Objective The aim was to evaluate the role of stent insertion in the common bile duct after compl... more Objective The aim was to evaluate the role of stent insertion in the common bile duct after complete stone clearance by endoscopic retrograde cholangiopancreatography (ERCP). Background Biliary stents are usually inserted when complete stone clearance cannot be achieved. However, stent insertion after clearance may lower the pressure in the bile ducts and provide better bile drainage, thus preventing recurrent biliary events. Patients and methods This is a prospective study that was done on a consecutive sample of 40 patients who were admitted to Menoufia University Hospital during the period between May 2016 and May 2018 with choledochocystolithiasis, who underwent complete stone clearance by ERCP. The patients were divided into two groups: group I with bile duct stent insertion and group II without bile duct stent insertion. The patients were followed up for 1 month. The complications and the outcome of the operation were recorded. Results Three cases were omitted due to failed ERCP: 10.5% of group II developed recurrent obstructive jaundice, 5.3% needed repeat emergency ERCP compared with 5.6 who developed obstructive jaundice and needed emergency ERCP in group II and 5.6% of group I developed pancreatitis. Conversion to open cholecystectomy was done only in 5.6% of group I; 11.1% of group I had downward stent migration; 5.6% had upward migration; and 5.6% had their stent occluded. Conclusion Biliary stent insertion after choledocholithiasis clearance has the disadvantage of prolonging ERCP time, increasing its cost and the stent-related complications with no advantage for this group over the group without stent insertion.
Objective The aim of the study was to assess the success of endoscopic retrograde cholangiopancre... more Objective The aim of the study was to assess the success of endoscopic retrograde cholangiopancreatography (ERCP) for malignant obstructive jaundice using laboratory and radiological investigation. Background ERCP is a diagnostic and palliative treatment, which is used as the standard of investigation for patients with malignant obstructive jaundice; however, it failed in some patients. The prediction for success will be useful in the decision of management plan for patients with malignant obstructive jaundice and time and costs for patients and even countries. Patients and methods Collected laboratory investigation and radiological data for 20 patients presenting with malignant obstructive jaundice are included in this study, and malignant appearance of the tumor is confirmed using radiological finding or elevated tumor marker level. All patients presenting with benign stricture and duct stone are excluded from this study. Results ERCP was performed on 20 patients with malignant ob...
Summary Background 80% of individuals with cancer will require a surgical procedure, yet little c... more Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.
Background: Stroke is one of the major causes of permanent disability and mortality in the aging ... more Background: Stroke is one of the major causes of permanent disability and mortality in the aging population worldwide. Reduced libido, and poor erection and ejaculation are among common poststroke sexual dysfunctions, which is due to multiple factors, including both organic and psychosocial factors. Objective: We designed the study in order to detect the presence of erectile dysfunction (ED) among male patients with stroke using the International Index of Erectile Function (IIEF-5) and correlate the site of the lesion with the degree of ED. Also, we evaluated the serum total testosterone and prolactin levels among those patients and correlated their levels with the degree of ED using IIEF-5. Patients and Methods: Eighty male patients with ischemic cerebrovascular stroke were included in the study. The patients were diagnosed and divided according to the brain site lesion of cerebrovascular stroke into seven groups. The stroke patients completed the IIEF-5. Serum testosterone and prolactin levels were obtained and compared. Results: The mean age of the patients was 55.35±3.68 years. ED was detected in 53 patients representing 66.3% with variable degrees of severity (22.5% mild, 6.3% mild to moderate, 7.5% moderate, and 30.0% severe), while 27 (33.8%) patients had no ED. The mean testosterone level was lower than normal in basal ganglion affection and multiple areas affection only, while the mean prolactin level was higher than normal in all groups. Conclusion: ED is a common problem that may follow cerebrovascular stroke. We do recommend that counseling by a trained professional should be made part of stroke rehabilitation.
Objective The aim was to evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of ... more Objective The aim was to evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of gaping and chronic wounds. Background Nonhealing ulcers are a major health problem with high cost in terms of human and material resources. Application of autologous PRP has been a major breakthrough for the treatment of nonhealing ulcers, as it is an easy and cost-effective method and provides the necessary growth factors that enhance wound healing. Patients and methods A study was performed on 28 patients with nonhealing ulcers of various etiologies. Overall, 19 patients were treated with PRP at weekly intervals for a maximum of seven treatments and nine patients were treated with saline gauze dressings on alternative days. At the end of the 7, 14, 21, and 28-day periods, reduction in size of the ulcers (area and volume) was assessed and followed up till the healing completed, and the patients were followed up for a period of 12 weeks after treatment. Results The mean age ± SD of the patients was 39.68 ± 12.11 years. Of 19 ulcers in study group, there were two venous ulcers, nine traumatic ulcers, five pressure ulcers, and three diabetic ulcers. The mean ± SD duration of healing of the ulcers was 49.84 ± 22.23 days in study group and 108.67 ± 5.64 days in control group (P < 0.001). Conclusion Conventional therapies do not provide satisfactory healing for chronic nonhealing ulcers as they are not able to provide the necessary growth factors essential for the healing process. PRP is a safe, affordable, biocompatible, and simple office-based procedure for the treatment of nonhealing ulcers.
Papillary thyroid carcinoma (PTC) is the most common thyroid cancer with multiple risk factors in... more Papillary thyroid carcinoma (PTC) is the most common thyroid cancer with multiple risk factors including exposure to ionising radiation. Oestrogens contribute to papillary carcinoma development by promoting cell proliferation and invasion of mutated epithelial follicular cells. The present study aimed to assess ER-α and PR expression in PTC and to correlate their expression with the clinicopathological parameters in this cancer. This study included 62 primary and six metastatic papillary thyroid carcinoma cases. Nineteen and 38.7% of primary PTC cases showed positive nuclear expression for ER and PR, respectively. Metastatic cases showed 66.7% positive ER expression and all were negative for PR. Oestrogen receptor expression showed significant higher positivity in metastatic compared to primary PTC (p = 0.02) and it was significantly associated with primary PTC associated with thyroiditis (p = .002). Progesterone receptor expression was significantly associated with old age in primary PTC (p = .003) and it showed significant coparallel expression with ER (p = .000). Oestrogen and progesterone receptors expressed in papillary thyroid carcinoma opening the door for further studies to verify if those patients could benefit from hormonal therapy. Oestrogen receptor seems to have a role in metastatic process of PTC as malignant cells express it in metastatic more than primary site. The presence of lymphocytes in the stroma may promote ER expression in adjacent PTC, necessitating further studies on PTC cases associated with Hashimoto thyroiditis to verify this assumed relationship.
A screening questionnaire is an important tool for early diagnosis of neurological disorders, and... more A screening questionnaire is an important tool for early diagnosis of neurological disorders, and for epidemiological research. This screening instrument must be both feasible and valid. It must be accepted by the community and must be sensitive enough. So, the aim of this study was to prepare different Arabic screening questionnaires for screening different neurological disorders. This study was carried out in three stages. During the first stage, construction of separate questionnaires designed for screening the five major neurological disorders: cerebrovascular stroke, dementias, epilepsy, movement disorders, and muscle and neuromuscular disorders were done. Validation of the screening questionnaires was carried out in the second stage. Finally, questionnaire preparation was done in the third stage. Questions with the accepted sensitivity and specificity in each questionnaire formed the refined separate questionnaires.
Background: Multiple sclerosis (MS) is a chronic and disabling disorder with considerable social ... more Background: Multiple sclerosis (MS) is a chronic and disabling disorder with considerable social effects and economic sequelae. It is one of the major causes of disability in young adults. Objectives: This study aimed at detecting the prevalence of MS among the population of Al Quseir city. Methods: This study is a part of door-to-door survey of major neurological disorders that was conducted in Al Quseir city, Red Sea Governorate, Egypt. The sample size was 33,285 persons. The youngest patient was 17 years old. The number of people at and above 17 years of age was 21,827. They were screened by three neurologists. Then, the positive cases were subjected to meticulous clinical evaluation by three staff members of
Cerebral palsy (CP) is the most frequent cause of motor handicap. The present door-to-door survey... more Cerebral palsy (CP) is the most frequent cause of motor handicap. The present door-to-door survey was conducted in Al-Quseir City, Egypt, to investigate the epidemiology of CP. All inhabitants were screened by three neurologists. Medical and neurological examinations were performed for all residents and suspected cases of CP were confirmed by meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and testing with the Stanford-Binet Intelligence Scale. Forty-six of 12,788 children aged 18 years were found to have CP, yielding a childhood prevalence of 3.6 (95% confidence interval 1.48-2.59) per 1,000 live births. Five adults (aged 19-40 years) among 13,056 inhabitants had CP, giving an adult prevalence of 0.4 (95% confidence interval 0.04-0.72) per 1,000. The risk factors for CP identified in this study were premature birth, low birth weight, neonatal jaundice, neonatal seizures, and recurrent abortion in mothers of children with CP.
Background: Cerebral palsy (CP) is the most frequent cause of motor handicap among children. Aim ... more Background: Cerebral palsy (CP) is the most frequent cause of motor handicap among children. Aim of the study: We aim to study the relation of epilepsy in children with CP to various risk factors that affect the development of seizures. Patients and methods: In a cross-sectional, descriptive, population-based, case-control study, 98 children with CP (48 children with CP with epilepsy, and 50 children with CP without epilepsy) were compared with 180 children without CP or seizures. The children lived in two regions in Egypt: the Al-Kharga District-New Valley and El-Quseir city-Red Sea. These cases were subjected to meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and Stanford-Binet (4th edition) examination. Multinomial logistic regression was used to assess the risk factors. Results: Epilepsy was diagnosed in 48.9% of all cases of CP. Mental subnormality was observed more frequently in children with epilepsy than in those without epilepsy (84.6% versus 66.7%). The frequency of epilepsy was highest in patients with the spastic quadriplegic type of illness (58.3%). Multinomial logistic regression revealed that prematurity (,32 weeks of pregnancy), low birth weight (,2.5 kg at birth), neonatal seizures, jaundice, and cyanosis were significantly associated with CP with epilepsy. Conclusion: CP is associated with a high percentage of seizure disorders. Prematurity, low birth weight, neonatal seizures, cyanosis, and jaundice are significant risk factors among patients with CP with epilepsy compared to patients with CP without epilepsy or a healthy control group.
Epilepsy is a common neurological disorder affecting 4-10/ 1000 of the population. 18,25 Although... more Epilepsy is a common neurological disorder affecting 4-10/ 1000 of the population. 18,25 Although the prognosis for the majority of patients is good, 16 up to 30% of patients do not experience remission despite appropriate therapy with antiepileptic drugs. 7,26 This situation has substantial deleterious effects on patient health and quality of life and places a heavy burden on society. 11 The proportion of patients with intractable epilepsy among the Egyptian population is currently unknown. Thus, epidemiological data are important not only to improve our understanding of the condition but also to allow a rational approach in planning health services. 30 The early prediction of intractability would be valuable because earlier identification of patients at highest risk would allow physicians to consider these patients earlier for treatment with recently approved medications and other surgical and non-surgical approaches. 5 Therefore, we conducted this work to study the prevalence of patients with intractable seizures and to detect the predictors of intractability. 2. Subjects and methods 2.1. Study area This study involved the population of Al-Kharga District (New Valley Governorate). Geographically, the New Valley represents approximately 44% of Egypt. It is divided into 3 oases; Al-Kharga (the capital), Al-Farafra and Al-Dakhla districts. This area is far removed from Nile Valley and has different geographical (oases in the western Egyptian desert with hot dry weather, mainly depending on the underground water supply), social (mainly
Background: Stroke is a medical emergency. Nonfatal stroke may cause permanent neurologic damage,... more Background: Stroke is a medical emergency. Nonfatal stroke may cause permanent neurologic damage, complications, and disability. The aim of this study was to determine the epidemiology of nonfatal stroke in Al-Kharga District, New Valley, Egypt. Methods: The total population (62,583) was screened via a door-to-door study by three neurology specialists and 15 female social workers for demographic data collection. All subjects with probable stroke were subjected to a full clinical examination, neuroimaging (computed tomography and/or magnetic resonance imaging of the brain), and laboratory investigations including blood sugar, lipid profile, serum uric acid, a complete blood count, blood urea, and serum creatinine. Stroke severity and outcome were assessed using the Scandinavian Stroke Scale and Barthel Index. Carotid Doppler, echocardiography, and thyroid function tests were done in selected cases. Results: During the study period (June 1, 2005 to May 31, 2008), 351 subjects were diagnosed as having suffered a cerebrovascular stroke at some point during their lives, yielding a total lifetime prevalence of 5.6 per 1,000 population. Of these, 156 subjects were identified as having suffered a stroke during the year from January 1 to December 31, 2007, with an incidence rate of 2.5 per 1,000. Both prevalence and incidence rates were higher in urban (5.8 per 1,000 and 2.6 per 1,000, respectively) than rural communities (5.2 per 1,000 and 2.3 per 1,000), and were higher in males (6.1 per 1,000 and 2.7 per 1,000, respectively) than in females (5.1 per 1,000 and 2.3 per 1,000). Thrombotic stroke had the highest prevalence and incidence rates (4.2 per 1,000 and 1.7 per 1,000, respectively), whereas subarachnoid hemorrhage had the lowest prevalence and incidence rates (0.03 per 1,000 and 0.02 per 1,000). Conclusion: The prevalence of cerebrovascular accident in Al-Kharga lies in the lower range of that in developing countries, and is similar to that in industrialized countries.
Methodology and strategy play a very important role in epidemiological studies. Determination of ... more Methodology and strategy play a very important role in epidemiological studies. Determination of the study area, geographical features, facilities, difficulties, and key personnel from the same area are important factors for successful methodology. Over 31 months (July 1, 2009 to January 31, 2012), a screening and an examination survey were carried out to ascertain the prevalence of epilepsy, stroke, dementia, cerebellar ataxia, migraine, cerebral palsy, Parkinsonism, chorea, athetosis, dystonia, trigeminal neuralgia, Bell's palsy, multiple sclerosis, spinal cord disorders, and attention deficit hyperactivity disorders in Al Quseir, Red Sea Governorate, Egypt. A total of 33,285 people were screened by three neurologists in a doorto-door manner, including every door, using a standardized Arabic questionnaire to detect any subject with a neurological disorder. The methodological aspects of this project were carried out through eight phases: (1) data collection; (2) preparation; (3) screening; (4) case ascertainment; (5) investigations; (6) classifications; (7) data entry; and (8) statistics and tabulations. The results of this study reveal that the total prevalence of neurological disorders in Al Quseir was 4.6% and higher among females (5.2%) than males (3.9%). The highest prevalence was recorded in the elderly population (60+ years [8.0%]) and among the age group 18-39 years (5.4%).
Epidemiology of neurological disorders is still lacking in Egypt. The door-to-door method is the ... more Epidemiology of neurological disorders is still lacking in Egypt. The door-to-door method is the most suitable one to screen neurological disorders in our country. Over a 4-year period (June 1, 2005 to May 31, 2009), screening and examination had been carried out to ascertain the incidence and prevalence rate of epilepsy, stroke, cerebral palsy and Bell’s palsy, as well as the prevalence of dementia, extrapyramidal syndromes, muscle and neuromuscular disorders, cerebellar ataxia and primary nocturnal enuresis among the urban and rural population of Al Kharga District, New Valley, Egypt. A total of 62,583 people were screened by 3 neurologists in a door-to-door manner, including every door, using a standardized Arabic questionnaire to detect any patient with a neurological disorder. This was a project study of neurological disorders including 3 stages: first stage (June 1, 2005 to May 31, 2006) for data collection, designing a standardized questionnaire and screening; second stage (J...
Background: With aging, there is a parallel increase in the prevalence of dementia worldwide. The... more Background: With aging, there is a parallel increase in the prevalence of dementia worldwide. The aim of this work is to determine the prevalence of dementia among the population of Al Kharga District, New Valley, Egypt. Methods: Screening of all subjects aged ≥50 years (n = 8,173 out of 62,583 inhabitants) was done through a door-to-door survey by 3 neurologists, using a short standardized Arabic screening test and a modified Mini-Mental State Examination. Suspected cases were subjected to full clinical examination, psychometric assessment using the Cognitive Abilities Screening Instrument, Instrumental Activities of Daily Living Scale, Geriatric Depression Scale, Hachinski Ischemic Score, DSM-IV-TR diagnostic criteria, neuroimaging, and laboratory investigations, when indicated. Results: The prevalence rate of dementia was 2.26% for the population aged ≥50 years. It increased steeply with age to a maximum of 18.48% for those aged ≥80 years. Alzheimer’s disease (51.2%) was the most...
Background and purpose: Stroke is a medical emergency that can cause permanent neurological damag... more Background and purpose: Stroke is a medical emergency that can cause permanent neurological damage, complications, and disability. We aim to determine the epidemiology of non-fatal cerebrovascular stroke (CVS) and transient ischemic attacks (TIAs) in Al Quseir City, Red Sea, Egypt. Methods: The total population (n=33,285) was screened through a door to door study by three specialists of neurology and 15 female social workers (for demographic data collection). All suspected stroke patients were subjected to a full clinical examination, computerized tomography (CT) and/or magnetic resonance imaging (MRI) of their brain, blood sugar, lipogram, serum uric acid, complete blood cells, blood urea, and serum creatinine, as well as evaluated by Barthel Index and Scandinavian Stroke Scale. Carotid doppler, echocardiography, and thyroid functions were done for selected cases. Results: CVS was recorded among 130 patients out of 19,848 subjects aged 20 years and more, yielding a total prevalence of 6.55/1,000 population. From June 1, 2010 to May 31, 2011, 36 patients were recorded to have stroke within 1-year, yielding an incidence rate of 1.81/1,000. Prevalence and incidence rates were higher among males than females, and both indices increased steadily with advancing age to reach the highest prevalence (37.02/1,000) and incidence rate (9.5/1,000) among aged persons 60 years and more. Conclusion: The prevalence of non-fatal stroke in Al Quseir city (6.55/1,000) was at the lower range of that recorded in developing countries (5-10/1,000) and slightly higher than that recorded in industrialized countries (5/1,000 population). Ischemic stroke is the most common type of stroke. The prevalence of TIAs was 0.15/1,000.
Dementia is one of the most important public health problems as a result of the rapid increase in... more Dementia is one of the most important public health problems as a result of the rapid increase in the number of elderly persons worldwide. Improvement of prevention strategies and caring for people with dementia should be undertaken. We performed a door-to-door study to screen all subjects aged 50 years and older (n=4,329 of 33,285 inhabitants) in Al-Quseir city. The screening was performed by 3 neuropsychiatrists, using a modified form of the Mini-Mental State Examination. Suspected cases were subjected to case ascertainment according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnostic criteria for dementia; full clinical assessment; psychometric assessment using Cognitive Abilities Screening Instruments, Hachinski Ischaemic Score, Instrumental Activities of Daily Living Scale and the Geriatric Depression Scale; neuroimaging (computed tomography and/or magnetic resonance imaging); and laboratory investigations for selected patients when indicated. The prevalence of dementia was 2.01% for participants aged 50 years or older and 3.83% for those aged 60 years or older. It increased steeply with increasing age to a maximum of 13.5% for those aged 80 years or older. Alzheimer's dementia (48.3%) was the most common subtype, followed by vascular dementia (36.8%), dementia resulting from general medical conditions (11.5%), and last, dementia resulting from multiple etiologies (3.4%).
Objective The aim was to evaluate the role of stent insertion in the common bile duct after compl... more Objective The aim was to evaluate the role of stent insertion in the common bile duct after complete stone clearance by endoscopic retrograde cholangiopancreatography (ERCP). Background Biliary stents are usually inserted when complete stone clearance cannot be achieved. However, stent insertion after clearance may lower the pressure in the bile ducts and provide better bile drainage, thus preventing recurrent biliary events. Patients and methods This is a prospective study that was done on a consecutive sample of 40 patients who were admitted to Menoufia University Hospital during the period between May 2016 and May 2018 with choledochocystolithiasis, who underwent complete stone clearance by ERCP. The patients were divided into two groups: group I with bile duct stent insertion and group II without bile duct stent insertion. The patients were followed up for 1 month. The complications and the outcome of the operation were recorded. Results Three cases were omitted due to failed ERCP: 10.5% of group II developed recurrent obstructive jaundice, 5.3% needed repeat emergency ERCP compared with 5.6 who developed obstructive jaundice and needed emergency ERCP in group II and 5.6% of group I developed pancreatitis. Conversion to open cholecystectomy was done only in 5.6% of group I; 11.1% of group I had downward stent migration; 5.6% had upward migration; and 5.6% had their stent occluded. Conclusion Biliary stent insertion after choledocholithiasis clearance has the disadvantage of prolonging ERCP time, increasing its cost and the stent-related complications with no advantage for this group over the group without stent insertion.
Objective The aim of the study was to assess the success of endoscopic retrograde cholangiopancre... more Objective The aim of the study was to assess the success of endoscopic retrograde cholangiopancreatography (ERCP) for malignant obstructive jaundice using laboratory and radiological investigation. Background ERCP is a diagnostic and palliative treatment, which is used as the standard of investigation for patients with malignant obstructive jaundice; however, it failed in some patients. The prediction for success will be useful in the decision of management plan for patients with malignant obstructive jaundice and time and costs for patients and even countries. Patients and methods Collected laboratory investigation and radiological data for 20 patients presenting with malignant obstructive jaundice are included in this study, and malignant appearance of the tumor is confirmed using radiological finding or elevated tumor marker level. All patients presenting with benign stricture and duct stone are excluded from this study. Results ERCP was performed on 20 patients with malignant ob...
Summary Background 80% of individuals with cancer will require a surgical procedure, yet little c... more Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.
Background: Stroke is one of the major causes of permanent disability and mortality in the aging ... more Background: Stroke is one of the major causes of permanent disability and mortality in the aging population worldwide. Reduced libido, and poor erection and ejaculation are among common poststroke sexual dysfunctions, which is due to multiple factors, including both organic and psychosocial factors. Objective: We designed the study in order to detect the presence of erectile dysfunction (ED) among male patients with stroke using the International Index of Erectile Function (IIEF-5) and correlate the site of the lesion with the degree of ED. Also, we evaluated the serum total testosterone and prolactin levels among those patients and correlated their levels with the degree of ED using IIEF-5. Patients and Methods: Eighty male patients with ischemic cerebrovascular stroke were included in the study. The patients were diagnosed and divided according to the brain site lesion of cerebrovascular stroke into seven groups. The stroke patients completed the IIEF-5. Serum testosterone and prolactin levels were obtained and compared. Results: The mean age of the patients was 55.35±3.68 years. ED was detected in 53 patients representing 66.3% with variable degrees of severity (22.5% mild, 6.3% mild to moderate, 7.5% moderate, and 30.0% severe), while 27 (33.8%) patients had no ED. The mean testosterone level was lower than normal in basal ganglion affection and multiple areas affection only, while the mean prolactin level was higher than normal in all groups. Conclusion: ED is a common problem that may follow cerebrovascular stroke. We do recommend that counseling by a trained professional should be made part of stroke rehabilitation.
Objective The aim was to evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of ... more Objective The aim was to evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of gaping and chronic wounds. Background Nonhealing ulcers are a major health problem with high cost in terms of human and material resources. Application of autologous PRP has been a major breakthrough for the treatment of nonhealing ulcers, as it is an easy and cost-effective method and provides the necessary growth factors that enhance wound healing. Patients and methods A study was performed on 28 patients with nonhealing ulcers of various etiologies. Overall, 19 patients were treated with PRP at weekly intervals for a maximum of seven treatments and nine patients were treated with saline gauze dressings on alternative days. At the end of the 7, 14, 21, and 28-day periods, reduction in size of the ulcers (area and volume) was assessed and followed up till the healing completed, and the patients were followed up for a period of 12 weeks after treatment. Results The mean age ± SD of the patients was 39.68 ± 12.11 years. Of 19 ulcers in study group, there were two venous ulcers, nine traumatic ulcers, five pressure ulcers, and three diabetic ulcers. The mean ± SD duration of healing of the ulcers was 49.84 ± 22.23 days in study group and 108.67 ± 5.64 days in control group (P < 0.001). Conclusion Conventional therapies do not provide satisfactory healing for chronic nonhealing ulcers as they are not able to provide the necessary growth factors essential for the healing process. PRP is a safe, affordable, biocompatible, and simple office-based procedure for the treatment of nonhealing ulcers.
Papillary thyroid carcinoma (PTC) is the most common thyroid cancer with multiple risk factors in... more Papillary thyroid carcinoma (PTC) is the most common thyroid cancer with multiple risk factors including exposure to ionising radiation. Oestrogens contribute to papillary carcinoma development by promoting cell proliferation and invasion of mutated epithelial follicular cells. The present study aimed to assess ER-α and PR expression in PTC and to correlate their expression with the clinicopathological parameters in this cancer. This study included 62 primary and six metastatic papillary thyroid carcinoma cases. Nineteen and 38.7% of primary PTC cases showed positive nuclear expression for ER and PR, respectively. Metastatic cases showed 66.7% positive ER expression and all were negative for PR. Oestrogen receptor expression showed significant higher positivity in metastatic compared to primary PTC (p = 0.02) and it was significantly associated with primary PTC associated with thyroiditis (p = .002). Progesterone receptor expression was significantly associated with old age in primary PTC (p = .003) and it showed significant coparallel expression with ER (p = .000). Oestrogen and progesterone receptors expressed in papillary thyroid carcinoma opening the door for further studies to verify if those patients could benefit from hormonal therapy. Oestrogen receptor seems to have a role in metastatic process of PTC as malignant cells express it in metastatic more than primary site. The presence of lymphocytes in the stroma may promote ER expression in adjacent PTC, necessitating further studies on PTC cases associated with Hashimoto thyroiditis to verify this assumed relationship.
A screening questionnaire is an important tool for early diagnosis of neurological disorders, and... more A screening questionnaire is an important tool for early diagnosis of neurological disorders, and for epidemiological research. This screening instrument must be both feasible and valid. It must be accepted by the community and must be sensitive enough. So, the aim of this study was to prepare different Arabic screening questionnaires for screening different neurological disorders. This study was carried out in three stages. During the first stage, construction of separate questionnaires designed for screening the five major neurological disorders: cerebrovascular stroke, dementias, epilepsy, movement disorders, and muscle and neuromuscular disorders were done. Validation of the screening questionnaires was carried out in the second stage. Finally, questionnaire preparation was done in the third stage. Questions with the accepted sensitivity and specificity in each questionnaire formed the refined separate questionnaires.
Background: Multiple sclerosis (MS) is a chronic and disabling disorder with considerable social ... more Background: Multiple sclerosis (MS) is a chronic and disabling disorder with considerable social effects and economic sequelae. It is one of the major causes of disability in young adults. Objectives: This study aimed at detecting the prevalence of MS among the population of Al Quseir city. Methods: This study is a part of door-to-door survey of major neurological disorders that was conducted in Al Quseir city, Red Sea Governorate, Egypt. The sample size was 33,285 persons. The youngest patient was 17 years old. The number of people at and above 17 years of age was 21,827. They were screened by three neurologists. Then, the positive cases were subjected to meticulous clinical evaluation by three staff members of
Cerebral palsy (CP) is the most frequent cause of motor handicap. The present door-to-door survey... more Cerebral palsy (CP) is the most frequent cause of motor handicap. The present door-to-door survey was conducted in Al-Quseir City, Egypt, to investigate the epidemiology of CP. All inhabitants were screened by three neurologists. Medical and neurological examinations were performed for all residents and suspected cases of CP were confirmed by meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and testing with the Stanford-Binet Intelligence Scale. Forty-six of 12,788 children aged 18 years were found to have CP, yielding a childhood prevalence of 3.6 (95% confidence interval 1.48-2.59) per 1,000 live births. Five adults (aged 19-40 years) among 13,056 inhabitants had CP, giving an adult prevalence of 0.4 (95% confidence interval 0.04-0.72) per 1,000. The risk factors for CP identified in this study were premature birth, low birth weight, neonatal jaundice, neonatal seizures, and recurrent abortion in mothers of children with CP.
Background: Cerebral palsy (CP) is the most frequent cause of motor handicap among children. Aim ... more Background: Cerebral palsy (CP) is the most frequent cause of motor handicap among children. Aim of the study: We aim to study the relation of epilepsy in children with CP to various risk factors that affect the development of seizures. Patients and methods: In a cross-sectional, descriptive, population-based, case-control study, 98 children with CP (48 children with CP with epilepsy, and 50 children with CP without epilepsy) were compared with 180 children without CP or seizures. The children lived in two regions in Egypt: the Al-Kharga District-New Valley and El-Quseir city-Red Sea. These cases were subjected to meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and Stanford-Binet (4th edition) examination. Multinomial logistic regression was used to assess the risk factors. Results: Epilepsy was diagnosed in 48.9% of all cases of CP. Mental subnormality was observed more frequently in children with epilepsy than in those without epilepsy (84.6% versus 66.7%). The frequency of epilepsy was highest in patients with the spastic quadriplegic type of illness (58.3%). Multinomial logistic regression revealed that prematurity (,32 weeks of pregnancy), low birth weight (,2.5 kg at birth), neonatal seizures, jaundice, and cyanosis were significantly associated with CP with epilepsy. Conclusion: CP is associated with a high percentage of seizure disorders. Prematurity, low birth weight, neonatal seizures, cyanosis, and jaundice are significant risk factors among patients with CP with epilepsy compared to patients with CP without epilepsy or a healthy control group.
Epilepsy is a common neurological disorder affecting 4-10/ 1000 of the population. 18,25 Although... more Epilepsy is a common neurological disorder affecting 4-10/ 1000 of the population. 18,25 Although the prognosis for the majority of patients is good, 16 up to 30% of patients do not experience remission despite appropriate therapy with antiepileptic drugs. 7,26 This situation has substantial deleterious effects on patient health and quality of life and places a heavy burden on society. 11 The proportion of patients with intractable epilepsy among the Egyptian population is currently unknown. Thus, epidemiological data are important not only to improve our understanding of the condition but also to allow a rational approach in planning health services. 30 The early prediction of intractability would be valuable because earlier identification of patients at highest risk would allow physicians to consider these patients earlier for treatment with recently approved medications and other surgical and non-surgical approaches. 5 Therefore, we conducted this work to study the prevalence of patients with intractable seizures and to detect the predictors of intractability. 2. Subjects and methods 2.1. Study area This study involved the population of Al-Kharga District (New Valley Governorate). Geographically, the New Valley represents approximately 44% of Egypt. It is divided into 3 oases; Al-Kharga (the capital), Al-Farafra and Al-Dakhla districts. This area is far removed from Nile Valley and has different geographical (oases in the western Egyptian desert with hot dry weather, mainly depending on the underground water supply), social (mainly
Background: Stroke is a medical emergency. Nonfatal stroke may cause permanent neurologic damage,... more Background: Stroke is a medical emergency. Nonfatal stroke may cause permanent neurologic damage, complications, and disability. The aim of this study was to determine the epidemiology of nonfatal stroke in Al-Kharga District, New Valley, Egypt. Methods: The total population (62,583) was screened via a door-to-door study by three neurology specialists and 15 female social workers for demographic data collection. All subjects with probable stroke were subjected to a full clinical examination, neuroimaging (computed tomography and/or magnetic resonance imaging of the brain), and laboratory investigations including blood sugar, lipid profile, serum uric acid, a complete blood count, blood urea, and serum creatinine. Stroke severity and outcome were assessed using the Scandinavian Stroke Scale and Barthel Index. Carotid Doppler, echocardiography, and thyroid function tests were done in selected cases. Results: During the study period (June 1, 2005 to May 31, 2008), 351 subjects were diagnosed as having suffered a cerebrovascular stroke at some point during their lives, yielding a total lifetime prevalence of 5.6 per 1,000 population. Of these, 156 subjects were identified as having suffered a stroke during the year from January 1 to December 31, 2007, with an incidence rate of 2.5 per 1,000. Both prevalence and incidence rates were higher in urban (5.8 per 1,000 and 2.6 per 1,000, respectively) than rural communities (5.2 per 1,000 and 2.3 per 1,000), and were higher in males (6.1 per 1,000 and 2.7 per 1,000, respectively) than in females (5.1 per 1,000 and 2.3 per 1,000). Thrombotic stroke had the highest prevalence and incidence rates (4.2 per 1,000 and 1.7 per 1,000, respectively), whereas subarachnoid hemorrhage had the lowest prevalence and incidence rates (0.03 per 1,000 and 0.02 per 1,000). Conclusion: The prevalence of cerebrovascular accident in Al-Kharga lies in the lower range of that in developing countries, and is similar to that in industrialized countries.
Methodology and strategy play a very important role in epidemiological studies. Determination of ... more Methodology and strategy play a very important role in epidemiological studies. Determination of the study area, geographical features, facilities, difficulties, and key personnel from the same area are important factors for successful methodology. Over 31 months (July 1, 2009 to January 31, 2012), a screening and an examination survey were carried out to ascertain the prevalence of epilepsy, stroke, dementia, cerebellar ataxia, migraine, cerebral palsy, Parkinsonism, chorea, athetosis, dystonia, trigeminal neuralgia, Bell's palsy, multiple sclerosis, spinal cord disorders, and attention deficit hyperactivity disorders in Al Quseir, Red Sea Governorate, Egypt. A total of 33,285 people were screened by three neurologists in a doorto-door manner, including every door, using a standardized Arabic questionnaire to detect any subject with a neurological disorder. The methodological aspects of this project were carried out through eight phases: (1) data collection; (2) preparation; (3) screening; (4) case ascertainment; (5) investigations; (6) classifications; (7) data entry; and (8) statistics and tabulations. The results of this study reveal that the total prevalence of neurological disorders in Al Quseir was 4.6% and higher among females (5.2%) than males (3.9%). The highest prevalence was recorded in the elderly population (60+ years [8.0%]) and among the age group 18-39 years (5.4%).
Epidemiology of neurological disorders is still lacking in Egypt. The door-to-door method is the ... more Epidemiology of neurological disorders is still lacking in Egypt. The door-to-door method is the most suitable one to screen neurological disorders in our country. Over a 4-year period (June 1, 2005 to May 31, 2009), screening and examination had been carried out to ascertain the incidence and prevalence rate of epilepsy, stroke, cerebral palsy and Bell’s palsy, as well as the prevalence of dementia, extrapyramidal syndromes, muscle and neuromuscular disorders, cerebellar ataxia and primary nocturnal enuresis among the urban and rural population of Al Kharga District, New Valley, Egypt. A total of 62,583 people were screened by 3 neurologists in a door-to-door manner, including every door, using a standardized Arabic questionnaire to detect any patient with a neurological disorder. This was a project study of neurological disorders including 3 stages: first stage (June 1, 2005 to May 31, 2006) for data collection, designing a standardized questionnaire and screening; second stage (J...
Background: With aging, there is a parallel increase in the prevalence of dementia worldwide. The... more Background: With aging, there is a parallel increase in the prevalence of dementia worldwide. The aim of this work is to determine the prevalence of dementia among the population of Al Kharga District, New Valley, Egypt. Methods: Screening of all subjects aged ≥50 years (n = 8,173 out of 62,583 inhabitants) was done through a door-to-door survey by 3 neurologists, using a short standardized Arabic screening test and a modified Mini-Mental State Examination. Suspected cases were subjected to full clinical examination, psychometric assessment using the Cognitive Abilities Screening Instrument, Instrumental Activities of Daily Living Scale, Geriatric Depression Scale, Hachinski Ischemic Score, DSM-IV-TR diagnostic criteria, neuroimaging, and laboratory investigations, when indicated. Results: The prevalence rate of dementia was 2.26% for the population aged ≥50 years. It increased steeply with age to a maximum of 18.48% for those aged ≥80 years. Alzheimer’s disease (51.2%) was the most...
Background and purpose: Stroke is a medical emergency that can cause permanent neurological damag... more Background and purpose: Stroke is a medical emergency that can cause permanent neurological damage, complications, and disability. We aim to determine the epidemiology of non-fatal cerebrovascular stroke (CVS) and transient ischemic attacks (TIAs) in Al Quseir City, Red Sea, Egypt. Methods: The total population (n=33,285) was screened through a door to door study by three specialists of neurology and 15 female social workers (for demographic data collection). All suspected stroke patients were subjected to a full clinical examination, computerized tomography (CT) and/or magnetic resonance imaging (MRI) of their brain, blood sugar, lipogram, serum uric acid, complete blood cells, blood urea, and serum creatinine, as well as evaluated by Barthel Index and Scandinavian Stroke Scale. Carotid doppler, echocardiography, and thyroid functions were done for selected cases. Results: CVS was recorded among 130 patients out of 19,848 subjects aged 20 years and more, yielding a total prevalence of 6.55/1,000 population. From June 1, 2010 to May 31, 2011, 36 patients were recorded to have stroke within 1-year, yielding an incidence rate of 1.81/1,000. Prevalence and incidence rates were higher among males than females, and both indices increased steadily with advancing age to reach the highest prevalence (37.02/1,000) and incidence rate (9.5/1,000) among aged persons 60 years and more. Conclusion: The prevalence of non-fatal stroke in Al Quseir city (6.55/1,000) was at the lower range of that recorded in developing countries (5-10/1,000) and slightly higher than that recorded in industrialized countries (5/1,000 population). Ischemic stroke is the most common type of stroke. The prevalence of TIAs was 0.15/1,000.
Dementia is one of the most important public health problems as a result of the rapid increase in... more Dementia is one of the most important public health problems as a result of the rapid increase in the number of elderly persons worldwide. Improvement of prevention strategies and caring for people with dementia should be undertaken. We performed a door-to-door study to screen all subjects aged 50 years and older (n=4,329 of 33,285 inhabitants) in Al-Quseir city. The screening was performed by 3 neuropsychiatrists, using a modified form of the Mini-Mental State Examination. Suspected cases were subjected to case ascertainment according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnostic criteria for dementia; full clinical assessment; psychometric assessment using Cognitive Abilities Screening Instruments, Hachinski Ischaemic Score, Instrumental Activities of Daily Living Scale and the Geriatric Depression Scale; neuroimaging (computed tomography and/or magnetic resonance imaging); and laboratory investigations for selected patients when indicated. The prevalence of dementia was 2.01% for participants aged 50 years or older and 3.83% for those aged 60 years or older. It increased steeply with increasing age to a maximum of 13.5% for those aged 80 years or older. Alzheimer's dementia (48.3%) was the most common subtype, followed by vascular dementia (36.8%), dementia resulting from general medical conditions (11.5%), and last, dementia resulting from multiple etiologies (3.4%).
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