Role of triphasic computed tomography in prediction of response to transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma patients Ahmed A.E Hassan Desoky, Mohammed K Omar, Hala M Maghraby Journal of Medicine in Scientific Research 2019 2(3):181-184 Background The initial approach in the management of hepatocellular carcinoma (HCC) is to determine if either surgical resection or liver transplantation is feasible. Unfortunately, more than three-quarters of the patients are diagnosed during the intermediate or advanced stages of the disease and are considered ineligible for curative resection. Transarterial chemoembolization (TACE) is the current standard of therapy for patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer classification. Aim This study aims to evaluate the role of triphasic computed tomography (CT) in the prediction of the prognosis of irresectable HCC patients, who had been locally treated with TACE by studying the enhancement (vascularity) pattern and the volume changes of the HCC after TACE. Patients and methods Our study included 25 HCC patients as diagnosed by triphasic CT study and serum alpha fetoprotein (AFP) level. The patients were recruited from the National Liver Institute Menoufia HCC Clinic and Radiology Department for assessment of the target lesion after doing TACE as a locoregional therapy for HCC from September 2017 to July 2018. Results Prediction model of response in our study depends on all of these variables along with the maximum initial diameter of the target lesion, the baseline serum AFP level, serum level of total bilirubin, INR, splenic size and sex of the patient with an overall accuracy of 88%, sensitivity of 93.3%, specificity of 80%, PPV: 87.5%, and NPV: 88.88%. Conclusion Triphasic CT is the most commonly used as the standard imaging technique for predicting and evaluating the therapeutic response in patients with HCC after TACE. It is a more accurate prognostic factor than the AFP serum level estimation.

Role of pomegranate peel on ameliorated hyperglycemia and hypercholesterolemia in experimental rats Magda Ramzy Journal of Medicine in Scientific Research 2019 2(3):185-190 Introduction Pomegranate peels (Punica granatum) (contain fiber and antioxidants, which are beneficial to our health. This study aimed to investigate the effects of different concentrations of pomegranate peels on blood glucose, lipid profiles, and some physiological parameters, such as liver and kidney functions, in rats having diabetes and hypercholesterolemia. Methods Rats were divided into three main groups: the first main group was the negative control, the second main group was diabetic rats, and the third main group was hypercholesterolemic rats. Second and third main groups were divided into four subgroups (six rats/group) and fed with different diet levels of pomegranate peels (5, 10, and 15%) for 28 days. Body weight gain, feed intake, feed efficiency ratio, and relative weight of some organs were calculated at the end of the experiment. Fasting blood sample was taken for determination of serum glucose, total cholesterol, triglycerides, creatinine, urea, aspartate aminotransferase, and alanine aminotransferase. Results There was a significant reduction in both serum total cholesterol and triglycerides in all treated groups with pomegranate peels. The higher peels doses improved liver and kidney functions. However, the highest reduction was achieved by feeding diabetic rats with 15% pomegranate peels. Conclusion The study concluded that pomegranate peels ameliorated blood glucose, lipid profiles, liver enzymes, and kidney functions.

Computerized dynamic posturography in school-aged children with sensorineural hearing loss Naema M Ismail, Hoda Abu-Moussa Mina, Hanaa Fadel, Shereen Emad El Dein Abdel Moneim Journal of Medicine in Scientific Research 2019 2(3):191-197 Background According to embryological and anatomical connection between the cochlea and vestibular end-organs, children with sensorineural hearing loss (SNHL) may exhibit abnormalities of vestibular and balance function. Documentation of vestibular dysfunction in children with SNHL has a long and rich history indicating that 20–70% of children with SNHL demonstrate an element of vestibular end-organ dysfunction. Vestibular dysfunction was proved to correlate with severity of cochlear loss in many research works. Aim of the work To assess normative data of sensory organization test (SOT) and head shaking (HS) test according to age, weight, and height of children in control group and to detect any deviation from normal values of SOT and head shacking test in children with SNHL. Patients and methods This study was carried out in Audiology and Vestibular Units of Hearing and Speech Institute, Giza, Egypt, and included 50 children (29 males and 21 females). Their age range was from 6 to 12 years. They were divided into two groups: control group, which consisted of 20 children (12 males and eight females) with normal hearing, and case group, which consisted of 30 children (17 males and 13 females) with SNHL. All children underwent full basic audiological evaluation, Fukuda stepping test, videonystagmography, SOT of posturography, and HS–SOT. Results There were differences in balance skills between children with normal hearing and children with SNHL in Fukuda stepping test, caloric test, and HS–SOT; otherwise, there were no statistical significant differences between the two groups in smooth pursuit test, Dix–Hallpike test, and SOT. Conclusion HS–SOT showed significant difference between the two groups in horizontal, vertical, and roll axes of HS test, especially in horizontal CD5, vertical CD5, roll CD2, and roll CD5. This means that these axes could diagnose vestibular peripheral dysfunction accurately in children with SNHL.

The role of vitamin D therapy in patients with fibromyalgia and its effect on quality of life Abeer H Ismaiel, Aliaa El-Hady, Amal A Mohsen, Mohamed A Safy Journal of Medicine in Scientific Research 2019 2(3):198-203 Objective To investigate the level of vitamin D and the effect of its therapy on quality of life in patients with fibromyalgia who had vitamin D deficiency. Patients and methods Sixty patients presenting with fibromyalgia and 30 healthy controls were studied. Patients were grouped as deficient (<20 ng/ml), inadequate (20–30 ng/ml), and sufficient (>30 ng/ml) according to the levels of vitamin D. Vitamin D replacement was performed for patients with deficiencies and inadequacies and they were assessed before and after vitamin D therapy using the following scales: visual analog scale, fibromyalgia impact questionnaire, short form-36, Arizona sexual life questionnaire, and Beck depression scale and correlation were also calculated between vitamin D and different scores. Results Sixty women with fibromyalgia were included in this study. The mean age of all fibromyalgia patients was 30.9±6.1 years. Vitamin D deficiencies and inadequacies were observed in 63.3% of the patients (n=42). The 25(OH)D levels increased significantly after 3 months of supplementation. In scales examined after vitamin D replacement therapy, statistically significant differences were observed in the fibromyalgia impact questionnaire, Beck depression inventory, visual analog scale, and short form-36 compared with pretreatment; also there is negative correlation between vitamin D levels and parameters of measuring quality of life. Conclusion Vitamin D deficiency may be associated with fibromyalgia. Vitamin D supplementation seems to improve symptoms and quality of life in patients with fibromyalgia.

Comparable study between organic and nonorganic vegetables in their contents of some nutritive components Hamdy A El-Bassel, Hany H El-Gazzar Journal of Medicine in Scientific Research 2019 2(3):204-208 Background There is no doubt that vegetables play an essential role in human growth as they provide the human body the necessary needs of vitamins and minerals. Several analytical methods have been set up and improved to determine the quantity of vitamins and minerals in different fruits and vegetables. The purpose of this study is to evaluate the quantities of vitamins and minerals in organic and nonorganic vegetables in Egyptian. The results showed that organic tomatoes, eggplant, lettuce, squash, carrots, and cabbage had significantly higher content of vitamin C, vitamin E, β-carotene, phosphorus, and calcium. However, nonorganic vegetables showed significantly higher content of protein than the organic vegetables. Objective To identify which vegetables, organic or nonorganic, contain a higher level of vitamins and minerals. Results Organic crops contained a higher significant level of vitamin C, vitamin E, β-carotene, phosphorus, and calcium, whereas it contained less protein level than nonorganic crops. Conclusion The difference between organic and nonorganic content may be related to the type of soil and the method of cultivation.

Cardiac dysfunction in patients with community-acquired pneumonia El-Saied Shaheen, Ehab Elmelegy, Wael Hossam El Din Journal of Medicine in Scientific Research 2019 2(3):209-213 Background Community-acquired pneumonia (CAP) is still an important cause of morbidity and mortality worldwide especially in the elderly. Evidence shows a high correlation between acute respiratory infections and increased risk of cardiovascular events (CVEs). The occurrence of CVE in hospitalized patients with CAP may significantly affect the clinical status, and a severe CVE could be the primary cause of clinical failure. Aim To study the incidence of cardiac complications in patients with CAP. Patients and methods This clinical study was carried out on 120 patients (63 males and 57 females) hospitalized with a primary diagnosis of CAP. Patients with the presence of an alternative diagnosis that likely explained the pulmonary symptoms and radiographic infiltrate (e.g. lung carcinoma, pulmonary edema, or pulmonary embolus) were excluded. All patients were subjected to complete medical history, general and local chest examination, laboratory investigations, complete blood count, liver function tests, serum electrolytes, blood glucose, arterial blood gases, and serum troponin I. For microbial etiology, at least two sets of separate blood and sputum samples of each patient were gram stained and cultured. Radiological investigations (plain radiography and computed tomography on the chest), ECG, and echocardiography were also done. Results Among the studied 120 patients, 30 (25%) patients had a cardiac complication, such as new or worsening heart failure (12.5%), new arrhythmia (9.2%), and acute myocardial infarction in 3.3%. Patients who developed cardiac complication had significantly higher percentage of blood urea nitrogen (more than or equal to 30 mg/dl), hematocrit less than 30%, sodium less than 130 mm/l, pH less than 7.35, and PaO2 less than 60 and/or O2 saturation less than 90 mmHg than patients without cardiac complication. Regarding the outcome of the studied patients, patients who developed cardiac complication had a significantly higher percentage of patients who needed mechanical ventilation, needed inotropes and vasopressors, had higher occurrence of an acute renal failure, had prolonged hospital stays, and had higher mortality than patients without cardiac complication. Conclusion Incident cardiac complications are common in patients with CAP and are associated with increased mortality, acute renal failure, prolonged hospital stay, and need for mechanical ventilation. Further studies are required to test risk stratification and prevention and treatment strategies for cardiac complications in this population.

Endoscopic band ligation versus argon plasma coagulation in management of bleeding from gastric antral vascular ectasia in patients with portal hypertension Muhammad M Abdel Ghaffar, Hala M Abd El Maguid Journal of Medicine in Scientific Research 2019 2(3):214-219 Background Gastric antral vascular ectasia (GAVE) may cause recurrent hemorrhage, and thus, chronic anemia, in patients with portal hypertension. Treatment with argon plasma coagulation (APC) is an effective and safe method in adults but requires multiple sessions of endoscopic therapy. Endoscopic band ligation (EBL) was found to be a good alternative for APC as a treatment for GAVE, especially in refractory cases. The aim of this prospective study was to evaluate the safety and efficacy of EBL, as compared with APC, in treating nonvariceal upper GI bleeding GAVE in patients with portal hypertension. Patients and methods A total of 40 patients with bleeding from GAVE were prospectively randomized to endoscopic treatment with either EBL or APC, every 4 weeks, until complete obliteration was accomplished. Hemoglobin level was obtained before and after treatment; then they were followed up endoscopically after 6 months, with documentation of the recurrence of the lesion, if that occurred. Results We found that EBL significantly decreased the number of sessions required for complete obliteration of the lesions (1.85 ± 0.81 sessions compared with 4.15 ± 1.22 sessions in the APC group; P < 0.05). Moreover, EBL was significantly superior to APC with respect to lower rate of recurrence during the treatment and follow-up period (P < 0.05) and a higher rate of endoscopic cure after the follow-up period (P < 0.05). Hemoglobin levels increased significantly after obliteration of the lesions in both groups, compared with pretreatment values (P < 0.05), but with no significant difference between the two groups; however, the EBL group required a significantly smaller number of units of blood transfusion than the APC group (P < 0.05), greater decrease in hospital admissions (P < 0.05), and shorter procedure time (P < 0.05). Postprocedural abdominal pain and vomiting occurred more frequently in the EBL group, with a significant difference (P < 0.05). No major complications or deaths were observed during the study period. Conclusion We concluded that GAVE could be safely and successfully managed by EBL or APC. Our study revealed that EBL is more effective, more time saving, and is comparable in safety to APC, in treating nonvariceal upper GI bleeding GAVE in patients with portal hypertension.

Using ondansetron as an oral premedication drug for prevention of postanesthesia shivering Ashraf A M. Soliman Journal of Medicine in Scientific Research 2019 2(3):220-223 Introduction Postanesthesia shivering (PAS) is one of the most common complications after surgeries. There are two methods to reduce the shivering, including pharmacological and nonpharmacological methods. Aim This study compared the efficacy and safety of 4-mg oral ondansetron premedication on preventing PAS, perioperative core body temperature changes, and hemodynamic stability. Patients and methods This prospective, observational study consisted of 100 adult patients scheduled for general surgery or interventional structural heart disease. The patients were randomized into two groups of 50 patients each. Group I received 4 mg of oral ondansetron, and group II received an oral placebo 60–90 min before the operation. All patients were assessed for perioperative hemodynamic changes, core body temperature changes, and PAS. Results Regarding the efficacy of the preoperative administration of oral ondansetron, this study reports the valuable preventive effect on shivering for ondansetron group (8.1%) compared with control group (44.3%), and there was a highly significant difference between both groups according to the incidence and scoring of shivering. On the contrary, we found no significant difference between groups according to heart rate, systolic blood pressure, and diastolic blood pressure. However, reduction in systolic blood pressure and diastolic blood pressure was recorded in both groups after induction, which came back up at the end of surgery. In addition, tympanic temperature reduction was recorded intraoperatively and came back up during the recovery period, with no statistically significant differences between groups. Conclusion Oral ondansetron premedication adequately decreases PAS compare with placebo. Ondansetron does not have any significant effect on the core or peripheral temperature.

Haptoglobin genotyping and risk of cerebral vasospasm after aneurysmal subarachnoid hemorrhage Ahmed M Ateya, Ahmed A El-Bassiouny, Sobhy H El-Nabi, Nagia A Fahmy, Mahmoud H Ibrahim, Islam El-Garwany, Khaled Gobbah Journal of Medicine in Scientific Research 2019 2(3):224-229 Background Aneurysmal subarach noid hemorrhage (aSAH) represents roughly 6&#8211;8&#37; of all stroke types. Almost 70&#37; of patients develop angiographic vasospasm, and 30&#37; of them will have delayed cerebral ischemia (DCI). An &#39;omic signature&#39; could combine genetic, proteomic, and metabolomic phenotypes into an accurate predictive model. Haptoglobin (Hp) genotypes could be used to stratify risk of resulting cerebral vasospasm (CV) and DCI, to give prognostic data dependent on distributed result probabilities, and to develop novel medications dependent on individual pathophysiological models. Objective This research intends to investigate the clinical and radiological factors as indicators for risk of development of CV after aSAH in Egyptian population, with the review of Hp genotype role as a predictor for CV. Patients and methods A total of 50 patients with aSAH were enrolled and followed up clinically and radiologically by transcranial Doppler examination for 14 days following presentation to early recognize hemodynamic changes related with CV and additional events of DCI as a result of CV. In this investigation, we attempted to analyze clinical data to find the potential hazard factors that are prescient of CV and DCI during the acute phase of aSAH. Results Approximately 34 (68&#37;) patients developed CV; among them, 19 (38&#37;) patients had DCI. History of hypertension [relative risk (RR)&#61;1.6], diabetes mellitus (RR&#61;1.5), and smoking (RR&#61;1.5) had a significant independent relationship (P<0.05) with short-term hazard to develop CV following aSAH. However, age, sex, dyslipidemia, cardiovascular disease, and peripheral vascular disease did not show any relationship. Regarding poor Fisher scale and poor Hunt and Hess score, both demonstrated significant relationship with CV (P<0.05). Conclusion Hypertension, diabetes, smoking, poor Fisher grade, and poor Hunt and Hess scale are independent risk factors for CV. The Hp genotype may be used as a predictor for risk for development of CV after aSAH. This has the potential for use in risk stratification.

Effect of liver cirrhosis on patient outcomes from open heart surgery Wael A Elhakeem, Ahmed A Faragalla, Hossam B Kashlan Journal of Medicine in Scientific Research 2019 2(3):230-237 Background We designed this prospective controlled study to evaluate the early postoperative outcomes in patients with liver cirrhosis (LC) after open heart surgery (OHS). Patients and methods Between May 2011 and February 2017, 120 patients with elective OHS were included and categorized into a control group (50&#37;) and patients with LC (50&#37;), who were further subdivided according to Child&#8211;Turcotte&#8211;Pugh (CTP) score into group CTP A (49 patients) and CTP B (11 patients). All preoperative demographic and clinical data in addition to operative and postoperative data were evaluated. Patients with CTP (class C) were excluded. Results Overall, 48 (40&#37;) patients experienced a postoperative complication: 47&#37; of group A cirrhosis, and 91&#37; of group B cirrhosis (P &#60; 0.001). Of these, 21&#37; were cardiac complications, with the majority occurring in patients with CTP A (n &#61; 19) and CTP B (n &#61; 9). There were 12 (10&#37;) postoperative deaths: four (7&#37;) patients in the control group, four (8&#37;) patients in CTP A group, and four (36&#37;) patients in CTP B (P &#61; 0.009). Factors associated with postoperative death included preoperative CTP classification (P &#61; 0.01), European System for Cardiac Operative Risk Evaluation (0.01), New York Heart Association classification (P &#61; 0.01), presence of ascites (0.02), a measurements of the right ventricular diameter (P &#61; 0.03), ventilation time (P &#60; 0.001), and postoperative chest tube drain output (0.04). Conclusion Patients with LC have a high incidence of morbidity and mortality after OHS compared with the control. The more the severity of LC, the more the complications and deaths. Patients with mild LC had acceptable outcome compared with others with advanced LC. The Child&#8211;Pugh score is more predictive of postoperative course than European System for Cardiac Operative Risk Evaluation.