@article { author = {Ghali, Ali A}, title = {Bimanual Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {2952-2957}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.33795}, abstract = {Background: Diabetic retinopathy (DR) is considered the commonest cause of diabetic epiretinal membrane (ERM) worldwide. DR remains one of the leading causes of legal blindness in the working- age population. Aim of the work: was to evaluate the efficacy, safety and complications of bimanual pars plana vitrectomy (PPV) for management of ERM associated with tractional retinal detachment (TRD). Patients and methods: 27 eyes in 23 patients presented with diabetic ERM associated with TRD. After full ophthalmic examination all patients underwent bimanual PPV with silicone oil injection or gas tamponade without or with phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Results: Complete removal of ERM was achieved in 23 cases (85.18 %) while has incompletely removed in four cases (14.81%). Residual tractional RD was observed in one cases (3.7%). Iatrogenic breaks were occurred in five cases (18.51%). Endo-laser photocoagulation was done in 19 cases (70.73%). There was improvement of BCVA in 23 (85.18%) cases, while remained the same in two cases (7.4%) and deteriorated in two eyes (7.4%) due to reproliferation and development of neovascular glaucoma. Conclusion: It could be concluded that bimanual PPV is an effective, safe and an attainable technique for management of diabetic ERM associated with TRD, learning curve with this technique and coast benefit ratio may be considered.}, keywords = {Bimanual vitrectomy,tractional,retinal detachment}, url = {https://ejhm.journals.ekb.eg/article_33795.html}, eprint = {https://ejhm.journals.ekb.eg/article_33795_687e2e03421051175917ee9bfacc725f.pdf} } @article { author = {Mohamed, Mohamed A. and Moussa, Assem A. and El-Taybe, Hazem M.}, title = {Effect of Sildenafil Citrate on Uterine Artery Blood Flow in Patients with Unexplained Recurrent Miscarriages: A Randomized Clinical Trial}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {2958-2964}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.33796}, abstract = {Background: Unexplained recurrent miscarriage can be a challenging and frustrating condition for both patients and clinicians. Sildenafil citrate is one of the currently available lines of treatment according to simplicity of use, reliability and degree of invasiveness but up to now there are no prospective randomized studies, powerful enough. Aim of this Work: To evaluate the efficacy of oral sildenafil citrate 20 mg on uterine arteries Doppler flow studies in patients with unexplained recurrent miscarriages. Patients and Methods: This prospective case control study was conducted at Sayed Galal Maternity Hospital outpatient clinics on 180 women who' were divided into 2 groups: (group 1) which included 91 patients who took sildenafil citrate 20 mg orally, 4 times per day for 21 days and (group 2) which included 89 patients who took placebo orally, 4 times per day for 21 days in the period starting from (August 2017 to June 2018). Results: The statistical comparison between group I (sildenafil citrate) and group II (placebo) before and after administration of drug regarding endometrial thickness showed non-significant difference before and significant difference after 3 weeks of administration of sildenafil citrate in group I and placebo in group II. The statistical comparison in patients in group I (sildenafil citrate) before and after 1 week, 2 weeks and 3 weeks administration of drug regarding pulsatility index, resistance index and systolic/diastolic ratio showed significant difference. Conclusion: Sildenafil citrate has an effective role in increasing the uterine arteries blood flow in patients with recurrent miscarriage.}, keywords = {Sildenafil citrate,uterine artery blood flow,unexplained recurrent miscarriages}, url = {https://ejhm.journals.ekb.eg/article_33796.html}, eprint = {https://ejhm.journals.ekb.eg/article_33796_c2d154456b77452f19eaa11189e86d36.pdf} } @article { author = {Hassan, FI and Shehata, M and El-Sheikh, W.A. and Younis, Mostafa M.M.}, title = {The Role of Transdermal Testosterone Patch Over Pregnancy Rates in Poor Ovarian Responders Undergoing ICSI Cycles}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {2965-2970}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.33797}, abstract = {Background: poor responder management in IVF represents a critical dispute for fertility specialists. Meanwhile, there is a lack of evidence to support the use of any particular intervention to improve treatment outcomes in poor responders because of the small sample size and the heterogeneity between the trials on the definition of poor ovarian responders (POR). Objective: the aim of this study was to evaluate the role of transdermal testosterone on the probability of pregnancy achievement in poor responders undergoing ICSI trials. Thus, the number of oocytes, pregnancy rates (clinical and live birth) and HMG dose and duration were compared between both trials. Patients and Methods: This single-centre, randomized controlled trial was conducted from August 2016 to August 2017. A total of 61 poor responder patients with previous failed trial underwent their second ICSI trial. The patients received ovarian stimulation using a short GnRH agonist protocol in both trials with transdermal testosterone patches being used in the second trial starting five days prior to HMG. Results: The oocytes recruitment and the pregnancy rates were higher after testosterone pretreatment in the second trial, however, the difference between the previous and the second trial didn’t reach the statistical significance. Conclusion: Testosterone patches effect on oocyte number and pregnancy rates appears to be minimal for poor responders. However, further trials are needed to prove the study’s conclusion in the future.}, keywords = {Transdermal Testosterone Patch,Over Pregnancy Rates,Ovarian Responders Undergoing ICSI Cycles}, url = {https://ejhm.journals.ekb.eg/article_33797.html}, eprint = {https://ejhm.journals.ekb.eg/article_33797_c50bd559ab89a8a1d6d6acc9bdc20fc9.pdf} } @article { author = {Elbatrawy, Yasser Ali and Ismail, Mahmoud Ali and Abdel-Rahman, Abdel-Rahman Elsayed}, title = {A Systematic Review of Ankle Reconstruction with Limb Lengthening in Fibular Hemimelia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {2971-2976}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.33798}, abstract = {Background: fibular hemimelia (FH) is a congenital deficiency where part or all of the fibular bone is hypoplastic, dysplastic or aplastic associated with hypoplasia and dysplasia of the tibia and hypoplasia, dysplasia and aplasia of parts of the foot. Objective: this systematic review was aimed to review the different method of ankle reconstruction with limb lengthening in patients with Fibular Hemimelia to restore normal weight-bearing and normal limb length so that the patient can walk with a normal gait as possible. Material and Methods: online search was done using the Medline database on PUBMED, Google Scholar and SCINCEDIRECT from 2001 to 2018; all the English language published studies were identified with the search keywords of, ankle reconstruction with limb lengthening in fibular hemimelia, fibular hemimelia and treatment of fibular hemimelia. Literature search database on PUBMED, Google Scholar and SCINCEDIRECT showed 193 studies. Results: Our search revealed 6 studies accounting for total of 74 patients included in the final analysis. Numbers of males were 24 patients and females were 30 patients. The mean age is 20.4 month, with average follow up time is 38.6 month. Each study was analyzed, and the following postoperative data were collected: outcomes, recurrence, dorsiflexion, planter-flexion, and complication. Conclusion: SUPER ankle procedure is a widely used technique with or without lengthening showing good results in correction of equinovalgus deformity of the ankle. Performing the reconstruction of the ankle at an earlier age plays a significant role in preventing recurrent foot deformities.}, keywords = {FH,ankle}, url = {https://ejhm.journals.ekb.eg/article_33798.html}, eprint = {https://ejhm.journals.ekb.eg/article_33798_7fe84e6eb097401e4a1464919328d94f.pdf} } @article { author = {El-Alfy, Mohammed Noshi and Dousoky, Khaled Masoud and Shaheen, Ahmed Anwer Mohammed and Abdel-Hassib, Mohammed and Abd Elwahed, Abdullah Mahfouz}, title = {Diabetes as a Risk Factor Hepatic Encephalopathy among Egyptian Cirrhotic Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {2977-2983}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.33799}, abstract = {Background: Hepatic encephalopathy (HE) is one of the leading consequences among patients with cirrhotic liver, which influence more than 35% of these patients. It was established that more than 95% of cirrhotic patients were associated with glucose intolerance and approximately 33% of them had type 2 diabetes mellitus (DM). This investigation was conducted to evaluate the possible association between DM and the development of HE. Objective: this study was designed to examine the association of DM with the prevalence and severity of HE in Egyptian patients with decompensated cirrhosis. Patients and methods: This study was carried out prospectively on 100 patients presented with HE. Those further had been classified into diabetic (60 patients group 1) and non-diabetic (40 patients group 2). All patients in this study were subjected to a thorough assessment of history taking, thorough physical examination, laboratory investigations including complete blood picture, kidney and liver function tests, viral HBsAg and HCVAb, serum sodium, potassium, calcium and magnesium, serum ammonia levels, fasting and glycosylated hemoglobin (HbA1C %) and abdominal ultrasonography. Results: Diabetic patients showed a higher incidence of Grades, III, and IV of HE compared to the non-diabetic group with p value < 0.0001 for each grade. Furthermore, there was a statistically significant difference between both groups regarding the Child-Pough classification. A statistically significant positive correlations between fasting blood sugar level, and glycosylated hemoglobin with HE grades (r = 0.430 and p =0.0006), (r = 0.314, p = 0.0145) respectively among diabetic patients group 1. Conclusions: Egyptian diabetic patients have a potential risk of developing HE among cirrhotic liver patients relative to non-diabetic patients.}, keywords = {Diabetes mellitus,hepatic encephalopathy and liver cirrhosis}, url = {https://ejhm.journals.ekb.eg/article_33799.html}, eprint = {https://ejhm.journals.ekb.eg/article_33799_00c78862063015af81eeebc0f341b976.pdf} } @article { author = {Nassar, Al Araby Abd Elghany and Abd Elghany, Abd Elghany Ibrahim and Mohamed, Ahmed Osama}, title = {The Role of Pattern Visual Evoked Potential in Primary Open Angle Glaucoma}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {2984-2992}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.33800}, abstract = {Background: Primary open-angle glaucoma (POAG) is one of the leading causes of blindness worldwide. The death of retinal ganglion cells in POAG is reflected by increased cupping of the optic disc, loss of nerve fiber layer and functional visual field defect. Objective: The aim of the work was to assess the role of Pattern Visual Evoked Potential (VEP) in diagnosis of primary open angel glaucoma. Patients and methods: We studied 40 eyes of 21 subjects, the eyes were classified into 2 groups: Group I included 20 eyes of 11 patients with primary open angel glaucoma and Group II included 20 eyes of 10 normal control (age and sex) matched group. All eyes underwent a full field ophthalmic, OCT and pattern VEP. Results: OCT results showed significant reduction of retinal nerve fiber layer (RNFL) thickness in glaucoma and glaucoma suspect eyes in the majority of quadrants as well as in the average RNFL thickness p < 0.001. The pattern VEP of glaucomatous patient when compared to normal control group reported affection of the VEP by causing both reductions in amplitude and increases in latency. And by statistically analysis of the results that there were highly statistically significant differences between both groups of the VEP measurements (p < 0.001). Conclusion: The pattern visual evoked potential (VEP) has been shown to be sensitive to optic nerve lesions caused by ischemia and glaucoma has also been reported to affect the VEP by causing both reductions in amplitude and increases in latency.}, keywords = {POAG,OCT,RNFL,VEP}, url = {https://ejhm.journals.ekb.eg/article_33800.html}, eprint = {https://ejhm.journals.ekb.eg/article_33800_865038544d51821f6d5639ff06c35b2d.pdf} } @article { author = {Yonis, Mohammed Abd ElMon&#039;em and Abd Elgalil, Ahmed Seddiq and Elshamy, Mahmoud Ibrahim and Eldiehy, Ibrahim Mohammed Mohammed}, title = {The Relationship between Ethmoid Roof, Cribriform Plate Dimensions and Degree of Septal Deviation Angle}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {2993-2999}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.33801}, abstract = {Background: endoscopic sinus surgery (ESS) is a common operation for the management of sinonasal pathologies, the surgeons dealing with endoscopic sinus surgery should understand the crucial complex anatomy of the anterior cranial base to avoid the intracranial violation during ESS. Objective: the aim of this work is to investigate the relationship between degree of septal deviation angle and the dimensions of cribriform plate and ethmoid roof by radiological paranasal CT evaluation. Patients and methods: forty patients, 20 females and 20 males, were selectively collected according to inclusion and exclusion criteria from the out-patient E.N.T clinics of El-Hussein and Bab-El-She'reya Hospitals from November 2017 to January 2019 with their age ranged from 18 – 60 years old. Results: the severity of deviation didn’t have impact on the dimensions of the ethmoid roof and cribriform plate in terms of depth and width except right ethmoid roof width (direct proportion) and the left cribriform width (inverse proportion). There was a significant direct relationship between ipsilateral and contralateral ER width and between ipsilateral and contralateral ER depth. This study showed no significant relation between ipsilateral and contralateral CP width. High rate of asymmetry between CP and ethmoid roof in our study (100 %) was noted. Conclusion: in cases of deviated nasal septum, this study suggests that the increase in the severity of septum deviation rises the possibility of the increasing right ethmoid roof width and of decreasing the left cribriform width and this possibility should be taken into consideration to avoid iatrogenic injury during ESS.}, keywords = {Ethmoid Roof,Cribriform Plate Dimensions,Degree of Septal Deviation Angle}, url = {https://ejhm.journals.ekb.eg/article_33801.html}, eprint = {https://ejhm.journals.ekb.eg/article_33801_0afa43d4b8280bb9ad305eb5daad5093.pdf} } @article { author = {Abd Elmoktader, Magdy A. and Mekky, Moustafa and Sholkamy, Khallad and Nageh, Mohamed}, title = {Evaluation of Different Modalities of Tendon Transfer in Ulnar Nerve Palsy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3000-3005}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.33803}, abstract = {Background: Tendon transfer surgery is a type of hand surgery that is performed in order to improve lost hand function. A functioning tendon is shifted from its original attachment to a new one to restore the action that has been lost. Aim of the study: the present study was performed to evaluate the different modalities of tendon transfer in management of clawing of little and ring fingers in ulnar nerve palsy. Patients and Methods: Correction of clawing of ring and little fingers was done in 20 patients (with ulnar palsy whether high or low; age range: 5-60 years). Different techniques of tendon transfer were used including Zancolli-lasso procedure using flexor digitorum superficialis (FDS), Stiles Bunnel procedure using FDS and Brand procedure Results: Anti-claw procedures were performed in 20 cases, 10 patients showed excellent results, 6 patients showed good results, 3 patients showed fair results, while 1 patient showed poor result according to MRC grading system. Conclusion: It could be concluded that among many techniques of tendon transfer procedures prescribed for treatment of claw hand in ulnar nerve palsy, FDS transfer is the best reconstructive tendon transfer procedure for correction of ulnar claw hand especially in low ulnar palsy. In case of high ulnar palsy when FDS isn’t available ECRL transfer is the next choice.}, keywords = {Tendon Transfer,ulnar nerve palsy,claw hand}, url = {https://ejhm.journals.ekb.eg/article_33803.html}, eprint = {https://ejhm.journals.ekb.eg/article_33803_8bf58c80aaeca5788214c85f47b16f29.pdf} } @article { author = {Abo Samra, Marwa Abd-Allah and Ali, Naeima Khodeir and El-Madboly, Asmaa Abd Elsalam}, title = {Detection of Multi-Drug Resistant Klebsiella Pneumoniae in Al-Zahraa University Hospital}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3006-3012}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34176}, abstract = {Background : the rate of multidrug resistant (MDR) klebsiella pneumonia is increasing worldwide, its detection by available phenotypic methods represents a challenge. However, every lab should estimate its frequency for infection control measures and antibiotic stewardship program. Objective: The aim of the study was to estimate the frequency of MDR klebsiella pneumoniae in Al-Zahraa University Hospital, Cairo, Egypt, and to determine their different phenotypic methods. Methods: frequency of MDR K. pneumoniae isolates from different clinical samples provided to the microbiology laboratory, Al-Zahraa University Hospital, Cairo, Egypt during the period from May 2016 to January 2017 was detected by different phenotypic methods including ESBL detection (ESBL combined disk test, the double disk synergy test and the ESBL NDP test), AmpC production, carbapenemase production, the temocillin disk diffusion test, the Carba NP test, the Blue carba test and the genotypic detection of OXA-48 gene). Results: out of 2058 samples provided to Al-Zahraa University Microbiology Lab, 143 isolates were K. pneumoniae (6.94 %), 120 out of these 143 (83.9 %) were MDR. Their incidence rate (0.1) from the total and (0.8) and from the K. pneumoniae isolates respectively.98.3% of these MDR were ESBL producers, 45.8% were AmpC B lactamase, 39.16% were carbapenem resistant while quinolone and aminoglycoside resistance were 63.6% and 68.3% respectively. Conclusion: continuous laboratory surveillance for different types of resistance in all K. pneumoniae isolates is recommended. ESBL NDP test and blue carba test could be used as routine tests in the microbiology lab for rapid detection of ESBL and carbapenem isolates.}, keywords = {MDR klebsiella pneumoniae,ESBL,Carbapenem resistance,AmpC B lactamase}, url = {https://ejhm.journals.ekb.eg/article_34176.html}, eprint = {https://ejhm.journals.ekb.eg/article_34176_6f3edf72a77944abb24ab0fa4b8c5f44.pdf} } @article { author = {Salama, Mohsen Ali Mahmoud and Hasan, Yasser El Sayed Mohammed and Farag, Moataz Abd Al Rahman Abd Al Salam}, title = {The Relation of Left Ventricular Diastolic Dysfunction and Increased Left Ventricular Mass with Blood Pressure Variability in Non-Established Hypertensive Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3013-3017}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34198}, abstract = {Background: long term high blood pressure is a major risk factor for coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss and chronic kidney disease.Objective: the aim of this study is to demonstrate the relation between left ventricular diastolic dysfunction, increased left ventricular mass and ambulatory blood pressure recording in subjects not known to be hypertensive. Patients and Methods: this study is cross sectional study that was carried out on (100) normotensive patients in Cardiology Department Clinic at Matrouh Specialized Cardiothoracic and Interventional Catheterization Center from October, 2017 to January 2019. Results: significantly marked difference in left ventricular (LV) mass between two groups (normal blood pressure and latent hypertension) and significantly marked difference in diastolic dysfunction. According to (normal circadian and impaired circadian) there is significant difference between the two major groups in sex wheremale >female and marked difference in LV mass between the two groups (normal circadian and impaired circadian) and in smoking. Conclusion: ambulatory blood pressure (AMBP) plays an important role as a predictor to estimate prevalence of hypertension based on diastolic dysfunction and increased left ventricular mass in persons with normal blood pressure measures at office specially masked hypertension in white coat hypertensive patients.}, keywords = {Left ventricular diastolic,Blood Pressure Variability}, url = {https://ejhm.journals.ekb.eg/article_34198.html}, eprint = {https://ejhm.journals.ekb.eg/article_34198_78e93553b24b59d25cca1ac4d4501ab4.pdf} } @article { author = {Ezzat, Mohamed Hesham Hassan and Abu Elmaged, Mohamed Sarhan and Fakher, Osama Abd Elaziz Mohamed and Mahmoud, Mohamed Ahmed}, title = {Gender Differences of Pulsed and Tissue Doppler Indices of Left Ventricular Diastolic Function in Type II Diabetic Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3018-3026}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34200}, abstract = {Background: LV diastolic dysfunction is one of the first signs of diabetic cardiomyopathy, often developing before systolic dysfunction. Diastolic dysfunction in women differs in many aspects from that of men. Some of these differences may have a pathophysiological basis. These sex differences may have widespread implications in the field of heart failure with normal ejection fraction. Objective: To assess gender differences of left ventricular diastolic function by pulsed and tissue Doppler echocardiographic indices in patients with type II diabetes mellitus. Patients and Methods: The study included 300 patients with type II diabetes mellitus and was conducted in the Cardiology Department (Faculty of Medicine, Azhar University). It is an observational case control study started from January 2017 to March 2019. 150 age and gender matched healthy volunteers as control. Results: Our study showed that there is no statistically significant difference between diabetic males and diabetic females as regard LA dimensions, E/é lateral, e’ lateral, E/A ratio, A velocity. It was significant for E/e’ septal, E velocity, EF, LVEDD and LVESD with p values 0.033, 0.006, 0.001, 0.007 and 0.001 respectively. Conclusion: Diabetic patients should be evaluated for subclinical diastolic dysfunction by Doppler studies as well as good control of diabetes for deceleration of the development of clinical cardiomyopathy, and decreased morbidity and mortality.}, keywords = {DM,HF,LV,CVD}, url = {https://ejhm.journals.ekb.eg/article_34200.html}, eprint = {https://ejhm.journals.ekb.eg/article_34200_a96128732c11f8cd163bce5825458c5f.pdf} } @article { author = {Ibrahim, Atef Abou El fotouh and El Dahshan, Tarek Abd El Kareim and Zakarya, Zakarya Mohamed and Oadaa, Bahaa Najeeb Abd Elwahab}, title = {Kallistatin as a New and Reliable Biomarker for the Diagnosis of Liver Cirrhosis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3027-3032}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34202}, abstract = {Background: Cirrhosis represents the final common pathological outcome for the majority of chronic liver diseases. Most patients with cirrhosis die from one or more clinical complications including ascites, hepatic encephalopathy and variceal hemorrhage. Objective: The aim of the study was to explore the relationship between serum kallistatin and clinical evidence of cirrhosis and to determine if serum kallistatin levels could be used as a diagnostic indicator of hepatic health status especially human liver cirrhosis. Patients and methods: The present study included 70 patients with liver cirrhosis and 25 healthy volunteers served as controls. Cirrhotic patients were subdivided into groups A, B and C according to Child score. Results: The results in the current study revealed that there was highly significant decrease of kallistatin level in liver cirrhosis patients compared to control group. The level of kallistatin was significantly decreased in decompensated patients more than compensated patients. These findings pointed to the value of kallistatin as a new biomarker for diagnosis of liver cirrhosis. Conclusion: Our findings support that kallistatin may be an efficient biomarker in early detection of liver cirrhosis. Also combination of kallistatin with Fib4 score could improve the sensitivity and specificity for chronic liver disease.}, keywords = {Cirrhosis,Kallistatin,Encephalopathy}, url = {https://ejhm.journals.ekb.eg/article_34202.html}, eprint = {https://ejhm.journals.ekb.eg/article_34202_3c9108a6e63fb79a053e302cf2769e10.pdf} } @article { author = {Elhaieg, Omar Mokhtar Ibrahim and Daha, Ahmed Said Ahmed and Abd-Elhamid, Sameh Attia Ali}, title = {Role of Retrograde Transpopliteal Angioplasty for Superficial Femoral Artery Occlusion}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3033-3038}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34206}, abstract = {Background: surgical interventions are indicated for patients with peripheral arterial disease (PAD) who developed CLI or debilitating IC that is refractory to conservative management; while bypass, with an autologous vein or prosthetic conduit, is the mainstay of open surgical management of PAD. On the other hand, the percutaneous endovascular interventions has emerged as an alternative effective, and safe, treatment option in patients with PAD. Objective: the aim of the study was to evaluate the effectiveness and safety of the retrograde popliteal approach for recanalization of long segment occlusion of superficial femoral artery in cases with chronic lower limb ischemia. Patients and Methods: this is a prospective study conducted on 30 patients presenting to Al-Azhar University Hospitals and Mataria Teaching Hospital; all of them have chronic lower limb ischemia due to proximal long segment occlusion of superficial femoral artery (SFA) after failure to pass through the antegrade access either by the ipsilateral or by the contralateral femoral approach. Results: ankle brachial index (ABI) is a commonly used surrogate marker of atherosclerosis. In the present study, the rate of complications was relatively low (16.7%) in which pseudoaneurysms were encountered in 10% and arteriovenous fistulae were encountered in 6.7% of the patients. Conclusion: retrograde popliteal approach is feasible, safe, and effective technique for the management of CTO of superficial femoral artery in patients with failure of pass through the antegrade access either by the ipsilateral or by the contralateral femoral approach.}, keywords = {PAD,SAF,CTO}, url = {https://ejhm.journals.ekb.eg/article_34206.html}, eprint = {https://ejhm.journals.ekb.eg/article_34206_a49d11316d45b8c5a5c1c10cb2dd3b7c.pdf} } @article { author = {Kamel, Madeha Abdelfatah and Hasan, Zeinab Sayed and El Toukhi, El Sayed Mohammed and Ali, Amani Mohammed}, title = {Horizontal Recti Muscle Plication Versus Resection in Squint Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3039-3045}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34208}, abstract = {Background: Strabismus surgery serves to align the visual axes to provide binocular single vision, or improve cosmesis, or restore normal eye contact, or enhance the quality of life. Objective: this study aims at evaluating muscle scleral plication technique as regards efficacy, stability, predictability and possible complications and comparing it to the standard resection technique. Patients and Methods: this study was carried out in the Ophthalmology Department in Al-Zahraa University Hospital and Research Institute of Ophthalmology between 2015 and 2018 on 40 patients. Their ages ranged from 1 to 40 years. 28 patients were males and 22 were females. 23 patients were exotropia and 17 patients were esotropia. Results: from this study it was found that the effect of plication is more or less the same as that of resection. But it can be noted that muscle scleral plication offers a safe, predictable, alternative to resection with no especially alarming complications that differ from those of ordinary strabismus surgery. This technique can be used instead of resection whenever there is fear of anterior segment ischaemia (ASI), such as when there is a possibility of operating on more than two rectus muscles or when the patient suffers from blood diseases or dysthyroid ophthalmopathy. Conclusion: from the results of this study, it can be concluded that the muscle-scleral plication technique is an easy alternative to resection that can be used on horizontal muscles especially when anterior ciliary vessels sparing is needed.}, keywords = {Horizontal Recti Muscle Plication,Squint Surgery}, url = {https://ejhm.journals.ekb.eg/article_34208.html}, eprint = {https://ejhm.journals.ekb.eg/article_34208_01d1a715358557eef3f7a7073a4bc099.pdf} } @article { author = {Refai, Hesham Hamed and Basiony, Morsy Mohammed and Ahmed, Moataz Bellah Yousef Salh}, title = {Results of Treatment of Distal Radius Fracture in Geriatrics Patients Using Closed Reduction and Percutaneous K-Wires Fixation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3046-3051}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34214}, abstract = {Background: distal radius fractures are a common fracture among geriatric population. Requiring comprehensive understanding of fracture anatomy and comprehensive selection of method of treatment. Aim: aim of this study is to observe treatment of unstable distal radius fracture by closed reduction and percutaneous pinning among old age. Patients and Methods: prospective study for analysis of 30 patients above age of 50 suffering from distal radius fracture and managed by closed reduction and percutaneous pinning in Aswan university hospital. After acceptable reduction of the fracture was achieved, two or more percutaneous K-wires were inserted through the distal radius with the wrist in traction to maintain the reduction. All cases were assessed by Gartaland and Werely score and by radiological assessment. Patients were followed up for a period of about 6 months. Results: the majority of cases were women (70%). Majority of the patients (76.6%) sustained the injury due to fall. The side of involvement was predominantly the right side (60%). According to scoring system of cases; NO excellent results (36.7%), scored Good (50%), scored Fair (13.3%), and scored Poor at the end of 6 months follow up. Conclusion: closed reduction and percutaneous pinning of distal radius fracture can considered as a satisfactory treatment in old age group and doesn't give an excellent results after short period of follow up.}, keywords = {Distal radius fracture,Closed reduction,Percutaneous Kirschner wire fixation,geriatrics}, url = {https://ejhm.journals.ekb.eg/article_34214.html}, eprint = {https://ejhm.journals.ekb.eg/article_34214_55c9502be48083c1bf4cf9bcb45c16b9.pdf} } @article { author = {Abdel Azim, Amira Ahmed Adel and El-Sayed, Gamal El-Din Abd El-Hamid and Mahmoud, Marwa Said and Ibrahim, Heba Ibrahim Mostafa}, title = {The Diagnostic Value of Tzanck Test in Vesiculobullous, Pustular, and Oral Lesions in The Dermatology Clinic}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3052-3059}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34217}, abstract = {Background: Vesiculobullous disorders represent a heterogeneous group of dermatoses with protean manifestations. The accurate diagnosis of bullous disorders of the skin and mucous membrane requires evaluation of clinical, histological, and immunofluorescence findings. Objective: The aim of this study was to investigate Tzanck smear findings and to determine the diagnostic value of this test in moist (erosive, vesicular, bullous, and pustular) skin and oral lesions. Patients and Methods: This cross sectional study was conducted on one hundred patients presented with vesicular, bullous, and pustular skin lesions and/or oral lesions. All patients were included from Dermatology Outpatient Clinic at Al-Zahraa University Hospital over the period from March 2018 to March 2019. Results: Positivity of multinucleated giant cells in herpetic infection, acantholytic cells in pemphigus, dyskeratotic acantholytic cells and cocci in bullous impetigo were useful landmarks in Tzanck smear. A decrease in viral shedding from herpetic lesions of longer duration may correlate with the lower sensitivity of the Tzanck smear. Therefore, in this study we excluded the lesions older than 3 days. The percentage of positivity in vesicles was much higher than that of pustules. Conclusion: According to this study, Tzanck smear was an inexpensive, simple, and rapid test and did not require any specialized laboratory equipment for evaluation of various vesiculobullous and pustular lesions either skin or mucosal one.}, keywords = {Tzanck test,Vesiculobullous,Pustular,oral lesions,Dermatology}, url = {https://ejhm.journals.ekb.eg/article_34217.html}, eprint = {https://ejhm.journals.ekb.eg/article_34217_223b17074311c0b81b65fc2b6aea7742.pdf} } @article { author = {Hamada, Mohamed Hussien and Ibrahim, Wael Mohamed Elmahdy and Ashiry, Mohamed Adel}, title = {Comparative Study between Dexmedetomidine and Dexamethasone as an Adjuvant to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3060-3069}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34218}, abstract = {Background: Brachial plexus block is frequently used for ambulatory upper limb surgery. It can significantly reduce pain and nausea, allowing for faster discharge from hospital when compared with general anesthesia (GA). Doing this block through ultrasound has higher index of safety, allowing providers to identify the appropriate point of injection and performing this block with greater accuracy under direct visualization. Objective: the aim of the study was to compare the efficacy of bupivacaine plus dexamethasone versus bupivacaine plus dexmedetomidine as adjuvants on block characteristics including onset and duration of sensory and motor blockade, duration of postoperative analgesia, post-operative pain score and sedation score. Patients and Methods: This prospective double – blinded, randomized controlled trial included a total of 60 patients divided to two groups, each group contained 30 patients. Group 1 (dexmedetomidine group) had received 1μg/kg of dexmedetomidine + 20 ml bupivacaine 5%. Group 2 (dexamethasone group) had received dexamethasone + 20 ml of bupivacaine5%. Results: In this study the onset and duration of sensory and motor blockade was statistically shorter in dexamethasone group when compared to dexmedetomidine group. Conclusion: It could be concluded that addition of dexmedetomidine to bupivacaine prolongs the time of block and analgesia duration longer than dexamethasone, but the onset of block was shorter when dexamethasone was added to bupivacaine.}, keywords = {Dexmedetomidine,supraclavicular block,Bupivacaine,Upper limb surgery}, url = {https://ejhm.journals.ekb.eg/article_34218.html}, eprint = {https://ejhm.journals.ekb.eg/article_34218_02903c02500b7dba53e2dddb73e1e410.pdf} } @article { author = {Baki, Gad Ragheb Abdel and Mohamed, Abd El Alim Mohamed and Elsharkawy, Kareem Mohamed Naguib Yousef}, title = {Evaluation of the Results of Management of Humeral Shaft Fractures Using Flexible Intramedullary Nails}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3070-3078}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34234}, abstract = {Background: the humerus is the most mobile long bone of the upper limb. Humeral shaft fractures comprise about 3 to 5% of all body fractures. Objective: the aim of the work was to assess the results of using the flexible intramedullary nails in the treatment of humeral shaft fractures. Patients and Methods: the study included 20 patients presented to Alexandria Police Hospital and El-Zahra Hospital, suffering from humeral shaft fracture. A full workup including history taking, clinical examination and radiological evaluation as well as laboratory investigations was performed for every patient on admission. Results: the results obtained after a mean follow up time of 32 weeks, were excellent in twelve patients (60%), good in six patients (30%), fair in one patient (5%), and poor in another one patient (5%). The difference between excellent and good groups was statistically significant, that the younger the patient the more rapid the fracture healing occurred. Conclusion: flexible intramedullary nailing is a simple, easy semi rigid and quick technique for stabilization of humeral diaphyseal fractures in selected cases of humeral shaft fractures in different ages.}, keywords = {Management of Humeral Shaft Fractures,Flexible Intramedullary Nails}, url = {https://ejhm.journals.ekb.eg/article_34234.html}, eprint = {https://ejhm.journals.ekb.eg/article_34234_2d4958607aec37be8cddd7969ec67405.pdf} } @article { author = {Ali, Abd El-Mongy El Sayed and Abd Al-Halim, Nour El Din Abd Al-Hamid and Hussein, Moaaz Mohamed Sayed}, title = {Optical Coherence Tomography Angiography of Acute Non-Arteritic Anterior Ischemic Optic Neuropathy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3079-3082}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34239}, abstract = {Background: Non-arteritic anterior ischemic optic neuropathy (NAION) is an ischemic change involves the 1 mm thickness of the optic nerve head (optic disc). We depend on fundus fluorescein angiography (invasive investigation) and visual field for diagnosis of NAION. Optical coherence tomography angiography (OCT A) is a new modality (non-invasive) for assessment of vascular tissue at multiple retinal levels. We are seeking for a role of OCT A in diagnosis of NAION. Objective: The aim of the current study was to assess the optical coherence tomography angiography peripapillary perfusion density in diagnosed non-arteritic acute ischemic optic neuropathy patients within a period from one week to 3 weeks during (acute stage while the disc is still edematous) of acute painless diminution of vision. Patients and Methods: This study included a total of ten patients diagnosed with non-arteritic anterior ischemic optic neuropathy and 10 age-matched normal control individuals with normal RNFL thickness, attending at ophthalmology outpatient clinic of Al-Azhar University Hospitals. OCT A 6x6 on the disc is done for all subjects and control group with Zeiss angioplex (cirrus 5000). Results: showed a decreased perfusion density in a ring from 3 to 6 mm around the center of the disc in all quadrants except the lower one. Central to this ring, the perfusion density is higher in NAION cases, which may be due to superficial displacement of the deeper capillary plexa with edema. Conclusion: We can depend on the perfusion density in ring 3- 6 mm in diameter when assessing a case of acute NAION not the central circle.}, keywords = {Optical coherence tomography angiography,non-arteritic anterior ischemic optic neuropathy,superficial peripapillary plexus perfusion density}, url = {https://ejhm.journals.ekb.eg/article_34239.html}, eprint = {https://ejhm.journals.ekb.eg/article_34239_3855d2b7262cc14af715cc86ab3f6db3.pdf} } @article { author = {Abu Al-Naga, Abu Bakr Farid Abu Al-Naga and Khalil, Hisham Fawzy and Mostafa, Mostafa Mahmoud and Gomaa, Bassem Ismail Khalil}, title = {Macular Microstructure Assessment by Optical Coherence Tomography and Fundus Fluorescein Angiography before and after Silicone Oil Removal}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3083-3092}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34242}, abstract = {Background: since the early use, silicone oil (SO) has been used as long-term retinal endotamponade to manage complicated retinal diseases such as proliferative vitreoretinopathy, advanced proliferative diabetic retinopathy, and complex retinal detachment. A favorable anatomical success was reported after SO injection. Objective: the aim of this study was to investigate the macular microstructural changes in eyes filled with silicone oil (SO) and course of these changes after SO removal, to determine the possible cause of unexplained visual loss by the use of optical coherence tomography and fundus fluorescein angiography. Patients and Methods: This prospective observational study included a total of 40 eyes of 40 adult patients of both sexes with rhegmatogenous retinal detachment and scheduled for pars plana vitrectomy with silicone oil tamponade attending at ophthalmology outpatient clinic of Al-Azhar University Hospitals. This study was conducted between October 2015 to August 2018. Results: There were insignificant differences in visual prognosis between the group with persistent SRF and the group without. But VA bad prognosis can be explained through the other OCT finding not only the SRF. This confirm our conclusion of the importance of OCT examination after successful retinal detachment repair operation for VA prognosis prediction. In our study there was no difference between OCT finding before SOR and after, this means that duration of 3-month silicon oil tamponading is a safe duration. Conclusion: Delayed or incomplete visual recovery after uncomplicated surgery for macula-off retinal detachment may be related not only to persistent subretinal fluid, but also to other pathological changes.}, keywords = {Optical Coherence Tomography,Fundus Fluorescein Angiography,Silicone Oil}, url = {https://ejhm.journals.ekb.eg/article_34242.html}, eprint = {https://ejhm.journals.ekb.eg/article_34242_8dce0086f5ca68e17e056d5b49316ff1.pdf} } @article { author = {Abd Alla, Mohamed Darwish Ahmed and El-Dessouky, Yasser Mohamed Mohamed and Ali, Khaled Abdelmoamen Ahmed and Ramadan, Moukhtar Ragab and Abd El Fattah, Raefat Mohamed and Aish, Abdel Ghany Abdel Sattar and El Awady, Mostafa Kamel}, title = {Detection of Occult Hepatitis C Virus Infection (OCI) in Bone Marrow Mononuclear Cells}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3093-3098}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34249}, abstract = {Background and aim: Occult HCV infection (OCI) diagnosis by cellular-PCR encourages further research for more understanding of extrahepatic tissues affection during non-viremias. OCI among Egyptians recruits more attention because of the convenient diagnostic tools and the availability of direct acting antivirals (DAAs). Our study aims to recognize HCV-infection of bone marrow mononuclear cells (BMMCs) in antiviral IgG-antibody seropositive nonviremic subjects. Subjects and Methodology: Our case control study included 70 subjects who were divided into three groups: - I: non-viremic IgG-seronegative controls (n=25), II: naïve HCV-RNA viremic IgG-seropositive controls (n=15), III: naïve non-viremic IgG-seropositive patients (n=30). Sera of all study subjects were screened for anti-HCV IgGantibodies by ELISA and for HCV-RNA by PCR. BMMCs and peripheral blood mononuclear cells (PBMCs) of all study populations were tested for HCV-RNA infections by cellular-PCR. Results and conclusions: HCV-RNA viremias were seen when bone-marrow is functioning (P<0.05), while nonviremias were common in bone-marrow failure (P<0.05). There was 100% concordant positivity between serum and cellular HCV-RNA-PCRs in viremic patients. HCV-BMMCs and PBMCs PCRs respectively added extra 20% (P=0.024) and 13.33% (P=0.119) as newly diagnosed infections compared to none by serum-PCR in IgG-antibody seropositive non-viremic subjects. Respectively, non-viremic population (n=55) showed 14.29% and 9.1% positive intra-mononuclear cells HCV-RNA infection in bone marrow (P=0.002) and peripheral blood (P=0.057) compared to serum PCR. In conclusion, consecutive screening of peripheral blood and bone marrow mononuclear cells for HCV-RNA detection by cellular-PCR recognizes naïve OCI in IgG-seropositive non-viremic patients. Functioning bone marrow would be required for persistence of HCV-RNA viremia.}, keywords = {Occult HCV Infection,Bone Marrow and Peripheral Blood Mononuclear cell-PCRs}, url = {https://ejhm.journals.ekb.eg/article_34249.html}, eprint = {https://ejhm.journals.ekb.eg/article_34249_82fa3d1c96403c2177a6391309718ad9.pdf} } @article { author = {Ali, Wafek Ibrahim and Hammad, Mohamed Ismail and Alshazly, Tarek Mohamed Sayed Alazab}, title = {Role of Multi-Parametric Magnetic Resonance Imaging (MRI) in Assessment of Malignant Prostatic Lesions}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3099-3106}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34251}, abstract = {Background: carcinoma of the prostate is an important health problem. It is the one of the most frequently diagnosed solid malignant tumor among men. Multi-parametric MRI of the prostate has been increasingly used as an imaging technique through the last years. Objective: our study aimed to evaluate the sensitivity of multiparametric magnetic resonance (MR) imaging in detection of cancer prostate, using the Prostate Imaging Reporting and Data System (PIRADS) version 2.0. Patients and Methods: thirty patients were enrolled in the study. All patients with elevated PSA values greater than 4 ng/ml underwent sextant TRUS guided biopsies. MRI examination was done either prior to the TRUS biopsy or at least 3 weeks after the TRUS biopsy. Results: the application of PI-RADS version 2 has significantly improved the diagnostic performance in detection of clinically significant cancer. Considering PIRADS score greater than 3 as a strong indicator for malignancy, the sensitivity of PI-RADS version 2 was 80% for detection of malignant lesions in general (significant and insignificant). Moreover, our study revealed an 88% sensitivity and 33% specificity of mp-MRI in detection of clinically significant cancer prostate (with PIRADS score 4 or more for clinically significant caner that have a Gleason score 7 or more, or extraprostatic extension), with a significant p value <0. 001. Conclusion: as a preoperative imaging tool, use of PI-RADS version 2 helps to diagnose clinically significant prostate cancer, considering PI-RADS scores of 4 and 5 to be associated with the presence of clinically significant cancer.}, keywords = {MRI,Malignant Prostatic Lesions,PI-RADS}, url = {https://ejhm.journals.ekb.eg/article_34251.html}, eprint = {https://ejhm.journals.ekb.eg/article_34251_178c5f800cfdb84e687461eb300ba405.pdf} } @article { author = {Mostafa, El-Sayed Ahmed and Abd-Elrazik, Mahmoud Abdalla and Mohammed, Zahraa Futtoh and Gharieb, Mohamed Mahmoud}, title = {Comparative Study between Fibrin Glue and Surgical Treatment of Pilonidal Sinus}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3107-3112}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34252}, abstract = {Background: Published results have shown that fibrin glue may be effective in closure of pilonidal fistula. We report the final results of a randomized clinical trial evaluating the use of fibrin glue in treatment of pilonidal fistula. Objectives: to determine the efficacy of a new simple with minimal tissue loss and a low recurrence rate technique that uses fibrin glue in the closure of pilonidal sinus (PS) in comparison with surgical technique. Methods: the results of treatment of pilonidal fistula by fibrin glue in 10 patients were compared with those obtained by conventional surgery in another 30 patients, we carried out this study on 40 patients at Al-Zharaa University Hospital, Egypt between March 2017 and March 2019. The outcome was evaluated by recurrence or not. Results: out of 40 patients, 19 patients were male and 21 were female. Fibrin glue injection was done in 25% of patients and surgery was done in 75%. Recurrence occur in 10 % in fibrin glue and 36 % by surgical treatment. Conclusion: fibrin glue is a simple, reasonable, feasible, reproducible technique and competitive alternative to other surgical intervention. It is accompanied by a reduction in pain, reducing hospital stay, minimizing tissue assault, promoting early work resumption and with lower recurrence rate. Inspite of the surgical approach is still the standard modality for pilonidal sinus treatment.}, keywords = {Pilonidal fistula,Fibrin glue and Rhomboidal flap}, url = {https://ejhm.journals.ekb.eg/article_34252.html}, eprint = {https://ejhm.journals.ekb.eg/article_34252_02f758789aadee6d1d4ed327f6e91cbc.pdf} } @article { author = {Khalil, Mohammed Mohsen Ibraheem and Deabes, Shawky Mohamed and Amer, Yasser Ahmed}, title = {Comparative Study between Doppler-Guided Haemorrhoidal Artery Ligation (HAL) and Conventional Haemorrhoidectomy for Treatment of III& IV Degree Haemorrhoids}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3113-3118}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34253}, abstract = {Background: Haemorrhoidal disease is probably the most frequent reason for consultation in proctology with an estimated prevalence about 4.4%. The gold standard treatment is still excisional hemorrhoidectomy, which is considered a safe and definitive method. Objective: The study was designed to compare the clinical and functional outcome of Doppler-guided (DG) haemorrhoidal artery ligation (HAL) and conventional haemorrhoidectomy for treatment of grade III & IV haemorrhoids. Patients and methods: This study was conducted on 60 patients, divided into two groups: group A included 30 patients that were operated upon through the conventional haemorrhoidectomy and group B include 30 patients that were operated upon through Doppler-guided haemorrhoidal artery ligation (DG- HAL), and comparison between two groups as regard outcomes and complications. Results: It was found from this study that DG- HAL is a painless, easily learned, and minimally invasive therapeutic technique that offers a good alternative to all other known treatments of symptomatic hemorrhoids. During the postoperative check-up 6 weeks after the procedure, scar tissue that had been firmly connected to the underlying tissue structure was seen in areas where ligatures had been placed. Conclusion: Using DG-HAL complications are comparable with those associated with other methods, with no severe complications. The DG-HAL procedure is synonymous with a high level of patient comfort and is perfect for outpatient treatment.}, keywords = {DG-HAL,haemorrhoidectomy,Mucopexy,Hemorrhoids}, url = {https://ejhm.journals.ekb.eg/article_34253.html}, eprint = {https://ejhm.journals.ekb.eg/article_34253_1dd55c21eafcac21c792a6cf653ec479.pdf} } @article { author = {Baismail, Hattan Mohammed and AlSalem, Ali Salem and Abdulaziz, Mai Atef}, title = {Patient’s Awareness of Using Antibiotic without Prescription}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3119-3123}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34255}, abstract = {Background: there are many types of antibiotic drugs with different dosages and indications. Many patients often use antibiotics inappropriately and even without doctor’s prescriptions, in this study we want to determine the antibiotics knowledge among general population of Makkah and to determine the proportion of population using antibiotics without prescriptions. Aim of the work: this study aimed to determine the severity of misuse of antibiotics and to educate the general population regarding the same. Methods: 500 questionnaires were distributed to the general adult population of Makkah. Data were analyzed to compare education level with the antibiotic knowledge, proportion of population taking antibiotics without prescription. Results: when comparing the males with females, statistically significant differences were obtained when inquired about knowledge of different types of antibiotics (p-value: 0.004), allergies related to antibiotics use (p-value: 0.007), differences in doses of several antibiotics (p-value: 0.019). Second comparison was done on the basis of educational levels, which revealed statistically significant differences when inquired about basic function of antibiotics (p-value: 0.000), knowledge of different antibiotic types (p-value: 0.017), allergies related to antibiotics use (p-value: 0.029). Conclusion: the overall level of knowledge among the studied subjects was found to be on the lower side. Females tend to have a better attitude towards the use of antibiotics as compared to males. Higher education groups utilized more antibiotics without prescription as compared to lower education groups.}, keywords = {patient’s awareness,antibiotics,prescription,Makkah,KSA}, url = {https://ejhm.journals.ekb.eg/article_34255.html}, eprint = {https://ejhm.journals.ekb.eg/article_34255_63861eb4f2e47915e232a23dc989631e.pdf} } @article { author = {ElGioshy, Ali and Zayed, Emad and Mostafa, Mohamed}, title = {Endoscopic Treatment of Insertional Achilles Tendinopathy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3124-3130}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34257}, abstract = {Purpose: The purpose of this study was to evaluate the outcome of endoscopic treatment of insertional Achilles tendinopathy. Patient and Methods: This prospective study was held on 15 patients suffered from insertional achilles tendinopathy at Alazhar University Hospitals. There were 7 males and 8 females with mean age 46.27 years (28 to 60 years). Clinical examination, lateral weightbearing Xray of ankle and MRI of ankle were done for all patients. All patients were evaluated preoperatively and postoperatively by AOFAS hindfoot scale with mean follow up 6 months. Results: The Mean Preoperative AOFAS hindfoot scale of 15 patients in this study was 58.2 (36 to 80) and mean postoperative AOFAS hindfoot scale after 6 months follow up was 86.53 (67 to 97) with P value (.001). There were 3 patients with postoperative scar tenderness. There was neither sural nerve injury nor achilles tendon rupture during follow up period. Conclusion: Endoscopic treatment of insertional achilles tendinopathy had a lot of advantages as being safe and efficient procedure with small incision and cosmetic scar. This technique also could avoid catastrophic complications of open procedures in the form of wound dehiscence, ugly scar and affection of Achilles tendon insertion.}, keywords = {Insertional Achilles tendinopathy,Haglund syndrome,endoscopic treatment,sural nerve}, url = {https://ejhm.journals.ekb.eg/article_34257.html}, eprint = {https://ejhm.journals.ekb.eg/article_34257_ea28d9b4ac11bd0eaad8f3740b1ae71b.pdf} } @article { author = {Helal, Eman G.E. and Abdelaziz, Mohamed A. and Fadel, Hewaida A.E. and EL-Shenawe, Nahla S.A.}, title = {The Therapeutic Effects of Vitamin C on Changes of Some Biochemical Parameters in Male Albino Rats Treated with Mixture of Food Additives (Sodium Benzoate + Mono Sodium glutamate + Chlorophyllin)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3131-3138}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34259}, abstract = {Background: Food additives are substances intentionally added to food to change its characteristics, maintain and improve safety, maintain the nutrient value and to improve taste, texture, and appearance. Aim of the work: This study aimed to determine the therapeutic effects of vitamin C against the hazardous effects of sodium benzoate, chlorophyllin and monosodium glutamate on some physiological parameters in male albino rats. Materials and Methods: this study had been done on thirty male albino rats with an average body weight 120-140 g. The animals were divided into three groups. Group 1: control, Group 2: rats treated with mixture sodium benzoate, chlorophyllin and monosodium glutamate and Group 3: rats treated with food additives mixture and vitamin C. Blood samples were collected and the separated sera were used for estimation of some biochemical parameters (liver enzymes, kidney functions, glucose, protein profile and lipid profile) and hormonal levels [testosterone, triiodothyronine (T3) and thyroxine (T4)]. Results: The biochemical results showed an increase in levels of fasting glucose, insulin, HOMA-IR, activities of AST and ALT, urea, creatinine, total cholesterol (TC), triglycerides (TG), LDL-C, VLDL, ratios of TC/HDL-C and LDL-C/HDL-C (risk factors) in mixture group accomphined by a significant decrease in protein profile (total protein, albumin and globulin), HDL-and testosterone hormone levels . On the other hand, these results turned back nearly to normal values after receiving vitamin C. Conclusion: The present study revealed capability of vitamin C to fight the grievous effects of food additives mixture on major physiological parameters.}, keywords = {food additives,sodium benzoate (SB),Chlorophyllin(CHL),Monosodium glutamate (MSG),Vitamin C (VIT. C)}, url = {https://ejhm.journals.ekb.eg/article_34259.html}, eprint = {https://ejhm.journals.ekb.eg/article_34259_4c0dc8a0b86ee29c8188f0d9f8ca9140.pdf} } @article { author = {Eldahshan, Magdy and Albahrawy, Ashraf and Zkareya, Zakarya Mohamed and Mabrouk, Shadia Hussein and Alsawak, Alaa}, title = {The Role of Acetic Acid Chromoendoscopy and Narrow Band Imaging in Diagnosis of Esophageal Barrett Dysplasia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3139-3142}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34260}, abstract = {Background: Barrett’s esophagus (BE) is an important risk factor for the occurrence esophageal adenocarcinoma. Endoscopic surveillance for Barrett’s dysplasia is indicated in all patients with BE. Recent data found that with the use of advanced endoscopic techniques there is an increased diagnostic yield for dysplasia. Aim: The aim of this study is to assess the accuracy of acetic acid assisted narrow band imaging (AA-NBI) endoscopy in detection of Barrett’s dysplasia. Patients and Methods: Forty patients with BE surveyed for Barrett’s dysplasia by AANBI endoscopy. Patients with difficult sampling (n=1) or not proved to have Barrett’s mucosa by histopathology (n=5) were excluded. Patients with positive and negative dysplasia underwent targeted and random endoscopic biopsy, respectively. The diagnosis of BE based on Prague endoscopic classification. The pathological assessment of Barrett’s dysplasia based on Vienna classification. Results: A total of 34 patients were included; their mean age was 39.03±14.23 years; they were 19 (55.88%) males and 15 (44.11%) females. Of them 28 (82.35%) had cardiac type BE, 3 (8.82%) had fundic type BE and 3 (8.82%) had intestinal type BE. Five patients were depicted as Barrett’s dysplasia by AA-NBI. Low grade dysplasia was proved in 3 of them by histopathology. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of AA-NBI in diagnosis of Barrett’s dysplasia were 100%, 93.5%, 60%, 100%, and 94.1% respectively. Conclusion: Nine percent of patients with BE are positive for dysplasia. AA-NBI has promising sensitivity, specificity and accuracy in prediction of Barrett’s dysplasia.}, keywords = {Barrett’s esophagus. Dysplasia. Acetic acid chromoendoscopy. Narrow band imaging. esophageal,Adenocarcinoma}, url = {https://ejhm.journals.ekb.eg/article_34260.html}, eprint = {https://ejhm.journals.ekb.eg/article_34260_083f674bc82c0a840f63b6306e35e36c.pdf} } @article { author = {Abdelfattah, Ahmed and Zaghloul, Ahmed Ibrahim and Mahmoud, Mostafa}, title = {Prevalence of Open Angle Glaucoma in Patients with Obstructive Sleep Apnea}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3143-3147}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35085}, abstract = {Background: obstructive sleep apnea seems to have multi-organ harmful effects. Its association with glaucoma was previously reported. However, the debate exists around prevalence of glaucoma and the pathophysiology explains its association with obstructive sleep apnea is not fully known. Objective: the present study was designed to estimate the incidence of normal tension glaucoma among patients with obstructive sleep apnea. Patients and Methods: sixty patients with obstructive sleep apnea and another age and sex matched 60controls were included. Five patients in the study group refused to complete the study and only 55 patients constitute the study group.Allparticipants underwent polysomnographic and ophthalmologic (measurement of intraocular pressure and fundus examination) studies. Data was collected, documented and statistically analyzed. Results: both study and control groups were comparable regarding patients’ demographic and associated chronic medical disease. The prevalence of normal tension glaucoma in patients with obstructive sleep apnea was 27.3% and it was 3.3% in control subjects. Cup disk ratio and oxygen desaturation index were significantly increased, while oxygen saturation significantly decreased in patients with obstructive sleep apnea. In addition, obstructive sleep apnea index (measure of severity) was proportionately correlated with intraocular pressure, oxygen desaturation index, cup to disk ratio and negatively correlated with oxygen saturation. Conclusion: open angle glaucoma significantly increased in obstructive sleep apnea and significantly associated with disease severity.}, keywords = {Obstructive sleep apnea,polysomnography,normal tension glaucoma,open angle glaucoma}, url = {https://ejhm.journals.ekb.eg/article_35085.html}, eprint = {https://ejhm.journals.ekb.eg/article_35085_538660e711478be347812846e678385b.pdf} } @article { author = {Hassan, Hosny and Mahdy, Mohamed AE Soliman and Saleh, Mahmoud and Yousef, Nehad}, title = {One-Site Versus Two-Site Phacotrabeculectomy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {75}, number = {6}, pages = {3148-3162}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.34921}, abstract = {Background: surgical treatment for patients with concurrent glaucoma and cataract includes sequential surgery and combined phacotrabeculectomy. When combined surgery is planned, the next issue that must to deal with is whether two-site surgery is better or one-site surgery. Aim: the study aimed to compare the outcomes and to report on the efficacy and safety of the two procedures. Patients and Methods: this prospective randomized comparative interventional study included fifty subjects. Patients were recruited from those who attended to the outpatient Ophthalmology Clinic of Sayed Galal hospital, Al-Azhar University. The study was conducted in the period from October 2016 until May 2018. Patients were randomized into two groups: Group I (n=25), who was subjected to one-site phacotrabeculectomy and Group II (n=25), who was subjected to the two-site procedure performed by one experienced anterior segment surgeon. Results: no significant differences were observed in the main outcome measures of IOP and the need for supplemental antiglaucoma medications between the two glaucoma groups. Conclusion: both surgical techniques were effective in reducing IOP and to eliminate the need for antiglaucoma medications in many eyes over the entire study period.}, keywords = {phacotrabeculectomy,Glaucoma,Cataract}, url = {https://ejhm.journals.ekb.eg/article_34921.html}, eprint = {https://ejhm.journals.ekb.eg/article_34921_58bc387916a6024b142351e2ca3c78de.pdf} }