Correlation between modified shock index and severity index in predicting outcome in patients with hemorrhagic shock Hassan I. M. Kotb, Ayman A Mamdouh, Abualauon M Abedalmohsen, Sarah Abd El Mageed Mohammed Journal of Current Medical Research and Practice 2019 4(3):231-236 Introduction Trauma is the main cause of death in age group less than 45 years. A lot of clinical parameters including heart rate, pulse rate, blood pressure, shock index (SI), and modified shock index (MSI) are used to predict the severity of hemorrhage in trauma patients. In 2012 Choi and colleagues proposed for the first time a new index (NI) based on lactate concentration and peripheral perfusion index for assessment of shock in a rat model. In this trial, we propose for the first time a new severity predicting index (NI) based on lactate concentration/peripheral perfusion ratio as an indicator of hemorrhage-related mortality in humans. Materials and methods This prospective trial is a single-center study of 122 consecutive adult polytraumatized patients with hemorrhagic shock admitted to trauma center within 6 h of the trauma, and underwent resuscitation according to the advanced trauma life support protocol (2016). Protocol-related measurements were obtained immediately after admission and over 48 h postresuscitation for metabolic perfusion parameters, serum lactate, perfusion index, and other hemodynamic parameters. The period of the study corresponds to the outcome after 48 h of admission. Resuscitation measures were considered successful when lactate levels were less than or equal to 2 mmol/l in addition to stable macrohemodynamic parameters at the end of this period. Results Characteristically, the survivors had NI of 40 ± 2.7 on admission, compared with 87.1 ± 13 of nonsurvivors with highly significant difference. MSI showed a significant difference (nearly doubled) between survivors and nonsurvivors. SI showed nearly the same change, nearly doubled. NI showed lower prediction value for mortality than MSI and SI (P = 0.05) 0.884, 0.905, and 0.908, respectively. Conclusion This study confirms, for the first time in humans, the validity of severity index as independent parameter in prediction of mortality in comparison with MSI.

Clinical audit on infection control of catheter-related bloodstream infection in neonatal ICU Samia A Mohammed, Ahlam B Ali, Doaa H Mohammed Journal of Current Medical Research and Practice 2019 4(3):237-239 Introduction Intravascular catheters are indispensable in modern-day medical practice, particularly in neonatal ICU (NICU). Although such catheters provide necessary vascular access, their use puts patients at risk for local and systemic infection complications. Patients and methods The study included 100 newborns, admitted to NICU at Assiut University Hospital, for whom umbilical venous catheter was inserted during the first week of life. Evaluation was done for all newborns for appropriateness of steps of infection control measures before, during, and after fixation of umbilical catheter. The included cases were followed during the period of admission till discharge. Results Infection control measures before umbilical catheter fixation were done 100%. During umbilical catheter fixation, the measures were defective in 100% in the form of defective use of a large drape to cover patient in sterile fashion as well as defective use of face mask. After fixation, only 20% did not maintain sterile technique while applying dressing. Conclusion Infection control measures must be appropriately done with special attention for defective steps during and after fixation. The decision to insert a central line should always be carefully considered for every newborn individually, and the benefits must be weighed against the risks.

Effect of exposure to cadmium on the hippocampus in adult albino rat and the possible role of L-carnitine Faten Y Mahmoud, Ashraf H. Abd El-Hakim, Ayman S El Deen Amer, Mariam W Fidal Journal of Current Medical Research and Practice 2019 4(3):240-250 Background The hippocampus is an important structure for formation of new memories. Cadmium is one of the most toxic agents that can affect hippocampal neurons. L-carnitine is an antioxidant. Aim of work To demonstrate the effects of cadmium on principal cells of hippocampus of adult rats and possible protective role of L-carnitine. Materials and methods A total of 42 adult rats aged 1 month were subdivided into four subgroups: group I was the control group, which received no treatment. Group II was administered cadmium given at a dose of 4 mg/kg/day for 1 month. Group III (sham control) was administered L-carnitine given at a dose of 200 mg/kg/day for 1 month. Group IV was administered cadmium and L-carnitine given to the rats at the same previous doses and duration. For each group, six rats were used for light microscopic study (gallocyanin chrom alum stain), and six rats were used for electron microscopy (group III studied only by light microscopy). Principal cell count and thickness were measured and statistically analyzed. Results Principal cells in group II showed degenerative changes. Morphometric data showed a significant decrease in measured parameters. In group III, the results were similar to those of the control group. In group IV, semithin sections and the ultrastructure of the principal cells showed obvious improvement of cells. Morphometric data also increased compared with those treated with cadmium. Conclusion Cadmium induces changes in the structure of the principal cells of the hippocampus in adult rats. L-carnitine plays an important in protection of the hippocampus.

Treatment results of tuberculous patients in Assiut Chest Hospital Eman M Monazea, Saeed S Abduljalil, Lamiaa H Shaaban, Ayat-Allah A Ahmed Journal of Current Medical Research and Practice 2019 4(3):251-255 Aims The improvement of the quality of TB treatment is essential to control of TB. The aims of this study were to identify the outcomes of TB treatment in patient recorded in Assiut Chest Hospital during the period from 2011 to 2015 and factors associated with undesirable treatment outcome and to estimate proportion of drug resistance among TB patients and identify factors associated with it. Patients and methods This study was a descriptive retrospective review of TB patients' registry. All tuberculous patients notified to the TB registry in Assiut Chest Hospital in the period from 1 January 2011 to 31 December 2015 and completed at least 6 months of treatment management were included in the study. Patients' records were reviewed for the following data: personal data, presenting symptoms, pattern of TB, regimen of treatment, and drug-resistant TB. Results The percentage patients with drug resistance were 60.9%. A total 75.1% of patients were cured and 5.1% of patients died. Cure rate was significantly higher in patients with extrapulmonary TB compared with 63.5% in pulmonary TB patients. The predictors for undesirable treatment outcomes were male sex, positive family history, pulmonary TB patients. Conclusion The success rate of all registered patients was satisfactory but, below WHO target, one-fifth showed failure of treatment was associated with male sex, illiterate, and drug-resistance Mycobacterium tuberculosis, success treatment was highest in extrapulmonary TB patients, cure rate was highest in nonresistant TB patients, drug resistance represented about two-thirds of all studied TB patients, and ~ 65% of pulmonary TB patients had drug resistance.

Evaluation of efficacy and safety of daclatasvir and sofosbuvir in treatment of chronic hepatitis C infection Abdel-Ghani Abdel-Hameed Soliman, Mohamed A. A. Ghaliony, Sahar M Hassany, Shymaa A.-B. Ahmed Journal of Current Medical Research and Practice 2019 4(3):256-260 Introduction The era of direct-acting analogs in the management of chronic hepatitis C virus (HCV) infection stared in 2011, and since then, many agents were approved for management of HCV infection. Aim To assess the efficacy and safety of daclatasvir and sofosbuvir in the treatment of chronic hepatitis C infection. Patients and methods A prospective study was done at El-Rajhi University Hospital. It included 100 patients (75 patients with chronic HCV infection and 25 patients with HCV-related compensated liver cirrhosis). They received dual therapy (sofosbuvir 400 mg plus daclatasvir 60 mg) for 12 weeks or 24 weeks for patients with chronic hepatitis C and patients with liver cirrhosis, respectively. Results Mean age of all patients was 51.48 ± 10.90 years. Overall, 64% were males, 52% were from rural areas, and 56% patients were unemployed. Sustained virological response (SVR) 12 was obtained in 98 (98%) patients included in our study, and only two (2%) patients failed to achieve sustained virological response: one patient had chronic hepatitis but took irregular course of therapy, whereas the other was a cirrhotic patient. It was noticed that 69 (69%) patients had no adverse effects during the course of therapy. Headache was the most frequent event occurred in 17 (17%) patients, comprising seven (9.3%) patients with chronic hepatitis C and 10 (40%) patients with liver cirrhosis. Conclusion This regimen of therapy has high success rate for viral eradication with minimal tolerable adverse effects.

Microwave ablation versus hepatic resection in management of hepatocellular carcinoma Mohammed Hussien, Sahar Hassany, Mohamed El Kassas, Ahmed M Ali, Ehab F. A. Moustafa, Osman A. H. Osman Journal of Current Medical Research and Practice 2019 4(3):261-267 Background Management of early hepatocellular carcinoma (HCC) in cirrhotic patients is still a challenge. Hepatic resection remains the best curative treatment, but more complications with a risk of HCC recurrence in cirrhotic patients make it less favorable. Few studies have recently started to evaluate microwave ablation (MWA) as a method of HCC eradication in cirrhotic patient and compare it by other ablative methods. The aim of this study was to evaluate patient with HCC before and after both MWA and hepatic resection. Patients and methods A prospective study was performed in Assiut University Hospital in collaboration with National Hepatology and Tropical Medicine Research Institute in Cairo. We recruited 40 patients; all of them had radiology-proved HCC with lesion up to 5 cm and amenable for MWA or surgical resection. Results There is a statistically significant difference between Child score after hepatic resection in comparison with the mean Child score for patients who underwent MWA (before ablation was 6.1 ± 0.7 and after ablation was 6.1 ± 1.0, but was 5.5 ± 0.6 and was 7.2 ± 1.4 after hepatic resection). There is marked decrease of α-fetoprotein after hepatic resection (as the mean level before resection was 172.73 and after liver resection was 10.95). Fewer complications were recorded after MWA in comparison with that after hepatic resection. Conclusion Hepatic resection is superior to MWA in HCC eradication as no residual activity. MWA is better than hepatic resection in maintaining the Child score, as it was more affected in patients who underwent hepatic resection than those who underwent MWA.

Direct wrist magnetic resonance arthrography in triangular fibrocartilage lesions Eman S Abdul Monem, Nagham N Mahmoud, Mohamad K Mahmoud, Waleed R Saleh Journal of Current Medical Research and Practice 2019 4(3):268-271 Objective The objective of this study was to assess the diagnostic accuracy of direct wrist magnetic resonance arthrography (MRA) compared with arthroscopy in the diagnosis of triangular fibrocartilage complex (TFCC) lesions. Patients and methods A total of 25 (12 men and 13 women) consecutive patients, in the age range from 16 to 49 years (mean age: 28 years) complaining of unexplained chronic wrist pain and suspected to have TFCC lesions were prospectively examined by direct MRA with arthroscopic correlation. Results Compared with arthroscopic results, the sensitivity, specificity, and accuracy of direct MRA for central TFCC lesions were 100% for all three and 100, 90.9, 96%, respectively, for peripheral lesions. Conclusion Direct MRA can diagnose TFCC lesions with very high sensitivity and specificity and can help in reducing arthroscopies for pure diagnostic purposes.

Juvenile idiopathic arthritis: a clinical audit Enas Mohamed Sayed, Mohamed Mahrous Eltellawy, Ismail Lotfy Mohamed Journal of Current Medical Research and Practice 2019 4(3):272-276 Background Juvenile idiopathic arthritis (JIA) is an autoimmune, inflammatory noninfective joint disease that includes different disease subtypes that are characterized by the onset of arthritis starting before the age of 16 years with symptoms lasting at least for 6 weeks. Objective The aim of this study was to evaluate the compliance of healthcare providers at the Pediatric Rheumatology Unit, Assiut University Children's Hospital, to the 2011 American College of Rheumatology recommendations for treatment of JIA. Patients and methods The study was conducted on 50 patients who were younger than 16 years and diagnosed as having JIA at the Pediatric Rheumatology Unit, Assiut University Children's Hospital, to assess compliance of the unit's healthcare providers to American College of Rheumatology recommendations for treatment of JIA. Results The patients were grouped according to age into two groups: from 1 to 7 and 8 to 16 years. Polyarticular JIA was the most common type among studied cases followed by systemic-onset JIA. All studied cases presented with arthritis at the time of diagnosis. Complete blood count and erythrocyte sedimentation rate were done for all studied cases at the time of diagnosis. Rheumatoid factor was done for 84%. The most common complications among the studied group were those related to treatment. NSAIDs and corticosteroids were the most common drugs used. Conclusion Treatment of JIA includes pharmacological and nonpharmacological interventions and surgical treatment. Pharmacological treatment includes NSAIDs, steroids, disease-modifying antirheumatic drugs, and biological agents. The degree of disease activity and the presence or absence of features of poor prognosis greatly affect onset of complications and treatment of JIA. Nonpharmacological interventions include psychosocial therapy, nutrition, physical and occupational therapy, lifestyle factors, and home remedies. Through this study, some defects were found. First, there was deficiency in data recording. Second, there was also deficiency in laboratory (mainly rheumatoid factor and antinuclear antibody/anti-double stranded DNA) and radiological workup. Moreover, nonpharmacological therapy and surgery were not considered. Lastly, there was deficiency in regular follow-up of safety drug monitoring.

Comparison between dexmedetomidine, ketamine, or dexmedetomidine–ketamine combination for control of shivering during spinal anesthesia Sherif S. A. Rehim, Ghada M Aboalfadl, Alaa M Abdelatif Journal of Current Medical Research and Practice 2019 4(3):277-283 Background Regional anesthesia, like general anesthesia, influences the thermoregulatory process. In this study, we aimed to compare the efficacy, hemodynamic stability, and adverse effects of dexmedetomidine (DEX), ketamine, and the combination between them when used for control of shivering that occurs during spinal anesthesia. Patients and methods In this double-blind study, 90 male and female patients of ASA status I and II with age 18 up to 60 years old scheduled to undergo elective lower extraperitoneal abdominal and lower limb surgery using spinal anesthesia were included. This study was done from January 2017 to July 2017. Results There was no significant difference in shivering control among the three groups, which was complete (when post-treatment shivering score declined to score 0) in 28 (93.3%) patients in DEX group, 27 (90%) patients in ketamine group, and 25 (83.33%) patients in combination group (P = 0.321), whereas incomplete (when the scores decreased but did not abolish the shivering completely) in two (6.67%) patients in DEX group, three (10%) patients in ketamine group, and five (16.67%) patients in combination group (P = 0.234). Conclusion We concluded that intravenous DEX 0.4 mcg/kg, intravenous ketamine 0.3 mg/kg, or combination between DEX 0.25 mcg/kg and ketamine 0.25 mg/kg significantly controlled the shivering that occurred during spinal anesthesia. However, DEX is superior to ketamine and the combination in prevention of shivering.

Comparative study of shockwave lithotripsy for the treatment of large pediatric renal stones with and without stenting Ashraf S Said, Mohamed A Shalaby, Mohamed A .B. Sayed, Ahmad M Abd El.Aziz Journal of Current Medical Research and Practice 2019 4(3):284-288 Objective Pediatric urolithiasis is an important renal disease encountered in clinical practice. So, this study was designed to assess the safety and efficacy of shockwave lithotripsy (SWL) in the treatment of large pediatric renal stones. Patients and methods Eighty-four children with large renal stones (2–3 cm) were enrolled with a range of age between 1 and 16 years. Patients underwent SWL and were divided into two groups according to the presence of JJ stent (J shaped stent); 44 underwent SWL sessions without prior stenting and 40 patients underwent SWL after JJ sent insertion. Regular follow-up was done at 2, 6, and 12 weeks after the SWL session by urinalysis and renal bladder ultrasound. Results It was noticed that all baseline characteristics had no significant differences between both groups with exception of stone bilaterally that was significantly higher in the case stented group (35 vs. 4.5%;P < 0.001). Patients with stent had higher frequency of lower urinary tract symptoms, longer duration of lower urinary tract symptoms, and hematuria. Conclusion SWL is a highly effective and safe modality for the treatment of children with large renal stones (2–3 cm) and could be used as an alternative to the more invasive stone therapy approaches.