Current Medical Research and Practice

The role of transcranial magnetic stimulation in acute Bell's palsy Noha Abo El Fetoh, Nihal A Fathi, Rania M Gamal Eldein, Marian S Shehetta Journal of Current Medical Research and Practice 2020 5(1):1-6 This review discusses the reported data in studies using transcranial magnetic stimulation (TMS) in acute Bell's palsy (BP). These studies displayed the role of TMS in confirming the diagnosis and providing prognostic information about outcome of acute unilateral BP. In summary, two TMS roles have been discussed in these reviewed studies when employing TMS in patients with BP: firstt, the role of TMS as a diagnostic tool for BP when a lesion is of peripheral and lower motor in nature either applied over the ipsilateral parieto-occipital region (canalicular stimulation) or over the contralateral facial area of the motor cortex (cortical stimulation), and the second role of TMS is providing data about its prognostic value in recovery and BP outcome. The overall TMS studies are valuable in prognosis of BP regarding recovery and sequelae.

Irritable larynx syndrome (Internal and external correlates) Emad K Abdel Haleem, Eman S Hassan, Dalia G Yassen, Amira H. Abd El-Aal Aref Journal of Current Medical Research and Practice 2020 5(1):7-13 Irritable larynx is a condition of laryngeal dysfunction at which there is abnormal spasmodic closure of both vocal folds during inspiration. Patient complains of many symptoms as stridor, dysphonia, chocking, globus sensation, and dyspnea. These symptoms are not specific for irritable larynx only, but; they are frequently confused with other disorders such as gastroesophageal reflux, asthma, and different causes of chronic cough. The golden method for diagnosis is to visualize both vocal folds abducted during inspiration in acute attack by indirect laryngoscopy. To review recent available literature concerning irritable larynx syndrome to get essential recent data as a primary step for understanding this disorder.

Evaluation of bone mineral density and vitamin D in patients with systemic lupus erythematosus and their relation to disease activity Essam A M. Abda, Mohamed Esmail, Mohamed Z Abd Elrhman, Nadia M Ismail, Zeinab S Noaman, Samar H Goma Journal of Current Medical Research and Practice 2020 5(1):14-22 Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects multiple systems and is associated with an inflammatory status. The aim of our study is to estimate the serum level of vitamin D and bone mineral density (BMD) in SLE patients and their relation to disease activity. Patients and methods: Ninety SLE patients, fulfilling the updated American College of Rheumatology criteria 2012 and 60 age-matched and sex-matched controls were included in this study. The level of serum 25-hydroxyvitamin D (25(OH)D3) and dual-energy radiograph absorptiometry were done for patients and controls. Results: There was significant difference between systemic lupus erythematosus disease activity index (SLEDAI) score and vitamin D (P <0.02). There were significant difference (P <0.01) between SLE and control with BMD of total lumbar (L1–L4) and total hip and highly significant difference (P <0.001) with neck of the femur, Ward's angle of the femur, trochanter of the femur, and the radius. There was significant difference (P<0.05) between SLE and control groups regarding T score of lumbar spine (L1–L4) (P <0.03), neck of the femur (P<0.01), and total hip bone (P <0.02). Our results showed that there was significant difference between SLEDAI score and T score of neck of the femur (P <0.02) and radius bone (P <0.012), while there was no significant difference between SLEDAI score and T score of total hip, lumbar spine (L1–L4), Ward's angle of the femur, and the trochanter of the femur. Conclusion: Vitamin D deficiency and low BMD are common in SLE patients. There was significant difference between SLE patients and control group regarding vitamin D, BMD, and T score at different sites.

Audit on neonatal exchange transfusion in the Neonatology Unit of Assiut University applying American Academy of Pediatrics 2004 guidelines Ahmed M Elnaggar, Amira M Ahmed, Ghada O Elsedfy Journal of Current Medical Research and Practice 2020 5(1):23-26 Introduction: Exchange transfusion (ET) still has an important role in the Neonatal ICU of Assiut University Children Hospital as an emergency procedure for management of severe cases of hyperbilirubinemia. Therefore, this audit study was done on 26 patients for 1 year to detect the adherence to the American Academy of Pediatrics (AAP) 2004 guidelines, which are already implanted in the unit. The procedure involves incremental removal of the infant's blood having high bilirubin levels and/or antibody-coated red blood cells and simultaneous replacement with fresh donor blood providing fresh albumin with binding sites for bilirubin. Patients and methods: This study included 26 infants admitted at the Neonatal ICU of Assiut University Children Hospital for whom ET was done over 12 months from firstt day of September 2017 to the end of August 2018. The data were collected by recording the investigations done before and after ET and observation by the Neonatal ICU of Assiut University Children Hospital staff during ET in comparison with the checklist, which is already implanted in the unit and is based on the AAP 2004 guidelines. Results: Of the 26 studied infants, 73% had ABO incompatibility, where 19.3% had RH incompatibility and 7.7% have other diagnosed breast milk jaundice by exclusion of other causes, subgroup incompatibility, and polycythemia. Coombs test was done in 31% and not done in 69% of the studied cases. All the studied cases were given medication during ET in the form of calcium gluconate intravenously. Conclusion: AAP 2004 guidelines have been partially followed in ET in the studied cases, but there were some shortcomings that can affect the outcome. The study recommends avoiding these shortcomings.

Endoscopic surgical excision of third ventricular colloid cyst in upper Egypt: results of 2 years of practice Mohamed A Ragaee, Khaled Ismail Journal of Current Medical Research and Practice 2020 5(1):27-31 Background: Colloid cyst is a benign rare lesion that originates in the third ventricle. Headache, vomiting, visual deterioration, and memory deficits are the most common presenting symptoms. Endoscopic excision of colloid cyst is one of the recent advances in the field of minimally invasive neurosurgery. Aim: The aim was to assess the efficacy and safety of the endoscope for excision of the colloid cyst. Patients and methods: In this study, we review our experience in 14 patients who presented to us in two University Hospitals in south of Egypt in 2 years (2016 and 2017). The authors used LOTTA ventriculoscope with HOPKINS wide-angle straightforward telescope 6°. Results: Of fourteen patients, 13 (92.9%) improved completely postoperatively, and only one (7.1%) patient who had visual deterioration did not improve after surgery. Total to near-total excision was done in 11 (78.6%) patients, and evacuation of the cyst with partial excision was done in three (21.4%) patients. Conclusion: Endoscopic excision of third ventricular colloid cyst is a safe minimally invasive approach that can be used in patients who present with colloid cyst without the need to do cerebrospinal fluid diversion (shunt).

Helicobacter pylori eradication therapy in patients with immune thrombocytopenic purpura: a single-center experience Nabila Faiek, Safinaz Hussein, Reham Badr Journal of Current Medical Research and Practice 2020 5(1):32-35 Objective: The aim was to determine the frequency of Helicobacter pylori infection in patients with immune thrombocytopenic purpura (ITP) and to detect the effect of its eradication therapy on platelet count response in H. pylori-positive patients. Patients and methods: H. pylori stool antigen enzyme immunoassay test was done for 54 patients with ITP. H. pylori-positive patients received standard triple therapy for 2 weeks. Platelet count response to H. pylori eradication therapy was evaluated 2 and 3 months after the treatment. Results: H. pylori infection was positive in 38 (70.4%) patients with ITP. Eradication of H. pylori was achieved in 30 (78.9%) patients (responder group). There were statistically significant increases in platelet count (among the responder group) after H. pylori eradication therapy at 2 and 3 months (P < 0.05). Conclusion: Eradication of H. pylori infection in patients with ITP is associated with significant increase in platelet counts.

Laryngeal ultrasound as a bedside tool in detecting postextubation stridor in patients with respiratory illness Ashraf Z El-Abdeen Mohammed, Lamiaa H Shaaban, Hosam E. G. Mohammed El-Malah, Shereen F Gad, Maiada K Hashem Journal of Current Medical Research and Practice 2020 5(1):36-40 Context Postextubation stridor is a serious complication in respiratory ICU. Laryngeal ultrasound (US) could be helpful in its diagnosis. Aim The aim was to evaluate accuracy of laryngeal US in detecting postextubation stridor in patients with respiratory illness. Patients and methods A prospective observational study was conducted. A total of 167 mechanically ventilated patients were consequently included over a 2-year period. Laryngeal US air column width (ACW) was measured just after intubation and at the time of extubation. Air column width ratio (ACWR) (ACW before extubation/ACW after intubation) and air column width difference (ACWD) at the time of extubation (ACW with cuff deflated-ACW with cuff inflated) were calculated. Statistical analysis Statistical Package for the Social Sciences statistical software computer program version 20 and Medcalc v. 11.6 were used. Nonparametric tests were used. Results Among the included patients, 17 (10.2%) patients developed stridor. Both ACWR and ACED were significantly lower in patients with stridor than those without stridor (0.798 ± 0.051 vs 0.893 ± 0.056,P < 0.001; 0.541 ± 0.326 vs 1.237 ± 0.442,P < 0.001, respectively). The optimum cutoff value to detect postextubation stridor was less than or equal to 0.86 for ACWR, showing area under the curve of 0.894, 82.4% sensitivity, and 84% specificity and was less than or equal to 0.65 mm for ACWD, showing 76.5% sensitivity, 90% specificity, and area under the curve 0.896. Conclusions US is a valuable tool in detecting postextubation stridor. US -guided ACWR and ACWD could be accurate methods for predicting postextubation stridor in RICU.

The efficacy, safety, and stability of tacrolimus 0.03% ointment in treatment of nonsegmental vitiligo Nagwa E AbdElazim, Haidy A Yassa, Ayman M. Mahran Journal of Current Medical Research and Practice 2020 5(1):41-45 Background Topical immunoarm adulators have been successfully used as a monotherapy or in combination with other therapeutic modalities in vitiligo treatment. Topical tacrolimus has been reported to promote melanoblast differentiation and groth. Additionally, it promotes a favorable environement that enhances the proliferation of melanocytes/ melanoblasts through an interaction with keratinocytes, and thereby repopulating vitigiginous skin lesions. Aim To detect the effect of tacrolimus ointements in treatment of nonsegmental vitiligo. Method A total of 35 patients with vitiligo were enrolled in Tacrolimus this randomized placebo-controlled study. Two vitiliginous patches were chosen in each patient. The firstt lesion (A) was treated by tacrolimus 0.03% ointment, and the second lesion (B) was treated by panthenol cream as a placebo. Treatment course was 3 months, and follow-up was done for three extra months. Vitiliginous patches were assessed at baseline and monthly for 6 months. Results Moderate to excellent response was observed in 25.7% of lesions A compared with 0% of lesions B (P = 0.002). Disease duration has a negative effect on therapeutic response. No adverse effects were noted to tacrolimus ointment except for mild erythema in 6% of the patients. Coclusion Given its immunomodulatory properties and lack of cutaneous adverse effects, tacrolimus is a potential therapeutic alternative for vitiligo, with an improved benefit-risk ratio.

Evaluation of comma-shaped incision with a sacral flap in surgical treatment of pilonidal sinus Mina R.A.R. El Nahal, Mohammed Y.F. Aly, Ragai S Hanna, Gamal A Makhlouf, Gamal A Hameed Ahmed Journal of Current Medical Research and Practice 2020 5(1):46-49 Background: Pilonidal sinus disease is an infection in the subcutaneous fatty tissue, mainly in the natal cleft. Although surgery is the best line of treatment with a favorable prognosis, recurrences and wound complications do occur in some cases. The aim of our study is to evaluate the coma-shaped incision with sacral flap for the management of chronic pilonidal sinus. Patients and methods: Our study is prospective. All patients presented to the General Surgery Department, Assiut University Hospital by de novo chronic pilonidal sinus in the period from March 2017 to June 2018 were included in our study. Comma-shaped incision with sacral flap was planned to all patients. Data on patient demographics, operative time, blood loss, hospital stay, complications, and recurrence rate were evaluated. Results: We included 30 patients. They comprised 22 men and eight women with a mean age of 34 years. The mean operative time and hospital stay were 27 min and 1 day, respectively. Two (6.6%) patients developed superficial wound infection and two (6.6%) patients developed seroma and one (3.3%) patient developed recurrence. Conclusion: Comma-shaped incision with sacral flap provides good results and low recurrence rate. Further prospective studies of a larger number of patients are needed.

Thyroid dysfunction among chronic hepatitis C patients and its relation to Interferon therapy Lobna F El Toony, Marwa A Mohammed, Lobna A El-Wahid Ahmed Journal of Current Medical Research and Practice 2020 5(1):50-56 Background: Thyroid dysfunction (TD) represents an extrahepatic manifestation of chronic hepatitis C (CHC). Moreover, the currently approved treatment of CHC is often associated with TD. However, it remains debatable if TD is mainly virus or treatment related. The aim of this study was to assess the incidence of TD and to identify its predictors in treated and untreated CHC-infected patients. Patients and methods: A total of 1290 patients with CHC were evaluated for TD for 48 weeks: 200 were untreated (control group) and 1090 were treated with pegylated interferon α (PEG-IFN-α) plus ribavirin (treatment group). Results: The incidence of TD was more evident by the end of treatment (week 48); it was found to be 15.5%, mostly in the form of hypothyroidism (8.4%), whereas the least incidence was detected by week 12 (9.1%), mostly in the form of hyperthyroidism (5.2%). Generally, hyperthyroidism was higher than hypothyroidism in multiple folds, but in the end, hypothyroid cases became more dominant. Males were more affected, but the prevalence of hypothyroidism was more in females (10.1%) than males (8.0%). TD was not related to sex, age, BMI, pretreatment viral load, pretreatment laboratory characteristics, post-treatment biochemical tests, treatment duration, severity of hepatic inflammation and fibrosis, type of biopsy used, or virological outcome, but PEG-IFN formulation was related, particularly IFN-α-2a. TD did not lead to dose reduction or therapy withdrawal. Conclusion: Both hepatitis C virus and IFN-α therapy have been found to be inducing thyroid disorders in patients with CHC virus infection. Antiviral therapy of CHC possibly induces de novo or exacerbates pre-existing silent TD especially subclinical hypothyroidism. The role of CHC per se in TD remains to be determined.