Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401The Effect of Orally Administered Iron-Saturated Lactoferrin on Systemic Iron Homeostasis in Pregnant Women Suffering from Iron Deficiency and Iron Deficiency Anaemia285128578626ENAhmed M Rateb, Ahmed M Mamdouh, Khaled M BalshaObstetrics and Gynecology Department - Faculty of Medicine – Ain Shams UniversityJournal Article20180320<span>Background: </span><span>Anemia is a common medical disorder affecting a lot of women in pregnancy in the developing countries. Anemia is the second indirect obstetric cause of death after cardiac causes. </span>
<span>Aims: </span><span>To compare the safety, tolerability, efficacy and hematological response of lactoferrin in treatment of iron deficiency anemia during pregnancy versus ferrous sulfate capsules. </span><span>Methodology</span><span>: Hematological Response to lactoferrin versus ferrous sulfate in Treatment of Anemia with Pregnancy". Study site: Ain Shams University hospital. Study design: A double blind clinical trial. Study population: The study was included Two-hundred pregnant females with iron deficiency anemia attending the outpatient clinics of Ain shams university maternity hospital for routine antenatal care. For each pregnant woman, age, parity and gestational history were taken before treatment. All pregnant women took their allocated treatment regularly for eight weeks after diagnosis of iron deficiency anemia with hemoglobin level and serum ferritin level and followed up after four and eight weeks. Also, epigastric pain, diarrhea, constipation, nausea, vomiting or gastric distress reported to assess tolerability of the drugs. </span><span>Results: </span><span>The study included 200 pregnant women in a double blind study: Group I (lactoferrin): 100 cases were received 100mg of bovine lactoferrin (Pravotin sachets, Hygint, Egypt) twice a day. Group II (ferrous sulfate): 100 cases were received 150mg of dried ferrous sulphate + folic acid (vitamin B9) 0.50mg (Ferrofol, E.I.P.I.C.O, Egypt) three capsules per day. </span><span>Conclusion: </span><span>lactoferrin is more tolerable than ferrous sulphate. It has lesser GIT side effects and seems to icrease both hemoglobin and serum ferritin more than iron salts. </span>
<span>Recommendations: </span><span>Lactoferrin is recommended for patients with iron deficiency anemia.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Colloid Co-load versus Colloid Pre-load in a Parturient Undergoing Caesarean Delivery with Spinal Anaesthesia and Its Effects on Maternal Haemodynamics285828688627ENMohsen Abdelghany Bassiony, Mona Refaat Hossny, Abd El Aziz Abdallah Abd El Aziz, Mona Ahmed Mohamed, Noha Mohamed Abd El AzizFaculty of Medicine, Ain Shams University, Obstetrics Anesthesia, Intensive Care and
Pain Management departmentJournal Article20180320<strong>Background</strong>: cesarean section is the surgical delivery of a baby that involves making an incision in the mother’s abdominal wall and uterus. Spinal anesthesia is considered the “gold standard” technique for cesarean section. Hypotension is the most common side effect of neuraxial blocks in the obstetric patient with an incidence rate reported as high as 83%. This has remained a significant concern for the anesthesiologist during management of this patient.
<strong>Aim of the work: </strong>This study will be performed to compare the effects of colloid pre-load and colloid co-load on maternal haemodynamic changes during spinal anaesthesia for cesarean section.
<strong>Patient’s and Methods: </strong>A comparative cross sectional study was conducted at Ain Shams Maternity Hospital. After obtaining approval of research ethical committee and patients' informed consents at which 105 women with full term singleton pregnancies were scheduled for elective cesarean section and received spinal anesthesia. The patient's age were between 18 -42 years, of ASA physical status. In our study 3 groups of patients were compared; each group is formed of 35 patients <strong><em>Group 1</em></strong>; patients were pre-loaded with 500 ml of 6% HES(hydroxyethyl starch 130/0.4) 20 minutes before induction of anesthesia. <strong><em>Group2</em></strong>; patients were co-loaded with 500ml of 6% HES (hydroxyethyl starch 130/0.4) during injection of bupivacaine. <strong><em>Group 3;</em></strong> patients were pre-loaded with 500ml lactated ringer solution 20 minutes before induction of anaesthesia.
<strong>Results:</strong> There was a decrease in SBP, DBP,MAP and HR in the 3 groups where the lowest values were recorded in group 3 between 6-15 minutes and there was a high statistical difference p˂0.0001 while the intergroup comparison of the groups 1 and 2 showed no statistical significance as regards SBP,DBP,MAP and HR. <strong>Conclusion: </strong>In this study it was found that colloid co-load was somewhat how equal to colloid pre-load in prevention of hypotension in a parturient undergoing cesarean section under spinal anesthesia in addition it was found that crystalloid pre-load was inferior to colloid co-load or pre-load in maintaining blood pressure during spinal anesthesia in parturients .Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401The Value of Using Platelet Rich Plasma after Hysteroscopic Analysis of Severe Intrauterine Adhesions (A Randomized Controlled Trial)286928748628ENMohamed Ibrahim Mohamed Amer, Mortada El-Sayed Ahmed, Reda Mokhtar Kamal, Ahmed Mohamed Mahmoud Abd Elwahab TorkyDepartment of Obstetrics and Gynecology, Faculty of Medicine - Ain-Shams UniversityJournal Article20180311<span>Background: </span><span>Office hysteroscopic examination is now an established step in the diagnostic work up of cases with abnormal uterine bleeding, infertility, and recurrent miscarriage that can be performed safely and efficiently without anesthesia in most cases. </span><span>Objectives: </span><span>This study aimed at assessment of the efficacy of the use of platelet rich plasma (PRP) in decreasing occurrence and recurrence of intrauterine adhesions after operative hysteroscopy. </span><span>Patient and Methods: </span><span>This study was conducted in Ain Shams Maternity Hospital (Early Cancer Detection and Endoscopy Unit) during the period between January 2017 and February 2018. 60 patients seeking for conception with a history of primary or secondary infertility with sever intrauterine adhesions. 30 patients (case) injected with PRP and 30 patients (control) with IU balloon. All patients had normal complete blood count, and not taking anticoagulant or NSAID in the 10 days before procedure with no active cervical or uterine infection. </span><span>Results: </span><span>It was found that the mean age in PRP group was 31.8 ± 4 years old and balloon group was 30.5 ± 4.7 range: (20-45 years old). The mean of BMI in PRP group was 24.4 ± 2.2 and balloon group was 25.1 ± 2.4. In this PRP group (13.3%) of patients were nulliparous and balloon group (10%), (86%) of PRP group are multipara and in balloon group (90%). There was no significant association between ages, parity with any possible etiology. Our study showed significant increase of menses duration among the PRP group post-operative (3.0 ±1.2) days and preoperative menses duration (1.4 ± 1.5) days. Compared to balloon post-operative (1.8 ± 1.3) and preoperative (1.3 ± 1.4) days. </span><span>Conclusion: </span><span>platelet rich plasma had high efficacy and safety in improvement of menses duration, amount and adhesion score in cases of sever intrauterine adhesions and decreasing postoperative adhesions. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Awareness and Attitude towards Epilepsy among Saudi Arabia287528848629ENHanan Abid Alqurashi* , Abdulkader Al Juhani** , Bashaer Mahboub Alalwani**, Alhanouf Abdullah Alyahya*** , Roula Hadyan Alhadyan*** , Abla Muhammed Alhoshani**** , Rawan Nasser Alhunaki***Taif University*, Royal Commission Medical Center-Yanbu**,
Almaarefa Colleges***, Qassim University****Journal Article20180120<span>Background: </span><span>Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure</span><span>.<br /> Aim of the Study: </span><span>To asses and evaluate general population understanding, knowledge and attitude toward epilepsy and epileptic patients</span><span>. Methods: </span><span>It’s </span><span>a cross-sectional randomized study conducted in Kingdome of Saudi Arabia. An online questionnaire designed to survey public awareness and attitudes toward epilepsy that posted online & distributed to the public. Estimated about 1000 cases and the statistical package SPSS version 21 was used for data analysis. </span><span>Result: </span><span>20.2% of the participants have a family member with Epilepsy. When asked if they can define Epilepsy; (39.6%) from the Southern region believe that they can, followed by the rest of the regions with similar percentages. 40.3% of female participants knew the causes of epilepsy and also 40.3% of males. The western region was leading with 29% knowing the causes of Epilepsy. (30.4%) of females knew how to handle a seizing patient while only (22.4%) of males knew how. The Western region had the highest positive response (31.5%). A high percentage of Males (81.2%) did not think that </span><span>there’re </span><span>different levels of Epilepsy while only (4.3%) of females agree on that. Most the responses received from males (43.6%), females (43.6%) and by regional division; (40%) West, (49%) South, (41.8%) North, (45.5%) Centre, (47.1%) East, agreed that epilepsy </span><span>isn’t </span><span>a genetic disorder. (36.5%) of females did not think that epilepsy affects the brain function; (29.1%) of males, (34.9%) West, (37.8%) Central, (41.4%) East, (34.5%) North and (22.9%) South had the same opinion. </span><span>Conclusion: </span><span>we noticed that the awareness and attitudes of the Saudi public toward epilepsy is less than expected especially from college students. We plan to target all our community from the different level of education and regions for more education in order to lower this stigma of epilepsy.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Rice Bran Oil Ameliorates Hepatic Insulin Resistance in Fructose Fed-Rats288528918630ENSohaier A. Abd Elbast1, Mona A. Mohamed2*, Mervat A. Ahmed1, Nehad A. Ali11Zoology Department, Faculty of Science, Al-Azhar University, Cairo, 2Biochemistry Division, Chemistry Department, Faculty of Science, Al-Azhar University, Cairo, EgyptJournal Article20180320<span>Background: </span><span>Insulin resistance is a pathological condition characterized by inadequate peripheral tissue metabolic response to circulating insulin. High dietary fructose causes insulin resistance syndrome, primarily due to simultaneous induction of genes involved in glucose, lipid and mitochondrial oxidative metabolism. Rice bran oil (RBO) is a rich source of antioxidants which contribute to higher oxidative stability and longer shelf life than other edible oils. </span><span>Aim of the work</span><span>: The current study investigated the effects of the daily intake of RBO on insulin resistant rat liver, as a central organ in carbohydrate metabolism.<br /> </span><span>Materials and methods: </span><span>Rats were allocated in 5 groups. Animals in groups 1 and 2 received standard diet and standard diet containing RBO, respectively. Group 3: animals fed high fructose diet (HFD), which was categorized into: rats fed HFD either for one month (HFD1) or for 2 months (HFD2). Group 4, rats were fed HFD containing RBO for one month (HFD1+RBO), while rats in group 5 were fed HFD for 30 days then RBO was added to the diet for another 30 days (HFD2+RBO). </span><span>Results and conclusion: </span><span>addition of RBO to this model improved insulin sensitivity in liver.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Microscopic Evaluation of The Testis in Azoospermic Patients with Reference to Androgen Receptors in Sertoli Cells289229068631ENHeba Allah M. ElsherbiniDepartments of Dermatology and Venereology, Faculty of Medicine, Al Azhar University, EgyptAbdel-Hamid Mohmmed Abdel-Aziz,Fathy E. MattarDepartments of Dermatology and Venereology, Faculty of Medicine, Al Azhar University, EgyptAbdel-Raouf Mohmmed AlmohsenDepartments of Dermatology and Venereology, Faculty of Medicine, Al Azhar University, EgyptJournal Article20180320<strong>Background: </strong>The reproductive ability of sexually mature males is dependent on the capacity of the testes tubules to produce large numbers of highly viable sperms and the interstitial cells to produce adequate levels of androgens to ensure maturation of the reproductive system.Azoospermia, defined as the complete absence of spermatozoa in the ejaculate, invariably results in infertility but does not necessarily imply sterility. It is identified in approximately 1% of all men and in 10 to 15% of infertile males.<br /> <strong>Patients and methods: </strong>The use of biopsies had been approved by the ethics committee of the Faculty of Medicine, Al Azhar University. All testicular biopsies were taken after written informed consent at the Department of Clinical Andrology, International Islamic Center for Population and Research Studies.Eleven patients with idiopathic infertility, were enrolled in this study and were assessed and diagnosed by a complete examination and specific investigations.<br /> <strong>Results: </strong>This study included 11 patients. They were divided into two groups obstructive azoospermia (OA) and Non-obstructive azoospermia. Non-obstructive azoospermia is subdivided into 4 groups: Early maturation arrest, late maturation arrest, Sertoli cell only (Sco) and Klienfilter syndrome.<br /> <strong>Conclusion: </strong>Spermatogenesis and maintenance of reproductive functions are controlled by androgens which are steroid hormones. Androgens exert most of their effects through genomic actions, which involve their binding to the androgen receptor (AR).AR plays important roles during later stages of sperm formation and maturation by influencing the four major cell types: Sertoli, Leydig, peritubularmyoid, and germ cells. Except for maturation arrest non-obstructive azoospermia, AR positive staining was not detected in germ cells. The highest number of Sertoli cell androgen receptors was in sections of testis from obstructive azoospermia and non- obstructive late maturation arrest patients, Testicular sections from patients with Klinefelter syndrome presented the lowest number of androgen receptor positive cells.It was concluded that the present study revealed that demonstration of androgen receptors in testicular sections is a good indicator of spermatogenic activity. Such information is valuable for the decision of obtaining spermatozoa from the testis for ICSI.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Prophylactic Oral Nifedipine to Reduce Preterm Delivery: A Randomized Controlled Trial in Women at High Risk290729128632ENEmad El-Din A. Soliman1 , Mohammed A. Emara 1 , Haitham A. Hamza1 , Amira H. Al-Sabaawy 21- Obestetrics and Gynecology department, Faculty of Medicine, Menofiya university, 2- Obstetrics and gynecology at Ministry of health, Berket El Saba. H. , Menofiya, EgyptJournal Article20180118<span>Objective: </span><span>to evaluate </span><span>the efficacy of prophylactic nifedipine versus placebo in reducing spontaneous preterm delivery in asymptomatic women at high risk for preterm delivery.<br /> </span><span>Background: </span><span>Preterm birth (before 37 completed weeks of gestation) is a major cause of death and a significant cause of long-term loss of human potential. Prophylactic nifedipine in reducing spontaneous preterm delivery in asymptomatic women at high risk for preterm deliver </span>
<span>Patients and methods: </span><span>A Prospective randomized double-blinded study was carried out on 120 pregnant women at high risk of preterm labor (5 cases lost in follow-up), (5 discontinued before 28 days because they had preterm delivery or drug side effects) which attended from the Obstetrics and Gynecology outpatient clinic in Minoufia University Hospital during the period from March 2016 to August 2017. Detailed history, laboratory investigations, obstetric and ultrasound follow up study were done. </span>
<span>Results: </span><span>there was no significant difference (P > 0.5) between nifedipine and placebo groups regarding maternal age, gestational age, parity, Previous preterm labor and Inter pregnancy interval (years). While, there </span><span>was statistically significant difference (P ≤ 0.05) regarding mode of delivery, delivery time and medications </span><span>side effects, neonatal respiratory distress and neonatal Intensive care unit (NICU) admission in both group. Additionally, onset of labor between 34-37 week was significantly less frequent in nifedipine group than placebo group. </span>
<span>Conclusion: </span><span>we found that the superiority of nifedipine as prophylactic tocolosysis in the mean prolongation of pregnancy compared to that of placebo in high risk women for preterm labor, it has better effect on neonatal outcomes, fewer maternal side effects. We would only comment that nifedipine looks like a promising drug in this regard and further large studies are required to establish this fact. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Public Awareness towards Hypertension among Saudis in AL Riyadh, KSA291329158633ENMatra Mohammed Fagihi1, Ahmed Mousa Almuhanna2, Abdulmalik Abdulaziz Almughamis3, Saud Abdulmajeed Bin Rakhis3, Eman Aied Alosaimi4, Muntadar Abduljabar Alsalman5, Hanaa Naif Alharbi61Prince Mansour Military Hospital, 2King Saud University, 3Imam Muhammad ibn Saud Islamic University, 4Umm Al-Qura University, 5King Khalid University, 6Al Qassim UniversityJournal Article20180122<span>Background: </span><span>Hypertension is a major health problem all over the world, causing high mortality and morbidity. It is a major risk factor for brain and heart diseases.<br /> </span><span>Objectives: </span><span>To assess the level of public awareness and knowledge towards hypertension among Saudis in AL Riyadh City.<br /> </span><span>Methods: </span><span>A cross-sectional self-administrated questionnaire based study distributed among 300 Saudis of AL Riyadh City.<br /> </span><span>Results: </span><span>The age was ranged from 30 to 60 and 55% were females and 45% were males respondents. The majority of them had bachelor degree and were employed. Most of the respondents had acceptable knowledge about hypertension, risk factors and management. Also, education was significantly associated with high levels of knowledge of this disease. </span><span>Conclusion: </span><span>Generally, public knowledge was good with high knowledge about risk factors and managements. No enough campaigns about hypertension to fill the gap. Also, education significantly impacts the knowledge of population about hypertension.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Study of Structural Changes in Diabetic Macular Edema by Spectral Domain Optical Coherent Tomography after Intravitreal Injection of Triamcinolone Acetonide291629258634ENFatma AbdAlwahab Atwa, Zeinab Saad El-Din Elsanabary*, Mona Mohamad Aly Farag, Sahar Saad El-Deen MohamedOphthalmology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo University*Journal Article20180320<span>Purpose: </span><span>is to study the morphological changes in Diabetic Macular Edema (DME) before and after intravitreal injection of triamcinolone acetonide using the spectral domain</span><span>–</span><span>optical coherence tomography (SD-OCT) parameters.<br /> </span><span>Patient and methods: </span><span>The study was held at Al-Zahraa University Hospital. It included 49 eyes of 40 patients with clinically significant diabetic macular edema (CSDME). A single intravitreal injection of triamcinolone acetonide (IVTA) at the dose of 4 mg in 0.1 ml was administered. Best corrected visual acuity (BCVA), intraocular pressure (IOP) and OCT scanning of the macula were done before and 3 months after IVTA. The OCT study parameters included central foveal thickness (CFT), OCT pattern of DME, vitreomacular interface (VMI), presence or absence of serous macular detachment (SMD), hard exudates (HEs), hyper-reflective spots (HRS) and IS/OS junction (Foveal ellipsoid zone) & ELM integrity.<br /> </span><span>Results: </span><span>Mean BCVA ± SD were (0.23 ± 0.13) and (0.39 ± 0.22) pre and 3 months after IVTA respectively. The initial mean CFT ± SD was (424 ± 127.1 um) while 3 months after IVTAit was (283.1 ± 70.2 um). Eighteen eyes showed SMD which was completely absent 3 months after a single IVTA. There was insignificant statistical difference of the VMI state before and 3 months after IVTA. Out of thirty-four eyes that showed the presence of HEs in this study, twenty-seven eyes showed diminution of these HEs size 3 months after injection. Forty-one eyes and forty-three eyes showed the presence of HRS before and after IVTA respectively. There was insignificant statistical difference in foveal ellipsoid zone and ELM integrity before and 3 months after IVTA. Complications were reported in 16 eyes (32.6%). Cataract progression was noted in 6 eyes (12.2 %). Steroid induced IOP elevation was reported in 10 eyes (20.4%).<br /> </span><span>Conclusions: </span><span>The data collected from OCT macular B scan are effective in the prognosis and follow up of diabetic macular edema. IVTA remains a promising primary therapy for DME at least in short terms. It seems relatively safe, but not without complications.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Endovascular versus Open Surgical Reconstruction in Long Segment Superficial Femoral Artery Occlusive Disease292629318635ENAyman Ahmed Talaat, Ramez Mounir Wahba, Ahmed Ashraf KamelDepartment of General Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20180320<span>Background: </span><span>The concept of endovascular intervention has been well supported by the continuous advance in technology in long segment (superficial femoral artery) SFA occlusions. The rapid evolution of stent design, deployment approaches and adjunctive therapy made the practice of (percutaneous transluminal angioplasty) PTA safer and more predictable and has reduced superficial femoral artey surgery.<br /> </span><span>Objectives: </span><span>To compare the safety and effectiveness of endovascular treatment versus open surgical bypass in treatment of superficial femoral artery occlusive disease.<br /> </span><span>Patients and Methods: </span><span>This prospective study included 30 patients presenting to the Vascular Department in Cairo University Hospitals with femoropopliteal occlusive disease for whom percutaneous transluminal angioplasty with or without stenting was done for 15 cases. Femoropopliteal bypass surgery with saphenous or synthetic graft was done for 15 cases between March 2017 and January 2018. The procedure, possible complications, benefits, risks and other alternative interventions were all explained to the patients and an informed consent was obtained.<br /> </span><span>Results: In endovascular cases: </span><span>1/15(6.66%) cases, developed small haematoma at the site of puncture which resolved by conservative management. After 6 months follow up,6/15 cases (40%) had intact pedal pulsation, 6/15 cases (40%) had popliteal pulsation with marked improvement of their complaints (disappearance of rest pain in 3 cases, the other 3 cases which had gangrene, line of demarcation appeared). 1/15 case (6.66%) showed popliteal pulse at 3 months follow up which disappeared at 6 months but the patient had good circulation with improvement of rest pain. So, successful cases were 13/15(86.66%) at 6 months follow up. 2 /15 cases(13.33%) showed occlusion, by Duplex 1 case of them showed occlusion of stent and 1 case showed return to original occlusion. </span><span>In open surgical cases: </span><span>Postoperative wound infection at groin incision developed in 3/15(20%) cases, 2 cases of them were managed conservatively by IV antibiotic and repeated dressing, and one developed secondary haemorrhage in which ligation of femoral artery was done and the limb became gangrenous and Above knee amputation was done. After 6 months follow up, 5/15 cases (33.33%) had intact pedal pulsation, 7/15 cases (46.66%) had popliteal pulsation with marked improvement of their complaints. Disappearance of rest pain occurred in 3 cases, while 3 cases which had gangrene, line of demarcation appeared and 1 case which had non healing ulcer, healing of ulcer started to occur. So successful cases 12/15(80%) at 6 months follow up. Thus, 3/15 cases (20%) failed, 1 case developed wound infection at groin incision followed by secondary haemorrhage in which ligation of the graft was done, the limb was worsen ended in above knee amputation. The other 2 cases showed occlusion of graft, 1 case ended in above knee amputation, the other below knee amputation was done in which the stump became gangrenous followed by above knee amputation.<br /> </span><span>Conclusion: </span><span>Percutaneous transluminal angioplasty (PTA) has obtained a definite place in the management of peripheral arterial occlusive disease of the lower limb. It was widely accepted as a first line of treatment for many patients with SFA occlusive disease. The low complication rate and relatively non-invasive nature of PTA made it an increasing popular intervention.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Combined Low Dose Aspirin and 17 α Hydroxyl Progesterone versus 17 α Hydroxyl Progesterone Alone Study in Pregnancy: A Randomized Clinical Trial for Prevention of Spontaneous Preterm Birth293229438636ENHassan Awwad Bayoumy, Amgad Abou-Gamrah, Mostafa Fouad Gomaa, Asmaa Ahmed Mohamed AlashwahObstetrics and Gynecology Department, Faculty of Medicine - Ain Shams UniversityJournal Article20180315<strong>Background</strong>: Preterm birth: defined as any live birth occurring through the end of the last day of the 37<sup>th</sup> week (259<sup>th</sup> day) following the onset of the last menstrual period. Low-dose aspirin (LDA) has been noted to reduce the preterm birth (PTB) rate in multiple meta-analyses of the preeclampsia (PreE) prevention trials<strong>.</strong> It is unclear if this effect of LDA is entirely due to a reduction in indicated PTB versus reductions in preterm premature rupture of membranes (PPROM) or spontaneous PTB. In the Maternal-Fetal Medicine Unit (MFMU) high-risk aspirin (HRA) study, a near significant decrease in PTB was found despite no effect on preeclampsia. The objective of this study was to assess the impact of LDA on indicated PTB, spontaneous PTB, and PPROM PTB in the MFMU HRA study population. <strong>Aim of the work: </strong>This study aim to assess the efficacy of 17 alpha hydroxyl progesterone and low dose aspirin in reducing the rate of preterm birth in pregnant women at this risk. <strong>Patients and Methods: </strong><strong>Study type: </strong>A double blinded randomized placebo controlled clinical trial. <strong>Study settings: </strong>This study conducted at outpatient clinic of Ain Shams University Maternity Hospital. <strong>Time of the study: </strong>The study was held from August 2016 to November 2017.
<strong>Results: </strong>Data was analyzed according to the intention-to-treat principle. In a total 400 women whom recruited in the study, 160 were excluded. So we ended in to 240 women whom randomized and allocated in to 2 groups to intervention. Primary outcome measure was preterm birth. The most important secondary outcome is a composite of poor neonatal outcome (including bronchopulmonary dysplasia (BPD), periventricular leucomalacia, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity (ROP), sepsis and perinatal death).There was no statistically significant difference between both groups as regarding to age, gravidity, parity, body mass index, mean cervical length, and number of previous preterm labor. There was no significant difference between two groups as regard preterm premature rupture of membranes (P.PROM).There was no significant difference between two groups as regard time of delivery there was no significant difference between both groups in Need for NICU admission, neonatal birth weight, APGAR score, fetal complications (RDS, jaundice, BPD, HIE, NEC, bleeding, sepsis or even neonatal death).Long term neurodevelopmental complications was not conducted at this study as it needs more time.In maternal complications there was no significant difference between both groups.
<strong>Conclusion: </strong>Further randomized controlled trials with larger sample size should be done to demonstrate the efficacy of low dose Aspirin in prevention of preterm labor and its complications.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Length of Left Anterior Descending (LAD) Coronary Artery in Relation to Right & Left Dominancy: A Retrospective Computed Tomographic (CT) Coronary Angiographic Study294429498637ENIssam Tariq Abdul Wahaab1, Sherif Abou Gamra2, Fatma Magdy Mohamad Salama2, Khaleel A. Hadi31Department of Anatomy, Faculty of Medicine, Baghdad University 2Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University 3X-ray Institute, Medical City Directorate, Baghdad, IraqJournal Article20180320<span>Background: </span><span>the LAD artery supplies blood to a large part of the myocardium. However, the amount of myocardium supplied varies depending on the length of LAD artery and as a result; occlusion at different portion may influence perfusion of different part of myocardial.<br /> </span><span>Objective: </span><span>to estimate the length of LAD artery and its possible relationship with the coronary arterial dominance pattern.<br /> </span><span>Patients and Methods: </span><span>in this study we retrospectively compared 50 coronary CT angiograms of patients with left coronary dominance with 50 coronary CT angiograms of patients with right coronary dominance<br /> </span><span>Results: </span><span>it revealed that there was a significant relationship between the length of LAD artery and the pattern of dominancy since the P- Value appeared to be < 0.001.<br /> </span><span>Conclusion: </span><span>length of LAD artery appeared to be dependent on the dominance pattern and it was taller in left coronary dominant pattern.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Evaluation of Outer Retinal Layers Changes before and after Intervention in Diabetic Macular Edema295629598639ENSherif Zaki Mansour[1] ,Thanaa Mohammed Helmy [1] ,Samah Mahmoud Fawzy[1], Radwa Reda Mohamed[2][1]Ophthalmology Department, Faculty of Medicine, Ain Shams University,[2]Ophthalmology Department, Faculty of Medicine, Cairo UniversityJournal Article20180320<span>Aim of the work: </span><span>this study aimed to evaluate changes in photoreceptors, inner segment/outer segment (IS/OS) junction and external limiting membrane (ELM) following grid argon laser versus intravitreal injection of antivgef ( Ranibizumab ) in diabetic type2 patients affected by clinically significant macular edema. </span>
<span>Methods: </span><span>forty eyes of diabetic type2 patients who were affected by clinically significant macular edema were randomly categorized into two groups( Group treated by argon grid laser and group treated by intravitreal injection of antivgef for the first time) both groups were investigated for best corrected visual acuity (BCVA) and the integrity of the photoreceptors, IS/OS and ELM as being (Continuous(+), interrupted( ±) or Absent (-) ) by spectral-domain optical coherence tomography (SD-OCT)( CIRRUS HD-OCT) before treatment , 1month, 2months and 3months after treatment . Other variables, included central macular thickness (CMT) and central macular volume (CMV) were evaluated. </span><span>Results: </span><span>significant difference was found between [photoreceptor, is/os] (+), photorecptor, is/os (+,-) and photoreceptor, is/os (-) groups in BCVA at baseline; it was 0.61,0.73,and 1 and after 6 months it was 0.48,0.73 and 1 . Results were similar for ELM groups. Signiant difference was found between ELM (+), ELM (+,-) and ELM (-) groups in BCVA at baseline it was 0.59,0.72,and 1 and after 6 months it was 0.46,0.68 and 1 in lucentis group and signiant difference was found between photoreceptor, is/os (+) and photorecptor ,is/os (+,-) groups in BCVA at baseline was(0.32and 0.3 and after 6 months it was 0.27and 0.3 . Results were similar for ELM groups. Signiant difference was found between ELM (+) and ELM (+,-) groups in BCVA at baseline it was 0.29 and 0.5 and after 6 months it was 0.25 and 0.4 in argon laser group </span>
<span>Conclusion: </span><span>the more damage of outer retinal layers at the time of DME the lower visual acuity following DME resolution and the presence of intact of these layers is an important factor in determining final visual acuity. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Assessment of Attitude and Perception toward Neurology and Neurosurgery Specialties among Medical Students and Interns Attending College of Medicine at University of Tabuk in Tabuk City, Saudi Arabia-2017296029628654ENMohammed Ahmed Alhejaili1, Mohammed Hamad Alrashedi1, Abdullah Noman Alatawi1, Meshari Faisal Alenezi1, Khalid Awd Albalawi1, Mohammed Faisal Albalawi21 Medical Intern, Faculty of Medicine, University of Tabuk, Tabuk/ KSA
2Medical resident, King Salman Armed Forces Hospital, Tabuk/ KSAJournal Article20171220<strong>Background: </strong>Although neurological and psychiatric disorders account for only 1.4% of all deaths, they account for a remarkable 28% of all years of life lived with a disability. Thus, all doctors must be prepared to meet the needs of patients with such disorders and refer appropriately for specialized care and investigations, bearing in mind that neurologists often function as consultants for other physicians.
<strong>Methods:</strong> We have conducted a descriptive cross-sectional study in Tabuk city population, Saudi Arabia. The study was conducted during the period from October to December 2017. The participants who attended the clinical years and interns at College of Medicine at University of Tabuk were included in the study. The total sample obtained was 104. A self-administered questionnaire, about perception and knowledge about neurological specialties, was filled by participants.
<strong>Results: </strong>The range of age was 21-26, with a mean (SD) of 22.72 (1.837), the majority were interns (34.6%). Nearly (31%) of them reported neurosurgery as the most difficult specialty.
<strong>Conclusion</strong>: This study highlights some of the reasons and suggestions to improve and correct perception of neurological specialties and subjects.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Role of Botulinum Toxin Type A in Management of Vocal Fold Contact Granuloma Meta-Analysis Study296329738655ENAhmed A. Mohamed, Amr N. Rabie, Marwa M. ElBegermy, Wael A. SobihDepartment of Otorhinolaryngology, Faculty of Medicine, Ain-Shams UniversityJournal Article20180320<span>Background: </span><span>granulomas of the vocal process of the larynx are benign lesions of the posterior glottis generally centered over the tips of the cartilaginous vocal processes. Clinically they are associated with odynophagia, throat clearing, globus, and otalgia.<br /> </span><span>Aim of the Work: </span><span>this meta-analysis study aimed to know the role of botulinum toxin type A in management of vocal fold contact granuloma.<br /> </span><span>Materials and Methods: </span><span>this study strictly followed the recommendation of referred reporting items for systematic reviews and meta-analyses (PRISMA) statement. It was done in the following steps: target determination, identification the location of articles, screening and evaluation, data collection, data analysis and finally reporting and interpretation. </span><span>Results: </span><span>there was acceptable complete response rate of contact granuloma to botulinum toxin injection with event rate of 85.422% while rate of improvement among selected cases was 92.962%. Concerning to complications the most common complication was hoarsness of voice with rate of 52.737% while dysphagia was 21.125% among cases. </span><span>Conclusion: </span><span>botulinum toxin is a safe and effective therapy in resolving vocal process granulomas. Complete response and partial response are significant in our study also decreased Valsalva effort, failure rate and relapse rate are all significant outcomes. While temporary post injection hoarsness of voice, dysphagia, local pain at injection sites and fluid aspiration considered non significant outcomes.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Role of Dynamic MRI in Assessment of Pelvic Floor Dysfunction in Females297429818656ENNada Ahmed Hussein, Naglaa Hussein Shebrya, Nermeen Nasry KeriakosRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180305<span>Introduction: </span><span>Pelvic floor dysfunction is a major medical and social problem. Dynamic MR imaging of the pelvic floor is an excellent tool for assessing functional disorders of the pelvic floor. Findings reported at dynamic MR imaging of the pelvic floor are valuable for selecting patients who are candidates for surgical treatment and for choosing the appropriate surgical approach.<br /> </span><span>Aim of the work: </span><span>To highlight the role of dynamic MRI as a non-invasive method in the assessment of pelvic floor dysfunction in females.<br /> </span><span>Methods: </span><span>Dynamic and static MRI were performed in 20 female patients complaining of pelvic organ prolapse and/or stress urinary incontinence or defecation disorder. Full history was taken and clinical examination performed and findings compared with MRI results.<br /> </span><span>Results: </span><span>Good concordance was found between dynamic MRI and clinical examination in all three compartments, it was 75% in the anterior compartment, 80% in the posterior compartment, 65% in enteroceles and 75.0% in the middle compartment.<br /> </span><span>Conclusion: </span><span>MR imaging provides excellent soft tissue contrast to ensure adequate diagnosis of the muscular and fascial defects responsible for pelvic floor dysfunction.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Maternal Obesity and Its Effect in Late Pregnancy and Labour298229888657ENHossam Aldin H. Kamel, Abdel Sattar M. Ibrahim, Mahmoud M. Abdo*Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20180218<span>Background: </span><span>In recent years, obesity has become a major public health problem and its prevalence is increasing at an alarming pace. Moreover, this problem has affected children and adolescents in marked fashion with a higher prevalence in females than in males.<br /> </span><span>Objective: </span><span>To evaluate the effect of maternal obesity on length of gestation and mode of delivery and subsequent intrapartum and neonatal complications.<br /> </span><span>Methods: </span><span>This prospective cohort study involved a total no. of 600 women with singleton pregnancies delivered in the period between December 2011 and July 2012 and were categorized into three groups according to their BMI; normal weight (18.5-24.9 kg/m2), overweight (25-</span><span>29.9 kg/m2) and obese (≥30 </span><span>kg/m2). The main outcome measures were length of gestation, mode of delivery, risk of delivery and neonatal complications in overweight and obese women versus normal weight women. Results: Obese women had a significantly increased risk of post-term pregnancy and higher rate of induction ending in caesarean section </span>
<span>compared with women of normal weight. Again, there was a significantly longer median length of first stage, increased incidence of second-degree tear and significantly increased risk of low Apgar score. However, the incidence of postpartum haemorrhage and third-degree tear were similar in all body mass index categories. As regard shoulder dystocia, there was a trend towards increased incidence with increasing BMI for primiparous women but just failed to reach significance (P=0.05). There was a trend towards increased incidence of macrosomia with increasing BMI category (P=0.074) this trend was significantly true for primiparous women (P=0.047), but no trend was observed for analysis restricted to multiparous women. </span>
<span>Conclusion: </span><span>Increasing BMI is associated with increased incidence of post-term pregnancy, failed progress of labour, labour induction, CS delivery, low Apgar score and macrosomic babies.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Sildenafil Citrate and Uteroplacental Perfusion in Fetal Growth Restriction298929958658ENAmr Hasan El-ShalakanyObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityMohamed Mahmoud Abd El AleemObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityMohamed Zaifer Ali BawadyObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180320<span>Background: </span><span>Severe early-onset fetal growth restriction can lead to a range of adverse outcomes including fetal or neonatal death, neurodisability, and lifelong risks to the health of the affected child. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates the actions of nitric oxide, which leads to vasodilatation of the uterine vessels and might improve fetal growth in utero.<br /> </span><span>Objective: </span><span>To evaluate effectiveness and safety of Sildenafil citrate for treatment of intrauterine growth restriction (IUGR). </span><span>Design: </span><span>A prospective randomized control study.<br /> </span><span>Setting: </span><span>At Ain shams University hospital and Kafr Aldwwar main Hospital in El-Beheria governorate. </span><span>Subjects: </span><span>Eighty pregnant women with gestational age between 24 and 34 weeks having singleton pregnancy and suffering from IUGR attending an antenatal clinic.<br /> </span><span>Methods: </span><span>Eighty pregnant women with FGR and abnormal umbilical artery Doppler between 24and34 weeks were randomly allocated to sildenafil (n= 40) 25mg tid or placebo (n=40) with a plenty of fluids until delivery. </span><span>Main outcome measure: </span><span>Length of pregnancy, neonatal weight and ICU admission.<br /> </span><span>Results: </span><span>Sildenafil treatment was associated with a significant increase in length of pregnancy (P</span><span>> </span><span>0.05) and a significant increase in estimated fetal weight by ultrasound (P<0.05), and was associated with a significant decrease in neonatal ICU admission (P=0.218) and neonatal mortality (P=0.290).<br /> </span><span>Conclusion: </span><span>Sildenafil citrate can improve utero-placental perfusion and length of pregnancy in pregnancies complicated by IUGR. It appears to have a significantly positive effect on fetal weight. Sildenafil treatment may offer a new opportunity to improve perinatal outcomes, for pregnancies complicated by IUGR. However these observations require further studies on wide scale.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Recent Management of Abdominal Aortic Aneurysm299630008659ENHossam ElDin Hassan El Azzazy, Haitham Mostafa Elmaleh, Mohamed Ismail Mohamed, Mahmoud Ahmed Adel El-SaidDepartment of General Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20180307<span>Background: </span><span>Abdominal Aortic Aneurysms had always been one of the most serious causes of mortality in the past decades until recently. Thanks to the modern advances in medicine and the technological revolution in Imaging and endograft Industry, treatment of Abdominal Aortic Aneurysms no longer imposes that high mortality risk it previously had. </span><span>Objective: </span><span>This study aims to review currently available evidence aiming at designing an approach for the management abdominal aortic aneurysm.<br /> </span><span>Subjects and Methods: </span><span>We are planning to search Medline, Plumbed, Cochrane databases using the keywords: "management", " abdominal", " aortic", " aneurysm". Any studies published in English with subjects with surgical and endovascular management of abdominal aortic aneurysm will be included up to 1/3/2017. </span><span>Results: </span><span>The present systematic review confirmed this belief. EVAR patients had a significantly lower 30-day mortality, shorter hospital and ICU stay, less blood loss or blood transfusion requirement, fewer postoperative cardiac and respiratory morbidities, less colonic ischaemia, and fewer overall postoperative problems compared to open repaired aneurysm patients.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Role of MRI Diffusion Tensor Imaging in Assessment of Normal Appearing White Matter in Cases of Multiple Sclerosis300130068660ENHanaa Abdel Kader Abdel Hameed, Samer Malak Botros, Emad Hamid Abdel Dayem, Tarek Hamed GomaaDepartment of Radiodiagnosis, Ain Shams University, Cairo, EgyptJournal Article20180320<span>Background: </span><span>Multiple sclerosis (MS) is an inflammatory demyelinating condition of the central nervous system (CNS) that is generally considered to be autoimmune in nature. White matter tracts are affected, including those of the cerebral hemispheres, infratentorium, and spinal cord. Several methods have been proposed, mainly using conventional MR modalities like T1, FLAIR or T2 images and enhanced MRI to delineate lesions. Conventional MR techniques cannot give detailed information about the integrity and location of WM tracts. Diffusion MRI is one of the non-conventional MRI techniques used for assessment of multiple sclerosis. The emergence of diffusion tensor imaging (DTI) is of great interest in MS. DTI probe the details of water diffusion within tissues, and could therefore reveal alterations in normal appearing white matter fibers before being visible in conventional MRI. Fractional anisotropy (FA), is the measure of the portion of the diffusion tensor that results from anisotropy (i.e, a measure of the directionality of the molecular motion of water).<br /> </span><span>Purpose: </span><span>to evaluate the role of diffusion tensor imaging (DTI) in the examination of the brain white matter that shows normal appearance on conventional MRI sequences in patients with MS, thus assessing its ability to detect early abnormalities at diffusion level. </span><span>Methods</span><span>: the study included 50 patients; 38 females and 12 males having MS (between 20 and 40 years of age) referred from Neurologists to Radiodiagnosis Department with 10 age</span><span>s’ </span><span>matched healthy control volunteers. Each patient included in the study was subjected to full history taking, reviewing medical sheet and MR examination including: Conventional MR examination and Diffusion Tensor imaging. Technique was performed using a standard 3 Tesla unit (Acheiva, Philips).<br /> </span><span>Results</span><span>: the study showed that DTI can reveal normal appearing white matter affection in MS cases before visible sizable plaques can be detected by conventional MRI.<br /> </span><span>Conclusion</span><span>: the current application of diffusion MRI to patients with MS shows that it has enhanced our understanding of the disease pathophysiology. The study reviewed here provides evidence that DTI-derived measures are more specific to the disease pathological processes and sensitive to the diffuse microscopic injury in the NAWM.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Measurement of Uterine Leiomyomata Volume Pre and Post Uterine Artery Embolization Aided by MRI30073016866110.21608/ejhm.2018.8661ENTamara M. Abdullah, Samer M. Botros, Wafaa R. AlyDepartment of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20180320<span>Background: </span><span>uterine fibroid embolization (UFE) is now evolving to be the first-line treatment for symptomatic uterine leiomyomata alongside the conventional surgical treatment of hysterectomy and myomectomy. Cochrane review comprises six RCTs comparing UAE versus hysterectomy or myomectomy for management of symptomatic leiomyomata where UFE had similar short and midterm outcomes, inclusive of symptomatic relief, quality of life and patient satisfaction, while benefiting from uterine preservation, shorter hospital stay and a faster recovery before resuming ordinary life activities. These benefits are in line with the minimally invasive nature of the embolization procedures. </span><span>Aim of the Work: </span><span>t this study aimed to review and illustrate the role of MR imaging in the pre- and post-procedural assessment for uterine fibroid patients undergoing uterine artery embolization. </span><span>Patients and Methods: </span><span>the current study was carried out in Radiodiagnosis Department, Faculty of Medicine, Ain shams University and specialized private radiology centers during the period between April 2017 and December 2017. It included 30 patients that were referred from gynecology clinic with their ultrasonographic reports to Radiodiagnosis Department, body imaging unit with a view to carry-out pelvic MRI with contrast. </span><span>Results</span><span>: imaging follow-up via pelvic MRI with contrast was obtained in 30 patients at 3, 6 months after treatment. The mean uterine volume was reduced by 25% (standard deviation was SD 0.03763) 3 months after treatment and was further reduced by a mean of 30% (SD 0.02638) by six months after treatment. Post-procedural subtraction MRI revealed mean myoma enhancement to be 5.6 + 0.5 SI in contrast to 133.4 + 18.3 SI prior to UFE. The mean dominant fibroid volume reduced by 34 % (SD 0.09247) after 3 months, 44 % (SD 0.05994) after 6 months. A cumulative reduction in both uterine and dominant leiomyoma mean volume from baseline to 6 months post </span><span>– </span><span>UAE was evident with significant interval changes between 3, 6 months follow up (p 0.000) </span><span>Conclusion: </span><span>the MRI findings following UAE vary with the interval from embolization and success of the procedure. MRI with its multiplanar capabilities was typically employed to evaluate the uterus following UAE for fibroid infarction, size reduction, location change, persistent enhancement, fibroid recurrence, changes in adenomyosis, and unexpected complications that may require surgical intervention or identify women who would benefit from repeated UAE. </span><span>Recommendations: </span><span>further studies on a larger scale of patients are needed to confirm the results obtained by this work.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401The Effect of Endometrial Injury by Office Hysteroscopy on The Outcome of Intrauterine Insemination301730248663ENAbd Almonem M Zakaria, Amro E Abo El-Ezz, Amr M Elbanawanyobstetrics and Gynecologydepartment, Faculty of Medicine-Al Azhar UniversityJournal Article20180320<span>Background: </span><span>Evaluating the uterine cavity is a basic step in investigating infertile women. Both the condition of the endometrium as well as the uterine cavity are thought to be important factors in determining receptivity for embryo implantation. </span><span>Aim of the Work: </span><span>In our study we conducted a trial to assess the effect of endometrial injury by hysteroscopy in the outcome of intrauterine insemination (IUI).<br /> </span><span>Patients and Methods: </span><span>This interventional prospective randomized controlled clinical trial was conducted at ElSayed Galal University Hospital during the period from January 2016 to October 201<br /> 7. The study comprised 200 of women diagnosed as unexplained infertility or with mild male factor. </span><span>Results: </span><span>The biochemical and clinical pregnancy rates were higher in women of group I when compared to women of group II [28 (28%) vs. 8 (8%), p=0.012 and 25 (25%) vs. 4 (4%), p= 0.034, respectively. </span><span>Conclusion: </span><span>Performing endometrial scratch using hysteroscopy in the preceding cycle of intra uterine insemination is a simple cheap maneuver that improves the chemical and clinical pregnancy outcome. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Topographic Changes in Keratoconic Patients after Transepithelial (Epi-On) Collagen Cross-Linking302530318664ENMohamed Abdel Monem Mahdy, Ahmed Nabil El Sayed Hafiz, Mahmoud Ali Kotb KoritenahDepartment of Ophthalmology, Faculty of Medicine Al-Azhar University, Cairo, EgyptJournal Article20180704<span>Objectives: </span><span>To evaluate corneal changes as measured by Pentacam before and after transepithelial corneal collagen cross-linking in cases of Keratoconus.<br /> </span><span>Study design: </span><span>A prospective consecutive case series study carried out at a private lasik centre<br /> </span><span>Patients and Methods: </span><span>74 eyes of 50 patients with progressive keratoconus underwent transepithelial (Epi-on) CXL using both ParaCel</span><span>TM and </span><span>vibeX-Xtra. </span><span>Baseline examination included: </span><span>full ocular examination, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), corneal topog</span><span>raphy using PentacamTM </span><span>to determine; flat corneal curvature (K1), steep corneal curvature (K2), mean corneal curvature (Km), corneal astigmatism, corneal thickness at the thinnest location and posterior surface elevation at the highest point in the central 5 mm. The follow-up visits were scheduled on 3 and 6 months after treatment by checking the BCVA, Pentacam</span><span>TM</span><span>.<br /> </span><span>Results: </span><span>Our results showed an improvements in BCVA at the end of the 6</span><span>th </span><span>month post operative that showed an increase from 0.48 to 0.54 and this was statistically significant (P value 0.007) (<0.01), Pentacam topographic changes were found to be decreased postoperatively and were found to be statistically insignificant.<br /> </span><span>Conclusion: </span><span>In this study, with a follow-up for 6 months, we found the transepithelial corneal collagen cross- linking is beneficial and safe for patients with keratoconus. Transepithelial CXL treatment appeared to halt keratoconus progression, with a statistically significant improvement in visual acuity by stabilizing or partially reversing the keratectasia process.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Comparison between Rubber Band and Ethelon Suture as A Cutting Seton in Perianal Fistula303230388666ENAhmed Medhat Ahmed Mokhtar MehannaGeneral Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20180320<span>Background: </span><span>fistula-in-ano is a commonly encountered surgical problem. There is a risk of sphincter muscle damage during </span><span>fi</span><span>stulectomy. Seton suture is used to decrease this risk. Different types of Setons are used for this purpose.<br /> </span><span>Aim: </span><span>to compare 2 types of cutting Seton as regard Postoperative pain, duration until Seton cut through, post operative faecal incontinence and recurrence. </span>
<span>Methods: </span><span>this study was conducted on 80 patients in 2 groups with high perianal fistula or low perianal fistula associate with abscess cavity. Patients with inflammatory bowel disease, history of malignancy, and previous recto- anal operations were excluded from this study. One group with insertion of sterilized rubber band and silk suture was applied at the anal verge the other with Ethilon sutures. Follow up and tightening of the seton done as outpatient. </span>
<span>Results: </span><span>about half (46.25%) had low perianal fistulas with abscess cavity, and 53.75% had high perianal fistulas. Group (A) patients had 10% wound infection and group (B) had 5%, all responded to conservative management. The mean VAS score of the patients on the 1st day was (3.7±1.14), and (2.85±0.92) and on the 7th day was (1.28±0.85) and (0.88±0.88) respectively. Seton fell down after a mean time (26.35 days ± 5.12 days) in group (A) and (27.65 days ± 6.84 days) in group (B). Complete healing was achieved in 77.5% of group (A) and in 60 % of group (B) after 1 month and 40 patients (100%) in both groups at 3 months. 7.5% of recurrence in group (A) and 2.5% case of recurrence in group (B). </span>
<span>Conclusion: </span><span>rubber band Seton is easy and cheap and provide slow and steady cutting of the sphincter maintaining continence. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Comparative Study between Oral Zinc Sulphate, Amino Acids Chelated Zinc and Placebo in Treatment of Viral Warts30393048866710.21608/ejhm.2018.8667ENTalal A. Abd El-Raheem1, Shaheera M. El Shafie2, Marwa A. Nassar1, Marwa H. Sayed11Department of Dermatology, STDs, and Andrology, 2Department of Clinical Pathology, Faculty of Medicine, Fayoum UniversityJournal Article20180320<span>Background: </span><span>Warts are tumors or growths caused by infection with Human Papilloma virus (HPV). More than 100 HPV subtypes are known. They are a common presenting disease in children and adolescents which spread by direct contact or autoinoculation. </span><span>The aim of the Work: </span><span>The aim of this work was to assess and compare the efficacy and safety of oral zinc sulphate and amino acids chelated zinc in treatment of viral warts. </span><span>Patients and Methods: </span><span>This cross sectional case control study included 60 patients with multiple viral warts who were collected from the Dermatology, STDs and Andrology outpatient clinic of Fayoum university hospital during the period from November 2014 to November 2015. The patients were 29 males and 31 females with ages ranging from 15 to 60 years. </span><span>Results: </span><span>There was statistically significant difference in degree of response in zinc and control groups as no patient in control group showed any response while in both zinc groups 27.5% of patients showed variable degrees of response. Also, there was no statistically significant difference in degree of response in both zinc groups. </span><span>Conclusion: </span><span>oral zinc in its both forms used in our study is safe but needs time to act and the response is not high, so it is not fit to be used as a monotherapy, but rather to be combined with other wart treatment modalities. </span><span>Recommendations: </span><span>More studies are needed to assess the therapeutic effect of zinc and its efficacy in combinations in warts treatment with higher doses and longer duration of treatment.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Effect of Trigonella, Allium Sativum and Their Mixture on Some Physiological Parameters in Hyperthyroidimic Rats304930558668EN*Eman G.E Helal, Rasha AA El Sayed, Sara Ebrahiem, Mohamed A. MustafaDepartment of Zoology, Faculty of Science (Girls), Al-Azhar University, Cairo, Egypt.https://orcid.org/0Journal Article20180320<strong>Background: </strong>alterations in the level of hormones including thyroid hormones lead to physiological/ clinical abnormalities<strong>. Aim of work:</strong> this study aimed to illustrate the protective effect of <em>Trigonella, Allium sativum</em> or their mixture against hyperthyroidism induced by L-thyroxin in male albino rats. <strong>Materials and methods: </strong> thirty albino rats were divided randomly into five groups. <strong>Group A</strong>: healthy rats, <strong>Group B: </strong>normal rats were subcutaneously injected with 500 µg/kg body weight L-thyroxin once daily for two weeks to induce hyperthyroidism, <strong>Group C</strong>: hyperthyroid rats received oral dose of 250 µg/kg body weight/day <em>Trigonella</em> extract. <strong>Group D</strong>: hyperthyroid rats received oral dose of 250 µg/kg body weight/day <em>Allium sativum</em> extract. G<strong>roup E</strong>: hyperthyroid rats received mixture of <em>Trigonella and Allium sativum</em> extract. At the end of the experiment. Blood samples were collected for biochemical analysis. <strong>Results:</strong> hyperthyroid rats had significant increase (P<0.05) in serum levels of triodothyronine (T<sub>3</sub>), thyroxin (T<sub>4</sub>), TG, VLDL, AST,ALP,BUN and uric acid as well as a significant decrease in TSH, LDL, HDL, LDL/HDL and TC, total protein and percentage of body weight change compared to the normal control group. Oral administration of these extracts ameliorated most of the tested parameters.
<strong>Conclusion: </strong>This study concluded that <em>Allium sativum, Trigonella</em> or their mixture have a protective effect against hyperthyroidism
<span><br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Stress Among Medical Students during Simulation Training at King Saud bin Abdulaziz University for Health Sciences305630608669ENAlhanouf Alhedaithy1, Rawan Mesmar1, Nouf AlBawardy1, Amal Alomri1, Fadi Munshi2, Hani Lababidi2 And Evangelos Georgiou31 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 2 King Fahad Medical City, Riyadh, Saudi Arabia,3 Athens University Medical School, Athens, Greece.Journal Article20180123<span>Background: </span><span>Simulation training is increasingly being used as a safe format to instruct students and trainees in different skills and procedures in the field of medicine. In this study, we recorded stress levels among medical students during simulation training for a lumbar puncture (LP) procedure performed on a mannequin and investigated the association between stress and performance.<br /> </span><span>Methodology: </span><span>This study was conducted on 39 fourth year female medical students. Students wore a galvanic skin response (GSR) sensor on their wrist before being asked to attempt the LP procedure on the mannequin on two separate occasions. Students' performance was assessed using a validated LP checklist on each attempt. Data were compared across all simulation attempts and for each student.<br /> </span><span>Results: </span><span>Collectively, mean wrist GSR levels increased from the mental rehearsal phase 0.31 mS ± 0.40, during the first attempt 0.48 mS ± 0.62 and continued to increase significantly (</span><span>P </span><span>= 0.007) during the second attempt 0.60 mS ± 0.80. There were no significant differences (</span><span>P </span><span>= 0.32) between the checklist scores of the first and second attempts.<br /> </span><span>Conclusion: </span><span>The results of our study support the previous evidence that linked simulation training with emotional and physiological stress. Performing highly intense procedures such as LP is considered to be a potential source of stress. Our findings showed that there was a continuous increase in the level of stress associated with repeated attempts during the LP simulation that had no significant impact on clinical performance. As the practice of medicine involves exposure to a remarkable number of stressors and critical conditions, we emphasize the importance of training medical students in ways to cope more effectively with these situations.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Review of MRI Wrist Results at KAUH306130658670ENFawaz M. AlDhafiri1, Hatem E. Althagafi1, Abdullah H. Gadeer2, Suliman M. Kassar1, Mohammed Z. Lamfon2, Mohammed G. Alghanemi1, Amre S. Hamdi31- King Abdulaziz University, 2- University Of Jeddah, 3-Department Of Orthopedics, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaJournal Article20180124<span>Background: </span><span>Magnetic resonance imaging (MRI) is defined as one of the most important modalities used for diagnosing lesions of small and complex structures in the body (1). We aimed to investigate the most common wrist pathologies detected by MRI in KAUH (King Abdulaziz University Hospital) in Jeddah.<br /> </span><span>Methodology: </span><span>A retrospective study was done with a total sample size of 127 individuals who underwent wrist MRI investigation at KAUH in Jeddah (Saudi Arabia), between 2010-2016. The data entry was performed by using Microsoft Excel 2014, and statistical analysis was performed by SPSS V21.<br /> </span><span>Results</span><span>: The results of the analysis showed that the most common wrist pathology was ganglion cysts, constituting 17.8% of the 157 findings we observed. Other common findings were Tenosynovitis (10.2%), TFCC (Triangular fibrocartilage complex) tear (10.2%), TFCC degeneration (5.7%) and subchondral cysts (3.8%). There was also a significant relation between normal/abnormal findings in individuals and their age of presentation. Age mean was 29.27 (±7.46 SD) for those with normal findings, and 37.33 (±15.62 SD) for those with abnormal findings, (P value less than 0.001). Regarding X-ray investigation, we found that most of the sample (65.4%) did not undergo X-ray prior to MRI. </span><span>Conclusion: </span><span>It has been found that there is variance between all findings that were discovered by MRI, that there are differences between our study and those of others, and that due to the different sorts of cases that were presented to the hospital. We also found that most of the individuals with wrist pathologies did not get X-rays before MRI, so we recommend a clear policy of ordering MRI, also proper history and examination should be the essential tool to reach hand and wrist diagnoses. That will help in saving resources.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200271420180401Impact of Laparoscopic Ovarian Drilling (LOD) on Ovarian Reserve and Ovarian Stromal Blood Flow Using Two-Dimensional (2D) Power Doppler in Anovulatory Women with Polycystic Ovary Syndrome (PCOS)306630788671ENIsmael M. Algarhy, Mohamed A. Mohamed, Loay F. El-Desoky, Ibrahim A. AbdelmotaglyDepartment of Obstetrics and Gynacology, Faculty of Medicine, Al-Azhar UniversityJournal Article20180320<span>Aim of the Study: </span><span>this study aimed to determine the effect of LOD on ovarian reserve and ovarian stromal blood flow changes, by using Two-Dimensional (2D) Power Doppler Ultrasongraphy in anovulatory women with Polycystic Ovary Syndrome (PCOS) and whether this could explain the mechanism of action of LOD. </span><span>Patients and methods</span><span>: this study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Al-Hussein University Hospital, El-Sayed Galal Hospital and EL-Sheikh Zayed Especialized Hospital in the period between November 2016 and February 2018. This study included 30 anovulatory polycystic ovary women with clomiphene citrate (CC)-resistant and 30 fertile women as the control group. Laparoscopic ovarian drilling was done. Serum levels of hormonal profile were measured (AMH, LH, FSH, LH/FSH ratio and total testosterone), ovarian stromal blood flow Doppler indices (RI and PI) and occurrence of ovulation or pregnancy. </span><span>Result: </span><span>in this study we reported our findings regarding the effects of LOD on AMH, hormonal profile and ovarian stromal blood flow in women with PCOS with clomiphene resistance. These results suggested that the measurement of AMH, LH, LH/FSH ratio, total testosterone, ovarian volume and ovarian stromal blood flow by Doppler were in discrimination of PCOS from potentially normal women. The data in our study suggested that there were no significant differences as regard AMH, hormonal profile except total testosterone, ultrasound ovarian findings and ovarian stromal blood flow before and after LOD, but there were significant differences as regard total testosterone before and after LOD. Also, there was good predictive value for AMH after LOD for ovulation and clinical pregnancy. </span>
<span>Conclusion: </span><span>measuring AMH for anovulatory women with PCOS undergoing LOD may be a useful tool in evaluating the outcome of LOD, but ovarian stromal blood flow 2D Doppler indices did not show significant changes predicting ovulation or pregnancy rate after LOD.<br /> </span>