Medicine in Scientific Research

The use of microplates for fixation of mandibular fractures: a systematic review Magdy M Zaky, Nabila A Fayed, Mohamed F Shehab, Usama S Hellal Journal of Medicine in Scientific Research 2019 2(1):1-7 Background Microplates have thin diameter making them less palpable, more malleable, easily applied, and adaptable to fracture site. In the past, microplates were used in midface fractures only, but we can obtain their benefits in mandibular fractures as well. Objective The aim of this systematic review was to verify the efficiency of microplates either alone or in combination with miniplates for fixation of mandibular fractures in comparison with miniplates. Materials and methods A systematic review was conducted using electronic databases for collecting articles that met the inclusion and exclusion criteria. Data were extracted from each article, and the quality of studies was assessed by Jadad scale. Four articles were selected that met the inclusion and exclusion criteria. Conclusion Microplates have high holding power and were efficacious for internal fixation of simple, minimally displaced, isolated mandibular fractures, but to support this information safely, numerous future studies with sound method and larger sample size are needed to evaluate their use in the other forms of mandibular fractures.

Role of sclerostin, fibroblast growth factor-23, and Klotho in hemodialysis patients Azza A I. Elmenyawi, Ahmed Hassan Journal of Medicine in Scientific Research 2019 2(1):8-15 Introduction Chronic kidney disease–mineral bone disorder leads to decreasing bone health. Sclerostin is produced by osteocytes similar to fibroblast growth factor-23 (FGF-23) and might upregulate the FGF-23 production by the osteocyte. FGF-23 may act as a mineralization inhibitor. Klotho serves as an obligate coreceptor for the FGF-23 and represents a marker of chronic kidney disease–mineral bone disorder. Aim We examined the association between serum sclerostin, FGF-23, Klotho, parathyroid hormone, high-sensitivity C-reactive protein (hsCRP), and phosphorus levels in hemodialysis (HD) patients. Patients and methods A total of 63 HD patients in the National Institute of Urology and Nephrology and 20 controls were enrolled in the study. Serum sclerostin, FGF-23, Klotho, parathyroid hormone, hsCRP, and phosphorus levels were assayed. Results We found that serum sclerostin, FGF-23, Klotho, and hsCRP levels of the HD patients were higher than controls [median and interquartile range are 1.379 (0.217–11.680) ng/ml, 61.71 (9.821–565.5) pg/ml, 201.74 (90.53–402.73) pg/ml, and 25.79 (12.10–41.92) mg/l vs. 0.535 (0.169–0.830) ng/ml, 33.077 (10.45–67.342) pg/ml, 349.49 (201.23–721.5) pg/ml, and 4.375 (2.27–6.21), respectively; P < 0.001). The sclerostin level was significantly correlated with the serum phosphorus, FGF-23, Klotho, and hsCRP (r = 0.296, P < 0.007; r = 0.239, P = 0.03; r=−0.336, P = 0.002; and r = 0.469, P < 0.001, r espectively). Moreover, FGF-23 was significantly correlated with the serum phosphorus and hsCRP (r = 0.335, P = 0.002, and r = 0.379, P < 0.001, respectively). There were a significant negative correlation between serum Klotho and serum phosphorus, FGF-23, and hsCRP (r=−0.363, P < 0.001; r=−0.220, P = 0.046; and r=−0.881, P < 0.001, respectively). Conclusion There is an association between serum levels of sclerostin, phosphorus, and FGF-23 in HD patients, and Klotho may represent an early marker of renal damage.

Diffusion-weighted MRI: Role in diagnosing hepatic focal lesions Manal A El-Refaei, Mohammed A M. Yousef, Medhat M Refaat, Ibrahim M Helmy Journal of Medicine in Scientific Research 2019 2(1):16-23 Objective The objective of this study was to highlight the role of quantitative and qualitative diffusion-weighted MRI (DW-MRI) in differentiating benign and malignant hepatic focal lesions, thus increasing the efficacy of conventional hepatic MRI, in addition to evaluating the effect of using different b-values. Patients and methods This study was carried out from January to November 2016. We prospectively scanned patients with suspected liver focal lesion referred from Hepatology Unit by high-field 1.5 T MRI. The data were tabulated and manipulated using SPSS, version 14, with the level of significance set at less than 0.05. Results The study revealed that benign lesions such as simple hepatic cysts and hemangiomata showed facilitated diffusion [high signal intensity (SI) on diffusion-weighted imaging and also high SI on apparent diffusion coefficient (ADC) map], whereas malignant solid tumors such as hepatocellular carcinoma (HCC) and metastases demonstrated restricted diffusion (high SI on diffusion-weighted imaging and low SI on ADC map). Regarding the quantitative results, the mean ADC of non-neoplastic liver parenchyma, simple liver cyst, hepatic hemangioma, liver metastases, and HCC measured 1.08 ± 0.22, 2.83 ± 0.19, 2.11 ± 0.18, 1.34 ± 0.27, and 1.07 ± 0.21 × 10-3 mm2/s, respectively. There was a highly statistically significant difference in mean ADC between benign focal hepatic lesions such as hemangioma and malignant lesions such as metastases or HCC (P = 0.001). Conclusion DW-MRI is a very useful additive to conventional MRI sequences in categorizing focal hepatic lesions, thus increasing the confidence of differentiating benign and malignant lesions, particularly if there is a contraindication for contrast injection or for better detection of minute lesions adjacent to vessels.

Effect of acupressure on dysmenorrhea among adolescents Sahar Mohammed Othman, Safaa Gaber Aly, Maha Mohamed Mady Journal of Medicine in Scientific Research 2019 2(1):24-28 Background Dysmenorrhea is a significant public health problem, which has a negative effect on female's health, social relationships, school or work activities, and psychological status. Purpose The purpose of the study was to evaluate the effect of acupressure on Sanyinjiao Acupoint (SP6) on primary dysmenorrhea among adolescents. Patients and methods Research design was an experimental case–control study. A total of 100 girls were randomly assigned to two equal groups (A and B): group A included 50 girls who received SP6 acupressure, whereas group B included 50 girls who received only light skin touching. Menstrual pain was measured by using a structured questionnaire, a subjective menstrual pain scales (Visual Analog Scale and McGill Pain Questionnaire – part I), before (at 8 a.m.) and after the intervention (at 8 p.m.) during the first 3 days of menstruation for 2 consecutive months. Results There was a significant decrease in menstrual pain among the two groups. Conclusion SP6 acupressure was effective in decreasing menstrual pain and can easily be used as a nursing management method for adolescents. Recommendation Acupressure should be offered to cope with menstrual pain, as it is useful and has no adverse effects.

Effect of different doses of low-intensity laser therapy on total active range of motion after hand flexor tendon repair Feify A B. Mahmoud, Wadida H Abd El-Kader El-Sayed, Amir A.E Saidi Ahmed, Amir N W. Mawad, Osama F A. Al Balah, Eid R.A El-Azeem Ahmed Journal of Medicine in Scientific Research 2019 2(1):29-35 Objective To investigate the difference between the effects of different doses of low-level laser therapy (4 or 1 J/cm2) on the return of hand active range of motion (ROM) after flexor tendon repair. Participants and methods A small trial was conducted on 33 patients with 45 injured fingers of both sexes who underwent primary repair after complete cut of hand flexor tendon. Their age ranged from 20 to 40 years old. They were recruited from the plastic surgery department. The treatment began the first day postoperatively after permission by surgeons using Duran protocol and splinting. Transcutaneous electrical nerve stimulation (TENS), as well as LASER therapy, was started the seventh day after surgery. Laser treatment lasted for 3 weeks only, whereas other modalities lasted for 3 months. The sample was randomly divided into three groups each of 15 injured tendons. Group A received the conventional treatment plus laser therapy (1 J/cm2), three sessions/week for 3 weeks. Group B received the traditional treatment plus laser therapy (4 J/cm2), three sessions/week for 3 weeks. Control group received the conventional treatment only. All patients received the early conventional physical therapy after permission by the surgeon: TENS plus early therapeutic exercises following Duran protocol, three sessions/week for 3 months. The ROM was measured at eighth and 12th week after the commencement of treatment. Results At second month after commencement of treatment, there was a positive effect of laser therapy with either doses 1 or 4 J/cm2 on total hand active ROM after flexor tendons repair, with more effect noticed in group B (4 J/cm2). At third month after commencement of treatment, best results in hand active ROM were seen in group B (4 J/cm2), with prognosis being excellent in 46.7% of patients, good in 33.3% and fair in 20.0% according to the modified Strickland classification. Conclusion The 4-J/cm2 laser dose is more efficient than laser dose of 1 J/cm2 in the treatment of repaired hand flexor tendons in addition to conventional treatment (TENS stimulation plus Duran protocol therapeutic exercises) in early regain of active ROM that can affect return of early better hand function.

Endoscopic treatment of acute gastric variceal bleeding in patients with cirrhosis using isoamyl-2-cyanoacrylate Tarek A Fouad, El Saied E. Shabaan Journal of Medicine in Scientific Research 2019 2(1):36-41 Context Gastric variceal (GV) bleeding is a serious complication in patients with cirrhosis, as it is usually severe with high rate of mortality and rebleeding. Aim The aim of this study was to evaluate the efficacy and safety of endoscopic therapy with isoamyl-2-cyanoacrylate (Amcrylate) in patients with cirrhosis with GV (gastroesophageal varices type 2 and isolated gastric varices type 1) bleeding. Patients and methods We prospectively studied 34 patients with cirrhosis with bleeding GV who were treated with intravariceal injection of isoamyl-2-cyanoacrylate (Amcrylate). Statistical method Data were expressed as the mean ± SD or as number (%) for numerical variables. Results After a mean dose of 1.86 ± 0.49 ml (range: 1–3 ml) of isoamyl-2-cyanoacrylate was injected in each patient, hemostasis was achieved initially in 100% of patients and complete obliteration of GV in 100% of patients. Treatment-related complications occurred in 26.5% of patients (9/34), but all complications were transient and mild. Complications included ulceration at site of injection (8.8%), fever (2.9%), abdominal pain (5.8%), chest pain (5.8%), and transient dysphagia (2.9%). Only one (2.9%) patient died closed to the cyanoacrylate treatment during hospitalization owing to hepatic encephalopathy and hepatorenal syndrome type I. During mean follow-up of 11.9 + 5.2 months (range: 2 weeks–21 months), rebleeding occurred in 8.8% of our patients. Conclusion This study has demonstrated the efficacy and safety of endoscopic treatment of bleeding GV using isoamyl-2-cyanoacrylate injection with initial hemostasis and complete obliteration of GV with no serious complications and low risk of rebleeding and bleeding-related death.

Relationship between dietary intake and obesity among a group of primary school-aged children in Cairo Governorate Hany H El-Gazzar, Salwa M Saleh, Saher A Khairy, Ahmed S Marei, Khaled ElKelany, Mohamed F Al Soda Journal of Medicine in Scientific Research 2019 2(1):42-53 Context Currently, childhood obesity has been growing at an alarming rate, and it is a common nutritional problem among children in developed countries as well as in developing countries. It has become one of the most serious public health challenges of the 21st century. Aim This study attempts to determine the relationship between dietary pattern and obesity among primary school children. Patients and methods This is a cross-sectional descriptive study involving 842 children (6–12 years old), comprising 389 boys and 453 girls. This study was carried out by using anthropometric data and dietary assessment (24 h recall) and food consumption pattern. Results The finding revealed that high-density foods were significantly associated with obesity. Obese children adequately took bodybuilding food. Preventive food was adequately taken, but some of them were within the recommended dietary allowance percentage, and others were less than recommended dietary allowance percentage. Conclusion We concluded that there was a positive correlation between the increased intake of high-energy dense food (fat and sugar) and obesity in the studied group.

Carbetocin versus oxytocin in prevention of postpartum hemorrhage in late preterm twin pregnancy following cesarean section: a prospective clinical study Ashraf M Kansouh, Mohamed A El Naggar Journal of Medicine in Scientific Research 2019 2(1):54-58 Objective The objective of this study was to compare effectiveness and safety of carbetocin versus oxytocin infusion in prevention of postpartum hemorrhage (PPH) in women with late preterm twin pregnancy undergoing cesarean section. Patients and methods A prospective clinical study was conducted from June 2014 to August 2015 in Shibin El-Kom and Benha Teaching Hospitals in Egypt that enrolled 175 women with late preterm twin pregnancy undergoing cesarean section. Carbetocin group (n = 90) as a single intravenous bolus was compared with oxytocin (n = 85) 10 IU as six infusions as soon as the second twin was delivered, and the outcomes were compared. Results The mean blood loss during cesarean section was higher in oxytocin group as compared with carbetocin (685 ± 350 vs. 782.8 ± 370 ml, P > 0.05). The incident of primary PPH (>1000 ml) in cesarean delivery was lower in carbetocin group versus oxytocin group (3.33 vs. 11.76%, P < 0.05). The difference between hemoglobin levels 24 h after delivery was not significantly lower in carbetocin group (P > 0.05). The need for another uterotonic agents in carbetocin was lower than in oxytocin (23.33 vs. 35.29%, P < 0.05). Conclusion This study found that carbetocin was an acceptable option with reduction of PPH compared with oxytocin in late preterm twin pregnancy undergoing cesarean section, and both had similar safety profile with minor hemodynamic effect.

Significance of matrix metalloproteinase-9 expression in the ectopic endometrial tissue of women with endometriosis Ashraf M Kansouh, Abd Elatif M. Elbalshy, Samar E Ghanem Journal of Medicine in Scientific Research 2019 2(1):59-64 Background Degradation of the extracellular matrix is a basic step in the formation of endometriosis. The extracellular matrix degradation operated by matrix metalloproteinases (MMPs) Because matrix metalloproteinases (MMPs) are essential in orchestrating proper physiological functioning of the endometrium. MMP-9 is affected by many factors such as prostaglandin E2, tumor necrosis factor-α, interleukin 1β, interferon-γ, and tissue inhibitors of matrix metalloproteinase. Objective The aim of the present study was to evaluate MMP-9 forms in the ectopic and eutopic endometrial tissue of women with endometriosis. Patients and methods The study was carried upon 56 patients. Patients were divided into two groups (study and control). The study group included 28 patients, which were infertile, and in whome diagnostic laparoscopy, open laparotomy or hysterectomy for non-malignant lesions (fibroids) showed endometriotic implants. Control group included the other 28 patients, which were normal and fertile. Specimens were prepared and MMPs-9 was immunohistochemically detected and assessed in tissue sections. Results The results of the current study showed a significant increase in MMP-9 expression in the ectopic endometrial tissue of women with endometriosis. Conclusion MMP-9 could be considered a good marker for endometriosis and might play a significant role in the progression of endometriosis.

Key role of inferior turbinectomy and partial middle turbinectomy in endoscopic surgery for allergic fungal sinusitis: A comparative study Ahmad Mostafa, Wael A Alzamil, Essam Fatehy, Mohammad M Gaballah Journal of Medicine in Scientific Research 2019 2(1):65-70 Background Proper eradication of allergic fungal sinusitis (AFS) depends on three factors: first is proper preoperative evaluation and mapping via computed tomography and MRI. Second is the availability of adequate surgical tools in experienced hands. Third is the proper postoperative endoscopic follow-up to detect and remove recurrence if possible. Aim To evaluate the role of inferior turbinectomy (IT) and partial middle turbinectomy (PMT) in patients with AFS managed by endoscopic sinus surgery (ESS) for the prevention of recurrence and adequate management of residual disease (postoperative salvage). Patients and methods A prospective, comparative, randomized study conducted from March 2016 to April 2018. In all, 28 patients suffering from AFS were included. All patients have been presented and managed at the Department of Otolaryngology, Hearing and Speech Institute. Patients have been randomized into two groups of 14 patients each (groups A and B). The patients in group A have undergone ESS only, while the patients in group B have undergone ESS plus bilateral IT and PMT. Regular follow-up visits were done every 2 months for at least 6 months for both groups. Results In group A, there was difficulty in proper assessment in 11 patients out of 14. Recurrence occurred in five patients who showed rigorous assessment, which was managed via ESS adding to the maneuver bilateral IT and PMT. In group B, only two patients were difficult out of the 14. Recurrence occurred in two patients only and was managed easily in the outpatient office. No significant complications were detected in both groups. Conclusion IT and PMT may be considered as essential steps in the surgery for AFS as they play a role in lowering the recurrence rate and facilitating better, more comfortable, and more effective postoperative management of recurrence if happened.