Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101The Value of Late Mid-Trimester Ultrasound Cervical Assessment after Cerclage for the Prediction of Preterm Birth119712042660110.21608/ejhm.2019.26601ENYehia Abdul-Rahman El WasatDepartment of Obstetrics and Gynecology, Faculty of Medicine, Tanta University, EgyptWalid Mamdouh AtallahDepartment of Obstetrics and Gynecology, Faculty of Medicine, Tanta University, EgyptAhmed Tawfeek SulimanDepartment of Obstetrics and Gynecology, Faculty of Medicine, Tanta University, EgyptMostafa Zain Al Abideen MostafaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Tanta University, EgyptJournal Article20190205Background: Spontaneous preterm birth constitutes a significant obstetric dilemma as prematurity is a major risk factor of neonatal death or a lifelong morbidity. Despite extensive efforts to reduce preterm birth, the means to identify and prevent it remains limited. Sonographic surveillance of CL can identify the increased risk of spontaneous preterm birth. Objective: To determine the predictive value of ultrasonographic assessment of the cervix after cerclage insertion for the outcome of preterm birth before 34 weeks of gestation. Patients and Methods: A prospective study included fifty women with singleton pregnancies were followed-up with monthly transvaginal ultrasonographic examinations before and after cerclage insertion. Ultrasonographic parameters of the cervix included the closed endocervical canal length and funneling depth measured from the internal cervical os. Results: The change in cervical length was predictive; as with stable cervical length an association with a later gestational age at delivery was evident. Patients with cerclage who delivered after 34 weeks had a slower rate of cervical shortening compared to those who delivered prior to that date (median = 4mm versus 7mm per 4 weeks). The overall cervical length at 28 weeks was statistically different between patients who delivered before 34 weeks and those who delivered later (24.00±2.92 versus 33.19±5.5 p<0.001). Conclusions: Transvaginal ultrasound for cervical assessment can be a helpful tool in the prediction of preterm birth after cerclage insertion. A late second-trimester cervical transvaginal ultrasound scan can guide the addition of interventions such, progesterone and antenatal corticosteroids for fetal lung maturation.https://ejhm.journals.ekb.eg/article_26601_4656c2d692d004ec289abff2a34b0b57.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Reconstructive Option Selection for Lower Third Leg Defects120512142660210.21608/ejhm.2019.26602ENAhmed Mohamed SolimanPlastic and Reconstructive Surgery Department, Al Azhar UniversityWael Mohamed AyadPlastic and Reconstructive Surgery Department, Al Azhar UniversityAhmed Taha SayedPlastic and Reconstructive Surgery Department, Al Azhar UniversityYasser Helmy IsmailPlastic and Reconstructive Surgery Department, Al Azhar UniversityJournal Article20190205Background: patients with the lower 3rd leg defects are increasing in number especially among victims of road accidents .Due to anatomical features of this area nearly most cases required flap coverage. Aim of the work: the aim of this study was to help in selection of the appropriate option for coverage among available local perforator flaps and free microvascular flaps. Patients and methods: 30 patients with lower 3rd leg defect were included in this study and they were categorized into 2 groups. 15 patients underwent reconstruction by using local flaps (A) and 15 patients under went reconstruction using free micro-vascular flaps (B). Results: free flaps were more versatile than local flaps, but consumed more operative time and had higher morbidity Conclusion: small and moderately-sized lower 3rd leg soft tissue defects can be covered easily and safely by using locally available perforator flaps. Local flaps do not scarify any of the main arteries, consume less operative time, there was a specific like to like soft tissue replacement leading to a better cosmetic and reconstructive outcome. Free flaps have proven its versatility and reliability in coverage of significantly large and complex defects.https://ejhm.journals.ekb.eg/article_26602_de39d832eeb0dd640b9865e389a7e70d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Yields of Bronchoscopy and Bronchoalveolar Lavage in Diagnosis of Undefined Persistent Wheezy Chest Among Children121512252660310.21608/ejhm.2019.26603ENHussein Mohamed Ibrahim El-AssalDepartment of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHatem Refaat HablasDepartment of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed Sami El-HakimDepartments of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed Ibrahim Mohamed Abo SekkeenDepartment of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190205<strong>Background: </strong>Wheezing in infants and children is a common problem presented to primary care offices. Approximately 25 to 30 percent of infants will have at least one episode of wheezing. By three years of age, an episode of wheezing will have occurred in 40 percent of children, and by six years of age, almost one half of children will have at least one episode of wheezing. Most infants and children with recurrent wheezing have asthma, but other causes should be considered in the differential diagnosis. The most common diagnoses in children with persistent wheezing are asthma, allergies, gastroesophageal reflux, infections, foreign body aspiration and bronchopulmonary dysplasia. <strong>Objective:</strong> the present study was designed to evaluate the clinical role of different types of bronchoscope and bronchoalveolar lavage in diagnosis of undefined persistent wheezy chest among the age group from 6 months to 14 years, at Al-Azhar University Hospitals in Cairo. <strong>Patients and </strong><strong>Methods:</strong> This a prospective study was conducted on 50 children complaining from different respiratory problems who had enrolled consecutively from the Outpatient Clinic and the Inpatient Pediatric Department of Al-Azhar Faculty of Medicine University Hospitals (AL-Hussein and Bab-Elshareya), from January 2017 to December 2018. Patients ages ranged between 6 months and 14 years. <strong>Results: </strong>as regard distribution of patients according to post bronchoscopy diagnosis, the study showed that foreign body inhalation n16 (32%), Chronic aspiration n9 (18%), tracheobronchomalacia n2 (4%), bronchial mass n1 (2%), streptococcus pneumonia n7 (14%), hemophilus influenza n2 (4%), staphylococcus aureus n3 (6%) and pseudomonas aeuroginosa n2 (4%), candida albicans n1 (2%), Mycobacterium TB n1 (2%). <strong>Conclusion:</strong> It could be concluded that if radiography is normal and the child continues to wheeze, bronchoscopy should be the next step, the bronchoscope is a valuable tool in the diagnosis and treatment of airway disorders in children. It has a good safety profile with rarely reported life threatening or long-standing complications.https://ejhm.journals.ekb.eg/article_26603_582262af559c417ea48c33d170ade52f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Muscle Invasive Bladder Cancer: comparison between Radical Cystectomy and Bladder Sparing Therapy122612322660510.21608/ejhm.2019.26605ENMohamed EsmatDepartment of Surgery, Faculty of Medicine, Al-Azhar University, Cairo EgyptSabri MoussaDepartment of Urology, Faculty of Medicine, Al-Azhar University,
Cairo EgyptWael El-SheshtawyDepartment of Clinical Oncology, Faculty of Medicine, Al-Azhar University,
Cairo EgyptJournal Article20190205Background: bladder cancer (BC) is a life menacing disease that harvested a considerable number of deaths anniversary. Noteworthy, BC is the most predominant cancer among Egyptian men with a prevalence rate of more than 15% resulting in 8,000 deaths yearly. Aim of the work: this study was implemented to retrieve which modality (Radical cystectomy (RC) vs bladder-sparing therapy (BST)) had the superiority in the management of patients with muscle-invasive bladder cancer (MIBC). Methods: we performed a retrospective, case-control study from the archived files at the Urology Department in coordination with the Surgical Oncology Unit and Clinical Oncology Department at Bab-Elsharya and Al-Hussein University Hospitals, Faculty of Medicine, Al-Azhar University, Cairo between January 2007 and October 2013. Patients with MIBC, Stage II (T2a-T2b, N0, M0) or Stage III (T3a-T4a, N0, M0), and suitable for chemoradiation and surgery were enrolled in this study. Results: this study comprehended an overall 148 candidates diagnosed with MIBC. Of them, 95 participants were submitted to RC, whilst 53 patients were subordinated to BST. The overall 5-year survival rate was 58.9% and 39.6 % in RC and BST groups, respectively (log-rank test, P= 0.273). Additionally, disease-free survival rates were 86.8% in patients subjected to BST and 91.6% in patients subjected to RC (log-rank test, p= 0.6). Conclusion: despite no differences were established between RC and BST regarding overall survival rate and disease-free survival rate, BST is an emerging procedure with considerable low complications relative to RChttps://ejhm.journals.ekb.eg/article_26605_28e6bfa0c0b9c2e2b71951993763e18a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Comparative Study Between Systemically and Perineurally Administered Tramadol as an Adjunct in Ultrasound Guided Supraclavicular Brachial Plexus Block124212502660610.21608/ejhm.2019.26606ENAhmed Alsaied Abd ElrahmanAnesthesia, Surgical Intensive Care and Pain Medicine Department, Suhag UniversityHuda Fahmy MahmoudAnesthesia and Surgical Intensive Care Department, Aswan UniversityNagwa Mohamed Gamal EldinAnesthesia and Surgical Intensive Care Department, Aswan UniversityEman Mohamed Sobhy Abd ElshakoorAnesthesia and Surgical Intensive Care Department, Aswan UniversityJournal Article20190205<strong>Background:</strong>brachial plexus block remains the only practical alternative to general anesthesia for significant surgery on the upper limb. It can be extremely useful in patients with significant co-morbidities such as severe respiratory and cardiovascular disease, morbid obesity and in those with potential airway difficulties.
<strong>Aim of the Work:</strong>comparing the efficacy of systemically administered tramadol and perineurally administered tramadol as an adjunct to bupivacaine in supraclavicular brachial plexus blocks on onset of sensory, motor blockade and postoperative analgesia along with demand for rescue analgesic in the postoperative period.
<strong>Patients and Methods: </strong>
<strong>Group A</strong>: bupivacaine 0.5%-20 ml + lidocaine 2% -5 ml for block.
<strong>Group B</strong>: bupivacaine 0.5%-20 ml + lidocaine 2% -5 ml mixture for block and tramadol (100 mg) diluted to 10 ml intravenously.
<strong>Group C</strong>: bupivacaine 0.5%-20 ml+ lidocaine 2% -5 ml+ tramadol (100 mg).
<strong>Results: </strong>In motor onset block there was a highly significant difference between the three study groups. Also, it was highly significant faster in group C where tramadol given perineurally compared with those of placebo and systemic tramadol administrations. Duration of sensory block there was a highly significant difference between the three study groups. It was highly significant longer in group C where tramadol given perineurally compared with those of placebo and systemic tramadol administrations. Regarding First request of rescue analgesia there was a highly significant difference between the three study groups.
<strong>Conclusion:</strong>the mixture of tramadol, bupivacaine and lidocaine injected perineurally for supraclavicular brachial plexus block hastens the onset of sensory block, motor block and provides a longer duration of motor blockade and postoperative analgesia as compared to other two groups in which tramadol was either injected intravenously (systemic group) or was not given at all (control group). https://ejhm.journals.ekb.eg/article_26606_17786f1f72969bfa275a39eae4cc2c0d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Students' approaches to learning and perception of learning environment: A comparison between traditional and problem based learning medical curricula124212502660710.21608/ejhm.2019.26607ENAbdulrahman AlqulitiTaibah University, Medina, Saudi ArabiaEhab Abd ElmoneimTaibah University, Medina, Saudi ArabiaNisreen AlbouqTaibah University, Medina, Saudi ArabiaMotausm AboonqTaibah University, Medina, Saudi ArabiaKafaf JalaliTaibah University, Medina, Saudi ArabiaSahal ArabiTaibah University, Medina, Saudi ArabiaAhmad AlshamraniTaibah University, Medina, Saudi ArabiaJournal Article20190205<strong>Background:</strong> Teaching and learning are fundamentally different between conventional and problem based learning (PBL) curricula. There is a transformation in the College of Medicine, Taibah University, Saudi Arabia (CMTU) from the conventional to a PBL curriculum. <strong>Aim:</strong> To compare students’ approaches to learning and their perception of learning environment between conventional and PBL curricula at CMTU.<strong> Method:</strong> A cross sectional study was conducted through a self-administered questionnaire on a convenience sample from the third year undergraduate male and female medical students enrolled in both PBL and conventional curricula during the academic year 2015- 2016. Students' approaches to learning and perception of learning environment were measured using the “Approaches and Study Skills Inventory for Students (ASSIST)” and the “Dundee Ready Education Environment Measure (DREEM)” instruments, respectively. <strong>Results:</strong> A total of 101 questionnaires (49 (48.5%) and 52 (51.5%) from traditional and PBL curricula, respectively) were analyzed. When compared to conventional curriculum students, PBL curriculum students showed a significantly higher overall DREEM (136.98 ±21.45 vs. 111.59 ±27.93; <em>p</em> <0.001) as well as all its subscales. Significantly higher ratings for strategic approach towards learning (60.77 ±9.12 vs. 56.35 ±9.93; <em>p</em>=0.02) and net learning orientation (deep approach + strategic approach - surface apathetic approach; 85.60 ±17.32 vs. 77.76 ±20.63; <em>p</em>=0.04) were seen in PBL curriculum students. <strong>Conclusion:</strong> The transformation to a PBL curriculum at CMTU was accompanied by a tilt in the learning style towards a desired deep and strategic learning styles and a definite improvement in the perception of learning environment among students.https://ejhm.journals.ekb.eg/article_26607_7d71cae7b1b361ab470f26d5c7ff16cf.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Association of Albumin to Creatinine Ratio with Severity of Coronary Artery Disease125112592668710.21608/ejhm.2019.26687ENMostafa Atyia ELsawasanyDepartments of Cardiology, Faculty of Medicine, Al-Azhar UniversityAbd Alaleem Aly ELgendyDepartment of Clinical Pathology,
Faculty of Medicine, Al-Azhar UniversityAhmed Mohamed Salah EldeenDepartments of Cardiology, Faculty of Medicine, Al-Azhar UniversitySabry Abd ElhameedDepartment of Internal Medicine,
Faculty of Medicine, Al-Azhar UniversityELsayed Antar Mohamed AlyDepartments of Cardiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20190208Background: Coronary artery disease (CAD) is a major cause of mortality and morbidity in many countries. Atherosclerosis of coronary arteries is responsible for almost all cases of CAD. Pathology of endothelium is the main cause of atherosclerosis of coronary arteries. Coronary artery disease is affected by many factors and several different risk factors. Objective: To investigate the association between the level of microalbuminuria and the severity of coronary artery disease angiographically. Patients and Methods: The study was conducted on 100 patients who underwent coronary angiography in Cardiology department of Al-Azhar faculty and 6 October Cardiology Hospital on selective basis. The population study was divided into 2 groups according to microalbuminuria. Group (I): included 66 patients with angiographic evidence of coronary heart disease and without microalbuminuria. Group (II): included 34 patients with angiographic evidence of coronary heart disease and having microalbuminuria. Results: In the present study it was found that increased severity of coronary artery disease was more prevalent among patients with microalbuminuria compared to those with normoalbuminuria and the difference was statistically significant. Conclusion: Microalbuminuria is predictive for CAD independently with other risk factors. Microalbuminuria increase severity and number of CAD lesions and aggressive treatment of microalbuminuria may be beneficial in CAD patients.https://ejhm.journals.ekb.eg/article_26687_80195552bef0373481adf54e4723bd6e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Rapid onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation in children: a case series from Saudi Arabia126012652668110.21608/ejhm.2019.26681ENGawahir MukhtarPediatric Pulmonary Division, King Fahad Medical City (KFMC)Wadha AlotaibiPediatric Pulmonary and Sleep
Physician, Head of the Pulmonary Unit, KFMC, KSAKhalid Al-mobaireekPediatric Pulmonary Division, King Khalid
Hospital/ King Saud UniversitySafa EltahirPediatric Pulmonary Division, King Fahad Medical City (KFMC)Suhail Al-SalehDivision of Respiratory Medicine, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, CanadaJournal Article20190207Background: rapid onset of obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD), which was previously known as late-onset central hypoventilation with hypothalamic dysfunction, is a rare and complex syndrome that has been described in several case reports and series worldwide. Patients with ROHHAD are usually reported to be healthy prior to a characteristic rapid weight gain associated with autonomic and hypothalamic dysfunction and fatal central hypoventilation in the absence of mutations in the paired-like homeobox 2B (PHOX2B) gene. Case study: despite increased advancing knowledge of the disease course, the variable onset often results in delaying or missed diagnosis of ROHHAD syndrome which resulted in fatal cardiopulmonary arrest, central hypoventilation or impaired neurocognitive function. Here, we reported the first case series of ROHAAD syndrome from Saudi Arabia comprising four patients with different clinical manifestations. In this article we reported 4 cases of ROHHAD as a first serial cases from Arab area according to our Knowledge, with variable manifestations, but all sharing the rapid onset of obesity and hypoventilation, but case 1 her main striking feature was altered pain sensation and thirsty as autonomic dysregulation, while the second patient was twin 2 had pseudotumor cerebri and behavioral changes and her second twin was healthy, the third case also had behavioral changes and case 4 had obstructive sleep apnea. Conclusion: due to the overlap in symptoms and signs between ROHHAD and other well-characterized disease entities, multidisciplinary care with input from a center with expertise in ROHHAD was crucial to the successful management of patients with suspected ROHHAD syndrome. Furthermore, mortality associated with the high incidence of cardiopulmonary arrest may be prevented by early ventilatory support.https://ejhm.journals.ekb.eg/article_26681_d7bce5f83f192df6085cef15fffbe459.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Laparoscopic Ureterolithotomy Versus Ureteroscopy In Management Of Upper Ureteral Stone Larger Than 15 Mm In Adults126612782668210.21608/ejhm.2019.26682ENMohamed Zaki AliDepartments of Urology, Faculty of Medicine, Aswan UniversityAhmed Mohammed SaafanDepartments of Urology, Faculty of Medicine, Aswan UniversityMagdy Mostafa SalehDepartments of Urology, Faculty of Medicine, Aswan UniversityMostafa Ahmed Mostafa ElBakryDepartments of Urology, Faculty of Medicine, Aswan UniversityJournal Article20190207Background: There are multiple approaches for treatment of patients with upper ureteral stones. Extracorporeal shockwave lithotripsy (SWL), ureterorenoscopy (URS), percutaneous nephrolithotomy (PCNL), laparoscopic ureterolithotomy (LU) and open ureterolithotomy each has advantages and disadvantages. Although SWL is minimally invasive and can be performed as an outpatient procedure, disadvantages include a high retreatment rate, long treatment time, and inability to dissect a large or impacted stone. Objective: The aim of this study was to compare between laparoscopic ureterolithotomy and retrograde ureteroscopy for treatment of large upper ureteric stones as regard operative time, blood loss, hospital stay, post-operative pain, use of analgesia, intraoperative & postoperative complications and success rate. Conclusion: LU provides a higher stone-free rate than URS in the management of large proximal ureteral stones. There are no differences regarding overall post-operative complications or major postoperative complications between the procedures. Semirigid URS is associated with a short operative time and length of hospital stay; however it leads to a higher need for auxiliary procedures. When counseling a patient with a large proximal ureteral stone, LU should be advised as the procedure with the higher chance of stone removal, although it is also more invasive, leading to longer operative time and length of hospital stay. Utilization of flexible ureteroscopy in conjunction with semi-rigid ureteroscopy may impact these outcomes, and deserves further systematic evaluation.https://ejhm.journals.ekb.eg/article_26682_7cd6d9351d258df42e677b81ac2c6e8e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Assessment of Ventricular Outflow Tract in Macrosomic Neonates127912862668310.21608/ejhm.2019.26683ENAhmed Fetouh Abd Elrahman ElhassDepartment of Pediatrics and Neonatology, Faculty of Medicine, Al-Azhar UniversityAhmed Mohamed IsmailDepartment of Pediatrics and Neonatology, Faculty of Medicine, Al-Azhar UniversityMohamed Mahmoud Abd ElmohsenDepartment of Pediatrics and Neonatology, Faculty of Medicine, Al-Azhar UniversityIbrahim Mohamed AbofaragDepartment of Pediatrics and Neonatology, Faculty of Medicine, Al-Azhar UniversityJournal Article20190207Introduction: Fetal macrosomia is encountered in up to 10% of all deliveries. It occurs in 15-45% of diabetic pregnancies. Factors associated with fetal macrosomia include genetics; duration of gestation; presence of gestational diabetes; high pre-pregnancy body mass index (BMI); excessive gestational weight gain and diabetes mellitus. Macrosomia is reportedly associated with neonatal morbidity, neonatal injury, maternal injury, and cesarean delivery. Moreover, shoulder dystocia, brachial plexus injury, skeletal injuries, meconium aspiration, prenatal asphyxia, hypoglycemia, and fetal death. All types of maternal diabetes are risk factors for macrosomia and can affect the foetal cardiac development in the form of Hypertrophic cardiomyopathy and congenital cardiac malformation. Aim of work: To evaluate the cardiac changes and ventricular outflow tracts in macrosomic neonates clinically and by 2D transthoracic echocardiography. Patients and Methods: This prospective study was carried out in NICU of Sayed Galal University Hospital on fifty macrosomic neonates’ thorough detailed history, clinical examination, Chest X-ray, important laboratory investigation, two dimensional M-mode and Doppler echocardiographic examination. Results: The fifty macrosomic neonates consisted of 29 males (58%) and 21 females (42%) with mean age ± SD of 2.16±0.84 days (range, 1-5 days). Statistically, significant relation between inter ventricular septum diastole (IVSD) (mm) according to HbA1c level, increase IVSD with increase HbA1c level, and show statistically significant relation between inter ventricular septum diastole (mm) and LTVOTO. When IVSD increase the incidence of LVOTO increase While TABSE decrease with the increase in IVSD. It also showed significant negative correlation between IVSD and MPI and PAP. Conclusion: Elevated maternal HbA1c level can lead hypertrophic cardiomyopathy mainly septal hypertrophy, which increased incidence of ventricular outflow tract obstruction. These echocardiographic findings (TAPSE and MPI) seem to be a better index of the cardiac outcome of macrosomic neonates than other clinical, laboratory or radiological parameters. Recommendations: Early echocardiographic examination for early detection of myocardial dysfunction or cardiac defect is essential in all macrosomic neonates andIDM even those without audible murmur, especially so if not improving with proper intervention. Echocardiographic indices especially TAPSE and Tei index for all macrosomic neonates to detect early cardiac changes in particular left ventricular dysfunction.https://ejhm.journals.ekb.eg/article_26683_3b1bad0adf380cd116ab7f7194111201.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Study of Atrial Fibrillation and Venous Thromboembolism in Critically Ill Patients in Intensive Care Unit128712972668410.21608/ejhm.2019.26684ENYasser Elsayed MohammedCardiology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20190207Bachground: atrial fibrillation (AF) is the most common arrhythmia in patient hospitalized in ICU and is associated with increased morbidity and mortality. Venous Thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary Embolism (PE), is recognized as a common complication in critically ill patients. Risk factors including critical illness, mechanical ventilation, sedative medications and central venous catheter insertion are major contributing factors to the high risk of VTE. Objective: it was to evaluate the causes and outcomes of AF and VTE in patients admitted to intensive care unit due to non-cardiac causes. We studied 143 consecutive patients admitted to ICU for non-cardiac emergencies. Results: only 48 (33.5 %) patients were complicated. AF is the most common complication happened in 27 patients (56 %) of complicated cases; pulmonary embolism comes next with 13 patients (27.1%) of complicated cases, DVT in the third place with 8 patients (16.6 %) of complicated cases. The age of patients admitted to ICU was directly related to complication happened in ICU, the older the patient is the more he is vulnerable to complications, the increased body mass index and increased weight was directly related to complications, the hemoglobin level is strongly related to cardiac complications . There was increased risk of DVT and pulmonary embolism due to prolonged bed ridden state. Conclusion: patients of ICU who have a higher risk than other for adverse cardiac complications, the most common cardiac complications are AF, DVT and pulmonary embolism and finally cardiac complications leads to increased rate of mortality and morbidity.https://ejhm.journals.ekb.eg/article_26684_c3b93d939ff8313eab50dd48268db2af.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Epidemiology and risk factors of end stage renal disease in Aswan Governorate, Upper Egypt129813059623210.21608/ejhm.2019.96232ENMohamed Zain Eldeen HafezInternal Medicine Department, Faculty of Medicine, Aswan UniversitySoumaia Ahmed KassemInternal Medicine Department, Faculty of Medicine, Aswan UniversityHosny Abdelwahab GafaarInternal Medicine Department, Faculty of Medicine, Aswan UniversityOmaima Mohamed AliInternal Medicine Department, Faculty of Medicine, Aswan UniversityJournal Article20181022Background: End-stage renal disease (ESRD) has become a health issue worldwide. There is electronic data registry in developed countries, which allows for quick statistical analysis and assessment of the issue size for future planning. Objective: The aim of the study was to assess the prevalence rate, etiology, and risk factors for end stage renal disease (ESRD) in Aswan governorate, Upper Egypt, during the period from June 2017 to June 2018. Patients and methods: Our study was subjected to Patients with end stage renal disease on maintenance hemodialysis. This cross sectional study was carried on 1000 patients with ESRD in Aswan governorate from June 2017 to June 2018 Results: The etiology of ESRD was unknown in 13.7% of cases, whereas hypertension was responsible for 19.6 % of cases, diabetic nephropathy was 19.5 % of cases, Obstructive uropathy was 14.5 % of cases, Glomerulonephritis was 7.1 % of cases, Chronic Pyelonephritis was 5 % of cases, Congenital was 4.9 % of cases, Analgesic Nephropathy was 4.8 % of cases, Preeclampsia was 3.6 % of cases, Poly Cystic Kidney was 3.3 % of cases, Gouty Nephropathy was 2.5 % of cases and lastly Lupus Nephritis was 1.5 % of cases. Conclusion: In Aswan Governorate, the most common cause of ESRD was hypertensive renal disease followed by diabetic nephropathy then Obstructive Uropathy followed by Unknown cause. https://ejhm.journals.ekb.eg/article_96232_8ac40fcbd376c33984ca625245edf214.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101The Use of Trans Abdominal Ultrasound in Assessment of the Lower Uterine Segment Thickness in Patients with Previous Cesarean Section130613132668810.21608/ejhm.2019.26688ENIsmael M. MiraDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University,Cairo, EgyptAbdel-Monsef A. SedekDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University,Cairo, EgyptAhmed T. AhmedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University,Cairo, EgyptJournal Article20190208Introduction: There is a steady increase in the rate of cesarean delivery. In Egypt, Cesarean sections were performed in 38.84% of deliveries in 2008, 37.88% in 2009, 39.08% in 2010, 37.72% in 2011 and 41.17% in 2012, repeated cesarean sections (RCS) was the main indication. In making plans for delivery, physicians and patients should consider a woman's chance of a successful VBAC as well as the risk of complications from a trial of labor. Approximately 60-80% of appropriate candidates who attempt vaginal birth after cesarean (VBAC) will be successful. Aim of the Work: was to determine a cut-off value that can be clinically used to allow a safe vaginal delivery by using abdominal ultrasound to evaluate the thickness of the lower uterine segment in patients with history of previous cesarean section. Patients and Methods: The lower uterine segment thickness was measured by both transabdominal ultrasound in 200 cases, gravidas (37 week – 40 week),100 cases with previous CS (study group) undergoing repeated CS, and the other 100 cases without any scar in the uterus (control group), then the grade of the scar was assessed intraoperatively. Results: By TAS the best cut- off value was 2.5 mm and this yielded a sensitivity of 77.3% and a specificity of 73.5%. At this cut-off value, the positive predictive value was 85% while the negative predictive was 62.5% and the accuracy was 76%. Conclusion: Ultrasonographic evaluation permits good assessment of the risk of scar complications intra partum. The lower uterine segment thickness is related to the grade of the scar. The best timing to perform the scan is at late third trimester. A cut-off value of 2.5 mm by TAS can be safely used with high degree of sensitivity and specificity.https://ejhm.journals.ekb.eg/article_26688_2adac477515f81fbc1068a709eabaf55.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Effect of Tranexamic Acid on Blood Loss in Elective Cesarean Delivery131413212668910.21608/ejhm.2019.26689ENEsmail Talaat Al-GarhyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAshraf Hamdy MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityIslam Abdullatif BarakatDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20190208Background: tranexamic acid as an agent given before surgical procedures reduces the blood transfusion risk, mean volume lost, and the requirement for reintervention due to bleeding issues, without raising thrombotic risks. Aim: to evaluate Tranexamic acid agent infusion as regards its efficacy in blood volume loss reduction in practice of elective lower segment cesarean section delivery. Patients and Methods: A double blinded, randomized, controlled research clinical trial. All study subjects have been recruited from the cases scheduled for elective cesarean delivery in the labor ward of Mokattam Insurance Hospital. The study subjects were totally 200 cases allocated in by randomization into 2 research groups. The study research group have been composed of 100 cases that were administered a mixture of tranexamic acid 25mg/kg in 200 ml of normal saline by intravenous drip for 20 minutes before incision, while the control research group contained 100 cases administered a volume of normal saline in accordance to patient’s weight (25 mg/kg) by intravenous drip for 20 minutes before time of incision. Results: Blood loss volume was statistically significantly lower among Tranexamic research group than among placebo research group (p value <0.001). Postoperative hematocrit was statistically significantly higher among Tranexamic research group than among placebo research group (p value =0.020). Hematocrit reduction was statistically significantly lower among Tranexamic research group than among placebo research group (p value <0.001). PPH and blood transfusion were statistically significantly less frequent among Tranexamic research group (p values=0.010, 0.005 consecutively). Conclusions and Recommendation: The administration of tranexamic acid before starting a cesarean section is valuable as a prophylaxis against intra-operative and post-partum bleeding issues. Future research studies are required to consider various variables such as racial and ethnic differences and consider various clinical case scenarios e.g. previous cesarean delivery and categorization of more possible critical indications of cesarean such as second stage cesarean, emergency cesarean section and time interval of decision to incision as those variables could influence blood volume loss indices.https://ejhm.journals.ekb.eg/article_26689_d3fab2fbab6528cac5cb6540cb933eaf.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Comparative Study between Adenoidectomy with Myringotomy and Adenoidectomy with Ventilation Tube Insertion in Management of Secretory Otitis Media132213292667710.21608/ejhm.2019.26677ENWael Hassan AboulwafaOtorhinolaryngology Department, Faculty of Medicine, AL-Azhar University, EgyptHatem Salah Eldin El HabashyOtorhinolaryngology Department, Faculty of Medicine, AL-Azhar University, EgyptMarwan Ahmed IbrahimOtorhinolaryngology Department, Faculty of Medicine, AL-Azhar University, EgyptMohamed Sobhy AliOtorhinolaryngology Department, Faculty of Medicine, AL-Azhar University, EgyptJournal Article20190207<strong>Background:</strong>Otitis media with effusion is one of the most common chronic otological conditions and the most common cause of conductive hearing loss in the pediatric population. Ventilation tubes insertion with or without adenoidectomy is considered as a standard surgical procedure. <strong>Objective<em>:</em></strong>this study aimed to compare the efficacy and the complications of adenoidectomy with myringotomy in comparison with adenoidectomy and ventilation tube insertion in management of otitis media with effusion. <strong>Patients and Methods<em>:</em> </strong>this was a prospective study carried out between October 2017 to October 2018 (One year). The study included 60 cases diagnosed with persistent otitis media with effusion due to adenoid enlargement and they were categorized randomly into two groups (30 cases per each). <strong>Group I</strong> underwent myringotomy alone with adenoidectomy and <strong>group II</strong> underwent myringotomy with ventilation tube insertion with adenoidectomy. All patients were subjected to full ENT examination, tympanometry and hearing evaluation. Patients were followed up (After myringotomy healing, at one month and 3 months after healing) for 3 months after tube extrusion or myringotomy closure. Postoperative evaluation was done for all patients and complications were assessed. <strong>Results<em>: </em></strong>the mean healing time was significantly longer in children who underwent adenoidectomy with ventilation tube <strong>(Group II)</strong> compared to patients of <strong>group I,</strong> (p<0.001) (28.5 vs. 2.2 weeks). The number of cases with OME recurrence after 3 months of healed myringotomy were significantly higher in <strong>group I</strong> (18 ears, 30.0%) compared to <strong>group II</strong> (6 ears, 10.0%), (p<0.006). Postoperative tympanogram was improved in both groups but, it was significantly improved in the group who underwent adenoidectomy with ventilation tube <strong>(Group II)</strong> compared to the group who underwent adenoidectomy with myringotomy only at all follow up intervals (p=0.015, 0.002, 0.022), respectively. The incidence of some postoperative complications such as otorrhea and tympanic sclerosis was significantly higher in <strong>group II</strong> (p=0.024 for otorrhea and p<0.001 for tympanic sclerosis). <strong>Conclusion: </strong>both used procedures were effective in the treatment of OME in children, but adenoidectomy with ventilation tube insertion was significantly better in improving tympanogram and reducing OME recurrence, while, it may increase the incidence of some complications. Further studies are warranted with larger number of cases and longer follow-up period to confirm these results.https://ejhm.journals.ekb.eg/article_26677_fd284559f49b04e77ed4216ee83fa728.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Medial Hemisoleus Muscle Flap in Reconstruction of Soft Tissue Defects of Lower Leg133013362669710.21608/ejhm.2019.26697ENMohamed MakboulPlastic Surgery Department, Faculty of Medicine - Aswan UniversityAhmed MousaPlastic Surgery Department, Faculty of Medicine - Aswan UniversityMohamed ElotiefyPlastic Surgery Department, Faculty of Medicine - Aswan UniversityMohamed Hamdy Mohamed AhmedPlastic Surgery Department, Faculty of Medicine - Aswan UniversityJournal Article20190209<strong>Background: </strong>Reconstruction of lower leg represents a challenge task for plastic surgeons. Although microsurgical flaps have been the golden choice for this reconstruction, many hospitals do not have equipment or microsurgical staff trained for this type of procedure.
<strong>Aim: </strong>The objective of the current study is to evaluate of clinic applicability and functional outcome results of medial hemisoleus muscle as a reconstructive flap modality in lower third leg soft tissue defect. This includes clinical study comparison between two surgical modalities of hemisoleus muscle Hap elevation.
<strong>Methodology:</strong> This study was conducted in Plastic Surgery Department, Aswan University Hospital from May 2017 to August 2018. It was a descriptive study including 30 patients (23 males and 7 females with the age ranging between 29 and 51 years). <strong>Results:</strong> Our study confirmed this fact as preservation of lateral portion is suitable for planter flexion with gastrocnemius muscle and medial hemisoleus muscle flap showing long arc of rotation especially distally based posterior tibial artery medial hemisoleus muscle flap has long arc of rotation cover up to heal defect. <strong>Conclusion: </strong>Medial hemisoleus muscle flap is a reliable option for the reconstruction of soft tissue defects of lower leg based on minor pedicle or reversed flow based on posterior tibial artery. Careful flap dissection with preservation of as many perforators as possible is the key to success.https://ejhm.journals.ekb.eg/article_26697_af8d0fa78f6c33e817a8dd15abaaaa11.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Measurement of Epicardial Adipose Tissue Thickness and Vitamin D Status in Obese Egyptian Adolescents and their Relationship with Cardiovascular Dysfunction133713472669010.21608/ejhm.2019.26690ENAbd Allah Hussein El-SadekDepartments of Internal Medicine,
Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammed Noshy El-AlfyDepartments of Internal Medicine,
Faculty of Medicine, Al-Azhar University, Cairo, EgyptMansour Mohammed MustafaDepartments of Cardiology,
Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbd Allah Mohammed El-KhshenDepartments of Diagnostic Radiology,
Faculty of Medicine, Al-Azhar University, Cairo, EgyptKamel Soliman HammadDepartments of Clinical Pathology,
Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed Ali Hassan AliDepartments of Internal Medicine,
Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190208Background: Epicardial Adipose Tissue (EAT) is the cardiac visceral adipose tissue, influencing its structure and function, and easily assessed by trans-thoracic echocardiography. Vitamin D deficiency is prevalent among obese adolescents and is thought to affect the cardiovascular system. Objective: This study was aimed to assess the EAT thickness (EATT) and Vitamin D status in obese adolescents to clarify their relationship with cardiovascular dysfunctions. Patients and Methods: This was a case-control study done at the Internal Medicine Outpatient Clinics of Al-Azhar University Hospitals during the period from February 2016 to February 2018. It included 90 ado lescents divided into two equal groups; obese group (45 obese) and healthy non-obese group (45 ones). Hi story taking, clinical examination, laboratory investigations, and echocardiographic assessment were done to retrieve all relevant data. Results: Obese adolescents were substantially different from non-obese regarding their anthropometrics w ith worse glucose homeostasis, insulin resistance and lipid profile, with a high prevalence of Metabolic Sy ndrome (MetS) (57.8%). Echocardiographically, they had a significantly increased carotid intima-media th ickness (cIMT) and EATT, higher incidence of hypertrophic cardiac remodeling, impaired systolic and dia stolic LV and RV functions. 25-Hydroxy Vitamin D (25[OH]VD) levels was lower in obese group vs. non -obese (10.2 ± 3.8 vs. 19.09 ± 7.8) respectively. EATT, cIMT, and s. Adiponectin showed the highest diag nostic capability in identification of Adolescence obesity and MetS. Conclusion: EATT is an easily obtainable marker of cardiovascular structural and functional derangements. Vitamin D deficiency significantly worsen the cardio-metabolic risk profile and the cardiovascular function among Egyptians obese adolescents.https://ejhm.journals.ekb.eg/article_26690_a168609ee1e4f1d54b09184dd35f7ee4.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Impact of Extracorporeal Blood Flow on Blood Pressure, Pulse Rate and Cardiac Output in Hemodialysis Patients134813522669810.21608/ejhm.2019.26698ENMohammed Zein Eldeen HafezInternal Medicine Department, Faculty of Medicine - Aswan UniversityHala Abdellah MahmoudInternal Medicine Department, Faculty of Medicine - Aswan UniversityRamadan Ghaleb MohammedInternal Medicine Department, Faculty of Medicine - Aswan UniversityOmar Abdelrahman Ahmed AbdAllahInternal Medicine Department, Faculty of Medicine - Aswan UniversityJournal Article20190209<strong>Background</strong>: If blood pressure (BP) falls during hemodialysis (HD) (intradialytic hypotension (IDH)) a common clinical practice is to reduce the extracorporeal blood flow rate (EBFR). Consequently, the efficacy of the HD (Kt/V) is reduced. Aim of the Work: The aim of the present study is to investigate the impact of changes in extracorporeal blood flow rate (EBFR) on blood pressure (BP), pulse rate (PR) and cardiac output (COP) in hemodynamically stable patients during hemodialysis. <strong>Patients and Methods:</strong> The population of this study consisted of 40 patients that on renal dialysis (RD) three sessions weekly. Patients were investigated prior to and after one conventional hemodialysis session. Prior to the hemodialysis session, an echocardiograph was performed to evaluate left ventricular ejection fraction (LVEF) and establish the degree of potential heart failure. <strong>Result</strong>: In the present study regarding measure of BP, PR and COP in EBFR 200 ml/min, 300 ml/min and 400 ml/min, there was significant increase in systolic BP at an EBFR 200 ml/min as compared with EBFR 300 ml/min and EBFR 400 ml/min. but there was no significant change in systolic BP at an EBFR 300 ml/min as compared with an EBFR 400 ml/min. <strong>Conclusion</strong>: IDH has been associated with many adverse clinical events including myocardial stunning, cerebral atrophy and increased mortality. Change of BFR from 400 ml/min or from 300 ml/min to EBFR 200 ml/min can increase in BP so help in decrease occurrence of complications of IDH beside other methods of increasing BP during hemodialysis.https://ejhm.journals.ekb.eg/article_26698_cf6c5f0688efdc4e2046a39ccc163123.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss after Elective Cesarean Section135313582669910.21608/ejhm.2019.26699ENSamir Abd Allah AliDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptTamer Fares OofDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed Fouad ElmollaDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190209<strong>Background</strong>: Primary post-partum hemorrhage (PPH) is defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. Objective: was to determine the efficacy and safety of tranexamic acid in reduction of blood loss after the elective cesarean sections. <strong>Patients and Methods:</strong> We performed a randomized, controlled study of 200 pregnant females who underwent elective CS. The patients had attended the Labor Ward in Al-Azhar University Maternity Hospital. 100 of them received tranexamic acid 20 minutes before beginning of anesthesia in addition to oxytocin after delivery of the baby; the other 100 patients received oxytocin only. <strong>Results</strong>: In the 1st two hours post-partum vaginal bleeding was significantly less severe in study group than control group (p<0.019). There was nonsignificant difference between study and control groups as regards preoperative hemoglobin concentration (p=0.195), Postoperative hemoglobin concentration was significantly greater in study group than control group (p<0.001), Reduction in hemoglobin levels ware significantly less in study group than control group (p<0.001). There was nonsignificant difference between study and control groups as regards to preoperative hematocrite (p=0.967), Postoperative hematocrite levels were significantly higher in study group than control group (p0.015), Reduction in hematocrite levels ware significantly less in study group than control group (p<0.001).https://ejhm.journals.ekb.eg/article_26699_970729e70f032ced0a6bea1d22adf834.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Assessment of the Causes and Outcomes of Upper Gastrointestinal Tract Bleeding Patients in Aswan University Hospital135913642670010.21608/ejhm.2019.26700ENMohammed Zein Eldeen HafezInternal Medicine Department, Faculty of Medicine - Aswan UniversitySoumaia Ahmed KassemInternal Medicine Department, Faculty of Medicine - Aswan UniversityMohammed Ahmed Hamed Abd-AllahInternal Medicine Department, Faculty of Medicine - Aswan UniversityJournal Article20190209Background: Gastrointestinal (GI) bleeding is a potentially life threatening abdominal emergency that remains a common cause of hospitalization. Bleeding from the upper gastrointestinal tract is approximately five times more common than from the lower gastrointestinal tract bleeding and seems to be more common in men and the elderly. Aim: Identify various cause and outcomes of upper gastrointestinal tract bleeding patients in Aswan University Hospital by follow-up the patients and their different fates on the numerous lines of treatment. Methodology: This study included 100 patients who were complaining of upper gastrointestinal tract bleeding and selected from patients in Aswan University Hospitals. Results: The results of the current study showed that the most common causes of upper GIT bleeding are the variceal causes representing 57% of causes of GIT bleeding, followed by non-variceal causes representing 43% of causes of GIT bleeding. The most common cause of the variceal bleeding is the esophageal varices alone representing (40%) of the causes of variceal bleeding followed by combined esophageal and gastric varices representing (12%) and the gastric varices alone representing (5%) of the causes of upper GIT bleeding. Conclusion: The endoscopic therapy was successful in most cases. The recurrence rate of bleeding was significantly high among patients with variceal bleeding. The patients with variceal bleeding have fewer treatmentrelated complications and better survival rates when they are treated by band ligationhttps://ejhm.journals.ekb.eg/article_26700_c1c7fd8d9e3dad63fb90ac498c769636.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101The Predictive Value of the Integrated Weaning Indices in Mechanically Ventilated COPD Patients136513702670210.21608/ejhm.2019.26702ENSuzan Salama SayedDepartment of Chest Diseases and TB, Faculty of Medicine, Aswan University, EgyptKhalid Hussein AhmedDepartment of Chest Diseases and TB, Faculty of Medicine, Aswan University, EgyptSayed Abdelsabour KinawyDepartment of Chest Diseases and TB, Faculty of Medicine, Aswan University, EgyptIslam Galal SayedDepartment of Chest Diseases and TB, Faculty of Medicine, Aswan University, EgyptJournal Article20190209<strong>Background</strong>: COPD exacerbations necessitating mechanical ventilation representing important aspect of disease management. Attempts to search for better weaning index is a continuous process. Aim<strong> of the work:</strong> was to study the accuracy of the integrated weaning indices including, CROP index and CORE index as predictors of weaning success in COPD exacerbation under mechanical ventilation. <strong>Patients and Methods</strong>: 102 COPD patients necessitating mechanical ventilation >24 h underwent daily screen of subjective and objective indices for weaning readiness, and patients were classified according to weaning outcome into successful group (Group S) (60 patients) and failure group (Group F) (42 patients). <strong>Results</strong>: There were no significant observed difference regarding the demographic data between the successful and the failure groups. There was highly significant difference between both weaning groups regarding dynamic compliance, NIF, P0.1, CROP index and CORE index (P value < 0.05). AUC of CROP index (0.80) was moderately precise compared with that of CORE index (0.63). <strong>Conclusion</strong>: CROP index is superior to CORE index as a predictor of weaning success in mechanically ventilated COPD patientshttps://ejhm.journals.ekb.eg/article_26702_4d7f71009f9c6771adad7117470bff72.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Galectin-3 and Severity of The Coronary Artery Disease in Ischemic Patients Guided by Coronary Angiography137113762741310.21608/ejhm.2019.27413ENReda Biomy BastawesyFaculty of Medicine, Department of cardiology Kafr El Sheikh UniversityMohamed Kamal SalamaFaculty of Medicine, Department of cardiology, Aswan UniversityHossam Eldin Mohamed MansourFaculty of Medicine, Department of cardiology, Aswan UniversityAhmed Barakat AhmedFaculty of Medicine, Department of cardiology, Aswan UniversityJournal Article20190218<span>Background: </span><span>The inflammatory process is actively involved in atherosclerosis and underlies all stages of atherosclerotic plaque development: the beginning, the progression and the plaque rupture. It has been reported that during the inflammatory process the expression of Gal-3 is increased in human atherosclerotic lesions, suggesting its involvement in atherogenesis. </span><span>Aim: </span><span>In the present study, we tried to evaluate the levels of Gal-3 in patients with chronic stable angina and its relation to the severity of coronary artery disease (CAD) and the CAD risk factors such as Aging, Diabetes, Hypertension, Smoking and Dyslipidemia. </span><span>Patients and Methods: </span><span>Our study population consisted of 95 chronic stable angina patients who were planned for coronary angiography. All patients had clinical and/or electrocardiographic evidence of significant stable ischemic heart disease</span><span>.<br /> Results: </span><span>We found a significant positive correlation between CAD and Gal-3 levels (r = 0.207), (p value= 0.045). Patients with multi-vessel (MVD) had significantly higher plasma Gal-3 levels and syntax score than 3 vessel disease (TVD) and single vessel disease (SVD) (P value <0.001)., while Patients with TVD had significantly higher plasma Gal-3 levels and syntax score than SVD, but still lower than MVD Patients (P value <0.001. </span><span>Conclusion: </span><span>Gal-3 plasma levels were significantly correlated with the severity of CAD in chronic stable angina and can be used as a prognostic marker of chronic stable angina patients.<br /> </span><span>Recommendation: </span><span>We recommend that the Gal-3 might be useful for risk stratification and outcome prediction of coronary heart diseases.<br /> </span>https://ejhm.journals.ekb.eg/article_27413_c73d0502c346b9334a5638ccf1d9eef5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Evaluation of Silodosin in Comparison to Tamuslosin in Treatment of Benign Prostatic Hyperplasia with lower Urinary Tract Symptoms: A Prospective Study137713862670110.21608/ejhm.2019.26701ENMohammed H. M MousaDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptEl Sayed M. SalihDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptEl Sayed M. MousaDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190209<strong>Background</strong>: benign prostatic hyperplasia represents one of the main fields of urology. <strong>objective</strong>: aim of the study to verify the efficacy and safety of the alfa one adrenoreceptor blocker silodosin compared with tamsulosin in patients with lower urinary tract symptoms associated with bph. <strong>patients and methods:</strong> outcomes were assessed by change from baseline in ipss, quality of life (qol), qmax, pvr. responders to the treatments on the basis of ipss decrease ≥ 25% and qmax increase ≥ 30% were calculated. <strong>results</strong>: silodosin and tamsulosin significantly improved ipss total score in (p=0.625). both no statistically significant difference. improved qol (p<0.505) both no statistically significant difference between both improved qmax (p<0.633). silodosin and tamsulosin no statistically significantly. improved pvr; there no statistically significant difference between both (p<0.0001). in silodosin group, a retrograde ejaculation was reported in 25 patients from 40 patients were sexually active (62.5%). while in tamsulosin group, a retrograde ejaculation was reported in 1 patient from 41 patients sexually active (2.4%). <strong>conclusions</strong>: silodosin is not only comparable to tamsulosin in the treatment of luts/bph, with safety. however, retrograde ejaculation troublesome for sexually active patients.https://ejhm.journals.ekb.eg/article_26701_c0195f0d517ca114602fac7cdabae40a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Supine versus Prone Position Percutaneous Nephrolithotomy138713952697710.21608/ejhm.2019.26977ENAmir Elmetwally Ibrahim Abd ElgawadDepartment of Urology, Faculty of Medicine, Al-Azhar UniversityFarouk Ismail ElguoshyDepartment of Urology, Faculty of Medicine, Al-Azhar UniversityYasser Ali AhmedDepartment of Urology, Faculty of Medicine, Al-Azhar UniversityJournal Article20190212Background: percutaneous nephrolihotomy (PCNL) is the first choice for treatment of single more than 2cm and multiple renal stones. The prone position is the classical position preferred by most surgeons. Then the supine position was developed for percutaneous nephrolithotomy. Objective: to compare between supine and prone PCNL in the management of renal stones regarding number of puncture, stone free rate, operative time, intraoperative and postoperative complications. Patients and Methods: the patients were selected, all having multiple stones, or stone size 2 cm or more. They were 30 patients divided into two groups, group (A) prone 15 patients and group (B) supine 15 patients. The study excluded patients with renal anomalies, uncontrolled coagulopathy, pregnancy, immunosuppression, and ages less than 10 years. Results: the study demonstrated a significant difference only in operation time which was (89.00±30.37) in prone group & (64.67±24.75) in supine group with p-value (0.023) between the prone and supine position, with shorter operation time in the supine than the prone. The study has also demonstrated that there is no statistically significant difference between the two groups as regarding to stone free rates, hospital stay, intraoperative, and postoperative complications. Conclusion: in patients with multiple renal stones, or stone size 2 cm or more, supine PCNL has proved to be superior to prone PCNL as regarding operative time. However, Urologists should be familiar with the differences in the positions and be able to use the method appropriate for each patient.https://ejhm.journals.ekb.eg/article_26977_eb4eae7433c2319784d9d465b5927f29.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101The Role of Diffusion Weighted MRI in Assessment of Rectal Cancer139614052697810.21608/ejhm.2019.26978ENAhmed Abdel Fattah Abu RashedDepartment of Radiodiagnosis, Faculty of Medicine, Al-Azhar UniversityMohamed Ismail HammadDepartment of Radiodiagnosis, Faculty of Medicine, Al-Azhar UniversityMahmoud Sabry Qutb SallamDepartment of Radiodiagnosis, Faculty of Medicine, Al-Azhar UniversityJournal Article20190212Background: Magnetic resonance imaging has become the most accurate technique in local staging of rectal cancer. The identification and staging of rectal cancers at MR imaging is largely based on differences in T2 signal intensity between the tumor, the mucosa and submucosal layers, the muscular layer, the perirectal fat, and the mesorectal fascia. Objective: Was to assess the role of Diffusion Weighted MRI in assessment of rectal cancer and correlation of these findings with available histopathological findings. Patients and Methods: A total of 30 patients, proved by colonoscopy to have rectal carcinoma, were included in this retrospective study wich was carried out in the Radiology Department of Al-Azhar University Hospitals. The work took place during the period between June 2018 and Januray 2019.written consent was taken from each patient. The study was carried out after approval of the ethical committee of scientific research, faculty of medicine, Al-Azhar University. Results: we found that DW MRI measurement increased the specificity of the rectal MRI in characterizing different rectal cancers especially when it is combined with conventional MRI.Also the use of additional DW MR imaging yields better diagnostic accuracy than does use of conventional MR imaging alone in the evaluation of complete response (CR) to neoadjuvant chemoradiation treatment (CRT) in patients with locally advanced rectal cancer. Conclusion: DW MRI has a growing role in rectal cancer staging either primary staging or evaluating the post chemo radiotherapy state.https://ejhm.journals.ekb.eg/article_26978_ad60050f638ef3c1707597fd01a22aac.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Evaluation of Laparoscopic Splenectomy in Idiopathic Thrombocytopenic Purpura140614152697910.21608/ejhm.2019.26979ENAl Sayed Ahmed HamdyDepartments of General Surgery, Faculty of Medicine, Al-Azhar UniversityMohamed Fathi LabibDepartments of General Surgery, Faculty of Medicine, Al-Azhar UniversityAhmed Talaat GomaaDepartments of General Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20190212Background: primary ITP was defined according to the American Society of Hematology 2011 evidence-based practice guideline as a platelet count less than 100 × 109 /L without other causes or disorders that may be associated with thrombocytopenia. The main first-line therapy for ITP is oral corticosteroids. Splenectomy is generally considered a second-line therapy in patients who are refractory to steroids and in those who relapse after an initial response to medical therapy. Objective: the aim of this study was to evaluate the feasibility, safety and efficacy of LS in ITP patients. Patients and Methods: this study was carried out on 20 patients diagnose as having ITP and indicated for splenectomy, 60% were females and 40% were males. Their age ranged from 17-33 years with a mean of 24.3± 5.39 years. Results: the platelet count raised from (30000 to 140000/L) pre-operative to (90000 to 190000/ L) post-operative. There was statistically significance difference between pre and post-operative platelet count (p <0.001). From the assessment of platelet count according to American Society of Hematology 2011 evidence-based practice guidelines for ITP. Nineteen patients (95%) achieved complete response, while only one patient (5%) achieved partial response. Conclusion: it was concluded that LS produces an adequate postoperative rise in platelet count and it is associated with less operating time, post-operative hospital stay, blood loss and postoperative complications. https://ejhm.journals.ekb.eg/article_26979_236bc6a61ef1df62ce03fecaef91f408.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Trichoscopic Clues for Diagnosis of Patchy Scalp Alopecia in the Egyptian Patients141614222698010.21608/ejhm.2019.26980ENAbd Elrauof Mohamed AL MohsenDepartment of Dermatology, Venereology and Andrology,
Faculty of Medicine, Al Azhar UniversityMohamed Saeed Mohamed HasanDepartment of Dermatology, Venereology and Andrology,
Faculty of Medicine, Al Azhar UniversityAbd Elrhman Ali RizkDepartment of Dermatology, Venereology and Andrology,
Faculty of Medicine, Al Azhar UniversityJournal Article20190212Background: trichoscopy is a non-invasive office technique used for differentiating cicatricial from noncicatricial alopecia. Trichoscopy helps the dermatologist for diagnosis of alopecia with rarely need of histopathology. Hair loss is distressing problem and associated with psychological complications. Common causes of hair loss include Alopecia areata, Tinea capitis, Traction alopecia and trichotillomania. Objective: this study aimed to assess the trichoscopic features in the Egyptian patients with patchy hair loss and to find sensitive and/or specific trichoscopic findings that can help in their diagnosis and follow up. Methodology: our study included 500 patients categorized into two groups cicatricial (176 cases) and noncicatricial (324 cases). Cicatricial included four types 2ry alopecia 139, DLE 24. FD 5 &LPP 8 and non-cicatricial included five types AA 148, localized androgenetic 21, CTA 15, TC 117 and TTM 23. Results: in our study, the sensitivity and specificity of trichoscopic patterns were evaluated in diagnosis of PCAs and NCAs. We found some trichoscopic patterns that were sensitive and specific for making diagnosis of PCAs. The perifollicular scale had 90% sensitivity and 99.5% specificity for a diagnosis of PCAs. Hair tufting was only observed in LPP and FD. This study showed 100% specificity for the presence of each blood vessel pattern that was seen in PCA. The specificity of tortuous branching vessels was 100% for a diagnosis of DLE. Conclusion: dermoscopy was very useful to identify signs of early clinical response, adverse effects and markers of disease activity even if that couldn’t be detected by unaided naked eyes.https://ejhm.journals.ekb.eg/article_26980_819c6e6e2dbb82b98a53747398e01075.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Coproantigen Versus Classical Microscopy as a Diagnostic Tool for Entamoeba histolytica Infection in the Egyptian Patients142314272698210.21608/ejhm.2019.26982ENAhmed M.S. BayoumyDepartment of Parasitology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohsen T.I. ElkeiyDepartment of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, EgyptTarek K.I . ZaalokDepartment of Parasitology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHesham M. GadDepartment of Biochemistry,
Faculty of Pharmacy, Al-Azhar University, Cairo, EgyptWael A.M. Abd ElhamidDepartment of Parasitology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190212Background: Entamoeba histolytica, an amoebic protozoan, is considered as one of the most common causes of nonviral (Parasitic) diarrheal illness in humans. Laboratory diagnosis consists primarily of direct microscopic examination of stool specimen for both trophozoites and cysts. However, because of the intermittent fecal excretion of the parasite, the case may be mis-diagnosed and the patient may continue excreting the parasite and infecting others. That is why other methods of diagnosis should be looked for that can help overcome the defects and drawbacks of microscopy when used alone for diagnosis. Aim of the work: the current study aimed to evaluate the efficacy of coproantigen detection by ELISA test in comparison with direct microscopy in diagnosis of E. histolytica/dispar in stool specimens from patients with diarrhea and other gastrointestinal symptoms. Material and Methods: stool samples were collected form 250 children included in the present study (150 symptomatic and 100 asymptomatic groups) between the ages of 1 and 10 years and subjected to direct microscopic examination and ELISA test for coproantigen detection. Results: out of 250 stool samples, 64 specimens (25.6%) were positive for E. histolytica/dispar by direct microscopy, while 79 specimens (31.6%) were positive by ELISA test. The sensitivity and specificity of ELISA test compared to direct microscopy were found to be 96.9% and 90.9%, respectively. Conclusion: ELISA test for coproantigen detection in stool samples is a rapid and effective method with high sensitivity and specificity for diagnosis of amoebiasis in stool specimens even when the parasitic count is low, thus reducing the chances of missing positive cases even in the asymptomatic cases.https://ejhm.journals.ekb.eg/article_26982_0a006669a70f90d0b00fd134c815b635.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Macrophage Migration Inhibitory Factor in the Early Diagnosis of Endometriosis and Relationship to the Stage of the Disease142814322698310.21608/ejhm.2019.26983ENAbdel Monem M. ZakariaDepartment of Obstetrics and Gynecology,
Faculty of Medicine - Al Azhar UniversitySameh S. SayedDepartment of Obstetrics and Gynecology,
Faculty of Medicine - Al Azhar UniversityMekky A. AlyDepartment of Clinical Pathology
Faculty of Medicine - Al Azhar UniversityWael M. Abou HedebaDepartment of Obstetrics and Gynecology,
Faculty of Medicine - Al Azhar UniversityJournal Article20190212Background: Endometriosis is a chronic disease affecting women of reproductive age. Adolescent onset of symptoms is common. Macrophage migration inhibitory factor (MIF) is one of non-invasive blood biomarker that was found in endometriosis. Aim of the work: to evaluate the value of macrophage MIF in peripheral blood of women with and without endometriosis as a non-invasive early diagnostic method and correlate its level to the stage of the disease. Patient and methods: This observational case-control study was conducted in El-Hussein Hospital, Al-Azhar University, Cairo and private clinics. The study was approved by the local research ethics committee. During the period from May 2016 till July 2018. Results: Both groups were comparable as regard the incidence of infertility and the presence of chronic pelvic pain. The infertility was equal in both groups; it affected 96% of patients and control groups. The chronic pelvic pain was symmetrically present in both groups; it affected 70% of endometriosis and the control group. The level of MIF was 10.03±1.78 pg/ml in patients with endometriosis and 4.82±1.78 pg/ml in control group with significant P value (P <0.001). In our study, the level of MIF differed according to the stage of endometriosis, in stage I, it was 8.6±0.2 pg/ml, in stage II, it was 10.1±0.1 pg/ml, in stage III, it was 11.3±0.2 pg/ml and in stage IV, it was 14+0.0 pg/ml. Conclusion: MIF factor is a promising marker not only for noninvasive diagnosis of endometriosis but as a target for therapy alsohttps://ejhm.journals.ekb.eg/article_26983_dc05c6a170ffaa883a3038e1534e9bc4.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274620190101Assessment of Retinal Vascular Plexuses and Choriocapillaris in Adult High Myopia Using Enhanced Depth Imaging Optical Coherence Tomography Angiography143314472698410.21608/ejhm.2019.26984ENMohamed Anwar El-MassryOphthalmology Department, Faculty of Medicine, Al-Azhar UniversityHassan Metwaly BayoumyOphthalmology Department, Faculty of Medicine, Al-Azhar UniversityAtef Hassan SayedAbdellatifOphthalmology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20190212Background: High myopia is a common eye health problem due to its sight threatening complications. Using the newly introduced noninvasive devices, it’s easier now to assess the morphological, anatomical and pathological changes accompanied with high myopia. Objectives: The aim of this study was to assess retinal vascular plexuses and choriocapillaris density and measuring the FAZ in the SCP & DCP with also assessment of central macular and subfoveal choroidal thickness in high myopia in adults using enhanced depth imaging optical coherence tomography angiography. Patients and Methods: This prospective observational study was carried out from June 2018 to November 2018 on 75 eyes of patients attending outpatient clinic of Ophthalmology department of Research Institute of Ophthalmology in Giza. Results: The best corrective visual acuity in the normal group was statistically significantly higher than the Myope group. The Macular thickness in the normal group was statistically significantly higher than the Myope group. The choroidal thickness in the normal group was statistically significantly higher than the Myope group. The FAZ DCP in the Myope group was statistically significantly higher than the normal group. Conclusion: The OCTA is certainly able to take over other invasive imaging techniques and new researches using this device might be able to study different pathologies affecting the posterior segment.https://ejhm.journals.ekb.eg/article_26984_fd813236e717eb40eba0c59112f4bc70.pdf