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   2013| Jan-June  | Volume 8 | Issue 1  
    Online since May 19, 2014

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Bacteriological study of diabetic foot infection in Egypt
Abd Al-Hamead Hefni, Al-Metwally R. Ibrahim, Khaled M. Attia, Mahmoud M. Moawad, Ayman F. El-ramah, Mohamed M. Shahin, Mahmoud Al-Molla, Lotfi Abd Al-Satar
Jan-June 2013, 8(1):26-32
Introduction Foot infections are one of the major complications of diabetes mellitus and are a significant risk factor for lower extremity amputation. Providing effective antimicrobial therapy is an important component in treating these infections. This study assesses the microbial isolates of patients with diabetic foot infections and their antibiotic susceptibility pattern. Patients and methods A prospective study of 75 patients with diabetic foot infections admitted to Al-Azhar university hospitals was undertaken. Bacteriological specimens were obtained and processed using standard hospital procedure for microbiological culture and sensitivity testing. Results Overall, 40 (54%) patients had subcutaneous infections, 22 (29%) had infected superficial ulcers, seven (9%) had infected deep ulcers involving muscle tissue, and six (8%) patients had osteomyelitis. A total of 99 pathogens were isolated. Forty percent of patients had polymicrobial infection, 39 (52%) had single organism infections, and six (8%) had no growth. Gram-negative bacteria (67%) were more commonly isolated compared with Gram-positive bacteria (30%). The three most frequently found Grampositive organisms were Staphylococcus aureus (10.2%), Streptococcus pyogenes (7.1%) and methicillin-resistant S. aureus (7.1%), and the most common Gram-negative organisms were Pseudomonas aeruginosa (19.4%), Klebsiella pneumoniae (15.3%), and Acinetobacter spp. (10.2%). Vancomycin was found to be the most effective against Gram-positive bacteria, whereas imipenem and amikacin were most effective against Gram-negative bacteria on antibiotic testing. Conclusion Forty percent of diabetic foot infections were polymicrobial. S. aureus and P. aeruginosa were the most common Gram-positive and Gram-negative organisms, respectively. This study helps us to choose empirical antibiotics for patients with diabetic foot infections.
[ABSTRACT]   Full text not available  [PDF]
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Effect of Boswellia serrata on Alzheimer's disease induced in rats
Nemat A.Z. Yassin, Siham M.A. El-Shenawy, Karam A Mahdy, Nadia A.M. Gouda, Abd El-Fattah H Marrie, Abdel Razik H Farrag, Bassant M.M. Ibrahim
Jan-June 2013, 8(1):1-11
Background/aim Alzheimer's disease (AD) is a progressive neurodegenerative disorder. Increased oxidative stress has been shown to be a prominent and early feature in AD. Medicinal plants with antioxidant activities have been used traditionally in the treatment of several human diseases. The present study aimed to investigate the possible prophylactic and therapeutic effects of aqueous infusions of Boswellia serrata on AD induced in rats. Materials and methods Ninety adult male Sprague Dawley rats were enrolled in this study and were divided into 9 groups (ten each). Groups 1-5 for the protective study, 6-9 for the therapeutic study as follows: 1st group: negative control group in which rats were given daily oral dose of 1ml tab water, 2nd group: induction of animal model mimicking AD by daily oral administration of aluminum chloride (AlCl3) to rats in a dose of 17 mg/kg for 4 successive weeks; 3rd, 4th, and 5th groups: rats were orally given rivastigmine (0.3 mg/kg/day), Boswellia serrata (45 and 90 mg/kg /day respectively), for two weeks followed by combination of each treatment with AlCl3 for another four successive weeks. Groups 6-9 for the therapeutic study: 6th group: AD induced group which acted as a model mimicking AD in humans received orally 1ml of tab water only for 12 successive weeks and served as therapeutic untreated group. 7th, 8th and 9th groups: AD rats treated orally with rivastigmine (0.3 mg/kg/day), Boswellia serrata (45 and 90 mg/kg /day respectively) daily for 12 successive weeks. At baseline (before induction of AD), before treatment, then after each treatment, behavioral stress tests as activity cages, rotarod, and T-maze tests were done. At the end of all experiments rats' brains were dissected and divided sagitally into two portions, the first portion was homogenized for determination of acetylcholine (Ach) and acetycholinesterase (AchE) levels. The second portion was used for histopathologic examination. Results The present study indicated that Boswellia serrata when was used for treatment of AlCl3 induced AD, its high dose only produced increased activity of rats in the activity cage, duration of rats revolving on the rotarod and reduction in the duration taken by rats to reach food in the T-maze test. Both doses produced elevation of Ach level and reduction of AchE activity in brain homogenates. These results were consistent with the histopathological findings in brain tissues where, the neurons appear more or less like normal ones. Conclusion This study revealed that the treatment of AD-induced rats with aqueous infusions of B. serrata significantly ameliorates the neurodegenerative characteristics of ADs in rats.
[ABSTRACT]   Full text not available  [PDF]
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Study of the possible cardioprotective effects of insulin, ATP, and L-arginine against isoproterenol-induced myocardial infarction
Fatma A. Mohamed, Mona A. Ahmed, Enas A. Abdel-Hady, Mohamed F Abdel-Salam, Mahmoud H Ayobe
Jan-June 2013, 8(1):12-18
Background/Aim Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide. The present study was carried out to investigate the possible protective effects of insulin, ATP, and L-arginine on cardiac dysfunction in experimental isoproterenol (ISO)-induced myocardial infarction (MI), aiming at achieving useful means for protection and therapy against MI. Materials and methods Wistar rats of both sexes were allocated into five groups: the control group, the untreated MI group, and MI groups treated with insulin, ATP, or L-arginine. All rats were subjected to ECG recording, and plasma levels of troponin I and triglycerides were determined. The isolated perfused hearts, according to Langendorff's preparation, were studied; the left ventricular weight (LV) was determined, and the LV per body weight ratio (LV/BW) was calculated. Results The percentage mortality and total arrhythmia were significantly reduced upon treatment with ATP and L-arginine. The ST segment elevation was significantly reduced in insulin-treated rats. The QRS duration and QTo intervals were significantly decreased in ATP-treated and L-arginine-treated rats, and the QTc interval was significantly shortened in all three treated groups. The levels of plasma triglycerides significantly reduced on treatment with insulin and ATP. In the three treated groups, the peak developed tension baseline value and maximal response were significantly increased when compared with the untreated group. In addition, the half-relaxation time baseline value was significantly decreased in the treated groups when compared with the control group. The myocardial flow rate baseline value and maximal response were significantly increased on L-arginine treatment. The LV weights and LV/BW ratios were significantly increased in all three treated groups. Conclusion Insulin, ATP, and L-arginine were variably effective in partially modifying the ISO-induced MI insults and offered partial protection against ISO-induced myocardial damage.
[ABSTRACT]   Full text not available  [PDF]
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Vascular trauma and its management: one and a half years after the 25th January revolution
Mahsoub Murad, Ashraf Eweda, Hani Abdel-moamen, Mohamed Hussien, Mohamed Elsaghir
Jan-June 2013, 8(1):43-47
Background/Aim Vascular trauma is a common life-threatening injury leading to serious consequences if not timely and efficiently managed. Although they represent less than 3% of all injuries, they deserve special attention because of their severe complications. The aim of this study was to analyze the causes of injury, presentations, surgical (recent) approaches, outcomes, and complications of vascular trauma. Patients and methods This was a retrospective analysis performed over 1.5 years. From January 2011 to June 2012, 48 patients were included in the study and were operated upon for peripheral vascular injuries. Diagnosis was made by physical examination as well as with hand Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was carried out whenever possible; however, if it was not possible, an interposition vein graft was placed. In some patients, endovascular approaches were applied, whereas in other patients a combination of open surgical and endovascular approaches was used (hybrid technique). Results Of the total 48 patients who sustained major vascular injuries during this period, 17 sustained injuries to the upper limb vessels, 26 had injuries of the lower limb vessels, two patients had injuries of the abdominal vessels, and three patients had injuries of the neck. A penetrating trauma was the cause in 45 cases and a blunt trauma was the cause in three cases. Of the 48 patients, 46 patients were successfully managed by vascular reconstruction without any residual disability. There were 46 male patients (95.83%) and two female patients (4.16%), and their ages ranged from 17-40 years (mean 28.5 years). Conclusion Patients who suffer vascular injuries should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.
[ABSTRACT]   Full text not available  [PDF]
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Comparative study between two-port and four-port laparoscopic cholecystectomy
Ayman M. Elwan, Mohammed A. Abomera, Nagah S. Atwa, Mahmoud A Abo Al Makarem
Jan-June 2013, 8(1):33-37
Background/aim Laparoscopic cholecystectomy has become the standard of care for patients requiring removal of the gallbladder. Traditional laparoscopic cholecystectomy is performed using the four-port technique. The aim of this study was to compare two-port with four-port laparoscopic cholecystectomy and to determine whether there are extra benefits with two-port laparoscopic cholecystectomy. Patients and methods Between March 2010 and March 2012, 70 adult patients with symptomatic cholelithiasis were enrolled into this study, which was carried out at New Dameitta University Hospital. They were randomly divided into two equal groups: group A underwent four-port laparoscopic cholecystectomy and group B underwent two-port laparoscopic cholecystectomy. Results The mean follow-up time was 13.18 months (range 6-23 months). The mean operative time was 36.285 min for group A and 39.142 min for group B. As regards group A, the severity of postoperative pain was mild in 11 patients (31.42%), moderate in 19 patients (54.28%), and severe in five patients (14.28%). As regards group B, the severity of postoperative pain was mild in 22 patients (62.85%), moderate in 12 patients (34.28%), and severe in one patient (2.85%). As regards cosmetic appearance and patient satisfaction for the scar, for group B they were excellent in 31 patients (88.57%) and good in four patients (11.42%); however, for group A they were excellent in 22 patients (62.85%) and good in 13 patients (37.14%). Conclusion In our study, we found that the use of two-port laparoscopic cholecystectomy did not affect the procedure's safety and conversion rate. Two-port laparoscopic cholecystectomy patients needed less analgesia and had a shorter hospital stay. Other advantages include fewer scars, more patient satisfaction, and cost effectiveness.
[ABSTRACT]   Full text not available  [PDF]
  562 79 -
Laparoscopic transabdominal preperitoneal repair versus open preperitoneal mesh repair for inguinal hernia
Ayman M. Elwan, Mohammed A. Abomera, Mahmoud A Abo Al Makarem, AbdAlhamed H. Mohammedain
Jan-June 2013, 8(1):38-42
Background/Aim The surgical history of inguinal hernias dates back to ancient Egypt, from Bassini's repair to today's mesh-based open and laparoscopic repairs. The aim of this study was to compare laparoscopic transabdominal preperitoneal (TAPP) repair with open preperitoneal polypropylene mesh repair for treatment of inguinal hernia. Patients and methods From June 2010 to June 2012, 40 adult patients with primary inguinal hernia were included in this study, which was carried at New Damietta University Hospital. The patients were randomly divided into two equal groups: Group A underwent laparoscopic TAPP polypropylene mesh repair and group B underwent open preperitoneal polypropylene mesh repair. Results The mean follow-up time was 14.8 months. The mean operative time was 66.8 min for group A and that for group B was 47 min. The mean hospital stay was 1.475 days for group A and that for group B was 1.575 days. Contralateral clinically occult inguinal hernia was discovered and repaired in nine patients (45%) in the TAPP group. As regards group A, the severity of postoperative inguinal pain was mild in 12 patients (60%), moderate in seven patients (35%), and severe in one patient (5%). As regards group B, the severity of postoperative inguinal pain was mild in six patients (30%), moderate in 10 patients (50%), and severe in four patients (20%). Conclusion The TAPP technique is an excellent tool for laparoscopic treatment of inguinal hernias. A prerequisite for excellent results is the strict application of a standardized technique. In experienced hands, all types of inguinal hernias, including large scrotal hernias, can be operated upon with low morbidity and recurrence rates. However, to achieve favorable results, a strong educational program on laparoscopy is recommended.
[ABSTRACT]   Full text not available  [PDF]
  557 78 -
Evaluation of laparoscopy in the management of abdominal emergencies
Mohammed S. Teamma
Jan-June 2013, 8(1):19-25
Background/Aim Laparoscopy has rapidly emerged as the preferred surgical approach for the management of abdominal emergencies. It allows for a correct diagnosis and proper treatment. The main aim of this study was to evaluate the role of laparoscopy as a major diagnostic and therapeutic tool for the management of patients with abdominal emergencies and to find a less invasive diagnostic approach. Methods Eighty patients with acute abdominal pain presented to the Department of surgery of Al-Azhar University (Bab El Shearia and Al Husein) hospitals during October 2009 to September 2011 were included in the study. They were divided into two groups: traumatic (40 patients) and nontraumatic (40 patients). Their ages ranged between 14 and 65 years (mean= 39.5 years); 49 patients were males and 31 patients were females. Complete clinical data were obtained. All patients underwent a routine preoperative workup. Laparoscopy was performed for all patients within 24 h of admission. The procedure was carried out under general anesthesia. Both open and closed pneumoperitoneum techniques were practiced. Results Diagnostic laparoscopy was beneficial in 79 patients (98.5%). Of them, 42 (52.5%) patients underwent successful therapeutic procedures with laparoscopy: 28 male patients (17 nontraumatic and 11 traumatic) and 14 female patients (12 nontraumatic and two traumatic). Conversion to therapeutic laparotomy was done for 12 patients (15%). In this study, the mean postoperative hospital stay after laparoscopy was 2.1 days and 4.55 days after laparotomy. Wound infections occurred in 2.5% of patients. Conclusion Early laparoscopic intervention for abdominal emergencies is as safe and effective as conventional surgery. It results in minor trauma, helps avoid extensive preoperative studies or delays in operative intervention, has a rapid postoperative recovery, and reduces morbidity. Such features make laparoscopy an attractive alternative to open surgery in the management of abdominal emergencies.
[ABSTRACT]   Full text not available  [PDF]
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