Menoufia Medical Journal

Platelet-derived growth factor in patients with liver fibrosis Enas S Essa, Fikry G Eskander, Amira Z Badawy Menoufia Medical Journal 2019 32(1):1-7 Objective To asses the changes in platelet-derived growth factor (PDGF) in liver fibrosis. Data sources The data were sourced from the PubMed database from the start of the database to 2017 and from all materials available in the Internet. Study selection The initial search presented 423 articles of which 39 met the inclusion criteria. The articles studied the relation between PDGF and liver fibrosis. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included when ethical approval was obtained, eligibility criteria defined, sufficient information, convenient controls, and known assessment measures. Data synthesis Comparisons were made through structured review with the results tabulated. Findings In total, 39 potentially relevant publications were included. The studies indicate an association between PDGF and liver fibrosis as PDGF increases in patients with hepatic fibrosis and correlates well with the grade of fibrosis. The majority of studies were performed on the effect of PDGF antagonists on liver fibrosis and they found that interference of PDGF pathway leads to reduction of liver fibrosis. Conclusion We found that PDGF levels increase in patients with liver fibrosis and its level correlates well with the stage of fibrosis; thus, PDGF can be used as a potential noninvasive marker for liver fibrosis either alone or in association with other fibrosis markers. Further, antagonizing the pathway of PDGF may offer a promising strategy for the treatment of liver fibrosis.

Immunotherapy for advanced bladder cancer: a new era Eman Abd ElRazek, Suzan Alhassanin, Hagar Al Agizy, Alshimaa M Alhanafy, Eman Helmy Desoky Menoufia Medical Journal 2019 32(1):8-13 Objectives The aim of this study was to analyze data and current trends in immune checkpoint targeting therapy for bladder cancer. Data sources A systematic literature search was performed for clinical trials in the Medline databases (Google Scholar, ClinicalTrials.gov, Cochrane, http://www.ekb.eg) and all materials available in the Internet from 2014 up to 2017 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Study selection The initial search yielded 35 articles, of which 30 fulfilled the inclusion criteria. The articles studied the role of Immune checkpoint targeting therapy in bladder cancer. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was obtained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Data synthesis Comparisons were made by structured review, with the results tabulated. Findings Humanized monoclonal antibodies that block CTLA-4 (ipilimumab, tremelimumab), PD-1 (nivolumab, pembrolizumab), or PD-L1 (atezolizumab, durvalumab, avelumab) have all shown antitumor activity in patients with urothelial carcinoma (UC). Atezolizumab and nivolumab are approved by the Food and Drug Administration for second-line therapy for advanced UC and a number of other checkpoint inhibitors are in clinical trials. Conclusion Immunotherapy for UC remains a promising and active area of research; intravesical Bacillus Calmette-Guerin has been used as a form of immunotherapy in nonmuscle invasive disease. Also, numerous agents, particularly the monoclonal antibodies targeting checkpoint inhibition pathways, are showing encouraging signs of clinical activity.

Aortic stiffness is increased with premature coronary artery disease: a tissue Doppler imaging study Ahmed M Emara, Wessam E. H. El Shafey, Nader Nabil Menoufia Medical Journal 2019 32(1):14-17 Objective The objective of this study was to review the relationship of the aortic wall structure velocities evaluated by tissue Doppler imaging echocardiography in coronary artery disease (CAD). Materials and methods Data resources included Medline directories (PubMed, Medscape, Research Direct) and all material available in the internet from 1985 to 2017. The original search offered 104 articles, of which 47 fulfilled the inclusion standards. The articles analyzed aortic rigidity in patients with early CAD. Studies that did not fulfill the inclusion criteria were excluded. Research quality evaluation included determining whether honest authorization was gained, eligibility conditions were specified, appropriate settings were used, enough information was present, and whether assessment measures were described. Evaluations were created by organized review with the results tabulated. Results Altogether, 47 possibly relevant magazines were included. The studies suggested that aortic rigidity is increased in patients with early CAD. Conclusion Increased aortic rigidity has been named a predictor of cardiovascular incidents. Our conclusions verify this finding. Pulse-wave tissue Doppler imaging of the ascending aorta is an easily available way for estimating aortic flexible properties, and early aortic velocities are correlated with recently defined variables of aortic rigidity. Thus, early aortic velocities may show increased aortic rigidity in patients with early CAD. The medical use of the parameter needs further investigation.

Relationship of coronary artery disease with testosterone level in young men undergoing coronary angiography Hala M Badran, Mahmoud A Soliman, Ibrahim Elmadbouh, Waleed A Ibrahim, Sameh F El Masry Menoufia Medical Journal 2019 32(1):18-24 Objective This study aimed to investigate the relation of testosterone level with the extent of coronary artery disease (CAD) in young adult male undergoing coronary angiography. Materials and methods Medline databases (PubMed, Journal of Clinical Endocrinology and Metabolism, British Medical Journal, Journal of American College of Cardiology and European Heart Journal) and also materials available in the internet were searched. The search was performed in the electronic databases from 2014 to 2017. The initial search presented 127 articles of which 61 met the inclusion criteria. The articles studied premature CAD, relation of testosterone level to CAD, and testosterone replacement therapy. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Comparisons were made by structured review with the results tabulated. Findings In total, 61 potentially relevant publications were included. The studies indicate that the serum levels of both total and free testosterone were significantly lower in young males with CAD, and both were significantly correlated with the severity of CAD as assessed by Gensini score. Conclusion The low testosterone level is associated with both the incidence and severity of premature CAD in young adult males.

Theory of mind: its development and its relation to communication disorders: a systematic review Mohammed Baraka, Hossam M El-Dessouky, Eman E Abd El-Wahed, Shimaa S Allam Amer Menoufia Medical Journal 2019 32(1):25-30 Objective To define theory of mind (TOM), its development, its significance, its assessment, its deficits and intervention. Data sources Medline databases (PubMed, Medscape and Science Direct) and all materials available in the Internet from 1990 to 2016. Study selection The initial search presented 250 articles of which 47 met the inclusion criteria. The articles studied the development, assessment, deficits and intervention of TOM. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information and defined assessment measures. Data synthesis Significant data were collected. It was heterogeneous. Thus, a structured review was performed with the results tabulated. Conclusion TOM is the ability to infer the mental states such as (beliefs, thoughts, intentions) to one-self and to the others. Joint attention is an early precursor of TOM development. Theoretical accounts of TOM mechanism are, the Theory Theory, Simulation Theory and Modularity Theory. Many tools used in its assessment as false belief tasks (e.g., Sally and Anne task) and TOM test. It is impaired in autism, attention deficits hyperactivity disorder, hearing impairment, schizophrenia and dementia. Intervention solutions for the deficit are undertaken. Phoniatritions should be aware of TOM as a cognitive capacity that plays a big role in our communication. They should initiate appropriate assessment and interventions for disorders having TOM deficits.

The role of growth factors in the treatment of voice disorders: systematic review Mohamed K. M. El-Sharnoby, Mohamed A. S. Baraka, Hossam M El-Dessouky, Eman E Abd El-Wahed, Amina G Abd El-Aleem Menoufia Medical Journal 2019 32(1):31-37 Objective The aim of this study was to present a review about the role of growth factors (GFs) in the treatment of some voice disorders. Materials and methods The data sources consisted of Medline databases (PubMed, Elsevier, and Wily Library) and all materials available in the internet from 1990 to 2017. The initial search presented 150 articles, of which 57 met the inclusion criteria, with level II-2 as the level of evidence. The articles studied the function, uses and the efficacy of basic fibroblast growth factor (bFGF) on vocal outcomes of patients with vocal fold (VF) lesions. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria were specified, appropriate controls were used, adequate information was given and whether the studies defined assessment measures. Significant data were collected. It was heterogeneous. Thus, a structured review was performed with the results tabulated. Conclusion VF lesions and paralysis induced severe dysphonia, and the fundamental therapy for these diseases is voice therapy; however, this approach is ineffective for severe dysphonia. Surgical approaches have been attempted, but the outcome varies. The aim of surgical treatment has recently changed to stimulate the regeneration of VF structures. GF therapy is considered to be a 'trigger' for jumpstarting biological processes. One promising GF is bFGF. Cases of severe dysphonia that were treated by the single, transoral bFGF injection method showed significant improvements in the vocal functions after injection. The single injection method is easy to perform as an office procedure. The use of bFGF injection to treat severe VF lesions and VF paralysis is still controversial.

Language processing in a bilingual child Mohamed Baraka, Hossam El-Dessouky, Eman Ezzat, Fatima M Al-Sharif Menoufia Medical Journal 2019 32(1):38-44 Objectives To review the language processing, 'central and linguistic processing,' in bilingual children. The age of second language acquisition, a factor which may impact language processing, was also reviewed. Data sources Medline databases (PubMed, Medscape, and Science Direct) using the terms 'bilingual' or 'bilingualism' with the word 'children' as the search criteria. The resulting materials available in the internet from 1980 to 2017 were further screened for the terms 'processing,' 'cognition,' or 'age of acquisition.' Study selection Our refined search included 124 articles and book's chapters out of which 83 met our selection criteria. Those data related to late bilingualism were excluded. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, adequate information, and defined assessment measures were made. Data synthesis Significant data were collected. It was heterogeneous. Thus, a structured review was performed with the results tabulated. Conclusion An unresolved issue in bilingualism is how different languages are represented in the brain and which cognitive mechanisms are required to regulate their use. In learning a second language, the brain has to build on a neural network that enables the segregation of the new language from the native one. A bilingual child can create languages' activation and inhibitory links at the lexical and the morphological level and also can develop the ability to select a word and its syntactic characters correctly.

Assessment of phonological awareness in children with delayed language development Mohamed Baraka, Hossam El-Dessouky, Eman Ezzat, Eman F El-Domiaty Menoufia Medical Journal 2019 32(1):45-53 Objective To study the relationship between language disorders in children and phonological awareness (PA) to identify children with reading difficulties as early as possible. Background PA is an important determiner of success in learning to read and spell. Early speech and early language difficulties are considered to be risk factors associated with future reading difficulties. Children with language difficulties are particularly at risk for poor literacy outcomes. Patients and methods Fifty cases (aged from 5 to 8 years) with delayed language development of average intelligence quotient participated in our study at Phoniatrics unit outpatient clinic in Menoufia University Hospital, from March 2015 to March 2016. They were divided into three groups (A, B, and C) and assessed by Arabic Phonological Awareness Test and Standardized Arabic Language Test. The results of cases were compared with the results of 50 controls matched for age and sex. Moreover, the results of the PA test were correlated with the results of standardized Arabic language test. Results By comparing the performance of PA skills for cases and control in the three age groups, there were significant differences in all skills (P < 0.05), except in segmenting words into syllables (P = 0.06) and blending syllables (P = 0.1) in group A. By studying the correlation between PA age and total language age, receptive language age, expressive language age, and semantics age, there were highly significant positive correlations (P = 0.000). Significant positive correlation was found between PA age and articulation (P = 0.029). Moreover, there was a significant negative correlation between PA score and the gap between language age and chronological age (P = 0.045). Conclusion Children with specific language impairments require specific therapy that includes explicit focus on PA and letter identification.

Laryngeal assessment of patients with rheumatoid arthritis using laryngeal photodocumentation Mohamed Baraka, Hossam El-Dessouky, Alaa Labeeb, Eman Ezzat, Asmaa El-Dessouky Menoufia Medical Journal 2019 32(1):54-61 Objective The aim was to assess the prevalence of dysphonia and laryngeal changes upon videolaryngoscopic examination of patients with rheumatoid arthritis (RA). Background RA effects on larynx vary from mild asymptomatic effect to life-threatening conditions. Many authors have emphasized the need of studies in different communities on its effect. In Egypt, the knowledge regarding its manifestations on the larynx, as well as its laryngeal alterations, is limited. Patients and methods A total of 79 patients diagnosed as having RA in Menoufia University Hospitals from March 2015 to March 2017 were assessed by taking history and asking about different laryngeal complaints followed by telescopic videolaryngeal examination. Results The estimated prevalence of laryngeal complaints in patients with RA was 57%. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Dysphonia prevalence was 25.3%. Regarding videolaryngoscopic findings, the prevalence of changes was present in 86.15% of the patients. Most common finding has been posterior laryngitis, which was found in 78.5% of patients, followed by glottic gap in 34.2% and vocal folds rheumatoid nodules in 26.6% of them. Conclusion Laryngeal complaints and videolaryngoscopic morphological findings are prevalent among patients with RA, with a prevalence rate of 57 and 86.15%, respectively. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Most common videolaryngoscopic findings have been posterior laryngitis, which was found in 78.5% of our patients, followed by glottic gaps in 34.2%.

Study of peripheral neuropathy in patients with type 2 diabetes mellitus Wafik M El-Sheikh, Ibrahim E Alahmar, Gelan M Mohamed, Mohamed A El-Sheikh Menoufia Medical Journal 2019 32(1):62-66 Objectives To compare serum levels of tumor necrosis factor-alpha (TNF-α) in patients with peripheral neuropathy and patients without neuropathy in type 2 diabetes mellitus (T2DM) and study the relation between nerve conduction studies of motor and sensory nerves and the serum level of TNF-α in T2DM. Background TNF-α presence in the serum of diabetic patients can be used as an indicator for the development of neuropathy with nerve conduction studies. Patients and methods This cross-sectional study was conducted in diagnosed T2DM patients. They were divided into two groups: group I (n = 40) with clinically detectable diabetic peripheral neuropathy (DPN) of shorter duration and group II (n = 40) with clinically detectable DPN of longer duration. They were compared with patients without clinical neuropathy (n = 40); clinical diagnosis was based on Neurologic Severity Score (NSS) and National Disability Services (NDS) for signs. Blood samples were collected for the estimation of serum TNF-α. Nerve conduction velocity was measured in the upper and lower limbs. Median, ulnar, common peroneal, and posterior tibial nerves were selected for motor nerve conduction study and median and sural nerves were selected for sensory nerve conduction study. Results The serum level of TNF-α in type 2 diabetic patients with peripheral neuropathy is higher than those without neuropathy. The serum level of TNF-α shows statistically significant negative correlation with nerve conduction velocities which is higher in type 2 diabetic patients (5–10 years duration) with peripheral neuropathy. Conclusion A high level of TNF-α in the serum of T2DM patients with neuropathy shows possible contribution in the development of neuropathy. This cytokine might be used as a biomarker for DPN.