Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Comparison Between the Use of a Genexpert Device and Conventional Diagnostic Methods in the Detection of Mycobacterial Tuberculosis and Its Resistance to Drugs740474111857910.21608/ejhm.2018.18579ENAhmed E. ElsayedDepartment of Medical Microbiology and Immunology, Faculty of
Medicine, Al-Azhar University, Cairo, Egypt4853-1209-0000-0000Mostafa Y. El-MishadDepartment of Medical Microbiology and Immunology, Faculty of
Medicine, Al-Azhar University, Cairo, EgyptMahmoud A. MohamedDepartment of Medical Microbiology and Immunology, Faculty of
Medicine, Al-Azhar University, Cairo, EgyptIbrahim M. El-hosinyDepartment of Medical Microbiology and Immunology, Faculty of
Medicine, Al-Azhar University, Cairo, EgyptAhmed Abdel TawabDepartment of Medical Microbiology and Immunology, Faculty of
Medicine, Al-Azhar University, Cairo, EgyptGhanem A. MohamedDepartment of chest diseases, Faculty of
Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181108Background: Mycobacterium tuberculosis (MTB) is the causative agent of tuberculosis (TB), which remains the leading cause of morbidity and mortality worldwide. The emergence of drug-resistant strains of MTB has put status of TB to threatening levels. Aim of the Work: was to detect MTB along with rifampicin (RIF) resistance using Genexpert (MTB/RIF). Its diagnostic, sensitivity and specificity were evaluated by comparing with conventional technique. Patients, Materials and Methods: This prospective study was conducted on two hundred and seven Egyptian patients at Abbasia Chest Diseases Hospital, from November 2016 to December 2017, and comprised clinically and radiologically diagnosed TB suspected cases. This study was approved by the Ethical Committee of faculty of medicine, Alazhar University and the Ethical Committee of Ministry of Health and after Verbal consents from the patients or their parents were taken. Pulmonary specimens (sputum and bronchial lavage) and pleural effusion as an extra-pulmonary specimen were included. All samples collected were sent to TB laboratory of Abbasia Chest Diseases Hospital for further analysis. Result: Out of the 26 Genexpert (MTB/RIF) positive samples for MTBC, 3 (11.54%) showed RIF resistance and diagnosed as MDR-TB. Using LJ and MGIT cultures for drug sensitivity test (DST) on 31 and 34 positive TB samples; respectively, the same three specimens showed resistance to rifampicin (RIF). Four positive specimens were also resistant to streptomycin (STR) using the previously mentioned cultures. Moreover, resistant to INH was reported in five positive TB samples using the same cultures. Finally, it was found that all positive specimens were sensitive to Ethambutol (ETH). Conclusion: Although the conventional methods remain the gold standard for diagnosing pulmonary TB, delayed diagnostic times demand for more rapid and sensitive nucleic acid amplification techniques. Genexpert (MTB/RIF) assay is simple, rapid and accurate method for detecting mycobacterial tuberculosisPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Outcome of Unilateral Intraocular Retinoblastoma741274171858110.21608/ejhm.2018.18581ENMohammad Ahmad WahdanOphthalmology Department, Faculty of Medicine, Al Azhar UniversityAbd Allah El Hussainy ShaleelOphthalmology Department, Faculty of Medicine, Al Azhar UniversityHossam El Dein Ahmed El ZomorOphthalmology Department, Faculty of Medicine, Al Azhar UniversityHossam El Din Hassan El Sayed El BazOphthalmology Department, Faculty of Medicine, Al Azhar UniversityJournal Article20181108Background: retinoblastoma is the most common primary, malignant intraocular tumor of childhood, the aim of the study is to evaluate the outcome of management of 50 consecutive cases of unilateral retinoblastoma. Aims of the Work: to evaluate the outcome of management of unilateral retinoblastoma and to assess the risk of recurrence. Patients and Methods: prospective study of 50 consecutive cases with unilateral intraocular retinoblastoma. The management of cases was performed in the National eye center (Rod El Farag). Fundus examination was done under general anesthesia with RetCam 3. Management of cases according to the staging was group A: Focal treatment, TTT or cryotherapy, group B & C: chemotherapy with focal treatment, group D: If the patient has good visual potential (according to macular affection) Chemotherapy with focal treatment, if the patient has poor visual potential Enucleation, group E Enucleation. Results: as regard cases that managed with chemotherapy, there was 23 cases, 13 out of them treated with chemotherapy and transpupillary thermotherapy and showed complete regression, 10 cases showed initial regression with further new tumor recurrence after finishing chemotherapy, 5 cases was well managed by focal therapy, and another 5 cases failed to be controlled by focal therapy and Intra vitreal melphalan and ended by enucleation. As regard cases that was managed by enucleation, there was 32 cases, 27 out of them managed by primary enucleation, and 5 cases managed by secondary enucleation after failure of chemotherapy and focal therapy, 17 cases out of the enucleated eyes revealed presence of high risk pathological features, none of the cases developed local or metastatic tumors in the follow up period. Conclusion: retinal seeding, vitreous seeding are major predictive factors for tumor recurrencePan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002739201810013 Yolk Sac Size and Shape, Gestational Sac Diameter and Embryonic Heart Rate as Prognostic Factors for First Trimesteric Outcome741874281864910.21608/ejhm.2018.18649ENEmad Maarof Abd EllatifDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar UniversityAbdalla Khalil AhmadDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar UniversityMohamed Ali Ali HalawaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar UniversityJournal Article20181109Background: it is estimated that approximately 30% to 40% of implanted pregnancies resulted in spontaneous abortion during the first trimester, most of which occur in very early stage. Significant number of losses predominantly occurs very early in gestation, but once the embryonic heart activity appears the rate of spontaneous abortion gradually decreases to 2-5%. Aim of the work: this work aimed to evaluate the correlation between the ultrasound parameters that were assessed in the first trimester (the gestational sac size, yolk sac size and shape and embryonic heart rate) to early pregnancy loss and the correlation between different ultrasound parameter to each other. Methodology: this study involved 100 pregnant women attending Al Hussein University Hospital. They were examined by using 2D ultrasonography starting early in the first trimester with a first scan between 6 and 8 weeks. A follow up scan was conducted at 9 and 12 weeks. During follow up, 7 women did not return for follow up and accordingly, the results (gestional sac diameter,embryonic heart rate and yolk sac size and shape ) of the remaining 93 women were shown. All patients were evaluated by transvaginal ultrasound using equipped with a real-time, 5-MHz sector electronic array endovaginal probe. The fetal heart rate was measured by M-mode in all cases and the yolk sac diameter (YSD) was determined by placing the calipers on the inner limits of the longer diameter. Results: in this study, there was a significant increase in age in fetal loss group more than complete pregnancy group. Regarding the relation between gestational sac diameter at different gestational age period and its relation to the outcome of pregnancy, the gestational sac diameter showed a significant decreasing in the fetal loss group at 6, 9 and 12 weeks, so the GS diameter was a good predictor to fetal loss (p < 0.05). Conclusion: first trimester ultrasound measurement of these parameters (FHR,YS diameter and shape and GS diameter) proved to be an important, helpful and noninvasive tool in the investigation, diagnosis as well as the follow up of pregnant females in their early pregnancy. Measurement of gestational sac diameter, CRL and fetal heart rate in combination provided better prediction of the prognosis of the first trimester than when either parameter used alone.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Prospective Study of Changes in Anti-HCV Immunoglobulin G Antibody Titers after Treatment with Direct Acting Antiviral Agents742974341865010.21608/ejhm.2018.18650ENDiaa Mohammad EltebiDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo.Islam Abdel-Mawla AmmarDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo.Mohammad Abu Elsoud MohammadDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo.Journal Article20181109Introduction: worldwide, approximately 180 million people are living with CHC, which corresponds to a global prevalence of 1.1% and millions more are newly infected each year. Annually, 700.000 people die from HCV-related complications, including cirrhosis and hepatocellular carcinoma (HCC). Aim of the work: the present study investigated the dynamics of change in various HCV antibodies in patients with CHC who achieved SVR after DAAs. Methodology: this was a prospective case-control study that was conducted on 150 patients. They were categorized into three main groups: Group I: included 100 patients with chronic HCV infection as diagnosed by SRT-PCR. They were submitted to treatment with DAAs for 12 weeks. Group II (positive control group): Included 25 patients who presented with CHC infection as diagnosed by positive anti-HCV IgG antibodies and positive HCV SRT-PCR, but either refuse or postpone HCV therapy or the treatment of HCV itself was contraindicated. Group III (negative control group): included 25 patients, apparently healthy individuals who test positive for anti-HCV IgG antibodies, but negative HCV SRT-PCR. HCV IgG Ab titers was assessed by commercially available third-generation enzyme-linked immunosorbent assay (ELISA) at base line, end of treatment and then at the 24th week (i.e. 12 weeks after the end of treatment). Results: as regard HCVAb, it showed a significant statistical difference (pvalue < 0.001) between titer results at baselin12th week and 24th week in patients group I; as HCV Ab titers were 3.3 ± 0.2 mg/dl at baseline and declined to 2.7 ±0.2 at 12th week and 2.4± 0.3 at 24th week. But, there was no statistical significant difference (p-value > 0.05) between HCV Ab titer results at baseline, 12th week and 24th week in the studied positive control patients group II as HCV Ab titers were 3.1 ± 0.2 at baseline, 3.2 ±0.2 at 12th week and (3.2± 0.1) at 24th week week. Also, there was no statistical significant difference (p-value > 0.05) between HCV Ab titer results at baseline, 12th week and24th week in studied negative control patients group III as HCV Ab titers were 1.22 ± 08 at baseline, (1.23±0.08) at 12th week and 1.24± 0.07 at 24th week. Conclusion: HCV antibody titer appeared to continue to decrease after eradication of HCV by DAAs therapy.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Immunohistochemical Study of Epithelial Mesenchymal Transition Markers Slug and E-Cadherin in Laryngeal Squamous Cell Carcinoma743574431869810.21608/ejhm.2018.18698ENLaila Abd El-Samea MoussaDepartment of Pathology, Faculty of Medicine, Al-Azhar University, EgyptMarwa Abd Al Moniem Al KholyDepartment of Pathology, Faculty of Medicine, Al-Azhar University, EgyptAzza Kamal TahaDepartment of Pathology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20181111Background: laryngeal carcinoma is the most common head and neck cancer, with a high rate of metastasis and poor prognosis. It has a global incidence of 3.2 cases per 100,000 and a death rate of 1.1 per 100,000 per annum. Squamous cell carcinomas constitute more than 95% of primary cancer larynx. Despite of the recent advances in the treatment modalities for laryngeal carcinoma, the survival rate of patients with this malignancy has not improved significantly. Therefore, there is an urgent need to identify novel biomarkers for the prediction of tumour progression and metastasis. Epithelial-mesenchymal transition (EMT) process promotes the aggressive behaviour of cancer through downregulation of epithelial markers and upregulation of mesenchymal markers of cancer cells in order to become motile and invasive. Several transcription factors are key regulators of EMT, including the Snail/Slug family, Twist, ZEB1 and ZEB2. Aim of the work: this study aimed to evaluate the immunohistochemical (IHC) expression of the transcription factor Slug as an inducer of EMT and E-cadherin as an epithelial protein in 50 Egyptian cases of laryngeal squamous cell carcinoma (LSCC) and investigation of the relationship between both markers and the clinicopathologic parameters. Material and Method: the material of this study included 50 specimens of LSCC. All specimens were embedded in paraffin and stained with Hematoxilin and Eosin (H & E) for histopathological evaluation. Other Sections were immunostained with antibodies to Slug and E-Cadherin. The results were tabled, statistically analyzed and discussed. Results: high tumor grade and high TNM stage were positively correlated with Slug IHC expression (P-value= 0.02 and 0.001) but inversely correlated with E-cadherin IHC expression (pvalue= 0.006 and 0.03) respectively. Conclusion: LSCC patients with Slug IHC overexpression and reduced Ecadherin IHC expression are at higher risk of metastatic carcinoma and might benefit from more aggressive treatment after surgery.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Prevalence of Asymptomatic Bacteriuria in Patients with Preterm Labor744474471869910.21608/ejhm.2018.18699ENHossam Aldin Hussein KamelDepartment of Obstetrics and Gyencology, Faculty of Medicnie – Al-Azhar UniversityMostafa Hussein Mohammed HegabDepartment of Obstetrics and Gyencology, Faculty of Medicnie – Al-Azhar UniversityAhmad Al-saeed Al-sehraweyDepartment of Obstetrics and Gyencology, Faculty of Medicnie – Al-Azhar UniversityHassan Mohammed HassanDepartment of Obstetrics and Gyencology, Faculty of Medicnie – Al-Azhar UniversityJournal Article20181111Background: asymptomatic bacteriuria (ASB) during pregnancy is the primary cause of acute pyelonephritis, preterm labor, low birth weight fetus, etc., if left untreated. Adequate and early treatment reduces the prevalence of these obstetric complications. Objectives: this study aimed to determine the prevalence of ASB during pregnancy and determine the association between asymptomatic bacteriuria and spontaneous preterm birth. Patients Methods: this was a case control study of 120 preterm pregnancies and 40 term pregnancies among those attending El-Galaa Teaching Hospital, Obstetric Emergency Unit to evaluate the incidence of ASB and determine the association between asymptomatic bacteriuria and spontaneous preterm birth from March 2016 to March2017.Urine analysis and culture with antibiotic sensitivity were performed . Results: out of the 160 patients studied, ASB was observed in 7 patients (6 cases in preterm group (5%) and 1 case in full term group (2.5%) with no significant difference between the two groups (p-value˃ 0.05), the incidence of ASB in preterm labor was quite lower 5%. E. coli was the most common pathogen (55.14%) followed by proteus 28.57 followed by klebsiella (14.28%). Conclusion: all pregnant women should be screened by urine culture to detect asymptomatic bacteriuria at their first visit to prevent overt urinary tract infections (UTI) and other complications in both mother and fetus.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Evaluation of Diagnostic Cerebral Angiography at Al-Hussein Neuro-Intervention Unit744874531870010.21608/ejhm.2018.18700ENSayed Ahmed Fathy El-ZayatDepartments of Neurology, Faculty of Medicine, Al-Azhar UniversityMohamed Fouad Abd El-MoatyDepartments of Radiology, Faculty of Medicine, Al-Azhar UniversityKhaled Mohamed SobhDepartments of Neurology, Faculty of Medicine, Al-Azhar UniversityHamada Abd-Eltwab Salama MohamedDepartments of Neurology, Faculty of Medicine, Al-Azhar UniversityJournal Article20181111Background: digital subtraction angiography (DSA) is important diagnostic tool for evaluation of cerebral vasculature and provides essential information regarding hemodynamic status and collateral circulation in patients with stroke and vascular malformations, so it is ideal imaging method of choice for diagnosis of cerebrovascular diseases. Aim of the Work: to register all cases undergoing diagnostic cerebral angiography in Al-Hussein University hospital, neuro-intervention unit performed by a neuro-interventional team and evaluate the results, and outcome of this procedure. Materials and Methods: the present study is single-center study included all patients subjected to diagnostic cerebral angiography during period from 2006 to 2018. The study protocol was approved by the local Ethics Committee in Al-Azhar University. The patients had been recruited from Al-Hussein and Sayed Galal Hospital outpatient's clinics, internal departments and stroke units, which indicated for diagnostic cerebral angiography. Results: in the present study the mean age of patients with arterial stenosis was (55.47 ±8.80), 1049(51%) of them were males, 1009(49%) were females. In our study, mild stenosis was present in 254 (12.3%), moderate stenosis in 525 (25.5%), severe stenosis in 567 (27.6 %), subtotal occlusion in 315 (15.3%) and total occlusion in 397 (19.3%) of the patients which detected by DSA. Conclusion: arterial stenosis is more common than cerebral aneurysms and AVM in the patients who subjected to DSA. The presence of hypertension and diabetes mellitus were found to be significantly more prevalent among patients with arterial stenosis. However, the prevalence of hypertension and smoking were more prevalent in cerebral aneurysms.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Incidence of Miss Targeting in Frame-based Stereotactic Brain Surgery745474571870110.21608/ejhm.2018.18701ENMohamed Hasan MansourDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20181111Background: accurate localization of a lesion is the ultimate goal of stereotactic surgery. Frame-based systems have the advantage of proven clinical utility and instrument carriage with a high degree of mechanical stability and accuracy. Aim of the work: this study aimed to investigate the incidence of miss targeting in frame based stereotactic brain surgery. Patient and methods: this was a retrospective study and included non-comparative, consecutive case series of 200 cases of different intracranial lesions, using CT imaged Leksell G stereotactic brain surgery, for diagnostic 180 cases or therapeutic 20 cases purposes and they performed at Sayed Galal University Hospital and other neurosurgical centers at Egypt between Jan 2015 and Jan 2018. Results: there were 120 males and 80 females. The procedures were performed under local anesthesia. Diagnostic purposes were the most encountered procedures for 180 cases, while therapeutic were 20 cases. The incidence of miss targeting was 2% of the studied group, which was noticed among the diagnostic group (2/180 = 0.011%) more than the therapeutic group (2/20=10%). Conclusion: the incidence of miss targeting in frame based stereotactic brain surgery is a concern and must be suspected. Recommendations: stereotactic surgical team must evaluate every surgery steps very carefully.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Evaluation of Safety and Efficacy of Radiofrequency Lesioning of Thoracic Dorsal Root Ganglion in Chest Cancer Pain Patients745874681870310.21608/ejhm.2018.18703ENAhmed El-Saeed AbdelrahmanDepartment of Anesthesia & ICU Department, Faculty of Medicine, Aswan UniversityRafaat Mahfouz ReyadDepartment of Anesthesia & ICU Department, Faculty of Medicine, Aswan UniversityAyman Mohamady El-DemerdoshDepartment of Anesthesia & ICU Department, Faculty of Medicine, Aswan UniversityMahmoud Mohamed Hassan MostafaDepartment of Anesthesia & ICU Department, Faculty of Medicine, Aswan UniversityJournal Article20181111Background: since cancer-associated pain is a common occurrence in malignancies involving the chest. In these cases, pain is complex and may have visceral, somatic or neuropathic components. It has been noticed that the number of cancer patients with refractory chest pain is increasing with more cancer prevalence, also with the advances in therapy and prolonged life expectancy. The demand for interventional procedures to control pain for these patients also increases. Interventional pain procedures are indicated for refractory pain when analgesic drugs are ineffective or associated with intolerable side effects. In controlling cancer pain it is commonly inadequately managed for these patients leading to suffer form of physical disabilities, psychological disturbance and avoiding treatment. Aim of the work: this study was designed to test both the efficacy and safety of thermo-coagulative ablation of the thoracic dorsal root ganglia for pain control in cancer patients that have refractory chest pain. Methodology: this prospective randomized study was conducted in the National Cancer Institute, Cairo University and Aswan University after board approval from October 2016 to March 2018. Sixty-five patients with Refractory Chronic Chest Cancer Pain were selected randomly and prospectively from the pain clinic of both the National Cancer Institute of Cairo University and Aswan University, after taken an informed written consent from the patient. The complete duration of the follow up lasted 3 months post-interventional with assessments after 1 week, 1 month and 3 months. At each follow up each patient was re-assessed with the following assessments; VAS, ECOG Performance Status. Results: we found that with effective pain relief there was a significant reduction in the mean VAS values; which means that there was functional improvement, in all the postinterventional follow ups. Also, there was an improvement in the functional state of the patients throughout the follow-up post-intervention with regards to the ECOG performance status from the results.Conclusion: we concluded that thermal radiofrequency ablation is considered an alternative for treating refractory chronic chest cancer pain of several types and causes. This is because of its efficacy, safety and ease of use. It also requires a minimal hospital stay or can even be performed on an outpatient basis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Surgical Release of Trigger Thumb in Pediatrics746974741870410.21608/ejhm.2018.18704ENMohamed S. AbdelhafizDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar UniversityAmro A. FouaadDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar UniversityMostafa M. AbdelatifDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20181111Background: trigger thumbs in children predominantly present with flexion deformity and a nodule at the MCP joint. Surgical release with a transverse incision and splitting of the A1 pulley achieves good cosmoses and attains a satisfactory range of motion with minimal complications. Aim of the Work: to analyze the results of treatment of congenital trigger thumb by open surgical release. Patients and Methods: this study was carried out on 12 patients with congenital trigger thumb treated by surgical release of A1 pulley after obtaining the hospital’s Research Ethics Committee approval and written informed consents from the patients. Results: twelve patients were followed up for a mean of 10 (range 4–16) weeks, by which time they were all free of pain and had normal strength subjectively. Of the 12 patients evaluated postoperatively, all were able to fully extend the interphalangeal joint of the involved thumb. Conclusion: Surgical management is the most common treatment, and this is done effectively and safely in the hands of experienced surgeons with pediatric anesthesiologists.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Radiofrequency Management of Trigeminal Neuralgia747574801870510.21608/ejhm.2018.18705ENEl Sayed AlmorDepartment of Neurosurgery, Al-Azhar UniversityMaamoun Abo ShoshaDepartment of Neurosurgery, Al-Azhar UniversityMohammed HassanDepartment of Neurosurgery, Al-Azhar UniversityMohamed Ellabbad Alaa RashadDepartment of Neurosurgery, Al-Azhar UniversityMostafa ElmaghrabyDepartment of Neurosurgery, Al-Azhar UniversityMoustafa RamzyDepartment of Neurosurgery, Al-Azhar UniversityJournal Article20181111Background: Trigeminal neuralgia (TN) is a unique disease. The first line of management in TN is medical treatment using antiepileptic drugs, when drugs failed to control the pain or when there is intolerability to them, surgical interventions are then indicated. Percutaneous Trigeminal rhizotomy (PTR) is recommended for elderly patients with higher operative risk factors. Objective: The aim of this work is to review the literature regarding the pathology, methods of investigations, operative techniques, complications of management of trigeminal neuralgia and eventually prognosis, also evaluation of the effectiveness of the radiofrequency percutaneous radiofrequency rhizotomy - for management of trigeminal neuralgia. Patients and Methods: This study included a total of 15 patients with trigeminal neuralgia presented predominantly in females. Female: male 1.7:1 and the mean age was 53 years. They were admitted and managed at the Neurosurgical Department of at Al-Azhar University Hospitals and other private centers between June 2017 and October 2018. Clinical follow-up was obtained in 15 (100%) patients. Results: follow up revealed that 11 patient (73.4 %) had favorable outcome and 4 patient (26.6%) had unfavorable outcome. The mean preoperative visual analogue scale(VAS) was 7.83 (range 7-10). It dropped immediately postoperative to 2.33 (range 1- 4).), intraoperative complication was noted in 3 cases (18%).Conclusion: Radiofrequency rhizotomy is the procedure of choice for most patients undergoing first surgical treatments and patients at high risk from general anesthesia (although not necessarily the elderly).Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Monitor of Water Quality Using The Grey Mullet (Mugil Cephalus) as Bioindicator in Two Egyptian Lakes748174911870710.21608/ejhm.2018.18707ENEman G.E. HelalZoology Department, Faculty of science (Girls), Al-Azhar University, Cairo, Egypthttps://orcid.org/0M. S. Abd El-AttiZoology Department, Faculty of Science, Zagazig University, EgyptShaymaa HusseinDepartment of Cytology and Histology, Fac. Vet. Med. Cairo University, EgyptYasmina M. EkraimZoology Department, Faculty of science (Girls), Al-Azhar University, Cairo, EgyptJournal Article20181111Background-Burullus Lake has brackish water and agricultural, industrial and sewage drainage water represent the major inflows and it represents one of the most subjected lakes to serious pollutants at the delta’s coastline. Mugil cephalus is one of the most important food fish species for the Egyptian people. This study was conducted to explain the effect of water pollution of both Qarun and Burullus Lakes on some biochemical and histological characteristics of mullet collected from both Lakes. Our results showed that water collected from Burullus Lake has higher levels of lead and cadmium than Qarun Lake. The liver function analysis showed that there were no significant differences between levels of GGT in M. cephalus livers collected from both Lakes. ALT and AST were significantly increased in livers of fishes collected from Qarun Lake than Burullus Lake, cholesterol, triglycerides, RF1, RF2, high density lipoproteins (HDL), low density lipoproteins (LDL) and very low density lipoproteins (VLDL) in muscles of the mullet collected from Burullus Lake were highly significant increase, while total proteins were significantly decreased in comparison with mullet of Qarun Lake. Histopathological investigations revealed that livers of mullet cached from both Lakes were suffered from marked area of hemorrhage, aggregates of hemosiderin granules and vacuolated hepatocytes. Ultrastructural observation showed degenerated and swelled cylindrical mitochondria in liver obtained from Burullus Lake with accumulation of lipid droplets and degenerated cytoplasmic organoids. Hepatocyte from Qarun Lake showed apoptotic nuclei, degenerated, swelled and cylindrical mitochondria, lipid droplets and dilated rough endoplasmic reticulum. Von Kupffer cells in liver of both lakes contained abundant lysosomes with corrugated walls and numerous cytoplasmic vacuoles. The kidney sections of mullet of both Lakes showed necrosis in the tubular epithelial lining with scattered apoptotic cells and interstitial inflammatory infiltrate.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Knowledge and Beliefs of Early Childhood Caries and Late Night Bottle Feeding among Mothers in Saudi Arabia749274971886710.21608/ejhm.2018.18867ENAbdulrahman Sulaiman AldakhiliDentist, Faculty of Dentistry, Al-Qassim University, Al-Qassim , Saudi ArabiaAnas Abdulrahman AlsoqeerDentist, Faculty of Dentistry, Al-Qassim University, Al-Qassim , Saudi ArabiaAbdulrahman Khaled AlothaimDentist, Faculty of Dentistry, Al-Qassim University, Al-Qassim , Saudi ArabiaAbdulaziz Sulaiman AlkhodairDentist, Faculty of Dentistry, Al-Qassim University, Al-Qassim , Saudi ArabiaSaleh Musaad AlsaykhanDentist, Faculty of Dentistry, Al-Qassim University, Al-Qassim , Saudi ArabiaJournal Article20181112Background:Early Childhood Caries is a public health problem that continues to affect babies and preschool children worldwide. A comprehensive review of the epidemiology of ECC showed that its prevalence varies from population to population, however, disadvantaged children, regardless of race, ethnicity or culture, are most vulnerable.It is considered one of the most prevalent diseases in childhood, affecting 60% to 90% of children globally.It is considered one of the most prevalent diseases in childhood, affecting 60% to 90% of children globally. ECC is still highly prevalent among children in communities in both developing and developed countries. Aim of the work:To assess and evaluate Saudi mothers' knowledge and believes of early childhood caries. Methods:Descriptivecross sectional studywas conducted during the period between 1st of November 2017 to the 4th of January 2018among Saudi mothers. Datawere collected through an online questionnaire distributed to all regions of Saudi Arabia. Results: Among the 1477 Saudis' mothers, the majority of participants were from the Middle region 1178 (79.8%).Less than half of mothers 637 (43.1%) have 1-3 children, 434 (29.4%) of them have 4-5 children, 348 (23.5%) have more than 5 children, and only 59 (4%) have no children.Nearly three fourths 1117 (75.6%) of the mothers thought deciduous teeth are important and 654 (44.2%) think bottle feeding of children at late night is not harmful to child’s teeth. Conclusion: Better knowledge of the cause of early childhood caries and effective strategies to reduce its risk should produce enormous reductions in initial and long-term dental treatment costsPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Magnetic Resonance Cholangiopancreatography versus Endosonography in Diagnosing Biliary Ducts Obstruction749875061886810.21608/ejhm.2018.18868ENEl-Sayed Gaber Abd-Elhamid AmmarTropical Medicine Department, Faculty of Medicine-Al Azhar University.Gamal Mohammad Mohammad SolimanTropical Medicine Department, Faculty of Medicine-Al Azhar University.Mokhtar Ragab RamadanRadiology Department, Faculty of Medicine-Al Azhar University.Mahmoud Ismail BastawyClinical Pathology Department,
Faculty of Medicine-Al Azhar University.Mahmoud Mohammad GhonameTropical Medicine Department, Faculty of Medicine-Al Azhar University.Journal Article20181112Background: biliary obstruction or cholestasis is a common medical or surgical problem. Broadly speaking, the causes can be divided into intrahepatic and extrahepatic. The diagnosis of biliary tree can be done by different imaging modalities starting from transabdominal ultrasonography, to magnetic resonance cholangeopancreatograpy (MRCP) to endoscopic ultrasonography (EUS) and endoscopic cholangeopancreatography (ERCP) for diagnosis and treatment. Aim of the present work: this study aimed to evaluate the accuracy of these different modalities when compared to ERCP as diagnostic methods for diagnosis of different biliary tree abnormalities. Patients and methods: eighty-four patients with obstructive jaundice were included and categorized into two groups group I: 56 patients with calcular obstructive jaundice, group II: 28 patients with non-calcular obstruction. Patients underwent history taking, clinical examination and routine laboratory investigations as well as tumor markers. Patients were examined by US, MRCP, EUS, ERCP and the findings of each modality were compared to ERCP. Results: the sensitivity and specificity of US in diagnosis of intrahepatic biliary dilatation (IHBRD) and common bile duct (CBD) dilatation were 81% , 100% and 33% and 100% for diagnosis of pancreatic tumors respectively. The sensitivity and specificity of MRCP in diagnosis of IHBRD was 97% and 100% successively and for CBD dilatation 79% and 100% successively and for diagnosis of pancreatic tumors 100% and 96% successively. The sensitivity and specificity of EUS in diagnosis of IHBRD were 100% and 100% successively and for CBD dilatation were 100% and 100% successively but in diagnosis of pancreatic tumors were 100% and 94% successively. Conclusion: Both MRCP and EUS were good diagnostic modalities for biliary obstruction and pancreatic tumors with sensitivity and specificity of >90% when compared to ERCP.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Clinical, and Biochemical Profile of Pediatric Diabetic Ketoacidosis Patients in Al-zahraa Hospital Pediatric ICU750775111886910.21608/ejhm.2018.18869ENRagaa Abd EL Salam MohammedDepartment of Pediatric, Faculty of Medicine, Medicine (for Girls),Al-Azhar UniversityNaglaa Abd El Monem AbdallaDepartment of Pediatric, Faculty of Medicine, Medicine (for Girls),Al-Azhar UniversityFatma Abdelghaffar Mohamed MahranDepartment of Pediatric, Faculty of Medicine, Medicine (for Girls),Al-Azhar UniversityJournal Article20181112Background: Diabetic ketoacidosis (DKA) is an acute and life-threatening situation that accounts for themajority of diabetes-related morbidity and mortality in children and adolescents who suffer from type 1 diabetes mellitus (T1DM). Objective: To assess pediatric patients presented with DKA regarding aspects of presentation, findings, and management and probable risk factors associated with DKA. Methods: a retrospective descriptive hospital-based study of 43 pediatric patients. Categorized into two groups, Group A: n=18, previously diagnosed T1DM children and Group B: n=25, newly diagnosed cases of T1DM admitted into Pediatric ICU at Alzahraa Hospital,during the period 2013 to 2017.The following data were analyzed: age, sex, weight loss, basic signs & symptoms, severity on admission, blood gas, blood glucose, glycated hemoglobin,risk factors, length of stay, and complications such as electrolyte disturbances were compared between the two groups. Results: Newly diagnosed diabetics accounted for 25 (58.1%) of the patients. Patients in group B had longer hospital stay of 5.88±2.55 days.This study reported more nausea, vomiting, polydipsia, and polyuria, and showed more weight loss (p =.017)in group B. There was a significant relationship between hypokalemia and clinical severity (P = 0.012), and between lower bicarbonate,acidosis and severity of DKA (P <.001). No deaths occurred. Conclusion: DKA was most prevalent in newly diagnosed T1DM cases. Significant differences in severity between groups were observed.Infections was the most common precipitating factors. No lethal complications were reported.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Neurophysiological Assessment of Peripheral Nerve Functions in a Sample of Egyptian Patients with Liver Cirrhosis751275161955110.21608/ejhm.2018.19551ENKamel HewediDepartments of Neurology, Faculty of Medicine, Al-Azhar University, EgyptYasser M. M. El-DessoukyDepartments of Tropical Medicine, Faculty of Medicine, Al-Azhar University, EgyptHossam Mohammed EmamDepartments of Neurology, Faculty of Medicine, Al-Azhar University, EgyptAhmed EssmatDepartments of Neurology, Faculty of Medicine, Al-Azhar University, EgyptAbdelsalam Abdalla Ali Abd ElkaderDepartments of Neurology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20181119Background: peripheral neuropathy is damage to or disease affecting nerves which may impair sensation, movement, gland or organs function or other aspects of health depending on the type of nerve affected. Peripheral neuropathy is a common complication of liver cirrhosis either due to viral (mostly HCV), NASH, Alcoholic or mixed. Objectives: the aim of this study was to define the prevalence of peripheral neuropathy in a sample of Egyptian patients with liver cirrhosis and to determine any etiologic correlation. Patients and Methods: this descriptive study was conducted on 47 Egyptian liver cirrhotic patients. Patients were subjected to history taking, detailed neurological examination and clinical and neurophysiological assessment. Results: viral hepatitis was the commonest cause of liver cirrhosis 59.6% while non viral causes 25.5% e.g. NASH, the main duration of liver cirrhosis was 10 + 3.98 yrs ranging from 3-23 yrs. The majority of patients were asymptomatic, 48.9%, while the most presenting symptoms were sensory symptoms 25.5%, the prevalence of PN among a sample of Egyptian patients with liver cirrhosis according to neurophysiological assessment was 72.3% mostly of mixed sensory and motor polyneuropathic pattern, not related to the cause of liver cirrhosis but affected by the duration and severity of liver cirrhosis determined by Child Pugh classification. Conclusion: peripheral neuropathy is a common complication of liver cirrhosis related mainly to the duration and severity of liver cirrhosis, but not affected by the causes of liver cirrhosis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Role of folic acid deficiency as a possible risk factor for erectile dysfunction751775251955210.21608/ejhm.2018.19552ENAttia Abdallah AttiaDepartment of Dermatology and Venerology Department, Faculty of Medicine, Al Azhar UniversityMohamed Abdelmawgoud AmerDepartment of Dermatology and Venerology Department, Faculty of Medicine, Al Azhar UniversityNagah Mohamed A. MohamedDepartment of Dermatology and Venerology Department, Faculty of Medicine, Al Azhar UniversityAhmed Mahmoud Mohamed AlhabashiDepartment of Dermatology and Venerology Department, Faculty of Medicine, Al Azhar UniversityJournal Article20181119Background: erectile dysfunction (ED) is the persistent inability to attain or maintain an erection. ED affects millions of men worldwide. The pathophysiology of ED includes vasculogenic, neurogenic, hormonal, anatomical, drug-induced and psychogenic causes. Endothelial dysfunction (EDys) is an important pathophysiologic factor underlying vasculogenic erectile dysfunction. The pathogenesis of both EDys and ED are linked through decreased expression and activation of endothelial nitric oxide synthase (NOS) which is responsible for formation of Nitric Oxide (NO). NO is a relaxing factor which plays a major role in activation and maintenance of the erection process. Aim of the work: this study aimed to detect the possible relationship between serum folic acid and erectile dysfunction by measuring serum FA concentration in patients with erectile dysfunction and comparing them with the healthy controls. Methodology: our study has been carried out on 90 individuals who were categorized into two groups. Group 1: 60 married males complained of ED. Group 2: 30 married potent males as a control.All participants were subjected to : personal history, past history of medical diseases and operations, sexual history, general examination, genital examination and evaluation of erectile function according to the International Index of Erectile Function (IIEF-5) Questionnaire). Fasting serum samples were collected from all participants and assayed for serum total testosterone, serum prolactin, serum cholesterol, serum triglycerides (TG), HbA1c and serum folic acid.Results: results of the current study showed a significant relation between folic acid and ED. FA level was declined as ED severity increased. It is thought that ED severity was related to HHcy which was related to the severity of FA deficiency.Conclusion: a significant association between serum FA level and ED severity was detected in the current study. Serum FA level decreased as the severity of ED increased. These results suggest that FA deficiency might reflect the severity of ED. Recommendations: serum folic acid assessment as a part of the routine investigations for patients complaining with erectile dysfunction. Additional experimental and clinical studies are needed to determine whether FA supplementation may be beneficial for patients having ED.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Predictive value of Cerebroplacental blood flow ratio for fetal heart rate disturbances and perinatal outcome752675301955310.21608/ejhm.2018.19553ENAlsaeed Elsayed Ahmed AskarObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar University DamiettaMahmoud Salah MahmoudObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar University DamiettaRamadan Sheta Ibrahim IbrahimObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar University DamiettaJournal Article20181119Background: Doppler ultrasound velocimetry foetal vessels have become established method of antenatal monitoring, allowing non-invasive assessment of foetal circulation. Aims: To determine the usefulness of Doppler velocimetry, based on cerebroplacental ratio (C/U) evaluation, in predicting intrapartum fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies from 36 to 40 weeks. Subjects and Methods: this is prospective study include 300 uncomplicated pregnant women, age ranged from 17 to 45 years, with gestational age 36 to 40 weeks. Results: there was significant relation between CPR and adverse neonatal outcome p-value <0.001 with sensitivity, specificity and PPV, NPPV of CPR in detecting neonatal adverse outcome 100%. Conclusion: better prediction of neonatal outcome can be done by C/U ratioPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Percutaneous Fixation of Split Fracture Tibial Plateau753175411955410.21608/ejhm.2018.19554ENAli Mohammed Mahmoud El- GyoshiDepartment of Orthopedic Surgery, Faculty of Medicine, Al Azhar UniversityFaisal Hassan Youssef ZayedDepartment of Orthopedic Surgery, Faculty of Medicine, Al Azhar UniversityMahmoud Hamouda Taha MassoudDepartment of Orthopedic Surgery, Faculty of Medicine, Al Azhar UniversityJournal Article20181119Background: tibial plateau fractures represented only 1% of all fractures. If not appropriately treated, the consequences may be severe and have a great social impact. The management of the fracture depends on several factors such as fracture configuration, concomitant soft tissue injury, the patient's age, activity level and bone quality. Tibial plateau fractures may be divided into low energy or high energy fractures. Low energy fractures are common in older patients due to osteoporotic bone and are typically depressed fractures. High energy fractures are commonly the result of motor vehicle accidents, falls or sportsrelated injuries. Split tibial plateau fractures may be treated by closed reduction and percutaneous fixation using cancellous screws and washers, with very good results as recommended by many authors.Objective: the aim of this study was to evaluate the results of closed reduction under fluoroscopic control and percutaneous fixation with cancellous screws 6.5 mm and washers of split type of tibial plateau fractures. Methodology: twenty patients were included in this study; they were admitted to the Department of Orthopedic Surgery, Sayed Galal Hospital and luxor International Hospital, from October 2016 to April 2018. On admission all patients were assessed by history taking, clinical examination and radiological assessment. The mean age of patients in this study was 37.15 ± 11.4 years. Age was ranged from 20 to 55 years. There were 13 males (65 %) and 7 females (35 %). 11 patients (55 %) had right side tibial plateau fracture, while only 9 patients had left side tibial plateau fractures. Results: 12 (60 %) patients had traffic accidents as a mechanism of injury, 4 (20 %) were falling from height, 4 (20 %) had direct trauma. Associated fractures of the head of fibulae was present in two patients (10 %), other associated fractures were Colles' fracture (5%), femoral shaft fracture (5 %) and fracture tibia (5 %).The time till operation varied from two days to five days, but the majority of the cases were done within the first two to three days after admission. The mean duration of follow up was 6.5 ± 2.86 months, ranging from six to eight months. After follow up period the result were assessed according to Rasmussen's grading system, eighteen patients (90%) had excellent results, and two patients (10 %) had good results. Conclusion: tibial plateau fractures represented only 1% of all fractures. If not appropriately treated, the consequences may be severe and have a great social impact. Early mobilization is an important factor in treatment of intra articular fracture, as immobilization result in death of chondrocyte. Percutaneous reduction and fixation technique is a simple procedure if facilitates, equipment and experience are available.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Uses of Ultrasound and Doppler in Assessment of Endometrial Receptivity in Patients of Unexplained Infertility754275501955510.21608/ejhm.2018.19555ENEmad Abd El-Rahman El-TamamyObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar UniversityMofeed Fawzy MohamedObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar UniversityBadawy Ezzat HamzaObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar UniversityJournal Article20181119<strong>Background:</strong>although the majority of infertile couples was found to have an identifiable male or female factor, 15–30% was categorized as having ‘‘unexplained infertility’’. The endometrium is considered to be a key determinant in successful implantation. Endometrial receptivity is regulated by many factors including endometrial perfusion. <strong>Aim of the Work: </strong>this study aimedto detect the role of the two dimensional ultrasound and Doppler ultrasonographic uterine markers of implantation in patients of unexplained infertility compared to fertile participants. <strong>Patients and Methods</strong><strong><em>: </em></strong>the study was performed on 50 patients presented to the outpatient clinic in Al-Hussein, Bab El-Shearia (Sayed Galal) Hospitals, Al-Azhar University from October 2017 to August 2018 and they were categorized into two groups:
<strong>Group A</strong> (Patients group): it was included 30 participants presented with unexplained infertility.
<strong>Group B)</strong> (Control group) who included 20 fertile women coming for contraception.
<strong>Results<em>: </em></strong>there was a significant statistical difference as regard the endometrial thickness between cases and controls, and the controls had a thicker endometrium. Lower pulsatility index (PI) in uterine artery in the controls compared to the infertile group. Increased sub endometrial vascularization in the controls compared to the infertile group. <strong>Conclusion:</strong>ultrasound as well as Doppler studies of the endometrial and subendometrial vascularization had a role in predicting endometrial receptivity. Uterine artery Doppler study and the endometrial thickness measurement had a role in detection of uterine receptivity.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Assessment of Wet Age-Related Macular degeneration by Optical Coherence Tomography Angiography755175561957610.21608/ejhm.2018.19576ENSayed A. SayedDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHossam Eldin A. ZiadaDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMahmoud S. MohammadDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181120<strong>Background: </strong>to date, fundus fluorescein angiography (FFA), remains the gold standard for the diagnosis of choroidal neovascular membrane (CNV). Optical coherence tomography angiography (OCTA) is a new imaging modality that allows a clear, depth-resolved visualization of the retinal vascular structures.
<strong>Aim of the Work: </strong>to evaluate the role of OCTA in diagnosis of CNV in patients with age-related macular degeneration (AMD).
<strong>Patients and Methods: </strong>this study enrolled 32 patients (40 eyes), including 20 patients (20 eyes) with wet AMD and 12 patients (20 eyes) with dry AMD. All patients underwent swept-source optical coherence tomography (SS-OCT), swept-source OCTA, and fundus fluorescein angiography (FFA). OCTA was used to evaluate neovascular networks in terms of their type, location and extent of visualization. Sensitivity and specificity of the method were assessed separately in a group of 20 CNV eyes and 20 dry AMD based on FFA diagnosis as the gold standard.
<strong>Results: </strong>sensitivity and specificity of en face OCTA were 95% and 100% respectively. Both Sensitivity and specificity of structural OCT were 100%.
<strong>Conclusion: </strong>OCTA enables diagnosis of both classic and occult choroidal neovascularization in patients with AMD. The method has high sensitivity and specificity.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Effect of gonadotrophin dose on oocytes yield and quality and embryonic development in Super ovulated mice755775651957710.21608/ejhm.2018.19577ENSamir A. M. ZaahkoukFaculty of science, Al-Azhar UniversityAhmed S. AbdonReproduction and Artificial Insemination, Veterinary Research Division, National Research CenterAhmed M. Al-AtrashMedical Administration, Nuclear Materials AuthorityOmaima M. KandilReproduction and Artificial Insemination, Veterinary Research Division, National Research CenterAmal A. A. AmmarMedical and Radiation Research Dept., Nuclear Materials Authority, Cairo, EgyptAsmaa A. M. YonesMedical and Radiation Research Dept., Nuclear Materials Authority, Cairo, EgyptJournal Article20181120<strong>Background: </strong>Hormonal control for multiple follicular growths in IVF program was directed toward maximizing the yield of fertilizable oocytes, enhance successful implantation and improve early embryonic development.
<strong>Aim: </strong>The effect of different doses of urinary human menopausal gonadotropin (U-hMG) in superovulation regimen was studied.
<strong>Materials and Methods:</strong> Four groups of immature female mouse were sequentially injected by 5 IU, 10 IU, 15 IU and 20 IU of U-hMG followed by injection of 15 IU human chorionic gonadotropin (hCG) for all groups. Mature cumulus oocytes complexes (COCs) were collected 12 hours later then the grading of cumulus cell expansion and oocytes maturity was determined. In vitro fertilization for mature oocytes was done by using epididymal sperm, the embryonic development was followed up till the blastocyst stage.<strong> Results: </strong>Results demonstrated that the super ovulatory response in immature mice increased with increasing dose of hMG. 15 IU U-hMG was the optimal dose that gave maximum number oocytes with higher maturation rate,minimum degeneration rate and support embryonic development.
<strong>Conclusion</strong>: 15 IU is the optimal dose for induction of superovulation and support in vitro embryo developmentin immature female mice.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Comparative Study of Transvaginal Sonography and Hysteroscopy for Detection of Pathological Endometrial Lesions in Women with Perimenopausal Bleeding756675731972110.21608/ejhm.2018.19721ENEmad Abd El-Rahman El-TamamyObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityMofeed Fawzy MohamedObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityGamal Kamel El-SayedObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20181123<strong>Background</strong>:abnormal uterine bleeding is a frequent condition in gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of haemostatic substances. In some specific cases with more intense and prolonged bleeding surgical treatment may be necessary. <strong>Aim of the Work:</strong> this study aimed to estimate the diagnostic accuracy of two dimensional transvaginal ultrasound and hysteroscopy compared to the histopathology in evaluation of uterine cavity lesions in peri menopausal women with abnormal uterine bleeding. <strong>Patients and Methods</strong><strong>: </strong>this was a prospective cohort study and it included 50 patients from Obstetrics and Gynecology Outpatient Clinic at Al-Hussein and Bab El-Shearia (Sayed Galal) Hospitals, Al-Azhar University during the period from October 2017 to May 2018. <strong>Results:</strong> 2D TVS were more sensitive and a little more accurate than hysteroscopy in detecting endometrial hyperplasia, while hysteroscopy showed higher specificity. Hysteroscopy showed highest accuracy for diagnosis of the endometrial polyp and was more sensitive, specific and accurate than 2D TVS in this diagnosis. 2D TVS were more sensitive and accurate than hysteroscopy in the diagnosis of adenomyosis, but both showed same specificity. For differentiating normal from abnormal endometrial cavity both 2D TVS and hysteroscopy showed high accuracy, but U/S was more sensitive and a little more accurate than hysteroscopy, while the last was more specific. Both 2D TVS and hysteroscopy ignore the diagnoses of one lesion when endometrial hyperplasia, endometrial polyp or adenomyosis were found in one case. <strong>Conclusion: </strong>endometrial hyperplasia was the commonest observed endometrial abnormality in our patient sample and the second most common pathology was the endometrial polyp.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Biomechanical Corneal Changes Post LASIK with Mechanical Microkeratome Flap versus Femtosecond Flap757475791972210.21608/ejhm.2018.19722ENMohamed ElmoddatherDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, AssuitAsaad NooredinDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, AssuitJournal Article20181123<strong>Back ground:</strong> The biomechanical impact of flap creation may be important in explaining changes in the curvature of the residual stroma after flap creation which plays a critical role in the development of ectasia.
<strong>OBJECTIVE:</strong> To evaluate the impact of the creation of corneal flaps with mechanical microkeratome versus femtosecond laser on the biomechanical properties of the corneas.
<strong>METHOD: </strong>This study included 100 eyes of 50 patients (Microkeratome Group) Compared with 100 eyes of 52 patients (Femtosecond Group) with myopia with or without astigmatism. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured with Ocular Response Analyzer before and1, 3,6and 12 months after surgery. We also investigated the relationship between these biomechanical changes and the amount of myopic correction.
<strong>RESULTS:</strong> Corneal resistance factor and hysteresis was changed significantly after flap creation in both groups. In Moria2 group, they decreased significantly from 11.55 ± 1.29 mm Hg and 11.68±1.40 mm Hg to 9.47 ± 1.29 mm Hg and 8.49 ± 1.54 mm Hg, respectively) (P <.0001). In femtosecond group, they decreased from11.51 ± 1.25 mm Hg and 11.66±1.41 mm Hg to 9.49 ± 1.30 mm Hg and 8.5 ± 1.53 mm Hg, respectively (P <.0001). The ablation depth (P=0.650), residual corneal thickness (P=0.442), and postoperative corneal curvature (P=0.354) were not significantly different between femtosecond group and Moria2 group after surgery.
<strong>CONCLUSION: </strong>Both femtosecond LASIK and Moria2 LASIK can affect the biomechanical strength of the cornea depending on the amount of myopic correction. The amount of biomechanical changes is larger after LASIK with mechanical microkeratome than after femtosecond from a biomechanical viewpoint. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Outcome of PRK in Management of Post LISIK Residual Myopia and Myopic Astigmatism758075861972310.21608/ejhm.2018.19723ENMohamed ElmoddatherDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, AssuitJournal Article20181123<strong>Background:</strong> Different retreatment options are available for management of post LASIK residual myopia and myopic astigmatism, however PRK reduces the risk of ectasia by preserving the corneal stroma as much as possible and avoids the flap-related complications.
<strong>Purpose: </strong>To evaluate the outcome as regards the safety, efficacy, and predictability of photorefractive keratectomy (PRK) for correction of residual myopia and myopic astigmatism after laser in situ keratomileusis (LASIK).
<strong>Patients and Methods:</strong> The study included 30 eyes of 15 patients retreated by PRK for residual myopia and myopic astigmatism after laser in situ keratomileusis (LASIK).Data included uncorrected and best corrected visual acuity (UCVA and BCVA), spherical equivalent (SE), central pachymetry, corneal higher order aberrations (HOAs), corneal hysteresis (CH), corneal resistance factor (CRF), and corneal haze.
<strong>Results</strong>: This study was performed on 30 eyes of 15patients. The mean age was 25.27±3.70 SD years old (9 women and 6 men). The average interval between procedures was 13.35 ± 5.51 months. The mean follow-up was 16.58 ± 3.06 months. Before PRK, the mean UCVA and BCVA were 0.35 ± 0.18 and 0.91 ± 0.07, respectively. The mean central pachymetry was 400.21 ± 7.8 μm, the mean SE was −1.74 ± 0.51 D. 12 months postoperatively. The mean UCVA and BCVA were 0.78 ± 0.14 (<em>P</em> = 0.01) and 0.92 ± 0.13 (<em>P</em> > 0.5), respectively. The mean central corneal thickness was 382.41 ± 2.61 μm, the mean SE was −0.18 ± 0.32 D (<em>P</em> < 0.01). Two eyes gained 1 line of best spectacle-corrected visual acuity; one eye lost 1 line because of corneal ectasia. No other sight-threatening complications was occurred postoperatively.
<strong>Conclusions: </strong>Photorefractive keratectomy and mitomycin C was an effective, predictable, and safe procedure for correcting residual myopia and myopic astigmatism less than 3 D after LASIK. This decrease postoperative ectasia and avoids the flap related complications but has no significant effect on HOAs.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Evaluation of Glycated Albumin to Glycated Hemoglobin Ratio as a Predictor for Esophageal varices and its Risk of Bleeding758775961972410.21608/ejhm.2018.19724ENAhmed Mohammed OsamaDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptEL-Sayd Mohammed Mohie EL-DienDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammed Abd El-Hamid BsyoniDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMostafa Shehata EL-saidDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181123<strong>Background</strong>: Variceal hemorrhaging due to portal hypertension is a severe complication of liver cirrhosis. Although several biomarkers have been reported as predictors of the presence of varices, it is still difficult to assess the risk of variceal bleeding without esophagogastroduodenoscopy (EGD). The ratio of glycated albumin (GA) to glycated hemoglobin (HbA1c) was reported to increase with the progression of liver fibrosis. The aim of the study was to investigate whether the GA/HbA1c ratio is related to the severity and bleeding risk of the varices. <strong>Aim of the work:</strong> goal of our study was to assess the value of Glycated albumin to Glycated hemoglobin ratio in the prediction of esophageal varices and assessing its risk of bleeding. <strong>Methods</strong>: We measured the GA/HbA1c ratio of HCV-related cirrhotic patients and analyzed its relationship with the presence and bleeding risk of varices. <strong>Results</strong>: The GA/HbA1c ratio was higher in the patients who had the varices with a high risk of hemorrhage than in the patients with a low risk of bleeding. In addition, the GA/HbA1c ratio was higher in patients with varices than that in patients without varices. Furthermore, the GA/HbA1c ratio was the most significantly different parameter of all the factors examined, including the platelet count, prothrombin activity and albumin level. <strong>Conclusion</strong>: The GA/HbA1c ratio is increased in patients with varices and with the bleeding risk of the varices.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001The Relationship between Helicobacter Pylori Virulence Factors and Gastric Carcinoma759776031978710.21608/ejhm.2018.19787ENMohamed Shees AhmedMicrobiology and Immunology Department, Faculty of Medicine, AL-Azhar University,
Cairo, Egypt.Mohamed Amer AfifiMicrobiology and Immunology Department, Faculty of Medicine, AL-Azhar University,
Cairo, Egypt.Hany Mostafa Abu-ShukkaMicrobiology and Immunology Department, Faculty of Medicine, AL-Azhar University,
Cairo, Egypt.Ragaae Mohamede Fath-ElbabMilitary Medical Academy, Cairo, Egypt.Raafat Zaher Abdel RahmanMilitary Medical Academy, Cairo, Egypt.Ahmed FkirinMilitary Medical Academy, Cairo, Egypt.Journal Article20181125Background: Helicobacter pylori is a gram-negative microaerophilic bacterium found usually in the stomach and use several mechanisms to survive in the stomach lumen. The presence of these bacteria in the stomach can lead to gastritis and reduction in stomach acid production. Aim of the work: this study aimed to investigate the seroprevalence of six highly immunogenic virulence factors (Cag A, Vac A, Gro EL, gGT, Hcp C and Ure A) in patients with different gastric histology in a high-risk population of gastric cancer and explore the relationship between H. pylori virulence factors and gastric carcinoma. Methods: this study included 100 patients: 25 patients were diagnosed histopathologically as gastric cancer (Group I) and 75 patients were diagnosed endoscopically as mild gastritis (Group II). Their samples were collected from Military Armed Hospitals. Noninvasive serologic test was performed to detect immune responses to H. pylori by stool antigen test, ELISA and by Recomoline H. pylori test. Results: on comparing results of gastric carcinoma and chronic gastritis by Recomoline H. pylori test, it was found that Cag A was detected in 88% (22/25) in group I. While, in group II it was 57.33% (43/75) of cases and Vac A was detected in 80% (20/25) in group I while, it was in group II in 44% (33/75) of cases. Gro EL was detected in 72% (18/25) in group I while; it was 49.33% (37/75) group II and Urea A was 52% (13/25) in group I while, it was 52% (39/75) in group II. Hcp c was 56% (14/25) in group I while, it was 40% (30/75) in group II and gGT was 48% (12/25) in group I while, it was 34.67% (26/75) in group II. Conclusion: in this study, a statistically significant association was found between Cag A, Vac A and Gro EL antigen in the studied groups of patients. However, no such statistically significant association was found between Urea A, Hcp c and gGT antigen. (P value > 0.05). Thus, Cag A, Vac A and Gro EL antigen proved to be virulence markers for gastric carcinoma group.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Role of MRI in Detection of Repaired Cleft Palate Muscles and Correlation to Speech760476091978810.21608/ejhm.2018.19788ENAmro Mahmoud Abdelrahman AliDepartment of plastic Surgery, Faculty of Medicine, Al-Azhar UniversityMahmoud Ibrahim El ShamyDepartment of plastic Surgery, Faculty of Medicine, Al-Azhar UniversityAhmed Ali AbdElmonemDepartment of plastic Surgery, Faculty of Medicine, Al-Azhar UniversityFawzy Ahmed HamzaDepartment of plastic Surgery, Faculty of Medicine, Al-Azhar UniversityTarek Mahmoud El BanobyDepartment of plastic Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20181125Background: Cleft palate is a birth defect when the roof of the mouth contains an opening into the nose. It occurs in about 1:2 per 1000 births. These disorders can result in speech disorders, feeding problems and frequent ear infections. It is the result of tissues of the face not joining properly during development. Speech therapy and dental care may also be needed. Approximately 30 percent of patients having undergone cleft palate repair require secondary surgery for velopharyngeal dysfunction. Magnetic resonance imaging (MRI) is one of the common used tests in variable fields of medicine and surgery. Now trials are done for use of MRI in the postpalatoplasty velopharyngeal dysfunction patients. Objective: This study aims to detect static craniofacial and velopharyngeal measures of repaired cleft palate patients specially repaired muscle state (levator veli palatini muscle) by using MRI and correlate these data to speech state. Patients and Methods: this prospective study conducted in AlAzhar and Beni-suef University Hospitals in the period of February 2018 till November 2018. It is conducted on twenty children who complained of postpalatoplasty velopharyngeal dysfunction and examined by nasendoscopy and speech analysis then MRI palate was done using 1.5 T MRI; to correlate MRI data to speech data. Results: our statistical results revealed significant decrease in the velopharyngeal variants than normal ranges. That prove that static MRI is a valid procedure for diagnosis of anatomical abnormality. But after correlation with speech data it showed that it should be accompanied with dynamic procedure (e.g. Nasendoscopy) especially in patients with normal ranged anatomy. Conclusion: this study was done in variant range of children who suffer from post-palatoplasty speech abnormality, scanned by MRI palate and correlate these data by speech data. Static MRI is efficient technique to demonstrate structural defects in these patients.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Mini-Open Reconstruction of Rotator Cuff of The Shoulder761076141978910.21608/ejhm.2018.19789ENIbrahim HusseinOrthopedic Surgery Department, Faculty of Medicine, Al-Azhar UniversityEmad Mohamed ZayedOrthopedic Surgery Department, Faculty of Medicine, Al-Azhar UniversityMohamed Ahmed Mahmoud Abd-AllahOrthopedic Surgery Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20181125Background: shoulder pain is one of the most common musculoskeletal (MSK) disorder affecting a large portion of the population. It is estimated that one in three persons will have at least only one episode of shoulder pain within their lifetime. Rotator cuff tears are very common in the general population. Radiographic studies have shown the prevalence of rotator cuff tears to be 4-13% in the population aged between 40-60 years and 20% in population whom age between 60-70 years and 30-50% in population above 70 years. Rotator cuff tears are a common pathology associated with degenerative changes in the shoulder joint. They cause significant disability, pain, dysfunction and poor health status and their prevalence is currently increasing within an aging population. Aim of the Work: the aim of this work was to study the results of mini open rotator cuff repair of the shoulder joint. Patients and Methods: this study was conducted on ten patients presented to Al-Azhar University Hospital with rotator cuff tear of the shoulder. They are treated with mini-open repair technique. All our patients completed a period of at least one year of follow up. Results: a clinical success rate was found in ten patients treated by mini open technique, 70% had excellent and good results according to Constant and Murly score after one year of follow up. Conclusion: repair of rotator cuff tears by mini-open technique is one of the good viable options providing improvement in pain and function of the shoulder joint. Also it is more economic than arthroscopic repair and it does not need high learning curve as arthroscopic repair.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273920181001Use of Drain in Laparoscopic Cholecystectomy761576211979010.21608/ejhm.2018.19790ENAyman Helmy IbrahimDepartment of General Surgery, Faculty of Medicine, Al Azhar University0000-0001-6864-9082Abdel Wahab M. Abdel WahabDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityKarim A. Abdel Rahman AliDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityJournal Article20181125Background: laparoscopic cholecystectomy has become the procedure of choice for treatment of patients with gall stones. The routine placement of drains becomes a part of this operation for a long period of time. However, controversy has surrounded this practice in elective conventional cholecystectomies, with most surgeons departing from this approach. Aim of the Work: this study aimed to assess the value of the drain in uncomplicated laparoscopic cholecystectomy and if the insertion of a drain should be routinely done or not. Patients and Methods: this study was conducted at AL-Azhar University Hospitals in Cairo (Al Hussien and Bab Al Shaaria Hospitals), Kafr Al-Sheikh General Hospital and Biala Central Hospital on 180 patiants presented to general surgery clinic with gall stone disease. Patients were randomized into two groups and both groups underwent laparoscopic cholecystectomy, group A (90 patients) received a drain in gall bladder bed and group B (90 patients) receivd no drain. Postoperative mortalities and morbidities shuch as pain, nausea, vomiting, fever, abdominal collection, wound infection, need for analgesics and time of discharge from hospital were assessed. Statistical analysis was performed. Mean and standard deviation were estimated for each continuous variable. Results: there was no mortality in either groups and no statistically significant difference in postoperative pain, nausea, vomiting, wound infection or abdominal collection between the two groups. However, hospital stay was longer in the drain group than in group without drain. Conclusion: our study suggested that insertion of drain should not be routinely done in elective laproscopic cholecystectomy as it has no significant effect on postoperative morbidity, moreover, it delays hospital discharge.