Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Lateral Tarsal Strip, Can It Be One Solution for All Types of Lower Eyelid Malposition?
2745
2752
EN
Mohamed
Al-Taher A. A
Department of Ophthalmology, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt
drmaltaher75@yahoo.com
Abd El Rahman
Awadeen
Department of Plastic, Burn, and Reconstructive Surgery,
Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt
10.21608/ejhm.2019.32066
Background: Due to the exact nature and complex anatomy of the eyelid, corrective surgeries require a comprehensive understanding of the anatomy as well as comprehensive preoperative planning and surgical enforcement. Aim of the study: the present study was performed to evaluate the functional and cosmetic sequels of the lateral tarsal strip (LTS) in the correction of lower eyelid malposition Patients and Methods: this prospective single-arm interventional study was carried on 27 patients (27 eyelids) with lower eyelid malposition, executed from January 2015 to December 2017. Patients with lower eyelid malposition in the form of entropion, ectropion, or laxity as a sequence of facial palsy, involutional changes, spastic entropion and lid laxity with failure of opposition to the artificial shell were included. Results: Patients were 12 males and 15 females with a mean age of 59.37±10.27 years. Out of them, 17 (62.9%), 8 (29.6%), and 2 (7.4%) were suffered from ectropion, entropion, and lower eyelid laxity, respectively. As for the functional and aesthetic outcomes, 10 (90.9%) of patients with lower eyelid malposition, as a resultant effect of facial nerve palsy, have experienced complete healing of the epithelial defects; additionally, 4 (66.6%) of involutional ectropion candidates showed improvement of the tearing eye. Eventually, 6 (22.2%) participants developed postoperative complications. Conclusion: LTS is a simple procedure which proved its safety and efficacy in the surgical correction of lower eyelid malposition of different types and etiologies
Lateral tarsal strip,Eyelid Malposition,Entropion,Ectropion,Facial nerve palsy
https://ejhm.journals.ekb.eg/article_32066.html
https://ejhm.journals.ekb.eg/article_32066_8f774d2f254a2c246c71f9aed6af7bf0.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Congenital Ptosis Correction with an Expanded Polytetrafluoroethylene (GORE-TEX) sling: Comparative Study Between Crawford and Fox Techniques
2753
2758
EN
Mohamed
Al-Taher A. A
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
drmaltaher75@yahoo.com
Omar H.
Salama
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
10.21608/ejhm.2019.32067
Background: Frontalis suspension is the procedure of choice for surgical management of congenital ptosis associated with poor elevator function. Objective: The aim of the work was to compare the results of two different frontalis suspension surgery techniques, i.e., the Crawford and Fox techniques, using GORE-TEX for the correction of congenital ptosis with poor levator function. Patients and Methods: fifty eyelids of 30 patients with severe ptosis and poor levator function (≤ 4 mm) were randomly divided into two groups: Group A included 26 eyelids of 16 patients corrected with the Crawford technique, and Group B included 24 eyelids of 14 patients corrected with the Fox technique. The results were evaluated and statistically compared. Results: at the end of the follow-up period (18 months postoperatively), most of the patients in both groups (80.8% of group A, 79.2% of group B) achieved good to excellent cosmetic results. The intergroup difference was not statistically significant (P < 0.05). Regarding contour, Group A was 96.2 %, and Group B was 95.8 %. Regarding symmetry, Group A was 88.5%, and Group B was 79.2%. Conclusion: considering the use of the same sling material (GORE-TEX suture), the Crawford and Fox techniques are both safe and effective with comparable results in the correction of severe ptosis with poor levator function.
Congenital Ptosis,GORE-TEX,Frontalis suspension,Crowford,Fox
https://ejhm.journals.ekb.eg/article_32067.html
https://ejhm.journals.ekb.eg/article_32067_d942a2e774546edd91455fe8d59d550c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Role of the Renal Arterial Resistive Index in Early Prediction of Contrast Induced Acute Kidney Injury after Coronary Angiography
2759
2762
EN
Mohammed
Tawfik
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
drmohammedtawfik78@gmail.com
Mohamed
Khalfallah
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
Taimoor
Moustafa
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
Mai
Salama
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
10.21608/ejhm.2019.32254
Background: contrast-induced acute kidney injury (CI-AKI) is defined as acute impairment of renal function after administration of intra vascular iodinated contrast media, and it is considered as the third leading cause of acute kidney injury in hospitalized patients. Objectives: This study aimed to evaluate the clinical significance of pre-procedural Doppler based renal arterial resistive index for the prediction of CI-AΚI in patients with coronary artery disease (CAD). Patients and Methods: one hundred patients undergoing cardiac catheterization at risk of CI-AΚI were studied. All patients presented with at least two CI-AΚI risk factors and were free of other identifiable causes of acute kidney injury or arrhythmia. Doppler RRI was measured before and the one day after catheterization. CI-AΚI was assessed and was defined by increase in serum creatinine by 25% above the pre-procedural baseline or rise in serum creatinine >0.5 mg/dl from baseline value or >25% decrease in e-GFR within 5 days after cardiac catheterization. Results: fifteen subjects were developed CI- AΚI within five days post-procedure. Post procedural RRI value was higher in CI-AΚI subjects [RRI: 0.76±0.0l with CI-AΚI patients vs. 0.6l±0.04 without CI-AΚI P<0.00l]. In addition, the RRI was increased significantly in the first day after the procedure in patients with CI-AΚI (p<0.00l). Post procedural RRI >0.744 predicted CI-AΚI with a sensitivity of 94% and specificity of 92%. Conclusions: measurement of the Doppler-based RRI before and early post-coronary catheterization in high-risk patients enabled early prediction of contrast induced acute kidney injury.
Acute kidney injury,Contrast media,resistive index,Cardiac Catheterization
https://ejhm.journals.ekb.eg/article_32254.html
https://ejhm.journals.ekb.eg/article_32254_d31aa92c887343b8723ee6ae73a41bd2.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Role of Multidetecter CT in Diagnosis of Mediastinal Masses
2763
2768
EN
Mahmoud Abdelhamid
El Bargisy
Radio-diagnosis & Medical Imaging Department, Faculty of Medicine, Tanta University
Mahmoud Abdelaziz
Dawoud
Radio-diagnosis & Medical Imaging Department, Faculty of Medicine, Tanta University
Abdelhady Mohammed
Taha
Cardiothoracic Surgery Department,
Faculty of Medicine, Tanta University
Omar Ahmed
Hassanien
Radio-diagnosis & Medical Imaging Department, Faculty of Medicine, Tanta University
10.21608/ejhm.2019.32973
Background: The mediastinum is a vital sector of the thorax that contains vital intrathoracic structures such as the heart and great vessels, trachea and main bronchi, esophagus, thymus, venous and lymphatic structures, and nerve tissue. CT is the imaging modality of choice in diagnosis of mediastinal masses. The multiplanar capability of multidetector computed tomography (MDCT) is extremely helpful in delineating the full extent and source of vascularity thus helping in pre-operative planning of these patients. Objective: Detection of the role of multidetector CT in diagnosis and differentiation of mediastinal masses. Patients and methods: Forty patients were included in this study (20 females and 20 males), who presented with signs and symptoms suggestive for mediastinal masses. All patients were subjected to detailed history taking, clinical examination, laboratory studies, chest xray and MDCT examination. The correlation was done between the MDCT findings and the final diagnosis. The final diagnosis was made by operative procedures, CT guided biopsy, histopathological results and conservative management Results: Lymphoma was the commonest mediastinal mass forming 20% of cases , followed by neurogenic tumors (neuroblastoma, , neurofibroma , ganglioneuroma and schwannomatosis) forming about 17.5 % , then retrosternal thyroid (10%), teratoma (5%), thymoma (5%), metastatic lymphadenopathy (5%), esophageal carcinoma (5%), aortic aneurysm (5%), Bochdalek hernia (5%), hiatus hernia (5%), morgagni hernia (5%), esophageal achalasia (5%), esophageal leiomyoma (5%) and paraspinal abscess (2.5%). MDCT sensitivity was 92.86% & MDCT specificity was 100%. Conclusion: MDCT has a major and reliable role to play in the evaluation and assessment of the mediastinal masses; regarding the organ of origin, its density and mass effect upon adjacent structures, distribution pattern and extent of the lesion.
mediastinal masses,MDCT,Lymphoma,Neurogenic tumors
https://ejhm.journals.ekb.eg/article_32973.html
https://ejhm.journals.ekb.eg/article_32973_abe8da1a6d56926fd9f408c79a82082a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Visual Outcome of Pars Plana Vitrectomy for Treatment of Premacular Hemorrhage
2769
2774
EN
Ali A
Ghali
Ophthalmology department, Faculty of medicine, Al-Azhar University, Damietta, Egypt
Ashraf M Gad
Elkareem
Ophthalmology department, Faculty of medicine, Al-Azhar University, Asyut, Egypt
silicon2030@gmail.com
Mohamed AA
Al-Taher
Ophthalmology department, Faculty of medicine, Al-Azhar University, Cairo, Egypt
10.21608/ejhm.2019.32974
Background: premacular hemorrhage can lead to painless loss of central vision. Several modalities of treatment have been described in previous reports. Purpose: to evaluate the visual outcome after pars plan vitrectomy (PPV) for treatment of premacular hemorrhage of different etiology. Patients and methods: A series of retrospective study 17 eyes of 17 patients presented with premacular hemorrhage due to different pathologies. Complete ophthalmic evaluation was done including visual acuity (VA), intraocular pressure (IOP), anterior segment examination, slit lamp biomicroscopy, fundus photography± fluorescein angiography (FA), and ocular ultrasound ± biometry. PPV was performed using 23gauge system with proper tamponade ± Phaco with PCIOL.No intraoperative lens touch or iatrogenic retinal tear has been recorded. Results: BCVA was improved from CF 50 cm in2 cases, hand movement (HM) in 15 cases to 0.1 (Log MAR) in 2 eyes (11.76%), 0.3 in one eye (5.88%), 0.4 in 5 eyes (29.41%), 0.6 in 3 eyes (17.64%), 1.00 in 3 eyes (17.64%), (3/60) in 2 eyes (11.67%), CF (1/60) in one eye (5.88%). No serious complications weredetected. Conclusion: PPV is a beneficial surgical treatment for premacular hemorrhage of different pathologies ensuring rapid visual recovery. The visual outcome is an encouraging and the complications are comparable to other studies.
premacular hemorrhage,ND: YAG laser,vitrectomy
https://ejhm.journals.ekb.eg/article_32974.html
https://ejhm.journals.ekb.eg/article_32974_a64037a79c547e424631910b45c7ea3a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Biliary Disorders in Morbidly Obese Patients Before and After Sleeve Gastrectomy
2775
2783
EN
Essam El-Dien Abd El-Azim
Zayed
Department of General Surgery, Faculty of Medicine - Al-Azhar University
Abd El-Hafez Abd EL-Aziz
Selim
Department of General Surgery, Faculty of Medicine - Al-Azhar University
Mohamed Ahmed Suliman
Abd El-Hafez
Department of General Surgery, Faculty of Medicine - Al-Azhar University
dr.muhammadsuliman@gmail.com
10.21608/ejhm.2019.32976
Background: Obesity is an increasingly serious public health problem on a global level. Morbid obesity is defined as a Body Mass Index (BMI) of 40 Kg/m2 or more or a BMI of 35 Kg/m2 or more with obesity related comorbidities. Morbid obesity is associated with an increased incidence of wide spectrum medical and surgical pathological problems. Objective: To clarify the relation between morbid obesity, rapid loss of weight after sleeve gastrectomy and gallstone formation and if there is a need for adding prophylactic cholecystectomy during sleeve gastrectomy to obtain the best possible results after surgery. Patients and Methods: A total number of 50 morbidly obese patients were included in the study from September 2018 to April 2019 (prospective study). All patients were treated at Surgery Department of Al-Azhar University Hospitals. Males and females were considered for inclusion. Results: In our study, five cases (10%) underwent simultaneous cholecystectomy (selective cholecystectomy) for their asymptomatic gall stones detected by routine pre-operative pelvi-abdominal ultrasound. Simultaneous cholecystectomy was associated by a significant increase in the operative time by about 36 minutes without effect on the post-operative morbidity or hospital stay compared with other patients with no gallstones. Conclusion: Sleeve Gastrectomy for morbidly obese patients was followed by gall bladder stones in only 6.2%. Therefore, prophylactic intra-operative cholecystectomy seems to be not indicated and should be replaced by short-term (3 months only) of oral ursodeoxycholec acid during the period of maximum weight loss.
sleeve gastrectomy,morbidly obese
https://ejhm.journals.ekb.eg/article_32976.html
https://ejhm.journals.ekb.eg/article_32976_ee7a5c8d3067f12b5ddf221a81b5136e.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Awareness of Gestational Diabetes among Antenatal Women at The King Fahd Military Medical Complex Hospital in Dhahran, Saudi Arabia
2784
2793
EN
Latteefah Saleh
Alnaeem
0000-0002-3677-2454
College of Applied Medical Sciences, Obstetrics and Gynecology department, King Faisal University,
AI Hfouf, Kingdom of Saudi Arabia.
latifa_alnaeem@hotmail.com
10.21608/ejhm.2019.32977
Background: Gestational diabetes mellitus (GDM) has recently gained increasing attention among researchers and health professionals. This growing interest is attributed to the rising rate in the development of type 2 diabetes mellitus (DM) during pregnancy and puerperium and later on, as established in GDM patients. Materials and methods: patients engaged in this survey were informed verbally that their involvement was voluntary, and that completing the distributed questionnaires implied that they had agreed to take part in the study, using questionnaires administered data were gathered by an obstetrics and gynecology doctor, questionnaire was designed following a comprehensive discussion with a team of experts in the field of GDM as it was tested via a pilot study to insure it’s reliability. The final copy of the questionnaire that was used in the actual study included 25 questions, a score of one was assigned to each correct answer and zero to each incorrect or “I don’t know” answer. A higher score showed that the respondent had better knowledge about GDM. Conclusion: This research found a considerable lack of awareness about GDM of the pregnant women interviewed. Moreover, the results showed that the respondents were aware that GDM is related to certain factors such as advanced maternal age, overweight, and obesity, among others. It was noted that the lack of awareness and knowledge among pregnant women led to poor self-care and management of GDM, which reflects unmet needs.
GDM,DM awareness,antenatal,Gestational diabetes,Saudi Arabia
https://ejhm.journals.ekb.eg/article_32977.html
https://ejhm.journals.ekb.eg/article_32977_b86b1801a7809aff53d3e48ebdbe6aec.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
The SYNTAX Score and Angiographic "No-Reflow" in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention
2794
2800
EN
Ahmad Hassan
Sadek
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo
Ezz EL Din
AL Sawy
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo
Mohammed Saad
Al Gammal
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo
Mohammad Ahmad
Mosaad
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo
10.21608/ejhm.2019.32979
Background: in patients with acute myocardial infarction, the immediate therapeutic goal is to establish patency of the infarct-related artery and to achieve optimal myocardial tissue reperfusion. The Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) score (SS) quantifies the extent and complexity of angiographic coronary artery disease. Patients and Methods: a total of 543 patients presenting with acute myocardial infarction undergoing primary PCI for the STEMI patients and early invasive strategy for the NSTEMI patients, both admitted within 24 hours from the symptoms onset, were analyzed. SS, thrombolysis in myocardial infarction (TIMI) flow grade score, and TIMI myocardial blush grade score (MBG) were determined in all patients. No-reflow was considered as the prescence of TIMI blood flow in the infarct related artery (IRA) 2 or TIMI grade 3 with myocardial blush grade (MBG) 0 or 1, at least 10 minutes after the end of the PCI procedure. Results: no-reflow was observed in 26% of patients. The mean SS of the no-reflow group was higher than that of the TIMI III flow group . On multivariate logistic regression analysis a long target lesion (OR= 8.637, 95% C.I 1.975–37.768, p = 0.004) were found to be significantly associated with no-reflow and were the independent predictors of no-reflow phenomenon. The cutoff value of SS obtained by the receiver-operator characteristic curve analysis was 31 for the prediction of no-reflow . Conclusion: the SS is a predictor of no-reflow in patients with acute myocardial infarction treated with percutaneous coronary intervention.
Acute myocardial infarction,percutaneous coronary intervention,No-reflow,SYNTAX score
https://ejhm.journals.ekb.eg/article_32979.html
https://ejhm.journals.ekb.eg/article_32979_76f8dbd1ca2368ded9244db9371997cf.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Review of the Effectiveness of Composite Barrier Mesh Used for Laparoscopic Ventral Hernia Repair
2801
2805
EN
R. K.
Mishra
World Laparoscopy Hospital, Delhi, India
md@laparoscopyhospital.com
Abinadabe dos Santos Pires
Soares
Hospital Santa Joana Recife, Graças, Brazil
abinas@zipmail.com.br
Abdullah Jassim
Al-Qattan
King Khalid Hospital, Najran, KSA
dr.alqattan90@gmail.com
10.21608/ejhm.2019.32982
Background: The objective of this research is to provide an overview of the physical and biomechanical properties of composite barrier meshes frequently used in Laparoscopic Ventral Hernia Repair as well as reviewing the existing relevant literature assessing the characteristics and effectiveness of both procedures. Methods: A secondary research is used using existing literature review of the preclinical and clinical literature designed to compare the Composite prostheses with permanent barriers (COMPOSIX, VENTRIO, DUALMESH, DYNAMESH and TiMESH ) to composite prostheses with absorbable barriers ( PROCEED, C-QUR, PHYSIOMESH, PARIETEX and SEPRAMESH ). Results: Significant differences were observed between Composite prostheses with regard to its physical and biomechanical properties. Amongst the permanent barrier meshes, Dualmesh showed the highest suture retention strength. On the other hand, between the absorbable barrier meshes, Sepramesh proved to have the most significant suture retention and tears strength. Overall, all meshes established tensile strengths greater than 16-32 N/cm. Moreover, that composite meshes with absorbable barriers had less complications of adhesions, recurrences and wound infection compared with meshes with permanent barriers. Conclusion: Composite meshes with absorbable barriers proved to be superior to permanent ones. Other findings demonstrated there was no significant difference of effectiveness among absorbable barriers.
Absorbable barrier,Laparoscopy,Ventral hernia,Mesh,Adhesions,Recurrence,Permanent barrier
https://ejhm.journals.ekb.eg/article_32982.html
https://ejhm.journals.ekb.eg/article_32982_94e6a479a334eaebce044cfecd9bc5e1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Refractive Outcome after Phacoemulsification Using Optical Biometry versus Immersion Ultrasound Biometry
2806
2812
EN
Fatma A.
Atwa
Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University
Hayam S.
Kamel
Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University
Rehab M.
Kamel
Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University
rehabmoustafakamel@yahoo.com
Ahmed A.
Abd El Fatah
National Eye Center, Rod El Farag , Cairo , Egypt
10.21608/ejhm.2019.32983
Purpose: To compare refractive outcome after phacoemulsification using optical biometry versus immersion ultrasound biometry (US) .Patients and methods: A prospective, comparative, non-randomized interventional study included 100 eyes divided into 2 groups: Group (A): (Immersion US biometry) included 50 eyes. Axial Eye Length (AEL) was measured by immersion B scan (immersion A-scan with B- mode guided image). It was further subdivided into Group A1 (AEL ≥ 25 mm) and Group A2 (AEL < 25 mm). Group B (Optical biometry) included 50 eyes. AEL was measured using optical biometry. It was also subdivided into Group B1 (AEL ≥ 25) mm and Group B2 AEL < 25. Intra ocular lens (IOL) power was calculated using Haigis formula targeting post-operative refraction –0.5 to -1 D. Phacoemulsification with posterior chamber IOL was performed. The 2 groups were compared preoperatively for AEL, Keratometic measurements, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and density of cataract. They were compared postoperatively for UCVA, BCVA, spherical equivalent (SE) and mean absolute error (MAE). Results: The study included (100 eyes). Group A1 included 9 eyes (18%) and Group A2 included 41 eyes (82%). Group B1 included 18 eyes (36%) and Group B2 Included 32 eyes (64%). Preoperative comparisons revealed insignificant statistical differences between the 2 groups in the mean AEL, IOL power, preoperative UCVA and BCVA, degree and density of cataract, and K readings. Post operatively there was insignificant statistical differences between the 2 groups in the mean of UCVA and BCVA. There was insignificant statistical differences between subgroups A1and B1 and subgroups A2 and B2 in the median of SE and MAE. Conclusion: The immersion B scan biometry and optical biometry gave comparative results with precise final post-operative refractive outcome.
Optical biometry,Immersion ultrasound biometry,Phacoemulsification
https://ejhm.journals.ekb.eg/article_32983.html
https://ejhm.journals.ekb.eg/article_32983_e9e98df59df7a98d719db9d7427a6595.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Falciform Ligament Plug in Laparoscopic Hiatus Hernia Repair
2813
2818
EN
Ibrahim Aboulfotoh
Mohammed
General Surgery Department, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.33000
Background: A prospective and retrospective collected databases to identify outcome in Laparoscopic paraesophageal hiatal hernia repair is a challenging procedure. The falciform ligament is used as an autologous onlay flap to achieve tension-free closure of the crural defect of a para-esophageal hernia (PEH). Aim of the work: To assess the use of Falciform ligament for hiatus hernia repair and to evaluate the outcomes results. Patients and Methods: From December 2015 to august 2018, a total of 24 patients with para-esophageal hiatus hernia were conducted; Hernias were diagnosed with esophago-gastroscopy, barium contrast X-ray study and esophageal manometry. Results: twelve patients underwent falciform ligament plug repair while twelve patients underwent crural approximation and fundoplication repairs. The classical traditional procedure time for repairs was significantly longer (p=0.004). Hospital stays, resting lower esophageal sphincter pressure, and mean contraction amplitudes were similar between groups. Discussion: The well documented advantages of laparoscopic hiatal hernia repair less pain; shorter hospital stays, and faster recovery and the rates of failure are higher in patients had open repairs. Conclusion: Use of falciform ligament as a vascularized autologous onlay flap is a safe and effective procedure to close the crural defect of para-esophageal hiatus hernia.
Hiatal Hernia,Gastro-esophageal reflux,Laparoscopy,Falciform ligament plug
https://ejhm.journals.ekb.eg/article_33000.html
https://ejhm.journals.ekb.eg/article_33000_e47e41c073229b3288d8a0d2f37c8b5f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Co-morbidity of Attention Deficit / Hyperactivity Disorder among A Sample of Egyptian Children with Idiopathic Epilepsy Attending Outpatient Clinic in Al Hussein University Hospital
2819
2819
EN
Mohamed Abdalla
Ghowinam
Department of Psychiatry, Al-Azhar University, Cairo, Egypt
Mahrous Ibrahim
Seddeek
Department of Neurology, Al-Azhar University, Cairo, Egypt
10.21608/ejhm.2019.32988
Background: Attention deficit/hyperactivity disorder (ADHD) is a complex disorder that affects about 5:8% of school-aged children worldwide. Many researchers reported increased prevalence of ADHD among epileptic children. Objectives: Detection of the prevalence of ADHD among a sample of Egyptian epileptic children attending Al Hussein University Hospital, Neurology clinic, & determination of associated risk factors. Methods: A cross-sectional study was performed at Al Hussein University Hospital, Neurology Clinic, starting at January 2016 until January 2017. The study was conducted on Egyptian patients aged 3: 18 years with an affirmed diagnosis of epilepsy for one year or more. Data was gathered using a questionnaire performed by the interviewer. ADHD was diagnosed according to (DSM-IV TR). Results: Our study included 160 epileptic children. In our sample 102 patients had Generalized Tonic-clonic seizures and 13 had Absence seizures, 45 patients had Partial epileptic seizures. (26.3%) of the epileptic patients included had ADHD. We reported that partial epileptic seizure type; duration of epilepsy over 2 years and uses of more than one anti-epileptic drug were significantly associated with increased risk of having ADHD, and that having Partial epileptic seizures and use of more than one antiepileptic agent were independent predictors for ADHD. Conclusions: 26.3% of epileptic children in this study had associated ADHD. Partial epileptic seizure type, duration of epilepsy over 2 years and use of more than one antiepileptic drug were significantly associated with ADHD. Recommendations: Further studies are needed on large number of epileptic children.
Epilepsy,ADHD,and children
https://ejhm.journals.ekb.eg/article_32988.html
https://ejhm.journals.ekb.eg/article_32988_8ebdb6058256fe03c9b9746b54365cd8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Combined Low Dose Aspirin and Steroids vs Aspirin Only in Management of Unexplained Recurrent Miscarriage
2825
2832
EN
Fahd A.
El Omda
Department of Gynecology and Obstetrics, Faculty of Medicine, Al-Azhar University
Ahmed T.
Abd ElFattah
Department of Gynecology and Obstetrics, Faculty of Medicine, Al-Azhar University
Ahmed M.
Ragab
Department of Gynecology and Obstetrics, Faculty of Medicine, Al-Azhar University
manareisa89@gmail.com
10.21608/ejhm.2019.32989
Background: recurrent pregnancy loss (RPL) is defined as at least two or three sequential abortions before the 20th week of gestation. RPL occurs in 1% to 5% of all pregnancies. Aim of the Work: to assess the efficacy of low dose aspirin and steroids therapy versus Aspirin Study in the management of women with recurrent miscarriage. Patients and Methods: this randomized clinical trial was conducted in the repeated miscarriage clinics in the Obstetrics and Gynecology Department, in Al-Azhar University Hospital on 100 pregnant women, who fulfilled the inclusion criteria and after taking an informed consent. Group 1: included 50 pregnant females administered with low dose aspirin 75 mg tablet (one tablet twice daily) and prednisolone 5mg two tablets twice daily (20mg). Group 2: included 50 pregnant females administered with low dose aspirin 75 mg tablet (one tablet twice daily). Both groups were followed in Elhussein hospital recurrent miscarriage clinic every two weeks by ultrasonography from the incidence of the pregnancy till delivery. Results: women treated with prednisolone (PSL) plus LDA had a 32.2% higher live birth rate than group II and according to on-going pregnancy data was in group I 37/50(74%) and in group II 21/50(42%) OR (C.I. 95% 4.128 [2.142-7.952] RR (C.I. 95%1.875 [1.401-2.505] p<0.001, with a significant difference between the two groups. There was a significant difference between the two groups as regards the development of bruising (P<0.05). Conclusion: combination treatment consisting of prednislone and low dose aspirin might be an effective treatment for women with idiopathic pregnancy loss.
aspirin,steroids,Unexplained Recurrent Miscarriage
https://ejhm.journals.ekb.eg/article_32989.html
https://ejhm.journals.ekb.eg/article_32989_4aaea302e24e21c9606e6eb9af5680af.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Comparison of the effects of Penicillin versus Erythromycin in Treatment Group B Streptococcus Infection in Preterm Premature Rupture of Membranes
2833
2838
EN
Mohamed Mohamed
Gebriel
Department of Obstetrics and Gynecology, Faculty of Medicine - AL-Azhar University
Adel Aly
Elbghdady
Department of Obstetrics and Gynecology, Faculty of Medicine - AL-Azhar University
Mohamed Elsayed
Abo Ghabsha
Department of Obstetrics and Gynecology, Faculty of Medicine - AL-Azhar University
Maged Abd Elatef
Abd Elftah
Department of Obstetrics and Gynecology, Faculty of Medicine - AL-Azhar University
10.21608/ejhm.2019.32991
Background: group B streptococcus (GBS) can cause significant morbidity in pregnant women. Manifestations of symptomatic maternal infection include chorioamnionitis, endometritis, cystitis, pyelonephritis and febrile GBS bacteremia. Objective: this work aimed to assess the effectiveness of penicillins versus erythromycin in treatment GBS infection following PPROM. Patients and Methods: the study included 50 pregnant females presented with PPROM before 36 weeks gestation who were attending to Outpatient Obstetrician Clinic at El Sayed-Galal University Hospital. The cases were classified into 2 groups, 25 cases each as follows: Group A (penicillin- treated group) and group B (erythromycin-treated group). Results: the results of the study showed that there were no significant difference between the cases within the two study groups as regard the different demographic data, the obstetric history and the state of the current pregnancy. There was a significant difference between the two groups as regards the fetal and maternal outcomes being less in group A (penicillin-treated group). Conclusion: our study revealed the superiority of penicillin over erythromycin in treatment of GBS associated maternal infections.
Penicillin,Erythromycin,GBS,PPROM
https://ejhm.journals.ekb.eg/article_32991.html
https://ejhm.journals.ekb.eg/article_32991_1e0b1d57cbd1a6b26ca84807175c341b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Assessment of Fetal Kidney Length as a Parameter for Detection of Gestational Age at the Third Trimester of Pregnancy
2839
2844
EN
Samira
Al-Mlah
Obstetrics and Gynecology Department, Faculty of Medicine (for Girls), Al-Azhar University
Aziza
Nasef
Obstetrics and Gynecology Department, Faculty of Medicine (for Girls), Al-Azhar University
Heba Ahmed Mohammed
El-Masry
Obstetrics and Gynecology Department, Faculty of Medicine (for Girls), Al-Azhar University
bobbaelmasry@yahoo.com
10.21608/ejhm.2019.33002
Background: the accurate knowledge of gestational age is a keystone in an obstetrician's ability to successfully manage the antepartum care of a patient and is of critical importance in ante-natal test and successful planning of appropriate therapy or intervention. Failure can result in iatrogenic prematurity which is associated with increased perinatal morbidity and mortality. Objectives: the aim of this study is to evaluate the accuracy of fetal kidney length in estimation of gestational age in normal singleton pregnancies. Patients and Methods: observational study, the study was conducted at the antenatal outpatient clinics of Obstetrics and Gynecology at Alzahraa University hospitals and Ahmed Maher Teaching hospital in the period between December 2017 and December 2018. Approval from Ethical Committee at Al Zahraa University was taken. This study included 120 asymptomatic, pregnant women, with singleton pregnancy (30 cases at each gestational age 32, 34, 36 & 38 weeks gestation). Results: the study shows that fetal kidney length is a good indicator of gestational age and can be used alone due to its accuracy in comparison to other measurements (BPD, FL &AC) that may be changed in the third trimester. There was a significant difference between right and left kidney length through different age of gestation (The Lt KL measurement was larger than the measurement Rt KL). Gestational age in weeks is nearly equal to MKL. Conclusion: fetal kidney length correlates well with gestational age, so it can be concluded that kidney dimensions can be helpful in determining the gestational age when menstrual dates are uncertain.
Fetal Kidney Length,Gestational age,Third Trimester of Pregnancy
https://ejhm.journals.ekb.eg/article_33002.html
https://ejhm.journals.ekb.eg/article_33002_59644ff5144b8ac359fd14f674813eb5.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Serum Zinc Levels in Patients with Acne Vulgaris and Its Relation to The Severity of Disease
2845
2848
EN
Hassan A. Aziz
Gaber
Department of Clinical Pathology, Al-Hussien University Hospital, Al-Azhar Faculty of Medicine
Ahmed Abdul-Hameid
Abozied
Department of Clinical Pathology, Al-Hussien University Hospital, Al-Azhar Faculty of Medicine
Ibrahim Mohammed
Abd-Elkareem
Department of Clinical Pathology, Al-Hussien University Hospital, Al-Azhar Faculty of Medicine
Youssef Nasser Youssef
El-Shazly
Department of Clinical Pathology, Al-Hussien University Hospital, Al-Azhar Faculty of Medicine
el_shazly.y@yahool.com
10.21608/ejhm.2019.33005
Background: acne vulgaris is a chronic inflammatory disease of the skin that affects the individuals of all ages, especially adolescents. An association between serum zinc levels and acne vulgaris have been reported in some studies. Objective: the aim of our study was to estimate serum zinc level in patients with acne vulgaris and healthy subjects and its association with severity of disease. Patients and Methods: this study was conducted on 60 patients (subdivided into 4 groups according to severity of disease according to Global Acne Grading System) and 60 normal individuals as a control group. Results: there was highly significantly statistical difference between all patients and control groups as regard serum zinc level (mean of serum zinc level in patients and control groups were 49.85 ±19.61 and 63.46 ± 22.95 respectively, p=<0.001). Conclusion: it is concluded that zinc deficiency in acne patients could be one of the causes of acne and also that zinc levels may not be related to the severity.
Acne vulgaris,zinc,Global Acne Grading System (GAGS),Inflammation,Propionibacterium acnes,Pilosebaceous unit,Sebaceous glands,Comedones,Retinol binding protein (RBP),Interleukin 6 (IL-6),Tumor necrosis factor alpha (TNFα)
https://ejhm.journals.ekb.eg/article_33005.html
https://ejhm.journals.ekb.eg/article_33005_c041ea81c9bd57ce1a3334fece2647c5.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Primary Fixation of Intertrochanteric Fracture with Hemiarthroplasty in Elderly Patients
2849
2856
EN
Ibrahim
Mostafa
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Hesham
Safwat
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed Saeed Abdel Raouf
Sadeek
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
drraouf2011@gmail.com
10.21608/ejhm.2019.33008
Background: trochanteric fractures are extracapsular fractures of the proximal femur between the greater and lesser trochanters. Approximately half of all hip fractures will be trochanteric fractures. Trochanteric fractures occur in a more aged population than do femoral neck fractures. These elderly people are more affected by osteoporosis and medical comorbidities. Objective: the aim of this study was to evaluate the results of primary hemiarthroplasty in management of intertrochanteric fractures in elderly patients. Patients and Methods: this study was a prospective study involving 20 patients with unstable trochanteric fractures performed at Orthopedic Department, Al Hussein and Sayed Galal, Al-Azhar University Hospitals between the period of September 2017 till March 2019. Patients were checked with X-rays, clinical evaluation, and functional assessment according to the Harris hip score (HHS). Results: in the current study, data on the effect of internal fixation versus endoprosthesis on mortality rate are available only for femoral neck fractures. When adjusted for age, there is no significant difference in the mortality rates for patients treated with internal fixation or hemiarthroplasty. Conclusion: It could be concluded that the use of hemiarthroplasty is recommended for cases with old age, osteoporotic bone, medical comorbidities, preexisting ipsilateral symptomatic degenerative hip disease or patients with renal failure or pathological fracture with metastases.
hip,Intertrochanteric fracture,Hemiarthropalsty,Elderly Patient
https://ejhm.journals.ekb.eg/article_33008.html
https://ejhm.journals.ekb.eg/article_33008_9010e67896440d1057281938c06b50a1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Macular and Subfoveal Choroidal Thickness before and after Phacoemulsification Using Optical Coherence Tomography in Diabetic and Non-Diabetic Patients
2857
2863
EN
Mohamed A.
El Malah
Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ehab A.
El sheikh
Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mohamed B.
El lakany
Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
dr_7amada2012@yahoo.com
10.21608/ejhm.2019.33010
Introduction: Cataract surgery by phacoemulsification is an invasive procedure that has become the most common intraocular surgery and usually improves the visual outcome. However, it is an inflammatory process to the eye and in many cases can lead to worsening of pre-existing retinal diseases such as diabetic macular edema or development of new diseases such as Irvine-Gass syndrome. This inflammatory response is mostly induced by the release of prostaglandins. Objective: The aim of this study was to evaluate the effect of uneventful phacoemulsification on the morphology and thickness of the macula and the choroid. Patients and Methods: In 30 eyes from 30 patients (15 non-diabetic and 15 diabetic), central retinal macular thickness, and subfoveal choroidal thickness, were measured preoperatively and one month and three months after phacoemulsification using optical coherence tomography. Results: In non-diabetic patients, central macular thickness was 202.80±22.39 μm before phaco and 216.27±23.97 μm after 1 month and 208.13±23.59 μm after 3 months while Subfoveal choroidal thickness was 203.73±28.66 before surgery and 218.80±31.09 after 1 month and 209.20±30.63 after 3 months.In diabetic patients central macular thickness was 233.33±12.74 before surgery and 253.27±15.89 after 1 month and 246.93±22.39 after 3 months while subfoveal choroidal thickness was 233.80±24.14 before surgery and 252.80±26.59 after 1 month and 243.47±24.45 after 3 months. Conclusion: Uncomplicated phacoemulsification induces non pathologic increases in subfoveal choroidal thickness and macular thickness probably due to the inflammatory effect of the surgery but it decreases nearly to normal after 3 months; however these changes are not accompanied by significant decrease in visual acuity.
Phacoemulsification,Macular Thickness,choroidal thickness,diabetes,Optical Coherence Tomography
https://ejhm.journals.ekb.eg/article_33010.html
https://ejhm.journals.ekb.eg/article_33010_3461cce9e240d2f0abe4e17d89d86e81.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Assessment of The Efficacy of Trastuzumab as Adjuvant Chemotherapy in Correlation with Clinicopathological Features in Patients with Her/2neu Positive Breast Cancer Attending Suez Canal University Hospital
2864
2870
EN
Walaa
Saeed
Clinical Oncology and Nuclear Medicine Department, Suez Canal University
walaasaeed89@gmail.com
Soheir
Abdelmohsen
Clinical Oncology and Nuclear Medicine Department, Suez Canal University
Ehap
Hasanin
Clinical Oncology and Nuclear Medicine Department, Suez Canal University
Zamzam
Maha
Clinical Oncology and Nuclear Medicine Department, Suez Canal University
10.21608/ejhm.2019.33360
Materials and Methods: Retrospectively, data was collected from patients with HER2- positive early stage breast cancer who were receiving adjuvant trastuzumab. Then analysis of clinicopathological features of 88 patients and their treatment outcome was done. Results: 61 patients received trastuzumab and 27 patients didn't receive it. In patients who received trastuzumab (trastuzumab group), the median follow-up period was 24 months (8.0-40.0 months). Relapse-free survival (RFS) was 31.2 months (95% CI: 28.0-34.4) and overall survival (OS) was 34.9 months (95% CI: 32.3-37.5). The 3-year OS for all patients was 76.9% and RFS was 62.3%. In non-trastuzumab group: the median follow-up period was 26 months (8.0-40.0 months). They were followed up during the course of treatment and it was found that relapse-free survival (RFS) was 30.18 months (95% CI: 25.2-35.1) and overall survival (OS) was found to be 32.0 months (95% CI: 27.3-36.6). So, the 3-year OS for all patients was 59.8% and RFS was 48.3%. 13.1% of the patients in the trastuzumab group had an asymptomatic decrease in left ventricular ejection fraction by more than 10% which is discovered by the end of the treatment course. Data obtained from univariate analyses revealed that larger tumor size, positive nodal involvement, and positive estrogen receptor status were significantly associated (p<0.05) with RFS. Positive lymph node was identified as an independent prognostic factor with multivariate analyses of covariates displaying p<0.05 (HR=1.8, 95%CI 1.1 - 3, p=0.01).
breast cancer,Trastuzumab,Her2neu,Survival analysis
https://ejhm.journals.ekb.eg/article_33360.html
https://ejhm.journals.ekb.eg/article_33360_fd51c6ea5af9e4d5ef009f9d6be703b1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Accelerated versus Conventional Corneal Collagen Cross-Linking in The Treatment of Keratoconus
2871
2877
EN
Hosny Hassan
Mohammad
Department of Ophthalmology, Faculty of Medicine – Al-Azhar University
Sayed Abbas
Sayed
Department of Ophthalmology, Faculty of Medicine – Al-Azhar University
Abdelghany Ibrahim
Abdelghany
Department of Ophthalmology, Faculty of Medicine – Al-Azhar University
Mohamed El-Sayyed Mokhtar
El-Sayyad
Department of Ophthalmology, Faculty of Medicine – Al-Azhar University
m_sayyad@hotmail.com
10.21608/ejhm.2019.33361
Background: corneal collagen cross-linking (CXL) is one of the interesting topics in corneal surgery, with several recent modifications of the original Dresden protocol under investigation. Accelerated CXL is one of the exciting modifications of the original technique but with few published results. It Objective: the aim of the present study was to compare the effect of accelerated (both continuous and pulse) crosslinking on the keratoconic cornea versus conventional protocol. We stuck to inclusion and exclusion criteria of the study. Patients and methods: in this study we evaluated 90 eyes; 30 eyes received standard Dresden protocol (S-CXL), 30 eyes received continuous light accelerated protocol (cl-ACXL), and 30 eyes received pulsed light accelerated protocol (pl-ACXL). The refractive status, visual acuity, corneal topography, central corneal thickness and corneal biomechanics were evaluated preoperatively, at 1 st month, 3rd month, 6th month and 12th month postoperative. Results: all groups showed an improvement of MRSE, UCVA and BCVA one year after surgery. The central corneal thickness (CCT) markedly decreased at 1st month follow-up, then gradually increased till 12th month but still below the baseline. Both maximum and minimum keratometry (K-max and K-min) decreased significantly at 12th month follow-up. The corneal biomechanics; corneal hysteresis (CH) and corneal resistance factor (CRF) showed no significant changes all over the follow-up period. Conclusion: the results in this study showed that both continuous and pulsed light accelerated cross-linking are as safe as standard Dresden protocol in halting keratoconus disease.
CXL,Keratoconus
https://ejhm.journals.ekb.eg/article_33361.html
https://ejhm.journals.ekb.eg/article_33361_a7b47917cd02975414b75d75f33c992c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
A Comparative Study between Nifedipine, Ritodrine and Magnesium Sulfate as Tocolytics in Cases of Preterm Labor and Their Effect on Utero Placental Perfusion
2878
2887
EN
Asem A. Abdo
Mousa
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Mohamed A.
Mohamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
badi388@gmail.com
Mohamed S.
Radwan
Department of Clinical Pathology Faculty of Medicine, Al-Azhar University
Khaled F.
El Sayed
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
tantawy_wael@yahoo.com
10.21608/ejhm.2019.33362
Background: in the developed world, preterm birth (PTB) is a major problem in modern obstetrics; its prevalence is still rising in many industrialized countries. Early PTB (before 34 weeks) is particularly associated with high rates of mortality and morbidity. Aim of the Work: to compare the efficacy of oral nifedipine, intra venous ritodrine and magnesium sulfate as tocolytics in cases with preterm labor and evaluate their effects on the utero placental perfusion in order to choose the safest and most cost-effective drug. Patients and Methods: a prospective study that was conducted in El sayed Galal and El Hussien University hospitals from November 2016 to November 2018. By identifying 150 pregnant women with gestational age from 24-37 weeks gestation with preterm labour pain, intact membranes, singleton pregnancy. Results: a statistically significant difference was found between groups according to fetal umbilical artery PI before and after treatment. Also, significant difference between before and after treatment according to fetal umbilical artery PI in magnesium sulfate group. Also a statistically significant difference between groups according to fetal middle cerebral artery PI before and after treatment. Also, significant difference between before and after treatment according to fetal middle cerebral artery PI in nifedipine and magnesium sulfate group. Conclusion: there was no overall difference between nifedipine, magnesium sulfate and ritodrine, in their efficacy as tocolytic for preterm labor. However, Nifedipine had fewer maternal side effects followed by magnesium sulfate than ritodrine. Irrespective of their tocolytic effects, magnesium sulfate has the most significant effect on Doppler study.
Nifedipine,Ritodrine,magnesium sulfate,Tocolytics,preterm labor,Utero placental perfusion
https://ejhm.journals.ekb.eg/article_33362.html
https://ejhm.journals.ekb.eg/article_33362_6dd17c798993ae86eda1e74409187331.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Endoscopic Management of ERCP Bleeding
2888
2893
EN
Fawzy M.
Mustafa
Department of General Surgery, Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
Hany F.
Ali
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
10.21608/ejhm.2019.33363
Background: post endoscopic retrograde cholangiopancreatography (ERCP) bleeding is a common complication and the incidence varies from 1% to 48%. It can be challenging to manage or localize the bleeder through a sideviewing endoscope. Objective: this study aimed to evaluate the risk factors of post ERCP bleeding and efficacy of endoscopic intervention therapies. Patients and Methods: this prospective randomized clinical trial was carried out on 100 consecutive patients at General Surgery Department Al-Azhar University Hospitals (Cairo) Egypt. All patients underwent ERCP, between January 2016 and August 2018, All ES procedures were performed by experienced surgeons and the decision to perform sphincterotomy was based on clinical, endoscopic, and radiologic findings. Results: comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray and pancreatitis was higher in patients who received electrocoagulation. Conclusion: clinically, endoscopic hemostasis therapy is very effective to manage post ERCP bleeding but increases the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each therapeutic modalities and appropriate management of different levels of bleeding are important.
ERCP
https://ejhm.journals.ekb.eg/article_33363.html
https://ejhm.journals.ekb.eg/article_33363_0c3352c700b7a9eed133f615e871541d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Detection of Creatinine in Vaginal Fluid for Diagnosis of Preterm Premature Rupture of Membranes
2894
2899
EN
Ismail T.
El-Garhy
Department of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar University
Noha M.
Sabry
Department of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar University
Medhat A.
Abdel-Gahfar
Department of Clinical Pathology,
Faculty of Medicine – Al-Azhar University
Ahmed A.
Ahmed
Department of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar University
ahmeddr107@gmail.com
10.21608/ejhm.2019.33364
Background: to evaluate the role of vaginal fluid creatinine level in diagnosis of preterm prelabour rupture of membranes among patients giving history of amniotic fluid leak. Objectives: the aim of this study was to evaluate the reliability of vaginal fluid creatinine level in the vaginal fluid for diagnosis of prelabour premature rupture of membranes. Patients and Methods: 100 pregnant women with gestational age 24: 37 weeks gestation participated in the present study divided into 2 groups. Group I (confirmed PROM group) & group II (control non-PROM group). All patients underwent a sterile speculum examination for detection of amniotic fluid pooling in the posterior vaginal fornix followed by taking 3ml from vaginal fluid. Creatinine measurement was done using ELISA. Results: The mean creatinine levels in vaginal fluid in group (I) & group (II) were.70 ± 0.88 and.04 ± 0.18 mIU/mL respectively. The difference was statistically significant (P value < 0.001). With creatinine cut-off value of 0.25 mIU/ml, the sensitivity & specificity in confirming PROM were 72 and 94% respectively. Conclusion: Creatinine level was significantly higher in pregnant women with definite PROM. Therefore, vaginal fluid creatinine can be used as an easy, rapid, reliable and non-invasive test for confirming the diagnosis of PROM and can be used as an adjunctive test in equivocal cases.
creatinine,preterm prelabour rupture of membranes
https://ejhm.journals.ekb.eg/article_33364.html
https://ejhm.journals.ekb.eg/article_33364_4da071275bd3a381cb35872c11574364.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Study of Serum Immunoglobulins G and M Levels in Children with Down Syndrome and Their Relation with Recurrent Lower Respiratory Tract Infection
2900
2907
EN
Manar Emad Aldeen
Ghazy
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
maysaakubasi@yahoo.com
Heba Said
El Mahdy
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
Maaly Mohamed
Mabrouk
Department of Clinical Pathology,
Faculty of Medicine, Tanta University, Egypt
Mohamed Shawky
Al-Farargy
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
10.21608/ejhm.2019.33365
Background: Children with Down syndrome appear to be more likely susceptible to respiratory tract infections and it is an important cause of morbidity and mortality among them. Aim of the study: It was to investigate the relationship between levels of IgG and IgM in Down syndrome and recurrent lower respiratory tract infections. Subjects and Methods: This study was conducted on 40 children who were categorized into 2 groups: patient group, which includes children with Down syndrome patients presented with LRTIs, their karyotyping revealed trisomy 21 in all cases and their age range from 1 to 13 years. Control group, which includes 20 healthy children matched for sex and age with patient group. They were subjected to full history taking & thorough clinical examination, and they investigated for complete blood picture, C-reactive protein and serum immunoglobulins (IgG & IgM) using ELISA technique. Results: Plasma levels of immunoglobulin G (IgG) were elevated in Down syndrome with significant increase the frequency of lower respiratory tract infections and hospital admission. Plasma levels of immunoglobulin M (IgM) were decrease in down patients with significant increase in the frequency of lower respiratory tract infections and hospital admission. Conclusion: These findings suggest the importance of estimation and follow up of serum levels of IgG &Ig M in cases of Ds with recurrent respiratory tract infections.
immunoglobulins,Down syndrome,Recurrent Lower Respiratory Tract Infection
https://ejhm.journals.ekb.eg/article_33365.html
https://ejhm.journals.ekb.eg/article_33365_aaa9f011dfb9554ce8d87e1e168f01a4.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Factors Influencing Surgical Outcome of Intermittent Exotropia
2913
2920
EN
Hanan S.
Hegazy
Department of Ophthalmology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
hanansaied27@yahoo.com
10.21608/ejhm.2019.33367
Purpose: The purpose of this study was to analyze the factors affecting surgical results of intermittent exotropia. Methods: A prospective interventional study included patients with basic type of intermittent exotropia who had undergone surgical treatment with a postoperative follow up period of 1 month or more. Surgical success was defined as an alignment between 10 prism diopters (PD) of exotropia or 10 PD of esotropia at 1 month. The factors investigated were: sex, age of patients, and age at initial surgery, family history, preoperative angle of deviation, type of surgery, the tendon width of lateral rectus muscle, refractive error, near binocular single vision, and postoperative alignment. After data collection, data were analyzed in SPSS version 25 software. Results: The study included 26 patients, 13 (50%) male and 13 (50%) female followed up for 3 months. All of patients achieved surgical success but patients with larger preoperative angle of deviation, older age and larger tendon muscle width showed exotropia with in (10PD) which showed slight improvement during period of follow up while those with smaller preoperative angle, younger age and smaller tendon muscle width showed esotropia with in (10) PD and associated with postoperative diplopia relieved during period of follow up with improvement of esotropia. Conclusion: In intermittent exotropia, age, tendon width, preoperative angle of deviation may predict the surgical success rate. Younger age, smaller preoperative angle, smaller tendon muscle width, early postoperative small angle esotropia were associated with a higher surgical success.
Intermittent exotropia,surgical outcome,tendon muscle width
https://ejhm.journals.ekb.eg/article_33367.html
https://ejhm.journals.ekb.eg/article_33367_fcf3c8d3868e241e3b3b2a6f719cdfda.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Sleep Disorders in Egyptian MS Patients: Clinical and Polysomnography Study
2921
2929
EN
Seham E.
Abd Elsadek
Department of Neurology, Faculty of Medicine, Al-Azhar University
Manal H.
Maabady
Department of Neurology, Faculty of Medicine, Al-Azhar University
Mohamed A.
Shafik
Department of Neurology, Faculty of
Medicine, Ain Shams University, Egypt
mshafik@gmail.com
10.21608/ejhm.2019.33733
Background: multiple sclerosis (MS) is an inflammatory disorder of the brain, spinal cord, and optic nerves. MS affects more than two million people worldwide; sleep disorders are very common in the general population; their high prevalence rate suggests that MS patients will certainly be suffering from comorbid sleep disorders. Objective: study the prevalence of sleep disorders among MS patients by clinical and Polysomnography (PSG) studies. Patients and Methods: twenty-five MS patients and 12 healthy controls were examined by expanded disability status scale (EDSS) for functional disability, Pittsburg sleep quality index (PSQI) for sleep quality, Epworth sleepiness scale (ESS) for excessive daytime sleepiness, international restless leg syndrome scale (IRLSS) for restless led syndrome (RLS). PSG studies were done for all subjects for assessment of quality of sleep and sleep parameters. Magnetic Resonance Imaging (MRI) Brain was done for MS patients g to subtype it according to McDonald criteria 2010. Results: seventy six percent of MS patients had poor sleep quality according to PSQI (8.6 ±3.7). While 44% had excessive daytime sleepiness according to ESS (12.2±3.6) and 40% had RLS according to IRLSS. Patients with progressive MS (PMS) either primary (PPMS) or secondary (SPMS) subtypes had poorer sleep quality index and excessive daytime sleepiness compared to relapsing remitting MS (RRMS) subtype. PSG study showed decreased total sleep time (TST) and sleep efficiency index in MS patients with prolonged sleep latency and decreased rapid eye movement (REM) latency and higher total arousal index and periodic limb movement (PLM) index than control. EDSS of MS patients had positive correlation with PSQI and ESS. Also EDSS had inverse correlation with TST and sleep efficiency index on PSG. Conclusion: sleep disorders are prevalent among MS patients. PPMS and SPMS patients showed more prevalence of sleep disorder than RRMS with poorer sleep parameters on PSG.
Multiple Sclerosis (MS),Polysomnogram (PSG),Pittsburg sleep quality index (PSQI),Epworth sleepiness scale (ESS),international restless leg syndrome scale (IRLSS),expanded disability status scale (EDSS)
https://ejhm.journals.ekb.eg/article_33733.html
https://ejhm.journals.ekb.eg/article_33733_9e8cdafad4b4742eb4b97c985e6de96b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Corneal Endothelial Cell Changes in Type 2 Diabetic Patients
2930
2933
EN
Mahmoud Abd El Haleem
Rabea
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mohamed Mohamed Aly
Ibrahim
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed Ismail Mohamed
Ismail
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
dr_m_aly@hotmail.com
10.21608/ejhm.2019.33734
Background: Diabetic eye disease is an end-organ response to the effects of the condition on the human system. The cornea is a transparent structure protecting the anterior one-sixth of the eye. Chronic hyperglycemia can affect the corneal layers shape and functions that responsible for corneal transparency. Objectives: Comparison of the changes in corneal endothelium namely, cell density (CD), percentage polymegathism, cell volume (CV) and pleomorphism (6A) along with central corneal thickness (CCT) in patients of type 2 diabetes mellitus with normal age and sex- matched subjects. Patients and methods: A case-control study in Sayed Galal University Hospital. 20 eyes of type 2 diabetic patients and 20 eyes of age and sex matched controls were included in the study. Age, gender, other demographic data, and relevant diabetic history were obtained. Full evaluation of both cases and controls including both anterior and posterior segment complete evaluation was done. Non- contact specular microscopy was used to study the corneal endothelial cells. Results: The mean endothelial cell density (ECD) was non-significantly lower in type 2 diabetics compared to controls (p value = 0.751.). There was a highly significant reduction in hexagonally in the cases compared to controls and highly significant increase in coefficient of variation in the cases compared to controls Conclusion: This study acknowledged that type 2 diabetes causes a significant decrease of hexagonality and increase CV (polymegathism). However, non-significant reduction of ECD was documented
diabetes,cornea,Endothelial cell changes,Specular microscopy
https://ejhm.journals.ekb.eg/article_33734.html
https://ejhm.journals.ekb.eg/article_33734_8af2bc980043b63df6d750e2d680b7ad.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Effect of Sildenafil Citrate When Added to Low Molecular Weight Heparin and Small Dose Aspirin on Uteroplacental Perfusion in Cases of High-Risk Pregnancy
2934
2941
EN
Asem A. Abdo
Mousa
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar
University
Mohamed A.
Mohamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar
University
badi388@gmail.com
Mohamed S.
Radwan
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar
University
Amr M.
Sholkamy
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar
University
amr_sholkamy@yahoo.com
10.21608/ejhm.2019.33735
Background: incubation with sildenafil citrate limits the effects of vasoconstrictors on myometrial small arteries of normal pregnancy women and pregnant women with fetal growth restriction. So that phosphodiesterase inhibitors seem to improve uterine perfusion safely in pregnancies with fetal growth restriction.
Objective: the main aim of this study was to demonstrate the effect of sildenafil citrate when added to low dose aspirin and low molecular weight heparin on the uterine and umbilical artery Doppler to improve neonatal outcome in patients with high-risk pregnancy.
Subjects and Methods: The study was conducted at Al-Azhar University Hospitals, Cairo, Egypt. From March 2017 to January 2019. One hundred patients (50 in each arm of the study), who had or have a high-risk pregnancy, were selected and enrolled into a randomized clinical trial.
Results: there was significant increase in amniotic fluid index (AFI) and umbilical artery Doppler parameters. Group B (heparin/aspirin) also showed significant improvement in fetal biometry and Doppler parameters but when comparing the differences between the two groups, none of these changes were statistically significant except for the femur length measurement and the uterine artery resistance index.
Conclusion: from the results of our study we concluded that heparin and aspirin combination or when sildenafil is also added have beneficial effects in the treatment of pregnant women whom vascular impairment is expected showing improvement in the fetal growth parameters and reduction of admission.
sildenafil –heparin,aspirin – Outcome
https://ejhm.journals.ekb.eg/article_33735.html
https://ejhm.journals.ekb.eg/article_33735_20b329253c9d92da705c66e2f61af284.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
75
5
2019
04
01
Treatment of Bicondyler Tibial Plateau Fracture by Single Lateral Locked Plate
2942
2951
EN
Ahmed
Badawy
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Hesham
Safwat
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Mohamed El-Sheshtawy
El-Saedi
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
doc.mohamed.elsaedi@gmail.com
10.21608/ejhm.2019.33736
Background : bicondylar tibial plateau fractures need surgical treatment to achieve good clinical results. The locking plate combines the technical advantages of an angular stable plate with those of the modern biological plating technique. Aim of the study: to verify management of bicondylar tibial plateau fractures by single lateral locked plate including patient selection, fracture type suitable for this kind of surgery, timing of surgery, operative technique, postoperative instructions and follow up. Patients and Methods: between January 2018 and February 2019, 20 patients with a mean age of 38 years (Range: 24-57 years) with bicondylar tibial plateau fractures with or without metaphyseal extension. Patients were diagnosed clinically, checked with standard X-rays, CT was done for all cases. Patients were treated by single lateral anatomically contoured locked plate through LISS or polyaxial locking plate systems with or without additional screws from medial side. Results: the mean Functional Rasmussen Knee score at last follow-up was 94.7% ranged between 83.3% and 100%. The mean Anatomical Rasmussen Knee score at last follow-up was 92.2% ranged between 77.7% and 100%. Mean Functional Rasmussen Knee score of patients had (Schatzker V fractures) was 96%, however it was 82.5% in those had (Schatzker VI fractures). Conclusion: surgical treatment of bicondylar tibial plateau fractures with the single lateral locked plate that was evaluated in our study can lead to a good functional and anatomical outcome and considered an effective system for providing fracture stabilization provided that the correct surgical technique is used.
Tibial plateau fracture,Locked plate,LISS,Polyaxial locking plate
https://ejhm.journals.ekb.eg/article_33736.html
https://ejhm.journals.ekb.eg/article_33736_88d708ea876815e62d34a36b4c9a734b.pdf