@article { author = {Gaber, Nourhan A. and Habib, Lobna A. and Hussein, Rasha S.}, title = {Role of Diffusion Weighted MRI in Grading of Endometrial Carcinoma}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4230-4235}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9232}, abstract = {Background: Recent developments in diagnostic imaging techniques have magnified the role and potential of MRI in female pelvic imaging. Functional imaging by means of diffusion weighted magnetic resonance imaging (DW-MRI) is now part of the standard imaging protocols for evaluation of the female pelvis. Objective: This study aimed to highlight the role of Diffusion Weighted MRI in tumor grading noninvasively prior to surgery. Methodology: This study carried out in Radiology Department of Ain Shams University Hospitals. This study included 20 patients. All patients were subjected to careful history taking, Histologic diagnosis of endometrial carcinoma and pelvic MRI was done. Result: The difference between the mean ADC values of high grade and low grade endometrial carcinoma was significant. Conclusion: MRI is accurate in assessing the depth of myometrial invasion and cervical extension, allowing for selective lymphadenectomy, with higher accuracy measures for Diffusion Weighted MRI than for Dynamic Contrast Enhanced MRI in both lesion characterization and staging.}, keywords = {Endometrial carcinoma,DW MRI}, url = {https://ejhm.journals.ekb.eg/article_9232.html}, eprint = {https://ejhm.journals.ekb.eg/article_9232_9a7e7d84ed98f8ea4ddd77f36a7eeef7.pdf} } @article { author = {Yousef, Ayman A. and Badr, Gamal A. and Ibrahim, Atef A.E. and Aboul Fotouh, Ahmad M.}, title = {An Ultrasound Guided Technique of Central Venous Catheterization versus Anatomical Landmark Guided Technique in Medical Intensive Care Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4236-4240}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9233}, abstract = {Background: Central venous catheterization (CVC) is an important procedure in the practice of emergency medicine. Insertion of CVC is amongst the most frequently performed invasive procedures in ICU. In severely ill and long-stay patients, inserted CVCs enable relatively safe and painless application of parenteral nutrition, long-term antibiotics, chemotherapy, intravenous fluids, and blood components and are also used for repetitive blood sampling. Furthermore, CVCs are used for invasive hemodynamic monitoring, hemodialysis, plasmapheresis and in case of shortage of a peripheral access. With the increasing availability of bedside ultrasound, emergency physicians have begun to incorporate this new technology to reduce error and improve patient care. Objective: To compare the outcome of an ultrasound guided technique versus an anatomical landmark guided technique for central venous catheterization. Patients and methods: The present study was performed on one hundred patients of both sexes; the study was conducted at El-Hussein University Hospital. They were scheduled for insertion of central venous line for various purposes. The patients were assigned into two groups each group formed of fifty patients (n=50). Group (A): Anatomical guided technique for insertion of CVC, Group (B): Ultrasound guided technique for insertion of CVC. Patients with local infection, known vascular abnormalities, untreated coagulopathy (INR more than 1.5, platelets less than 50000/mm3) and age less than 16 years old were excluded from the study. Results: A total of 100 patients were included. The outcome of each group was recorded regarding success rate, number of attempts and access time in seconds. The use of ultrasound guided central venous catheterization has better outcome and higher-safety in comparison to anatomical landmark-based technique. Ultrasound guidance elevated significantly the success rate of central venous catheterization than anatomical landmark-based technique. In addition, the access time was reduced in a significant trend by using ultrasound guidance. In the same manner the average number of attempts needed for accessing the vein was limited significantly when Ultrasound guidance was applied. The incidence of hematoma formation, arterial puncture and malposition was reduced in a significant trend by using ultrasound guidance in comparison to landmark-based techniques. When comparing ultrasound guidance to anatomical landmark-based guidance we found that all mechanical complications were significantly lower when central venous catheterization was carried out by means of ultrasound guidance. Conclusion: Ultrasound examination of the region of interest offers some additional information compared to clinical examination as Position of the vessel, Patency of the vessel, Size of the vessel and Stenosis or hematoma. The implementation of ultrasound guidance improves success and reduces complication rate during central venous catheterization.}, keywords = {Central,venous,Catheterization,Ultrasound,Anatomical,landmark,Guided,Technique}, url = {https://ejhm.journals.ekb.eg/article_9233.html}, eprint = {https://ejhm.journals.ekb.eg/article_9233_7f381c13dd5924fca56da38b27fe9b35.pdf} } @article { author = {Salama, Mohsen A.M. and Abd El-Aziz, Islam S. and Elsaeid, Ayman S. and Abd Elhameed, Ahmed E.}, title = {Left Ventricular Diastolic Function in Patients with Heart Failure with Preserved Ejection Fraction}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4241-4245}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9234}, abstract = {Background: Left ventricular heart failure in sitting of preserved left ventricular ejection fraction constitutes up to 50% of heart failure. It increases with age and is correlated with the presence of systemic hypertension and left ventricular hypertrophy. It has significant morbidity, approaching that of systolic heart failure. Heart failure preserved ejection fraction (HFpEF) is a clinical syndrome resulting from increased resistance in the filling of the left ventricle (LV) leading to symptoms of congestion although the exact cause continues to be unknown and the identification of markers that predict HFpEF risk have not been proven. Aim of the Work: Assessment of left ventricular diastolic function in patients with heart failure and preserved ejection fraction. Patients and Methods: This study included 90 patients with ages ranging from 30 to 70 years old referred to Al Hussein University Hospital, Bab Al Shearia University Hospital, Cardiology Outpatient Clinic suffering from low functional capacity, exertional dyspnea and even exertional chest discomfort. Over a period from November 2015 to May 2018. The study population was divided into two groups according to incidence of positive stress ECG. Group A (patient group): Patients with positive stress ECG. Group B (control group): Patients with negative stress ECG. Results: This study included (90) patients with their ages ranging from 30 to 70 years referred to (Al Hussein University Hospital), (Bab Al Shearia– University Hospital) cardiology outpatient clinic from November 2015 to September 2017, with low functional capacity, exertional dyspnea and even exertional chest discomfort and are evaluated to rule out coronary artery disease (CAD). Those patients were evaluated by stress ECG and Transthoracic Echodoppler and Tissue Doppler imaging. The study population was divided into two groups according incidence of positive stress ECG into: Groups according incidence of positive stress ECG. Group I patients group: Included 60 patients presented by chest pain with dyspnea NYHA class 1 (12 patients), class II (37 patients), or class III (11 patients) with mean age 54.05±7.9 years, this group included 19 females (31.7%) and 41 males (68.3%), Group II control group: Included 30 patients with mean age 52.7±5.11 years. Female number was 13(43%) and males were 17(60%). Conclusion: The assessment of diastolic function is now essential on routine testing for HF. The noninvasive nature of echocardiography has allowed an increase in diagnosis and awareness of diastolic dysfunction.}, keywords = {Left ventricular diastolic function,Heart failure,Preserved Ejection Fraction}, url = {https://ejhm.journals.ekb.eg/article_9234.html}, eprint = {https://ejhm.journals.ekb.eg/article_9234_7721ce5d6808f19d0b828703897369ff.pdf} } @article { author = {Ali, Arwa T.M. and Hussein, Rasha S.E. and Moftah, Sherine G.}, title = {Mutiparametric Magnetic Resonance Imaging in Assessing Ovarian Cysts}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4246-4251}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9235}, abstract = {Objective: Is to study the role of multi-parametric MRI including the novel sequences, diffusion weighted images (DWI) in the characterization of ovarian cystic lesions. Methodology: This study carried out in MRI unit, Radiology Department of Ain Shams University Hospitals. 20 patients with pathologically proven nature of ovarian cyst underwent pelvic MRI examination including diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) Result: Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) to detect nature of ovarian cysts can’t be carried alone but need to be combined by conventional and DCE MRI.}, keywords = {Multi-parametric MRI (Mp-MRI),Adnexal,Ovarian,cysts,Apparent diffusion coefficient (ADC)}, url = {https://ejhm.journals.ekb.eg/article_9235.html}, eprint = {https://ejhm.journals.ekb.eg/article_9235_44e58b6512066ebfff0808892bd310cd.pdf} } @article { author = {Shaldoum, Fayez M. and Hassan, Mostafa I. and Hassan, Mohammed S.}, title = {Natural Honey Bee venom Manipulates Human Immune Response}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4252-4258}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9236}, abstract = {Background: Honey bee venom is an important toxin which has various useful properties. Bee venom possesses various peptides including melittin, apamin, adolapamin and mast cell degranulating peptide. It appears to stimulate cortisone secretion, enhances antibody production, and affects cytokine production. Aim: The aim of the work is to study changes in levels of complement system proteins, C3 and C4, together with C-reactive proteins and rheumatoid factors (CRP and RF) in response to bee venom in subjects exposed naturally to sting with honey bee workers. Subjects and Methods: Subjects (12) were randomly selected from patients visiting El-Mostafa bee house, Elmarg, cairo, Egypt; to get natural bee venom therapy for various diseases. Blood samples (24) were collected from these volunteers, before and after honey bee sting, at the laboratory of Egypt Air Hospital, Cairo, Egypt following the standard protocol. Serum levels of C3 and C4 were measured by radial immunodiffusion technique. CRP was quantitatively measured by in vitro diagnostic test using auto analyzer (Dimension® EXEL) clinical chemistry system. Serum RF was measured by Rapid latex agglutination test for qualitative screening. Result: After exposure of patients to bee sting: all abnormal levels of C3 returned to normal values while abnormal C4 levels did not change; Half of cases that were showing abnormal high CRP levels have dropped to normal levels and All RF positive cases have become negative. Conclusion: The complement system has been activated, in patients, by both classical and alternative pathways before treatment with bee venom where it became only classically activated after treatment. Improved values of both CRP and RF indicate reduction in the inflammatory immune response after exposure of patients to honey bee venom.}, keywords = {Honey bee,Venom,human,C3,C4,CRP,RF,Egypt}, url = {https://ejhm.journals.ekb.eg/article_9236.html}, eprint = {https://ejhm.journals.ekb.eg/article_9236_ed584c54aa413566e91c299206163d6e.pdf} } @article { author = {Mahmoud, Mohamed Hafez and Abd El Aziz, Mahmoud Abd El Hady and Ahmed Ali, Mohamed Magdy}, title = {A Comparative Study of Primary Colonic Repair versus Stoma in Emergency Cases}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4259-4263}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9237}, abstract = {Background: In emergency surgery, management of an enterotomy, either spontaneous or following resection of a bowel segment can be by approximation of cut edges, referred to as primary repair or by exteriorization of the involved segment, referred to as ostomy. Indication of this operation can be a perforated bowel segment (produced as a result of trauma or secondary to an inflammatory process of gut) or a devitalized/redundant segment of bowel requiring resection. Penetrating colon injury or blunt abdominal trauma carries a high risk of a high-risk rate of infectious morbidity. The development of infectious complications is related to the injury severity and haemodynamic status of the patient, not the type of operation performed. Aim of the Work: Comparing the outcome of primary repair versus colon diversion in emergency cases regarding efficacy, safety and usefulness. Patients and Methods: A prospective study on 40 patients undergoing either primary repair of bowel or intestinal stoma formation following emergency laparotomies in the Department of Surgery in El-Hussien and El-Haram Hospitals, which is a big emergency and trauma center and cover large geographic area. All persons will give their informed consent. The people who have the decision in performing and choosing the type of the operation are specialists and consultants (they have the license as decision makers). All patients presented in ER department with colorectal emergencies, included trauma (penetrating, gunshot & blunt), obstruction (malignant & non-malignant) and acute abdomen due to perforation, and need emergent laparotomy confirmed by history, clinical examination and investigations. Results: It included 40 patients divided into three age groups with main age of 31.2 ± 20.1 years old. There were 26 males and 14 females. Etiological causes were trauma 30 patients (75%), benign obstruction 2 patients (5%), malignant obstruction 4 patients (10%) and the acute abdomen 4 patients (10%). Time between injury and admission was less than 8 hours in 28 patients and it was between 9 to 24 hours in 12 patients (30%) and more than 24 hours in 4 patients (10%). Shock defined by systolic blood pressure less than 90 mmHg was present in 7 (17.5 %) patients and non-shocked patients were 33 patients (82.5%). Conclusion: After reviewing many literatures and studies, after this work. We recommend primary repair of the colon in colorectal emergent conditions. Especially injuries and benign obstruction and care must be taken when performing primary repair in cases of malignant obstruction and peritonitis due to non-traumatic colonic perforation (PNTCP). First of all the main indicator for the primary repair is the patient's general condition. Over all the main determine to do primarily repair or to divert is the general condition of the patient.}, keywords = {Primary Colonic Repair,Stoma IN Emergency Cases}, url = {https://ejhm.journals.ekb.eg/article_9237.html}, eprint = {https://ejhm.journals.ekb.eg/article_9237_ed457e077df15fa6c9723c3659729f83.pdf} } @article { author = {Sabry, Maged M. and Girguis, Mounir S. and Osman, Ahmed M.}, title = {Role of PET/CT in Differentiating Bronchogenic Carcinoma from Inseparable Pseudo-Neoplastic Lesions}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4264-4269}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9238}, abstract = {Background: Bronchogenic carcinoma is the single most important cause of cancer-related deaths with approximately 1.5 million cases worldwide every year. Computed tomography (CT) scanning can only estimate the proximal extent “with difficulty in visualization the real borders” of a tumor. The role of MRI in local staging of bronchogenic carcinoma is limited by the signal loss secondary to respiratory motion and heterogeneity of the magnetic field caused by the tissue/air interfaces. Positron Emission tomography combined with CT (PET/CT can accurately delineate the viable tumor from surrounding atelectasis and collapse/consolidation, this information cannot only demarcate the size and extent of the tumor for accurate T staging, but also provide guidance for biopsies if histological confirmation is required Purpose: It was to emphasize the role of PET/CT in differentiation the bronchogenic carcinoma from its inseparable pseudo-neoplastic lesions for better staging and increase the accuracy of follow up by ruling out the pseudo progression as well as pseudo regression. Patients and Methods: The study involved 32 patients proved histo-pathologically to have bronchogenic carcinoma and referred for PET/CT scanning. Each patient included in the study was subjected to full history taking, reviewing medical sheet and PET/CT examination. The study was done in private center (Techno-scan holding center, Heliopolis branch using PET-CT machine (GE Discovery VCT 64 PET/CT, USA); in which PET-CT examination was followed by diagnostic contrast enhanced CT examination and processed at Ain Shams University, Radiology department. Results: In this study we found presence of inseparable pseudo neoplastic lesions among 20 patients out of 32 patients and the mean diameter of the bronchogenic mass lesion was 6.89 +/- 3.65 SD as measured by CT, while it was 5.77 +/-3.38 SD as measured by PET/CT in centimeters. Conclusion: The combined PET/CT using 18F-FDG is the best oncologic imaging modality with valuable role in local staging and follows up in patients of bronchogenic carcinoma.}, keywords = {Bronchogenic carcinoma–PET/CT– Pseudoneoplastic lesions}, url = {https://ejhm.journals.ekb.eg/article_9238.html}, eprint = {https://ejhm.journals.ekb.eg/article_9238_2657a4986c25a7c1445e5b8c916cd0eb.pdf} } @article { author = {Al-Isawi, Aws R and Eldin, Mostafa M.G. and Shokry, Wessam S}, title = {Role of MDCT Angiography in Diagnosis and Evaluation of Anatomical Variations and Anomalies of the Coronary Arteries}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4270-4277}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9239}, abstract = {Background: Coronary anomalies are often asymptomatic and may be accidentally discovered. With the increase of interventional coronary procedures, the detection of coronary anomalies is becoming of major clinical importance, the coronary anomalies cannot be considered just rare aspects because they may often lead to relevant clinical consequences. That is reason why the diagnosis of coronary anomalies should be a healthcare priority. Aim of the Study: This study was designed to identify the MDCTA appearance of the anatomic variations and anomalies of the coronary arteries and determine their prevalence. Patients and Methods: This study was conducted as a cross-sectional study in Radio-Diagnosis Department, Faculty of Medicine, Ain Shams University and other specialized private radiology centers, during the period between December 2017 and June 2018. All patients gave their written informed consent for taking part in this study. Patients inclusive of 70 males and 50 females with their ages ranged between 4-82 years. The study was approved by Ethical Committee of Faculty of medicine, Ain Shams University. It included 120 patients that were referred for MDCTA for coronary arteries study, Patients were referred for coronary CTA because of known or suspected coronary artery disease (CAD). Results: The total number of studies population were 100. 60 (60%) were males ages ranging 4-82 years and 49.5± 11.3 years mean age, and 40 (40%) were females with 25-77 age group and 52.75 years mean age.In 79 patients out of 100 (79%), the RCA was dominant giving off PDA and PLB, in 11 patients (11%) the left coronary artery was dominant and in the remaining patients 10 (10%) were Co-dominant. in 2% the LMCA originated from right sinus of valsalva with interarterial course. In 23.46 % the LMCA trifurcated to LAD, LCx and an intermediate ramus artery. The LAD showed myocardial bridging 16% more than other coronary arteries. One coronary aneurysm seen in the LAD.The LCx had abnormal origin from Rt. coronary sinus in two patients (2%) with retro aortic course. The myocardial bridging is very rare in LCX, present in 1% only. LCx fistula also rare detected in 1 patient (1%), no aneurysm was detected in the LCx. The origin of RCA was from right sinus of valsalva in 99 patients (99%) while one patient had abnormal origin from left coronary sinus (1%), in this case the RCA course was inter-arterial. In general, the normal variations and anomalies of coronary arteries were more common in LMCA 27%, in LAD 19%, LCx was 9 % and least 3% in RCA. Conclusion: Complex anatomy of the coronary artery system can accurately be depicted by MDCTA because of the improved isotropic spatial resolution and flexible post-processing tool. This noninvasive modality is useful in detecting coronary artery variants and anomalies and is a valid alternative to conventional coronary angiography in their diagnosis. Recommendations: Further studies are needed with large sample volume and correlate clinical presentation of patients with coronary anomalies & variant.}, keywords = {Coronary artery,Anatomical variant,Multi detector cardiac Computed Tomography}, url = {https://ejhm.journals.ekb.eg/article_9239.html}, eprint = {https://ejhm.journals.ekb.eg/article_9239_7631e8bf94e0307919b7c1e4f4fdbc5c.pdf} } @article { author = {Mohammed Saleh, Nesma A.H and Ibrahim, Ayman M. and Nasser, Haytham M.}, title = {Sonographic Evaluation of Synovium of Wrist Joint in Rheumatoid Arthritis Patients during Activity}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4278-4282}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9240}, abstract = {Background: Rheumatoid arthritis (RA) is an inflammatory rheumatic disease with progressive course affecting articular and extra-articular structures resulting in pain, disability and mortality. Persistent inflammation leads to erosive joint damage and functional impairment in the vast majority of patients. The onset of disease is not similar in all patients but varies in regard to type, number, and the pattern of joint involvement. The course of disease may be also different according to the presence or absence of several variables including genetic background, frequency of swollen joints, autoantibody in the serum and the severity of inflammatory process. Objective: The aim of this study was to demonstrate the role of Ultrasonography and Power Doppler in diagnosis of activity of rheumatoid arthritis in the hands and wrist joints among different aged population, compared with the laboratory investigations. Patients and Methods: This study was carried out in Radiology department of Ain Shams university hospitals. Twenty-five patients known patients with rheumatoid arthritis suspecting activity will underwent assessment by ultrasonography and power Doppler of both wrist and hand joints. Result: US & PD are highly sensitive and specific in detection of activity of the Rheumatoid Arthritis in correlation to laboratory investigations. So, they can be used as non-invasive methods in detection of RA activity changes in wrist and hand joints. Conclusion: Both ultrasonography and power doppler are good predicators for activity in rheumatoid arthritis patients}, keywords = {Ultrasonography (US),Power Doppler (PD),Rheumatoid arthritis (RA)}, url = {https://ejhm.journals.ekb.eg/article_9240.html}, eprint = {https://ejhm.journals.ekb.eg/article_9240_82ed6118caa1bd218126d78928ad605c.pdf} } @article { author = {Al-Bialy, Mohammad and El-Shandawily, Mohammed}, title = {Stents Technique for Endovascular Management of Intracranial Aneurysms}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4283-4291}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9241}, abstract = {Background: Endovascular detachable coil embolization has become an important method in the management of intracranial aneurysms. However, coil embolization alone may fail to treat some wide-neck aneurysms and other complex anatomy configuration. Herein, we report our experience with and outcome of stent techniques of intracranial aneurysms. Objective: The aim of the study was to evaluate the feasibility safety and efficacy of stent usages either conventional or flow diverting stents in endovascular management of intracranial aneurysms. Patients and Methods: Between October 2011 to May 2018 a prospective study was done on a series of 17 consecutive patients harboring 17 intracranial aneurysms approached with endovascular therapeutic stent techniques, these 17 aneurysms (5 have history of rupture, 29 % and 12 unruptured, 71%), Angiographic and clinical follow-up was obtained in 17 (100%) patients (mean 21 months, range 0.5 to 84). Results: In late follow-up 16 patient (94%) had favorable outcome and 1 patient (6%) had unfavorable outcome, over all Complete occlusion Grade 0 with stent technique was achieved in 10 patients (59%), Grade I in 3 patients (17%), Grade II in 1 patients (6%), Grade III in 1 patient (6%), Grade IV in 1 patient (6%) and Grade V in 1 patient (6%), intraoperative complication was noted in 3 cases (18%) with favorable outcome. Conclusion: Endovascular stent-assisted coiling was a feasible, effective and relatively safe technique for the treatment of broad neck and complex configuration intracranial aneurysms.}, keywords = {Intracranial Aneurysms,coiling,Endovascular treatment,Intracranial stent,Flow diverter}, url = {https://ejhm.journals.ekb.eg/article_9241.html}, eprint = {https://ejhm.journals.ekb.eg/article_9241_68aca9b94fc17e953c4defa3ad706280.pdf} } @article { author = {Abdellatif, Ayman E. and Fahmy, Nabila M. and Abdel Hamid, Hatem S. and Rabie, Amal H. and Salib, Hany M.}, title = {Dexmedetomedine versus Standard Sedatives in Weaning from Mechanical Ventilation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4292-4299}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9242}, abstract = {Background: Sedation in the intensive care unit Patients is assumed to reduce discomfort from care interventions, increase tolerance of mechanical ventilation, prevent accidental removal of instrumentation, and reduce metabolic demands during cardiovascular and respiratory instability. Aim of the Work: The aim of the work was to evaluate the use of dexmedetomedine as a sedative to facilitate weaning from mechanical ventilation and extubation, so decrease the incidence of reintubation, ventilator complications and decrease the ICU cost and stay. Patients and Methods: This was a controlled randomized prospective clinical trial carried out at Ain-Shams University Hospitals. After approval of institutional ethical committee, the study included 90 adult postoperative patients and requiring postoperative mechanical ventilation in the surgical ICU for maximum duration of 48 hours postoperatively. Results: As regard to time to extubation, results of the current study showed a highly statistically significant difference between three groups regarding time to extubation (hr) when p-value was < 0.001. Conclusion: dexmedetomidine has clinically relevant benefits compared to midazolam and propofol in facilitating extubation because of its shorter time to extubation, more hemodynamic stability, easy arousability and lack of respiratory depression; hence, it can be used as an effective, and safe sedative agent to facilitate extubation in ICUs and decreasing ICU length of stay.}, keywords = {Dexmedetomedine,Standard Sedatives,Mechanical Ventilation,Weaning}, url = {https://ejhm.journals.ekb.eg/article_9242.html}, eprint = {https://ejhm.journals.ekb.eg/article_9242_a9add347bb2a38d15ccdb9db3bae4ed3.pdf} } @article { author = {A. Elhelaly, Mostafa and A. El-Ashmawy, Abd Elmegeed and A. Haseeb, Abd Alshafy and G. Abd Allah, Hatem and S. Abd-Alsamie, Hesham}, title = {Comparative Study of Vitamin D Level between Psoriatic Patients and Psoriatic Arthritis Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4300-4307}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9243}, abstract = {Background Psoriatic arthritis (PsA) is a seronegative (rheumatoid factor-negative) usually Cyclic Citrullinated Peptide (CCP) antibody negative, immunologically triggered, chronic inflammatory joint disease within the framework of psoriasis. Psoriasis affects 2–4% of the general population. It is a common, chronic, relapsing/remitting, immune-mediated systemic disease characterized by skin lesions including red, scaly patches, papules and plaques, which usually itch. Vitamin D is actually a fat-soluble steroid prohormone that has endocrine, paracrine and autocrine functions. Aim of the Work: To investigate the level of serum vitamin D in patients with psoriatic arthritis and compare it with patients with psoriasis to show if there is a role of vitamin D in development of arthritis in psoriatic patients or not. Patients and Methods: This study is a cross sectional study in which fifty patients with psoriatic arthritis and psoriasis age range 16-50 years selected from those attending the outpatient clinic and inpatients of rheumatology, physical medicine &rehabilitation department, Al-Azhar university hospitals from 2017 to 2018 and divided into two groups: Group (A): (25) patients with psoriatic arthritis were diagnosed according to the criteria for psoriatic arthritis classification “CASPAR criteria”. Group (B): (25) patients with skin psoriasis. In this study we measured of 25 hydroxy vitamin D3 using commercial ELISA kits, ESR, CRP, CBC, Blood urea, serum creatinine, Liver enzymes (SGOT & SGPT), Serum uric acid, Fasting blood glucose, RF, urine analysis, ANA, HCV Ab and HIV Ab. Plain x-ray on both hands postero-anterior view, Plain x-ray on lumbosacral spine antero- posterior and lateral views and Plain x-ray on both sacroiliac joints “cone” view. Results: There was female sex predicliction in psoriatic arthritis group. Otherwise, both groups were comparable regarding age, BMI, residence, co-morbid diseases, disease characteristics, and laboratory investigations, except significant increase of WBCs and inflammatory markers (ESR and CRP) in psoriatic arthritis group. Diseases severity was mild in 72%, moderate in 22% and severe in 6.0%; and there was statistically significant increase of moderate and severe disease in PA when compared to psoriasis group. vitamin D was sufficient in 32.0%, insufficient in 34.0% and deficient in 34.0%; and there was no significant difference between psoriasis and PA groups. In addition, vitamin D levels were increased in psoriasis when compared to PA groups. However, the difference was statistically non-significant. No significant relation was found between vitamin D from one side and each of patient characteristics, laboratory investigations (except significant positive correlation with hemoglobin and RBCs), disease characteristics (except significant inverse (negative) correlation with disease duration and disease severity), X-ray findings, and psoriatic arthritis disease activity indices. Conclusion: Vitamin D deficiency/insufficiency was common among psoriasis and psoriatic arthritis patients and the deficiency was significantly and inversely correlated with disease severity (PASI) and disease duration. Thus, is thought to play a role in development (or a consequence) of psoriasis. On the other hand, there was no correlation with PA disease activity and severity indices. Thus, the association seems to be linked to psoriasis proper. Vitamin D supplementation thought to have a potential therapeutic role in treatment of psoriasis.}, keywords = {Psoriatic arthritis,Psoriasis,Vitamin D}, url = {https://ejhm.journals.ekb.eg/article_9243.html}, eprint = {https://ejhm.journals.ekb.eg/article_9243_d55fab70afc129260cce37aafed928c0.pdf} } @article { author = {Kassem, Osama A.H. and ELgarhy, Ahmed M.M. and Salim, Mahmoud G.}, title = {Magnesium sulphate versus Dexmedetomidine as adjuvants for local anasthetics in peribulbar block for eye surgeries: Clinical comparative study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4308-4312}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9244}, abstract = {Background: Regional anesthesia is a preferred technique for ophthalmic surgery. It is safe, inexpensive and provides efficient ocular anesthesia for ophthalmic surgery. It is associated with less hemodynamic instability, less respiratory depression, better postoperative pain relief, and less nausea and vomiting compared to general anesthesia. Among regional blocks, peribulbar block is safer in comparison with retrobulbar block due to a lesser incidence of serious complications such as brain stem anesthesia, globe perforation, and retrobulbar hemorrhage. Objective: The aim of the study was to compare the safety and efficacy of the use of Magnesium sulfate versus that of Dexmedetomidine as an adjuvant to the local anesthetic in peribulbar anesthesiaas for inducing optimal operating conditions for eye surgery in terms of akinesia (as a primary end point), analgesia, incidence of complications, as well as patient and surgeon satisfaction (as secondary end points). Patients and Methods: The present study included 50 patients (females and males) aged 20-80 years. Materials: Anesthetic drugs, Needles size: 25 gauge, Intravenous cannula 22 G, Drugs for premedications: intravenous midazolam (5mg/ml, Mediathetic, Amoun, Egypt) (0.01mg/kg) and Fentanyl Citrate (50µg/ml, Fentanyl- Janssen, Belgium) (25 µg)was administrated 5minutes before the block, Monitors for vital signs registration were done for each of the following: Electrocardiograph (ECG), non-invasive blood pressure (NIBP), heart rate (HR) and oxygen saturation (SpO2), respiratory rate (RR), Anesthetic machine, resuscitation equipment and drugs. Results: The current study was carried on 75 patients divided into Three equal groups: first group (control group), second group (dexmedtomedine group) and third group (magnesium sulphate group). All patients were scheduled for surgery. Conclusion: Addition of 50 mg of magnesium 10% or 15 mic of dexmedetomidine to local anesthetic mixture for peribulbar anesthesia in the operations of phacoemulsification of cataract and intraocular lens implantation accelerated onset of globe anesthesia, akinesia of the globe and the lid, prolonged the duration of globe akinesia, lid akinesia, time to 1st analgesic request, and enhanced the satisfaction of the patients and quality of the operative conditions.}, keywords = {Magnesium sulphate,Dexmedetomidine,local anasthetics,peribulbar block,eye surgeries}, url = {https://ejhm.journals.ekb.eg/article_9244.html}, eprint = {https://ejhm.journals.ekb.eg/article_9244_b38c23c511049b4563fef4ef97e4f600.pdf} } @article { author = {Al-Meligi, Norhan K.M. Ali and Shaheen, Maha A. and Mahmoud, Mohammed T. and Al Husseiny, Rania M.}, title = {Evaluation of the clinical efficacy of Fractional CO2 laser combined with topical antifungal in the treatment of onychomycosis using SCIO (Score clinical index of onychomycosis)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4313-4319}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9245}, abstract = {Background: Onychomycosis, a fungal infection of the nail, is considered one of the most prevalent disorders of the nail. Score clinical index of onychomycosis (SCIO) enable comparison of the severity of onychomycosis between nails despite differences in the clinical presentation. Recently fractional CO2 laser and topical antifungal were found to be effective in treating onychomycosis. Aim of the Work: To evaluate the clinical efficacy of fractional carbon dioxide laser combined with topical antifungal in treatment of onychomycosis. Patients and Methods: The present study included 20 patients with toenail and fingernail onychomycosis of all age groups. The affected nails received 3 sessions of laser therapy (Fractional CO2 laser) at 4 weeks intervals and once daily application of topical antifungal (Oxiconazole) available at the market under the name tinox cream. Conclusion: We concluded that fractional carbon-dioxide laser therapy, combined with a topical antifungal agent, is effective in the treatment of onychomycosis. It can treat different types of onychomycosis safely and effectively and is especially suitable for older patients with low immunity or liver and renal dysfunction who are not appropriate candidates for systemic antifungal agents. Thus, it could be considered as an alternative treatment modality.}, keywords = {CO2: Carbon dioxide,DLSO: Distal-lateral subungual onychomycosis,SCIO: Score clinical index of onychomycosis}, url = {https://ejhm.journals.ekb.eg/article_9245.html}, eprint = {https://ejhm.journals.ekb.eg/article_9245_4c38e1c23b493ffe42a93a98ca4b67e4.pdf} } @article { author = {El-Zayat, Sameh A. and Aly, Hany M. and Labib, Abdelrahman M. and Gaafar, Abdullah M.}, title = {The effect of intraarticular glucocorticoid injection on the serum level of resistin in Osteoarthritis of the knees. Correlation of the level of resisitin to ultrasonographic findings}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4320-4326}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9246}, abstract = {Background: Osteoarthritis (OA) is one of the ten disabling diseases affecting 9.6% of men and 18 % of women aged over 60 worldwide. OA characterized by articular cartilage loss, subchondral bone remodeling, soft tissue damage and low-grade synovitis It is the most common form of arthritis and major cause of disability in the adult population. The main source of resistin in humans is mononuclear cells. Evidence has shown that higher serum levels of resistin in patients with severe OA compared to controls with no OA and resistin are detected in both serum and synovial fluid, proving its systematical and local involvement in inflammatory changes of OA. Aim of the Work: The aim of this work is to study the effect of local GC intra articular injection on the level of serum resistin in OA knees. Also, to study the relation between different serum levels of resistin and US findings of the knee. Patients and Methods: The ethical approval was obtained from the hospital ethical research committee and each patient entering the study will sign an informed consent. Thirty patients with primary knee OA will be recruited for the study from the Physical medicine, 'Rheumatology and Rehabilitation Outpatient Clinic of Al-Azhar University Hospitals starting from November 2017 till may 2018. In this study we measure Serum Resistin level and Musculoskeletal ultrasound examination of the knee before and three months after steroid injection Results: Serum resistin level is markedly decreased after intra articular steroid injection into OA knee joint. Conclusion: Our study revealed that: Resistin could be considered as an important severity marker of knee OA. Serum resistin level is markedly decreased after intra articular steroid injection into OA knee joint. The longer the duration of illness the higher the resistin level. The older the age the higher the resistin level. The longer the duration of illness, the higher the radiological grade. Serum resistin level should be equal to or higher than 2.8 ng / ml to diagnose a case of primary knee OA}, keywords = {osteoarthritis,Resistin}, url = {https://ejhm.journals.ekb.eg/article_9246.html}, eprint = {https://ejhm.journals.ekb.eg/article_9246_6764d574f39917a37e3fc0b23cf1dfc4.pdf} } @article { author = {Ali, Mohamed A. and Mostafa, Ashraf I. and El-Said, Mohsen M.}, title = {Detection of Urinary CD4TCell in Patients with Lupus Nephritis during Activity and Treatment period}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4327-4332}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9247}, abstract = {Background: Renal involvement is common in Systemic Lupus Erythromatosis (SLE) and is a significant cause of morbidity and mortality. It is estimated that as many as 90% of patients with SLE will have pathologic evidence of renal involvement on biopsy, but clinically significant nephritis will develop in only 50%. The clinical presentation of lupus nephritis is highly variable, ranging from asymptomatic hematuria and/or proteinuria, to frank nephrotic syndrome, to rapidly progressive glomerulonephritis with loss of renal function. Lupus nephritis typically develops within the first 36 months of the disease, although there are exceptions. Aim of the Work: The aim of this work was to study the level of urinary CD4 T cell and monitor the treatment in lupus nephritis patients. Patients and Methods: The ethical approval was obtained from the hospital ethical research committee and each patient participated in the study signed an informed consent.The present study was conducted on seventy-five female subjects, their age ranged from 20 to 40 years. They were divided into 3 groups a- 25 patients knowns as SLE with lupus nephritis, b- 25 SLE patients without lupus nephritis, c-25 normal control subjects. They were recruited from Physical Medicine, Rheumatology and Rehabilitation department of Sayed Jalal and Al-Hussein Al-Azhar University Hospitals, during the period from October 2013 to October 2017. Results: Urinary CD4 markedly decreased after treatment of lupus nephritis. Conclusion: Urinary CD4 T-cells marker has a valuable role in detecting LN in SLE patients and has a significant correlation with disease activity index. Significant Positive correlation was found between Cd4 t-cell and SLEDAI in before and after treatment.Significant positive correlation was detected with 24hr urine protein, SLEDAI, PGA, while Platelet, ESR and C3 significant and negative correlation in post treatment.Monitoring urinary CD4 T-cells may help to identify treatment responders and treatment failure and enable patient-tailored therapy in the future.}, keywords = {Lupus nephritis,CD4}, url = {https://ejhm.journals.ekb.eg/article_9247.html}, eprint = {https://ejhm.journals.ekb.eg/article_9247_b0c9f68572cfcf725b9251e43dc636be.pdf} } @article { author = {Saad, Hussein M.S. and Abashed, Ahmed A.F. and Alshamy, Mahmoud I.}, title = {Delayed Enhancement Cardiac MRI In Ischemic and Non-Ischemic Heart Failure}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4333-4338}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9248}, abstract = {Background: In patients with left ventricular systolic dysfunction, the primary diagnostic issue is to differentiate the underlying cause whether related to coronary artery disease or dilated cardiomyopathy, for which coronary angiography was often used. Aim of the Work: Using Delayed enhancement-magnetic resonance imaging (DE-MRI) to identify myocardial tissue characteristics through retention of gadolinium in areas with reduced density of viable myocytes so appear enhancing (bright). So, we can differentiate dilated from ischemic cardiomyopathy. Patient and Method: Our study included 34 patients with left ventricular systolic dysfunction (ejection fraction less than 40% by echocardiography). All of them were submitted to DE-MRI using achieva 1.5 Tesla MRI machine. Results: 15 patients (44%) showed infarct pattern of DE (presumed ischemic cardiomyopathy) while 19 patients (56%) showed no DE or non-infarct pattern of DE (presumed dilated cardiomyopathy). Conclusion: DE-MRI could be considered as an effective non-invasive tool to differentiate ischemic from non-ischemic cardiomyopathy.}, keywords = {Delayed enhancement- MRI- Heart failure- Coronary artery disease- Dilated cardiomyopathy}, url = {https://ejhm.journals.ekb.eg/article_9248.html}, eprint = {https://ejhm.journals.ekb.eg/article_9248_58a11f8191ba36dd07f078b569f67979.pdf} } @article { author = {Sobhy, Ibrahim A and Monib, Ahmed M. and Abd Elhafez, Essam M}, title = {MRI In Achilles Tendon Injuries}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4339-4342}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9249}, abstract = {Background: The prevalence of Achilles tendon injuries is a common musculoskeletal disorder affecting the foot in athletic and non-athletic population. The Achilles tendon is the thickest and strongest tendon in the human body. It is the major plantar flexor of the foot and contributes to the maintenance of the upright position. MRI is an excellent imaging modality for suspected Achilles tendon lesions due to its accuracy, efficiency, multiplanar imaging capabilities and excellent soft tissue characterization. Objective: The aim of this study is to evaluate the role of MR imaging in clinically diagnosed Achilles tendon rupture and how MRI influences the management. Patients and Methods: This study was conducted at the radiology department, Faculty of medicine, Ain shams University. 20 patients with clinically diagnosed partial and full thickness tear of the Achilles tendon underwent MRI evaluation after four clinical tests.  Results: The results of our study revealed many limitations in clinical tests that revealed defective details which were essentially significant for the way of management being operative or conservative. Conclusion: MRI is the method of choice and superior to clinical tests when evaluating Achilles tendon lesions, facilitating the choice of treatment being operative or non-operative, evaluating intra-tendinous changes in all types of AT tear and follow up during the healing period.}, keywords = {Achilles tendon lesions,MRI,clinical Tests}, url = {https://ejhm.journals.ekb.eg/article_9249.html}, eprint = {https://ejhm.journals.ekb.eg/article_9249_930837b3d4755cb5999e53de1c2f63fb.pdf} } @article { author = {Abulaban, Orjwan and Alrifai, Abdulrahman and Almosallam, Salma Ayman and Abulaban, Aseel Anas and Hamdi, Amre Sami}, title = {Radiological Assessment of Surgical Treatment of Distal Radius Fractures among Patients at an Academic Center in Jeddah}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4343-4348}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9282}, abstract = {Background: Distal radius fractures (DRFs) are mainly treated by surgery; however, there is no strong evidence to establish the superiority of one modality over another. Aim: To determine the most efficient surgical procedure in terms of restoring anatomical angles in DRFs. Methods: This retrospective study was conducted at King Abdulaziz University Hospital, Jeddah between 2010 and 2016. It involved 31 patients with DRF treated surgically. All patients were assessed pre-and post-operatively to measure radial height (RH), radial inclination (RI),ulnar variance (UV) and volar tilt (VT) on posteroanterior and lateral radiographs. The Shapiro-Wilk test was performed to determine the normality of measurements. Results: Pre-operative variables, including (RH), (RI), (VT), and (UV), were not significantly different among patients in all treatment groups. In group 1 (closed reduction with K-wire, external fixation, or both), all the pre- and post-treatment variables were significantly different (p < 0.05), except (UV) (p = 0.867). Conversely, the difference between pre- and post-measurement variables in group 2 (open reduction with plate and screw) was significantly high (p < 0.05). Further, group 3 (open reduction with K-wire plus plate and screws) and group 4 (open reduction with K-wire plus plate and screws in combination with external fixation) showed no significant difference (p > 0.05). Conclusion: Open reduction with plate and screws was highly effective in the management of DRFs. However, additional studies are needed to establish an effective management for these fractures.}, keywords = {Distal radial fracture,Open reduction,Closed reduction,radial inclination}, url = {https://ejhm.journals.ekb.eg/article_9282.html}, eprint = {https://ejhm.journals.ekb.eg/article_9282_e11066f23b5273fc1a52338ac17afc70.pdf} } @article { author = {Aldauig, Badreyah Ahmad and Alshehri, Khalid A. and Alharbi, Ahmed A. and Bajaba, Rana M. and Alghamdi, Sarah and Attar, Suzan}, title = {The Prevalence of Infection in RA Patients using Biological DMARDs in King Abdul-Aziz University Hospital Jeddah, Saudi Arabia: A cross sectional study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4349-4354}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9286}, abstract = {Background: Rheumatoid Arthritis is one of the most common autoimmune disorders. Drugs used are only to slow the progression and to enhance the quality of life. These therapies have several disadvantages as lack of selectivity and it can cause loss of patient compliance. Aim: To identify the most common type of infection, rheumatoid arthritis patients in our region encountered, while using biologics and/or traditional DMARDs. Method: Cross-sectional study was carried out in Rheumatology clinics at King Abdulaziz University Hospital, included Rheumatic patients who visit the clinics from 2013 to 2017. Data sheet was including demographic, using drug and American College of Rheumatology classification criteria for RA were added. Result: Total of 164 patients were included in this study, 18 (11%) males, and 146 (89%) females. Trends among the target sample showed that 40 (24.4%) had diabetes and 51(31.1%) had hypertension. Patients who had been taking both DMARDs and Biologics, DRMADs only, biologics only were 49 (29.9%), 74(45.1%) and 15(9.1%) respectively. The total number of the infections was 180, among them 62.78% were taking DMARDs only and the most common infection was lower urinary tract infections (UTI) 28(37.38%). Conclusion: UTI have the highest rate of infection in patients using traditional DMARDs and patient using both drug groups. And we recommend conducting a cohort study to identify these infections. It can help in assessing their outcomes.}, keywords = {Rheumatoid Arthritis,biological drugs,DMARDs,Infection}, url = {https://ejhm.journals.ekb.eg/article_9286.html}, eprint = {https://ejhm.journals.ekb.eg/article_9286_38696034fd29c1a167a900998d7c585f.pdf} } @article { author = {Mahdy, Eslam H and Kamel, Tarek H and AbelAal, Dalia A and Kamal El-Din, Khaled R}, title = {Prognostic Factors of Non-Small Cell Lung Cancer and Their Relation to the Clinical Outcomes}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4355-4361}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9288}, abstract = {Background: Lung cancer is the main cause of cancer deaths worldwide. Around 1.8 million people are diagnosed worldwide with lung cancer each year. This accounts for about 13% of total cancer diagnoses making it the most common cancer disease. Lung cancer is also the type of cancer that has the highest mortality, killing approximately 1.6 million people annually.The highest incidence rates among men are in the United States and Eastern Europe, whereas the highest among women are in North America and Northern Europe. Aim of the Work: The aim of this study is to analyze the importance of clinicopathological parameters and treatment modality as prognostic factors affecting survival of patients diagnosed as Non-small cell lung cancer (NSCLC) and the quality of life. Methods: We retrospectively reviewed the clinical records of patients with inoperable stage III/IV NSCLC, who were treated at the department of Clinical Oncology, Ain Shams University Hospital and the International Medical center between 2009 and 2017. The association between the demographic and clinical characteristics and survival of these patients was analyzed. Results: A total of 69 patients (32 stage III& 39 stage IV) were identified and included in this study. Sex (males vs. females, p=0.04), Eastern cooperative Oncology group performance status (0 vs. 1 vs. 2, p=0.001), smoking habit (never vs. current vs. former, p=0.001), stage (IIIA vs. IIIB vs. IV, p=0.008) and the initial treatment (no vs. chemotherapy vs. concurrent chemoradiotherapy, p=0.001) were found to be factors affecting survival in univariate analyses. Sex and histological subtype did not affect survival. Performance status, stage and initial treatment were determined as the independent prognostic factors affecting survival in multivariate analyses. Conclusion: Performance status, stage and initial treatment with concurrent chemoradiotherapy in eligible patients were prognostic factors affecting overall survival of patients with advanced NSCLC.}, keywords = {Non-Small Cell Lung Cancer,Prognostic factors,Survival}, url = {https://ejhm.journals.ekb.eg/article_9288.html}, eprint = {https://ejhm.journals.ekb.eg/article_9288_934f7a0e288f6861fd1d3ce8ad4fc0dd.pdf} } @article { author = {Risha, Mahmoud I. and Al-Dahan, Mostafa A. and Al-Tamimy, Hegazy M. and Fahmy, Ahmed M.}, title = {Neuromuscular Ultrasound Versus Electrophysiological Studies in Assessment of Posterior Tibial Nerve Neuropathy in Rheumatoid Arthritis Patient}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4362-4367}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9290}, abstract = {Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming polyarthritis. Extra-articular manifestations occur in 10–20% of patients, especially those with high titers of rheumatoid factor. Neuromuscular ultrasound is useful for the work up of posterior tibial nerve neuropathy. Diagnosis of posterior tibial neuropathy is based on a combination of characteristic symptoms and electrophysiological abnormalities. Recently, neuromuscular ultrasound has become an attractive complement to electrodiagnostic (EDX) studies in the evaluation of peripheral nerves. Aim of the Work: To evaluate neuromuscular ultrasound versus electrophysiological studies in assessment of posterior tibial nerve neuropathy in rheumatoid arthritis patients. Patients and Methods: The subjects included in our study functionally were divided into two groups. Group (A): Thirty Egyptian patients with Rheumatoid Arthritis (RA), all fulfilled the American College of Rheumatology (ACR) 2010 criteria for diagnosis of RA and ACR criteria for classification of rheumatoid arthritis (1987). All were over the age of sixteen at time of diagnosis. They were recruited from Physical Medicine, Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from November 2017 to April 2018. They were complaining of burning pain or paresthesia on the plantar aspect of the foot and toes. Group (B): Thirty healthy individuals, age and sex matched, were used as a control group after an informed consent from all subjects. Results: Neuromuscular ultrasound had a complementary role in the diagnosis of posterior tibial nerve neuropathy. The combined use of electrophysiology with neuromuscular ultrasonography further confirmed the diagnosis of posterior tibial nerve neuropathy. Conclusion: Neuromuscular ultrasound became an attractive complement to electrodiagnostic (EDX) studies in the evaluation of posterior tibial nerve neuropathy. }, keywords = {Rheumatoid Arthritis,neuromuscular ultrasound,Nerve conduction studies}, url = {https://ejhm.journals.ekb.eg/article_9290.html}, eprint = {https://ejhm.journals.ekb.eg/article_9290_573545eb667f2b17dcef663dff472a34.pdf} } @article { author = {Ibrahim, Ahmed and Farrag, Safwat and El Ashkar, Ahmed and Aboul Fotouh, Ahmed and El Shorbagy, Mohamed}, title = {Factors Associated with Fistula Secondary Failure in Patients on Hemodialysis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4368-4373}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9291}, abstract = {Background: Native arteriovenous (AV) fistulas, which are the most commonly used access line, enable sufficient and repeated hemodialysis (HD) applications and improves the rate of survival and quality of life in patients with end-stage renal disease (ESRD) when performed timely in an appropriate anatomic location using a fine technique. Objectives: We aimed to assess factors responsible for fistula secondary failure in patients on hemodialysis. Patients and Methods: Thirty patients with end stage renal disease (ESRD) on regular HD were included. All patients underwent history taking, clinical examination and ultrasound examination was carried out for all patients to assess AVF and factors associated with its patency and failure. Results: There was no statistically significant differences between group I and group II as regards to age, BMI, HD duration and AVF age (p-value >0.05). There was statistically high significant difference between patients with well functioning AVF (group I) and patients with malfunctioning (secondary failed) AVF (group II) as regarding SVP and mean arterial blood pressure (P-value < 0.01) and there was statistically significant difference between group I and group II as regarding DVP (p-value < 0.05). There was statistically high significant difference between group I and group II as regarding venous diameter and FV (P-value < 0.01), while there was no statistically significant difference between group I and group II as regarding arterial diameter (P-value > 0.05). There was statistically high significant difference between group I and group II as regarding hemoglobin & dialysis adequacy (Kt/V) (P-value < 0.01). Conclusion: The native AVF is the vascular access of choice for patients who require hemodialysis: it lasts longer and is associated with fewer complications than other types of vascular access; for hemodialysis patients, these benefits translate into better quality of life and longer survival. The result of this study showed a significant positive correlation between access blood flow (Qa) and Kt/V. This confirm the importance of well-functioning non stenotic AVF in delivering adequate dialysis. }, keywords = {HD: Hemodialysis,AVF: Arteriovenous fistula,ESRD: End stage renal disease,Qa: Access blood flow,Kt/V: Dialysis adequacy}, url = {https://ejhm.journals.ekb.eg/article_9291.html}, eprint = {https://ejhm.journals.ekb.eg/article_9291_00c523985f0a10cf7ab687d12aae7bed.pdf} } @article { author = {Khedr, Yahya and El-Mekkawi, Tamer and Mostafa, Moamen and Soliman, Ashraf}, title = {A comparative study of the discrepancy in the horizontal white-to-white measurement using Calipers vs Pentacam}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4374-4377}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9292}, abstract = {Background: The accurate measurement of the horizontal corneal white-to-white (WTW) diameter is essential and has multiple applications in the field of ophthalmology whether medical or surgical. There are many means of measuring the horizontal white-to-white, which includes the Pentacam, the IOL Master and Manual Calipers. Both the Pentacam and Manual Calipers measure the external white-to-white diameter, whereas the IOL Master measures the internal white-to-white diameter. Objective: The aim of this study is to measure the accuracy of the Pentacam white-to-white camera in measuring the horizontal corneal WTW diameter in comparison to the Manual Calipers, which is considered to be the basic standard. Patients and Methods: The study was a cross sectional one, conducted at Maghrabi Eye Hospital, Cairo, Egypt. It was conducted in accordance with the ethical standards stated by the Ethical Committee of Ain Shams University. Informed consent was obtained from each participant following the explanation of the academic nature of the study. Results: Our study compared the accuracy of the Pentacam HR to the Manual Calipers and found a strong correlation between both methods regarding all parameters. A difference of 0.44 ± 0.17 mm was found between the manual calipers and the Pentacam (HVID Automated) measurements and a lesser difference of 0.24 ± 0.27 mm when comparing the manual calipers with the Pentacam manual digital calipers. On the other hand, the difference between the 2 methods of the Pentacam measurement used was 0.19 ± 0.13 mm. All of which, showed a highly significant correlation. Conclusion: The Pentacam gives larger WTW measurements than the manual calipers as it relies on the gray scale analysis of the HVID in the iris image display. }, keywords = {White to White,Manual Calipers,pentacam}, url = {https://ejhm.journals.ekb.eg/article_9292.html}, eprint = {https://ejhm.journals.ekb.eg/article_9292_2b7c63b404d9724e4a28a6e4d2656b94.pdf} } @article { author = {Fawzy, Maydaa and Abdel Aal, Mohamed and Mohamed El-Shahed, Ahmed Rashad}, title = {Epidemiological Study of Seborrheic Keratosis among Egyptians in Great Cairo}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4378-4381}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9293}, abstract = {Background: Seborrheic keratosis is one of the most common benign epidermal tumors. Seborrheickeratoses are hyperkeratotic lesions of the epidermis, which often appear to be “stuck on” the surface of the skin. Cherry angiomas are very common acquired vascular skin lesions. Objective: To find any relation between seborrheic keratosis and cherry angioma. Patients and Methods: A total of one hundred male and female patients, presented with Seborrheic keratosis with or without associated cherry angioma (62% present CA & 38% absent CA), were included in the study. Full history taking and full examination was done between December 2015 and May 2017. Twelve biopsies were taken from 6 patients. Results: The age of the patients ranged from 18 to 88 years old. The male patients were (63%) and the female patients were (37%). 17% of patients complained of itching, 20% had positive family history of Seborrheic Keratosis, 75% had skin photo type III. Flat Seborrheic Keratosis was 49% of the cases. The most common site of SK was face (76%). The most common site of cherry angioma was abdomen (88.7%). The examination of the biopsies revealed no histopathological correlation between seborrheic keratosis and cherry angioma. Conclusion: The patient with seborrheic keratosis sometimes may have cherry angioma in adjacent to it or in a different site which didn't necessarily means that they have the same pathological origin. }, keywords = {Seborrheic keratosis,cherry angioma,Biopsy,tumer,histopathology}, url = {https://ejhm.journals.ekb.eg/article_9293.html}, eprint = {https://ejhm.journals.ekb.eg/article_9293_4ad42993c321d45aab0b0ae718585338.pdf} } @article { author = {El Omda, Fahd and Abd El Fattah, Ahmed and Hashish, Mahmoud and Khalil, Mahmoud}, title = {A Randomized Trial of Combined Letrozole with Metformin Versus Clomiphene Citrate with Metformin in Polycystic Ovary (PCOS) patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4382-4388}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9294}, abstract = {Background: Polycystic Ovary Syndrome (PCOS) is one of the most common causes of anovulatory infertility. Currently, clomiphene citrate (CC) is considered the first-line therapy for ovulation induction for women with PCOS and infertility. Aromatase inhibitors (AIs) have been introduced as a new treatment option that could challenge CC for ovulation induction. Aim of the Work: The present study was designed to compare the efficacy of combined aromatase inhibitor (Letrozole) with metformin versus CC with metformin in PCOS patients. Patients and Methods: This study was done on 100 documented PCOS cases. They were divided into two groups, The 1st group received CC 50 mg twice daily from the 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with CC and continued for 3 cycles. The 2nd group received aromatase inhibitor (Letrozole) 2.5 mg twice daily from 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with letrozole and continued for 3 cycles. These cases were followed up for three cycles by transvaginal ultrasound folliculometry to document ovulation (size and number of follicles). Results: The results of the present study revealed both lines of treatment were effective in treatment of PCOS patients, with slight favorability in letrozole group but without statistically significant difference founded between CC group and letrozole group as regard ovulation rate, number of follicles at the end of first, second or third cycles, or as regard the diameter of follicles, i.e., both regimens showed efficacy to the same extent. Conclusion: both CC and letrozole are equally effective in treatment of infertility in PCOS patients, when combined with metformin treatment. }, keywords = {PCOs,Clomiphene citrate,Letrozole,Metformin}, url = {https://ejhm.journals.ekb.eg/article_9294.html}, eprint = {https://ejhm.journals.ekb.eg/article_9294_0f3c4b3b3b8d80c2ea24657127b11fe7.pdf} } @article { author = {Mohamed Ahmed, Mohamed Nashaat and Abo Al-Azaim,, Naglaa Gamal and Al-Sehrawey,, Ahmad Al-Saeed and Aly Elgendy,, Abd el aleem Abd el aleem}, title = {Effect of Silver nanoParticles on Carbapenem Resistant Gram-negative Bacteria}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4389-4391}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9296}, abstract = {Background: Gram-negative bacteria are common causes of both community-acquired and hospital-acquired infections. β-Lactam drugs are often the primary therapeutic option for serious infections, and carbapenems in particular are often considered agents of last resort. Thus, the emergence and spread of carbapenem-resistant (CR) bacteria are a significant public health concern. Infections with these resistant bacteria are associated with higher mortality rates than those for infections caused by carbapenem susceptible organisms. There have been considerable efforts to develop new antimicrobials drug against this type of resistant bacteria. Silver Nanoparticles (AgNPs) have emerged as promising weapons in the anti-microbial arsenal. Their anti-microbial efficacy is attributable to multiple mechanism of action. Objective: The aim of this study was to evaluate effect of AgNPs on CR Gram-negative bacteria. Materials and Methods: Effect of AgNPs on CR Gram-negative bacteria alone and in combination with carbapenems. 50 CR Gram-negative bacterial samples were included in this study. They were divided into 4 types; Acinetobacter, E. coli, klebseilla and P. aeruginosa. Each type was divided into (subtypes) metalo and non metalo carbapenemase producers. Results: There was statistically significant difference between all types of CR Gram-negative bacteria with AgNPs alone and some of them with AgNPs plus antibiotic (P-value < 0.05). A comparison of the effect of AgNPs alone between different types of detected CR Gram-negative bacteria showed different levels of response. Lowest response was observed with klebsiella (metalo), while highest was remarked with P. aeruginosa (metalo). Highest synergy with highly statistically significant difference (P-value < 0.001) occurred with Meropenem in P. aeruginosa Conclusion: AgNPs showed anti-microbial effect against CR Gram-negative bacteria alone and synergistic effect against some of detected CR Gram-negative bacteria with certain antibiotics. }, keywords = {AgNPs,CR Gram-negative bacteria,Synergistic effect}, url = {https://ejhm.journals.ekb.eg/article_9296.html}, eprint = {https://ejhm.journals.ekb.eg/article_9296_8471a31e0b1b06767e5901bfb0a89ae3.pdf} } @article { author = {Hashim, Amira and Shadi, Mariam and Hafez, Nirvana}, title = {Effect of Trans Cranial Magnetic Stimulation in Management of Dysphasia, A Systematic Review}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4392-4402}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9297}, abstract = {Background: Aphasia is the most disabling functional defect after ischemic stroke. It affects more than a third of all stroke victims. Effective therapeutic strategies are needed to treat aphasic patients. Novel techniques, such as methods of delivering cortical brain stimulation to modulate cortical excitability, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), are just beginning to be explored. The purpose of repetitive transcranial magnetic stimulation (rTMS) application in the neuro-rehabilitation of aphasic patients is to act on specific networks involved in the pathophysiology of language processing and to promote adaptive cortical reorganization after stroke. TMS was shown to have lasting effects on cortical excitability that persisted beyond the actual stimulus delivery. Given the ability of this treatment to modulate cortical activity in a focal way, focus was soon placed on the use of this technique in various neurological and psychiatric diseases such as aphasia. Aim of the work: The aim of this work is to evaluate the effect of Transcranial Magnetic Stimulation as a therapy for dysphasia in order to promote an evidence-based practice. This will be made by conducting a systematic review of literature in this topic area. Materials and Methods: This was a systematic review. Seven electronic databases (Medline, Google scholar, CINHAL, Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Embase) were searched for articles. Relevant studies were further evaluated and studies that met inclusion criteria were reviewed. Results: The literature search yielded 5097 studies. Twenty-six articles were further evaluated to be included. Eleven studies met all inclusion criteria and were chosen for review. The studies provided moderate to strong evidence that rTMS may be an effective treatment for non-fluent stroke aphasia. We have found significantly higher scores on the language assessment scales of patients after the rTMS treatment than those with sham TMS treatment, in most of the included studies. The studies reviewed here established the beneficial effect of rTMS in multiple language domains. The domain of naming is the most affected, with almost all studies demonstrating improvement in naming after stimulation. Conclusion: The current systematic review suggests that inhibitory low frequency rTMS with 90% resting motor threshold (rMT) targeting pars triangularis of the right inferior frontal gyrus can improve multiple language domains in right-handed post-ischemic stroke patients.}, keywords = {Dysphasia,TMS,language assessment,Treatment}, url = {https://ejhm.journals.ekb.eg/article_9297.html}, eprint = {https://ejhm.journals.ekb.eg/article_9297_8cd327ee4e328c232618858275801188.pdf} } @article { author = {Farhan Mohammed, Ihab Nehad and Motawa, Ilham Aly and Abd El Monem Aly, Mekky and Mohammed Metwally,, Mahmoud Mohammed}, title = {Assessment of Interleukin (8) in Type 2 Diabetes Mellitus}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4403-4406}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9298}, abstract = {Background: Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long- term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Type 2 diabetes (T2D) is characterized by a condition of systemic low-grade inflammation. IL-8 is an important member of the chemokine family of proinflammatory chemotactic cytokines. IL-8 was initially characterized as a potent chemoattractant of neutrophils and was later shown to also activate neutrophils. IL-8 is also known to be a potent promoter of angiogenesis. Objective: It was the Assessment of Interleukin (8) in Type 2 Diabetes Mellitus. Patients and Methods: Serum IL 8 level in Type 2 Diabetes Mellitus. 30 patients compared to 30 normal individuals were included in this study. Results: There was a highly statistical significant difference between all patients and control groups as regard serum IL 8 level (mean of serum IL 8 in patients and control groups were 69.9 ± 20.5 and 5.4 ± 3.3 respectively, p= < 0.001). Conclusion: Type 2 diabetes mellitus patients showed marked elevation of circulating IL-8 levels which identify subjects with worse inflammatory state and metabolic control and therefore it may be used as a marker for the rate of development of diabeteic complications.}, keywords = {Type 2 diabetes mellitus,Interleukin-8,CXC chemokine}, url = {https://ejhm.journals.ekb.eg/article_9298.html}, eprint = {https://ejhm.journals.ekb.eg/article_9298_7954b981fa091226d344185a4890e089.pdf} } @article { author = {El Samkary, Mahmoud A. and Rashad, Saad M. and Abd Elhamid, Mahmoud A. and El-nenaey, Samah H.}, title = {A comparative study between anterior lamellar repositioning and anterior lamellar repositioning with blepharoplasty in management of upper eyelid entropion trichiasis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {4}, pages = {4407-4412}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.9299}, abstract = {Background: Entropion is the inward turning of the lid margin that brings both lashes and external keratinized skin into contact with the globe. Aim of the study: It was to compare the surgical outcome and aesthetic appearance between anterior lamellar repositioning only and anterior lamellar repositioning with blepharoplasty in management of upper eye lid entropion trichiasis. Patients and Methods: This was prospective interventional study includes 20 lids of 13 patients with upper eyelid cicatricial entropion selected from the ophthalmology outpatient clinic of "Ain Shams University" Hospitals. Patients were randomly divided in 2 groups: group A: Ten lids had an anterior lamellar reposition technique (ALR) with grey line split (GLS) technique. Group B: Ten lids had an anterior lamellar reposition with GLS technique and blepharoplasty. All surgeries were performed by one surgeon (third author) in Ain Shams University hospital. Results: Our study showed that after 3 month follow up, success rate of first group was 70 %, patient satisfaction was 60% and final aesthetic outcome was 30% excellent, 30% fair and 40% poor results. The second group success rate was 100%, patient satisfaction was 100% and final aesthetic outcome was 100% excellent results. Conclusion: Combining the procedure of ALR with GLS technique with blepharoplasty in surgical correction of upper eye lid cicatricial entropion has excellent both functional and aesthetic outcome and a higher success rate with minimal complication than anterior lamellar reposition only.}, keywords = {Cicatricial,upper lid,trachoma,anterior lamellar reposition,blepharoplasty,Lid malposition}, url = {https://ejhm.journals.ekb.eg/article_9299.html}, eprint = {https://ejhm.journals.ekb.eg/article_9299_2dac8ac42a3a76b8091162404ab7a23b.pdf} }