@article { author = {Kabbash, Mansour Mohammed and Abdu El Shenawy, Anwar and Sayed, Sherief El Prince and Eloteify, Mohamed Mahmoud and Suleiman, Khaled Abdeen Talha}, title = {Oncological Outcome and Patient Satisfaction in Skin-Sparing Mastectomy and Immediate Breast Reconstruction}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {1-8}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.66692}, abstract = {Background: Breast cancer represents 10% of all cancers diagnosed worldwide annually and constitute 22% of all new cancers in women. The burden of breast cancer has increased steadily, almost doubling, in terms of estimated new cases annually over a 20-year span. Objective: This study was aimed to evaluate the outcome on oncological standard and patient satisfaction on the aesthetic side with skin-sparing mastectomy and immediate breast reconstruction for patients with early breast cancer. Patients and methods: this study included 80 female patients with breast cancer, 60 cases were operated upon at National Cancer Institute (NCI), Cairo University, 20 cases were operated upon at Oncosurgery Unit, Aswan University Hospitals, between 2015 and 2019. Results: In the current study, all patients were closely followed up to detect any signs of local recurrence (LR). The duration of postoperative follow up ranged from 24 to 48 months with a mean of 31.55 months. Only 1 patient (1.2 %) showed signs of local recurrence after 1 year of surgery. This condition was not associated with any sign of regional or systemic recurrence. This low incidence of local recurrence may be attributed to the early stage of the disease at the time of surgical intervention, the mastectomy procedure itself and the justified administration of neoadjuvant and adjuvant therapy to the studied patients. However, a relatively short period of follow up might be a drawback of obtaining a solid conclusion. Conclusions: It could be concluded that skin sparing mastectomy and Immediate breast reconstruction is a technically feasible and oncologically safe procedure. Accepted cosmetic result was attained in most of patients.}, keywords = {breast cancer,Oncological outcome,Skin-sparing mastectomy,Immediate breast reconstruction}, url = {https://ejhm.journals.ekb.eg/article_66692.html}, eprint = {https://ejhm.journals.ekb.eg/article_66692_452891b36670cffe7039177f5a3ca3a8.pdf} } @article { author = {Mohamed, Elham Anwar and Morsy, Amal Abd Alaleim and Mohamed, Hanaa Taha and Abd Alrahim, Nosaiba Mohammed}, title = {Predictive Roles of Urinary Liver Type - Fatty Acid-Binding Protein and N-Acetyl-β-D-Glucosaminidase for Progression of Diabetic Nephropathy in Type 2 Diabetic Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {9-20}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.66841}, abstract = {Background: diabetes mellitus (DM) is a common metabolic disorder characterized by chronic hyperglycemia leading to significant morbidity and mortality as a result of the development of chronic macrovascular and microvascular complications. The onset of type 2 diabetes mellitus (T2DM) is often silent and insidious and this accounts for the relatively high prevalence of complications at initial presentation. Objective: The aim of the current study was to evaluate the urinary level of liver type-fatty acid binding protein (u-LFABP) as a proximal tubular damage biomarker in prediction or early detection of Diabetic nephropathy (DN) and whether its levels parallel the severity of kidney disease in type 2 diabetic patients, as assessed by the degree of albuminuria and other biochemical indices of renal dysfunction (e-GFR, serum creatinine and urea). Patients and Methods: the study was conducted on 69 diabetic patients and 20 age and sex- matched apparently healthy control subjects. All patients included in this study were recruited from the inpatient and outpatient Endocrinology Clinic, Al-Zahraa University Hospital, between October 2016 and April 2018. The enrolled patients included 37 women and 32 men with age ranged from 40 to 67. They were diagnosed as having type 2 diabetes mellitus (T2DM). Results: Statistical analysis of results presumed that u-L-FABP levels ˃37.2 and 92.2 ng/L were the optimum cutoff levels to discriminate micro- and macroalbuminuric diabetic patients from controls with 90% and 100% diagnostic specificity and 96% and 100% accuracy, respectively. In addition, u-L-FABP levels ˃ 28.5 and ˃386.1 ng/L, were the optimum cutoff values that predict the progression of microalbuminuria and macroalbuminuria with 100% diagnostic sensitivity and 87.9% and 99.7% accuracy, respectively. Conclusion: the use of u-L-FABP as a specific proximal tubular damage biomarker alone, or together with microalbumin, is beneficial for early diagnosis and monitoring of DN, compared to u- N-Acetyl-β-DGlucosaminidase (NAG) excretion.}, keywords = {Urinary Liver- Fatty Acid-Binding,N-Acetyl-β-D-Glucosaminidase,diabetic nephropathy}, url = {https://ejhm.journals.ekb.eg/article_66841.html}, eprint = {https://ejhm.journals.ekb.eg/article_66841_016e65d8b5f921d17900362e46aca810.pdf} } @article { author = {Rayea, Mohammed M Farid and Amer, Medhat Kamel and Mousa, Ahmed Abdelhady and Farghaly, Mohammed Gamal}, title = {The Effect of Two Different Sperm Cryopreservation Methods on The Integrity of Its DNA Content (a Comparative Study)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {21-27}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.66842}, abstract = {Background: Sperm cryopreservation is currently the only clinically available technique for preservation of male gametes for subsequent use in assisted reproduction technologies. Objective: The objective of this study was to determine the impact of semen cryopreservation on human sperm DNA. Patients and methods: The study sample consists of 20 male patients seeking seminal fluid analysis at the andrology laboratory of a specialized IVF center (ADAM International Hospital for Fertility and Sterility, Giza, Egypt), and accepting to sign a consent of approval to participate in the study, with the diagnoses of normozoospermia, oligozoospermia (either isolated or combined with asthenozoospermia or teratozoospermia). Results: There is no statistical difference between Pre-freezing and vitrification regarding DNA fragmentation, P>0.05. No statistical difference between Pre-freezing and slow frozen regarding DNA fragmentation, P>0.05. Finally, there is no significant statistical difference between vitrification and slow frozen regarding DNA fragmentation, P>0.05. Conclusion: The sperm DNA fragmentation index was not affected during cryopreservation under the various methods of storage tested. Clinicians and investigators should take this information into consideration when using cryopreserved sperm for assisted reproduction.}, keywords = {Sperm cryopreservation,DNA content}, url = {https://ejhm.journals.ekb.eg/article_66842.html}, eprint = {https://ejhm.journals.ekb.eg/article_66842_fefd05be4e874ab7a75a5ccae979a146.pdf} } @article { author = {Hefny, Abdelsalam Mohammed and Khira, Yuosuf Mohammed and Mohamed, Ashraf AbdEldayem and Mousa, Mohammed Nasr Mahmoud}, title = {Treatment of Distal Femoral Fractures by Retrograde Nail Versus Minimally Invasive Percutaneous Plate Osteosynthesis: A Comparative Study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {28-33}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67656}, abstract = {Background: Distal femoral fractures are serious injuries and represent a real challenge as regards their management. Objectives: The purpose of this study was to assess the results of treatment of distal femoral fractures by retrograde intramedullary nail versus minimally invasive locking compression plate. Patients and methods: This is a retrospective study that included 20 patients with distal femoral fractures; 10 of them treated by retrograde nail (group A) and the remainder treated by locked plate using minimally invasive plate osteosynthesis technique (group B) at El-Hadra University Hospital and Kafr-Eldawar General Hospital from AUG 2016 till AUG 2018. Results: In group A, the results were excellent in 2 patients (20.0%), good in 3 (30.0%), fair in 3 (30.0%) and poor 2 patients (20.0%). In group B, the result was excellent in one patient (10.0%), good in 4 patients (40.0%), fair in 3 patients (30.0%) and poor in 2 patients (20.0%). There was no significant statistical difference regarding final score in the two studied groups (P < 0.05). Conclusions: It could be concluded that retrograde nailing provides a good intramedullary stability and firm callus and may be effectively implanted in segmental fractures of the distal femur. unrelenting knee pain and inability to move the knee in type C fractures are the main limiting factors of retrograde nail. LCP was associated with less morbidity in terms of persistent knee pain and better range of movements than retrograde nailing. Locked plating may be utilized for all distal femur fractures including type C fractures and osteoporotic fractures.}, keywords = {Distal femoral fractures,Locking plate (LCP),Retrograde nail (RGN)}, url = {https://ejhm.journals.ekb.eg/article_67656.html}, eprint = {https://ejhm.journals.ekb.eg/article_67656_4de4f4b0a61503efdae6f94e0f234379.pdf} } @article { author = {Ali, Hadeer Osama Mohamed and Kadah, Sayed Mohammed Saeid and Rashid, Rashida Ahmed Ali and Saif EL-Din, Doaa Abd El-Halim}, title = {Intrapolyp Corticosteroid Injection versus Oral Corticosteroid versus Topical Nasal Corticosteroid Spray in Treatment of Allergic Nasal Polyposis: Comparative Study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {34-41}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67657}, abstract = {Background: Nasal Polyposis are treated with topical steroids, systemic oral steroids, surgical excision, and intrapolyp steroid injection. Local and systemic steroid treatment is the mainstay of therapy for nasal polyposis. Objectives: The aim of this study was to evaluate the role of intrapolyp steroid injection in the treatment of nasal polyposis and its efficiency, and to compare these results with that of oral and topical nasal spray corticosteroid. Patients and Methods: This study involved 60 patients presented at ENT Outpatient Clinic, Al-Zahraa University Hospital and diagnosed as nasal polyposis. Their age ranged between (18-60) years. They were randomly divided according to type of treatment (nasal corticosteroid spray, oral corticosteroid and intranasal injection of corticosteroid) into 3 groups, each consisted of 20 patients. Results: There were statistically significant differences in total nasal symptom score (TNSS), nasal polyp score (TNPS) and endoscopic analysis. It has been noted that in nasal spray group, Improvement of symptoms with No Regression of Polypis observed in 13 patients (65%) and no change at all in 7 patients (35%). While in oral steroids group, complete regression is observed in 4 patients (20%), partial improvement in 11 patients (55 %), and no response in 5 patients (25%) and in injection group, complete regression of polyps is observed in 2 patients (10%), partial improvement in 13 patients (65%), and no change at all in 5 patients (25%). Conclusion: It could be concluded that intrapolyp steroid injection could be considered one of the alternative treatments of sinonasal polyposis as it is effective, easy, and safe procedure and its effect lasts for at least 3 months.}, keywords = {Intrapolyp Corticosteroid Injection,Oral Corticosteroid,Topical Nasal Corticosteroid Spray,Allergic Nasal Polyposis}, url = {https://ejhm.journals.ekb.eg/article_67657.html}, eprint = {https://ejhm.journals.ekb.eg/article_67657_6ff7954824601e455b2b8f317ec4df99.pdf} } @article { author = {El Hendawy, Mahmoud Mahmoud and Mohammed, Mohammed Soliman and Saad, Ahmed Hassan}, title = {Surgical Management of Open Traumatic Head Injury}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {42-47}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67658}, abstract = {Background: Head injury remains one of the most common causes of death worldwide. Approximately 10 to 50% of patients with head injury developed disability at some point in their illness, and represent one of the most common brain casualty encountered by neurosurgeons. Objective: This study was aimed to assess and evaluate a group of patients with open head injury including depressed skull fracture and skull fractures associated with epidural hematoma, subdural hematoma, intracerebral hematoma or foreign body penetration regarding surgical management and post-operative results. Patients and methods: The study was done prospectively in the Neurosurgery Department, Al-Azhar University Hospitals and Matareya Teaching Hospital; the study included 30 patients with acute open traumatic head injury requiring surgical intervention in the form of Decompressive. Craniotomy with evacuation of hematomas if existed or elevation of depressed skull fractured bones. Results: In this study, depressed fracture was present in 17 cases, fissure fracture in 7 cases, skull base fracture in 2 cases, diastatic fracture in 1 case and beveling (bullet inlet and exit) in 1case. Also, in this study, 9 cases (30%) had Glasgow Outcome Score I (GOS I), 3 cases (10%) had GOS III, 3 cases (10%) had GOS IV and 15 cases (50%) had GOS V. Regarding the overall complications, chest infections were detected in 4 cases, frontal manifestations in 1 case, grade 4 Lt. sided weakness in 1 case, stable GCS at 14 in 2 cases, reoperation in 1 case and right hemiparesis in 1 case. Conclusion: It could be concluded that surgical intervention is the ideal solution for the management of acute traumatic brain injury (TBI) with persistent increased ICP when the other medical management fail under the good circumstances of early intervention and the other factors.}, keywords = {Open Traumatic,Head Injury,Depressed skull fracture,Skull fractures,Epidural hematoma,Subdural hematoma,Intracerebral hematoma}, url = {https://ejhm.journals.ekb.eg/article_67658.html}, eprint = {https://ejhm.journals.ekb.eg/article_67658_7973f743f22d6479ebd304bd8532f2b2.pdf} } @article { author = {Mohamed, Ahmed Swailam and El Hendawy, Mahmoud Mahmoud and Ismail, Shymaa Adel}, title = {Surgical Management of Closed Head Injury}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {48-55}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67676}, abstract = {Background: Closed-head injury is a type of traumatic brain injury in which the skull and dura mater remain intact. Closed-head injuries are the leading cause of death in children under 4 years old and the most common cause of physical disability and cognitive impairment in young people. Objective: The study aimed to evaluate cases of closed head injury as regard clinical picture, investigations, surgical management, outcome, and prognosis. Patient and methods: A prospective study was conducted on Sixty Two patients, twenty two of them were subjected to surgery. Many preoperative factors were studied to evaluate the prognosis of such cases. Results: Among 62 cases, 22 cases were submitted to surgery 17 extradural hematomas (EDH) were submitted to surgery, some associated with sub arachnoid hemorrhage (SAH) and acute subdural hematomas (SDH). Conclusion: Early diagnosis and management of primary lesion of closed head injury is very important to prevent secondary brain injury.}, keywords = {Glasgow coma scale,post-concussion syndrome,Computerized tomography,Traumatic brain injury}, url = {https://ejhm.journals.ekb.eg/article_67676.html}, eprint = {https://ejhm.journals.ekb.eg/article_67676_6899fe45a4de783e71927df4d4512714.pdf} } @article { author = {Yasin, Heba Mahmoud Mohammed and Aly, Naema Khodair and Abdelaziz, Sarah Younes}, title = {The Role of Soluble Triggering Receptor 1 Expressed on Myeloid Cell (STREM-1) as an Early Biomarker in Diagnosis of Sepsis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {56-61}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67677}, abstract = {Background: Sepsis remains a leading cause of death worldwide especially in the intensive care unit (ICU) setting. It is currently accepted that improving the outcome of critically ill patients with sepsis relies mainly on the adequacy and the timeliness of key interventions such as administering appropriate antibiotics and sufficient amounts of fluid, especially the sickest ones. Objectives: The aim of the current study is to explore the utility of sTREM-1 in early diagnosis of sepsis and determine its predictive value. Materials and Methods: This is a case control study. It was conducted in Al-Zahraa University Hospital during the period from December 2018 to March 2019. Forty (40) subjects were included in this study; they were classified into two groups as follows: 25 patients with two or more of clinical signs of sepsis according to the four SIRS criteria, and 15 subjects as a control group. Results: The present study revealed that there was a highly statistically significant (p = 0.001) moderate positive correlation (r = 0.707) between the WBC count and sTREM level in the cases group, with no other significant correlations between sTREM level and age, CRP level, hemoglobin level or platelet count. The present study revealed that at a sTREM cut-off point of >97.8 pg/ml, its sensitivity was 100%, its specificity was 100%, its positive predictive value was 100% and its negative predictive value was 100% to differentiate sepsis cases. Conclusion: The sTREM-1 is qunque biomarker having wide range of application in the medical field. It is useful in diagnosis of sepsis and differentiating between microbial and non-microbial infection cases.}, keywords = {Soluble Triggering Receptor 1,Myeloid Cell,Early Biomarker,Sepsis}, url = {https://ejhm.journals.ekb.eg/article_67677.html}, eprint = {https://ejhm.journals.ekb.eg/article_67677_6ab6ca96b41852e3bbe68e0d544694e9.pdf} } @article { author = {Sarhan, Hazem, K.A. and Naoum, Lilian, N.}, title = {Protective Role of Royal Jelly Against Gamma Radiation Induced Oxidative Stress, Cardio-Toxicity and Organ Dysfunctions in Male Rats}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {62-67}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67678}, abstract = {Background: Oxidative stress is known to be a key factor in several diseases and was reported as a result of radiation exposure in human and experimental animals. Royal jelly contains free amino acids, proteins, sugars, fatty acids, minerals, and vitamins, which are reported as a preventive treatment of a wide range of disorders. Aim: The present study was designed to determine the possible protective effects of royal jelly against gamma (γ-) radiation-induced oxidative stress in male rats. Materials and Methods: Thirty two rats were divided into four groups (n=8), control, treated (rats were administrated by RJ (250 mg/kg/day) by stomach tube for 15 days, irradiated (rats were exposed to (10 Gy) whole body gamma radiations as a fractionated dose (2Gy X 5 times), treated irradiated, (rats were administrated by RJ (250 mg/kg/day) by stomach tube for 15 days before exposure to whole body gamma irradiation (10 Gy) as a fractionated dose (2X5). Serum reduced glutathione (GSH) content, superoxide dismutase (SOD) activity and lipid peroxide [malondialdehyde (MDA)] levels were assessed as well as serum total cholesterol (TC), triglyceride (TG), High density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), creatinine kinase-MB (CK-MB) and cardiac troponin I (cTnI). Also, histopathologic and histochemical changes were assessed. Results: The results showed that, GSH content, SOD activity and HDL-C were highly significantly decreased, while there was marked highly significant increase in MDA, TC, TG, LDL-C, CK-MB and cTnI due to irradiation. Numerous histopathologic changes were detected in the heart tissue of rats of the irradiated group with altered cardiac muscle fibres of the radiation-exposed group. These changes manifested good amelioration in the exposed groups that supplemented with RJ (250 mg/kg/day). Conclusion: Royal jelly has a beneficial role in reducing oxidative stress and cardio-toxicity induced by radiation exposure.}, keywords = {royal jelly,γ-irradiation,antioxidant,cardio-toxicity}, url = {https://ejhm.journals.ekb.eg/article_67678.html}, eprint = {https://ejhm.journals.ekb.eg/article_67678_bca8c9a3a061c5d8f11f71337b25539c.pdf} } @article { author = {Sarhan, Hazem, K.A.}, title = {Protective Role of Lycopene Extracted from Tomato (Tomato pomace) against Gamma Irradiation or Carbon Tetrachloride-Induced Brain and Liver Toxicity in Male Albino Rats}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {68-76}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67679}, abstract = {Background: Based on the effect of substance possessing antioxidant effect previously reported, it was hypothesized that lycopene extracted from tomato (Tomato pomace), a substance possessing antioxidant activity, might be able to protect against oxidative stress induced by either carbon tetrachloride or gamma radiation. Materials and Methods: A total of 72 experimental male albino rats were randomly divided into equal six groups of twelve rats each. Group 1: served as the control group. Group 2: rats were administrated with (5 gm) tomato extract/kg body weight by gastric lavage tube for 15 days. Group 3: rats were exposed to single dose (10 Gy) whole body gamma irradiation. Group 4: rats were administered with CCl4 only in groundnut oil (1:1) at a dose of 3 ml/kg body weight by single intraperitoneal administration. Group 5: rats were treated with lycopene extract for 15 days before exposure to single dose (10 Gy) whole body gamma irradiation. Group 6: rats were treated with lycopene extract for 15 days before administered with CCl4 for 15 days. Results: showed highly significant increase in activities of alanine transferase (ALT), aspartate amino transferase (AST) and alkaline phosphatase (ALP) in serum, 24 hours after CCl4 administration or radiation exposure. Highly significant decrease in activities of superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) content in the brain tissues. Meanwhile, highly significant increase in MDA content in the brain tissues. Supplementation with lycopene before CCl4 intraperitoneal administration or radiation exposure, exerted marked amelioration of CCl4 and ionized radiation induced disturbances in all the investigated parameters. Histopathological evaluation of the tissues also demonstrated a significant decrease in cellular degeneration and infiltration parameters after lycopene administration. Therefore, lycopene could have a beneficial role in modulating oxidative stress by improving the natural antioxidant mechanism. Conclusion: Administration of lycopene by using suitable stomach tube pre-CCl4 intraperitoneal administration or gamma irradiated has significantly ameliorated the disturbances induced in all the investigated parameters.}, keywords = {Oxidative Stress,Brain,Ionizing radiation,CCl4,lycopene extract,Antioxidant enzymes}, url = {https://ejhm.journals.ekb.eg/article_67679.html}, eprint = {https://ejhm.journals.ekb.eg/article_67679_e79d518bce3e716d3268776d8082176f.pdf} } @article { author = {Hamad, Samia M.E and Ibrahim, Mahasen M.M. and Gad, Monira M. and Hassan, AsmaaS. and Abo El Elea, Asmaa M.}, title = {Vitamin D and Spontaneous Pregnancy Loss Among Attendants of Al Zahraa University Hospital}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {77-87}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67681}, abstract = {Background: Pregnancy loss (PL), the most common negative outcome of pregnancy, has an important emotional impact on women and their partners. Aim of the work: This work aims to assess serum vitamin D status among pregnant females with and without abortion and to determine possible risk factors influencing vitamin D deficiency among pregnant females. Participants and Methods: a case control study included250 pregnant women during the first 20 weeks of gestation, aged from 20 to 35 years. Cases comprised those presented with current idiopathic abortion (125), while those without current or previous abortion were selected as controls chosen from attendees of Obstetric and Gynecological Department of Al Zahraa University Hospital in Cairo, Egypt during 2017&2018. The data were collected by completing interview questionnaire, taking anthropometric measurement (weight and height) then calculating body mass index (BMI) and taking blood sampling to assess vitamin D level. Results:Vitamin D deficiency (VDD) and insufficiency were high among all studied pregnant women (deficient in 57.5% and 60%, insufficient in 32.5% and 27.5% of cases and controls respectively) while optimal level was only among 10% of cases and 12.5% of controls with OR =1.28 and C.I = (0.319- 5.186) . By comparing deficient and optimal groups, it was found that obesity (OR=1.5), nullipara parity (OR=7.77), less indoor activity (OR=1.4) and less outdoor activity (OR=16.47), more fish intake (OR=19) and less yogurt consumption (OR=1.57) were possible risk factors for VDD, while urban residence, no working status, low educational level; low socio economic status, white skin color and exposure to sun with more duration and more body surface exposed were protective factors. Conclusion:Vitamin D deficiency was more among pregnant females and it was detected as one of the possible modifiable risk factors of spontaneous pregnancy loss especially among recurrent ones.}, keywords = {Spontaneous pregnancy loss,Vitamin D}, url = {https://ejhm.journals.ekb.eg/article_67681.html}, eprint = {https://ejhm.journals.ekb.eg/article_67681_af57d4bfc2ecb9f79a5dc8c7cd2a3b8a.pdf} } @article { author = {Al Mogairen, saleh}, title = {Case Report: Hyperparathyroidism in a Patient with Aldosterone-producing Adenoma}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {88-90}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67900}, abstract = {Background: The primary aldosteronism (PA) is one of the secondary hypertension causes. The classic presenting signs are hypertension (HTN) and hypokalemia. Objectives: The study aimed to differentiate between aldosterone-producing adenoma (APA) which is surgically curable and the bilateral adrenal hyperplasia (BAH) which is medically treatable. Material and methods: A case study of a 35 years old Saudi male patient referred from primary health care center with uncontrolled HTN. Results: In presence of hypertension, hypokalemia and metabolic alkalosis, the primary aldosteronism should be suspected. Patients with PA, a challenging task is to differentiate between aldosterone-producing adenoma (APA) which is surgically curable and the bilateral adrenal hyperplasia (BAH) which is medically treatable. The differentiation usually require adrenal venous sampling however it is costly, invasive, with high risk and not available in most of centers. There is relation between elevated parathyroid hormone and APA in patients with biochemically confirmed primary aldosteronism. Conclusion: In patients with confirmed PA, routine assessment of serum parathyroid hormone may be helpful to identify those who are more likely to have APA, which is treated surgically before the adrenal venous sampling.}, keywords = {Hyperparathyroidism,Primary aldosteronism,Adenoma}, url = {https://ejhm.journals.ekb.eg/article_67900.html}, eprint = {https://ejhm.journals.ekb.eg/article_67900_f757a8263187f5d8d1156129f3d344d7.pdf} } @article { author = {Rayan, Yasser Mohammed Seddeik Abd El Raheim and Khairallah, Sherif Mohamed and Mousa, Ahmed K and Alsharkawy, Kamal Abdel Aal Mohamed Hassanein and Kabbash, Mansour M}, title = {Predictors of Complications After Flap Reconstruction of Oral Cavity Defects Following Ablation of Squamous Cell Carcinoma}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {91-100}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.67902}, abstract = {Background: Head and neck cancers represent the sixth most common cancer worldwide with an incidence of over 600,000 new cases per year. More than 90% of head and neck cancers are squamous cell carcinomas (SCC) that arise from the mucosal surfaces of the oral cavity, oropharynx and larynx. Objective: The aim of the current work was to investigate the predictors of complications after flap reconstruction of oral cavity defects following ablation of squamous cell carcinoma. Patients and methods: This prospective comparative study included a total of 41 patients who diagnosed to have oral SCCs, attending at the outpatient clinic of Head and Neck Surgery Unit, National Cancer Institute (NCI), Cairo University and Aswan University Hospital. Written informed consent of all the subjects was obtained after explaining the benefits and hazards for each method step. This study was conducted between 2015 to 2018. Approval of the ethical committee was obtained. Results: Patients with positive history of neoadjuvant chemoradiotherapy (CRTH) are 52% less likely to developing complications than those with negative history of neoadjuvant CRTH. Detection of the short-term oncologic outcome; in the 4 flaps was better in contralateral submental island flap (CSMIF) cases than others. CSMIF were found to be 58% less liable for recurrence in comparison with pectoralis major myocutaneous flap (PMMCF) that was why it didn't show any clinical or radiologically detectable recurrence within the period of 24 months postoperatively. Thoracodorsal artery perforator (TDAP) flaps were 2.6 times more liable for recurrence in comparison with PMMCF. RFFF flaps were found to be 1.2 times more liable for recurrence in comparison with PMMCF. Conclusion: The chosen 4 flaps for this study are applicable to be used for post ablative oral cavity reconstruction. Our flaps were equal in suitability for defect coverage (50-60%).}, keywords = {Flap reconstruction,Oral cavity,Squamous cell carcinoma,PMMCF,CSMIF,RFFF,TDAP}, url = {https://ejhm.journals.ekb.eg/article_67902.html}, eprint = {https://ejhm.journals.ekb.eg/article_67902_8e57362ed1687878773ad5a3f1efd383.pdf} } @article { author = {Rayan, Yasser Mohammed Seddeik Abd El Raheim and Khairallah, Sherif Mohamed and Mousa, Ahmed K and Alsharkawy, Kamal abdel Aal Mohamed Hassanein and Kabbash, Mansour M}, title = {Pedicled Versus Microvascular Free Flaps Used for Reconstruction of Oral Cavity Defects Following Cancer Ablative Surgery: A Prospective Comparative Study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {101-109}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68357}, abstract = {Background: Oral cancer is currently a major global health issue. In developing countries, oral cavity cancer is estimated to be the third most common malignancy after cancer of the cervix and stomach. Surgical excision plays a major role in the treatment of oral cavity cancer patients. Objective: The aim of the study was to compare between pedicled and free flaps used for oral cavity reconstruction after ablation of squamous cell carcinoma. Patients and methods: This is a prospective comparative study that included 41 patients at National Cancer Institute (NCI) of Cairo University and Aswan University Hospital in the period from 2015 to 2018. Patients were selected from those who were attending the Outpatient Clinic of Head and Neck Surgery Unit at NCI, Cairo University and Aswan University Hospital. Results: Detection of short-term functional outcome regarding the swallowing, speech and oral competence, Contralateral Submental Island Flap (CSMIF) followed by Radial Forearm Free Flap (RFFF) showed better functional results than other flaps. The cosmetic outcome was better in 50% of CSMIF & RFFF cases. The Thoracodorsal Artery Perforator Flap (TDAPF) cases showed a slightly higher care costs than other cases although in other specialized centers the care costs were found to be higher in RFFF cases than others. Conclusion: Oncologic outcomes were better with CSMIF and cosmetic outcomes were better in CSMIF and RFFF cases. Relatively, TDAP flap cases were higher than others in the overall care costs.}, keywords = {Pedicled flaps,Free flaps,Oral cavity reconstruction,Squamous cell carcinoma}, url = {https://ejhm.journals.ekb.eg/article_68357.html}, eprint = {https://ejhm.journals.ekb.eg/article_68357_80c1c6edda253314ca5eaf870c880792.pdf} } @article { author = {Ahmed, Tamer and Howaidy, Ahmed and El-Amin, Abd Allah and Selim, Khalid}, title = {PASCAL Laser Produces Less Pain Responses Compared to Conventional Laser System During the Panretinal Photocoagulation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {110-114}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68358}, abstract = {Background: Majority of patients experience pain during complete the panretinal photocoagulation (PRP). Laser photocoagulation delivery progressed with the introduction of pattern-scanning laser systems (PASCAL). Shorter pulse duration and choroidal penetration are believed to reduce pain during laser treatment. Objective: The purpose of this study was to assess pain response in patients with proliferative diabetic retinopathy (PDR) who underwent either PASCAL or conventional laser. Subjects and Methods: Eighty eyes with newly diagnosed proliferative diabetic retinopathy were randomly divided in to two groups each composed of 40 eyes: group (A) in which patients were received standard argon laser panretinal photocoagulation and group (B) in which patients were received pattern scan multispot panretinal photocoagulation. Results: Mean pain scores were 0.515 ±0. 834 in the PASCAL laser and 0.128 ±...1 in the conventional laser group. Numerical pain score was statistically significant higher in conventional group than in PASCAL group (p<0.001). Conclusion: It could be concluded that pattern scan multispot laser PRP was associated with more patient comfort compared to conventional PRP.}, keywords = {proliferative diabetic retinopathy,panretinal photocoagulation,Multispot Panretinal Photocoagulation,PASCAL laser,Conventional argone laser}, url = {https://ejhm.journals.ekb.eg/article_68358.html}, eprint = {https://ejhm.journals.ekb.eg/article_68358_a8d4045c58c37f55d85f4e00420cb95b.pdf} } @article { author = {Mohammed, Amira M and Abd El-Hameed, Mohammed Y and Mohammed, Islam S}, title = {Study of the Psychological Aspect of Children with Internet Addiction}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {115-122}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68359}, abstract = {Back ground: Internet addiction is defined as an impulse control disorder that does not involve the use of an intoxicating drug and is very similar to pathological gambling. Internet addiction is defined as a maladaptive use of the Internet that can lead to social and functional impairment. Objective: To determine the risk factors of internet addiction & the relation between internet addiction & the effects on the psychological aspects of the internet-addicted children. Subject and methods: This study included 80 students, 40 cases aged 6-16 years. Another 40 of matched children regarding age (6-16 years) and sex were included in the study as control group. Results: As regards the score results of the Hamilton depression rating scale: of the patient group 32.5% (n=13) showed mild depression, 50% (n=20) showed moderate depression and 17% (n=7) showed severe depression, while 100% (n=40) of the control group showed no depression symptoms. As regards the score results of the Hamilton anxiety rating scale: of the patient group 37.5% (n=15) showed mild anxiety, 60% (n=24) showed moderate anxiety and 2.5% (n=1) showed severe anxiety, while 100% (n=40) of the control group show no anxiety symptoms Conclusions: No doubt that the internet is very important in our life. Our study showed strong association between positive family history of excessive internet use and the internet addiction among children of those families. Our study showed a significant association between internet addiction and depression and anxiety. Often there was a vicious cycle of depression or anxiety resulting from internet addiction which further begets depression or anxiety}, keywords = {internet addiction disorder,IAD,pathological internet use,problematic Internet use,PIU,Internet dependency}, url = {https://ejhm.journals.ekb.eg/article_68359.html}, eprint = {https://ejhm.journals.ekb.eg/article_68359_74fb39e6ecee4ebe5f78b1e962c44310.pdf} } @article { author = {Ahmed, Tamer and Howaidy, Ahmed and El-Amin, Abd Allah and Selim, Khalid}, title = {Effect of Diabetes Duration on Proliferative Disease Regression after Panretinal Photocoagulation Using a Conventional Laser Versus Pattern Scan Multispot Laser}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {123-127}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68360}, abstract = {Background: Panretinal photocoagulation (PRP) is considered the gold standard for first line therapy in proliferative diabetic retinopathy (PDR). The aim of PRP is to prevent visual loss following vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma, by leading to regression of neovascularization. Objective: The purpose of this study was to compare the effect of diabetes duration on proliferative disease regression after pan-retinal photocoagulation using a conventional green laser versus a multispot pattern scan laser. Subjects and Methods: Eighty eyes with newly diagnosed proliferative diabetic retinopathy were randomly divided in to two groups each composed of 40 eyes: group (A) in which patients were received standard argon laser panretinal photocoagulation and group (B) in which patients were received pattern scan multispot panretinal photocoagulation. Changes in central macular thickness and BCVA at 1st, 4th, 12th week and 6th month follow-up were compared to baseline measurements. Fundus fluorescein angiography was performed at 4 weeks, 12 weeks and 6 months to assess regression of PDR. Results: by the end of the study, complete regression occurred in 37 (92.5%) of patients in conventional laser group and 36 (90%) patients in PASCAL group, while persistence of the disease occurred in 3 (7.5%) patients in each group and recurrence occurred 1 (2.5%) in PASCAL group. There was no statistically significant correlation in each study group between clinical outcome and age or duration of DM. Conclusion: There was no statistically significant correlation in each study group between duration of DM and proliferative disease regression.}, keywords = {proliferative diabetic retinopathy,panretinal photocoagulation,pattern scan Multispot Panretinal Photocoagulation,Conventional argone laser}, url = {https://ejhm.journals.ekb.eg/article_68360.html}, eprint = {https://ejhm.journals.ekb.eg/article_68360_57cf47926c5a353a5f7f2f03d452e3ef.pdf} } @article { author = {Nassar, Samir A. and Algazeery, Ahmed and Ahmed, Gamal A. Sayed and Abo El-Maaty, Wafaa A.}, title = {Histological, Immunohistochemical and Molecular Alterations in Immature Mice Testes Due to Chronic Exposure to Mobile Phone Radiofrequency Radiation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {128-135}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68482}, abstract = {Background: increasing male infertility of obscured etiology may be attributed to environmental stressors. Extensive use of mobile phones has exposed the general population to unprecedented levels of radiofrequency radiations (RFRs) that may be implicated in the affected male reproductive health. Therefore, this study evaluated the possible toxicological effects of perinatal exposure of mice pups to 800 -1800 MHz like radiofrequency radiation (RFR) on the histological, immunohistochemical and molecular aspects of testicular tissue of mice. Materials and Methods: ten pregnant females of Albino mice were selected and used in this research after the recognition of the first gestational day by the appearance of vaginal plug. They were categorized equally into 2 groups; G1: sham-exposed pregnant females, their pups served as the control group. G2: pregnant females exposed to mobile phone radiation for all the gestational period (prenatal exposure) and their pups were subjected to postnatal exposure for 45 consecutive days. Animals were continually exposed to RFR emitted by talk mode for 0.5 hour / day from a mobile test phone. Results: mobile phone radiation affected the testicular structure and function via the degeneration of germ cells and Leydig cells. Moreover, it caused apoptosis of testicular cells as indicated by up regulation of caspase-3 and induced down regulation of PCNA at the immunohistochemical level confirmed by DNA damage at the molecular level. This onset may lead to infertility like condition due to RFR- exposure. Conclusion: RFR at the studied frequency caused significant histological, immunohistochemical and molecular changes in the examined tissues. The results of this study and other similar studies, when extrapolated to man, they must alert the scientific community to the possibility that RFR may have long-term deleterious effects on the reproductive health.}, keywords = {Mobile phone,testis,histology,Caspase-3,PCNA,Comet assay,Mice}, url = {https://ejhm.journals.ekb.eg/article_68482.html}, eprint = {https://ejhm.journals.ekb.eg/article_68482_61c5773658b2bfe0020e4e767995f141.pdf} } @article { author = {Abdelmoneim, Hanan M. and Ibrahim, Hanan M. and Ahmed, Ahmed R. and Mohammed, Khaled A.}, title = {Incidence of Central Line-Associated Blood Steam Infection in Pediatric Intensive Care Unit (PICU)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {136-141}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68483}, abstract = {Background: central line-associated blood stream infection (CLABSI) is responsible for almost 60% of the hospital-acquired infections. The rate of CLABSI in developing countries is higher than that in developed countries. Recently; gram negative bacilli are commonly isolated in CLABSI cases. Aim of the work: This was a prospective 6 month study to assess the occurrence of CLABSI at Pediatric Intensive Care Unit (PICU) of Ain-shams University Hospital. Patients and methods: present study was a prospective observational study conducted on 109 patients with a 152 central venous catheter (CVCs) inserted to them, who were admitted to the Pediatric Intensive Care Unit of Ain Shams University Hospital from July to December 2017. They were observed for development of central lineassociated blood stream infection (CLABSI) and also associated risk factors were studied. Results: There was 22 CLABSI cases with a CLABSI score 14.1 per 1000 central line days. In this study, the most common organism detected was Klebsiella that was isolated in 14 cases. This study shows multi-drug resistant pathogens as causative agent of CLABSI in 9 % of cultures. Conclusion: CLABSI is a common and serious complication to CVCs in PICU. Klebsiella, candida albicans are the common pathogens isolated in CLABSI.}, keywords = {CLABSI,Central line,Infection}, url = {https://ejhm.journals.ekb.eg/article_68483.html}, eprint = {https://ejhm.journals.ekb.eg/article_68483_3d4700a3a7420d533758704ef4f210a9.pdf} } @article { author = {Abdelmoneim, Hanan M and Ibrahim, Hanan M and Ahmed, Ahmed R and Mohammed, Khaled A.}, title = {Mechanical Complications of Central Venous Catheters in Pediatric Intensive Care Unit (PICU)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {142-148}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68484}, abstract = {Background: Central venous catheter (CVC) cannulations are associated with complications like arterial puncture, hematoma, pneumothorax and arrhythmias. These complications may be particularly dangerous in paediatric patients. Aim of the work: This was a prospective 6 month study to assess the incidence of mechanical complications to central venous catheters at the pediatric intensive care unit (PICU) of Ain-Shams University Hospital. Patients and Methods: present study was a prospective observational study conducted on 109 patients with a 152 CVCs inserted to them who were admitted to the Pediatric Intensive Care Unit of Ain Shams University Hospital from July to December 2017. They were observed for development of mechanical complications including arterial puncture, failed insertion, bleeding, false passage, pneumothorax, arrhythmia. Results: Among the total studied of 152 CVC cannulations, mechanical complications occurred in 6.6 % of cases. The complications included failed insertion (1.3%), arterial puncture (0.7%), false passage (0.7%), bleeding with hematoma (1.3 %), arrhythmia (1.3 %) and pneumothorax (1.3 %). Conclusion: mechanical complications have a low incidence in our study due to the use of ultrasound guidance during CVC insertion.}, keywords = {Central venous catheter,Complications,pediatric intensive care unit}, url = {https://ejhm.journals.ekb.eg/article_68484.html}, eprint = {https://ejhm.journals.ekb.eg/article_68484_a9db00628493e2f817156edd078d45b9.pdf} } @article { author = {Kaheil, Shimaa Hassan Mahmoud and El-Baz, Walaa Fahmey and Abd El Rahman, Eman Abd Rabo and Mansour, Hayam Hamza and Abd El Fattah, Ahmed Sadik and Okasha, Hussein Hassan}, title = {Role of Endoscopic Ultrasound-Fine Needle Aspiration in Management of Submucosal Lesions (SMLs) of GIT and Significant Predictors of Malignancy of GIST Lesions}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {149-156}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68582}, abstract = {Background: Submucosal lesion is a mass or bulge covered by normal-appearing mucosa identified during standard endoscopy. Endoscopic Ultrasound (EUS) allows precise differentiation of the individual layers of the gastrointestinal (GI) tract. Endoscopic Ultrasound-Fine Needle Aspiration (EUS-FNA) permits safe and accurate sampling of submucosal lesions (SMLs) for further histopathology. Gastrointestinal stromal tumors are the commonest mesenchymal neoplasms of the GI tract. They should be stratified by malignant potential according to tumor size, location, and mitotic count. Objectives: The aim of work was to evaluate the role of endoscopic ultrasound with EUS-FNA in management of submucosal gastrointestinal lesions, with special concern about gastrointestinal stromal tumors (GISTs) lesions and the criteria highly associated with malignant nature. Patients and methods: This multi-center prospective study included a total of 150 patients with gastrointestinal submucosal lesions, conducted to evaluate EUS and EUS-FNA as diagnostic tools of submucosal lesions, including 68 GIST lesions. All patients underwent conventional endoscopy, EUS-FNA and histopathological examination of the samples obtained in Theodor Bilharz Research Institute, Cairo University Hospital and Kobry El Qubba Military Hospital from 2015 to 2017. Results: There were 150 patients with submucosal GI lesions, including 93(62%) males and 57(38%) females, with the mean age of 52±11.9 years. Presentations included dyspepsia 73(48.7%), asymptomatic SMLs 31(20.7%). The lesions were mainly gastric 102(68%). Final diagnoses were GIST 68 (45.3%), lipoma 11(7.3%), leiomyoma 9(6%) and extramural lesions 7(4.7%). There were 68 patients with GIST lesions, including 43(63.2%) males and 25(36.8%) females, with the mean age of 54±10.3 years. Presentations included dyspepsia 41(63.2%), asymptomatic SMLs 16(23.5%). The lesions were mainly gastric 57(83.8%). Sensitivity and specificity were 88.6% and 100% of EUS-FNA as diagnostic tools for GIST lesions respectively. (PPV) and (NPV) were 100% and 82.8% respectively. Conclusion: It could be concluded that EUS and EUS-FNA were highly significant methods in diagnosis of GIST lesions in relation to final histopathology.}, keywords = {Endoscopic-Ultrasound-guided Fine-Needle Aspiration (EUS-FNA),submucosal lesions,GIST}, url = {https://ejhm.journals.ekb.eg/article_68582.html}, eprint = {https://ejhm.journals.ekb.eg/article_68582_a3c526c07b18740a6517eebdec94387d.pdf} } @article { author = {Mohamed, Fayez El. and Attia, Ismail A. and Mohamed, Moustafa F. and Mekled, Sameh F.}, title = {Assessment of Clinical and Investigations Probabilities for Pulmonary Embolism}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {157-160}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68885}, abstract = {Background: pulmonary embolism (PE) is one of the most frequent diseases that could be missed in overcrowded emergency departments. Early and accurate diagnosis could decrease the mortality rate and this standard algorithm should be defined. Aim: The aim of this study was to evaluate the role of estimating clinical probability of pulmonary embolism and to reveal which a combination of presented clinical data that is more predictable to PE. Patients and Methods: The study included 50 patients with suspected pulmonary embolism, admitted to El Hussein and Sayed Galal University hospitals. Results: according clinical probability of patients 90% of patients from 50 cases were approved positive by CT pulmonary angio. In the current study we found that sensitivity accuracy of clinical probability in diagnosing pulmonary embolism in comparison to CT pulmonary angio was 90%. Conclusion: clinical probability of pulmonary embolism was efficient like other diagnostic methods, so biochemical parameters, clinical findings, and scoring systems, when used altogether, can contribute to the diagnosis of PE.}, keywords = {age-adjusted D-dimer cut-off,clinical prediction rules,diagnostic tests,pulmonary embolism}, url = {https://ejhm.journals.ekb.eg/article_68885.html}, eprint = {https://ejhm.journals.ekb.eg/article_68885_6e51eee22b7d508a03cda5e480ca83ac.pdf} } @article { author = {Helal, Eman G.E. and Abdelaziz, Mohamed A. and Zakaria, Abeer}, title = {Effect of Both Bisphenol-A and Liquorice on Some Sexual Hormones in Male Albino Rats and The Amelioration Effect of Vitamin C on Their Actions}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {161-167}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68886}, abstract = {Background: Xenoestrogens are defined as chemicalsthat mimic some structural parts of the physiological estrogen compounds, therefore may act as estrogen or could interfere with the actions of endogenous estrogens. Phytoestrogens(plant estrogens) are substances that occur naturally in plants.They have asimilar chemical structure to our own body’s estrogen. Vitamin C, also known as ascorbic acid, is used to prevent and treat scurvy. Objective: The aim of the study was to clarify the effect of both bisphenol-A (BPA) and liquorice together on some sexual hormones and illustration of the effect of vitamin C on their actions. Materials and methods: Thirty male albino rats were used and divided into three groups: Group I: control (untreated group), Group II: rats treated with BPA and liquorice, Group III: rats treated with BPA and liquorice in addition to vitamin C. Blood samples were collected for different biochemical investigations. Results: The biochemical results showed high significant increase (p<0.01) in the activities of ALT, AST, urea, creatinine, FSH, prolactin, total cholesterol, triglycerides, LDL-C, VLDL, LDL/HDL and TC/HDL levels. There was high significant decrease (p<0.01) in HDL-C, total protein, albumin, globulin, testosterone, and LH. These results turned back to the normal values after receiving the vitamin C as compared to normal group. Conclusion: it could be concluded that phytoestrogen and xenoestrogen had undesirable effects and it's recommended to minimize the utilizing of these compounds to protect people from its hazardous effects.}, keywords = {BPA,Liquorice,vitamin c,Hormonal assay,biochemical parameters}, url = {https://ejhm.journals.ekb.eg/article_68886.html}, eprint = {https://ejhm.journals.ekb.eg/article_68886_836b0a55201bf460ef0a462b24693b8d.pdf} } @article { author = {Noaman, Khaled Mohamed and Mostafa, Ibrahim El Dessoky and Basha, Mohamed Ahmed Ali}, title = {Effect of Fiber Insertion on Cuspal Deflection and Microleakage of Resin Composite: An In Vitro Study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {168-176}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.68942}, abstract = {Background: Although resin composites are now the material of choice for most restorations, polymerization shrinkage remains a major deficiency and key shortcoming that complicate the use of such versatile restorative materials. Objective: The current study was designed to investigate the efficacy of fiber insert application on the cuspal deflection and microleakage of (MOD) cavities of bicuspids restored with resin composite restorations. Material and Methods: A total of 120 upper premolar teeth were selected and used in the present study. Each tooth was vertically embedded into self-curing acrylic resin where, the CEJ was kept 2 mm above the level of acrylic resin to mimic the alveolar bone support in healthy tooth. Forty premolars were used for cuspal deflection measurement and one hundred and twenty for microleakage assessment. Results: Cuspal deflection was significantly decreased of tooth restored with Ceram.X (0.0085±0.0031) using fiber inserts than that restored with Ceram.X resin composite only (0.0145±0.009) at (P= 0.032). Fiber inserts significantly decreased the cuspal deflection of tooth restored with Z350XT resin composite (0.0076±0.0015) than that restored without fiber inserts for the same material (0.0122±0.0051) at (P= 0.002). Conclusion: It could be concluded that the problem of cuspal deflection and microleakage in complex cavities prepared in premolars can be greatly reduced using fiber reinforced composite inserts. Nano filled composite with or without fiber insert has a better performance in cuspal deflection and microleakage than nanohyprid composite.}, keywords = {Fiber insertion,cuspal deflection,Microleakage,resin composite}, url = {https://ejhm.journals.ekb.eg/article_68942.html}, eprint = {https://ejhm.journals.ekb.eg/article_68942_347a67ad7de68bc4e1505d9919545396.pdf} } @article { author = {Rabey, Mohammed and Aly, Hamdy and Fouda, Maged and Behnsawy, Hosny and Sarhan, Moustafa}, title = {A Multiplex PCR-Based Assay for Detection of Plasma Cell Free DNA Integrity as a Marker of Bladder Cancer}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {177-181}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.69260}, abstract = {Background: Cell free DNA (cfDNA) analysis in patient plasma has been suggested for screening of different cancers. Healthy cells may shed more degraded DNA than non-apoptotic tumor cells. Objectives: Our goal was to check whether DNA fragments extracted from patient’s plasma with bladder cancer (BC) had higher integrity than DNA purified from plasma of healthy controls. Methods: cfDNA was extracted from the plasma of a healthy control group and patients with BC. The association between clinical status and length of DNA fragments was examined. Plasma cfDNA integrity was examined using multiplex PCR with specific primers producing progressively long PCR fragments (200, 400 & 800-bp). Length and concentration of PCR amplicons obtained from BC patients and healthy individuals were compared. Results: Using a multiplex PCR assay, the used p53 primers efficiently amplified the increasingly long fragments. High molecular weight DNA fragments (400 & 800-bp) in the plasma cfDNA are associated with the presence of cancer. Moreover, elevation of the 200-bp fragment concentration in the plasma cfDNA is significantly (p < 0.002) associated with the presence of cancer. Conclusions: The detected long DNA fragments in plasma cfDNA is associated with BC indicating that the multiplex PCR assay of plasma cfDNA integrity could be a useful future marker for the detection of BC.}, keywords = {Bladder cancer,cell free DNA,Multiplex PCR,DNA integrity}, url = {https://ejhm.journals.ekb.eg/article_69260.html}, eprint = {https://ejhm.journals.ekb.eg/article_69260_b21042a625e6e3054eeb2f41b59d58c9.pdf} } @article { author = {Noaman, Khalid Mohamed and Al-Samoly, Walaa Mohamed and Al-Hariri, Ahmed Abul-Khair Hassan}, title = {Evaluation of The Degree of Remineralization of Subclinical Carious Lesions Using Chitosan and Conventional Remineralizing Agents (An in vitro Study)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {182-189}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.69376}, abstract = {Background: Dental caries remains to be the most common oral disease, caused by the unbalance between demineralization effect of bacteria and remineralization process. In the early phase of caries, this balance can be restored and the demineralization effect reversed using an enhanced approach to remineralization. Objective: The aim of the study is directed to evaluate the degree of demineralization and remineralization in subclinical carious lesion using chitosan and conventional remineralizing agent. Materials and methods: A total number of 40 sound non-carious human anterior teeth were collected from oral surgery clinic, free of cracks and any developmental defects, were used in this study in age range (20-40) years old. Teeth were stored in distilled water at room temperature until use. The teeth were divided into four main groups (10 teeth each). Results: In the present study specimens treated with chitosan after six months storage time (the best result) recorded the highest mean value of remineralization while fluoride record the lowest mean value of remineralization (the worst result) through the remineralizing agents chitosan, casein, and fluoride. The specimens subjected to Diagnodent fluorescent reading proved that for all remineralizing agents (chitosan, casein and fluoride) and also control group the remineralization to tooth structure was increased by increasing the storage time. Conclusion: Chitosan is considered a valuable biomimetic remineralizing agent. Mineral precipitation to tooth structures by using remineralizing agents is a continuous dynamic process.}, keywords = {demineralization,remineralization,Subclinical carious lesions,Chitosan,Conventional remineralizing}, url = {https://ejhm.journals.ekb.eg/article_69376.html}, eprint = {https://ejhm.journals.ekb.eg/article_69376_87bd731d68d57128f358ec5daf41fb0a.pdf} } @article { author = {Madkhali, Jnadi and Hakami, Ammar Abdullah and Alharbi, Salha Marzoog}, title = {Hashimoto's Encephalopathy in A 30 Years Old Healthy Male: Case Report and Literature Review}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {190-193}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.69377}, abstract = {Context: Hashimoto's encephalopathy is a rare neurological disorder associated with autoimmune thyroiditis. It occurs primarily in the fifth decade of life. However, different age groups may also develop the disease, with serious consequences if unrecognized and untreated. Clinically, it comprises two forms: a sudden vasculitic, and progressive subacute type with wide neuropsychiatric manifestations including confusion, seizures, short term memory impairment, depressed mood and psychosis. Objective: The objective of this report is to present an unusual case of Hashimoto's encephalopathy presented with the acute confusional state. Case presentation: We report the case of a 30-year-old male medically free presented with acute behavioral changes and confusion. Serological studies revealed elevated thyroid peroxidase antibodies levels. In addition, EEG findings of slow background. He was diagnosed as a case of Hashimoto's encephalopathy and he was improved after initiation of intravenous Methylprednisolone therapy. Conclusion: Hashimoto's encephalopathy can present with a challenging clinical picture that may go unrecognized for a long time. Therefore, one should keep in mind the importance of evaluating thyroid function and thyroid antibodies levels in patients presented with unexplained neurocognitive and psychiatric manifestations.}, keywords = {Autoimmune thyroiditis,Hashimoto's encephalopathy,Intravenous Steroid,Case Report}, url = {https://ejhm.journals.ekb.eg/article_69377.html}, eprint = {https://ejhm.journals.ekb.eg/article_69377_e0aabd2661789bea02a9638accb57579.pdf} } @article { author = {Menshawy, Reham Zidan Abd-Allah and Mohammed, Magda Abd El-Latif and Awad, Ayat Abu-elnasr}, title = {Olfactory Impairment in Obese Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {194-199}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.69670}, abstract = {Background: Recently published work and emerging research efforts have suggested that the olfactory system abilities is intimately affected by morbid obesity. Morbidly obese patients demonstrate altered olfactory acuity. High body mass index (BMI) appears to be associated with olfactory dysfunction. Increasing BMI may be a risk factor for olfactory loss or lack of olfactory recovery after an inciting event. Objective: This study aimed to discuss olfactory impairment in obese patients and to elucidate what role olfactory loss may play in diet and feeding habits of obese patients Conclusion: Our study presented a strong evidence for a causal relationship between changes in olfactory abilities of obese patients. There was altered olfactory acuityand cardiovascular, inflammatory, and cognitive declines. It was found that consumption of diets high in fat are found to cause nervous system dysfunction.}, keywords = {Obesity,Olfactory,BMI}, url = {https://ejhm.journals.ekb.eg/article_69670.html}, eprint = {https://ejhm.journals.ekb.eg/article_69670_25ed891cd393c1478266352a135fbce7.pdf} } @article { author = {Ahmed, Osama Helal and Noor El-Din, Tawfik Mohammed and Ali, Waheed Mohamed and Sayed, Zeinab Mustafa}, title = {Opioid Free Anesthesia in Laparoscopic Cholecystectomy (Comparative Clinical Study)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {200-211}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.69672}, abstract = {Background: Opioid Free Anesthesia aims to avoid perioperative opioids, instead uses adjuvant agents for their opioid-sparing effect which could also affect recovery rates and hospital length of stay (LOS). Patients and Methods: This prospective, randomized, single-blinded clinical study included 62 patients aged between 21 to 50 years, scheduled for LC. Group OA (n=31) received OA with fentanyl as the main anesthetic adjuvant and peri-operative analgesic. Group OFA (n=31) received OFA with dexmedetomidine, ketamine, and paracetamol as an anesthetic adjuvant and peri-operative analgesics. The intraoperative assessment included HR, systolic, diastolic and mean BP, the need for rescue analgesia or ephedrine. The postoperative assessment included the same values plus VAS score, Aldrete score, duration of stay in PACU, the incidence of side effects and complications and hospital LOS. Results: No significant difference between both groups regarding intraoperative hemodynamic values. In the group, OA 22 patients (70.9%) required intraoperative rescue analgesia (with mean dose 55.6 ± 37.4µg, median 70µg and highest dose of 100µg) compared to none in group OFA. In the group, OA 10 (32.3%) patients had PONV compared to 3 (9.7%) patients from group OFA which was statistically significant (P-value 0.033). No significant difference between both groups regarding postoperative VAS score, analgesic requirement, discharge time from PACU or LOS. Conclusions: The study showed that OFA was as effective as OA in maintaining intraoperative hemodynamic stability although group OFA showed the lower need for intraoperative analgesia. OFA also showed a significant reduction of incidence of PONV compared to group OA.}, keywords = {OFA,Opioid,Fentanyl,Dexmedetomidine,Ketamine,Multimodal,Analgesia,PONV,LOS}, url = {https://ejhm.journals.ekb.eg/article_69672.html}, eprint = {https://ejhm.journals.ekb.eg/article_69672_3167c6e92bccddcbc74bac3145b0b6c6.pdf} } @article { author = {Abdallah, Abdallah Mohamed El-Amin and Gabr, Ahmed Fathy and Mahmoud, Hala Abdallah and Gamal, Samar Anwer}, title = {Effect of hemodialysis on Intraocular Pressure}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {78}, number = {1}, pages = {212-219}, year = {2020}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2020.69676}, abstract = {Background: Hemodialysis (HD) is an important and by far the commonest treatment for end stage renal failure (ESRF). Changes in intraocular pressure (IOP) are one of the eye problems among hemodialysis patients. Objective: To evaluate changes in intraocular pressure (IOP) before, during and after single dialysis session. To detect changes in retinal fiber thickness measured by Optical Coherence Tomography (OCT) 6 months after basic examination. Patients and methods: This prospective study was carried out on 80 eyes of 80 patients undergoing regular hemodialysis (HD), both males and females. The study was conducted in Aswan University Hospital. Results: There was statically significant (but clinically not significant) decrease in IOP during HD, but there was no significant decrease when measured six month later. No significant difference in the mean IOP as regarding group’s age, sex and duration of dialysis was found. Significant decrease in mean average RNFL thickness during the six months was noted as well as between age groups. There was no significance decrease in retinal nerve fiber layer (RNFL) thickness regarding sex and duration. Conclusion: As there was loss of RNFL thickness in hemodialysis patients, visual field changes is recommended to be investigated on such patients. Also the effect of hemodialysis on patients with high IOP or glaucoma should be investigated as well.}, keywords = {Hemodialysis,Chronic Kidney Disease,OCT,Intraocular Pressure}, url = {https://ejhm.journals.ekb.eg/article_69676.html}, eprint = {https://ejhm.journals.ekb.eg/article_69676_a080fff7fc551fcd19d6c013230c10fd.pdf} }