Metabolic outcomes of laparoscopic sleeve gastrectomy

Background Laparoscopic sleeve gastrectomy [LSG] is a recently developed technique for treating morbid obesity. As it is a simple procedure, many bariatric surgeons have adopted it in recent years with good results. LSG is a purely gastric restrictive procedure designed to reduce appetite by decreasing the size of the stomach

Objectives The aim of this study was to investigate the metabolic outcomes of LSG, including rate of weight loss, amelioration of obesity-related comorbidities as well as the intraoperative and postoperative complications

Patients and methods From August 2011 to August 2013, 60 consecutive patients with morbid obesity [eight males and 52 females] underwent laparoscopic sleeve gastrectomy at the Ain Shams University Hospital [El-Demerdash] and Ain Shams Specialized Hospital. Follow-up of the patients was done for a period of 2 years to investigate the preliminary results of this procedure including operative morbidity and mortality, short-term and long-term complications, rates and parameters of weight loss, as well as the effect on lipid and energy metabolism

Results There were two cases [2/60 [3.3%]] with intra-abdominal bleeding following LSG. Staple-line failure was detected in two cases [2/60 [3.3%]], two early complications [2/60 [3.3%]] were encountered, and late complications occurred in two patients [2/30 [3.3%]], with no mortality occurred. Substantial weight loss occurred in all patients. Mean excess weight loss was 48.04+/-4.34% at the end of first year and 67.85+/-3.75% at the end of the second year. Complete resolution of comorbidities was 73.3% for hypertension and 80% for diabetes mellitus at the end of second year

Conclusion LSG is a feasible and safe restrictive bariatric procedure, with good short-term results. It offers the advantages of a simple and reproducible technique with good outcome and low morbidity and mortality. LSG is accepted as a standalone definitive therapy, as it has a high percentage of postoperative excess weight loss as well as reduction of obesity-related comorbidities

Assessment of the nutritional knowledge and nutrient intake among lactating women and its impact on body mass index

The study was done to assess the nutritional knowledge and nutrients intake among lactating women. The total sample size was 151 lactating women selected randomly from those attending the breastfeeding clinic at the center for social and preventive medicine [CSPM]. The results revealed that obesity was the dominant feature in 47.7% of cases, while overweight and normal weight constituted 26.5% and 25.8% respectively. The majority of the women had very good nutrition knowledge [77.5%], while 22.5% had a good knowledge. 76.2% women were at risk of hunger and 23.8 were fed secure. Poor maternal dietary quality may have implications for both mother and child, and socioeconomic position and nutritional knowledge are likely to be important. Effective interventions to support mothers to achieve healthy diets for themselves and their families are needed. Lactation period is an opportunity to increase awareness of the mother toward healthy nutritional practices. Achievement and maintenance of good dietary habits is expected to duplicate the benefit of health outcomes when mothers become models for their children and their families. Nutrition education for mothers should be provided in the all health and PHC centers that deal with breastfeeding mothers. It also important to increase awareness of lactating mother's and educate them about the quality of diet through mass media

Significance of serum angiogenin assay as a novel marker for diagnosis of hepatocellular carcinoma in liver cirrhosis: a comparative study

Background: Hepatocellular carcinoma [HCC] is the third most common cause of cancer-related death worldwide. Angiogenin [ANG] is a potent angiogenic factor first isolated from the culture medium conditioned by colon carcinoma cells. Many reports have demonstrated an elevated serum ANG level in patients with various malignancies including colorectal carcinoma, melanoma, and pancreatic carcinoma. These results pointed to serum ANG as a novel marker for the diagnosis, progression, and aggressiveness of malignant tumors

Objective: The aim of this study was to evaluate the clinical significance of serum ANG as a novel marker for the diagnosis of HCC in liver cirrhosis and compare it with serum alpha-fetoprotein [AFP]

Patients and methods: The study included 40 patients who were divided into group I and group II. Group I included patients with HCC and group II included those with liver cirrhosis. Group III included age-matched and sex-matched apparently healthy controls. Patients in group I were further classified according to the TNM system into subgroup Ia, which included patients with tumor size less than or equal to 2 cm, and subgroup Ib, which included patients with tumor size greater than 2 cm. All individuals were subjected to an assay for evaluating the serum level of AFP and serum ANG

Results: For the diagnosis of HCC, serum AFP showed a sensitivity of 91.7% and specificity of 80%, whereas serum ANG showed a sensitivity of 95.8% and specificity of 85.7%. In discriminating patients with early hepatic cancer from those with more advanced stages, serum AFP showed a diagnostic sensitivity of 70% and specificity of 89.8%, whereas serum ANG showed a diagnostic sensitivity of 90% and specificity of 85.7%

Conclusion: Serum ANG is a promising marker for the diagnosis of HCC, being superior to serum AFP in both sensitivity and specificity. Moreover, serum ANG efficiently discriminates early from late stages of HCC

Depression among elderly in Beni Suef city [Upper Egypt]

Depression is a common mental health problem among elderly persons, about 10-15% of elderly suffers depressive symptoms. to find out the prevalence of depression among geriatrics living in geriatric homes versus those in clubs [living in home with their families], to detect the underlying risk factors of depression. In Beni Suef city there are three geriatric homes where the elderly are completely living away from their families, besides one geriatric club where the elderly people enjoy their daytime [there are two other clubs were inactive and under establishment], all the elderly above 60 years: males and females in geriatric homes and those attending the geriatric club were included [145] during the period [December 2008 - October 2009]. Those who can not communicate and answer the questionnaire were excluded. Data collection tools were a pretested questionnaire besides, Geriatric Depression Scale and Life Satisfaction Scale and Facing Daily Stressful Live Events Scale- Arabic version-. Appropriate statistical analysis was applied. Depression among elderly living in geriatric homes was higher [89.7%] in comparison to those in geriatric clubs [56.7%] i.e. living with their families [the difference was significant]. Chronic medical conditions are not considered as a risk of depression among elderly, also there was no significant difference between males and females while depression is common with those who suffer from loneliness as single, widowed or divorced elderly. Other factors as educational level, sex difference or family history of depression has no effect on presence of depression [difference was insignificant]. So it is recommended to strengthen social relationships and activities besides encouraging visiting geriatric homes either by related families or the civil societies and this is an important key in preventing depression. There must be a social and health programs about the importance of family support for the elderly in our community that will save a lot of medical and hospital care cost

significance of documenting clinical appearance of the uterine cervix in the cervical cytology form

To determine whether or not the Pap smear taker is reporting the clinical appearance of the cervix on the cytology request form, and if cytologist / smear taker are giving any importance to this information prior to issuing advice on subsequent follow-up. Finally, to evaluate the clinicians' response to normal Pap smear report in the absence of the clinical comment on the cervix. A retrospective study, for a total of 1196 random smear results performed between 1999 and 2000 at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia with its relevant charts were evaluated. The samples were divided into 2 main groups. Group I, the Pap smears sent with the absence of clinical description of the cervix, and group II, was sent with the clinical description of the cervix. Cytologist follow up recommendations and the clinicians' response were evaluated. A total of 1196 Pap smears were reviewed. Of the total 510 [42.6%] smears represented group I. Vast majority 506/510 [99.2%] were reported to be normal. A 12 months follow up was given for 505/506 [99.8%] smears. Only 4/510 [0.8%] Pap smears were abnormal and relevant cytologist's recommendations were given. Clinicians reassessed the uterine cervix for only 7.7% of the patients in the group. A total of 686/1196 [57.4%] smears represented group II. The vast majority 630 [91.8%] were with normal cervical appearance, 627/630 [99.5%] had normal cytology and only 3/630 [0.5%] had significant intraepithelial lesion. Relevant recommendations were given by the cytologist and were accepted by clinicians. A total of 56/686 [8.2%] had abnormal cervical appearance and 45/56 [80.4%] had normal cytology. A 12 months follow up was recommended for all except 7/45 [15.6%]. Clinicians have followed these recommendations for all except 5/45 [11.1%]. Eleven out of 56 [19.6%] smears were abnormal, relevant recommendations were given by the cytologist and all were followed by the clinicians. High proportion of cervical smears request did not report clinical appearance of uterine cervix [42.6%]. In patients whose cervical smear was reported abnormal [8.2%], 19.6% of them were found with significant intra-epithelial lesion. The clinical appearance of the cervix should be documented on the Pap smear request. Follow up recommendation for Pap smears carried out without clinical appearance description should be left to the clinician

Solitary pulmonary nodules: value and pathologic correlation of MSCT bronchus sign

To evaluate the relationship between solitary pulmonary nodules [SPN] and bronchi and its value in predicting the pathologic nature of the SPN. We performed preoperative volumetric targeted ultra-thin sections using multi-slice computed tomography [MSCT], and by reconstructing multiplanar reconstructions [MPR], curved multiplanar reconstructions [CMPR] and surface-shaded display [SSD] images of its adjacent bronchus in fifty two patients with SPN [35 malignant and 17 benign] and correlated the findings with those of macroscopic and microscopic specimens. With this CT protocol, the third to seventh-order bronchi were shown continuously and very clearly in all patients. CT findings were consistent with those of specimens. CT demonstrated the relationship between the SPN and bronchi in 31 [88.6%] malignant and 13 [76.5%] benign nodules. Ultra-thin section with MSCT can improve the demonstration of the patterns of tumor-bronchus relationships, which can reflect the pathological changes of the nodules to some extent and can help to differentiate malignant from benign tumors

Uterine artery doppler velocimetry in cases of perimenopausal bleeding

This study included 80 patients with perimenopausal bleeding, classified according to endometrium pathology, compared to 20 normal age-matching control group. Duplex transvaginal doppler velocimetry of the utretry was done for each participant, beside measurement of the endometrial thickness and the uterine volume. Our results show that the uterine artery S/D ratio and resistance index [RI], were significantly lower in the perimeopnpaual bleeding group, compared to the control group. The thickest endometrium was found in the endometrial hyperplasia group. Taking a cute off value of single layer endometrial thickness

Serum ferritin in cases of unexplained preterm labor

This study included 20 normal pregnant, and 20 patients with the diagnosis of unexplained labor. The gestational age ranged between 28 and 35 weeks. Serum ferritin was measured in each of the cases and controls. Our results show that there is a significantly lower level of serum among the cases of unexplained preterm labor, when compared to the control group. Current iron replacement therapy did not influence the results

Aneuropsychological study on workers exposed to inorganic lead in battery manufacture part I: affect

60 battery manufacture workers exposed to inorganic lead were randomly selected, together with an equal number of controls, not exposed to inorganic lead, matched as possible with the index group as regards the probable confounding variables. Workers were interviewed to fill the standardized Arabic forms of both Beck Depression Inventory and Taylor Manifest Anxiety Scale. Data were analyzed using SPSS/PC + and EP15 programs and non-parametric statistics were applied. The results revealed that, inorganic lead exposure had no effect on the distribution of exposed workers on the depression scale while, it seemed to cluster most of them in the severe and very severe grades of anxiety scales. Anxiety scores were significantly positively correlated with years of exposure while, depression scores were not. Also, it was clear that non-exposed workers had high scores on both anxiety and depression scales. This might be due to information bias or bad work conditions

neuropsychological study on workers exposed to inorganic lead in battery manufacture part II: intellect

60 battery manufacture workers exposed to inorganic lead were randomly selected together with 60 controls matched as possible with the index group as regards probable confounding variables. The digit symbol and digit span tests were the study tools. Data were analyzed using SPSS/PC+ program where non-parametric statistics were applied. Also, due to the known neurotoxicity of lead, one tailed significance levels were reported. The results revealed that lead exposed workers had significantly poorer performance than their controls in the studied intellectual abilities. Digit span scores were significantly negatively correlated with the duration of exposure to inorganic lead in years. These results were in agreement with several earlier studies. In view of these results, it was recommended to perform periodical neuropsychological assessment of lead exposed workers, and accordingly employment actions may be taken

study on cases admitted as fever of unknown origin to Alexandria hospital [1993]

The aim of the present study was to reveal some epidemiological features of cases recorded as fever of unknown origin on admission to the hospital and to study their clinical manifestations and the received medical care. Moreover, the relation between the presenting complaints and final diagnosis among the studied cases was studied. Sheets of all cases recorded as fever of unknown origin on admission to the hospital during the period from January 1st, 1993 to the end of April 1993 were included in the study [663 cases]. The results revealed that the mean age of the total sample was 25.95 + 17.821 years with slight male predominance [1.07: 1]. Infections topped the list of causes of fever of unknown origin [94.1%], especially respiratory infection. Gastrointestinal infections, especially enteric fever, ranked the second followed by urinary tract infections. Noninfectious causes accounted for 3.8% of the cases and the cause of fever could not be determined in 2.2% of cases. The main complaints proved to have low validity in diagnosing cases. Surprisingly, only 18 cases from the total sample was found to be coincide with the stated standard definition of FUO. Many patients are placed in the FUO category because the attending physicians overlook, disregard of reject an obvious clue

Health, social and child labour problems of an Alexandrian poor urban community

Child labour is one of the most important and difficult problems resulting from unchecked rapid urbanization. More than 100 million children all over the world are engaged in heavy and hazardous employment against international conventions. The problem of child labour in poor urban communities, often present in Alexandria was studied in the present work by interviewing forty four families from Kom El Nadoura sub-district to reveal the problem features, as well as to study the socio-demographic profile of the studied community and to find the prevailing health problems among the studied children. Twelve percent of the studied children were working either occasionally [n=15] or permanently [n=6] one family every two had a working child. All working were obliged to work either for economic reasons or to help their parents in their work. About half of the working children were employed in food processing industry, much prevalent in the studied area and fortunately with minimal exposure hazard, while about one third were exposed to chemical hazards either in car repair or chemical workshops. Social, educational and health problems were similar in families of working and non working children. Large scale studies are recommended to focus on this exacerbating problem in a trial to solve it properly

Plasma atrial natriuretic peptide, renin activity, aldosterone sodium and potassium in normal and hypertensive pregnancy

To clarify a possible role for atrial naturiuretic peptide [ANP] in the pathophysiology of pregnancy complicated by hypertension, we studied plasma levels of ANP, Aldosterone, plasma rennin activity [PRA], sodium [Na+] and potassium [K+] in normal non pregnant women [n = 20], pregnant women with preeclampsia [n = 30] and in pregnant women with chronic hypertension [n = 12]. Plasma levels of ANP were found to be significantly increased in preeclamptic and chronic hypertensive women with the highest levels in the severe preeclampsia. On the other hand PRA, serum aldosterone and serum Na+ were found to be significantly reduced in severe preeclamptic and chronic hypertensive, pregnant women. An inverse relationship was found between plasma ANP and either serum aldosterone, PRA or serum Na+ in the severe preeclamptic and chronic hypertensive groups