2024-03-28T15:12:36Z
https://ejhm.journals.ekb.eg/?_action=export&rf=summon&issue=1829
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Effect of Direct Acting Anti-viral Agents on Insulin Resistance in Chronic HCV Patients
Amgad Ali Abd El-Hadi
Alzahaby
Mohamed Mahmoud
Abdel-Halim
Ahmed Ali El-sayed
Hussien
Background: HCV infection is a major cause of chronic liver disease worldwide, ultimately leading to cirrhosis and hepatocellular carcinoma. Globally, it is estimated that up to 185 million people have been infected with HCV, and among these, according to the World Health Organization, ~ 130–150 millions are chronically infected. Recent estimates place to ~ 700,000 the yearly death toll of liver-related, long-term sequelae of HCV. In many regions of the world, where access to therapy is available, the number of deaths due to HCV has even surpassed. Aim of the work: The goals of our study is to evaluate the effect of direct antiviral agents (DAAs) on insulin resistance in chronic HCV patients receiving (daclatasvir + sofosbuvir +\- ribavirin) for 12 weeks and 12 weeks post treatment. Methodology: The study was conducted at, Gastroenterology and Hepatology Unit, Police Authority Hospitals. It included 80 patients with chronic HCV infection (treatment naive patients). Patients were classified in to 4 groups: Group 1: 20 non diabetic, non-obese patients; Group 2: 20 diabetic, non-obese patients; Group 3: 20 obese, non-diabetic patients and Group 4: 20 diabetic, obese patients. Results: The current study showed highly significant decrease in HOMA-IR in all groups at end of treatment and 12 weeks post treatment. Conclusion: Antiviral therapy (DAAs) improves insulin resistance during HCV treatment. These findings suggest that HCV plays an etiological role in the pathogenesis of impaired glucose homeostasis. Moreover, the decrease of insulin resistance through viral eradication implicates clinical benefits by readily available regimens. Recommendations: Confirmation of the current results by conduction of larger scale studies.
Direct acting anti-viral agents
HCV
2018
07
01
4413
4419
https://ejhm.journals.ekb.eg/article_9452_37a6de3d94c93518067b65c824b43126.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Pruritus Vulva in Adolescent Females in Arar City, KSA
Aisha Reja M
Alenazi
Nawal Ahmed M
Alshammari
Noof Saad M
Alruwaili
Alaa Jameel A
Ahmed
Nour Hamoud Abdullah
Alanazi
Batool Abdullah
Albahrani
Hajar Moosa
Alkhadhabah
Abdulaziz Saad M
ALShamrani
Wafa Hammad
Albalawi
Background: Pruritus vulvae or vulvar itch is an unpleasant vulvar sensation that provokes the urge to scratch to obtain relief. It is a common complaint in females of all ages. A pruritus vulva is not a condition. It is the symptom of various -most often benign, sometimes malignant – disorders. The study aimed at investigating the prevalence in valval itching and its manifestations and causes among young females in Arar city, KSA. Methods: This is across sectional study conducted among 300 of the studied women, Arar, KSA. Data were collected by using pre designed online questionnaire which include questions designed to fulfill the study objectives. Results: Pruritus vulvae were found in 30.7% of the studied sample. Most (60.7) of the examined girls age was between 15- 20 years old. 79.3% of the sample was single (unmarried). Manifestations of pruritus vulvae were 43.5% redness, 21.7% edema, 67.4% reported association of pruritus with increased vaginal discharge. 56.5% reported increased pruritus before menses and 37% after. Only 37% of the pruritus cases asked for medical help but only 23.9% got better after treatment. There was a significant correlation between pruritus vulvae and both age group and marital status (P= 0.001). Conclusion: Pruritus vulvae were found in 30.7% of the studied sample. Prevention of genitourinary infection among adolescents regarding personal hygiene is mandatory. Recommendations include counseling during periodic medical examination about personal hygiene, especially during menstruation.
Adolescents
Female genitourinary tract
Pruritus Vulva
Genitourinary infection
Hygiene
Personal hygiene. Arar City
KSA
2018
07
01
4420
4423
https://ejhm.journals.ekb.eg/article_9453_c3f619c4ccba38ad2ec915cdaef1cc5c.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Role of Ultrasound Guided foam Sclerotherapy in Treatment of Lower Limb Varicose Vein
Alaa Hamdy
Mohamed
Ahmed Hassan
Soliman
Mohamed El Gharib
Abo El Maaty
Background: Veins have one-way valves which prevent blood from backing up into the legs when we stand or sit. When the valves become incompetent (or begin to have reflux), blood pools and causes an increase in pressure in the leg veins becoming enlarged and twisted. Objective: It was to evaluate the safety and efficacy of foam sclerotherapy in the treatment of primary varicose veins. Methodology: This study was carried out in Radiology Department of Ain Shams University Hospitals. 20 patients with sonographically proven primary varicose veins for which they had foam sclerotherapy injection. Result: The 20 patients enrolled in this study were ranging from 24 to 52 years with mean age of 36.4 years. Conclusion: Foam Slcerotherapy is effective & safe in treatment of primary varicose veins.
Varicose veins (VV)
Phlebograph (PHL)
foam sclerosant (SCL)
2018
07
01
4424
4427
https://ejhm.journals.ekb.eg/article_9490_8946b4378444352fa0406645f08775f3.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Growth Kinetics of Egyptian isolates of Trichomonas vaginalis: Possible Correlation to Clinical Presentation
Khalifa E.
Khalifa
Basant O.
Mohammed
Noha A.
Elleboudy
Hesham M.
Hussein
Magda E.
Azab
Background: Trichomonas vaginalis is the most common non-viral sexually transmitted infection (STI) in the world. Trichomoniasis is an important risk factor for herpes simplex type II infections, human immunodeficiency virus (HIV) acquisition and transmission, pelvic inflammatory disease and cervical neoplasia. Studying the variation in growth patterns of the parasite can be used for biological characterization of the parasites and might be related to the severity of clinical presentation. Aim of the Work: Study the growth kinetics of Egyptian Trichomonas vaginalis isolates in term of log phase, growth peaks reached, division rate and generation time of each isolate and correlation of such parameters with the clinical presentation of the patients, if any. Material and Method: The study was carried on 300 vaginal washouts collected from Egyptian women patients aged 20-45 years suspected for trichomoniasis. Positive samples for Trichomonas vaginalis were cultured and sub cultured on modified Diamond’s medium. Growth kinetics for each isolate was done by inoculated 104 trophozoites/ml into 2 tubes containing 10 ml of sterile culture medium followed by counting the trophozoites every 24 hours over seven days using a hemocytometer. Growth curves were done for each isolate by plotting the parasites numbers against the time. Division rates and generation times were calculated for each isolate. Results: Out of the 300 collected samples, twelve were found positive for Trichomonas vaginalis trophozoite by wet mount examination and culture technique. Comparison of the growth kinetics of the twelve Trichomonas vaginalis isolates revealed a salient difference among all isolates after 48 to 96 hours. Isolates 1, 2, 6, 8 and 10 had a log phase of 48 hours. Isolates 4, 5, 7, 11 and 12 had a log phase of 72 hours. Isolates 3 and 9 had a log phase of 96 hours. The fast growing isolates of Trichomonas vaginalis reached maximum growth after 48 hours and the highest yield was observed in isolate 10 (150.25±3.13). Slowly growing isolates reached a maximum after 96 hours with the lowest yield in isolate 3 (40.5±21). Regarding the clinical presentation, isolates 1, 2, 3, 4, 5 and 11 showed mild discharge and congested cervix. Isolates 6, 7, 8, 9, 10, and 12 showed profuse discharge with varying clinical findings on gynecological examination. Isolate 10 had the most severe pathology with cervical erosion. Isolate 9, 12 showed bleeding during examination, isolate 8 showed vaginal ulcer while isolate 6 showed just erythema of the vagina. Conclusion: Comparison of the growth kinetics of the twelve Trichomonas vaginalis isolates revealed a salient difference among all isolates after 48 to 96 hours. Regarding the clinical presentation, no clear correlation was found between the growth kinetics and clinical presentation of the patients. Methods other than growth kinetics such as genotyping and determination of genetic variability are needed to verify the relation between isolates of Trichomonas vaginalis and clinical presentation.
Trichomonas vaginalis
growth kinetics
growth curves
2018
07
01
4428
4433
https://ejhm.journals.ekb.eg/article_9493_802e9a603406dc3f0d2a65e78317eac1.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Assessment of Vitamin D Status In Patients With Essential Hypertension
Sameh Ahmad
Abd-El Kader
Youssef Khalel
Ahmad
Esam Mohamed
El-Ghamry
Salwa
Tawfik
Wael Mohamed
Atia
Mohammad Mohammad
Keder
Background: There is close relationship between Vit D deficiency and hypertension. It was found that Vit D is potent inhibitor of Renin Aldosterone Angiotensin System (RAAS) which is the main mechanism responsible for development of hypertension. Aim of The Work: To assess the role of vitamin D deficiency in the development of essential hypertension and aggravation of its vascular complications. Subjects and Methods: This study was conducted on 80 individuals. Individuals were divided into two groups: Group 1: comprising 60 patients with essential hypertension. Group 2: comprising 20 healthy individuals. All individuals included in the study were submitted to: Complete history and physical examinations to evaluate exclusion criteria. Liver and renal function tests, fasting and PP blood glucose, CBC, lipid profile, serum vitamin D (25hydroxycholecalciferol), serum Ca & Ph. Doppler study on carotid artery to assess vascular complications and Echocardiography to assess ventricular mass was done. Results: There was statistically significant decrease (p value <0.05) in vitamin D in patients group in comparison to control group. There was highly statistically significant increase (p value <0.001) in intimal thickness and left ventricular mass in patients with low vitamin D level in comparison to patients with normal vitamin D level. In the patient group, 6 patients (10%) were suffering from vitamin D deficiency while 30 (50%) were suffered from vitamin D insufficiency while 24 (35%) show normal levels of vitamin D. Interestingly, intimal thickness and ventricular mass were significantly higher in patients with essential hypertension with low vitamin D than those with normal vitamin D levels. Conclusions: Vitamin D deficiency occurs in the majority of essential hypertension patients and therefore decreased serum vitamin D levels is considered an additional risk factor for cardiovascular morbidity and mortality.
Vitamin D Status
Essential hypertension
2018
07
01
4434
4438
https://ejhm.journals.ekb.eg/article_9496_236c0ef5648d291cb40ce8e5118b58f3.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
The role of transobturaor vaginal tape (TOT) in the management of female stress urinary incontinence - 2 year follow up, Minia University experience
Ahmed M.
Abdelghany
Objective: The aim of this study was to evaluate the effectiveness and safety of minimally invasive surgical procedure trans-obturator vaginal tape (TOT) in the treatment of female stress urinary incontinence and follow up these cases for 24 months regarding effectiveness, safety and possibility of complications.
PATIENTS: 30 women with genuine stress urinary incontinence (SUI) demonstrated by history, clinical examination and urodynamic study.
METHODS: 30 patients diagnosed with SUI underwent transobturator sling (inside-out technique) (TVT-O Gynecare ®, Johnson& Johnson, USA.) The patients were followed up for 24 - months regarding subjective and objective cure rates.
RESULTS: The mean operative time (min.) was 19.67 (±8.06). The mean intraoperative blood loss (ml) was 80±30.52. There was no case complicated by intraoperative bleeding (mild or severe), bladder, urethral, vascular injuries and anesthetic complications. Subjective and objective cure rates of these patients were (95%) both.
Conclusion: The results of this study concluded that management of genuine stress urinary incontinence by transobturator vaginal tape (TVT-O) is an easy and safe method with low complications and high success rate.
Stress Urinary Incontinence
Transobturator vaginal tape
2018
07
01
4439
4442
https://ejhm.journals.ekb.eg/article_9498_261d4992fe06ccb0490197c255b92031.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Role of Chest Ultrasound in Detecting Successful Pleurodesis in Patients with Malignant Pleural Effusion
Emad Khamis Ahmed
Seddik
Nabil Farouk
Awad
Abd-Allah Mohammad
ElBalsha
Wafik Ebrahim
Aly
Background: One of the easiest sign to identify during chest sonography is the movement of the visceral pleura compared to immobility of the parietal pleura. This sign of ‘pleural sliding’, firstly described in veterinary medicine and was used to exclude the presence of pneumothorax when present and to suspect atelectasis, fibrosis or pleural adhesions (pleurodesis) when absent.
Aim of the Work: This study aims to detect successful pleurodesis with povidone-iodine in patients with malignant pleural effusion by using the chest ultrasonography.
Subjects and Methods: This study was carried out on 30 patients with malignant pleural effusion attended to AL-Hussein University hospital, Al-Azhar University in the period between October 2017 and May 2018.All patients underwent full history taking, complete clinical examination, plain chest X-ray, routine lab investigations, CT scan of the chest, pleural fluid analysis including physical, chemical, Bacteriological and cytological examination for malignant cells, medical thoracoscopy, transthoracic ultrasonography before and after pleurodesis to assess the presence or absence of sliding sign.
Results: The results of this study revealed that the transthoracic ultrasound can easily detect sliding sign and assess the success of pleurodesis. Iodopovidone was effective in inducing pleurodesis in patients with malignant pleural effusion.
Conclusion: Transthoracic ultrasound for the evaluation of pleurodesis is feasible and simple.Iodopovidone was effective in inducing pleurodesis in patients with malignant pleural effusion.
Transthoracic ultrasound
Sliding sign
Pleurodesis
2018
07
01
4443
4447
https://ejhm.journals.ekb.eg/article_9500_ceaf9939cac7d3667ff29b848039142a.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Evaluation of the Use of Short Acting Insulin in the Management of Mild to Moderate Diabetic Ketoacidosis: A Simple Literature Review
Ali Abdullah
Alnajrani
Suhaib Abdulrahman
Al-Khilaifi
Sultan Salman
Aldhafeeri
Nasser Falah
Alqahtani
Reem Ahmed B.
Alanazi
Rawan Adel
Shafaay
Sufana Mohamedwageeh
Saadi
Aishah Abdulrahman
Al-Hamoud
Hadeel Salem
Alwagdani
Naseem Ahmad
Matari
Background: Diabetes mellitus (DM) is one of the most common chronic diseases. It can cause a lot of complications such as retinopathy, nephropathy, and neuropathy. Patients with DM are at risk of having acute attacks of hyperglycemia and ketoacidosis as well as hypoglycemia. Diabetic ketoacidosis management is accomplished by the administration of intravenous infusion of regular insulin. Intravenous insulin infusion requires ICU admission in most of institutions, which will increase the hospitals cost (infusion pumps, IV access, nurses). Accordingly, we have done a literature study to determine whether intermittent subcutaneous use of these rapid-acting analogs might be as effective as intravenous insulin infusions in treating uncomplicated diabetic ketoacidosis.
Objective: In this study, we aimed at evaluating the effect of using short acting insulin in the management of mild to moderate DKA.
Methods: PubMed database was used for articles selection, and the following keys were used in the mesh ("Insulin Lispro"[Mesh]) AND ("Diabetic Ketoacidosis/drug therapy"[Mesh] OR "Diabetic Ketoacidosis/therapy"[Mesh]) A total of 13 articles were found, with further restriction by PubMed filters, and reviewing the articles titles and abstracts the final results were 5 articles.
Conclusion: Subcutaneous (S/C) Aspart insulin every 2 hours can be as safe and effective as SC Lispro insulin every one hour and as continuous IV insulin infusion in the treatment of mild to moderate uncomplicated cases of DKA. There was no significant statistical difference among the 3 approaches regarding the efficacy, and the mean duration of the treatment period. SC aspart insulin every 2 hours is more economical and fairer type intervention.
Short acting insulin
Diabetic ketoacidosis
Evaluation
subcutaneous aspart insulin
2018
07
01
4448
4453
https://ejhm.journals.ekb.eg/article_9502_6c5ea72e7be432b613dd16a3a38b963b.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Pediatric Intestinal Obstruction, Management and Outcomes: A Simple Literature Review
Alaa Mutlaq
Alshareef
Shahd Saeed
Alghaseb
Lamia Saeed
Alghaseb
Shahad Ahmed
Alqahtani
Norah Fahad
Alshahrani
Norah Abdullah
Hasoosah
Alia Musfer
Alqahtani
Marwah Nasser E
Alabdrabalameer
Abdullah Salem
Al-Rayshan
Tareq Hamad
Alotaibi
Background: Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction in children can occur as a result of various causes such as, intussusception, adhesive small bowel obstruction, malrotation, and Hirschsprung’s disease. In this review paper we will go through the literatures that have been investigated to assess the various management measures and its outcomes.
Objective: In this review we aimed at assessing of different management plans of gastrointestinal obstruction in different conditions like Intussusception, Congenital Duodenal Obstruction and Adhesive Small Bowel Obstruction (ASBO), and the outcomes related. Moreover, providing a reference paper analyzing all the clinical studies in this field.
Methods: PubMed database was used for articles selection, and the following keys used in the Mesh ("Intestinal Obstruction/diet therapy"[Mesh] OR "Intestinal Obstruction/drug effects"[Mesh] OR "Intestinal Obstruction/ drug therapy"[Mesh] OR "Intestinal Obstruction/surgery"[Mesh] OR "Intestinal Obstruction/ therapy"[Mesh]).
Results: Intussusception should be treated with hydrostatic reduction (HR) even with more than one try because this method was associated with high success rate. After successful HR, patient can be discharged from ED if there were no suspected complications. Surgical treatment is indicated mostly in cases of complications. Manual reduction was associated with significantly better post-operative outcomes and lesser time to recovery. It is advised not to maintain high threshold for resection in order to avoid post-operative recurrence or perforation. The use of Gastrografin in treating children with adhesive small bowel obstruction when the conservative management fails is safe. However, half of the patients will need surgical management after all.
Conclusion: The laparoscopic approach in the management of congenital duodenal obstruction can be performed in neonates safely. It showed similar outcomes to the open approach despite the presence of high conversion rate.
Pediatric intestinal obstruction
congenital duodenal obstruction
gastrografin
laparoscopic approach
2018
07
01
4454
4462
https://ejhm.journals.ekb.eg/article_9507_dec0045ce184b7d555167c98a36873f3.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Clomiphene Citrate and Metformin" Stair Step" Protocol Vs. Traditional Protocol in Patients with Polycystic Ovary Syndrome "PCOS"
Ahmed Abdel Hay
Ali
Samir Fouad
Khalaf
Mohamed Mohamed
Farahat
Background: Clomiphene citrate is the most popular drug for ovulation induction mainly in cases of PCOS, used alone or with combination of other drugs e.g. metformin.
Aim: To evaluate the efficacy of stair step protocol versus traditional protocol using clomiphene citrate alone or combined with metformin and to assess the uterine and systemic side effects of cumulative doses in single cycle.
Patient and Methods: Sixty (60) patients in two groups diagnosed as PCOS, based on the revised Rotterdam criteria (2003), *Group 1: In the stair-step protocol (n = 30), Clomiphene Citrate was administered at 50 mg daily for 5 days following the onset of a spontaneous or progestin- induced menses. The follicular response monitored by TVS starting on day 8. When the mean diameter of the follicle size is below 11mm on cycle day 14, the dosage increases to 100 mg/day for 5days.Then on cycle day 19 re-evaluation by TVS was restarted. Metformin with initial dose 500mg/day (and gradually increased to 1,500 mg /day during 6 weeks).**Group 2: In the traditional protocol (n = 30), Clomiphene citrate was administered 100 mg daily for 5 days after the onset of spontaneous or progestin-induced menstruation. The following variables were measured: ovulation rate (The number of follicles that mature and ovulate during given menstrual cycle), Side effects on uterine artery & systemic side effects e.g. Hot flushes.
Results: The findings of this study indicated no significant difference between the 2 groups in using clomiphene citrate by stair step protocol or traditional protocol (P>0.05).
Conclusion: Clomiphene citrate in the stair step protocol combined with metformin has a higher efficacy compared to CC in the traditional protocol in patients with PCOS in terms of ovulation and clinical pregnancy rates without any detrimental side effects on endometrial thickness or Doppler of uterine arteries, stair step protocol suitable for use in clinical practice.
Clomiphene citrate- Stair step- Metformin- Ovulation induction
2018
07
01
4463
4468
https://ejhm.journals.ekb.eg/article_9511_d3b16c3081aace2d36b5103077b8b50d.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
In Vitro Antimicrobial Combinations for Pan-Drug Resistant Acinetobacter Species
Nashwa Mohamed Naguib Mahmoud
Omar
Samia Abdou
Girgis
Sherif Wadie
Nashed
Sally Mohamed
Saber
Rania Mohamed
AbdelHalim
Background: Pandrug resistant Gram-negative organisms (PDRGNs) have emerged, as a major threat to hospitalized patients. They have been associated with mortality rates ranging from 30 to 70%. Because of the high morbidity and mortality rates of severe pandrug resistant acinetobacter spp infections, combination therapies, as opposed to monotherapy, are suggested. A synergistic effect may be developed when antibiotics are used in combination. Through this synergistic effect, treatment efficacy can be improved and resistance can be prevented.
Aim of the work: To investigate the use of in vitro antibiotic synergy test (checkerboard) for pandrug resistant acinetobacter species with a clinical feedback on the most synergistic antimicrobial combination.
Materials and Methods: During this study, one hundred isolates of drug resistant acinetobacter species identified by routine culture and sensitivity using disc diffusion susceptibility test, were collected from critically ill patients admitted to Ain Shams University Internal Medicine Intensive Care Units. The isolates were subjected to: (i) Determination of MIC using Vitek 2 automated system to confirm resistance of acinetobacter species to all commercially available antibiotics, (ii) Broth micro-dilution method (BMD) for determination of tigecycline susceptibility, and (iii) Determination of antimicrobial synergy by broth micodilution (Checkerboard method).
Results: Vitek 2 system results showed that, all of the 100 isolates were resistant to all antibiotics included in the study. On the other hand, 100% of the isolates were sensitive (S) to Colistin. As regards the results by Broth microdilution antibiotic susceptibility method, all 100 isolates (100%) were resistant to ampicillin/sulbactam, meropenem and ciprofloxacin, whereas 95 isolates (95%) were resistant to amikacin, whereas all 100 isolates (100%) tested were sensitive to tigecycline. The results of the antibiotic combinations were as follows; the activity of ampicillin/sulbactam in combination with amikacin showed synergy in (48%), addition in (42%) and indifference in (10%). The activity of ampicillin/sulbactam in combination with ciprofloxacin showed, synergy in (36%), addition in (52%) and indifference in (12%). The activity of meropenem in combination with amikacin showed, synergy in (26%), addition in (53%) and indifference in (21%). No antagonistic activity was detected between any of the antibiotic combinations used.
Conclusion: The prevalence of XDR/PDR resistant Acinetobacter spp. was highest in blood samples (43%) followed by sputum samples (35%) recovered from critically ill patients admitted to Ain Shams University Internal Medicine Intensive Care Units. Vitek 2 system showed that, all of the 100 isolates were resistant to all antibiotics included in the study. On the other hand, 100% of the isolates were sensitive (S) to colistin. Broth microdilution antibiotic susceptibility method showed that, all 100 isolates (100%) were resistant to ampicillin/sulbactam, meropenem and ciprofloxacin, whereas 95 isolates (95%) were resistant to amikacin, whereas all 100 isolates (100%) tested were sensitive to tigecycline, indicating that acinetobacter spp. did not attain resistance to tigecycline yet. The broth microdilution antibiotic synergy test (Checkerboard method), being the reference method for assessing antimicrobial synergy, showed that the highest synergic activity belongs to ampicillin/sulbactam and amkacin (48%), and the lowest synergic activity belongs to meropenem and amikacin (26%).
PDRGNs
Antimicrobial combinations
Checkerboard broth microdilution method
2018
07
01
4469
4472
https://ejhm.journals.ekb.eg/article_9514_2de9e05e3dadf0c4f7cc1e6815ae58df.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Discussion of the Causes, Effect and Potential Methods of Alleviating Patient Anxiety When Undergoing Magnetic Resonance Imaging (MRI)
Zyad Mansour
Almutlaq
Background: In performing an MRI examination the patient may feel anxious due to the nature of the MRI scan as the patient would be inserted into the narrow bore of the MRI scanner and would be asked to be immobile during the examination period for approximately 20 to 90 minutes depending on the scan type. Patient feeling anxious may also be evoked by several causes and consequently may develop into anxiety reactions by the patient either before, during, or after the scan. Aim: This paper aim to study the issues surrounding the anxiety in patients undergoing MRI examinations by identifying the prominent causes, outlining the possible effects of anxiety, discussing the main potential methods for alleviating patient's anxiety. Materials and methods: This review is conducted by using a comprehensive search of PubMed, Google Scholar, and Elsevier, August 1993, through March 2018. The following search terms were used: causes of anxiety in MRI, claustrophobia and MRI, effects of anxiety in MRI, alleviation of anxiety in MRI patient. Conclusion: Patient's anxiety can pose problems that may impede the process of the MRI examination. Patient's anxiety may have adverse effects on both patient and the healthcare institution as it can cause financial losses for the healthcare institutions. However, sedation techniques, acoustic noise reduction, and adequate patient preparation for the MRI scan are possible methods that can alleviate patient's anxiety.
MRI
Medical Imaging
Patient Anxiety
Claustrophobia
2018
07
01
4473
4477
https://ejhm.journals.ekb.eg/article_9515_497dc2d02555a591343b4c53d85b0c2c.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Role Of Pet/Ct Scan In The Assessment Of Primary And Loco Regional Recurrent Breast Cancer
Maha Mourad
El-Saeed
Ahmed Mohamed
Basiouny
Yasser Ibrahim
Abd ElKhalek
Objective: Study the accuracy of 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scan in diagnosis of primary and loco regional recurrent breast masses compared with histopathological results and to correlate the results of 18F-fluoro-2-deoxy-D- glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with histopathological findings in breast carcinoma patients. Methodology: This study is a prospective study conducted on 24 female patients presented to Ain Shams University Hospitals (oncology,surgery and obstetrics and gynecology departments) with pathologically proven breast cancer underwent PET/CT. Result: SUVmax of the tumor is directly related to the histopathological grade and to the size of the tumor. Invasive ductal carcinoma has predominantly higher SUVmax than invasive lobular carcinomas. Also SUVmax tumor/ SUVaverage liver is more accurate that SUVmax tumor alone. However, no relation between SUVmax and the presence of distant metastasis. 18F-FDG uptake may serve as a prognostic indicator for biological behavior in breast tumors
breast cancer
18F-fluorodeoxyglucose
positron emission tomography/ computed tomography
Simple Uptake Value (SUV)
Prognostic factors
2018
07
01
4478
4485
https://ejhm.journals.ekb.eg/article_9517_7811f9b175504172de958a99c9349422.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Evaluation of the Internal Nasal Valve using Computed Tomography Pre and Post Rhinoplasty and Its Correlation to Symptomatic Improvement
Amr Gouda
Shafik
Tahany Mohamed
Rabie
Hussam Adel
Alkady
Ahmed Mostafa
Mohamed
Background: The INV area is the narrowest area of a nasal cavity, which is formed by the nasal septum, the caudal border of the upper lateral cartilage ULC, the head of the inferior turbinate, and the pyriform aperture and the tissues that surround it. Accurate evaluation of the INV is important to the workup for repair of problems that involve this area. The initial evaluation of the nasal valve occurs with the clinical examination, anterior rhinoscopy, the Cottle maneuver, and endoscopy, which all are used clinically to assess nasal airflow. Objective: This study aims to evaluate the internal nasal valve by using reformatted (CT) scans of the nasal airway pre and post rhinoplasty and its correlation to symptomatic improvement according to (NOSE) scale. Patients and Methods: This prospective study of twenty patients who were subjected to rhinoplasty at ENT departments of Ain-shams university hospitals. Results: This study included 20 cases of age’s ranges from 20 to 30 years. The mean age among study cases was 23.8 ±3.22. There were 14 males and 6 females. So, the majority of cases (70%) were males. In our study, we detected that there is no significant correlation between CT scans analysis of the INV pre and post- rhinoplasty and there is no significant correlation between CT scans analysis of the INV and the NOSE score pre and post-rhinoplasty. On the other hand, there is high significant correlation between NOSE score pre and post-rhinoplasty. Conclusion: In our study, we detected that there is no significant correlation between CT scans analysis of the INV pre and post-rhinoplasty and there is no significant correlation between CT scans analysis of the INV and the NOSE score pre and post-rhinoplasty.
External nasal valve
internal nasal valve
nose obstruction symptomatic evaluation
2018
07
01
4486
4489
https://ejhm.journals.ekb.eg/article_9518_55a806bf0afc314de632c8a6ef136dab.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Association of Scavenger Receptor Gene with Premature Coronary Artery Disease
Manal Mohamed
Abd Al Aziz
Wessam El Sayed
Saad
Hoda Ahmad Abdel Sattar
Abdel Sattar
Adham Ahmad Abd
El Tawab
Marium El Sayed Ahmad
Fathi
Background: Coronary artery disease (CAD) is one of the greatest causes of morbidity and mortality worldwide. It is the principal threat to health in countries in Africa and the Middle East and one of the leading causes of disease burden in developing countries. Scavenger receptor class B type1 (SCARB1) is a multi-ligand cell surface receptor. This membrane protein facilitates the uptake of cholesterol esters from high-density lipoprotein cholesterol (HDL-C) and drives cholesterol from tissues to the liver in the various stages of reverse cholesterol transport pathway.
Aim: The aim of this work is to study the association of rs5888 polymorphism of SCARB1 gene and premature coronary artery disease.
Patients and Methods: PCAD group included 20 patients newly diagnosed angiographically with premature coronary artery disease, and non-PCAD group that included 20 age and sex matched non-CAD individuals who showed no luminal stenosis in coronary angiographic results.
Results: The frequency of the wild type (CC) was higher in the control group (60%) than patients’ group (25%) and it can be considered as a negative risk factor for PCAD (OR: 0.71, 95% CI [0.60-0.82], p < 0.01). The homozygous and heterozygous mutations (TT & CT) were statistically more frequently distributed in PCAD patients compared to control subjects (30 % and 45 % respectively), however only the CT genotype was considered as positive risk factor for PCAD (OR: 4.02, 95% CI[1.96-10.54], p= 0.01).
Conclusion: Allele frequencies of studied SCARB 1 SNP revealed a higher frequency of distribution of T alleles in patients' group when compared with control group; on the other hand it shows the higher frequency of distribution of C alleles in control group when compared to patients' group.
PCAD
SCARB 1
2018
07
01
4490
4495
https://ejhm.journals.ekb.eg/article_9519_e30d06572441e9b1c7d8dff829f551fe.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Fixation of Unstable Femoral Neck Fractures in Adults, Review Article
Gergis
Nabil Benyameen
Shady S.
El-Beshry
Ahmed
H. Yousry
Backgroundː Femoral neck fracture is a common problem especially in young adults. There are different methods of fixation of unstable femoral neck fractures in adults, some of which are accompanied by complications.
Aim of Study: A systematic review on the different methods of fixation of unstable femoral neck fractures in adults with clarifying the incidence of nonunion, avascular necrosis, displacement and other complications in each type of fixation.
Methodsː A systematic review of literature was conducted on twelve studies (556 patients) published in literature using different methods of fixation with inclusion criteria includingː English literature, human studies on adults aged 18-70 years with unstable neck of femur fractures Pauwel grade 3. Exclusion criteria includingː in vitro studies, pathological and nonunited fractures in people aged below 18 or above 70 years with stable neck femur fractures Pauwel grade 1,2.
Results: Targon femoral neck device had been provided to achieve highest rate of union with less complications than other methods of fixation but further evaluation of this device should be done within multiple studies in the future.Primary valgus osteotomy achieved a high union rate but still carries some complications especially delayed osteotomy site healing,coxa vara if improper reduction or fixation in addition to that itʾs technically demanding and needs special surgical skills.Medial buttress plate augmentation should be studied more and more in further studies with longer follow up periods and larger number of patients
Conclusion: Targon femoral neck device had been provided to achieve highest rate of union with less complications than other methods of fixation but further evaluation of this device should be done within multiple studies in the future.
Unstable femoral neck fractures
pauwelʾs III
young adults
primary valgus osteotomy
2018
07
01
4496
4504
https://ejhm.journals.ekb.eg/article_9520_8b19e3b4a4dc02e680577eda2923d35c.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Management of Complications of Arteriovenous Grafts in Patients with Chronic Renal Failure
Mohammed Abou Al-azayem
El-Kenany
Islam Taha
Ghalwash
Mohamed Abd El Hamid
Abd El Rahman
Background: With increasing number of patients sustained on chronic Haemodialysis, access related surgery forms a significant proportion of vascular surgical practice today. A cursory review of patients with Arteriovenous graft access reveals a considerable variety in short and long-term complications that could happen and in the management of those complications.
Aim: The aim of this work is to assess the outcomes of different modalities of management of complications of Arteriovenous grafts in chronic renal failure patient on regular hemodialysis from arteriovenous graft.
Patients and Methods: Thirty chronic renal failure patients with complicated Arterio-venous grafts performed before for regular hemodialysis were enrolled into this study. The patients were recruited from the Vascular Surgery outpatient clinic of El-Hussein University Hospital. Patients were followed up at intervals of: immediately after fistula creation, first day after creation, 1 month, 3 months, 6 months and 9 months after creation for detecting any complications. Follow up of all patients was based on clinical examination and also by duplex ultrasound and CT venography if needed.
Results: Arteriovenous graft complications incidence were higher in male than females, those results were explained by male cases being associated with more co-morbidities and smoking. Venous outflow stenosis and venous hypertension were the most encountered complication, while surgical management in form of ligation and excision was the commonest management modality used. We also noticed a correlation between the duration from creation of AV synthetic graft and interval between primary and secondary intervention. The older the AV graft the longer was the interval between primary and secondary intervention. This can be correlated to years of education those group of patients had, as those patients tended to pay more attention to early manifestations and used better dialysis centers.
Conclusion: Surgical management in form of graft ligation and excision or surgical revision seems to be the simplest yet most effective management modality facing the majority of the complications not neglecting the role of endovascular intervention in venous hypertension.
ESRD
Hemodialysis
Complications
Management
surgical
endovascular
2018
07
01
4505
4508
https://ejhm.journals.ekb.eg/article_9521_536389a8aa3253f04d5fde0a55ff7110.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
A Two-Week Nitazoxanide-Based Quadruple Treatment as a Rescue Therapy for Helicobacter Pylori Eradication
Ali A.
Waheeb
Ahmed O.
Dorrah
Waleed M.
Mousa
Alaa M.
Ebrahim
Introduction: Helicobacter pylori is the most common prevalent chronic human bacterial infection estimated in 50% of the global population but only induces clinical diseases in 10-20% of infected individuals. These include peptic ulcers, acute and atrophic gastritis, intestinal metaplasia, gastric adeno-carcinoma and gastric B-cell lymphoma. H. pylori infection has become highly resistant to traditional first-line treatment regimens because of antibiotic resistance coupled with poor patient compliance with completing the treatment course. Many clinical studies proved that nitazoxanide (NTZ) was found to be well tolerated by humans, with an encouraging rate of eradication when it was administered with omeprazole.
Aims: The aim of the work is to compare between the efficacy of traditional triple therapy and nitazoxanide-based quadruple therapy in treatment of H. pylori and to evaluate the efficacy of nitazoxanide-based regimens as a rescue regimen for H. pylori eradication in resistant patients.
Methodology: This study was carried out on 85 Helicobacter pylori (H. pylori) infected patients; Patients were classified in to 3 groups: Group 1: 60 patients with positive H. pylori Ag taking 14 days triple therapy composed of amoxicillin (1 gm twice daily), clarithromycin (500 mg twice daily) and omeprazole (40 mg once daily).; Group 2: 25 patients with positive H. pylori Ag (naïve: not having previously taken or received a particular treatment for H. pylori) taking 14 days quadruple therapy composed of nitazoxanide (500 mg twice daily), in addition to triple therapy.; Group 3: 22 patients with positive H. pylori Ag after treatment (resistant for triple therapy from group 1) taking 14 days nitazoxanide-based quadruple therapy.
Results: This work recorded the best results for H. pylori eradication (92%) in group II who received nitazoxanide based quadruple therapy compared with group I eradication rate (63.3%), who received traditional triple therapy regimen and better results (77.3%) in group III (resistant patients from group I).
Conclusion: This study could state that, using nitazoxanide can overcome traditional triple therapy resistance; in addition to its efficacy in treating naïve patients who didn’t take any medical treatment for H. pylori.
Recommendations: Nitazoxanide (NTZ) based regimen namely NTZ/ clarithromycin / PPIs and amoxicillin is a recommended H. pylori therapeutic regimen in our community.
Helicobacter-Pylori
Nitazoxanide
2018
07
01
4509
4514
https://ejhm.journals.ekb.eg/article_9522_58208599ef0146078ed6b1ebdac6a9e5.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Study of Efficacy of the Use of Peri-Operative Pregabalin and Dexamethasone on Post-Operative Pain in Patients undergoing Lumbar Laminectomy
Bahaa Mohamed
Abd El-Raouf
Mohammed Ahmed
El-Feky
Wael Mohammed
El-Mahdi
Objective: This study aimed at studying the efficacy of the peri-operative use of pregabalin and dexamethasone for post-operative pain relief in patients undergoing lumbar laminectomy. Methods: It is a prospective randomized controlled study. The patients on whom the study had been carried out fulfilled the following criteria: Age: above 20 years till 60 years, Gender: both females and males, ASA I and II, Patients scheduled to undergo elective lumbar laminectomy without fusion, patients had been randomly categorized into 2 equal groups by closed envelope technique, 30 in each group. Group P: Pregabalin + Placebo: Patients had been orally given single dose of 150 mg of pregabalin dissolved in 10 ml distilled water one hour before the initiation of anesthesia and until the second post-operative day, the doses had been given every 12 hours for a total of 4 doses. Group PD: Pregabalin + Dexamethasone: Patients had been orally given single dose of 150 mg of pregabalin dissolved in 10 ml distilled water one hour before the initiation of anesthesia and until the second post-operative day, the doses had been given every 12 hours for a total of 4 doses. Patients received 16 mg dexamethasone intravenously with induction of anesthesia. Results: There was a significant difference about the heart rate intra operative and the mean arterial blood pressure intraoperative and postoperatively at different intervals. As regarding the ETCO2 group P had a higher average at baseline. Group PD had a significant lower consumption of pethidine in comparison with group P. However, there was no significant difference observed in the consumption of ketorolac between the two groups. In comparison between the two studied groups, the overall mean satisfaction score was significantly higher among group PD than among group P.
dexamethasone
Pregabaline
pain management
Lumbar Laminectomy
Anesthesia
2018
07
01
4515
4522
https://ejhm.journals.ekb.eg/article_9523_5397a2655c8969d05d66401251af4f7c.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Role of Ultrasound in Assessment of Joint Pain among Hemodialysis Patients
Mohammad Sobhy Abdulhameed
Abdulkhaliq
Ahmed Alaa Eldin Ahmed
Saad
Ahmad Mohammad Abdulfattah
Al-Ashkar
Ahmad Mahmoud Ahmed Mohamed
Fahmy
Nabil Fathy Ismael
Hassan
Background: Few studies including limited number of patients assessed the rheumatologic effects of hemodialysis (HD) on joints using ultrasonography. Joint ultrasound has been emerged as a cheap non-invasive tool for assessment of joint pain among HD patients. This was the aim of our study to make use of such tool in such life quality threatening complaint. Objective: to determine the role of ultrasound in evaluation of joint pain and its causes among patients on regular HD. Patients and Methods: One hundred and four patients with end stage renal disease (ESRD) who were regular on HD three sessions per week four hours per session were subjected to history taking, complete physical examination stressing on musculoskeletal examination and ultrasonography of painful joints by an ultrasonography expert. Results: Dialysis related arthropathy (DRA) was not the only cause of joint pain among HD patients but there were diverse causes in different joints. As regard affected joints, knee was the most affected one then came wrist, shoulder, ankle and elbow respectively. As regard causes of joint pain, DRA was the commonest one then came osteoarthritis, non-specific ultrasonographic findings and few cases showed normal ultrasonographic studies. Conclusion: This study confirmed that joint pain in HD patients has diverse causes not DRA by necessity but other causes must be considered as well as multifactorial etiologies.
Joint ultrasound
Dialysis related arthropathy
Joint pain
2018
07
01
4523
4526
https://ejhm.journals.ekb.eg/article_9524_430eb8c3d52ac4ccdbca1f00d07f7401.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Retrospective study to evaluate the results of medical thoracoscopy in diagnosis of exudative pleural effusion at chest department El-Hussein university hospital in the period from July 2013 to July 2018
Ahmed Adel Ibrahim
Eaid
Mahmoud Al- Saeed
Ahmed
Salim Mohammed
Mohammed Abo-Sabe
Ibrahim Abd El-Fattah
Mohsen
Background: Thoracoscopy is a minimally invasive procedure that allows visualization of the pleural space and intrathoracic structures. It enables taking pleural biopsies under direct vision, therapeutic drainage of effusions, and pleurodesis in one sitting. Persistent and recurrent exudative pleural effusions become common and thoracocentesis and blind pleural biopsy procedures do not give a definitive diagnosis in many patients. Therefore, thoracoscopy today remains the gold standard for these cases. In tuberculous pleuritis, the combined yield of histology and culture for rigid thoracoscopy was nearly 100%. Objective: This study was carried out to analyze our five years experience of medical thoracoscopy in the management of undiagnosed exudative pleural effusion at chest department El-Hussein University Hospital. Materials and Methods: All patients with undiagnosed exudative pleural effusion who underwent thoracoscopy during the period between July 2013 to July 2018 at Al Hussein University Hospital were included in the study. All patients were subjected to thorough history taking, clinical examination, routine laboratory investigations, pleural fluid analysis and medical thoracoscopy with multiple pleural biopsies. All patients data, thoracoscopy results and complications were recorded. Results: Thoracoscopy was successful for giving final diagnosis in 122 patients (84.13%) from total 145 patients. Malignancies reported in 113 patients (77.9%) of patients and TB reported in 6.2% of patients. Mesothelioma was the most common diagnosis in 67 patients(46.2%) Minor complications occurred only in 14 out of 145 patients (9.65%), 4 patients (2.8%) developed cellulitis, 8 patients (5.5%) developed surgical emphysema, and 2 patient (1.4%) developed bleeding. Conclusion: Medical thoracoscopy is an easy, safe procedure with high diagnostic sensitivity for pleural effusion of uncertain etiology.
Exudative pleural effusion
medical thoracoscopy
tuberculosis
2018
07
01
4527
4532
https://ejhm.journals.ekb.eg/article_9525_a7274c1d9ac02d8a2188345f452d40a2.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Plasma Factor VII and Histidine-Rich Glycoprotein as A Potential Markers in Pre Eclampsia
Sanaa Mohamed
Abdel Aty
Buthyna Ahmed
El Sharawy
Sahar
Abdel Maksoud
Entsar
Raafat
Mahmoud Ahmed
Ghareeb
Background: Preeclampsia (PE) is a complex and serious multi-system disorder of pregnancy with a worldwide incidence of 5-7% and contributes significantly to maternal and perinatal morbidity and mortality. Normal pregnancy is associated with a local hypercoagulable state that becomes more profound in PE. Histidine-rich glycoprotein (HRG) is a protein interacting with angiogenesis, coagulation, and inflammatory responses, processes known to be altered in preeclamptic pregnancies.
Aim of the work: Is to analyze changes in the circulating levels of plasma factor VII (Plasma F VII) and HRG in women developing PE and to evaluate them as markers for early diagnosis of PE.
Subjects and Methods: This study was carried out on 80 pregnant women after 20 weeks of gestation. The subjects were divided into: Group I (G1): 40 cases with preeclampsia; Group II (G2): 40 normal pregnant women who were matched for age and gestational period. Plasma FVII and HRG were measured by ELISA
Results: Plasma FVII levels were significantly higher in G1 (206.22 ± 46.25 ng/ml) as compared to G2 (97.46 ± 21.95 ng/ml) (p<0.001). Significant positive correlation of plasma FVII with fibrinogen and significant negative correlation with platelet count and HRG were detected. At cut off 125.75 ng/ml plasma FVII levels shows high sensitivity and specificity (95%). HRG levels were significantly lower in G1 (37.1 ± 7.52 pg/ml) as compared with G2 (79.87±24.15 pg/ml) (p<0.001). HRG shows significant positive correlation with platelet count and significant negative correlation with each of fibrinogen and plasma FVII. At cut off 46.45 pg/ml. HRG shows high sensitivity (92.5%) and specificity (87.5%).
Conclusion: Plasma FVII and HRG can be used as early marker for detection of PE.
PE: preeclampsia-HRG: histidine rich glycoprotein-plasma factor VII
2018
07
01
4533
4538
https://ejhm.journals.ekb.eg/article_9539_dbdf95b12c2fd696fe476663699c3846.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Surgical Management of the Infected Femoral Pseudoaneurysms In Intravenous Drug Addicts
Mohammed Abdessalam Abdallah
Hemdan
Ashraf Mohammed
Ewida
Yasser Hussin Hassan
Metwally
Background: Vascular system complications are an ongoing hazard of intravenous drug abuse.
Patients and Method: This is a prospective study. The study was conducted on twenty patients who were presented at AL Hussein University Hospital in Cairo with infected femoral artery pseudoaneurysm over a period of eight months from Nov 2017 to July 2018. The inpatient medical charts were reviewed. Data were obtained on their demographic, clinical, management and outcome parameters.
Result: Among the twenty intravenous drug users presenting with infected femoral artery pseudoaneurysms, (16) of the patients (80%) were seropositive for HCV. All were operated, with (5%) mortality. Primary ligation and debridement was the technique used almost exclusively (75%). One patient was managed by primary reconstruction by direct in-situ repair. Four patients were managed by primary revascularization through exta-anatomical bypass. Mean follow up period was three months.
Conclusion: Ligation and debridement appears to be a simple, safe and effective procedure in infected pseudoaneurysms in IV drug users.
IV drug users
infected pseudoaneurysms
Revascularization
ligation
2018
07
01
4539
4542
https://ejhm.journals.ekb.eg/article_9541_18b94f74181afba98e8c45e053352466.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Transverse Comparisons Between Ultrasound and Radionuclide Parameters in Children with Pelvi-Ureteric Junction Obstruction
Samer Malak
Botros
Ali Hagag
Ali
Norhan Osama
shawky
Pelvi-ureteric junction (PUJ) obstruction is one of the causes of an obstructive uropathy which may be congenital or acquired. Ureteropelvic junction (UPJ) obstruction is a blockage at the point where ureters attaches to the bladder. This blocks the flow of urine out of the kidney, Urine can build up and damage the kidney, so radiologic imaging is crucial in diagnosing UPJ obstruction. It seemed therefore interesting to determine if some US parameters could predict the radionuclide parameters and which ultrasound parameter most influencing the kidney function. The initial step was to grade the severity of hydronephrosis, calyceal dilatation and cortical thinning, although it was easy for us to classify the importance of hydronephrosis in three groups according to anteroposterior diameter (APD). AP diameter of renal pelvis and differential renal function were the most effective parameters for surgical decision. These parameters can be used for appropriate management of antenatal hydronephrosis.
UPJ: Uereteropelvic junction
US: Ultrasonography
APD: anteroposterior diameter
2018
07
01
4543
4550
https://ejhm.journals.ekb.eg/article_9542_07f100eacc25d51a2d09401b74257da2.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Retrospective Study of The Corticosteroids Administration in Glioblastoma Patients as A Prognostic Factor in The Disease
Abdelrahman Mostafa El-Sayed
El-Adawy
Khaled Abdel Karim
Mohamed
Mohamed Reda
Kelany
Omar Mohamed
Abdelrahman
Background: Glioblastoma multiforme (GBM) is the most common and most malignant of the glial tumors. Optimum management consists of maximal safe surgical resection, followed by concurrent chemo-radiotherapy treatment then adjuvant chemotherapy with temozolomide. A considerable part from the care of patients with GBM involves general medical management, containing corticosteroids. Despite steroids common use, there is experimental and clinical evidence that corticosteroids have direct effects on tumor cell proliferation and apoptosis.
Aim of the Work: was to discuss the clinical relation between corticosteroids usage in Glioblastoma Multiforme (GBM) patients and quality of life as well as the disease progression free survival according to the recorded data from the joined hospitals.
Patients and Methods: Retrospective analysis of 66 adult patients diagnosed with GBM by surgery or imaging criteria. In order to assess the relation between corticosteroid dependence and the survival, patients were recruited into two groups (arms) according to dependency. Arm (A) was steroid dependent (34 patients) and arm (B) was steroid non-dependent (32 patients).
Results: Corticosteroids dependency was statistically significant correlated to both Overall Survival (OS)(median 2.5 in arm (A) vs. 13.1 months in the arm (B), p < 0.001), and Progression-free survival ratio (PFS)(median 2.3 in arm (A) vs. 9.4 months in arm (B), p = 0.035). Also, steroid dependency was independent prognostic factor by doing the COX regression analysis.
Conclusion: Dependence on corticosteroids during course of treatment is identified as a poor prognostic factor.
Corticosteroids
GBM
Glioblastoma Multiforme
dexamethasone
prognostic factor
2018
07
01
4551
4555
https://ejhm.journals.ekb.eg/article_9544_968cde6d8fa25bade41b7b7f47708d6c.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Management of Pseudo Tumor Cerebri by Frequent Tapping VS lumboperitoneal Shunt
Mohammed R.
Metwally
Ali K.
Ali
Maamoun M.
Abo Shousha
Background: The syndrome known as pseudotumor cerebri (PTC) is generally thought of as a condition characterized by increased intracranial pressure (ICP) without evidence of dilated ventricles or a mass lesion by imaging, normal cerebrospinal fluid (CSF) content, and papilledema occurring in most cases in young, obese women without any clear explanation. Aim of the Work: to highlight the early diagnosis, causes of visual deterioration of idiopathic intracranial hypertension, its pathophysiology will be discussed. Special emphasis will be given for trends in management of this disease especially frequent tapping and lumboperitoneal shunt and comparing results of both techniques. Patients and Methods: This prospective and retrospective study was conducted on 20 patients of special criteria confirmed to have pseudotumor cerebri by clinical presentation, radiological findings, fundus and visual field examination. Results: The papilledema of PTC was identical with that in patients with other causes of increased ICP. In most of cases it was bilateral symmetrical, however it was asymmetric in 1% of cases. In the frequent tapping patients group, results showed improvement of all symptoms in about 80% of patients. And in 20% of patients there were persistent complaints especially headache and blurred vision. In the lumboperitoneal shunt group, 65% of Cases showed improvement of all symptoms while 35% of cases showed shunt failure and complications.
Conclusion: Concerning the category of patients participated in this study, and particularly with whom medical measures were failing, consideration should be given to investigation of the cranial venous outflow tract with a view to some therapeutic intervention if appropriate.
Intracranial pressure
Lumboperitoneal shunt
papilledema
2018
07
01
4556
4560
https://ejhm.journals.ekb.eg/article_9545_2178711068536d27904730aac42717de.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Correlation Between Visual Acuity and Optical Coherence Tomography Macular Parameters In Controlled Type II Diabetic Patients
Mariana Nashaat William
Yacob
Tamer Mohamed Fathi
El-Mekkawi
Mouamen Mohamed
Mostafa
Rania Serag
El-Kitkat
Background: Diabetes Mellitus (DM) is a chronic metabolic disease with considerable morbidity and mortality. Diabetic retinopathy (DR) and diabetic macular edema (DME) are major complications of DM and are the principal cause of vision loss among the working age group in developed countries. Optical coherence tomography (OCT) uses low-coherence interferometry to provide noncontact and noninvasive optical biopsy of the tissue morphology of the retina, making it a useful tool for detecting and managing DME.
Aim of the Work: To study the effect of controlled type II DM on visual acuity (VA) and macular changes by OCT. In addition, to correlate VA to macular parameters detected on OCT retinal examination.
Patients and Methods: This is a retrospective case control study that included 30 eyes of 22 controlled type II diabetic patients (group1) and 30 eyes of 19, age and sex matched healthy subjects (group 2). All diabetic patients were diagnosed as DME using OCT parameters. Correlation between central foveal thickness (CFT) and VA was done.
Results: There were statistically significant differences in UCVA & BCVA between the 2 groups. The difference in the central foveal thickness (CFT) from ETDRS map of OCT between the 2 groups was statistically significant. There were statistically significant differences between CFT from ETDRS map and both UCVA & BCVA. Statistically significant differences were detected between CFT and both FBS and 2HPP levels. Furthermore, statistically significant differences were detected between BCVA and both FBS and RBS levels.
Conclusion: Based on the data in our study, results pose a recommendation of regular follow up of three blood sugar-assessing parameters (FBS, 2HPP and RBS) and referring patients to ophthalmologists if abnormal values were detected.
Recommendations: Using large sample size will give more valid results. In our study, we evaluated the structure of the fovea, further studies can evaluate structure using OCT and function by electrophysiology. OCT angiography also could be useful in scanning retinal vasculature.
Diabetic macular edema (DME)
visual acuity(VA)
optical coherence tomography(OCT)
2018
07
01
4561
4564
https://ejhm.journals.ekb.eg/article_9546_6ba9973ac63b11a84ec2d729ab576575.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Three-Dimensional Ultrasound versus Hysteroscopy in Uterine Cavity Assessment after Failed Intracytoplasmic Sperm Injection: a study for accuracy of a diagnostic test
Faten Mosbah Ibrahim
Al-Zinaty
Tarek Aly
Raafat
Mohammed Sayed
Ali
Mohammed Mahmoud
Al Sherbeeny
Background: Implantation failure after intracytoplasmic sperm injection (ICSI) is related to either maternal factors or embryonic causes. The maternal factors include uterine anatomic abnormalities either congenital or acquired. Three-dimensional transvaginal ultrasound allows detailed evaluation of pelvic organs. Office hysteroscopy is the gold standard tool for visualization of intracavitary lesions and the cervical canal in an office-based environment.
Aim of The Work: It was to compare between three-dimensional ultrasound (3D USS) and hysteroscopy for evaluation of the intrauterine cavity after trial of ICSI and to study the accuracy of diagnostic test in a tertiary care facility.
Patients and Methods: It was a prospective; blinded; controlled clinical trial comparative study. Both hysteroscopy and 3D USS procedures were done for uterine cavity assessment after failed attempt of ICSI treatment for fifty-two asymptomatic infertile women.
Results: Seventeen cases of our studied patients were without intracavitary or cervical lesions. From all studied cases, lesions (n=66) were seen either by hysteroscopy or by 3D USS where lesions (n=24) were seen by hysteroscopy and seen by ultrasound. Lesions (n=34) were seen by hysteroscopy. Lesions (n=36) were seen by ultrasound. Measure of agreement of Kappa was 0.273. Overall sensitivity of 3D USS was 70.59% and specificity 62.50% with positive predictive value (PPV) 66.67% and negative predictive value (NPV) 66.67%, accuracy was 66.67%, positive likehood ratio (LR+ve) 1.88% and negative likehood (LR-ve) 0.47%. The p-value was 0.026, which is statistically significant.
Conclusion: It is important to investigate the uterine cavity in infertile women with history of unsuccessful ICSI. 3D USS has a good sensitivity and specificity for diagnosis of uterine cavity abnormalities and it could be used before hysteroscopy as a first line of investigation of intrauterine lesions.
Intracytoplasmic Sperm Injection (ICSI)
Repeated implantation failure (RIF)
Hysteroscopy
Three-Dimensional Ultrasound (3D USS)
Gold Standard
sensitivity
specificity
2018
07
01
4565
4571
https://ejhm.journals.ekb.eg/article_9548_2d5ca582072071eb5733d28adebec137.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Juvenile Nasopharyngeal Angiofibroma in a Woman: A rare case report
Mohammad S.
Al-Ahmari
Kholood S
Assiri
Background: Juvenile nasopharyngeal angiofibroma (JNA) is rare otolaryngology disorder worldwide and in Saudi Arabia. It is a benign tumor that tends to bleed and occurs in the nasopharynx which most commonly occurs in men more than women.
Methods: A view of rare case report following a 27-year-old woman presented with recurrent attack of epistaxis for six months which was associated with nasal obstruction and snoring who was radiologically and surgically managed in Otolaryngology-Head and Neck Surgery (ORL-HNS) Clinic of Khamis Mushayt General Hospital and follow up for one year who was completely asymptomatic. Conclusion: Juvenile nasopharyngeal angiofibroma in a female is very rare, and if confirmed sex chromosome studies must be performed. Surgery is the mainstay of treatment of JNA. Preoperative embolization result in less blood loss and complete resection.
Juvenile nasopharyngeal angiofibroma
rare
Female
otolaryngology disorder
2018
07
01
4572
4575
https://ejhm.journals.ekb.eg/article_9549_2ec0fd367929c05c2952e290dfb8f51c.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2018
72
5
Assessment of Corneal Thickness in Healthy and Diseased Corneas by Different Imaging Techniques
Doaa Maamoun
Ashour
Ahmed Taha
Ismail
Maged Maher Salib
Roshdy
Khaled Abd Elwahab
El Tagoury
Background: Accurate measurement of corneal thickness (CT) is highly important in decision making and planning for refractive surgery. It is also important in diagnosis of keratoconus, measuring intraocular pressure and monitoring corneal edema. Different methods are available for CT measurement including optical and ultrasound based techniques.
Aim of the Study: was to assess the diagnostic accuracy of optical (AS OCT and Pentacam) and ultrasound imaging systems (USP) in measuring corneal thickness in healthy and diseased corneas.
Materials and Methodology: Three groups were included: 20 healthy corneas, 20 eyes with keratoconus (KC) and 20 eyes with corneal scars. In all cases central corneal thickness (CCT) was measured using ultrasound pachymetry, Pentacam and anterior segment optical coherence tomography (AS OCT).
Results: In normal corneas the mean difference (MD) between US and Pentacam, US and OCT & Pentacam and OCT (-1.3±9.4, 0.4±10.4 &1.7±10.7µm) to be statistically insignificant between the 3 pairs with coefficient of determination 1 between the 3 pairs. In KC group the mean difference (MD) between US and Pentacam (-7.7±15.1 µm) was statistically significant while the MD between US and OCT & Pentacam and OCT (4.7±15.7 and 12.3±14.1 µm) was not statistically significant. In scar group the MD between the 3 pairs (-1.1±79.1, -13.6±20.8 &-12.5±73.0) with statistically significant difference between USP and OCT. Coefficient of determination was found 0.9.
Conclusion: USP, AS OCT and Pentacam have high agreement regarding CCT measurement in normal corneas. However, when we studied KC and scarred corneas we found that OCT measurements are higher than those of Pentacam in most of the cases regarding CCT.
CCT
pentacam
AS OCT
2018
07
01
4576
4581
https://ejhm.journals.ekb.eg/article_9551_db4a9cbda8b78acc3ef97aca246f4b2e.pdf