Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Systematic Review: The Burden of Post-operative Complications Following Colectomy for Ulcerative Colitis
285
293
EN
Bandar Kamal Mufreh
Alsirhani
University Of Gezira
MasadMasaeedMasad
Almutairi
University Of Gezira
SaadMunawwikh
Alshammari
Lublin Medical University
Abdulraouf Mohammad
Altaleb
King Abdulziz University
Othman Rushdy
Filfilan
Umm Al-Qura University
Mohammed Abdulaziz
Othman
King Abdulziz University
Mohammed Seror
Bawahal
King Abdullah Hospital
bawhal_01@yahoo.com
Abdullah Hussain
Muzaffar
Umm Al-Qura University
<strong>Background: </strong>Ulcerative colitis (UC) patients failing medical management require colectomy. <br /> <strong>Methods:</strong>Literature search in MEDLINE , CINAHL and Embase, targeting studies reporting the outcomes of colorectal procedures (from 2002 to 2016 with total and subtotal colectomy postoperative complications in adults with ulcerative colitis as an endpoint. Texts and authoritative Web sites were also reviewed then identification of papers according to the inclusion and exclusion criteria and data extraction were performed by two independent researchers.<br /> <strong>Results:</strong>Following data extraction and synthesis, we identified 24 articles for review. Reporting outcomes from procedures conducted from 2002–2016. Most frequent short-term complications: infectious complications and ileus (mean incidence 21% and 19%), while most frequent long-term complications: pouchitis, fecal incontinence and small bowel obstruction (mean incidence 31%, 22% and 18%). Post-operative early complications (≤30 days) occurred in 18–63% of patients with ulcerative colitis while late complications (>30 days) occurred in 19–58% of patients. Rates of early infection and late pouch failure decreased significantly from 2002 to 2015 (22% to 2% respectively).<br /> <strong>Conclusion:</strong>although Colectomy remains an appropriate therapeutic strategy for specific groups of patients- it is not the optimal cure for UC. Clinicians need to fully understand the various postoperative complications and comorbidities that are highly prevalent with over a third of patients expected to experience long-term or late arising post-operative complications. Thus, while surgical procedures are recommended as an appropriate therapeutic strategy for a specific group of patients, the post-operative complications associated with these surgical procedures should not be underestimated.<br /> <strong> </strong>
ulcerative colitis,post-operative complications,colectomy,pouchitis,colon surgery
https://ejhm.journals.ekb.eg/article_13959.html
https://ejhm.journals.ekb.eg/article_13959_1d6fbb87528381b29b3936e0efc55795.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
A Systematic Review ofthe Safety of Nipple Sparing Mastectomy
294
304
EN
Ayman Mohammed
Al-Jehani
IbnSina College
SaadSaleh
Algarni
Security Forces Specialized Polyclinic
Nada Khalaf
AlOdhilah
King Saud University
AsalSuweid Abdullah
Aldosari
King Saud Hospital City
Shaykhah Ali
Almalki
Um Alqura University
<strong>Background:</strong>Breast cancer is a complex disease, and local recurrence and cancer-related death is likely multifactorial.Over the past three decades there has been a move towards breast conservation and a focus on aesthetic outcomes while maintaining oncological safety. For some patients, mastectomy is the preferred option. There is growing interest in the potential use of nipple sparing mastectomy (NSM). However, oncological safety remains unproven, and the benefits and indications have not been clearly identified<br /> <strong>Methods:</strong>A Systematic search in the scientific database ( Medline, EMBASE , Google Scholer and Ovid ) from 1980 to 2016 was conducted for all relevant retrospective studies including; randomized controlled trials, cohort studies and case–control studies involving women undergoing either NSM were analyzed and included based on the preset inclusion criteria.<br /> <strong>Results:</strong>The search yielded 1193 articles, of which 55 studies with 9053 patients met our selection criteria. After a mean follow up of 41 months (range, 7.1–78 months), the overall pooled locoregional recurrence rate (LRR) was 3.25%, the overall complication rate was 21.8%(1309 of 6003) , and the overall incidence of nipple necrosis, either partial or total, was 6.6 % (561 of 8438 ). Significant heterogeneity was found among the published studies and patient selection was affected by tumor characteristics.<br /> <strong>Conclusion:</strong>There is growing evidence that NSM has been marked as oncologically safe in women with small, peripherally located tumors, without multicentricity, or when performed as a prophylactic mastectomy. Hence, NSM has been recommended only if carefully selected for a particular group of patients.<br /> <strong> </strong>
mastectomy,Recurrence,NSM,NAC
https://ejhm.journals.ekb.eg/article_13962.html
https://ejhm.journals.ekb.eg/article_13962_dc4236d49edbe01bfd0b9fd48e933ca8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Chronic Hepatitis C Treatment: A Systematic Review
305
313
EN
Aishah Mohammed
Alenezi
Northern Border University
Abdulaziz Hassan Mohammed
Al-Fakih
Hadhramout University
Sultan Mohammed
Al-Afif
Hadhramout University
Abdulkarem Mohammed
Al-Afif
Hadhramout University
Bashayer Abbas
Habib
Almaarefa Colleges
<strong>Background:</strong> Chronic hepatitis C (CHC) infection affects almost 3% of the global population and can lead to cirrhosis, liver failure, and hepatocellular carcinoma in a significant number of those infected. Thus, there is a complelling need to develop and introduce new therapeutics with a direct-acting antiviral effect in order to target various stages of the HCV lifecycle for HCV eradication without concomitant interferon.<br /> <strong>Study Objective:</strong> to provide treatment recommendations for chronic HCV for specialists and generalists based on published evidence.<br /> <strong>Methods:</strong> A literature search of Web of Science, Scopus, Embase, Agricola, Cochrane Library, Cinahl Plus, Google Scholar, and Oaister was conducted from 1990 to 2016, records were filtered according to the Inclusion criteria and 27 hits were yielded.<br /> <strong>Results:</strong> Hepatitis C virus genotype 1 is more difficult to cure than genotype 2 or genotype 3. Patients with HCV genotype 1 should receive treatment with sofosbuvir + pegylated interferon + ribavirin because of the shorter duration of therapy and high rates of SVR (89%-90%). Simeprevir + pegylated interferon + ribavirin is an alternative for patients with HCV genotype 1 (SVR, 79%-86%). Patients with HCV genotypes 2 and 3 should receive therapy with sofosbuvir + ribavirin alone (SVR for genotype 2, 12 weeks’ duration: 82%-93%; SVR for genotype 3, 24 weeks’ duration, 80%-95%). Patients with HIV-HCV coinfection and patients with compensated cirrhosis (ie, cirrhosis but preserved synthetic liver function) should receive the same treatment as HCV-monoinfected patients. <strong>Conclusion:</strong> A growing body of evidence suggests that recently developed HCV combined treatment modalities have transformed chronic HCV into a routinely curable disease being relatively available and well tolerated ,which can potentially reduce the need for liver transplantation and reduce HCV-related mortality. Treatment protocol for genotype1 is based on a combined regimen of Pegylated interferons with ribavirin and sofosbuvir or simeprevir while Sofosbuvir with ribavirin alone should be used to treat patients infected with HCV genotypes 2 and 3. Patients coinfected with human immunodefiency virus and HCV genotype 1 should be treated for HCV with pegylated interferons, ribavirin, and sofosbuvir by a physician with experience in treating this particular group of patients and familiar with potential drug interactions.<br />
hepatitis C,Treatment,SVR,HCV genotype,simeprevir,Ribavirin
https://ejhm.journals.ekb.eg/article_13967.html
https://ejhm.journals.ekb.eg/article_13967_2edc03d3a2c8f424d17d3ff8d7f84cb0.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Histological and Histochemical Studies on The Alimentary Canal of Spur-Winged Lapwing Vanellus spinosus
314
321
EN
Fatma M.A.
Taki-El-Deen
Department of Biological and Geological Sciences, Faculty of Education,
Ain Shams University – Egypt
<strong>Aim of the work:</strong> The present study aims to describe and compare between the different parts of the alimentary canal of Spur-winged lapwing <em>Vanellus</em><em> spinosus</em> from the histological and histochemical reviews.<br /> <strong>Materials and methods:</strong> This animal was caught from its natural habitat (Nile Delta in Egypt); dissected and the alimentary canal was fixed in the suitable fixatives for histological and histochemical investigations.<br /> <strong>Results:</strong> Histological findings revealed that the alimentary canal wall in different parts under investigation is consisted of four main layers which are; serosa, muscularis, submucosa and mucosa. The serosa is composed of simple squamous epithelium. The muscularis is formed of outer circular and inner longitudinal muscle fibers. The submucosa is showing green colour with Masson’s stain due to its content of connective tissue. The mucosal folds of oesophagus are characterized by stratified squamous epithelium. At the base of these folds, oesophageal glands which secrete acid mucopolysacchride are located. The stomach composed of two parts; cardiac (glandular) and pyloric (muscular). The gastric glands of glanular portion are differentiated into deep and superficial gastric glands. The deep gastric glands are of compound-branched alveolar and have neutral mucopolysacchride secrections. While, the superficial gastric glands are of compound tubular type and secreting acid and neutral mucopolysacchride since they give blue and red colours with Alcian PAS stain. The gastric glands in muscular portion of stomach, are compound tubular type and have acid and neutral mucopolysaccharides. The mucosal villi of duodenum and ileum are characterized by tubular glands (crypts of Leiberkhün), which contain acid and neutral mucopolysaccharides. The mucosal layer of rectum is covered by simple columnar epithelium containing goblet cells in addition to the rectal glands. This layer nature is acid and neutral mucopolysaccharides. The histochemical results showed differences in the stainability and distribution of polysaccharides, acid and neutral mucopolysaccharides in different parts of alimentary canal of investigated animal.<br /> <strong> </strong>
Bird,Spur-winged lapwing,alimentary canal,histology,histochemistry
https://ejhm.journals.ekb.eg/article_13970.html
https://ejhm.journals.ekb.eg/article_13970_7e04a43aa9a8a358f46e6d212dccbe8c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
The Effect of Amoxicillin on The Fetuses of Albino Mice
322
329
EN
Sahar A.
Sabry
Department of Biological and Geological Sciences,
Faculty of Education, Ain Shams University
Heba I.
Rashad
Department of Biological and Geological Sciences,
Faculty of Education, Ain Shams University
<strong>Introduction: </strong>The present study was carried out to evaluate the effect of the beta-lactam antibiotic amoxicillin on the fetuses of albino mice from the morphological and skeletal points of view.<br /> <strong>Material and methods</strong>: Twenty four adult pregnant mice were used in the present study. They were allocated into 3 groups (8 mice each). The first group served as a control and were injected intraperitoneally (i.p.) with the solvent of the drug and the second and third groups were treated with 205 and 820 mg/kg body weight of amoxicillin for 8 days (gestation days 7-14), respectively.<br /> <strong>Results:</strong> The morphological examination of the fetuses of treated groups showed growth retardation of mice fetuses as represented by the conspicuous decrease in the average body weight and body length in the two treated groups. No external malformations were recorded among fetuses maternally treated with the low dose of the drug. On the other hand, the fetuses maternally treated with the high dose showed mild external morphological malformations. In addition, the skeleton of the two treated groups exhibited incomplete ossification in most skeletal elements.<br /> <strong>Conclusion:</strong> The beta-lactam antibiotic amoxicillin had exerted mild morphological malformations and skeletal abnormalities in mice fetuses maternally treated during organogenesis period of gestation.<br /> <strong> </strong><br />
amoxicillin,Morphology,Skeleton,Fetuses of albino mice
https://ejhm.journals.ekb.eg/article_13973.html
https://ejhm.journals.ekb.eg/article_13973_50a317b0f7a6bdb33e2895889d5844fb.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Assessment of the Physiological Changes Induced by Sodium Nitrite, Annatto or Mono Sodium Glutamate in Male Albino Rats
330
335
EN
Eman G.E.
Helal
https://orcid.org/0
Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Egypt
emanhelal@hotmail.com
Rasha A.A.
El-Sayed
Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Egypt
Mariam S.
El-Gamal
Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Egypt
<strong>Background:</strong> food additives are added to most junk and fast foods, especially those for kids. Sodium nitrite is an inorganic salt with widespread applications in the food industry as a color fixative and preservative in meat and fish. Annatto extract is a natural food color obtained from the outer coatings of the seeds of the Annatto tree (<em>Bixa orellana L</em>.). Monosodium glutamate (MSG), the sodium salt of amino acid glutamate, is a food additive that popularly used all over the world as “flavor enhancer”. <strong>Aim of the work:</strong> this study was aimed to determine the hazardous effects of sodium nitrite, annatto and monosodium glutamate on some physiological parameters in male albino rats. <strong>Materials and methods: </strong>this studyhad been done on fourty male albino rats with an average body weight 100-145 g. The animals were divided into four groups; <strong>Group 1: </strong>control (untreated group),<strong> Group 2:</strong> sodium nitrite treated group < strong>, Group 3: annatto treated group and <strong>Group 4:</strong> monosodium glutamate treated group. Blood samples were collected, sera were separated and used for estimation of some biochemical parameters (liver enzymes, kidney functions, glucose, protein profile and lipid profile) and hormonal levels [testosterone, T3 (triiodothyronine) and T4 (thyroxine<strong>)</strong>]. <strong>Results:</strong> the biochemical results showed an increase in the activities of liver enzymes [aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT)], and the levels of glucose, kidney functions (urea, and creatinine), lipid profile [total cholesterol, triglycerides, low density lipoprotein (LDL-C)] and thyroid hormones [thyroxin (T4) and triiodothyronine (T3)] in all treated groups when compared to the control group. A drop in protein profile (total protein, albumin, globulin and A/G ratio), testosterone hormone and HDL level were observed in the treated groups as compared to the control rats.<strong> Conclusion:</strong> it could be concluded that some food additives like sodium nitrite, annatto, and monosodium glutamate have extreme effects on liver and kidney functions, protein and lipid profiles and also on thyroid and testosterone hormones. So, it is recommended to minimize the use of these additives to protect young children and mature people from these destructive effects.<br /> <strong> </strong>
Sodium Nitrite,annatto (Bixa orellana),monosodium glutamate (umami),Liver and kidney functions
https://ejhm.journals.ekb.eg/article_13979.html
https://ejhm.journals.ekb.eg/article_13979_adcc37672497313aff4b7a553220e820.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Protective Effect of Morin against Flutamide-Induced Hepatotoxicity in Mal Wister Rats
336
343
EN
Mazhar
F. M.
Department of Zoology, Faculty of women for Arts, Science & Education,
Ain Shams University, Cairo, Egypt
Kadry S. M., Hala F.
Abd-Ellah
Department of Zoology, Faculty of women for Arts, Science & Education,
Ain Shams University, Cairo, Egypt
Hala F.
Abd-Ellah
Department of Zoology, Faculty of women for Arts, Science & Education,
Ain Shams University, Cairo, Egypt
Hend A.
Sabry
Department of Zoology, Faculty of women for Arts, Science & Education,
Ain Shams University, Cairo, Egypt
Saleh
A. S.
Department of Zoology, Faculty of women for Arts, Science & Education,
Ain Shams University, Cairo, Egypt
<strong>Aim of the work</strong>: The aim of this work was to investigate the protective role of morin against the hepatotoxic effect of flutamide (FLU) that is widely used drug for treatment of metastatic prostate adenocarcinoma. Administration of FLU to male rats in a dose of 100 mg/ kg b.w. daily for 4 weeks resulted in serious hepatic injury.<br /> <strong>Materials and Methods:</strong> Male Wistar rats were equally divided into six experimental groups (n = 10): Group I (control group) received appropriate vehicle (carboxy methyl cellulose, CMC) for 8 weeks, Group II (CM group) received CMC for 4 weeks then morin for another 4 weeks, Group III ( M group) were treated with morin for 8 weeks, Group IV (CF group) received CMC for 4 weeks then FLU for another 4 weeks, Group V (CMF group) received CMC for 4 weeks then morin for another 4 weeks then received morin associated with FLU for additional4 weeks and Group VI (MMF group) was pretreated with morin for 4 weeks then treated with morin simultaneously with FLU for additional 4 weeks.<br /> <strong>Results:</strong> In FLU treated rats, highly significant increases in each of serum ALT, AST, direct and total bilirubin as well as hepatic MDA were observed relative to the control group. Moreover, highly significant decrease in hepatic SOD, GSH and GST activities were observed. On the other hand, administration of morin with FLU resulted in mild and marked reduction in the elevated serum ALT, AST, direct and total bilirubin and hepatic MDA levels induced by FLU intoxication, respectively (regardingco-treatment and pretreatment with FLU).<br /> <strong>Conclusion:</strong>These data showed protective effect of morin against FLU-induced hepatic damage, especially when administered prior to and concomitantly with FLU.<br /> <strong> </strong>
Flutamide,Morin,Hepatotoxicity,Lipid peroxidation and Antioxidatant activity
https://ejhm.journals.ekb.eg/article_13987.html
https://ejhm.journals.ekb.eg/article_13987_7290fea91d92cdc50f57eabeeaf253e2.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Adverse Effects of Two Kinds of Food Additive Mixtures (Flavor Enhancer, Food Preservative or Food Coloring Agent) on Physiological Parameters in Young Male Albino Rats
344
351
EN
Eman G.E.
Helal
https://orcid.org/0
Department of Zoology, Faculty of Science (Girls), Al-Azhar University
emanhelal@hotmail.com
Rasha A.A. El-Sayed, Mohamed A.
Mustafa
Basic Centre of Science, Misr University for Science and Technology, Egypt
Mariam S.
El-Gamal
Department of Zoology, Faculty of Science (Girls), Al-Azhar University
<strong> Background: </strong>food additives are substances used in food industry in order to improve the food’s taste, appearance by preserving its flavor and preventing it from souring. Food additives are added to the most junk and fast foods, especially food for kids.<br /> <strong>Aim of the work:</strong> this work was aimed to investigate the adverse effects of some food additives on the biochemical parameters in addition to study the side effects of these food additives in male albino rats.<br /> <strong>Materials and Methods: </strong>this study was performed on twenty four young male albino rats with an average 120-145 g body weight. Animals were divided into four groups (6 /cage);<strong> Group I</strong> (Control untreated group), <strong>Group II</strong> (administered orally with sodium nitrite (0.1 mg/kg b.wt./day) and annatto (0.065 mg/kg b.wt./day)), <strong>Group III</strong> (administered orally with sodium nitrite (0.1 mg/kg b.wt./day) and monosodium glutamate (MSG) (15 mg/kg b.wt./day)) and <strong>Group IV</strong> (administered orally with annatto (0.065 mg/kg b.wt./day) and monosodium glutamate (15 mg/kg b.wt./day)). Blood samples were collected on the last day of experiment, for biochemical estimations which included levels of serum glucose, total protein (TP), albumin, creatinine, urea, testosterone , thyroid hormones (T3 and T4), activities of AST and ALT in addition to lipid profile.<br /> <strong>Results:</strong> showed marked elevation in levels of fasting glucose, activities of AST, ALT, urea, creatinine, total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-C), VLDL and ratios of TC/HDL-C and LDL-C/HDL-C (risk factors) as well as albumin / globulin ratio and serum thyroid hormones (T3 & T4) accompanied with marked decline in levels of serum total proteins, albumin, globulin, albumin/ creatinine ratio, testosterone and HDL-C in all treated groups in comparison to the control group. There was a significant reduction in the body weight in groups that received (NaNO2 with annatto) and (MSG with NaNO2) while treated rats with (MSG and annatto) showed a significant increase in body weight as compared to control rats.<br /> Conclusion:Due to the harmful effects of food additives, the use of these compounds must be limited as it resulted in a vehement disturbance in the biochemical and physiological parameters that was grievously pronounced on many hormones.<br /> <strong> </strong><br />
food additives,thyroid hormones,Monosodium glutamate,biochemical parameters,Coloring agent
https://ejhm.journals.ekb.eg/article_13988.html
https://ejhm.journals.ekb.eg/article_13988_46e830716453bc6ce4292116354ed640.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Biochemical and Genetic Studies on Inhibin as a Hormonal Candidate in Prediction and Diagnosis of Premature Ovarian Failure in the Egyptian Women
352
358
EN
Azza M.
El-Wakf
Zoology Department, Physiology Division, Faculty of Science, Mansoura University, Egypt
Amal K.
Selim
Biochemistry Department Faculty of Medicine, Mansoura University, Egypt
Abdel Aziz
El-Refaay
Obstetrics and Gynecology department, Faculty of Medicine, Mansoura University, Egypt
Hosam Abdel-
Fatah
Obstetrics and Gynecology department, Faculty of Medicine, Mansoura University, Egypt
Shimaa M.
Saad
Zoology Department, Physiology Division, Faculty of Science, Mansoura University, Egypt
<strong> Background</strong>: Recent studies have implicated a role for inhibin alpha (<em>INH</em>α) gene abnormalities in the etiology of premature ovarian failure (POF).The present study aimed at demonstrating the possibility that -16C>T polymorphism of <em>INHα</em> gene may enhance susceptibility to this disease among Egyptian women undergoingt <em>in-vitro</em> fertilization(<em>IVF</em>) technique.<br /> <strong>Methods:</strong> A total of 50 POF Egyptian women at age (31.5±7.3) and 50 control women at age (29.1 ± 6.8) were included in this study. Genotyping of <em>INHα</em>-16C>T gene was performed by restriction fragment length polymorphism. Levels of inhibin, activin, FSH and LH were also assessed.<br /> <strong>Results</strong>: Serum levels of FSH and LH showed significant increase coupled by decrease in serum inhibin and inhibin/activin ratio, however, levels of activin were within normal values in POF women comparing to control ones. The frequencies of CC, CT and TT genotypes showed no significant changes in POF women compared to control group. Moreover, there were no significant differences in frequency of C and T alleles among the POF women in comparison to controls.<br /> <strong>Conclusion:</strong> Obtained data indicated that -16C>T polymorphism of <em>INHα</em> gene can not imply a functional effect on the current decline of serum inhibin and hence the risk of developing POF in the studied Egyptian women. Further studies on POF women are needed to expand the present data.<br /> <strong> </strong>
Premature ovarian failure (POF),Inhibin,Activin,INHα gene polymorphism
https://ejhm.journals.ekb.eg/article_13991.html
https://ejhm.journals.ekb.eg/article_13991_c41ff806135c6ea728ba2f6a271efe87.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Comparative Microscopic Study on the Tongue, Oesophagus and Stomach of Two Different Birds in Egypt
359
365
EN
Fatma M.A.
Taki-El-Deen
Department of Biological and Geological Sciences, Faculty of Education
, Ain Shams University – Egypt
<strong>Aim of the work: </strong>The present investigation aims to compare between the tongue, oesophagus and stomach of two birds in Egypt having different food habits.<br /> <strong>Materials and methods: </strong>The animals under investigation are Whimbrel (<em>Numenius phaeopus</em>) and domestic duck (<em>Anas platyrhnchos</em>). These birds were caught from Abou-Rawash Constituency and Nile Delta in Egypt. The birds were dissected the tongue, oesophagus and stomach were fixed and stained for the microscopic comparative study.<br /> <strong>Results: </strong>Histological results of this study found that the tongue of each bird (Whimbrel and domestic duck) is composed of three layers; mucosa, submucosa and muscularis. No lingual papillae are observed. The mucosal layer consists of stratified squamous epithelium. This layer in <em>Numenius phaeopus</em> is thicker than in <em>Anas platyrhnchos</em>. The submucosa is constructed from connective tissue. The muscularis is represented by bundles of muscle fibers extending in different directions. The lingual glands of <em>Anas platyrhnchos</em> are of compound alveolar type and have neutral mucopolysacchride content.<br /> The muscularis of the oesophagus consists is consisting of outer circular and inner longitudinal muscle fibers. This layer is thick and well represented in <em>Anas platyrhnchos</em> than in <em>Numenius phaeopus</em>. The mucosal folds have stratified squamous epithelial cells. Oesophageal tubulo alveolar glands have acid mucopolysacchride content in<em> Numenius phaeopus</em> and neutral mucopolysacchride content in<em> Anas platyrhnchos</em>. The stomach in each bird (Whimbrel and domestic duck) is differentiated into glandular and muscular portions. The gastric glands of the glandular portion are differentiated into deep and superficial gastric glands. The muscularis of the muscular portion in the investigated birds is composed of circular and longitudinal muscle fibers. This layer in <em>Anas platyrhnchos</em> is thicker than in <em>Numenius phaeopus</em>. The mucosal layer in <em>Anas platyrhnchos</em> has thick tough keratin-like layer (cutica gastrica). The mucosal glands in the investigated birds have acid and neutral mucopolysacchride content.<br /> The histological and histochemical results showed differences in the tongue, oesophagus and stomach between the investigated birds.<br /> <strong> </strong>
Bird,whimbrel,domestic duck,Tongue,alimentary canal,histology,histochemistry
https://ejhm.journals.ekb.eg/article_13994.html
https://ejhm.journals.ekb.eg/article_13994_28759bc11e1b2cae39d18c16b6a74fb6.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Histological and Ultrastructural Studies on the Effect Amoxicillin on the Stomach of Mouse Fetuses
366
376
EN
Sahar A.
Sabry
Department of Biological and Geological Sciences, Faculty of Education, Ain Shams University
<strong>Introduction:</strong> B-Lactam antibiotics are widely used because of their lack of toxicity in humans. However, during pregnancy, exposure of the fetus is likely to occur due to b-lactam antibiotics cross the placenta. The potential adverse effects of amoxicillin were examined in stomach of mice fetuses.<br /> <strong>Material and Methods:</strong> This study was aimed to evaluate the possible side effects produced by amoxicillin prenatal administration on the stomach of fetuses.<br /> Twenty pregnant mice were used in this study; and were divided into two groups: the first group served as a control group and injected by saline solution (the drug solvent); the second group treated with amoxicillin dose of 205 mg/kg body weight. The treatment was daily administered interperitoneally, from the 7<sup>th</sup> day of gestation till the 14<sup>th </sup>day of gestation (GDs 7-14). The developing 19-days old fetuses were examined histologically and ultrastructurally to determine any disorders in the stomach.<br /> <strong>Results:</strong> This study illustrated marked deleterious consequences in the gastric wall of 19 day old fetus, following the treatment with amoxicillin, ranging from marked vacuolations and erosions in the epithelial and glandular cells of the gastric mucosa to conspicuous necrosis of glandular (parietal and zymogenic) cells. The electron microscopical examination of the gastric mucosal cells of fetuses maternally treated with amoxicillin, revealed conspicuous alterations, in the cytoplasmic organelles of gastric mucosal cells (surface epithelial, peptic and parietal cells). The cisternae of RER were dilated and fragmented. The mitochondria displayed gradual devastations.<br /> <strong> Conclusions:</strong> Therefore, the destructive impacts of amoxicillin on the stomach of mice fetuses indicated that it should be used under restricted precautions in the medical fields to protect the pregnant women from its hazardous impact.<br />
amoxicillin,Stomach,histology,Ultrastructure,Mice fetuses
https://ejhm.journals.ekb.eg/article_13997.html
https://ejhm.journals.ekb.eg/article_13997_62ed0339338740fd9e14aca0ac27f739.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Optical Biometry versus Applanation Ultrasound Biometry in Axial Eye Length Measurement in Pseudophakia
377
381
EN
Hayam Sayed
Kamel
Ophthalmology Department, Faculty of Medicine (for Girls) , Al – Azhar University, Cairo, Egypt
<strong>Purpose</strong>: to compare axial eye length (AEL) measurement in pseudophakic eyes by optical biometry and applanation ultrasound (u/s) biometry.<br /> <strong>Methods</strong>: a prospective, case controlled and comparative study was performed at Al-Zahraa University Hospital clinic from (January 2016 – December 2016). In total 45 eyes were enrolled; 24 pseudophakic eyes were attending the clinic for routine post operative follow up; and 21 eyes with clear crystalline lens as a control group. AEL was measured in both groups using both optical biometry and applanation u/s biometry.<br /> <strong>Results & Conclusions: </strong>both optical biometry andapplanation u/s biometry show no significant difference in AEL measurement in pseudophakic eyes as well as the control group.<br /> <strong> </strong>
Pseudophakia,Ultrasound biometry
https://ejhm.journals.ekb.eg/article_13998.html
https://ejhm.journals.ekb.eg/article_13998_5e81051968c4ef6fd24ecad7aefb7a5d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2017
04
01
Therapeutic Effects of an Ethanolic Olive Leaves Extract or Bone Marrow Mesenchymal Stem Cells against Liver Injury Induced by Gamma Radiation
382
391
EN
Samir Attia
Zahkouk
Department of Zoology, Faculty of Science (for boys), AL-Azhar University
Hanan Ahmed
El-kabany
National Centre for Radiation Research and Technology, Atomic Energy Authority (AEA),
Eman Mohammed Hassona
Dawoud
Department of Zoology, Faculty of Science (for girls), AL–Azhar University, Cairo, Egypt.
10.12816/0036652
<strong>Background: </strong>Ionizing radiation absorption causes immediate biochemical, sub cellular and cellular damage, while its morphological expression and organ dysfunction are often considerably delayed. This study was aimed to investigate the possible therapeutic effects of ethanolic olive leaves extract or bone marrow derived-mesenchymal stem cells (BM-MSCs) transplanted in the liver of rats exposed to gamma radiation. For this purpose, hematological and biochemical parameters were determined
<strong>Materials and methods</strong>: 50 adult male albino rats (Sprague dawely strain) were used in this study. They were divided into 5 groups (C group: Untreated control rats; R group: rats exposed to a single dose of gamma-radiation (6 Gy), OLE group: rats treated with olive leaves extract (15 mg /kg body weight / day for 30 days), R+OLE group: animals of this group were irradiated with 6Gy then treated with OLE(15 mg /kg body weight/ day) after 3 hours post irradiation for 30 days. and R+MSCs group: Mesenchymal stem cells-irradiated animals (MSCs +R): animals of this group were irradiated with 6Gy then injected after 6hours post irradiation with (BM-MSCs) 3×10<sup>6</sup> cells/ml suspension through caudal vein . All these groups were subjected to hematological and biochemical investigations.
<strong>Results</strong>: Hematological and liver function changes were shown in gamma irradiated rats, these changes included a significant depression in hematological parameters of blood such as (RBCs, Hb, Hct and WBCs)and a significant increase in liver parameters (ALT,AST and ALP) at different intervals of the experiment in comparison with the control group. These changes manifested good amelioration in the exposed groups by using either olive leaves extract (OLE) or bone marrow mesenchymal stem cells (BM-MSCs). <strong>Conclusion:</strong> Ethanolic olive leaves extracts and mesenchymal stem cells have ameliorated hematological and biochemical parameters changes in liver of the irradiated group. their actions may be due to their anti-inflammatory and antioxidant properties.
<strong> </strong>
gamma radiation,liver- Ethanolic olive leaves extract (OLE),Bone marrow mesenchymal stem cells (BM-MSCs)
https://ejhm.journals.ekb.eg/article_14002.html
https://ejhm.journals.ekb.eg/article_14002_b275999d810cf356b091781d215aa4f1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Assessment of Endovascular Management of Extracranial Internal Carotid Artery Stenosis
392
396
EN
Ayman H.
El Sudany
Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
aymanhsudany@gmail.com
Amira A.
Zaki
Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
M. Ossama
Abdulghani
Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Azza
Abdel Naser
Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Salma H.
Khalil
Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Ahmed
El Bassiouny
Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
<strong>Background:</strong> carotid artery stenting (CAS) had become widely used as an alternative to carotid endarterectomy (CEA) in revascularization therapy of carotid artery stenosis, especially in some high risk patients for surgical intervention<strong>.</strong><br /> <strong>Objective: </strong>the purpose of this study was to evaluate the outcome and follow up of cases that undergo extracranial CAS at the Neuroendovascular Unit of Ain Shams University Hospital.<br /> <strong>Methods: </strong>during a 30 month period, 50 cases were enrolled and underwent carotid artery stenting with open cell (Protégé® - EV3) or closed cell (Wall stent® - Boston scientific) stents. A filter device for embolic protection (Spider filter® - EV3) was used. Clinical assessment with the National Institute of Health Stroke Scale (NIHSS) together with post procedural diffusion-weighted magnetic resonance imaging (DW-MRI) was used to determine cerebral embolization.<br /> <strong>Results: </strong>CAS was performed in 50 cases; 40 (80%) symptomatic and 10 (20%) asymptomatic . A similar number of open-cell and closed-cell stents were used. New acute cerebral emboli were detected with DW-MRI in 12% (6/50) of cases after the procedure. Three (3/50) cases (6%) showed corresponding clinical deterioration in NIHSS; two cases developed minor stroke and the third case developed a major stroke.<br /> <strong>Conclusion: </strong>CAS at Ain Shams Neuroendovascular Unit showed a high technical success rate and good short term clinical outcome.<br /> <strong> </strong>
Carotid artery stenting (CAS),brain DW-MRI,NIHSS
https://ejhm.journals.ekb.eg/article_14004.html
https://ejhm.journals.ekb.eg/article_14004_dd5ec491cdeaf33b877a7639de3ba1a4.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Fecal Lactoferrin as a New Marker of Disease Activity in Inflammatory Bowel Diseases
397
406
EN
Mohammed Nabil
Rafat
Internal Medicine Department
Atef Abo Al-fotouh
Ibrahem
Internal Medicine Department
Abd-ELgawad Saied
Mohammed
Internal Medicine Department
Mohammed
Al-Shahawey
Internal Medicine Department
Mohammed Salah
Ali
Internal Medicine Department
dr_msalahali@azhar.edu.eg
Wael Refaat
Hablus
Clinical Pathology Department, Faculty of Medicine - Al-Azhar
Amr
Abd El-Aziz
Clinical Pathology Department, Faculty of Medicine - Al-Azhar
<strong> Background: </strong>Inflammatory bowel diseases (IBD) including ulcerative colitis (UC) and Crohn's disease (CD) are organic inflammatory diseases, caused by chronic mucosal inflammation of the gasrtointetinal tract. As the presenting manifestations of IBD and other diseases are similar, obtaining a clinical diagnosis can be difficult, and further invasive diagnostic procedures may be required in order to obtain a confirmed diagnosis. The aim of this study is to evaluate the diagnostic utility of measuring fecal concentrations of lactoferrin as a simple and noninvasive indicator of disease activity in patients IBD and to be correlated with endoscopic findings and disease activity index and acute inflammatory response including leucocytic count, high sensitive CRP, ESR. <strong>Methods: </strong>This study was carried on 40 patients with IBD; 24 patients with active IBD (16 UC patients and8 CD patients) and 16 patients with inactive IBD (10 UC patients and 6 CD patients) versus 40 healthy controls. All patients underwent blood and stool sampling as well as an interview to assess the disease severity utilizing UC activity measured by the Truelove and Witts Severity Index and Crohn's Disease Activity Index. Measurement of FLA levels at different stages of inflammatory bowel disease activity to detect its role in assessment of disease severity. <strong>Results: </strong>This study showed that FLA levels were highest in patients with IBD in comparison with healthy group. FLA levels also correlated significantly with disease severity in patients with IBD where higher levels of FLA were found in patients with severe UC or Crohn`s disease. At cutoff value 9.68 ug/ml FLA showed 100% sensitivity and specificity in identification of patients with IBD from healthy subjects.<br /> <strong>Conclusions: </strong>FLA is a sensitive and specific biochemical marker of inflammation for use in the diagnosis of suspected IBD cases, and its level correlates well with both clinical disease activity indices.<br /> <strong> </strong><strong> </strong>
inflammatory bowel disease,ulcerative colitis,Crohn's Disease,Fecal lactoferrin
https://ejhm.journals.ekb.eg/article_14007.html
https://ejhm.journals.ekb.eg/article_14007_2eeff5452a5eca6fb00a43f6a6b934a1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
A Review of β-Thalassemia in Saudi Arabian Children
407
414
EN
Jassim Mohammed Ali
Aljaryan
Pediatric Department, Maternal and Child Hospital, Dammam
Beta-Thalassemia being particularly prevalent in the Mediterranean region. Thalassemia syndromes are common in Saudi Arabia: the Beta-Thalassemia genes occur with variable frequency in different regions of Saudi Arabia and both B+ and Bo thalassemia have been reported. Over the last few years, a great deal of information regarding the clinical, molecular and management of these disorders has accumulated in the literature. This paper summarizes some of the recent studies on the subject along with experience and attempt to clarify the importance of early detection and treatment β- Thalassemia in children.<br /> <strong> </strong>
thalassemia,Saudi Arabian children,blood disorders
https://ejhm.journals.ekb.eg/article_14008.html
https://ejhm.journals.ekb.eg/article_14008_6642da6aa339154f7c82d65c663a3a9b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Assessment of Left Ventricular Diastolic Function in Nonalcoholic Fatty Liver Disease
415
424
EN
Mohamed Elhussein Mohamed Ali
Elnahas
Departments of Cardiology
mohamedalnahas@yahoo.com
Mohamed Amin
Kamal
Departments of Cardiology
Wael Refaat
Hablas
Clinical Pathology
Raed Elsayed Hamed
Mansour
Tropical Medicine
Ayman Elsaid
Sadek
Departments of Cardiology
<strong>Background: </strong>nonalcoholic fatty liver disease (NAFLD) is a spectrum of fat-associated liver conditions that can result in end stage liver disease<strong>. </strong>NAFLD patients when compared to control subjects have a higher prevalence of atherosclerosis which is independent of obesity and other established risk factors. Recent studies have identified NAFLD as a risk factor for early subclinical abnormalities in myocardial metabolism as well as in cardiac structure and function. In particular, it has been shown that NAFLD is associated with left ventricular hypertrophy and impaired diastolic function.<br /> <strong>The Objective:</strong> the aim of this study is to assess left ventricular diastolic function in NAFLD patients.<br /> <strong>Patients and Methods:</strong> the study included thirty Egyptian NAFLD patients their age between 20 and 45 years old, and twenty healthy control subjects who were age and sex matched. Full medical history, complete physical examination and laboratory tests were done in form of ALT, AST, total cholesterol, LDL, HDL, triglyceride, hemoglobin A1C, creatinine, urea and CBC. Abdominal ultrasonography and transthoracic echocardiography also were done.<br /> <strong>Results:</strong> NAFLD patients had higher diastolic blood pressures, increased body mass indices, ALT, AST and glycated hemoglobin A1C more than controls. Also in our study the mean of E, E/A ratio, DT, lateral E/eˋ and septal E/eˋ is significant higher in NAFLD patients than control group. The mean of lateral eˋ and septal eˋ is lower in NAFLD patients than control group.<br /> <strong>Conclusion: </strong>patients with NAFLD had significant impairment on diastolic function in the non-diabetic and normotensive NAFLD patients compared to the controls as measured by two-dimensional echocardiography Doppler imaging in addition to tissue Doppler imaging.<br /> <strong> </strong>
Left ventricular diastolic function,Nonalcoholic fatty liver disease,Echocardiography,Tissue Doppler
https://ejhm.journals.ekb.eg/article_14011.html
https://ejhm.journals.ekb.eg/article_14011_c67cbbffe9ba00f2328d016983a60650.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Comparison of Usefulness of Percutaneous Coronary Intervention Guided by Angiography plus Computed Tomography versus Angiography Alone and its Impact on Instent Restenosis
425
435
EN
Tarek Mounir
Zaki
Department of Cardiology, Faculty of Medicine, Ain Shams University
Yasser Gomaa
Mohamed
Department of Cardiology, Faculty of Medicine, Ain Shams University
Alaa Mahmoud
Roshdy
Department of Cardiology, Faculty of Medicine, Ain Shams University
Ahmed Mohamed
Onsy
Department of Cardiology, Faculty of Medicine, Ain Shams University
Mohamed Abdel Kader
Abdel Raheem
Department of Cardiology, Faculty of Medicine, Ain Shams University
Mahmoud Maher Abdou
Ibrahim
Department of Cardiology, Faculty of Medicine, Ain Shams University
mahmoudmaher501@yahoo.com
<strong>Background</strong>: optimal stent selection and placement would be expected to improve clinical outcomes. Coronary computed tomography angiography (CCTA) may permit better preprocedural planning.<br /> <strong>Objectives</strong>: to assess the impact of incorporating coronary computed tomography angiogaphy guidance in defining reference value for stent length and diameter on angiographic and clinical outcomes in comparison to quantitative coronary angiography and its effect on incidence of instent restenosis. <br /> <strong>Methods</strong>: the study was conducted on 153 diabetic patients with stable coronary artery disease. Patients were divided into two groups: group A and group B according to PCI guidance either with quantitative computed tomography angiography (QCTA) datasets or quantitative computed tomography (QCA) datasets respectively. Follow up clinically for six months to assess incidence of major adverse cardiac events (MACE) and angiographically by coronary angiography at six months or before if clinically indicated to assess incidence of instent restenosis (primary end point).<br /> <strong>Results</strong>: QCTA was associated with longer lesions (p=0.001) and larger reference vessel diameter (p=0.001) than that measured by invasive QCA in group A. No statistical significant difference between group A and group B regarding restenosis rate, minimum lumen diameter at follow up and incidence of MACE.<br /> <strong>Conclusions</strong>: CCTA guided percutaneous coronary intervention (PCI) is a safe and effective strategy for treatment of coronary artery disease however it didn't add a beneficial role in reducing incidence of instent restenosis or MACE in comparison to angiographic guidance alone.<br /> <strong> </strong>
CCTA,PCI,Instent restenosis
https://ejhm.journals.ekb.eg/article_14013.html
https://ejhm.journals.ekb.eg/article_14013_bff55abd15d771c2c83d2ea285ea3740.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Axial Eye Length Assessment in Silicone Oil-Filled Eyes
436
438
EN
Hayam S.
Kamel
Ophthalmology department, Faculty of Medicine (For Girls), Al Azhar University
Mona N.
Mansour
Ophthalmology department, Faculty of Medicine (For Girls), Al Azhar University
mansour04@hotmail.com
<strong>Purpose: </strong>to compare the reliability of axial eye length (AEL) measurement in silicone oil-filled phakic eyes by conventional B-scan ultrasonography through the eyelid, after a correcting factor,to partial coherence interferometry (PCI) measurement.<br /> <strong>Methods: </strong>a prospective and comparative study was performed at Al-Zahraa University Hospital clinic from (January 2016 - December 2016). In total 13 phakic eyes of 13 patients who underwent vitrectomy and silicone oil filling were enrolled into the study. AEL was measured by B-scan and compared to measurement by PCI.<br /> <strong>Results & Conclusions: </strong>there was no significant difference in AEL measurement by either B-scan ultrasonography through the eyelid, after a correcting factor, and PCI.<br /> <strong> </strong><br />
Silicone Oil,Optical biometry,B-scan ultrasonography
https://ejhm.journals.ekb.eg/article_14015.html
https://ejhm.journals.ekb.eg/article_14015_767554c3761c26e652f863f9f44dc6a9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
A Case report: Aggressive Fibromatosis in a One-year Old Child
439
443
EN
Mohammad T.
Melibary
East Jeddah General Hospital, Jeddah, Saudi Arabia
Talal
Al-Khatib
Department Of Otolaryngology-Head & Neck Surgery, Faculty of Medicine,
King Abdulaziz University
Saad
Almuhayawi
Department Of Otolaryngology-Head & Neck Surgery, Faculty of Medicine,
King Abdulaziz University
Fadwa J.
Altaf
Department of Pathology , King Abdulaziz University
Aggressive fibromatosis, also defined as desmoid tumor, is an uncommon tumor. A review of literature detected less than 100 cases that have been reported of pediatrics aged 16 years or younger with aggressive fibromatosis in the head and neck. In this study we report a 1-year old girl who presented with an oral mass . The clinical , radiological, the histopathological features, and treatment are discussed .<br /> <strong> </strong>
aggressive fibromatosis,desmoids tumor,Pediatric,and head and neck
https://ejhm.journals.ekb.eg/article_14018.html
https://ejhm.journals.ekb.eg/article_14018_a7f365672c3aef818fb84aed2cce018e.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Ameliorative Potential of Selenium against Bisphenol A- Induced Hepatotoxicity in Rats
444
454
EN
Hany A.
Abdel Samie
Dept. of Zoology, Faculty of Science, Menoufia University
hanyabdelsamei@yahoo.com
Samir A.
Nassar
Zoology Department, Faculty of Science, Zagazig University, Zagazig
Youssef
Hussein
Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
<strong>Background</strong>: environmental pollutants affect various tissues. Bisphenol A, a compound used in making epoxy resins and polycarbonate plastics<strong>,</strong> induces many hazardous effects. <strong>Aim of the work:</strong> this work was designed to test the ameliorative potential of selenium against hepatotoxicity caused by bisphenol A.<br /> <strong>Materials and Methods:</strong> male rats were divided into four groups. Group 1 served as control, group 2 given sodium selenite, group 3 was administered with suspension of bisphenol A that is dissolved in corn oil. Rats of group 4 were administered with selenium plus bisphenol A. Liver specimens and blood samples were inspected after 3 and 6 weeks of treatment.<br /> <strong>Results</strong>: there was no statistical difference between control and selenium -administered rats in all parameters. Rats treated with bisphenol A suffered significant depression in weight whereas selenium administration decreased the effect on rat's weight. Bisphenol A administration induced blood vessels congestion, inflammatory infiltration, bile duct proliferation, cytoplasmic vacuolization and macrosteatosis while selenium administration improved liver histopathological criteria either after 3 or 6 weeks. Bisphenol A treatment elevated nuclear PCNA and caspase-3 expression in the cytoplasm and liver function enzymes (serum AST and ALT) and bilirubin. Again, selenium ameliorated these changes. In <strong>conclusion</strong>, bisphenolA exerted deleterious impact on rats' hepatocytes and serum biochemical parameters in a time-dependent manner. Selenium supplementation provides an extent of amelioration against bisphenol A- induced hepatotocixity.<br /> <strong> </strong>
bisphenol A,selenium,histology,Immunohistochemistry,biochemistry
https://ejhm.journals.ekb.eg/article_14019.html
https://ejhm.journals.ekb.eg/article_14019_29af1d727d495f06df34b02417c02d81.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Imported Malaria in Egypt
455
458
EN
Anwar H.
Abo Hashim
Department of Parasitology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Tarek K.
Zaalouk
Department of Parasitology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mohamed Y.
Saad
Department of Parasitology, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt.
<strong>Background</strong>: With the dramatic increase in international travel among Egyptian people, the risk of malaria importation from malaria-endemic regions threatens the achievement of the malaria elimination goal of Egypt.<br /> <strong>Patients and methods: </strong>Blood samples from 700 patients were collected from different medical laboratories in Egypt from travelers to African endemic areas either Egyptians or foreigners coming to Egypt within previous 8 weeks; during period from January to December 2016. All samples were done by direct microscopic examination of the Giemsa-stained thick and thin blood smears (“gold standard”), as well as the rapid diagnostic test (RDT) (Accurate MAL-w23, Polymed) for feverish cases as a confirmatory test.<br /> <strong>Results:</strong> A total of 25;3.57%(out of 700) imported malaria cases were recorded.<em>P. falciparum </em>(15 cases,60%) and <em>P. vivax </em>(14 cases, 56%) were the two predominant species as well as one case (4%)<em>P ovale.</em> From them 4 cases had mixed<em> P.falciparum</em> and <em>P.vivax</em> and one case had<em> P. falciparum</em> and <em>ovale</em>,<br /> The cases were coming from 11 African countries and their distribution was, Sudan,11; Nigeria, 5; Ghana,3; Cameroon,1; Angola,1; Congo,1; Chad,1; Guinea,1; Togo,1; South Africa,1; and Eritrea,1case.<br /> RDT was performed for feverish (300) patients and positive results were obtained among 27 cases. Twenty five of them had parasitemia while the other two had history of past infection.<br /> <strong>Conclusions:</strong> Imported malaria infections pose an increasing challenge to the malaria elimination in Egypt. The risk of potential re-introduction of malaria into inland malaria free areas of Egypt should be urgently addressed, also the rapid diagnostic tests (RDTs), offer a useful tool for rapid diagnosis in suspected cases.<br /> <strong> </strong>
Malaria,imported,Epidemiology,Egypt,Diagnosis
https://ejhm.journals.ekb.eg/article_14024.html
https://ejhm.journals.ekb.eg/article_14024_d791a04ed8de6cb39fcf1adb85e4c6fd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
The Effect of Hormone Receptor Status on Pathological Response after Preoperative Therapy in Breast Cancer Patients
459
464
EN
Iman
Elsharawy
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University.
Erich
Solomayer
University hospital of Saarland, Homburg, Germany.
Hesham
Elghazaly
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University
Engi
Elkholy
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University
Dalia
Elsheikh
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University.
<strong>Background: </strong>The pathological complete response of preoperative therapy in breast cancer patients has been correlated with outcome and prognosis in terms of local and distant relapse. Response rates vary according to clinical and pathological prognostic factors of patients including hormone receptor status. This study was performed to assess response in terms of pathological response rates in relation to Estrogen and progesterone receptor status.<br /> <strong>Methods: </strong>This studyanalyzed99 female patients with non metastatic breast cancer who received neoadjuvant chemotherapy +/- targeted therapy during the period of April 2007 to March 2014. Patients were treated at the university hospital of Saarland in Homburg, Germany. Records were reviewed and correlation of response to Estrogen (ER) and Progesterone (PR) status was done. Response was assessed and pathological complete response was defined as absence of invasive and in situ disease in breast and axilla.<br /> <strong>Results: </strong>Out of 99 patients, 29 (29.3%) patients achieved pathological complete response (pCR). Forty two percent of tumors with negative Estrogen receptor status achieved complete response, versus 18% of ER positive tumors which was found to be of statistical significance (P value 0.009). Similarly 42.6% of tumors with negative Progesterone receptors showed pCR versus only 10% of PR positive tumors which also showed high significance (P value 0.001).<br /> <strong>Conclusion:</strong> This study confirmed that high pCR rates are achievable in ER and PR negative disease using preoperative chemotherapy. It was concluded that each of the ER, PR status significantly impact pCR rates where ER, PR negative status achieve higher pCR rates.<br /> <strong> </strong>
neoadjuvant,breast cancer,Preoperative,Pathological response
https://ejhm.journals.ekb.eg/article_14025.html
https://ejhm.journals.ekb.eg/article_14025_367fb438dac7bec38bce5e306dcbbe0b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Behavioral and Educational Interventions to Improve Asthma Outcomes in Children: A Systematic Review
465
474
EN
Fawzya
Aref
Maternity Hospital Jeddah
Abdulaziz Sulaiman B
Emam
Jeddah Center
Mohmed Salem
Basalama
King Fahad Hospital, Taibah University
Aljawharah Mohammad
Aljohani
Al Imam Muhammad Ibn Saud Islamic University
Ahmed Majed
Alghamdi
Umm Al-Qura University
Bandar Aedh
Alyami
Umm Al-Qura University
Rayan Ali
Barakat
Umm Al-Qura University
<strong>Background:</strong>Asthma, being a chronic inflammatory disease requires not only medical treatment but also complimentary healthcare, self-management strategies and interventions for the appropriate management and possible prevention of attack as well as reduction of school absences and days of restricted activity and decrease emergency room utilization.<br /> <strong>Methods:</strong>Randomized clinical trial (RCT) data reviewed for outcomes and processes associated with asthma educational and behavioral interventions provided by different types of health professionals. Thestudy group has synthesized studies that identified barriers and interventions to improve asthma symptoms and management in children through searching in MEDLINE,Cochrane EMBASE, TOXLine and CINAHL considering papers starting from 1999.<br /> <strong>Results:</strong>Physician-led interventions were most successful for outcomes related to the use of health care. Multidisciplinary teams were best in achieving symptom reduction and quality of life. Lay persons were best in achieving self-management/self-efficacy outcomes. Components most frequently employed in successful programs are skills to improve patient–clinician communication and education to enhance patient self-management. Fifty percent of interventions achieved reduction in the use of health care and one-third in symptom control. A combination approach including self-management and patient–clinician communication involving multidisciplinary team members may have the greatest effect on most outcomes.<br /> <strong>Conclusion:</strong> strong evidences suggest that the development of self-management and clinician–patient communication skills are essentially required and considered as critical factors for Asthma patients particularly children symptoms alleviation and outcomes improvement in the long term. This can be achieved by appropriate self-care, awareness programs through effectiveeducational and behavioral intervention which are crucial components associated with success across outcomes and providers.<br /> <strong> </strong>
Asthma,health education,interventions
https://ejhm.journals.ekb.eg/article_14026.html
https://ejhm.journals.ekb.eg/article_14026_265821d855bd7fd004c0a0e1bd981dec.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Common Dermatological Diseases in Saudi Arabia: A Literature Review
475
481
EN
Abdulrahman M
Albahlool
King Fahad Hospital
Bariah Yahya
Drain
Ibn Sina College
Ghayda Ghazi
Alqurashi
Ibn Sina College
Rehab Abdulmohsen Al
Ali
Alexandria University
Rawan Jabril Ahmad
Khamaj
Ibn Sina College
Areen Jibreel Ahmad
Khamaj
Ibn Sina College
Shaden Falah
Alharbi
Hail University
Nasir Fahad
Alqurashi
BMC
<strong>Background:</strong> over the last two decades, only few dermatology research papers have been published in Saudi Arabia provided the small number of experts -in this field -enlisted in higher education institutions. Hence a compelling need to review the recent publications and define the current prevalence, status and interventions needed.<br /> <strong> Objective: </strong>To present an overview of the common dermatological diseases, particularly eczema and dermatitis, in Saudi community as well as their effects and ways to mitigate them.<br /> <strong>Methods:</strong> Review of Randomized Controlled Trials (RCTs) researches conducted and published in Saudi Arabia.<br /> <strong>Results:</strong> Empirical findings revealed that Acne, Eczema and Psoriasis are the most common dermatological disorders among the Saudi community while Atopic Dermatitis was the most common mostly affecting children. In the meantime, Vitiligo emerged to be the most rampant pigmentary ailment, also viral warts appeared predominant covering up to 12% of the patients in the subject. On the other hand, dermatophytoses occurred commonly among the fungal conditions, while psoriasis arose as the most recurrent papulosquamous condition.<br /> <strong>Conclusion:</strong> The prevalence of dermatological disorders in Saudi Arabia is rather high with the issue being overlooked and deprioritized in favor of graver pathological conditions despite the significant social, psychological and quality of life impact on the patients. Thus, we recommended that proper education and awareness campaigns on skin diseases should be provided at all academic and social levels as one way of prevention and alleviation of skin diseased in Saudi Arabia.
https://ejhm.journals.ekb.eg/article_14028.html
https://ejhm.journals.ekb.eg/article_14028_bac54f4930c6b2004885f641aeb05fc7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Thyroid Dysfunction andThyroid Autoantibodies in Egyptian Patients with Systemic Lupus Erythematosus (SLE)
482
490
EN
Ayman
Abd El-Aziz
Internal Medicine Faculty of Medicine, Al-Azhar University
d.aymann.abdelaziz@hotmail.com
MostafaAbdElal
Doma
Physical Medicine &Rehabilitation Faculty of Medicine, Al-Azhar University
Abdel Hamead A.
Mohammed
Clinical Pathology andCommunity Medicine Faculty of Medicine, Al-Azhar University
Essam A.
El-Moselhy
<strong>Background</strong>: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with many clinical manifestations and immunological abnormalities. SLE and autoimmune thyroid disease are at the two endpoints of a shared immunogenetic mechanism. <strong>Aim of the study</strong>: To evaluate the link between SLE and thyroid disorders.<strong> Patients and Methods</strong>: Thirtypatients known to have SLE were recruited in this study, with ageranged from 17 to 35 years. All patients were submitted to history taking, clinical examination, and relevant laboratory investigation. <strong>Results</strong>: Thyroid disorderswere common (33.3%) in lupus patients. Hypothyroidism was the commonest (16.6%) abnormality in SLE patients then euthyroid (10.0%), and lastly hyperthyroidism (6.6%). The mean age of SLE patients was 26.1<span style="text-decoration: underline;">+</span>1.5 year. Eighty percent ofthe patientswere females. The most common SLEcharacteristics were malar flush (90.0%), photosenstivity (80.0%), fever (70.0%), and arthritis (50.0%). Mean Hb level was 9.2±0.59 g/dL. While, mean values of acute phase reactants were erythrocyte sedmentaion rate (ESR) at 1<sup>st</sup> and 2<sup>nd</sup> hour (74.3±6.6 and 121.4±5.26 mm/h, respectively) and C-reactive protein (20±6.7 mg/L). The meansof FT<sub>3, </sub>FT<sub>4</sub>, TSH, TG Ab, and anti thyroperoxidase (TPO) Abin SLE patiets were 136.6±14.1 ng/dL, 8.83±1.2 ng/dL, 4.15±1.27ng/dL, 15.12±11.15ng/dL, and 121±65.4 IU/mL, respectively. Meanwhile, 30.0% and 76.7% of SLE patients were +ve for rheumatoid factor (RF) and antineuclearAb, respectively. There were 6.7% and 16.7% of the patients +ve for thyroglobulin Ab and anti TPO Ab, respectively. The statistically significant differences parameters in SLE patients with normal and abnormal thyroid function were ESR at 1 & 2 hours, RF, and antiTPO Ab (P=0.00, 0.00, 0.03, and 0.03, respectively). The statistically significant differences parameters of demographic, clinical, and laboratory data in SLE patients with normal and subgroups of abnormal thyroid function were age, SLE duration, Hb level, RBC, WBC, PLT, and ESR at 1 & 2 hours (P=0.00, 0.00, 0.00, 0.001, 0.0001, 0.00, 0.00, and 0.00, respectively). <strong>Conclusion and Recommendation</strong>: Thyroid disordersare common in SLE patients. The most common form is hypothyrodism. Patients with SLE should be evaluated for thyroid disorders by testing FT<sub>3</sub>, FT<sub>4</sub>, TSH, TG Ab, and anti PO Abfor early detection of thyroid abnormalities. Further studies are needed to support and clarify the association between SLE and thyroid disorders.<br /> <strong> </strong><br /> <strong> </strong>
Systemic lupus erythromatosus,Clinicalmanifistations,Thyroid dysfunction
https://ejhm.journals.ekb.eg/article_14030.html
https://ejhm.journals.ekb.eg/article_14030_ba7ee1a9102c7c582f19c49cdf22b960.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Rickets among Saudi Infants in Jeddah, Saudi Arabia
491
493
EN
Ibrahim Hussain
Muzaffar
Umm Alqura University
dr.ibrahim.muzaffar@outlook.sa
Mashael Abdullah
Abdulsubhan
Batterjee Medical College
Abdulrahman Mohammedsaeed
Baqasi
Umm Alqura University
Omar Badr
Bawazir
Umm Alqura University
Renad Mousa
Aljohani
Umm Alqura University
Yazeed Waleed O
Alfadl
Ibn Sina National College
Mohammed Taha A
Alnoor
Ibn Sina National College
Akram Abdulwahed G
Atbay
Ibn Sina National College
Manar Ibrahim Y
Sangoura
Ibn Sina National College
<strong>Background: </strong>In most developing countries, nutritional rickets is a major health problem. The aim of this study was to explore the magnitude of nutritional rickets among Saudi infants, and the various clinical presentations, as well as to address the possible operating risk factors behind the disease.<br /> <strong>Methods: </strong>Cross sectional study has been conducted among Infants, aged 4 – 24 months, who were seen and evaluated, at King Abdulaziz Hospital and Oncology center, pediatrics endocrine clinic in Jeddah - Saudi Arabia, during the period from January 2015 to December 2016, and confirmed to have rickets were included.<br /> <strong>Conclusion: </strong>Infants under 2 years of age are liable to have vitamin D deficiency and rickets, if they are exclusively breast fed and having inadequate exposure to sunlight. Delayed introduction of complementary foods and malnutrition are also important contributing factors in nutritional rickets. Vitamin D deficiency can present with variety of symptoms other than musculoskeletal symptoms like recurrent acute respiratory, diarrhea and seizures.<br /> <strong> </strong>
rickets,vitamin D deficiency,Saudi infants
https://ejhm.journals.ekb.eg/article_14031.html
https://ejhm.journals.ekb.eg/article_14031_c1222781f845abf64130eeee0d8c76a3.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Clinical Presentation of Polycystic Ovary Syndrome among Saudi Arabian Women – Jeddah – Saudi Arabia
494
498
EN
Najla Abdullahh
Alsibyani
Battarjee Medical College
najla863@hotmail.com
Mohammed A
Malibary
King Abdulaziz University
Ahmad Ayed
Derham
King Abdulaziz University
Abdulrahman Abdulelah
Almnabri
Um Alqura University
a.almnabri93@gmail.com
Nuha Khalid
Jazzar
Um Alqura University
Rzan Waleed
Melibari
Um Alqura University
Reem Aaidh
Alnefayi
Ibn Sina National College
Alanoud Saed
Alnefaie
Ibn Sina National College
<strong>Background: </strong>Polycystic ovary (PCO) is a highly variable condition with a wide array of presentations. The Polycystic ovary syndrome should meet at least two of the following three criteria: oligo- or anovulation; clinical and/or biochemical signs of hyperandrogenism; polycystic ovaries on ultrasound. The prevalence of PCO is largely unknown in Saudi Arabia.<br /> <strong>Objectives: </strong>The aim of this study was to investigate the reproductive hormones levels in patients with polycystic ovary syndrome (PCOS) in addition to the effect of age and body mass index (BMI) on the hormonal findings ,ultrasound and to determine the clinical, biochemical, and etiologic features of hirsutism in Saudi females.<br /> <strong>Methodology: </strong>A cross sectional study has been conducted among total of 183 patients diagnosed with PCOS had been assessed clinically along with measuring the level of reproductive hormones in Obstetrics and Gynecology Clinic at King Abdul-Aziz hospital and oncology center in Jeddah, Saudi Arabia, between June 2015 and June 2016.<br /> <strong>Conclusion: </strong>Elevated levels of luteinizing hormone / Follicle stimulating hormone LH/FSH and testosterone and reduced FSH, hormone-binding globulin (SHBG), and progesterone were predictors of PCOS. This was independent of BMI or age. Future studies with larger sample size and data on insulin levels are needed for greater understanding of the manifestations of PCOS in the Saudi population.<br /> <strong> </strong>
polycystic ovary syndrome,Polycystic ovary disease – PCOS
https://ejhm.journals.ekb.eg/article_14035.html
https://ejhm.journals.ekb.eg/article_14035_de92903b8bfd15d9dfadcdc4b6fbd4a7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Adults Knowledge and Attitude of Family Medicine Practice in Saudi Arabia Adil Ali N. Ayed
499
504
EN
Adil Ali N.
Ayed
Outpatient Clinics, King Khalid University, Abha, Kingdom of Saudi Arabia
<strong>Background: </strong>suboptimal knowledge on medication practices, safety, and negative attitudes has some negative impact concerning managing different types of diseases.<br /> <strong>Objectives: </strong>the primary objective of this research work was to measure the public knowledge and to identify their attitudes and practices on medication practices, with mainly focus on colorectal cancer and diabetes. This is because they are ranked as the major diseases in the Kingdom of Saudi Arabia, accounting for about 10.4% according to recent researches<br /> <strong>Subjects and methods: </strong>the study was based on two cross-sectional surveys focusing on public support and the internet based research.<br /> <strong>Results: </strong>women constituted 55% of the cohort (n=420). The age of the participants ranged between 18 and 74 with the mean of 37 years. About a quarter of the respondents correctly identified colonoscopy and FOBT as primary screening tools. Seventy percent of the respondents agreed with the statement that there are misconceptions about the contraction of cancer and diabetes. Nearly forty participants reported that they never combined traditional medicine in treating the epidemics with about 30 of them had a failure to ask the community doctors on the need to be checked on the possibility of the having the disease.<br /> <strong>Conclusion: </strong>majority of the adult had adequate knowledge and attitudes scores, but they were not adhering to health promotion activities. Furthermore, misconceptions in knowledge, attitudes, and practices on medication use were prevalent.<br /> <br /> <strong><br clear="all" /> </strong><br /> <strong> </strong>
Knowledge,colorectal cancer,diabetes
https://ejhm.journals.ekb.eg/article_14036.html
https://ejhm.journals.ekb.eg/article_14036_4c3026112c59d877939d7512225d8484.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Human Myometrial Interstitial Cajal like Cell (Telocyte) in Preterm and Full Term Labour: Histological and Immunohistochemical Studies
505
513
EN
Hoda M.
Elsayed
Department of Histology, Faculty of Medicine, Sohag University
hoda_abdelrasowl@med.sohag.edu.eg
Yasser A.
Helmy
Department of GYN and OBS, Faculty of Medicine, Sohag University
<strong>Introduction: </strong>Preterm labour is a common obstetric problem. The human myometrium is formed of two types of cells namely smooth muscles and interstitial Cajal like cells or telocytes which express both estrogen and progesterone receptors<strong>.</strong><br /> <strong>Aim of the work: </strong>This study aimed to know how many telocytes are present in the pregnant uteri at time of labour in the different gestational ages and the possible role of telocytes in preterm labour.<br /> <strong>Patients and methods</strong>: 10 pregnant women were included in the study planned to do cesarean section. They were divided into two groups: <strong>Group I</strong>: included 5 cases whose gestational age was less than 37 weeks (preterm). <strong>Group II</strong>: included 5 cases whose gestational age was more than 37 weeks (full term). Specimens were obtained from the myometrium at the time of the operation and processed for histological and immunohistochemical study.<br /> <strong>Results: </strong>H&E stained sections revealed hypertrophied smooth muscle fibers with different orientations. Methylene blue stain revealed telocytes between the smooth muscle fibers as a branched cell with small cell body and thin long processes. CD 117 (ckit) immunostaining revealed an apparent increase in the number of telocytes in preterm cases (<strong>Group I</strong>) compared to full term cases (<strong>Group II</strong>). Morphometric study revealed a significant increase in the number of ckit positive telocytes in preterm cases compared to the full term one.<br /> <strong>Conclusion</strong>: telocytes are present in the pregnant uteri at different gestational ages with a significant increase in their number in the preterm cases; they may have a possible role in preterm labour.<br /> <strong> </strong>
Myometrim,telocytes,Preterm,full term,c kit
https://ejhm.journals.ekb.eg/article_14037.html
https://ejhm.journals.ekb.eg/article_14037_e5bf426b4ec5735f24ae6a1506767b1c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
67
1
2018
04
01
Prevalence of Hepatitis C Virus among Patients with Human Immunodeficiency and Its Association with Intra-Venous Drugs Addiction in Jeddah, Saudi Arabia
514
517
EN
Alaa Mohammed
Aldehry
Ibn Sina National College
alaamohamed1@outlook.sa
Abdallah Mohamed
Cheick
King Abdulaziz University
Sultan Mohammed
Badri
Ibn Sina National College
sultanbadri@gmail.com
Shahad I.
Faraj
Ibn Sina National College
Shatha Abdulrauf
Yousef
Ibn Sina National College
Amna F.
Ammar
Ibn Sina National College
Amjad Turki
Fakieh
King Khaled University
Majid Talat
Tounsi
Al Kaakya Primary Healthcare Center
<strong>Background: </strong>Despite extensive research on HIV and hepatitis C (HCV), there remains a gap in knowledge on the burden.<br /> <strong>Objectives: </strong>to assess the prevalence of hepatitis C virus (HCV) among positive human immunodeficiency virus patients and to study the relationships between these infections and intravenous drug addiction.<br /> <strong>Methodology: </strong>a cross sectional study has been conducted among total of 325 positive immunodeficiency patients (HIV) diagnosed to have HCV infection in the gastroenterology clinic at King Abdul-Aziz hospital and oncology center in Jeddah, Saudi Arabia between January 2015 and January 2016.<br /> <strong>Conclusion: </strong>The high prevalence of these major virulent infections among drug addiction is a sign of a major public health problem. Other than complicating addiction illnesses of patients, they could play major roles in spreading these infections to other intravenous drug addictors.<br /> <strong> </strong>
Hepatitis C virus,human immunodeficiency virus,Intra-venous Drugs addiction
https://ejhm.journals.ekb.eg/article_14038.html
https://ejhm.journals.ekb.eg/article_14038_376ae344cb8c0b9be7b579c41476a242.pdf