Menoufiya University Hospital Research Articles

SERUM CORTISOL LEVEL AND DEPRESSION AMONG SHIFT-WORKING NURSING STAFF IN A UNIVERSITY HOSPITAL

Introduction: Night shift is one of the most frequent reasons for disturbance of circadian rhythm, altering biological functions and can negatively affect physical, psychological well-being and work performance. Aim of work: To evaluate the associations between circadian rhythm differences in shift-working nurses by using serum cortisol level and depression. Materials and Methods: a cross-sectional study was conducted by means of anonymous self-administered questionnaire for one hundred ninety-two nurses working at Menoufiya University Hospital, Shebin Al-Kom City, Egypt. The study involved 96 nurses working night-shifts and 96 in day-shifts. To assess their depression levels, self-rated depression scale (SDS) was used. Serum cortisol level was measured at 8:00 am for all respondents. Results: The response rate was 97%. A significant increase in serum cortisol level was observed among night-shift respondents compared to day-shift ones. Among night-shift workers, older nurses with more years of employment and higher cortisol levels were significantly more prone to develop depression (P<0.001). Conclusion: Nurses working night-shifts need special attention due to the higher risk of depression and possibly other undesirable health effects. Systems for early identification of nurses with depression and for providing environments allowing nurses at work to take rest and relax in the early morning after night shift are necessary.

L-carnitine serum level in healthy and septic neonates

Objective The aim was to measure plasma l-carnitine concentration in healthy and septic neonates, and the relation between l-carnitine concentration and gestational age, birth weight, and presence of neonatal sepsis. Background Neonatal sepsis and endotoxemia result in impaired lipid metabolism and hepatic energy generation from fatty acid oxidation which could put those neonates at risk of l-carnitine deficiency. Materials and methods The study was carried out at the Menoufiya University Hospital over 1 year on 40 of healthy and septic neonates. All neonates were subjected to full history taking, clinical examination, and laboratory investigations included measurement of serum l-carnitine level, sepsis workup, and other laboratory investigations. Results Our study included 40 neonates, They were divided into four groups. Group 1: 10 healthy preterm neonates with a mean gestational age of between 33.50±1.18 weeks and mean birth weight of between 1.82±0.18 kg. Group 2: 10 healthy full-term neonates with a mean gestational age of between 38.80±1.03 weeks and mean birth weight of 2.98±0.23 kg. Group 3: 13 septic preterm neonates with a mean gestational age of between 33.46±1.13 weeks, and mean birth weight of 1.95±0.31 kg. Group 4: seven septic full-term neonates with a mean gestational age of between 38.57±1.27 weeks and mean birth weight of between 3.00±0.34 kg. Septic neonates groups (groups 3 and 4) have a low level of l-carnitine than healthy neonates groups (groups 1 2) and among septic groups the septic preterm neonates group (group 3) have a high level of l-carnitine than septic full-term neonates group (group 4). Also among healthy groups, the healthy preterm neonates group (group 1) have a high level of l-carnitine than healthy full-term neonates group (group 2). There was no correlation between l-carnitine and maternal age, gestational age, birth weight, and laboratory investigations in all groups. Conclusion There is a significant decrease of serum l-carnitine level in septic neonates, so they need assessment and supplementation. There is no correlation between serum level of l-carnitine and both gestational age and birth weight.

Quality of life in patients with erectile dysfunction in Shebin El Kom District

Objective This study aimed to assess the risk factors for erectile dysfunction (ED) and the sociodemographic characteristics of patients with ED in Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital. Background ED is a common disorder that affects the quality of life (QoL) of millions of people worldwide. Numerous factors can disrupt erectile function – for example, age, smoking, cardiovascular disease, and diabetes mellitus (DM). Patients and methods This was a cross-sectional study that was conducted on 169 patients with ED from Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital during the period 1 December 2015 to 31 May 2016. Information on sociodemographic data, risk factors for ED, and effect of ED on QoL was collected using self-administered questionnaires: a sociodemographic questionnaire, the International Index of Erectile Dysfunction (IIEF) questionnaire, a risk factors questionnaire, and the shorter version of the World Health Organization Quality of Life questionnaire. Results The main sociodemographic characteristics affecting ED were age of the patient (P = 0.001) and age of the patient's wife (P = 0.0001). The main risk factors for ED were lifestyle risk factors such as smoking (P = 0.000) and obesity (P = 0.005), medical conditions such as DM (P = 0.0001), hypertension (P = 0.0002), heart disease (P = 0.019), dyslipidemia (P = 0.013), lower urinary tract symptoms (P = 0.005), and hypogonadism (P = 0.004), intake of drugs (β-blockers (P = 0.000), insulin (P = 0.016), psychiatric drugs (P = 0.006), and silymarin (P = 0.001)), and penile and pelvis injury (P = 0.032). Pychogenic factor was present in most cases of ED. In patients with ED other domains of IIEF, including orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction (89.7%) were reduced. Also ED negatively affected all domains of QoL. Conclusion According to our results, the main risk factors are aging, cardiovascular disease, DM, dyslipidemia, lifestyle issues (such as smoking and obesity), penile or pelvic injury, and side effects from medication. ED has a significant negative impact on other domains of IIEF and on the QoL.

Study of epidemiological features of hepatitis D virus infection in HBsAg-positive chronic hemodialysis patients

Objective Study the prevalence, clinical, and laboratory features of hepatitis D virus (HDV) infection in hepatitis B surface antigen positive chronic hemodialysis (HD) patients. Background Delta virus or HDV is a small RNA-containing virus requiring the concomitant presence of hepatitis B virus (HBV) for its survival and pathogenicity. Worldwide, 20 million of chronic HBV patients are thought to be infected with HDV. It is important to know that HDV infection is present in a HD patient with HBV infection, because it allows a more accurate determination of prognosis, and the response of HDV patients to antiviral therapy and needed dosage therapeutic regimens are different from those with chronic hepatitis B alone. Materials and methods The study included 50 chronic HBV-infected renal patients and 25 chronic HBV nonrenal patients collected from Shebin El-Kom Fever Hospital and Menoufiya University Hospital, Menoufiya, Egypt. The study was conducted from January 2013 to May 2014. Enzyme-linked immunosorbent an assay was used to detect hepatitis B surface antigen and HDV antibodies (total antibody). Results HDV antibody (total) was positive in 58% of the HBV renal patients and in 24% of the HBV nonrenal patients, with high significant statistical difference. Laboratory data showed significant statistical differences between the two groups regarding platelet concentration (higher in HBV renal patients), albumin and prothrombin (higher in HBV nonrenal patients), bilirubin levels, and renal functions (higher in HBV renal patients). Furthermore, the infection with hepatitis delta is more common in HBV renal patients in the HD group IA (72%) than HBV renal patients on conservative treatment group IB (44%), with significant statistical differences of laboratory data between the two groups regarding hemoglobin (higher in group IB) and platelet concentration (higher in group IA), albumin and prothrombin (higher in group IA), bilirubin levels (higher in group IB), and renal functions (higher in group IA). Conclusion It is concluded that HD may have a major role in widening the prevalence of delta infection among the studied HBV renal patients (72%).

Study of fungal infections in pediatric intensive care unit in Menoufiya University Hospital

Objective The aim of the study was to determine the incidence and risk factors of fungal infections in patients admitted to pediatric intensive care unit (PICU) in Menoufiya University Hospital. Background Critically ill patients are immunosuppressed, invasively monitored, and exposed to aggressive interventions that put them at increased risk for infectious complications while residing in PICU. Fungal pathogens are an increasing important cause of infection among patients in PICU. Patients and methods This study was conducted on 492 critically ill pediatric patients admitted to PICU from July 2010 to July 2011; each patient was examined and sampled on the day of admission and after 5 and 7 days of admission. Samples were taken from oropharyngeal, axillary, and rectal areas in addition to blood sample. All specimens were cultured on Sabouraud dextrose agar. The analysis of samples included a direct examination, culture, and susceptibility of isolates to antifungal drugs. Results Candida albicans was the most common colonizing organisms, as about 156 (31.7%) patients were colonized by it on the day of admission. The most commonly acquired fungi were: C. glabrata in 71 (25.7%) patients, C. tropicalis in 61 (22.1%) patients, C. albicans in 46 (16.7%) patients, C. krusei in 33 (11.9%) patients, Aspergillus flavus in 20 (7.3%) patients, and mixed infection in 45 (16.3%) patients. Patients on previous antibiotic therapy, parenteral nutrition, and central venous line had an increased risk of acquiring fungal organisms. Conclusion Monitoring for colonization with Candida spp. in children admitted to PICU and children undergoing treatment for severe sepsis or septic shock in PICU for more than 5 days may offer an opportunity for early intervention for prevention of candidemia.

Thyroid disorders associated with alopecia areata in Egyptian patients

Context:Alopecia areata (AA) is a common form of localized, non-scarring hair loss. The etiopathogenesis of the disease is still unclear, but the role of autoimmunity is strongly suggested. AA is commonly associated with various autoimmune disorders; the most frequent among them is autoimmune thyroid disorders.Aim:To determine whether AA is associated with thyroid autoimmunity or thyroid function abnormalities in Egyptian patients.Materials and Methods:Fifty subjects with AA (37 males and 13 females) without clinical evidence of thyroid disorders were selected from Dermatology Outpatient Clinic, Menoufiya University Hospital, Menoufiya Governorate, Egypt, during the period from June 2009 to February 2010. They were divided into 3 groups according to severity of AA. Fifty age and sex-matched healthy volunteers (35 males and 15 females) were selected as a control group. Every case and control were subjected to history taking, complete general and dermatological examination. Venous blood samples were taken from cases and controls after taking their consents for measurement of thyroid stimulating hormone (TSH), free T3, freeT4 and detection of Anti-thyroglobulin Antibody (Tg-Ab) and Anti-thyroid Peroxidase Antibody (TPO-Ab).Results:Subclinical hypothyroidism was detected in 16% of cases. There were statistically significant differences between cases and controls regarding levels of TSH, free T3 and free T4. There were significant differences between cases and controls regarding the presence of Tg-Ab and TPO-Ab.Conclusions:Every patient with AA should be screened for thyroid functions and presence of thyroid autoantibodies even in absence of clinical manifestations suggestive of thyroid affection.

Total serum immunoglobulin E in patients with alopecia areata

Context:Alopecia areata (AA) is a common form of localized, non-scarring hair loss. The pathogenesis of the disease is unknown. Previous evidence suggested the involvement of Th2 cytokines in disease pathogenesis.Aim:To determine serum level of total IgE, this is mainly influenced by Th2 cytokines, in Egyptian patients with AA.Materials and Methods:Fifty subjects with AA (28 males and 22 females) were selected from Dermatology Outpatient Clinic, Menoufiya University Hospital from February 2012 to December 2012. Subjects with other conditions that might elevate serum IgE were excluded from the study. Fifty age- and sex-matched healthy subjects were selected as a control group. Venous blood samples were taken from cases and controls for measurement of total serum IgE by enzyme-linked immunosorbent assay. Skin biopsy was taken from every case from an active area of hair loss.Results:Total serum IgE was elevated in 27 (54%) cases. Its values among patients ranged from 13.5 IU/ml to 780 IU/ml. There was a statistically significant difference between cases and controls with regard to mean value of serum IgE (P < 0.05). Mean value of IgE did not vary significantly with disease severity, patients’ age, patients’ gender, disease duration, site of lesions, and positive family history of AA. No correlation was found between serum IgE levels and histopathological changes detected in examined cases.Conclusions:Total serum IgE is elevated in AA. This elevation is not related to age, gender, disease duration, disease severity, site of affection or family history of AA.

Prevalence of Pica among Children Attending Pediatrics Clinic at El-Menoufiya University Hospital

Objectives: to highlight the epidemiology of pica among children attending paediatrics outpatient clinic of Menoufiya university hospital. Background: Pica is a persistent eating of non-nutritive substance, which is inappropriate to the developmental level. Numerous etiologies have been proposed to explain pica. Different forms of pica are associated with a high rate of complications and substantial morbidity and mortality. Methods: The prospective study was undertaken at a pediatric outpatient clinic of Menoufiya university hospital. The mothers were interviewed and data were collected. General physical, systemic examination and investigations were done. Anemia was defined as haemoglobin thresholds for age (0.5-4.99 years) is11 g/dl and 11.5 g/dl for age (5.00–11.99 years). Iron depletion was defined as serum ferritin levels of <15 ng/ml. And iron deficiency as serum iron level <50 µg/dl. Hypozincaemia was defined as serum zinc level of<0.6 mg/L. Results: From two thousands and four hundreds children visited pediatrics clinic, of them one hundred and seventy four patients of them were suffering from pica (prevalence of pica was 7.2%). Clay was the material used by 43.1% children (major form of pica in this study) followed by Dust (25.9 %) followed by paper and cigarette (both 4 %). The hemoglobin and serum iron levels, serum ferritin and serum zinc were below the reference range. Conclusion: Prevalence of pica is higher in males, four years or less age, rural residents, bottle feeders, poor nourished children, children came from low socioeconomic families, illiterate housewife mothers. Children with pica had low level of zinc, hemoglobin, iron and ferritin, which confirmed that there is a relationship between pica and iron deficiency anemia and / or hypozincaemia. The children who practice pica are prone to worm infestation.

Prevalence of depression in schizophrenic patients evaluated by the Calgary Depression Scale in Shebin El-Kom, Menoufiya

Middle East Current Psychiatry 2013, 20:191–196 Background Psychiatric comorbidities are communal among patients with schizophrenia. A significant percentage of patients with schizophrenia show depressive symptoms during the development of their illness. Objectives The aim of this study was to evaluate the prevalence of depression using the Calgary Depression Scale for Schizophrenia (CDSS) in a sample of Egyptian patients (Shebin El-Kom, Menoufiya) with schizophrenia and without a diagnosis of depression. Participants In this cross-sectional study, we included outpatients from Menoufiya University Hospital and Shebin El-Kom Educational Hospital, 20–50 years old, with a diagnosis of schizophrenia or schizophreniform disorder that had not been diagnosed with depression. Methodology We administered the CDSS and the Positive and Negative Syndrome Scale (PANSS) to the schizophrenia patient sample. Also, schizophrenia patients were studied according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria. Results A total of 120 patients were recruited and included in the statistical analysis (72 men and 48 women). Sixty-three patients had a total score of 5 or more points on the CDSS, making the prevalence of depression 30%. The prevalence of depression in men (n = 24) was 33% versus 25% in women (n = 12). There was no significant difference between men and women in terms of the prevalence of depression. The CDSS had a higher correlation with the depressive factor of the PANSS and a moderate correlation with the general psychopathology subscale of the PANSS. Nonetheless, the correlation of the CDSS total score with the PANSS-negative was low. There was no correlation between depressive symptoms and positive symptoms. Conclusion Our results suggest that patients with schizophrenia who have not been diagnosed with depression frequently have clinically symptoms of depression, with the possible exception of a contribution from negative symptoms. CDSS is a more specific instrument to measure depressive symptoms in schizophrenia.

Significance of serum leptin and adiponectin levels in Egyptian patients with chronic hepatitis C virus associated hepatic steatosis and fibrosis

To study serum levels of leptin and adiponectin in patients with chronic hepatitis C virus infection genotype-4 (HCV-4) related steatosis and fibrosis. We prospectively studied 45 untreated men with chronic HCV-4, with proven steatosis (group I, 30 patients), and fibrosis (group II, 15 patients), on liver biopsy. In addition, 15 healthy men (group III), matched for age, and body mass index were included. However, we excluded another five patients with steatohepatitis, and six patients with cirrhosis. We measured total serum leptin and adiponectin levels, as potential predictors for liver steatosis and fibrosis. Also, a correlation between these adipokines and various clinical and laboratory data were evaluated. All subjects were selected from Tropical and Internal medicine departments, Menoufiya University Hospital, Menoufiya, Egypt, during the period from February 2010 to August 2011. In group I, severity of hepatic steatosis was mild, moderate, and severe, in 19 patients (63.5%), 8 patients (26.5%), and 3 patients (10%), respectively. In contrast, in group II, hepatic fibrosis was found to be in stage 1, 2, and 3, in 6 patients (40%), in 6 patients (40%), and in 3 patients (20%), respectively. On comparing group I with group II, there was a significant decrease in serum adiponectin levels (131.4 ± 7.91 pg/mL vs 436 ± 9.75 pg/mL, P < 0.001), while there was no significant difference between both groups regarding serum leptin levels (34.69 ± 7.69 ng/mL vs 35.17 ± 1.06 ng/mL, P > 0.05). However, in the same group, when compared with group III, there was a significant increase in serum leptin levels (34.69 ± 7.69 ng/mL vs 10.69 ± 0.84 ng/mL, P < 0.001), while there was a significant decrease in serum adiponectin levels (131.4 ± 7.91 pg/mL vs 342.4 ± 44.48 pg/mL, P < 0.001). In contrast, in group II, when compared with group III, there was a significant increase in serum leptin and adiponectin levels (35.17 ± 1.06 ng/mL vs 10.69 ± 0.84 ng/mL, P < 0.001, and 436 ± 9.75 pg /mL vs 342.4 ± 44.48 pg/mL, P < 0.05, respectively), while there was no significant difference between both groups regarding serum creatinine (0.83 ± 0.34 vs 0.89 ± 0.24, P > 0.05). On the other hand, serum leptin was not correlated with serum adiponectin in group I and in group II (r = 0.09, P > 0.05, and r = -0.1, P > 0.05, respectively). However, serum adiponectin was significantly negatively correlated with serum aspartate transaminase in group I, but no correlation detected in group II (r =-0.39, P > 0.05, and r = -0.03, P > 0.05). In male patients with chronic HCV-4, serum adiponectin levels are elevated in hepatic fibrosis, but decreased in steatosis. Therefore, in contrast to leptin, adiponectin may be used as a non-invasive marker.

Long term results of pneumatic retinopexy

BackgroundRhegmatogenous retinal detachment is a commonly encountered retinal problem where rapid treatment can prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple, minimally invasive procedure for retinal reattachment.PurposeThis study aimed to assess the long-term anatomical and functional outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment.Patients and methodsA prospective interventional study was performed. Subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy from May 2006 to May 2007 at Menoufiya University Hospital were included in this study with at least 3 years follow-up.ResultsA total of 40 cases were included in the study. The mean age of patients was 44.25 ± 10.85 years. Reattachment of the retina was achieved in 100% of cases. In 75% of cases, the primary intervention was successful. However, the retina redetached in 20% of these during the first 6 months, requiring reinjection or another procedure. Three years after the first intervention, follow-up measurement of the mean visual acuity of the eyes without reoperation was 0.40 ± 0.21 while the mean visual acuity of the eyes which needed additional operations was 0.22 ± 0.13.ConclusionSixty percent of the cases obtained long-term retinal reattachment with a single operation success (SOS), with good visual recovery and less morbidity than other more invasive procedures like scleral buckling or pars plana vitrectomy, translating to higher productivity for the patient. This procedure, being quicker than the alternatives, also saves the surgeon’s time, making PR a good choice for managing primary rhegmatogenous retinal detachment in developing countries.

Anterior rectus sheath flap for closure of the abdominal wall defects

Introduction: The most important functions of the abdominal wall are protection and compression. Reconstruction of large abdominal wall defects following trauma, abdominal wall tumor resection and recurrent hernia represents a great challenge. Multiple techniques have been described to restore the integrity of the abdominal wall as primary fascial repair, component separation, and interpositional materials. Aim of the work: To evaluate the effectiveness of the anterior rectus sheath flap to bridge the fascial defect with supporting polypropylene mesh. Patients & methods: Twenty nine patients with abdominal wall defects were managed at Menoufiya University Hospital between January 2005 and October 2009 using the anterior rectus sheath flap with supporting polypropylene mesh. Conclusion: This technique will be added as one of the methods of closing abdominal wall defects that can be used in appropriate patients. The clear indication, advantages, disadvantages, and long term outcomes compared with other methods will be hopefully explored by more time and studies.

Abdominal wall integrity and cosmetic outcome after minicholecystectomy incision with half rectus muscle preservation

Background: Today the removal of the gallbladder is the safest, the most effective and widely recommended treatment for gallstone disease. Three essential methods are used for removal of the gallbladder: standard open cholecystectomy, laparoscopic cholecystectomy and minicholecystectomy. Traditionally, the surgical community has resisted accepting minicholecystectomy. Aim of the work: Evaluation of the efficiency of minicholecystectomy incision with half rectus muscle preservation in improving abdominal wall integrity and cosmetic outcome after cholecystectomy incision. Patients & methods: Thirty seven patients had undergone cholecystectomy with a mini incision in Menoufiya University Hospital from September 2006 to May 2008. Their age ranged from 24 to 58 years old. The follow up period was one year. Results: As regard early wound complications there were no subcutaneous haematomas, only one case of wound sepsis and two cases of seroma that were managed conservative. Late wound complications included two cases of hypertrophic scar. No angular wound dehiscence or incisional hernia. The scar was small with good cosmetic outcome and almost all patients were satisfied with the scars. Conclusion: Minicholecystectomy incision with preservation of half the rectus muscle improves the abdominal wall integrity & cosmetic outcome

EVALUATION OF OCCUPATIONAL EXPOSURE TO GLUTARALDEHYDE AMONG ENDOSCOPY NURSING STAFF IN MENOUFIYA UNIVERSITY HOSPITAL

Background: Glutaraldehyde is the best disinfectant for fibreoptic endoscopes. A number of studies has reported that glutaraldehyde is an irritating substance affecting ocular and nasal mucosae and may give rise to sensitization. Cases of allergic dermatitis, rhinitis, epistaxis, asthma, lacrimation and headache were also reported amongexposed workers. Aim of the work: This study aimed at finding the nature and prevalence of workrelatedsymptoms (WRSs) among nurses working in endoscopy units and assessment of the concentration of glutaraldehyde in the work environment. Subjects and Methods: Thirty non-pregnant non-smokers nurses occupationally exposed to glutaraldehyde (GA) in various endoscopy units in Menoufiya University hospital were chosen as subjects of this study. An equal number of nurses never occupationally exposed to GA were chosen as a non-exposed group. The Medical ResearchCouncil Respiratory Questionnaire was used to record work-related symptoms,spirometric measurements and laboratory measurement of total immunoglobulin