-term follow-up of cases.

Assessment of fusion rate with transforaminal lumbar interbody fusion in degenerative lumbar spine diseases

ObjectivesThe aim of the study was to assess the fusion rate with transforaminal lumbar interbody fusion (TLIF) in degenerative lumbar spine diseases regarding its advantages, complications, and clinical outcomes.BackgroundTLIF should offer the same benefits of circumferential fusion with higher safety than other interbody fusion methods because it avoids the direct traction to dura and nerve roots.Participants and methodsThis study included 30 patients suffering from continuous low-back pain due to degenerative lumbar spine diseases, which were treated by TLIF using PEEK banana cage supplemented by pedicle screw fixation in the Orthopedic Department of Menoufia University Hospital during November 2018 till December 2020, with follow up of at least 9 months. All patients were subjected to full history taking, clinical examination, preoperative and postoperative follow-up.ResultsAt preoperative follow-up, all the studied patients had severe Oswestry disability index (ODI). While postoperatively, on the first day all of them cannot be assessed. Also, most of the studied patients (76.67%) had improved to mild ODI after 9 months of follow-up. The ODI showed significantly linear improvement in the studied patients with the greatest improvement observed in at the 3-month follow-up.ConclusionTLIF provides good clinical and radiological outcomes in the management of degenerative lumbar spine diseases after a follow-up period of 9 months. Operative complications are less in the TLIF technique, and the risk of dural tear is diminished significantly. TLIF can save much operative time and blood loss.

Association of maternal serum lipids levels at late gestation with large for gestational age and neonatal macrosomia in nondiabetic women

ObjectivesTo evaluate the relationship between maternal serum lipids at late gestation in nondiabetic women and the risk of large for gestational age (LGA) and neonatal macrosomia.BackgroundLGA is defined as an infant with a birth weight greater than the 90th percentile for the given week of pregnancy. Maternal dyslipidemia can also induce excessive fetal growth by changes in lipid metabolism during pregnancy.Patients and methodsA prospective observational study was conducted on 161 pregnant women aged 20–35 years recruited from the Department of Obstetrics and Gynecology of Menoufia University Hospital and Shebin El-Kom Teaching Hospital from January 2020 till December 2020. The patients included in the study were singleton live pregnancy, pregnant at 37–42 gestational weeks, and naturally conceived. For all patients, detailed history taking, including family history of diabetes mellitus among first-degree relatives, complete clinical examination, and measurements of maternal lipid profile, including total cholesterol, triglyceride (TG), high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol (LDL-C), and fasting blood sugar and 2 h postprandial blood sugar, were done. Obstetric ultrasound was performed to assess fetal growth. Accordingly, patients were classified into three groups as follows: group 1, normal group; group 2, LGA; and group 3, LGA and neonatal macrosomia.ResultsOur results reported that cholesterol level, TG, LDL levels, and fasting blood sugar level were significantly higher in the LGA group when compared with the normal group. These significant higher levels were consistent between the neonatal macrosomic group and the normal group, with the exception of LDL level, which showed a nonsignificant difference. A cutoff level of cholesterol more than 214 has a sensitivity of 93.8%, a specificity of 82.2%, and an accuracy of 85%, whereas a cutoff level of TG more than 244 has a sensitivity of 96.6%, a specificity of 55.3%, and an accuracy of 63%.ConclusionsElevated TG and cholesterol at late gestation are independent predictors for LGA and neonatal macrosomia in nondiabetic pregnant women.

Correlation of anterior ocular-segment biometry with glycated hemoglobin level in type-2 diabetic patients

BackgroundDiabetic retinopathy (DR), nephropathy, and peripheral neuropathy are the common complications of diabetes mellitus. DR is one of the causes of blindness worldwide. Although diabetic-eye disease is often thought to refer merely to the retina, the anterior segment of the eye has also been shown to be affected in diabetes.ObjectiveTo compare the anterior ocular-segment biometry among type-2 diabetes mellitus with no DR, nonproliferative diabetic retinopathy (NPDR), and evaluate the correlation of anterior ocular-segment biometry with glycosylated hemoglobin (HbA1c) level.Patients and methodsA cross-sectional study was conducted on 48 patients. The patients were randomly selected from the Ophthalmology Outpatient Clinic of Menoufia University Hospital. Also, they were divided into group I that included 16 diabetic patients with no DR group, group II included 16 diabetic patients with NPDR group, and group III included 16 healthy participants of comparable age and sex. The results were collected, tabulated, and statistically analyzed. Descriptive statistics included percentage (%), mean, SD, range, and median, and analytic statistics included χ2 test, Student's t test, Spearman correlation, Mann–Whitney test, and analysis of variance (F).ResultsNumbers of angle-opening distance and anterior-chamber angle were significantly increased among diabetic patients with no DR group (524.69 ± 41.92, 29.75 ± 3.28) than diabetic patients with NPDR group (491.06 ± 40.80, 27.50 ± 2.53) and control group (479.00 ± 49.55, 26.94 ± 2.08). Also, central corneal thickness (CCT) was significantly increased among diabetic patients with the NPDR group (561.50 ± 14.93) than diabetic patients with no DR group (505.31 ± 46.15) and control groups (452.06 ± 32.14) (P > 0.05). There were significant positive correlations between HbA1c with age, HbA1c%, CCT, and number of angle-opening distance.ConclusionDiabetic patients appear to have significantly thicker CCT, regardless of retinopathy status, whereas anterior-chamber width was significantly narrower in diabetics with the NPDR group compared with a diabetic with no DR. Development of new noninvasive diagnostic technologies has provided a better understanding of corneal-tissue changes related to diabetes.