@article { author = {Al Saeed, Mohammed}, title = {Popliteal Vascular Injuries}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {467-474}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23185}, abstract = {Background: Injury of the popliteal vessels is one of the most limb-threatening peripheral vascular injuries. The high morbidity after popliteal vascular injury can be explained by the fact that the popliteal artery is an end artery with an insufficient collateral supply; in addition, the popliteal vein provides the bulk of lower leg and foot drainage. Delays in diagnosis and interference in addition to associated complex tissue injuries would be associated with high amputation rate. However, high level of suspicion with early recognition and management by multidisciplinary team are necessary to optimize limb salvage. The aim of this review is to discuss the different factors that may affect the morbidity, incidence, presentation and diagnostic tools, various management options, and outcome of popliteal vascular injury. }, keywords = {popliteal trauma,vascular injury,Outcome}, url = {https://ejhm.journals.ekb.eg/article_23185.html}, eprint = {https://ejhm.journals.ekb.eg/article_23185_8dd85c3a00baccf94a5ab3ad995ce57e.pdf} } @article { author = {Al-Saeed, Mohamed and Saleh, Hossam M}, title = {Early and Mid-Term Results of Treatment of Superficial Venous Insufficiency of the Lower Extremity Using Endovenous Laser Therapy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {475-481}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23186}, abstract = {Background and aim of the study: Endovenous laser ablation (ELA) has become an important procedure to treat saphenous vein reflux. In this study the early and mid-term results of endovenous laser ablation of the long or/and short saphenous veins (ELAS) will be evaluated. Patients and methods: This prospective study was conducted from March 2010 to December 2016. The study enrolled 35 symptomatic patients with unilateral or bilateral superficial venous insufficiency (CEAP; 2-6) with documented reflux in long saphenous, short saphenous, or both veins by duplex ultrasound. Results: Thirty five patients were enrolled in this study, 30 women with mean age 35.5± 8.2 years and 5 men with mean age of 32.2± 7.8 years.  ELAS was performed in 52 limbs 9 of them had ulcers. Early postoperative clinical and ultrasound examination revealed complete ablation of the targeted veins (100%) with no reflux. Great saphenous alone was ablated in 76.9% of limbs, short saphenous in 13.5%, and both 9.6%. Postoperative complications were minimal, well tolerated, and completely resolved within 3-27weeks with treatment. In 88.9% of limbs with active ulceration, healing occurred after a mean of 6.6±1.6 months. Only 61.5% of legs (including all ulcer patients) were followed up for 49.5±11.3 months; recorded recanalization by duplex ultra sound was 0%, 10.3%, and 20.8% after 1, 3, and 5 years respectively. Recanalization was insignificantly higher in long than short saphenous veins. The recorded recurrence of ulcers after 1, 3, and 5 years of follow up was 0%, 12.5%, and 40% respectively. Conclusion: endovenous laser ablation of the saphenous veins is safe and has excellent early and mid-term outcomes for treatment of superficial venous insufficiency with or without ulceration of the lower extremities.}, keywords = {Endovenous laser ablation,saphenous veins,venous insufficiency,varicose veins,venous ulcer}, url = {https://ejhm.journals.ekb.eg/article_23186.html}, eprint = {https://ejhm.journals.ekb.eg/article_23186_2636f3b47fc4abac6e60f4a01e26c11e.pdf} } @article { author = {Khalil, Hisham Fawzy and Hodaib, Ahmed Elsayed and Elsaeid, Ahmed Younis}, title = {Optical Coherence Tomography Angiography Study for Evaluation of Microvascular Changes in the Subclinical Diabetic Retinopathy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {482-490}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23187}, abstract = {Background: diabetic retinopathy is the specific microvascular complication of diabetes mellitus and affects 1 of 3 with DM. DR remains a leading cause of vision loss in working adult population. Patients with severe levels of DR were reported to have poor quality of life and reduced physical, emotional and social well-being, and they utilize more health care resources. Objective: this study aimed to evaluate the vascular density, perfusion density and foveal avascular parameters changes in subjects with diabetes mellitus showing no manifestations of diabetic retinopathy using optical coherence tomography angiography. Methods: 40 subjects were categorized into two groups, group A for healthy subjects and group B for the diabetic subjects. HbA1c, renal functions, liver functions and lipid profile were obtained from each individual. Best corrected visual acuity were obtained from each individual and each were subjected to full ophthalmic examination, IOP measurement, fundus fluorescein angiography FFA, Optical Coherence Tomography OCT and Optical Coherence Tomography Angiography OCTA. Results: statisticallysignificantdifferenceswerefoundbetweenthehealthygroupand the diabeticgroupin OCTA parameters. Full vascular density VD significantly decreases in the diabetic patients even in those showed BCVA ≥ 0.7 and totally intact FFA and OCT (P>0.001). Perfusion density PD also was significantly decreased in the diabetic patients (P>0.001). Foveal avascular zone showed significant changes in area value and perimeter, however the circularity changes were statisticallyinsignificant.Conclusion: using OCTA was proven to be clinically significant in differentiating healthy eyes from diabetic eyes that showed no clinically acceptable hallmarks. So, that the term “Subclinical diabetic retinopathy” was suggestible to refer to a clinical state where the FAZ metrics, vascular density and perfusion density showed a particular deviation from the normal healthy parameters.}, keywords = {OpticalCoherence Tomography Angiography,diabetic retinopathy}, url = {https://ejhm.journals.ekb.eg/article_23187.html}, eprint = {https://ejhm.journals.ekb.eg/article_23187_e28309e7138e760cee2feb987501907e.pdf} } @article { author = {Mahfouz, Karima Abd-elhalim and Hablas, Hatem Refaat and Hashish, Mahmoud Abdellatif and Sokkar, Mohammed}, title = {Effect of perinatal risk factors on coagulation system in premature infants}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {491-496}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23188}, abstract = {Background: neonates have different blood clotting and fibrinolytic activities from the adults. Compared with full-term infants, premature infants are more prone to bleeding diathesis after birth, such as intracranial hemorrhage and pulmonary hemorrhage. The defective coagulation factors in premature infants contribute to predisposition of bleeding in premature infants. Objective: it wasto assess the hemostatic profile by screening tests in preterm infants with perinatal risk factors. Patients and Methods: the study was conducted on 90 subjects, 30 preterm with risk factors, 20 preterm without risk factors, 30 full term and 10 adults. All of them were subjected to full clinical history, examination and routine investigation including CBC, prothrombin time, activated partial thromboplastin time, thrombin time and fibrinogen concentration. Results: the results of this study revealed a prolongation in the PT, APTT and TT together with a lower fibrinogen concentration in the group of preterm without risk factors in comparison with the group of full term and adult and revealed that there is more prolongation in the PT, APTT and TT together with more decrease in fibrinogen concentration in the group of preterm with risk factors in comparison with the group of preterm without risk factors, full term and adult but there is no significant difference between full term and adult as regard PT, APTT, TT and fibrinogen concentration. Conclusion:  preterm infants without perinatal risk factors show a lower hemostatic profile when compared with healthy full term and adult. Preterm infants with perinatal risk factors show more decrease in hemostatic profile when compared with healthy full term and adult. Perinatal risk factors (preeclampsia, diabetes and urinary tract infection) seem to interfere with coagulation protein synthesis.}, keywords = {Perinatal risk factors,preterm infants,fibrinogen concentration,thrombin time,coagulation system}, url = {https://ejhm.journals.ekb.eg/article_23188.html}, eprint = {https://ejhm.journals.ekb.eg/article_23188_951e2639b99c5ff8b1bfedf97f0e728f.pdf} } @article { author = {Zakaria, Abd-Elmonem M. and Mohammed, Mofeed F. and Shehab, Abdelhakeem O.}, title = {Relation between Lactate in Vaginal Fluid and Time to Spontaneous Onset of Labour for Women with Suspected Prelabour Rupture of the Membranes}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {497-503}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23189}, abstract = {Background: investigation of the relationship between lactate level in vaginal fluid and the latent phase of labour in pregnancies is complicated by preterm premature rupture of membranes (PPROM). To assess whether lactate determination in vaginal fluid can predict, onset of labour for women with suspected prelabour upture of the membranes (PROM). Patient and Methods: 110 pregnant women with history of PPROM recruited from the outpatient clinic and emergency room in EL Hussein Hospitals and Om El Masreen Hospital during the period from February 2018 till August 2018. All women underwent sterile speculum examination; then 5 ml of sterile saline solution was injected in the posterior vaginal fornix using a sterile speculum and 2ml of the injected saline was withdrawn with the same syringe for lactate Measurement. Results: the best cutoff point of vaginal fluid lactate concentration as a predictor of onset of labor within 48 hours after PPROM was 4.7 mmol/L above which the onset of labor within 48 hours was likely with a sensitivity of 95.4%, specificity of 91.3%, a positive predictive value of 97.7%, a negative predictive value of 84%, an overall accuracy of94.6%, a positive LR of 10.97 and a negative LR of 0.05. Conclusion: lactate determination in vaginal fluid seems promising as a tool to predict onset of labor within 48hours in women with PPROM. The best cutoff point of vaginal fluid lactate concentration as a predictor of onset of labor within 48 hours after PPROM was 4.7 mmol/L.}, keywords = {amniotic fluid,Lactate,PROM,spontaneous onset of labour}, url = {https://ejhm.journals.ekb.eg/article_23189.html}, eprint = {https://ejhm.journals.ekb.eg/article_23189_0a65275273c24cee9ecc1ff99b4516a0.pdf} } @article { author = {Sharaf, Mohamed Fathy and Ghalwash, Eslam Taha and Elkelany, Mohammed}, title = {Comparative Study between the Complications of Sleeve Gastrectomy versus the Complications of Gastric Bypass}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {504-510}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23190}, abstract = {Background: obesity means having too much body fat. Causes of obesity includes: diet, sugar overload, genetics, insufficient sleep, social determinants, environment, and stress. Complications of obesity includes: type II diabetes mellitus, heart diseases, metabolic syndrome, hyperlipidemia, respiratory diseases, male sexual dysfunction, neurological diseases, gastrointestinal diseases, rheumatic diseases, urological diseases, psychological abnormalities, trauma, pancreatic diseases, gall bladder diseases, diverticulitis and hernia. Sleeve gastrectomy is an excellent procedure for management of morbid obesity. Complications of Sleeve gastrectomy includes: Hemorrhage, leakage, nutritional deficiencies, ineffective EWL and weight regain, cholelithiasis, stenosis, gastroesophageal reflux disease GERD and hiatus hernia, gastric torsion, gastro-bronchial fistula and venous thrombosis. Complications with Roux-en-Y Gastric Bypass includes: Hemorrhage, leakage, nutritional deficiencies, ineffective excess weight loss EWL and weight regain, trocar site hernia, cholelithiasis, dumping syndrome, Internal hernia, obstruction of the biliopancreatic limb, intussusceptions volvulous, gastrogastric fistula, marginal ulceration and gastrojejunostomy anastomotic stricture. Aim:To compare complications associated with Sleeve Gastrectomy versus complications associated with open or laparoscopic Gastric Bypass and its effects on patients' life and to know which procedure is better. Patients and Methods: group (A): includes 15 cases underwent sleeve gastrectomy. With inclusion criteria of obese patients with body mass index (BMI) ≥ 40 kg/m2 or BMI ≥ 35 kg/m2with associated co morbidity (hypertension, Diabetes mellitus, hyperlipidemia, arthritis, cardiac diseases, etc.) and exclusion criteria of patients with previous bariatric surgery, previous upper gastrointestinal surgery, hiatus hernias, heavy sweet eaters, drug and/or alcohol addiction, psychiatric disorders and patients >60 years old or <18 years old were excluded and group (B): includes 15 cases underwent gastric bypass with inclusion criteria of obese patients with body mass index (BMI) >40 kg/m2 or BMI > 35 kg/m2 with associated comorbidity (hypertension, Diabetes mellitus, hyperlipidemia, arthritis, cardiac diseases, etc.) and heavy sweet eaters and exclusion criteria of patients with previous bariatric surgery, previous upper gastrointestinal surgery apart from laparoscopic cholecystectomy. Patients with hiatus hernias, drug and/or alcohol addiction, psychiatric disorders and patients >60 years old or <18 years old were excluded. Results: three complications developed with sleeve gastrectomy 20% as follows 1 case of hemorrhage 6.6% , 1 case of leakage 66% and one case of gall bladder stones while gastric bypass complications resembles 2 cases 13.3% as follows:1case of deep venous thrombosis 6.6% and one case of gall bladder stones 6.6%. Conclusion: obesity is a common disease affecting more than 300 million adults worldwide. It is defined as a body mass index greater than 30 kg/m2. The laparoscopic sleeve gastrectomy was adopted as a primary procedure and over time it has become the most popular bariatric operation worldwide and it is effective for weight loss and results in improvement and even resolution of co-morbidities like type 2 diabetes.  Laparoscopic gastric bypass surgery is another safe and simple surgical intervention for treating morbid obesity and diabetes mellitus and is now being performed more frequently Recommendations: both sleeve gastrectomy SG and roux-en-y gastric bypass RYGB are safe, short, simple and effective bariatric operations. Our study showed Roux-en-y gastric bypass has less complication than Sleeve gastrectomy. Further prospective studies have to be applied to a larger number of patients for longer periods of follow up are needed.}, keywords = {Obesity- Sleeve Gastrectomy- Roux-En-Y Gastric Bypass}, url = {https://ejhm.journals.ekb.eg/article_23190.html}, eprint = {https://ejhm.journals.ekb.eg/article_23190_a820464d871890bcf5d74673db0fad74.pdf} } @article { author = {Shaban, Mahmoud M. and Mansy, Mohamed ElSayed and El Shahat, Khaled M.}, title = {Dosimetric Study Comparing Three-Dimensional Conformal Radiotherapy to Intensity Modulated Radiotherapy in Management of Rectal Carcinoma. Retrospective study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {511-516}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23191}, abstract = { Background: the External radiotherapy (EBRT) is the common treatment selection in patients with locally advanced rectum carcinoma. Three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) are most techniques used in radiotherapy. However, which one is superior is all controversial. Patients and Methods: thirty-two patients of RC treated with IMRT were selected for current retrospective study. 3DCRT plans were also plan   for all the patients. 3DCRT plans in compared to   IMRT plans were on the basis of planning target volume (PTV) coverage, dose to normal organs, homogeneity index (HI) and conformity index (CI). Results and Discussions:  in both the planning techniques 98% of PTV was covered with more than 96% of prescribed dose. D 95% 15, D 35 and D (Dose to 15%, 35% and 50% volume respectively) for bladder was reduced by 2.09%, 14.623% and 32.57% in IMRT compared to 3DCRT. V (Volume received 45 Gy also volume received 50.4Gy) and in case of bowel doses were found to be better in IMRT than to 3DCRT.  There is significant difference found between doses to both femoral heads in IMRT and 3DCRT. The CI 95% 45 in IMRT plans was found much better than that in 3DCRT whereas HI in both the techniques were found almost same. Conclusion:  IMRT in better significantly in reduction the irradiated of OAR and improved dose conformity in the PTV compared to that by 3DCRT. So, it can be concluded that IMRT should be chosen as best technique for the radiotherapy of Rectum carcinoma}, keywords = {IMR,Rectal carcinoma,treatment planning,dosimetric comparison,3DCRT}, url = {https://ejhm.journals.ekb.eg/article_23191.html}, eprint = {https://ejhm.journals.ekb.eg/article_23191_d207678c524f75f6fb619fd3053f060e.pdf} } @article { author = {Elke&#039;iy, Mohsen Taha and Hamad, Kamel Suliman and Zahran, Al Hassan Mustafa and Nafady, Haytham Muhammad and Gouda, No&#039;man Al Basiouny}, title = {Pattern and Outcome of Acute Disseminated Encephalomyelitis (ADEM)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {517-523}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23192}, abstract = {Background: Acute disseminated encephalomyelitis (ADEM) is an immune disease marked by widespread of inflammation in the brain and spinal cord. ADEM typically damages myelin, causing destruction of white matter. It often occurs following a viral infection or vaccination. Its symptoms are similar to multiple sclerosis (MS) and are considered part of the multiple sclerosis borderline diseases. Patients and Methods: This is an observational prospective study done in Bab Al-Shariah University Hospital in period between 31th of December 2017 to 30th of December 2018 on children from birth to 18 years old who were having definite ADEM by neuroradiological study of the brain (MRI brain) presented to the Neuropediatric outpatients clinic or inpatients of Pediatric Department during the period of the study. Those with history suggestive of definite perinatal asphyxia or with other congenital malformation of neurological system were not involved in our study. Results: We found that the most common clinical features of ADEM in our community are fever, disturbed conscious level (DCL), motor system weakness and convulsions, and the most valuable tool in diagnosis is brain MRI. These findings are very important in the diagnosis, management and counseling of patients with ADEM. Conclusion: ADEM is an area of active research especially in the field of imaging where there is a rapid development. In future we may have better diagnostic and therapeutic options for ADEM.  }, keywords = {Multiple sclerosis,acute disseminated encephalomyelitis,multiphasic disseminated encephalomyelitis}, url = {https://ejhm.journals.ekb.eg/article_23192.html}, eprint = {https://ejhm.journals.ekb.eg/article_23192_22927ae1006536650be296c99ad43cbd.pdf} } @article { author = {El-Gamal, Abdullah A. and Salama, Omar H. and Hassouna, Adel A.}, title = {Multifocal electroretinogram changes in Egyptians with axial high myopia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {524-533}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23193}, abstract = {Background: high myopia is a global burden that attracted researchers to its consequences. Although, there is few data regarding what high myopia causes to the normally appearing eyes. Effect of high myopia on retinal function can be detected by the multifocal electroretinography, which is capable of measuring and mapping retinal functions. Purpose: to measure changes in retinal functions in response to elongation of the axial length (AL). Patients and Methods: this is a descriptive study in which 15 patients aging 18-40 years with spherical equivalent (SE) of ≤-5 were included. A thorough ocular examination, including but not limited to visual acuity; best corrected visual acuity; anterior segment examination and fundus examination, was done and standard multifocal electroretinogram (mfERG) was performed. The measurements were taken in concentric rings and in quadrants, and then analyzed and statistically compared to normal readings of the matching age group. Results: a total of 30 eyes those were completely normal except for long AL with normal or tessellated fundi. The mfERG showed varying reductions in amplitudes (amp.) as well as elongations of implicit times (Imp.T), of both P1 and N1 components, at almost all rings and quadrants. Conclusion: retinal functions at different layers were significantly affected by extension of the AL, and that increases as the axial length increases. Recommendations: future studies should consider high myopia in normally appearing eye as well as in Egyptians to detect any special pattern of retinal function affection for that ethnicity. }, keywords = {Multifocal Electroretinogram,Axial length,High myopia,retinal function,Egypt}, url = {https://ejhm.journals.ekb.eg/article_23193.html}, eprint = {https://ejhm.journals.ekb.eg/article_23193_4ae81baa175dfa1046c58337357c9163.pdf} } @article { author = {Khoreba, Ahmed Abdel-Monem and El-Sayed, El-Sayed El-Meghawry and Al-Azhary, Sabry Mohamed and El-shreef, Saad El-Deen Mohamed and Emran, Tarek Mustafa and Mohamed, Magdy Ahmed}, title = {The role of immune metabolic mediators (IL-1β, visceral adiposity index and Apo- β lipoproteins) in the pathogenesis of pre-diabetic state in obese persons}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {534-542}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23194}, abstract = {Background: Pre-diabetes is the stage before Diabetes mellitus (DM) there are two forms of prediabetes Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Many inflammatory markers have been found to be related to Pre-diabetes, such as interleukin-1β (IL-1β), visceral adiposity index, insulin resistance, and insulin secretory states and serum levels of Apo- β lipoproteins in the pathogenesis of pre-diabetic state in obese persons. AIM OF THE WORK: To assess the role of Interleukin-1β, visceral adiposity index, insulin resistance, and insulin secretory states and serum levels of Apo- β lipoproteins in the pathogenesis of pre-diabetic state in obese persons. Patients and Methods:  This study is a prospective one that was carried out on one hundred and twenty (120) patients attending to internal medicine outpatient clinic and inpatient department of internal medicine, Al-Azhar university hospital, Damietta. The populations of the study were classified into (60) obese persons and (60) non obese persons. All were subjected to full history and Clinical examination, Laboratory tests include HbA1c, Fasting blood sugar, post prandial glucose level, Liver  Function Test (ALT, AST, serum albumin, bilirubin, and GGT), Renal Function Test (Creatinine, Urea, Uric Acid), Lipid Profile (Cholesterol, Triglycerides, HDL Cholesterol, and LDL Cholesterol) and  High  sensitive  C-reactive proteins, OGTT, Visceral adiposity index based on (WC, BMI,TG, and HDL-C, it estimates the visceral adiposity functionality, Male VAI=(WC/{39.68+(1.88×BMI)})×(TG/1.03)×(1.31/HDL-C), Female VAI=(WC/{36.58+(1.89×BMI)})×(TG/0.81)×(1.52/HDL-C), serum  Interleukin-1β levels and Apo β-lipoproteins. Results: Our study showed that there was statistically significant increase in VAI, IL-1β, Apo- β lipoproteins, ALT, AST, Cholesterol, TG, LDL, HDL, S. insulin, HOMA and HbA1c in group I  in comparison to group III, on the other hand there was statistically significant increase in VAI, IL-1β, Apo- β lipoproteins, ALT, AST, Cholesterol, TG, LDL, HDL, S. insulin and HOMA in group II  in comparison to group IV and there was statistically significant increase in IGT in group I  subjects in comparison to group III subjects. Conclusion: IL-1β and Apo- β lipoproteins consider as a risk factor in the pathogenesis of pre-diabetes in obese persons, which may progress to Diabetes So Therapy targeting IL-1β may ameliorate the condition and VAI is associated with insulin resistance.  }, keywords = {Pre-diabetes,Immune metabolic mediators,IL-1β,Apo- β lipoproteins,VAI}, url = {https://ejhm.journals.ekb.eg/article_23194.html}, eprint = {https://ejhm.journals.ekb.eg/article_23194_a7087ac4c4ff78db1d5b363ab7e1ddb4.pdf} } @article { author = {Hamed, Abdullah Hussein and Bayoumi, Hassan Metwally and Morad, Maged Muhammad Mokhtar}, title = {Comparative study between usage of topical azithromycin versus conventional therapy in treatment of posterior blepharitis causing dry eye}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {543-549}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23195}, abstract = {Background: blepharitis is an inflammatory condition of the eyelid that is usually associated with bacterial infection or some skin conditions (such as dandruff on the scalp, or acne rosacea). Aim of the Work: this study aimedto compare the outcome of using topical azithromycin and conventional therapy in improving signs and symptoms of posterior blepharitis causing dry eye.Patients and Methods: this comparative study was done between usage of conventional therapy and topical azithromycin in treatment of posterior blepharitis causing dry eye. One hundred and twenty eyes of sixty patients of both sexes above age of 18 diagnosed with posterior blepharitis causing dry eye disease are recruited from the ophthalmological clinic of Al-Azhar university Hospitals. Results: the azithromycin group showed a significant improvement of sign, symptoms and investigations over the conventional group in the 2nd visit (after 1 week) while, there was a non significance regarding the 3rd visit after one month of treatment and 3rd after one month of stoppage of treatment. Conclusion: conventional therapy and topical azithromycin are effective on posterior blepharitis causing dry eye disease, azithromycin has more compliance and better tolerability to the patients with sustained effect on the ocular tissue that give it a preference over the conventional therapy. }, keywords = {topical azithromycin,conventional therapy,posterior blepharitis causing dry eye}, url = {https://ejhm.journals.ekb.eg/article_23195.html}, eprint = {https://ejhm.journals.ekb.eg/article_23195_23eddfe6ec89c545db01a35ff17ac3da.pdf} } @article { author = {Aggag, Mohamed Farouk and Shehata, Mohamed Said Abdul Aziz and Badawy, Ziad El Sayed El Sayed}, title = {Role of Magnetic Resonance Cholangiopancreatography in Evaluation of Biliary Obstruction}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {550-557}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23541}, abstract = {Background: obstructive jaundice which is caused by bile duct obstruction can be clinically and biochemically indistinguishable from cholestatic jaundice caused by hepatocellular disease. The management of both these conditions being radically different, the principle task of the radiologist is to differentiate between hepatocellular and obstructive jaundice, by using available imaging modality and help in further management. With the availability of non-invasive modality like magnetic resonance imaging (MRI), it is possible to diagnose obstructive jaundice early and accurately without any patient discomfort. The purpose of this article is to describe the protocol for evaluation of obstructive jaundice with use of magnetic resonance cholangio pancreatography sequence of MRI and to describe the imaging features of the most common causes of obstructive jaundice like biliary calculi, bile duct strictures, choledochal cyst, gall bladder carcinoma, cholangiocarcinoma, primary sclerosing cholangitis, and pancreatic head carcinoma. Aim of work: this work aimed to study and evaluate the role of MRCP in patients with biliary obstruction. Patients and Methods: this study included 30 patients with biliary obstruction during the period from December 2017 to October 2018. MRCP was performed on a 1.5 T MRI system, using a phased-array body coil. Fasting for 4 hours prior to the examination is required to reduce gastro-duodenal secretions, reduce motility to eliminate motion artifacts and to promote distension of gall bladder.For optimum visualization of ducts, acquired images were reformatted in different planes using multiplanar reconstruction (MPR) and maximum intensity projection (MIP). Results: in all cases, MRCP displayed the different parts of the biliary tract and localized the exact site of obstruction in all of the obstructed cases. According to the morphology encountered at the site of obstruction, MRCP was found highly specific in differentiating the calcular, malignant and benign causes of obstruction.  The quality of images were degraded by the presence of massive ascites, marked patient obesity in our study by the instability to hold breath in a reproducible manner. Lack of the therapeutic role and the inability to perform functional studies mainly at the papilla remain the main limitation of the technique. Conclusion: MRCP should be the next step following depiction of biliary obstruction by U/S. Consequently in the near future there will be no place for the diagnostic use of the ERCP which shall be then restricted to a therapeutic role. }, keywords = {MRCP, obstructive jaundice, biliary stricture, cholangiocarcinoma,choledocholithiasis }, url = {https://ejhm.journals.ekb.eg/article_23541.html}, eprint = {https://ejhm.journals.ekb.eg/article_23541_d0e75e525607ee7b63530c9be093bb79.pdf} } @article { author = {Abdelhalim, Nour Elden A}, title = {Corneal Topographic and Biomechanical Changes after Small Incision Lenticule Extraction (SMILE) In Myopic Eyes}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {558-563}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23542}, abstract = {Background: Small incision lenticule extraction (SMILE) offers laser vision correction by using a less invasive technique that creates a lenticule inside the intact cornea. This procedure limits the biomechanical strength of the cornea and reduces flap-induced complications. Purpose: To evaluate outcome, post-operative corneal topographic and biomechanical changes in myopic patients who had undergone SMILE. Methods: The study included 40 eyes of 20 patients treated by SMILE for myopia and myopic astigmatism. Data included uncorrected and best corrected visual acuity (UCVA and BCVA), spherical equivalent (SE), central pachymetry Pentacam (oculus) topography to evaluate changes in keratometric readings (K1 and K2) and asphericity (Q). Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured with ocular response analyzer. Patients were treated and followed for 12 months. Results:  SMILE procedure for the correction of myopia and myopic astigmatism was performed on 40 eyes of 20 patients. There was highly significant difference between pre and postoperative keratometric regarding K1 and K2 was change from 42.9 ± 0.82 and 39.8 ± 1.14 to 43.9 ± 1.21 and 40.5 ± 1.18 respectively (P value <0.001).Corneal resistance factor and hysteresis were also change from 11.55 ± 1.29 mm Hg and 11.68±1.40 mm Hg to 9.47 ± 1.29 mm Hg and 8.49 ± 1.54 mm Hg, respectively) (P < .0001). At the end of follow up UDVA was 20/20 or better in 86 % of eyes. Conclusions: Biomechanical stability with small-incision lenticule extraction has been demonstrated with establishment of myopic and astigmatic corrective ability, so SMILE represents a safe and effective refractive option. The incidence of intraoperative and or postoperative complications remains minimal. Although visual recovery may be slower than LASIK in most cases.}, keywords = {SMILE,LASIK,Myopia and Topography}, url = {https://ejhm.journals.ekb.eg/article_23542.html}, eprint = {https://ejhm.journals.ekb.eg/article_23542_79e815c20a90f63ce48104a18ed909eb.pdf} } @article { author = {El-Habashy, Samir Mohamed Yassin and Abo-El Enin, Mostafa Abd-Elhamid Hassan and El Khiat, Amgad Zakaria and Mohamed, Ayman Mahmoud}, title = {Compartment and Sciatic Nerve Block for Knee Arthroplasty}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {564-574}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23565}, abstract = {Background: Ambulatory knee procedures have become increasingly common due to the effectiveness of the anesthetic techniques that facilitate rapid and safe discharge. Objective: To compare between spinal anesthesia versus ultrasound guided combined fascia iliaca compartment and sciatic nerve block for knee arthroplasty. Patients and Methods: This study enrolled 40 patients (ASA) physical status (1, 2, 3), 20 patients in each group scheduled to undergo elective unilateral knee arthroplasty procedures. All patients of block group (group B) received premedication with 0.05 mg/kg midazolam intravenous injection. Group (S) (20) patients received spinal anesthesia attained by 20 mg/4ml of 0.5% heavy bupivacaine together with fentanyl 25 µg injected aseptically using a 22-G needle in subarachnoid space at the L4-5 level then the patients were required to wait in the lateral decubitus position on operated side for 5 minutes. Group (B) (20) patients received ultrasound guided combined fascia iliaca compartment and sciatic nerve block using a 22-G needle. Results: In the present study, sufficient block could not be obtained in two patients in block group, they shifted to general anesthesia and excluded from the evaluation, and we replaced them by two other patients. Conclusion: The preferential selection and successful use of anesthesia techniques are based on not only having a short preparation time and rapid onset of action, but also on providing lower rate of complications and adverse events, a longer duration of analgesia, good patient satisfaction and optimal condition for patient discharge compared with other available agents.}, keywords = {visual analogue scale,surgical anesthesia time,Total-knee joint arthroplasty}, url = {https://ejhm.journals.ekb.eg/article_23565.html}, eprint = {https://ejhm.journals.ekb.eg/article_23565_e4681b445a20b5b5a5761e3d43c7fb66.pdf} } @article { author = {Abdul Wahab, Adel M. and El-kasaby, Mohammed I. and Elnaggar, Mohammed T. and Mostafa, Shaimaa M.}, title = {Visual Acuity, Rafraction, And K Reading Changes After Five Versus Six Millimeters Optical Diameter Intracorneal Ring Segments For Treatment Of Keratoconus}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {575-583}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23566}, abstract = {Purpose: To evaluate changes in visual acuity, refraction, and keratometric (K) readings after implantation of five millimeters versus six millimeters optical diameter of intracorneal ring segments (ICR) for treatment of keratoconus grade (2-4). Patients and methods: A prospective nonrandomized clinical comparative study. Thirty four eyes were included in this study. They were classified into two groups: Group I: Seventeen eyes of patients with Keratoconus grades (2-4) were subjected to 5 mm optical diameter intracorneal ring implantation. Group II: Seventeen eyes of patient with keratoconus grade (2-4)were subjected to 6 mm optical diameter intracorneal ring implantation. Results: Thirty four eyes of 22 patients (9 males and 13 females) with keratoconus grade (2-4) were enrolled in this study. The mean age + SD of the patients in group I was 26.36 ± 7.06 years and in group II was 23.09 ± 6.92 years. The mean keratometric (K) reading decreased from 50.05 ± 3.64D. to 46.96 ± 4.42D in group I and from50.48 ± 5.18D to 46.91 ± 5.44D in group II. There was a statistically significant improvement in the postoperative uncorrected distance visual acuity, corrected distance visual acuity, K readings, manifest spherical and cylindrical refractive errors, and spherical equivalent in both groups. No serious intraoperative complications were reported. Conclusion: Both 5mm and 6mm ICR improve significantly UCVA, BCVA, decreased the corneal power and corneal astigmatism but 6 mm showed significant improvement in cylindrical errors and BCVA compared to 5 mm ICR.}, keywords = {Corneal topography,pentacam,femtosecond laser,keraring segment,Keratoconus}, url = {https://ejhm.journals.ekb.eg/article_23566.html}, eprint = {https://ejhm.journals.ekb.eg/article_23566_612da8a13c5938a692d4a00f31bc68ff.pdf} } @article { author = {Radwan, Mohammed El-Sayed and Desoky, Mohammed Abdel Razek and Shabaan, Ahmed Abdel Raouf Abdel Monem}, title = {Evaluation of Double Face Preputial Flap for Management of Hypospadias in Children}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {593-601}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23568}, abstract = {Background: hypospadias is a congenital anomaly in which meatal orifice opens in the vental aspect of penis instead of the glans tip. The meatal orifice may be located anywhere between the tip of the penis and the perineum.Objective: the aim of this study was to evaluate double face preputial flap for management of hypospadias in children about success rate, cosmetic result and appearance of complications such as fistula, strictures or disruption. Methodology: this study was conducted on 30 patients who were suffered from mid penile, proximal penile and peno scrotal hypospadias.  The age of our cases at the time of repair were ranged between 4-12.5 years. Results: after finishing results of our study we noticed that was no statistically significant difference between results after double face preputial flap technique and ordinary transverse preputial island flap technique (Duckett's procedure) regarding fistula formation or skin infection. Conclusion: although the incidence of fistula formation was lower than that was reported in the classic Duckett repair, however, there was no statistically significant difference between results of double face preputial flap technique  and current Duckett's procedure regard skin disruption and fistula formation.}, keywords = {double face preputial flap,incidence of fistula}, url = {https://ejhm.journals.ekb.eg/article_23568.html}, eprint = {https://ejhm.journals.ekb.eg/article_23568_bfe3bf38c97b45ff1533c38e8611ad73.pdf} } @article { author = {Al Shamrani, Abdullah and Al Tawil, Ashwaq and Bin-Khathlan, Afaf and Alwadei, Ali H.}, title = {Pseudotumor cerebri controlled with ventriculo-peritoneal shunt as a rare complication of ROHHAD syndrome: a case report}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {602-607}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23569}, abstract = {Background: rapid-onset obesity with hypoventilation, hypothalamic dysfunction and autonomic dysregulation (ROHHAD) is a rare yet possibly fatal condition. It is similar to common obesity syndromes (whether exogenous or genetic) sideways with other endocrinopathy in early childhood. Objective of the study: this study aimed to present the clinical manifestations, laboratory and imaging results as well as complications and treatment particularly for ventriculo-peritoneal shunt for a ROHHAD patient with pseudotumor cerebri. Patient and methods: in this case report, a 10-year-old girl was presented to the emergency department with recurrent episodes of dyspnea, hypernatremia and cyanosis. Results: her obesity was controlled with sleeve surgery and hormonal evaluation showed high prolactin level and hypothyroidism. She continued to have symptomatic hypoventilation and severe Pseudo-Tumor Cerebri (PTC), idiopathic intracranial hypertension (IIH), in addition to significant reduction in her visual acuity. She was diagnosed with ROHHAD syndrome based on the clinical, laboratory and radiological findings. Brain and abdominal magnetic resonance imaging were performed to demonstrate a possible accompanying neural crest tumor, which was normal, but follow-up images were recommended. Conclusion: ROHHAD syndrome should be suspected in all cases of rapid onset obesity associated with hypothalamic-pituitary endocrine dysfunction. Also provided the high prevalence of cardiorespiratory arrest and potentially associated neural crest tumors, early recognition of ROHHAD syndrome is quite crucial to avert mortality and morbidity. Moreover, Early ventriculoperitoneal shunt insertion might be a lifesaving procedure to avoid visual impairment and subsequent blindness in severe pseudotumor cerebri.}, keywords = {Obesity,hypoventilation,Hypothalamus,papilledema,hypernatremia,shunt,pseudotumor cerebri,Idiopathic intracranial hypertension}, url = {https://ejhm.journals.ekb.eg/article_23569.html}, eprint = {https://ejhm.journals.ekb.eg/article_23569_8e677898c12c500612843d7dc61f4858.pdf} } @article { author = {AbdelHafez, Kamal Abdel Rahman and Hassan, Mohammed AbdelAziz and Mohammed, Wael Said Altaher}, title = {Anatomy, Biomechanics and Complications of Arthroscopic Anterior Cruciate Ligament Reconstruction}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {608-616}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23677}, abstract = {Background: With increasing road traffic accidents and athletic participation, traumatic lesions of the ligaments about the knee are becoming increasingly more common. Those injuries can be isolated or combined with other components of the knee. No procedure is ever completely free of risks. However, Anterior Cruciate Ligament (ACL) reconstruction is a safe procedure that is performed thousands of times each year. ACL reconstruction surgery uses a graft to replace the ligament. The most common grafts are autografts using part of body, such as patellar tendon or one of the hamstring tendons. Results of arthroscopic ACL reconstruction have been excellent; the success rate has been reported to be more than 95% in term of patient satisfaction. Aim of the work: was to discuss anatomy and biomechanics of anterior cruciate ligament and the complications of arthroscopic anterior cruciate ligament reconstruction. Conclusion: It could be concluded that the challenge is to perform the reconstructive procedure with high success and minimal complications and morbidity. To accomplish this, it requires a combination of a skilled surgeon, appropriate graft selection and careful attention to the details of rehabilitation.}, keywords = {Arthroscopic,Anterior cruciate ligament}, url = {https://ejhm.journals.ekb.eg/article_23677.html}, eprint = {https://ejhm.journals.ekb.eg/article_23677_1f980fb6ea4bf2f90dd4bbcea8a0ae9f.pdf} } @article { author = {Hegazy, Hassan Mohamed and Ali, Mahmoud Mohammed Ahmed and Ghoneimy, Mohamed}, title = {Phacoemulsification with Posterior Sub-Tenon Triamcinolone Acetonide Injection for Prevention of Progression of Diabetic Macular Edema after Cataract Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {617-626}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23678}, abstract = {Background: diabetic macular edema (DME) is the most common cause of visual loss in diabetic patients. The pathogenesis of DME is multifactorial. It results from multiple biochemical and cellular changes that eventually cause leakage and exudation. A number of patient characteristics such as increasing age, females, duration of DM, poor glycemic control and moderate to severe retinopathy have been found associated with poor prognosis after cataract surgery in diabetic patients. Objective: the aim of this study was to evaluate the efficacy of phacoemulsification with posterior sub-Tenon’s triamcinolone acetonide injection for prevention of progression of diabetic macular edema following uneventful cataract surgery by phacoemulsification. Patients and Methodology: this interventional study included 20 eyes of 20 diabetic patients with visually significant cataract and coexisting DME during the period from December 2017 to October 2018. Preoperative and postoperative best corrected visual acuity (BCVA) using LogMAR and intraocular pressure (IOP) were recorded. Results: statistically significant improvement in BCVA was detected when comparing postoperative values at one week, one month and three months to corresponding preoperative values. In addition, values at one month and three months were significantly improved when compared to values at one week post-operative. On other hand, values at three months revealed non-significant difference when compared to values at one month. Conclusion: this study suggests that posterior sub-Tenon’s triamcinolone acetonide injection can be given safely and easily at the time of phacoemulsification surgery in patients with visually significant cataract and DME.}, keywords = {Sub-Tenon’s,Triamcinolone acetonide,diabetic retinopathy,DME,OCT}, url = {https://ejhm.journals.ekb.eg/article_23678.html}, eprint = {https://ejhm.journals.ekb.eg/article_23678_28b481061fe75fe7457951365a4219be.pdf} } @article { author = {Hassan, Hassan Ali and Al-Zaree, Gehan Abdel Rahman and Monzer, Mahmoud Abdel Moety and Ahmad, Sameh Abdel Aziz and Al-Tantawy, Mahmoud Atef Abdel Qader}, title = {Electroencephalogram study in non-convulsing children with delayed language development}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {627-631}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23679}, abstract = {Background: Speech is the motor act of communicating by articulating verbal expression, whereas language is the data of an emblem system used for social communication. Aim of the work: This study aims to find a relationship between childhood speech, language disorders and epileptiform discharges without seizures and to evaluate the cognitive function in those children, which may help in early diagnosis and management of such cases. Study Design: Case control study Place: Pediatrics Department at Al-Azhar University Hospitals. Methodology: The study was conducted on fifty patients with speech/language disorder without epilepsy, their age ranged from 2-5 years, who were selected from Outpatient Clinic of Pediatric Neurology, Al-Azhar University Hospitals through the period from March 2018 to October 2018. The study also included fifty normal language developed children who were matched both in age and gender as control group. Results: The control group matched the study group in age and gender with no statistical difference between them. Delayed language development (DLD) affected males (64%) more than females (36%) with ratio of 1.78: 1. Caesarean section (C.S.) represented 44% of cases 56% of the cases were delivered through the normal vaginal delivery (p value > 0.05). In our study we were unable to find any influence of epileptogenic activity on IQ levels. Conclusion: Electrocardiogram must be performed for the child who suffers from delayed development of the language even if he does not complain of clinical convulsions. Diagnosis and treatment should be carried out by a multi-disciplinary team and not a single specialty.}, keywords = {EEG. Language. Development. Interictal epileptiform activity}, url = {https://ejhm.journals.ekb.eg/article_23679.html}, eprint = {https://ejhm.journals.ekb.eg/article_23679_323c3a21b0fddf7e8e2f645aec29c3db.pdf} } @article { author = {Menecie, Tarek Ibrahiem and Khedr, Sherif Abd-El-fattah and Hassan, Mohammad Ali Saeed and Zaghloul, Mahmoud Hassan Mohammad}, title = {Role of susceptibility weighted imaging in acute ischemic stroke}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {632-638}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23680}, abstract = {Background: stroke is a clinical syndrome of rapidly developing symptoms and signs of focal loss of cerebral function without apparent cause other than vascular origin, lasting 24 hours at least, or may lead to death. Objective: in our study, we aimed to determine the diagnostic value of susceptibility weighted image in detection of cerebral micro bleeds and prediction of hemorrhagic transformation in patients with acute ischemic stroke and their impact on choosing the most appropriate therapeutic protocol. Patients and Methods: this study included 28 patients with acute ischemic stroke. Patients admitted in Neurology Department of Nasser Institute Hospital within 72 h after the onset of the neurological symptoms, during the study period from 1/1/2018 to 30/8/2018, their age ranged between 23-85 years. Results: SWI image was a highly sensitive MRI sequence for detection and evaluation of cerebral micro bleeds especially on 3T magnet. Microbleeds were traditionally categorized according to their presumed underlying etiology into lobar (CAA related pathology) and deep (arteriosclerosis) microbleeds. There was a highly significant positive correlation between both age and hypertention with number of both cortical and basal ganglionic microbleeds. While, the age was obviously more correlated with cotical microbleeds, hypertention, in contrast, was more correlated with basal ganglionic microbleeds. Conclusion: presence of microbleeds in cerebral infarct lesions requires a comprehensive assessment for the therapeutic option, especially when using thrombolytic therapy or anticoagulants, but a relatively small number of microbleeds would not affect safety when using antiplatelet therapy. }, keywords = {hemorrhagic transformation,diffusion-weighted imaging,susceptibility-weighted imaging}, url = {https://ejhm.journals.ekb.eg/article_23680.html}, eprint = {https://ejhm.journals.ekb.eg/article_23680_6892fc8956385a445a484618748da64f.pdf} } @article { author = {Awny, Tarek Mohamed and Mohamed, Wael Osman and Ali, Ahmed Hamed and Kaoud, Ahmed Khairy Elsayed Fahmy Ahmed}, title = {Vertebrobasilar Occlusive Diseases in a Group of Egyptian Patients with Posterior Circulation Ischemiaat Interventional Neurology Unit Al-Hussein University Hospital}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {639-647}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23681}, abstract = {Background: stroke is the third leading cause of long-term disability and a major cause of mortality worldwide. Eighty percent of strokes are ischemic. Twenty percent of ischemic events involve tissue supplied by the posterior (Vertebrobasilar) circulation. Aim of the Work:the aim of the study was to assess clinical, risk factors, etiology and vascular lesions of vertebrobasilar occlusive diseases in a sample of Egyptian patients with posterior cerebral circulation ischemia at Al-Hussein Neuro-intervention Unit. Patients and Methods: this study was carried out on patients presented with posterior cerebral circulation ischemia undergoing diagnostic cerebral angiography at the Neuro-interventional Unit in Neurology Department of Al -Hussein University Hospital and Bab-Alshaeria University Hospital. We studied risk factors, vascular lesions, symptoms and signs in patients with vertebrobasilar disease. Results: in the present study, DM was the most frequent risk factor, present in 20 patients (66.67%), followed by hypertension (19 patients [63.33%]), hyperlipidemia (14 patients [46.67%]), smoking (13 patients [43.33%]) and IHD (12 patients [40%]). Conclusion: early detection of stenotic lesions is highly valuable for preventing patients from recurrent TIAs and strokes. Recent improvements in imaging with application the arrival of vertebral artery angioplasty and stenting, however, have opened up new opportunities for intervention in this disease. Digital subtraction angiography is the gold standard method for diagnosis of vertebrobasilardiseasesand the most sensitive for detecting intracranial and extracranial stenotic lesions.}, keywords = {vertebrobasilar occlusive diseases,posterior circulation ischemiaat interventional neurology}, url = {https://ejhm.journals.ekb.eg/article_23681.html}, eprint = {https://ejhm.journals.ekb.eg/article_23681_54d2798f87d9c8ed84646f4f4dc4196c.pdf} } @article { author = {Hamoud, Hesham S. and Ghait, Mohamed M. and Hussein, Yasser A. and Harb, Muhammad M.}, title = {Effect of Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors on Trabecular Bone Score and Bone Mineral Density in Primary Fibromyalgia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {648-659}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23682}, abstract = {Background: fibromyalgia is characterized by chronic widespread pain classified as primary and concomitant. Aim of the Work: this work aimed to determine the correlation between selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) usage and bone mineral density (BMD) and trabecular bone score (TBS) changes in primary fibromyalgia patients. Patients and Methods: The present study was conducted on study on 100 Egyptian patients diagnosed as primary fibromyalgia categorized according to drug medication into two 2 groups, 50 patients on SSRIs and 50 patients on SNRIs, recruited from Rheumatology, Physical Medicine and Rehabilitation Departments at Al-Hussein and Sayed Galal, Al-Azhar University Hospitals. In addition to another 50 age matched the control group subdivided into 25 primary fibromyalgia patients not on those drugs and 25 healthy individuals selected by nurses and medical staff, after an informed consent from all subjects from June 2018 to December 2018.Results: DXA and TBS revealed that usage of SSRIs and SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (partially degraded and degraded) particularly for old people. Conclusion: the present study provided evidence that usage of SSRIs or SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (Partially degraded and degraded) particularly for old people and despite low BMD was found in the SRI users; it also found in 1ry fibromyalgia not on SRIs so 1ry fibromyalgia should also be considered as a contributing factor for low BMD. }, keywords = {ssri,SNRI,FMS,Fibromyalgia,Osteoporosis,TBS,BMD,Bone Mineral Density,Trabecular Bone Score}, url = {https://ejhm.journals.ekb.eg/article_23682.html}, eprint = {https://ejhm.journals.ekb.eg/article_23682_ef5c13b575cc8e852fe12621c11ffe67.pdf} } @article { author = {Shalaby, Rafik Yousef and Mostafa, Magdy Mahmoud and Abd El-Rahman, Ahmed Said and Akl, Mabrouk Maowed and Abd Al-Monem, Islam Mohamed}, title = {Laparoscopic Appendectomy versus Glove Single Port Laparoscopic Appendectomy in Pediatrics under Spinal versus General Anesthesia. A controlled Randomized Study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {660-668}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23683}, abstract = {Background: The glove single-port laparoscopic appendectomy it is a novel SILS technique which is extremely cheaper than the other commercial devices. Objective: this study aimed to compare between conventional laparoscopic appendectomy (CLAP) and glove single port laparoscopic appendectomy (GSPLAP) under tow different anesthetic technique. Patients and Methods: this study of laparoscopic appendectomy was conducted over thirty six children (n=36). All patients were randomized into 4 groups by a random-number table sequence after giving informed parental consent. The allocations will be contained in opaque sequentially numbered closed envelopes and every patient drew an envelope. Results: Two cases of GSPLAP were converted to multi-port due to difficult accessibility of the appendix and adhesions (suppurative appendicitis). The Mean operative time for CLAP was significantly lower than GSPLAP procedure. For CLAP was 38.39±10.12 min (ranged from 26 to 75 min) and was 49.11±11.98 min (ranged from 38 to 86 min) for GSPLAP. We observed that GSPLA was less painful significantly than CLAP for the first postoperative hours (≤3hrs) the time of postoperative needs of analgesia in pt. underwent LA under SA is delayed. Conclusion: Using a combination of 0.5% hyperbaric bupivacaine and a fentanyl provided effective anesthesia for laparoscopic appendectomy with low-pressure Co2 Pneumoperitoneum. It offers better pain management for the patients, earlier recovery and less operating room costs. We recommend an increasing use of spinal anesthesia for laparoscopic appendectomy especially in patients with risks for general anesthesia.}, keywords = {acute appendicitis,general anesthesia,post- operative nausea and vomiting,Spinal anesthesia}, url = {https://ejhm.journals.ekb.eg/article_23683.html}, eprint = {https://ejhm.journals.ekb.eg/article_23683_3eca2185a6aacf600f245984970af7c6.pdf} } @article { author = {Khalil, Muhammad Ramadan Ismael and El-Shafey, Mohammad Hassan and Lasheen, Adel Mohammad AbdulHaleem}, title = {Comparative Study Between Lightweight Meshes Versus Traditional Heavyweight Meshes for the Repair of Inguinal Hernia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {669-678}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23798}, abstract = {Background and aim: the ideal outcome of inguinal hernia surgery is to provide a repair that is free from recurrence, pain and infection with minimal scarring and with improvement in patient's quality of life. Aim of the work: this study aimed to compare light weight poliglecaprone (Ultrapropolypropylene/Monocryl), UltraPro™ mesh with the standard heavy weight polypropylene mesh in tension free Lichtenstein inguinal hernia repair. Patients and methods: the current study included 40 patients complained of uncomplicated inguinal hernia and they were randomized into two groups according to the type of mesh used in tension free Lichtenstein inguinal hernia repair. Group I, 20 patients received the standard polypropylene mesh. Group II, 20 patients received light weight UltraPro™ mesh, using sutures for their fixation. Results: the UltraPro™ (LWM) mesh proved to be as safe and effective as the standard (HWM) prolene mesh in repair of uncomplicated inguinal hernia. There was no difference between the two groups as regard to the technical difficulties, operative complications and surgeons were equally satisfied. There was more incidence of chronic pain with prolene mesh (25%) compared to (zero%) with UltraPro™ mesh. The mesh fixation time and the overall operative time were shorter with UltraPro™ mesh. Conclusion: the shorter operative time and the no-need to use analgesics could partially compensate the higher cost of UltraPro™ mesh in the absence of other economic factors such as the duration of patient improvement and return to work.}, keywords = {Hernia,Inguinal,Lichtenstein,Mesh,UltraPro™,polypropylene}, url = {https://ejhm.journals.ekb.eg/article_23798.html}, eprint = {https://ejhm.journals.ekb.eg/article_23798_f9674e5b8ddc0a1ab799a936a5a9500e.pdf} } @article { author = {Fahmy, Mohammed Abd El Baky and Abd El Hamid, Sameh Abd El Hay and Elsamahy, Omar Mohammed and Mohammed, Hanan Mahmoud}, title = {Comparative study between transanal endorectal pull-through and modified Duhamel’s procedure in management of Hirshsprung’s disease}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {679-683}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23799}, abstract = {Background- Hirschsprung’s disease (HD) is a congenital disorder characterized by an absence of neuronal cell bodies in both myenteric and submucous plexuses in the intestinal wall. The aganglionosis always starts distally and is limited to the rectum and the sigmoid colon in 80–85% of the cases.HD occurs in about 1/5000 live born babies and is more common in boys than girls (4:1). Patients with HD are most often diagnosed in the neonatal period. The clinical presentation is distended abdomen, delayed passage of meconium and vomiting, older children more often present with chronic constipation, approximately 10% of patients with HD present with enterocolitis. Surgical management for HD aims at removing the aganglionic bowel and reconstructing the intestinal tract. There has been a continuous development over the years of operative techniques used for HD from multi-staged procedures (a preliminary colostomy) to one stage pull-through.Aim of the work: comparative study between transanal endorectal pull-through and modified Duhamel’s procedure in management of Hirshsprung’s disease. Patients and Methods: this randomized prospective study was done on 20 patients with Hirschsprung’s disease during the period from January 2016 to January 2018, group A included 10 patients underwent modified Duhamel’s procedure compared to group B 10 patients underwent trans-anal endorectal pull-through procedure. Results: the two techniques were nearly equivalent in the post-operative outcomes. Conclusion: currently, as there was no evidence suggesting that one technique has significant superiority over another, so it is up to surgeon’s choice to select the technique that was easy and feasible in his hands, but TEPT was preferable for neonates, with no past history of enterocolitis and using modified Duhamel’s if the two staplers were available is safe and with less complications}, keywords = {Hirschsprung’s disease,transanal endorectal pull through,modified Duhamel’s procedure}, url = {https://ejhm.journals.ekb.eg/article_23799.html}, eprint = {https://ejhm.journals.ekb.eg/article_23799_b8e8d1c0165ea3b946c393f3701ba7bd.pdf} } @article { author = {Osman, Adel Abd El-Rahman and El-Sheikh, Ehab Abd-Elsamea and El-Sanhoury, Ayman Shawky Abd El-Haleim}, title = {Comparative study between corneal biomechanical parameters in the diabetic patients and normal individuals using ocular response analyzer (ORA)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {684-693}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23800}, abstract = {Background: the cornea exhibits viscoelastic properties, which give it the quality of hysteresis. Corneal hysteresis is an important indicator of the biomechanical properties of the cornea. Objective: this study aimed to show the impact of diabetes on corneal biomechanics and to compare corneal biomechanics in diabetic to that in healthy non diabetic individuals using ocular response analyzer (ORA). Patients and Methods: we conducted our study on the diabetic patients and healthy non diabetic individuals to detect the relation between diabetes mellitus and the corneal biomechanics. Our study was performed on 120 eyes of 60 individuals as we categorized them into three groups. Group A involved 40 eyes from 20 controlled diabetic patients, group B involved 40 eyes from 20 non-controlled diabetic patients and 40 eyes from 20 healthy non diabetic individuals (Group C). Results: our study reported that diabetes mellitus led to an increase in corneal biomechanics as CH and CRF were elevated in patients with diabetes mellitus (Groups A & B). Conclusion: the corneal biomechanics in the diabetic groups were significantly higher compared to those of the control group, as the mean CH was 9.23 ± 0.98 mmHg in the controlled diabetic group (Group A), 10.11 ± 0.44 mmHg in the noncontrolled diabetic group (Group B) and is 8.03 ± 0.94 mmHg in the healthy non-diabetic individuals (Group C). The difference in CH between the three groups was statistically highly significant (P = 0.00). Meanwhile, the mean CRF was 9.26 ± 1.35 mmHg in the controlled diabetic group (Group A), 10.03 ± 0.99 mmHg in the non-controlled diabetic group (Group B) and 8.37 ± 0.56 mmHg in the healthy non-diabetic individuals (Group C). The difference in CRF between the three groups was statistically highly significant (P=0.00).}, keywords = {cornea,ocular response analyzer,Corneal Hysteresis,corneal resistance factor,intra-ocular pressure,Diabetes mellitus,corneal compensated intra-ocular pressure,Goldman correlated intra-ocular pressure}, url = {https://ejhm.journals.ekb.eg/article_23800.html}, eprint = {https://ejhm.journals.ekb.eg/article_23800_18d25ba89b05152715e6291220739eb8.pdf} } @article { author = {Khallaf, Magdy E. and Atwa, Fatma A and El Husiny, Abd Allah and Salah Eldein, Ahmad M}, title = {High Resolution Ultrasonic Imaging in the Evaluation of the Posterior Segment Disorders}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {694-701}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23801}, abstract = {Purpose: to evaluate the role of high resolution 20 MHz ultra sound in assessment of posterior segment disorders. Patients and Methods: a prospective, case series study was conducted on 40 patients who attended the ophthalmology outpatient clinic of Al-Azhar university hospitals (2014-2018). All should have a posterior segment disorder either retinal, vascular, vitreo-macular, optic nerve head or choroidal disorder. They should be with clear media, therefor we can reach a diagnosis based on clinical examination and augmented by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) whenever indicated, the patients were evaluated using both high resolution 20 MHz ultrasound(US) and conventional 12.5 MHz US and compare their results to the gold standard clinical diagnosis to assess their sensitivity to reach the diagnosis. Results & Conclusion: we have two main characters for well diagnosis by any US tool, resolution and sensitivity, and neither the 20 MHz nor 12.5 MHz could combine both of them. Therefore, we recommended tocombine the examination by both of them as they are complementary to each other.}, keywords = {High Resolution US,OCT,FFA,20MHz US}, url = {https://ejhm.journals.ekb.eg/article_23801.html}, eprint = {https://ejhm.journals.ekb.eg/article_23801_88975fe2a5d2dc1edc60692d6b315369.pdf} } @article { author = {Abd El-Hafiez, Hassan and Abdel Rasheed, Mohamed and Fadel, Mohamed Ismail}, title = {Predictive Factors for Failed Endoscopic Retrograde Cholangiopancreatography}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {74}, number = {3}, pages = {702-704}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.23802}, abstract = {Background: failure during cannulation renders the endoscopic retrograde cholangiopancreatography (ERCP) unsuccessful and gives rise to various consequences, including cholangitis and pancreatitis, which may require interventions, such as percutaneous transhepatic cholangiography (PTC) and surgery, with higher morbidities. Aim of the Work: we aimed to establish predictive factors for ERCP failure. Patients and Methods: a total of 103 ERCP procedures were done from October 2016 to October 2017 in the endoscopy unit at AL Hussein university hospital. Patients were divided according to ERCP results into 2 groups; group I consists of 93 cases of successful ERCP procedure (90.2%) and group II consists of 10 cases of failed ERCP procedure (9.7%). After clear written consent, full clinical, sonographic and laboratory evaluation were done for all patients. Results: patients with history of previous abdominal surgery and\or CBD stricture had a significant higher rate of ERCP failure. Duodenal diverticula, papillary mass and gastric outlet obstruction were significantly higher in failed ERCP group. Conclusion: any patient with history of previous abdominal surgery, CBD stricture and benign or malignant tumors should be investigated before ERCP with non-invasive image as magnetic resonant cholangiopancreatography (MRCP) or Endoscopic ultrasound (EUS).}, keywords = {Endoscopic retrograde cholangiopancreatography,Magnetic Resonant Cholangiopancreatography and Endoscopic Ultrasound}, url = {https://ejhm.journals.ekb.eg/article_23802.html}, eprint = {https://ejhm.journals.ekb.eg/article_23802_1daf5f058e8cd791a379647a241a5034.pdf} }