Effect of eating and psychopathological traits in psoriatic patients Naglaa A Ahmed, Taghreed M El Shafie, Sherihan M Abd Alhalim Al-Azhar Assiut Medical Journal 2019 17(1):1-8 Background Psoriasis is a chronic inflammatory immune-mediated skin disease. Few studies have investigated the link between psychiatric disorders including eating disorders (EDs) and psoriasis. We hypothesized that EDs and the psychological effect of psoriasis contribute to the development of obesity and metabolic syndrome in psoriatic patients, who are frequently susceptible to psychiatric comorbidity. Objective The objective of this study was to evaluate the presence of EDs and psychological distress in patients affected by psoriasis compared with a control population and correlate these data with different features of the cutaneous disease and BMI. This was done to suggest the importance of a psychological support that could reduce the occurrence of loss of control over food and help psoriasis improvement. Patients and methods From September 2014 till February 2015, we enrolled 100 consecutive psoriatic outpatients and a control group of 100 selected nonpsoriatic outpatients, matched by age, sex, and BMI to the study group. The assessment utilities were composed by the Eating Disorder Inventory (EDI), the Symptom Checklist-90-Revised (SCL-90-R), and the Psoriasis Area Severity Index score. Results Regarding EDI and SCL-90-R subscales, psoriatic patients had higher scores for all EDI and SCL-90-R subscales than nonpsoriatic patients. According to the relation between BMI and SCL-90-R subscales in psoriatic patients, obese and overweight groups showed higher scores in all SCL-90-R subscales than the normal weight group. Conclusion In patients with psoriasis, EDs and severe psychiatric symptoms seem to be associated with overweight/obesity more frequently than in the general population.

Peripheral blood mononuclear cells hepatitis C virus RNA as a predictor for the response to daclatasvir-containing oral antiviral regimen in chronic hepatitis C patients from the Damietta Governorate Alaa E Hashim, Samy Zaky, Naglaa Azab, Fathiya El-Raey, Mahmoud A Halim Al-Azhar Assiut Medical Journal 2019 17(1):9-13 Background Eradication of hepatitis C virus (HCV) infection is the goal of direct-acting antivirals with a high rate of sustained virological response (SVR). Currently, SVR is determined by negative serum HCV RNA by real-time (RT)-PCR that may not give any information about intracellular HCV replication. Aim To study peripheral blood mononuclear cells (PBMCs) HCV RNA as a predictor for the response to daclatasvir-containing oral antiviral regimen in chronic hepatitis C patients. Patients and methods In all, 150 patients with chronic HCV, classified into 100 easy-to-treat patients (group I) and 50 difficult-to-treat patients (group II), who achieved SVR to sofosbuvir plus daclatasvir with or without ribavirin were enrolled in the study. HCV RNA was evaluated in both sera and isolated PBMCs using the polymerase chain at 3 and 12 months from the end of treatment (EOT). Results As regards HCV RNA in peripheral blood mononuclear cells (PBMCs) we found that no case was positive in the easy to treat (group I). In difficult to treat (group II), six (4%) patients were positive at 3 months and 24 (16%) patients at 12 months after EOT. However, there is no virological, clinical, or biochemical relapse noted during the follow-up period among positive cases. All positive cases were cirrhotic, with significantly lower platelets count and albumen level but higher bilirubin than group I. Conclusion All easy-to-treat groups were HCV RNA in PBMCs negative at EOT and during the follow-up period (1 year). Follow-up of cirrhotic patients with positive HCV RNA in PBMCs showed no clinical, biochemical, or virological relapse.

Assessment of comorbidities in patients with chronic obstructive pulmonary disease: a cross-section study Ammar M Nashwat, Hamada Kawshty, Yasin Abd-ElKareem, Ibrahim M Shalan Al-Azhar Assiut Medical Journal 2019 17(1):14-23 Background Chronic obstructive pulmonary disease (COPD) is common and usually coexists with other diseases. The aim of this study was to assess comorbidities in patients with COPD. Patients and methods This is a cross-sectional controlled study of comorbidities in patients with COPD that was carried out on 200 patients with COPD and 180 non-COPD patients as control. They were admitted to or investigated in outpatient clinic of Chest Disease Department of Assiut Hospital, Al-Azhar University, during the period from November 2016 to May 2018. A patient with COPD was defined as a smoker with forced expiratory volume in first second/forced vital capacity less than 0.7, and comorbidities were defined based on objective laboratory findings and questionnaires. Results This study included 380 patients, comprising 200 patients with COPD (75% males and 25% females, with mean age of 62±10.1 years) and 180 non-COPD patients (76.7% males and 23.3% females, with mean age of 61.1±5.6 years). The most common comorbidities reported in our COPD population versus non-COPD in decreasing order of frequency were hypertension (40 vs. 30%) followed by dyslipidemia (35 vs. 30%), asthma (30 vs. 13.8%), gastroesophageal reflux disease (30 vs. 16.1%), obesity (22.5 vs. 20%), bronchiectasis (21 vs. 6.1%), diabetes mellitus (19 vs. 12.2%), anemia (19 vs. 12.2%), ischemic heart disease (17 vs. 10%), and pneumonia (15.5 vs. 7.8%). Conclusion COPD is more common in smoker old aged male individuals, and the most common comorbid conditions associated with COPD are hypertension, dyslipidemia, gastroesophageal reflux disease, diabetes mellitus, and ischemic heart disease.

Harmonic scalpel versus conventional hemorrhoidectomy Hazem A Megahed Al-Azhar Assiut Medical Journal 2019 17(1):24-29 Introduction In this study, harmonic scalpel hemorrhoidectomy was compared with the classical Milligan–Morgan hemorrhoidectomy regarding the outcome and the postoperative complication rates. Patients and methods Between June 2014 and September 2018, 40 patients aged between 30 and 60 years old underwent a hemorrhoidectomy operation in Al-Azhar University Hospital, New Damietta. The patients were randomly subdivided into two groups: group A included 20 patients who underwent the classical Milligan–Morgan hemorrhoidectomy operation, which represented the conventional method, and group B included 20 patients who underwent a hemorrhoidectomy with the use of a harmonic scalpel. The outcome and postoperative complications were compared between the two groups. Results In the harmonic scalpel group (group B), the posthemorroidectomy static pain was significantly lesser on the postoperative days 3, 7, and 14, but it was nonsignificantly lesser on the first postoperative day. Moreover, there was significant decrease in mean hospital stay in group B (1.0±0.2 days) vs. in group A (conventional method group) (1.3±0.4 days). The operative time was significantly decreased in group B (15±1.1 min) versus group A (20±2.1 min). Regarding early complications such as minor bleeding and urinary retention, they were lesser in group B, but without significance. Conclusion Harmonic scalpel hemorrhoidectomy is a less time-consuming bloodless procedure and has lesser postoperative pain and bleeding when compared with conventional hemorrhoidectomy.

Risk factors for cessation of breastfeeding Hussein Koura Al-Azhar Assiut Medical Journal 2019 17(1):30-34 Introduction The Kingdom of Saudi Arabia is advancing quickly in all parts of life and health care. Nonetheless, breastfeeding is said to be on the deterioration. Patients and methods A case–control study was carried out to evaluate the risk factors that may lead to cessation of breastfeeding among infants and children less than 2 years who live in Al Kharj and Al Riyadh cities, Saudi Arabia. Cases included mothers of infants who stopped breastfeeding during first year after delivery, whereas controls were mothers of infants or children who were breastfed for 1 year or more. In total, 366 mothers were enrolled: 183 for continued breastfeeding group and the same number for stopped breastfeeding group. Each enrolled mother was interviewed by a specially designed questionnaire. Results Risk factors for cessation of breastfeeding were delivery by caesarean section, full- or part-time mother’s employment, usage of oral contraceptives, higher level of education, and absence of support for breastfeeding. Adjusted odds ratios were 2.2, 2, 1.9, 1.8, and 1.6, respectively. Conclusion As a result of the study, it was recommendation to pay attention toward pregnant women with these risk factors to support them to continue breastfeeding for 2 years.

Comparative study between ranibizumab and aflibercept in the management of macular edema caused by diabetes mellitus in age group more than 40 years Abd El-Magid M Tag El-Din Al-Azhar Assiut Medical Journal 2019 17(1):35-47 Background Diabetic macular edema (DME) is a common cause of blindness and visual impairment in diabetic patients, which can affect the quality of life. Aflibercept and ranibizumab are used as intravitreal anti-vascular endothelial growth factor injections; both of them have a relatively safe effective treatment of DME. Aim of the work To compare the effect of aflibercept and ranibizumab in the management of DME. Patients and methods A prospective invasive and nonrandomized study, including 20 eyes in 20 patients, more than 40 years old, was conducted in Al-Azhar Faculty of Medicine, Cairo, with three times injections 1 month apart. Eyes were divided into two groups: group A included 10 patients who received ranibizumab 0.5 mg (0.05 ml of 10 mg/ml solution) as an intravitreal injection, and group B included 10 patients who received aflibercept 2 mg (0.05 ml of 40 mg/ml solution) as an intravitreal injection. Follow-up period was 4 months. Results A statistically significant improvement of best-corrected visual acuity (BCVA) and central macular thickness with ranibizumab was reported over the follow-up period. There was also a statistically significant improvement of BCVA, central macular thickness, and intraocular pressure over the follow-up visits with aflibercept. Ranibizumab was more effective in BCVA correction and in the reduction of central macular thickness than aflibercept. Conclusion Both ranibizumab and aflibercept are effective in improving the BCVA and in the reduction of central macular thickness. Ranibizumab is more effective for BCVA correction and in the reduction of central macular thickness than aflibercept Recommendations Further studies are needed to confirm the effect of ranibizumab and aflibercept intravitreal injection on the central macular thickness and intraocular pressure.

Role of central lymphadenectomy in managment of differentiated thyriod cancer Mohammed Mamdoh Ahmed Asar, Mohamed Kamel El Awady, Ahmed Seddik Abdelgelil, Mohammed El Sharkawy, Osama Mostfa Mostafa Al-Azhar Assiut Medical Journal 2019 17(1):48-53 Background Differentiated thyroid cancers may be associated with regional lymph node (LN) metastases in 20–50% of cases. Papillary thyroid cancer is the most common thyroid malignancy, and cervical nodal metastases are frequent at presentation. Objective This study aims to detect the therapeutic and prophylactic results of centeral neck dissection (CND) in an adjunct to total thyroidectomy for the treatment of differentiated thyroid cancer and its effect in reducing local recurrences and the need for postoperative radioiodine ablation. Patients and methods This study was carried out on 30 patients with thyroid cancers. They were managed at Oncological Surgery Departments of Al-Azhar University between January 2017 and August 2018. This study included 30 patients, comprising 10 (33.3%) males and 20 (66.6%) females, and their ages ranged from 26–82 years old, with a mean age of 51 years. They all underwent total thyroidectomy and CND for differentiated thyroid cancer, which was proved preoperatively by fine-needle aspiration from thyroid swelling. Neck ultrasound and high-resolution neck computed tomographic scan with contrast were done to detect size and extension of thyroid cancer and any concerning LNs. Results The analysis of nodal spreading in this study showed an ipsilateral central nodal metastasis on the same side of affected lobe and bilateral central LN metastasis when the tumor arose within each lobe or from isthmus, as the lesions from isthmus had wide diffusion. Moreover, this study showed tumors with size of 20 less than or equal to T2 less than 40 mm associated with the presence of LN metastases were subjected to postoperative 131I ablation, and also a size greater than or equal to 40 mm with vascular invasion or tumor extension beyond the thyroid capsule even not associated with the presence of LN metastases were subjected to postoperative 131I ablation. Conclusion Prophylactic central compartment neck dissection (ipsilateral or bilateral) should be considered in patients with differentiated thyroid cancer (DTC) with clinically noninvolved central neck LNs (cN0) who have locally advanced primary tumors (T3 or T4), and prophylactic ipsilateral CND and lateral neck dissection for DTC less than 2 cm in diameter allowed selection of patients for postoperative 131I ablation and modified the indication for 131I ablation in patients with pT1 tumors.

Comparison of endoscopic findings in Egyptian and Indian patients: a retrospective cohort Essam A Hassan, Tarek I Ahmed, Sanjay Rajput Al-Azhar Assiut Medical Journal 2019 17(1):54-60 Aims Esophagogastroduodenoscopy is the commonest diagnostic procedure performed to evaluate upper gastrointestinal tract. However, there are limited data on the differences in endoscopic findings in different populations. Therefore, we conducted this study to compare the frequencies of endoscopic findings in two different populations. Patients and methods We used a large endoscopic database to retrieve the data of patients who underwent esophagogastroduodenoscopy at Fayoum University Hospital, Egypt and Ansh Clinic, Ahmadabad, India in the year of 2016. Results A total of 7107 patients were included in the final analysis: 5527 from India and 1580 from Egypt. Indian patients were more likely to present with normal finding (54.6 vs. 22.7%, P<0.001), whereas Egyptian patients were presenting with varices more commonly (49.5 vs. 15.9%, P<0.001). The Egyptian cohort showed a high frequency of grades I and III gastroesophageal reflux disease, whereas the Indian cohort revealed higher grades I and II varices (P<0.001). Gastritis was more common in Indian patients (67.2 vs. 35.2%, P>0.001). Overall, varices are most common in older male patients (>20 years), gastroesophageal reflux in males, and gastritis in females. Conclusion Further research is needed to validate our findings regarding the effect of age and sex on the frequency of endoscopic findings.

Role of drug-eluting beads versus conventional transarterial chemoembolization in the treatment of hepatocellular carcinoma Mahmoud Abu Elfadl, Mohamed S. Abdelaziz Shehata, Mohammed G Mohamed, Ahmed S Elskaan Al-Azhar Assiut Medical Journal 2019 17(1):61-67 Background Transarterial chemoembolization has become the current standard therapy for the intermediate-stage hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer staging system. Conventional transarterial chemoembolization (cTACE) involves the injection of an embolic agent into the tumor-feeding arteries to block its major nutrient source resulting in tumor ischemic necrosis. Drug-eluting beads transarterial chemoembolization (DEB-TACE) was developed to deliver higher doses of chemotherapeutic agents over longer drug-tumor contact times. Objective The aim of this study was to highlight on the safety and efficacy of DEB-TACE versus cTACE in patients with intermediate-stage HCC. Patients and methods This study was carried out on 55 patients presented with irresectable who HCC underwent either cTACE: group 1, 25 patients or DEB-TACE; group 2, 30 patients from July 2016 to June 2017. All patients were subjected to full history taking, thorough clinical examination, investigations, imaging, adequate follow-up at 1, 3, and 6 months and were categorized according to the modified Response Evaluation Criteria in Solid Tumors. Results According to the modified Response Evaluation Criteria in Solid Tumors responding disease was seen in 28 patients who underwent DEB-TACE and 18 who patients underwent cTACE, while nonresponding disease was found in two patients who underwent DEB-TACE and seven patients underwent cTACE (P=0.033). Complications such as postembolization syndrome and ascites occurs more in patients who underwent cTACE than after DEB-TACE (P=0.04, P=0.61). Conclusion DEB-TACE is more effective than cTACE in intermediate-stage HCC with less side effects.

Inflammatory biomarkers as prognostic indicators for liver cirrhosis Naglaa Abou-Elfattah Tawfik, Naglaa A El-Gendy, Hanaa Abou Elyazid Abou Elhassan, Eman Elshohat Ebrihem, Rayyh Abdelazeem M Saleh Al-Azhar Assiut Medical Journal 2019 17(1):68-74 Background Severity of liver cirrhosis is commonly assessed by Child–Pugh and model of end-stage liver disease (MELD) scores, which reflect liver dysfunction mainly and do not assess associated systemic events, which influence the failure of other organs. Aim To study the role of serum level of copeptin (CPP) and high-sensitivity C-reactive protein (hsCRP) as indicators of prognosis in liver cirrhosis and compare these results with usual prognostic scores, raising the importance of proper management of systemic infections in cirrhotic patients to prevent cirrhosis progression. Patients and methods A cross-sectional study was carried out on 80 cirrhotic patients, who were classified into four equal groups: Child A, B, C, and Child C with systemic infections. Serum CPP and hsCRP were measured by enzyme-linked immunosorbent assay technique. Results There was a statistically significant increase in CPP serum levels among cirrhotic patients [9.70 (7.70–14.30)] in comparison with its serum level in healthy participants [5.95 (5.40–6.75)]. There were gradually increases of CPP serum levels through Child–Pugh A, B, and C groups [6.40 (5.42–8.05), 10.15 (7.75–14.20), and 13.05 (8.77–17.27), respectively] in comparison with the control group. There were positive correlations of CPP with MELD score, Child–Pugh, and hsCRP (r=0.60, 0.71, and 0.60, respectively, P<0.000). There was a significantly increase in serum level of hsCRP among cirrhotic patients [9.90 (7.12–16.67)] than control group [2.50 (1.67–5.91)]. Its median values and interquartile range concentrations were the lowest among healthy group and increased gradually through Child–Pugh A, B, and C and Child–Pugh C with infection groups [2.50 (1.67–5.91), 7.15 (6.32–9.45), 8.35 (7.12–12.17), 9.20 (6.95–13.15), and 20.35 (14.85–32.22), respectively] (P=0.000). There were significant positive correlations of hsCRP with CPP, MELD score, and Child–Pugh (r=0.51, 0.54, and 0.75, respectively). Conclusion CPP and hsCRP serum levels can be used as prognostic indicators of liver cirrhosis and account for systemic infections involved in deterioration of liver cirrhosis.