ORIGINAL_ARTICLE
Multidetector Computerized Tomography Versus Magnetic Resonance Imaging in Diagnosis of Basal Ganglia Signal Intensity Alteration
Background: the basal ganglia are part of the extrapyramidal motor system, participating in the production of movement, but they are also involved in memory, emotion, and other cognitive functions. Objective: This work aimed to study the role of multidetector computerized tomography versus magnetic resonance imaging in diagnosis of basal ganglia signal intensity alteration with highlight on accuracy, sensitivity, specificity of each tool in reaching the proper diagnosis. Patients and Methods: this study was designed to examine the effectiveness of both computed tomography and magnetic resonance imaging in diagnosis of different basal ganglia lesions. It included 50 patients, selected from Al-Azhar University hospital. Results: sensitivity of CT in diagnosis of basal ganglia lesion was 86.0%, and failed to elicit diagnosis in 14.0% of patients. There was no significant difference between males and females. MRI sensitivity in diagnosis of basal ganglia lesions was 92%, while it was unable to diagnose 4.0%. There was no significant difference between males and females (the sensitivity in males was 94.7% and in females, it was 83.3%). Conclusion: MRI is superior to CT for diagnosis of different basal ganglia lesions, except for senile calcification, where CT was superior to MRI. However, CT presents a considerable sensitivity. Thus, it is advisable to start with CT examination to avoid high cost of MRI, otherwise start with MRI when the cost is not a matter or the condition is not in an emergency situation. In such emergent situations, MRI must be used as a first choice.
https://ejhm.journals.ekb.eg/article_27414_9929101a148afe750f027ede727e90a4.pdf
2019-01-01
1448
1456
10.21608/ejhm.2019.27414
CT
MRI
Basal Ganglia
Mostafa Ali
Motawie
1
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
AUTHOR
Mostafa Mohammad
Shakweer
2
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohammed Ashraf Abd El Moniem Aly
Ahmed
m.ashrf88@yahoo.com
3
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Double Silicone Intubation for Management of Recurrent Acquired Nasolacrimal Duct Obstruction
Background: the obstruction of the nasolacrimal excretory system may occur in the proximal puncta, canaliculi, common canaliculus, or more distally within the lacrimal sac or nasolacrimal duct. Nasolacrimal duct obstruction occurs as a congenital or acquired disease. Acquired causes can be numerous. Aim of the Work: to evaluate Dacryocystorhinostomy (DCR) with double silicone tube in the management of recurrent epiphora after failed conventional DCR. Patients and Methods: This is a prospective study which was done on 30 patients with recurrent or persistent acquired epiphora who gave positive past history of previous DCR. Results: Epiphora improved significantly in 27 out of 30 patients (90%) after six month postoperatively. Conclusions: DCR is the gold treatment intervention for acquired nasolacrimal duct obstruction (NLDO) in adults, Silicone intubation (SI) increases success rates and double SI further increases the success rates of DCR for recurrent cases and is considered safe and effective technique.
https://ejhm.journals.ekb.eg/article_27415_134ae4605d43b73ee6e50e7b3192c8a4.pdf
2019-01-01
1457
1461
10.21608/ejhm.2019.27415
DCR
epiphora
NLDO
Mahmoud Abd El-Halim Soliman
Rabea
1
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohamed Al Taher
Abd El Wahab
2
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
AUTHOR
Ehab El Sayed
Abd El Salam
dr.ehab_salam@yahoo.com
3
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Sonographic Assessment of Myometrial Thickness as A Predictor for the Latency Interval in Women with Preterm Premature Rupture of Membranes
Background: Spontaneous rupture of membranes is a normal component of labor and delivery. Rupture of membranes before the onset of labor is considered premature (PROM), and induction of labor is common if the patient is at or close to term. Patient management becomes more challenging when rupture of membranes occurs preterm (PPROM), and in the absence of labor. Objective: The aim of this work was to measure the myometrial wall thickness (MT) by ultrasound scanning in women with PPROM as predictors for the latency interval, and see other impacts that predict the latency interval. Patients and Methods: This study included a total of 100 pregnant women attending at Labor and Delivery Ward in Al Hussein Hospital, Al-Azhar University. This study was conducted between May 2018 to December 2018. Pregnant women were divided into three groups: preterm premature rupture of membranes (PPROM, n=50), and term nonlabor control (T-CTR, n =25) and preterm nonlabor control (P-CTR, n=25). Results: revealed that women with PPROM were slightly older compared with those in P-CTR group and T- CTR group but with no statistical significant difference. There was no significant difference among groups in number of previous pregnancies. There was also no significant difference in maternal body weight among groups. Regression analysis suggested that there was a direct correlation between latency interval and fundal MT with a very strong positive Pearson correlation and a highly significant p value. Conclusion: It could be concluded that there was a significant thickening of the fundal walls of the uterus follow PPROM. A thick myometrium in no laboring PPROM women is associated with long latency interval.
https://ejhm.journals.ekb.eg/article_27416_4d69ffad5d474f51a900c5de5683478c.pdf
2019-01-01
1462
1472
10.21608/ejhm.2019.27416
PPROM
Myometrium
Oligohydramnios Ultrasound preterm birth
Latency interval
Abdalmonem Mohamed
Zakaria
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Waleed Alsayed Alsayed
Alnagar
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Khaled Mahmoud Ahmed
Ahmed
dr.khaled.m.a.a@gmail.com
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Arthroscopic Bankart Repair with Subscapularis Augmentation in The Treatment of Recurrent Anterior Shoulder Instability with Bone Loss
Background: In this study, we focused on the analysis of new published surgical technique in the management of recurrent anterior shoulder dislocation in presence of glenoid bone defect using traditional Bankart repair augmented with subscapularis tendon. Method: This prospective study was performed on 30 patients having recurrent anterior shoulder dislocation; these patients were managed between January 2016 and December 2018, Thirty-one shoulders in thirty-one patients had arthroscopic Bankart repair and subscapularis augmentation. One patient was lost to follow up; thirty patients with thirty shoulders were evaluated using American shoulder and elbow surgeons score, the percentage of glenoid bone defect was evaluated using PICO method. Results: 30 patients were followed for 22.03 Months range 16 – 24 Months. Only one patient had recurrent dislocation after significant trauma. The American Shoulder and Elbow Surgeon Score (ASES) shows significant improvement in score from Mean ± SD 13.27 ± 3.24 to 23.47 ± 3.14 after, function Mean ± SD from 6.23 ± 2.01 to 8.83 ± 0.75 and pain decrease from Mean ± SD 6.17 ± 1.53 to1.33 ± 0.80, with no significant functional changes in ROM even ER at 90 abduction Mean ± SD changes from 79.00 ± 9.95 to 77.33 ± 7.85 or ER at side Mean ± SD changes from 68.67 ± 18.14to 66.33 ± 15.31. Conclusion: The procedure of Bankart repair with Arthroscopic Subscapularis Augmentation (ASA) is an effective procedure in the management of recurrent anterior shoulder dislocation associated with GBD ≤ 25% with good results.
https://ejhm.journals.ekb.eg/article_27417_04dddc1771af7e2b17a2b15d0dcfc6ea.pdf
2019-01-01
1473
1480
10.21608/ejhm.2019.27417
Bankart repair
Subscapularis augmentation
recurrent anterior shoulder dislocation
and glenoid bone loss
Ibrahem A.
Hussein
1
Orthopedic Department, Faculty of Medicine, Al-Azhar University, Cairo
AUTHOR
Mohamed Abdel-Aziz
Hassan
2
Orthopedic Department, Faculty of Medicine, Al-Azhar University, Cairo
AUTHOR
Samir A.
Nematallah
drsamirortho@azhar.edu.eg
3
Orthopedic Department, Faculty of Medicine, Al-Azhar University, Cairo
LEAD_AUTHOR
ORIGINAL_ARTICLE
Results of Coronary Artery Bypass Graft Surgery in Sharq Elmadina Hospital, Alexandria
Background: coronary artery bypass graft (CABG) surgery has been shown to be an effective method for treating angina pectoris and prolonging life in patients with severe coronary artery disease. Aim of the Work: to assess postoperative short-term results of coronary artery bypass graft surgery in Shark Elmedina hospital, Alexandria. Patients and Methods: This retrospective study was conducted on 170 patients with isolated ischemic heart disease admitted to Shark Elmadina hospital from January 2016 to January 2017. In the current study, pre-operative data were collected to identify the risk factors that may affect the outcome of surgery and intraoperative data and post-operative complications. Results: The most common risk factors were dyslipidemia (64.7%), hypertension (57.1%), diabetes mellitus which represents 50%, smoking which represents 37,6%, peripheral vascular disease which represents 31,7%. Other risk factors which had a low percent were history of chronic hepatic disease, previous stroke or myocardial infarction or lung disease or renal disease. What is worth to mention that echo preoperative affects the outcome of surgery as in our study EF of patients’ ranges from 40% to 75%. Intraoperative data also affects the outcome of surgery as number of grafts as there was one patient had done 5 grafts and 34 patients have done 4 grafts. Another important event was LLIMA dissection as there were 9 patients have dissected LIMA during harvesting. Another event was endartrectomy as there were 11 patients have LAD endartrectomy, 6 patients have RCA endartrectomy. Long bypass time and clamp time affects the results of surgery maximum bypass time 200 minute and maximum clamp time 120 minute. Post-operative ICU and ward stay affects the results as maximum ICU or ward stay was 9 days. The most common complication was wound infection which had an incidence 7% and the second complication was renal impairment which had an incidence 5.2%, reopening (2.9%), elevated liver enzymes which represents 2,3% and other complications which had low incidence as pleural effusion, lung atelectasis and stoke. Finally, mortality was 1.1%. Conclusion: CABG surgery is safe and the risk of major complications is low. Although major complications occur rarely they pose a great challenge to the patient and the surgeon. Early recognition and management of major complications are paramount to long term outcome.
https://ejhm.journals.ekb.eg/article_27418_8b3e87cc888558f2df3be616e299c2ac.pdf
2019-01-01
1481
1490
10.21608/ejhm.2019.27418
coronary artery bypass graft surgery
postoperative short-term outcome
El Husseiny E.
Gamil
1
Departments of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Ali R.
Mahmoud
2
Departments of General Surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohamed E.
Mahmoud
3
Departments of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohamed A.
Mohamed
badi388@gmail.com
4
Departments of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Limb Lengthening for Achondroplasia: Systematic Review and Meta-analysis
Background: Achondroplasia is the most common genetic skeletal dysplasia. It is characterized by a rhizomelic form of dwarfism, exaggerated lumbar lordosis, a prominent forehead and a low nasal bridge. The trunk is generally of near normal length. The incidence of achondroplasia is approximately 1 in 25000 people. Objectives: In the present systematic review, we have aimed to synthesize evidence from the published literature about the safety and efficacy of limb lengthening in patients with achondroplasia. Also, we have aimed to assess which age is preferred to start the lengthening and effect of early management on natural growth and psychiatric health. Methods: An electronic search was conducted from the inception till September 2018 in Medline via PubMed. Data entry and processing were carried out using a standardized Excel sheet and reviewers extracted the data from the included studies. We performed all statistical analyses using Review Manager (RevMan) 5.3 for windows. Results: In the present study, 17 studies were included in the present systematic review and meta-analysis. In terms of gained length of femur, the overall effect estimate showed that limb lengthening procedure achieved a mean increase in femur length by 11.9 (95% CI 9.39 – 14.43) cm. In addition, the overall effect estimate showed that limb lengthening procedure achieved a healing index of femur 30.46 (95% CI 24.326 – 36.59) days/cm. Similarly, the overall effect estimate showed that limb lengthening procedure achieved a mean increase in tibia length by 9.5 (95% CI 8.169 – 10.927) cm. The overall effect estimate showed that limb lengthening procedure achieved a healing index of tibia of 32.09 (95% CI 18.65 – 25.52) days/cm Conclusion: It could be concluded that limb lengthening is a reliable procedure with a relatively low complication rate in increasing the length of femur and tibia in patients with achondroplasia.
https://ejhm.journals.ekb.eg/article_27419_16edd78d12326db1ee394d20e6ed7856.pdf
2019-01-01
1491
1513
10.21608/ejhm.2019.27419
Achondroplasia
Meta-Analysis
Yasser Ali
Elbatrawy
1
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Ashraf Mohammed
Abdelaziz
2
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohamed Ahmed Abdel-Meged
Zidan
drmohamedzidan@gmail.com
3
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Levetiracetam Induced Cutaneous Side Effects: Case Report
Background: Many drugs have been successfully used for the treatment of epilepsy. However, medications related complications are usually inevitable. The aim of the work was to report the limited rare cutaneous manifestations associated with Levetiracetam (LEV); a commonly used anti-epileptic drug (AED). Two cases were reported with literature review. Method: This is a retrospective case report enrolling two patients with primary generalized epilepsy who developed different cutaneous manifestations that were previously reported in the literature on minimal occasions. Conclusion: LEV is not known to induce cutaneous manifestations, and if occurred, it would be dose- related. Therefore, utmost care should be taken when prescribing LEV dosage to avoid such complication.
https://ejhm.journals.ekb.eg/article_27420_628d728d3f1916b4a30819ba34b0d1b9.pdf
2019-01-01
1514
1515
10.21608/ejhm.2019.27420
Saud
Alnaaim
1
Clinical Neurosciences department, College of Medicine, King Faisal University
AUTHOR
ORIGINAL_ARTICLE
The Value of Middle Cerebral Artery and Umbilical Artery Doppler Indices in Assessment of Fetal Wellbeing and Prediction of Neonatal Outcome in Preeclampsia
Aim of The Study: To evaluate the value of middle cerebral artery and umbilical artery Doppler indices in assessment of fetal wellbeing and prediction of neonatal outcome in pregnant women with preeclampsia. Patients and Methods: This study included 100 pregnant women with preeclampsia, 50 women with uneventful pregnancies, Ultrasound and Doppler studies were carried out to estimate fetal weight, fetal biophysical profile and resistance indices of the middle cerebral and umbilical arteries. C/U RI <1.0 was considered abnormal. Adverse neonatal outcome was diagnosed when Apgar score <6 at 5 minutes, C.S for fetal distress, stained meconium, abnormal BPP, perinatal death and/or neonatal admission to neonatal intensive care unit.
Results: adverse neonatal outcome in groups A, B and C was significantly correlated to UA-RI and UA-PI. Between the normal and adverse neonatal outcome, in group A, there was a significant difference in UA-RI (P-value = 0.021); in group B, there was a significant difference in UA-RI and UA-PI (P-value <0.001 and P-value <0.001 respectively); and in group C, there was a significant difference in UA-RI and UA-PI (P-value <0.001 and P-value =0.004 respectively). In our study, both absent and reversed diastolic flows were significantly correlated with bad neonatal outcome in the study group (P value <0.001, r-value = 0.428). Conclusions: MCA and UA Doppler indices are good utilities for the assessment of fetal wellbeing and prediction of neonatal outcome in pregnant women with preeclampsia.
https://ejhm.journals.ekb.eg/article_27421_d932344bcd05366abd1a5bdbd4351cdf.pdf
2019-01-01
1516
1524
10.21608/ejhm.2019.27421
Doppler indices
preeclampsia
Neonatal Outcome
Yehia A.
Wafa
1
Department of Obstetrics and Gynecology, Faculty of Medicine-Al-Azhar University
AUTHOR
Fahd A.
Mohammed
2
Department of Obstetrics and Gynecology, Police Hospitals
AUTHOR
Osama M.
Deif
3
AUTHOR
Mohammed A.
Shosha
dr.mshosha.ms@gmail.com
4
Department of Obstetrics and Gynecology, Faculty of Medicine-Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Procoagulant Activity of Platelets and Tissue Factor Microparticles in Behçets Disease
Background: Microparticles are found in all body fluids including peripheral blood. They play an important role in blood clot formation and increased cell aggregation. Aim of this work: Was to evaluate the level of circulating platelet microparticles (PMP) and tissue factor microparticles (TFMP) in Behcet`s disease and to assess the relation of these procoagulant markers and Behçet’s disease activity. Patients and methods: This study included 100 persons divided to three groups; Behçet’s disease (BD) group (40) patients, systemic lupus (SLE) group (40) patients as a comparative and control group (20) persons. Platelet-free plasma was ultra-centrifuged. PMPs and TFMPs were identified and enumerated with flow cytometry using anti CD61PE and CD142Percp antibodies. D-dimer was measured by ELISA. Results: There was statistically significant increase of PMP (CD61), tissue factor MP (CD142), CD61-MFI and CD142-MFI in Behcet`s group in comparison to Control group (p˂0.001). There was statistically significant increase of PMP and tissue factor MP in Behcet`s when compared to Lupus group (p˂0.001), while CD61/CD142, CD61- MFI and CD142-MFI revealed no significant difference. D-dimer was significantly increased during Behcet`s and SLE disease activity (p=0.036 & p=0.021 respectively). Active Behcet`s disease had significant increase of both CD61 and tissue factor expressing PMP (CD61/CD142) when compared to patients with inactive state (p˂0.001 & p=0.004 respectively), while CD142 showed no significant difference (p=0.38). In Behcet`s group, there was significant positive correlation between CD61 and each of CD61/CD142 and D-dimer (p=0.001). Conclusion: PMP and TF MP are significantly elevated in BD in comparison to SLE. PMP, PMP expressing TF and D-dimer are markers of disease activity in both BD and SLE, while ESR and CRP are not. PMP is positively correlated to TF expressing PMP and D-dimer in BD denoting enhanced prothrombotic state. PMP, PMP expressing TF and D-dimer are characters of ANCA positive BD.
https://ejhm.journals.ekb.eg/article_27632_06e832dac854ca23d0db163bac9ecd57.pdf
2019-01-01
1525
1533
10.21608/ejhm.2019.27632
Platelet microparticles
Tissue factor microparticles
Behçets` disease and Systemic lupus erythematosus
EL Desouki EL Desouki
Fouda
1
Department of Internal medicine, Faculty of Medicine, Al-Azhar University(Cairo)
AUTHOR
EL-Sayed AL Maghawri
EL-Sayed
2
Internal medicine AlAzhar Faculty of Medicine (Damietta)
AUTHOR
Mona Hilmy
Alrayes
3
Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University
AUTHOR
Mohammed Abdel Maboud
El Shennawy
mohamedmina936@gmail.com
4
Department of Internal medicine, Faculty of Medicine, Al-Azhar University(Cairo)
LEAD_AUTHOR
ORIGINAL_ARTICLE
Comparative Study between Mesotherapy and Conventional Systemic NSAIDs in the Treatment of Chronic Low Back Pain with Sciatica
Background: Chronic low back pain is a common painful medical problem which has significant socioeconomic impact. Conventional pharmacological therapy usually associated with adverse effects. Mesotherapy is the injection of active substances into the surface layer of the skin. This method allows a slower spread, higher levels, and longer lasting effects of drugs in the tissues underlying the site of injection compared with those following intramuscular injection. This technique is useful when a local pharmacological effect is required and relatively high doses of drug in the systemic circulation are not. Objective: The aim of this study was to compare mesotherapy versus conventional systemic administration of NSAIDs in chronic low back pain with sciatica (radicular pain). Patients and Methods: Fifty patients were randomized to receive anti-inflammatory therapy according to the following protocols: group I had received ketoprofen 100 mg (2 ml) + 2% lidocaine (1 ml) + saline (2 ml) for 4 injections. Group II had received: 100 mg ketoprofen orally twice daily. Results: After receiving treatment (After one and three months; As regarding VAS, repeated measure of the mean VAS score for each group separately showed statistically significant reduction (P < 0.01), and statistically highly significant higher percentage regarding sever grade of disability in group II (57.1% and 72.7%; respectively) compared with group I (42.9% and 27.3%; respectively) (P < 0.05). Conclusion: It could be concluded that the administration of NSAIDs via mesotherapy technique provides better therapeutic benefit than that induced by oral drug administration. That beside the lower drug amounts administered to patients undergoing mesotherapy and the low frequency of administration.
https://ejhm.journals.ekb.eg/article_27860_9465d8856c30cd9fab6fda98fc3a6a91.pdf
2019-01-01
1534
1543
10.21608/ejhm.2019.27860
Mesotherapy and Conventional Systemic NSAIDs
Chronic low back pain
Sciatica
Eman Ahmed
Saad
dr.monnemo@gmail.com
1
Department of Rheumatology, Physical Medicine and Rehabilitation, Faculty of Medicine, Aswan University, Egypt
LEAD_AUTHOR
Fatma Hussein H.
El Nouby
2
Department of Rheumatology, Physical Medicine and Rehabilitation, Faculty of Medicine, Aswan University, Egypt
AUTHOR
Ghada
El Fayomi
3
Department of Rheumatology, Physical Medicine and Rehabilitation, Faculty of Medicine, Mansoura University, Egypt
AUTHOR
Amal Abd Elaziz
Fehr
4
Department of Rheumatology, Physical Medicine and Rehabilitation, Faculty of Medicine, Helwan University, Egypt
AUTHOR
Nehal Ahmed
Fathy
5
Department of Rheumatology, Physical Medicine and Rehabilitation, Faculty of Medicine, Assiut University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Potency of Dexamethasone in Labor Induction
Background: Induction of labor is one of the most common interventions practiced in modern obstetrics. In the developed world, the ability to induce labor has contributed to the reduction in maternal and perinatal mortality and morbidity. Objective: The aim of this study is to establish whether dexamethasone plays a role in shortening the duration interval between initiation of labor induction and beginning of the active phase of labor in post-term pregnancy, so shortening the duration of labor. Methodology: This case-controlled trial study was conducted in the labor ward of El Hussein University Hospital and El-Shiekh Zaid Specialized Hospital to evaluate the effect of dexamethasone infusion administration on the duration of induction of labor. This study comprised 100 pregnant women with full term pregnancy, who admitted to the labor ward for induction of labor because of full-term pregnancy (gestational age ≥40 weeks). Results: There was a high significant statistical difference between the two studied groups as regards duration between labor induction and active phase of labor being shorter in case group. Active phase and second stage of labor were shorter in duration in cases of study than control. No significant statistical difference between the two studied groups as regards mode of delivery, neonatal outcome (birth weight, Apgar score at 1 minute, Apgar score at 5 minutes and fetal complications (meconium stained liquor and admission to NICU). Conclusion: Intravenous infusion of two ml (8 mg) of dexamethasone appears to shorten labor duration.
https://ejhm.journals.ekb.eg/article_27861_8e4169dbf79ecea247cd4f1bf347b7a1.pdf
2019-01-01
1544
1551
10.21608/ejhm.2019.27861
dexamethasone
labor induction
Abd Elazeem Mohamed
Ahmed
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
AUTHOR
Osama Mohamed
Deif
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohamed Aly
El-Saftawy
mohamedsofyomar@hotmail.com
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Comparison between The Effect of Sucralose and Sodium Saccharin on Some Physiological Parameters in Male Albino Rats
Background: Non-nutritive sweeteners (NNSs) are becoming popular as sugar substitutes for diabetic patients or to decrease body weight. Aim of the work: This study was aimed to determine the effects of sucralose and sodium saccharin on some physiological parameters in male albino rats. Materials and methods: We used thirty male albino rats weighing from 100 to120 gm. The period of the experiment was 30 days. The animals were divided into three groups; Group 1: control, Group 2: rats received sucralose and group 3: rats received sodium saccharin. The following parameters were processed: serum glucose, ASAT, ALAT, serum creatinine, serum urea, protein and lipid profiles and hormonal levels (insulin, testosterone, serum T3 and T4). Results: There was an increase in ASAT and ALAT activities, serum creatinine and serum urea levels in group 2 and group 3, lipid profile in the group received sucralose (TC and HDL) and T3&T4 in the group received saccharin as compared to the control group. Meanwhile, a drop in serum glucose, insulin, total protein, albumin, albumin/globulin ratio and triglycerides in group 2 and group 3, lipid profile in the group received saccharin (TC and HDL) and T3&T4 in the group received sucralose was observed when compared to the control group. Conclusion: it could be concluded that sucralose and sodium saccharin must be carefully used because they have very dangerous effects-especially sodium saccharin- and we have to replace them with natural sugar.
https://ejhm.journals.ekb.eg/article_28025_71b359885cd166f0e9b015454c7570dd.pdf
2019-01-01
1552
1558
10.21608/ejhm.2019.28025
sucralose
sodium saccharin
ASAT
ALAT
T3
T4
testosterone
Insulin
Eman G.E.
Helal
emanhelal@hotmail.com
1
Department of Zoology, Faculty of Science (Girls), Al-Azhar University
AUTHOR
Abdullah
Al-Shamrani
2
2Pediatric Pulmonology and Sleep Medicine, Prince Sultan Medical Military City, King Saud bin Abdulaziz University and Health Science
AUTHOR
Mohamed A.
Abdelaziz
3
Medical Physiology, Faculty of Medicine, Al-Azhar University
AUTHOR
Mariam S.
El-Gamal
4
Department of Zoology, Faculty of Science (Girls), Al-Azhar University
AUTHOR
ORIGINAL_ARTICLE
Retrospective Study of Facial Fractures Fixation Outcome in Al-Azhar University Hospitals (El-Hussein and Bab-Elsharia)
Background: maxillofacial fractures incidence varies between different nations, mandibular fractures are the most common, multidisciplinary approach is often required, and early consultation with other specialties is recommended also understanding of common posttraumatic complications will guide surgical management. Aim of the work: to analyze the outcome of maxillofacial fractures fixation helping optimization of surgical practice and medical service appraisal. Patients and Methods: the data were retrospectively collected from the medical records of 76 cases treated at Plastic Surgery Department, Al-Azhar University, from 2014 to 2017 and patients were examined as full maxillofacial examination. Results: the total number of patients with maxillofacial trauma presenting to Plastic Surgery Department, during the period from 2014 to 2017 was 76 patients. Males were more frequently affected than females, where males accounted for 92.1% (70 patients) and females accounted for 7.9% (6 patients) of the study population. The ages of the patients ranged from 4 to 61 years, with a mean of 24.84 ± 10.57 years. Road traffic accident (RTA) was the most common cause of trauma, 42.1% of cases. A total of 43 (56.5%) cases had mandibular fractures. Most of the fractures were treated by means of open reduction and internal fixation using plates (67 cases; 88.2%), whereas 6 (7.9%) cases were treated by means of closed reduction and maxillo- mandibular fixation and 3(3.9%) were treated by splinting. Conclusion: the main etiological factor in maxillofacial injuries is RTA with males between 11 and 30 years of age being affected predominantly.
https://ejhm.journals.ekb.eg/article_28026_2768b951e7b4ddf87b187298d7eac236.pdf
2019-01-01
1559
1565
10.21608/ejhm.2019.28026
Retrospective study
maxillofacial fractures
maxillofacial trauma
Abdelmonim Hussein
Houta
1
Department of Plastic, Reconstructive& Burn Surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Abdelrahman Awadeen
Abdelrahman
2
Department of Plastic, Reconstructive& Burn Surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Mahmoud Metwally
Mahmoud
mahmoudmetwally@azhar.edu.eg
3
Department of Plastic, Reconstructive& Burn Surgery, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Management of Postcholecystectomy Obstructive Jaundice
Background: Although laparoscopic cholecystectomy (LC) has many unquestionable advantages, this type of surgery has a higher incidence of complications than those of open cholecystectomy including biliary tract injury or stricture causing hyperbillirubinaemia and jaundice and subsequently a lot of complications as acute peritonitis or acute cholangitis as well as complications of jaundice that may be so severe causing hepatorenal failure. Objective: To find the proper method of management of postcholecystectomy obstructive jaundice. Patients and Methods: A retrospective study of 20 patients who were presented with postcholecystectomy obstructive jaundice within 2 years from the date of surgery were selected for this study. Patients were subclassified according to the cause of postcholecystectomy jaundice into 4 groups: Group A: patients presented with jaundice due to missed common bile duct (CBD) stones. Group B: patients presented with jaundice due to biliary injury. Group C: patients presented with jaundice due to biliary stricture. Group D: patients presented with jaundice due to medical causes. Results: ERCP should only be attempted when there is biliary contiuity evident by MRCP. Roux en Y hepaticojejunostomy is the most used modality in management. The best treatment of post-cholecystectomy obstructive jaundice is undoubtedly prevention of bile duct injury during cholecystectomy. Conclusion: The classic pattern of laparoscopic injury appears to be misidentification of the common duct for the cystic duct, resection of a portion of the common and hepatic ducts, and an associated right hepatic arterial injury.
https://ejhm.journals.ekb.eg/article_28115_79ac025134239c14d4d24bc03ad2aaa9.pdf
2019-01-01
1566
1576
10.21608/ejhm.2019.28115
Cholecystectomy
Obstructive jaundice
bismuth classification
Mohammad Mohsen
Salem
1
Department of General Surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Yasser Hussein
Hassan
2
Department of General Surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Abdou Ibrahim
Zeyada
abdozyada42@gmail.com
3
Department of General Surgery, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
The Outcome and Safety of a Long Course of Inhaled Tissue Plasminogen Activator in The Management of Plastic Bronchitis: A Case Report
Background: Plastic bronchitis (PB) is a rare disease that is characterized by formation of rubber-like tracheobronchial casts that occlude the airway, occurring secondary to several conditions, most commonly as a complication of single-ventricle palliative cardiac surgery. Inhaled tissue plasminogen activator (t-PA) was reported to be effective in treating PB. Aim of the work: To show the outcome and safety of a long course of inhaled tissue plasminogen activator in the management of plastic bronchitis. Methodology: this was a case report, we report the case of a teen with PB treated with a prolonged course of t-PA with no adverse effects. Results: we reported the case of an 11-year-old boy with trisomy 21 who had a Fontan procedure for his complex congenital heart disease, complicated by PB that was treated with a prolonged course of t-PA. Our patient was an 11-year-old boy with trisomy 21 who was diagnosed with an unbalanced AV canal defect with a small right ventricle and bilateralsuperior vena cava. His surgical cardiac course consisted of a pulmonary artery banding at 2 months of age and bilateral bidirectional Glenn with tightening of the pulmonary artery banding at 24 months of age. He had pulmonary artery debanding and ligation of both right and left Glenn shunts at the age of 6 years. Since the age of 3 years, he was admitted many times to the hospital with various diagnoses, including bronchial asthma, bronchopneumonia and pulmonary hypertension, all of which were treated accordingly. He was admitted at the age of 9 years with a history of fever and cough productive of plastic-like material that took the form of the bronchial tree. The diagnosis of PB was confirmed. Subsequently, he was admitted frequently with the diagnosis of PB and was treated with aggressive airway clearance including hypertonic saline, dornase alpha and t-PA. The longest t-PA duration was 82 days, which clinically proved to be effective and safe. Conclusion: PB is a rare and serious disease. The long-term use of inhaled t-PA was effective and safe.
https://ejhm.journals.ekb.eg/article_28116_ce95f7f663d99fc13d9e97ea7d3628f8.pdf
2019-01-01
1577
1579
10.21608/ejhm.2019.28116
plastic bronchitis
t-PA
Fontan surgery
Ayed M.
Alenazi
ammalonazi@psmmc.med.sa
1
pediatric pulmonologist at Prince Sultan Military Medical City/Riyadh/KSA
LEAD_AUTHOR
Khaled
Baqais
2
pediatric pulmonologist at Prince Sultan Military Medical City/Riyadh/KSA
AUTHOR
Abdullah
AL-Shamrani
3
pediatric pulmonologist at Prince Sultan Military Medical City/Riyadh/KSA
AUTHOR
Mohammed
Alzaid
4
pediatric pulmonologist at Prince Sultan Military Medical City/Riyadh/KSA
AUTHOR
ORIGINAL_ARTICLE
Ultrasound Guided Percutaneous Nephrostomy, Feasibility in Lateral Position
Background: ultrasound guided percutaneous nephrostomy was reported in various positions to different indications. Objectives: this study was conducted to determine the feasibility of Percutaneous Nephrostomy (PCN) in lateral position. Patients and methods: this study was conducted during the period from March 2018 to November 2018. Fifty patients with urinary tract obstruction who were candidate for percutaneous nephrostomy at El-Hussein and Bab El-sharia hospitals were enrolled in the present study. Results: out of 50 patients who underwent percutaneous nephrostomy in lateral position (56%) were males, 44% were females. Success rate for fixation of PCN was 90%. Total number of patients with marked hydro nephrosis before the procedure represented 58% of total patients and 42% with moderate hydro nephrosis. Complication of technique : no complication represented 80% ,minor complications were 20%,9% showed transient hematuria, single patient with pain 2.2%, 4.4% showed catheter related complications, 4.4% showed Inflammation of skin at the side of the wound. Cause of obstruction, pregnant females were 10%, PUJ causes were 18%, ureteric causes were 46%, urinary bladder mass was 14%, single case was emphysematous pyelonephritis, others were10%. Conclusion: ultrasound guided percutaneous nephrostomy in lateral position is feasible and equal to standard technique but recommend PCN in lateral position in, pregnant female, obese patients, ascetic patients and patient with special difficulties in breathing.
https://ejhm.journals.ekb.eg/article_28262_e1584c474cc20da71f7f7ecc85e5edea.pdf
2019-01-01
1580
1586
10.21608/ejhm.2019.28262
Ultrasound
percutaneous nephrostomy
lateral position
Ayman F.
Alham
aymankandel90@gmail.com
1
Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
LEAD_AUTHOR
Mohamed A.
Hindawy
2
Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Sayed M.
El-Eweedey
3
Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
ORIGINAL_ARTICLE
Role of Nonsteroidal Anti-Inflammatory Drugs in Prevention of Macular Edema after Uneventful Phacoemulsification in Diabetic and Non-Diabetic Patients
Background: Pseudophakic cystoid macular edema (PCME) is one of the most important complications after cataract surgery. This can result in decreased visual acuity. Purpose: The study aimed to assess the efficacy of using Non-steroidal anti inflammatory drugs (NSAIDs) as a prophylaxis, to prevent macular edema. Patients and methods: The study included 100 eyes with cataract and accepted phacoemulsification, classified into: Group 1: Non-diabetic patients were subdivided into: (1A didn’t receive NSAIDs, 1B received NSAIDs). Group 2: Type 2 diabetic patients were subdivided into: (2A didn’t receive NSAIDs, 2B received NSAIDs). One drop of nepafenac 0.1% was administrated four times daily for 2 days before surgery, 30-120 minutes prior to surgery. Postoperatively nepafenac was given four times daily for four weeks. SD-OCT was performed to measure central macular thickness(CMT) before phacoemulsification, repeated 1 week and 1 month postoperatively. Results: In subgroup 1A; CMT increased through one month, while subgroup 1B, CMT decreased through the same time. There was significant difference in CMT between preoperative and 1week postoperative as well as between preoperative and 1 month postoperative (p=0.025, 0.037 respectively). For subgroup 2A; CMT increased through one month. There was significant difference in CMT (p<0.001) between preoperative and 1week postoperative as well as between preoperative and 1 month postoperative (p<0.008) between subgroup 2B and subgroup2A Conclusion: The prophylactic use of topical NSAIDs appears to be effective for preventing CMT change after phacoemulsification. It reduces the incidence of PCME in normal and diabetic patients and ensures a favorable outcome.
https://ejhm.journals.ekb.eg/article_28263_2148f54d831bfe45a7a9cefd38238507.pdf
2019-01-01
1587
1598
10.21608/ejhm.2019.28263
Pseudophakic cystoid macular edema
Phacoemulsification
Nepafenac
Marwa M.
Al Fassih
janamohamed1978@yahoo.com
1
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
LEAD_AUTHOR
Hanan S.
Hegazy
2
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
AUTHOR
Abd El Magid M.
TagEldin
3
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
AUTHOR
Naglaa A.
Elkoussy
4
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
AUTHOR
ORIGINAL_ARTICLE
Revision for Aseptic Loosening of Primary Total Knee Arthroplasty
Background: the modes of failure of total knee replacement(TKR) can be classified as intra-articular or extraarticular, as biological or mechanical, as early or late. Aseptic loosening is one of leading cause of failure of total knee replacement. Purpose: it was to spot light on different surgical strategies; to assess the results of 20 cases of revision total knee arthroplasty after aseptic loosening of primary total knee arthroplasty. Materials and Methods: this is a prospective interventional study which was conducted during the period from June 2016 to April 2019 with mean follow up two years. It included 20 patients (20 knees) which were undergone for revision TKR due to aseptic loosening of knee prosthesis. These cases were operated at Al-Azhar University hospitals (Al Hussein & Bab El Shaeria). Results: the average knee society score (KSS) was 79 (range from 55 to 94) compared with an average preoperative KSS of 38 (range from 28 to 48). The mean knee function score at the last follow up was 72 (range from 35 to 95) compared with the mean preoperative knee function score of 31 (range from 10 to 55). Conclusions: results of revision TKA due to polyethelene (PE) wear and its resultant osteolysis were mostly satisfactory to the patients
https://ejhm.journals.ekb.eg/article_28264_83286068e84aee5cbb9bfdde23876e42.pdf
2019-01-01
1599
1603
10.21608/ejhm.2019.28264
Aseptic loosening
total knee
revision
Elsherbiny Ali
Elsherbiny
elsherbinyortho@gmail.com
1
Department of Orthopedic surgery, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
Ismail Ahmed
Yaseen
2
Department of Orthopedic surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
Hisham Mohamed
Safwat
3
Department of Orthopedic surgery, Faculty of Medicine, Al-Azhar University
AUTHOR
ORIGINAL_ARTICLE
Case Report: Arthroscopic Fixation of Type V Acromioclavicular Joint Dislocation
Acromioclavicular Joint (ACJ) dislocation is a common injury. It is common among athletes involved in contact sports and victims of motor vehicle accidents. High-grade (ACJ) dislocation (Type IV-VI) is managed surgically through different procedures. These range from a simple plate and screw fixation to more complex procedures involving ligament repair, transfer and reconstruction. The rationale for an arthroscopic approach to treat a dislocated AC joint is to minimize the soft tissue injury through preserving as much blood supply as possible to support post-operative healing. Also, to decrease the risk of surgical site infections and better postoperative outcomes. On the other hand, the arthroscopic technique needs an experienced surgeon. In this case, report our aim to encourage fixing (ACJ) with this technique.
https://ejhm.journals.ekb.eg/article_28266_212170d456dfa3d6e7d96e351e73e328.pdf
2019-01-01
1604
1606
10.21608/ejhm.2019.28266
Omer
Alrasheed
omar-2614@live.com
1
Orthopedic Surgery Department, King Faisal University, KSA
LEAD_AUTHOR
ORIGINAL_ARTICLE
The Value of Target Therapy in Metastatic Cancer Colon
Background: Colorectal cancer is the third leading cause of cancer-related deaths in the United States when men and women are considered separately, and the second leading cause when both sexes are combined It is expected to cause about 49,700 deaths during 2015. Aim of the Work: The present work was aimed to study the efficacy of treatment of metastatic cancer colon (KRAS wild type) with chemotherapy plus anti-EGFR (Erbitux) and chemotherapy alone. Patients and Methods: This phase II prospective study included a total of 37 patients of metastatic cancer colon (KRAS wild type) treated with chemotherapy plus anti-EGFR (Erbitux) and chemotherapy alone for (KRAS wild type) attending at Police Hospital. This study was conducted between September 2016 and August 2018. Results: We have studied the value of adding target therapy in the metastatic colon cancer patients. Some of them received chemotherapy with cetuximab as target therapy versus patients received chemotherapy alone. In the current study, median progression-free survival (PFS) of the whole studied sample (n =37) was 10.0 months (range.3.0.-.21.0). Median survival was significantly higher in the chemotherapy and cetuxumab group (P: less than 0.001). Using cox regression analysis group with cetuximab associated with better survival (P=0.047) with protective hazard ratio of 0.974. The cumulative PFS proportion is presented at 12 months. Median overall survival of whole studied samples (n=37) was 21.0 months (range 18-23 months) and there were 25 cases dead and all cases progressed. Median OS was higher in chemotherapy with cetuximab group and was of a significant difference (P=0.001). There were others factors studied their relation to OS like age but no significant difference bit older patient had better OS by (34.8 % vs 28.6 %), also PS no significant difference but patient with PS =0 had better OS by (41.7% vs 28%) according to RT and LT colon there was LCC with better OS than RCC but no significant difference but LT site of colon had better survival by (42.9 %vs 18.8%). Conclusion: Cetuximab was beneficial in down-staging programs and significantly improve progression-free survival and response rates and overall survival for patients with metastatic colorectal cancer
https://ejhm.journals.ekb.eg/article_28267_72d6588879ee4d61b90476f0e8d25a66.pdf
2019-01-01
1607
1615
10.21608/ejhm.2019.28267
Target Therapy
Metastatic Cancer Colon
Ahmed Yousery
Al Agamawy
1
Clinical Oncology & Nuclear Medicine Department, Al-Azhar University
AUTHOR
Sohier Sayed
Ismail
2
Clinical Oncology & Nuclear Medicine Department, Ain Shams University, Cairo, Egypt
AUTHOR
Shaymaa Mamdouh Anwar
Ibrahim
rshaltout80@gmail.com
3
Clinical Oncology & Nuclear Medicine Department, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Effect of Phytoestrogen (Fennel) on Some Sex Hormones and Other Physiological Parameters in Male Albino Rats
Background: Phytoesrogenis plant derived compounds which have an estrogenic effect. Objectives: The present study was carried out to investigate some pharmacological and biochemical effects of fennel oil on male albino rats. Materials and methods: Twelve animals were divided randomly into two groups. Group A: Control. Group B: Treated rats. The rats were given an oral dose of 1 ml/kg body weight/day fennel oil once daily for one month. At the end of the experiment, blood samples were collected for biochemical analysis. Results: The fennel oil induced highly significant decrease (p<0.01) in total cholesterol(TC), triglycerides (TG), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), LDL/high-density lipoprotein (HDL), while significant increased (p<0.05) HDL. In addition, it showed highly significant decrease (p<0.02) in FSH, testosterone and sperm count compared to normal control group. Conclusion: Fennel herb has several therapeutic benefits, but it also has negative effect on male sex hormone and sperm count. So men must reduce their usage of it.
https://ejhm.journals.ekb.eg/article_28268_bb33374b81f0033911e09ba04b46450f.pdf
2019-01-01
1616
1620
10.21608/ejhm.2019.28268
Eman G.E.
Helal
emanhelal@hotmail.com
1
Zoology Department, Faculty of Science, Al-Azhar University (Girls), Cairo, Egypt
LEAD_AUTHOR
Nora Abdul-Aziz
AL Jalaud
2
Imam Abdulrahman Bin Faisal University
AUTHOR
Mohamed A.
El-Aleem
3
Physiology Department, Faculty of Medicine, Al-Azhar University (Boys), Cairo, Egypt
AUTHOR
Shaimaa S.
Ahmed
4
Zoology Department, Faculty of Science, Al-Azhar University (Girls), Cairo, Egypt
AUTHOR
ORIGINAL_ARTICLE
Evaluation of Ultrasonographic and Anti-Müllerian Hormone (AMH) Changes as Predictors for Ovarian Reserve after Laparoscopic Ovarian Drilling Versus Conservative Treatment for Women with Polycystic Ovarian Syndrome
Background: Until recently, there was no international consensus either on the definition of polycystic ovarian syndrome (PCOS) or on what constitutes a polycystic ovary. At a recent consensus of The European Society of Human Reproductive and Embryology/American Society of Reproductive Medicine (ESHRE/ASRM), a refined definition of the PCOS was agreed: namely two out of the following three criteria; Oligo- and/or anovulation, Hyperandrogenism (clinical and/or biochemical) and Ultrasonographic features of PCOS. Aim of the Work: evaluation of ovarian volume, antral follicles count and anti mullerian hormones as predictors of ovarian reserve after conservative treatment versus laparoscopic ovarian drilling in women with polycystic ovarian syndrome. Patients and Methods: This prospective controlled study was conducted on 20 women attending Outpatient Clinics of Al Hussein University Hospital & Aswan University Hospital for infertility treatment. It was conducted between January 2016 and February 2018. Results: No significant difference was found between clomiphene citrate (CC) and laparoscopic ovarian diathermy (LOD) groups regarding to AFC and summed ovarian volume in follow up periods, (P= 0.645,P=0.401//P=0.238, P=0.301) respectively. There was a highly significant difference between CC, LOD and control groups regarding to AMH (P < 0.001) after 6 months of treatment. The study revealed that there was no statistically significant difference between groups according to clinical & reproductive outcomes. Conclusion: The relative contribution of each individual measure of the ovarian reserve is clearer and most authors agree that antral follicle counts and serum anti-müllerian hormone levels had the most discriminative. Antral follicle counts are easy to perform and cheap in comparison as all units had access to ultrasound facilities. Follicle counts, as a quantitative measure of the ovarian reserve, are also subject to ‘assay’ variation due to intra- and inter-observer differences and require additional time and manpower to perform.
https://ejhm.journals.ekb.eg/article_28269_cc3d6e1ab2340b96c525c653a7486bc3.pdf
2019-01-01
1621
1630
10.21608/ejhm.2019.28269
Ultrasonography
Anti-müllerian hormone
ovarian reserve
laparoscopic ovarian drilling
conservative tremens
PCOs
Yahia A.
Wafa
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
AUTHOR
Ibrahim R.
Al sawi
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
AUTHOR
Salah A.
El beltagy
3
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University
AUTHOR
Ebtsam G.
Hussien
dr_ebtsam.2010@yahoo.com
4
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Study of The Outcome of Staged Cutting Seton in Treatment of High Perianal Fistula
Background: an inexpensive and effective method of treatment of high complex perianal fistulae is seton suture. Most difficult point in seton is maintaining tension and pressure on suture to produce muscle cutting in anal sphincters. Objective: the aim of this study was to assess the consequence, which fail to be noticed in seton suture to diminish the recurrence rate and incontinence after the treatment of fistulae. Patients and Methods: this study was conducted on 53 patients who underwent treatment for an anal fistula with staged seton suture. Clinical examination and MRI fistulogram was done to all patients. Prolene 1 was used as drainage then cutting. Follow up in outpatients was recorded. Results: there was no pain or mild pain in all cases. The recurrence rate in two cases (3.7%). Incontinence to flatus in three cases (5.6%) and one case to soft stool (1.8%). Conclusion: there were many factors affecting outcome of high perianal fistula surgery by seton suture to decrease recurrence and incontinence such as proper examination of the patient, magnetic resonance image (MRI) fistulogram, meticuolous surgery and good identification of internal opening.
https://ejhm.journals.ekb.eg/article_28388_acfc72ae7460bf8ba08aef3b645c5167.pdf
2019-01-01
1631
1635
10.21608/ejhm.2019.28388
Perianal Fistula
prolene
Seton
extracorporeal knotting
Abd El Fattah
Morsi
doc_amsmk82@yahoo.com
1
Department of General Surgery, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Effect of Collateral Circulation on Left Ventricular Systolic Function in Patients with Totally Occluded Artery Undergoing PCI
Background: Over the past three decades, accumulating evidence has documented that pre-existing welldeveloped CCC at the onset of acute myocardial infarction plays an important role in preserving left ventricular function, reducing infarct size, preventing left ventricular aneurysm formation, and survival. Objective: The aim of this study is to evaluate the effect of collateral circulation as measured by Rentrop score on left ventricular regional and global systolic function in patients with totally occluded vessel pre and post PCI and the ensuing impact of successful PCI. Methodology: Sixty patients have single vessel coronary chronic total occlusion with viable myocardium of CTO related territories, successful revascularization at ERMED and ICS, between June 2017 and December 2018, were considered to participate in this prospective study, The study subjects were divided into three groups according to Rentrop score , each group contain 20 patients : Group (I) Rentrop score 0 , Group (II) Rentrop score 1 and Group (III) Rentrop score 2. Results: There was no statistically significant difference between the three groups regarding the incidence of diabetes, smoking and hypertension. There was high statistically significant difference in EF between each group after revascularization, EF was higher in group (III) than group (I) and group (II). There was statistically significant difference in WMSI comparison between each group after revascularization WMSI was lower in group (III) than group (I) and group (II). Conclusion: In general increase Rentrop score before revascularization lead to more improvement in WMSI and EF after successful revascularization with improvement of quality of life.
https://ejhm.journals.ekb.eg/article_28389_ec06e53faeb7f03f8cc0d670a725a056.pdf
2019-01-01
1636
1642
10.21608/ejhm.2019.28389
Coronary collateral circulation
CTO
PCI
ORIGINAL_ARTICLE
Effect of Intensive Phototherapy on Bilirubin Induced Neurological Defect (BIND) Score in Neonates with Severe Hyperbilirubinemia
Background: neonatal hyperbilirubinemia is a leading cause of morbidity and mortality in developing countries. Adverse consequences include neonatal mortality, classic manifestations of choreoathetoid cerebral palsy, isolated auditory impairment, and a diverse manifestation of subtle processing disorders because of BIND. Aim of the Work: the aim of the current study was to evaluate the effectiveness of intensive phototherapy on BIND score in neonates with severe hyperbilirubinemia. Patients and Methods: the current study is a prospective study conducted on 100 neonates with severe hyperbilirubinemia admitted to NICU at university Hospital, Faculty of Medicine, Al-Azhar University, Assuit, Egypt in the period between November 2017 and May 2018. The study group was divided into 2 groups, hemolytic and non-hemolytic hyperbilirubinemia groups. Results: regarding TSB and direct bilirubin at admission no significant difference was detected between both groups (p=0.543 and 0.632). Regarding TSB and direct bilirubin at discharge no significant difference was detected between both groups (p=0.712 and 0.213). Results show no significant change between hemolytic and nonhemolytic jaundice regarding rate of decline per hour of total bilirubin and direct bilirubin after 8 hs. No significant difference between study groups regarding BIND score at admission. At discharge, 95 (95%) neonates had BIND score 0 and 4 (4%) had BIND score 1-3. One neonate (1%) died before scoring. Conclusion: care must be taken not to delay the decision of exchange transfusion to the degree that endangers baby's life. BIND score can be used to assess the efficacy of intensive phototherapy in newborn with hyperbilirubinemia.
https://ejhm.journals.ekb.eg/article_28390_7f9a533fbbdad5307bb84f86cda81572.pdf
2019-01-01
1643
1648
10.21608/ejhm.2019.28390
Intensive Phototherapy
Bilirubin
Neurological Defect
Neonates
Severe Hyperbilirubinemia
Yasser Abdelrahman
Ahmed
1
Pediatrics and Neonatology Department, Faculty of Medicine, Al-Azhar University, Assuit
AUTHOR
Yasser Tolba
Kassem
2
Pediatrics and Neonatology Department, Faculty of Medicine, Al-Azhar University, Assuit
AUTHOR
Samar Abdel Nafae
Ismail
dr7oodasamar@gmail.com
3
Pediatrics and Neonatology Department, Faculty of Medicine, Al-Azhar University, Assuit
LEAD_AUTHOR
ORIGINAL_ARTICLE
Serum Dickkopf-1 as A Biomarker for The Diagnosis and Prognosis of Hepatocellular Carcinoma
Background: Hepatocellular carcinoma is one of the commonest cancers in world. It is one of the major health problems and its incidence is increasing. The main routinely used parameter for diagnosis of HCC is AFP, also it can be elevated in the liver cirrhosis. It represents a liver cell specific, not a tumor specific marker, for these reasons, we suggest use AFP as a supplementary marker for HCC diagnosis. So, identification of a sensitive biomarker to improve early diagnosis of HCC is in need. Aim of the work: this study was aimed to evaluate the clinical significance of serum Dickkopf-1 (DKK1) as a diagnostic and prognostic marker in hepatocellular carcinoma. Patients and Methods: in this study 100 subjects were included and divided into 3 groups, Group I: included 50 patients with HCC, and divided into 2 subgroups according to Barcelona Clinic Liver Cancer (BCLC) into early HCC (24 patients) and late HCC (18 patients). Group II: included 25 patients with liver cirrhosis. Group III: included 25 healthy subjects (control). Clinical assessment, routine laboratory evaluation, CT scan and measurements of serum alpha-fetoprotein (AFP) and DKK1 were performed to all patients and repeated to group I patients 1 month after treatment. Results: the current study showed that Serum DKK1 was significantly elevated in HCC group compared to liver cirrhosis and healthy control groups, with increased level in late than early stage. The optimum cut off values of DKK1 for diagnosis of HCC was 1.92 ng/mL (AUC 0.926, sensitivity 88% and specificity 83%). While the optimum cut off value for AFP was 102 ng/mL (AUC 0.904, 71% sensitivity and 84% specificity). Testing of both serum DKK1 and AFP increased the diagnostic accuracy for HCC (AUC 0.964, sensitivity 91%, and specificity 90%). Serum DKK1 level significantly decreases after HCC treatment with radio-frequency ablation. Conclusion: It could be concluded that Testing of both serum DKK1 and AFP significantly increased the diagnostic accuracy for HCC. Meanwhile, DKK1 can be used alone for diagnosis of HCC even in HCC with inconclusive AFP. Serum DKK1 might be a potential diagnostic and prognostic marker for HCC.
https://ejhm.journals.ekb.eg/article_28391_d25ddfc1ab0a7a901329caa38b12739d.pdf
2019-01-01
1649
1654
10.21608/ejhm.2019.28391
HCC patients
DKK1
AFP
Khalid Mahmoud
Abd El-Hafeez
1
Departments of Tropical Medicine, Faculty of Medicine, Al-Azhar University-Cairo, Egypt
AUTHOR
Mahmoud Bastawy
Ismael
2
Departments of Clinical Pathology, Faculty of Medicine, Al-Azhar University-Cairo, Egypt
AUTHOR
Ahmed Abd-Elaleem
Abuo-Elhasan
3
Departments of Tropical Medicine, Faculty of Medicine, Al-Azhar University-Cairo, Egypt
AUTHOR
Amir Abd El-Aziz Mohammed
Al-Damaty
mero4u2012@yahoo.com
4
Departments of Tropical Medicine, Faculty of Medicine, Al-Azhar University-Cairo, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Effect of Adding Ketamine as An Adjuvant to Lidocaine in Ultrasound Guided Supraclavicular Brachial Plexus Block
Background: Brachial plexus block is one of the most commonly used regional anesthetic techniques for postoperative analgesia. Its popularity originates in part from easily palpable landmarks and relative ease of placement. A number of adjuvants, such as ketamine, dexmedetomidine, and others have been studied to prolong the effect of supraclavicular brachial plexus block. Aim of the Work: Evaluation of the effect of adding Ketamine as an adjuvant to lidocaine in ultrasoung guided supraclavicular brachial plexus block. Patients and Methods: This randomized controlled study was conducted at the Department of Anesthesia, EL-Hussein Hospital, AL-Azhar university on 60 patients of ASA physical status I-II of either sex aged 18- 60 years. They were randomized into two equal groups 30 patients in each. Group A (Ketamine group): received 5 mg/kg lidocaine 2% and 2 mg/kg ketamine in a total volume 30 cc. Group B (Control group): received 5 mg/kg lidocaine 2% and saline in a total 30 cc. Results: the study showed a significant increase in mean control group compared to ketamine group according to postoperative VAS. Conclusion: Using of ultrasound led to decreasing the complications of supraclavicular brachial plexus block and adding ketamine as an adjuvant to lidocaine decreased the postoperative pain and the need for analgesics, without significant adverse effects. Therefore, it could be considered as an option to enhance the analgesic effects of the brachial plexus block.
https://ejhm.journals.ekb.eg/article_28392_cb33b3eb3aede1473690eb3e6bdf41f7.pdf
2019-01-01
1655
1662
10.21608/ejhm.2019.28392
Ketamine
Adjuvant
Lidocaine
US-guided supraclavicular brachial plexus block
Mohamed M.
Shamlol
1
Department of Anesthesia & Intensive Care, Faculty of Medicine, AL Azhar University
AUTHOR
Saad EL-Din M.
EL-Khateeb
2
Department of Anesthesia & Intensive Care, Faculty of Medicine, AL Azhar University
AUTHOR
Khaled M. Alaa
Saleh
khaled.alaasaleh@gmail.com
3
Department of Anesthesia & Intensive Care, Faculty of Medicine, AL Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Comparative study between Ondansetron, Alizapride and Dexamethasone in Prevention of Postoperative Nausea and Vomiting in Laparoscopic Surgery
Background: Post-operative nausea and vomiting (PONV) is a common cause of post-operative discomfort with incidence ranges from (50%-70%) after laparoscopic surgery. Objective: To compare the effectiveness of dexamethasone, ondansetron and alizapride as monotherapy administered intravenously in postoperative nausea and vomiting prophylaxis for patients with moderate to high risk for nausea and vomiting undergoing laparoscopic surgery under general anesthesia. Patients and Methods: The study population was 120 Egyptian patients from both sexes undergoing laparoscopic surgery under general anesthesia with endotracheal intubation at Al-Azhar University Hospitals (El Hussein Hospital and Bab Al-Sharya Hospital). Approval of the study was taken from the Ethics Committee of Al-Azhar University. Prior to initiation of the study, written informed consent of the patient was obtained after full explanation of elements contained in the research protocol. There were 4 study groups; Control group, ondansetron group, alizapride group and dexamethasone group. Results: Age, sex, smoking history, related history, duration of surgery, type of surgery, vital signs and postoperative pain severity did not have any significant value in our study. Comparing the 4 studied groups according to postoperative nausea and vomiting presence, time of incidence and number of episodes had a significant value. Conclusion: Intravenous 0.1 mg/kg of ondansetron is very safe and highly significant in control of postoperative nausea and vomiting (PONV), it is even more effective than using 50 mg of intravenous alizapride or 8 mg of intravenous dexamethasone as prophylaxis. Dexamethasone is slightly better than alizapride in control of postoperative nausea and vomiting.
https://ejhm.journals.ekb.eg/article_28433_dd9a25aebf6cd8ddee6d8cd5701fa961.pdf
2019-01-01
1663
1669
10.21608/ejhm.2019.28433
dexamethasone
Ondansetron
Alizapride
laparoscopic surgery
post-anesthetic care unit
Ismail A.
Shabaik
1
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
AUTHOR
Hamed A.
Sanad
2
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohamed A.
Abdel-Halim
3
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
AUTHOR
Amr M.
Zaki
amrzaki2001189@gmail.com
4
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Prospective Analysis of Pressure Injuries Patients in Relation to Deep Venous Thrombosis
Background: Pressure injuries are a serious complication of multimorbidity and immobility. They are defined as a wound that develops in the upper layers of the skin as the result of sustained, externally applied pressure and then enlarges both radially and into the deeper tissue layers. Objective: It is prospective analysis of the possibilities of occurrence of deep venous thrombosis in pressure injures patients. Patients and methods: This study was conducted to analyze the possibilities of incidence of DVT in pressure injuries patients at AlAzhar University Hospitals; ElHussein and Sayed Galal Hospitals. This study was performed on 30 patients complaining of pressure injuries. The age of the patients ranged from 19 to 59 years and there were 20 males and 10 females. Results: The results of the study revealed that there was no incidence of deep venous thrombosis in 29 patients with pressure injuries during the follow up period. The incidence of DVT of this present research was not statistically significant with only one case of DVT with 0.03% (p = 0.08). Conclusion: From all the above-mentioned data, we might conclude that all patients with pressure injuries had less incidence of deep venous thrombosis. Therefore, we encourage further research and exploration in this promising field that may help in discovering a solution for deep venous thrombosis.
https://ejhm.journals.ekb.eg/article_28434_b5e10c21bdedf37003356edaabc49f38.pdf
2019-01-01
1670
1674
10.21608/ejhm.2019.28434
Pressure Injuries Patients
Deep Venous Thrombosis
Fawzy Ahmed
Hamza
1
Department of Plastic and Burn Surgery, Faculty of Medicine - Al Azhar University
AUTHOR
Abd Elnaser Mohammad
Abdelrahman
2
Department of Plastic and Burn Surgery, Faculty of Medicine - Al Azhar University
AUTHOR
Mahmoud Zidan
Abdelaziz
drmahmoud59@yahoo.com
3
Department of Plastic and Burn Surgery, Faculty of Medicine - Al Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Predictive Value of First Trimester Uric Acid in Development of Gestational Diabetes
Background: Gestational diabetes mellitus (GDM) is considered a common complication in pregnancy, affecting greater than 10% pregnancies worldwide. However, the definitive underlying causes still not fully explained. Objectives: This study aimed to detect the predictive value of uric acid level at first trimester in development of GDM. Patients and Methods: The study was conducted on 300 first trimester pregnant females attending the Outpatient Clinic of Al-Azhar University Hospital. All cases underwent measurement of first trimester serum uric acid level. Between 24 and 28 weeks of gestation glucose challenge test was done. Positive cases underwent confirmation by 3 h glucose tolerance test. Results: The Pearson’s test showed that there was a highly significant correlation between serum uric acid at first trimester and plasma glucose levels at 24-28 weeks. Conclusion: There is increased risk in development of GDM with the increase in uric acid level at the first trimester.
https://ejhm.journals.ekb.eg/article_28435_2c86ae9c6d54de1a35d67999ddd31fb9.pdf
2019-01-01
1675
1679
10.21608/ejhm.2019.28435
GDM
Uric acid
first trimester
Osama Al Saeed
Ali
1
Departments of Obstetrics and Gynecology, Clinical Pathology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
AUTHOR
Ibrahim Ramadan
Al Sawy
2
Departments of Obstetrics and Gynecology, Clinical Pathology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
AUTHOR
Medhat Ali
Salah
3
Departments of Obstetrics and Gynecology, Clinical Pathology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
AUTHOR
Mohammad Kamel
Kattaria
qattaria@yahoo.com
4
Departments of Obstetrics and Gynecology, Clinical Pathology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
LEAD_AUTHOR