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   2014| January-June  | Volume 9 | Issue 1  
    Online since July 22, 2014

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Assessment of compliance to standard precautions among surgeons in Zagazig University Hospitals, Egypt, using the Health Belief Model
Eman M Mortada, Marwa M Zalat
January-June 2014, 9(1):6-14
Background/aim Although it is recommended that healthcare professionals should comply with the standard precautions to prevent acquiring blood-borne diseases (AIDS, hepatitis B and C), yet, they frequently do not comply with this recommendation. Understanding the reasons for compliance and noncompliance will help in designing educational programs for hospital staff and in determining a strategy for improving health behavior. The present study aimed to assess surgeons' compliance to standard precautions and determine surgeons' perceived beliefs affecting their compliance using the Health Belief Model. Participants and methods A cross-sectional study was carried out at surgical departments in Zagazig University Hospitals from December 2012 to May 2013. A questionnaire on various aspects of infection control and standard precautions practices was provided to 307 surgeons, with a response rate of 70%. Results Our findings indicated that 57.5% of the surgeons sampled in Zagazig University Hospitals were compliant with standard precautions. 59.8% of compliant surgeons had been exposed to at least one needle-stick injury in the previous 3 months, whereas slightly less than half of compliant surgeons (48.4%) had been exposed to splashes, with a highly significant difference compared with nonexposed surgeons. All Health Belief Model subscales were correlated directly with the surgeons' compliance, except perceived barriers. Conclusion There is adequate compliance with standard precautions among surgeons in Zagazig University Hospitals, especially female surgeons, with a high level of knowledge among compliant compared with noncompliant surgeons. All Health Belief Model subscales were correlated directly with the surgeons' compliance, except perceived barriers. Adequate training of surgeons, provision of infection prevention equipment, regular reporting, follow-up, and assessment of occupational exposures need to be introduced.
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Lymphatic and testicular artery-sparing laparoscopic varicocelectomy in children and adolescents
Abdelaziz Yehya
January-June 2014, 9(1):1-5
Background/aim The ideal operation for the treatment of adolescent varicocele has been debated for many years. The division of lymphatic vessels during varicocelectomy is complicated by hydrocele formation and decline in testicular function. The aim of this study is to report on our series of children who underwent lymphatic and testicular artery-sparing laparoscopic varicocelectomy (LTASLV). Patients and methods Thirty boys with primary left-sided varicocele were subjected to LTASLV. The indications for intervention were scrotal pain and discomfort in 18 cases (60%), hypotrophy in nine cases (30%), and family preference in three cases (10%). An intraparenchymal injection of 2 ml methylene blue was administered after induction of anesthesia. LTASLV was performed for all patients. The main outcome measurements included operative time, hospital stay, development of hydrocele, varicocele recurrence, and testicular atrophy. Results The study included 30 patients with primary left-sided varicocele. Their mean age was 12.25 ± 1.6 years (range 9-16 years). Grade 3 varicocele was present in 21 cases (70%) and grade 2 varicocele was present in nine cases (30%). Stained lymphatics could easily be observed alongside the testicular artery and veins in 28 cases, whereas in two cases, a second injection of methylene blue with lowering of CO 2 pressure was required for visualization. All procedures were completed laparoscopically without conversions or complications. The mean operative time was 40 ± 2.6 min (range 30-50 min). All patients achieved full recovery and were discharged within 24 h. The mean follow-up period was 18 ± 4.3 months (range 10-36 months). Residual varicocele was noted in one case (3.3%) with no hydrocele formation or testicular atrophy. Conclusion This study shows good results with respect to postoperative hydrocele rates. LTASLV resulted in 0% of hydrocele and decreased the risk of varicocele recurrence. However, larger series are necessary.
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Risk factors and outcome in ICU patients with end-stage liver disease
Hanan M Nafeh, Soha S Abdelmoneim, Sahar M Hassany, Youssef M Swifee
January-June 2014, 9(1):33-39
Background/aim Acute or chronic liver failure is associated with numerous complications that may occur in combination, and patients may require ICU treatment. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. The present study aims to estimate the frequency of mortality and evaluate morbidity from cirrhosis in patients with end-stage liver disease (ESLD) admitted to the ICU and evaluate the relationship between the demographic, clinical, and laboratory data (potential risk factors) of those patients and mortality. Patients and methods A total of 120 patients with ESLD were enrolled [102 (85%) male and 18 (15%) female patients]. History taking, clinical examination, and other laboratory investigations were carried out, and patients were classified according to the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD) scores. Results Regarding the clinical presentation, hepatic encephalopathy (HE) was found in 87.5% of patients, jaundice in 60%, hematemesis in 41.7%, hepatorenal syndrome (HRS) in 35.8%, and spontaneous bacterial peritonitis in 20.8% of patients. The mortality rate was 57.5%; the main causes of death were HRS (40.8%), HE (21.7%), aspiration pneumonia (10%), septic shock (2.5%), and irreversible shock (1.7%). There was a significant relationship between mortality and old age, CTP and MELD scores, and a longer stay at the ICU. Increased white blood cell count, increased hemoglobin and decreased prothrombin concentration, and elevated creatinine were independent risk factors of mortality in ESLD patients in the ICU. Mortality rates were higher in patients with 5-6 risk factors (86.2%) than in those with 1-2 risk factors (21.7%). Conclusion Mortality rate in ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP, MELD score, HE, HRS, and jaundice were significant predictors of mortality in ESLD patients. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin, and prothrombin concentration were independent risk factors of mortality in ESLD patients.
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The impact of neuromuscular electric stimulation versus aerobic exercise in rehabilitation of patients with chronic heart failure
Manal K Youssef
January-June 2014, 9(1):40-47
Background/Aim Heart failure can be defined as an abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a rate commensurate with the requirements of the metabolizing tissues, despite normal filling pressures. Cardiac rehabilitation programs have become an integral part of the standard of care in modern cardiology. The current study was carried out to determine the effect of neuromuscular electric stimulation (NMES) versus aerobic exercise in cases of chronic heart failure. Patients and methods Overall, 30 patients with chronic heart failure were included in this study from Cairo University Hospitals. Their ages ranged from 40 to 60 years and they were divided randomly into two groups (A and B). Group A received aerobic training. Group B received lower limb NMES for 2 months. All participants were evaluated before the first session of treatment and at the end of treatment by physical evaluation that included minute ventilation, maximum ventilation, heart rate, systolic blood pressure, diastolic blood pressure, and the 6-min walk test. Results Analysis of results showed a significant increase in minute ventilation and maximum voluntary ventilation in both groups (P ≤ 0.001) and no significant difference between both groups, 7.3 ± 0.6 and 7.4 ± 0.6. There was a significant decrease in heart rate, systolic blood pressure, and diastolic blood pressure in group A (P ≤ 0.001) and also a significant decrease in heart rate, systolic blood pressure, and diastolic blood pressure in group B (P ≤ 0.001). There was a significant difference between group A and group B in the decrease in heart rate, 131.1 ± 9.9 and 134.5 ± 9.6, respectively, systolic blood pressure, 121.3 ± 7.4 and 139.3 ± 24.9, respectively, diastolic blood pressure, 80.3 ± 3.5 and 84.7 ± 3.1, and 6 min walk, 33.9 ± 2.6 and 32.2 ± 8.1. Conclusion NMES can be used instead of aerobic exercise in cardiac rehabilitation, especially in critically ill patients. It exerts an effect similar to that of aerobic exercise without cardiac load, especially in the beginning of rehabilitation.
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Biochemical evaluation of renal osteodystrophy in uraemic patients
Maha H Mohamed, Magda S Mahmoud, Mohamed D.E. Abd El-Maksoud, Tamer E Mosa, Adel A Ali
January-June 2014, 9(1):15-22
Background/aim Renal osteodystrophy is a multifactorial disorder of bone remodelling that develops in patients with chronic renal failure (CRF). Biochemical markers of bone turnover have been proposed for the noninvasive diagnosis of renal osteodystrophy. The purpose of this study was to evaluate intact parathyroid hormone (iPTH) and some markers of bone disease in predialysis (preD) and haemodialysis (HD) CRF patients and correlate them with bone mineral density (BMD). Patients and methods Several biochemical markers were measured in the serum of 74 CRF patients (38 preD patients and 36 patients on regular HD). In addition, 30 healthy volunteers were included as controls. BMD of all patients was measured by means of calcaneal ultrasonography. Results BMD was measured by means of ultrasound. BMD was significantly decreased in both patient groups when compared with controls. Also, it was significantly lower in patients with osteoporosis than in those with osteopenia. iPTH, total alkaline phosphatase (ALP) and osteocalcin (OC) levels were significantly elevated in both patient groups when compared with controls. Ionized calcium (Ca 2+ ), free carnitine and insulin-like growth factor-1 (IGF-1) levels were significantly decreased in patients compared with controls. There was a significant inverse correlation of BMD with iPTH, ALP and OC and a significant positive correlation with Ca 2+ and IGF-1 in HD patients. PreD patients showed significant inverse correlation of BMD with iPTH and ALP and significant positive correlation with Ca 2+ . Conclusion The results of the present study suggested that ultrasound is a useful method for evaluating BMD and provides information about diverse regional skeletal changes in CRF patients. iPTH, ALP, OC and Ca 2+ can predict renal osteodystrophy in preD and HD CRF patients. PreD and HD CRF patients often have low serum concentrations of free carnitine and IGF-1.
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The association between serum thyroid-stimulating hormone concentration and development of differentiated thyroid cancers in nodular thyroid disease
Mohammad Arafat, Sameh Gabr, Ibrahim A Ghaffar, Ahmad A Rahman, Zakaria Hamza, Ahmad A Fattah, Mohammad A Fattah, Mohammad Mira
January-June 2014, 9(1):28-32
Objective To evaluate the relation between serum thyroid-stimulating hormone (TSH) and development of differentiated thyroid cancers in nodular thyroid disease (NTD) in Egyptians. Patients and methods One hundred patients were included in this study at Al-Azhar University Hospitals from 2010 to 2013; all patients with NTD, who were fit for surgery, were selected for study. The preoperative TSH level was estimated and was compared with the final histopathological diagnosis for the presence of malignant thyroid lesions. Results A total of 100 patients were included in the study, with an average age of 46 years. The male to female ratio was 1 : 4.7. Seventy-five patients had multinodular goiter, whereas 25 patients had a solitary thyroid nodule. Eighty-six patients underwent total thyroidectomy, whereas 14 patients underwent near- total thyroidectomy. The final histopathological data showed no evidence of malignancy in 83 patients, 83% (benign group), whereas malignant lesions were present in 17 patients, 17% (malignant group). The preoperative mean TSH level in the benign group was 1.72 ± 1.4 mIU/L, whereas the mean TSH concentration in the malignant group was 2.61 ± 2.2 mIU/l. Conclusion There is a definite relation between serum TSH and development of differentiated thyroid cancers in NTD as the risk of thyroid malignancy increases with increased serum TSH concentrations.
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The outcome of a combination of superficial femoral artery angioplasty with infragenicular angioplasty in the treatment of critical lower limb ischemia
Wael ElShimy, Abdelrahman M Gameel, Ashraf Eweda, Mohamed Effat, Waleed A Sorour, Ayman Samir, Ayman Salem
January-June 2014, 9(1):23-27
Background/aim As endovascular disease with significant femoropopliteal or infragenicular arterial lesions largely affects the outcome in critical limb ischemia (CLI), the aim of this study is to examine the impact of dealing with distal outflow infragenicular arterial lesions on the outcome of CLI in terms of patency and limb salvage rates. Patients and methods A prospective study was carried out of all endovascular interventions performed for patients with CLI encountering femoropopliteal and tibial arterial lesions between February 2012 and January 2014; the patients were randomly divided into two groups. The first group included patients who received a concomitant tibial intervention and the second group included those who received femoropopliteal interventions alone. The duration of follow-up was 12 months, which was within the period of this study. Results Endovascular procedures were used to treat 54 patients with a runoff score of greater than 10. The first group included 29 patients and the second group included 25 patients with CLI. Primary success reached 89.6% in the first group and 96% in the second group. Primary patency rates at 12 months were 59 and 51% in both groups, respectively, whereas secondary patency rates at 12 months were 70 and 52% in both groups, respectively, with no statistically significant difference. The limb salvage rate over 12 months was better in the first group (83%) than in the second group (76%). Conclusion Although simultaneous superficial femoral artery with tibial angioplasty did not yield a significant increase in patency rates, the better limb salvage rates make interventional treatment for infragenicular arteries a key part of the vascular specialist armamentarium when treating CLI.
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