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   2013| July-December  | Volume 8 | Issue 2  
    Online since December 27, 2013

 
 
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ORIGINAL ARTICLES
Management of bile duct injuries: comparative study between Roux-en-Y hepaticojejunostomy and primary repair with stent placement
Adel M Khalaf
July-December 2013, 8(2):89-95
DOI:10.4103/1687-4293.123792  
Background Bile duct injury (BDI) is a major complication in biliary surgery such as laparoscopic cholecystectomy. The management of major BDI is a surgical challenge even for experienced hepatobiliary surgeons. The aim of this study was to introduce a new surgical technique for reconstruction of the biliary duct by primary repair after stent placement. Patients and methods The present study was carried out on a selected group of BDI patients (34 patients), who were referred for management of BDIs. Patients were divided into two equal groups: group A underwent primary repair of the bile duct by placement of a plastic stent (which is used in endoscopic retrograde cholangiopancreatography) and group B underwent Roux-en-Y hepaticojejunostomy. Results The study included 34 patients, 10 men (30.9%) and 24 women (69.1%) with a mean age of 40.84 years, whose main presentations were postoperative jaundice (82%) and bile leak (15%). All the patients underwent surgery successfully. There was no intraoperative mortality and bile leakage during the observation period, but primary repair of the bile duct with plastic stent placement was associated with better results as regards operation time, hospital stay, cost, safety, and postoperative complications. Conclusion Primary repair of the bile duct with stent placement showed good results, involved minimal morbidity, hospital stay, and cost; and helped avoid the drawbacks of Roux-Y hepaticojejunostomy. It also replaced exploration of the common bile duct with a T-tube, with advantages of function of the Oddis sphincter.
  5,842 328 -
Health related quality of life of children with epilepsy in Egypt
Zeinab M Monir, Inas R EL-Alameey, Eman Eltahlawy
July-December 2013, 8(2):53-66
DOI:10.4103/1687-4293.123787  
Background/aim Children with epilepsy are at an increased risk of poor health-related quality of life even in the absence of active seizures. The study was undertaken to assess the health-related quality of life and its predictors in children with epilepsy, comparing the relationship between different types of seizures and health-related quality of life in Egypt. Patients/methods This cross sectional case control study included 50 epileptic children aged 8-12 years, with a mean age of 9.35 ± 1.59 years and a male to female ratio of 1.8 : 1. They were divided into two subgroups according to the types of seizures: 26 patients with generalized seizures in subgroup I and 24 patients with partial seizures in subgroup II, and 50 apparently healthy children of matched age, sex, and social class were included as the control group. The Arabic version of the 23-item Pediatric quality of life Generic Core Scale (Parents' scale) was applied to evaluate the health-related quality of life of both patients and healthy controls. Results Diminished health-related quality of life is a common feature of epilepsy. Highly significant lower overall quality of life scores of all functioning domains of health-related quality of life were present between patients' subgroups (P < 0.001), and between total patients versus control groups (P < 0.001). Univariate analysis was performed to identify significant predictors of poorer quality of life in children with epilepsy. On analyzing the risk factors using odds ratio, epilepsy-related risk factors such as age at onset of seizures, types of seizures, duration of the illness, number and duration of antiepileptic drugs as well as children's clinical variables such as learning problems, developmental delay in milestones, limitation in child hobbies, urine incontinence, and prolonged sleep, and some family-related variables such as marital disharmony and parental anxiety were found to be significantly strong predictors of poorer health-related quality of life in children with epilepsy, with prediction of 95%. Conclusion Epileptic patients were found to be at a higher risk of developing impaired quality of life with lower mean scores of all domains of quality of life, especially patients with generalized, frequent fits, those on polytherapy, and patients with a younger age of seizure onset and a longer duration of illness. The scope of management of epilepsy should include optimal seizure control and improvement of the health-related quality of life of the affected children.
  3,352 319 7
Volatile compounds and antioxidant activity of the aromatic herb Anethum graveolens
Manal M Ramadan, Nadia N Abd-Algader, Hatil H El-kamali, Kadry Z Ghanem, Abdel Razik H Farrag
July-December 2013, 8(2):79-88
DOI:10.4103/1687-4293.123791  
Background/Aim Anethum graveolens L. (dill) (Apiaceae) is one of the most popular culinary herbs in the world. Dill has been cultivated since ancient times, and the use of this plant for medicinal and consumption purposes has been recorded dating back to the Greek and Egyptian civilizations. Dill is widely used to give flavor to food. The aim of this work was to assess the chemical composition of the volatile compounds in dill as well as their hepatoprotective and nephroprotective activity against free radicals generated by paracetamol. Materials and methods The chemical composition of the volatile compounds of dill was assessed by gas chromatography and gas chromatography-mass spectrometry. Four groups of rats were used (the normal control group, the A. graveolens-supplemented group, the paracetamol-intoxicated group, and the A. graveolens-protected group) for studying the effect of plant infusion on panadol (paracetamol)-induced free radicals and hepatotoxicity. Plasma total antioxidant capacity, plasma catalase, cellular glutathione peroxidase, plasma total protein, albumin, alanine amino transferase, aspartate amino transferase, alkaline phosphate, γ-glutamyl transferase, total bilirubin, and direct bilirubin levels were determined. In addition, kidney functions (plasma urea and creatinine) and histopathological and histochemical changes in the liver were investigated. Results The phytochemical results identified volatile components 7-α-hydroxy manool (24.43%), l-carvone (14.28%), limonene (13.9%), epi-α-bisabolol (6.81%), α-terpinene (5.44%), and α-phellandrene (4.63%) as the main constituents. p-Cymene (2.13%), sabinene (1.98), and α-pinene (1.43%) were determined as the minor constituents. The biochemical results showed that a mega dose of paracetamol induced the production of free radicals, which caused damage to hepatocytes and nephrocytes in rats. The aqueous extract of dill revealed high antioxidant properties and acted as an extracellular neutralizer of free radicals. Histopathological and histochemical observations showed severe damage in the liver. Supplementation with dill in paracetamol-intoxicated rats attenuated the damage to the liver. Conclusion The present study revealed that A. graveolens has antihepatotoxic properties that could minimize the deleterious effects generated by hepatotoxin paracetamol, and therefore it can be used as a potent antihepatotoxic agent.
  2,826 305 13
Evaluation of the phenolic content and antioxidant potential of Althaea rosea cultivated in Egypt
Nagwa M Ammar, El-Sayeda A El-Kashoury, Lamiaa T Abou El-Kassem, Rasha E Abd El-Hakeem
July-December 2013, 8(2):48-52
DOI:10.4103/1687-4293.123786  
Objective The aim of this study was to evaluate the total phenolic content (TPC) and antioxidant potential of Althaea rosea Cav., family Malvaceae, as well as to isolate and identify the flavonoid content of the methanolic extract of the aerial parts. In addition, a comparison between the TPC and antioxidant capacity of the methanolic extract of both aerial parts and flowers was carried out to discover new active constituents that can be utilized in drug industry. Materials and methods The extraction of the flavonoid compounds was carried out by percolation of the dried aerial parts of the plant under investigation with 70% methanol until exhaustion. The combined extract was then concentrated and defatted with petroleum ether (60-80°C). After separation of the lipoidal matter, the remaining extract was purified from mucilage and subjected to several column chromatographic techniques for isolation of the flavonoids. The identification of flavonoid compounds was carried out using physical, chemical, and spectral methods such as ultraviolet, 1 H NMR, and 13 C NMR. The antioxidant potential of the methanolic extracts of both aerial parts and flowers was determined using the s[table 2], 2-diphenyl-1-picrylhydrazyl free radical scavenging activity method. Furthermore, their TPC was also determined using the Folin-Ciocalteu method. Results Five flavonoid compounds were isolated from the aerial parts of A. rosea Cav., which were identified as quercetin 3-O-β-d-glucuronopyranoside-8-C-β-d-glucopyranoside, kaempherol-3-O-β-d-rutinoside, kaempherol-4΄-O-β-d-glucoside, kaempherol-3-O-β-d-glucoside, and kaempherol. The antioxidant activity was measured in terms of their IC 50 . The IC 50 values of the methanolic extracts of the aerial parts and flowers were 11 and 1 mg/ml, respectively, whereas the TPCs were 48 and 73 μg/ml, respectively. Conclusion The methanolic extracts of both aerial parts and flowers of A. rosea Cav. are rich in phenolic compounds and have a prominent antioxidant activity. The antioxidant activity of both extracts may be attributed to their phenolic content.
  2,494 317 5
Effect of smoking on skin elastic fibers: a morphometric and immunohistochemical analysis
Hanan M El-Kahky, Nehal M Zuel-Fakkar, Dalia G Ali, Amani S Mahdy, Abdel Razik H Farrag, Noha A Helmy
July-December 2013, 8(2):74-78
DOI:10.4103/1687-4293.123790  
Background/aim Tobacco smoking is one of the major health problems in the world. This study was conducted to investigate the morphological changes of the dermal elastic tissue of sun-protected skin induced by smoking. Participants and methods Punch biopsies were obtained from the nonexposed skin of 15 smokers and 15 nonsmokers to evaluate the dermal elastic fibers using morphometric analysis and immunohistochemical techniques. Results Elastic fibers of the reticular dermis were more numerous, thickened and fragmented in smokers than in nonsmokers. Correlations between the cumulative tobacco dose and the morphology of the elastic fibers were highly significant. Immunohistochemical analysis for α-1-antitrypsin showed negative cytoplasmic staining for all samples of both smokers and nonsmokers. Conclusion This study indicates that smoking is one of the risk factors that lead to an increase in elastic fibers of the reticular dermis. This increase is due to elastic tissue degradation rather than by new synthesis, as in solar elastosis. Furthermore, smoking has multiplicative effects on facial ageing and could share, at least in part, a pathophysiological pathway.
  2,072 138 -
Serum vitamin D level as a predictor of bronchial asthma in Egyptian children
Hala G Elnadya, Eman M Foudac, Ola M Elsheikha, Inas R ElAlameeya, Amal I Elshafied, Lobna S Sherifa, Eman R Younessb, Nadia A Mohamedb
July-December 2013, 8(2):67-73
DOI:10.4103/1687-4293.123788  
Background/Aim This study was designed to assess the relationship between the serum level of 25-hydroxyvitamin D and the clinical, functional severity and the level of asthma control among Egyptian asthmatic children. Patients and methods This case-control cross-sectional study was conducted on 50 asthmatic patients from those regularly attending the Pediatric Chest Clinic, Children's Hospital, Ain Shams University. Twenty healthy children of matched age and sex were recruited as the control group. Results Pulmonary function tests were significantly decreased in the asthmatic cases compared with the control (P < 0.01). The serum vitamin D level was found to be significantly decreased in asthmatic children compared with the control group (P < 0.001). Out of the 50 asthmatic children, 20 had a serum vitamin D level of less than 25 ng/ml, and were considered to be 'vitamin D deficient', whereas the remaining 30 children had a level ranging between >25 ng/ml and ≤30 ng/ml and were considered to be 'vitamin D insufficient'. The asthmatic children had a highly significant increase in the total leukocytic count, the eosinophilic count, serum immunoglobulin E, and serum alkaline phosphatase (P < 0.001 in all). There was also a significant increase in the serum phosphorus level in the asthmatic children group compared with the control group (P < 0.01). The serum vitamin D level was 24.1 ng/ml ± 2.9 in the asthmatic patients on inhaled corticosteroid therapy and 28 ng/ml ± 1.4 in those not on inhaled corticosteroid therapy. Significant positive correlations were found between the serum vitamin D level and the predicted percentage of forced expiratory volume in 1 s (r = 0.871, P < 0.001). A highly significant negative correlation was found between the serum vitamin D level and serum immunoglobulin E (marker of allergy; r = −0.589, P < 0.001). Moreover, serum vitamin D showed an inverse correlation with the clinical severity of bronchial asthma (r = 0.903, P < 0.001) and the level of control of asthma (r = 0.923, P < 0.001), classified according to the Global Initiative for Asthma (GINA) classification. The accuracy of vitamin D as a predictor of asthma was found to be 88% by automatic linear modeling. Conclusion Our results revealed an important support for the association between bronchial asthma in children and vitamin D deficiency, with a direct relationship between its serum level and pulmonary function test measures and the increased asthma severity. Vitamin D deficiency can be considered as a strong predictor of asthma. Improving the vitamin D status can help in the primary prevention of asthma and in decreasing exacerbations of attacks. Clinical trials of vitamin D supplementation to prevent asthma exacerbation are recommended.
  1,984 178 6
Volatile oils, lipid constitutes and the antimicrobial activity of Daucus syrticus growing in Libya
Fatma M Abd Alla, Khaled A Abdelshafeek, Ali M El-soll, Wael M ELsayed
July-December 2013, 8(2):96-103
DOI:10.4103/1687-4293.123793  
Background/aim Apiaceae is a large plant family; it comprises about 60 annual and biannual species mostly distributed in Europe, Africa, West Asia, and Australia. The Daucus genus is one of the most common genera of this family in which Daucus syrticus (DS) is a common member, growing mainly in the Sirt region (Libya). It is locally known as wild carrot. This study aims to investigate volatile oils, lipid constitutes, and the antimicrobial activity of DS extracts. Materials and methods The herb of DS was collected from Wadi Telal, Sirt region (Libya), during January and April 2011. About 250 g of different parts from fresh plant material (aerial parts, roots, and seeds) of DS were subjected to hydrodistillation. Extraction of lipid constituents was carried out as follows: About 1500 g of dried powdered plant material of DS were extracted with petroleum ether in a soxhlet. The antimicrobial activity was determined using the disk diffusion method, and the inhibition zone (IZ) was measured for each extract under study against Escherichia coli, Bacillus subtilis, Aspergillus niger, and Candida albicans. Results Results of Gas chromatography/Mass spectrometry GC/MS analyses of the volatile oils of the aerial parts (January and April collections) proved that they contain a mixture of 47 and 33 compounds, respectively, whereas the roots (April and July) were found to contain a mixture of 32 and 20 compounds, respectively. In addition, the seeds (July) were found to contain 18 compounds, with β-asarone (26.23%) as the main compound. Investigation of the lipid fraction of the herb revealed the presence of a mixture of fatty alcohols; the major contents of the unsaponifiable fraction were identified as a series of n-alkanes C 8 -C 28 (84.85%), four steroidal compounds, triterpene, and a mixture of fatty acid methyl esters consisting of eight different acids. The antimicrobial evaluation of DS extracts exhibited different IZ values against the tested microorganisms. Conclusion The main constituents of the different volatile oils of the aerial parts, the roots, and the seeds were identified. The fraction of total fatty acid had the highest activity against E. coli (IZ = 2.7, minimum inhibitory concentration = 250 mg/ml).
  1,813 159 1
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