Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Maximizing Resection of Diffused Low-Grade Glioma Functional Outcome
3465
3472
EN
Ahmed Maamoun Ashour, Hassan Jalalod’din , Ayman El Shazly , Mohamed W. Samir,
Hossam M. El Huseiny
Neurosurgery Department, Ain Shams University, Cairo, Egypt
<span>Background: </span><span>most of adults with Diffuse Low Grade Gliomas (DLGGs) are diagnosed with an average age of 39 years and the diagnosis is often made around fully functioning individuals. Currently extent of resection (EOR) is a generally known variable that impacts overall survival (OS), progression free survival and malignant transformation in these gliomas. </span><br /> <span>Aim of the study</span><span>: this study aimed to evaluate the risks and benefits of maximizing the extent of resection of DLGGS, while preserving neurological function.<br /> </span><span>Methodology and Materials: </span><span>this was a prospective observational study of group of consecutive 20 patients with initial imaging diagnosis of supratentorial DLGGs. Preoperatively planned for maximal resection even if presuming the proximity of these lesions to eloquent cortex and their relative diffuse nature on imaging. </span><span>Results: </span><span>40 % were near eloquent area and 30 % at eloquent areas. GTR achieved in 10% and STR in 65%. Pre-operative Karnofsky Performance Scale (KPS) was 100 in 10%, 90 in 65%, 72 hours post-operative 70 in 60%. During the first 6 months of follow-up KPS was 100 in 60% of the study cohort while only one patient (5%) died. After 6 months KPS was 100 and represented 95% of the whole study. LOS was the longest (4-16 days) in near eloquent and shortest in eloquent (5-8 days). 30% had pre-operative uncontrolled seizures, which cured post-operative, 50% stopped AED within a year. Average back to work period was 2.5 for eloquent, near eloquent 2.8 and non-eloquent 2.6 months. </span><br /> <span>Conclusion: </span><span>careful pre-surgical planning based on proper reviewed history, recent imaging techniques and utilizing up-to-date intra-operative technology is helping to maximize safe surgical resection, while saving patient function and quality of life.<br /> </span>
astrocytoma,oligiodendroglioma,extent of resection,KPS
https://ejhm.journals.ekb.eg/article_8317.html
https://ejhm.journals.ekb.eg/article_8317_1a857c3c2ee7eb694cbe8532bc9f22c9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Verapamil as An Adjunct to Local Anaesthetic for Brachial Plexus Blocks
3473
3478
EN
Amir Ibrahim Mohamed Salah, Manal Mohamed Kamal, Ashraf Nabil Saleh Mostafa,
Ahmed Fakher Mohamed Abdou
Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams University, Cairo, Egypt
<span>Background: </span><span>Upper extremity surgeries are recently performed under regional anesthesia. Regional anesthesia of the upper extremity has several advantages over general anesthesia, such as improved postoperative pain, decreased postoperative narcotic consumption, and reduced recovery time. Supraclavicular approach of the brachial plexus block has gained importance for surgical and interventional pain management purposes. Supraclavicular brachial plexus block provides an ideal condition for surgery of the upper limb, maintains hemodynamic stability, decreases postoperative pain and allows for early ambulation. However, the duration of the supraclavicular brachial plexus block is limited by the duration of action of the local anesthetic used in the block.<br /> </span><span>Aim of the Work: </span><span>The aim of this study is to evaluate whether additional anesthetic effects could be derived from addition of verapamil into local anesthetics injected into brachial plexus sheath. </span><br /> <span>Patients and Methods: </span><span>This study was a prospective, randomized, controlled, double blind study had been carried out in Matareya Teaching Hospital on 60 adult patients with a physical status ASA I & II classification scheduled for upper limb surgeries for 6 months. </span><span>Patients were randomly classified using sealed envelopes into two equal groups (group I & group II) each of 30 patients. </span><span>Group I: 30 patients who received 40 ml of 1% lignocaine (20ml) with 0.25% bupivacaine solution (20ml), Group II: 30 patients who received 40 ml of 1% lignocaine(20ml) with 0.25% bupivacaine solution with 2.5mg verapamil (20ml). </span><br /> <span>Results: </span><span>Onset of sensory blockade time was marginally faster in Group II (12 ±1.8minutes) as compared to Group I (12.6 ± 1.4 minutes). However this difference was statistically not significant. The increase in duration of sensory blockade in Group II (209.90 ± 13.22 minutes) as compared to Group I (183.80 ± 11.68 minutes) was statistically significant (p < 0.001). Increase in duration of motor blockade in Group II (172.00 ± 9.32minutes) as compared to Group I (168.20 ± 8.91 minutes) was statistically not significant (p = 0.112). </span><br /> <span>Conclusion: </span><span>we conclude that adding 2.5 mg verapamil with 0.25% bupivacaine solution (20ml) with 1% lignocaine (20ml) to brachial plexus block can prolong sensory anesthesia without significant effect on duration of motor block, onset of sensory and motor block.</span>
Verapamil,Brachial Plexus Blocks
https://ejhm.journals.ekb.eg/article_8318.html
https://ejhm.journals.ekb.eg/article_8318_091316e0c234d344bddbf3cc216f8522.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
A Comparison between Magnesium Sulphate and Ritodrine on Delaying The Active Phase of Labor in Women with Premature Rupture of Membranes with Preterm Labor
3465
3486
EN
Emad Maarouf Abd - Allatif 1, Abdallah Khalil Ahmed 1
Alaa Ibrahim Abd- El Fatah Mohamed 2
1- Department of Obstetrics and Gynecology. Faculty of medicine, Al-Azhar University, Egypt.
2- Department of Obstetrics and Gynecology. General Authority for Health Insurance,
Damietta branch, Egypt
<span>Background: Preterm premature rupture of membranes (PPROM) refers to PROM before 37 weeks of gestation. It is responsible for, or associated with, approximately one-third of preterm births and the single most common identifiable factor associated with preterm labor (PTL). This is the leading cause of perinatal morbidity and mortality. Management of preterm labor includes bed rest, adequate hydration, prophylactic cervical cerclage and use of tocolytic drugs. Administrations of tocolytic drugs including magnesium sulphate (MgSO4) and ritodrine have considerable influences on pregnancy outcomes. Objective: The present study aimed at comparing between the effects of magnesium sulphate administration and ritodrine on delaying the active phase of labor in women with premature rupture of membrane (PROM) and preterm labor, and determining the best drug with best results and fewest side effects. Patients and Methods: The present study was conducted on 80 patients, with established PROM, whose gestational ages ranged between 28 and 34 weeks, admitted to the hospital with PROM with PTL. In the current study, patients were allocated into two equal groups: group A (MgSO4), and group B (Ritodrine). Results: Both drugs (MgSO4 and ritodrine) were effective on prolonging the gestational age of the studied women in both groups, and there was no significant difference between both groups. MgSO4 had fewer side effects than ritodrine, and there was significant difference between both groups. Conclusion: Both magnesium sulphate and ritodrine increase delay in reaching the active phase of labor in women with PROM with preterm labor.</span>
PROM,PTL,Tocolytics,Delay,Labor,Magnesium Sulphate and Ritodrine
https://ejhm.journals.ekb.eg/article_8319.html
https://ejhm.journals.ekb.eg/article_8319_dc5b07a3009ea8c5b108eff30859c95e.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Knowledge and Attitude of Mothers on Risk Factors Influencing Pregnancy Outcomes in Qassim, Saudi Arabia: A Cross-Sectional Study
3487
3491
EN
Ibtehaj M. Alharbi, Alhanof F. Alharbi, Seetah M. AlHarbi, Hessa M. Alharbi, Thekra F. AlHarbi,
Nawal H. Alawaji, Albatoul A. Alluhaida
College of Medicine, Qassim University, Buraydah, Qassim, Saudi Arabia
ibtehajmh@gmail.com
Background: One of the goals of the antenatal clinic is to prevent and recognize adverse pregnancy outcomes (APO). APO include hypertensive diseases of pregnancy, pre-term birth, pregnancy loss and maternal death. Our objective is to investigate the knowledge and attitude of mothers on risk factors of developing APO in Saudi Arabia. Methods: A cross-sectional study of female school teachers was conducted. 195 women were selected from four different schools in the region. Inclusion criteria were women of reproductive age who had at least one previous pregnancy. A self-administrated questionnaire on the knowledge and attitudes of risk factors that influence pregnancy outcomes were used. Results: 192 out of 195 mothers completed the questionnaire (98.4% response rate). The mean age of those women was 33.6. Responses revealed that most women have good knowledge about the risks resulting from malnutrition, diabetes, and drug abuse as the agreement on all of these statements were 80%. However, their knowledge about the importance of maternal education and their attitude towards cesarean section was not satisfactory. Conclusion: Although our sample was an educated group; low knowledge was detected in essential items. This study revealed that the public had extremely low knowledge regarding cesarean section, the importance of maternal age during pregnancy and how mother education can affect the delivery of her newborn. We recommend that pregnant women should be educated in the importance of attending the antenatal clinic regularly.
Pregnancy,outcomes,Knowledge,Attitude,Saudi Arabia
https://ejhm.journals.ekb.eg/article_8320.html
https://ejhm.journals.ekb.eg/article_8320_df683742af053bfde965d6485f0c7cc5.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Three-Dimensional Conformal versus Intensity Modulated Radiation Therapy in Treatment of Nasopharyngeal Carcinoma
3492
3499
EN
Sherif A AbdElWahab, Doaa A Mohammed, Ahmed M Gaballah,
Mahmoud M Abdallah
Department of Clinical Oncology and Nuclear Medicine, Ain Shams University
<span>Background: </span><span>Nasopharyngeal carcinoma is an endemic disease of Southeast Asia with incidence rates of between 15 and 50 per 100 000. There is an intermediate incidence in North Africa and Far Northern hemisphere while in the West the disease occurs sporadically. In Egypt the incidence rate is low and the peak at age (50-54) is 3.4%, and other age varying between 0.3 and 0.4 per 100 000</span><span>.<br /> Aim of the Work: </span><span>The aim of this study was to evaluate and compare both techniques as regard their efficacy on tumor response, local control, overall survival and progression free and treatment related toxicity between both techniques. </span><br /> <span>Patients and Methods: </span><span>This retrospective analysis included 54 patients diagnosed with primary nasopharyngeal carcinoma recruited from the clinical oncology department, Ain Shams University and the International Medical Center during 3 years (January 2014 -December 2016). They were divided into 2 groups, group A was treated using 3D conformal radiotherapy (CRT) whereas group B was treated using </span><span>i</span><span>ntensity modulated radiation therapy (IMRT). </span><br /> <span>Results: </span><span>In general, acute toxicity was tolerable and complete healing was the rule. As a whole, group A showed a higher toxicity profile as compared to group B. IMRT was able to decrease xerostomia and spare at least part of the parotid gland excretory function which was shown in the salivary gland scintigraphy. Results of the dosimetric comparison between both techniques showed that IMRT had a better tumor coverage and conformity index. Homogeneity index was similar in the two groups. Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT. </span><span>Conclusion: </span><span>IMRT is considered as a more advantageous radiation treatment technique as it can deliver high-dose irradiation to defined tumor targets while minimizing the dose delivered to the surrounding normal organs and tissues, thereby improving the therapeutic ratio of radiation therapy. IMRT has been shown to offer superior dose conformity to the tumor target and better sparing of critical organs in the treatment of NPC. </span>
three-dimensional ultrasound conformal,intensity modulated radiation therapy,Nasopharyngeal carcinoma
https://ejhm.journals.ekb.eg/article_8321.html
https://ejhm.journals.ekb.eg/article_8321_e9c05b59e180da2bccb1b3ca2ba61996.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Evaluation of the Various Risk Factors Associated with Placenta Previa Development: A Simple Literature Review
3500
3503
EN
Amina Abdo Salhi 1, Abdulaziz Abdullah Alhazmi 1, Rana Yahya Al-Qasem 2, Nouf Abdulrahman Alqahtani 3, Maisa Khedir Ahmed 4,
Marwah Sami Aljahli 5, Faten Talal Ashour 6, Rahaf Ali Alqahtani 7, Elaf Mohammed Albasheri 8, Mohammed A. Syam 9
1- Najran University, 2- Al-Qasem University, 3- King Khalid University, 4- Al-Zaeim Al-Azhary University, 5- Imam Abdulrahman University, 6- Dallah Hospital, 7- Taif University, 8- Ibn Sina Medical
College, 9- Suliman Al-Rajhi Colleges
<span>Background: </span><span>Placenta previa is defined as ,the growth of placenta in the lower uterine segment over or near </span><span>the internal cervical osseous, it’s an obstetric complication which usually occurs in the second trimester. A </span><span>lot of literatures have been done to study the risk factors associated with its development. Therefore, assessment of the recent literatures must be done to provide a summarized paper analyzing the various risk factors that stands behind placenta previa development, which will help in prevention and control the increasing in the incidence of the condition. </span><span>Objective: </span><span>This study aimed to assess the various studies that investigate the risk factors that stand behind the development of placenta previa, and provide a reference paper analyzing the last progression has been reached. </span><span>Methods: </span><span>PubMed database was used for articles selection, and the following keys used in the mesh ("Placenta Previa/etiology"[Mesh] OR "Placenta Previa/genetics"[Mesh] OR "Placenta Previa/history"[Mesh]). A total of 582 articles were found, with further restriction by PubMed filters, and reviewing the articles titles and abstracts, the final results were 6 articles.<br /> </span><span>Conclusion: </span><span>Further studies are still needed to be done to evaluate the modifiable risk factors, and to find a solution for the increase in the number of cesarean because it have a significant impact on placenta previa development.</span>
Evaluation,risk factors,Placenta Previa,Lower uterine segment
https://ejhm.journals.ekb.eg/article_8323.html
https://ejhm.journals.ekb.eg/article_8323_e5d3d44855ba67b649a3effa6174f7ba.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
The Chronotype (Eveningness-Morningness) Effects on Academic Achievement among Medical Students in Tabuk City, Saudi Arabia
3504
3507
EN
Shelian Juweed Alnomsi1, Khalid Saleh Albalawi1, Omar Yarub Alali1 , Waled Mohammed Albalawi1, Khalid Mohammed Albalawi1, Wedyan Saleh Albalawi1
Hyder Osman Mirghani2
1Medical students, Faculty of Medicine, University of Tabuk, 2Medical Department, Faculty of Medicine, University of Tabuk, Saudi Arabia
<span>Background</span><span>: Thereis increasing awareness about theeffects of chronotype and sleep qualityand academic performance among medical students.<br /> </span><span>The aim of the work: </span><span>This study assessed the relationship between chronotype, sleep quality, and academic performance among Saudi medical students.<br /> </span><span>Materials and Methods: </span><span>A cross-sectional study was conducted among169 clinical phase medical students during the period from May 2017 to January 2018. Participants were invited to sign a written informed consent then responded to a self-administered questionnaire, using the Pittsburgh Sleep Quality Index (PSQI) and the weekdays and weekends bedtime and wake-up time, the chronotype was calculated from mid-sleep and wake up time during weekends and sleep dept. Students also completed a diary detailing their sleep habits fortwo weeks priorto filling out the questionnaire. The chi-square and Pearson's correlation were used for the statistical analysis. </span><span>Results:</span><span>Participants (48.5% males), their meanage was22.90±1.27, 83.4% had poor sleep quality. No correlation was found between cumulative grades (GPA), sleep quality, chronotype, body mass index, and sleep duration during weekdays and weekends (p>0.005), the females medical students had good sleep quality and lower body mass index, were more likely morning chronotype, and had higher GPA compared to males.<br /> </span><span>Conclusion: </span><span>No correlation was evident between the GPA, chronotype, and sleep quality. The women had better sleep quality and GPA, they were more likely morning chronotype and had lower body mass index. </span>
Sleep quality,chronotype,Academic Performance,Medical students,Saudi Arabia
https://ejhm.journals.ekb.eg/article_8324.html
https://ejhm.journals.ekb.eg/article_8324_7ae0c1fe2a63c3f90abc78e50432a394.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Comparative Study between Anterior Chamber Iris Claw Phakic Iol and Posterior Chamber Phakic Iol (Icl) for Correction of Myopia3508
3508
3517
EN
Ahmed
S. Abdel Rehim1
1,2,3 Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Nour Eldin
A. Abdel Halim2
1,2,3 Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Fathy
M. Elsalhy3
1,2,3 Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
<span>Background: </span><span>Compared to other refractive surgeries, implantation of phakic intraocular lenses (pIOLs) have more desirable results and are potentially reversible procedures due to the possibility of explanting these lenses. These methods usually do not require expensive or special surgical equipment and most ophthalmologists are able to perform these procedures; however disabilities resulting from pIOLs are more severe compared to corneal refractive surgery. Due to the potential risk of damage to anterior segment structures, especially corneal endothelial cell loss.<br /> </span><span>Aim of the Work: </span><span>to compare between anterior chamber (AC) pIOL and posterior chamber (PC) pIOL in patients with myopia as regard: </span>
<span>1- Uncorrected and best corrected visual acuity (UCVA & BCVA). </span>
<span>2- IOP(Intra ocular pressure). </span>
<span>3- Endothelial cell count (ECC). </span>
<span>4- Postoperative inflammation and complications. </span>
<span>Patients and Methods: </span><span>This prospective comparative study included 30 eyes of patients suffering from high myopia at Al-Hussein University Hospital from 2017 to 2018. The patients were divided into two groups:<br /> Group (A): included (15) eyes where Polymethyl methacrylate (PMMA) iris-fixated AC pIOL were implanted (Artisan). Group (B): included (15) eyes where the PC pIOL were implanted (Implantable CollamerLens (ICL V4). </span>
<span>In this study we did pre and postoperative specular microscopy, pentacam and IOP measurement by applanation tonometer to evaluate endothelial cell count and IOP changes over 6 months. The main outcome measures were central corneal ECC, the percentage of corneal endothelial cell loss and IOP changes. Secondary outcome measures were UCVA, BCVA, manifest refraction, and complications. </span>
<span>Results: </span><span>The mean pre-operative ECC in Group A was 3365±403 cell/mm2 ranged from 2830 to 3846 cell/mm2. In Group B, it was 3329±356 cell/mm2 ranged from 2901 to 3989. Post operative mean ECC in group A was 3183±344 cell/mm2 ranged from 2609 to 3686. In Group B, it was 3251±361cell/mm2 ranged from 2432 to 3621 at 6 month after surgery. The mean percentage endothelial cell loss in group A was 5.4% While in group B, it was 2.3% at the end of the follow up period (6 months). The mean pre-operative IOP in group A was 15.63 ±1.74 mmHg ranged from 12 to 18.2 mmHg, while in Group B, it was 15.53 ±1.98 mmHg ranged from 13 to 20 mmHg. Post operative mean IOP in group A was 14.95±1.01 mmHg ranged from 12.5 to 16.2 mmHg, while in Group B, it was 14.69±1.20 mmHg ranged from 12.6 to 16.7 mmHg at 6 month after surgery. The mean pre-operative UCVA in Group A was 0.03 ± 0.011 ranged from 0.01 to 0.04, while in Group B, it was 0.06 ± 0.023 ranged from 0.01 to 0.083. And by the end of the 6th month after surgery, the mean UCVA was 0.39 ± 0.10 in Group A, while it was 0.5 ± 0.27 in Group B. The mean pre-operative BCVA in Group A was 0.3 ±0.12 ranged from 0.16 to 0.7, while in Group B, it was0.4 ± 0.22 ranged from 0.25 to 1.00 the mean BCVA at 6 month after surgery was 0.49± 0.12 in Group A, while it was 0.62 ± 0.23 in Group B. The mean pre-operative spherical error (SE) in Group A was -15.3 ± 2.68 D ranged from -11D to -20D, while in Group B, it was -13.72 ± 3.97D ranged from -7D to -20.25D. by the end of the 6th month after surgery, the mean post operative SE was-1.02 ± 0.53 in Group A, while it was -1.18 ± 0.67 in Group B. </span>
<span>Conclusion: </span><span>Our study revealed that pIOLs implantation (AC IOLs or PC IOLs) in high myopes had excellent results including; stability of refraction for high myopes, reversibility, high optical quality, potential gain in visual acuity, preservation of corneal architecture, asphericity and accommodation the comparison between the two types of pIOLs proved that the ICL was superior over the Artisan as regards the effect on corneal endothelium and postoperative AC inflammation, and they were equal as regards predictability, efficacy and the effect on IOP. </span>
phakic intraocular lenses,endothelial cell count,High myopia
https://ejhm.journals.ekb.eg/article_8325.html
https://ejhm.journals.ekb.eg/article_8325_33b2d72129e1a6e9fb0b73be11ea4a64.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Monitoring of Free Living Amoeba in Some Drinking Water Treatment Plant in Great Cairo Governorate, Egypt
3518
3528
EN
Lamiaa A. Shawky 1 Faten El-Feky 2, Hanan Taher 2,
Wael I. Ashour1.
1 Reference Laboratory for Drinking Water, Holding Company of Water And Waste Water,
2 Faculty of Science, Girls Branch Al-Azhar University, Cairo, Egypt
<span>Background: </span><span>Free-living amoebae (FLAs) in drinking water exerts an indirect public health hazards as they may harbor pathogenic microorganisms that can escape drinking water treatment processes and reach to end user. The aim of this study was to observe the existence of free-living amoebae through drinking water treatment plants in Great Cairo governorate, Egypt. Water samples were collected from 3 drinking water treatment plants (DWTPs) and filtered through nitrocellulose membranes, then placed on non-nutrient agar with </span><span>Escherichia coli </span><span>for cultivation of free-living amoebae. Results:The obtained amoebae were morphologically identified and confirmed to genus level. The results revealed that the occurrence of free-living amoebae in intakes and finished water of the examined DWTPs reached 95% and 31%, respectively. The removal percentage of free-living amoebae through different treatment processes reached its highest rate in Rod Elfarag DWTP (100%), followed by Embaba DWTP (63.64%), and reached to (41.67%)in Shubra El-Kheima DWTPs. Almost all the morphologically identified (FLA) strains proved to be related to genus </span><span>Acanthamoeba, Naegleria</span><span>. </span><span>Conclusion</span><span>: the presence of free-living amoebae in drinking water exerts an indirect public health hazards as they may harbor pathogenic microorganisms that can escape drinking water treatment processes and reach to end user.<br /> </span>
Free Living Amoeba,Drinking water treatment plants,Greater Cairo
https://ejhm.journals.ekb.eg/article_8326.html
https://ejhm.journals.ekb.eg/article_8326_8c8a44967465714cce11275c0485d47d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Comparison of Ultrasonic (Harmonic Scalpel) Hemorrhoidectomy versus Milligan-Morgan Hemorrhoidectomy for Hemorrhoidal Disease
3533
3536
EN
Mohamed Ahmed Shawky Abdelaziz Deyab* , Mohamed Tag Eldin,
Alsayed Hamdy.
AL-Azhar University, Faculty of medicine, General Surgery Department, Cairo, Egypt
<span>Background: </span><span>Surgical excision using the Harmonic Scalpel is a modern technique for symptomatic third- and fourth-degree hemorrhoids. The resulting mucosal defect is then left open.<br /> Objectives: The purpose of this study was to compare techniques of hemorrhoid excision using the Harmonic Scalpel versus the routine Milligan-Morgan technique.<br /> </span><span>Methods: </span><span>From August 2017 to May 2018, 30 patients underwent surgical excision of complex grade III or grade IV hemorrhoids via the Harmonic Scalpel another 30 patients operated with the traditional Miligian Morgan technique. Data collected about patient clinical condition and perioperative details including operative time and blood loss then post-operative acute pain and delayed pain and other complications then the quality of life after returning to routine life including degree of satisfaction of the patients were recorded in a master sheet and short form survey for documentation and statistical analysis.<br /> </span><span>Results: </span><span>Both groups were comparable in terms of patient demographics and type of anesthesia. There were no late complications. Mean follow-up was 4.9 (range, 4</span><span>–</span><span>6) months. Conclusion: hemorrhoidectomy with Harmonic Scalpel significantly reduces perioperative time, blood loss and thus postoperative pain, without diminishing quality of life.<br /> </span>
Harmonic Scalpel- Miligian Morgan- hemorrhoidectomy
https://ejhm.journals.ekb.eg/article_8328.html
https://ejhm.journals.ekb.eg/article_8328_08897b97d64d0dc88dbdd18a29eac5e8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
The Use of Intra-Operative Nerve Monitoring (IONM) in Thyroid Surgery to Reduce Recurrent Laryngeal Nerve Injury
3537
3540
EN
1Ashwag Jamal Al Jehani, 2Feras Mohamed S.Alahmed, 3Abdulmalik Abdulfatah Al Atar,
4Saud Al Rashedi
1General Surgery Department, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh,
2 Security Forces Hospital Program, Riyadh, Saudia Arabia, 3Armed Forces Hospital, Oman,
4 General Surgery Training Center, Riyadh, Saudi Arabia
Objectives: To assess the relation between use of Intraoperative nerve monitoring (IONM) in thyroid surgery and the prevalence of RLN injury, and to assess its significance of IONM in reduction of RLN injury among patients who underwent thyroid surgery. Background: Recurrent laryngeal nerve (RLN) palsy is one of the big concerns for surgeons during thyroid surgery. Surgeons tried to find ways to identify this nerve and preserve it. The most popularly used way is the use of Intraoperative nerve monitoring (IONM). Methods: In this retrospective study, we collected the data for all cases that underwent thyroid surgery in Security Forces Hospital (SFH), Riyadh, Saudi Arabia during the period of 2010 to 2012. We divided participants to two groups, those who used IONM and those who did not used IONM. The statistical Package for Social Sciences (SPSS, version 22) was utilized for data entry and analysis. Categorical variables were described by frequencies and percentages. Descriptive analysis involving Chi-square test was used to test significance of association between categorical variables. The level of significance was set at P< 0.05. Results: Post-operation RLN injury was higher in those who underwent thyroid surgery without IONM, but the difference was insignificant (p=0.460). Three of those patients who underwent the surgery without IONM has RLN injury (3.1%), and no RLN injury reported of those who underwent surgery with IONM (0%). Conclusion: IONM could help in identifying the RLN and preserving it from injury. Although, in this study there were insignificant correlations between RLN injury and IONM. Further researches on a larger-scales is recommended to get more informative results and allow better comparison.
Keywords: Recurrent laryngeal nerve,intraoperative nerve monitoring,THYROID,Surgery,Complications
https://ejhm.journals.ekb.eg/article_8329.html
https://ejhm.journals.ekb.eg/article_8329_4377036353c53f52ae92970cbd1367b5.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block Versus Bupivacaine alone for Upper Limb Orthopedic Surgery; A Comparative Study
3541
3549
EN
Hesham Mohamed El Azzazi, Ashraf El Sayed El Agamy, Marwa Mostafa Mohamed,
Mostafa Mohamed Nageeb Abd Al-Salam
Department of Anesthesia, Intensive Care and Pain Management,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
https://ejhm.journals.ekb.eg/article_8330.html
https://ejhm.journals.ekb.eg/article_8330_1cab12a65e6b84a42c302602bf35b47f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Color Doppler and Duplex Study in Assessment of Recipient Patients in Post Liver Transplantation
3550
3553
EN
Marwa Ibrahem Mohamed *, Ahmed Mohamed Bassiony *, Yousef Ahmed Yousef **,
Ahmed Hassan Ibrahem*
* Radio-Diagnosis Department, Faculty of Medicine, Ain Shams University, ** Radio-Diagnosis Department, Faculty of Medicine, Misr University for Science and Technology
<span>Background: </span><span>Liver transplantation is currently accepted as a first line treatment for patients with end-stage acute or chronic liver diseases</span><span>. </span><span>Graft survival and overall patient survival have steadily improved since the first transplants were performed in the early 1960s, but a significant percentage of transplants develop complications related to vascular and biliary insufficiency. Graft ischemia after liver transplantation is associated with a high incidence of morbidity and mortality</span><span>. </span><span>Aim of the Work: </span><span>was to evaluate the sensitivity of Duplex ultrasound in detection most of vascular complication after liver transplantation in correlation with CT angiography. </span><span>Patients and Methods: </span><span>The study was done from July 2017 until January 2018, where 20 cases who underwent living donor liver transplantation with post-operative complications. The cases were done at Dar Al Fouad Hospital and National Liver Institutes. The cases were 16 males and 4 females. All cases where admitted to post-transplanting intensive care unit in the postoperative period where a routine full laboratory and radiological assessment were done. The laboratory assessment included full liver function tests, kidney function tests, complete blood picture, and C-Reactive Protein. Immunosuppressant level and bilirubin level in drains had also done. </span><span>Results: </span><span>The patient age ranges from 43 to 80 years with the mean age of 61.5 years. Eighteen cases had hepatitis C related cirrhosis (90%) One case had veno-occlusive disease related cirrhosis (Budd Chiari syndrome). One case was Wilson disease. About 95% of cases were suffering from end stage liver disease. The results we have reached are that Doppler U/S sensitivity in diagnosis of these complications is about 75%. </span><span>Conclusion: </span><span>It could be concluded that gray-scale US and color Doppler are the investigations of choice in postoperative liver transplantation. They can be used as routine steps in the assessment of liver transplant graft postoperatively in recipient patient as early as possible within the first 3 days after operation and used as a late follow up, as they are noninvasive, safe, cheap, and accurate. Routine use of gray- scale US and color Doppler showed to minimize the impact of postoperative complications and maximize both graft and recipient patient survival.<br /> </span>
Color Doppler,Duplex Study,Recipient Patient,Post Liver Transplantation
https://ejhm.journals.ekb.eg/article_8331.html
https://ejhm.journals.ekb.eg/article_8331_fdd64492f6f8acc0512fd1bc5cdb3a1d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
The Possible Radio Protective Role of Aphanizomenon Flos-Aquae (AFA) on Heart of The Adult Male Albino Rats
3559
3571
EN
Fatma A.
Eid
Department of Zoology, Faculty of Science, Al- Azhar University, Cairo, Egypt
Asmaa A. M.
Eldahshan
Department of Zoology, Faculty of Science, Al- Azhar University, Cairo, Egypt
Safaa M. A.
Hamid
Department of Zoology, Faculty of Science, Al- Azhar University, Cairo, Egypt
<span>Aim of the work: </span><span>this study demonstrated the drastic effects of ionizing radiation on the heart tissue of the adult male albino rats and the possible radio protective role of AFA extract.<br /> </span><span>Material and Methods: </span><span>a total of forty-eight mature male albino rats (</span><span>Rattus rattus</span><span>) weighing 180-200g were fed on standard rodent pellets. Rats were equally categorized into four groups; each group contained 12 rats. These groups were: 1-untreated normal control rats (C); 2- rats exposed to 4Gy of gamma-radiation (Irradiated group </span><span>R</span><span>) and then they were sacrificed on days 5 and 21 (</span><span>R</span><span>1</span><span>& R</span><span>2 </span><span>groups respectively) post-irradiation; 3- rats were treated orally with 94.5mg/kg body weight/day of AFA extract for 3 weeks (AFA group) and then they were sacrificed on 5 and 21 days (</span><span>A</span><span>1</span><span>& A</span><span>2 </span><span>groups respectively) post- treatment; 4- rats were treated orally with 94.5mg/kg body weight/day of AFA extract for a period of one week before irradiation and three weeks after irradiation (AFA-irradiated group), then the rats were sacrificed on 5 and 21 days (</span><span>AR</span><span>1</span><span>& AR</span><span>2 </span><span>groups respectively) post-irradiation and treatment, then the hearts were immediately excised.<br /> </span><span>Results: </span><span>many drastic changes were observed in the cardiac muscle fibres of rats of </span><span>R</span><span>1 </span><span>group. These changes included: numerous hemorrhagic areas which contained hemolyzed blood cells and some nuclei of myocardiocytes were pyknotic and others were hypertrophied with destruction in some fibres and widened endomysium. Aggravated changes were also observed in the heart of rats of </span><span>R</span><span>2 </span><span>group such as highly elongated and congested cardiac blood vessels which contained hemolyzed blood cells and hemosiderin granules, numerous hemorrhagic areas, necrotic areas and widened endomysium. On the other hand, highly increased collagen fibres and amyloid-</span><span>β deposits </span><span>were also noticed in the cardiac tissues of rats of </span><span>R</span><span>1 </span><span>and R</span><span>2 </span><span>groups with decreased PAS positive materials, total protein and DNA materials. Normal architecture of the cardiac muscle fibres was detected in the rats of </span><span>A</span><span>1</span><span>, A</span><span>2 </span><span>groups with slightly increased collagen fibres and slightly decreased PAS positive materials, total protein, amyloid-</span><span>β </span><span>protein and DNA materials. Also, </span><span>AR</span><span>1</span><span>, AR</span><span>2 </span><span>groups showed somewhat normal appearance and well developed cardiac muscle fibres, but some dilated endmysium spaces were still detected in the cardiac muscle fibres of rats of group </span><span>AR</span><span>2</span><span>. Furthermore, increased collagen fibres and amyloid-</span><span>β deposits </span><span>were realized in the cardiac muscle fibres of rats of AR</span><span>1</span><span>, </span><span>AR</span><span>2 </span><span>groups with decreased PAS positive materials, total protein and DNA materials.<br /> </span><span>Conclusions: </span><span>AFA showed cardio- protective effect and powerful antioxidant action. So, it can be used under medical supervision as a natural supplement.<br /> </span>
gamma-radiation,AFA,heart tissue
https://ejhm.journals.ekb.eg/article_8465.html
https://ejhm.journals.ekb.eg/article_8465_8bf2a2c208d583c576f49120c91deae9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
07
01
Knowledge, Awareness, and Attitude Regarding Infection Prevention and Control among Medical Students in Al-Taif University
3572
3577
EN
Nourah Ali Alshamrani, Rahaf Ghazi Altuwairqi,
Hanouf Abdullah Alnofea
Al-Taif University
<span>Background: </span><span>Infection prevention and control is required to prevent the transmission of communicable diseases in all health care settings. The risk of acquiring a healthcare associated infection is related to the mode of transmission of the infectious agent. As a result we wanted to assess the awareness level of infection control among medical students. </span><span>Objective: </span><span>In this research we aim to identify the extent of knowledge, awareness, and attitude regarding infection prevention and control among medical students in Taif University. </span><span>Methods: </span><span>The researchers used the descriptive method for its relevance to the current research. The research population included 250 medical students in Al Taif University. The researcher designed questionnaire as a data collection method to serve the purpose of this research, and the descriptive approach was used for its relevance to the current research. </span><span>Conclusion: </span><span>Most students were almost completely aware of the risk of infection transmission through the hospital, and about all the precautions needed to prevent and control the infection within the hospital. Also, the students were aware about the different kind of infectious disease.<br /> </span>
Knowledge,Awareness,Attitude,Infection Prevention and Control,Medical students,Al-Taif University,KSA
https://ejhm.journals.ekb.eg/article_8466.html
https://ejhm.journals.ekb.eg/article_8466_9d7cfff797496ec0db07478a7032700f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Comparative Study between the Corneal Volume in Mild and Severe Keratoconic Eyes Using Pentacam Tomography
3578
3584
EN
Amr S. Mousa, Ahmed A. Abdul Latif, Weam M. Ebeid,
Amal S. Abu Shusha
Department of Ophthalmology, Faculty of Medicine, Ain Shams University
<span>Background: </span><span>Keratoconus is the most common corneal ectasia. It usually appears in the second decade of the life and affects both genders and all ethnicities. Tomographic-</span><span>based data have added significantly more </span><span>information to the screening of corneal ectasia. In addition to anterior corneal analysis, tomography also provides information about the posterior cornea and the pachymetric distribution, which can increase our ability to identify early and subtle corneal changes.<br /> </span><span>Aim of the Work: </span><span>The main aim is to determine how the corneal volume measurement changes in different diameters of corneal tissue, in the central 3 mm and 5 mm in mild and severe cases of keratoconus; in an attempt to quantify the loss of corneal tissue in keratoconus.<br /> </span><span>Patients and methods: </span><span>This cross-sectional study included 20 eyes of keratoconic patients, from 15 to 36 years old. They were divided into 2 groups, each group included 10 eyes: Group A: mild keratoconic cases with steepest keratometry reading lower than 45 D. Group B: severe cases with steepest keratometry greater than 52 D, All cases were diagnosed as keratoconus using pentacam parameters.<br /> </span><span>Results: </span><span>Corneal volume at 3 and 5 mm diameter was significantly lower in the severe keratoconic cases than in mild cases (P<0.01). </span><br /> <span>Conclusion: </span><span>based on the data in our study, we think the effect of keratoconus is not limited to corneal thickness. Rather, it affects all anterior segment parameters of the eye and results in significant alternations with the progression of the disease. There is a clear reduction of corneal volume in early keratoconus, and such reduction increases significantly with the severity of the disease. Measurement of corneal volume could prove to be a useful tool to monitor the progression of the disease and in other applications, such as assessing the effect of treatments including corneal collagen crosslinking and implatation of Intacs. </span>
corneal volume,Keratoconus,pentacam tomography
https://ejhm.journals.ekb.eg/article_8467.html
https://ejhm.journals.ekb.eg/article_8467_2c8ec42925ff55af0db8fc4c1bdf72dd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
The Role of Advanced Techniques of MRI in Evaluation of Pediatric Bone Tumors
3585
3590
EN
Abeer Maghawry Abdelhameed *, Ayman Mohamed Ibrahim *, Noha Mohamed Osman *, Sherif Ishak Azmy **,
Eman Aly El-Din El-Sayed *
* Radiodiagnosis Department, Faculty of Medicine, Ain Shams University ** Orthopedic Surgery Department, Faculty of Medicine, Ain Shams University
<span>Background: </span><span>Functional magnetic resonance imaging (MRI) improves tissue characterization and staging of bone tumors compared to the information usually supplied by structural imaging. Dynamic MRI and diffusion MRI can be performed in everyday practice. Tumour characterization can benefit from perfusion MRI with dynamic gadolinium injection and enhancement time-intensity curve analysis combined with quantitative and qualitative diffusion MRI. </span><span>Aim of the Work: </span><span>is to elucidate the role of advanced MRI techniques in diagnosis of pediatric bone tumors and to assess the diagnostic potential of Dynamic contrast enhancement (DCE) in conjunction with Diffusion weighted imaging (DWI) in differentiating benign from malignant bone tumors.<br /> </span><span>Patients and Methods: </span><span>a prospective study conducted on thirty pediatric patients with clinically suspected and radiologically proven bone tumor or tumor like lesion. The patients were referred from the Department of Orthopedics, Ain Shams University. The patients were investigated using 1.5 Tesla magnetic resonance device. They were subjected to conventional MRI and DCMI.<br /> </span><span>Results: </span><span>DWI with measurement of Apparent diffusion coefficient (ADC) values helped in the differentiation of benign and malignant bone tumors, and that the best cut-</span><span>off criterion is ADC of ≤ 0.9 and this means that ≤ 0.9 </span><span>indicates malignant result while >0.9 is defined as benign results with overall sensitivity 100% and specificity 100%. A type II curve was seen in 23 cases (one malignant and twenty two benign), type IV was seen in 5 cases (all are malignant) and type V curve was seen in two malignant cases (after chemotherapeutic treatment). ROC analysis for the Dynamic contrast enhancement (DCE) showed a sensitivity of 75 % and specificity of 100%.<br /> </span><span>Conclusion: </span><span>DWI and DCE-MRI had been proven to be highly useful in the differentiation of benign and malignant bone tumors. Measurement of ADC values improved the accuracy of the diagnosis of bone tumors. Moreover; they could be used in the follow up of tumors and their response to therapy.<br /> </span>
Magnetic resonance imaging (MRI),Pediatrics,Bone tumors,Diffusion weighted imaging (DWI),Apparent diffusion coefficient (ADC) – Dynamic study- Dynamic contrast enhancement (DCE)
https://ejhm.journals.ekb.eg/article_8468.html
https://ejhm.journals.ekb.eg/article_8468_776f606c3b2615c7401ad18d48573d0a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Comparative Study between Different Modalities of Treatment of HCV in New Era of Direct Acting Antiviral Drugs (DAAs) in Aswan Governorate
3591
3600
EN
Eman M El-Gindy, Ehab F Abdou Mostafa, Iman M Montasser,
Fawzy M Ismail
Department of Tropical Medicine
Faculty of Medicine – Ain Shams University
<span>Background: </span><span>Hepatitis C virus (HCV) infection is considered a national progressing problem that threatens the life of Egyptian people as Egypt has the highest prevalence of HCV infection in the world with prevalence rates of 14.7 % of the adult population. HCV infection causes chronic hepatic inflammation and severe liver diseases, such as liver cirrhosis and hepatocellular carcinoma. Currently, HCV is curable, unlike HIV and HBV. Goals of therapy are to eradicate HCV infection to prevent hepatic cirrhosis, decompensation of cirrhosis, hepatocellular carcinoma (HCC) and death. End point of therapy: undetectable HCV RNA in a sensitive assay ( </span><span>Aim of the Work: </span><span>To assess the efficacy of DAAs in the treatment of HCV in Aswan Governorate; and to compare between the different combinations of DAAs ± ribavirin ±interferon which were available during the study period as regards efficacy and possible side effects in each treatment combination.<br /> </span><span>Patients and Methods: </span><span>This retrospective study was conducted in Aswan Fever Hospital, Aswan Hospital Health Insurance and Tropical Medicine Department Ain Shams University. Study population: Patients with chronic hepatitis C who received treatment in the period from January 2015 to July 2016. Group I: Triple therapy (Sofosbuvir + Ribavirin + Interferon) for 3 months. Group II: Sofosbuvir + Ribavirin for 6 months. Group III: Sofosbuvir + Simeprevir for 3 months. Group IV: Sofosbuvir + daclatasvir ± Ribavirin for 3 months.<br /> </span><span>Results: </span><span>In Group I SVR was 74.3% ,Group II SVR was 60% ,Group III SVR was 85.7% and Group IV SVR was 100% </span><span>Conclusion: </span><span>This is a large real-life report of the use of very low-cost generic medications for treating HCV-G4 within the largest treatment programme worldwide. The use of entirely generic SOF DCV combination with or without generic RBV was well tolerated and associated with high response rate in patients with different stages of liver disease. This can be an example for other countries of similar limited resources for managing their patients with HCV.<br /> </span>
HCV,Direct Acting Antiviral Drugs
https://ejhm.journals.ekb.eg/article_8469.html
https://ejhm.journals.ekb.eg/article_8469_0d721f86a2cb702208261c6af55081c3.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Correlation between Haemoglobin A1c and Umbilical Artery Doppler as Predictors for Perinatal Outcome in Pregestational Diabetic Pregnancy and Pregestational Diabetic Pregnancy Complicated By Preeclampsia In Third Trimester
3601
3613
EN
Yahia M Mizar 1, Ismael EL Garhy 2,
Ashraf H Mohamed 2
1 Department of Obstetrics and Gynecology, Helwan General Hospital.
2 Department of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar University
<span>Background: </span><span>Diabetes mellitus is one of the most common metabolic disorders that occur during pregnancy. It has two clinical patterns; either pregestational diabetes mellitus or gestational diabetes mellitus. Pregestational diabetes mellitus is associated with worse maternal and fetal outcomes compared to gestational diabetes mellitus. </span><span>Objectives: </span><span>To assess usefulness of using both heamoglobin A1C and umbilical artery Doppler velocity waveform analysis in predicting adverse perinatal outcomes for both pregestational diabetic pregnancies & pregestational diabetic pregnancies complicated by preeclampsia.<br /> </span><span>Methods</span><span>: </span><span>This comparative study was conducted on 150 pregnant women with gestational age 34 </span><span>– </span><span>40 weeks who were equally divided into 3 groups; 50 pregnant women with pregesational diabetes melleitus alone and 50 pregestional diabetes melleitus complicated with preeclampsia. These two groups were compared with 50 healthy pregnant women, free from medical disease, as control group. </span><span>Results: </span><span>In pregnant women with pregestational DM, HbA1c should be kept below 7% and it is better to be less than 6.5% by proper glycemic control, as higher levels of HbA1c were associated with bad perinatal outcomes in the forms of RDS, neonatal hypoglycemia, macrosomia, IUGR, Apgar score 1 & 5min and NICU24. In addition to, bad maternal outcomes in the forms of polyhyramnios, preterm labor, PROM, prolonged labor, mode of delivery, postpartum hemorrage, puerperal sepsis, pulmonary embolism, preeclampsia and its complications as eclampsia, HELLP syndrome, renal affection, hepatic affection and retinal affection. There was no significant relation between long term maternal glycemic control (HbA1c) & the changes of blood flow velocity in the umbilical artery in pregnancy complicated with diabetes mellitus unless the pregnancy is complicated with fetal growth restriction or preeclampsia. </span><span>Conclusion: </span><span>An increased pulsatility index of umbilical Doppler was found in our study to be the important predictor of perinatal outcome in diabetic pregnancies complicated by preeclampsia but not in uncomplicated diabetic pregnancy.<br /> </span>
Diabetes Mellitus – Heamoglobin A1c – Umbilical Artery Doppler – Preeclampsia
https://ejhm.journals.ekb.eg/article_8470.html
https://ejhm.journals.ekb.eg/article_8470_075b15f77115da11bfef14a395a4b8e1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
A Case Report of Dengue Encephalitis: An Atypical Neurologic Manifestation of Dengue Fever in Adults
3614
3615
EN
<span>Dengue fever is a febrile disease caused by infection from one of the four dengue virus serotypes (DENV1, DENV2, DENV3 and DENV4). The clinical manifestations of dengue fever are broad-spectrum, ranging from asymptomatic to life threatening, shock syndrome. Usually, the dengue virus doesn't cause neurologic manifestations, but recently this has been documented in some cases. We report a case of dengue encephalitis in a 42- year-old gentlemen from Bangladesh who was presented with a history of altered level of consciousness associated with headache, subjective fever, fatigue, nausea and vomiting. Blood test results of Dengue Immunoglobulin M (IgM) antibodies and polymerase chain reaction (PCR) were positive. In addition, other causes of encephalitis were ruled out by appropriate laboratory investigations. Dengue Encephalitis should be considered in the differential diagnosis of fever with altered level of consciousness, especially in areas where dengue fever is endemic. </span>
Dengue Encephalitis,Viral Encephalitis,Dengue fever,Neurological manifestations
https://ejhm.journals.ekb.eg/article_8471.html
https://ejhm.journals.ekb.eg/article_8471_dd6a613c8fb57e703b9b6f9b35410862.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Immunohistochemical Expression of Napsin A, CD82 and Cyclin D1 in Some Renal Tumors
3616
3621
EN
Ibrahim Hassan Mohammed Yousef1, Sayed Abdel Raheem Sayed Ali1, Murad Mahmoud Murad2,
Yasien Mohammed Abdel Ghafour1
1.Department of Pathology, Faculty of Medicine. Al-Azhar University, 2.Department of Urology, Faculty of Medicine. Al-Azhar University, Egypt.
<span>Background: </span><span>most of renal neoplasms are of epithelial origin and they are malignant. Renal cell carcinoma (RCC) accounts for approximately 2% of all cancers. The disease resulted in more than 100,000 yearly deaths worldwide. Histologic diagnosis of renal neoplasms is usually straight forward by routine light microscopy. However, immunohistochemistry may be essential in several contexts, including differentiating renal from non- renal neoplasms, differentiating subtypes of primary renal epithelial neoplasms and diagnosing rare types of renal neoplasms or metastatic RCC in biopsy specimens. </span><span>Aim of the work</span><span>: multiple therapeutic options tailored to an individual patient are now being offered. In view of these developments, availability of a robust and dependable panel of immunohistochemical stains becomes even more important because pathologists are frequently asked to render diagnosis on limited material. </span><span>Material and methods</span><span>: in this study a total number of 50 cases of some types of renal cell tumors were immunohistochemically stained for Napsin A, CD 82 and Cyclin D1. Results: these cases included 18 cases of ccRCC (36%), 16 cases of PRCC (32%), 8 cases of ChRCC (16%) and 8 cases of oncocytoma (16%).</span><span>Conclusion: </span><span>we concluded that napsin A may be useful in differentiating between ccRCC and PRCC (particularly type 1 which showed more vacuolated or clear cytoplasm). CD82 may be useful in differentiating between ChRCC, which was CD82 positive and oncocytoma, which was CD82 negative. Cyclin D1 had no significant value in the differentiation of different types of renal epithelial tumors. </span>
<span>Recommendation: </span><span>we recommended the usage of Napsin A in differentiating between ccRCC and PRCC and CD82 in differentiation between ChRCC and oncocytoma. More studies are needed to evaluate napsin A in differentiating between ChRCC and oncocytoma.<br /> </span>
RCC,napsin A,CD82,cyclin D1
https://ejhm.journals.ekb.eg/article_8472.html
https://ejhm.journals.ekb.eg/article_8472_26af4d315187f6e94ba9838ef00c7fde.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Neglected Perforated Gall Bladder with Generalized Peritonitis in Old & Morbid Obese Patient
3622
3625
EN
Hessa S. Alhabes, Samer Alkarak,
Mohammed D. Alzamanan
King Khalid hospital –NAJRAN city - KSA
<span>The main cause of perforation of the gallbladder is cholecystitis with or without cholelithiasis. In old age, </span>
<span>spontaneous perforation of gallbladder can be due to decrease in its blood supply, which can be due to </span>
<span>atherosclerosis, focal vasospasm or localized vasculitis. Perforation of gallbladder is associated with high </span>
<span>morbidity and mortality, if left untreated. Here we report a case of a 60-year-old male with perforation of </span>
<span>gallbladder. </span>
Spontaneous perforation,chronic cholecystitis,gallbladder,Diabetes mellitus,Elderly,gangrenous cholecystitis,Acute Cholecystitis,Cholelithiasis
https://ejhm.journals.ekb.eg/article_8473.html
https://ejhm.journals.ekb.eg/article_8473_1e3f5834c61418269787b2c10f920e40.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Incidence and Evaluation of Cases of Cannabis Use among Injured Patients Admitted to Al-Azhar University Emergency Hospitals in Cairo
3626
3633
EN
Sherif Fahmy, Ibrahim Nour, Mohammed Khedr, Abd El-Fattah Morsi,
Abd El-Rahman Mohammed
Department of Forensic Medicine and Clinical Toxicology Faculty of Medicine, Al-Azhar University
<span>Background: </span><span>Trauma remains the leading cause of death among young adults, excessive alcohol and drug consumption are not only significant contributors to this epidemic, but are also independent predictors of injury recidivism (repeated trauma). </span><span>Patients and Methods: </span><span>In the present study five hundred injured patients with different types of injuries were randomly selected from Al-Azhar University Emergency Hospital. Trauma sheet was done for every patient. Ten ml urine was obtained from each patient at the time of admission and before receiving any kind of treatment whether medical or surgical. Then, toxicological screening was done for every patient by using D-THC-123626(one step Drug of Abuse rapid test) is a uni drug panel Enzyme Immunoassay (EIA) test. </span><span>Results: </span><span>Toxicological screening of urine samples of the studied injured patients for drug of abuse revealed that the overall prevalence of positive screen was 84.2 % of the total injured patients.<br /> </span>
Trauma,substance of abuse,urine screening
https://ejhm.journals.ekb.eg/article_8474.html
https://ejhm.journals.ekb.eg/article_8474_2e4b6fb0fbfd8dd4b15997d87b934fa1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Awareness of Chronic Kidney Disease in Hail Region
3634
3640
EN
Alanoud Mansour Ayed Albalawi1, Mohammed Ahmed2, Abdullah Abdulhadi Hammad Alharbi1, Ali Dawood Mohammed Almansour1,
AbdulRahman Ali AbdulRahman AlSogair1
1 College of Medicine, University of Hail, 2 Nephrologist, King Abdullah Center for Kidney Diseases, Hail, KSA
<strong>Background:</strong> Chronic kidney disease (CKD) is a common and growing problem worldwide; Earlier recognition of chronic kidney disease (CKD) could slow progression, prevent complications, and reduce cardiovascular-related outcomes. <strong>Study objective:</strong> to show the knowledge of the population Hail region on CKD and its causes, risk factors, appropriate treatment, and consequences.
<strong>Methods:</strong> A cross sectional study carried out in Hail region during the period from 1 October to 31 December. Data was collected by personal interview using a predesigned questionnaire containing all the relevant questions.
<strong>Results:</strong> Majority (60%) of participant have a good knowledge about CKD, 678 (71.4%) of participant think that alcohol drinking are the most cause of CKD, 81.2% think smoking, 62.7% think DM and 60.7% think that hypertension is the cause. Side pain are the most (84.4%) known symptom of CKD followed by difficulty urination known in 74.4%, Oliguria in 67.8% and hypertension in 34.4%. About the risk factors of the disease, 96.6% think that some food was the risk factors of CKD, 89.8% think about obesity, 81.5% think about Analgesic, 56.0% think about DM and 30.5% think about positive family history of CKD. It's found also that 85.6% of participant know that CKD 85.6% can't be treated without renal transplantation, 83.3% with dialysis and 71.2% by drugs also large number of them know that it can be treated in high percentage. Almost all of them say that CKD can be decreased by performing muscular exercises.
<strong>Conclusion:</strong> Current estimates of CKD awareness indicate that awareness remains unsatisfactory. Also, little is known regarding whether increased awareness improves clinical outcomes for CKD patients. Further research is necessary to continue to design and refine awareness campaigns aimed at dissemination of basic CKD information, given both the high prevalence of CKD and its risk factors and the low estimated awareness of CKD.
Chronic Kidney Disease,Awareness,Knowledge,population,Hail region
https://ejhm.journals.ekb.eg/article_8475.html
https://ejhm.journals.ekb.eg/article_8475_5678b06f13509c4d5b98edc6b7659f6b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Underweight Adolescents in Northern Saudi Arabia - A Community-Based Study
3641
3647
EN
Areej Muteb S. Alanazi1, Abdalla Mohamed Bakr Ali2, Zainab Muhammad Ibrahim Ory3, Reem Mudhhi Essa Alanazi1, Nujud Muteb D. Alshammari1, Jawaher Mohammed Hassan Al Ruwaili1,
Jawaher Naif M. Althayidi1, Waad Salamah Alaleimi1, Rayyanah Mufadhi R. Alanazi1, Rawan Hamdan Salem Alenazy1, Maha Ibrahim Alanazi1
1 Faculty of Medicine, Northern Border University, KSA.2 Faculty of Medicine, Sohag University, Egypt
3 Pediatrics Department, Faculty of Medicine, Northern Border University, KSA
<strong>Background:</strong> Adolescence refers to the developmental period between childhood and adulthood, and the WHO defines adolescents as individuals between the ages of 10–19 years. They make up about 20% of the world population. Rapid development and urbanization of KSA has resulted in changes in nutritional and diet patterns that have affected the BMI of children and adolescents and led to nutritional transition. The objective of this study was to evaluate and estimate the weight status and prevalence of underweight in school-aged male and female adolescents in Arar city, Northern Saudi Arabia using the BMI. <strong>Methods:</strong> This was a cross-sectional study that has been conducted among school adolescents of both sexes, aged 12-18 years during the academic year 2015–2016 over a period of 9 months (October 1st, 2015 to June 30th, 2016). Information obtained through an interviewer administered semi-structured questionnaire. Body mass index (BMI) was calculated as per the formula BMI = weight (kg) / height(m2). Age and sex-specific BMI percentiles were computed based on the Centre for Disease Control (CDC)/National Centre for Health Statistics growth curves. <strong>Results:</strong> In the studied participants (n = 849), the male-female ratio was (48.1%:51.9%). About half (50.4%) of the studied adolescents had normal BMI, 25.7% were underweight (below the 5th percentile), 18.1% were overweight and only 5.8% were obese (above 95th percentile). <strong>In conclusion;</strong> nutritional status among adolescents is not so well. Yet more work is needed to identify the more influential factors which can improve the nutritional status among adolescents in Arar beside nutritional education programs to the mothers and/or care givers.
Nutritional Status,BMI,Adolescents,Underweight,Arar city,Northern Saudi Arabia Introduction
https://ejhm.journals.ekb.eg/article_8476.html
https://ejhm.journals.ekb.eg/article_8476_5fe2a20696b4e1638679ed277c52dc13.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Association between Uric Acid Levels and Lipid Profiles in Adult Population of Alkharj City
3648
3654
EN
*Abdulrahman Bader Alaql1, Abdulrahman Ibrahim Almousa1, Fahad Saleh Alonazi1, Mohammed Abdullah Aldossari1,
Deepak Pathania1.
1 Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
<strong>Background: </strong>High uric acid level used to predict many diseases including left atrial thrombus, it may indicate aspirin-resistant patients. It could be also used as a biochemical index for diagnosing adolescence depression. High uric acid level is a known risk factor for deterioration of renal function in chronic kidney disease. It is also as a risk factor for cardiovascular disease and found to be associated with increased arterial stiffness <strong>Aim: </strong>is to investigate the independent association between serum uric acid and lipid profiles. <strong>Methods: </strong>Cross sectional study conducted over 200 patients who attended the various out-patient department of Prince Sattam Bin Abdulaziz University Hospital Al Kharj in Saudi Arabia. The data included individuals between 20 and 75 years old with lab test within the last year. <strong>Results: </strong>The data showed that the highest level of uric acid was in patients older than 50 years old (394 SD ±77.77) and it decreased in proportionate. The data showed significant association between the uric acid and the triglyceride (P = 0.003) and no significant association with the total cholesterol (P= 0.511). It also revealed no significant differences between the antihypertensive as well as antidiabetic groups and normal patients (P = 0.520 and 0.594 respectively). <strong>Conclusions: </strong>There is strong association between the uric acid and triglyceride, while high level of uric acid is not associated with high level of total cholesterol. The antidiabetic as well as antihypertensive drugs have significant effect over the triglyceride level while there is no significant effect on the TC level and the UA.
triglyceride,Total cholesterol,Antihypertensive drugs,antidiabetic drugs,Hyperuricemia
https://ejhm.journals.ekb.eg/article_8477.html
https://ejhm.journals.ekb.eg/article_8477_a6a071cb6162ea9565e917b71d810dd3.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Impact of Ultrasound Elastography in The Diagnosis of Solid Breast Lesions
3655
3666
EN
Ahmed M. Monib, Amr M. AbdelSamad,
Amany A. AbdElhakam
Department of Radiodiagnosis, Faculty of Medicine Ain Shams University
<strong>Background: </strong>Ultrasound scanning is noninvasive, usually painless procedure that used as the main adjuvant modality with mammography for depiction of the breast lesions nature. It is easy-to-use and less expensive than other imaging modalities. Besides lacking the exposure risk to ionizing radiation as in mammography, it also provides real-time imaging, and can easily detect lesions in women with dense breasts. Conventional ultrasound however is not free from limitation. It cannot replace annual mammography and careful clinical breast examination. Being an operator dependent, US needs experienced radiologists as well as good equipment to avoid misinterpretation of the lesions, and to decrease the number of false positive and false negative results. <strong>Aim of the Work: </strong>is to detect the impact of ultrasound elastography in diagnosis of solid breast lesions, and to evaluate its capability in differentiating benign form malignant lesions, with special focus on: A-Evaluation of sensitivity and specificity of sonoelastography, with cyto-histological diagnosis taken as the reference. B-Detection of the ability of sonoelastography to provide additional information on tissue elasticity in the event of equivocal mammographic and/or sonographic findings in order to guide the diagnostic workup towards biopsy or follow-up. <strong>Patients and methods:</strong> The present study is a prospective research work that included 39 patients with breast lesions where elastographic ultrasound was performed following screening or diagnostic mammography and breast ultrasound to evaluate its possible impact on accurate diagnosis and consequent guidance for management planning. This study was performed at a private center in the period from September 2017 to March 2018. The patients’ age ranged between (24 - 72 years) with a mean of 48 years. <strong>Results: </strong>The elastography scores for different breast lesions was:Lesions that scored 1, 2, and 3 were considered benign(30/39 cases, 77 %), whereas lesions that scored 4 and 5 (9/39 cases, 23%) were considered malignant. After revising pathology results of the 30 cases diagnosed as benign by elastography scoring 26/30(87%) were benign (true negative) by pathology and 4/30(13%) were malignant by pathology (false negative).After revising pathology results of the 9 cases diagnosed as malignant by elastography scoring 7/9(82.8%) lesions confirmed to be malignant by pathology (true positive) and 2/9(17.2%) lesions were proved to be benign by pathology (false positive).The calculated sensitivity of elastography score was 80%, specificity was 88.9%, PPV and NPV were 82.8% and 87% respectively, and the total accuracy was 85.3%.<strong>Conclusion: </strong>Sonoelastography is a simple, non-invasive diagnostic technique that provides information about the stiffness of a breast masses, thus completing the morphological assessment of B-mode ultrasound.<strong> Recommendations: </strong>Other studies are recommended to be performed on axillary lymph nodes, to evaluate the elastographic efficacy in differentiating between reactive and malignant pathologically enlarged axillary lymphadenopathy.
Ultrasound Elastography,solid breast lesion
https://ejhm.journals.ekb.eg/article_8478.html
https://ejhm.journals.ekb.eg/article_8478_92d7e962a55d31fdf6df17391011eed0.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
71
7
2018
04
01
Evaluation of Central Auditory Processing in Egyptian Multiple Sclerosis Patients
3667
3675
EN
Gehan A. El-Zarea,1 Amany A. Shalaby2, Hussin M. Hussin3,
Mohammad S. Ali1
1- Audiology Unit, Department of Otolaryngology, Faculty of Medicine – Al-Azhar University, 2- Ain-Shams University,
3- Department of Neurology, Faculty of Medicine – Al-Azhar University, Cairo, Egypt
<span>Background: </span><span>Many multiple sclerosis (MS) patients with normal peripheral hearing suffer from difficulties in their hearing especially speech perception in background noise, which is possibly because of deficit of central auditory processing in this group.<br /> </span><span>Objective: </span><span>To elaborate the effect of MS on central auditory processing.<br /> </span><span>Subjects and methods: </span><span>Seven audiologic tests including masking level difference (MLD), auditory memory test (recognition, content and sequence), dichotic digit test (DDT), speech intelligibility in noise test (SPIN) and gap in noise test (GIN) as well as electrophysiologic assessment (speech evoked ABR c-ABR and P300) were used for comparing aspects of central auditory processing between MS patients and controls. Scores for each test obtained through cross-sectional non-invasive study conducted on 30 Egyptian subjects with relapsing-remitting MS who had mean age of 37.07 ± 11.43 years, and 30 controls with normal peripheral </span>
<span>hearing and mean age of 33.40 ± 9.38.<br /> </span><span>Results: </span><span>This study demonstrated reduced MLD in MS at 500 & 1000 Hz in relation to controls. MS patients were worse than controls in recognition memory (pv = 0.011), memory for contents (pv <</span><span>0.001</span><span>) and memory for sequence (pv </span><span><0.001</span><span>). in addition, low scores of DDT (version I & II) revealed in MS patients (pv = </span><span><0.001</span><span>& 0.011 for I & II respectively), reduced SPIN test score in MS subjects (pv</span><span><0.001</span><span>), elevated threshold and reduction of percent of correct answer obtained from GIN test in MS patients (</span><span>Pv </span><span><0.001</span><span>). Furthermore, in MS patients, there were prolonged latencies and reduced amplitudes of c-ABR waves and P300. In addition, significant differences were revealed between MS subjects and controls in all c-ABR measures analysis.<br /> </span><span>Conclusion: </span><span>this study revealed apparent effect of MS on auditory processing.<br /> </span>
Multiple sclerosis,Central Auditory Processing,Egyptian Multiple Sclerosis patients
https://ejhm.journals.ekb.eg/article_8479.html
https://ejhm.journals.ekb.eg/article_8479_81cb0cced82b1c0f50bfb021cdf37821.pdf