@article { author = {Kayed, Mohammed Osama Fathy and Hassan, Yasser El-sayed Mohammed and Abuhassan, Reda Sayed Ahmed Albahnasy}, title = {Two-Dimension Echocardiographic Assessment of Left Atrial Volumetric Changes in Patients with Paroxysmal Atrial Fibrillation After Reversion to Sinus Rhythm}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3163-3169}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35086}, abstract = {Background: Although often referred to as “the forgotten chamber”, compared with left ventricle (LV), especially in the past years, the left atrium (LA) plays a critical role in the clinical expression and prognosis of patients with heart and cerebrovascular disease, as demonstrated by several studies. Objective: The aim of the work was to assess the left atrium functional and volume changes during atrial fibrillation (AF) and after sinus rhythm cardioversion in patients with paroxysmal AF, to detect recovery of effective mechanical atrial function (EMAF) after cardioversion with preserved bioelectrical function. Patients and methods: This prospective observational study included a total of 75 subjects divided on two groups: Group 1 (control) consisted of 25 apparently normal people with normal sinus rhythm, and Group 2 (patients) consisted of 50 patients with paroxysmal atrial fibrillation, attending at Damanhur Medical National Institute, for cardioversion. 25 (50%) of patients were cardioverted pharmacologically either by amiodarone or propafenone and 25 (50%) of patients were cardioverted by DC shock. Results: Mean age of controls involved in the study was 44.60 ± 9.82 years. 56% of them were males. Mean age of patients was 51.40 ± 7.23, 54% of them were males. Left Anterior Descending Artery (LAD) showed a significant decreased after cardioversion and after one month. It showed insignificant decrease after 2 months. Number of patients who did not recovered effective mechanical atrial function (EMAF) after one month were 6 (12%). Conclusion: Left atrial diameters and left atrial volumes increase in AF and showed significant reduction by the time after successfully cardioversion. Patients who were underwent DC shock had a slower recovery of atrial function and of LA volumes reduction, implying a greater degree of atrial dysfunction.}, keywords = {2D,EG,LV,LA,AF,HF}, url = {https://ejhm.journals.ekb.eg/article_35086.html}, eprint = {https://ejhm.journals.ekb.eg/article_35086_2176975fe7fa52f4839bc70d3ed5a2b2.pdf} } @article { author = {Bastawy, Samah and Ahmed, Ali Mahmoud}, title = {The Role of Serum Levels of Insulin-Like Growth Factor-1 and Brain-Derived Neurotrophic Factor in Predicting Recovery in Stroke}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3170-3175}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35089}, abstract = {Background: Despite the neurotrophins like brain-derived neurotrophic factor and insulin-like growth factor-1 are thought to have important role in neurorehabilitation, the factors that affect these biomarkers are not well known. Objectives: We aimed to investigate the effect of maximal aerobic exercise on serum neurotrophins levels in patients with chronic stroke and to investigate the factors that affect their resting and exercise-associated levels. Patients and Methods: Potential factors of resting and exercise-related serum neurotrophins levels were studied among 35 patients with chronic stroke. Resting brain derived neurotrophic factor, resting insulin-like growth factor, exercisedependent change brain derived neurotrophic factor, and exercise- dependent change in insulin-like growth factor were studied using demographic, disease burden, and cardiometabolic factors. Results: Brain-derived neurotrophic factor did not change after exercise (p = 0.38) while insulin-like growth factor decreased (p = 0.001). Higher resting brain-derived neurotrophic factor was determined by greater lower extremity impairment (p = 0.004, r2 = 0.23). The greater response of brain-derived neurotrophic factor to exercise was determined by higher fluid intelligence (p = 0.01, r2 = 0.18). Resting insulin-like growth factor-1 was not changed by all of the studied factors. Conclusion: Resting and percent change in brain-derived neurotrophic factor were associated with cognitive and physical recovery after chronic stroke. On the other hands, insulin-like growth factor-1 was not useful in chronic stroke. Interestingly, fluid intelligence was positively associated with exercise-related rise in brain-derived neurotrophic factor.}, keywords = {Neurotrophins,IGF-1,BDNF,stroke}, url = {https://ejhm.journals.ekb.eg/article_35089.html}, eprint = {https://ejhm.journals.ekb.eg/article_35089_202d10f2ff880018a1cd269baa6e43e9.pdf} } @article { author = {Hasan, Mohammed Raafat Abdelalim and AbdelMagid, Mostafa Ezzeldeen and Tagreda, Ibrahim Alaaeldeen}, title = {Sub-urethral Mini Sling versus Transobturator Vaginal Tape for Treatment of Female Stress Urinary Incontinence, One Year Follow-up}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3176-3183}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35090}, abstract = {Background: Stress urinary incontinence (SUI) is a common problem in women, which accounts about 50% of all incontinent women and affects the quality of life. The mid-urethral sling is the mainstay of SUI treatment over the last years. Tension-free vaginal tape (TVT), has been used as minimally invasive procedure for SUI. Objective: To compare outcomes of sub-urethral minisling and transobturator tape (TOT) for treatment of female SUI, one year follow up regarding operative time, length of hospital stays, postoperative pain perception, general postoperative complications, surgical site infections and early recurrence. Patients and Methods: This comparative study has been conducted in Al-Hussein and Sayed Galal Hospitals; Al-Azhar University; Cairo; Egypt and it included 96 cases, 8 patients missed communication data, 9 refused to participate, 34 in minisling group and 45 in transobturator tape (TOT) group. This a retrospective study for follow up of operated cases during the period from July 2015 to June 2018 at the Urology Department, Al-Hussein, Sayed Galal University Hospitals; Cairo; Egypt. Results: In our study, the minisling operation was associated with nearly the same hospital stay of transobturator tape (TOT). We had early recurrence rate among minisling operation. Finally, the transobturator tape (TOT) operation was associated with less recurrence rate and recurrence time postoperatively compared to the minisling. Conclusion: Minisling when compared to transobturator tape (TOT) for treating SUI; transobturator tape (TOT) yielded better outcomes regarding the postoperative 1 year follow up compared to the minisling.}, keywords = {Minisling,Transobturator Tape (TOT),SUI,1 year follow up}, url = {https://ejhm.journals.ekb.eg/article_35090.html}, eprint = {https://ejhm.journals.ekb.eg/article_35090_c2547f7f30c68ab9d0881c96b99de917.pdf} } @article { author = {Abd El-Mottaleb, Hatem Ali Ahmed and Mahmoud, Shrief Fahmy and Hassan, Ashraf Ibrahim and Tealeb, Al-Sayed Mohamed Ibrahim and Almorsy, Gamal Zakaria}, title = {Effects of Chronic Use of Tramadol on Uterus and Ovary of Albino Rats}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3184-3190}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35091}, abstract = {Backgrounds: The researches on endocrinopathy related with oral opioids had focused more on males, while fewer studies had focused on females. Objective: it was to demonstrate the possible chronic tramadol toxic effect (histopathological & biochemical) on ovary and endometrium of adult female albino rats. Materials and methods: Twenty-five female rats (control group), were given normal food and water, while one hundred adult female rats were given 30 mg/kg/day tramadol dissolved in distilled water (which represent 1/10 LD50) on daily basis for each rat for 3 months (An average 0.6ml for each rat). Rats were weighted at the beginning of the study and then 2 times weekly. At end of this period, blood samples were taken for Biochemical analysis. Rats’ ovaries and uterus were examined by light microscope after staining with Haematoxylin and Eosin, and then data were analyzed and statistically studied. Results: Our study showed gradual decrease in female body weight and levels of sex hormones. In tramadol treated group, ovaries showed apparent decrease in the number of growing follicles and an increase in the number of corpora lutea. The medulla showed dilated congested blood vessels. Many of the follicles appeared atretic. In the corpora lutea, there were degenerated cells. While endometrium in tramadol treated group there was apparent atrophic glands and stroma in the surface of the endometrium with appearance of inflammatory cells in the stroma. Conclusion: it has harmful histopathological and functional effects on the reproductive organs of female albino rats.}, keywords = {tramadol,Ovary,Uterus,rat}, url = {https://ejhm.journals.ekb.eg/article_35091.html}, eprint = {https://ejhm.journals.ekb.eg/article_35091_6cc4322d6ad33e99ec098b7a5d948357.pdf} } @article { author = {Helal, Eman G.E. and Abdelaziz, Mohamed A. and Taha, Neama M and EL-Shenawe, Nahla S.A.}, title = {Amelioration Effects of Aphanizomenon Flos-aqua (AFA) on Hazardous Effects of Mixture (Sodium Benzoate, Mono Sodium glutamate and Chlorophyllin) Intake in Male Albino Rats}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3191-3197}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35092}, abstract = {Background: Food additives are products added to the basic foodstuffs with an aim of improving its aspect, flavor, taste, color, texture, food value and conservation. Aim of the work: This study aimed to determine the effects of AFA against the hazardous effects of sodium benzoate, chlorophyllin and monosodium glutamate. Materials and methods: This study was done on thirty male albino rats with an average body weight 120-140 g. The animals were divided into three groups (10 rats/each) as follows: Group 1: control, Group 2: rats treated with food additives mixture (sodium benzoate, chlorophyllin, and monosodium glutamate) and Group 3: rats treated with mixture, in addition to AFA (blue green algae). Blood samples were collected, and the separated sera were used for estimation of some biochemical parameters (liver enzymes, kidney function tests, glucose, HOMA-IR, protein profile and lipid profile) and hormonal levels [testosterone, triiodothyronine (T3) and thyroxine (T4)]. Results: The study 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/HDLC (risk factors) in mixture group. This was accompanied by a significant decrease in protein profile (total protein, albumin and globulin), HDL-and testosterone hormone levels as compared to the control rats. On the other hand, these results turned back nearly to the normal values after receiving the AFA (blue green algae). Conclusion: the present study clearly revealed the therapeutic capability of AFA to fight the grievous effects of food additives mixture on major physiological parameters.}, keywords = {food additives,sodium benzoate (SB),Chlorophyllin(CHL),monosodium glutamate(MSG),AFA (blue green algea)}, url = {https://ejhm.journals.ekb.eg/article_35092.html}, eprint = {https://ejhm.journals.ekb.eg/article_35092_813ce5e28ba145c2e67ce16c61dc6cc3.pdf} } @article { author = {Ali, Enas Tawfiq and Ibrahim, Asmaa Abd El Wakeel and Abo Ghabsha, Mohammed El-Sayed and Abd Elwhab, Mohammed Shabana}, title = {Folic acid Deficiency and Bronchial Asthma Exacerbations in Children}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3198-3203}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35088}, abstract = {Background: Little is known about folate and asthma exacerbations. We examined whether folate deficiency is associated with asthma exacerbations in Children. Aim of the work: was to assess association of folate deficiency with increased asthma exacerbations in children. Subjects and methods: The study carried out on fifty children known to have a history of bronchial asthma aged from 6–15 years. All subjects were subjected to thorough medical history, full clinical examination, laboratory investigations including pulmonary function tests (spirometry) and serum folic acid levels. Results: this study showed Percentage of asthma in males more than in females. Viral infection, exercise, exposure to cold and fumes are the commonest precipitating factors. Analysis of Forced Expiratory Volume in the first second (FEV1) showed that 30% of cases had a level above 80% (mild impairment), 54% had a level between 60 and 80% (moderate) and 16% had a level below 60% (severe). Serum level of folic acid was lowest in the severe group (1.20.1), followed by the moderate (2.40.3) then the mild group (3.40.4), with a significant difference when all the groups were compared with each other (p <0.001).There were significant, positive strong correlations between folic acid level and each of FEV1% and FEV1/FVC%. Serum folic acid level contributed significantly to the degree of asthma severity, when adjusted for the other variables and indicated that increase in asthma severity with associated with each decrease in folic acid level. Conclusions: It could be concluded that folate deficiency is associated with increased degree of severe asthma exacerbations in children.}, keywords = {Asthma,children,folate}, url = {https://ejhm.journals.ekb.eg/article_35088.html}, eprint = {https://ejhm.journals.ekb.eg/article_35088_d22e3d1b1ddff5d22d70e44fdc52e1f2.pdf} } @article { author = {Oun, Ibrahim Ahmed and Ahmed, Abdallah Khaleel and Khedr, Mohamed and Ragab, Mohamed Aly Abdelmonem}, title = {Comparative Study of Mean Platelet Volume in Preeclampsia versus Normal Pregnancy in 3rd Trimester}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3204-3210}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35093}, abstract = {Background: Preeclampsia is a pregnancy-specific multisystem disease that is characterized by development of hypertension and proteinuria after 20 weeks of gestation, resolving by 6-12 weeks postpartum in previous normotensive women. The pursuit of safe, reliable, and cost-effective screening tests for prediction of preeclampsia has been the goal of researchers for many decades, with the aim of improving maternal and fetal outcome, despite the fact that the only current effective treatment remains delivery of fetus and placenta. Objective: The aim of this study is to compare mean platelet volume (MPV) in pre-eclamptic and normal pregnant women in the third trimester of pregnancy, and to evaluate whether this parameter have a prognostic significance in determining the presence of preeclampsia. Patients and methods: This study was done at Kafr Elsheikh General Hospital from January 2018 to December 2018. 80 pregnant women in their third trimester (from 31weeks gestation to completed 37 weeks gestation) were selected to participate in the study. Result: We found in our study that CBC, and MPV values do not have any determining effect on the presence of preeclampsia but the platelet count showed difference. In the literature, papers that include conflicting results especially on MPV values are available, yet this fact is most probably due to the differences between the methods and/or equipment used. Conclusion: Our study found that MPV values do not have any determining effect on the presence of preeclampsia.}, keywords = {MPV,preeclampsia,Pregnancy in 3rd trimester}, url = {https://ejhm.journals.ekb.eg/article_35093.html}, eprint = {https://ejhm.journals.ekb.eg/article_35093_dd1b6255320674cc0c802fcb08ae68a3.pdf} } @article { author = {Hamed, Abdallah Hussein and El Mahdy, Ahmed Gomaa and Mahmoud, Mohamed Abdo Badawy}, title = {Retinal Nerve Fiber Layer Thickness Affection in Diabetic Retinopathy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3211-3214}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35094}, abstract = {Background: diabetic retinopathy is a chronic progressive, potentially sight-threatening disease of the retinal microvasculature associated with the prolonged hyperglycaemia and other conditions linked to diabetes mellitus such as hypertension. Objective: Evaluation of the retinal nerve fiber layer thickness in patients with type II diabetes mellitus. Patients and Methods: Cross sectional design;, there is greater confidence the study has internal validity due to the systematic subject selection and equity of groups being compared. This is a prospective comparative study will be carried on forty eyes in patients with Type II Diabetes Mellitus. All investigations were carried out at AlAzhar University hospitals. Written and informed consent were taken before the investigations. Results: The male to female ratio in our study showing in diabetic group without retinopathy 12 to 8, while in the NPDR group showing 10 to 10 with a total male to female 22 to 18 in the study. In our study, the difference between NFL thickness measurements between four quadrants (upper, lower, nasal and temporal) between Diabetic group with no diabetic retinopathy and NPDR group is significant.. Conclusion: All quadrant retinal nerve fiber layer thinning is associated with peripheral neuropathy in patients with Type 2 diabetes.}, keywords = {ganglion cell layer,nerve fiber layer,intraretinal microvascular abnormalities}, url = {https://ejhm.journals.ekb.eg/article_35094.html}, eprint = {https://ejhm.journals.ekb.eg/article_35094_11866682242772ca19392310b80648df.pdf} } @article { author = {Elmofty, Ahmed Maged and Sayed, Ahmed Taha and Hanno, Ahmed Mohammed Abd El Fattah}, title = {Evaluation of Corrective Rhinoplasty in Cleft Lip Nasal Deformity}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3215-3223}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.35096}, abstract = {Background: Cleft lip nasal deformities are challenging problems in all aspects and there are debates about timing, approaches, techniques as well as types of the used grafts. Objective: Evaluation of the results of corrective rhinoplasty in post cleft lip nasal deformity at Al-Azhar University Hospitals (Al-Hussien and Said Galal Hospitals). Patients and Methods: This is a prospective clinical study which included thirty patients having post cleft lip nasal deformity whom underwent corrective rhinoplasty for cleft lip nasal deformity. These patients were managed at AlAzhar University Hospitals (Al-Hussien and Said Galal Hospitals) during the period from May 2017 to January 2019. Results: The vast majority of the operated upon patients had an obvious degree of satisfaction after 6 months to 12 months of postoperative follow up. Conclusion: Autologous cartilaginous grafts are the most suitable type of nasal grafts, and costal cartilage graft is the most superior between them. Further studies are needed to justify if primary rhinoplasty is beneficial or it disturbs the nasal symmetry and leave scared tissues for a potential future intervention.}, keywords = {Cleft nasal deformity,cleft lip}, url = {https://ejhm.journals.ekb.eg/article_35096.html}, eprint = {https://ejhm.journals.ekb.eg/article_35096_e65a57a9722f9ca383f0137f0d3c15d5.pdf} } @article { author = {Ali, Asmaa A.}, title = {Right Ventricular Outflow Tract Time Velocity Integral: A Noninvasive Echocardiographic Parameter of Right Ventricular Systolic Function In Cardiomyopathic Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3224-3231}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36032}, abstract = {Background: Right ventricular dysfunction (RVD) is considered a powerful predictor in patients with left ventricular dysfunction. So, we should evaluate right ventricular (RV) function in patients with cardiomyopathy to predict RVD and avoid progression of the disease. Due to the burden of disease, an easily utilized screening tool for identifying such patients would be helpful to facilitate assessment for advanced therapies. Aim of the work: to assess RVOT-TVI and its correlation with RV systolic function by different echocardiographic modalities in patients with dilated cardiomyopathy. Methods and study population: 70 cases (40 myopathic patients and 30 age and sex-matched healthy persons as a control group). All cases underwent complete TTE study to measure LV and RV dimensions, volumes and functions. In addition, TAPSE and RVFAC. RVOT-VTI is calculated. The LV and RV longitudinal strain was also assessed using 2D STE analysis. Results: This study included 70 individuals divided into two groups; G “I” represented 40 patients with cardiomyopathy and G “II” represented 30 age-and sex-matched healthy subjects as control. Patients with DCM had significantly increased RV volumes (p<0.001) and significantly lower RV systolic function. In addition, there was significant decreased RVOTTVI in cardiomyopathic patients group versus normal group. Moreover, The RVOT-VTI had a significant correlation with different indices of RV systolic function (RVEF (r=0.457, p<0.001), RV Sm (r = 0.495, p < 0.001) and 2D-RVGLS (r = 0.453, p<0.001), % FAC (r=0.398, p =0.001)). Conclusion: Right ventricular dysfunction is common in dilated cardiomyopathy. RVOT-VTI is a simple, non-invasive measure assess RV systolic function in cardiomyopathic patients.}, keywords = {dilated cardiomyopathy,RV systolic function,RVOT time velocity integral}, url = {https://ejhm.journals.ekb.eg/article_36032.html}, eprint = {https://ejhm.journals.ekb.eg/article_36032_9ee1ffc4c0a0c55f6dbb2c8a6450aa8f.pdf} } @article { author = {Kabil, Ahmed E and Basiony, Fareed Shawky and Nour, Mohamed Osama and Makboul, Khaled S.}, title = {Prevalence of Pulmonary Disorders in Patients with End Stage Renal Disease on Hemodialysis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3232-3236}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36033}, abstract = {Background: The prevalence of patients with end stage renal disease is increasing. Pulmonary diseases have been suggested to be more common in end stage renal disease patients on haemodialysis. Aim of the work: It was to evaluate the pulmonary function state and the prevalence of pulmonary disorders in hemodialysis patients. Subjects and methods: A retrospective study on 61 patients with chronic renal failure on regular Hemodialysis at El-Hussein University Hospital, Al-Azhar University. Results: The study included 61 chronic renal failure patients fulfilling the inclusion criteria with mean age 54.23 ± 10.07 years that ranged from 26 – 77 years old. Females represent 62.3%, about one third of patients (31.15%) were smokers and slightly more than half of them living in rural areas Pulmonary functions were affected in nearly half of them (restrictive 27.87%, obstructive 14.75% and mixed 6.56%). Variety of pulmonary disorders coexisted in about 69% of patients with 22.95% suffered from pleural effusion, 16.39% had TB, 11.48% and 8.20% developed pulmonary embolism and pulmonary edema respectively and finally community acquired pneumonia and uraemic asthma. Conclusion: Respiratory disorders especially restrictive lung pattern, pleural effusion, pneumonia and pulmonary embolism were associated with end stage renal disease on regular hemodialysis. Recommendation: Any patient with chronic renal failure, especially patients on regular hemodialysis should be observed early for detection of any pulmonary diseases or disorders.}, keywords = {renal failure,Hemodialysis,pulmonary disorders}, url = {https://ejhm.journals.ekb.eg/article_36033.html}, eprint = {https://ejhm.journals.ekb.eg/article_36033_7ef7240798ff04515b51ecbfa23e5f77.pdf} } @article { author = {Naeem, Suhaib and Sabry, Hassan and Abduh, Mohammed and Matboly, Marwa}, title = {Histological Study of Emerging Role of Exosomes Based Therapeutic in Management of Hepatocellular Carcinoma Rat Model}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3237-3244}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36034}, abstract = {Background: hepatocellular carcinoma (HCC) is the most common type of primary liver cancers with high incidence and mortality rates. The major risk factor for HCC is cirrhosis, which occurs usually due to HBV and HCV infection. Exosomes thought that have a major role on the promotion and spread of HCC, which can be uased as therapeutic and diagnostic marker. Objectives: we aimed to use evaluate their role in HCC assessment and their use as potential selected diagnostic biomarkers, and to characterize the efficacy of Hesperidin on modulating exosomal production and exosomal non-coding RNA related HCC expression using animal models. Materials and Methods: the study included 30 Rats devised to 5 groups 6 on each, controle and DiethyleNitros amine (DEN) and Acetamidofluorene (2-AAF) to iduce HCC group and Hispiridine treated groups with three different dosos 50 mg, 100 mg and 200 mg respectively for three groups. infants with neonatal cholestasis in three groups. Results: improvement of all of them, regarding liver histopathology wich the HCC focus regressed , regarding exosomal abundance in the serumand tissues while the evaluation of exosomal RAB11A-mRNA in rats' samples was performed by real time PCR, then the results were statistically analyzed by the SPSS software. Finally regarding to liver function test which the ALT, bilirubin and AFP reduced in the treated groups. Conclusion: exosomal RAB11A-mRNA as biomarkers for HCC inducedrats and target these exosomal markers using Hesperidin in animal model and hence we can uses as thrapuetic bases in HCC in the future.}, keywords = {HCC,exosomes,DEN and 2-AAF and Hispiridine}, url = {https://ejhm.journals.ekb.eg/article_36034.html}, eprint = {https://ejhm.journals.ekb.eg/article_36034_28289b266fc3fe15a9f455e98c1f2f29.pdf} } @article { author = {Omar, Tawfik Alaaeldein Tawfik and Abdelhafez, Abdelaziz Ahmed and Elhayeg, Omar Mokhtar and Ahmed, Ashraf Abd Elmonem Sayed}, title = {Randomized Comparative study between Reversed and Insitu Great Saphenous Vein Grafts in Infrapopliteal Revascularization}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3245-3248}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36035}, abstract = {Background: Foot ulcer is a disabling complication and not uncommon among patients with DM, the predictive factors for diabetic foot ulcer development were peripheral neuropathy, duration of diabetes, poor glycemic control, and peripheral vascular disease which was a major significant risk factor. Aim of the study: to determine whether Reversed or Insitu Great Saphenous Vein Grafts is the optimum In Infrapopliteal Revascularization. Patients and Methods: diabetic patients referred to Vascular Surgery department of Al-Azhar University Hospitals and Nasr City Hospital were included if they had foot lesions such as ulcers, gangrene or tissue necrosis and had no palpable pedal pulses. End points were healed, healing, non healing or amputation. Fifty diabetic foot patients were included. Results: twenty-four patients reached the end point of adequate healing or complete healing, whereas twenty-six patients had nonhealing lesions. The Ankle Peak Systolic Velocity (APSV) was significantly higher in patients with Reversed Great Saphenous Vein Grafts compared with patients with Insitu Great Saphenous Vein Grafts: 57.8cm/s (±12.72) versus 24.9 cm/s (±9.55), p < 0.001. At a cutoff point of 40 cm/s, the APSV showed sensitivity of 90.91%, specificity of 100%, positive predictive value of 100%, negative predictive value of 92.3%, with diagnostic accuracy of 97.4% in predicting healing of diabetic foot lesions. There was a significant difference between the APSV before and after revascularization: 23.4 cm/s (±6.5) versus 58.8 cm/s (±12.3), p < 0.001. Conclusion: both reversed and insitu great saphenous vein grafts have good patency in infrapopliteal revascularization.}, keywords = {Diabetes mellitus,diabetic foot ulcer,Ankle Peak Systolic Velocity,Peripheral vascular disease}, url = {https://ejhm.journals.ekb.eg/article_36035.html}, eprint = {https://ejhm.journals.ekb.eg/article_36035_4a1e538c99563d42f97e32af90417c5d.pdf} } @article { author = {Ahmed, Mohamed Abdelwahab Seid}, title = {An Audit of Cesarean Section in Obstetric Department at Benha Educational Hospital}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3249-3253}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36036}, abstract = {The aim of the study is to make an audit for all females delivered by cesarean section (CS) at the Department of Obstetrics and Gynecology at Benha Educational Hospital for 6 months, so as to improve the quality of care and perform continuous quality improvement. Our study concluded that cesarean section was performed for women of different ages commonly between 18 – 45 years. The most common indication of cesarean section was previous cesarean section. Postoperative stay was mainly between 1 to 4 days. The resident doctors were the main surgical staff who performed cesarean section and spinal anesthesia was the most common method of anesthesia used.}, keywords = {Audit,cesarean section,Benha Hospital}, url = {https://ejhm.journals.ekb.eg/article_36036.html}, eprint = {https://ejhm.journals.ekb.eg/article_36036_1713a318e7dd98358d6890bb5d70c25c.pdf} } @article { author = {Gaber, Hassan Abdel Aziz and Eldahshan, Tarek Abdel Kareim and Ghanem, Sabry Mohammed and Abdel Fatah, Mostafa Ahmed Abdo}, title = {Value of Serum Zinc, Magnesium and Copper in Obese and Normal Weight Children}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3254-3259}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36887}, abstract = {Background: Childhood obesity is one of the most serious public health challenges of 21st century. The problem is global and is steadily affecting many low- and middle-income countries. The rising prevalence of childhood overweight and obesity represent a major health concern, as obesity is an important risk factor for a number of diseases. A strong evidence indicating that a disturbance of serum levels of zinc, copper and magnesium plays important role in the development of obesity and its related diseases. Our aim is to determine the mean zinc, magnesium and copper levels in obese and overweight children as compared to the levels in normal weight controls to study its relationship with overweight and obesity. Objective: We aimed to assess, evaluate and compare serum zinc, magnesium and copper in obese, overweight and normal-weight children. Patients and methods: The study was a case-control study conducted on 60 subjects 20 obese children, 20 overweight children and 20 normal weight children. All of them were subjected to full history taking, complete examination, and routine investigation including CBC, SGOT, SGPT, RBS, urea, Creatinine, TSH, lipid profile and specific laboratory investigation including serum zinc, magnesium and copper. Results: In obese and overweight children, there were increased serum copper levels together with reduced serum levels of zinc and magnesium regardless age and sex when compared to normal weight children. Conclusion: In obesity, there were increased serum copper levels together with reduced serum levels of zinc and magnesium regardless age and sex. Obese and overweight may be at a greater risk of developing imbalance (mainly deficiency) of trace elements, which may be playing an important role in the pathogenesis of obesity and related metabolic risk factors.}, keywords = {childhood,Obesity,overweight,normal weight,zinc,Magnesium,copper}, url = {https://ejhm.journals.ekb.eg/article_36887.html}, eprint = {https://ejhm.journals.ekb.eg/article_36887_47a80dbb73a426ecc98d929d61e29273.pdf} } @article { author = {Esheba, Ghada E.}, title = {Prognostic Value of Programed Cell Death-1 Ligand Expression in Colorectal Cancer and Its Correlation with Cytotoxic Tumor-Infiltrating Lymphocytes}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3260-3267}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36888}, abstract = {Background: colorectal cancer (CRC) is a major cause of cancer-related death worldwide. In recent years, targeting the programed cell death (PD-1)/ programed cell death-1 ligand (PD-L1) immune checkpoint signaling has been tested as a novel promising treatment strategy in several tumors. Aim of the work: the present study aimed to examine expression of PD-L1 and CD 8+ T cells in CRC and to evaluate the relationship between their expressions and the different clinicopathological features. Material and methods: expression of PD-L1 in tumor cells (TC) as well as in tumor infiltrating immune cells (TIMC) was separately evaluated in 85 cases of CRC by the immunohistochemistry, in addition, CD8+ T cell count was assessed. Results: 12.9 % of cases showed PD-L1 expression in TC while, 28.2% showed PD-L1expression in TIMC. PD-L1 expression in TC was significantly associated with higher tumor grade (P =0.001), lymph node metastasis (LNM) (P =0.006) and lymphovascular invasion (LVI) (P > 0.001). On the other hand, PDL-1 expression in TIMC was significantly associated with low tumor grade (P=0.016), negative LVI (P = 0.004), high tumor infiltrating lymphocytes (TILs) count (P <0.0001), as well as high CD8+ T cells count (P = 0.002). High intra CD8-positive T cells was significantly associated with absence of LNM (P =0.013) and negative LVI (P =0.035). Conclusion: these findings indicated that expression of PD-L1 can be used as a new biomarker to predict the prognosis of colon cancer and may provide a clue for immunotherapy in the adjuvant treatment of CRC patients.}, keywords = {colorectal cancer,PD1,PDL-1,CD8 + lymphocytes}, url = {https://ejhm.journals.ekb.eg/article_36888.html}, eprint = {https://ejhm.journals.ekb.eg/article_36888_f68dee509f83b8a6fa04a7910177915e.pdf} } @article { author = {Abdelaziz, Imam Mohamed and Mohamed, Ahmed Ibrahim and Abd Elhamid, Yasmin Ashraf Kamel}, title = {Role of Multislice CT in Assessment of Great chest Vessels Anomalies}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3268-3272}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36889}, abstract = {Background: Multidetector computed tomography (MDCT) is a useful, less invasive technique for diagnosing most types of vascular variations. CT is superior to radiology for identification of normal anatomy, anatomic variants and early abnormalities or pathological processes. Objective: The aim of this work was to evaluate the role of MDCT in Assessment of great chest vessels Anomalies. Patients and methods: The study included 30 patients in the age group between 2 months up to 30 years with a mean of 3 months. All patients were referred for evaluation Great chest vessels anomalies suspected to be in association with congenital heart disease. Results: CT provide an accurate assessment of Aortic vessel (Ascending, Arch and descending parts) four cases diagnosed as moderate to severe Aortic coarctation, two cases diagnosed as supravalvular and subvalvular aortic stenosis, two cases associated with right sided Aortic Arch, one case with hypoplastic Aortic Arch and another case had tortuous course of the Aorta. Substantial benefit of CTA is depiction of airway compromise owing to aortic rings. In the setting of coarctation, collateral vessels are better displayed. Conclusion: It could be concluded that the nowadays ease of the scan acquisition, the high spatial resolution and the accurate assessment of modern CT techniques make CT chest angiography an investigation ideally suited for the great chest vessels anomalies.}, keywords = {Multislice CT,Great chest Vessels Anomalies,MDCT}, url = {https://ejhm.journals.ekb.eg/article_36889.html}, eprint = {https://ejhm.journals.ekb.eg/article_36889_a32a39145e383ae678242dd09b135cf0.pdf} } @article { author = {El-malah, Mohamed Ahmed Ahmed and Ibrahim, Mohamed Mohamed Aly and Mohamed, Ahmed Mohamed Khater}, title = {Epithelium-On Versus Epithelium-Off Corneal Collagen Cross-Linking for The Management of Keratoconus}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3273-3281}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36890}, abstract = {Background: Keratoconus is a noninflammatory, bilateral, frequently asymmetrical, and most common corneal ectatic disorder characterized by central corneal thinning, biomechanical weakening, and steepening of the corneal curvatures leading to substantial distortion of vision. The estimated prevalence worldwide is 54.5 cases/100,000. Objective: The aim of the work was to compare epithelium-on and epithelium-off corneal collagen cross-linking for the management of keratoconus as regards keratoconus progression and visual outcome. Patients and methods: In this study, 20 eyes of 11 keratoconus patient were included. All were having keratoconus and presented with diminution of vision, increasing myopia and / or astigmatism. Cases with corneal scarring, corneal thickness less than 400 μm at the thinnest point and active corneal infections were excluded. The preoperative evaluation of patients showed UCVA, In epithelium-on (group 1) ranging from 0.05 to 0.60 with a mean 0.29 ± 0.21 and in epithelium-off (group 2) UCVA ranging from 0.05 to 0.50 with a mean 0.23 ± 0.13. Results: The postoperative results revealed improvement of UCDVA and BSCVA at 6 month postoperative in both groups. The postoperative manifest refraction spherical equivalent showed stability with mild improvement in both groups. Keratometric readings showed a decrease in curvature in both groups in the follow up period. Corneal hysteresis (CH) and corneal resistance factor (CRF) showed no significant difference after 6 months of follow up. Conclusion: It could be concluded that UVA/Riboflavin cross-linking of ectatic cornea by its two techniques is effective, safe, stable and do not affect corneal biomechanical characteristics, that leads in the majority of the cases to a halt the progression of ectasia.}, keywords = {Epi-Off cross-linking,Epi-On Cross-Linking,Corneal,Keratoconus}, url = {https://ejhm.journals.ekb.eg/article_36890.html}, eprint = {https://ejhm.journals.ekb.eg/article_36890_93029785a2f6bbc1b4143c5be9aff0c2.pdf} } @article { author = {Abdel-Rehim, Ahmed Salah and Ali, Abdul-Mongy Elsayed and Sadaka, Alaa Abdul-Mongy Abdul-Fattah and Mohamed, Dina Hamdy Mohamed}, title = {Management of Intermittent Exotropia in Children}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3282-3290}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36891}, abstract = {Background: Intermittent exotropia (IXT) is a common form of childhood exotropia, accounting for about 50–90% of all the exotropia and affecting about 1% of the general population. Objective: The purpose of this study was to evaluate difference modalities for treatment of intermittent exotropia either by non-surgical and surgical methods. Patients and Methods: this study included 40 patients of both sexes with exodeviation divided into 2 groups; Group (A): 20 patients subjected to non-surgical treatment and Group (B): 20 patients underwent surgical treatment; bilateral lateral rectus recession (BLR). Results: In non-surgical group the success rate was 55% after 12 months of treatment. Overminus glasses are more effective in control of IXT than part-time occlusion (PTO) and convergence exercise. The success rate was 86%. While the success rate in PTO was 43% and the success rate of convergence exercise was 33%. Poor compliance in PTO and convergence exercise therapy affect the treatment effectiveness. In surgical group (BLR) the success rate was 75%. Under-correction was 20% and the overcorrection was 5%. No complications were found. No lateral incomitance was observed. Conclusion: Surgical method is more effective in treatment of IXT than non-surgical methods, but the non-surgical method is more important in younger children. The over-minus glasses is more effective in treatment of IXT than the other non-surgical method due to poor compliance among children in PTO and Convergence exercise therapy. A larger trial for a longer duration is warranted to assess the effectiveness of different modalities of treatment of IXT}, keywords = {Intermittent exotropia,children,IXT}, url = {https://ejhm.journals.ekb.eg/article_36891.html}, eprint = {https://ejhm.journals.ekb.eg/article_36891_1752d9c3c474a08ab1c41e21ec4bf54f.pdf} } @article { author = {Al-Ameen, Ali Mohammed and Atia, Mohammed Adel and Bashandy, Mohammed Sayed and Ahmed, Osama Mohammed and Nawar, Bahaa El-din Mahmoud}, title = {Cardiac Arrhythmia and Blood Pressure Variability in Hemodialysis Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3291-3298}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36892}, abstract = {Background: end-stage renal disease is a global public health burden bearing high morbidity and mortality, and cardiovascular disease is a major cause of mortality in hemodialysis patients. Objective: the aim of this study is detection of arrhythmia and blood pressure variability in hemodialysis (HD) patients. Patients and Methods: this prospective observational study included 100 chronic renal failure patients on regular HD came to the hemodialysis center of Al-Azhar University Hospital, New Damietta and Kafr Elsheikh General Hospital. The study was carried out over a period of eight month from July 2017 until September 2018. Results: the intradialytic (ID) blood pressure was normal in 38%, ID hypertension was reported in 44% and ID hypotension was reported in 18% of HD patients, also we found that arrhythmia was developed in 84% of HD patients and the prevalence of arrhythmia was VES in 56%, PAC in 50%, SVT in 4%, AF in 8.0%, sinus tachycardia in 26% and sinus bradycardia in 20%. The sympathetic over activity (LF/HF ratio < 1.5) was reported in 38%; and high risk standard deviation of normal-to-normal intervals (SDNN) was reported in 22% and moderate risk in 70.0% while low risk was reported in 8.0% of HD patients. Conclusion: cardiac arrhythmias are common findings in patients with chronic renal failure on regular hemodialysis.}, keywords = {Cardiac arrhythmia,Blood Pressure Variability,Hemodialysis patients}, url = {https://ejhm.journals.ekb.eg/article_36892.html}, eprint = {https://ejhm.journals.ekb.eg/article_36892_d2822efdb6b73221afba9be5af50d237.pdf} } @article { author = {Mehanna, Mervat Shaker and Al-Shahed, Fatma Al-Zahraa Nabil Mohammed and Taha, Marwa Kamal}, title = {Histological Study of Effect of Exposure to Emamectin Benzoate on the Kidney of Adult Male Albino Rats and the Possible Protective Effect of Ginger Nanoparticles}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3299-3036}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36893}, abstract = {Background: pesticides are pivotal for pest control. However, due to their cumulative nature humans are vulnerable to daily sub-lethal exposure with increased risk for clinical disorders including kidney diseases. Oxidative stress is the main proposed mechanism for pesticides biohazards. Aim of this study: to clarify the effect of exposure to emamectin benzoate (EMB) on structure and ultrastructure of the kidney of adult male albino rats and the possible protective effect of aqueous ginger nanoparticles extract (GNE) on these changes. Materials and Methods: four groups were incorporated in this study, six animals each. GI: control group; GII: received aqueous GNE (100 mg/kg/d); GIII: received EMB (5 mg/kg/d); GIV: received EMB and aqueous GNE. Initial/final body weight (BW) variations and biochemical tests of serum creatinine (sCr) and blood urea nitrogen (BUN) were assessed. After one month, both kidneys from all groups were excised under anesthesia and prepared for light and electron microscopic assessment. The results were statistically evaluated. Results: comparing mean final BW among all groups revealed insignificant decrease in BW of GIII. There was a significant increase in the mean final sCr and BUN in GIII which was improved in GIV (p< 0.001). There was a significant increase in area percent of both collagen fibers deposition and Bax immune-expression in GIII which was markedly diminished in GIV (p< 0.001). Morphologic alternations were detected in kidney of rats of GIII which was ameliorated in GIV. Conclusion: EMB altered kidney morphology and aqueous GNE exerted an ameliorative effect.}, keywords = {kidney,EMB,Nanoparticles,Ginger}, url = {https://ejhm.journals.ekb.eg/article_36893.html}, eprint = {https://ejhm.journals.ekb.eg/article_36893_2d68f21e1da0c4d437ee629bd4b73da4.pdf} } @article { author = {Ali, Abdel Mongy El Sayed and Abdulla, Abdulla Mohammed Al Amin and Howaidy, Ahmed Ibrahim and Mohammed, Reham Mahmoud Ahmed}, title = {Comparative Study between The Refractive Outcome Following Phacoemulsification and Small Incision Cataract Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3037-3038}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36894}, abstract = {Background: phacoemulsification is the preferred technique for cataract surgery for most surgeons. An alternative surgical technique MSICS has been gaining popularity, because of this technique has been shown to yield comparable surgical outcomes as phacoemulsification. Objective: In our study we compared the two techniques as regard their effect on visual acuity, surgically induced astigmatism (SIA). Patients and Methods: forty patients were included in this study. Patients were divided into two groups: Group A (20 patients) underwent phacoemulsification and Group B (20 patients) underwent MSICS. Results: both groups were studied preoperatively and postoperatively regarding uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) andsurgically induced astigmatism (SIA). We found that both techniques give excellent postoperative visual results and that the SIA was 0.43±0.25 in phacoemulsification group and 0.61 ±0.55 in MSICS group at 3 month postoperative with no statistical difference between both groups (p=0.348) . Conclusion: according to our study, it is recommended for all surgeons to master MSICS technique for its excellent results which are comparable to phacoemulsification. For the beginners it could be considered like a step to phacoemulsification due to many common steps between the two techniques, also for expert surgeons it could be useful and can replace phacoemulsification efficiently in very hard nuclei and could be done if conversion is decided during phacoemulsification surgery.}, keywords = {Phacoemulsification,SIA,MSICS}, url = {https://ejhm.journals.ekb.eg/article_36894.html}, eprint = {https://ejhm.journals.ekb.eg/article_36894_fd3db805a1e136c7b24802591253c4a5.pdf} } @article { author = {Hasan, Ahmed Muhammed and Alashkar, Ahmed Mohammed and Esmael, Nabil Fathy and Ibrahim, Atef Abou Elfotouh}, title = {Assessment of Pulmonary Function in End Stage Renal Disease Patients on Regular Hemodialysis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3319-3323}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36895}, abstract = {Background: end-stage renal disease (ESRD), is the last stage of chronic kidney disease. When your kidneys fail, it means they have stopped working well enough for you to survive without dialysis or a kidney transplant. Objective: it was to assess the pulmonary function in patients with ESRD after hemodialysis. Patients and Methods: Prospective study which was done in tertiary level care center.Thirty ESRD patients who were on hemodialysis regularly were studied. Results: The mean FEV1/FVC% which was observed in the patients of this study was 67.8±20.8% of the predicted value, after hemodialysis, the mean FEV1/FVC% increased up to 82.3±20.1% of the predicted value, and this increase was statistically significant with P value <0.006. The mean of the forced expiratory flow 25-75% (FEF 25-75%) of the studied patients pre-dialysis was 53.1±33% of the predicted value, after hemodialysis, the mean of the FEF 25-75% increased up to 58.3±34.6% of the predicted value and that was statistically significant with P value <0.05. The mean of the peaked expiratory flow rate (PEFR) was 47.8±31.7% of the predicted value and after hemodialysis, the mean PEFR increased to 52.1±30.9% of the predicted value and that was statistically significant with P value <0.05). Conclusions: pulmonary function tests decrease significantly among ESRD patients who undergo hemodialysis regularly pre and after the sessions of hemodialysis. Most ESRD patients were with abnormal pulmonary functions, mainly of a restrictive pattern.}, keywords = {ESRD,Regular Hemodialysis}, url = {https://ejhm.journals.ekb.eg/article_36895.html}, eprint = {https://ejhm.journals.ekb.eg/article_36895_cd12ffe84d8d831995fb77b8497db9c9.pdf} } @article { author = {El Maraghy, Atef Abdallah and Younis, Mohamed Abd Elmoniem and Dawood, Yehia Mohamed and Mohammed, Mamdouh Makram}, title = {Comparative Study between Absorbable Carboxymethyl Cellulose and NonAbsorbable Merocel Nasal Packs after Sinonasal Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3324-3328}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36896}, abstract = {Background: Nasal packings can help in control of postoperative bleeding and healing following functional endoscopic sinus surgery (FESS) and nasal surgeries, but traditional non-resorbable packs have several inherent drawbacks. Objectives: This study was done to evaluate the effect of carboxy methyl cellulose (CMC) gel and merocel nasal packs after sinonasal surgery regarding postoperative bleeding, pain, pressure headache and formation of synechia. Patients and Methods: A total of 40 patients who had undergone sinonasal surgery were studied prospectively. At the end of the operation each patient was packed with dissolvable CMC gel in the right side of the nose and merocel in the left side. The haemostatic effect of the CMC and merocel was assessed during the recovery period. Results: six (15%) of the patients packed with CMC had primary postoperative bleeding during the recovery period. Bleeding appeared in four (10%) patients packed with merocel. We observed significant intergroup differences in the level of pain and pressure headache. The CMC group was superior to merocel group and there was a significant low level of pain and pressure headache in the CMC group. Two (5%) of CMC patients and six (15%) of merocel patients developed a synechia at the 4 weeks period. Four (10%) of CMC patients and Ten (25%) of merocel patients developed synechia at the 8 weeks period post operative. Conclusion: We found that dissolvable CMC pack is associated with very low levels of localised pain, pressure headache and with low levels of postoperative bleeding and synechia formation.}, keywords = {Endoscopic sinus surgery,Carboxymethyl cellulose – Merocel,Resorbable,Nasal synechia,Nasal packing,Nasal complications}, url = {https://ejhm.journals.ekb.eg/article_36896.html}, eprint = {https://ejhm.journals.ekb.eg/article_36896_895dd4ed9f0f9e624750957d612e72b1.pdf} } @article { author = {El-Asmar, Abo Bakr Helal and Awad, Taha Abd Elhamid and El-Didamony, Ahmed Attia}, title = {Comparative Study between Airway Pressure Release Ventilation and Synchronized Intermittent Mandatory Ventilation in Treatment of Acute Respiratory Distress Syndrome}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3329-3334}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36897}, abstract = {Background: Various animal and human studies have demonstrated that airway pressure release ventilation (APRV) may have advantages over conventional ventilation in the management of acute respiratory distress syndrome (ARDS); however, it is still not used consistently because of the few studies in this regard. Aim of the work: The aim of this work is to compare outcomes of APRV in patients with ARDS with synchronized intermittent mandatory ventilation (SIMV) where positive end expiratory pressure (PEEP) is used. Patients and methods: the study included (50) patients with ARDS, they were randomly divided into two groups, group (A) patients were given APRV pattern, and group (B) patients were given (SIMV+PEEP). Data were obtained before and throughout the period of mechanical ventilation and up to 60 days. Changes in arterial blood gases, hemodynamics and LIS and outcome measures were compared in both groups. Results: demographic and baseline clinical data were similar in both groups with no differences. Follow up data showed that APRV was associated with better oxygenation, less ICU length of stay, more ICU-free days, less ventilation days, more ventilator free days and more sedation free days in comparison to SIMV+PEEP (p>0.05). However, there were no significant differences between groups regarding mortality, length of hospital stay and rates of tracheostomy and successful extubation (p<0.05). Conclusion: In comparison to SIMV+PEEP, APRV can significantly improve oxygenation, decrease need for sedatives, increase free ventilation days and shorten duration of ICU stay; however, APRV has no advantage over SIMV+PEEP regarding mortality.}, keywords = {acute respiratory distress syndrome,Airway pressure release ventilation,Mechanical Ventilation}, url = {https://ejhm.journals.ekb.eg/article_36897.html}, eprint = {https://ejhm.journals.ekb.eg/article_36897_e71b304c4ef33997d4ea278888428b84.pdf} } @article { author = {El Gharabawy, Gamal Soliman Hassan and Abdallah, Ezz Elden Alsharkawy and Kaabo, Hassan Fathy and Abdel Aleem, Ahmed Mohamed Ahmed}, title = {Histological Effects of Sofosbuvir on The Kidney of Male Albino Rats and The Possible Protective Role of Vitamin C}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3335-3354}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36898}, abstract = {Aim of the work: hepatitis C virus (HCV) infection is a major worldwide public health issue. Direct Acting Antiviral Drugs (DAA) is a revolution that occurred in treatment of hepatitis C virus (HCV). The Second class of DAA is HCV NS5B polymerase inhibitors (Which included Sofosbuvir) was shown to be effective in suppression of HCV replication and became an important component of currently recommended regimens. Material and Methods: forty adult male albino rats (Rattus norvigicus) weighting 140±20g were selected for this 36-days experiment The rats were randomly categorized into six groups (10 animals each for the first four groups and the remaining groups V&VI were served as the recovery groups). The kidney was excised and prepared in two different techniques for light & electron microscopic examination. For light microscopy serial sections (5 um thick) were stained with hematoxylin-Eosin technique for studying the morphological changes; periodic Acid Schiff technique (PAS) for studying of general carbohydrate ; Masson’s trichrome stain for detecting the collagen fibers and transmission electron microscopy (TEM) to detect the ultrastructural changes induced by Sofosbuvir. Results: the present study showed that group II which received the therapeutic dose of Sofosbuvir (0.06 mg/gm./body weight) showed renal tubular affection compared to the control rats. Tubular affection included massive tubular vacuolization especially cells of the proximal and distal convoluted tubules. Group III which received the toxic dose of Sofosbuvir (0.25 mg/gm./body weight) resulted in glomerular affection compared to the control rats. Conclusion: the present study provided promising results about reduction of Sofosbuvir nephrotoxicity by the concomitant use of vitamin C.}, keywords = {hepatitis C virus (HCV) infection,Sofosbuvir,vitamin c,rat,kidneys,histology}, url = {https://ejhm.journals.ekb.eg/article_36898.html}, eprint = {https://ejhm.journals.ekb.eg/article_36898_d8dd22d3b484c9937bdfbbb7bd8a5267.pdf} } @article { author = {Abd El Fatah, Thoraya A. and Ali, Nagafa A. and Elazazy, Emad M and Dowidar, Nabil L and Abd Elgalil, Heba M. and Mohamed, Soso S.}, title = {Assessment of Clinical Governance in Primary Health Care Services: A Case Study on Dakahlia Governorate, Egypt}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3355-3365}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36899}, abstract = {Background: universal health coverage and the health-related sustainable development goals can only be achieved with a stronger emphasis on Primary Health Care (PHC). In spite of the essential role of clinical governance (CG) in enhancing quality of services provided by PHC facilities, a scientific framework with precise criteria for evaluating them has not been developed so far in Egypt. Objective: to assess the CG in PHC in Egypt considering PHC of Al-Dakahlia governorate as a case study and to clarify the barriers for implementing CG at PHC. Subjects and Methods: a cross sectional study was conducted over a period of one year at 8 PHC facilities in selected two districts; Al-Sinbelawin and Aga in Al-Dakahlia governorate, Egypt. The assessment of CG indicators was through multi-level approaches from different perspectives of 327 PHC utilizers, 40 PHC providers, 10 PHC executive directors who were drawn from the selected districts. Thirteen experts in PHC and CG in Egypt were also participated. Results: CG index for PHC facilities was scored higher percentage degree by PHC directors (91.0%) than by PHC utilizers, providers and the experts (70.0%, 59.6% & 53.3% respectively). The CG indicators showed disparities between the participating groups. Experts reported several challenges for CG implementation as shortage of clear policies, lack of awareness about governance culture and lack of experience in this field. Conclusion: the successful CG framework should be based on plan & implement as a team and create better relationships between directors and all stakeholders.}, keywords = {Clinical governance,primary health care,Egypt}, url = {https://ejhm.journals.ekb.eg/article_36899.html}, eprint = {https://ejhm.journals.ekb.eg/article_36899_fa006461db557f6ffee3cd3bfdb67b80.pdf} } @article { author = {Abd El-Rahman, Mohamed Abd El-Hamid and Abd El-Fattah, Hany Abd El-Momen and Ghanem, Maged Mohamed Abd El-Aziz and Metwally, Mahmoud Mohamed Mohamed and Ibrahem, Mohamed Ibrahem Abdo}, title = {Comparative Study between Contralateral and Ipsilateral Approaches in Endovascular Treatment of High Superficial Femoral Artery Lesions}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3366-3372}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36900}, abstract = {Background: peripheral arterial disease (PAD) is defined as a slowly progressing, occlusive vascular disease of the extremities primarily due to atherosclerosis which can involve vasculitis and thrombosis. The incidence of PAD is increasing worldwide due to an overall increase in diabetes, obesity, and other cardiovascular disorders. Objective: the purpose of this study was to compare the outcomes, including the safety, of antegrade and retrograde puncture for SFA angioplasty access especially when lesion occurs in proximal part of SFA. The effect of these approaches upon procedure time and radiation dose was also assessed. Patients and Methods: a group of 40 consecutive patients (19 men, 21 women) were randomized for antegrade puncture or retrograde puncture of the common femoral artery. Following retrograde puncture the guidewire was turned’ and placed into the superficial femoral artery. The time for gaining access, screening time, radiation dose, and complications were recorded. Results: there was no significant difference in the time to achieve arterial access between the two groups but the retrograde puncture required a substantially longer screening time and resulted in a higher radiation dose than antegrade puncture. Conclusion: antegrade puncture is the standard means of obtaining access to the common femoral artery to carry out infrainguinal intervention. The antegrade approach has the advantage of permitting the use of shorter tools, and additional support for manipulating catheters and guidewires.}, keywords = {Endovascular treatment,PAD,SFA}, url = {https://ejhm.journals.ekb.eg/article_36900.html}, eprint = {https://ejhm.journals.ekb.eg/article_36900_ea4458620ba48a373b4f0d0969f7caf1.pdf} } @article { author = {El-Khateeb, Saad El-Deen Mahmoud and Nouh, El-Desoky Mohammed Ibraheem and Ali, Mohammed Abd-Elsalam Abd-Allah}, title = {Effect of Paracetamol and Dexamethasone with Lidocaine in Intravenous Regional Anesthesia of Upper Limb Surgeries}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3373-3379}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36901}, abstract = {Background: Upper limb surgeries may be done under general anaesthesia or other methods such as nerve block or regional anaesthesia such as intravenous regional anesthesia (IVRA). Intravenous regional anesthesia has many advantages such as cost effectiveness, day case surgeries and reduced hemorrhage risk. Objective: The primary objective was to evaluate the effect of paracetamol and dexamethasone when combined with lidocaine on the depth and duration of IVR anesthesia in upper limbs. The secondary objective was to evaluate the onset of tourniquet-associated pain, time of 1st analgesic request, total opioid consumption and haemodynamic stability. Patients and Methods: Patients of this study were classified into 4 groups, 1 st group received 3 mg/kg lidocaine 2% completed by normal saline to 40 cc total volume without any additives and named as group L. 2 nd group received 3 mg/kg lidocaine 2% plus 8 mg dexamethason completed by normal saline to 40 cc total volume and named as group D. 3 rd group received 3 mg/kg lidocaine 2% plus 250 mg paracetamol completed to 40 cc total volume and named as group P. 4th group received 3 mg/kg lidocaine 2% plus 8 mg dexamethasone plus 250 mg paracetamol completed to 40cc total volume and named as group LDP. These groups were evaluated for haemodynamics and onset of sensory and motor block and time of recovery of sensory and motor block as well as intraoperative VAS score and fentanyl consumption. Results: As regard average values of intraoperative VAS, 4 th group had the lowest numbers then 2nd group, 3 rd group then 1st group which had the highest numbers. As regard the time to 1st analgesic request, the 1 st group showed the shortest time meanwhile the 4 th group showed the longest time to 1st analgesic request while 2 nd and 3rd groups were in between. Total opioid consumption was the least among the 4th group in comparison with the other three groups especially the 1st one, which showed the highest consumption. Finally, 4 th group proved to be the best one as regarding good anaesthesia and analgesia and reduction in intraoperative pain score as well as reduction in opioid consumption. Conclusion: Paracetamol and dexamethasone when combined to lidocaine in intravenous regional anaesthesia in upper limb produce synergistic effect on sensory and motor block, reduce intraoperative pain score and decrease amount of intra operative opioid consumption.}, keywords = {Intravenous regional anesthesia,dorsal root ganglia}, url = {https://ejhm.journals.ekb.eg/article_36901.html}, eprint = {https://ejhm.journals.ekb.eg/article_36901_180f675465f9958cecfa392d3a42c65b.pdf} } @article { author = {Abd El Hak, Mohammed Taha and Metwally, Nadia Abd El Sater and Abdrabo, Ahmed Sobhy Mohammed}, title = {Role of Diffusion-Weighted MRI in Hepatocellular Carcinoma Patients Following Transarterial Chemoembolization (TACE)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {76}, number = {1}, pages = {3380-3391}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.36902}, abstract = {Background: Hepatocellular carcinoma is one of the commonest cancers all over the world with very high mortality rates. TACE is used to deliver chemotherapeutic agents locally to the tumor. Aim of the work: The purpose of this study was to evaluate the role of diffusion-weighted MRI and ADC value in comparison with dynamic MRI in the assessment of response and necrosis to treatment of hepatocellular carcinoma after transcatheter arterial chemoembolization. Patients and Methods: Precontrast T1, T2, STIR, respiratory triggered diffusion-weighted (b factor 20, 500 and 800 s/mm2) and dynamic contrast enhanced MR images obtained in 50 patients with HCC who underwent TACE. Diffusionweighted MR images, gadolinium-enhanced MR images after TACE were assigned confidence levels for postoperative HCC recurrence. Results: Dynamic MRI had a sensitivity of 90.5%, a specificity of 96.6%, a positive predictive value of 95 %, a negative predictive value of 93.3% and overall agreement of 94%. Compared to 95.83%, 69.23%, 74.19%, of 94.74% and 82% respectively of diffusion-weighted imaging. The difference between the malignant and negative groups' ADC variables were statistically significant (P value 0.006). The ROC curve showed that the area under the curve is C = 0.728 with SE = 0.075 and 95% CI from 0.582 to 0.874. Conclusion: Diffusion-weighted MR imaging has lower specificity compared to dynamic MRI with increased false positives. We suggest that the increase is due to intra-lesional hemorrhage or liquefactive necrosis causing diffusion restriction. Diffusion-weighted imaging may act as a supplementary sequence to compensate the dynamic MRI in patients who could not hold their breath adequately.}, keywords = {HCC,Post TACE,DWI,Locoregional treatment,Liver}, url = {https://ejhm.journals.ekb.eg/article_36902.html}, eprint = {https://ejhm.journals.ekb.eg/article_36902_9cae91e9be976fa40a6ed976029f1563.pdf} }