Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Assessment of Renal Functions in Infants and Children with Congenital Heart Diseases2192252283810.21608/ejhm.2019.22838ENMohamed Seif MohamedPediatric Department, Faculty of Medicine, Al-Azhar UniversityMoftah Mohammed RabeeaPediatric Department, Faculty of Medicine, Al-Azhar UniversityHassan Saad Abu SaifPediatric Department, Faculty of Medicine, Al-Azhar UniversityKamel Soliman HammadClinical Pathology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20181224<strong>Background</strong><strong>:</strong><em> </em>children with congenital heart diseases have a number of risk factors for potential development of chronic kidney diseases later in life such as : including pathophysiological changes related to a structurally abnormal heart, polycythemia, cyanosis and chronic hypoxia change in renal blood flow and intraglomerular hemodynamics with derangements in neurohormonal activation. <strong>Objectives</strong><strong>:</strong>this study aimed to assess renal functions in infants and children with congenital heart diseases and to compare renal functions between children with congenital cyanotic and acyanotic heart diseases.<br /> <strong>Patients and Methods</strong><strong>:</strong> this across sectional case control study was carried out on 50 infants and children with congenital heart diseases (25 patients with congenital acyanotic heart diseases (Group A) and 25 with congenital cyanotic heart diseases (Group B) who were attended at the Pediatric Cardiology Units at Al-Azhar University Hospitals (El-Hussein and Bab El-Sheryia Hospitals) and apparently 25 healthy children age and sex matched included as a control group (Group C). Their age ranged from one month to 5 years old. Patients were subjected to full history taking, full medical examination which included the heart and abdomen and laboratory investigations which included complete blood picture, urine analysis, estimation of glomerular filtration rate, urinary albumin creatinine ratio. Data were collected, tabulated and statistically analyzed. <strong>Results:</strong> comparing both groups A and B by group C as regards renal functions results; group B had higher values in all parameters (Estimated glomerular filtration rate (EGFR) and urinary albumin and creatinine ratio.<br /> <strong>Conclusion:</strong> risk of renal dysfunctions increase by time especially in children with cyanotic CHD which may be due to effect of chronic hypoxia and other conditions such as polycythemia.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Assessment of Heart Rate Variability in Young Patients with Primary Hypertension2262362283910.21608/ejhm.2019.22839ENMansour M. MoustafaCardiology Department, Faculty of Medicine, Al-Azhar University (Cairo)Mohamed SamyCardiology Department, Faculty of Medicine, Al-Azhar University (Cairo)Mohamed OmarCardiology Department, Faculty of Medicine, Al-Azhar University (Cairo)Journal Article20181224<strong>Objective:</strong> this study aimed to determine the association between HRV and hypertension young adult patients, the effect of antihypertensive medications on HRV parameters was also studied. <strong>Subjects and Methods:</strong> 70 subjects under age of 40 years were classified into two groups: A- Patients’ group, It included 50 subjected they were classified according to type of antihypertensive medications into 3 subgroups; 1): 20 patients on ACE-I, (2): 15 patients on BB, 3): 15 patients on CCB. B)- Control group included 20 healthy subjects. Pulse rate, BP, ECG, and 24h Holter monitor were used to measure heart rate variability (HRV). <strong>Results:</strong> high statistical significant difference was found between patients and control according to SDNN rMSSD, pNN50 and LF/HF ratio ( P < 0.001). HRV parameters showed improvement in patient treated by BB and ACE-I, whereas no improvement was seen in patients treated by CCB. <strong>Conclusion:</strong> disturbed cardiac autonomic function was found in young hypertensive patients, treating such patients with either BB or ACE-I was associated with improvement of such autonomic imbalance.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Evaluation of Intravitreal Aflibercept Injection for Macular Edema Secondary to Retinal Vein Occlusion2372432298110.21608/ejhm.2019.22981ENEmad Abdel Aal SaliemLecturer of Ophthalmology, Ophthalmology Department, Al-Azher Faculty of Medicine, AssuitJournal Article20181226<strong>Background:</strong> To evaluate the efficacy of intravitreal aflibercept injection in eyes with macular edema due to retinal vein occlusion (RVO). <strong>Patients and Methods:</strong> prospective, non-randomized clinical study included 60 eyes of 60 patients with macular edema due to RVO. Thirty patients had branch RVO (BRVO) and 30 had central RVO (CRVO). Each patient had received intravitreal injection of aflibercept once followed by re-evaluation of BCVA and CMT monthly during the follow up period up to 6 months after injection. <strong>Results:</strong> One month after IV aflibercept injection in patients with RVO ≤ 3 months, the main best-corrected visual acuity improved from 1.05±0.004 µm at baseline to 0.75±0.07 logMAR at 1 month, to 0.58±0.10 logMAR at 3<sup>rd</sup> month and at the 6th month improved to 0.45±0.14 logMAR (p≤0.05). On the other hand, the mean BCVA improved from 1.40±0.03 µm at baseline to 1.13±0.07 logMAR at 1 month, to 0.98±0.06 logMAR at 3<sup>rd</sup> month and to 0.92±0.08 logMAR at 6<sup>th</sup> month (<em>P</em>≤ 0.05) in patients with RVO > 3 months. The mean central macular thickness reduced from 485.57±71.51 µm at baseline to 316.78±58.38µm (P≤0.05) after 1 month, to 259.45±50.84µm (P≤0.05) at the 3<sup>rd</sup> month and to 225.85±34.44µm (P≤0.05) at 6<sup>th</sup> month in patients with RVO ≤ 3 months. Meanwhile, in those with RVO > 3 months the main CMT reduced from baseline 625.91±167.56µm to 395.07±98.89µm (P≤0.05), to 319.53±53.28µm (P≤0.05) and at the 6th month reduced to 276.50±38.89 µm (p≤0.05). No intra-operative or post-operative complications as retinal detachment, vitreous hemorrhage, or elevated intraocular pressure. Subconjunctival hemorrhage or local hyperemia at the injection site may be observed in some cases. Long term duration without treatment is associated with less improvement in the visual acuity. <strong>Conclusion: </strong>Intravitreal injection of aflibercept is more clinically effective and generally well tolerated for treatment of macular edema due to RVO.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Comparative Study between the Use of Room Temperature and Cold Intra-Thecal Heavy Bupivacaine and Its Effect on Intraoperative Shivering in Lower Limb Orthopedic Surgery2442532298210.21608/ejhm.2019.22982ENHassanein Abd- Elkareem HamzawyDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAlsayed Mostafa StohyDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityWael Mohamed El-MahdiDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAyman Baligh Hassan GamalDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityJournal Article20181226<strong>Background: </strong>the mechanisms responsible for shivering in patients undergoing surgery are intra-operative temperature loss increased sympathetic tone, pain, and systemic release of pyrogens, and the direct effect of local anesthetic temperature on temperature-sensitive neurons in the spinal cord. <br /> <strong>Objective: </strong>to compare the effects of warm intrathecal bupivacaine versus cold intra-thecal bupivacaine on shivering and haemodynamic stability in parturient candidate for elective lower limb orthopedic surgery under spinal anesthesia.<br /> <strong>Patients and Methods: </strong>the current study was carried out in in Alexandria Police hospital, on 80 parturient, aged 20-60 years old, ASA I-II, scheduled for elective lower limb orthopedic surgery under spinal anesthesia, after the approval from the Local Ethical Committee and informed written consents from all the patients of the study. Patients were randomly allocated into two equal groups (40 patients each); group R (Warm group), group C (Cold group).<br /> <strong>Results: </strong>Comparison between the two studied groups showed no significant statistical differences at all the measured times.<br /> <strong>Conclusion: </strong>Shivering continues to be a common problem after spinal anesthesia. The etiology of this symptom is unknown, and there is no definite treatment. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Effect of successive cyclic oral contraceptive pills on pregnancy outcome pretreatment of PCOS patient in ICSI2542612298310.21608/ejhm.2019.22983ENHana Abd El Moneim YounesDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityYousef El Said Abo ShadyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityFayza A. Abdel HakamDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAsmaa Mohamed Awad GomaaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20181226<strong>Introduction:</strong> Polycystic ovarian syndrome (PCOS) is a common endocrine disorder that primarily affects women of reproductive age, with prevalence rates ranging from 5% to 10%.
<strong>Objective:</strong> To evaluate the role of oral contraceptive pills (OCP) pretreatment in the improvement of intra cytoplasmic sperm injection (ICSI) pregnancy outcome, in patient with PCOS.
<strong>Methodology</strong><strong>:</strong>Started with 200 proved PCOS and after exclude of any patient with criteria rather than including criteria, so 60 proved PCOS women undergo ICSI were elected and divided into tow groups 30 patients for each. The 1<sup>st</sup> group treated with COC (3-6monthes) before ICSI and the 2<sup>nd</sup> group was a control group.
<strong>Results: </strong>Clinical pregnancy rate as a main outcome was significantly more frequent in the study group than in the control group. The LH mean as a secondary outcome was significantly more decreased in the study group than in the control group and the FSH/LH ratio before and after COC increasing ratio towards normalization<strong>.</strong>
<strong>Conclusion:</strong> Successive cyclic oral contraceptive pills for patients with PCOS as a pretreatment in ICSI can increase clinical pregnancy rates as a main outcome, improve the synchronism of follicular development, decrease the LH mean as a secondary outcome. And increase FSH/LH ratio before and after COC towards normalization.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101The Role of Visceral Fat, IL-6, Adiponectin and Leptin Levels on Reflux Esophagitis in Obese Patients2622692298410.21608/ejhm.2019.22984ENSalem Soliman Ahmed SalamaInternal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbd El-Monem Mohamed BarrakInternal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAmin Mahmoud Hejazi Kamel SolimanHammadInternal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed Farag Abd-AlkaderInternal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181226Background: Gastroesophageal reflux disease (GERD) is one of the most common problems encountered in clinical practice today. The pathophysiology of GERD is complex, involving diverse factors. Aim of the work: was to assess the role of visceral fat and IL-6, adiponectin and leptin levels on reflux esophagitis in obese patients. Patients and Methods: This prospective observational case-control study included a total of 90 participants; 60 patients with reflux esophagitis and 30 age and sex-matched healthy controls. Evaluation of the Role of Visceral Fat, IL-6, Adiponectin and Leptin Levels on Reflux Esophagitis in Obese Patients was done. Results: An overall 90 patients were enrolled in this study, 50 males and 40 females, were assorted into three groups, obese and had GERD group, non-obese and had GERD, included 30 patients (33.3%),17 males (56.7%) and 13 females (43.3%), and control group, included 30 patients (33.3%),18 males (60%) and 12 females (40%). The mean levels of body mass index, weight circumference, fasting-plasma glaucous, two hours post-prandial plasma glucose, Creatinine, liver enzymes, and lipid parameters were elevated in obese group when compared with non-obese and control groups. Consequently, the mean levels of leptin and interleukin-6 were high in obese group in comparison with other groups. Interestingly, the mean level of adiponectin was high in non-obese group in comparison with obese and control groups. Conclusion: Inflammatory cytokines, adipokines, and visceral fat referring abdominal obesity had an association with reflux esophagitis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Immunohistochemical Study of CDK5 and Ki-67 in Cervical Precancerous Lesion and Carcinoma2702762298510.21608/ejhm.2019.22985ENAmira Nasr ElsokaryDepartment of Pathology, Faculty of Medicine, Al-Azhar University, EgyptSamah Mohamed AttiahDepartment of Pathology, Faculty of Medicine, Al-Azhar University, EgyptBahaa Bedair GhannamDepartment of Pathology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20181226Background: cervical carcinoma is one of the commonest female tumors worldwide arises from cervical intraepithelial neoplasia. Cervical cancer is a multifactorial process and infection with some types of human papilloma virus (HPV) has been suggested as the most important risk factor. The genesis of cancer was correlated with abnormal regulation of DNA damage and repair. A research proved that CDK5 was mandatory for the DNA damage response in cancer cells. Ki-67 is a nuclear protein that is associated with RNA transcription and cell cycle progression. Aim of the work: the purpose of this study was to evaluate the expression of CDK5 in cervical precancerous lesions and carcinoma to clarify its role in carcinogenesis and progression of cervical cancer, as well as the expression of Ki-67. Material and Method: specimens included (55 cases) consisted of precancerous lesions (15), SCC (30), adenocarcinoma (10). All specimens were formalin-fixed and embedded in paraffin blocks. Multiple serial 5-microne thick sections were cut from the paraffin blocks of the specimens; one was stained by Hematoxylin and Eosin for histopathological examination, Other Sections were immunostained with antibodies to CDK5 and K-i67. Results: high tumor grade and high FIGO stage were positively correlated with CDK5 IHC expression (P-value=0.012 and 0.042) and with Ki67 IHC expression (p-value= 0.01 7and 0.044) respectively. Conclusion: there is a direct positive correlation of both CDK5 and Ki-67 expression with high tumor grade and high FIGO stage of cervical carcinoma.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Prediction of Ipsilateral and Contralateral Cervical Lymph Node Metastasis in Unilateral Papillary Thyroid Carcinoma2772832298610.21608/ejhm.2019.22986ENEl Sayed R. AhmedDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversitySaid H. BendaryDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityMohamed EsmatDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityIbrahim M. HasanDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityMohamed F. Abd ElmoatyDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityMohamed R. Abd ElhamidDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityJournal Article20181226Background: Surgical therapy is the cornerstone of treatment in patients with papillary thyroid cancer (PTC). Surgical therapy in PTC includes hemithyroidectomy or total thyroidectomy (TT) and, in cases of lymph node metastases, cervical lymph node dissection (CLND). The inclusion of prophylactic central compartment neck dissection (pCCND) as a new approach in the management of patients with PTC with clinically negative cervical lymph nodes raised controversies among the endocrine surgeons and predictive factors for central lymph node (CLN) metastasis in unilateral PTC cases not well defined. Objectives: To investigate the risk factors associated with CLNM in clinical lateral cervical lymph node-negative (cN0) and analyze the rate of ipsilateral and contralateral CLN metastasis in unilateral PTC cases in Al Azhar University Hospitals in the period from May 2016 tillJune 2018. Patients and Methods: A prospective case-control descriptive study was performed to investigate the research questions during the period from the 1st of May 2016 till the end of June 2018 in Al-Azhar University Hospitals. A total of 04 selected patients suffering from papillary thyroid with clinically negative cervical lymph nodes who have received total thyroidectomy with bilateral CLND. The clinicopathological features of PTC patients with respect to sex, age, observation, tumor diameter, multifocality, extrathyroidal invasion, lymphovascular invasion and capsular invasion.The risk factors of CLNM were analyzed by Chi-squared test and multivariate logistic regression model. Results: Ipsilateral CLN metastasis were present in 47.5% (19/40).Results analysis showed that males patients with tumor size (>1 cm) (P=0.027; OR, 2.153), agePan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Relationship between Estradiol Level, Transvaginal Ultrasound Endometrial Thickness, Body Mass Index and Endometrial Pathology in Women with Postmenopausal Bleeding2842932298710.21608/ejhm.2019.22987ENMohammed Samir Fouad KhalafDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMahmoud Samy ZakiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMohamed Saied ElshourbgyDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityAhmed Magdy Lotfy AbdelmageedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20181226<strong>Background: </strong>menopause is derived from the Greek words; men (month) and pauses (Cessation). A woman is considered menopausal after cessation of menstruation for 1 year after an average age of 46. Postmenopausal bleeding (PMB) is defined as bleeding recurring in a menopausal woman at least 1 year after cessation of cycles. It must always be investigated because many causes are premalignant or malignant. The most common premalignant and malignant causes are complex hyperplasia with atypia and carcinoma of the endometrium. These disorders are present in as many as 1/3 of the patients evaluated for PMB in many series. <strong> </strong><strong>Objective: </strong>this study aimed to explore the relationship between estradiol level, transvaginal ultrasound, endometrial thickness and body mass index and their correlation to endometrial pathology in women with postmenopausal bleeding.<strong> Patients and Methods:</strong> in the present study, 80 patients with postmenopausal bleeding were examined regarding BMI, ultrasonographic assessment of endometrial thickness and pathological findings of the endometrium. D&C was performed for all patients under general anesthesia using a sharp ended curette starting first with the fundus, posterior wall, anterior wall, right and left lateral wall. The patients' age ranged from 46-69 years, with a mean of 53.53 ± 4.1 years. <strong>Results: </strong>in the present study, there was a highly statistically significantdifference between benign and malignant groups as the endometrium was markedly thicker in the malignant group. Our study displayed thatthere was a statistically high significantdifference between benign and malignant groups as regard the presence of fibroid uterus (due to presence of excess unopposed estrogen in those obese women) and the presence of adenomyotic or normal uterus inbetween both groups. <strong>Conclusion: </strong>transvaginal ultrasonography is an excellent first-step diagnostic method of excluding the endometrial abnormalities in women with postmenopausal bleeding. Ideally, a non-invasive investigation is preferred over an invasive one and also an economical investigation preferred over an expensive one; this applies equally to affluent countries and third world. Endometrial biopsy is the ‘‘gold standard’’ for diagnosing abnormalities in the endometrial tissue of patients with PMB.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Use of Toric Intraocular Lens in Correcting Regular Astigmatism during Cataract Surgery2942982298810.21608/ejhm.2019.22988ENMahmoud M. IsmailDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmad E. HudeibDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed F. KhattabDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181226<strong>Background: </strong> to date Toric intraocular lenses (IOLs) have reported to be an effective method to reducepre existing refractive corneal astigmatism and so spectacle independence following cataract surgery.
<strong>Aim of the Work: </strong>wasto evaluate the visual and refractive outcomes and the rotational stability of the EnvistaToric Intraocular Lens after cataract surgery in patients with pre-existing corneal astigmatism.
<strong>Patients and Methods: </strong>this study included 20 Eyes of 20 patients submitted to cataract surgery with pre-existing corneal astigmatism of 1.50 D. or moreat Al-Hussein University Hospital and Nour Al-Hayah Eye Hospital between July 2017 and August 2018 that were implanted with EnvistaToric Intraocular Lens after phacoemulsification surgery
<strong>Results:</strong>Using toric IOL to correct corneal astigmatism is a relatively new surgical choice in patients with a cataract and previous corneal astigmatism. After three months post operative, UCVA(Decimal), BCVA(Decimal) and Rotation(degrees) were: 0.5_1 (0.81±0.14), 0.9_1 (0.97±0.05) and 0_7 (2.75±1.65) respectively
<strong>Conclusion: </strong>It could be concluded that Toric IOL implantation was a successful surgical forcorrection of astigmatism and cataractwithout affecting corneal integrity.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Dystrophic Epidermolysis Bullosa Pruriginosa Presenting with Flagellate Scarring Pattern Before and After Treatment2993022298910.21608/ejhm.2019.22989ENSafia T. MetwalyAl-Haud AL-Marsoud Hospital for Dermatology, Venereology and Andrology, Cairo, EgyptZizette A. MoussaAl-Haud AL-Marsoud Hospital for Dermatology, Venereology and Andrology, Cairo, EgyptNivin Y. K. ShenoudaAl-Haud AL-Marsoud Hospital for Dermatology, Venereology and Andrology, Cairo, EgyptMounira WakedAl-Haud AL-Marsoud Hospital for Dermatology, Venereology and Andrology, Cairo, EgyptMariam AlfonsAl-Haud AL-Marsoud Hospital for Dermatology, Venereology and Andrology, Cairo, EgyptGhada M. RaslanAl-Haud AL-Marsoud Hospital for Dermatology, Venereology and Andrology, Cairo, EgyptAhmed SadekAl-Haud AL-Marsoud Hospital for Dermatology, Venereology and Andrology, Cairo, EgyptFady W. GeorgyAl-Haud AL-Marsoud Hospital for Dermatology, Venereology and Andrology, Cairo, EgyptJournal Article20181226<strong>Introduction: </strong>dystrophic Epidermolysis Bullosa Pruriginosa (DEB-Pr) is a rare subtype of DEB which is characterized by intense pruritus and leading to skin blistering and nodular or lichenoid lesions most prominent on the extremities, especially shins of tibia. Toenail dystrophy is also frequently observed, but not necessary for diagnosis. Although many cases of DEB-Pr are caused by mutations of type VII collagen due to reported variants in COL7A1 gene, the clinical pictures vary. We report a patient with DEB-Pr who presented with striking flagellate hypertrophic scarring lesions. Histopathological and electron microscopic findings are essential for diagnosis, given the considerable overlap with clinically similar presentations such as hypertrophic lichen planus, prurigo nodularis, lichen simplex chronicus and dermatitis artefacta.<strong> Case Presentation:</strong> Herein, we report a case with a history of blistering since childhood followed by intensely pruritic papulonodules, predominantly on the shins of tibia and dorsum of feet with distinct flagellate scarring pattern and toenail dystrophy. Our case was monitored before and after treatment with topical Tacrolimus 0.03% ointment and systemic Cyclosporine. <strong>Conclusion: </strong>Our case had an excellent response to topical Tacrolimus 0.03% ointment and systemic Cyclosporine treatment.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101MRI Versus Ultrasound In Diagnosis Of Meniscal Tear In Knee Joint3033092305110.21608/ejhm.2019.23051ENHossam Adel Mohamed MostafaDepartment of Radiodiagnosis, Faculty of Medicine, Al-Azhar UniversityAhmed Mohamad Abou ElfotuhDepartment of Radiodiagnosis, Faculty of Medicine, Al-Azhar UniversityMohamad Mobarak AlsakkaDepartment of Radiodiagnosis, Faculty of Medicine, Al-Azhar UniversityJournal Article20181227Background: the menisci of the knee are complex structures with various important functions within the knee. Loss of the menisci leads to a significantly increased risk of developing degenerative changes in the long term. Purpose: this study aimed to investigate the role of Ultrasound (US) in diagnosis of meniscus tears as compared to Magnetic Resonance Imaging (MRI) Patients and Methods: this study included 50 patients, presented by pain, swelling, stiffness/limitation of movement or a history of acute/chronic knee trauma, in the duration between November 2017 and July 2018. The research was carried on the Radiology Department, Al Azhar General Hospital, Zagazig, Sharkia Governorate, Ministry of Health. All patients underwent musculoskeletal ultrasound in different position then underwent magnetic resonance imaging included different pulse sequences and scanning planes. Results: this study included 50 patients, 31 (62%) males and 19 (38%) females. The patient’s age ranged between 10 and 67 years with a mean of 37.65 ± 10.24 SD. Male patient’s age ranged between 10 and 67 years with a mean of 36.35 ± 11.03 SD, while female patient’s age ranged between 29 and 55 years with a mean of 40 ± 8.34 SD. Conclusion: high resolution ultrasonography had high accuracy in detecting presence of tears in both the medial and lateral menisci. MRI is more sensitive in detection and determines types of tears than US.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Assessment of serum vitamin D level before and after narrowband therapy in vitiligo3103172305210.21608/ejhm.2019.23052ENHassan Abou KhodairDepartment of Dermatology, Venereology and Andrology Department, Faculty of Medicine
(Damietta), Al-Azhar UniversityAhmed Wahhed-Allah AmerDepartment of Dermatology, Venereology and Andrology Department, Faculty of Medicine
(Damietta), Al-Azhar UniversityHesham Samir Abd Al SameeDepartment of Dermatology, Venereology and Andrology Department, Faculty of Medicine
(Damietta), Al-Azhar UniversityNaglaa Fathy Arafat GadDepartment of Dermatology, Venereology and Andrology Department, Faculty of Medicine
(Damietta), Al-Azhar UniversityJournal Article20181227Background: Vitiligo is an acquired, progressive, multifactorial, depigmenting disorder characterized by the appearance of circumscribed white macules in the skin due to chronic progressive loss of functional melanocytes in the epidermis. The etiology of vitiligo is not clear, although various hypotheses have been proposed. Objective: To evaluate the serum levels and the possible role of 25 OH vit D in vitiligo and to detect whether its level is modulated by Narrowband ultraviolet (B NB-UVB) therapy. Patients and Methods: The current study included 30 patients with vitiligo. In addition, 30 healthy subjects who were age and gender matched, served as a control group. All persons were recruited from the outpatient clinic of Al-Azhar University hospital (Damitta) and from Dermatology, Leprosy and Venereology Mansoura Hospital, from March 2018 to June 2018. Results: Vitamin D levels were lower in patients with vitiligo as compared to the control subjects. Levels of vitamin D increased significantly after NB-UVB therapy. Also, VASI scores showed improvement after NB-UVB therapy. The mean VASI score in both groups showed highly significant decrease after treatment by NB-UVB. Comparison and correlation between VASI before NB- UVB therapy and 25(OH) D showed good negative correlation. Conclusion: Decreased vitamin D serum level was found in vitiligo patients, indicating its possible involvement in the pathogenesis of the disease. This level was increased significantly after NB-UVB therapy. In addition, vitamin D serum level correlated negatively with the severity of the disease.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Assessment of right ventricular outflow tract fractional shortening as a measure of right ventricular function in chronic heart failure patients3183242305310.21608/ejhm.2019.23053ENNura Ibrahim MaiyadiDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, Egypt Specialist Hospital Sokoto, Sokoto State, NigeriaIbraheem FaragallahDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, EgyptAhmad Abdelhameed RozzaDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20181227<strong>Background</strong>: assessment of RV function is a major component of the management and prognostication of heart failure (HF) patients. Its complexity makes this task difficult and therefore not appropriately considered. Right ventricular outflow tract fraction (RVOT FS) can serve that purpose if done. The functional capacity of a HF patient must always be assessed and decision made on that basis.
<strong>Aim of the study</strong><strong><em>:</em></strong> this study aimed to investigate the applicability of RVOT FS in assessment of RV function and also its relation to functional capacity.
<strong>Patients and methods:</strong> seventy-one (71) patients with heart failure with reduce ejection fraction (HFrEF) were studied prospectively and nineteen (19) control healthy individuals (normal ECG, normal left and right ventricular function and no cardiac risk factors). A 2D guided M-mode was taken in the parasternal short axis view to determine RVOT FS and a six-minute walk test (6MWT) was done to determine their functional capacity.
<strong>Results</strong><strong><em>:</em></strong> there was a reduced RVOT FS reduced in the HFrEF group (p value =0.005), 6MWT D was reduced in the HFrEF group (p value <0.001), there was a positive correlation of RVOT FS with RVFAC (r=0.839, p value<0.001) TAPSE (r=0.830, p value<0.001), S’(r=0.830, p value<0.001) 6MWT D (r=0.953, p value<0.001) and a negative correlation with RIMP(r=-0.867, p value<0.001), RV FLS(r=-0.878, p value<0.001), SPAP(r=-0.633, p value<0.001). 6MWTD with RVFAC (r=0.851, p value<0.001) TAPSE (r=0.825, p value<0.001), S’ (r=0.837, p value<0.001), RVOT FS (r=0.953, p value<0.001) and a negative correlation with RIMP (r=-0.827, p value<0.001), RV FLS (r=-0.902, p value<0.001), SPAP (r=-0.621, p value<0.001). RVOT FS between HF subgroups significant (p value<0.001).
<strong>Conclusion</strong><strong><em>:</em></strong> RVOT FS is a simple and reliable parameter that can be used in assessment of RV function and has very positive correlation with functional capacity assessed by 6MWT.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Doppler and 3D ultrasound in prediction of the nature of adnexal swelling3253342305410.21608/ejhm.2019.23054ENYahia A. WafaDepartment of Obstetrics and GynecologyIsmail M. Al-GarhyDepartment of Obstetrics and GynecologyNabeil M. FekryAl-Agouza Police HospitalAhmed S. AbdelhamidDepartment of Obstetrics and GynecologyJournal Article20181227<strong>Background: </strong>An adnexal mass (mass of the ovary, fallopian tube, or surrounding connective tissues) is a common gynecologic problem. Early diagnosis and intervention is essential especially in younger women to conserve the ovarian function.<strong> Aim of the Work: </strong>to evaluate the usefulness and value of Doppler and 3D Ultrasound as a method to enhance differentiation between benign and malignant pathologies before surgical intervention in women having adnexal swellings.<strong> Patients and Methods</strong>: This study was carried out in Obstetric and Gynecology Departments in Al-Azhar University Hospitals on 30 patients who had a preliminary diagnosis of an adnexal mass. After history taking and clinical examination, all patients underwent abdominal sonographically, Doppler examination and 3D ultrasound scan from April 2017 to September 2018.<strong> Results: </strong>Women with malignant masses were older than those with benign masses (46.00±9.76 vs 44.50±7.62 years) respectively. BMI in benign cases was lower than recorded in malignant cases (30.13±3.21 vs 38.57±0.81) with statistical significant difference between two them (P <0.01). Malignant cases were higher in postmenopausal 4(67 %) while Benign masses were higher in premenopausal 19 (79.2%) while, five cases (83%) of malignant cases were nulliparous. Regarding the diagnostic accuracy for the prediction of adnexal malignancy with 3DPD histogram analysis have been satisfied. Resistance index (RI) in benign cases ranged from 0.50-1.90 with mean value 1.18±0.41 and in malignant cases ranged from 0.30-1.50 with mean value 0.77±0.50. Sensitivity, specificity, PPV, NPV of RI was 78.8%, 75.0%, 77.2% and 76.1% respectively. Pulsatility index (PI) in benign cases ranged from 0.61-2.50 with mean value 1.80±0.52 and in malignant cases ranged from 0.80-1.37 with mean value 1.09±0.24. Sensitivity, specificity, PPV, NPV of PI was 90.9%, 88.0%, 91.0% and 86.5% respectively Peak systolic velocity (PSV) in benign cases ranged from 2.00-11.00 with mean value 6.88±2.71 and in malignant cases ranged from 14.00-35.00 with mean value 22.83±7.31. Sensitivity, specificity, PPV, NPV of PSV was 100%, 100%, 100% and 100% respectively. There was statistical significant difference between two studied groups regarding to resistance index, pulsatility index and peak systolic velocity (P < 0.05). The high risk was higher in malignant cases with 5 (83.3%) and lower in benign cases (1; 4.2%). There was statistical significant difference between two studied groups regarding to 3D ultrsound examination (P < 0.05). Conclusion: 3D ultrasound with color Doppler scan characteristics are found to be very important for discriminating benign from malignant tumors.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Comparative study between sub-coronal and peno-scrotal approach of semi-rigid penile prosthesis implantation3353402305510.21608/ejhm.2019.23055ENBasiony Abd AlhadyDepartment of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar UniversityMohamed AbdelshafyDepartment of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar UniversityOsama Al ShahatDepartment of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar UniversityMourad MahmoudDepartment of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar UniversityAhmed TahaDepartment of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar UniversityAbdel Rahman AwadeenDepartment of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20181228<strong>Aim of the work:</strong> study was done to compare the benefits and risks for patients doing insertion of penile prostheses for treatment of erectile dysfunction by two different approaches (sub-coronal and penoscrotal) and to try discover the most suitable one. <strong>Patients and Methods</strong><em>: </em>a total of 24 patients were included in this study that had all complaining from sever erectile dysfunction. All patients were subjected to pre as well as post-operative fixed assessment. International Index of Erectile Function (IIEF), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). Patients were classified into two groups according to the approach of implantation. Procedure was done for every individual patient. Analysis of the final results was done to compare the different procedures and evaluate them individually and comparatively in an effort to categorize the overall benefit of each procedure. <strong>Results:</strong> each of the two test groups showed a significant improvement and satisfaction of complaining, as well as a significant difference between the two groups as regard(EDITS) (<em>p</em>-value <0.005). <strong>Conclusion</strong><em>: </em>In general, management of erectile dysfunction had a strong impact on the quality of life of the patients especially who underwent the penile prostheses implantation, most significantly affecting their “selfesteem”, the penoscrotal approach was more suitable for semi-rigid penile prostheses than subcoronal one.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Myocardial bridge analysis by multidetector computed tomography and its association with coronary atherosclerosis3413512305610.21608/ejhm.2019.23056ENIslam Shwaky Abd ElazizDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, EgyptMansour Mohamed SallamDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, EgyptMohamed Abo Mandour MousaDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, EgyptAhmed Raouf NawarDepartment of Cardiology, Denshal Teaching Hospital, EgyptJournal Article20181228<strong>Background: </strong> myocardial bridge is still a major public health problem despite the impressive stride in diagnosis and management. Furthermore, the early and accurate diagnosis with the proper management is an important challenge. The determination of the prevalence of myocardial bridges and their location and morphology is extremely important for the prediction of potential complications which are likely to cause greater myocardial damage. <strong>Aim of the work: </strong>this study aimed to assess noninvasively by using MDCT the presence of atherosclerotic plaques in relation to myocardial bridge coronary segments and to determine the prevalence of myocardial bridges and their morphology (length, depthand diameter) and location. <strong>Methods: </strong>this was a prospective observation study that was done from June 2017 to April 2018 and included 52 patients presented to the Coronary Care Unit at Al-Azhar University Hospital with stable angina. All patients were subjected to: thorough history taking, full clinical examination, surface ECG, treadmill stresses ECG and do MDCT scan to detect of the presence of myocardial bridge: as regard site, length, depth and degree of systolic obstruction, coronary plaque assessment. <strong>Results</strong>: among the 52 patients we found that 23 patients had MB and coronary plaque included in group A, 29 patients had MB without coronary plaque included in groupB, In group A, MB was in Mid LAD in 18(78.3%) patients, Distal LAD in 5(21.7%) patients, the mean depth of MB was 3.89 ± 1.75 mm, the mean length of MB was 22.16 ± 9.44 mm, the mean degree of systolic obstruction of MB was 61.65 ± 19.47 %. While, in group B mid LAD in 20 (69.0%) patients, distal LAD in 7 (24.1%) patients and proximal LAD in 1 (3.4%) patients, distal RCA in 1(3.4%) patient, the mean depth was 2.83 ± 1.54 mm (p = 0.017), the mean length was22.22 ± 13.55 mm, the mean degree of systolic obstruction was is 41.72 ± 24.94 % (P < 0.004).
<strong>Conclusion</strong>: some anatomic characteristics of myocardial bridge, such as degree of systolic obstruction and depth, may help the development of coronary plaque.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Assessment the Role of Bisphenol A on Chemotherapeutic Efficacy of Cisplatin against Hepatocellular Carcinoma in Male Rats3523632305710.21608/ejhm.2019.23057ENHanaa M. SeragZoology Department, Faculty of Science, Mansoura University, Mansoura, EgyptMagda M. El KomyZoology Department, Faculty of Science, Mansoura University, Mansoura, EgyptHend S. AhmedZoology Department, Faculty of Science, Mansoura University, Mansoura, EgyptJournal Article20181228Aim: the objective of this study was to investigate the effect of bisphenol A (BPA) in DENA and CCl<sub>4</sub> induced hepatocellular carcinoma male rats. Materials and Methods: DENA was given as a single intraperitoneal injection of freshly prepared (200 mg/kg.bw)for initiation the carcinoma and CCl<sub>4</sub> once every week (3ml/kg.bw) for 10 weeks to promote the carcinogenic effect of DENA in male rats. In addition, the study aimed to elucidate the chemo-resistant role of bisphenol A (322 mg/kg.bw) against cisplatin chemotherapeutic effect, as a potent antineoplastic agent in the treatment of hepatocellular carcinoma male rats induced by DENA and CCl<sub>4</sub>. Results: obtained result showed that the group of rats which was orally administrated by BPA , as well as hepatocellular carcinoma treated rats group significantly have increased relative liver/body weight ratio, serum ALT, AST, ALP, serum total bilirubin, serum total protein and serum AFP and TNF-α, serum TL, TC,TG,LDL,V-LDL levels while a decrease in HDL level .Additionally there was an elevation in hepatic MDA, H<sub>2</sub>O<sub>2</sub> and a significantly depression in SOD, CAT, GST activities and GSH level, as well as an increases in hepatic p53, caspase-3 while a decrease in Bcl-2 level .on the other hand an intraperitoneal injection of cisplatin (1.5mg/kg /bw) repeated two times a week for 3 weeks to the hepatocellular carcinoma induced rats group showed amelioration in the above parameters significantly more than that of hepatocellular carcinoma group treated also with BPA. Conclusion: the consumption of BPA might resist the cisplatin chemotherapy treatment of hepatocellular carcinoma in male rats.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Comparative Study between the Effect of Nifedipine, Ritodrine and Magnesium Sulphate Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour3643742305810.21608/ejhm.2019.23058ENHosam Eldin Hussein KamelDepartment of Obstetrics and Gynecology Department, Faculty of Medicine, Al Azhar UniversityNoha Mohamed Sabri HosamEldinDepartment of Obstetrics and Gynecology Department, Faculty of Medicine, Al Azhar UniversityMohamed Ahmed Attia SoltanDepartment of Obstetrics and Gynecology Department, Faculty of Medicine, Al Azhar UniversityJournal Article20181228<strong>Background:</strong> Spontaneous preterm labor (SPTL) and preterm birth (PTB), is the single most important cause of perinatal mortality and morbidity in high-income countries despite the enormous efforts over the past several decades. Preterm labor is defined as regular, painful, frequent uterine contractions causing a progressive effacement and dilatation of the cervix occurring before 37 completed weeks of gestation. Many drug therapies were used as tocolytics in cases of preterm labor, however none of them proved to be the best. The present study was performed to compare three of the used drugs for tocolysis to assess their efficacy and side effects on the mother and fetus.
<strong>Aim: </strong>The aim of this study is to compare the effect of oral nifedipine, intravenous ritodrine infusion and magnesium sulfate infusion used as tocolytics in cases of preterm labour on Doppler parameters of fetal umbilical and middle cerebral artery and to evaluate their effects on the mother and the fetus in order to choose the safest and the most effective drug.
<strong>Methodology: </strong>This study was held in the period from December 2014 to october 2015 on 90 patients attended and admitted from the Casualty Unit of the Obstetric Department In Elsayed Glal University Hospital with preterm labor pains , intact membranes, singleton pregnancy between 28 and completed 34 weeks gestation. All patients had been dated accurately with a gestational age based on the last menstrual period and if available a corresponding second trimester ultrasound report performed before 20 weeks gestation.
Treatment continued until contractions stopped for 24 hours, maximum doses were attained without response; unacceptable side effects occurred or labor proceeded. Successful treatment was defined as cessation of contractions observed for 24 hours and no further cervical changes. Patients with successful treatment were put under observation for another 24 hours without additional treatment then discharged on no maintenance therapy.
<strong>Results: </strong>Maternal tachycardia, palpitation and dyspnea were more common in the ritodrine group with (p-value = 0.000). The present study showed increase in umbilical artery PI after treatment in the magnesium sulfate group only which was statistically significant (P value = 0.016). The study showed statistically significant increase in middle cerebral artery PI after treatment in magnesium sulfate group with a P value=0.000 and statistically significant decrease in middle cerebral artery with nifedipine group with P value=0.027. When comparing the cerebroplacental ratio before and after treatment in the three groups; the study showed significant increase in cerebroplacental ratio after treatment in the magnesium sulfate group with P value = 0.000, which is statistically significant. This suggests that nifedipine could be used as a safer alternative to ritodrine and magnesium sulfate.
<strong>Conclusion:</strong> In our study, nifedipine therapy was not associated with a significant change in maternal systolic and diastolic blood pressure after 24h, with minor insignificant effect on maternal heart rate. Fetal heart rate was not affected after therapy. Fetal Doppler study found no clinically significant effect on the pulsatility index (PI) of umbilical and middle cerebral artery, while with magnesium sulfate therapy there was increase in cerebro- placental ratio 24hr after treatment, these findings ensure safety of the drugs on the maternal and fetal aspects.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Role of susceptibility weighted imaging in acute ischemic stroke3753812310210.21608/ejhm.2019.23102ENTarek Ibrahiem MenecieDepartment of Neurology, Faculty of Medicine- Al-Azhar UniversitySherif Abd-El-fattah KhedrDepartment of Radiology, Faculty of Medicine, Cairo UniversityMohammad Ali Saeed HassanDepartment of Neurology, Faculty of Medicine- Al-Azhar UniversityMahmoud Hassan Mohammad ZaghloulDepartment of Neurology, Faculty of Medicine- Al-Azhar UniversityJournal Article20181230<strong>Background: </strong>stroke is a clinical syndrome of rapidly developing symptoms and signs of focal loss of cerebral function without apparent cause other than vascular origin, lasting 24 hours at least, or may lead to death before this. Hemorrhagic transformation (HT) is defined as hemorrhagic change in ischemic brain and includes a wide range of radiologic phenomena, from petechial hemorrhage to frank hematoma with mass effect. <strong>Objective: </strong>in our study, we aimed to determine the diagnostic value of susceptibility weighted image in detection of cerebral micro bleeds and prediction of hemorrhagic transformation in patients with acute ischemic stroke and their impact on choosing the most appropriate therapeutic protocol.<strong> Patients and Methods: </strong>this study included 28 patients with acute ischemic stroke. Patients admitted in Neurology Department of Nasser Institute Hospital within 72 h after the onset of the neurological symptoms, during the study period from 1/1/2018 to 30/8/2018, their age ranged between 23-85 years. <strong>Results: </strong>SWI image was a highly sensitive MRI sequence for detection and evaluation of cerebral micro bleeds especially on 3T magnet. Microbleeds were traditionally categorized according to their presumed underlying etiology into lobar (CAA related pathology) and deep (arteriosclerosis) microbleeds. There was a highly significant positive correlation between both age and hypertention with number of both cortical and basal ganglionic microbleeds. While, the age was obviously more correlated with cotical microbleeds, hypertention, in contrast, was more correlated with basal ganglionic microbleeds. <strong>Conclusion: </strong>presence of microbleeds in cerebral infarct lesions requires a comprehensive assessment for the therapeutic option, especially when using thrombolytic therapy or anticoagulants, but a relatively small number of microbleeds would not affect safety when using antiplatelet therapy. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Topography-guided photo-refractive keratectomy followed by corneal collagen cross-linking for keratoconus3823872310310.21608/ejhm.2019.23103ENMagdy Ezzat KhallafDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityMohamed Ahmed El-MallahDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityRasha Hassan IsmailDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityJournal Article20181230<strong>Background:</strong> KC is a bilateral, progressive, non-inflammatory corneal degeneration. Corneal deformation and thinning causes irregular astigmatism and leads to visual impairment. <strong>Aim of the work:</strong> this study aimed to evaluate simultaneous topography-guided partial PRK and CXL as a therapeutic intervention in patients with KC. <strong>Methodology:</strong> the present study was designed to evaluate simultaneous topography-guided partial PRK and CXL as a therapeutic intervention in patients with KC. It included 25 keratoconic eyes of 17 patients; 8 cases were bilateral and 9 cases were unilateral. All included cases underwent full history taking and ophthalmologic examinations for preoperative evaluation and postoperative assessment. Follow up was carried out at first postoperative day and at 1, 3 and 6 months post-operatively. <strong>Results:</strong> when comparing K1, K2, thinnest location and BCVA at 1, 3 and 6 months postoperatively to the corresponding values at first postoperative day, there was non-significant difference at any point of time. <strong>Conclusion: </strong> simultaneous topography-guided partial PRK and CXL as a therapeutic intervention in patients with keratoconus is an effective without significant complications; thus, it had a good efficacy, stability over time and safety.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Assessment of Procalcitonin Level in Chronic Hemodialysis Patients with Obesity3883952310410.21608/ejhm.2019.23104ENMustafa Abd-Elfattah El-BallatInternal Medicine and Nephrology Department, Faculty of Medicine, Al-Azhar University, CairoEl-Sayed Mohammed RashidInternal Medicine and Nephrology Department, Faculty of Medicine, Al-Azhar University, CairoAbd-Elraouf Abd-Elraouf Abo NarClinical Pathology Department, Faculty of Medicine, Al-Azhar University, CairoSalah Fathi Ali RadwanNephrology Department, El-Sahel Teaching Hospital, Cairo, EgyptJournal Article20181230<strong>Background:</strong> Circulating procalcitonin (PCT) is an inflammatory marker produced by several cell types including adipose tissue following cytokine stimulation. In contrast to its role in the general population, obesity has been associated with improved survival in chronic renal failure patients undergoing haemodialysis. The aim of our study was to evaluate the link between plasma PCT concentration and metabolic parameters of obesity in chronic hemodialysis patients.
<strong>Patients and methods</strong>: We determined PCT in 80 subjects; they were divided into: 30 obese, body mass index(BMI)>28Kg /m<sup>2</sup>, chronic renal failure patients’ undergoing haemodialysis, 30 non obese, body mass index(BMI)<28 Kg/m<sup>2</sup>, chronic renal failure patients’ undergoing haemodialysis,20 obese, body mass index(BMI) >28Kg/m<sup>2</sup>,normal healthy subjects as control. Complete clinical examination and laboratory investigations were done.
Results: Elevated plasma procalcitonin (PCT) levels, within the normal range, of the 80 subjects included was not dependent on anthropometric measures including body weight, height, body mass index and waist circumference. It was found to be correlated to age (0.020, P<0.05) and urea (0.024, P<0.05) in obese haemodialysis patients’.
<strong>Conclusion</strong>: Our findings based on community-based data showed that higher plasma procalcitonin levels in the normal range are associated with increased measures of obesity in chronic renal failure patients’ undergoing haemodialysis. Because associations were not dependent on BMI, plasma procalcitonin may serve as a new marker for adipocyte dysfunction, chronic low-grade inflammation, or both.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Efficiency of Lepidium sativum Seeds in Modulation the Alterations in Hematological Parameters Induced by Sodium Nitrite in Rats3964022310510.21608/ejhm.2019.23105ENEnas S. Abdel-BakyDepartment of Biological and Geological Sciences, Faculty of Education, Ain Shams University, Cairo, EgyptJournal Article20181230<strong>Background: </strong>Sodium nitrite is an inorganic compound with the chemical formula NaNO<sub>2</sub>. It is probably best known as a food additive to prevent botulism.
<strong>Aim of the work: </strong>The current study was designed to investigate the possible protective effect of aqueous extract of <em>Lipidium sativum </em>seeds on hematotoxicity induced by sodium nitrite (NaNO<sub>2</sub>) in male albino rats.
<strong>Materials and Methods: </strong>The experimental animals were divided into four groups. The first group without any treatment and served as control. The second group was given an intraperitoneal injection (IP) of a single dose of sodium nitrite (50 mg/kg body weight) 24 h prior to decapitation.The third group was received orally 300 mg/kg body weight of <em>Lipidium sativum </em>seeds extract for four weeks. The fourth group were treated orally with <em>Lipidium sativum </em>seeds extract (300 mg/kg body weight) for four weeks, prior to IP injection with a single dose of sodium nitrite (50 mg/kg body weight). Finally, blood samples were collected for hematological parameters estimation including red blood cell count (RBCs), hemoglobin (Hb), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet count (PLTs) and total and differential white blood cells (WBCs).
<strong>Results: </strong>The obtained data revealed that NaNO<sub>2 </sub>induced a significant decrease in the percentages of RBCs count, Hb content, PCV, MCH, MCHC, platelets, WBCs, neutrophils, monocytes, eosinophils and basophils count. On the other hand, a noticeable increase in the percentage of lymphocytes was recorded in NaNO<sub>2 </sub>treated rats. Whereas, the treatment with <em>Lipidium sativum </em>seeds extract alone to rats did not cause a significant alterations in the hematological indices comparing to control group. There was a significant increase in total WBCs and neutrophils counts and a significant decrease in lymphocyts, monocyts, eosinophils and basophils counts. The treatment with <em>Lipidium sativum </em>seeds extract before injection with sodium nitrite were significantly ameliorated the changes induced in hematological parameters which caused by sodium nitrite comparing with the control group. Whereas, there were a significant increase in total WBCs count, neutrophils and eosinophils and a significant decrease in lymphocytes, monocytes and basophils.
<strong>Conclusion: </strong>It could be concluded that the treatment with <em>Lipidium sativum </em>seeds extract significantly improved the changes in hematological parameters that caused by sodium nitrite and induced a significant increase of WBCs count may stimulate the animal’s immune system activation.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Vestibular Evoked Myogenic Potentials (VEMP) in patients with Multiple Sclerosis4034102310610.21608/ejhm.2019.23106ENGehan Abdel-Rahman El-ZareaDepartment of Audio Vestibular Medicine ENT Department, Faculty of Medicine Al-Azhar UniversityAhmed Ismail AbbasDepartment of Audio Vestibular Medicine ENT Department, Faculty of Medicine Al-Azhar UniversityAhmed Mohamed AlmeciryDepartment of Audio Vestibular Medicine ENT Department, Faculty of Medicine Al-Azhar UniversityMohamed Hamed RashadDepartment of Neurology, Faculty of Medicine Al-Azhar UniversityJournal Article20181230<strong>Background: </strong>multiple sclerosis (MS) is a chronic demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged and this damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms.<strong> Objective: </strong>this study aimed to assess cervical vestibular evoked myogenic potentials (cVEMP) in patient with multiple sclerosis and to demonstrate the value of cVEMP as a good method for the assessment of vestibulospinal tract in patients with MS.<strong> Patients and Methods: </strong>to achieve this target, we enrolled 50 subject: 30 patients diagnosed as MS in addition to 20 healthy control. The cVEMP response was evaluated for the presence of positive (p1) and negative (n1) peaks of the first biphasic wave complex; latency (p1 and n1 latency) and peak to peak amplitude. The bilateral otoscopy was normal in cases and controls, with no middle or outer ear disease that could bias the study results being found. The pure tone audiometry showed levels of hearing compatible with normal hearing in the 20 healthy subjects, with hearing thresholds that did not exceed 25 dB for any individual. <strong>Results: </strong>the present results showed that 60 % of MS patients had VEMP abnormalities (absent responses and/or prolonged latencies). In the present study, patients with absent VEMP wave were found to have significantly higher disease duration. In the present study, the absence of P13–N23 waves were more frequent in patients with greater EDSS score, and also absence of P13–N23 waves were more frequent in patients with MS with vestibular symptoms and greater disability.
<strong>Conclusion: </strong>we can say that in patients with MS in which demyelination has extended to the vestibulospinal tract, there is going to be a prolongation of the p13 and n23 wave. In fact, this increase in the p13 and n23 latencies is clear in the patients with MS in comparison to the control group.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Diagnostic Accuracy of chest Ultrasonography versus Other Diagnostic Imaging Tools for Identification of Lower Respiratory Diseases in Children4114192310710.21608/ejhm.2019.23107ENSherif Mostafa Kamal RedaDepartment of Pediatrics, Faculty of Medicine, Al-Azhar UniversityHatem Refaat HablasDepartment of Pediatrics, Faculty of Medicine, Al-Azhar UniversityMohamed Ali AbboudDepartment of Radiology, Faculty of Medicine, Al-Azhar UniversityMoustafa Abdelhafez ZedanDepartment of chest disease, Faculty of Medicine, Al-Azhar UniversityMahmoud Mohamed Abd ElnabyGhallabDepartment of Pediatrics, Faculty of Medicine, Al-Azhar UniversityJournal Article20181230<strong>Background:</strong> respiratory distress is the primary diagnosis in nearly 50% of children admitted to the pediatric emergency room and is a common cause of cardiopulmonary arrest in children. There is substantial variability in the etiology and severity of illness. The presenting clinical findings usually help to determine the type of problem. The causes include pneumonia, bronchial asthma, pneumothorax, acute bronchiolitis and pleural effusion. <strong>Objective:</strong> the present study was designed to compare chest ultrasound, as a diagnostic tool in the diagnosis of children with acute conditions of RD with the diagnosis of other radiological tools (Chest X-ray and CT chest. <strong>Methodology:</strong> this study included 200 infants and children, attending the Paediatric Department in Sayed Galal and Al- Hussein, AL-Azhar University Hospitals and they were suffering from respiratory distress. Their ages ranged from 12 month to 60months with mean age 32.52 months ± 13.91 months. Males were 134/200 (67%) while, females were 66/200 (33%) with male to female ratio 2.03:1. <strong>Results: </strong>as regard distribution of patients according to clinical or radiological diagnosis, the study showed that uncomplicated pneumonia n84 (42.0%), pneumonia with effusion n32 (16.0%), non pneumonic effusion n8 (4.0%), lung abscess n4 (2.0%), pneumothorax n14 (7.0%), lung collapse n16 (8.0%), mediastinal mass n4 (2.0%) and acute bronchiolitis n38 (19.0%). <strong>Conclusion:</strong> from our study, we can conclude the following:in view of our study it can be concluded that, chest US offers an important contribution to the diagnostic procedures of pleuro-pulmonary disorders in children, as pneumonia, pneumothorax, pleural effusion, lung abscess, lung collapse, mediastinal mass and acute bronchiolitis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Comparative Study between Betamethasone and Dexamethasone as a Prophylactic Corticosteroids Therapy on Neonatal Outcome in Elective Cesarean Section at 37 Weeks4204272310810.21608/ejhm.2019.23108ENAbdalla Khalil IssaObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar UniversityWael Soliman TahaObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar UniversityAbdelsattar Abdullah ElsayehPediatrics Department, Faculty of Medicine, Al Azhar UniversityHany Khayri ElhadadObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar UniversityJournal Article20181230<strong>Background<em>: </em></strong>preterm birth is the most costly complication of pregnancy and the leading cause of neonatal morbidity and mortality. There are multiple strategies to minimize the risk and the impact of prematurity, such as administration of antenatal corticosteroids (ACS), in association with tocolysis, neuroprotection with magnesium sulphate, and neonatal life-saving therapies. <strong>Aim of the Work<em>:</em></strong> this study aimed to assess the comparison between betamethasone and dexamethasone before elective cesarean section at (37-37+6) weeks, in reducing neonatal respiratory morbidity and admission to neonatal intensive care unit (NICU) with respiratory complications. <strong>Patients and Methods</strong><strong><em>: </em></strong>this clinical observational prospective study had been conducted at El Hussein University Hospitals Obstetrics and Gynecology Department from December 2017 to July 2018 to assess the comparison between betamethasone and dexamethasone as a prophylactic corticosteriodes before elective cesarean section at (37-37+6) weeks. Five hundred pregnant women attended to out-patient clinic, the patient were at risk of preterm labour before 37 weeks. <strong>Results:</strong> the rate of neonatal admission to primary care baby unit (PCBU) and TTN was significantly lower in group I [Betamethasone Group] when compared to group II [Dexamethasone Group]. There was a statistically significant difference between both groups regarding need for mechanical ventilation (1 to 9) respectively with p value of 0.011.<strong>Conclusion:</strong>antenatal corticosteroids (ecpecially betamethasone) were effective in prevention of respiratory complications after elective caesarean section at term.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Assessment of validity of the ‘Culprit Score’ for predicting the culprit artery in patients with acute inferior wall myocardial infarction4284352310910.21608/ejhm.2019.23109ENKarim Adel EllakanyDepartment of Cardiology, Damanhour Teaching HospitalIbrahim Abdelfattah YasinDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityMoustafa Ibrahim MokarrabDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityMansour Mohamed SallamDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20181230<strong>Background: </strong> Acute myocardial infarction is still a major health problem inspite of the impressive stride in diagnosis and treatment. Therefore, the early diagnosis and proper management is an important challenge. The identification of infarct related artery and site of occlusion in inferior wall myocardial infarction is extremely important to predict complications.
<strong>Aim of the work: </strong>evaluating the use of ‘culprit score’ for prediction of the culprit artery in inferior wall MI
<strong>Methods: </strong>This was a prospective observation study that was done from June 2017 to July 2018 and included 100 patients presented to the coronary care unit at Al-Azhar University Hospitals and National Heart Institute with inferior wall myocardial infarction. All patients were subjected to: history taking, clinical examination, ECG, cardiac enzymes, echocardiography and coronary angiography. Culprit Score is defined as: <strong>[(II -V2) / (III + V1 – aVL)] </strong>by measuring ST elevation in leads (II, III) and ST displacement in leads (V1, V2, AVL).
<strong>Results:</strong>Mean age of patients involved in the study was 56.42+10.78 years with 80% of patients being male. The sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV) of <strong>Culprit Score ≤ 0.5 to predict proximal RCA </strong>occlusions were 79.49 %, 86.89 %, 79.49 %, and 86.89 %, respectively and <strong>0.5 to ≤ 1.5 to predict distal RCA</strong> occlusions were 78.13 %, 86.76 %, 73.53 %, and 89.39 %, respectively; and <strong>score >1.5 to predict LCX</strong> occlusions were 79.5 % and 86.9 %; 78.1 % and 86.7 %; and 75.8 % and 92.9 %, respectively.
<strong>Conclusion</strong>: Culprit score could reliably predict the site of occlusion in inferior wall myocardial infarction.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Study of Cognitive Impairment in Euthymic Bipolar Disorder Patients4364502311010.21608/ejhm.2019.23110ENMohammed Hashem Kamal BaharyPsychiatry Department, Faculty of Medicine, Al-Azhar UniversityAli Ismail Abd El-Rahman IsmailPsychiatry Department, Faculty of Medicine, Al-Azhar UniversityIsmail Sayed Muhammad SadekPsychiatry Department, Faculty of Medicine, Al-Azhar UniversityMahmoud Ahmad Ahmad El-GendyPsychiatry Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20181230Background: researchers came to agreement on that bipolar disorder is commonly linked to impairment in cognitive functions by a remarkable degree. More and more evidence continue to support that the cognitive impairment remains persistent even within euthymic periods which in turn points to cognitive impairment as a possible characteristic of the disorder. Aim of the Work: objective assessment of bipolar patients' cognitive deficits present during remission and holding a Comparison of these deficits with control subjects who are completely healthy. Patients and Methods: assessing cognitive functions including executive functions, attention and memory in euthymic bipolar patients by using relevant scales, then using SPSS for comparing the results with those of a control group. Results: when compared to healthy control subjects, euthymic bipolar patients were found to exhibit a markedly noticeable impairment in attention, executive functions and total memory score. It was also noteworthy that the association between the duration of illness demonstrated through the number of episodes and the extent of impairment in cognitive functions. Conclusion: there is an apparent association of bipolar disorder with cognitive impairment even when patients are in euthymic state and consequently, the number of episodes increases the impairment degree.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Management of Acute Appendicitis during Pregnancy4514592311110.21608/ejhm.2019.23111ENMohamed Sobhy TeammaDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHamada Rashad Abdel-KaderDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptWael Soliman TahaDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed Atef Radi AhmedDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181230<strong>Background: </strong>Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis. Appendectomy is the most common abdominal operation performed as an emergency basis.
<strong>Objective: </strong>The aim of the study was to evaluate the management of acute appendicitis during different stages of pregnancy as regard the diagnosis, operation time, operative and post-operative complications and pregnancy outcome.
<strong>Subjects and Methods: </strong>This prospective study included a total of 20 pregnant women who had signs and symptoms of acute appendicitis which admitted at Al-Azher University Hospitals and Elmenia General Hospital from March 2018 till November 2018. All patients were subjected to open appendectomy under spinal anesthesia.
<strong>Results: </strong>Abdominal pain, nausea, vomiting, leucocyte count, CRP and body temperature were not helpful in establishing the correct diagnosis. There was no maternal morbidity related to the appendectomy. We found no increase in pregnancy complications in cases with appendicitis.
<strong>Conclusion: </strong>Accurate and prompt diagnosis of acute appendicitis should be done to avoid un-necessary exploration and to aim for timely surgical intervention in pregnant women suspected of having appendicitis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274220190101Evaluation of Diagnostic Laparoscopy with laparoscopic Appendectomy in Females with Acute Right Lower Quadrant Pain, a Multicenter Study4604662311210.21608/ejhm.2019.23112ENNesreen ArefDepartment of Obstetrics and Gynecology, Taif University, Saudi ArabiaMohamed Al SaeedDepartment of Surgery, Taif University, Saudi ArabiaBilal O Al-JiffryDepartment of Surgery, Taif University, Saudi ArabiaMajed Al-MourgiDepartment of Surgery, Taif University, Saudi ArabiaAlaa YounesDepartment of Surgery, Taif University, Saudi ArabiaTamer Abdel-RahmanDepartment of Surgery, Taif University, Saudi Arabia General Organization of Teaching Hospitals and Institutes (Benha)Samir BadrDepartment of Surgery, Taif University, Saudi Arabia General Organization of Teaching Hospitals and Institutes (Damanhur)Abdullah Al-SawatDepartment of Surgery, Taif University, Saudi ArabiaJournal Article20181230<strong>Background and aim of the study: </strong>Diagnostic laparoscopy is the gold standard for diagnosis of acute right lower abdominal pain (ARLQP) in females especially in child bearing age and its value to perform laparoscopic appendectomy in such complex conditions is gaining acceptance amongst surgeons. The aim of this multicenter study was to evaluate the values of diagnostic laparoscopy with laparoscopic appendectomy in female patients with acute right lower quadrant abdominal pain.
<strong>Material and method:</strong> This multicenter prospective study enrolled 253 female patients who presented with acute right lower quadrant pain to Taif tertiary hospitals (Saudi Arabia) and performed laparoscopic appendectomy during diagnostic laparoscopy from May 2012 to April 2017.
<strong>Results: </strong>The study included 253females with mean age of 31.1±6.8 years. Diagnostic laparoscopy with laparoscopic appendectomy was done for all of them. Acute appendicitis was the most common cause of ARLQP (22.1%). 10.5% of macroscopically normal appendices had acute appendicitis. Mean total operating time was 65.6±14.7 and for the appendectomy portion of the operation it was 14.3±2.8 minutes when the appendix was grossly inflamed and it was 11.8±2.3 minutes when the appendix was apparently normal (incidental appendectomy).The mean hospital stay for grossly inflamed appendix was 24.8±5.5 hours, of incidental appendectomy without associated pelvic pathology was 22.3±5.2 hours increased to 72.4±16.5 hours if other pelvic pathology was managed. Post operative complications occurred in 4%. No operative or early postoperative mortality was recorded.
<strong>Conclusion: </strong>This study supports the value of diagnostic laparoscopy in diagnosis and management of females with ARLQP and verified that acute appendicitis is the most common cause in such females. The study proved also that laparoscopic appendectomy is safe, effective, quick in addition; the study verified the role of incidental appendectomy in prevention of reoperation for future appendicitis.