Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Role of Urinary Chitinase 3 Like Protein 1 for Early Detection of Acute Kidney Injury in Adult Critically Ill Patients197819881177710.12816/0041032ENOsama Mahmoud MohamedDepartment of Internal Medicine and Nephrology, Faculty of Medicine- Ain Shams UniversityHesham Mohamed Abo ElleilDepartment of Internal Medicine and Nephrology, Faculty of Medicine- Ain Shams UniversityHussein Sayed HusseinDepartment of Internal Medicine and Nephrology, Faculty of Medicine- Ain Shams UniversityFatma Mohamed Abbas AminDepartment of Internal Medicine and Nephrology, Faculty of Medicine- Ain Shams UniversityJournal Article20180828<strong>Background: </strong>AKI is a common problem in ICU patients and is mostly multifactorial. Also, it is known to increase mortality, duration of ICU and hospital stay and increase the cost of care in critically ill patients. Early diagnosis in these settings helps in decreasing the outcome of AKI. Multiple biomarkers have developed concentrating on early diagnosis of acute kidney injury. Urinary Chitinase 3 like protein 1 is a novel biomarker studied for early detection of acute kidney injury.
<strong>Objectives:</strong> the current study was aimed to assess the role of urinary chitinase 3 like protein 1 (CHI3L1) as an early biomarker for detection of acute kidney injury in adult critically ill patients.
<strong>Patients and methods: </strong>this was a prospective cohort study that was conducted in Ain Shams University Hospital. This study included 30 adult critically ill patients with normal kidney function and they were observed for 48 hours. The development of Acute Kidney Injury was based on serum creatinine and urine output criteria according to KDIGO criteria. Urine samples, for assessment of urinary CHI3L1, urine creatinine and urine CHI3L1/Cr ratio were collected under aseptic techniques at 3 times intervals ( 0, 12 and 24hrs).
<strong>Results: </strong>our results showed that, of these 30 patients, 15 patients developed acute kidney injury using KDIGO criteria and 15 patients had normal kidney function. Our results showed the percentage of patient who developed AKI according to KDIGO, stage Ι 60.0%, stage ΙΙ 33.3% and stage ΙΙΙ 6.7%. Of these patients 80% developed AKI based on serum creatinine and 20% based on serum creatinine and urine output. Our results showed that there is statistically significant difference between AKI group and non-AKI group as regards urine chitinase 3 like protein 1(CHI3L1) at 0hour, 12 hours and 24hours (P≤0.05). As the higher level of urine CHI3L1 was found in AKI group which ranges from 35-135ng/ml with mean 94±34.02 at 0 hour, from 70-200ng/ml with mean 126.80±43.77 at 12 hours and from 105-200ng/ml with mean 160.57±28.02 which means that urine CHI3L1 level increases with AKI. Our results showed that there is statistically significant difference as regards urine CHI3L1 between non-AKI group and the 3 stages of AKI in AKI group at 0hr, 12hrs and 24hrs (P≤0.05).
<strong>Conclusion: </strong>Urinary chitinase 3 like protein 1 is a highly sensitive early marker in prediction of acute kidney injury in adult critically ill patients. https://ejhm.journals.ekb.eg/article_11777_106336626b1f2953a04b257aba0499f1.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Effect of Apocynin on Liver Toxicity Induced by Microwaves in Rats198919971177810.12816/0041033ENPassant Medhat HewadyDepartment of Physiology, Faculty of Medicine, Tanta UniversityRizk Mahmoud ElkholyDepartment of Physiology, Faculty of Medicine, Tanta UniversityGhada Mahmoud EsmaeilDepartment of Physiology, Faculty of Medicine, Tanta UniversityAbeer Abed Abo ZeidDepartment of Physiology, Faculty of Medicine, Tanta UniversityJournal Article20180828<strong>Background: </strong>electromagnetic waves could cause oxidative stress and generate ROS that lead to free radical production and lipid peroxidation which damage liver tissue. Apocynin (APO) exerts its antioxidant effect by reducing ROS production via inhibition of NADPH oxidase. The present study intended to demonstrate effects of microwaves exposure on hepatic pro-oxidant/antioxidant systems and to investigate protective effects of APO against microwaves induced hepatotoxicity. <strong>Aim of the work</strong>: The aim of the present work is to evaluate the effect of Apocynin on liver toxicity induced by exposure to microwaves in rats of local strain. <strong>Subjects and </strong><strong>Methods:</strong> Thirty local strain rats were randomly assigned into three equal groups: a) control group; b) microwave exposed group (frequency of 2.45 GHz for 15 minutes once daily for a period of 16 days); c) apocynin treated prior to microwave exposure group (apocynin 20 mg/kg intraperitoneally injected 1 hour before microwave exposure and continued during the other 16 days). Liver tissue was biochemically assessed in all groups biochemically through the determination of tissue MDA, MPO, GPx and iron in liver tissue. Also, serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and Tumor necrosis factor alpha (TNFα) levels were estimated in all groups.
<strong>Results</strong>: The microwave exposed group showed that there was a significant increase in serum ALT, AST, ALP, TNF-α, as well as significant increase in the level of MPO, MDA and iron in the liver tissue. However, there was a significant decrease in the GPx and zinc level in the liver tissue. These results Were estimated and calculated in comparison with those of control group. Moreover, Apocynin treated group showed a significant decrease in serum ALT, AST, ALP, TNF-α , in addition to a significant decrease in the level of MPO, MDA and iron, along with a significant increase in the GPx level in the liver tissue, as compared with microwave exposed group.
<strong>Conclusion:</strong> It is possible to conclude considering the abovementioned results that apocynin has a significantly protective effect against hepatotoxicity induced by microwaves exposure.https://ejhm.journals.ekb.eg/article_11778_36157ce494fc2e69b4354dc48a7b51e8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Role of Diffusion MRI in Evaluation of Renal Masses199820071178010.12816/0041047ENMedhat Atef MorsyDepartment of Radio-diagnosis, Faculty of Medicine, Ain Shams UniversityRania Ali MaaroufDepartment of Radio-diagnosis, Faculty of Medicine, Ain Shams UniversityAhmed Mohammed Abd RabouDepartment of Radio-diagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20180828<strong>Background: </strong>renal masses are being exposed more frequently in the last decades due to advances in cross sectional imaging such as CT and MR. Accurate characterization of renal masses is essential to ensure appropriate case management, to assist in staging and prognosis and to differentiate surgical lesions from nonsurgical lesions. However, in some cases there is an overlapping between the ADC values of benign and malignant masses. Thus, the use of ADC values alone may lead to inaccurate assessment of renal masses.
<strong>Aim of the Study: </strong>to assess the roles of DWI in combination with quantitative ADC measurements the differentiation between benign and malignant renal masses. <strong>Conclusion: </strong>The combination of conventional MRI and ADC value in the diagnosis of renal masses can increase the diagnostic accuracy and considered of most value in cases where IV contrast agents are contraindicating.
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https://ejhm.journals.ekb.eg/article_11780_b7a5c5d813d29486d2b4322e9bb8f804.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Corneal Endotheleal Cells Changes After Phacoemulsification in Type II Diabetes Mellitus200420111178110.12816/0041050ENMohamed S. ELKadyDepartment of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMahmoud M. SalehDepartment of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed S. AboalhamdDepartment of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20180828<strong>Background: </strong>Corneal endothelial cells are responsible for the clarity of the cornea; however, endothelial cells have limited cell division ability. Studies have proven that cornea is more vulnerable to chronic changes affecting endothelial cells in diabetic patients. Cataract extraction by phacoemulsification is one of the most ophthalmic surgeries having a negative effect on the corneal endothelial cells especially in elders. Age of the patient and diabetes mellitus have a negative effect on the outcome of phacoemulsification. The aim of the study is to compare the changes occur in corneal endothelium pre and post cataract extraction by phacoemulsification in diabetic patients in aspects of BCVA, CCT, CD, CV and HEX. <strong>Aim of the work</strong>: To assess endothelial cells changes following cataract extraction by phacoemulsification and posterior chamber IOL implantation in type II diabetic patients. <strong>Methods: </strong>The study included 20 eyes of 20 patients scheduled for cataract surgery by phacoemulsification at Al Azhar university hospitals. The patients were assigned <br /> to 2 groups. Group 1: Ten patients without diabetes were used as a control group, and a casual blood glucose test and glucose tolerance test were undertaken in accordance with the recommendations of the American Diabetes Association to disclose undetected diabetes. Group 2: Ten patients diagnosed with type II diabetes based on medical history and all were on oral anti-diabetic medication or subcutaneous treatment with insulin. Serum glycosylated hemoglobin (HbA1c) was obtained in all patients with diabetes to evaluate their glycemic status.In this prospective randomized study we did Preoperative specular microscopy and serial postoperative specular microscopy ( Topcon SP- 1P,Topcon Medical Inc., Japan).) were performed to evaluate endothelial cell count changes over 6 months. Endothelial cell images were collected in the central region of the cornea before surgery and 1 and 6 months after surgery. The main outcome measures were central corneal thickness (CCT), cell density (CD), coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). <strong>Results: </strong>In term of CCT, in group 1 the CCT mean ±SD in preoperative is 510.7 ±35.13, <br /> in 1 month postoperative is 522.1 ±35.91 and in 6 months postoperative is 512 ±34.91, <br /> the difference between preoperative CCT and 6 months postoperative is 1.3 ±0.95.
In group 2 the CCT mean ±SD in preoperative is 497.45 ±25.82, in 1 month postoperative 515.64 ±26.59 and in 6 months postoperative is 500.18 ±25.5, the difference between preoperative CCT and 6 months postoperative is 2.73 ±1.64. In term of CD, in group 1 the CD mean ±SD in preoperative is 2678 ±390, <br /> in 1 month postoperative is 2599 ±378 and in 6 months postoperative is 2571 ±355, <br /> the difference between preoperative CD and 6 months postoperative is -107.17 ±15.53.
In group 2 the CD mean ±SD in preoperative is 2872 ±335, in 1 month postoperative is 2703 ±326 and in 6 months postoperative is 2441 ±284, the difference between preoperative CD and 6 months postoperative is -430.8 ±50.31. In term of CV, in group 1 the CV mean ±SD in preoperative CV is 34.4 ±2.95, in 1 month postoperative is 35.2 ±3.05 and in 6 months postoperative is 35 ±2.6, the difference between preoperative CV and 6 months postoperative is 0.7 ± 1.34 which is statistically insignificant. In group 2 the CV mean ±SD in preoperative CV is 36 ±3, in 1 month postoperative is 37 ±3.16 and in months postoperative is 36 ±3.2, the difference between preoperative CV and 6 months postoperative is -0.3 ±1.64 which is statistically insignificant. In term of HEX, in group 1 the HEX mean ±SD in preoperative is 34 ±8, in 1 month postoperative 29 ±7 and in 6 months postoperative 28 ±7, the difference between preoperative and 6 months postoperative is -6.2 ±1.55 which is statistically significant. In group 2 the mean HEX mean ±SD in preoperative is 33 ±10, in 1 month postoperative is 25 ±7 and in 6 months postoperative is 24 ±7, the difference between preoperative HEX and 6 months postoperative is -8.7 ±2.58 which is statistically significant.
In term of BCVA, in group 1 the BCVA mean ±SD in preoperative is 0.15 ±0.05, in 1 month postoperative is 0.38 ±0.11 and in 6 months postoperative is 0.5 ±0.07, the difference between preoperative BCVA and 6 months postoperatively is statistically significant. In group 2 the BCVA mean ±SD in preoperative is 0.128 ±0.034, in 1 month postoperative is 0.285 ±0.0369 and in 6 months postoperative is 0.392 ±0.093, the difference between preoperative BCVA and 6 months postoperatively is statistically significant.
<strong>Conclusion: </strong>The endothelium in diabetic subjects is more vulnerable to surgical trauma and has a lower capability in the process of repair.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11781_723bd2c0f2a7016ac0a773c4ef43659f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Role of MRI in Evaluation of Traumatic Ankle Injuries201620241178210.12816/0041051ENMervat Mohamed Ibrahim Ali ElgoharyDepartment of Radiology, Faculty of Medicine - Ain Shams UniversitySusan Adel Ali Abdul RahimDepartment of Radiology, Faculty of Medicine - Ain Shams UniversityThura Aamer Ahmed IbrahimDepartment of Radiology, Faculty of Medicine Almosel UniversityJournal Article20180828<strong>Background:</strong> MR imaging has become the diagnostic modality of choice for the evaluation of traumatic ligamentous, tendinous injures of the ankle and occult bony trauma. This article reviews the current applications of MR imaging for the evaluation of most of these lesions. Ankle sprains are considered the most common lower limb injuries (incidence between 5 - 7 per 1000 persons/year in Europe), affecting more frequently young athletes; the most common mechanism of injury is represented by inversion of the foot (less frequently eversion).
<strong>Aim of the Work:</strong> The aim of the current study is to emphasize the value of Magnetic Resonance Imaging (MRI) in evaluation of patients with ankle pain caused by traumatic injury.
<strong>Patients and Methods:</strong> A descriptive study, conducted from March 2017 till June 2017. Sixty patients underwent MRI examination (patients with traumatic ankle pain) during this period. Twenty patients have normal MRI examination and not included in the study while forty patients have positive MRI findings. All patients were performed MRI in radiology department, Ain Shams University Hospital. The examination carried out after signing the informed consent by the patient himself or his guardian if the patient is incapacitated by any means.
<strong>Results:</strong> According to the data collected from our study, we have 70 pathologies diagnosed by MRI after traumatic ankle injuries.
- 17 (24.3%) of them were ligamentous injuries.
- 16 (22.9%) were tendon injuries.
- 14 (20%) were bone injuries [3 (21.43%) of them were fractures and 5 (35.71%) of them were osteochondral lesions and 6 (42.86%) of them were Bone contusions].
- 23 (32.8%) from the seventy pathology have joint effusion.
<strong>Conclusion:</strong> MRI is modality of choice in evaluating ankle injuries due to its high soft tissue contrast resolution, and multi-planar capabilities. It provides a non-invasive tool for the diagnosis of Ankle injuries, which are often difficult to diagnose with alternative modalities. MRI is particularly advantageous for assessing soft tissue structures around the ankle such as tendons, ligaments, nerves, and fascia and for detecting occult bone injuries.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11782_9027f455004fbdf2c244f7188ed35c66.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Prevalence of Pulmonary Manifestations in a Cohort of the Egyptian Patients with Rheumatoid Arthritis202520291178510.12816/0041054ENMohamed S. Abdel BakyInternal Medicine and Rheumatology, Ain Shams University, Cairo, EgyptDalia F. MohamedInternal Medicine and Rheumatology, Ain Shams University, Cairo, EgyptSherin M. HosneyInternal Medicine and Rheumatology, Ain Shams University, Cairo, EgyptDalia A. ElSherbinyInternal Medicine and Rheumatology, Ain Shams University, Cairo, EgyptMohamed RezkaInternal Medicine and Rheumatology, Ain Shams University, Cairo, EgyptAshraf A. GomaaDepartment of Chest Diseases,
Ain Shams University, Cairo, EgyptJournal Article20180828<strong>Background</strong>: rheumatoid arthritis can affect the lung in many ways including lung parenchymal affection (Interstitial lung disease), pleural inflammation, upper and lower airways affection and pulmonary vasculature. <strong>Aim of the work: </strong>this study aimed toestimate the prevalence of pulmonary manifestations in Egyptian RA patients. <strong>Patients and methods: </strong>this study included seventy patients with RA. All patients were subjected to detailed medical history taking, general examination including chest examination, local musculoskeletal examination, laboratory investigations including CBC, ESR, CRP titre, ALT, AST, BUN and creatinine, rheumatoid factor titer (RF), Anti-CCP antibodies titer, radiological investigations including chest X ray, HRCT and PFT. <strong>Results: </strong>pulmonary manifestations were prevalent in 50% of patients. Spirometric abnormalities were detected in 45.7%, while HRCT abnormalities were detected in 42.85%. HRCT severity score was correlated with age, tender joint count (TJC), swollen joint count (SJC) and ESR. There was a statistically significant negative correlation between HRCT and FVC, FEV1. There was no correlation regarding other parameters. <strong>Conclusion: </strong>pulmonary affection was prevalent in RA and can be detected by radiological and pulmonary functions. There was correlation with age, ESR and pulmonary functions
<strong> </strong>https://ejhm.journals.ekb.eg/article_11785_08553665c7441adafd672cae7c22127d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Frequency of Low Bone Mineral Density and Osteoporosis in a Cohort of Egyptian patients with Systemic Lupus Erythematosus203020351178610.12816/0041055ENAbdel-Azeim Mohammad ElhefnyDepartment of Internal Medicine, Rheumatology and Immunology
Faculty of medicine - Ain-Shams UniversitySherin Mohamed Hosny HamzaDepartment of Internal Medicine, Rheumatology and Immunology
Faculty of medicine - Ain-Shams UniversityDalia AbdelHamid ElSherbinyDepartment of Internal Medicine, Rheumatology and Immunology
Faculty of medicine - Ain-Shams UniversityRehab Fathy IbraheemDepartment of Internal Medicine, Rheumatology and Immunology
Faculty of medicine - Ain-Shams UniversityJournal Article20180828<strong>Background: </strong>several studies have found an increase in bone loss and risk of fracture in patients with systemic lupus erythematosus. <strong>Objectives:</strong> To determine the frequency of low bone mineral density and osteoporosis in a cohort of Egyptian patients with systemic lupus erythematosus and their relation to disease activity. <strong>Patients and Methods: </strong>This is a cross sectional study which was carried out on 60 patients fulfilling SLICC classification criteria for systemic lupus erythematous. All patients were attending the Rheumatology Outpatient Clinic and Internal Medicine and Rheumatology Inpatient Department at Ain Shams University Hospital from April (2016) to august (2016). <strong>Results</strong>: Mean values of lumbar spine, femoral neck BMD were 1.0 ± 0.15 and 0.9 ± 0.15 g/cm2, respectively, with mean T-score values at each site of -1.4 ± 1.3 and -0.8 ± 1.0, the frequency of osteopenia among the studied 60 SLE patients was 40.0% and the frequency of osteoporosis was 25.0%. <strong>Conclusion: </strong>We found that there is increased frequency of low bone mineral density and osteoporosis among SLE patients.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11786_f2fb7de2e87c48fd8b4d02704d05fed8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Antral Follicle Count versus Basal Follicle Stimulating Hormone as Predictors of Ovarian Response in Women Undergoing Superovulation with Long Protocol for Assisted Reproduction203620421179010.12816/0041056ENKarim Hassanin Abd El-MaeboudDepartment of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams UniversityAhmed El-Sayed Hassan El-BohotyDepartment of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams UniversityMohamed Abd El-AlimDepartment of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams UniversityAbeer Maged Ali El-SopkyDepartment of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams UniversityJournal Article20180828<strong>Background:</strong> the prediction of ovarian response before undertaking the expensive IVF treatment is quite important; it seemed that Patient characteristics, rather than the stimulation protocol are the determinant of the individual response. Advance identification of patient who will elicit a poor response or hyper response to standard treatment would be of great clinical advantage. Several parameters have been postulated as predictors of the ovarian response. <strong>Aim of work:</strong> to compare between bFSH and AFC in predicting the ovarian response in women undergoing super-ovulation with long protocol for assisted reproduction.
<strong>Patients and Methods: </strong>this is an observational cohort study that included 80 infertile women who performed IVF/ICSI. It took place at Assisted Reproductive Technology (ART) Unit. Ain shams University Maternity hospital. No extra interventional measures were taken in the study apart from routine investigations and procedures done during ART therapy, being already approved in signed consent to undergo treatment. Patients who are fulfilling the inclusion and exclusion criteria were enrolled in the study. They all underwent superovulation with long GnRH agonist. They were followed up through the stimulation protocol steps, then data were analysed. <strong>Results:</strong> all basal measured data such as Age <em>p. value </em>=0.035, AFC <em>p. value </em>=0.000, basal FSH <em>p. value</em> =0.000 and basal E2 p. value =0.020 showed statistical significant difference between the good responders and poor responders when both groups were compared, When we apply ROC curve to compare between AFC and basal FSH as regards both (good and poor responders) to detect which one of them is better, there was no statistical significance difference between them with p. value = 0.371, the best cut off point for AFC as a predictor for good responders was found > 3 follicles with sensitivity of 90.5%, specificity of 94.1% and area under curve (AUC) of 97.5%, while while the best cut off point for basal FSH level was found ≤ 8 with sensitivity of 77.78%, specificity of 100% and AUC of 93.7%.
<strong>Conclusion:</strong> AFC and basal FSH are good predictors of ovarian response in women undergoing superovulation with long protocol. There was no absolute superiority of AFC on basal FSH in predicting ovarian response. Age and basal E2 are also considered good predictors of ovarian response.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11790_30585456a0684d89d06b5080339ba5fe.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001First Trimester Placental Volume and Vascular Indices by 3D Ultrasonography and 3D Power Doppler in Pregestational Diabetic and Non-Diabetic Pregnant Patients204320511179210.12816/0041057ENMagd E. MohamedDepartment of Obstetrics and Gynecology,Faculty of Medicine - Ain Shams UniversityAmr M. ElhelalyDepartment of Obstetrics and Gynecology,Faculty of Medicine - Ain Shams UniversityMahmoud H. AbdelfattahDepartment of Obstetrics and Gynecology,Faculty of Medicine - Ain Shams UniversityJournal Article20180828<strong>Background: </strong>3D power Doppler ultrasonography enables the quantitative analysis of the region observed through vascular indices as VI (vascularization index), FI (flow index) and VFI (vascularization flow index), which show the quantity of vessels, the local blood flow and their combination and placental volume. These indices can be calculated using VOCAL program. <strong>Aim of the Study: </strong>This study aimed at comparing placental volume and vascular indices using 3D ultrasonography and 3D power Doppler in pregestational diabetic and non-diabetic pregnant women at the first trimester (11<sup>th</sup> week and 13<sup>th</sup> week). <strong>Patients and Methods: </strong>This current study was conducted at Antenatal care Clinic in cooperation with "the feto-maternal Unit for ultrasound assessment", Ain-Shams University Maternity Hospital during the period between <strong>November 2015</strong> and <strong>April 2017</strong>, on 46 women at the <strong>eleventh 11<sup>th</sup> week</strong> and <strong>thirteen 13<sup>th</sup> week</strong> of gestation. They were divided into two groups: Group (A) included 23 women with pregestational diabetes mellitus and group (B) included 23 non-diabetic pregnant women as a control group after respecting certain inclusion and exclusion criteria. <strong>Results:</strong> There was no statistically significant difference between pregestational diabetic and non - diabetic group as regard placental volume and vascular indices (VI, FI and VFI). <strong>Conclusion: </strong>There was no statistically significant difference as regard placental volume and vascular indices (FI,VI and VFI) in pregestational diabetic compared to non-diabetic pregnant patients at the first trimester of pregnancy especially with good glycemic control but changes may be present with poor glycaemic control. <strong>Recommendations: </strong>Further studies are recommend as regard evaluating placental volume and vascular indices (FI,VI and VFI) in pregestational diabetic at the second and the third trimester of pregnancy giving more time for the pathological effect of diabetes mellitus to appear.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11792_a40e6b12194da052155ec2c23d9f5ea2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Total Hip Replacement after Acetabular Fracture: A Review Article205920621179610.12816/0041059ENOsama M. Elsayed ElsayedDepartment of Orthopedics, Faculty of Medicine, Ain Shams University, EgyptAhmed M. MohassabDepartment of Orthopedics, Faculty of Medicine, Ain Shams University, EgyptMagdy G. MazeedDepartment of Orthopedics, Faculty of Medicine, Ain Shams University, EgyptJournal Article20180828<strong>Bachground: </strong>Total hip replacement (THR) after acetabular fracture is a complex procedure and presents the surgeon with unique challenges. THR maybe indicated in two distinct clinical scenarios; firstly, if an acute acetabular fracture would result in a predictably poor outcome if treated with open reduction and internal fixation (ORIF), and secondly (and most commonly) after a patient develops post-traumatic arthritis after either non-operative or operative treatment of an acetabular fracture.
<strong>Purpose: </strong>Purpose of this article wad to assess the outcome of total hip replacement in the management of selected acetabular fractures among adult with traumatic hip arthritis.
<strong>Methods:</strong> Prospective and retrospective studies of 494 patients who underwent primary total hip arthroplasty for acute Acetabular fractures. The study was done in different places. Collected during the period from 1990 to Jan 2015. <strong>Results:</strong> in our series of primary total hip replacement for acute acetabular fractures
we had excellent/good results. Mean Harris Hip Score = 82.5.
<strong>Conclusion:</strong> primary total hip replacement is a reasonable method of treatment of selected acetabular fractures and good method for treatment neglected acetabular fracture. Outcomes may not be as good as total hip replacement done for other conditions.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11796_5be0cb5be51f57e4fde2e50c54130e22.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Effect of Low Dose Aspirin Therapy on Pregnancy Rate in Women Undergoing in vitro Fertilization: A Randomised Controlled Trial206320671179910.12816/0041060ENRadwa Abd-Elshafy Ali AhmedObstetrics and Gynecology Department, Faculty of Medicine, Cairo UniversityKhaled Saiid Mohammed MoussaObstetrics and Gynecology, Faculty of Medicine, Ain Shams UniversityNoha Abd El-Sattar Afify SaknaObstetrics and Gynecology, Faculty of Medicine, Ain Shams UniversityJournal Article20180828<strong>Background</strong>: acetylsalicylic acid was synthesized in 1897. The product was called aspirin. In 1971, Vane described the mechanism of action of aspirin and showed that it inhibited the enzyme cyclooxygenase, thus avoiding prostaglandin (PG) synthesis. Aspirin (acetylsalicylic acid) is well known to have analgesic, anti-inflammatory and antipyretic properties. Since aspirin has been shown to increase uterine perfusion<strong><em>, </em></strong>it was not unreasonable to assume that aspirin administration may increase endometrial receptivity and blastocyst implantation. <strong>Aim of the work:</strong> this study aimed to assess the efficacy of low dose aspirin treatment in increasing the clinical pregnancy in infertile women undergoing IVF /ICSI.
<strong>Patients and methods</strong>: this study included 200 infertile women undergoing IVF/ICSI who recruited from the Infertility Clinic of Ain-Shams University, Maternity Hospital and a Private Center.
<strong>Results</strong>: there was no statistically significant difference between both groups (Aspirin and Placebo) as regard age, cumulus, MII, fertilization rate, grade 1 embryo, grade 2 embryo and total ET. There was statistically non-significant difference between both groups as regard clinical pregnancy. There was statistically non-significant difference between both groups as regard living birth. There was statistically non-significant difference between both groups as regard miscarriage.
<strong>Conclusion</strong>: in the total of 200 women were recruited. The clinical pregnancy rate of the Aspirin group showed no statistically significant difference from that of the placebo group (39% compared to 35%).
<strong>Recommendations</strong>: the use of Aspirin before IVF is not associated with a higher pregnancy rate. Therefore, no need for Aspirin to be added before IVF, However, further studies are needed to confirm our study.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11799_5fa6deea0b5bfebd03fc2f46a2094b5e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Impact of Diabetes Duration on The Extent and Severity of Coronary Atheroma Burden in Type 2 Diabetic Patients: Evaluation by Coronary CT Angiography206820741180210.12816/0041061ENMona Ibrahim Abul SoudDepartment of Cardiology, Faculty of Medicine, Ain Shams UniversityAhmad El Sayed YousefDepartment of Cardiology, Faculty of Medicine, Ain Shams UniversityDiaa El Din Ahmad KamalDepartment of Cardiology, Faculty of Medicine, Ain Shams UniversityKhaled Mohamed SayedDepartment of Cardiology, Faculty of Medicine, Ain Shams UniversityJournal Article20180828<strong>Aim of the work: </strong>this study aimedto explore the association between diabetes duration on both the extent and severity of coronary atheroma burden using coronary computed tomography angiography (CCTA) in type 2 diabetic patients.
<strong>Patients and methods: </strong>we analyzed 105 symptomatic type 2 diabetic patients without known CAD who underwent CCTA from August 2016 to June 2017. Patients were categorized into two groups according to the duration of diabetes: < 10 years, and ≥ 10 years. Stenosis by CCTA was scored as none (0%), non-obstructive (1–49%), or obstructive (≥50%) for each coronary artery segment. For these patients, we compared the prevalence, extent, and severity of CAD, including coronary artery calcium score (CACS), atheroma burden obstructive score (ABOS), segment involvement score (SIS), segment stenosis score (SSS) and syntax score.
<strong>Results: </strong>patients with longer duration of type 2 diabetes possessed higher rates of obstructive CAD. Patients with longer duration of diabetes also manifested greater degree of CACS, ABOS, SIS, SSS and syntax score (P < 0.001 for all).
<strong>Conclusion:</strong> in symptomatic type 2 diabetic patients, longer diabetes duration was associated with a higher prevalence, extent, and severity of CAD so, increased risk of developing atherosclerotic cardiovascular disease including major events as myocardial infarction or even sudden cardiac death.
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<strong>INTRODUCTION</strong>
Reducing atherosclerotic cardiovascular disease (ASCVD) burden in diabetes mellitus (DM) is a major clinical imperative that should be prioritized to reduce premature death, improve quality of life and lessen individual and economic burdens of associated morbidities, decreased work productivity, and high cost of medical care <strong><sup>[1]</sup>.</strong> Atherosclerotic cardiovascular disease remains the principal cause of death and disability among patients with diabetes mellitus, especially in those with type 2 diabetes mellitus in whom it typically occurs 14.6 years earlier <strong><sup>[2]</sup></strong>, with greater severity, and with more diffuse distribution than in individuals without diabetes mellitus <strong><sup>[3]</sup>. </strong>Furthermore, about two-thirds of deaths in people with diabetes mellitus are attributable to cardiovascular disease: of these, ≈ 40% are from ischemic heart disease, 15% from other forms of heart disease, principally congestive heart failure, and ≈10% from stroke. Among those with diabetes mellitus, excess risks of death from any cause and of ASCVD mortality are particularly prominent in those with younger age, higher burden of glycaemia, and greater renal complications, in comparison with those without <strong><sup>[4]</sup>.</strong> Although the incidences of diabetes mellitus–related complications including cardiovascular disease have decreased over the past 2 decades, patients with diabetes mellitus continue to have significantly increased risk for vascular complications in comparison with individuals without diabetes mellitus <strong><sup>[5]</sup>.</strong> An estimated 382 million people worldwide have diabetes mellitus and this number is expected to reach 592 million by the year 2035 <strong><sup>[6]</sup></strong>. Key manifestations of ASCVD in diabetes mellitus included advanced atherosclerosis manifest as coronary artery disease (CAD), ischemic stroke, peripheral vascular disease, and heart failure. Understanding the mechanisms, strategies for and challenges with managing ASCVD and heart failure risk in diabetes mellitus, as well as the potential cardiovascular risks and benefits of glucose-lowering drugs, is important for managing cardiovascular disease in diabetes mellitus <strong><sup>[1]</sup>.</strong> Coronary computed tomography angiography (CCTA) has emerged as a non-invasive imaging modality for the detection or exclusion of CAD, with prior studies observing a high prevalence of CAD in asymptomatic type 2 diabetic patients using CCTA that is associated with worsened outcomes <strong><sup>[7]</sup>. </strong>Ahttps://ejhm.journals.ekb.eg/article_11802_02569247c866b64d0c62382826647f57.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Rubella and Congenital Rubella Syndrome in Pediatric207520811180510.12816/0041062ENAshwaq Ali AbsalemTabuk UniversityRola Mohammed AlanaziKing Fahad Armed Forces Hospital –JeddahSajida Hassan AlkhawajahMaternity and Child Hospital (MCH) DammamOhoud Ahmed HijaziTaif UniversityFahad Abdulaziz JaradKing Khalid UniversityBassmah Hassan AlrowaithiIbn Sina National College for Medical StudiesZahra Jaber Husseinmam Abdulrahman Bin Faisal University,
Dammam, Saudi ArabiaAmina Bashir Shikeh AdamBanadir UniversityJournal Article20180828 The name rubella is derived from a Latin expression signifying "minimal red". Rubella is, for the most part, a benign transferable exanthematous disease. It is caused by rubella virus, which is an affiliate of the Rubivirus class of the family Togaviridae. About half of people contaminated with rubella are asymptomatic. Clinical indications and severity of disease fluctuate with age. For example, contamination in children is portrayed by mild constitutional symptoms, suboccipital adenopathy, and rash; on the other hand, in adolescents and adults, rubella might be complicated by arthritis, thrombocytopenic purpura, and arthralgia. Uncommon cases of rubella encephalitis have likewise been depicted in children. The main complication of rubella is its teratogenic impacts when pregnant ladies get the disease, particularly in the early weeks of pregnancy. The virus could be transmitted to the fetus through the placenta and is equipped for causing genuine congenital defects, stillbirths, and abortions. Fortunately, as a consequence of the successful vaccination program, rubella contamination and congenital rubella syndrome infrequently are seen today. We conducted this review using a comprehensive search of MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from January 1, 1970, through February 28, 2017. The following search terms were used: rubella, rubella syndrome, congenital, paediatric rubella, vaccination, rubella-containing vaccine, and rubella immunization campaigns.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11805_3f95a848b12fdb9fee5fd8fa1520c1a5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Knowledge, Attitude and Practicetowards Stroke Risk Factors and Warning Symptoms in Saudi Arabia, 2017208220871180610.12816/0041063ENFaris Mohammed AlreshidiUniversity of HailAbdullah Saleh AlrashidiUniversity of HailFayez Nashi Motlaq AlshammariUniversity of HailAlya Bakr A. QadiMedical University of ŁódźAli Ghannam Mohammed AlrashidiUniversity of HailSaleh Muflih Srai AlghaythiUniversity of HailFouad Taiwilaa AlshammariUniversity of HaiSaud Mohammed Saud AleisaTaif UniversityJournal Article20180828<strong>Background:</strong>stroke is a neurological defect that could result in death thus adequate knowledgeof stroke is a must for correct treatment andprevention of stroke consequences and disability.
<strong>Objectives:</strong>assessing theknowledge, attitude and practice(KAP) of Saudi population toward stroke risk factors and warning symptomsin Kingdom of Saudi Arabia (KSA).
<strong>Methods:</strong>2021 adult Saudi subjects were enrolled in the study who were chosen from different parts of KSA. This cross sectional study was conducted using a structuredquestionnaire designed to examine KAP of participants about stroke risk factors.
<strong>Results: </strong>most of subjects were 41-50 years old, females, employed and had a college degree.About 9% of the participated subjects were suffering from stroke while, 28% had relatives who suffered from stroke. The majority of subjects had insufficient knowledge regarding the risk factors and warning symptoms of stroke thus, resulting in inadequate KAP in 63.8% of the respondents while only 36.2% had good KAP. The good KAP was significantly associated with younger age participants and highly educated.
<strong>Conclusion: </strong>The level of KAP toward stroke risk factors and warning symptoms wasinadequate among the majority of participants. Good KAP was associated with high educational degree and young age.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11806_0a726564295c0981fb6eab754a8762a7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Assessment of Osteoporosis Knowledge among Saudi Females in Riyadh, KSA208820921181110.12816/0041064ENBasim Khalid AlHarthiTaif UniversityAbdulmalik AlkhodairImam Mohammed bin Saud UniversityAmro Youssef EliasKing Abdulaziz UniversitySaud Nasser AleisaImam Mohammed bin Saud UniversityFaisal Abdullah ALMoumenImam Abdulrahman Bin Faisl UniversityMohammed Yahya Hassan Al-yamiNajran UniversityJournal Article20180828<strong>Background: </strong>osteoporosis is considered as a major worldwide health problem. Little is known about its definition, risk factors and prevalence in Kingdom of Saudi Arabia (KSA).
<strong>Objectives: </strong>Evaluating the general knowledge of Saudi females in Riyadh about osteoporosis.
<strong>Subjects and Methods: </strong>this was an analytical and descriptive study. A reliable osteoporosis knowledge assessment tool (OKAT) questionnaire was published online for considering the levels of osteoporosis awareness from February 2017 to July 2017.
<strong>Results: </strong>The majority of females were educated, married, had college degree and living in medium economic state. Only ten patients reported having osteoporosis. The majority of participants (%) had high OKAT score indicating high prevalence of good knowledge among included subjects. The young age, being highly educated and good economic status were significantly associated with good awareness.
<strong>Conclusion: </strong>a good level of knowledge about osteoporosis was found among included subjects. Although having good awareness about osteoporosis in Riyadh, the majority of subjects obtained their knowledge from relatives and physicians. Thus, authorities should create educational programs at all health care facilities to assess a preventive programs for osteoporosis.
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<strong> </strong>https://ejhm.journals.ekb.eg/article_11811_032786c98383d5beeb545753e33a6bdc.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Treatment Options for Relapsing-Remitting Multiple Sclerosis209320991181610.12816/0041065ENYara Mohsen AlbalawiTabuk UniversitySultan Sameer AlhunbusiTaif UniversityMeshari Sultan AlsudayriHail UniversityNeda Ali Al-BatiImmam Abdulrahman Bin Faisal University (IAU)Ahmad Hamza Omar KhalidTaif UniversityTalal Hamid AlfallajDow University of Health Sciences - PakistanElham Hamid Al FallajAlmaarefa Colleges for Science & Technology (MCST)Abdulrahman Zaid AlshamraniJeddah UniversityAdilah Hamoud Al TuraifiIbn Sina National College for Medical StudiesAbdulrahman Mubarak AlmutairiMajmaah UniversityJournal Article20180828Multiple sclerosis (MS) is a chronic inflammatory autoimmune demyelinating disease of the central nervous system that usually affects young adults, particularly women. The pathobiology of multiple sclerosis contains inflammatory and neurodegenerative mechanisms that affect both white and grey matter. These mechanisms cause the relapsing, and frequently progressive, course of multiple sclerosis, which is heterogeneous; confident prediction of long-term individual prognosis is not yet promising. Though, as revised MS diagnostic criteria that include neuroimaging data facilitate early diagnosis, most patients are encountered with making important long-term treatment decisions, most particularly the utilization and selection of disease modifying therapy. Presently, there are numerous approved MS disease modifying therapy with changing degrees of efficacy for decreasing relapse risk and preserving neurological function, but their long-term benefits stay imprecise. Furthermore, available disease modifying therapy vary with regard to the route and frequency of management, common adverse effects, tolerability and possibility of treatment adherence, risk of major toxicity, and pregnancy-related risks. Thorough understanding of the benefit risk profiles of these therapies is essential to establish logical and safe treatment procedures for patients with multiple sclerosis.
https://ejhm.journals.ekb.eg/article_11816_fd118b9efb0d421fced6240b06f7f91f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Assessment Level of Awareness about Risk of Using Chronic Steroid Causing Cataract in Saudi Arabia, 2017210021041182010.12816/0041066ENSaad Saud AljuaidTaif UniversityWala Hassan BakhameesKing Abdulaziz UniversitySamah Ali AlharbiIbn Sina National CollegeIbrahim Ahmed AlkulaybiUmm Alqura UniversityKhaled Freeh Aoudah AlnawaimissHail UniversityAbdullah Hisham Al-MullaKing Faisal UniversityFaisal Abdullah ALMoumenImam Abdulrahman Bin Faisal UniversityJournal Article20180828<strong>Background: </strong>the risk of cataract was increased in patients using steroid therapy for long periods in a dose dependent manner.
<strong>Objectives:</strong> assessing the knowledge of Saudi population toward chronic use of steroid therapy impact on cataract.
<strong>Subjects and Methods: </strong>this is a cross sectional study conducted from February 2017 to June 2017 among 918 adult subjects randomly chosen from 15 primary health care centers in KSA. All subjects were asked to fill up a questionnaire that included their demographics and questions about using steroid therapy and it effects.
<strong>Results: </strong>the mean age of included subjects was 58.7 years old, 52% of were males and 48% were females. More than half of included subjects had college degree (51.2%) and 66.8% were working. Only 7.8% of subjects had cataract and 20% of subjects received steroid therapy for more than 4 months per year. The knowledge score was good in 23.3% of subjects and poor in 76.7% of subjects. There was no association between age, gender, and working status but the higher education was significantly associated with good knowledge.
<strong>Conclusion: </strong>there was inadequate knowledge about cataract induced by using steroid therapy among adult Saudi population and no significant impact of age, gender and working status has been evidenced. But the higher education was associated with higher levels of good knowledge.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11820_e21b2789f903afad1c3ff5eccf7d3b7d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Assessment of The Effectiveness of Lifestyle on BMI in Adult People in Saudi Arabia, 2017210521081182110.12816/0041067ENTahani Abdullah Doshijazan UniversityHind Fahad AlqubaliTabuk UniversityAqeela Najim Al-khamisImam Abdulrahman Bin Faisal UniversityAmnah Essa Abu LahsahJazan UniversityRahma Ibrahim MohzariJazan UniversityMohammed Hadi AssiriArmed Forces Hospital, South RegionNouf Mohammed MariJazan UniversityLayla Ali Hussin MohammedJazan UniversityKhetam Hamod MoafaJazan UniversityAbdulrahman Fahad AL-AqlImam Muhammad Ibn Saud Islamic UniversityJournal Article20180828<strong>Background: </strong>food habits and lifestyle significantly affect the prevalence of overweight and obesity thus impact the body mass index (BMI) among Saudi population.
<strong>Objectives: </strong>assessments of the impact of lifestyle on the BMI among the adult population in Kingdom of Saudi Arabia (KSA). <strong>Subjects and Methods: </strong>a cross sectional study conducted on 1055 adult Saudi subjects aged between 20-40 years old. A predesigned questionnaire was distributed among included subjects from January 2017- May 2017consisted of questions about subject’s demographics, anthropometric measures, and lifestyle.
<strong>Results: </strong>this study included 1055 subjects from which 40.9% normal, 5.9% were underweight, 25% were overweight, 17.1% were obese, 8.4% were severely obese and 2.7% were morbidly obese. Being female, older age and smoking were significantly related to overweight and obesity. The bad lifestyle habits, lack of exercise and watching TV and video games were significantly associated with a high prevalence of obesity and overweight among studied subjects.
<strong>Conclusion: </strong>bad lifestyle habits, smoking, not practicing physical exercise and using entertainment means for a long time significantly increased the BMI thus revealing high rates of overweight and obesity.
https://ejhm.journals.ekb.eg/article_11821_15a23cd6ba134b9409dfd020fd8d0e06.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Effect of Maternal Diabetes on Cord Blood Concentrations of Iron Status Parameters210921141182210.12816/0041068ENNehal Mohamed El-RaggalDepartment of Pediatrics, Faculty of Medicine-Ain Shams UniversityRania Mohamed Abdou, Mohamed Tarif HamzaDepartment of Pediatrics, Faculty of Medicine-Ain Shams UniversityShorouk Mostafa Hassan El OufyDepartment of Pediatrics, Faculty of Medicine-Ain Shams UniversityJournal Article20180828<strong>Background: </strong>iron is essential element involved in a broad range of biologically important reactions critical for cellular function and also plays a role in oxygen transferring and despite its low daily requirements iron deficiency is the most common nutritional disorder in the world. Increased serum concentration of TfR is a sensitive and quick response to the development of iron deficiency. Conversely, the serum TfR concentration decreases in response to treatment with iron before a change in hemoglobin occurs, so the response to iron can be monitored by changes in serum TfR. TfR-F index is proposed to be a more accurate reflection of tissue iron status than ferritin. Many factors can influence the iron status of the fetus at birth<strong>,</strong> Maternal diabetes mellitus was thought to be associated with depletion of fetal iron stores in proportion to the degree of maternal control and presence or absence of complications of diabetes, but not maternal iron status.
<strong>Aim of the work: </strong>in this study we aimed to assess the effect of maternal diabetes on neonatal cord blood iron stores. <strong>Patient and Method: </strong>this case-control study was conducted on 100 maternal/cord blood pairs who were randomly included in the study from Obstetrics and Gynecology Department at El- Nile Insurance Hospital, Shubra El Khema, during the period from November 2015 to July 2016.
<strong>Results: </strong>this study was done on the fetal iron status in the diabetic mothers and the control group using the transferrin receptos-ferritin index<strong>(TfR-F index)</strong> as a measure of cellular iron status and results showed that infants of the diabetic mothers<strong>(IDM)</strong> had significantly lower iron stores represented as lower s.ferritin (P=0.000) and significantly higher serum transferring receptors<strong>(STfR)</strong>levels than infants born to the control mothers <strong>(P=0.038</strong>) and also higher sTfR level in insulin dependent diabetes mellitus (IDDM) mothers ; this was suggesting a state of increased erythropoiesis.
<strong>Conclusion</strong>: this study confirmed that iron stores are lowerat birth in infants of women with diabetes mellitus. Thisappeared to be due to the effects of increasederythropoiesissecondary to chronic intrauterine hypoxia.Fetal iron stores were affected by maternal glycemic control and not related to maternal iron supplement.
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https://ejhm.journals.ekb.eg/article_11822_ef687fbd1c90de0cd4e5f5a7fdb26e95.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Morpho-Functional Adaptations of the Lingual Epithelium of Two Bird Species Which Have Different Feeding Habits211521271182310.12816/0041069ENAli G. Gadel- RabDepartment of Zoology, Faculty of Science, Al-Azhar University, AssuitNahed A. ShawkiDepartment of Zoology, Faculty of Science, Assuit universitySamy A. SaberDepartment of Zoology, Faculty of Science, Al-Azhar University, Cairo, EgyptJournal Article20180828The dorsal epithelium of the free portion of tongue of laughing dove, <em>Streptopelia senegalensis</em> (granivorous) is characterized by presence of well-developed keratinized epithelium with desquamate parakeratinized one which is covering the anterior part of the free portion. Highly keratinized and stratified epithelium is covering the ventral surface of the anterior third of the free portion of the tongue and forming the lingual nail. Laryngeal area is covered dorsally by non-keratinized squamous epithelium. Frenulum is covered by a transitional-like epithelium. Both the dorsal and ventral surfaces of the free portion of the tongue of the common hoopoe, <em>Upupa epops</em> (insectivorous) are covered by thin non-keratinized squamous epithelium except that covered the areas of lingual tubercles, lingual wings and lingual papillae, which are covered by epithelium furnished dorsally by detached keratin. The laryngeal area is covered by non-keratinized squamous epithelium. The frenulum is covered by non-keratinized stratified squamous epithelium. It has been summarized that the differences in the structures of the avian tongue reflecting the differences in the feeding habits. The epithelium covering the tongue of the laughing dove is constructed for high mobility (up-down movement) in comparison with the epithelium of the common hoopoe that depends on its first action of feeding on the movement of the jaws and beak.
<strong> </strong>https://ejhm.journals.ekb.eg/article_11823_b400e4b31f8fe2f169db5bd640ae8ffd.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Study of Analgesic Intake among Patients with Chronic Low Back Pain and their Side Effects212821321182410.12816/0041070ENMolook Shebeeb AlotibiKing Saud UniversityAbdullah Ibrahim SaeedKing Saud UniversityHussam Sunaid Dhaher AlmuzainiAl-Imam Muhammad Ibn Saud Islamic UniversityGhadah Meshaal Al-RubayaImam Abdulrahman Bin Faisal UniversityBara'ahSohaib Anwar ButtIbn Sina National College for Medical StudiesAlzahrani Rashad MohammedTaif UniversityMeshari Ahmad Aali Al-MalkiTaif UniversityNedaa Mohammed A AlromailiKing Saud UniversityAbdullah Atallah Al-EneziMajmaah UniversityHanan Abdulwahab Al-HawajArabian Gulf UniversityJournal Article20180828<strong>Background:</strong> chronic low back pain is one of the most common causes of chronic pain. Low back pain can have many causes but most cases have nonspecific etiology. There are many approaches in the management of chronic low back pain. <strong>Methodology:</strong> we carried out a systematic review on observational (nonrandomized) of 43 studies using PUBMED. <strong>Aim:</strong> to evaluate the use of analgesics, mainly Non-Steroidal Anti-inflammatory Drugs and opiates, compare their efficacies for symptomatic treatment of low back pain, and study the side effects briefly for both category of drug.
<strong>Conclusion:</strong> management of chronic low back pain aims mainly to improve function, and quality of life, and to decrease level of disability, and therefore, it remains as a big challenge for the general practitioner. More studies must be done to compare efficacies of various lines of management for both short and long term.https://ejhm.journals.ekb.eg/article_11824_73fb103fbbbde7734c73fe4b683088f6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Urinary Tract Infection in Patients with Diabetes Mellitus213321361182510.12816/0041071ENFaisal Abdullah AlrwitheyTaibah UniversityAbdullah Eid Ayyadah AlahmadiTaibah UniversityAli Mohammed Fayez AlshehriKing Khalid UniversityIbrahim Abdullah AbalhassanPrince Sattam Bin Abdulaziz UniversityFatimah Mohammed Salman AlhamadImam Abdulrahman Bin Faisal UniversityYousef Zaki KhedherKing Abdulaziz UniversityAlaa Mohammed AldehryIbn Sina National CollegeShaima Tariq Mansoor BeigIbn Sina National CollegeAwatif Ahmed AlthubyaniIbn Sina National CollegeReham Ahmed Al GhamdiIbn Sina National CollegeJournal Article20180828<strong><span lang="EN-US">Background: </span></strong><span lang="EN-US">urinary tract infections (UTI) are one of the most common types of bacterial infection in patients with diabetes mellitus (DM). There are certain aspects to diabetes that makes it a risk factor for getting urinary tract infection and additionally, diabetes may also predispose to certain complications.<br /> <strong>Methodology:</strong> in this paper we aim to carry out a systematic review on observational (nonrandomized) studies on PUBMED. <strong>Aim:</strong> to evaluate the prevalence, pathogenesis, diagnosis, management and complications of UTI in patients with DM. <strong>Conclusion: </strong>the proper management of UTI in diabetics is crucial, as prompt diagnosis and correct use of antibiotics is vital for treatment. Future research in this regard will hopefully decrease the burden of UTI in diabetic patients.</span>https://ejhm.journals.ekb.eg/article_11825_393a7cc65827b831215284ab0a602323.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Effect of Egyptian Red Cabbage on Some Physiological Parameters in Hyperthyroidimic Rats213721421182610.12816/0041072ENEman HelalDepartment of Zoology, Faculty of Science, Al-Azhar University (Girls), Cairo, Egypt.https://orcid.org/0Rasha A. A. El SayedDepartment of Zoology, Faculty of Science, Al-Azhar University (Girls), Cairo, Egypt.Sara EbrahiemDepartment of Zoology, Faculty of Science, Al-Azhar University (Girls), Cairo, Egypt.Journal Article20180828<strong>Background</strong>: this study aimed to illustrate the protective effect of red cabbage extract against hyperthyroidism induced by L-thyroxin in male albino rats. <strong>Materials and methods: </strong>Eighteen animals were divided randomly into three groups. <strong>Group A</strong>: healthy rats, <strong>Group B:</strong> normal rats were subcutaneous injected with 500 µg/kg body weight/day L-thyroxin once daily for two weeks to induce hyperthyroidism and <strong>group C</strong>: hyperthyroid rats received red cabbage extract. At the end of the experiment, blood samples were collected for biochemical analysis. <strong>Results</strong>: hyperthyroid rats induced by L-thyroxin had significant decrease (P<0.05) in serum levels of triodothyronine (T3), thyroxin (T4), protein profile, lipid profile (TC, HDL) as well as a significant increase in kidney function test (BUN, uric acid), in liver enzymes (ALP, ALT), and a significant decrease in TSH, TG, VLDL compared to the normal control group. Oral administration of red cabbage extract ameliorated most of the tested parameters.https://ejhm.journals.ekb.eg/article_11826_cd5188ca63d925210885224e915dc5c7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Lidocaine Infusion on Hysteroscopic Media versus Oral Diclofenac for Pain Relief during Outpatient Hysteroscopy: A Randomized Controlled Trial214321481183910.12816/0041073ENHatem Hussein El-GamalDepartment of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, EgyptAhmed Elsayed Hassan ElbohotyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, EgyptAhmed Hamdy Gouda AboutablDepartment of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180828<strong>Aim of the work:</strong> this work aimed to assess the analgesic efficacy of lidocaine dissolved in the distension medium compared to oral diclofenac before outpatient diagnostic hysteroscopy
<strong>Patients and methods: </strong>this randomized controlled trial included 44 nulliparous women schedules to undergo diagnostic office hysteroscopy.
The participants were randomly categorized into two groups; <strong>group D</strong> (n=22) received diclofenac 100 mg oral tablets and <strong>group L</strong> (n=22) received 10 ml of lidocaine 2% dissolved in saline (The distension medium). Pain was evaluated during hysteroscope insertion and 5, 10, 15 and 30 minutes after using visual analog scale (VAS). The patient was considered in pain if the VAS score was ≥ 4. <strong>Results: </strong>hysteroscope insertion was associated with pain in 35 patients (79.5%); more frequently in <strong>group L</strong> (p = 0.021). Severe pain was reported by 13 patients (29.5%); more in <strong>group L</strong> (p = 0.099). All patients were pain-free 15 minutes after procedure start. <strong>Group L</strong> showed significantly higher pain scores with hysteroscopic insertion (p = 0.017). The two groups had comparable pain scores 5, 10 and 15 minutes from the procedure start. Few adverse reactions were recorded. The two drugs were hemodynamically stable.
<strong>Conclusion</strong>: oral treatment with 100 mg diclofenac one hour before office hysteroscopy was a safe and more effective in pain control during the procedure compared to lidocaine dissolved in saline used as the distension medium. https://ejhm.journals.ekb.eg/article_11839_04accb85d3a254c478970e3ed5d27565.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Outcomes of Patients with Morbidly Adherent Placenta in Ain Shams Maternity Hospital: a Retrospective Study214921581184110.12816/0041074ENAmr Hassan El-ShalakanyDepartment of Obstetrics and Gynecology, Faculty of Medicine Ain Shams UniversityAmr Abdel Aziz ElsayiedDepartment of Obstetrics and Gynecology, Faculty of Medicine Ain Shams UniversityAhmed Mohammed RagabDepartment of Obstetrics and Gynecology, Faculty of Medicine Ain Shams UniversityJournal Article20180828<strong>Background: </strong>morbidly adherent placenta is defined as an abnormal adherence of all or part of the placenta to the underlying uterine wall. <strong>Aim of the work: </strong>this study aimed to evaluate the management of morbidly adherent placenta in Ain Shams Maternity Hospital during the 5-year period from January 2012 to December 2016.<strong>Study Design: </strong>this is a retrospective study. <strong>Study Setting: </strong>Ain Shams University Maternity Hospital.
<strong>Patients and Methods: </strong>records of hospital admissions during the planned time frame with the diagnosis of antepartum hemorrhage or placenta accreta/increta/percreta were reviewed.
<strong>Results: </strong>Ain Shams University Maternity Hospital (ASUMH) is a major tertiary referral hospital in Egypt. In evaluation of the management and short term maternal and perinatal outcomes of morbidly adherent placenta offered to women at ASUMH, the hospital archives were examined for hospital records fulfilling the criteria of this study population during the 5-year period from January 2012 to December 2016. During the 5-year period of the current study, there were 58,529 deliveries; 29,282 cases; they were delivered by CS (50.03%). MAP was diagnosed in 429 cases 0.7 % of total deliveries with an incidence of 1 in 136, 1.5% of total CS. These results indicated a high incidence of MAP, as a result of high rates of CS.
<strong>Conclusion:</strong> morbidly adherent placenta was highly associated with the existence of placenta previa, especially in cases with previous cesarean section. When morbidly adherent placenta was diagnosed or suspected antenatally, the patient must be referred to a tertiary center. Generally, the recommended management is cesarean hysterectomy. However, this approach might not be considered first-line treatment for women who have a strong desire for future fertility. Therefore surgical management of morbidly adherent placenta may be individualized.https://ejhm.journals.ekb.eg/article_11841_9246d7e518de30a2276214087f4c045c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Oxidative Stress in Segmental Versus Non Segmental Vitiligo215921641184310.12816/0041075ENNader Fouad RagabDermatology and Venereohiilogy Department, Faculty of Medicine - Ain Shams UniversityMahmoud Abdel Rahim AbdallahDermatology and Venereohiilogy Department, Faculty of Medicine - Ain Shams UniversityManal Louis LukaDermatology and Venereohiilogy Department, Faculty of Medicine - Ain Shams UniversityNoha Sobhy Abd El WahabDermatology and Venereohiilogy Department, Faculty of Medicine - Ain Shams UniversityJournal Article20180828<strong>Background:</strong> vitiligo is a coetaneous autoimmune disease, cosmetically non-acceptable to patients with higher Fitzpatrick skin type because of the contrast between lesional and non-lesional skin<strong>.</strong> Oxidative stress through H<sub>2</sub>O<sub>2</sub> that is converted by superoxide dismutase (SOD) into H<sub>2</sub>O and super oxide anion (O<sup>.-</sup>) which affects directly on preopiomelanocortin (POMC) system in the epidermis of vitiligo patients which plays the key role in melanogenesis<strong>.</strong>
<strong>Aim of the work:</strong> this study aimed to measure H<sub>2</sub>O<sub>2 </sub>in segmental vs. non-segmental vitiligo. This was done through colorimetric evaluation of H<sub>2</sub>O<sub>2</sub> in the epidermis of patients with vitiligo and it was focused on the role of the oxidative stress in the pathogenesis of vitiligo.
<strong>Patients and methods:</strong> this pilot study was included 30 patients recruited from the outpatient clinic of Dermatology and Venereology at Ain Shams University Hospital and outpatient clinic of Al Haud Al Marsoud Hospital. They were all suffered from vitiligo. Fifteen of them had non-segmental and the other 15 had segmental vitiligo. Each group was subdivided into active and stationary. The active disease was defined as appearance of a new lesion and/or extension of preexisting lesionsin less than one year<strong>.</strong>
<strong>Results:</strong> there was a significant increase of H<sub>2</sub>O<sub>2</sub> level in the lesional vs. non-lesional skin in all number of patients, NSV patients, NSs patients, NSa, and SVs, but not in SVa patients. The H<sub>2</sub>O<sub>2</sub> raised in NSV patients when compared to SV patients. There was a non-significant rise of H<sub>2</sub>O<sub>2;</sub> also in patients with SVa. There was a significant increase in the epidermal H<sub>2</sub>O<sub>2</sub> level in the NSV patients above that of SV patients.
<strong>Conclusion:</strong> this study suggested that oxidative stress was present in both SV and NSV. This might open a window for several studies concerning the patients of SV and whether the oxidative stress is primary or secondary. Also whether these patients might benefit from antioxidant medications or not.https://ejhm.journals.ekb.eg/article_11843_dfd7fd847f96372dad52e9990415b6c0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001The Prognostic Value of the Prechemotherapy Neutrophil - Lymphocyte Ratio in Gastric Cancer216521701184510.12816/0041076ENTarek HusseinClinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams UniversityAhmed EzzatClinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams UniversityAhmed GaballahClinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams UniversityMonika Magdy YoussefClinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams UniversityJournal Article20180828<strong>Background: </strong>gastric cancer is the 5<sup>th</sup> most common cancer worldwide, with about one million newly diagnosed cases annually. It causes one of the highest cancer burdens, as measured by disability-adjusted life years lost. It is the third-leading cause of cancer-related death worldwide, after lung and liver malignancies. It is increasingly recognized that variations within clinical outcomes in cancer patients are influenced by not only the oncological characteristics of the tumor, but also the host-response factors.
<strong>Aim of the work: </strong>this study aimed to investigate the prognostic value of prechemotherapy NLR in the gastric cancer patients and also to assess the association between high NLR and clinicopathological features; e.g. tumor stage, site, gross morphology …etc. <strong>Patients and methods: </strong>this retrospective study included patients, diagnosed with gastric or gastroesophageal cancer, who presented to Oncology Department in Ain Shams University Hospital from January 2013 till December 2016. 61 patients were included in this study. <strong>Results: </strong>we found a significant correlation between presence of ascites and high NLR. This relation wasn’t discussed in any previous study as far as we know. There was a significant correlation between NLR and each of the following: - overall survival and event-free survival. This was consistent with the results of previous studies worldwide. Therefore, our study proved that the prechemotherapy NLR is a prognostic factor in gastric cancer.
<strong>Conclusion:</strong> the prechemotherapy NLR was significantly correlated with presence of ascites at diagnosis of gastric cancer. It is an independent prognostic factor in gastric cancer. It affects both event free survival and overall survival.https://ejhm.journals.ekb.eg/article_11845_4fef13171dcab654e7b05e3994933b1f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Role of Diffusion Weighted MRI Imaging in Detection of Liver Metakstases217121751184710.12816/0041077ENKhalid E. AllamDepartment of Diagnostic Radiology, Faculty of Medicine, Ain Shams UniversityMennatallah H. ShalabyDepartment of Diagnostic Radiology, Faculty of Medicine, Ain Shams UniversityIsraa A. MouloodDepartment of Diagnostic Radiology, Faculty of Medicine, Ain Shams UniversityJournal Article20180828<strong>A</strong><strong>im of the work: </strong>diagnosis of liver metastases is of essential importance in the staging of patients with a known primary tumor. So, the present study aimed to evaluate role of DWI in diagnosis of liver metastasis.<strong>Patients and methods:</strong> twenty patients were included in this study. The cases were evaluated over 6 months at Ain Shams University Hospital with a 1.5 Tesla Phillips (MR System Achieva) whole body imager. <strong>Results: </strong>in the sample of the study which was composed of 20 patients, there were two patients who presented with negative lesion in DW MRI with sensitivity 100%, specificity 90% and accuracy 95%. <strong>Conclusion:</strong> DWI alone performed equally well as Gd-MRI in the diagnosis of liver metastases. In cases where gadolinium injection was not allowed, dynamic contrast-enhanced imaging can be replaced by a protocol based on unenhanced T1- and T2-weighted imaging combined with DWI.
<strong>Recommendations:</strong> further studies on larger scale of patients are needed to confirm the results of the study. https://ejhm.journals.ekb.eg/article_11847_f235039f43c7ea0e397361eebeb50c28.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269320171001Assessment of Osteoporosis Knowledge Test among Community Population in Abha City, KSA217621801184910.12816/0041078ENAlanazi Munif SalehNorthern Border UniversityAbdullah Eid AlahmadiTaibah UniversityMalik Abdul Rahman AlmalkiTaibah UniversityAhmed Ali JaafariJazan UniversityTaef Hassan Al-HussanKing Khalid UniversityMohammad Ali AlfaifiKing Khalid UniversityMohammed Abobakr AlammariBatterjee Medical CollegeAbdullah Ismail AlsharifTabuk UniversityJournal Article20180828<strong>Background: </strong>there is a high prevalence of osteoporosis in KSA indicating a low preventive measures and a lack of knowledge about radiological investigations importance and hazards.
<strong>Objectives:</strong> assessing the general knowledge of osteoporosis risks, screening, treatment and physical activity as well as evaluating the awareness about radiological investigations timing and effects.
<strong>Methods:</strong> a community survey study based on a reliable questionnaire that was distributed among general community in Abha city from March 2017 to June 2017.
<strong>Results: </strong>most of subjects were young, females and have college degree. Only 17% of subjects reported having osteoporosis. Most of participants (52%) have good overall general knowledge but only 42% had good knowledge regarding the calcium recommendations and 21% have good knowledge about importance of physical activity in prevention of osteoporosis. 60% of subject shave good knowledge about the risk factors of osteoporosis and 75% had good knowledge regarding the symptoms and radiological investigations.
<strong>Conclusion: </strong>The overall knowledge in Abha City was good in 52% of subjects however, the levels of knowledge about preventive measures were poor while the majority had adequate knowledge regarding the risk factors, symptoms and radiological investigations. Although, a moderate prevalence of good knowledge, educational programs must be adopted by health authorities to motivate healthy behaviors for prevention of osteoporosis in our community.https://ejhm.journals.ekb.eg/article_11849_e5174b6ac56e06dd30aabc7d96f059a1.pdf