Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Relationship between Type 2 Diabetes Mellitus and the occurrence of Gastroesophageal varices in patients with chronic Hepatitis C Virus Related Liver Cirrhosis719672031778710.21608/ejhm.2018.17787ENFathy G. Abdel-RaziqInternal Medicine Department, Faculty of Medicine, Al-Azhar University (Damietta)Mahmoud S. BerengyInternal Medicine Department, Faculty of Medicine, Al-Azhar University (Damietta)Ahmed RA MohammedInternal Medicine Department, Faculty of Medicine, Al-Azhar University (Damietta)Tarek M. EmranClinical Pathology Department, Faculty of Medicine, Al-Azhar University (Damietta)Journal Article20181028<span>Background: </span><span>Hepatitis C virus (HCV) infection is a challenging health problem in Egypt. Esophageal varices are a major complication of it which may bleed and endanger patient's life.<br /> </span><span>Aim of the work: </span><span>to assess the relationship between type-2 DM and the development of gastroesophageal varices and explore the role of insulin resistance as a predictor of gastroesophageal varices.<br /> </span><span>Patients and methods: </span><span>This study included 100 patients with Child A, HCV-induced cirrhosis. They were divided into two main groups: Group A included 50 patients with type-2 DM, while Group B: included 50 non-diabetic which were subdivided into: Group B1: patients without DM but, with insulin resistance (IR) {32}, and Group B2: patients without DM or IR {18}. All patients were subjected to full history taking, clinical examination, laboratory and imaging studies (abdominal ultrasound) and upper GI endoscopy.<br /> </span><span>Results: </span><span>The prevalence of esophageal varices in patients with Child A HCV-induced cirrhosis was 80%, elevated to 88% in patients with type-2 DM. Insulin resistance played the major role in development of esophageal varices. There are statistically significant elevated HOMA-IR score, lower platelet count/spleen diameter ratio and higher right liver lobe diameter/albumin ratio in patients with varices.<br /> </span><span>Conclusion: </span><span>Insulin resistance is a major contributor for development of esophageal varices in HCV induced cirrhosis. Platelet count/spleen diameter ratio, right liver lobe diameter/albumin ratio and insulin resistance measured by HOMA-IR are good predictors for the presence of esophageal varices. </span><span><br /> </span>https://ejhm.journals.ekb.eg/article_17787_f60b93718e2728f900e20dbd94918bf7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Clinical comparative study between Magnesium sulphate versus Rocuronium versus Dexmedetomidine as adjuvants for local anesthetic in peribulbar block for eye surgeries720472101779110.21608/ejhm.2018.17791ENSayed Ahmad AbdAlaliDepartment of Anesthesiology and Intensive care,Faculty of medicine, Al-Azhar UniversityGamal Farouk MohamedDepartment of Anesthesiology and Intensive care,Faculty of medicine, Al-Azhar UniversityAmr Soliman AbdAlmagidDepartment of Anesthesiology and Intensive care,Faculty of medicine, Al-Azhar UniversityMahmoud Alsayed Hussin DesokiDepartment of Anesthesiology and Intensive care,Faculty of medicine, Al-Azhar UniversityJournal Article20181028<span>Background</span><span>: Regional anesthesia is a preferred technique for ophthalmic surgery. It is safe, inexpensive and provides efficient ocular anesthesia for ophthalmic surgery. It is associated with less hemodynamic instability, less respiratory depression, better postoperative pain relief, and less nausea and vomiting compared to general anesthesia.<br /> </span><span>Objectives: </span><span>The aim of the study was to compare the safety and efficacy of the use of Magnesium sulfate versus that of Rocuronium versus </span><span>Dexmedetomidine </span><span>as an adjuvant to the local anesthetic in peribulbar anesthesia. It is characterized by generating </span><span>optimal operating conditions for eye surgery in terms of akinesia, analgesia, incidence of complications, as well as induction of patient and surgeon satisfaction.<br /> </span><span>Patients and Methods</span><span>: </span><span>The present study included100 patients of the American Society of Anesthesiology (ASA), physical status I, II, III or IV of both sex, (20-80) years old and undergoing to anterior and posterior segment surgeries. Informed written consent from all patients was taken after approval of Al-Azhar University Ethical Committee.<br /> </span><span>Results</span><span>: Evaluation of the globe akinesia was done at (2.5),(5),(7.5),and(10) min. after injection. The onset of motor block showed a statistically significant difference between the four groups, the rocrounium group showed more rapid onset of motor block then dexmedtomedine group then magnisum sulphate group then lastly the control group.<br /> </span><span>Conclusion: </span><span>The present study concluded that using Rocuronium as an additive to local anathestic drugs in peribublar block it makes onset of block more rapid and dense but it has less effect on analgesic aspect. On the other hand, when Dexmedetomidine or </span><span>Magnesium sulfate were used as additive they increased analgesic effect of local anathestic and decreased the need for early postoperative rescue analgesia, as well as fastening the onset of block but to a lesser extent less than Rocuronium as an additive to local anathestic.<br /> </span><span><br /> </span>https://ejhm.journals.ekb.eg/article_17791_86d2c65bcf54d62ffc9cb590bdca8026.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Comparison between the Effects of Insulin versus Corticosteroid Local Injections in Diabetic Patients with Carpal Tunnel Syndrome721172191779310.21608/ejhm.2018.17793ENAhmed Ismail Ali ShalabyDepartment of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al- Azhar University, Cairo, EgyptKalthom Mohamed Abd El HamidDepartment of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al- Azhar University, Cairo, EgyptIbrahim Abd Alsamie EmamDepartment of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al- Azhar University, Cairo, EgyptAdel Ibrahim AzzamDepartment of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al- Azhar University, Cairo, EgyptMohamed Ahmed ZakiDepartment of
Neurology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181028<span>Background: </span><span>Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Carpal tunnel syndrome is the most commonly diagnosed and treated entrapment neuropathy and is a significant cause of morbidity. It is estimated to affect one out of ten people during their lifetime. Diabetic patients have a higher incidence with carpal tunnel syndrome. It has been reported that insulin improves the nerve regeneration and myelination through its role as neurotrophic factor.<br /> </span><span>Aim of the Work: </span><span>was to compare the short-term effects of insulin and corticosteroid local injections in the treatment of diabetic patients with carpal tunnel syndrome.<br /> </span><span>Patients and Methods: </span><span>Fifty diabetic patients with clinical and electrophysiological evidence of mild to moderate carpal tunnel syndrome were included in this study. All Patients had been sub-classified into two equal groups:- </span><span>Group (1): </span><span>Twenty five patients have received local insulin injection of 10 IU Neutral Protamine Hagedorn (NPH) {Insulinagypt N} into the affected carpal tunnel at the first visit and the same dose of insulin after 2 weeks. </span><span>Group (2): </span><span>twenty five patients have received a single dose of 40 mg triamcinolone acetonide {Epirelefan} local injection into the affected carpal tunnel. Nerve conduction study (NCS), Boston Carpal Tunnel Questionnaire (BCTQ) and clinical evaluation were carried out for both groups at baseline and four weeks after second dose of insulin injection and one month after steroid injection.<br /> </span><span>Results: </span><span>In steroid group, significant improvement in nerve conduction study as regard distal sensory latency and sensory conduction velocity without significant improvement in distal motor latency and motor conduction velocity and significant improvement in (BCTQ). In insulin group, a more significant improvement in all parameters of nerve conduction study and also in (BCTQ) was observed with insulin injection than steroid done. Also</span><span>, </span><span>there were significant differences between results of both groups for insulin injection group.<br /> </span><span>Conclusion: </span><span>Local insulin injection is an effective treatment for restoring median nerve function in diabetic patients with mild to moderate carpal tunnel syndrome and produce significant improvement in NCS and BCTQ.<br /> </span><span><br /></span>https://ejhm.journals.ekb.eg/article_17793_9ae8dcc324004b3fdcb04443ae428cd4.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Comparative Study between Augmentation Skin Mastopexy versus Augmentation Glandular mastopexy after Massive Weight Loss722072301779410.21608/ejhm.2018.17794ENMoustafa H. ELHelwPlastic & Reconstructive Surgery Department, Mataria Teaching HospitalAmir A. SaedyPlastic & Reconstructive Surgery Department, Mataria Teaching HospitalAhmed A. ELDanafPlastic & Reconstructive Surgery Department, Mataria Teaching HospitalAhmed M. ELMoftyPlastic & Reconstructive Surgery Department, AL Azhar UniversityMagdy A. Abd Al MoktaderPlastic & Reconstructive Surgery Department, AL Azhar UniversityTarek M. ELBanobyPlastic & Reconstructive Surgery Department, AL Azhar UniversityJournal Article20181028<span>Background: </span><span>an increase in the number of massive weight loss patients resulted in increase of body contouring surgery including breast reshaping.<br /> </span><span>Aim of the study: </span><span>it was to compare two procedures of augmentation skin mastopexy augmentation skin glandular mastopexy with analysis and evaluation of the final aesthetic results.<br /> </span><span>Patients and Methods: </span><span>forty female patients after massive weight loss patients were included in this study, divided in to two groups. 20 patients underwent augmentation skin mastopexy (A) and the other 20 patients underwent augmentation skin-glandular mastopexy (B). Augmentation was done through implant. Breast measurements and aesthetic outcome were assessed.<br /> </span><span>Results: </span><span>both groups showed well improvement in breast shape, volume, and projection with no significant difference regards patient satisfaction and expectations and measurements.<br /> </span><span>Conclusion: </span><span>augmentation mastopexy as a combined procedure is a good solution for breast ptosis after massive weight loss. Skin glandular mastopexy is the same as skin mastopexy but it showed fewer complications, no revision, and more satisfaction than skin mastopexy.<br /> </span><span><br /></span>https://ejhm.journals.ekb.eg/article_17794_e6b63439aaeaf2ed57fee3693d3661b0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Evaluation of Oral Anti-HCV Therapy (OAT) Effects on Serum Lipids Profile in Diabetic Patients723172361779510.21608/ejhm.2018.17795ENAbdou Mabrouk Al-ShafeyDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Diaa Mohammad EltebiDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Islam Abdel-Mawla AmmarDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Mohamad Ali AlnadarDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Journal Article20181028<span>to down regulation of cholesterol level. Interferon (INF) therapy has been shown to decrease cholesterol even further during treatment .With the availability of direct acting antiviral agents (DAAs) the effect of suppressing </span><span>HCV on lipid metabolism </span><span>warrantes re-evaluation. </span><span>Aim of the work </span><span>: </span><span>goal of our study was evaluation the changes in lipid profile after treatment of chronic HCV infection with oral antiviral medications in diabetic patients. </span><span>Methods</span><span>: this prospective study conducted on 90 HCV infected patients, all patients received Sofosbuvir (SOF) & Daclatasvir (DCV) as a dual therapy for 3 months. They were divided according to the presence or absence of diabetes mellitus (DM) and hyperlipidemia into three main groups; Group I: included 30 diabetic hyperlipidemic patients, Group II: included 30 non-diabetic hyperlipidemic patients, Group III: included 30 non-diabetic non- dyslipidemia patients.Changes of lipid profile on treatment with DAAs were assessed by checking fasting lipid profile at base line, then at end of treatment, and finally 3 months after treatment. </span><span>Results</span><span>: there was a statistically </span><span>significant increase </span><span>in total cholesterol </span><span>level </span><span>(TCHOL) </span><span>which was </span><span>maintained after the end of therapy. </span><span>Changes </span><span>in TCHOL </span><span>were driven by </span><span>changes in low-</span><span>density lipo</span><span>-protein (LDL) cholesterol</span><span>, whereas </span><span>high-density lipo-protien (HDL) </span><span>cholesterol and </span><span>very low-density lipo-protein (VLDL) cholesterol showed no significant changes. There were also no significant changes in tryglyceride (TG) level on treatment. </span><span>Conclusion</span><span>: eliminating HCV with </span><span>DAAs increased </span><span>TCHOL but had no effect on TG level. </span>
<span> </span>https://ejhm.journals.ekb.eg/article_17795_09a64c947b4e5ccc1b8b83d502000a29.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Relation of neutrophil-to-lymphocyte, platelet-to-lymphocyte ratio and CRP level with coronary artery disease severity in patients undergoing coronary angiography723772431826110.21608/ejhm.2018.18261ENMamdouh Helmy Al TahhanDepartment of Cardiology and Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityWael Refaat HablasDepartment of Cardiology and Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityAbdul Mohsen MostafaDepartment of Cardiology and Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityMohammed SarhanDepartment of Cardiology and Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityMostafa AdelMostafaDepartment of Cardiology and Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20181102<span>Background: </span><span>coronary artery disease (CAD) is the leading cause of morbidity and mortality throughout the world. It has a complex pathophysiology, and inflammation seems to play an important role in CAD</span><span>. </span><span>Previous studies have shown that higher levels of inflammatory markers are associated with the severity of CAD and worse cardiovascular outcome. Although endothelial damage has been known as the triggering factor for the formation of atherosclerotic plagues, inflammatory process is responsible in the initiation and progression of the atherosclerosis. The neutrophil-to-lymphocyte ratio (NLR) and platelet- to-lymphocyte ratio (PLR) have recently been investigated as new predictors for worse cardiovascular outcome. Previous studies have shown that NLR is associated with morbidity and mortality in many cardiovascular diseases such as hypertension, heart failure, infective endocarditis, and acute coronary syndromes (ACS). </span>
<span>Aims: </span><span>The aim of this study was to explore the relation of NLR , PLR and CRP level with severity of coronary artery disease (CAD) using the Syntax score (Sxscore).<br /> </span><span>Patients and Methods: </span><span>This study was conducted to investigate the relationship between the severity of coronary artery disease and inflammatory markers (lymphocyte ratio, lymphocyte platelet, CRP) by sytax score in patients undergoing elective coronary angiography, the active number of 100 patients with a chronic stable was taken Coronary angiography, different markers for coronary assessment, renal function tests, INR, ECG and Echocardiography. A complete clinical evaluation was performed for each of our patients </span>
<span>Results: </span><span>Coronary lesions were evaluated by the result of camel synthesis and there was a strong relationship between NLR, PLR, CRP level, and coronary heart disease r. 526 p 0.001, r 0.317 p 0.001, r 0.699 p 0.001 However, when we divided the patient for a result Syntax The results show some difference in determining who are drafting the sentence above 21, we found a negative relationship between NLR, PLR and syntax points, while the CRP level was positively correlated at the level of the structure below 31 a significant negative correlation was found with the construct conclusion above 31. </span><span>Conclusion: </span><span>Our study concluded that the severity of coronary artery disease is associated with NLR, PLR, CRP levels to some extent in the patient with angina for chronic stable chest. </span>
https://ejhm.journals.ekb.eg/article_18261_92d042c85957010a3f29b890844412be.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Magnesium Sulfate Nebulizer versus Ketamine Nebulizer in Decreasing Incidence and Severity of Post Operative Sore Throat with Endotracheal Intubation in Adults724472501826210.21608/ejhm.2018.18262ENEssam Ali MostafaAnesthesia and Intensive Care Medicine and Pain Management Department, Faculty of Medicine, Al-
Azhar UniversityAhmed Saied Abdel RahmanAnesthesia and Intensive Care Medicine and Pain Management Department, Faculty of Medicine, Al-
Azhar UniversityMahmoud Darwish MahmoudAnesthesia and Intensive Care Medicine and Pain Management Department, Faculty of Medicine, Al-
Azhar UniversityJournal Article20181102<span>Background: </span><span>Endotracheal intubation is the prominent cause of airway mucosal injury which results in postoperative sore throat (POST), with an incidence of 21%</span><span>–</span><span>65%. Although this complication is minor, if left unresolved, it produces significant agony and annoyance to the patient.<br /> </span><span>Aim of the Work: </span><span>to compare efficacy of magnesium/ nebulizer versus ketamine nebulizer in decreasing postoperative sore throat incidence, severity and duration with fixed endotracheal tube intra cuff pressure at or below 20 cm H</span><span>2</span><span>O using handheld tracheal cuff pressure monitor in adults ASA (American Society of Anesthesiologists) I-II in 20-60 years age group of either sex in operations less than 2 hours. </span><span>Methodology: </span><span>our study included 90 adult patients, status I-II (ASA I-II) in the age group 20-60 years, of either sex undergoing operation under general anesthesia (GA) scheduled for a day case surgery and operation time less than 2 hours with fixation of endotracheal tube cuff at 20 cm H</span><span>2</span><span>O using hand held tracheal cuff pressure monitor (Pressure Gauge) and checked every half hour till end of surgery and maintained at or below 20 cm H</span><span>2</span><span>O. </span>
<span>Results: </span><span>Our study showed reduction in POST incidence and severity after preoperative magnesium sulfate nebulization in all time points 0, 2, 4, 8, 12 and 24 hours postoperative, so it was proved that magnesium nebulizer has great role in reduction of incidence, severity and duration of POST. </span><span>Conclusion: </span><span>we concluded that preoperative magnesium sulfate nebulization reduce incidence and severity of POST and it is more effective than preoperative ketamine nebulization. </span>
<span> </span>https://ejhm.journals.ekb.eg/article_18262_069ec5a613cc3ece810a876c316b3b27.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Reducing risk of coronary heart disease in primary care, and roles of family doctors725172571826310.21608/ejhm.2018.18263ENAlhussain Abdullah Jarullah AlbudaydiNajran UniversityNasser Naji Mohsen Al HarthiNajran UniversityAbdullah Salem Al HaiderNajran UniversityYaqoub Mubarak Ali AlhamamiNajran UniversityMana Ali Mueidh Al HajlanNajran UniversityMohammed Hundur AlasmariNajran UniversityAbdulaziz Abdullah AlhazmiNajran UniversityJournal Article20181102<span>Background: </span><span>CVD is a long-term status with serious and often fatal results. In this review we discussed the main areas targeted for primary prevention of CVD in primary care and recommendations to reduce </span>
<span>risk of CHD. </span>
<span>Method: </span><span>We systematically searched electronic databases (MEDLINE, Embase, SCOPUS, CINAHL,) for published articles discussing coronary artery disease management in primary care, and the roles of </span>
<span>family doctors in reducing the risk of CHD. </span>
<span>Conclusion: </span><span>CVD is a major cause of disability as well as premature death throughout the globe. The underlying pathology of atherosclerosis established over several years and is generally advanced by the time the signs and symptoms occurrence, normally in midlife. The threat of creating CAD raises with age, as well as consists of age > 45 years in men as well as > 55 years in women. A family history of early heart disease is also considered a danger factor, such as cardiovascular disease in the father or a </span>
<span>brother detected before age 55 years as well as in the mother or a sister detected prior to age 65 years. </span>
<span> </span>https://ejhm.journals.ekb.eg/article_18263_20fe49f76ee9d8b027619cae583a4f4b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Effect of Indirect Biliary Cannulation on Endoscopic Retrograde Cholangiopancreatography Outcome725872611826410.21608/ejhm.2018.18264ENMohamed Abdelrasheed AllamTropical Medicine Departments, Internal Medicine Departments, General surgery department, Al-Azhar UniversityMahmoud Abdelrasheed AllamTropical Medicine Departments, Internal Medicine Departments, General surgery department, Al-Azhar UniversityEmad AdsTropical Medicine Departments, Internal Medicine Departments, General surgery department, Al-Azhar UniversityJournal Article20181102<span>Background and aim: - </span><span>Variable techniques could be used to raise the success rate and reduce complications of endoscopic retrograde cholangiopancreatography (ERCP). </span>
<span>Patients and methods: - </span><span>From 73 patients subjected to ERCP in our endoscopy unit, during the period between January 2016 to December 2017, 47 patients were managed with standard free direct cannulation maneuver (group- I), 21 patients managed with indirect maneuvers (DGT and\or TPS as group-II) and ERCP was failed in 5 cases; in 3 of them temporary pancreatic stent was placed but with no value. </span>
<span>Results</span><span>: - From 73 patients, standard free direct cannulation was done in 47 patients with success rate 64.4%, the remaining 26 patients managed with indirect maneuvers with successful cannulation of CBD in 21 cases with success rate 80.7% and total success rate of 94.4%.<br /> Procedure duration was longer in patients of indirect maneuvers than patients of standard free direct cannulation maneuver, with high significant difference (P value of 0.0036). </span>
<span>The post-ERCP complications were noticed in 21 patients with complications rate of 28.8 %. Complications were significantly higher in patients of indirect maneuvers than patients of standard direct maneuver (47.6% vs. 23.4%). Post-ERCP pancreatitis recorded in 7 patients (9.6%) with significant higher rate in patients of indirect maneuvers than patients of direct maneuver (23.8% vs. 4.3%). </span>
<span>Conclusion: - </span><span>Indirect biliary cannulation (DGT and/or TPS) solved the problem of failed cannulation but had a higher rate of complications and took longer time.<br /> </span><span><br /></span>https://ejhm.journals.ekb.eg/article_18264_7f2674ce038d442b3182d2ff9316c9fe.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001The Molecular Approach in Pain Management and Improve Aesthetics Modules726272671826510.21608/ejhm.2018.18265ENKhalid Mohammed AlqahtaniKing Khalid UniversityAmal Radi Ayesh AlJuhaniKing Khalid UniversityAbdulrahman Mohammed - AladhadhiKing Khalid UniversityMohammad Saad AlshomraniAlMaarefa Colleges for Science & TechnologyRasha Fahad AlShafiTaibah UniversitySaja Hussain Majed AlsharifTaibah UniversityRawan Mohammed NattoUmm Al- Qura UniversityAbdulaziz Badr AbualalaaImam Mohamed Bin Saud Islamic University - IMSIUJournal Article20181102<span>In this review we discussed the developments in pain research and defined how the area is building on this progress to understand how pain is recorded. We likewise speculated on how these insights could lead to even more effective and specific analgesics. </span><span>Methods: </span><br /><br /> <span>Results: </span><span>Pain has been defined as an unpleasant sensory and emotional experience associated with actual or potential damage, or described in terms of such damage. It is primarily a protective mechanism designed to avoid tissue damage, is very subjective in nature with wide interpatient variability in pain sensitivity, and has been </span><span>described as “a conscious experience to which the outside observer is not privy”. Despite the widespread </span><span>prevalence of pain, it is inadequately managed due to a lack of appropriate formal physician training that is coupled with concerns regarding the addictive liabilities of the opioids, a global phenomenon described as </span><span>“opiophobia”. On the other hand, patients may </span><span>tolerate pain to an extent that can prevent effective treatment </span><br /> <span>and result in long-term nerve damage that is frequently irreversible. </span><span>Keywords: </span><span>molecular approach, pain management, aesthetics modules. </span><br /> <br /> <span>language controlled studies assessing molecular approach in pain management and improve aesthetics modules published to 2018. Our search was limited to only Human subject with English language. </span><br /> <br /><span>Computerized databases were searched for English- </span><br /> <br /><span>Moreover, references of identified studies were manually searched for more relevant articles. </span>https://ejhm.journals.ekb.eg/article_18265_3ec63ee376e7d5ba7f282380ada1dd14.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Pediatrics Iron deficiency anemia from diagnosis to treatment726872731835110.21608/ejhm.2018.18351ENAbdulrahman Mohammed AladhadhiKing Khalid UniversityKhalid Mohammed AlqahtaniKing Khalid UniversitySaoud Tariq EtaiwiMedical University of GdanskAli Ahmed BajafarKing Khalid UniversityAhela Faisal NonoIbn Sina National CollegeSara Edrees AldreesKing Faisal UniversitySaleh Mohammed AlmutawaKing Khalid UniversityShroq Abdulkreem AlghraibiUmm al-Qura UniversityJournal Article20181105Aim: the significant points in diagnosis and treatment of iron deficiency which is one of the most common diseases observed in children have been compiled in terms of directing pediatricians, the recent studies performed in this area have been reviewed and the experiences of our center have been explained. Methods: Medline and PubMed database searches were performed for articles about acute cholangitis published in English up to September 2018. Results: iron deficiency anemia continues to be a considerable public health issue worldwide. The major concepts in treatment of iron deficiency anemia consist of making the diagnosis, investigating the condition which triggers to iron deficiency and removal of this problem, replacement of deficiency, enhancement of nutrition and education of patients and families. Conclusion: The serum ferritin level is the best indicator of the iron stores in the body and the first biochemical variable to change in ID.https://ejhm.journals.ekb.eg/article_18351_f0b46b5d3187322a88f83c68eda61966.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Comparative Functional Analysis of the Anatomy of the appendicular skeleton in two reptilian species727472871835310.21608/ejhm.2018.18353ENAli G. Gadel-RabDepartment of Zoology, Faculty of Science, Al-Azhar University, Assiut, EgyptFatma A. MahmoudDepartment of Zoology, Faculty of Science, Assuit University, Assiut, EgyptSamy A. SaberDepartment of Zoology, Faculty of Science (Boys branch), Al-Azhar University, Cairo, EgyptBoshra A. ElSalkhDepartment of Zoology, Faculty of Science (Girls branch), Al-Azhar University, Cairo, EgyptAsmaa A. El-DahshanDepartment of Zoology, Faculty of Science (Girls branch), Al-Azhar University, Cairo, EgyptDoaa I. GewilyDepartment of Zoology, Faculty of Science (Girls branch), Al-Azhar University, Cairo, EgyptJournal Article20181105Aim of the work: the present study aimed to illustrate the osteological characters of the appendicular skeleton of two Egyptian lizard species, Acanthodactylus boskianus and Ptyodactylus guttatus and clarify the relationship between characteristics of the appendicular skeleton and mode of their locomotion of the two species. A. boskianus is diurnal insectivorous lizard forage in open area and it is a generalized ground-dwelling species and P. guttatus is a diurno-nocturnal omnivorous gecko which is a highly specialized climbing on vertical substrates. Material and methods: in the present study we used Alizarin red and Alcian blue as double skeletal staining to investigate the the bony and cartilaginous pattern of limbs and girdles of A. boskianus and P. guttatus. Results: in P. guttatus, the pectoral girdle was characterized by the presence of the interclavicles was dagger in shape and partially fused with clavicles, while it was cruciform and completely fused with the clavicles in A. boskianus. In P. guttatus, the epicoraoid was well developed, broad bony plates and fused with the interclavicles, while in A. boskianus it was narrow cartilaginous, plates and overlap in the mid-line. Moreover, in P. gutattus two fenestrae were appeared within coracoid and scapula with un-fenestrated cartilaginous sternum, while one fenestra appeared in both coracoid and sternum of A. boskianus. On other hand, the pelvic girdle of P. guttatus had complete fusions between the pubis, ischium and ilium, while in A. boskianus the pubis articulated poster-omedially with the ischium. In both P. gutattus and A. boskianus, the forelimbs posture was in horizontal plane, while the hind limbs were in vertical plane. In P. gutattus both the fore and hind limbs were relatively equal in length, while the fore limb in A. boskianus was greatly shorter than the hind limb. Conclusion: the P. gutattus is considered as a one of climbers species which have stout appendicular skeleton to support the climbing process on the vertical surface with relatively short limbs, while A. Boskianus is ground-dwellers and also good climbers and use their claws to walk and climbing on rocky areas and these abilities of locomotion depend on the flexibility of skeletal elements of its appendicular skeleton.https://ejhm.journals.ekb.eg/article_18353_27dc1d0a3f35efb53a39475e07bc91af.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Free Thyroxine in Early Pregnancy and Risk of Developing Gestational Diabetes728872921835410.21608/ejhm.2018.18354ENMohamed S. FouadDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMohamed F. IbrahimDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityYoussef M. YoussefDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20181105Background: Pregnancy has a considerable physiological impact on the thyroid gland and its metabolic unction and to meet the increased demands during pregnancy. Thyroid disease is known to impact pregnancy outcomes, and gestational diabetes is the most common obstetric metabolic disease. Both of these conditions can cause short- and long-term harm to the mother and child, and an increasing number of scholars have therefore begun to investigate whether there is a correlation between thyroid disease and GDM Objective: evaluation of the relations between different thyroid hormone levels in early pregnancy and the incidence of gestational diabetes mellitus (GDM). Study design: This prospective observational cross-sectional study was conducted during the January 2018 to June 2018. The study comprised one hundred, euthyroid women with singleton pregnancy who provided early pregnancy serum samples for analyses of thyroid function. GDM was diagnosed using a 2 hours, 75-g oral glucose tolerance test, and the mothers were grouped and compared according to the results. Results: The incidence of GDM in pregnant women tended to increase with age (P< .0001). The level of free T4 (FT4) in early pregnancy in GDM women was lower than that in non GDM women (P< .0001) also found that high maternal weight was associated with a higher GDM rate in the first trimester (P< .0001). Conclusion: Low thyroxine levels in early pregnancy could be a risk factor for GDM development.https://ejhm.journals.ekb.eg/article_18354_0cdc6a3b451ddded6d1e896368a3d5a5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Choroidal Thickness in Patients with Diabetic Macular Edema and its Correlation to Macular Thickness and Vision729372991845910.21608/ejhm.2018.18459ENMona N. MansourDepartment of Ophthalmology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.Hanan S. HegazyDepartment of Ophthalmology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.Journal Article20181107Purpose: To investigate the relationship between subfoveal choroidal thickness, central macular thickness, visual acuity and the presence of diabetic macular edema (DME) using spectral domain optical coherence tomography (SD-OCT). Methods:A prospective, nonrandomized case control study of 124 eyes was included in the study and divided into three groups: Group I: 56 eyes having NPDR without macular edema, Group II: 27 eyes having NPDR with DME, Group III: 41 eyes of normal healthy subjects. Central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were measured on the OCT images and statistically compared. Pearson correlation analysis used to evaluate the relationships between choroidal thickness, macular thickness and visual acuity. Results: A total of 124 eyes of 76 patients; mean age 52.56 ±8.91years were included in the study. Mean bestcorrected visual acuity LogMAR was better in the control group (0.20 ± 0.40) than diabetic groups (0.42 ± 0.40 in group I, 0.80 ± 0.45 in group II) and the difference was significant among the groups (P= 0.01). Mean CMT was thicker in DME group (374.63μm ± 105.43) than the other 2 groups (246.66± 24.85 μm in group I, 227.05 μm ± 21.97 in group III) and the difference was significant among the groups (P= 0.00). Mean SFCT was thinner in DME group (234.93 μm ± 42.68) than d the other 2 groups (246.41 μm ± 44.37 in group I, 250.20 μm ± 53.10 in group III) but the difference was not statistically significant (P= 0.41). A significant correlation was found between LogMAR and CMT in group II (r=0.391, P=0.044) indicating that the vision may decrease as the central macular thickness increases in diabetic groups. A weak inverse correlation was found between LogMAR and SFCT in all groups indicating that the vision may decrease as the choroidal thickness decrease. A weak negative correlation was found between CMT and SFCT in diabetic groups (r=-0.142 in group I, r=-0.152 in group II) indicating that the choroidal thickness may decrease as the central retinal thickness increases in diabetic groups. Conclusion: In diabetic eyes, there is an overall thinning of the choroid. SFCT is directly related to vision and macular thickness. https://ejhm.journals.ekb.eg/article_18459_b86fc9ea10fc3e1ae84cf7160d5039ed.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Comparison between Taans Cerebellar Diameter, Biparietal Diameter and Femur Length for Gestational Age Measurement Accuracy in The 3rd Trimester730073051846010.21608/ejhm.2018.18460ENAlsaied Abdelmaksod AskrDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMahmoud Salah MahmoudDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAsmaa Ahmed Mahmoud SalloumDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20181107Backgound: the provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality, independent of maternal characteristics. Many patients in Egypt due to socio-economic reasons come for their first antenatal visit in the third trimester. Most of them are uneducated and come from remote areas. Also, many being lactating mothers are unsure of their LMP or have irregular cycles. Because of non availability of any dating scans or earlier ultrasound and uncertainty in LMP, it becomes very difficult to calculate their due dates, so many pregnancies considered to be preterm or posterm were wrongly classified. The use of ultrasonography has significantly improved evaluation of fetal growth and development and had permitted prenatal diagnosis of a variety of congenital malformations. Ultrasonographic fetal biometry is highly reliable in the first and second trimester of pregnancy, but reliability of any ultrasound method greatly diminishes as gestational age advances, in the third trimester, reliability of any single ultrasound parameter alone is poor without correlation with other parameters.Objective: in our study, TCD was compared to FL and BPD in accuracy of assessment of gestational age in the third trimester of pregnancy. We correlated between the three parameters, Transcerebellar (TCD) and Biparietal diameter (BPD) and Femur length (FL), for accurate determination of gestational age in third trimester of pregnancy. Methods: a total of 200 pregnant women in the third trimester pregnancy was assessed in this observational study in Department of Obstetrics and Gynecology, Damietta Hospital, Al-Azhar University (Outpatient) by two-dimensional ultrasound to assess the accurate method for assessment of gestational age in the third trimester of pregnancy. Examinations were performed after a verbal consent from the patient with the patient lying in the dorsal supine position. Two dimensional ultrasounds were carried out. Fetal biometry and amniotic fluid volume were assessed. All women included in this study were subjected to history taking and clinical examination.Results: we found that out of 200 patients, TCD gave correct assessment of gestational age within 3 days in 118 patients (59%) and within 1 week in 180 patients (90%). While, FL gave correct assessment of gestational age within 3 days in 92 patients (46%) and within 1 week in 160 patients (80%). The least accurate was BPD that gave correct assessment of gestational age within 3 days in 59 patients (29.5%) and within 1 week in 120 patients (60%). Conclusion: from this study, we concluded that TCD was the most accurate method for assessment of gestational age in the third trimester followed by FL and the least accurate was the BPD. Also, by combining accuracy of TCD (90%) and that of FL (80%) we can be near certain of gestational age in most of our patients even if they are unsure of their dates. Recommendations: measuring TCD as routine in the third trimester as it has the same accuracy as the current fetal biometry (BPD and FL). https://ejhm.journals.ekb.eg/article_18460_b9f590475fe3577b48f9bb88df82d36e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Post‐Mortem Caesarean Section Performed 20 Minutes after Maternal Cardiac Arrest: A Case Report730673071846110.21608/ejhm.2018.18461ENMajd MryaniDepartment of Obstetrics and Gynecology, Hera General Hospital, Makkah Al- Mukarramah, Kingdom of Saudi ArabiaMaha MessawaDepartment of Obstetrics and Gynecology, Hera General Hospital, Makkah Al- Mukarramah, Kingdom of Saudi ArabiaAhmad KadibalbanDepartment of Obstetrics and Gynecology, Hera General Hospital, Makkah Al- Mukarramah, Kingdom of Saudi ArabiaNabawia Ali EissaDepartment of Obstetrics and Gynecology, Hera General Hospital, Makkah Al- Mukarramah, Kingdom of Saudi ArabiaJournal Article20181107Background: Postmortem caesarian section is defined as a low segment caesarian section that is performed to deliver a fetus after the death of his mother. Objective: An approach of when and how to manage a post-mortem pregnancy. Materials and method: in this report, we are discussing a case of 26 years old, primigravida, 39 weeks pregnant Nigerian patient who was arrested, unconscious and unresponsive. Post-mortem caesarian section was performed and a live fetus was delivered. Results: Duration between the mother cardiopulmonary arrest and performing a Pfannenstiel incision was a total of 20 minutes. A live baby boy was delivered weighted 2.278 Kg with an Umbilical cord pH: 6.7 and APGAR score of 0-0-3-4 at 1,3,5 and 10 minutes respectively, the baby was comatose and cyanosed after the delivery but showed a slight respond 5 minutes later. Eventually, the baby was admitted to the neonatal intensive care unit(NICU). The reason for the mother's cardiac arrest is unknown and her medical condition was unrecorded. Conclusion: According to the information mentioned above. The only solution to manage this case was performing a post-mortem caesarian section as quickly as possible.https://ejhm.journals.ekb.eg/article_18461_423d5fed80419bba916739cf171e32c5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Evaluation of Safety and Efficacy of Radiofrequency Lesioning of Thoracic Dorsal Root Ganglion in Chest Cancer Pain Patients Daily Activities and their Quality of Life730873161846210.21608/ejhm.2018.18462ENAhmed El-Saeed AbdelrahmanDepartment of Anesthesia & ICU Department, Faculty of Medicine, Aswan UniversityRafaat Mahfouz ReyadDepartment of Anesthesia & ICU Department, Faculty of Medicine, Aswan UniversityAyman Mohamady El-DemerdoshDepartment of Anesthesia & ICU Department, Faculty of Medicine, Aswan UniversityMahmoud Mohamed Hassan MostafaDepartment of Anesthesia & ICU Department, Faculty of Medicine, Aswan UniversityJournal Article20181107Background: in controlling cancer pain it is commonly inadequately managed for these patients leading to suffer in the form of physical disabilities, psychological disturbance, avoiding treatment. Therefore pain that is caused by cancer may directly affect the patient's quality of life; by having an effect on his/her daily activity, physical state and also psychological and emotional status. Thus, making pain relief and control the patient's right; right for a new life "pain free" or at least tolerable non-disabling pain. Aim of the work: this study aimed to test both the efficacy and safety of thermo-coagulative ablation of the thoracic dorsal root ganglia for pain control in cancer patients that have refractory chest pain And the impact on quality of life for patients. Patients and Methods: our prospective study was done on sixty-five patients selected from pain clinics of both the National Institute of Cancer, Cairo University and Aswan University with refractory chronic chest cancer pain according to the inclusion and exclusion criteria. The complete duration of the follow up lasted 3 months postinterventional; with assessments after 1 week, 1 month and 3 months. At each follow up each patient was reassessed with the following assessments; VAS, ECOG performance status, QOLS, drug consumption, side-effects (complications) and patient satisfaction. Results: we found that with effective pain relief there was a significant reduction in the mean VAS values which means that there was functional improvement, in all the postinterventional follow ups. Also, there was an improvement in the functional state of the patients throughout the follow-up post-intervention with regardsto the ECOG performance statusfrom the results. In addition to the ECOG improvement there was also a significant improvement in the QOL (Quality of Life) results, which was due to the pain relief. Regarding drug consumption, it was recorded that all three drugs; pregabalin, oxycodone and amitryptline, should maximum reduction after 1 month following the intervention, with a slight increase 3 months post-interventional, which matched the degree of pain reduction based on the pain scaling scores. Only 11% of our patients were found with numbness and neuritis, which were the only two complications reported. With regards to our patients, 30.6% certainly would repeat the procedure, 54.8% probably would, and 12.9 % probably would not while, only 1.6% certainly would not repeat it. With25.8% certainly would recommend the same procedure, 56.5% probably would, 14.5% probably would not and only 3.2% certainly would not recommend it. Conclusion: we concluded that thermal radiofrequency ablation is considered an alternative for treating refractory chronic chest cancer pain of several types and causes. This is because of its efficacy, safety and ease of use, patient’s quality of life of was largely affected. https://ejhm.journals.ekb.eg/article_18462_5e860092249ad661a84f630f37c87e9f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001A Comparative Study between Appendicitis Inflammatory Response Score and Alvarado Score in The Diagnosis of Acute Appendicitis731773221846310.21608/ejhm.2018.18463ENMohamed Kamel El-MezayenDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityAli Ragab MahmoudDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityEslam Nouman ShehatahDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20181107Background: appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads to its other parts. Despite diagnostic and therapeutic advancement in medicine, appendicitis remains a clinical emergency and is one of the most common causes of acute abdominal pain and one of the most frequent surgical complains in the emergency room. Aim of the Work: the aim of this work was to compare the Appendicitis Inflammatory Response Score to the traditional Alvarado score to determine which is more accurate in the diagnosis of acute appendicitis. Patients and Methods: this descriptive prospective study was carried on 50 patients admitted to the surgical ER of Rashid General Hospital from December 2017 to April 2018 complaining from right lower quadrant pain between the age of 5 years old and 70 years old. All 50 patients had lower quadrant abdominal pain with suspicion of having acute appendicitis, all of them were thoroughly examined and both Alvarado Score and Appendicitis Inflammatory Response Score were applied to all of them, patients with moderate to high probability of having appendicitis(Alvarado Score = 7 or higher, AIR = 8 or higher) underwent open appendectomy and then the resected appendices were sent for histopathology to confirm the diagnosis. Results: the total number of cases with confirmed diagnosis of acute appendicitis by means of post-operative histopathology in our study was 46 out of 50 patients, the AIR score had sensitivity of 95.65% while the Alvarado score had sensitivity of 91.3%. Conclusion: this study demonstrates that the Appendicitis Inflammatory Response Score (AIR) appears to be more accurate than the Alvarado score, easy-to-use and reliable when dealing with a case of right lower quadrant pain with the suspicion of acute appendicitis and can help reduce the negative appendectomy rate.https://ejhm.journals.ekb.eg/article_18463_d403733af134761f1ae207d57994e74f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Comparison between Upper Mini Sternotomy and Full Sternotomy in Aortic Valve Replacement732373281846410.21608/ejhm.2018.18464ENMorsi Ameen AlyCardiothoracic Surgery Department, Faculty of Medicine, Suez Canal UniversityMohammed Ahmed AmrCardiothoracic Surgery Department, Faculty of Medicine, Suez Canal UniversityEl-Sayed Ahmed FayadCardiothoracic Surgery Department, Faculty of Medicine, Suez Canal UniversityOsama Elsayed Aly MohammedCardiothoracic Surgery Department, Faculty of Medicine, Suez Canal UniversityJournal Article20181107Background: aortic valve disease is common and its prevalence increases with age. For people over the age of 75 years, the prevalence of aortic stenosis (AS) is 5%. More than one in eight people over the age of 75 have moderate or severe valve disease. Aim of the Work: the aim of this study was to compare the short term results of aortic valve replacement through upper mini sternotomy and full sternotomy. Patients and Methods: This study was a prospective randomized controlled clinical trial. The study was conducted at Suez Canal University Hospital in the cardiothoracic operating rooms and inward after approval of Research and Ethics Committees. The study included 50 patients having aortic valve disease presented to Suez Canal University Hospital, cardiothoracic outpatient clinic for isolated aortic valve replacement. Results: The mean age of patients in Full Sternotomy in Aortic Valve Replacement (FSAVR) group was 33.48 ± 17.74 while it was 32.03 ± 15.29 in Mini Sternotomy in Aortic Valve Replacement (MSAVR) group which showed insignificance difference (p > 0.05). (20- 29y) was the most frequent age group in both study groups (28% in FSAVR group and 32% in MSAVR group). No significance different found (p > 0.05) according to gender in both group. Male gender was the most frequent in both group (56% in FSAVR group and 64% in MSAVR group). Conclusion: Mini Sternotomy (MS) can be considered as excellent option with favorable outcomes that should be considered part of the routine practice of cardiac surgeons in the modern erahttps://ejhm.journals.ekb.eg/article_18464_0f3f2d4c37fb2d2a38aa2fe822be48eb.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Subjective Evaluation of Smell Dysfunctions before and after Different Nasal Surgeries732973331846510.21608/ejhm.2018.18465ENWafaie Abd El-Rasoul M. MouradDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University.Atef Abd Allah El MaraghyDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University.Tarek Mohamed Abd El-Hamed El-ZyatDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University.Ayman Yehia AbbasDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University.Gamal Abd Al-Elah Abd Al-SameaShabanDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University.Journal Article20181107<span>Background: olfactory dysfunctions affect daily life activities. Nasal surgeries primarily aims at elimination of nasal obstruction and removal of nasal polyps or inflamed mucosa. Improved olfactory function after these surgeries may be a secondary benefit. Objectives: this study aimed to evaluate different types of smell dysfunctions before and after different nasal surgeries and its liability to improve or not after surgery and to discuss CT scan results in these cases in correlation to clinical and surgical results. Study Design: prospective study. Methods: a total of 50 patients were included in this prospective study (32 men, 18 women; age range was 20–49 years, mean age 32 years, standard deviation =7.3years). Patients were suffered from different nasal diseases requiring surgical interference and complaining of smell dysfunctions as one of the main nasal symptoms. Patients were selected from those attending E.N.T Clinic in Bab EL-Sharia Hospital, Faculty of Medicine, Al-Azhar University from February 2017 to April 2018. Prior to surgery, patients received a detailed otorhinolaryngologic examination included nasal endoscopy. Olfactory function was evaluated subjectively. CT scan nose and paranasal sinuses (coronal and axial) was done before the surgical interference and repeated after complete healing of the operation. Questionnaire was directed to each patient to tell which type of smell dysfunctions he was complaining of and the severity of this dysfunction, this questionnaire was repeated after the complete post-operative period. The patients were followed up after the operation in scheduled sessions for five months. Results: after different nasal surgeries no change of olfactory dysfunction was found in 26% and improvement was seen in 74%. As regard patients underwent endoscopic sinus surgery no change of olfactory dysfunction was found in 32% and improvement was seen in 68%; however in the septoplasty group no change of olfactory dysfunction was found in 50% and improvement was seen in 50% and in septoplasty and inferior turbinectomy group, no change of olfactory dysfunction was found in 14.3% and improvement was seen in 85.7%. in patients who had hyposmia no change of olfactory dysfunction was found in 17.9% and improvement was seen in 82.1%, whereas in patients who had anosmia, no change of olfactory dysfunction was found in 42.9% and improvement was seen in 57.1%; patients who had cacosmia, no change of olfactory dysfunction was found in 14.3% and improvement was seen in 85.7%. Free postoperative CT was found in 92% and recurrence was seen in 8%. Conclusion: the different nasal surgeries showed significant effect on olfactory function in Patients with subjective olfactory dysfunction. However, considerable number of patients with olfactory dysfunctions did not improve after surgery. CT scan is useful in the assessment of patients with olfactory dysfunction associated with many sinonasal diseases. </span>https://ejhm.journals.ekb.eg/article_18465_e1a83f8afc9dacc5c7e4636b54b19fe1.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Incidence of Placenta Accreta and Its Complications in Cases of Previous Cesearean Sections with Placenta Praevia Anterior at El-Sayed Galal Hospital733473421846610.21608/ejhm.2018.18466ENMohammed A. MohammedDepartment of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar UniversityAdel A. Al-BoghdadyDepartment of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar UniversityIslam S. IbraheemDepartment of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar UniversityJournal Article20181107Background: due to the increasing rate of cesarean delivery, there has been a 10-fold rise in the incidence of placenta accreta since the 1970. In a recent survey, placenta accreta was even found to become the leading cause of emergency peripartum hysterectomy which represented 40–60% of cases. Aim of the Work: the purpose of this study was to determine the incidence of placenta accreta and its complications in cases of previous cesarean sections with placenta praevia anterior at El-Sayed Galal Univerity Hospital. Patients and Methods: this prospective study was done at El-Sayed Galal Maternal Unevirsity Hospital during the period from March 2017 to March 2018 on 100 pregnant women diagnosed by ultrasound as placenta praevia or low lying placenta anterior with previous cesarean section, they were selected from Outpatient Clinic, Ultrasound Unit and women admitted in El-Sayed Galal Maternal University Hospital Departments. Results: the incidence of placenta accreta in cases of previous cesarean section with placenta praevia anterior were 63%. Risk factors of placenta accreta were: 1) Placenta praevia with prior cesarean section. All cases had placenta praevia and had at least one previous CS, 2) Increased maternal age (the mean age 32.60±5.018 years in cases of placenta accrete ), and 29.14±4.889 years in cases with normal placenta. 3) Multiparity [the median parity was 3 (range: 1-6). The ultrasonography and Doppler was suggestive of morbid adherence in 60 cases (95.2%)of cases approved with placenta accreta, with accuracy 96, sensiyivity 95.24, specificity 97.3, +ve predictive value 98.36, and -ve predictive value 92.31. The intraoperative data were:, - Cesarean hysterectomy performed in all cases of placenta accrete (63 cases), and 2 cases (5.4%) of normal placenta due to severe bleeding from placental ped and uterine atony. , - Bladder injury occured in 31 cases(49.2%) all of them approved placenta accreta, all of them do C.S hystrectomy and performed bladder repair. Bowel injury in 2 cases (3.2%) all of them have placenta accreta and C.S hysterectomy done. All cases of placenta accreta received intra operative blood transfusion. Uterine preserving procedures (Bakry balloon) done in one case after spontaneous separation of the placenta. The postoperative data were:, - ICU admission occurred in 40 cases (63.5%) of cases with placenta accrete, and in 2 cases (5.4%) of cases with normal placenta. 61 cases (96.8%) of cases with placenta accreta received postoperative blood transfusion. -No cases complicated with DIC or death. Conclusion: from the above our results showed that the incidence, risk factors and Feto-maternal outcome of management of Patients with placenta accreta at El-Sayed Galal University Maternity Hospital are comparable with those in the previous literatures. https://ejhm.journals.ekb.eg/article_18466_ac28c589571b557930e85ba9d4ea3e50.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001The Effect Of Bipolar Radiofrequency Ablation (Novasure Endometrial Ablation System) on Endometrial Thickness and Bleeding in Patients with Premenopausal Bleeding734373491846710.21608/ejhm.2018.18467ENIsmael T. ElgarhyDepartment of Obstetrics and Gynecology, Faculty of Medicine-Al- Azhar UniversityAshraf HamdyDepartment of Obstetrics and Gynecology, Faculty of Medicine-Al- Azhar UniversitySherif M. ElagamyDepartment of Obstetrics and Gynecology, Faculty of Medicine-Al- Azhar UniversityJournal Article20181107Background: Ablation of the endometrial lining of the uterus as an alternative to hysterectomy was found to be a less invasive and aggressive method. A large number of clinical trials, as well as retrospective analysis of clinical and financial data, has shown that endometrial ablation allows for a lower morbidity and mortality rate and significantly lower procedure costs. Worldwide, endometrial ablation is increasingly being adopted by the gynecological community. Aim of the Work: to study the effect of bipolar radiofrequency ablation system on endometrial thickness and bleeding in patients with premenopausal bleeding. Patients and Methods: This study was conducted on: 30 women with premenopausal bleeding not responding to medical treatment. All subjects enrolled in the study were asked to give an informed written consent after explaining the nature, steps and aim of the study. The approval of Medical Ethics Committee was obtained. Results: the net results after treatment, the majority of the patients was improved (83.3%), 19 of them was complete recovery (63.3%) while 6 cases (20.0%) had minor bleeding, 4 cases (13.3%) had bleeding less before treatment, while only one case had no change.Conclusion: Bipolar radiofrequency ablation performed under local anaesthetic in the postmenstrual phase is an effective and efficient method of treating the majority of women who wish conservative surgical treatment for heavy menstrual loss.https://ejhm.journals.ekb.eg/article_18467_305e1e0afa48148ecf5dc3fc7bff7437.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Comparative Study between Three-Dimensional Transvaginal Ultrasonography and Hysteroscopy in the Diagnosis of Uterine Cavity Abnormalities735073571846810.21608/ejhm.2018.18468ENFahd AbdAlal MohammadObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityAhmed Taha Abdal FattahObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityAhmed Maher Abd-ElrahmanObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20181107Objective: It was aimed at carrying out a comparative study between three dimensional transvaginal ultrasonography and hysteroscopy in the accuracy of detecting intrauterine cavitary lesions. Study design: Three dimensional transvaginal ultrasonography was done followed by hysteroscopy for all cases (number=50). Data obtained were compared and analyzed to estimate the accuracy of 3D transvaginal ultrasound. Results: The comparison with using Hysteroscopy, the sensitivity, specificity, positive predictive value, negative predictive values and total overall accuracy of Three dimensional transvaginal ultrasonography for total abnormal findings were 89.13%, 100%, 100%, 44.44% and 90% respectively. Conclusion: The three dimensional transvaginal ultrasound is a sensitive method to evaluate the endometrial cavity lesions or abnormalities, before resorting to invasive procedures such as diagnostic hysteroscopy. But hysteroscopy allows direct visualization of the uterine cavity so it can detect small intrauterine lesions which could be missed by vaginal ultrasound. https://ejhm.journals.ekb.eg/article_18468_b6d003b000bd055aecbbd2a139b32339.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Evaluation of ALBI, MELD and Child-Pugh Scores as non-Invasive Predictors of Esophageal Varices735873641846910.21608/ejhm.2018.18469ENAmer Abdel Hamid GomaaTropical Medicine Department, Al-Azhar University-Cairo, EgyptSayed Farouk MohammedTropical Medicine Department, Al-Azhar University-Cairo, EgyptWaleed Mohamed MousaTropical Medicine Department, Al-Azhar University-Cairo, EgyptNabil Fathy Esmael HasanClinical Pathology Department, Faculty of Medicine,
Al-Azhar University-Cairo, EgyptMohamed Ahmed Mohamed MhdyTropical Medicine Department, Al-Azhar University-Cairo, EgyptJournal Article20181107Background: the prevalence of esophageal varices (OV) in newly diagnosed cirrhotic patients is approximately 60-80% and the 1-year rate of first variceal bleeding is approximately 5% for small esophageal varices & 15% for large esophageal varices. Non invasiveness has become a major goal in hepatology in the latter years, several serum markers and imaging methods have been tried for the non invasive assessment of portal hypertension or presence of esophageal varices. Aim of the work: this study aimed to compare ALBI, MELD and Child-pugh scores in prediction of esophageal varices and for discrimination between risky and non risky esophageal varices. Methods: in this Prospective study evaluation of of ALBI, MELD And Child-Pugh Scores As non-Invasive Predictors of Esophageal Varices was done in 80 patients with liver cirrhosis. They were divided into 2 groups, Group I: included 60 patients with liver cirrhosis & esophageal varices diagnosed by upper GIT endoscopy and will be divided into 3 subgroups 20 patients each as described below: Small, Moderate and Large esophageal varices. Group II: included 20 patients with liver cirrhosis with no esophageal varices as the control groupg. Results: the current study showed that ALBI score could be used as a non invasive predictor of esophageal varices with a cut-off value > - 2.2, with 96.7% sensitivity, 100% specificity, Child score could be used with a cut-off value > 5.5, with 93.3% sensitivity, 100% specificity, and MELD score could be used with a cut-off value > 8.5, with 90% sensitivity, 95% specificity. Conclusion: ALBI score is more accurate than Child and MELD scores as non invasive predictor of esophageal varices and its gradinghttps://ejhm.journals.ekb.eg/article_18469_4156f71acb032cfabe35c905cf39c9bc.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Conservative Management versus Using of Bakri Balloon Catheter with Intrauterine Washing with Misoprostol in Cases of Atonic Postpartum Hemorrhage736573751847010.21608/ejhm.2018.18470ENIsmaeal El-GarhyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Alazhar UniversityFahd A. ElmodaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Alazhar UniversityAhmed A. DowyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Alazhar UniversityJournal Article20181107Background: post partum hemorrhage is an obstetrical emergency that can follow vaginal or cesarean delivery. It is one of the bleeding causes of maternal mortality, especially in the developing countries. A step-wise approach to management of post partum hemorrhage was recommended. Aim of the Work: this study aimed to compare between conservative treatment and using Bakri balloon catheter in cases atonic postpartum hemorrhage. Patients and methods: this prospective randomized study was conducted on 100 patients managed by conservative treatment or by using Bakri balloon catheter with intrauterine washing with misoprostol at the Department of Obstetrics and Gynaecology, Aswan General Hospital in the period from 1 October 2017 to 30 September 2018. Results: the descriptive of risk factor of all the studied cases indicated that anemia was the major risk factor (34 cases, 34%). The causes of PPH showed that uterine atony was the major cause of PPH (71 case which contributed 71% of the total cases) and the second cause was placenta previa (29%) with 29 cases of the total. Bakri ballone catheter with intrauterine wash with misoprostol decreased significantly (p<0.001) the number of patients who need blood transfusion from 50 cases (100%) in group 1which received conservative management only to 44 case (88%) in group 2. Also, using Bakri ballone catheter with intrauterine wash with misoprostol decreased significantly (p<0.001) the amount of blood units needed. Conclusion: postpartum hemorrhage (PPH) remains one of the top five causes of maternal mortality worldwide in both the developed and developing countries. The use of tamponade test in a tonic postpartum hemorrhage has a good predictive value in controlling of bleeding. Our study showed that tamponade with Bakri ballone deserved a place in the treatment of post partum hemorrhage. It is simple, readily available, effective and safe procedure. Bakri ballon tamponad (BBT) does not exclude the use of other procedures if necessary. Even if BBT failed, it may provide temporary tamponad and time to prepare for other intervention or transportation from local hospital to tertiary centerhttps://ejhm.journals.ekb.eg/article_18470_8415f56ee5a3a2d9754080be9b71700f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Review on Omega-3-Supplementation in Eating Disorders738473871847210.21608/ejhm.2018.18472ENYazed Mohammed AlashmaliRoyal College of Surgeons, IrelandAbdulrahman Sameer BasabrainRoyal College of Surgeons, IrelandAbdulaziz Ibrahim HabadiDepartment of Psychiatry, Al-Amal Hospital, Ministry of Health,
Jeddah, Saudi ArabiaNoura Ghaleb AlroweliMinistry of Health, Jeddah, Saudi ArabiaHamza Ahmed BanaFaculty of Medicine, King Abdulaziz
UniversityKhaled Farouk Helmi FaisalImam Abdulrahman Alfaisal Hospital (Riyadh)Maryam Abdalhadi AltayebBatterjee Medical CollegeLuay Abdullah AlqurashiDepartment of Psychiatry, Al-Amal Hospital, Ministry of Health,
Jeddah, Saudi ArabiaAli Ibrahim H SabeiSalhaba and New
Sabya Primary Health Care Centre in JazanElyas Mahmoud Alsa’atiDepartment of Psychiatry, Al-Amal Hospital, Ministry of Health,
Jeddah, Saudi ArabiaJournal Article20181107Background: Eating disorders are complex, potentially life-threatening conditions, characterised by disturbances in eating behaviours and extreme fear of weight gain with significant morbidity and mortality rates. Individuals avoid fattening foods. This avoidance of fattening foods may lead to the avoidance of foods which may include those with omega 3 fatty acids. Aim of the work: Aim of the review is to explore the consequence of starvation on the brain both in adolescence and in adults and particularly due to omega 3 deprivation. It also aims to explore the role of the benefits and possible mechanisms of omega 3 supplementation on other mental health conditions and to consider these implications for eating disorders. Methods: The search was undertaken by using PubMed and the search terms , eating disorders, anorexia nervosa and Omega-3. Alternatively, search terms such as depression, schizophrenia or other mental health conditions and omega-3 were used. References lists of identified reviews and articles were also searched for relevant empirical studies. Results: According to a growing body of evidence, the role and importance of omega-3 fatty acids in mental health is well-recognised and well-established to be beneficial. Fatty acids are fundamental components of the brain and are necessary for normal body physiology. Since the body cannot synthesize these fats, it has to be completely obtained from the diet. Brain tissue is rich in omega-3 fatty acids. These acids have a major role within cell membranes and in connections between neurons.Omega-3 FAs deprivation may be correlated with the happening of many psychiatric conditions, such as obsessive-compulsive disorder, depression, bipolar disorder, and schizophrenia. Conclusion: The clinical research evidence on omega-3 supplements in eating disorders is preliminary and not definitive in comparison to other mental health disorders. Thus, this will be an important area for future research, and may lead to the development of newer interventions.https://ejhm.journals.ekb.eg/article_18472_311e67e1869d62cd808e4f5f210b7798.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Study of Lipid Profile in Different grades of Non- Alcoholic Fatty Liver Disease738873931847310.21608/ejhm.2018.18473ENFarag Khalil, Mohamed Nabil RafatInternal Medicine Department, Faculty of Medicine Al-Azhar University Cairo Egypt.Mohamed SalahInternal Medicine Department, Faculty of Medicine Al-Azhar University Cairo Egypt.Mamdouh Attia MohamedInternal Medicine Department, Faculty of Medicine Al-Azhar University Cairo Egypt.Wafeek IbrahimRadiology department, Faculty of Medicine Al-Azhar University Cairo Egypt.Journal Article20181107Background: The prevalence of NAFLD (non- alcoholic fatty liver disease) is increasing as it exceed (31.79%) in Middle East and the metabolic syndrome prevalence in patients with NAFLD ranges from 18% to 67%, according to the body weight. Imaging or histology is very important tools in diagnosis of NAFLD. Early detection of NAFLD is very important especially if there is a non-invasive method. The clinicians in the primary, secondary and tertiary care are in need for specific and sensitive diagnostic tool that can be used easily. Aim: To study and analyze serum lipid changes in non-alcoholic fatty liver disease of different grades. Patients and methods: 100 patients diagnosed by ultrasonography as NAFLD, whose age was more than 18 years, were included in the study. History taking, full clinical examination and anthropometric measurement of weight, height and body mass index (BMI) were done for all patients. Serum lipid profiles including total cholesterol, HDL, LDL, triglycerides, ALT, AST. CBC, fasting and 2hpp blood glucose and TSH were measured. Results: The largest group of patients (38%) was in the fifth decade of life. followed by 30% in the sixth decade of life. As the grade of NAFLD increased, there was associated significant increase in levels of serum total cholesterol (P-value 0.005), TG (P-value 0.002) LDL (P-value 0.001) and VLDL (P-value 0.003) and associated significant decrease in HDL (P-value 0.001). Conclusions: abdominal ultrasonography and increased lipid profile values can be used to detect NAFLD earlyhttps://ejhm.journals.ekb.eg/article_18473_df09c9de88f3a2db23a617c11f4e3c31.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Minimally Invasive Spinous Process Splitting Approach for Management of Lumbar Canal Stenosis739473991847410.21608/ejhm.2018.18474ENAli Mohammad AlGioushyDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar UniversityMohammad Abd Almonem NegmDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar UniversityMohammad Abd ElBaset Abd ElHakimDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20181107Background: for years, the gold standard treatment of symptomatic lumbar canal stenosis refractory to conservative management is a facet preserving laminectomy. However, it has been suggested that extensive resection of the posterior bone, posterior ligaments and muscular structures led to increase postoperative pain, perioperative blood loss, complications and length of hospital stay. More recently, various authors have recommended surgical techniques that preserve posterior midline structures (i.e. spinous processes, vertebral arches, interspinous and supraspinous ligaments), as removal of these structures may contribute to instability after surgery. Objective: the purpose of our prospective study is to evaluate the surgical outcome of minimally invasive spinus process splitting approach in the treatment of lumbar canal stenosis. Patients and Methods: this prospective study included 20 patients that were operated in Al Azhar University Hospitals in the period between January 2017 and March 2018 via minimally invasive spinus process splitting approach in the lumbar canal senosis. Pre- and postoperatively disability and pain scores were measured by using the Oswestry Disability Index (ODI) and Visual Analog Score (VAS). Results: our statistical results revealed that there was a statistically significant difference in the outcome between pre and postoperative after follow up period of 12 months regarding VAS for back pain and leg pain, postoperative ODI changes were significantly better. There was a significant decrease regarding operation time and postoperative hospital stay, blood loss and postoperative pain. Conclusion: so, the relevance of preservation of the posterior midline structures should be clarified in further studies.https://ejhm.journals.ekb.eg/article_18474_f7817b2597bd23708885ad5bed312a51.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273820181001Osteoid Osteoma; Surgical Resection and Per-Cutaneous Radiofrequency Thermo-Ablation Outcome Comparison740074031847510.21608/ejhm.2018.18475ENAbdullah I. QashgryKing Saud Bin Abdulaziz University for Health Sciences (KSAU-HS)Abdullah H. AlnemariKing Abdulaziz Medical City,
National Guard Health AffairsAbdulaziz R. AlshehriKing Abdulaziz Medical City,
National Guard Health AffairsAlwaleed A. AlyamiKing Saud Bin Abdulaziz University for Health Sciences (KSAU-HS)Ammar F. QutubKing Abdulaziz UniversityAli H. AlyamiKing Saud Bin Abdulaziz University for Health Sciences (KSAU-HS)Journal Article20181107Background: Oteoid osteoma is a benign bone tumor that affects mainly children and adolescents. Most patients complain of pain as the main symptom, which is usually managed by analgesia. Less commonly, the lesion can lead to bone deformity or restricted mobility. Ultimate treatment of this disease is to remove the lesion surgically, or by the recently adopted, less invasive, per-cutaneous radiofrequency thermo-ablation. Objective of the study: To evaluate the outcome of patients diagnosed with osteoid osteoma treated with either surgical resection or per-cutaneous radiofrequency thermo-ablation (PRT). Methods: Our data were collected during the period from January 2000 to December 2016. A total number of 28 patients who underwent either surgical resection or PRT therapy were included. We evaluated the presence of residuals after treatment, symptomatic relief, recurrence rate, and length of stay at hospital following treatment. Results: Mean age of diagnosis in our patients was 14.7 years (±7.63), and 13 patients (46%) underwent surgical treatment, and 15 had PRT therapy (54%). The presence of post-therapy residuals, symptoms relief, and recurrence rate were not significantly different between the two treatment groups, while median length of stay post-op (surgical = 4 days, PRT = 1 day) was significantly different and favored PRT treatment group (p-value=< 0.001). Conclusion: PRT therapy was shown to be less invasive, safer, and significantly reduced the lengths of stay, which could be a determinant factor in fast recovery to patients and a cost-effective option.https://ejhm.journals.ekb.eg/article_18475_bd1adc35aeba139b99a90dfdfe1bd22c.pdf