@article { author = {Mohammad, Alaa Eid and El-Shebiny, Ahmed Ali and Tomas, Michael Naser Saba}, title = {Neuraxial versus Peripheral Nerve Block for Postoperative Pain Management in Drug Abusers Undergoing Orthopedic Surgeries}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {4964-4968}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10270}, abstract = {Background: While all surgical procedures are associated with some degree of pain, it is a well-accepted fact that orthopedic surgeries are some of the most painful. Despite the increasing interest and continuous advancement in postoperative pain management, more than half of the patients who undergo orthopedic surgeries experience inappropriate level of postoperative pain. Poorly treated pain can have negative impact on recovery especially owing to disruption in physiotherapy resulting in stiffness of joints and slow progress in mobility. In order to achieve good quality of postoperative analgesia, careful history should be taken from the patients about any coexisting medical conditions such as substance abuse or withdrawal, anxiety disorder, affective disorder, hepatic or renal impairment and any past history of poor pain management. Aim of the Work: The purpose of this study was to compare efficacy, side effects, opiate consumption and hemodynamic effects of neuraxial blocks versus peripheral nerves blocks placed under ultrasound guidance, for postoperative pain management in drug abusers undergoing orthopedic surgeries. Patients and Methods: Sixty patients presenting to Ain Shams University hospitals for orthopedic surgeries were enrolled in this prospective randomized controlled study after providing written consents. Participants were instructed about the study protocol and visual analogue scale (VAS). Approval was obtained from the research ethics committee of anesthesia and intensive care department, at Ain Shams University. In this study, all patients were preoperatively assessed for evaluation of their medical status, mode of trauma, post-traumatic critical symptoms or signs, hemodynamic stability, evidence of coagulopathy and any previous history or concurrent drug abuse. Results: This study included 60 drug-abuser patients, undergoing orthopaedic surgeries, starting from January 2018 till May 2018 at Ain Shams University Hospitals and randomly distributed within 2 groups, 30 patients each: Group A: EPI group, Group B: PNB group. As regard to age, gender, body weight, height, ASA and duration of surgery, there were no statistically significant differences between both groups (P-value>0.05). Regarding effects on hemodynamics and intraoperative ephedrine administration, the present study found statistically significant difference in the mean arterial blood pressure measured intra operatively with more drop in group A (EPI) than group B (PNB) with a (P value < 0.001). Also there was significant increase in heart rate from baseline readings in group A compared to group B (P value < 0.001). Statistically significant more incidence of intraoperative ephedrine administration was found in group A compared to group B with a (P value < 0.001). Regarding incidence of postoperative side effects such as sedation, dizziness, nausea, vomiting and urine retention, there was statistically significant more incidence in group A (EPI) than group B (PNB) with a (P value < 0.001). Regarding postoperative pain assessment using VAS, opioids consumption, fulfillment of rehabilitation programs and hospital stay, there were no statistically significant differences between both groups (P value > 0.05). Conclusion: The choice of continuous femoral and sciatic block technique placed under ultra-sound guidance for postoperative pain control provides equivalent analgesia, opioid consumption, postoperative rehabilitation and hospital stay with a lower incidence of hemodynamic side effects when compared to continuous epidural analgesia in drug-abuser patients undergoing orthopedic surgeries. It was also associated with decreased risk of postoperative side effects as sedation, dizziness, nausea and\or vomiting and urinary retention.}, keywords = {Neuraxial,Peripheral Nerve Block,Drug abusers,orthopedic surgeries}, url = {https://ejhm.journals.ekb.eg/article_10270.html}, eprint = {https://ejhm.journals.ekb.eg/article_10270_5695a448d7a8e31cc3613099cdf6b2cb.pdf} } @article { author = {Ali, Mahmoud Mohamed Ahmed and Aboud, Mohamed Ali and El-Feshawy, Mohamed Salah and El-Gyoshy, Ali Mohamed}, title = {Role of Magnetic Resonance Imaging in evaluation of postoperative knee surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {4973-4976}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10272}, abstract = {Background: MRI has high sensitivity and specificity regarding the assessment of the post-operative knee joint. Purpose: to assess the role of MRI in evaluation of the post-operative knee joint and assessment of the post complications after ACL, meniscal and cartilage surgical repair procedures. Patients and Methods: this study included 20 patients, their age range between 14-50 years, all presented postoperative knee were referred to Radiology Department at El-Hussien University Hospital and private centers for MRI exam for post-operative assessment, complication or follow up after orthopedic examination from Orthopedic Department at El-Hussien Hospitals and Outpatient Clinic. Patients had MRI imaging of the affected knee joint using high field strength scanners (1.5 T) MRI unit (Achieva, Philips medical system) MRI was performed by Knee coil in all cases. Results: this study included 15(75%) males and 5 females (5%)(A) Due to different types of operations 10(50%) had ACL reconstruction,6(30%) had menisectomy,4(20%) had cartilage repair. (B) Due to causes16(80%) trumatic,4(20%)non trumatic. (C) Due to types of complications: 3(15%) had no complications,12(60%)had swelling, 2(10%) had limitation of movement,2(10%) had pain and limitation,1(5%)had pain and swelling. Conclusion: MRI proved as an accurate method for evaluation of the knee joint after ACL, meniscus and cartilage repair that can help predict post-operative complications.}, keywords = {MRI postoperative knee,Postoperative knee complications}, url = {https://ejhm.journals.ekb.eg/article_10272.html}, eprint = {https://ejhm.journals.ekb.eg/article_10272_70d58f9597ceab81b1114eaa44628ad1.pdf} } @article { author = {Mohamed, Abeer El-Sayed Metwally and Kamel, Omar Farouk and Ghazy, Mohamed Shaker}, title = {Accuracy of Lung Ultrasonography in Diagnosis of Community Acquired Pneumonia as Compared to Chest X-Ray in Pediatric Age Group}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {4977-4983}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10273}, abstract = {Objective: It was aimed at investigating the role of lung ultrasonography in assessment of pneumonia as compared to chest x-ray in pediateric age group. Purpose: to evaluate the ultrasound efficiency in the assessment of pneumonia in pediatric age group as compared to chest x-ray. Methodology: This study was carried out at the general pediatric wards and PICUs of El-Demrdash hospital, Ain Shams University.40 patients were clinically diagnosed with pneumonia. For every child included in the study, a chest x-ray and a chest US were performed. Result: the detection rate of consolidative patches was higher in ultrasound compared to the x-ray technique. Conclusion: Lung ultrasound is safe and accurate for the diagnosis suspected cases of community-acquired pneumonia and it is more sensitive than chest X-ray and allows a radiation-free technique for detection of consolidations in children, thus reducing radiation exposure in this population.}, keywords = {Lung Ultrasonography (LUS),Chest x-ray (CXR),Radiation,Imaging tool,Consolidation}, url = {https://ejhm.journals.ekb.eg/article_10273.html}, eprint = {https://ejhm.journals.ekb.eg/article_10273_a7a57bca7e090d06c25ce928eef34f9c.pdf} } @article { author = {Fayed, Said Mohamed and Mahdy, Mostafa Mohamed and Ahmed, Abdallah Mohamed and Hefny, Amr Mohamed Ahmed}, title = {Comparative Study between Effects of Addition of Fentanyl versus Dexmedetomidine to Local Anesthetic Mixture for Peribulbar Block for Cataract Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {4984-4989}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10274}, abstract = {Background: regional anesthesia is currently more preferable than general anesthesia in ophthalmic surgery and include many types as; peribulbar (extraconal) and retrobulbar (intraconal) anesthesia. Peribulbar block is commonly used because there is reduced risk of globe perforation and optic nerve damage in different to retrobulbar block, but it needs sometimes block supplementations to improve the quality of the block such as clonidine and hyaluronidase. Also, fentanyl and dexmedetomidine was added in this study as an adjuvant to local anesthetics in peribulbar block for cataract surgery. Objective: the aim of this study was to evaluate and compare the effect of adding fentanyl and dexmedetomidine as adjuvants to local anaesthetic mixture in peribulbar block as regards duration (anesthesia and akinesia), efficacy and pain relief. Patients and Methods: in this study sixty patients of ASA I-III of both gender, aged 30-60 years arranged into three equal groups (group S, group F and group D) received peribulbar block for phacoemulsification with intraocular lens implantation operation. Group F and group D received fentanyl and dexmedetomidine respectivly with local anaethetics (LA) solution and showed statistically significant difference in onset and duration of globe akinesia respectively compared to group C which received local anaethetics (LA) solution only. Results: the onset of globe analgesia was significant in group F and group D compared to Group S. Postoperative pain was assessed by using a 5-points verbal rating score and recorded data showed significant difference between the three groups with better postoperative pain control in group F and group D. There was no statistical significant difference between the two groups as regarding the hemodynamics (MBP, HR and SPO2) and the incidence of complications. Conclusion: the current study concluded that adding fentanyl or Dexmedetomidine to local anaethetics (LA) in peribulbar block significantly reduced the time of onset of globe akinesia and analgesia and reduced the need for second injection. Also, it increased the duration of globe akinesia and analgesia with better postoperative pain control.}, keywords = {myocardial infarction,Oxygen saturation - Intravenous}, url = {https://ejhm.journals.ekb.eg/article_10274.html}, eprint = {https://ejhm.journals.ekb.eg/article_10274_c8a8172c90f5791544a5d20ab2c5abe2.pdf} } @article { author = {Alruwaili, Bader Arar Shadad and Hussain, Malik Azhar and Alruwaili, Thamer Arar Shadad and Alruwaili, Taghreed Arar Shadad and Alanazi, Osama Mazha Mutkhan and Alenezi, Adel Turki D and Al Shakarah, Mohammed Khalil and Alanazi, Saud Rteamy R and Alshammari, Anwar Khulaif B and Alanazi, Khawlah Hameed and Alanazi, Abdulaziz Salamah and Aldaghmi, Ahmed Saud A and Alanazi, Abdullah Saad A and Alenezi, Munif Saleh}, title = {Predictors, complications and outcome of coronary artery bypass surgery in patients attending the cardiac center of Arar City, Northern Saudi Arabia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {4990-4994}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10275}, abstract = {Background: The increased incidence of cardiovascular disease between patients nowadays led to upsurge in the number of cardiac operations. After coronary artery bypass surgery, most patients remain free of symptoms for up to 15 years. The surgery also reduces the risk of heart attack and improves survival. Objective: to determine the predictors and outcome of coronary artery bypass surgery in patients attending the cardiac center in Arar, KSA all over the study period. Methods: The current study is a cross sectional study conducted during the period from September 2017 to March 2018. The current study included 72 individuals attending the cardiac center in Arar City. Collecting patients’ data was conducted through interviewing the patients included in the study and reviewing their medical files. A predesigned questionnaire was used for data collection. Results: We found that 81.9% of cases were males, 61.1% aged from 30 to 39 years old, 34.4% of cases have a myocardial infraction as a clinical diagnosis before the operation, 25% had angina pain, and 50.0% were smokers. Hyperlipidemia, chronic kidney disease, and chronic obstructive lung disease were found in 59.7%, 83.3% and 77.8% respectively. There were 41.6% who had postoperative arrhythmia, 13.9% had bacterial infection in the site of operation and another 13.9% had hypotension, 11.1% re-operated due to bleeding, and 6.9% got  postoperative acute myocardial infarction. After 6 month of the operation, 69.4% of cases were quite good while recurrence of chest pain found in12.5%, heart failure in 2.8% and 8.3% died. There was significant association between outcome of cases after 6 months of operation and patients age (P<0.05) and all the dead cases were males. Conclusion: Our findings indicated that, among cardiac patients attending the cardiac center in Arar, KSA, the preoperative characteristics are suggestive of 30 to 39 years old males with myocardial infraction, angina pain, smokers, have hyperlipidemia, chronic kidney disease, and chronic obstructive lung disease is undergoing coronary artery bypass surgery. The death rate was low and 69.4% of cases were quite good.}, keywords = {Coronary artery bypass surgery,indications,Complications,Outcome,Cardiac center of Arar City,Northern Saudi Arabia}, url = {https://ejhm.journals.ekb.eg/article_10275.html}, eprint = {https://ejhm.journals.ekb.eg/article_10275_bc806ecb53a0eca0031519ad9b505c3c.pdf} } @article { author = {Abd-Allatif, Emad Maarouf and Mohammed, Mofeed Fawzy and Doweir, Hossam Mohammed Abdel-Satar}, title = {A Comparison of Efficacy Of Aromatase Inhibitors (Letrozole), Clomiphene Citrate And Recombinant F.S.H In Induction Of Ovulation In Polycystic Overian Syndrome}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {4995-5000}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10276}, abstract = {Background: Polycystic ovarian syndrome is also called hyper-androgenic anovulation syndrome.It is a set of symptoms due to elevated male hormone in women. The major features of PCOS include menstrual dysfunction, anovulation and signs of hyperandrogens Other signs and symptoms of PCOS include hirsutism, infertility, obesity, metabolic syndrome, diabetes and obstructive sleep apnea. On examination, finding in women with PCOS may include virilizing signs, acanthosis nigricans, hypertension and enlarged ovaries (may or may not present).Ovulation induction in women with PCOS suffering from anovulatory infertility includes the use of antioestrogen, insulin sensitisers, aromatase inhibitors (Letrozole), gonadotropin (FSH) and surgical treatment. Objective: The present study aimed at comparing between the efficacy of aromatase inhibitors(letrizole), clomiphene citrate and recombinant (FSH) on induction of ovulation in polycystic ovarian syndrome. Patients and Methods: the present study was conducted on 150 patients with polycystic ovarian syndrome according to the Rotterdam criteria for polycystic ovarian syndrome with history of menstrual disturbance and whose age ranged between 18-37 years. In the current study, patients were allocated into 3 equal groups: group A (Clomiphene citrate), group B (Letrizole) and group C (Recombinant FSH). Results: Clomiphene citrate, letrizole and recombinant (FSH)were the common to be used for induction of ovulation in polycystic ovarian syndrome.In our study we proved that recombinant (FSH) is the most effective of these drugs,followed by letrizole and the least is clomiphene citrate. Conclusion: PCOS is a major cause of infertility in women.Medical treatment (induction of ovulation) is one of the major methods of management of PCOS. Recombinant (FSH) has the higest efficacy in our study.}, keywords = {PCOs,Clomiphene citrate,Letrizole,Recombinant,(FSH),Induction and Letrizole}, url = {https://ejhm.journals.ekb.eg/article_10276.html}, eprint = {https://ejhm.journals.ekb.eg/article_10276_3c7b898530c6667823f1d3e1b1bc7afb.pdf} } @article { author = {Elsayed, Zeinab Mohammed Abdel-Hafeez and Elkady, Mohammad Sabry and Biomy, Waleed Abd Elmmonem and Ezz El Din, Mai Mohamed Ali and Ahmed, Lamiaa Moustafa Abdel Megied Mohamed and El-khazragy, Nashwa}, title = {Correlation between T Stage of the Tumor and Tumor Behavior in Locally Advanced Head and Neck Squamous Cell Carcinoma}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5001-5004}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10277}, abstract = {Background: Head and neck cancer (HNC) represents more than 550,000 cases annually. It accounts for 380,000 deaths every year. Despite aggressive treatment, only 35% to 55% of patients who present with locally advanced HNC remain alive and free of disease 3 years after standard curative treatment. Thirty percent to 40% of patients develop locoregional recurrences, and distant metastases occur in 20% to 30%. Most recurrences appear quickly within 2 years of initial treatment and an additional 10% of patients will have evidence of distant metastases at the time of first presentation. Purpose: To retrospectively determine the prognostic effect of T stage in locally advanced head and neck cancer. Patients and Methods: This study retrospectively analyzed 40 patients diagnosed with locally advanced head and neck cancer. Patients were diagnosed by a tissue biopsy and they were staged by endoscope and CT neck or MRI neck with contrast. They received their treatment and were followed up every 3 months by CTs. Results: We found a statistically significant correlation between T stage and both PFS and OS in HNC (95%, CI 1.00 – 3.10, p=0.04 and 95% CI 1.01 – 2.65, p=0.05 respectively). We did not find any other statistically significant correlation between other patients’ sub-groups such as age, gender, smoking, affected site, stage, lymph node infiltration, receiving induction chemotherapy, receiving radiotherapy with or without chemotherapy, and response to treatment and between PFS and OS. Conclusion: This study confirmed that the T stage of the tumor is an important prognostic factor in locally advanced head and neck cancer. }, keywords = {Locally advanced head and neck cancer,T stage,prognosis}, url = {https://ejhm.journals.ekb.eg/article_10277.html}, eprint = {https://ejhm.journals.ekb.eg/article_10277_2d3adef47b8623d0d42f8240368605ac.pdf} } @article { author = {Meawad, Maged A. and Abd El Aziz, Akram and Obaya, Hany E. and Mohamed, Sabah A. and Mounir, Khaled Mohamed}, title = {Effect of Chest Physical Therapy Modalities on Oxygen Saturation and Partial Pressure of Arterial Oxygen in Mechanically Ventilated Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5005-5008}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10278}, abstract = {Background: Chest physical therapy plays an important role in increasing Pao2 and SaO2 among ICU patients which is considered as a good indicator for the general improvement of the patient besides decreasing ICU staying and costs. Purpose: To figure out the effect of chest physical therapy on oxygen saturation and partial pressure of arterial oxygen. Patients and Method: Thirty patients post MV, their age ranged from 50 to 60 years old were recruited in this study. The patients were selected from ICUs of Kasr al Ainy hospital, Faculty of Medicine, Cairo University. The patients received chest physiotherapy (percussion, vibration, manual hyperinflation), positioning and upper and lower limbs exercises. Results: Increase in Pao2 and SaO2 in addition to decreased incidence of chest infection and decreased ICU stay. Conclusion: The results of this study support the importance of chest physiotherapy on increasing SaO2 and Pao2, decrease ICU duration and decrease health care costs.}, keywords = {Chest physiotherapy,partial pressure of arterial oxygen (Pao2),oxygen saturation (SaO2) and Mechanical ventilation (MV)}, url = {https://ejhm.journals.ekb.eg/article_10278.html}, eprint = {https://ejhm.journals.ekb.eg/article_10278_3e6b8bcaaff910fd61a0152429c5cbc2.pdf} } @article { author = {Zakaria, Abd El Monaem Mohamed and Hammour, Mohamed Elsayed and Aly, Mekky Abd El Monaem and Holla, Ahmed Hussein Abd El Hamed}, title = {Comparative Study between Effect of Clomiphene Citrate, Tamoxifen and Letrozole on Endometrial Thickness in Induction of Ovulation in Patient with Polycystic Ovarian Syndrome}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5009-5013}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10279}, abstract = {Background: Infertility is the inability of a married couple to conceive within one year in spite of regular marital life. Globally 10-15% of the married couples are experiencing this problem. CC is non-steroidal selective estrogen receptor modulator (SERM), has both estrogen agonist and antagonist properties. It binds to estrogen receptors primarily in the hypothalamus, which interrupts the negative feedback of the increasing estrogen level and results in continued production of FSH, which stimulates follicular growth and maturation. Its anti-estrogenic effect causes long standing estrogen receptor depletion due to its long half life (2 weeks), so it has adverse effects on the quality and quantity of cervical mucus and negative impact on endometrial development causing its thinning, implantation failure and decreased blood flow during the peri-implantation stage. Objectives: The aim of the study is to compare the effect of the following 3 drugs during induction of ovulation: 1- Clomiphene citrate, 2- Tamoxifen, 3- Letrozole. Patients and Methods: This study was carried out in El Entag El Harby Hospital. The patients were recruited from the Infertility outpatient clinic between December 2017 and June 2018. This prospective study included 150 infertile women who were diagnosed as anovulatory infertility and meet the inclusion criteria. This study followed the ethical committee rules of Obstetrics & Gynecology department, Al Azhar University. For all women with anovulatory infertility in this study; explanation of the study procedures was done to all women sharing in the study and informed written consents were obtained. In the current study, patients were divided into three groups, each group formed of 50 patients: Group 1 (CC), Group 2 (letrozole), Group 3 (TMX). First of all, the groups in our study were matched as regard to age, BMI, type and duration of infertility. Results: The current study shows a statistically significant difference between the three groups regarding the endometrial thickness, which was significantly thinner in group 1 (CC) than the other two groups; group 2 (letrozole) and group 3. Conclusion: Clomiphene citrate has a negative effect on endometrial thickness which is mostly attributed to its antiestrogenic effect. A triple layered endometrium (trilaminar pattern) is associated with higher pregnancy rates; therefore, patients receiving CC with non trilaminar pattern have reduced pregnancy rates.}, keywords = {Clomiphene citrate,tamoxifen,Letrozole,Endometrial Thickness,Polycystic Ovarian Syndrome}, url = {https://ejhm.journals.ekb.eg/article_10279.html}, eprint = {https://ejhm.journals.ekb.eg/article_10279_2824ec672a80d4472abf4c5de1afd767.pdf} } @article { author = {Abdulrahman, Ahmed Elsaied and Gamaleldeen, Nagwa Mohamed and Ali, Shazly Boghdady and Ahmed, Mohamed Kamel}, title = {Effect of protective lung ventilation on oxygenation & hemodynamics in obese patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5014-5020}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10280}, abstract = {Background: The number of obese patients undergoing surgery, either bariatric or non-bariatric, is steadily increasing. These patients are more labile to the perioperative complications, such as hypoxemia, hypercapnia, and atelectasis. Intraoperative protective ventilation consisting of low tidal volume, high PEEP and recruitment maneuvers resulted in alveolar recruitment and optimization of intraoperative respiratory mechanics. Objective: This study tested two strategies of mechanical ventilation in obese patients during pneumoperitoneum to conclude which is better as regard gas exchange optimization and hemodynamic stability. Methods: Study was a randomized prospective comparative control study which was carried out on 50 obese patients with BMI 30-50 kg/m2. Patients were prepared for laparoscopic cholecystectomy. Patient’s selection according to attendees at time of operation as a single numbers were protective ventilation (group A) and a double numbers were conventional ventilation (group B). Results: Study showed significance between oxygenation in both groups. Post-operative oxygenation in protective ventilation (group A). Mean Post P (A-a) O2 in group A was 27.93 (±7.76) mmHg, while in group B was 35.82 (±11.98) mmHg, p value (0.022).Hemodynamic instability observed in 24% in group A, but only occurred in 8% in group B. Conclusion: Study found that protective ventilation was superior to conventional ventilation as it was associated with better oxygenation in the post-operative in obese laparoscopic cholecystectomy. In spite of it was very effective in optimizing gas exchange, but associated with more hemodynamic affection.}, keywords = {obese,Laparoscopy,protective,Lung ventilation,conventional,Recruitment,Pulmonary function tests}, url = {https://ejhm.journals.ekb.eg/article_10280.html}, eprint = {https://ejhm.journals.ekb.eg/article_10280_38e7a910b7c43b21fadf3820c4f8bcf3.pdf} } @article { author = {Alanazi, Ohud Falah M and Hashim, Sawsan Hassan Abdullah and Abo El-Fetoh, Nagah Mohamed and Alenazy, Manal Hajea Eid and Alhazmi, Ayashah Moulfi A and Alenezi, Reham Aref and Alanazi, Ibtisam Matan and Alanzi, Fai Mulfi S and Alruwaili, Raghad Khalid R and Alanazi, Ahlam Sultan and Alruwaili, Aliah Saad M and Alruwaili, Noof Saad M}, title = {Overweight and obesity in association with factors related to breastfeeding in Arar, Northern Saudi Arabia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5021-5025}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10281}, abstract = {Background: There is evidence that breastfeeding (BF) may have protective effect against obesity. In some studies, a time-dependent association between duration of BF and obesity has also been shown. Objectives: This community-based study was conducted aimed to evaluate the prevalence of overweight and obesity in children 2-12 years in association with factors related to breastfeeding in Arar City, Northern Saudi Arabia. Participants and methods: A cross-sectional study was carried out in Arar City, mothers were selected from the attendees of the female side of 5 randomly selected primary health care centres in the city. They were interviewed and filled a questionnaire which included the needed questions. Results: Among the 562 studied children, 54.8% were females and the estimated proportion of obese and overweight children are 39.9% and 13.9%, respectively. The BMI group proportions were significantly affected by the period of breastfeeding, father’s obesity, and type of feeding; whether it was artificial or breast-feeding, or both (P<0.05). We found that 43% of those who were underfed; breastfed for less than 4 months only, were obese and 8.8% were overweight. Among those who were breast-fed for 4 to 6 months, 31.2% were obese and 20.8% were overweight and for those that had a 6 months to a year breastfeeding, 19.4% and 12.9% were obese and overweight, respectively. Conclusion: In Arar City, Northern Saudi Arabia, the BMI of children 2-12 years is significantly affected by the period of breastfeeding, father’s obesity, and type of feeding; whether it is artificial or breast-feeding, or both (P<0.05). So policy makers must condense their efforts to increase the awareness of the mothers about the protective effect of breastfeeding from obesity and its comorbidities.}, keywords = {breastfeeding,childhood,artificial feeding,BMI,Obesity,Arar city,Northern Saudi Arabia}, url = {https://ejhm.journals.ekb.eg/article_10281.html}, eprint = {https://ejhm.journals.ekb.eg/article_10281_ccf421f40b44b34e7c3c4503045cb48d.pdf} } @article { author = {Osman, Magda H. and Shahin, Radwa S. and Elzefzafy, Wafaa M. and Ghazzawi, Maha R.}, title = {Assessment of IL-10 Polymorphism and TGF beta 1 Polymorphism in Egyptian Patients with Chronic Liver Disease}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5026-5033}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10282}, abstract = {Aim of the work: to determine the role of Interleukin-10 (IL-10) polymorphism (rs 1800896) and Transforming Growth Factor-Beta-1(TGF-β1) polymorphism (509 CT) as markers for cirrhosis in Egyptian patients with chronic liver disease. Subjects and Methods: This case-control study was carried out on selected patients admitted to Tropical medicine department, Al Zahraa University Hospital during the period from March 2016 to April 2017. Genotyping of IL-10 (rs 1800896) and TGF-β1 (509 CT) polymorphisms were performed using real-time polymerase chain reaction (PCR) technique. Results: There was significant increase in IL10 and TGF β1 509 gene polymorphisms in compensated and de-compensated groups as compared to control group. Conclusion: Interleukin 10 rs 1800896 gene polymorphism and TGF β1 509 gene polymorphism are associated with risk of liver cirrhosis in patients with chronic hepatitis C virus infection. These findings could be useful for future screening for early detection of liver cirrhosis.}, keywords = {IL-10,Polymorphism,TGF Beta,Chronic liver disease}, url = {https://ejhm.journals.ekb.eg/article_10282.html}, eprint = {https://ejhm.journals.ekb.eg/article_10282_8b128d46ff1e4a6cc0793c2ccbec2129.pdf} } @article { author = {Ali, Walid and Alaghory, Islam and El-Ghannam, Osama}, title = {Endoscopic Assisted Microscopic Skull Base Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5034-5038}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10283}, abstract = {Background: Over the last decade skull base surgery has been significantly progressed because of the obvious improvements in imaging, anesthetic, surgical techniques as well as the advancement of microsurgical instruments. However, the anatomical complexity of skull base makes dealing with lesions in such area a “surgical challenge”. That’s why looking for alternative methods is always needed. Meanwhile there have been significant advances in the field of cranial base surgery with the help of endoscopic techniques to manage such lesions. Objective: To demonstrate the value of endoscope-assisted microsurgical technique for resection of skull base tumors. Patients and Methods: Twenty patients had skull base tumors were operated through Endoscopic-assisted microscopic skull base surgery technique at Al-Azhar University & Mansoura International Hospital between 2015 to 2017 using a rigid endoscope for inspection of tumor boundaries and neighboring vascularity in addition to confirm the extent of resection. Tumor resection was tried in all cases. Intra-operative resection rate and post-operative radiological outcomes were assessed. Results: Total resection was done in 10 patients (50%). Subtotal resection was done in the other 10 cases due to excessive bleeding and adhesions of the tumors with vascular structures. Conclusion: Endoscopic-assisted microsurgical approach is a reliable, safe and effective option for adequate surgical resection of skull base tumors. The technique allowed proper inspection of the tumor relations and vascularity, detection of any residual portions, providing better chance for gross total resection with minimal tissue damage or vascular injury as well as convenient clinical outcome.}, keywords = {Endoscopic neurosurgery,Endoscopic-controlled micro neurosurgery,Endoscopic inspection,Endoscopic assisted micro neurosurgery}, url = {https://ejhm.journals.ekb.eg/article_10283.html}, eprint = {https://ejhm.journals.ekb.eg/article_10283_9b07a3a40602087dfa65ee16cd10bf51.pdf} } @article { author = {Reyad, Mostafa Kamel and Elhennawy, Ahmed Mohamed and Abdelghafar, Wael Sayed Ahmed and Abdelmotagly, Mohamed Fathy}, title = {Caudal Bupivacaine versus Systemic Nalbuphine for Post-Operative Pain Management in Children undergoing Inguinal Hernia Repair}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5039-5043}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10284}, abstract = {Background: it’s considered that post-operative pain management in children is essential as it reduce the pain as well as anxiety of the parents regarding post-operative pain. There are some options which are found and being used currently by pediatric anesthetists. However there is no consensus over a single best method. Post- operative pain management had always been a major concern of parents as well as pediatric anesthetists. Contrary to the ancient notion that children don’t feel pain, many studies have focused on the importance of good pain management in children. According to the studies, children in surgical ward feel more pain than children in medical ward and prevalence was found to be 44% and 13% respectively and it was found that about 64% of pediatric patients after surgery experience moderate to severe pain while 29% experience mild pain. Objectives: the aim of this study was to compare pain scores in patients undergoing inguinal herniotomy after caudal block and intravenous nalbuphine. Patients and Methods: this comparative double blind study was conducted at Paediatric Surgery Department. We included patients with age range of 3-12 years. The children were randomly divided into two groups. Group C included Caudal Block; and Group N included patients who received Nalbuphine. In group C patients, after herniotomy and before extubating the patient, caudal block was introduced by giving Bupivacaine 0.25% according to body weight. In patients in group N, immediately after herniotomy, nalbuphine was given intravenously 0.18 mg/kg according to body weight. Patients were shifted to post-operative ICU where pain scores were measured at 0,1,2,4 and 8 hours. Also any side effect of the drugs was noted and taken care of. For pain measurement Faces Pain scale was used. If any patient developed pain score 8 or more, patient was given paracetamol10 mg/kg. Results: we have used FACES pain scale in our study which is a verified scale for pain assessment in children with the age range of 3-12 years. There was no significant difference between the two study groups as regard side effects, as 14.8% of group 2 (Caudal Group) cases had side effects compared to 3.6% for group 1 (Nalbuphine cases(p=0.052). As regard the need for rescue analgesia, no significant difference was found between the two study groups. Regarding our study, there was no significant difference between the two study groups as regard pain scale at 1 hour. However, a highly significant difference was found between the two study groups as regard pain score at 2, 4, and 8 hours with higher pain among caudal block group. Conclusion: nalbuphine is better than caudal block for post-operative pain management after inguinal herniotomy in children.}, keywords = {Caudal Bupivacaine,Systemic Nalbuphine,Inguinal hernia repair,Inguinal Herniotomy}, url = {https://ejhm.journals.ekb.eg/article_10284.html}, eprint = {https://ejhm.journals.ekb.eg/article_10284_670ed2f5b52b9f26a18630581f3f2405.pdf} } @article { author = {Abdelhafiz, Ahmed Abdelshafy and Ali, Samir Abdalla and Faris, Tamer and Abd Elaziz, Ahmed Fathy}, title = {Ratio between Low Serum Maternal 25-Hydroxy vitamin D Concentration and the Risk of Preeclampsia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5044-5049}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10285}, abstract = {Background: Vitamin D may play a role in the etiology of preeclampsia by regulating the transcription and function of genes associated with placental function, including placental invasion, normal implantation, and angiogenesis. Vitamin D also, modulates immune function and inflammatory response. Maternal vitamin D concentration may be influenced by several factors, including diet, supplementation, sun exposure, skin pigmentation, and genetics. Therefore, vitamin D deficiency is a potentially modifiable risk factor for preeclampsia. Objective: To find out if lower levels of vitamin D is more prevalent in preeclamptic women. Patients and Methods: This study carried out on 50 pregnant women recruited at pre labour room. They divided into preeclamptic group and non-preeclamptic group, 25 cases in each group. Current study was conducted as a case-control study to compare vitamin D level between preeclamptic and non-preeclamptic women at Al-Hussein University Hospital as current study recruited 50 primigravida. Women after 36 weeks of gestation without any other medical disorders. They were classified into preeclamptic case group and normotensive control group. Results: The current study found that vitamin D levels were lower in preeclamptic group than normotensive control group but these differences were not statistically significant.}, keywords = {Pregnancy,preeclampsia,Hypertension,vitamin D deficiency,25-Hydroxyvitamin D}, url = {https://ejhm.journals.ekb.eg/article_10285.html}, eprint = {https://ejhm.journals.ekb.eg/article_10285_b120ab097a8945d3c7174f7d6ddf8feb.pdf} } @article { author = {Shokry, Engy Kameel and Ahmad, Khaled Aboualfotouh and Mohamed, Mohamed Mamdouh and Ragab, Iman Ahmed}, title = {Role of CT in the Diagnosis and Follow up of Pediatric Oncology Patients with Fungal Infection}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5050-5055}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10468}, abstract = {Background: invasive fungal infections are rare in pediatric population, but have a high morbidity and mortality rates despite the development of antifungal treatment. It ranges from superficial, mucosal to invasive infection. Aim of the Work: to assess the value of CT in the diagnosis of invasive fungal infection and differentiating it from other causes of infection or metastatic deposits in patients with childhood cancer and persistent fever in spite of antibacterial treatment and to assess the radiological response after treatment with antifungal drugs. Patients and Methods: our study was done over period from October 2017 to June  2018, included 22 immunocompromised pediatric patients from El -Demerdash tertiary hospital, included (8 male, and 14 female) with age range (14m- 16 yrs.). We identified immunocompromised patient of having underlying malignancy or auto-immune deficiency. We included all patients with fever, neutropenia and high CRP, in whom we suspected chest or paranasal sinus infection. Results: in our case group; the most common underlying disease was ALL-B cell (n=6, 40%), followed by ALL-T cell (n=2, 13.3%), AML (n=2, 13.3%), aplastic (n=3, 20%), hepatobalstoma (n=1, 6.7%) and auto-immunodeficiency (n=1, 6.7%).Analysis of the radiological data showed that macronodules was the most significant finding to suggest fungal rather than bacterial infection (53.3% vs. 0% respectively, p=0.015), followed by consolidation (40% vs. 57.1%, p=0.45) and ground glassing (26.7% vs. 14.3%.Cavitary lesions, pleural effusion and lung abscess were associated only with fungal disease, yet it is not considered significant enough in our study as a reliable sign to suggest fungal infection Conclusion: increase number of hospitalized pediatric patients with fungal infection is a rising problem, with no specific criteria for early diagnosis among this population causing delay of the proper treatment. In our study hematological malignancy was the most common underlying disease with macronodules being the most specific finding to suggest fungal infection in pediatrics.}, keywords = {Pediatric Oncology Patients,Fungal Infection – Candida,Aspergillus}, url = {https://ejhm.journals.ekb.eg/article_10468.html}, eprint = {https://ejhm.journals.ekb.eg/article_10468_2318137a6b535e98fcfdd71e11383017.pdf} } @article { author = {Abd El Latief, Samia Abd El Mohsen and El Fawal, Sanaa Mohamed and Barsom, Sabah Naguib and Ali, Mohamed Mohsen Mohamed}, title = {Evaluation of Efficacy of Ultrasound Guided Paravertebral Nerve Block as Postoperative Analgesia in Abdominal Surgeries}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5056-5061}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10469}, abstract = {Background: abdominal surgeries requires either general or regional anesthesia. Normally, general anesthesia needed for abdominal surgeries consists of a mixture of neuromuscular blockers, opioids and inhalation anesthetics. Airway control can be achieved by either endotracheal intubation or laryngeal mask. Regional anesthesia can be used alone in abdominal surgeries or in combination with general anesthesia. If regional anesthesia is used alone then effective sedation is required. Pulmonary functions impairment has a higher incidence of happening in upper abdominal surgeries than non-abdominal and non-thoracic surgeries. Intraoperative patient’s ventilation is closely related to the amount of the analgesics received give that depression of ventilation and excessive sedation should be avoided. The postoperative length of hospital stay prolongs after major gastro-intestinal surgeries due to immobility, pain and gastric immobility and that’s why postoperative pain control is essential to speed up mobility and gastro-intestinal functions. Objectives: the aim of this study was to evaluate the efficacy of ultrasound-guided paravertebral nerve block as postoperative analgesia in abdominal surgeries. Patients and Methods: a total of 64 patients were assessed for eligibility to our study, but two patients not meeting inclusion criteria and other two patients were declined to participate so four patients were excluded from the study. Sixty ASA physical status I and II patients of both sex, 18-60 years old, undergoing abdominal surgery in surgical operating theater of El-Sheikh Zayed Specialized hospital and Ain-Shams Surgery hospital, who fulfilled the inclusion criteria, had been enrolled in the study. All enrolled patients have already completed the study. Those patients were randomly allocated into two groups, 30 patients each. Results: demographic data including (age, gender and type of operation) did not show any statistically significant difference between the two studied groups with P=0.176 for the age and P =1.0 for the gender and the type of operation. Patients’ characteristics included age, sex, ASA score and type of operation. There was no significant difference in the demographic data of the two groups of the study.  The mean age was 49.9 year in the Paravertebral block group, while the mean age was 47.6 year in the control group. The females’ count in group A and group B exceed the males’ amount with 20% and 6.66% respectively. According to the ASA classification, both groups have 60% classified as ASA-1 and 40% as ASA-2. In this study, four types of operations are done, Lap-cholecystectomy, Umbilical Hernia, Appendectomy and Inguinal Hernia. Conclusion: this study proved that PVB provided better postoperative pain control, fewer opioids consumption, less postoperative nausea and vomiting compared with other analgesic treatment strategies, indicating that a postoperative PVB is a feasible and an effective method for an improved postoperative pain treatment after abdominal surgery. The current study concluded that there was a significant difference in post-operative period regarding morphine consumption between PVB group and control group with the mean of total morphine consumption 0.9 and 6.9 respectively, with the P-value < 0.001.}, keywords = {Ultrasound Guided Paravertebral Nerve Block,Postoperative Analgesia,Abdominal surgeries}, url = {https://ejhm.journals.ekb.eg/article_10469.html}, eprint = {https://ejhm.journals.ekb.eg/article_10469_b01c144a6bc4a9fe5e26ab15172002ab.pdf} } @article { author = {Mustafa, Mansour and Abo El Magd, Mohamed Sarhan El Sayed and Aly Farh, Ahmed Ramadan}, title = {Comparison of the Accuracy of Three Algorithms in Predicting Accessory Pathways among Adult Wolff-Parkinson-White (WPW) Syndrome Patients in our Population}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5062-5066}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10470}, abstract = {Background: after the introduction of catheter ablation of atrioventricular accessory pathways (APs) in Wolff-Parkinson-White (WPW) syndrome, to facilitate planned ablation and minimize catheter-related injury, predicting the AP was required. Localization of APs can be anywhere around the atrioventricular (AV) annuli, left- or right-sided, or within the septum or a rare possibility of Mahaim fibers. Objective: to compare between three algorithms in their accuracy in predicting the exact site of accessory pathway. Patients and Methods: one hundred patients with manifest pre-excitation who underwent electrophysiological study (EPS) and successful ablation of accessory pathway who were subjected to history taking, complete physical examination stressing on 12-lead of pre-excited electrocardiogram (ECG). Results: the distributions of the accessory pathway with left lateral accessory pathway being the most prevalent (27%) while the postero-lateral being the least prevalent one (2%) and that Right-sided accessory pathway was most frequently predicted by Arruda algorithm in 31% of patients and least frequently predicted by D’Avila in 17% of patients while its actually present in 23% of patients according to the EP study, Left-sided accessory pathway was most frequently predicted by D’Avila (61%) and least frequently predicted by Arruda (49%) whereas it was truly present in 51% of patients according to EP study. Mid and antero-septal accessory pathways were most frequently predicted by Chiang and least frequently predicted by Arruda while it was present in 26% of cases proved by EP study. In all algorithms, 72 % of predictions were correct for Chiang, 81 % for D’Avila, and 71 % for Arruda and the percentage of predictive accuracy of all algorithms did not differ between the algorithms (p=1.000; p=0.076; p=0.064, respectively) The best algorithm for prediction of right-sided and left-sided accessory pathways was D’Avila (p<0.001). The best algorithm that is particularly useful in predicting antero-septal and mid-septal accessory pathways was Chiang (p<0.001). Conclusion: prior knowledge of the AP location allows better planning, faster and safer procedure, as well as decreased exposure to ionizing radiation and unnecessary punctures. In all algorithms, 72% of predictions were correct for Chiang, 81% for D'Avila, and 71% for Arruda and the percentage of predictive accuracy of all algorithms did not differ between the algorithms (p=1.000; p=0.076; p=0.064, respectively). The best algorithm for prediction of right-sided and left-sided accessory pathways was D'Avila (p<0.001). The best algorithm that is particularly useful in predicting anteroseptal and mid-septal accessory pathways was Chiang (p<0.001).}, keywords = {WPW,Accessory pathway,electrophysiological study}, url = {https://ejhm.journals.ekb.eg/article_10470.html}, eprint = {https://ejhm.journals.ekb.eg/article_10470_f662a37915595b224daf43045f049fce.pdf} } @article { author = {Abo-Gamra, Sherif H. and sheha, Aliaa S. and Abd-Elhafez, Alaa S. and Thabet, Marian A.}, title = {Role of Magnetic Resonance Imaging in diagnosis of Endometriosis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5067-5071}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10471}, abstract = {Background: Endometriosis is defined as the presence of functional endometrial glands and stroma outside of the uterine cavity. Although laparoscopy is the standard of reference for diagnosis of endometriosis, reliable identification of the disease before laparoscopy would aid the gynecologist in choosing the preferred therapeutic approach, medical or surgical. Ultrasound is performed initially, but MRI is increasingly being used, particularly when sonographic findings are unclear, when deep pelvic endometriosis is suspected or when surgery is planned. Objective: This study aimed to evaluate the accuracy of Magnetic Resonance Imaging in diagnosis of Endometriosis. Patients and Methods: 30 Premenopausal female Patients with clinical and/or sonographic suspicion of endometriosis underwent pelvic MRI. All our imaging results were finally compared to the laparoscopic results with histopathologic verification which was our gold standard. The main outcome parameters, The Sensitivity, Specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of MRI in diagnosing endometriosis were calculated. Results: The Sensitivity, Specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of MRI in diagnosing endometriosis were 95.65%, 57.14%, 88%, 80%, 86.7% respectively. Conclusion: MRI is the best problem-solving tool as in cases of indeterminate adnexal findings on sonography, when deep infiltrating endometriosis is suspected, or for presurgical mapping.}, keywords = {Endometriosis,MRI,Pelvis,Ultrasound,Laparoscopy}, url = {https://ejhm.journals.ekb.eg/article_10471.html}, eprint = {https://ejhm.journals.ekb.eg/article_10471_daf5cc99ae528b433591071751d25a77.pdf} } @article { author = {Ahmed, Heba A. and El-Shahawy, Ahmed A. and Sammour, Hazem M.}, title = {Effect of immediate versus early oral hydration on caesarean section postoperative outcomes: a randomized controlled trial}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5072-5078}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10472}, abstract = {Background: Caesarean sections are increasing in number dramatically all over the world. So, it became very important to give more attention for their postoperative care. Objective: to evaluate the effect of immediate oral hydration initiated within 2 hours after uncomplicated Caesarean Section on the following post-operative outcomes: post-operative vomiting and abdominal distention, post-operative nausea and abdominal pain, the return of intestinal movements, duration of intravenous fluid administration, duration of hospital stay and participant satisfaction. Methods: this randomized controlled study was conducted at Ain Shams University Maternity Hospital. It was carried during the period from July 2016 to July 2017. 140 women, all of them underwent uncomplicated Cesarean Section under regional anesthesia were randomly assigned into two groups. In the immediate group: oral hydration was received in the first 2 hours postoperatively, and in the early group: oral hydration was received after 8 hours postoperatively. Results: all the results of the postoperative outcomes of both groups had non-significant differences except for the psychological satisfaction which was significantly higher in the immediate group with a (p<0.001). Conclusion: immediate oral hydration group showed non-significant differences comparing with early oral hydration group regarding most of the postoperative outcomes, but the results were relatively better towards the immediate group. Also, immediate hydration is significantly better than early hydration regarding psychological satisfaction of women, allowing them to be more able to breastfeed their kids and to spend a less stressful time in the hospital.}, keywords = {Immediate/Early Oral Hydration,cesarean section,postoperative outcomes,Vomiting,Nausea}, url = {https://ejhm.journals.ekb.eg/article_10472.html}, eprint = {https://ejhm.journals.ekb.eg/article_10472_5732cf71b05cfc10c209559efc58e7de.pdf} } @article { author = {Bastawy, Mohamed and El-Sheety, Anwar Gomaa and Abd El-Aleem, Ahmed and El-Dessouky, Yasser M. M. and Rabie, Ayman and Hegab, Sherif Mohammad El-sayed Amine}, title = {The Role of Fibroscan as a Non-Invasive Predictor for Oesophageal Varices in Post HCV Cirrhotic Egyptian Patients With or Without Bilhariziasis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5079-5085}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10473}, abstract = {Background: Development of oesophageal varices is a major complication that may occur in up to 90% of cirrhotic patients. The endoscopic screening is an invasive procedure. This is why the selection of patients with large oesophageal varices at high risk for bleeding has become an issue of growing importance. In this respect, several clinical, biochemical, ultrasonographic and elastrogarphic (transient elastography-TE) methods have been proposed (and some of them validated) as noninvasive alternatives to endoscopy. Objectives: It was to evaluate transient elastography by fibroscan in the prediction and determination of the grade of esophageal varices in cirrhotic patients due to chronic hepatitis c virus (HCV) infection with or without bilharziasis. Patients and Methods: Sixty Egyptian patients with body mass index (BMI) <35, no history of: upper gastro-intestinal tract (GIT) bleeding, hepatocellular carcinoma, moderate and tense ascites or any other cause of liver cirrhosis. The patients were divided into two groups: Group I included thirty patients with liver cirrhosis due to HCV infection only. Group II included thirty patients with liver cirrhosis due to HCV infection associated with bilharziasis. The patients were subjected to: 1) Thorough history taking. 2) Detailed clinical examination. 3) Laboratory tests. 4) Abdominal ultrasound. 5) Rectal snip for diagnosis of bilharziasis. 6) Upper gastrointestinal endoscopy. 7) fibroscan. Results: Regarding fibroscan in both groups, the mean values of fibroscan were lower in patients without esophageal varices than patients with esophageal varices or with large esophageal varices with statistically high significant differences (p<0.01). Regarding fibroscan in group I, the mean values of fibroscan were lower in patients without esophageal varices than patients with small esophageal varices with statistically high significant differences (p<0.01). But in group II, the mean values of fibroscan were lower in patients without esophageal varices than patients with small esophageal varices with statistically non significant differences (p > 0.05). In both groups, the mean values of fibroscan were lower in patients with small esophageal varices than patients with large esophageal varices with statistically non significant differences (p > 0.05). Conclusion: fibroscan is valuable in predicting the presence of esophageal varices and large esophageal varices in patients with post HCV liver cirrhosis with or without bilharziasis but couldnot predict the grade of esophageal varices.}, keywords = {FibroScan,Liver Stiffness,Esophageal varices,Grading,Non-invasive methods,Liver cirrhosis}, url = {https://ejhm.journals.ekb.eg/article_10473.html}, eprint = {https://ejhm.journals.ekb.eg/article_10473_3bd202df5a9e090a8d859976799e3ec7.pdf} } @article { author = {Sabry, Alaa Abbas and El Fouly, Mohamed Gamal and Fawzy, Mohamed Walaa El Dien}, title = {Leak after Laparoscopic Cholecystectomy; Incidence and Management}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5093-5098}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10576}, abstract = {Background: laparoscopic cholecystectomy is currently the procedure of choice for symptomatic gallstones. It has evolved from an innovative, but time-consuming, novelty to a routine day-case procedure over the last 20 years. Purpose: to estimate the incidence and management options of post laparoscopic cholecystectomy biliary leaks. Also, it is a trial to advocate a minimally invasive structured management protocol to treat patients with bile leak. Patients and Methods: this study was a case series of 100 patients who underwent laparoscopic cholecsystectomy. We didn’t include patients who had: Biliary leak post Laparoscopic converted to open cholecystectomy. Biliary leak due to other procedures. Biliary leaks managed by open surgery. Biliary injuries discovered and definitively managed intra-operatively. The included patients presented to the General Surgery Department at Manshyt El Bakry General Hospital. Patients’ age ranged from 12 to 65 years and patients’ sex was distributed as 78 females and 22 males. Results: in our cases there were two out of the 100 patients suffered from biliary leak ,one of the two cases that were presented with biliary leak after surgery was due to direct injury to accessory duct of Luschka and the other one was due to a slipped clips. Conclusion: cholecystectomy is the most frequently performed abdominal operation in the United States, with currently over 700,000 cases occurring per year. Bile leak as a result of cholecystectomy is uncommon. The frequency in large series is less than 2% and in our study it was exactly 2%. And the treatment of that leak varies from conservative treatment to ERCP and stent insertion like we did.}, keywords = {Laparoscopic cholecystectomy,Endoscopic Biliary Sphincterotomy,Endoscopic retrograde cholangiopancreatography}, url = {https://ejhm.journals.ekb.eg/article_10576.html}, eprint = {https://ejhm.journals.ekb.eg/article_10576_353ae7de612e78567d01feb1f78ba92f.pdf} } @article { author = {Mostafa, Yasser and Abd Elfattah, Nevine and Mohammed, Rehab M. and Roshdy, Lobna and Ibrahim, Mahmoud}, title = {Value of Broncho-Alveolar Lavage in Diagnosis of Newly Developed Lung Infiltrates in Mechanically Ventilated Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5099-5105}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10577}, abstract = {Background and Objectives: in a developing country, cost effectiveness is an important consideration. The aim of this study was to investigate the efficiency and safety of mini broncho-alveolar lavage (mini BAL) samples in the diagnosis of newly developed lung infiltrates in mechanically ventilated patients. Methods: fifty mechanically ventilated patients with newly developed lung infiltrates were assessed by mini-BAL and subsequent microbiological examination. An infant Ryle catheter FG-10 was used as the inner catheter, a Nelaton catheter size 18 FG was used as the outer protective catheter and was blocked by sterile K-Y gel instead of the pre-packaged catheters. Results: eighty six percent of samples collected by Mini-BAL technique from mechanically ventilated patients showed positive growth for culture and sensitivity. Thirty percent of patients had bi microbial infection while fourteen had polymicrobial infection. Fungal infection (Candida) was the most frequent isolated pathogen (32%) followed by Gram-negative bacteria (Klebsiella) (30%). Legionella was the commonest isolated atypical bacteria. Conclusion: this study highlighted the mini-BAL technique as a simple, safe, cheap, available and non-invasive bedside procedure for acquiring uncontaminated lower respiratory secretions in patients with newly developed pulmonary infiltrates.}, keywords = {Broncho-Alveolar Lavage,Newly Developed Lung Infiltrates,Mechanically Ventilated Patients}, url = {https://ejhm.journals.ekb.eg/article_10577.html}, eprint = {https://ejhm.journals.ekb.eg/article_10577_d798167afd47306886f350f66975ba9f.pdf} } @article { author = {Farag, Abd Elhakim Abd Allah and Hegazy, Galal Mohamed Mansour and El Sharnoby, Islam Ahmed Mohamed}, title = {Fixation of Lateral Humeral Condyle by Screw in Children}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5106-5109}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10578}, abstract = {Background: fractures of the lateral condyle of the humerus represent the second most common type of fracture of the elbow in children. Although this injury is seen at all ages, it is predominately observed in children aged between 5 and 10 years. These injuries are typically the result of an avulsion of a portion of the humeral condyle by pull of the extensor musculature due to a varus force on a supinated forearm or by the direct force of the radial head onto the condyle in the setting of a fall and axial load through an extended elbow.  Objective: the purpose of this study was to evaluate the results of fixation of lateral humeral condyle by screw in children by assessment of time to full union, range of motion, and percentage of complications according to Hardacre criteria. Patients and Methods: a randomized prospective interventional study aiming at evaluating of open reduction and fixation of lateral humeral condyle by screw. Our series was conducted in Wadi El- Natroun   hospital in the period from February 2017 to December 2017; 15 patients with pediatric lateral condyle fractures cases operated with open reduction internal fixation by partially serrated 4.0 o. Mean follow up was 6.8 months. Results: we compared our results with the results of the studies in literature, which used screw fixation in management of pediatric lateral condyle fracture. Conclusion: the current follow-up is insufficient to determine whether growth disturbance may be problematic. One other important consideration when screw fixation is utilized is the additional cost of a secondary procedure for screw removal and the medulla of children is small which may lead to the screw crosses the olecranon fossa. }, keywords = {fixation,Lateral,Humeral Condyle}, url = {https://ejhm.journals.ekb.eg/article_10578.html}, eprint = {https://ejhm.journals.ekb.eg/article_10578_630f8aa597ef02245ed0592bf38c7b3c.pdf} } @article { author = {ELaidy, Naglaa A. and Elsalahy, Eman M. and Sayed, Marwa M. and Mahmoud, Mahmoud A.}, title = {Assessment of Non Coding RNA Expression as a Potential Stem Cell Biomarker in Breast Cancer}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5110-5115}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10579}, abstract = {Background: worldwide, breast cancer is the most common malignancy among women and there is a deep need for precise novel methodologies for breast cancer (BC) diagnosis. Major advances in cancer control will be successfully achieved with early cancer detection. So, recent trends are going toward using circulating non-coding RNA as diagnostic tool for their critical role in cancer detection. Aim: retrieve non coding RNA that is mechanistically linked to breast cancer stem cell with validation of the results in a group of breast cancer patients versus control groups to evaluate their usefulness as a potential biomarker in breast cancer diagnosis. Patients and Methods: we retrieved LncRNA that is linked to stem cell differentiation and specific to BC utilizing bioinformatics tools. Then we validated this biomarker in serum of 30 patients with BC, 12 patients with benign breast lesion and 12 healthy volunteers using RT-qPCR. We evaluate the power of diagnosis of the serum profiling system using ROC curve analysis. Results: hoxd antisense growth-associated long non coding RNA (HAGLR) had great sensitivity and specificity for differentiating BC from patients with benign breast lesion and also from healthy controls. Conclusion: the chosencirculatory RNA based biomarker can be used as a potential diagnostic biomarker for BC. In addition it could be therapeutic target.}, keywords = {breast cancer,long non coding RNA,Bioinformatics,Diagnosis}, url = {https://ejhm.journals.ekb.eg/article_10579.html}, eprint = {https://ejhm.journals.ekb.eg/article_10579_163a04434722ce17b1229b01f5c08041.pdf} } @article { author = {Mansour, Howaida El Sayed and Allam, Mohamed Farouk and Hosny, Sherin Mohamed and Abdu, Amira Ibrahim}, title = {Inflammatory Bowel Disease in Systemic Lupus Erythematosus Patients: A Meta-analysis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5116-5121}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10580}, abstract = {Background: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with features of multisystem involvement, relapsing and remitting course. Gastrointestinal system affection is common in Lupus patients but coexistence of the inflammatory bowel disease (IBD) and SLE is rare. The coexistence of signs and symptoms of both diseases in the same patient represents a diagnostic challenge. Diagnoses of both diseases is difficult as both may share the same gastrointestinal features. Some of the therapies used in IBD may induce lupus. Aim of the study: To detect the presence of IBD in SLE patients. Methods: Only19 studies investigating the coexistence of IBD in SLE patients were published from January 2000 to March 2017 searching the Medline, PubMed, Ovid, Trip and Cochrane database. We excluded 16 studies (case reports) as they lacked the inclusion criteria for the meta-analysis. Only three studies were included in this systematic review. The prevalence/frequency and its 95% CI are included or estimated whenever possible. Results: Most of the studies that detected a statistical association between both diseases were case series and case control study that revealed the presence of IBD in some lupus patients. Criteria for the diagnosis of SLE cases and IBD cases were clearly explained in these studies, and same stratified results according to gender. The pooled results of all cases with SLE were (total 6665) showed that, there were IBD cases (total 79) associated with lupus with a frequency (95% CI) is 1.19% (0.96-1.48). Conclusion: The prevalence of IBD in SLE patients is rare however, the coexistence of both diseases in the same patient could occur.}, keywords = {Systemic lupus erythematosus,inflammatory bowel disease,Crohn’s disease,ulcerative colitis,coexistence,gastrointestinal symptoms}, url = {https://ejhm.journals.ekb.eg/article_10580.html}, eprint = {https://ejhm.journals.ekb.eg/article_10580_4c2eae9124bbe64b44e65b8f072bd365.pdf} } @article { author = {Ibrahim, Ahmad Aboelkassem and Moustafa, Reda M. and Moustafa, Ashraf Abdulmoghni and EL-Rabaa, Saleem and Salama, Yahya}, title = {Enhanced Recovery Program (ERP) versus Traditional care after Elective Left Side Colorectal Cancer Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5122-5129}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10582}, abstract = {Aims: We aimed to study the effect of ERAS protocol after left side colorectal cancer surgery in comparison with patients  were subjected to traditional care. Methods: Retrospective study comparing 2 groups of patients who underwent elective left side colorectal cancer surgery. Group A: 25 patients admitted between November 2014 and April 2015 subjected to ERAS, and Group B: 25 patients admitted between January 2008 and August 2008 received traditional care. Both groups were consecutive cases. The notes were examined to determine the following outcome measures: Short-term morbidity, Length of stay, 30 days Readmission rate and Mortality. Results: 25 patients with ERAS matched with 25 traditional recovery cases for baseline demographics. 96% started oral fluids on D1 in group A compared to  8%  in group B, 96% in group .  A tolerated full diet on D6 compared to 72% in group B. Bowel movements by D5 was group A 92% compared to only 36%  in group B. Total LOS mean for group A was 7 days vs 12.48 in group B (p=0.005). Complications occurred less frequently in group A compared to group B (anastomotic leak with 8% (n=2) in group A versus 16% (n=4) in group B, prolonged ileus with 8% (n=2) in group A versus 16% (n=4) in group B (p = 0.663). Mobility on D1 40% (n=10) in group A was an independent factor which decreased LOS, as all stayed< 5 days (p=0.002) and developed less complications (4% (p=0.027)). Conclusion: ERAS didn’t affect complications rate significantly following left side colorectal surgery, however reduced LOS as it improved tolerating oral intake and bowel movement. Mobility D1 can be independent pridector of reduced both complications and LOS and should be encouraged for all patients.}, keywords = {inhanced recovery program,traditional care,colorectal cancer surgery}, url = {https://ejhm.journals.ekb.eg/article_10582.html}, eprint = {https://ejhm.journals.ekb.eg/article_10582_dc15f254b9e858854ba2b1a70e400a36.pdf} } @article { author = {Hewedi, Kamel M. and Mohamed, Wael O. and Mostafa, Amr A. and Zaki, Mohamed A. and Mansour, Fathy M.}, title = {Effect of interictal epileptiform EEG discharges on cognitive functions in epileptic children}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {8}, pages = {5130-5136}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10583}, abstract = {Background: Epilepsy is a chronic disorder of the brain that affects people of all ages Neuropsychological impairment is an important comorbidity of chronic epilepsy in the majority of children with epilepsy. interictal epileptiform EEG discharges may present as a complicating factor in spite of being seizure free. In a group of children with interictal EEG discharges there is sudden and unexpected decline of school performance as the first symptom of epilepsy. Consequently, accumulating cognitive impairment, and even a decline in IQ scores, is reported in epileptic children with frequent episodes with epileptiform EEG discharges. Aim of the Work: To evaluate the possible relationship between interictal EEG discharge and cognitive    function in a sample of Egyptian epileptic children. Patients and Methods: The ethical approval was obtained from the Hospital Ethical Research Committee. Each patient and/or parents entering the study signed an informed consent. This study was conducted on 140 children selected from Epilepsy Outpatient Clinic of Al-Azhar University Hospitals during a period of two years starting from June 2016 untill June 2018. A specialized pediatric neurology sheet was taken. EEG and cognitive assessment of epileptic patients with and without epileptiform EEG discharges using Stanford-Binet intelligence scale and P300 by ERP were performed to each patient two times 3 months in between. Results: we found that patients with frequent IEDs had high mean P300 latency and low IQ when compared to patients with infrequent and normal EEG examination. In addition, the mean p300 latency significantly reduced with rising in IQ (more improvement in cognitive function) after disappearance of IED in some patients. Conclusion: Interictal epileptiform EEG discharge had an additional effect on cognitive function especially if generalized and of high frequency. This effect might be often underestimated and might accumulate, and have a severe cognitive impact. So, treatment of epileptic patients should put in concern reduction or even treatment of IEDs as controlling of these IED lead to improvement of cognition.}, keywords = {Epilepsy,interictal epileptiform discharge,Cognition}, url = {https://ejhm.journals.ekb.eg/article_10583.html}, eprint = {https://ejhm.journals.ekb.eg/article_10583_21986d1e55e6e15829d1c31839eb2133.pdf} }