Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Effect of Sildenafil Citrate on the Outcome of in vitro Fertilization after Multiple IVF Failures Attributed to Poor Endometrial Development: A Randomized Controlled Trial1553155711581ENMekled A.K.H, Abd El-Rahim A.M, El-Sayed ADepartment of Obstetrics and Gynecology, Ain Shams UniversityJournal Article20180826<strong>Aim of the work: </strong>this study aimed to evaluate the effect of sildenafil citrate on endometrial development in women with history of recurrent implantation failure after IVF.<br /> <strong>Setting</strong>: This study was conducted in obstetrics and gynecology department of Ain Shams University.<br /> <strong>Patients and methods: </strong>this is arandomized controlled trial on 80 women with previous two or more failed IVF. Women in <strong>group A</strong> (N=40) took oral sildenafil citrate at dose 25mg tab/ 6h daily from day six of induction of ovulation until day of HCG administration; while those in <strong>group B</strong> (N=40) took placebo tablets. <strong>Outcome</strong> <strong>measuers</strong>: The primary outcome was change in endometrial thickness before and after intervention. <strong>Results</strong>: Endometrial thickness in both groups was statistically insignificant between the two groups when measured in day 6 with p-value 0.070.Endometrial thickness on day of HMG injection measured and found that it was higher in <strong>group A</strong>(Sildenafil Group) than <strong>group B</strong>(Placebo Group) with significantly increased statistically difference between the two groups with p-value <strong><</strong>0.001.<br /> <strong>Conclusion</strong>: sildenafil citrate leads to smooth muscle relaxation and vasodilation. This may enhance endometrial development and increased pregnancy rate in females undergoing IVF which may be attributed to the increase in the endometrial thickness.<br /> <br /> Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Serum level of Visfatin in Psoriasis and its Relation to Disease Severity155815621158410.12816/0040100ENWaleed Mohamed Abd ElfattahDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine,
Ain shams UniversityJournal Article20180826<strong>Background:</strong> psoriasis is a chronic, debilitating, autoimmune disease that adversely affects the individual's quality of life; the disease progresses with periods of flare-ups and remission. Psoriasis affects approximately 2% of the global population. Psoriasis can begin at any age, however, the mean age of onset was 15-20 years old and the second peak period was 55-60years of age .
<strong>Aim of the Work:</strong> this study aimed to evaluate the serum level of visfatin in psoriatic patients and its relation to duration and severity of psoriasis.
<strong>Subjects and Methods:</strong> the present study represents a case-control study which was carried out on 20 patients with psoriasis vulgaris and 20 age and sex matched healthy volunteers as the controls.
<strong>Results:</strong> in the present study, serum level of visfatin in patients group was statistically significant higher than serum level of visfatin in the control group. There was a significant positive correlation between visfatin level and PASI score proposing visfatin as a marker of psoriasis severity.
<strong>Conclusion:</strong> Visfatin is one of adipokines that may have a role in the pathogenesis of psoriasis and its severity in addition to its role in the cardiovascular system diseases, which may explain the relation between psoriasis and cardiovascular complications and their severity in the psoriatic patients.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Value of Pre-Procedural Multi-Detector Computed Tomography Angiography Prediction Outcome in Retrograde Approach Recanalization for Coronary Chronic Total Occlusion156315691158810.12816/0040101ENAhmed Ahmed KhashabaDepartment of Cardiology, Faculty of Medicine - Ain Shams UniversityKhaled Abdel Azeem ShokryProfessor of Cardiology, Military Medical AcademyYaser GomaaDepartment of Cardiology, Faculty of Medicine - Ain Shams UniversityDiaa El Din Ahmed KamalDepartment of Cardiology, Faculty of Medicine - Ain Shams UniversityThanaa Maghraby Ogeal AwadDepartment of Cardiology, Faculty of Medicine - Ain Shams UniversityJournal Article20180826<strong>Background:</strong> Computed tomography coronary angiography(CTCA) can be useful in procedure planning for CTO PCI by identifying factors known to influence PCI success rates, such as calcification, severe tortuosity and length of the occluded segment. Percutaneous coronary intervention for CTO is considered to be one of the most challenging procedures of interventional cardiology, and in the earlier studies, successful recanalization rates of CTO ranged from 51% to 74%. However, with improved operator experience and the development of novel equipment and techniques, procedural success rates have been increased, which brings an increasing number of CTO into a treatable category.
<strong>Patients and </strong><strong>Methods: </strong> An exploratory pilot study was conducted on 40 patients using retrograde wire approach with various strategies by highly experienced CTO operators in Ain Shams University hospitals and in Kobry Elkobba Military hospital from August 2015 to 2017.
<strong>Results: </strong>According to the results CTOs were divided into two groups, group1 with successful retrograde PCI in 32 pts. (80%), and group 2 with failed-retrograde PCI in 8 pts. (20%) All CTOs were correctly identified by MIP,MPR,cMPR images. Most of the CTOs were located in the proximal 21 patients 52.5% then mid 14 patients 35% ostial 3 patients 7.5% and lastly distal 2 patients 5%. In failed group there were more calcified plaques. There was more calcification in the CTOs segments (p=0.005). Ten arc-calcified and two circular-calcified lesions were identified only 4 from ten patients (40%) had arc calcified Plaques which were successfully recanalized and 6 patients 60% failed. <em>In circular-calcified lesions</em> one patient (50%) succeeded and one failed. Proximal artery tortuosity between two groups showed a significant difference (p=0.000). <strong>Conclusion: </strong>Complex CTO lesion morphology is still an important issue for CTO-PCI procedural success, and further improvement of technologies (MDCT) and medical devices, such as guide wires and catheters are required to improve the success rate.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Prevalence of Intake of Dietary Supplements in the Population of Saudi Arabia– Jeddah157015751159110.12816/0040102ENIbrahim Abdullah AlbakriNajran UniversityMayssan Hussein AlmalkiBatterjee Medical CollegeSamaher Maher BukhariBatterjee Medical CollegeShahad Sami EkramUm Alqura UniversityAbdulrahman Khalid AldhubayiQassim UniversityMarium Mohammed IqbalBatterjee Medical CollegeYosra Abdallh Frag Al-AloyTaibah UniversityAljoharah Mohammed AlmazrouAlmaarefa CollegeAbdullah Saud AlotaibiKing Faisal UniversityMadihah Nafea S AlruwailiNorthern Border UniversityNourah Ali AlshamraniTaif university,Zahra Jaber HusseinImam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaJournal Article20180826<strong>Background: </strong>Several studies have shown micro-nutrient deficiencies in the Middle East region. Prominent defects in vitamin D, folate, and iron were especially noted. There are not many studies currently that tell us about the prevalence of dietary supplement intake in Saudi Arabia.<br /> <strong>Aim: </strong>The aim was to observe the current prevalence of dietary supplement use in Saudi Arabia. We will also attempt to elicit the reason they take the supplements, and how it affects their overall quality of life. <br /> <strong>Method: </strong>Cross-sectional study among 489 Saudi patients was without any exclusion criteria using a standard questionnaire. The study was held at the endocrinology department of King Abdul Aziz Hospital & Oncology Center in Jeddah, Saudi Arabia. <br /> <strong>Results:</strong> The overall prevalence of multivitamin, mineral and supplement intake in the Saudi population was found to be 22%. Among them 16% were male and 24% were female.<br /> <strong>Conclusion: </strong>Healthcare providers must spread more awareness about the potential benefits of dietary supplements in preventing non-communicable diseases. <br /><br />Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Role of MRI Assessment of the Patellar Instability Mariana Fikry Nashed, Mohammed Amin Nassef, Amir Louis Louka157615811159410.12816/0040103ENMariana Fikry NashedRadiology Department, Faculty of Medicine, Ain-Shams UniversityMohammed Amin NassefRadiology Department, Faculty of Medicine, Ain-Shams UniversityAmir Louis LoukaRadiology Department, Faculty of Medicine, Ain-Shams UniversityJournal Article20180826<strong>Background: </strong>Patello-femoral stability is principally influenced by anatomic factors. Understanding the anatomy and biomechanics of the patello-femoral joint provides insight into the etiology and management of patellar instability. Magnetic resonance imaging (MRI) has emerged as an auxiliary method for investigating patello-femoral instability, particularly for detecting osteochondral lesions and for evaluating the medial patello-femoral ligament (MPFL). <strong>Objective: </strong>descriptive study including analysis of MRI knee done for patients with patellar instability suspected clinically with or without history of trauma.
<strong>Patients and Methods: </strong>Thirty patients were included in the study, all with suspicious patellar instability from Ain-Shams University orthopedic clinic and other private clinics. A cross-sectional study was held where all the patients under-went MRI routineknee protocol. MRI knee images were interpreted for identification of different pathologies contributing to patellar instability.
<strong>Results: </strong>Sixty percent of the patients included in our study had MPFL injury, 43% showed patella alta, 83% showed trochlear dysplasia (by different measurements) and 43% showed lateral displacement of TT.
<strong>Conclusion: </strong>MRI the modality of choice in diagnosing different pathologies of patellar instability, for its value in assessing soft tissue structures, detailed imaging of the cartilage and applying all measurement required.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Decidual Natural Killer Cells (Cd56+) Population in the Placental Bed in Accidental Hemorrhage158215881159710.12816/0040104ENHassan Tawfik KhairyDepartment of Obstetrics and Gynecology, Faculty of Medicine - Ain Shams UniversitySherif Fathi El-MekkawiDepartment of Obstetrics and Gynecology, Faculty of Medicine - Ain Shams UniversityMohammed Saeed Eldin ElsaftyDepartment of Obstetrics and Gynecology, Faculty of Medicine - Ain Shams UniversityAml Shawqi Kamal El ShialDepartment of Obstetrics and Gynecology, Faculty of Medicine - Ain Shams UniversityJournal Article20180826<strong>Background: </strong>Accidental hemorrhage is defined as abnormal complete or partial separation of normally implanted placenta after 20 weeks of gestation and prior to birth. Risk factors which have been found associated with accidental hemorrhage include maternal age, parity, smoking, hypertension, past history of accidental hemorrhage, thrombophilic disorders, abdominal trauma and polyhydramnios. <strong>Aim of the Work:</strong> The aim of our study was to find if there is any role for decidual natural killer cells in cases with placental abruption. <strong>Patients and Methods:</strong> This is a case control study in which 60 pregnant women recruited from Obstetric Department of Ain Shams University Maternity Hospital. Patients were subjected to emergency cesarean section. Multiple tissue biopsies (5 mm thick) were taken from the decidua basalis of the placental bed and immunostained for decidual CD 56+ve bright natural killer cell marker.
<strong>Results:</strong> Our results show that there was a highly statistically significant difference between the study and control group as regard immunohistochemical scores (according to CD 56+ %), In control group: score 0 = 0.0%, score 1+ = 0.0%, score 2+ = 18.5%, score 3+ = 29.6%, score 4+ = 51.9% while in the study group: score 0 = 25.9%, score 1+ = 40.7%, score 2+ = 29.6%, score 3+ = 3.7%, score 4+ = 0.0%; (Chi square 42.133 FE) and (P. value = 0.000). Also there was a highly statistically significant difference between the study and control group as regard dNK cells density (uNK cells as a percentage of total stromal cells), in control group: low density = 18.5% and high density = 81.5% while in the study group: low density = 96.3% and high density = 3.7%; (Chi square 33.400 FE) and (P. value = 0.000). <strong>Conclusion:</strong> These findings suggest that low dNK score and density was associated with cases of placental abruption.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Using Serum Beta Trace Protein to Estimate Residual Kidney Function in Hemodialysis Patients158915941160010.12816/0040105ENHesham M. El-SayedNephrology Department, Faculty of Medicine, Ain Shams UniversityHussein S. HusseinNephrology Department, Faculty of Medicine, Ain Shams UniversityAhmad M. ElarnosyNephrology Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180826<strong><span lang="EN-US">Aim of the work: </span></strong><span lang="EN-US">residual kidney function (RKF) in end stage kidney disease (ESKD) patients contributes significantly to solute clearance. This improves survival as well quality of life in these patients. Kidney Diseases Outcomes Quality Initiative (KDOQI) guidelines suggest that hemodialysis (HD) dose can be safely reduced in those with RKF in the form of residual urea clearance (KRU) of 2 ml/min/1.73 m<sup>2</sup> or more. However, measurement of RKU is difficult as it requires regular inter-dialytic urine collections. Simpler methods for measuring KRU and thus RKF are needed. Beta trace protein (BTP)have been proposed as alternative markers of RKF and RKU. Dialysis specific equations to estimate KRU based on serum BTP wererecentlydeveloped. This study aimed to compare measured KRU using inter-dialytic urine collection and estimated KRU using serum BTP.<strong>Patients and Methods</strong>: we included 60 ESKD patients in this study;they were divided into 2 groups. Group-1(G-1) had daily urine output <500ml and group-2(G-2) haddaily urine output >500ml. We estimated and measured KRU in both groups. Correlation between measured and estimated KRU in each group was done using Pearson correlation coefficient. <strong>Results</strong>: the estimated and measured KRU was strongly correlated in G-1 with r=0.746 at p<0.01 , but it was week in G-2 with r=0.44 and p<0.05.Mean bias between estimated and measured KRU was 0.7 mL/min in G-1. In G-2 the mean bias was -0.54mL/min. <strong>Conclusion</strong>: KRU and thus RKF can be better estimated using serum BTP in patients with urine output >500mL than in patients with daily urine output200-500mL.<br /> <strong><br /></strong></span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Awareness About the Role of Bariatric Surgery in Mortality and Morbidity among General Population of Albaha City159516021160210.12816/0040106ENAli M.A. AlamriFaculty of Medicine, Albaha University, Albaha, KSARaed A.M. AlzahraniFaculty of Medicine, Albaha University, Albaha, KSAFares A.M. AlzahraniFaculty of Medicine, Albaha University, Albaha, KSAAbdulrahman A. AlghamdiFaculty of Medicine, Albaha University, Albaha, KSAAbdulrahman H.A. AlghamdiFaculty of Medicine, Albaha University, Albaha, KSAOsama H.A. AlhabiFaculty of Medicine, Albaha University, Albaha, KSASaeed Y.S. AlghamdiFaculty of Medicine, Albaha University, Albaha, KSAJournal Article20180826<strong>Background:</strong> Obesity is an emerging health concern worldwide and in Saudi Arabia. Until now bariatric surgery is the most effective treatment for morbid obesity.
<strong>Objective:</strong> The aim of this study was to measure awareness about the role of bariatric surgery in mortality and morbidity among general population in Albaha city in Saudi Arabia.
<strong>Methods:</strong> A questionnaire was distributed among the general public in Albaha city, Saudi Arabia. The questionnaire consisted of two parts, the first one included personal data and the second one was concerned with awareness and knowledge of people regarding effectiveness and complications of bariatric surgery. Only completed questionnaires without missing data were subjected to statistical analysis.
<strong>Results:</strong> The majority of respondents opposed surgery and didn't believe in its effectiveness compared with other treatment lines. There were false beliefs about the regaining of weight after surgery and exaggeration of its complications. The most common causes for refusal of surgery were lack of need and fear of complications while the most common motives for acceptance were desire of more weight loss and health benefits.
<strong>Conclusion:</strong> Health education is necessary to increase patients' awareness and knowledge about bariatric surgery. The topics to be focused upon are the expected benefits after surgery, the maintenance of weight and the nature and incidence of surgical complications.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Spontaneous Spinal Epidural Hematoma in Pregnancy160316061160510.12816/0040107ENAli Malik AlahmedImam Abdul-Rahman Bin Faisal UniversityFaisal AlabbasKing Fahad university of Dammam,
Faculty of MedicineMajdi Saleh AlzahraniUmm Al-Qura University, Makkah , Saudi Arabia.Journal Article20180826 Spinal epidural hematoma (SEH) is an uncommon condition. Spontaneous SEH, accounting for 0.3–0.9% of all spinal epidural space occupying lesions, instead is associated with risk factors (such as substantial soft trauma or coagulation abnormalities).The pathophysiology of spontaneous and idiopathic SEH is still under debate: There are only a few reports in literature of spontaneous evolving SEH with progressively increasing pain and neurological impairment.
Magnetic resonance imaging may be inconclusive for differential diagnosis. Here, we present a 38-years old female on the 2nd trimester of her pregnancy preset with spontaneous spinal epidural hematoma with a sudden onset of weakness and back pain fallowed by a sudden paraplegia. MR imaging showed high intensity irregular dotted lesion seen in the lower thoracic region (T12), in addition, MRI revealed an intervertebral disk prolapse with a cord compression between (L3-L4) (L4-L5).
The Surgical treatment of the case, the patient underwent laminectomy and an evacuation of the hematoma by the neurosurgical team allowed a correct diagnosis but still paraplegic. Our aim is to discuss the clinical and radiological features and the treatment options.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Study of Relationship between G894T Variant of Endothelial Nitric Oxide Synthase Gene and Acute Ischemic Stroke160716131160810.12816/0040108ENEman A. EL GoharyClinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Adel A. El Azab,Manal M. M. Kamal EL-DinClinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Shaimaa K. MohammedClinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180826<strong>Background: </strong>Cerebral stroke (CS) is considered as one of the major causes of death and disability worldwide<strong><em>. </em></strong>Ischemic stroke is the most common type of stroke in Egypt, as in other countries, accounting for 43% to 79% of all stroke types <em>.</em>There are some traditional factors that increase the risk of ischemic stroke such as hypertension and smoking, but genetic risk factors, suggested by evidence from inheritance-based studies, might contribute to predisposition to ischemic stroke.Among investigated genetic variations of eNOS is G894T polymorphism that leads to a change of glutamate to aspartate at site 298 and is said to have increased susceptibility to cleavage of eNOS enzyme which contribute to the development of stroke<em>.</em>
<strong>Patients and methods: </strong>The study was conducted on a group of thirty <strong>(30) </strong>Egyptian patients admitted to the Neurology Department and Stroke Units of Ain Shams University hospitals (Al-Demerdash hospital).They were presented with acute ischemic stroke in the first 48 hours and diagnosed according to clinical neurological and radiological examinations. Oral informed consents were obtained either from the patients or their relatives before enrollment in the study according to the Ethical Committee of Faculty of Medicine, Ain Shams University. In addition, ten (10) Egyptian apparently healthy, age and sex- matched subjects were investigated as control group. All individuals included in this study were subjected to full history taking, thorough general, neurological and radiological assessment. The laboratory investigations included complete blood count, coagulation profile, and blood glucose level assay. Furthermore, eNOS G894T gene polymorphism was assessed by PCR- RFLP. Results: In this study, we couldn’t find a significant association between eNOS G894Tgene polymorphism and acute stroke Egyptian patient.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Awareness about Cruciate Ligament Injury among General Population of Albaha City161416231161410.12816/0040109ENFares A.M. AlzahraniFaculty of Medicine, Albaha University, Albaha, KSARaed A.M. AlzahraniFaculty of Medicine, Albaha University, Albaha, KSAAbdulrahman A. AlghamdiFaculty of Medicine, Albaha University, Albaha, KSAAbdulrahman H.A. AlghamdiFaculty of Medicine, Albaha University, Albaha, KSASaeed Y.S. AlghamdiFaculty of Medicine, Albaha University, Albaha, KSAMashhour M.H. AlghamdiFaculty of Medicine, Albaha University, Albaha, KSAAli M.A. AlamriFaculty of Medicine, Albaha University, Albaha, KSAJournal Article20180826<strong>Background:</strong> Anterior cruciate ligament (ACL) injury is very common in young and active individuals who have continued active participation in sports. This injury might cause functional disability with many economic and social consequences. So, there is a need to raise awareness of the general population about this type of injury in order to decrease its incidence and complications.
<strong>Objective:</strong> This cross sectional study was undertaken to investigate the awareness of the general population in Albaha city, Saudi Arabia towards ACL injury.
<strong>Methods:</strong> A self-administered questionnaire was randomly distributed to individuals aged 18-60 years of both sexes, 464 subjects agreed to participate, answered the questionnaire and were involved in the study.
<strong>Results: </strong>Findings showed that 77.8% of the study participants were aware of ACL injury and ranked it as a serious disease. Great percent (36.0%) of the studied persons realized the role of sports as a risk factor of ACL injury. The majority (60.8%) proposed an interaction between two or more of; incorrect technical movements, lack of self- protection awareness, insufficient preparation and overload of exercise. Low percentages of all participants considered prolonged walking, prolonged standing, going up and down stairs, prolonged sitting, getting up from a sitting position, kneeling or squatting or running actions that might increase the incidence of ACL injury.
<strong>Conclusion:</strong> Findings showed reasonable awareness of the general population in Albaha city about the seriousness of ACL injury, but there was lacking in their information about risk factors other than sports, dangerous actions that increase incidence of ACL injuries and their characteristic symptoms. There is a need for increasing health education and raising awareness and more implementation of prevention programs for ACL injuries.
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<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Role of Intervention Radiology in Renal Vascular Injuries162416271161710.12816/0040110ENAmr Ahmed Hanafy Mahmoud AbdelkaderRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptSameh Mohamed Abd EL WahabRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptRasha S. HussienRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptKarim Ahmed Abd El-TawabRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180826<strong>Background: </strong>Trans-catheter renal artery embolization has a role in the management of iatrogenic and traumatic renal vascular injuries. <strong>Objective: </strong>To assess the technical success and short term clinical efficacy of renal artery Embolization in patients with iatrogenic and traumatic renal vascular injuries. <strong>Methodology: </strong>All cases were done at interventional radiology unit Ain Shams University. <strong>Conclusion: </strong>Renal artery embolization plays a great role in the management and treatment of renal vascular injuries either traumatic or iatrogenic. <br /> <strong><br /></strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Granulocyte-Colony Stimulating Factor Prevents Motor Dysfunction and Histological Damages In A Rat Model Of Parkinson’s Disease162816331162110.12816/0040111ENMariama S. AzmyDepartment of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, EgyptEsther T. MenzeDepartment of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, EgyptReem N. El-NagaDepartment of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, EgyptMariane G TadrosDepartment of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, EgyptJournal Article20180826<strong>Aim of the work</strong>: Parkinson’s disease is the most common neurodegenerative movement disorder worldwide. The main motor clinical manifestations of Parkinson’s disease are resting tremors, bradykinesia, rigidity, and postural instability. In the present study, we aimed to evaluate the effects of granulocyte-colony stimulating factor (G-CSF) on the body weight, motor function, and brain histology of rotenone-treated rats.
<strong>Material and methods</strong>: Rats were divided into four groups, as follows: <strong>Group 1</strong> the control rats, <strong>Group 2</strong> the rotenone-treated rats (2 mg/kg, 28 days), <strong>Group 3</strong> the rotenone + G-CSF (20 µg/kg, 28 days)-treated rats and <strong>Group 4</strong> the rotenone + G-CSF (40 µg/kg, 28 days)-treated rats. Body weight was measured on weekly basis. Postural instability was evaluated at the end of the study and the motor behavior was monitored. Then, rats were decapitated and brain histology was examined. <strong>Results:</strong> Rotenone resulted in body weight loss, bradykinesia/akinesia, rigidity, postural instability, and histological damages. All these deficits were prevented by G-CSF at 40 µg/kg. Therefore, G-CSF may be a potential neuroprotective agent in Parkinson’s disease.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Maternal Serum Vascular Endothelial Growth Factor in Patients with Preeclampsia163416401162410.12816/0040112ENMohammed Salah El-SokkaryObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityTamer Ahmed El-RefaieObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityNoha Bassiouny Hassan MostafaObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityMona Mohamed Soliman ElaassarObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180826<strong>Background:</strong> Vascular endothelial growth factor and placental growth factor levels were significantly lower in patients of sever or early onset (34 weeks or less gestational age at onset of PET) pre-eclampsia than in controls. <strong>Aim of the Work:</strong> Will there be a rise in serum vascular endothelial growth factor in pregnant women suffering from preeclampsia than in normotensive pregnant women.<br /> <strong>Patients and Methods:</strong> 150 pregnant women from 28 weeks of gestation till term will be enrolled into this comparative clinical trial at the time of their antenatal visit to the outpatient department of obstetrics and gynecology Ain Shams University maternal hospital. <strong>Results:</strong> We recruited 150 pregnant women after 28 weeks of gestation and they were classified into 3 groups: Group1:50 pregnant women with mild preeclampsia from 28 weeks of gestation till term, Group2: 50 pregnant women with severe preeclampsia from 28 weeks of gestation till term and Group 3: 50 normal pregnant women serving as controls. <strong>Conclusion:</strong> We conclude that serum VEGF level measured after 28 weeks of gestation can be used as a predictor for preeclampsia and its degrees (mild and severe) with high sensitivity and specificity.<br /> Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Laser-Assisted New Attachment Procedure – LANAP164116451162510.12816/0040113ENAhmad Farid AtteyaIbn Sina national College for Medical StudiesReem Mohammad ShafeiIbn Sina national College for Medical StudiesAbrar Aqeel A JefriIbn Sina national College for Medical StudiesMohammad Abdulsalam AlhindiIbn Sina national College for Medical StudiesJournal Article20180826 The LANAP process is a protocol that compacts with inflammation, the infectious procedure, occlusion, tooth mobility, and an osseous component. The LANAP protocol is rather simplistic. Utilized by a certified and trained periodontist or dentist, it is a surgical laser procedure intended for the treatment of periodontitis through regeneration rather than resection. The definitive objective is to set up the periodontal condition to advance self-regeneration of the lost attachment and osseous structure that result from periodontal ailment. Regeneration is a fairly complex event and, as observed with guided tissue regeneration or scaling and root planning alone, can be very unpredictable. LANAP is predictable. This article introduces a general depiction of the LANAP protocol (laser-assisted new attachment procedure) and the advantages of its utilization to patients.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Comparative Study between Measuring FSH, LH and E2 on Day Two and on Any Day of the Cycle164616541162710.12816/0040114ENShereif A. HameedObstetrics and Gynecology, Faculty of Medicine, Ain Shams UniversityAhmed H. SalamaObstetrics and Gynecology, Faculty of Medicine, Ain Shams UniversityDina H. SalamaObstetrics and Gynecology, Faculty of Medicine, Ain Shams UniversityShaimaa M. AliObstetrics and Gynecology, Faculty of Medicine, Ain Shams UniversityJournal Article20180826<strong>Background: </strong>evaluation of ovarian reserve has become an essential part of the treatment assessment of woman to undergo assisted reproductive technique.<strong> Aim of the Work: </strong>this work was conducted to measure FSH, LH and E2 at any day of the whole menstrual cycle compared to day2 with measurement and establishing an actual negative correlation between FSH & E2. <strong>Patients and methods: </strong>observational analytical prospective study on 50 women attending the Gynecology Outpatient Clinics of Maternity Hospital, Ain-Shams University in 2016. <strong>Results:</strong> there was a significant negative correlation between E2/FSH on the 3<sup>rd</sup>, 5<sup>th</sup> and 10<sup>th</sup> days of the cycle. Also there was insignificant negative correlation on day 21. <strong>Conclusion: </strong>there was negative correlation between basal day2 E2/FSH which was equivalent or similar to that ratio on days (5,10,21) so there was no need to wait for hormonal analysis to the next cycle (day 2 or 3) to save time specially in patients >35years; for them there was importance of cycle day3 for evaluation of ovarian reserve and prior ovulation induction and subsequent pregnancy potential during the infertility work up. <strong>Recommendations:</strong> during the infertility work up, rigid adherence to cycle day3 collection, no longer seems necessary ,no need to wait for hormonal analysis to Estradiol and FSH to the next cycle as there was equivalent negative correlation between E2/FSH on menstrual cycle days (3,5,10,21) aiming for saving time.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Role of MRI Assessment of the Patellar Instability165516601162810.12816/0040115ENMariana Fikry NashedRadiology Department, Faculty of Medicine, Ain-Shams UniversityMohammed Amin NassefRadiology Department, Faculty of Medicine, Ain-Shams UniversityAmir Louis LoukaRadiology Department, Faculty of Medicine, Ain-Shams UniversityJournal Article20180826<strong>Background: </strong>Patello-femoral stability is principally influenced by anatomic factors. Understanding the anatomy and biomechanics of the patello-femoral joint provides insight on the etiology and management of patellar instability. Magnetic resonance imaging (MRI) has emerged as an auxiliary method for investigating patello-femoral instability, particularly for detecting osteochondral lesions and for evaluating the medial patello-femoral ligament (MPFL).
<strong>Objective: </strong>descriptive study including analysis of MRI knee done for patients with patellar instability suspected clinically with or without history of trauma.
<strong>Patients and Methods: </strong>thirty patients were included in this study, all with suspicious patellar instability from Ain-Shams University, orthopedic clinic and other private clinics. A cross-sectional study was held where all the patients under-went MRI routine knee protocol. MRI knee images were interpreted for identification of different pathologies contributing to patellar instability.
<strong>Results: </strong>sixty percent of the patients included in our study had MPFL injury, 43% showed patella alta, 83% showed trochlear dysplasia (by different measurements) and 43% showed lateral displacement of TT.
<strong>Conclusion: </strong>MRI the modality of choice in diagnosing different pathologies of patellar instability, for its value in assessing soft tissue structures, detailed imaging of the cartilage and applying all measurement required.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Evaluation of Tuberculosis Awareness in Eastern and Western Saudi Arabia166116671162910.12816/0040116ENMahdi M AlmuhannaKing Faisal UniversityMohammed J BusalehKing Faisal UniversityHassan A AlkhalafKing Faisal UniversityYousif T AlMalakKing Faisal UniversityZahra A AlhussainKing Faisal UniversityMeshal A AlmustafaKing Faisal UniversityNshwa M AshorKAUHTameem A AlhomaidQassim UniversityMuhannad M AldubaykhiQassim UniversityMuath S AlshammasiQassim UniversitySaleh A AlghadouniQassim UniversityMuna J AlhuthaliUmm Alqura UniversityHassan M AlradhwanWroclaw Medical UniversityMohammed D AlharbiAl Imam Mohammad Ibn Saud Islamic UniversityHadeel A AlZiyadiTaif UniversityAnas S AlsamaaniQassim Mental Health HospitalJournal Article20180826<strong> Background:</strong> Previously, and specifically at the last period of 20th century, TB was one of the major leading cause of death. However, the incidence of TB has been decreased. Around ten million cases have been reported in 2015, 61% of them are recorded in Asia. The yearly incidence rate of TB that is recorded in Saudi Arabia is 12/100,000. Eradicating TB is the future plan for the entire world, and WHO are intending to get free TB world. This plan can't be real if general populations are not aware of TB.
<strong> Aim:</strong> The aim of this study is to assess knowledge, attitude and practice with TB among eastern and western Saudi Arabia community. <strong>Method:</strong> That was cross-sectional study. So, participants have been selected by random sample from public places in eastern and western Saudi Arabia. The tool that we used to collect data is Self-administrated questionnaire contains demographic part and awareness of TB evaluation part. Then we compare evaluations results according to many variables specifically the region by Chi-Square Test. We consider the result of the comparison is significant level once P-value < 0.05.
<strong> Result:</strong> Around 750 participants in this study (Response rate 93.75%) by mean age 32. Only 3.6% have a history of TB and 16.8 % have relative with a history of TB. Only 18.1% of participants have good knowledge, only 15.1% have favorable attitude and most of the participants have a good practice (63.7%). People with high degree educational level have better knowledge than others. People who have relative with a history of TB have better knowledge. Females are better in attitude more than male, western populations have a better attitude than eastern, and people who have relative with a history of TB have a better attitude. People with high degree education have a better practice than others and people who have relative with a history of TB have a better practice.
<strong> Conclusion:</strong> Eastern and western region in Saudi Arabia have a very poor knowledge and Attitude towards TB, and Western populations have better attitude compared to that of Eastern. Participants have high percentage of a good practice which still needs to be improved Level of education is an important factor that may control the level of knowledge about TB.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Role of Surveillance CT in Detection of Pre-Clinical Relapse in Patients with B-Cell lymphoma: A Retrospective Study166816731163010.12816/0040117ENAhmad Hassan SolimanDepartment of Radiodiagnosis, Faculty of Medicine
Ain Shams UniversityShorouq Sabry Rizq AlyDepartment of Radiodiagnosis, Faculty of Medicine
Ain Shams UniversityJournal Article20180826<strong>Background: </strong>with the evolution of curative treatment regimen, the rate of complete remission achieved in patients with diffuse aggressive non-Hodgkin lymphoma is continuously rising. It is achievable at the end of primary treatment in about 60-80%. On the other hand relapse is very common in the 1<sup>st</sup> two years after end of primary treatment in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma, that is to say, about 20-25% of patients relapse after complete response. Use of routine surveillance imaging for relapse detection is still an area of controversy. Evidence is still lacking to support the utility of routine imaging (namely CT scan) in detection of pre-clinical relapse in diffuse aggressive non-Hodgkin lymphoma (NHL). This work aims at adding further evidence to the pool of studies available in the literature which might encourage, or disapprove the rule of CT as a routine imaging procedures in lymphoma patients who achieved CR.
<strong>Objectives: </strong>I. To clarify whether surveillance CT scan has a significant role in early detection of asymptomatic relapse in B-Cell lymphoma patients. II. To assess the contribution of image-based relapse detection to the overall survival of B-Cell lymphoma patients<strong>.</strong>
<strong>Design: </strong>this is a retrospective cohort study in which 50 Patients with B-Cell lymphoma diagnosed between 2014 and 2016 were selected from the PACS of Radiology Department at Ain Shams University Hospitals. Age ranges between 20 and 70 year-old. All diagnoses were confirmed by histopathology studies. All patients underwent treatment and follow-up strategy as planned by their treating oncologist/hematologist, after which they entered CR or SD according to IWG Cheson criteria of treatment response. Disease progression was retrospectively reviewed over a period of 6 months up to 2 years. Surveillance CT scan was performed on the neck, chest, abdomen and pelvis on each of the planned follow-up visits. Relapses were defined as “asymptomatic” if there were no reported symptoms and a normal examination was recorded.
<strong>Results:</strong> the most common cause of relapse detection was patient-reported symptoms alone (41%) or in combination with abnormal blood tests and/or physical examination (23%). Routine imaging was responsible for relapse detection in 27% of the patients. The unadjusted median OS for patients with imaging-detected relapse was 90 months versus 38 months for patients non imaging-detected relapse (P = 0.0008). Although surveillance imaging proved no significance in detection of pre-clinical relapse, our regression analysis showed that it remained significantly associated with reduced risk of death.
<strong>Conclusion: </strong>clinical symptoms remain the leading factor in diagnosing recurrent lymphoma in the era of modern imaging, and this study questions the clinical relevance of current practice. A possible survival advantage was seen for patients with image-detected relapse.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Radioembolization in Treatment of Hepatocellular Carcinoma with Portal Vein Invasion167416791163210.12816/0040120ENElsahhar Ahmed HettaRadiodiagnosis Department, Faculty of Medicine, Ain Shams UniversityOsama Mohamed Abdel HameedRadiodiagnosis Department, Faculty of Medicine, Ain Shams UniversityAly Haggag Aly NoreldienRadiodiagnosis Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180826<strong>Aim of work: </strong>this study aimed assess the efficacy of radioembolization (Yttrium-90) therapy in Hepatocellular carcinoma (HCC) patients with portal vein thrombosis.
<strong>Patients and methods:</strong> this study included 24 patients diagnosed with HCC and portal vein invasion to be treated with Transarterial Radioembolization (TARE). They were 17 males and 7 females. Patients received a single course of treatment.
<strong>Results: </strong>tumor radiological response assessment revealed that the tumor was controlled in 92% of the patients. Complete response was observed in 21 % of the patients, partial response in 29 % of the patients, stable disease in 42 % of the patients and progressive disease in 8% of the patients.
<strong>Conclusion</strong>: Yttrium-90 radioemblization appeared to be an effective, safe and feasible treatment option for patients with hepatocelluar carcinoma with portal vein invasion.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Role of Diffusion Weighted MRI Sequence in Evaluation of Cholangiocarcinoma168016911163410.12816/0040118ENAhmed H. E. IsmailTheodor Bilharz Research InstituteMohamed F. HusseinTheodor Bilharz Research InstituteYasser A. M. Abd El MawlaFaculty of Medicine, Ain Shams UniversityAmr M. Abd El SamadFaculty of Medicine, Ain Shams UniversityJournal Article20180826<strong>Background</strong>: cholangiocarcinoma requires accurate diagnosis, which relies on appropriate imaging and image-guided biopsy. Diffusion weighted MRI is a relative new and increasingly used technique. It can be obtained during a single breath-hold, there is no need to use contrast media and it provides information that reflects tissue cellularity and organization. ADC maps can provide quantitative measurements of tissue water diffusivity. It proved to be helpful in the characterization of cholangiocarcinoma. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Effect of Sublingual Misoprostol on Intraoperative Blood Loss During Abdominal Hysterectomy: Randomized Controlled Trial169216971167510.12816/0040119ENMakled A KDepartment of obstetrics and gynecology- Ain Shams UniversityAlsaied A, Ismail ODepartment of obstetrics and gynecology- Ain Shams UniversityFarhan S.Department of obstetrics and gynecology- Ain Shams UniversityJournal Article20180827<strong>Objective:</strong> To investigate whether the use of preoperative misoprostol can reduce blood loss during total abdominal hysterectomy (TAH).
<strong>Methods</strong>: In a randomized single-blind placebo-controlled trial at Ain Shams university maternity hospital, between May 2016 and June 2017, women (n = 118) undergoing TAH with or without bilateral salpingo-oophorectomy for symptomatic myomas were randomly allocated to receive either 400 μg of misoprostol or placebo 30 minutes before surgery.
The primary outcome measure was postoperative drop in hemoglobin.
The secondary outcomes were intraoperative blood loss, need for blood transfusion, and incidence of adverse effects. <strong>Results</strong>: The 2 groups were similar with regard to demographic and clinical characteristics. There was a significant reduction of blood loss during TAH after sublingual administration of misoprostol compared with placebo before surgery (355.1 mL vs 531.4 mL; P < 0.001). The mean postoperative hemoglobin concentration was higher (11.1g/dL vs 10.7 g/dL; P < 0.015) and the postoperative drop in hemoglobin was smaller (1.2 g/dL vs 1.8 g/dL; P < 0.001) in the misoprostol group than in the placebo group.
No significant adverse effects occurred in either group.
<strong>Conclusion: </strong>The results showed that a single dose of misoprostol administered before abdominal hysterectomy resulted in a significant reduction of blood loss with minimal adverse effects.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Review of Microtia: A Focus on Current Surgical Approaches169817051167610.12816/0040136ENNujaim H. AlnujaimDivision of Plastic and reconstructive surgery, Department of SurgeryMohammed H. AlnujaimCollege of Medicine, King Saud University, Riyadh, Saudi ArabiaJournal Article20180827 A wide spectrum of anomalies may involve the auditory system. As a visible structure, auricular malformations constitute a great burden. A wide set of anomalies may affect the ear including the microtia spectrum, protruding ears (bat ear), constricted ear (Lop and Cup ears), Stahl ear, and cryptotia.In plastic surgery practice protruding ears and microtia are common presentations. Microtia literally means <em>small ears</em>. Microtia is a spectrum of anomalies of the auricle that range from disorganized remnant of cartilage attached to soft tissue lobule to complete absence of the ear (anotia). Ear reconstructive procedures has made in impact in the lives of these patients. The early attempts to surgically restore the ear in microtia was in <strong><em>1920</em></strong> using a rib cartilage<strong>.</strong> Up to 49% of microtia cases are associated with other anomalies or a known syndrome. The most common syndromic associations are <em>hemifacial microsomia, Towens Brocks syndrome, Treacher Collins, Goldenhar and Nager syndrome.</em> O<em>culo-auriculo-vertebral spectrum (OAVS).</em> Generally, the ear can be retrieved by two possible methods:<em> Surgical reconstruction</em> using <em>autologous</em> or <em>alloplastic</em> cartilage and the use of <em>prosthesis</em> which could be adhesive or implant retained. Surgical reconstruction proved to be superior to other methods due to its longevity and less complications. The only limitation is the skill of the surgeon. Ear prosthesis are reserved for special cases including traumatic anotia in adults.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Awareness Level of Parents about Antibiotics Those Are Given to Children in Riyadh Region 2017170617121167910.12816/0040137ENAli H AlhawajIbn Sina National College for Medical StudiesFay S Al-DossariPrincess Nourah Bint Abdulrahman UniversityMohammed N ALMusaadAL Imam Mohammad Ibn Saud Islamic UniversityMohammed D AlharbiAL Imam Mohammad Ibn Saud Islamic UniversityHassan A AlkhalafKing Faisal UniversityMuath S AlshammasiQassim UniversityMohammed F ALMujalliAL Imam Mohammad Ibn Saud Islamic UniversityEsraa M BakhshPrincess Nourah Bint Abdulrahman UniversityNawal S AlosaimiUmm AlQura UniversityAsma A AltalhiTaif UniverstyAminah H AlAliUmm AlQura UniversityNaif A AlajjiKing Saud UniversityHadeel A AlZiyadiTaif UniverstyNourah A AlsumairiTaif UniverstyMaram M AljohaniKing AbdulAziz UniversityJournal Article20180827<strong>Background:</strong> Defect of use of antibiotics is bothering pediatricians. This defect is participating in the prevalence of one of global health problem called antibiotic Resistance. Many articles are supporting the idea that use of antibiotics is positively related to antibiotic resistance and this problem is increasing and growing up. By the way, incorrect use of antibiotics has many factors that contribute on, like patient attitude and deficiency of education from the physician who prescribed the antibiotic. Also, patient's knowledge and practice with the antibiotic like self-prescription. What is patient expecting from antibiotic and previous experience with antibiotics? Parents are responsible to give medications to children. So, we need to increase parents' knowledge, attitude and practice (KAP) toward antibiotics to reach new generation without antibiotic resistance. Regarding Saudi Arabia, antibiotic resistance already exists and the rate of resistance is increased in the last decade. <strong>Aim of the work:</strong> To assess how parents are aware of antibiotics those given to their children by evaluating knowledge, attitude, and practice of parents in Riyadh region, central Saudi Arabia.
<strong>Methods:</strong> This is questionnaire based cross-sectional study. Authors were circulating on Riyadh Region to find volunteers to fill questionnaires among parents of children in public places by selecting parents of children up to 12 years old by choosing random samples from each place. The questionnaire has two parts: the first part, as usual, is containing demographic data. While the second part: is the part that is evaluating KAP of parents towards antibiotics. Then we compared the final results by Chi-Square test and p-values less than 0.05 was considered as significant value.
<strong>Results:</strong> around 1058 parents volunteered to participate in this study (response rate was 88.16%) by mean age of 38. Around 89.6% used antibiotics for their children before. There are 9.5% of parents were believe that their children need antibiotics each time they get sick. More than 35% of our participants don’t complete period of antibiotic use to their child as what is mentioned on prescription. About 82.3% believe that antibiotics can harm children. There are 41.7% of parents bought antibiotics to their children from the previous prescription. Around 61.1% don’t know the term antibiotic resistance. There are 28.4% of participants could change their doctors if they don't prescribe antibiotics easily, while only 642(60.7%) could change their doctors if they prescribe antibiotics excessively. About 68.1% of participants believe that doctors prescribe antibiotics excessively. Nearly 49% have good KAP, 41% of participants have intermediate KAP and remaining 10% have poor KAP. Females are better than male in KAP, people with high degree education are better than other and parents who used antibiotics before are better than those who didn’t (p-value < 0.05).
<strong>Conclusion:</strong> Level of knowledge, attitude, and practice of people in Riyadh region is ranging between good to moderate, and tends to be good. We can expect antibiotics resistance to happen among new generation in Riyadh region. There is an unacceptable idea that is highly prevalent among parents that doctors excessively prescribe antibiotics. Moreover, mothers have better awareness than fathers. People with high degree level of education have better awareness than others.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Corneal Endothelial Changes after Iris-Claw Anterior Chamber Phakic Intraocular Lens Implantation171317221168110.12816/0040138ENMagdy E. KhallafDepartment of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHassan M. BayomiDepartment of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptTaha A. FaroukDepartment of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20180827<strong> Background: </strong> Compared to other refractive surgeries, implantation of phakic intraocular lenses (pIOL) have more desirable results and are potentially reversible procedures due to the possibility of explanting these lenses. These methods usually do not require expensive or special surgical equipment and most ophthalmologists are able to perform these procedures., however disabilities resulting from pIOL are more severe compared to corneal refractive surgery. Due to the potential risk of damage to anterior segment structures, especially corneal endothelial cell loss, pIOL implantation is subjected to debate.
<strong>Aim of the Work: </strong>To evaluate the endothelial cell count changes in eyes implanted with the iris-claw phakic lens for treatment of moderate to high myopia as regard changes in cell density.
<strong>Patients and Methods: </strong>This study included Ten eyes of patients with moderate to high myopia implanted with The Iris-Claw Anterior Chamber Phakic Intraocular Lens at Al-Hussein University Hospital, In this prospective randomized study we did Preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japan).) were performed to evaluate endothelial cell count changes over 6 months. Endothelial cell images were collected in the central region of the cornea before surgery and 1 and 6 months after surgery. The main outcome measures were central corneal ECD and the percentage of corneal endothelial cell loss. Secondary outcome measures were UCVA, BCVA, manifest refraction, and complications.
<strong>Results: </strong>Preoperative mean endothelial cell count was 3198.50 ± 444.67 cells/ mm² (range, 2715.00 – 3846.00 cells/ mm²)., it was 3074.50 ± 410.76 cells/ mm² (range, 2609.00 – 3686.00 cells/ mm²) at 1 month after surgery., 3003.00 ± 411.91cells/ mm² (range, 2532.00 – 3610.00cells/ mm²) at 6 months after surgery. The mean endothelial cell loss was 6.07% at the end of the follow up period with 3.79% at one month postoperative, 2.37% from one to six months postoperative. The mean BCVA improved from 0.27 ± 0.09 preoperatively to 0.44 ± 0.12 postoperatively and the mean UCVA, from 0.02 ± 0.01 to 0.33 ± 0.09 postoperatively, the mean SE was -0.93 ±0.57 D Postoperatively.
<strong>Conclusion:</strong> Artisan phakic IOL had excellent results including., their suitability for high myopes, reversibility, high optical quality, predictability, safety, efficacy, potential gain in visual acuity in myopic patients and did not produce significant corneal endothelial cell loss 6months after surgery.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Clinicoepidemiological Study and Survival Analysis of Right versus Left Sided Colon Cancer Patients172317371168510.12816/0040139ENRokaya. M. RegeaiClinical Oncology and Nuclear medicine department, Ain Shams University Hospitals. EgyptAmr. L. FarajClinical Oncology and Nuclear medicine department, Ain Shams University Hospitals. EgyptAmr. S. TawfikClinical Oncology and Nuclear medicine department, Ain Shams University Hospitals. EgyptNesreen. A. MosalamClinical Oncology and Nuclear medicine department, Ain Shams University Hospitals. EgyptJournal Article20180827<strong>Background: </strong> Recently, there is a great attention, about the clinicopathological differences between right and left colon cancer, and how much these differences will affect the outcomes of colon cancer patients. Many epidemiological studies have demonstrated, that tumor at the right and left colon, respectively, occur with different incidence in diverse region of the world. Differences in clinical presentation, patient’s demographics, and tumor biology between right- and left- sided colon cancers have long been reported in the literatures.
<strong>Methods: </strong>The current study was conducted in Clinical Oncology and Nuclear medicine department, Ain Shams University Hospitals, during the period from January 2011 to December 2015, data on all patients histologically confirmed with colon cancer, were evaluated right-and left-sided cancers were compared with regard to epidemiological, clinical and pathological parameters as well as survival data.
<strong>Results:</strong> The study showed that, there was 129 patients, 70(54.2%) patients had left-sided colon cancers and 59(45.7%) patients had right-sided colon cancers, most of the cases were aged above 50 years 61.2%. Histopathological type was mainly adenocarcinoma 72.09%, moderately differentiated 79.8%, the mucinous carcinoma was more in right sided colon 56.25%. Comparison of progression free survival in stage IV, showed higher progression rate (58.3%) in right sided patients, than left sided patients (41.6%), this difference was not statistically significant. We also found that patients with right-sided colon cancer had a statistically significantly worse overall survival (OS) P value=0.019, than patients with left-sided colon cancer. We demonstrated that the differences in OS were significant only in patients with stage IV colon cancer.
<strong>Conclusion: </strong>In conclusion, our results support evidence that there are differences in the biology and outcomes for right- and left-sided colon cancers. Significantly better survival is seen for metastatic colon cancer with a left-sided, and this was confirmed by multivariate analysis. This might have been due to several environmental and lifestyle factors, which contributed to this anatomical shift. The differences in genetic and molecular pathologic profiles in each side of the colon were observed. Stratification based on the primary site should be considered in the future for trials assessing survival for colon cancer.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Role of Transvaginal Contrast Enhanced MRI in Early Detection and Staging of Cervical Cancer: A Review173817471168610.12816/0040140ENNermeen Mostafa Abd Elmonam AliDepartment of Radio Diagnosis, Faculty of Medicine, Ain Shams UniversityFaten Mohmed Mahmoud KamelDepartment of Radio Diagnosis, Faculty of Medicine, Ain Shams UniversityMennatallah Hatem ShalabyDepartment of Radio Diagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20180827Cervical cancer is the second most common gynecologic malignancy. It usually takes years for pre-cancerous changes to turn into cervical cancer. This pre-cancerous changes when detected is 100% treatable. Accurate cervical cancer staging is crucial for appropriate treatment selection and treatment planning. The greatest difficulties in the clinical staging are the estimation of tumor size, especially if the tumor is primarily endocervical in location. MRI has excellent soft-tissue contrast resolution, which exceeds that of CT and US. Consequently, MRI is significantly more valuable in the assessment of the size of the tumor, the depth of cervical invasion, and the local-regional extent of the disease.
<strong>Aim of the Study: </strong>to highlight the role of transvaginal contrast enhanced MRI in the early detection& staging of cervical cancer to guide for accurate management.
<strong>Conclusion: </strong>High-resolution MRI is accepted as optimal for evaluation of the main prognostic factors and selection of therapeutic strategy for cervical cancer.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Magnetic Resonance Spectroscopy in Evaluation of Multiple Sclerosis174817561168810.12816/0040141ENMustafa Al Hassan Abdou HeidarDepartment of Radio Diagnosis, Faculty of Medicine, Ain Shams UniversityIman Soliman MetwallyDepartment of Radio Diagnosis, Faculty of Medicine, Ain Shams UniversityTougan TahaDepartment of Radio Diagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20180827MS is a diffuse immune-mediated inflammatory disease that evolves over time; it’s characterized by the presence of CNS lesions disseminated in space and time. Plaques of inflammatory demyelination within the CNS are the pathologic hallmark of MS. 1H-MRS is a noninvasive imaging technique that’s promising as diagnostic technique for MS as well as a good marked for immune-modularity therapy response and as a predictor for clinical disability in MS. Aim of the Study: To highlight the value of MR spectroscopy in evaluation & monitoring patients with multiple sclerosis and how MR spectroscopy can add valuable information to conventional MR. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Study of the Level of Copeptin in Patients with Diabetic Retinopathy175717631168910.12816/0040142ENMohamed Reda HalawaDepartment of Internal Medicine Department of Ophthalmology and Ophthalmic Surgery,
Faculty of Medicine, Ain Shams University, Cairo, EgyptAbeer Ahmed AbdullahDepartment of Internal Medicine , Department of Ophthalmology and Ophthalmic Surgery,
Faculty of Medicine, Ain Shams University, Cairo, EgyptEvit Ezzat Eid IskandarDepartment of Internal Medicine Department of Ophthalmology and Ophthalmic Surgery,
Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180827<strong>Background: </strong>there were over 7.8 million cases of diabetes in Egypt in 2015. The prevalence of diabetic retinopathy in Egypt among adult diabetic patients in 2010 was around 20.5%. 90 percent of all cases of blindness from diabetes can be prevented. Copeptin, a novel biomarker (a surrogate to arginine vasopressin was found to increase with diabetic nephropathy. <strong>Objectives: </strong>this study aimed to detect the level of copeptin in patients with diabetic retinopathy.<strong>Patients and Methods: </strong>the study was conducted on individuals attending the diabetes and the ophthalmology outpatient clinics in Ain Shams University Hospitals between February and August 2017. This study included 96 individuals and they were divided into 4 groups. <strong>Group I</strong> consisted of 24 patients with proliferative diabetic retinopaty (PDR), <strong>group II</strong> 24 patients with non proliferative diabetic retinopathy (NPDR), <strong>group III</strong> included 24 diabetic patients with no fundus abnormalities and <strong>group IV</strong> included 24 healthy non diabetic individuals. The individuals were subjected to full medical history taking, slit lamp biomicroscope fundus examination and the measurement of serum fasting blood sugar, 2 hour post prandial blood sugar, glycated hemoglobin, serum creatinine, serum copeptin and urinary albumin creatinine ratio. History taking included age, gender, type of diabetes, duration of diabetes, antidiabetic medications, any other medical comorbidities and pregnancy for females. <strong>Results: </strong>the present study showed a statistically significant rise in the level of copeptin in patients with PDR (<strong>Group I</strong>) and NPDR (<strong>Group II</strong>) when compared to those with no diabetic retinopathy (<strong>Group III</strong>) and the control group (<strong>Group IV</strong>) (P value <0.001). There was a statistically significant positive correlation with duration of diabetes (r = 0.589) and level of albumin/creatinine ratio (ACR) (r = 0.540) (P value <0.001) for both parameters.
<strong>Conclusion:</strong> level of copeptin was found to be higher in patients with diabetic retinopathy, in patients with longer duration of diabetes and in those with elevated ACR. It was higher in diabetics in comparison to normal individuals.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269120171001Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios and Their Relation with Disease Activity in Systemic Lupus Erythematosus Patients176417691169010.12816/0040143ENHanan Mohammed FaroukDepartment of Intenal Medicine, Faculty of Medicine, Ain Shams UniversityMaryam Ahmed Abdel RahmanDepartment of Intenal Medicine, Faculty of Medicine, Ain Shams UniversityNaglaa Afify MohamedDepartment of Intenal Medicine, Faculty of Medicine, Ain Shams UniversityOmnia Bahaa AttiaDepartment of Intenal Medicine, Faculty of Medicine, Ain Shams UniversityJournal Article20180827<strong>Background: </strong>systemic lupus erythematosus (SLE) is a chronic disease which had diverse clinical manifestations, course and prognosis. Search for diagnostic markers is continuous process to enhance the diagnostic and treatment process.<br /> <strong>Aim of the study:</strong> this study aimed to investigate correlation between both of neutrophil/lymphocyte and platelet/lymphocyte ratios and disease activity in SLE patients who did not receive any treatment.<br /> <strong>Patients and Methods</strong>: a case control study involving 60 adult SLE patients and 40healthy controls was performed. NLR and PLR levels between SLE patients and healthy controls were compared, and correlations between these indices and clinical characteristics were analyzed.<br /> <strong>Results</strong>: increased NLR and PLR were observed in SLE patients. NLR was positively correlated with erythrocyte sedimentation rate (ESR) (r=0.621, p<0.001) ,SLEDAI scores(r=0. 0.774, p<0.001) and SLICC score(r=0.638, p<0.001). PLR was positively correlated with with erythrocyte sedimentation rate (ESR) (r=0.500, p<0.001),SLEDAI scores(r=0.445, p<0.001). and SLICC score(r=0.377, p<0.001) SLE patients with nephritis had higher NLR and PLR levels than those without nephritis (p<0.001). <strong>Conclusion: </strong>NLR and PLR could reflect inflammatory response and disease activity and disease damage in SLE patients.<br /> <strong> </strong>