Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001El-Sayed Mohamed El-Habibi; Magda Protective Effect of Date Palm Extracts on Cadmium-Induced Infertility in Male Rats218121901185210.12816/0041514ENMahmoud El-KomyPhysiology Division, Zoology Department, Faculty of Science,
Mansoura University, Mansoura, EgyptHeba Osama SaadPhysiology Division, Zoology Department, Faculty of Science,
Mansoura University, Mansoura, EgyptJournal Article20180828<strong>Background:</strong> Infertility is a problem which affects one in six couples. However, male factor considers solely responsible in about 20% of infertile couples and contributory in another 30–40%. <strong>Objective:</strong> The aim of this study was to elucidate the effect of date palm pollen (DPP) and date palm seed extract (DPS) on cadmium-induced infertility in male rats. <strong>Materials and Methods: </strong>Thirty six male albino rats were divided into six groups (n=6) and received their treatment orally for 30 days: group 1, control; group 2, (DPP): (240mg/kg) daily<strong>,</strong> group 3, (DPS): (100mg/kg) daily, group 4, (CdCl<sub>2</sub>): (5mg/kg) every other day, group 5, (CdCl<sub>2</sub> + DPP): CdCl<sub>2</sub> as group 4, followed by DPP as group 2 (each dose given 2 hours after CdCl<sub>2</sub>); group 6, (CdCl<sub>2</sub> + DPS): CdCl<sub>2</sub> as group 4, followed by DPS as group 3 (each dose was given 2 hours after CdCl<sub>2</sub>). <strong>Results:</strong> The current data exhibited significant decrease in the sperm quality, T, E2, FSH, LH, aromatase enzyme, TAC, GSH, SOD and CAT, with marked increase in MDA& XO and severe destruction in testis histoarchitecture in CdCl<sub>2</sub> treated rats. However, there was a significant improvement in all these parameters with DPP& DPS administration. <strong>Conclusion: </strong>consumption of DPP or DPS might be considered as a functional treatment for retarding risks of infertility associated with cadmium exposure.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Comparison between Corneal Biomechanics in Normal and Keratoconic Corneas Using Ocular Response Analyzer219121981185310.12816/0041515ENShaker A. KhedrOphthalmology Department, Faculty of Medicine, Ain Shams UniversityAmany A. El-ShazlyOphthalmology Department, Faculty of Medicine, Ain Shams UniversityOssama T. NadaOphthalmology Department, Faculty of Medicine, Ain Shams UniversityKareem A. AbouelezzOphthalmology Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180828<strong>Background: </strong>keratoconus (KC) is an idiopathic degenerative eye disease characterized by localized thinning and conical protrusion of the cornea, which typically develops in the inferior-temporal and central zones. Consequently, visual acuity is reduced due to irregular astigmatism and high myopia resulting from asymmetric topographical changes in the corneal surface. KC is the most prevalent form of corneal ectasia and affects all ethnicities. However, higher incidence has been reported in Asians when compared to caucasians. <strong>Aim of the work:</strong> this study aimed to compare the biomechanical properties of the cornea between topographically normal individuals with topographically keratoconic patients.
<strong>Patients and methods:</strong> this prospective study was carried out from January 2017 to July 2017 on 40 eyes of patients attending outpatient clinic of Ain Shams University Hospitals and Ophthalmology Department of Research Institute of Ophthalmology in Giza.
All participant names were hidden and were replaced by code numbers to maintain privacy of the patients. Ocular response analyzer (ORA) values were obtained from 20 eyes of keratoconus patients and 20 eyes of non keratoconus subjects both topographically tested.
<strong>Results:</strong> corneal hysteresis (CH) was found to be higher in normal group than keratoconus group; the values were found to be 10.9 ± 1.5 in normal group and 7.88 ± 1.23 in keratoconus group. Corneal resistance factor (CRF) was found to be higher in normal group than keratoconus group, the values were found to be 12.7 ± 1.05 in normal group and 6.7 ± 1.7 in keratoconus group. Goldmann correlated intraocular pressure (ORA_IOPg) was found to be higher in normal group than keratoconus group, the values were found to be 13.13 ± 2.91 in normal group and 10.31 ± 2.99 in keratoconus group. Corneal compensated intraocular pressure (ORA_IOPcc) was found to be 14.17 ± 3.44 in normal group and 14.23 ± 2.01 in keratoconus group, there was no difference between normal group and keratoconus group.
<strong>Conclusion:</strong> corneal biomechanical properties, characterized by corneal hysteresis and the corneal resistance factor, provide new indicators for the diagnosis of keratoconus.
<strong>Recommendations: </strong>this study recommended to follow up IOP in keratoconus patients by ORA due to false low results which may be taken by using the Goldman applanation intraocular pressure. Large studies should be done to detect the prevelance of keratoconus in Egypt as this information was missing from peerviewed studies we researched.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Knowledge, Attitude and Practice About Allergic Rhinitis in Saudi Arabia, 2017219922031185410.12816/0041516ENFaris Mohammed AlreshidiUniversity of HailAbdullah Saleh AlrashidiUniversity of HailFayez Nashi Motlaq AlshammariUniversity of HailAlya Bakr A. QadiMedical UniversityAli Ghannam Mohammed AlrashidiUniversity of HailSaleh Muflih Srai AlghaythiUniversity of HailFouad Taiwilaa AlshammariUniversity of HailSaud Mohammed Saud AleisaTaif UniversityJournal Article20180829<strong>Background: </strong>allergic rhinitis (AR) is considered a worldwide health disease therefore the lack of knowledge would result in poor adherence to management and preventive protocols and increasing the prevalence of AR. <strong>Objectives: </strong>evaluating the knowledge, attitude and practice(KAP) of Saudi adult subjects toward AR in Kingdom of Saudi Arabia (KSA).
<strong>Methods: </strong>a cross sectional study conducted on 900 Saudi adult subjects admitted to primary health care centers. The subjects were interviewed and filled up a questionnaire including the respondent’s demographics, questions related to knowledge, attitude and practice.
<strong>Results: </strong>most of the respondents aged from31-45 years old, 59.7% were females and 49% were graduated from college.30% of participants had a family history of allergic rhinitis and 34% suffered from allergic rhinitis. Inadequate KAP was found among the participants with higher KAP scores related with higher educational degree. But there were no association between KAP level and gender or age.
<strong>Conclusion: </strong>an inadequate knowledge was found among most of respondents thus resulting in poor attitude and practice pattern. Also, higher educational levels were associated with higher KAP scores.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Relationship between Obesity and Iron Deficiency220422081185510.12816/0041517ENTahany A El-kerdanyDepartment of Clinical Pathology, Faculty of Medicine, Ain Shams UniversityDoaa G EissaDepartment of Clinical Pathology, Faculty of Medicine, Ain Shams UniversityMaha HassanDepartment of Clinical Pathology, Faculty of Medicine, Ain Shams UniversityWafaa A FahmyNational Nutrition Institute2, Cairo, EgyptJournal Article20180829<strong>Background:</strong> obesity and iron deficiency anemia are major health problems that are increasing in Egypt especially in females.
<strong>Aim of work:</strong> this study aimed to evaluate the iron status in obese Egyptian females in comparison to normal weight females. <strong>Patients and Methods:</strong> forty four obese adult female patients and 44 normal weight healthy females as control group were included in this study. They were all tested for iron profile and CRP using semi quantitative rapid latex agglutination test. <strong>Results:</strong> the patient group in this study showed a significant lower serum Fe and TSI than the control group, while ferritin was higher in patients than the control group. The comparison between the three groups of obesity showed that the grade III patients had the lowest median value in serum iron and the highest median value in TIBC and ferritin, however no statistical significant differences were detected between the three groups of patients (P>0.05). Our results showed that 70.4%) of patients had positive CRP with positive correlation between CRP and BMI.
<strong>Conclusion and Recommendations: </strong>obesity is a low inflammatory disease which affects iron profile and increases CRP. Further, study on larger number of cases is recommended to analyze the exact mechanism of iron deficiency anemia in obese female patients.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Infection with Genital Herpes Virus and Its Treatment in Relation to Preterm Delivery220922141185710.12816/0041518ENAhmad Ayed DerhamKing Abdulaziz UniversityMohannad Ali AlghamdiKing Abdulaziz UniversityHanadi Hezam AL-ThobiatiUmm AL-Qura UniversityNasir Ahmad AlsubaiUmm AL-Qura UniversityRazan Hussain AlhasawiBatterjee Medical College for Science and TechnologySara Falah AlsahafiBatterjee Medical College for Science and TechnologyLamees Hatim AldoobieKing Abdulaziz UniversityJournal Article20180829 Infection with herpes simplex is a standout amongst the most well-sexually transmitted infections. As the infection is common in women of reproductive age it may be contracted and transmitted to the fetus amid pregnancy and the new-born. Herpes simplex virus is a significant cause of neonatal infection, which could lead to death or long-term disabilities. Infrequently in the uterus, as it happens frequently during the transmission delivery.
The most serious danger of transmission to the fetus and the new-born happens in case of an early maternal infection contracted in the second half of pregnancy. The danger of transmission of maternal-fetal-neonatal herpes simplex could be diminished by applying a treatment with antiviral medicines or depending on a caesarean section in some particular cases. The aim of this paper is to provide recommendations on the management of herpes simplex infections in pregnancy and approaches to decrease perinatal transmission of herpes simplex virus.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Update on Congenital Glaucoma221522181185810.12816/0041519ENAbdel Mongy E. AliDepartment of Ophthalmology, Faculty of Medicine, Al Azhar (Cairo) UniversityAlaa H. LabibDepartment of Ophthalmology, Faculty of Medicine,Aswan University, Aswan, Egypt.Journal Article20180829<strong>Background:</strong> primary infantile glaucoma, commonly termed congenital glaucoma or trabeculodysegenesis, is an unusual, inherited congenital anomaly of the trabecular meshwork and anterior chamer angle which leads to obstruction of aqueous outflow, increased intraocular pressure, and optic nerve damage. Primarycongenital glaucoma is a worldwide diagnostic and therapeutic challenge. Although medical management is often a temporizing measure, early surgical intervention is the definitive treatment.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Early versus Delayed Initiation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury221922211185910.12816/0041520ENAbdel-Basset El-Shaarawy Abdel-AzeemInternal Medicine and Nephrology Department, Faculty of Medicine - Ain Shams UniversityWalid Anwar Abdel-MohsenInternal Medicine and Nephrology Department, Faculty of Medicine - Ain Shams UniversityMaha Abd El Moneim BehairyInternal Medicine and Nephrology Department, Faculty of Medicine - Ain Shams UniversityIbrahim Al-Sayed Ibrahim OmarInternal Medicine and Nephrology Department, Faculty of Medicine - Ain Shams UniversityJournal Article20180829<strong> Aim of the work</strong> this study aimed to evaluate the impact of early versus late initiation of continuous renal replacement therapy on clinical outcomes in critically ill patients with AKI. <strong>Results</strong> regarding our retrospective cohort study and after prolonged exhaustive analysis of all the related data, some variables were found to be significantly related to the outcome of these critical ICU patients. These variables were systolic BP, WBCs, albumin, magnesium, PTT and INR at the start of CRRT. Some patients with AKI were associated with sepsis; there was a little benefit of early CRRT, in terms of ICU mortality. This needs further clarification by larger and high-powered studies.
<strong>Conclusion</strong> finally, the decision for early or late CRRT, in patients with AKI, should be individualized according to the clinical and laboratory parameters of each patient. It should also include the opinion of senior nephrologists, experienced in management of AKI. The decision should be sensitively communicated to the patients and/or their relatives, explaining the actual role of CRRT in management of their critical disorder.
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<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001The Ameliorative Effect of Cleome droserifolia (Samwa) on Myocardial Injury Associated with Diabetes in Male Rats222222311186110.12816/0041521ENEl-Komy MMFaculty of Science, Mansoura University EgyptSerag MH And Emsalam AAFaculty of Science, Mansoura University EgyptJournal Article20180829<strong>Background:</strong> Diabetes is an imperative risk factor for cardiac complications development. <em>Cleome droserifolia </em>(Cd) is used in Egyptian traditional medicine for treatment of diabetes mellitus. <strong>Aim:</strong> The aim of the present study was to measure the possible protective effects of ethanolic extract of Cd against cardiacmyopathy in Streptozotocin (STZ) induced diabetic rats.<strong> Materials and Methods:</strong> Experimental diabetes was induced by intrapritoneal injection with a single dose of STZ (45 mg/kgbw). Oral dose Cd extract was administered daily for four weeks (310 mg/kg bw). <strong>Results:</strong> Diabetic rats exhibited an increase in glucose level and lipid profile as well as cardiacpro-inflammatory, pro-apoptotic markers and oxidative stress, while a decrease was recorded in antioxidant enzymatic activities. On the other hand the administration of diabetic rats with Cdextract for four weeks resulted in a significant amelioration in the most of the parameters mentioned above when compared with diabetic rats. <strong>Conclusion:</strong> The data clearly indicated that the treatment with <em>Cleome droserifolia</em> exerts a therapeutic protective nature in cardiac complications due to diabetes by decreasing oxidative stress and cardiac damage which may be attributed to its antioxidative potential.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Knowledge, Opinions and Attitude of Surgeons in Saudi Arabia toward Informed Surgical Consent223222371186210.12816/0041522ENAli M AlsaihatiQatif Central HospitalAmer B AlotaibiKing Abdullah HospitalAli M AlhawajIbn Sina National College For Medical StudiesAreej M AlabdulsalamKing Saud UniversityNourah A AlajmiKing Saud UniversityMohamed T BoukhetKing Saud UniversityWaleed H AltulayqiKing Saud UniversityAli S AlkahtaniKing Saud UniversityNawaf A AlmarekKing Saud UniversityZahra A AlhussainKing Faisal UniversityAli S Al-SultanKing Faisal UniversityMohammed B Al KhalafKing Faisal UniversityHani A AlAbdullahKing Faisal UniversityAbdulhalim B Hafizallah HafizallahTaibah UniversityFahad F AlmutairiMCSTBothayna A AlanzanPrincess Nora Bint AbdulrahmanMohammed S AlrashedImam Muhammad Ibn Saud Islamic UniversityJournal Article20180829<strong>Background:</strong> Informed consent has become a vital factor for the clinical treatment of modern practice in the medical field, it is participating in legal, ethical and administrative compliance side. However, informed consent is variably applicable and rarely fulfills its theoretical ideal. Disclosure of adequate information is very important before signing informed consent. It is important to make patient enable to take a proper decision with good knowledge about his/her case. Informed consent for the surgical procedure is consent that taken from the patient before surgical operations and invasive procedures after explaining advantages and disadvantages. Getting patient's signature for the consent of operations and the surgical procedure is surgeon's job. The opinion of the surgeon about informed consent is important, as that may affect the performance of surgeon in explaining procedure with its risks and benefits. <strong>Aim:</strong> Assessment of knowledge, opinion, and attitude of surgeons towards informed consents. Find out how to improve the quality of informed consent from surgeons' suggestions. <strong>Method:</strong> This cross-sectional study is questionnaire-based study. Our target was to reach many surgeons in Saudi Arabia with different specialties, different status and from different hospitals. We take our sample using random sampling technique. We selected surgeons from each hospital that our data collector can reach and enter easily. Collection of data was done by interview. Our questionnaire contained four parts in addition to demographic data part. The first part was asking about surgeons' opinions regarding informed surgical consent process. The second part was responsible for inquire about obtaining informed surgical consent. The third part is about the refusal to sign informed surgical consent. Last part is to ask about surgeons’ suggestions to improve informed surgical consent. <strong>Result:</strong> Total number of respondents was 140 (Response rate is 93.3%). Around 34% of participants agreed that surgeons don’t give adequate information about the surgical procedure. 33.6% insisted to know about their surgery. After asking each surgeon about the importance of informed surgical consent they selected the following answers in descending order; informing patients about advantages, hazards and alternatives (81.4%), Medico-legal importance (79.3%), decision taking about procedure (72.1%), hospital policy (50.7%) and surgical tradition (19.3%). Most of the doctors (85%) complained that sometimes, their patients refused to sign consent. Fear was the most common cause of singing consent refusal according to opinions of 62.9% of surgeons. Conclusion: Surgeons in Saudi Arabia have acceptable knowledge about informed surgical consent and how to obtain it. But still there were some opinions of surgeons opposite to what is practiced, and also some of them practiced something not ideal while obtaining informed surgical consents. However, most of the surgeons know the importance of consent and what is important to be disclosed in it. In general, the frequency of consent refusal was low.<br /> <strong><br /></strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Relapse in Patients with Non-Hodgkin’s Lymphpma223822441186310.12816/0041523ENAzza Mohammed AdelClinical Oncology and Nuclear Medicine department, Ain Shams UniversityAmr Shafik TawfikClinical Oncology and Nuclear Medicine department, Ain Shams UniversityNesreen Ahmed MosalamClinical Oncology and Nuclear Medicine department, Ain Shams UniversityRana Mohamed El ShishtawyClinical Oncology and Nuclear Medicine department, Ain Shams UniversityJournal Article20180829<strong>Background: </strong>non Hodgkin Lymphoma is the most common hematologic malignancy and it is the 6<sup>th </sup>leading cause of cancer death. Relapses still occur in the majority of patients; overall, more than 30% of DLBCL will ultimately relapse. <strong>Aim of study: </strong>primary objective was to retrospectively correlate the occurrence of relapsed, refractory and in remission diffused large B cell lymphoma patients to both clinic-pathological features of the disease and line of treatment received.
<strong>Patients and Method: </strong>a total of 116 patients with aggressive high grade NHL patients (DLBCL) representing 86.6% of all patients presented to Clinical Oncology Department, Ain Shams University in the period between January 2009 and December 2015. Data were collected between January 2017 until Marsh 2017.
<strong>Results: </strong>the mean age at diagnosis of the studied patients was 45 years. The incidence in male was higher than female (52.6% vs. 47.4%), the majority of the cases didn't have B symptoms (57.7%), high LDH level was measured among the cases (37%)and in only 36 patient’s files,16.37% of the cases had positive HCV.The most common stage at diagnosis was stage IV (33.6%)followed by stage III (29.3%). Based on response to the 1<sup>st</sup> line chemotherapy, DLBCL patients were further statistically analyzed into three categories:24 refractory patients (20.07%), 43 relapsed patients (37.1%) and 49 patients in remission (non relapsed) (42.2%). Regarding 1<sup>st</sup> line treatment regimen by R-Chop, complete response rates were significantly higher in patients who received R-CHOP than in the group who received CHOP alone (57.1% vs 42.8%). The median disease freesurvival in the relapsed groupwas 8 months. The median survival time for the DLBCL patients was 24 months. The survival rate after 1 year was 83.7%, while after 2 years it was 52.8% and after 3 years it was 21.3%.<strong><br /> </strong><strong>Conclusion: </strong>relapsed and refractory disease continues to represent the most significant challenge in treating NHL, the addition of rituximab to the CHOP regimen increased the CR rate and prolonged event-free and overall survival.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Wound Treatment in Relation to Surgical Site Infections224522491186410.12816/0041524ENAbdullah Mohammed AlkhamriKing Saud UniversityZainab Mohammed Al SulaimanGulf Medical UniversityNojood Hassan A TurkeyKing Abdulaziz UniversityAbdullah Rashed AlaboudiQassim UniversitySarhabdulhadi M FallataBatterjee Medical CollegeKhaled Saad AljedaaniKing Abdulaziz UniversityZahra Ali A AhussainKing Faisal UniversitySarah Abdullah AltaroutiB.A.U , LebanonAlaaeid AljohaniOhud Hospital, MedinaAmr Mohammed AldreesImam Muhammad Ibn Saud UniversityYousef Safar AlsahliPHC RiyadhAhmed Abdulaziz AlrajhiImam UniversitySama Mohammed Al SulaimanKing Abdulaziz UniversityMeshary Saad AlsohimImam Muhammad Ibn Saud UniversityAnwar Abdullatif S AlhulaibiKing Faisal UniversityJournal Article20180829<strong>Background: </strong>Surgical wounds heal by essential purpose in all the elective and emergency surgical processes. Current practice is to place dressing over the closed wound before the patient leaves the sterile environment of the operating theatre. Dressing is a material used to protect a wound and help its healing. On the other hand, to leave wound open in direct contact to environment following any procedure by only applying some ointment on it, the purported open wound treatment is yet debatable one. In the current study we have compared open wound treatment versus occlusive dressings in elective surgical cases with respect to surgical site infections. <strong>Materials and Methods: </strong>The current study was directed on 50 patients experienced for elective general surgery. Patients were divided randomly in to two equal groups each containing of 25 patients. In Group 1, patients had occlusive dressing till removal of stitches and in Group 2, patients wounds were retained exposed to environment after the surgical procedure. <strong>The study was done after approval of ethical board of King Abdulaziz university</strong>.
<strong>Results: </strong>In the current study, we perceived total 7% of postoperative wounds were infected of all the clean and clean contaminated wounds we studied. In Group 1, patients had occlusive dressing and these patients had 8% infection rate whereas in Group 2 patients, wounds were kept exposed to the environment and these patients had 6% infection rate. <strong>Conclusion: </strong>It is thus, concluded that in the elective surgical cases there was no damage in leaving the wounds open postoperatively. This process not only supports in arresting the infective pathology at a reduced stage but likewise saves surgeon’s time and patient’s cash.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Four Petal Evisceration: Pros and Cons225022531186510.12816/0041525ENRehab M. KamelDepartment of Ophthalmology, Al-Azhar University University, Faculty of Medicine for Girls,Doaa A. MahmoudDepartment of Ophthalmology, Al-Azhar University University, Faculty of Medicine for Girls,Ahmed M. AminDepartment of Ophthalmology, Al-Azhar University University, Faculty of Medicine for BoysJournal Article20180829<strong>purpose: </strong>To evaluate four petals evisceration as one of the best modifications in evisceration surgery, allowing the use of large orbital implant with low incidence of complications.
<strong>Methods:</strong> We conducted a retrospective, interventional study on evisceration with placement of spherical non porous orbital implant after four petal evisceration. Preoperative examination included full history, ophthalmological examination, indication for surgery, B-scan ultrasonography, axial length in cases of atrophic and socket surface in secondary cases. All patients were operated a four petal evisceration with spherical non porous implant of size 18 to 22. Postoperative, all patients were followed for at least 6 months for presence of complications, implant and prosthesis motility and the final cosmetic results.
<strong>Results: </strong>18 eyes were included. Diagnosis necessitating evisceration was atrophia bulbi in 8 patients, endophthalmitis in 2 patients, and implant exposure in 4 patients, corneoscleral melting due to caustic exposure in 1 patient, self-eviscerated globe due to severe trauma in 1 patient and anopthalmic socket following evisceration without implant in 2 patients. Implant size was 18 in 1 patient, 20 in 6 patients, and 22 in 11 patients. No implant exposure occurred; superior sulcus deformity occurred in 3 patients, downward implant migration occurred in 1 patient. Regarding implant motility, it was good with mean of 75% in 14 patients; moderate with mean of 66% in 4 patients. The prosthesis motility was fair with mean of 35% in 12 patients (66.6%) and poor with mean (10%) in 6 patients.
<strong>Conclusion: </strong>Four petals evisceration facilitates the use of large sized implant in all cases even in implant exposure with deficient sclera with good post-operative final cosmetic results, very low rate of complications and moderate prosthesis motility.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001MRI Enhancement as A Predicator of Uterine Fibroid Volume Reduction after Embolism225422571186610.12816/0041526ENAmor Abdullah Al MehdarMinistry of HealthAlaa Ibrahim TukrunaBatterjee Medical CollegeAbdulaziz Raja Najim AlotaibiKing Faisal Medical ComplexAlaa Mohammed Ali AlshahraniKing Khalid UniversityFatimah Nasser AlsaadImam Abdulrahman Bin Faisal UniversityZahra Adel Ali JaffaAlmaarefa CollegesAzharmuslimsarhan AljohanTaibah UniversityZahra Ibrahim AlqarrashImam Abdulrahman Bin Faisal UniversityHajarayad AlluhaybiTaibah UniversityAfnan Omer AludainiKing Abdulaziz UniversityLuayesam HakamiUmm Al-Qura UniversityAmnah Abdullah AlanziUniversity of TabukAbdullah Abdulrahman I MuharibKing Saud Bin Abdulaziz University for Health SciencesAbdulsalam Ibrahim A. AlthumairyKing Khalid UniversityAtheer Raja AlyamiNajran UniversityJournal Article20180829<strong>Aim of the Study: </strong>To evaluate the response of necrotic fibroids to UAE and to identify whether pre-UAE enhancement or other factors are predictors of fibroid shrinkage.
<strong>Materials and methods: </strong>This is a retrospective review of all women who underwent UAE for symptomatic fibroids from January 2013 till July 2017, who experienced a follow-up MRI 5-6 months after UAE were included. There were 54 fibroids (37 non-enhancing and 17 enhancing) among 24 women with a mean age of 56 (range 40-59) years. All fibroids were assessed for size, position, enhancement on subtraction images, and Apparent Diffusion Constant (ADC).
<strong>Results</strong><strong>: </strong>Enhancing fibroids had an average decrease in diameter by 23 ± 6%, not significantly different compared to that non-enhancing fibroids which decreased by 19 ± 3% (<em>p</em>=0.491). Multiple linear regression with percent change in fibroid diameter as the dependent variable and patient age, fibroid position, and pre-UAE fibroid diameter, enhancement, and ADC as independent variables, showed that ADC (<em>p</em><0.005) and pre-UAE diameter (<em>p</em><0.005) were the only significant independent variables.
<strong>Conclusion</strong><strong>: </strong>Pre-UAE size and ADC, but not contrast enhancement, predicted fibroid diameter reduction. Enhancing and non-enhancing fibroids had similar size reduction after UAE. Non-enhancement should not be considered a contraindication to UAE.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Impact of Dysphagia Therapy in Parkinson’s Disease225822651186710.12816/0041527ENFaisal Ahmed M. Abu ShaigahDammam Medical ComplexAhlammohammed ZabbaniBatterjee Medical CollegeAlya Bakr A. QadiMedical University of LodzAbdulrahman Mohammed M AloufiKing Khalid UniversityAnmar Ahmed T SultanKing Salman HospitalHussain Abdullah AljuwaydMaastricht University, NetherlandsAhmed Ali H GhawasKing Faisal UniversityAhmed Mohammed AlawadhArabian Gulf UniversityFayezaemadaldeen AlamKing Abdulaziz UniversityMohammed Abdullah AlghamdiKing Abdulaziz UniversityReem Salem M AlenziNorthern Border UniversityFatimah Nader Al JishQatief Central HospitalJournal Article20180829<strong>Background: </strong>Dysphagia is a common symptom in Parkinson's disease (PD) which indicates a difficulty in swallowing. It has been accompanied with poor quality of life (QoL), anxiety and depression.
<strong>Aim of the Study: </strong>to assess the effects of dysphagia treatment in Parkinson’s disease.
<strong>Materials and methods: </strong>Studies published up to July 2017 were found via a systematic comprehensive electronic database search using PubMed, Embase, and The Cochrane Library.Two reviewers independently assessed the studies using strict inclusion criteria. <strong>Results</strong><strong>: </strong>Thirteen studies were enrolled in the present study and qualitatively analyzed using critical appraisal items. The review includes rehabilitative (exercises, electrical stimulation, bolus modification etc.) and pharmacologic treatment. Some well-designed controlled trials were included. However, none of the included studies fulfilled all criteria for external and internal validity. Thus, a meta-analysis was not carried out as most of the studies were not of sufficient quality. <strong>Conclusion</strong><strong>: </strong>Rehabilitative treatment including Expiratory Muscle Strength Training (EMST) may be effective for dysphagia treatment solely coupled with dopaminergic therapy for PD. Recently developed other treatment methods such as implant-prosthodontic treatment and percutaneous injection of botulinum neurotoxin type A in the cricopharyngeal muscle on dysphagia is rather promising. Nevertheless, these preliminary results warrant further investigation concerning their clinical applicability, and further research should be conducted.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Chronic Daily Headache Disorders and Their Management- A Study226622701186810.12816/0041528ENAdilah Hamoud Al TuraifiIbn Sina National CollegeSalem Mohammed Al-QarniAlmajaridah Health Care CenterAshwaq Fathi Nasser AL-DossaryUniversity of Imama Abdurhman Bin FaisalKhalid Abdulrahman AlsagaiheAlmaaraefa CollegesFatimah Ibrahim AlshabeebYemen University of Science And TechnologyDareen Hussain AlhendiTaibah UniversitySokinh Ahmed AlmaghaslahPavol Jozef Safarik UniversityAbdullah Mohammad AlsufiIbn Sina National CollegeFatimah Taqi AlmozayinArabian Gulf UniversityBassam Sameer MolawiUmm Alqura UniversityJournal Article20180829<strong>Background:</strong> headaches account for 10% of all consultations with the general practitioner, and the third leading cause of emergency department visits. The current prevalence of headache can go from 7.4% to 22.7% and may be associated with much comorbidity, and can cause significant disabilities in an individual’s quality of life. <br /> <strong>Methodology:</strong> in this paper we carried out a systematic review on 32 observational (nonrandomized) studies using PUBMED. <strong>Aim:</strong> our aim in the study is to evaluate the prevalence, associated risk factors, pathogenesis, management, and the effect on quality of life caused due to chronic headaches.<br /> <strong>Conclusion:</strong> chronic headache adds to a huge burden in overall health care system, and a very frequent general practice visit. Treatment of this type of headache is very challenging due to its chronicity as well as its risk of conversion into medication onset headache. More researches that can promise better quality of life for individuals that suffer from chronic daily headache must be done.<br /> <strong><br /></strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Role of Pet/Ct in Assessment of Post Therapeutic Hepatocellular Carcinoma227122771186910.12816/0041529ENOmar Hussain OmarRadiodiagnosis Department, Ain Shams University, Cairo, EgyptMohamed Elgharib Abo ElmaatyRadiodiagnosis Department, Ain Shams University, Cairo, EgyptAyman Mohamed IbrahimRadiodiagnosis Department, Ain Shams University, Cairo, EgyptSherif Sameh SolimanRadiodiagnosis Department, Ain Shams University, Cairo, EgyptJournal Article20180829<strong>Aim of the work<em>: </em></strong>this study aimed to highlight the role of PET/CT in evaluation of post-therapeutic hepatocellular carcinoma, hence guiding the clinician to proper management strategy.
<strong>Patients and methods</strong><em>:</em> 35 patients (32 male and 3 female) were included in this study. All patients had history of local treatment of HCC; most of the cases were treated with TACE or RFA. They had undergone <sup>18</sup>F-FDG PET/CT for evaluation of the therapeutic effect after the end of the therapy.
<strong>Results</strong>:our study demonstrated that <sup>18</sup>F-FDG PET/CT is a significant prognostic factor for tumor recurrence in post-therapeutic HCC with a cutoff TSUVmax/LSUVmax value of 1.3.
<strong>Conclusion</strong><em>:</em> <sup>18</sup>F-FDG PET/CT imaging have a prognostic significance in evaluation of patients with post-therapeutic HCC and provide valuable information that can be used in the treatment response evaluation and clinical decision making process.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Management of Diabetic Ketoacidosis in Patients with Diabetes Type I227822851187010.12816/0041530ENZuhaer Sindi BasamUmm Alqura UniversityNaif Mishkhas AlazwariKing Abdulaziz University,Abdulaziz Mohammed KhateebKing Abdulaziz University,Aqil Abdulmonem AlzaherImam Abdulrahman Bin Faisal UniversityMohammad Abdulaziz M AlkhawajahImam Abdulrahman Bin Faisal UniversityAtheer Khalid AlmutairiImam Abdulrahman Bin Faisal UniversityNajd Abdulrahman Al-MutairiImam Abdulrahman Bin Faisal UniversityZainab Reda AlghanimImam Abdulrahman Bin Faisal UniversityAmeera Ahmad NemerImam Abdulrahman Bin Faisal UniversityHazim Abdulkarim KhatibKing Abdulaziz UniversityJournal Article20180829<strong>Background:</strong> DKA is the leading cause of mortality among pediatric age and young adults with T1D, responsible for almost 50% of all fatalities in diabetic patients younger than 24 years of age. Goals of DKA management include optimization of volume status, hyperglycemia and ketoacidosis, electrolyte abnormalities, and potential precipitating factors. <strong>Methodology:</strong> we conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1987, through February 2017. The following search terms were used: ketoacidosis, management of diabetic ketoacidosis, type I diabetic patients’ emergency complication, fluid replacement in DKA, insulin therapy approach. <strong>Aim:</strong> in this review, we aim at evaluating the various ways of approaching patients who suffer from type-one diabetes during ketoacidosis and keto-acidotic coma. We will try to understand the triggers and pathophysiology behind this condition, and explore ways to prevent them. <br /> <strong>Conclusion:</strong> prompt diagnoses, aggressive treatment, and education of patient and their care providers about prevention strategies must be implemented. Also, more studies are required in the area of preventing health complications due to these types of diseases to effectively manage DKA in the future.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Orthodontic Management for Class III Malocclusion228622931187110.12816/0041531ENShaimaa Gamal TagridaAlfarabi Private College-JeddahAlanoud Turki AlhelaliAlfarabi Private College-JeddahSarah Nassar Hasan AlmadaniAlfarabi Private College-JeddahDhay Abdullah Al TawiBatterjee Medical CollegeLaura Jamal MusairyBatterjee Medical CollegeAbrar Mohammed AlghamdiIbn Sina CollageFawaz Atteq AlsumiryIbn Sina CollageAbdulrahman Saleh AldamookKing Abdulaziz UniversityMajed Sonitan AlharbiAlfarabi Private College-ReyadhJournal Article20180829<strong>Background:</strong> Class III malocclusion influences between 5% and 15% of the population. The 2 most common quandaries encompassing Class III management are the planning of treatment and the type of appliance. Various appliances have been utilized to correct a Class III skeletal discrepancy; however there is little proof accessible on their adequacy in the long term. Additionally, early management of Class III malocclusion has been practiced with expanding interest. Nevertheless, there has been no strong confirmation on the advantages in the long term. <strong> Aim of the study:</strong> we conducted this systematic review to assess the adequacy of orthodontic techniques utilized in the early treatment of Class III malocclusion in the short and long terms. <strong>Methods:</strong> A systematic search was performed in the scientific database independently of language, particularly MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and individual orthodontic journals were searched to November 2016. The selection criteria included randomized controlled trials (RCTs) and prospective controlled clinical trials (CCTs) of children between the ages of 7 and 12 years on early treatment with any type of orthodontic/orthopaedic appliance compared with another appliance to correct Class III malocclusion or with an untreated control group. The primary outcome measure was correction of reverse overjet, and the secondary outcomes included skeletal changes, soft tissue changes, quality of life, patient compliance, adverse effect, Peer Assessment Rating score, and treatment time. <strong>Results:</strong> Ten studies, 6 RCTs and 4 CCTs, are involved in this review. In the RCT group, only 2 of 6 studies were assessed at low risk of bias, and the others were at high or unclear risk of bias. All 4 CCT studies were classified as high risk of bias. Two RCTs involving 109 participants looked at the comparison between protraction facemask and untreated control. The results for ANB angle (mean difference, 3.40; 95% CI, 2.6-3.15; P <0.0001) and reverse overjet (mean difference, 2.5 mm; 95% CI, 1.21-3.79; P< 0.0001) were statistically significant favouring the facemask group. All CCTs validated a statistically significant advantage in favour of the use of each appliance. Nonetheless, the studies had high risk of bias. <strong>Conclusions:</strong> There is a moderate amount of evidence to show that early treatment with a facemask results in positive improvement for both skeletal and dental effects in the short term. Though, there was absence of evidence on long-term benefits. There is certain evidence regarding the chin cup, removable mandibular retractor, and tandem traction bow appliance; however the studies had a high risk of bias. Additional high-quality, long-term studies are assessing to evaluate the early treatment effects for Class III malocclusion patients.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Role of Magnetic Resonance Imaging and Ultrasonography in Diagnosis and Follow Up Rheumatoid Arthritis in Hand and Wrist Joints229423001187210.12816/0041532ENAhmed Mohamed Safwat ZakiDepartment of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, EgyptMohamed Abd El Hamid HettaDepartment of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, EgyptOmar Hussein OmarDepartment of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, EgyptAhmed Fathy Abdel GhanyDepartment of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180829<strong>Aim of the work</strong>: to compare the role of ultrasonography and magnetic resonance imaging in the diagnosis of wrist joint affection in patients with rheumatoid arthritis<strong>. </strong><strong> Patients and methods</strong>: this study included 50 patients diagnosed as rheumatoid arthritis (41 females and 9 males) with mean age 43 years; they were subjected to high resolution ultrasound and MRI of the wrist joint for the dominant affected wrist clinically. Comparison and correlation between both modalities was done. <strong>Results:</strong>our results showed agreement between ultrasound and MRI in the assessment of synovial inflammation, activity and bone erosions in wrist joint in rheumatoid arthrtis patients. <strong>Conclusion:</strong> we concluded that both modalities were comparable and close to each others as regards the bony erosions and synovial hypertrophy and inflammation in the wrist joints in patient with rheumatoid arthritis and the ultrasound was useful tools in detection of erosions and synovial inflammation so can be used in patients without erosions on conventional x ray and also can be used in follow up and monitoring the patients with established diagnosis of rheumatoid.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001A study of Intratympanic Dexamethasone Injection in Meniere's Disease (Continuation study)230123071187310.12816/0041533ENAdel A.M NassarENT Dept. – Audiology Unit, Faculty of Medicine, Ain Shams University, Military Medical AcademyAhmed E.F. ChedidENT Dept. – Audiology Unit, Faculty of Medicine, Ain Shams University, Military Medical AcademyRasha H. El-KabarityENT Dept. – Audiology Unit, Faculty of Medicine, Ain Shams University, Military Medical AcademySameh M.A. BeshryENT Dept. – Audiology Unit, Faculty of Medicine, Ain Shams University, Military Medical AcademyJournal Article20180829<strong>Background:</strong> Meniere's disease is a condition that is thought to arise from abnormal fluid and ion homeostasis in the inner ear. The disease is named for Prospere Meniere, a French physician who was first known victim of this disease and reported that the inner ear could be the source of a syndrome manifesting episodic vertigo, tinnitus and hearing loss. The origin of Meniere's disease is presently controversial. While, in the past, it was felt that endolymphatic hydrops (excess fluid) in the inner ear were responsible for the disease, the most current opinion is that hydrops are just a marker for the Meniere's disease, rather than absolutely being responsible for the symptoms.
<strong>Aim of the work:</strong> this study aimed to follow up (2 and 2.5 years) the effect intratympanic (IT) dexamethasone in the prognosis of Meniere's disease (MD) with two different concentrations (4 and 10 mg/ml). <strong>Patients and methods:</strong> twenty patients with unilateral Meniere's disease received intra tympanic dexamethasone injection were included in this study <strong><sup>.</sup></strong>The studied subgroups were categorized according to the concentration of dexamethasone (4 and 10 mg/ml) used into two subgroups. Detailed history was taken from all patients. They were exposed to Dizziness Handicap Inventory scale, basic audiological evaluation and cervical-vestibular evoked myogenic potential assessment. The presence or absence of spontaneous, post-head-shaking, and positional nystagmus was evaluated using a video-nystagmography system. The patients in the two groups were followed -up for 2 and 2.5 years.
<strong>Results:</strong> the dosage of 10mg/ml dexamethasone showed more stability in signs and symptoms of Meniere's disease than the dose of 4 mg/ml dexamethasone in follow up study. The long term study of intratympanic (IT) dexamethasone injection in both subgroups shows nearly no improvement as regard pure tone average, speech reception thresholds, word discrimination scores, subjective hearing loss, tinnitus, aural fullness, vertigo interruption with daily activities and vertigo associated symptoms compared to the previous study thesis. <strong>Conclusion:</strong> the long-term study of intratympanic (IT) Dexamethasone injection in both subgroups showed nearly no improvement in most assessments performed.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001The Accuracy of Three-Dimensional Ultrasound Imaging in Detection of Lip and Palate Clefts230823141187410.12816/0041534ENSarah Saeed AlshahraniFaculty of Medicine, King Khalid University, Abha, Saudi ArabiaRoa Fahad AlshabanahFaculty of Medicine, King Khalid University, Abha, Saudi ArabiaTahani Saeed AlmohayyaFaculty of Medicine, King Khalid University, Abha, Saudi ArabiaEbtesam Mohammed AlahmariFaculty of Medicine, King Khalid University, Abha, Saudi ArabiaJournal Article20180829<strong>Background: </strong>Although there is a lack of robust evidence from prospective cohort studies that supporting using 3D ultrasound, it becomes widely used in the clinical practice of obstetrics. This review aimed At evaluating the evidence assessing the accuracy of 3D ultrasound, in the detection of cleft lip and palate in different populations at different trimesters. <strong>Methods: </strong>In July 2017, we conducted a systematic search of the databases (MEDLINE, EMBASE and Science Direct databases) as demonstrated in table 1. The titles and abstracts of the detected articles were screened to exclude irrelevantly and duplicated, in addition to articles of case reports and reviews. Finally, articles were finally included in this review and subjected to data extraction and qualitative data analysis. <strong>Results: </strong>The detection rates of cleft lip ± alveolar bone cleft by 3D ultrasound imaging were found very high by many of the included studies. A range of 85%-100% detection rate of cleft lip only and cleft lip with cleft alveolus was reported by many studies. The detection rate of cleft palate with or without cleft lip varied between 50%-100%. This review revealed a detection rate of cleft lip and palate in low-risk populations ranged between 80-100%, while in high-risk populations the detection rate varied widely between 50% -100%.
<strong>Conclusion</strong>: Although there is a wealth of evidence demonstrated the high accuracy of 3D imaging in the detection of cleft lip and palate, the available studies had a poor methodology with a high risk of bias in their findings.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Quantitative Morphometric Study of The Chorionic Villi in Hypertensive Mothers231523221187610.12816/0041535ENAbdulrhman Saleh DairiMedical Intern, Faculty of Medicine and Surgery, Umm Al-Qura UniversityWagih Gamal ElbarranyProfessor of Anatomy, Faculty of Medicine and Surgery, Umm Al-Qura UniversityAmna Abdul Rahim MoulanaConsultant of Anatomical Pathology, Maternity and Children’s Hospital, Ministry of Health, Makkah, Saudi ArabiaAhmad Sami A Himayda HimaydaMedical Intern, Faculty of Medicine and Surgery, Umm Al-Qura UniversityIyad M HakeemMedical Intern, Faculty of Medicine and Surgery, Umm Al-Qura UniversityJournal Article20180829<strong>Background: Several</strong> studies have reported that mothers with pregnancy induced hypertension or those suffering from hypertensive disorders have abnormalities in histological features of the placenta. The fetus connection with the mother is through chorionic villi. Besides several other histological features changes in the chorionic villi have also been reported. This lead to the reduced supply of the necessary nutritional elements for the fetus.
<strong>The aim</strong><strong> of the Study: </strong>The principal objective of this study was to evaluate morphometric changes in the placenta of expecting mothers have hypertensive disorders of pregnancy and women without any symptoms of hypertension. As the placenta is capillary-rich region and any physiological change can adversely affect the fetal health.
<strong>Patients and Methods</strong>: In this study, a total of 84 expecting mothers were recruited. Among these 42 have hypertensive symptoms before pregnancy whereas the other 42 have their blood pressure in normal ranges. Among the 42 hypertensive women, only 13 met the study inclusion criteria,i.e., blood pressure in the range of 140/90 mmHg in the 30<sup>th</sup> week of the pregnancy. The quantitative morphometric parameters included shape and size of the placenta, damage to the blood vessels mainly in the chorionic villi and an overall number of blood vessels.
<strong>Results: A</strong> comparative evaluation of placenta from the hypertensive and normotensive expecting mothers showed that blood vessels area in the hypertensive mothers was significantly reduced when compared to normotensive mothers, same holds from the blood vessels in the perimeter areas. These findings have important implications as far as the fetal development among hypertensive mothers is concerned.
<strong>Conclusions: </strong>Higher blood pressure associated changes in the placenta are manifested in the form of several histological and morphological changes mainly in the chorionic villi structures involved in fulfilling nutritional requirements of the fetus.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Management of Pain in The Intensive Care Unit232323281188210.12816/0041536ENFatimah Abdulwahab AlhawajImam Abdulrahman Bin Faisal UniversityZohairRadi AlghazalImam Abdulrahman Bin Faisal UniversityMohammed Saleh AlonaziImam Muhammad Bin Saud UniversityNura Nasser AlahmadiTaibah UniversityAlmutari AbdulmajedSemmelwies UniversityAli Mohammed AlhijabImam Abdulrahman Bin Faisal UniversityImtinan Abdulrahman MalawiBatterjee Medical CollegeSohaib Osama BaarimahUmm Al-Qura UniversityAbdulhadi Salem TowairqiUniversity of JeddahJournal Article20180829<strong>Background: </strong>Pain assessment in ICU patients turns out to be a daily challenge for the attending teams, particularly in those patients who are intubated endotracheally; on mechanical ventilation or analgosedated as such patients are unable to self-assess existence and intensity of pain. Guidelines to identify pain in these patients are crucial for physicians for effective management.<br /> <strong>Methodology: </strong> We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1994, through March 2017. The following search terms were used: pain management in ICU, pain in ICU, pain assessment by behavior, pain assessment in intubated patients.<br /> <strong>Aim: </strong>Our aim in this study was to understand how to assess and manage pain in an intensive care unit patient, particularly those patients who are unable to self-report or assess.<br /> <strong>Conclusion: </strong>Physical clues given by comatose or intubated patients in critical care unit must be used as a method to identify existence of pain, and must be managed effectively to decrease discomfort and prevent short and long term adverse effects.
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Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Assessment of Preoperative Anxiety among Patients Undergoing Elective Surgery232923331188410.12816/0041537ENMohammed Saleh AlmalkiCollege of Medicine, Umm Al-Qura UniversityOthman Ahmed Othman HakamiFaculty of Medicine, Jazan University;Areej Mohammed Al-AmriCollege of Medicine, Taibah UniversityJournal Article20180829<strong>Introduction: </strong>Although patients undergoing elective surgery are assumed to have a lower level of preoperative anxiety, studies reported a high level of anxiety among those patients.
. This study aimed at assessing the level of preoperative anxiety and its predictors in adult patients undergoing elective surgery.
<strong>Methods: </strong>This study is a cross-sectional design conducted among patients admitted for elective surgery. A total of 278 patients with non-life-threatening surgeries were included and those who had mental or psychological problems were excluded from this study. Sample type and sample size. The data collected through a questionnaire about demographics, preoperative knowledge and anxiety in the preoperative room 24 hours before the operation. The frequencies, percentages, mean and SD were calculated, and t-test was used to detect significant associations.
<strong>Results: </strong>The overall preoperative anxiety score had a mean ±SD of 18.2±5.8 and the questions regarding knowledge component reported higher scores than those about anxiety component. The components of anxiety about surgery reported higher scores than those of anxiety about anesthesia. Age, gender, availability of family support and type of surgery were found as significant predictors for preoperative anxiety prior to elective surgery. However, the association between preoperative anxiety and marital status and previous experience of surgery were found statistically non-significant.
<strong>Conclusion</strong>: This study concluded that patients underwent elective surgery had high preoperative anxiety. The patients with younger age, female gender, patients under general anesthesia, or those who had no family support showed a higher level of preoperative anxiety.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Physical Activity Profile in Adult Patients Attending Family Medicine Clinics233423391188610.12816/0041538ENYousef HussainFamily Medicine Resident, Saudi Board of Family Medicine Program, Abha, Saudi ArabiaJournal Article20180829<strong>Background</strong>: Scientific evidence has been accumulated about the health benefits of physical activity and exercise on the health of adults in the last decades. However, few studies attempted to study the physical activity profile among adults in Saudi Arabia. Thus, this study aimed to identify the physical activity profile among patients who attend family medicine clinics in Jeddah city, Saudi Arabia.
<strong>Methods</strong>: The cross-sectional design with 382 patients attended family medicine clinics in King Faisal residential city clinics and King Khalid residential city clinics were surveyed using a validated structured questionnaire. The short form of IPAQ questionnaire, which was used in this study, consists of 7 items questioning physical activity, in addition to questions about time spent (minutes per day and days per week) and intensity of physical activity (moderate or vigorous). The data collected in the paper forms of questionnaire then coded and introduced into computers, and then they analyzed using the Statistical Analysis System (SAS), Version 9. <strong>Results: </strong>In the study participants, only 12.6% reported that they were highly active, 28.5% were moderately active, 17.85% lightly active, and 41.1% were inactive. A highly significant difference (P <0.001) was found between age groups (72.3% of participants with age <40 years were physically active compared to 52% with age ≥40 years). The percentage of physically active males were significantly more than females (57% compared to 53.3%). Participants with normal BMI were significantly more physically active than participants with abnormal BMI (69.9% compared to 53.7%).
<strong>Conclusion</strong>: The majority of the study population did not reach the recommended values of physical activity. In addition, no differences between the different types of the educational level were found regarding physical activities.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Helicobacter Pylori Infection in Patients with HCV Related Liver Cirrhosis and Its Association with Portal Hypertensive Gastropathy Severity234023451188810.12816/0041539ENTarek ElsakatyInternal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptMarcel WilliamInternal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptNabil AbdelgawadInternal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180829<strong>Aim of the work:</strong> Helicobacter pylori infection is a major health problem because about 50% of all humans worldwide are infected with Helicobacter pylori. Portal hypertensive gastropathy (PHG), a term used to describe the endoscopic appearance of gastric mucosa with a characteristic mosaic-like pattern with or without red spots is a common finding in patients with portal hypertension. The role of H. pylori infection on PHG severity is controversial so we try to prove if there is any role of H. pylori infection and severity of PHG. <strong>Patients and methods: </strong>eighty consecutive patients with HCV-related liver cirrhosis were enrolled in the study. Diagnosis of H. pylori infection was done by detection of H. pylori Ag in the stool by ELISA test. 80 consecutive patients with HCV-related liver cirrhosis were enrolled. Patients and Methods: all patients were subjected to an upper gastrointestinal endoscopy and ELISA test of H. pylori Ag in the stool. The diagnosis and the severity of portal hypertensive gastropathy (PHG) were evaluated on doing endoscopy. Child-Pugh and MELD scores were calculated to assess the severity of liver cirrhosis. <strong>Results:</strong> H. pylori infection was reported in 46 patients with overall prevalence 57.5%. PHG was found in 57 patients (71.25%); 36 (63.15%) of them had mild and 21 (36.15%) had severe PHG. H. pylori was more prevalent among patients with PHG than those without PHG (57.5% vs. 42.5%; p<0.001). No significant relation was found between H. pylori infection and severity of liver cirrhosis as regards Child-Pugh score (p= 0.383) and MELD score (p= 0.666). <strong>Conclusion:</strong> our results showed a significant association between H. pylori infection and the occurrence and also the severity of PHG in patients with HCV-related liver cirrhosis. Yet, the severity of liver cirrhosis itself did not correlate with H. pylori or the severity of PHG. Thus, eradication of H. pylori may be beneficial to ameliorate PHG.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Hodgkin Lymphoma: A Retrospective Clinical and Pathological Analyses with Correlation to Treatment Outcome234623541188710.12816/0041540ENElleithy MMClinical Oncology and Nuclear Medicine Department, Ain Shams UniversityMustafa MYClinical Oncology and Nuclear Medicine Department, Ain Shams UniversityMohamed DAClinical Oncology and Nuclear Medicine Department, Ain Shams UniversityAlShahawy NSClinical Oncology and Nuclear Medicine Department, Ain Shams UniversityJournal Article20180829<strong>Aim of the work: </strong>the aim of the study was to analyze the correlation between several clinico-pathological prognostic factors in classical type Hodgkin lymphoma and its effect on response to treatment and survival rates (PFS and OS). The primary endpoint is response rate and secondary endpoints are survival rates.
<strong>Patients and methods: </strong>this study was performed on 76 patients diagnosed as classical Hodgkin lymphoma that were recruited retrospectively from January 2010 to December 2015 in Nasser Institute Oncology Centre and Ain Shams Clinical Oncology Department. Patients’ risk factors in the whole group were analyzed using univariate and multivariate regression analysis. They included age, sex, pathological type, B symptoms, performance status, stage, extranoadal disease, bulky disease, inflammatory markers and their correlation on complete response rate (CR), progression free survival (PFS) and overall survival (OS).
<strong>Results: </strong>nodular sclerosing type was the most common in 44.7% of patients followed by mixed cellularity in 21.1% of patients followed by lymphocyte predominant in14.4% of patients, while unclassified classical constituted 19.7%. Early disease (Stage I, II) constituted 68.4% of patients and late disease (Stage III, IV) was found in 31.6% of patients. Bulky and extranodal diseases were found in 28.9% and 21.05% of patients respectively. All of patients received first line ABVD with 59.2% of patients received consolidative or palliative radiotherapy. CR rate was 65.8% being 71.2% in the early versus 52% in the advanced stage (p=0.07) with a relapse rate of 7.8%. The CR was negatively correlated with pathological type being worse in nodular sclerosing subtype than mixed cellularity (p=0.02), poor performance status (p=0.016), bulky disease (p=0.004), extranodal disease (p=0.0381), elevated LDH (p=0.045) and leucocytosis and lymphopenia (p=0.005). Median PFS was 17.5 months with a range of 1 to 75 months<em>. </em>5 year PFS was negatively correlated with advanced stage than early stage (p=0.019), Bulky disease than non bulky (p=0.003), extranodal disease than nodal (p=0.014), leucocytosis and lymphopenia (p= 0.002).Median overall survival is 28 months with a range of 6-81 months with 5 years survival rate of 82.9% and mortality rate of 17.1%. 5 year overall survival was negatively associated with bulky rather than non bulky (p=0.05) and extranodal more than nodal (p=0.007).
<strong>Conclusion: </strong>this study concluded that both overall and progression free survival and response rates were negatively affected by stage, bulky and extranodal disease mainly. Pathological subtype and elevated ESR and LDH negatively affected CR rate. Leucocytosis and lymphopenia had a significant negative effect on response rate and progression free survival. This allowed the use of risk adapted treatment at several stages tailoring treatment to each patient separately.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy for The Treatment of Renal Stones Greater Than 2 Cm235523601188910.12816/0041541ENAlaa Hussain Ahmed AlhamraniKing Faisal UniversityAbdulla Abduljaleel AlkhalifaKing Faisal UniversityHussain Ali AlramadhanKing Faisal UniversityIbrahim Abdullah AbalhassanPrince Sattam Bin Abdulaziz UniversityMoaz Hassan H AlharbiPrince Sattam Bin Abdulaziz UniversityAhmad Khaled M AlshangitiKing Saud Bin Abdulaziz University for Health SciencesAhmed Maithem AlnasserDammam Medical ComplexHatim Saeed T AlshahraniKing Khalid UniversityHassan Mohammed AljadaaniIbnsina National Medical CollegeAbdulmalik AbdulAziz AlkhamisKing Faisal UniversityAbdulrahman Ahmed H AmanBatterjee Medical CollegeIyad Mashhoor HakeemUmm Al-Qura UniversityHassan Hamza A AlmirImam Abdulrahman Bin Faisal UniversityKhalid Ayed Abdullah ALahmariKing Khalid UniversityMohammed Ayed AlmuziniOctober 6th UniversityJournal Article20180829<strong>Background: S</strong>tone size is a key factor in the determination of the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery.
<strong>Aim of the Study: </strong>to assess and compare the efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones greater than 2 cm versus percutaneous nephrolithotomy (PCNL).
<strong>Patients and methods: </strong>A retrospective analysis was carried out for a total of 118 patients, of which 46 patients underwent RIRS while 72 patients underwent PCNL between May 2013 and May 2017.
<strong>Results</strong><strong>: </strong>The mean duration of operation was 96.39±41.11 min in the RIRS group and 69.51±19.3 min in the PCNL group (p<0.001). Hospital stay was significantly shorter in the RIRS group (1.32±0.6 vs. 4.19±1.9 days) in the RIRS and PCNL groups respectively (p<0.001). Stone-free rates after one session were 67.4% and 90.3% of the RIRS and PCNL groups, respectively. Blood transfusions were required in two patients in the PCNL group. Complication rates were generally higher in the PCNL group.
<strong>Conclusion</strong><strong>: </strong>The present study concluded that RIRS can be a successful substitute to PCNL in the treatment of kidney stones with a diameter of 2–4 cm particularly in patients with comorbidities.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Incidence of Fat Embolism after Long Fracture Fixation Operations: Review Article236123651189010.12816/0041542ENSami Amer M AlqarniKing Khalid University, Abha, Saudi ArabiaLama Ibrahim AlorainImam Abdulrahman bin Faisal University, Dammam, Saudi ArabiaMohammed Salman AlHabibImam Abdulrahman bin Faisal University, Dammam, Saudi Arabia,Awath Fahim AlsulamiUmm Al-Qura University, Mecca, Saudi ArabiaAbdulaziz Muhammed AlEssaKing Faisal University, Hofuf, Saudi ArabiaZohor Abdullah AlamriKing Khalid University, Abha, Saudi ArabiaRakan Fraih Jarallah AlmuazziHail University, Hail, Saudi ArabiaHala Mohammed Bin ZaidPrincess Nourah bint Abdulrahman University, Riyadh, Saudi ArabiaYousif Ali Brshoum AlmutairiOctober 6 University, Cairo, EgyptMohammed Ahmed H AgeeliJazan University, Jazan, Saudi ArabiaSaleem Othman Rafi AlamriOhud Hospital, Medina, Saudi ArabiaOmar Abdulmohsen AlshadokhiImam Muhammad ibn Saud Islamic University, Riyadh, Saudi ArabiaSaeed Hamed AlzahraniNajran University, Najran, Saudi ArabiaSulaiman Dawoud DashtiUniversity of Malta, MaltaAhmed Atiah Awwadh AlsalmiTaif University, Taif, Saudi ArabiaJournal Article20180829In spite of being rare, fat embolism syndrome is considered a fatal complication after bone fracture and orthopedic procedures. It was suggested that early immobilization might reduce the incidence of fat embolism syndrome. However, no enough data are available to justify this finding. <strong>Objectives</strong>: The aim of this review is to determine the incidence of fat embolism among patients who had long fracture fixation. <strong>Methods</strong>: A systematic review of Medline and Cochrane library was conducted on their database. This search yielded 34 papers, 13 of which were related. <strong>Results:</strong> The incidence of fat embolism syndrome after long fracture fixation ranged from 2.7% and 11%. More specifically, the incidence among long bone fracture patients who were operated early (within the first 24 hours after injury) ranged from zero% in some studies (16,19) to 1.8% in others. As regards late operation, after 24 hour of bone fracture, the incidence of fat embolism syndrome (FES) ranged from 3.5% to 10.4. <strong>Conclusions</strong>: The incidence of fat embolism in post long fracture fixation is very low. Several research works indicate that early fixation significantly reduce the incidence of FES compared to late fixation. <br /> <strong> </strong><br /> Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200269420171001Types and Management of Chronic Intestinal Ischemia236623721189110.12816/0041543ENHesham Abd El Raouf El AkkadDepartment of General Surgery, Faculty of Medicine, Ain Shams UniversityAhmed Adel Ain ShokaDepartment of General Surgery, Faculty of Medicine, Ain Shams UniversityKhaled Ibrahim Mohammed El BeltagyDepartment of General Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20180829<strong>Background:</strong>chronic intestinal ischemia is unusual but important cause of abdominal pain. Although this condition accounts for only 5% of all intestinal ischemic events, it can have significant clinical consequences
<strong>Aim of the Work<em>: </em></strong>the objective of this systematic review was to assess the value of different types of management of chronic intestinal ischemia (Open surgery versus endovascular interventions). PubMed and EBSCOHost electronic databases were methodically searched for English-language articles published between 1996 and 2015.
<strong>Conclusion<em>: </em></strong>chronic mesenteric ischemia is a condition characterized by postprandial abdominal pain, which is ascribed to intestinal hypoperfusion. Patients were frequently malnourished and develop significant weight loss due to sitophobia. Traditionally, open surgery has been the treatment of choice; however, endovascular surgery was gaining wider acceptance. Based on the data, open surgeries surpass endovascular procedures in terms of symptom amelioration and long-term vessel patency, along with less significant symptomatic recurrence. Patients undergoing open procedures do, however, have a higher rate of complications. Nonetheless, there was no statistically significant difference in mortality rates between the two approaches.
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