Search

Background: Migraine is considered as a neurovascular coupling disorder where the cerebral vascular reactivity is malfunctioning and measuring hemodynamic changes during migraine without causing more disturbances has always been a challenge. Objective: This study aimed to detect the role of transcranial Doppler ultrasound in assessing the vasomotor reactivity of cerebral blood vessels in migraine patients. Patients and Methods: This case control study included thirty-two migraine patients and thirty-two healthy individuals that were recruited from Neurology Department at Zagazig University Hospital and Neuropsychiatry Department at El-Sahel Teaching Hospital Outpatient Clinics during the period from April to December 2020. We performed Transcranial Doppler (TCD) on all participants and Breath Holding Index (BHI) was measured on both sides from the middle cerebral artery (MCA). Results: There was a significant decrease in breath holding index in patients of migraine. There was a statistical significance decrease in BHI and Maximum flow velocity in the left MCA (Max. FV Lt MCA) among severe patients compared to moderate patients. Conclusion: Migraineurs have significantly lower BHI compared to control group. The noninvasiveness of TCD and the possibility it provides for obtaining instantaneous information about cerebral blood flow changes indicates its usefulness in the study of vascular changes in different types of migraine.

Background: There are several possible causes of vocal fold polyps in adults. The mechanical damage is the main cause for polyp formation. Laryngopharyngeal reflux and human papilloma virus are possible co-factors. Objective: The aim of this study was to find out the associated roles of laryngopharyngeal reflux and human papilloma virus in the development of adult vocal fold polyps. Patients and Methods: This cross-sectional observational study included 50 adult patients presented with vocal fold polyps. Patients were preoperatively assessed for the presence of laryngopharyngeal reflux using the validated nine-item reflux symptom index and eight-item reflux finding score. All patients were subjected to excision of the laryngeal polyp by microlaryngoscopic surgery. The excised samples were sent for human papilloma virus (HPV) detection by PCR. Results: Laryngopharyngeal reflux (LPR) was presented in 34 patients (68%). Reflux symptom index ranged from 6 to 25 (mean 13.06 ± 4.95). Reflux finding score ranged from 3 to 18 (mean 10.08 ± 4.32). Seventeen patients (34%) had positive HPV-6. Fifteen patients had positive HPV-6 out of 34 patients diagnosed with LPR (44.11%), compared to only two patients had positive HPV-6 among 16 patients without LPR (12.5%) (P = 0.027). There were significant relations between presence of HPV-6 and both reflux symptom index and reflux finding score; both were significantly higher among patients with positive HPV-6 (P = 0.028) and (P < 0.001) respectively. Conclusion: Both laryngopharyngeal reflux and human papilloma virus play important associated roles in the development of vocal fold polyps in adults.

Objective: The aim of this cross-sectional study was to examine and compare the prevalence of internet addiction and internet gaming disorder with examination of related sleep problems. Also identifying risk factors associated with them . Patients and methods: Data were collected from 60 students of Al-Azhar University. From randomly selected 6 different faculties. We found a high prevalence rate of Internet Addiction (IA) among them. This prevalence was higher than Internet Gaming Disorder (IGD) prevalence. Both of IA and IGD are inversely correlated to sleep quality. Theoretical faculties are at higher risk for IA and IGD. Middle Socioeconomic status (SES) of adolescents’ parents is related to IA but not related to IGD. The study was approved by the medical ethics committee of Al-Azhar University Hospitals and a written informed consent was obtained from all patients. Results: According to the results of the Internet Addiction Test (IAT), 46.7% of the sample had moderate internet addiction, 3.3% had severe internet addiction and 40% had mild internet addiction. According to results of (IGD) Scale 50% were at risk to develop Internet Gaming Disorder (IGD)&13.6% were disordered. According to Pittsburgh Sleep Quality Index (PSQI), (60%) of the participants were suffering from poor sleep Quality. Conclusion: The current study has revealed a high prevalence rate of Internet Addiction (IA) among Al-Azhar university students. This prevalence was higher than Internet Gaming Disorder (IGD) prevalence. Both of IA and IGD are inversely correlated to sleep quality.

Background: HIV, HBV and HCV are still major public health concerns. Infections with these viruses rank among ten leading causes of death attributable to infectious diseases. The variability in the prevalence of HIV/hepatitis coinfection worldwide is multifactorial, and depends on geographic regions, infections’ risk factors and type of exposure. Objective: To investigate HBV and HCV prevalence in HIV patients. Patients and Methods: This study was conducted on HIV infected, and AIDS patients attending Alexandria Fever Hospital during the period from August 2018 to July 2019, assuming prevalence of HCV in HIV patients is 15% sample was calculated to be 141 patients using epi info version 7 program with test power 80%, CI 95%. Results: The incidence of infection with hepatitis C virus was 45 patients (31.9%), all the 45 tested positive for PCR for HCV RNA as HIV accelerated progression of the disease making it almost impossible for HCV spontaneous clearance. This percentage is much higher than that of ordinary people, and the incidence of hepatitis B infection is 9 patients (6.4%). The Prevalence of co-infection between hepatitis C virus and HBV among immunodeficiency patients was 2.8%, with the combined infection among the three viruses in only 4 patients out of 141 patients. Conclusion: the results of the present work underline the importance of continued screening of HIV positive for HBV as well as HCV markers before initiation of highly active antiretroviral therapy (HAART) as this practice would guide correct choice of drug combination.

Background: The conversion from open to laparoscopic simple nephrectomy was considered as an initial and most dramatic step toward progression, the second step is trying to miniaturization of the endoscope and instruments, in this study we aimed to evaluate miniaturization of laparoscopic simple nephrectomy looking for reduction perioperative morbidity and enhance cosmoses without significant operative disability. Patient and Methods: We prospectively reviewed 120 patients (60 in each group) who underwent trans-peritoneal conventional laparoscopy (CL) or mini laparoscopy (ML) simple nephrectomy between April 2015 and May 2018. The CL was done using 3 to 4 ports ranged from 5 to12 mm in diamond manner distribution. ML was done using same ports number and distribution ranged from 3- 5 mm except umbilical one was 10 mm. All operations were performed by same surgeon Results: However, ML experienced a significant longer operative time, significant more blood loss and insignificant increased conversion rate. The Post-operative data in the interest of ML were as follows; significantly lower pain scores, lower hospital stay, earlier return to activities and significant increase of cosmoses score of patients, Lastly, port site hernia was 6.7% in CL group and none in ML group (p = 0.042) Conclusion: ML trans-peritoneal simple nephrectomy is associated with lower post-operative pain, hospital stay, early return to normal activity, better cosmoses and less port site hernia. However operative time, blood loss and conversion rate are potentially more than CL.

Background: neonatal hyperbilirubinemia is a leading cause of morbidity and mortality in developing countries. Adverse consequences include neonatal mortality, classic manifestations of choreoathetoid cerebral palsy, isolated auditory impairment, and a diverse manifestation of subtle processing disorders because of BIND. Aim of the Work: the aim of the current study was to evaluate the effectiveness of intensive phototherapy on BIND score in neonates with severe hyperbilirubinemia. Patients and Methods: the current study is a prospective study conducted on 100 neonates with severe hyperbilirubinemia admitted to NICU at university Hospital, Faculty of Medicine, Al-Azhar University, Assuit, Egypt in the period between November 2017 and May 2018. The study group was divided into 2 groups, hemolytic and non-hemolytic hyperbilirubinemia groups. Results: regarding TSB and direct bilirubin at admission no significant difference was detected between both groups (p=0.543 and 0.632). Regarding TSB and direct bilirubin at discharge no significant difference was detected between both groups (p=0.712 and 0.213). Results show no significant change between hemolytic and nonhemolytic jaundice regarding rate of decline per hour of total bilirubin and direct bilirubin after 8 hs. No significant difference between study groups regarding BIND score at admission. At discharge, 95 (95%) neonates had BIND score 0 and 4 (4%) had BIND score 1-3. One neonate (1%) died before scoring. Conclusion: care must be taken not to delay the decision of exchange transfusion to the degree that endangers baby's life. BIND score can be used to assess the efficacy of intensive phototherapy in newborn with hyperbilirubinemia.

Background: If blood pressure (BP) falls during hemodialysis (HD) (intradialytic hypotension (IDH)) a common clinical practice is to reduce the extracorporeal blood flow rate (EBFR). Consequently, the efficacy of the HD (Kt/V) is reduced. Aim of the Work: The aim of the present study is to investigate the impact of changes in extracorporeal blood flow rate (EBFR) on blood pressure (BP), pulse rate (PR) and cardiac output (COP) in hemodynamically stable patients during hemodialysis. Patients and Methods: The population of this study consisted of 40 patients that on renal dialysis (RD) three sessions weekly. Patients were investigated prior to and after one conventional hemodialysis session. Prior to the hemodialysis session, an echocardiograph was performed to evaluate left ventricular ejection fraction (LVEF) and establish the degree of potential heart failure. Result: In the present study regarding measure of BP, PR and COP in EBFR 200 ml/min, 300 ml/min and 400 ml/min, there was significant increase in systolic BP at an EBFR 200 ml/min as compared with EBFR 300 ml/min and EBFR 400 ml/min. but there was no significant change in systolic BP at an EBFR 300 ml/min as compared with an EBFR 400 ml/min. Conclusion: IDH has been associated with many adverse clinical events including myocardial stunning, cerebral atrophy and increased mortality. Change of BFR from 400 ml/min or from 300 ml/min to EBFR 200 ml/min can increase in BP so help in decrease occurrence of complications of IDH beside other methods of increasing BP during hemodialysis.

Background: chronic hepatitis C is a common condition. Transfusion of blood or blood-related products was one of the main routes of HCV transmission. Furthermore, nosocomial infections represent a key source of infection, particularly in some of the high-prevalence countries (such as Egypt, Pakistan and Eastern Europe). In general, prevalence increases with increasing age until peak prevalence at 55–64 years in most regions. At least six HCV genotypes are known, Genotype 4 frequency is the highest from Central Africa to the Middle East. Worldwide people infected with HCV are at an increased risk of developing serious hepatic complications including cirrhosis and hepatocellular carcinoma. Aim of the Work: the aim of this work is to study vitamin D level in post HCV liver cirrhosis patients before and six months after liver transplantation in addition to chronic HCV patients without cirrhosis. Patients and Methods: this prospective case control study was conducted on 25 patients. 15 of them with liver cirrhosis due to chronic hepatitis C virus evaluated before and six months after liver transplantation in addition to 10 chronic HCV patients without cirrhosis as control group. Liver cirrhosis or transplantation patients were recruited from Ain Shams specialized hospital liver transplantation unit and chronic HCV patients without cirrhosis were recruited from hepatology outpatient clinic of Ain Shams university hospital in the period from February 2017 to November 2017. Symptoms suggestive of liver disease (e.g. jaundice, bleeding tendency, increased abdominal girth). Results: this study was conducted on 25 patients. 15 of them with liver cirrhosis due to chronic hepatitis C virus evaluated before and six months after liver transplantation in addition to 10 chronic HCV patients without cirrhosis as control group. Group I: Consists of 15 (60%) patients with post HCV liver cirrhosis before liver transplantation. They were 13 males (86.6%) & 2 females (13.3%). Their mean age was 50.53 ± 4.52. Group IΙ: Consists of the same patients of group I evaluated six months post liver transplantation. Group III: Consists of 10 (40%) patients with chronic HCV without cirrhosis. They were 6 males (60%) & 4 females (40%). Their mean age was 53.0 ± 8.46. Conclusion: this study concluded that vitamin D deficiency is prevalent among patients with liver cirrhosis. Liver transplantation improves vitamin D level but not to the recommended normal level i.e. vitamin D deficiency or insufficiency can persist after transplantation.