@article { author = {Zahra, Mohammed Kamal and Okasha, Kamal Mohamed and Hagras, Maha Mahmoud and Elzahaby, Mai Samir Abd-Elhady}, title = {Impact of NGAL (Neutrophil Gelatinase Associated lipocalin) on Outcome of Hepato-renal Syndrome}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2112-2119}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.29836}, abstract = {Background: Renal dysfunction is a severe complication of advanced cirrhosis as well as of acute-on-chronic liver failure (ACLF). Hepato-renal syndrome (HRS) has been defined as a syndrome that occurs in patients with advanced liver disease, characterised by impaired renal function and marked abnormalities in the arterial circulation and over-activity of the endogenous vasoactive systems. Objective: The aim of this work was to study the role of plasma NGAL level in patients with hepatorenal syndrome in order to identify patients with high risk of renal dysfunction, correlate clinical outcome with therapeutic management and provide a clue on better management to prevent renal deterioration. Patients and methods: This study was carried out on 50 patients. They were divided into 3 groups in addition to control group; group I of 25 patients with decompensated liver cirrhosis , group II of 25 patients with hepato-renal syndrome , group III of 25 hepato-renal patients who followed up after treatment in addition to 25 healthy individuals as a control group ( group IV) . Results: of NGAL in different study groups were as follows: There was a significant increase of NGAL in Group 2 & 3 compared to Group 1& 2. There was a statistical significance between the four groups (p< 0.001). Conclusions: NGAL could be used in conjuction with serum creatinine to assess the hepato-renal affection and may aid in stratifying patients in need for liver transplant.}, keywords = {NGFAL,HRS,MELD,ESLD}, url = {https://ejhm.journals.ekb.eg/article_29836.html}, eprint = {https://ejhm.journals.ekb.eg/article_29836_3fe035854f3a2f81079b3ed0592d6792.pdf} } @article { author = {Hegazy, Ahmed Magdy and El-Sheikh, Raghda Ghonimy and Abo Ammo, Desoky Ezzat and Zoair, Amr Mohamed}, title = {Serum Highly Sensitive Cardiac Troponin I (hs-cTnI) as a Diagnostic Biomarker of Myocardial Injury after Pediatric Cardiac Catheterization}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2120-2127}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.29837}, abstract = {Background: new Highly Sensitive Cardiac Troponin I assay (as hs-cTnI) represents an important advance with added sensitivity for cardiac myocyte necrosis and could have several distinct roles in clinical practice. Aim of the present study: it was to determine the serum level of highly sensitive cardiac troponin I (hs-cTnI) before and after pediatric cardiac catheterization (diagnostic or interventional), as a diagnostic biomarker of myocardial injury in these patients. Patients and Methods: a Prospective Cohort study was carried out during the period from January 2017 to June 2018 at Pediatric Cardiology Unit and Cardiology Department, Tanta University Hospital. It included 30 patients who were admitted and required pediatric cardiac catheterization. Doppler echo- cardiography and Estimation of serum highly sensitive cardiac troponin I (hs-cTnI): using the ELFA technique (Enzyme Linked Fluorescent Assay) was done. Results: there was highly significant increase of serum hs-cTnI levels immediately after and 12 hours after therapeutic pediatric cardiac catheterization (p <0.001), whereas in diagnostic pediatric cardiac catheterization there was no significant differences of serum hs-cTnI levels (p >0.05). There was significant negative correlation between serum hscTnI levels and Fractional shortening (FS) %, and also there was significant negative correlation between serum hs-cTnI levels and ejection fraction (EF) % (measured by echocardiography). Conclusion: serum highly sensitive cardiac troponin I (hs-cTnI) was significantly increased immediately after pediatric cardiac catheterization, with more significant increase after 12 hours, suggesting myocardial injury in these patients. Also, elevation of this diagnostic biomarker of myocardial injury was more after therapeutic than diagnostic pediatric cardiac catheterization.}, keywords = {Highly Sensitive Cardiac Troponin I,myocardial injury,Pediatric Cardiac Catheterization}, url = {https://ejhm.journals.ekb.eg/article_29837.html}, eprint = {https://ejhm.journals.ekb.eg/article_29837_bc5e88e874a517c24cf693847a01956f.pdf} } @article { author = {Shamlool, Mohamed Mohamed Salah and Ismail, Maamon Mohamed and Elshaer, Khaled Shehata Ali}, title = {Comparative Study between Setting Position Versus Left Lateral Position Effects During Spinal Anesthesia Block in Caesarean Section}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2128-2135}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.29838}, abstract = {Background: A caesarean section is recommended when vaginal delivery is a threat to the mother or child. Aim of study: The aim of the study was to compare the effect of position (sitting versus left lateral) during spinal anesthesia application in cesarean section. The sample of the study was 60 patients. Patients and Methods: Half of the patients received spinal analgesia consisting of 2 ml (10 mg) of 0.5% hyperbaric bupivacaine and 25μg fentanyl in the sitting position, while the other half received spinal analgesia consisting of 2 ml (10 mg) of 0.5% hyperbaric bupivacaine and 25μg fentanyl in the left lateral position. Results: both Left lateral and sitting position in spinal anesthesia in cesarean section have the same effect on hemodynamics, also satisfactory sensory and motor block can be achieved in both positions. So left lateral position is safe and can be performed in parturient who are sedated, in pain or using entonox. Conclusion: Satisfactory sensory and motor blockade were successfully achieved in both sitting and lateral positions during intrathecal injection in cesarean section without significant difference in the hemodynamic changes or motor blockade. With superiority of faster onset of sensory blockade in lateral position, while sitting position is more comfortable for he parturient.}, keywords = {Spinal anesthesia,Sitting,Left Lateral,cesarean section}, url = {https://ejhm.journals.ekb.eg/article_29838.html}, eprint = {https://ejhm.journals.ekb.eg/article_29838_75a5be256abfe191edb7703cf1f91a92.pdf} } @article { author = {Elsayed, Ahmed N}, title = {Comparisons of Ranibizumab Injection and Dexamethasone Implant in Macular Oedema Secondary to Central Retinal Vein Occlusion}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2136-2141}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30100}, abstract = {Background: central retinal vein occlusion (CRVO), a common retinal vascular disorder, is characterized by dilated and tortuous retinal veins with hemorrhages in all four quadrants of the retina, CRVO can reduce vision severely, and its prevalence is estimated at 0.80 per 1000 persons. Purpose: Comparing the efficacy and safety of intravitreal ranibizumab versus dexamethasone implant (DEX) in patients with macular oedema secondary to CRVO. Patients and Methods: a prospective randomized comparative study was performed at Al-Azhar University hospitals on forty eyes in thirty-four patients presented by macular oedema secondary to CRVO included in this study, divided into two equal groups: Group (1) included 20 eyes with intravitreal ranibizumab for six months and group (2) included 20 eyes with dexamethasone implant for six months. Results: in group (1) visual acuity improved and CMT decreased slightly but not significantly after 1 month to 0.25±0.12 and 335.3±75.5 μM, respectively. After 6 months of follow-up, the mean BCVA had significantly increased to 0.73±0.4 (P=0.007) and retinal thickness had significantly decreased to 271.3±145 μM. In group (2) visual acuity improved and CMT decreased slightly after 1 month to 0.25±0.13and 480.35±185.25 μM, respectively. After 6 months of follow-up, the mean BCVA had significantly increased to 0.63±0.3 (P=0.008) and retinal thickness had significantly decreased to 290.3±155 μM Conclusion: intraocular injections of 0.7mg ranibizumab provided rapid, effective treatment for macular edema following CRVO, and patients who do not respond to consecutive anti-VEGF treatment may benefit from switching the therapy to dexamethasone implant.}, keywords = {ranibizumab,dexamethasone,Central Retinal vein occlusion,Macular oedema}, url = {https://ejhm.journals.ekb.eg/article_30100.html}, eprint = {https://ejhm.journals.ekb.eg/article_30100_8e35de95d5c898066a2ab44b81aea30e.pdf} } @article { author = {Kasem, Osama A. and El-Sayed, Mostafa M. and Abd Elasttar, Mahmoud N.}, title = {Comparative Study between Dexmedetomidine, Magnesium Sulphate and Meperidine as Anti-Shivering Agent Following Neuraxial Anesthesia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2142-2148}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30101}, abstract = {Background: shivering is a protective phenomenon which occurs when there is a drop in the core body temperature. As the patients plunge into anesthesia, shivering is always bound to happen, and its avoidance is of prime importance. Aim of the Work: compare the efficacy of intravenous dexmedetomidine 0.5 μg/kg body weight (bw) versus magnesium sulphate 30 mg/kg bw and meperidine 0.5 mg/kg bw in the management of shivering in patients undergoing elective surgery under neuraxial anesthesia in Al-Azhar University Hospitals. Patients and Methods: a prospective, double-blinded and controlled randomization study was conducted on 120 ASA grade I and II patients, posted for orthopedic, general surgeries and gynecological surgeries undergoing spinal and combined spinal-epidural anesthesia in Al-Azhar University Hospitals, following approval from the Ethics Committee of the Al-Azhar University. Results: dexmedetomidine was effective in the prevention of shivering throughout a period of 30 minutes. Bradycardia and hypotension were observed in 10 out of 40 patients who received dexmedetomidine and also in 6 out of 40 patients in the magnesium group and with no hypotension and bradycardia in the pethidine group. But of these how many occurred because of dexmedetomidine cannot be commented upon, as spinal and epidural anesthesia itself causes hypotension. Whereas it was observed in 8 out of 40 patients in the magnesium sulfate group. There was no nausea and/or vomiting in pethidine group. These were treated with ondansetron 0.08 mg/kg by the intravenous route. Conclusion: Dexmedetomidine is an effective drug in the prevention of shivering in patients undergoing neuraxial block.}, keywords = {Dexmedetomidine,Magnesium sulphate,Meperidine,anti-shivering agent,neuraxial anesthesia}, url = {https://ejhm.journals.ekb.eg/article_30101.html}, eprint = {https://ejhm.journals.ekb.eg/article_30101_19e9079ae8136fecceb0bf63916f9319.pdf} } @article { author = {Mostafa, Mohammed Khaled and Ouf, Tamer Fares and Abd AL- Aziz, Ahmed Fathy and Hegazy, Hesham Ahmed}, title = {The Relation between Serum C-Reactive Protein Level and Gestational Diabetes}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2149-2153}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30102}, abstract = {Background: Gestational diabetes is one of the most common medical condition during pregnancy and its early detection is necessary to prevent prenatal and maternal complications. There is a link between raised CRP and development of gestational diabetes, so early detection of raised CRP may avoid serious maternal and neonatal hazards. Objective: The goal of this study was to detect the prevalence of raised high sensitivity C‑ reactive protein (hs‑ CRP) in normal pregnancy and gestational diabetes mellitus (GDM) and to compare the prevalence in both groups. Materials and methods: A case–control study was conducted between April 2018 and December 2018. A number of 60 pregnant women who were investigated for oral glucose tolerance test at 24–28 weeks of gestation were enrolled in this study. They were divided into 30 women with GDM as cases and 30 normal pregnant as control. They were investigated for the level of hs‑ CRP. Results: The prevalence of elevated hs‑ CRP in controls was 60%, whereas in cases it was 83.3%, with a P = 0.045 which is significant in this study.Conclusion: The study showed a raised level of hs‑ CRP in GDM in comparison with normal pregnant subjects.}, keywords = {C-reactive protein,Gestational diabetes}, url = {https://ejhm.journals.ekb.eg/article_30102.html}, eprint = {https://ejhm.journals.ekb.eg/article_30102_250abcb0985377969d55cfbc270d9bbd.pdf} } @article { author = {El-Shazly, Sumaya H. and Hammam, Olfat A. and El-Zefzafy, Wafaa M. and Ibrahim, Moshira A.}, title = {Tissue Expression of Caspase-4 and-5 in Some Chronic Colorectal Diseases}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2154-2165}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30103}, abstract = {Background: Colonic lining epithelium is subject to variety of insults ranging from inflammatory, infectious to neoplastic processes. One of the most common colon problems are inflammatory bowel disease, colorectal polyps, cancerous growths. Caspases are involved in apoptosis, necrosis, and inflammation. Altered Caspase activity has been associated with a variety of colonic diseases, including inflammatory bowel disease (IBD) and colorectal cancer. Caspases-4 and -5 involvement during intestinal homeostasis and disease has not yet been established. Aim: Detection of the tissue expression of Caspases-4 and -5 in some chronic colorectal diseases. Methods: 100 patients underwent colonoscopy divided into four groups: colorectal cancer (CRC) (35 patients), inflammatory bowel disease (IBD) (25 patients), colorectal polyp (CRP) (20 patients) and irritable bowel syndrome (IBS) as control (20 patients). The diagnosis was established on the basis of clinical history, laboratory (CBC, ESR, liver function tests, CEA), endoscopic and histological data. Immunohistochemistry (IHC) techniques were employed to examine the cellular expression profile of Caspase-4 and -5. Results: Tissue Caspase-4 and -5 were statistically highly significantly increased in the epithelium of CRC in comparison to the other groups. On the other hand, stromal expression of Caspase -4 and -5 were statistically highly significantly increased in IBD group in comparison to the other groups. Conclusions: This study identified epithelialexpressed Caspases -4 and -5 as biomarkers with diagnostic potential in CRC. Also they were a potential marker of dysplasia in IBD and colorectal polyps.}, keywords = {Caspase-4 and-5,colorectal cancer,inflammatory bowel diseases,colorectal polyp}, url = {https://ejhm.journals.ekb.eg/article_30103.html}, eprint = {https://ejhm.journals.ekb.eg/article_30103_a8895ee4a3ba254802805069f8250512.pdf} } @article { author = {Wafa, Yehia A. and Elomda, Fahd A. and Abdel Fattah, Ahmed T. and Abdel Rahman, Hanan M.}, title = {Impact of Endometriosis on Pregnancy Outcome of Intracytoplasmic Sperm Injection}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2166-2172}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30104}, abstract = {Background: endometriosis is one of the most challenging diseases that constitute 20%-40% of women searching for their infertility diagnosis. The effects of endometriosis on assisted reproductive outcomes are the issues continuously debated. Aim of the work: This study was undertaken to compare the outcome of intracytoplasmic sperm injection (ICSI) in women with endometriosis and women with tubal factor infertility as controls. Patients and Methods: from 2016 to 2018 a retrospective study was carried out on patients with endometriosis (n=40) and tubal infertility (n=40) after treatment with ICSI. The main outcome measures were implantation rate, chemical and clinical pregnancy rates while secondary outcomes were COH, such as dosage and duration of gonadotropins, the number of oocytes retrieved, endometrial thickness and E2 level on the day of hCG, fertilization rate and the number of transferred embryos. Results: no statistically significant difference between the two groups in percentage of metaphase II oocyte, number of embryo transferred, implantation rate and chemical and clinical pregnancy rates, suggesting that embryo quality and uterine receptivity remains unaffected despite the number of oocyte retrieved and fertilization rate were significantly lower in endometriosis group. Conclusion: our data suggest that the presence of endometriosis in patients undergoing ICSI does not affect pregnancy outcome, although significantly fewer oocytes retrieved from patients with endometriosis, and lower fertilization rate.}, keywords = {ICSI,COH,HCG,Endometriosis}, url = {https://ejhm.journals.ekb.eg/article_30104.html}, eprint = {https://ejhm.journals.ekb.eg/article_30104_6a0a190e4f1f3715cb13a153b3fa174a.pdf} } @article { author = {Wafa, Yahia A. and ALKhouly, Mohammed Moh. and Mosalam, Reham M. Salah Abdelsalam}, title = {Role of Low Dose Sildenafil in Improvement of Implantation Rate in Case of Recurrent ICSI failure}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2173-2182}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30105}, abstract = {Background: Infertile couples to have healthy children are one of primary tasks of assisted reproductive technologies. In order to fulfill these tasks, reproductive medicine constantly needs to obtain information on physiology and pathophysiology of infertility and to develop efficient strategies for ovarian hyper-stimulation. Objectives: Aim of the current Work was to evaluate the efficacy of oral sildenafil citrate 25 mg on pregnancy outcome, endometrial thickness, pattern and uterine arteries Doppler blood flow in patients with 3 or more concoctive unexplained recurrent IVF/ICSI implantation failure. Patients and Methods: This prospective, randomized, double blinded study included a total of seventy patients undergoing ICSI trial attending at the University Maternity Hospital IVF\ICSI unit. The included subjects were randomly allocated into two groups: Group I (study group): included 35 women with recurrent ICSI implantation failure with another trial of ICSI using the standard drugs and technique with the addition of sildenafil 25 mg orally twice daily. Group II (control group): included 35 women with recurrent ICSI implantation failure with another trial of ICSI using the standard drugs and technique (control group). Results: The statistical comparison between group I (Sildenafil Citrate) and group II (control) regarding endometrial thickness showed non significant differences before and significant differences after 21days of administration of Sildenafil Citrate. The statistical comparison in patients in group I (Sildenafil Citrate) regarding Pulsatility index, Resistance index and Systolic/ diastolic ratio showed significant differences of these parameters. Conclusion: It could be concluded from this study that adding of sildenafil citrate 25 mg orally twice daily for 21 days to patients with unexplained recurrent ICSI implantation failure, increase in pregnancy rate.}, keywords = {sildenafil,Implantation Rate,Recurrent ICSI failure}, url = {https://ejhm.journals.ekb.eg/article_30105.html}, eprint = {https://ejhm.journals.ekb.eg/article_30105_0725be33284b8e332c3a598b48604b0c.pdf} } @article { author = {Hudieb, Ahmad El-Sayed}, title = {Evaluation of Vascular Morphological Changes in The Superficial and Deep Retinal Plexuses by Optical Coherence Tomography Angiographyin Cases of Acute Phase Branch Retinal Vein Occlusion}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2183-2192}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30106}, abstract = {Background: Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy and an important cause of visual morbidity and blindness Aim of the work: was to detect if there are diagnostic signs in the two intra retinal layers superficial network layer and deep network layer by Optical coherence tomography angiography (OCT-A) to diagnose branch retinal vein occlusion. Patients and Methods: an observational cross-sectional study included a total of ten patients with branch retinal branch retinal vein occlusion of recent onset within three months attending at the Ophthalmology Department AlAzhar University Hospitals, Cairo. Demographic data such as age, gender, sex and hypertensive history were obtained. A detailed evaluation of cases including complete anterior segment evaluation and posterior segment evaluation was done. OCT-A and fluorescein angiography (FA) were used to study the vascular morphological changes in the branch retinal vein occlusion (BRVO)area. Results: As regarding 5 disc area of retinal ischemia FA detected ischemia in 2 cases (20%), detected no ischemia in one case (10%) and was not able to evaluate ischemia in 7 cases (70%) compared to OCT-A, that detected the ischemia in the superficial retinal plexus (SCP) in 4 cases (40%) and detected no ischemia in 6 cases (60%), but it detected the ischemia in the deep retinal plexus (DCP) in 6 cases(60%) and detected no ischemia in 4 cases (40%). Conclusion: It could be concluded that that OCT-A was superior to FA in detection of macular ischemia, macular ischemia detected by OCT-A had stronger negative relation with V.A. than macular ischemia detected by FA and retinal ischemia in the DCP was more evident than that of SCP by OCT-A.}, keywords = {}, url = {https://ejhm.journals.ekb.eg/article_30106.html}, eprint = {https://ejhm.journals.ekb.eg/article_30106_912359a352dc7e7585bf6e55d529bf10.pdf} } @article { author = {Almabrouk, Salwa A. and Madbouly, Wafaa A. and Kamel, Hayam S.}, title = {Lateral Rectus Recession Considering the Tendon Width in Intermittent Exotropia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2193-2199}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30107}, abstract = {Background: Intermittent exotropia (IXT) is a common form of childhood exotropia. Surgery is thought to be an effective method for the treatment, recession of lateral rectus (LR) muscles most frequently used. The tendon width of the LR which has been reported to be a useful indicator for estimation of the effect of LR recession in IXT. Aim : It was to determine whether the tendon width of the LR would predict the effects of lateral rectus recession. Patients and Methods: This was a prospective study included 30 patients had IXT, they were divided into two groups: group 1 (age ≤10 y), group 2 (>10 y). All of them underwent unilateral or bilateral LR recessions according to the preoperative angle of deviation, the tendon width of LR muscle was measured by surgical calipers. The actual effect of lateral recession was calculated then compared it to hypothetical effect. Results: there is statistically significant negative correlation between tendon width and actual effect in all group (r= -0.7921, P.<0.05). The actual effect was 2.60, 2.51, and 1.76PD when ranges of tendon width were 8mm, 8.5- 9mm, and 9.5-10mm, respectively. Conclusion: In our study we found the tendon width of LR muscle significantly affect surgical dose response, where the effects of LR recession were larger in cases in which the tendon width of muscle was decreased, and the effect was smaller in cases in which the tendon width of muscle was increased.}, keywords = {Intermittent exotropia,lateral rectus recession,tendon width}, url = {https://ejhm.journals.ekb.eg/article_30107.html}, eprint = {https://ejhm.journals.ekb.eg/article_30107_587cd05868e9f796ee0600d4ab2f1156.pdf} } @article { author = {Abd El Gawad, Mohamed and El Behairy, Hassan and Farhoud, Hesham}, title = {Functional, Radiological and Sagittal Balance Outcomes in Surgically Treated Degenerative Cervical Disc Diseases}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2200-2204}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30285}, abstract = {Background: The treatment of degenerative spinal diseases remains focused on dealing with symptoms, using both conservative and surgical methods. Though surgery is considered an effective treatment for many cervical disorders, at times it leads to significant problems including adjacent level disease. Objectives: The aim of this study was to correlate the functional, radiographic and sagittal balance outcome in surgically treated patients for the degenerative cervical disc diseases, outline the advantages, disadvantages and the effect of the sagittal balance on the patient function and activities. Patients and Methods: This study included a total of thirty patients who had degenerative disc disease of the cervical spine at multiple levels treated by microscopic anterior cervical decompression. The average age of participants was 43.267 ± 10.780 years (26– 64). 18 patients (60%) were females and 12 patients (40%) were males. All patients were assessed and classified before and after surgery using the neck disability index and visual analogue scale. This assessment was done for both neck and arm disability. Results: The average neck disability index at the last follow-up was 17.74 ± 2.135, which was statistically significant (P < 0.05) among groups and visual analogue scale improved from 7.4 ± 0.926 to reach 3.6 ± 0.35 six months postoperatively. Full recovery was obtained between three and six months. All patients underwent a rehabilitation protocol and found no postoperative neurological deficit in this series. Conclusions: It could be concluded that cervical sagittal imbalance arising from regional and/or global spinal sagittal malalignment plays an independent role in exacerbating adjacent segment pathomechanics after multilevel fusion and should be considered during cervical fusion surgical planning. Also, it concludes that surgery significantly led to improvement of symptoms three months post operatively.}, keywords = {cervical spine,Degenerative diseases,Sagittal balance,PEEK cage,Plate & screw}, url = {https://ejhm.journals.ekb.eg/article_30285.html}, eprint = {https://ejhm.journals.ekb.eg/article_30285_e3c91c82efa65181bcaa50e7ab8456f8.pdf} } @article { author = {Al Mohammady, Abd El-Shakour Abd El- Hafiz and Abd El-Aziz, Hassan Mamdoh and Aamer, Loay Hazem}, title = {Comparative Study between Intralesional Injection versus Intradermal Injection of Candida Albicans Antigen as An Effective Treatment of Common Warts}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2205-2209}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30286}, abstract = {Background: Warts, or verrucae, are benign epithelial proliferations of skin and mucosa caused by infection with human papilloma virus (HPV). They are common skin condition that can range in severity from a minor nuisance that resolves spontaneously to troublesome, chronic condition. Objective: The aim of the present study is to compare between intralesional injection of candida albicans antigen versus intradermal injection as an effective treatment of common warts. Patients and methods: This study included 60 (sixty) patients (adult males and females) were suffering from common warts. The patients were divided into two equal groups of 30 patients each: Group A treated by intradermal injection of candida albicans antigen. Group B treated by intralesional injection of candida albicans antigen in one of their warts (mother wart) which was chosen and marked. The patients were collected from the outpatient's clinics of Dermatology and Venereology Department of Al- Hossein University Hospital. Results: As we compared the response to candida albicans antigen injection, we found a highly significant cure response in intralesional injections over intradermal injections. After 6 months follow up in patients who responded by complete cure (29 patients), there was no recurrence in 26 patients (89.6%) and only 3 cases (10.4%) developed partially recurrence. As regard to side effects there were no side effects in 43 cases (71.7%). Conclusion: candida albicans antigen injection seems to be promising effective and safe remedy for cutaneous warts with good cure rates and excellent safety profile.}, keywords = {Intralesional injection,Intradermal injection of candida albicans antigen,Warts}, url = {https://ejhm.journals.ekb.eg/article_30286.html}, eprint = {https://ejhm.journals.ekb.eg/article_30286_0873852749cf9e55c0fab7ebb79838fa.pdf} } @article { author = {Ewaiss, Ibrahem G. and Hendam, Hedaya M. and Elhoufi, Ahmed E.}, title = {Gamma Knife Radiosurgery for Post-Operative Vestibulocochlear Schwannomas}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2210-2217}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30287}, abstract = {Background: The discovery of Schwann cells as the oncologic cells led to the recommendation by a consensus meeting in 1992 to use the term vestibular schwannoma. In the literature, the terms acoustic neurinoma, acoustic neuroma, and vestibular schwannoma are used interchangeably. Objective: Evaluation of the outcome of the management of post-operative recurrent or residual vestibular schwannomas by using gamma knife radiosurgery (GKRS). Patients and Methods: In this retrospective descriptive case series study during the year of 2018 on twenty (20) consecutive cases at the International Medical Center (IMC) with residual or recurrent post-operative vestibulocochlear schwannomas (VS) whom underwent gamma knife stereotactic radiosurgery (SRS). Clinical & radiological follow up done for a period of 6 months minimum up to 3 years. Results: After GKRS, it was shown that the cerebellar ataxia improved in 7 cases (100%). 5th cranial nerve affection improved in 6 cases (100%). 7th cranial nerve affection improved in 5 cases (100%). Hearing affection deterioration occurred in 4 cases (20%), 16 cases had stationary course (80%), Local tumor control in 90% of patients & Regrowth of tumor in 10% of patients. Conclusion: GKRS is the best choice in small size VSs less than 3 cm in maximum diameter X, Y, Z either prior surgery was done or not due to its advantageous preservation of all cranial nerves as they can withstand the prescribed SRS dose for VSs.}, keywords = {Gamma Knife Radiosurgery,Vestibulocochlear Schwannomas}, url = {https://ejhm.journals.ekb.eg/article_30287.html}, eprint = {https://ejhm.journals.ekb.eg/article_30287_86c093d97cf74328a593e6088e9ea5c8.pdf} } @article { author = {Megahed, Hazem A.}, title = {Cyanoacrylate Glue Versus Suture Fixation of Mesh in Adult Inguinal Hernioplasty}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2218-2223}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30288}, abstract = {Background: Tissue glues have been present for over twenty years and are used in surgery for a variety of indications. Use of N butyl- 2-cyanoacrylate based in inguinal hernia surgery were practiced for the first time in the mid-nineties. These non-suture techniques was aimed to decrease the chronic groin pain after hernioplasty without adversely affecting the outcomes Aim of the work: this study was designed to compare the operative outcomes of mesh fixation with glue versus that with suture. The primary objective was to compare pain in the immediate postoperative period and also to compare chronic postoperative pain. Patients and Methods: This prospective randomized study was performed Between January 2018 and January 2019 on 40 patients with unilateral inguinal hernia for whom open hernioplasty was done in the Department of surgery, Al-Azhar University Hospital, Damietta. Results: in the present study, there was significant difference in postoperative pain perception at 24 hours, at one week and at one month (p < 0.05) between glue group and suture group with lesser pain perception in the glue group. After the first month the difference between the two groups was non-significant. The mean operative time which was 44.35 min in the glue group and 57.33 min in suture group showed significant difference. As regard to the postoperative complications, the postoperative hematoma, infection and seroma were lesser in glue group but the difference was not significant. There was no recurrence in both groups. Conclusions: Cyanoacrylate glue for mesh fixation in Lichtenstein repair of adult inguinal hernia shows advantages over mesh fixation by sutures in terms of immediate and chronic post-operative pain, operative time, and postoperative complications.}, keywords = {Cyanoacrylate glue,Mesh fixation,hernioplasty,Inguinal hernia repair}, url = {https://ejhm.journals.ekb.eg/article_30288.html}, eprint = {https://ejhm.journals.ekb.eg/article_30288_3fbdf3ab19d38ab495adb01513e302f9.pdf} } @article { author = {Abd Elaziz, Sara M. and Abo Elenein, Amany M. and Ziadh, Dina H. and Hamam, Sara A.}, title = {Study of Oncoprotein 24p3 as Diagnostic Marker for Hepatocellular Carcinoma on Top of Hepatitis C Virus}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2224-2230}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30289}, abstract = {Background: Hepatitis C virus is one of the main causes of chronic liver disease worldwide. Egypt has the highest prevalence of HCV in the world, estimated nationally at 14.7% and is therefore confronted with a disease burden of historical proportions that distinguishes this nation from others. In HCC, 24P3 is overexpressed in tissues and closely associated with the proliferation and invasion of HCC cells.24P3 is mainly expressed in myeloid cells and later assigned to a cluster of at least three lipocalins on the long arm of human chromosome 9. Aim of the Work: was to shed the light on the role of oncoprotein 24p3 as a diagnostic marker in patients with hepatocellular carcinoma complicating hepatitis C virus. Subjects and Methods: This case control clinical study was carried out on 60 subjects who were divided into three groups: Group I: Twenty Patients diagnosed with HCC on top of HCV. Group II: Twenty Patients diagnosed with HCV without HCC. Group III: Twenty normal subjects with matched age and sex as a control group. Studied groups were subjected to abdominal ultrasonography, triphasic CT for patients with focal lesions, laboratory investigations including; liver function tests included hepatitis markers and serum 24P3, detected by enzyme linked immunosorbent assay (ELISA). Results: The study revealed a significant increase in AFP in Group I compared to Group II and in Group II compared to Group III. A significant difference P=0.001 was found among the three different groups. The cutoff for AFP was >20ng/mL, sensitivity was 70%, specificity was 85%, PPV 90%, NPV 65% and accuracy 78%. There was a significant increase of 24P3 in Group I compared to Group II and in Group II compared to Group III. A statistical significance p=0.001 was found among the three different groups. The cutoff for 24P3 was >250ng/mL and its sensitivity, specificity, PPV, NPV, and accuracy were all 100%. Based on the present study, 24P3 has a higher sensitivity, specificity and accuracy as compared to AFP, a famously used biomarker in HCC. Conclusion: Serum 24P3 levels in patients with HCV may be used as a guide for progression and prognosis of HCC. In these patients, if 24P3 levels were found to be high, serum alpha‑ feto protein and ultrasonographic examination could be repeated at more frequent intervals. This may also be used as a guide in terms of the treatment plan. Measurement of 24P3 in sera of large number of patients and follow up may pave the way to pick up early stage of HCC and showed its prognostic effect.}, keywords = {oncoprotein 24P3,Hepatocellular carcinoma,Hepatitis C virus}, url = {https://ejhm.journals.ekb.eg/article_30289.html}, eprint = {https://ejhm.journals.ekb.eg/article_30289_b48f5a5d0ed203897a233d7ca8689315.pdf} } @article { author = {Morsi, Abd El Fattah}, title = {Comparative Study between Outcomes of Abdominoplasty with or without Use of Diuretics in Postoperative Treatment}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2231-2235}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30290}, abstract = {Background: Seroma formation is a common complication after abdominoplasty and is associated with delayed wound healing, infection, skin flap necrosis, patient discomfort and repeated visits to the outpatient clinic to deal with seroma and its sequelae. Closing the dead space after abdominoplasty seems to be key in reducing seroma and its complications. Objective: The aim of this study was to compare outcome amount of serous fluid in the drain and incidence of seroma post abdominoplasty with and without use of spironolactone in medical treatment in postoperative period. Patients and Methods: This study was conducted on 40 patients who underwent classical abdominoplasty without use of mesh, all laboratory and radiological investigations were done. Patients were divided into two groups group A involved 20 patients who didn't take spironolactone and group B included 20 patients that had taken spironolactone for 15 days postoperative. Results: In group A, there were 3 males and 17 females and mean age was 34 ± 8.6 years. Group B consisted of 5males and 15 females, their mean age was 40 ± 10.8. BMI was 13 patients >25 in group A and in group B was 6 cases >25. There is small paraumbilical hernia in 4 patients in group A and in 3 patients in group B. Group B who took spironolactone showed significant improvement in outcome including volume of fluid in the drain, time of removal of drain and no occurrence of flap edema. Conclusion: There was statistically significant decrease in the incidence of seroma formation after abdominoplasty with the use of spironolactone postoperative.}, keywords = {Abdominoplasty,seroma,diuretics,Spironolactone}, url = {https://ejhm.journals.ekb.eg/article_30290.html}, eprint = {https://ejhm.journals.ekb.eg/article_30290_229c316645f5eab17ae7323f84ff5ed2.pdf} } @article { author = {El Dab, Mohamed Abd El Aziz and Younis, Mohamed Abd El Mon&#039;m and El Sharkawy, Mohamed Ahmed and Abd El Aziz, Mohamed Abd El Razek and Anwar, Ahmed Mohamed}, title = {Correlation between Subjective and Linear Measurements of The Palatal Airway on Lateral Cephalometric Radiography}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2236-2240}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30522}, abstract = {Introduction: hypertrophied adenoid tissue is one of the most common health problems that occurs in childhood that results in many symptoms including 1. Nasal obstruction. 2. Mucoid, mucopurulent nasal discharge and postnasal discharge 3. Snoring and obstructive sleep apnea. 4. Recurrent acute otitis media (A.O.M). Objective: to evaluate the correlation between subjective and linear measurements of palatal airway on lateral cephalographs. Patients and Methods: Diagnostic lateral cephalometric imaging study that took place from March 2017, to July 2018. 200 Children with chronic mouth breathing (116 boys and 84 girls), with age range from 2 to 14 years, were enrolled in this study. Patients were grouped into three groups according to age: a- 2 - <6 years were 84 patients (42%). b- 6 - <10 years were 76 patients (38%). c- 10 – 14 years were 40 patients (20 %). Results: The age was inversely correlated with the grade of airway obstruction. The correlations between the palatal airway grading with the shortest adenoid distance (SAD) and the most convex adenoid distance (CAD) were r= -0.826 and r= -0.424, respectively, which is statistically significant. The relation between SAD and CAD was directly proportional to each other accounting for correspondence of evaluation in more than 50% of the population which is statistically significant. Conclusion: subjective grading of palatal airway obstruction correlates with the objective measurements of SAD and CAD. Although both methods are reliable in measurement particularly the more severe obstructions, SAD is a more favorable objective tool.}, keywords = {hypertrophied adenoid,CAD,SAD}, url = {https://ejhm.journals.ekb.eg/article_30522.html}, eprint = {https://ejhm.journals.ekb.eg/article_30522_8b32e12873da05da165c2562bf001a4e.pdf} } @article { author = {Abo El-Wafa, Wael Hassan and El-Dsoky, Ibrahim Ibrahim}, title = {Comparison of Temporalis Fascia Graft Medial and Lateral to Handle of Malleus in Dry Central Tympanic Membrane Perforation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2241-2244}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30523}, abstract = {Background: Tympanoplasty is a surgical method, to eradicate middle ear infection and improve its function. The two most common techniques for positioning the graft relative to the remnant of both the tympanic membrane and the tympanic annulus are the ‘overlay’ and the ‘underlay’ techniques. Objectives: To compare two methods of tympanic membrane (TM) grafting when graft materials medial (group A) or lateral (group B) to malleus. Materials and Methods: This prospective study was carried out on thirty patients (30) from May 2017 to August 2018. All operations were done at Hearing and Speech Institute. They were divided into two groups; the first one (group A): included 15 patients treated by grafting with temporalis fascia medial to handle of malleus. The second one (group B): included 15 patients treated by grafting with temporalis fascia lateral to it. Patients with obvious ossicular dysfunction or external ear pathology were excluded from the study. Patients with ear discharge were initially treated conservatively and were included in the study when their ear became dry for at least 3monthes. Any patient requiring ossiculoplasty was subsequently excluded from the study. Diagnosis of the disease was established by clinical, otoscopic, endoscopic and microscopic examination. All patients examined and tested by audiometry 3 month after surgery. Success of surgery is defined as complete repair of TM, without lateralization, atelectasis or retraction pocket. Results: 83.33 % was total graft success. 86.7% with (group A) underlay technique comparing this with 80.0% with (group B) over-underlay technique. Differences of air-bone gap in each group before and after surgery was 33.42 ±3.71 dB in Group A, and 22.30 ± 5.56 dB in Group B. Improvement of hearing level was not significant between the two surgical methods. Conclusions: Both techniques (medial and lateral to malleus handle) of TM grafting are effective with success rates 86.7% and 80.0% respectively.}, keywords = {Chronic otitis media,Tympanoplasty,tympanic membrane perforation}, url = {https://ejhm.journals.ekb.eg/article_30523.html}, eprint = {https://ejhm.journals.ekb.eg/article_30523_080794e6bf6f9de6adaf78d23249637f.pdf} } @article { author = {Ali, Ali El- Shabrawy and Abdo, Hend Salah and Mansour, Ahmed El- Sayed and Abdalla, Marwah Fathy}, title = {Early Detection of Gestational Diabetes Mellitus (GDM) by Measuring Maternal Serum Uric Acid in the First Trimester of Pregnancy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2245-2253}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30524}, abstract = {Background: Gestational diabetes mellitus (GDM) is a common condition with risks for mother and baby. Type 2 diabetes mellitus (T2DM) and obesity are occurring with increasing frequency, and the incidence of GDM reflects this trend. Objective: The aim of the study was to determine the relationship between first trimester elevated uric acid levels and subsequent development of gestational diabetes mellitus during pregnancy. Patients and Methods: The study included 78 pregnant women in the first trimester attending the outpatient clinic of Zagazig University Hospitals, Zagazig for antenatal care. In this study, patients were classified according to their serum uric acid level into 3 groups. Results: Women’s GDM in group (I) showed that 3 (11.5%) were normal, 16 (61.5%) their fasting blood sugar levels (FBS) were high in 2nd trimester and 7 (26.9%) their FBS were high in both 2nd and 3rd trimesters while in group (II) 1 (3.8%) were normal, 9 (34.6%) their FBS were high in 2nd trimester and 16 (61.5%) their FBS were high in both 2nd and 3rd trimesters and in group (III) 1 (3.8%) was normal, 5 (19.2%) their FBS were high in 2nd trimester and 20 (76.9%) their FBS were high in both 2nd and 3rd trimesters. There was statistically significant differences between groups where P=0.007. Conclusion: First trimester serum uric acid levels are associated with subsequent development of IGT and GDM. The test has good predictive value for the diagnosis of GDM and it can be used in a risk assessment model.}, keywords = {Gestational diabetes mellitus,Uric acid,First Trimester of Pregnancy}, url = {https://ejhm.journals.ekb.eg/article_30524.html}, eprint = {https://ejhm.journals.ekb.eg/article_30524_5e720cf3e11308ef3c4b4316fcb8aba9.pdf} } @article { author = {Abd Rabou, Mervat Ahmed}, title = {Histological and Histochemical Alterations Induced in Rats Fetal Esophageal Tissue Intoxicated Maternally with Carisoprodol}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2254-2260}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30525}, abstract = {Background: skeletal muscle relaxants are a varied set of drugs which treat pain of muscles or shudders from marginal musculoskeletal circumstances. Aim of the work: this work targeted to detect the histopathological and histochemical alternations in the rats fetal esophageal treated maternally with Carisoprodol (Soma). Material and methods: thirty gravid rats were branded into three sets: 1-Rats of the 1 st group served as the control group and they were administered oral doses of distilled water, 2- Group of 10 pregnant rats served as the 2nd group and they were treated daily with 10.8 mg/100g/day b.wt. of Carisoprodol, 3-In group 3 pregnant rats were treated with 21.6 mg/100g body weight/day of Carisoprodol (treatment started from the 6th till the 20th day of gestation). Pregnant mothers were sacrificed and small sections of fetal rat esophagus were taken for the histopathological and histochemical purposes. Results: numerous histopathlogical and histochemical changes were detected in the fetal esophageal tissue of the two treated groups compared to the control group and the alternations were amplified with raising the doses of carisoprodol. Conclusion: treatment of the pregnant rats with carisoprodol caused dystrophic variations in the fetal esophageal tissue, so the usage of this medicine during gestation should be under strict protections.}, keywords = {carisoprodol,fetuses,pregnant rats,esophagus,histopathology and histochemistry}, url = {https://ejhm.journals.ekb.eg/article_30525.html}, eprint = {https://ejhm.journals.ekb.eg/article_30525_ed1702ff612b196ef6208fd9a5705074.pdf} } @article { author = {El-behairy, Doaa S. A. and Diaa Eldin, Nayera H. and Elbadry, Entsar E. and Mohamed, Amira A. and Farrag, Islam M.}, title = {Hepato-Renal Toxicity of Titanium Dioxide Nanoparticles and The Protective Effects of Moringa Oleifera Leaves Extract and Vitamin E in Male Albino Rats}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2261-2271}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30526}, abstract = {Background: Titanium dioxide nanoparticles (TDN) one of the most common nanomaterial used in a wide range of applications. Moringa oleifera leaves extract (MOLE) has hepato- and nephron-protective effects amongst other medicinal and nutritional benefits. Vitamin E (Vit. E) is an important lipid soluble vitamin. Aim: The present work aimed to study hepato-renal toxicity of TDN in adult male albino rats through biochemical and histopathological study and protective effects of either MOLE or Vit. E or both. Materials and Methods: 49 adult male albino rats were divided randomly into 7 groups (7 rats each). Group 1: served as control, Group 2: Rats received (MOLE) once daily by oral gavage Group 3: Rats received (Vit. E) once daily by oral gavage Group 4: Rats received TDN subcutaneous on alternate days Group 5: Rats coadministrated TDN and MOLE Group 6: Rats co-administrated TDN and (Vit. E), Group 7: Rats coadministrated TDN, (MOLE) and vitamin E. All groups received the treatment for four weeks, then blood samples were collected for assessment of liver function markers and kidney function markers. Also, Liver and kidney were excised for histopathological examination. Results and Conclusion: TDN treated animals recorded a significant increase in ALT, AST. ALP, total bilirubin, urea and creatinine and a significant decrease in total protein. Significant improvement occurred on co-administration of either (MOLE) or (Vit.E) or both. Histopathological lesion in both liver and kidney which were observed in TDN treated animals improved on co-administration of either (MOLE) or (Vit. E) or both.}, keywords = {TDN,Moringa oleifera leaves extract,Vitamin E,hepatotoxicity and nephrotoxicity}, url = {https://ejhm.journals.ekb.eg/article_30526.html}, eprint = {https://ejhm.journals.ekb.eg/article_30526_f8fcaab823285a05c12a231c851295db.pdf} } @article { author = {Madkour, Huda T. and Wafa, Yahia A. and Amer, Ahmed S.}, title = {Effect of Vaginal Low Dose Sildenafil on the Outcome of ICSI after ICSI Failures Attributed to Poor Endometrial Development}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2272-2275}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30527}, abstract = {Background: Endometrial thickness is a marker of endometrial receptivity and a prognostic factor for embryo transfers (ET). Poor endometrium is a multifactorial condition; so, its management should be cause-related. One of the treatment options is Sildenafil citrate intake. It causes uterine vascularity improvement. Objectives: The aim of the current work was to evaluate the effects of vaginally administered doses of sildenafil on endometrial lining and ICSI outcome in infertile women with poor endometrial development. Patients and Methods: This study included a total of thirty infertile women with at least one prior ICSI failure attributed to inadequate endometrial development, undergoing ICSI procedure attending at a private assisted reproductive center. All patients underwent ICSI using a long GnRH-a protocol with the addition of sildenafil vaginal suppositories (20 mg, 4 times per day) for 10 days beginning with ovulation induction and continued until trigger day. Results: The results showed that increased endometrial thickness due to treatment with sildenafil to reach 12-14 mm in 28 out of 30 cases and was associated with a pregnancy rate of 60.7% if compared to the same group thickness. Also, another effect of sildenafil citrate was increasing the endometrial trilaminar pattern in 27 case and subsequently with high pregnancy rate. Conclusion: Increased endometrial thickness due to sildenafil therapy was associated with high pregnancy rat and its intake was associated with increased trilaminar endometrial pattern in 90% of patients which causes high pregnancy rate.}, keywords = {sildenafil,ICSI,Endometrial}, url = {https://ejhm.journals.ekb.eg/article_30527.html}, eprint = {https://ejhm.journals.ekb.eg/article_30527_3eec984033242441526ebf893851e9e8.pdf} } @article { author = {Ahmed, Glonar Otiefy and Morsy, Amal Abdel Aleem and Abo El Eneen, Samah Roshdy Abo El Eneen}, title = {Role of Kidney Injury Molecule-1 and β2-Microglobulin in Early Diagnosis of Diabetic Nephropathy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2276-2284}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30528}, abstract = {Background: Diabetes mellitus has been described as a metabolic disorder of multiple etiology characterized by chronic hyperglycemia with disturbances of carbohydrate metabolism. Diabetic nephropathy is typically characterized by a gradual increase in urinary albumin excretion. Albuminuria, a marker of glomerular involvement in early renal damage, cannot always detect early diabetic nephropathy (DN). Aim of the Work: Is to determine the suggested promising diagnostic role of kidney injury molecule-1 (KIM-1) level and β2 microglobulin and how could improve the early diagnosis, predict disease progression and deliver new insights in pathogenic of diabetic nephropathy. Subjects and Methods: this study included 80 subjects. Group I: sixty (60) patients with T2DM classified into 3 subgroups according to the level of albumin/creatinine ratio (ACR). Thirty (30) diabetic patients with normoalbuminuria (1a), 20 diabetic patients with microalbuminuria (1b) and 10 diabetic patient with macroalbuminuria (1c). Group II: Twenty, age and sex matched, apparently healthy individuals serving as a control group. Results: Our results revealed a statistical significant increase in FBS, blood urea, as well as microalbuminuria with GFR decline in patients group when compared to control group. However, serum levels of creatinine were only significantly elevated in diabetic patients with ACR ≥300 mg/g when compared to control group. The results revealed a highly statistically significant increase in urinary KIM and β2 microglobulin levels in micro than normo and in macro than micro albuminuric group. Conclusion: Our data revealed that tubular biomarkers were increased in T2DM patients with normoalbuminuria when compared with controls.}, keywords = {Kidney Injury Molecule-1,β2-microglobulin,diabetic nephropathy}, url = {https://ejhm.journals.ekb.eg/article_30528.html}, eprint = {https://ejhm.journals.ekb.eg/article_30528_abac96b850c656ee137efe58369f8ffa.pdf} } @article { author = {Mohammad, Mohammad Sayed Ali}, title = {Common Errors in Diagnosis and Treatment of Pediatric Epilepsy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2285-2289}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30529}, abstract = {Background: epilepsy affects people in all nations and of all races. Its incidence is greater in African American and socially disadvantaged populations. Epilepsy is the most commonly encountered neurologic conditions in children. Aim of the Work: learning from one's mistakes is the best learning tool in medicine and this applies as well to epilepsy, so the aim of our work is to review some of the most frequently identified mistakes and errors in the diagnosis and treatment of pediatric epilepsy and how to avoid their occurrence. Patients and Methods: the study included fifty children with epilepsy and condition mimic epilepsy, aged less than fifteen years (35 males and 15 females). The children participating in the present study were selected randomly from patients attending the pediatric neurology outpatient clinic of Al-Azhar University Hospital. The present work was conducted from January 2018 till the end of September 2018. Results: in the present study it was found that 70 % of the studied patients are males and 30 % females. 76% of our patients were coming from rural areas, and only 24% living in urban. In this study we found that 34 % of our patients are wrongly diagnosed as Epilepsy. The study showed that 27% of epileptic cases are not controlled mostly due to improper selection of drug in 55.6 % and 44.4 % due to improper dose. Conclusion: In fact, in patients with epilepsy, a detailed history is likely to lead to an accurate diagnosis in up to 90% of patients}, keywords = {Diagnosis,Treatment of Pediatric Epilepsy}, url = {https://ejhm.journals.ekb.eg/article_30529.html}, eprint = {https://ejhm.journals.ekb.eg/article_30529_5149d88934f39c5212a128c35a99ea08.pdf} } @article { author = {Dardyr, Mohamed El Moddather Ahmed and Ahmed, Ibrahim Mohammed and Mohamed, Mohamed Abd Elaal}, title = {Comparative Study between Conventional and Custom Lasik Ablation in The Treatment of Myopic Astigmatism}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2290-2297}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30690}, abstract = {Background: The popularity of laser-assisted in situ keratomileusis (LASIK) stems from its ability to treat a wide range of refractive errors with rapid visual recovery and minimal patient discomfort. The conventional treatment is a Munnerlyn based spherocylindrical ablation, Customized Ablation is a topography and wavefront guided ablation treating corneal high-order aberrations Objective: to evaluate the visual and refractive outcomes of customized ablation and conventional ablation in the treatment of myopic astigmatism. Patients and Methods: This randomized prospective comparative study was carried out on 60 eyes of 34 patients with compound myopic astigmatism (myopic sphere ≤ -10.0 D and myopic cylinder ≤ - 4.0D) with age range between 18 and 50 years at Al-Azhar University Hospital, Assuit and Al-Nahar Eye Centre, Assuit, between April 2018 and October 2018. These patients were divided into two groups: Group (1) included 30 eyes of 18 patients who had Standard LASIK ablation. Group (2) included 30 eyes of 16 patients who had WFG (Custom) LASIK ablation. Results: Regarding the refractive safety, both procedures were highly safe (all the patients maintained the preoperative BSCVA in the 6th month). It was obvious that the WFG LASIK was superior to the conventional LASIK in the visual outcome and this can be approved by applying the efficacy index for the procedures (mean postoperative UCVA/mean preoperative BSCVA), and it was 1.14 in the custom group and 0.97 in the conventional group in the 1st month. Improving the visual acuity after custom LASIK, in spite of similar refractive results (predictability) indicates that not only the defocus, but also the high order aberrations affect the final visual acuity level. Conclusion: the two procedures have high degree of safety, refractive stability and predictability but the custom LASIK is superior to the conventional LASIK.}, keywords = {Myopic astigmatism,Custom LASIK,Conventional LASIK,Visual quality,High order aberrations}, url = {https://ejhm.journals.ekb.eg/article_30690.html}, eprint = {https://ejhm.journals.ekb.eg/article_30690_30eea9d7425a561e5a9426830adacd46.pdf} } @article { author = {Alkhawaga, Ismaeil Abd- Almaguid and Elkaseer, Mohamed Hasan and Abozeid, Ahmed Abdul Hameid and Mohamed, Mostafa Sayed}, title = {Recent Trends in Management of Perianal Fistula}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2298-2304}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30691}, abstract = {Background: Perianal fistula is a tract lined by infected granulation tissue that connects anal canal or rectum to the skin around anus. Its wall is made of inflammatory granulation as well as fibrous tissue. Perianal fistulae occur in approximately 10 out of 10,000 persons. Objective: The aim was to discuss the classification, diagnosis and management of perianal fistula with special emphasis on most recent trends. Patients and methods: The study was carried out on 50 Egyptian patients suffering from perianal fistula. Patients were managed in Sayed Galal University Hospital. The study was controlled prospectively. Ethical approval from the local Ethics Committee of Surgery Department was obtained. The patients were divided into two groups group A diagnosed by endoanal U\S and B by MRI fistulogram. Results: The current results on difference between Seton operation and other types. Regarding surgical data, there was localization of the internal opening occurred in 60% of patients operated with Seton technique. Among those operated with Seton technique, 80% had no complications, while recurrence occurred in 13.3%. Conclusion: In this study, seton technique was the best surgical technique in management of perianal fistula with less post-operative complication than other techniques.}, keywords = {Management,Perianal Fistula,Seton,MRI}, url = {https://ejhm.journals.ekb.eg/article_30691.html}, eprint = {https://ejhm.journals.ekb.eg/article_30691_d8b4df8c1ec44d73a104640164d24d08.pdf} } @article { author = {Abdalla, Samir and Fares, Tamer and Mohamed, Mohamed Ali Eisa}, title = {Placental Thickness in First Trimester (11-14) Weeks and Correlation with Preeclampsia and Intrauterine Growth Retardation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2305-2311}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30692}, abstract = {Background: First trimester trophoblastic invasion has far-reaching consequences for the fetus; failure at this stage may result in fetal growth restriction with morbidity both in the immediate perinatal period, as well as throughout development into adulthood. Objective: The aim of this study was to estimate the placental thickness in first trimester (11-14) weeks and investigating the correlation with preeclampsia and intrauterine growth retardation. Patients and methods: This prospective cross-sectional study was conducted at Al-Azhar University Hospital. The study included 50 patients. Results: There was a significant increase in the maximal placental thickness (PT) to placental volume ratio in growth restricted fetuses in our study. This may be a reflection of reduction in placental surface area. Further work is required to confirm this finding using more accurate stereological analysis of the placenta in utero. In this study, the MRI appearance of suspected retroplacental haemorrhage, placental infarct, and subchorionic haemorrhage was confirmed by placental histology in 100%, 100%, and 33% of cases respectively. Conclusion: From our study, it can be concluded that PT can be used as a predictor of the GA, in the women in whom the LMP is unreliable or is not known}, keywords = {Placental thickness,first trimester,preeclampsia,intrauterine growth retardation}, url = {https://ejhm.journals.ekb.eg/article_30692.html}, eprint = {https://ejhm.journals.ekb.eg/article_30692_f3267e0ecfa7513d4ab9523664926031.pdf} } @article { author = {Elsayed, Ahmed N.}, title = {Comparison Between Intravitreal Ranibizumab Injection, Corticosteroid Implants and Intravitreal Triamcinolone Acetonide injection In Treatment of Noninfectious Uveitic Macular Edema}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2312-2318}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30694}, abstract = {Background: Uveitis is a broad term for inflammation involving the eye. It is classified according to the location of the inflammatory process either anterior, intermediate, posterior or panuveitis. Uveitis can be secondary to an infectious etiology, such as tuberculosis, toxocara canis, toxoplasmosis, herpes virus, Lyme, and syphilis. Purpose: comparing the efficacy and safety of intravitreal ranibizumab injection, corticosteroid implants and Intravitreal triamcinolone acetonide (IVTA) injection in treatment of noninfectious uveitic macular edema. Patients and Methods: A prospective study was conducted in Al-Azhar University Hospitals (El-Hussein and BabElsheryia Hospitals). A total of 60 eyes of 45 uveitic patients were recruited in this study. First group; 20 eyes undergo intravitreally injection with ranibizumab 0.5 mg (0.05 ml), one dose per month (six doses). Second group; 20 eyes undergo corticosteroid implants. Third group 20 eyes undergo IVTA injection. Results: All patients included in this study completed the period of follow up (six months) in group 1 Visual acuity (VA) improved and central macular thickness (CMT) decreased slightly but not significantly after 1 month to 1.35 ± 0.25 and 365.3 ±185.5 μM, respectively. In group 2; VA improved and CMT decreased after 1 month to 1.75 ± 0.2 and 470.45 ± 175.20 μM, respectively. In group 3; VA improved and CMT decreased slightly after 1 month to 2.15 ± 0.22 and 460.45 ± 185.45 μM, respectively, an increase of intra ocular pressure (IOP) between 6 mmHg and 15 mmHg was maintained in 16 of 20 eyes (80%) at 1 months and was maintained in 4 of 20 eyes at 3 months (20%). Conclusion: Intravitreal injection can be used as a single therapy to treat uveitic ME secondary to noninfectious uveitis. With a variety of intravitreal therapeutic agents available for treatment of uveitic ME in this study (Intravitreal ranibizumab injection, corticosteroid implants and IVTA) and each drug having its own advantages and disadvantages, the final treatment should be individualized based on the severity of disease, risk /benefit ratio of each therapy and choice of the patient.}, keywords = {ranibizumab,dexamethasone,IVTA,uveitic macular oedema}, url = {https://ejhm.journals.ekb.eg/article_30694.html}, eprint = {https://ejhm.journals.ekb.eg/article_30694_a1334d0c867342e7d9810400c8b4ca77.pdf} } @article { author = {Khairy, Ahmed Mohamed and El Sebaie, Adnan Abd El-Aleem and Negm, Mohamed Abd El Monem}, title = {Early results of Ceramic on Ceramic versus Ceramic on highly cross linked polyethylene Total Hip Arthroplasty}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {2}, pages = {2319-2324}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.30693}, abstract = {Background: Nowadays, other bearing surfaces such as ceramic on highly cross-linked polyethylene (HXLPE) and ceramic on ceramic have been proposed as an alternative to metal on polyethylene as a solution to osteolysis and loosening. Purpose: it was to spot light on a comparison of early results of use two different bearing surfaces, ceramic on ceramic versus ceramic on HXLPE in primary total hip replacement Materials and Methods: this is a prospective comparative study which was conducted during the period from June 2016 to April 2019 with mean follow up two years. It included 38 patients (42 hips) which were undergone for total hip replacement (THR) due to end stage arthritis. Of these, there were 22 ceramic on ceramic and 20 ceramic on HXLPE implants. These cases were operated upon Al-Azhar University Hospitals (Al-Hussein & Bab El-Shaeria). Results: No statistically significant difference in clinical and radiological outcomes scores between the two studied groups with higher rate of implant related fracture and squeaking in ceramic on ceramic group. Conclusions: there was no statistically significant difference in the clinical and radiological outcome between the two studied groups at the time of last clinical follow-up. Long-term follow-up is required for further evaluation.}, keywords = {ceramic on ceramic,Total Hip Replacement,HXLPE}, url = {https://ejhm.journals.ekb.eg/article_30693.html}, eprint = {https://ejhm.journals.ekb.eg/article_30693_b64dc3376603202a7263f741b654ead2.pdf} }