Menoufia University Research Articles

Effect of Supine versus Sitting Position on Post-Dural Puncture Headache among Patients Receiving Spinal Anesthesia

One of the most commonly reported complications associated with spinal anesthesia is post-dural puncture headache, even while, the precise mechanisms causing post-dural puncture headache are still not well known, which if left untreated, can lead to severe complications such as subdural hematoma and convulsions. The aim of the current study was to evaluate the effect of supine versus sitting position on post-dural puncture headache among patients receiving spinal anesthesia. Design: A quasi-experimental research design Sitting: The present study was carried out at the Menoufia University Hospital's urology and orthopedic surgery departments, Menoufia Governorate, Egypt. Subjects: A purposive sample of 100 adult patients with spinal anesthesia who volunteered to participate in the study and met the inclusion criteria were randomly divided evenly into two study groups. Tools: For data gathering, three instruments were utilized in this study are: 1.Patients' characteristics questionnaire was used to analyze their sociodemographic features, as well as their past, present, and family medical history 2. Visual Numerical Analogue Scale (VAS) was adopted for headache Severity evaluation 3.Headache Impact Index had been adopted to grade severity of post-dural puncture headache's associated complications. Results: There were a statistically significant decrease in post-dural puncture headache's incidence, severity and associated complications among supine position group (study group I) subjects than among sitting position group (study group II) subjects with statistically significant differences existed between the two studied groups. Conclusion: Maintaining patients in supine position for the first 72 hours post spinal anesthesia as a management technique significantly improved their post-dural puncture headache's incidence, severity and associated complications. Recommendations: Designing a plan of care for post-spinal anesthesia patients should include positioning as a simple management technique that could lead to preferable effects regarding their post-dural puncture headache's incidence, severity and associated complications. Replication of the current study on a larger sample size and for longer follow-up period to allow for results' generalization

Effect of Workplace-Based Assessment Utilization as a Formative Assessment for Learning Among Family Medicine Postgraduates at the Faculty of Medicine, Menoufia University: A Prospective Study.

Background Workplace-based assessment (WBA) is a group of assessment approaches that assesses the trainees' performance through their observation and monitoring in real clinical settings and then provides them with constructive and relevant feedback. Many WBA tools are available, including the mini-clinical evaluation exercise (mini-CEX), direct observation of procedural skills (DOPS), case-based discussions, and multisource feedback (peers, seniors, and patients). A WBAcan help medical students improve their clinical competencies and ensure that qualified physicians graduate. Methods This prospective study was done in the family medicine department at the Menoufia Faculty of Medicine in Egypt and passed through two phases. Phase I was introducing an orientation lecture for family medicine staff and a convenient sample of 21 family medicine postgraduates about WBA. Phase II was conducting a monthly mini-CEX and DOPS for the postgraduates. Finally, students' satisfaction with the WBA was assessed, and all collected data were analyzed via Statistical Package for Social Science (SPSS) version 23 (IBM Corp., Armonk, NY). Results A total of 105 feedback sheets were obtained. These feedback sheets were subdivided into 63 mini-CEX feedback sheets (21 sheets from each mini-CEX session for three sessions) and 42 DOPS feedback sheets (21 sheets from each DOPS session for two sessions), all of which were collected and analyzed. A significant improvement was detected in the mini-CEX and DOPS feedback scores of the postgraduates throughout the consecutive sessions (9.5 ± 2.7, 24.9 ± 2.5, 27.29 ± 1.5) (P < 0.001) for Mini-CEX and (6.1 ± 1.8 versus 9.0 ± 1.2) (P < 0.001) for DOPS. About 93% of the postgraduates recommended the application of WBA for their peers, and 86% of them requested to perform it again for other different clinical cases and procedures. Conclusion Workplace-based assessment in the form of Mini-CEX and DOPS revealed its ability to improve clinical knowledge and skills among family medicine postgraduates who became motivated to undergo it again in search of improving their clinical performance and reducing their stresses related to final summative and objective structured clinical examinations (OSCEs).

Assessment of bone mineral density and bone turnover markers in patients with juvenile idiopathic arthritisy

Juvenile idiopathic arthritis (JIA) is one of the most common chronic inflammatory diseases occurring in childhood, associated with decreased bone mineral density (BMD) and increased risk of osteopenia and osteoporosis, which increases the fracture risk. Aim of the work: to assess BMD and bone turnover markers (serum osteocalcin for bone formation and C terminal telopeptide of type 1 collagen for bone resorption) in JIA patients and their relation to disease activity. This study included 50 patients with JIA (female:male – 20:30). The study was approved by the Ethical Research Committee and Institutional Review Board of the Faculty of Medicine, Menoufia University, Egypt (Approval number: 19519INTPH48). Written informed consent was obtained from each patient or the parents. These patients were diagnosed with JIA according to the criteria of classification of the International League of Associations for Rheumatology. BMD was measured by Dual-energy X-ray absorptiometry (DEXA) of the lumbar spine using the Z-score. The results were correlated with JIA disease duration, disease activity, bone turnover markers and serum level of vitamin D. Clinical disease activity was evaluated by juvenile arthritis disease activity score (JADAS-27). There was a significant negative correlation between DEXA Z-score and disease activity (p-value &lt; 0.001), bone turnover markers (p-value &lt; 0.001), and duration of JIA (p-value &lt; 0.05). There was a significant difference between vitamin D level and DEXA Z-score; DEXA Z-score was lower in vitamin D deficient patients. JIA patients with higher disease activity are at a higher risk of osteopenia and osteoporosis. Well-timed and efficient treatment of JIA and proper control of disease activity may help to improve the bone status and reduce the incidence of osteoporosis. Consequently, valuable targeted interventions are essential to preserve bone health during JIA.

Brain-derived neurotrophic factor and neuroimaging in pediatric patients with sickle cell disease

BackgroundThe risk of neurological complications is increased in children with sickle cell disease (SCD), such as silent cerebral infarction (SCI) and stroke. Brain-Derived Neurotrophic Factor (BDNF) is a nerve growth factor associated with elevated transcranial Doppler (TCD) velocities and increased risk of stroke in SCD patients. So, we assessed the BDNF level in children with SCD and its relation to neurological complication as silent stroke.MethodsA comparative cross-sectional study was conducted on 40 patients with SCD, recruited from the Hematology Unit, Pediatric Department, Menoufia University Hospital, and 40 healthy children as controls. Laboratory investigations including BDNF were done. TCD was done for all patients and Magnetic Resonance Imaging (MRI) was done on high-risk patients.ResultsBDNF levels were significantly higher in children with SCD than in controls with a significant relation to TCD findings. There was a statistically significant diagnostic ability of BDNF in the prediction of SCD complications as its sensitivity was 89.5%, specificity (95% CI) was 80% with a cut-off point >0.69, AUC = 0.702, and p = 0.004).ConclusionSerum BDNF levels were higher in sickle disease patients who had abnormal transcranial Doppler. BDNF had a significant diagnostic ability in the detection of SCD complications.ImpactSilent stroke is a very serious complication in children with sickle cell disease, so regular follow up should be every six months.BDNF is considered a potential biomarker for stroke risk prediction in patients unable to receive TCD.

Association of chorioretinal thickness with chronic kidney disease

ObjectiveTo assess retinal and choroidal thickness changes in chronic kidney disease (CKD) patients using spectral domain optical coherence tomography (SD-OCT).BackgroundCKD is a devastating health trouble. The eye and the kidney share similar structural and genetic pathways, so that kidney disease and ocular disease may be closely linked. OCT is a precise, fast method for high-definition scanning of the retina and choroid.Patients and methodsA cross sectional study was conducted at Menoufia University Hospital ophthalmology department on 144 eyes of 72 CKD patients divided into 3 groups according to the stage of CKD as follows: group 1: CKD stage 1–2, with Glomerular Filtration Rate (GFR) > 60 ml/min/1.73m2 group 2: CKD stage 3, GFR 30–59 ml/min/1.73m2 and group 3: CKD stage 4–5, eGFR < 29 ml/min/1.73m2. All patients underwent full ophthalmologic examination followed by OCT assessment of retinal, retinal nerve fiber layer (RNFL) and choroidal thickness.ResultsRetinal and choroidal thickness were reduced in group 2 (CKD stage 3) and group 3 (CKD stage 4–5) compared with group 1 (CKD stage 1–2). The reduction was more severe in group 3 than group 2. RNFL thickness did not differ between groups. A thinner retina and choroid were associated with an elevated serum C-reactive protein (CRP) concentration, and greater degrees of proteinuria.ConclusionChorioretinal thinning in CKD is associated with a lower eGFR, a higher CRP, and greater proteinuria. Further studies, in a large scale of patients, are needed to detect whether these eye changes reflect the natural history of CKD.

Pediatric sepsis diagnostic and prognostic biomarkers: pancreatic stone protein, copeptin, and apolipoprotein A-V

BackgroundWe assessed serum concentrations of pancreatic stone protein (PSP), copeptin, and apolipoprotein A-V (APOA5) biomarkers for the diagnosis and prognosis of pediatric sepsis, a condition associated with high mortality.MethodsThis prospective study included 180 children admitted to the Pediatric Intensive Care Unit and 100 healthy controls at Menoufia University Hospital. Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality-2 (PIM2), and Pediatric Sequential Organ Failure Assessment (pSOFA) scores were calculated. Serum PSP, copeptin and APOA5 were measured once within 24 h of admission.ResultsPSP, copeptin, and APOA5 were significantly higher in the patients than in the controls (p < 0.001). PSP and copeptin were increased among children who required mechanical ventilation (MV), had multiple organ dysfunctions, and were non-survivors, but APOA5 was decreased in those children. Logistic regression analyses showed that high pSOFA, high PSP and copeptin, low APOA5, and use of MV were associated with mortality. The receiver operating characteristic revealed that the area under the curve (AUC) for APOA5, copeptin, and PSP (0.965, 0.960, and 0.868, respectively) demonstrated high sensitivity (96%, 94%, and 80%) for sepsis diagnosis. The AUC values for PSP, copeptin, and APOA5 were 0.709, 0.705, and 0.571, respectively, with sensitivities of 74%, 58%, and 58% for mortality prediction.ConclusionsPSP, copeptin, and APOA5 are promising diagnostic biomarkers for pediatric sepsis but inadequate predictors of mortality.ImpactApolipoprotein A-V (APOA5), copeptin, and pancreatic stone protein (PSP) are acute-phase proteins with diagnostic value in evaluating critically ill pediatric patients with sepsis and detecting sepsis severity.PSP and copeptin had the power to discriminate non-survivors from survivors.APOA5 was less powerful than the other biomarkers in discriminating between survivors and non-survivors.

Abdominal Sacrohysteropexy using Proline mesh versus Mersilene tape in apical prolapse: A randomized clinical trial

Importanceuterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. Objectivecompare between using Polyproline mesh and Mersilene tape in abdominal Sacrohysteropexy repairing apical prolapse stage ӀӀ or more. Study designThis RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned Sacrohysteropexy for uterine prolapse ≥ stage 2 assigned to two groups: Mesh group (n = 38), underwent Sacrohysteropexy with polyproline mesh, and Tape group (n = 38), underwent Sacrohysteropexy using Mersilene tape. ResultsHigh statistically significant difference between TAPE group and MESH group concerning hysteropexy time was 50.4 min in TAPE group vs 90.6 min in MESH group (p < 0.001), need for post operative analgesia was14 in TAPE group vs 27 in MESH group (p < 0.005). The mean hospital stay was 2.8 days in TAPE group vs 5.2days in MESH group (p < 0.001). ConclusionsUsing Mersilene tape in Sacrohysteropexy is a safe alternative to Polyproline Mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.

Comparación entre el uso de malla de prolene y cinta de mersilene en la sacrohisteropexia abdominal para el prolapso apical: ensayo clínico aleatorizado

BackgroundUterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. ObjectiveCompare between using polyproline mesh and mersilene tape in abdominal sacrohysteropexy repairing apical prolapse stage ?? or more. Study designThis RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned sacrohysteropexy for uterine prolapse≥stage 2 assigned to 2 groups: Mesh group (n=38), underwent sacrohysteropexy with polyproline mesh, and tape group (n=38), underwent sacrohysteropexy using mersilene tape. ResultsHigh statistically significant difference between tape group and mesh group concerning hysteropexy time was 50.4minute in tape group vs 90.6minute in mesh group (P<.001), need for post operative analgesia was 14 in tape group vs 27 in mesh group (P<.005). The mean hospital stay was 2.8 days in tape group vs 5.2days mesh group (P<.001). ConclusionsUsing mersilene tape in sacrohysteropexy is a safe alternative to polyproline mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.

Application of workplace-based assessment for family medicine postgraduates students in faculty of medicine Menoufia university

Background: Formative assessment is one of the most valuable approaches that could help medical students to learn and improve their clinical knowledge and skills. Its value comes from the informative and constructive feedback after careful observation of the candidates by their medical educators.

Does amyloid β precursor protein gene expression have a role in diagnosis of biliary atresia?

Biliary atresia (BA) is an important cause of surgical jaundice. Although the precise etiology is unknown, β-amyloid (Aβ) has been observed around the bile ducts in BA livers. It is unclear whether Aβ plays a role in the pathogenesis of this disease. This study aims to assess the amyloid β precursor protein (APP) gene expression in infants with BA in comparison with other causes of neonatal cholestasis. This could help explore the role of Aβ in the pathogenesis and diagnosis of BA. A prospective study was conducted at the outpatient clinic of Paediatric Hepatology, Gastroenterology, and Nutrition Department, National Liver Institute, Menoufia University, Shebin El Kom, Menoufia, Egypt during the period March 2022 to December 2022. Clinical data were gathered and laboratory and radiological investigations were conducted including β precursor protein gene expression measured in liver biopsies of the three groups using quantitative real-time PCR (qPCR). Gene expression of APP was considerably higher in the BA group (p = 0.0001) compared to neonatal cholestasis (NC) patients. Gamma glutamyl transferase (GGT) and APP had a positive correlation (p = 0.001). No significant association was found between APP and fibrosis. APP was noticeably higher in BA than NC other than BA. Also, APP in BA was higher (statistically significant, p = 0.0001) than the control. There was no statistically significant difference among NC, BA, and control groups regarding APP (p = 0.07). Both males and females did not show significant differences as regards APP (p = 0.851). Age did not have a statistically significant correlation with APP (p = 0.532). Also, there were no correlations between APP and alkaline phosphatase (ALP), aspartate transaminase (AST), or total bilirubin (TB) (p > 0.05). We concluded that the development and identification of BA may depend on the liver expression of serum APP. Surgeons may be able to carry out early intraoperative cholangiography for BA confirmation if the combination of APP with GGT and other hepatic function parameters exhibits a high predictive potential as a diagnostic test for BA. To evaluate this hypothesis, more research with sizable sample numbers is necessary.

APRI and FIB-4 indices as diagnostic noninvasive scores for prediction of severe fibrosis in patients with biliary atresia.

Biliary atresia (BA) is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder. The aspartate aminotransferase to platelet ratio (APRI), and Fibrosis-4 (FIB-4) scores are commonly used compound surrogates for advanced fibrosis. However, the use of APRI and FIB-4 entails a risk of overestimating the fibrosis stage due to the impact of necroinflammatory activity on transaminases. So, we determined the optimal cutoff values of the APRI and FIB-4 indices in prediction of fibrosis in BA patients. The aim of the study was to evaluate the validity of the APRI and FIB-4 indices in prediction of fibrosis in patients with BA. A cross sectional hospital-based study was conducted on 121 children complaining of BA attending the National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt, during the period from January 2022 to February 2023. The APRI score was significantly higher among neglected BA than BA type II a, BA type III, type II b and type I (p = 0.001). Also FIB-4 was significantly higher among neglected BA than BA type II a, BA type II b, type III and type I (p = 0.001). Receiver operating characteristic (ROC) curve analysis showed that the cutoff point of the APRI score in prediction of fibrosis in patients with BA was 1.29, with sensitivity of 88.6% and specificity of 76.0%, while the cutoff point of FIB-4 in prediction of fibrosis in patients with BA was 9.82 with sensitivity of 89.0% and specificity of 70.0%. Our study confirms that FIB-4 and APRI scores are both able to predict severe fibrosis. APRI score and FIB-4 are good non-invasive alternatives to liver biopsy in the detection of liver fibrosis and its extent in patients with BA.

Anxiety and depression in patients with obstructive sleep apnea before and after treatment with continuous positive airway pressure

Aim To evaluate the prevalence of anxiety and depression in patients with obstructive sleep apnea (OSA) and effect of continuous positive airway pressure (CPAP) or weight reduction treatments on anxiety and depression. Background OSA is a life-threatening condition. Poor sleep quality, frequent arousals during sleep, and intermittent hypoxia that accompany patients with OSA could contribute to psychological disturbances. Patients and methods A total of 40 patients with OSA (19 males and 21 females) who were admitted to the Chest Department of Menoufia University Hospitals were included and divided into two groups based on different treatment: 20 patients were treated with CPAP and 20 patients were treated with weight reduction. Results There were no significant differences between both groups regarding age, sex, and BMI. The patients in both groups had high scores in Hamilton anxiety rating scale, Hamilton depression scale, and quality-of-life scale. CPAP and weight reduction treatment for 3 months resulted in significant improvements of anxiety and depressive symptoms. The Hamilton anxiety rating scale decreased from 11.7 ± 6.5 to 3.3 ± 1.8 in group 1 and from 9.6 ± 4.4 to 3 ± 2.1 in group 2, whereas the Hamilton depression scale score decreased from 16.5 ± 5.8 to 4.8 ± 2.1 in group 1 and from 17.5 ± 6.4 to 5.7 ± 2.6 in group 2 (both P&lt;0.001). There were significant improvements in the quality of life in the two groups after 3 months of treatment. Conclusion Anxiety and depression are associated with OSA which improved after CPAP and weight reduction treatment.

Outcomes of mini-open retrograde intramedullary headless screw fixation of metacarpal fractures

Abstract Background Metacarpal fractures accounting around one-third of hand fractures, which account for ten percent of all fractures and happen predominantly between the ages of 30 and 40. This research objected to examine the radiological, functional, and complication-reduction effects of closed reduction and internal fixation utilizing headless compression screws in metacarpal fractures cases. Patients and methods This prospective one-arm research involved 24 subjects with a total of 25 unstable metacarpal neck and shaft fractures surgically treated at Menoufia university hospital and Sheikh-Zayed Specialized, Egypt. They were controlled with intramedullary headless compression screws (IMHS). Results Complications were reported in 5 (20.8%) patients, Union of fracture was reported in 23 (95.8%) patients. The mean TAM score was 250.63 ± 19.58 ranging between 180 and 260 with a median of 260. The mean dash score was 1.75 ± 2.91 ranging between 0 and 11.36 with a median of 0.00. Conclusion The metacarpal fractures IMHS fixation is an effective, safe, and complication-free treatment and looked to need less imposing and restore function more quickly.

Colistin Susceptibility among Carbapenem Resistant Klebsiella pneumoniae Isolated from Menoufia University Hospitals

Colistin Susceptibility among Carbapenem Resistant Klebsiella pneumoniae Isolated from Menoufia University Hospitals

Cross Matching to Transfusion Ratios: Comparison between Menoufia University Surgical Departments, Egypt. Surprising Results

Cross Matching to Transfusion Ratios: Comparison between Menoufia University Surgical Departments, Egypt. Surprising Results

Prevalence of SEN Virus and Torque Teno Virus in Hemodialysis Patients and Healthy Blood Donors in Menoufia University Hospitals

Prevalence of SEN Virus and Torque Teno Virus in Hemodialysis Patients and Healthy Blood Donors in Menoufia University Hospitals

Pattern and Risk Factors of Suicide Mortality in Children among Cases arrived at Menoufia University Hospitals and analysis through the Suicide Assessment Five-Step Evaluation and Triage

Pattern and Risk Factors of Suicide Mortality in Children among Cases arrived at Menoufia University Hospitals and analysis through the Suicide Assessment Five-Step Evaluation and Triage

The Effectiveness of a Mobile Learning Strategy via WhatsApp in Developing EFL Prospective Teachers' Reading and Writing Skills

The aim of this study is to investigate the effectiveness of the mobile learning strategy via WhatsApp in developing EFL reading and writing skills among third -year prospective teachers. The participants included (30) third -year prospective teachers at English department at the Faculty of Education, Menoufia University. They are assigned to one study group. To reach the goal of the study, the researcher prepared an integrated reading - writing skills checklist, an integrated reading –writing skills pre-test, an integrated reading–writing skills post-test, and an integrated reading –writing skills rubric. The mobile learning strategy via WhatsApp is designed to develop EFL reading skills and writing skills among third -year Prospective teachers at the Faculty of Education. Results show that mobile learning strategy via WhatsApp emphasized it is effective in improving third year prospective teachers’ reading and writing skills. Thus, the suggested app is effective in developing EFL reading and writing skills among third year prospective teachers.

Calprotectin as a Biomarker for Diagnosis and Severity of Acute Noninfectious Anterior Uveitis in Egyptian Patients.

To study the relation between serum calprotectin level and acute noninfectious anterior uveitis in Egyptian patients. An observational prospective study carried out at Menoufia University Hospital during the period from March 2021 till June 2022, after informed consent from all studied patients. This study included 20 eyes of patients with Acute Anterior Uveitis (AAU) and 20 eyes healthy individuals matched sex and age as the control group. Full history taking, ophthalmological examination and serum calprotectin levels were performed for both patients and controls. Serum calprotectin levels were substantially higher in patients' eyes with acute anterior uveitis than in healthy eyes (61.45±7.89 vs 32.50±11.64; 95% CI: 22.58-35.32; P < 0.001). ROC curve analysis showed that the cut-off point of serum calprotectin in severity detection of AAU was ≥58.0, with sensitivity of 95%, specificity of 43% at AUC of 0.986, with reached to significant level (p < 0.001). Serum calprotectin levels were significantly elevated with positive previous uveitis and marked grade indicating a possible role of calprotectin in the pathogenesis of non-infectious AAU. The serum calprotectin cut-off points for severity detection of AAU were 58.0, with sensitivity of 95% and specificity of 43%. Finally, we identified serum calprotectin as a potential biomarker for detection of anterior uveitis severity and patients' morbidity risk. Further investigation with large sample size is needed to assess the relationship between calprotectin and uveitis activity.

Extracorporeal versus intracorporeal stapled anastomosis in laparoscopic right hemicolectomy: preliminary results of Menoufia University Hospital experience

article: Extracorporeal versus intracorporeal stapled anastomosis in laparoscopic right hemicolectomy: preliminary results of Menoufia University Hospital experience - Chirurgia 2022 December;35(6):329-34 - Minerva Medica - Journals