Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Comparative Study between Treatment of Lumbar Disc Herniation with Intra Discal Ozone and Transforaminal Steroid Injection versus Steroid Injection only7057202406810.21608/ejhm.2019.24068ENAbd El Shafy Ahmed HaseebDepartment of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, AlAzhar UniversityAbd El Hameed Abd El HaresDepartment of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, AlAzhar UniversityKhaled Mohamed Abd El MoezDepartment of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, AlAzhar UniversityAshraf Ismail MustafaDepartment of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, AlAzhar UniversityOsama Eid Ahmed AhmedDepartment of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, AlAzhar UniversityJournal Article20190109Background: Oxygen-ozone therapy is a minimally invasive treatment for lumbar disc herniation that exploits the biochemical properties of a gas mixture of oxygen and ozone. Objective: The purpose of our study was to prospectively evaluate the clinical effectiveness of oxygenozone therapy and compared the therapeutic outcome of injection of oxygen-ozone combined steroid with injection of steroid alone at different follow-up period. Patients and Methods: One hundred patients were included for this study from al-Agouza Physical Medicine, Rheumatology and Rehabilitation center. From March 2014 to April 2016, we treated 100 patients (42 men, 58 women; age range, 23–65 years) with lumbar disk herniation (L3-4, 23 patients; L4-5, 61 patients; L5-S1, 75 patients) and radicular pain. The mean duration of radicular pain at the time of treatment was 8 weeks. Result: Satisfactory clinical outcomes were obtained in both groups after two weeks, three months and at 6 months. Treatment was successful in patients in group I and patients in group II. The difference between group I and group II was insignificant. Conclusion: O2–O3 seems to play a role in pain relief, and we suggest the administration of the O2– O3 mixture combined with transforaminal steroid injection as a first-choice treatment before recourse to surgery or when surgery is not possible. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Corneal Endothelial and Central Corneal Thickness Changes after non Complicated Uneventful Phacoemulsification7217252406910.21608/ejhm.2019.24069ENMohamed A. El MasryOphthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbdelghany I. AbdelghanyOphthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed R. ElrefaeiOphthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190110Aim of the work: this study aimed to evaluate the central corneal thickness and the corneal endothelium by specular microscopy in torsional phacoemulsification versus longitudinal phacoemulsification. Methods: in our study we did a comparative analysis of the changes in endothelial cells of the cornea (Central cell density and cell loss) and central corneal thickness after cataract extraction surgeries by torsional phacoemulsification versus longitudinal phacoemulsification. In our study thirty eyes of thirty patients were chosen from Ophthalmology clinic at Bab Al-Shaariah University Hospital for uneventful phacoemulsification surgeries (15 eyes of 15 patiens for torsional phaco and 15 eyes of 15 patients for longitudinal phaco). The types and densities of cataract were determined as cortical, posterior supcapsular (PSC), nuclear I, nuclear II and nuclear III. Divide and Conquer technique was used for phacoemulsification using (Infiniti, Ozil technology, Alcon) phaco machine. A noncontact specular microscope Topcon SP-1P (Topcon Corporation, Japan) was used to evaluate the central endothelial cell density (CD) and central corneal thickness (CCT). Results: The mean U/S time was lower in the torsional group than in the longitudinal group (p< 0.05). On comparing between the torsional Phaco and longitudinal phaco groups, the longitudinal phaco group had higher average central corneal thickness (p > 0.05) and higher average corneal endothelial cell losses at 2 weeks postoperative (p > 0.05). Conclusions: our study suggested a better efficiency by the torsional mode rather than the longitudinal mode.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Evaluation of Psychological and Sexual Effects of Female Genital Mutilation (Circumcision)7267342407310.21608/ejhm.2019.24073ENZakaria Mahran ObaidDepartments of Dermatology, Venereology & Andrology, Faculty of
Medicine, Al-Azhar University, Damietta, EgyptAhmed Wahhed-Allah AmerDepartments of Dermatology, Venereology & Andrology, Faculty of
Medicine, Al-Azhar University, Damietta, EgyptMohammed Abdel Fatah El MahdyDepartments of Psychiatry, Faculty of
Medicine, Al-Azhar University, Damietta, EgyptAmira Elmaadawy Barakat MohammedDepartments of Dermatology, Venereology & Andrology, Faculty of
Medicine, Al-Azhar University, Damietta, EgyptJournal Article20190110Background: female genital mutilation (FGM), also known as female circumcision (FC), but more recently as female genital mutilation/cutting (FGM/C) according to the World Health Organization (WHO), has occurred in many forms in all societies. The psychosocial consequences include post-traumatic stress disorder (PTSD), anxiety disorders, panic disorders, depression and suppression of feeling and thinking, and sometimes attempted suicide. Objective: To evaluate sexual and psychological effects of female genital mutilation. Patients and Methods: The two groups were compared as regard many demographic data such as age, level of education, associated chronic diseases and previous gynecological history. The results revealed no significant difference between the two groups in the educational level. The females in the two groups also showed significant difference in their agreement with the process and subsequently in their future decision in performing circumcision for their daughters. Other demographic data included in this study revealed no difference between the studied groups. Results: The study used different questionnaires and scores to compare the sexual satisfaction and psychological effects of the females in the study. For assessment of sexual satisfaction, Female Sexual Function Index (FSFI) questionnaire translated into Arabic was used and showed no significant difference between the two groups except for only a single domain" lubrication". Conclusion: Concerning the psychiatric analysis of the two groups, Anxiety Hamilton score and Depression Beck score were used and showed no statistically significant difference between the two groups in the two scores. Also 19% of the females in the group of FGM showed positive symptoms for post-traumatic stress disorder (PTSD). Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Surgical Outcomes of Right Anterolateral Minithoracotomy versus Median Sternotomy in Atrial Septal Defect7357432408310.21608/ejhm.2019.24083ENHossam ElSayed Abd Al-FattahDepartment of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar UniversityMohammed Eldesoky SharaaDepartment of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar UniversityMohammed Abd Al-FattahDepartment of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20190110Background: the atrial septal defect repair has been traditionally approached through a median sternotomy. However, significant advances in surgical optics, instrumentation, tissue tele manipulation and perfusion technology have allowed for atrial septal defect repair to be performed by using progressively smaller incisions including the minithoracotomy. Aim of the study: this study aimed to compare the surgical outcome of right anterolateral minithoracotomy versus median sternotomy in atrial septal defect repair. Methods: this study was done in Department of Cardiothoracic Surgery at Elhussen Hospital, Al-Azhar University, after approval of the local ethical committee in the period between July 2017 till July 2018. 30 patients with ASD required ASD repair were included in this study for operative and short term postoperative results to evaluate the impact of two approaches of repair on quality of life of patients who survived the operation was studied. Results: The patients in both groups were similar in age preoperative comorbidities and ejection fraction but more female s were in Right anterolateral mini -thoracotomy group. There was a highly statistically significant prolonged pump-run time in the thoracotomy group than the sternotomy group with p-value ¼ 0.0 0 4. Interestingly, in the thoracotomy group, mechanical ventilation time (hours) was shorter with p-value ¼ 0.0 02. There were similar blood transfusion rate, chest tube drainage, intensive care unit stay and hospital length of stay. However, more wound infection was found in the sternotomy group which was statistically significant (p-value ¼ 0.035). There were no patients requiring conversion to full sternotomy, no residual defect across the atrial septum and all patients were alive on a month follow-up of the hospit al discharge. Conclusion: right antero-lateral mini-thoracotomy technique for atrial septal defect anomaly closure was safe and reliable technique as sternotomy incision. Apart from its restricted operating field and longer pump-run time, it kept the sternal integrity, it had better esthetic incision, it reduced wound infection and the need for analgesia. Moreover, it is associated with an early recovery and short ICU stay.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Toxic effects of chronic exposure to dyes among workers of synthetic textile industries7447512408410.21608/ejhm.2019.24084ENAhmed F.M. MohammedForensic Medicine and Clinical Toxicology, Internal Medicine Department, Faculty of Medicine, Al-Azhar UniversityMagdy M. SherifForensic Medicine and Clinical Toxicology, Internal Medicine Department, Faculty of Medicine, Al-Azhar UniversityAshraf I. HasanForensic Medicine and Clinical Toxicology, Internal Medicine Department, Faculty of Medicine, Al-Azhar UniversityBahyeldein E. MakrahyClinical Pathology Department,
Faculty of Medicine, Al-Azhar UniversityNabil E. HasanClinical Pathology Department,
Faculty of Medicine, Al-Azhar UniversityJournal Article20190110Background: textile industry is one of the major industries in Egypt. However, the working environment is associated with potential health hazards. Aim of the work: to study the toxic effects of different types of dyes among workers in textile industries and its effect on their respiratory, renal, and immunological systems. Subjects and methods: this study was conducted on 50 male workers exposed to textile dyeing of different ages, selected from all textile plants with dyeing industry at Borg Al-Arab City compared with 50 males, who were not exposed to textile dye as a control group. Results: both groups were comparable as patient age, while smoking was significantly increased in exposed group (38.0% vs 14.0%). Reported symptoms such as itching, abdominal pain, etc. and respiratory symptoms were significantly increased in exposed group. There was significant increase of AST, ALT, total bilirubin and alkaline phosphatase, urea and serum creatinine in study when compared to control group. Furthermore, there was statistically significant decrease of respiratory function percentage of predicted in study group, and there was statistically significant increase of serum lead concentration in study when compared to the control group (17.18±2.35 vs 6.74±2.29 respectively). In addition, there was significant increase of IgM and IgG in study group. Conclusion: workers in textile industry were significantly exposed to health hazards especially on respiratory system. However, multi-organ affection is the role with increased oxidative stress.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Adherence of surgeons to surgical prophylaxis guidelines7527632416610.21608/ejhm.2019.24166ENIbrahim M. AlshehriInpatient Pharmacy Supervisor, Rabigh General Hospital, JeddahIbraheem M. AlbishryRabigh General Hospital,
Pharm.,DKhuwailid R. AlharthiKing Abdullah Hospital, Bishah, BPharm, Pharm.Bader A. Al QarniAl-Thagar General Hospital, Jeddah,
BPharm, Pharm.Journal Article20190110Background: surgical site infections (SSIs) are microbial contamination of the surgical wound during a period of one month that could result in major post-operative morbidity and mortality rates. Objectives: this study aimed to identify the adhesion of surgeons to antibiotics prophylaxis guidelines at Kingdom of Saudi Arabia (KSA). Methods: this study included 180 adult subjects who were scheduled to undergo major surgeries in the hospital. The data of the patients were collected from the surgical wards and day care unit. Results: most of the included surgeons showed no error during pre, intra and post operative duration as give the required antibiotics and didn’t give the non-require antibiotics. The preoperative adherence of surgeons as most of the surgeons (73.9%) followed the prophylactic measures that included correct choice, indications, dosage and duration. Most of the surgeons (76.1%) followed the prophylactic measures including correct choice, indications, dosage and duration during intra-operative period. The majority of the surgeons (75%) followed the prophylactic measures including correct choice, indications, dosage and duration during post-surgical duration. Conclusion: The level of surgeon’s adherence to antibiotic prophylactic guidelines was efficient among most of surgeons regarding the proper choice of antibiotic, duration, timing and indication. However, these results differ from other available studies, this study showed a good sign for application of antibiotic prophylactic measures in KSA hospitals. Further studies should be conducted to increase the knowledge and adherence of surgeons all over KSA.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Double Guidewire Technique versus Transpancreatic Sphincterotomy for Difficult Biliary Cannulation7647702416710.21608/ejhm.2019.24167ENMohie Eldin Mohamed AmerDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar UniversityMohamed Abdel Rasheed Abdel Khalik AllamDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar UniversityMohamed Hamza Al-SisiDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar UniversityJournal Article20190110Background: The standard biliary cannulation technique has been reported to fail in approximately 5– 20% of cases so, several supplementary techniques have been recommended to facilitate access to the common bile duct (CBD); Double-guidewire technique (DGT) and transpancreaticsphincterotomy (TPS) are effective method in cases of standard biliary cannulation failure. Objective: To compare the outcomes between DGT and TPS in patients with difficult biliary cannulation regarding the procedure duration, success rate and complications. Patients and Methods: This was a randomized study conducted in Al-Hussein University Hospital, Endoscopy Unit in the period between May, 2016 to October, 2017. A total of 40 patients, who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved were randomized into DGT (n = 19) and TPS (n = 21) groups. DGT or TPS was done for selective biliary cannulation. We measured the technical success rates of biliary cannulation, median cannulation time, and procedure related complications. Results: The distribution of patients after randomization was balanced, and both groups were comparable in baseline characteristics. There was no significant difference between both groups regarding age and sex distribution, clinical presentation, laboratory findings and sonographic findings. Successful cannulation rate and mean cannulation times in DGT and TPS groups were 94.7% vs 95.2% and 20.1 ± 8.7min vs 21.5 ± 7.8min, P = 0.602, respectively. There was no significant difference between the two groups. Conclusion: When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved, DGT and TPS facilitated biliary cannulation and showed similar success rates. However, post-procedure pancreatitis and Cholangitis were significantly higher in the DGT group.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Predictive Factors for Failed Endoscopic Retrograde Cholangiopancreatography7717742416910.21608/ejhm.2019.24169ENHassan Abd El-HafiezTropical Medicine Department, Al Azhar UniversityMohamed Abdel RasheedTropical Medicine Department, Al Azhar UniversityMohamed Ismail FadelTropical Medicine Department, Al Azhar UniversityJournal Article20190111Background: failure during cannulation renders the endoscopic retrograde cholangiopancreatography (ERCP) unsuccessful and gives rise to various consequences, including cholangitis and pancreatitis, which may require interventions, such as percutaneous transhepatic cholangiography (PTC) and surgery, with higher morbidities. Aim of the Work: we aimed to establish predictive factors for ERCP failure. Patients and Methods: a total of 103 ERCP procedures were done from October 2016 to October 2017 in the endoscopy unit at AL Hussein university hospital. Patients were divided according to ERCP results into 2 groups; group I consists of 93 cases of successful ERCP procedure (90.2%) and group II consists of 10 cases of failed ERCP procedure (9.7%). After clear written consent, full clinical, sonographic and laboratory evaluation were done for all patients. Results: patients with history of previous abdominal surgery and\or CBD stricture had a significant higher rate of ERCP failure. Duodenal diverticula, papillary mass and gastric outlet obstruction were significantly higher in failed ERCP group. Conclusion: any patient with history of previous abdominal surgery, CBD stricture and benign or malignant tumors should be investigated before ERCP with non-invasive image as magnetic resonant cholangiopancreatography (MRCP) or Endoscopic ultrasound (EUS).Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101The Role of Ultrasound versus Hysteroscopy in Assessment of Cesarean Section Scar in Non Pregnant Females7757812417110.21608/ejhm.2019.24171ENIslam Ibrahim Abdel-Aziz El-EwinyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-azhar University, Cairo, EgyptFarid Ahmed KassabDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-azhar University, Cairo, EgyptKamel Nour El-Dean Abdul-JaleelDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-azhar University, Cairo, EgyptJournal Article20190111Background: cesarean section is one of the most commonly performed surgical procedures in obstetric practice. It has become increasingly important to study the sequelae of this procedure on the future reproductive capacity. Special investigations are required for assessment of CS scar integrity to avoid its dehiscence or rupture during pregnancy or labor. Objectives: to compare between the accuracy of ultrasound and hysteroscopy in visualization of the site of Cesarean section scar in non-pregnant females and also to determine and comment on thickness, vascularity, continuity and ballooning of the scar. Patients and Methods: in a comparative cross-sectional study, 50 women with previous cesarean section attending the Ob/Gyne outpatient clinic complaining of infertility or recurrent pregnancy loss. They had been examined by transvaginal ultrasound (TVS), then by hysteroscopy to evaluate and compare their accuracy in assessment of the scar. Results: it was found that hysteroscopy can't comment on scar thickness but transvaginal ultrasound can do it in all patients of the study with a mean value 1.57 mm. There is a statistically significant correlation between the use of ultrasound and hysteroscopy in determination of the site, continuity and vascularity of scar, while there is a statistically insignificant correlation between ultrasound and hysteroscopy in determination of the balloning of the scar. Conclusion: ultrasound is more accurate than hysteroscopy in evaluating scar thickness and detection of scar defect.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Evaluation of the Effect of Diabetes Mellitus on Corneal Biomechanics7827882417210.21608/ejhm.2019.24172ENAbd Elmagid Mohamed Tag EldinOphthalmology department, Faculty of Medicine, Al-Azhar UniversityAbdulmoez Haddad AhmedOphthalmology department, Faculty of Medicine, Al-Azhar UniversityAmr Khalil AbdelmonemOphthalmology department, Faculty of Medicine, Al-Azhar UniversityJournal Article20190111Background: the cornea exhibits viscoelastic properties, which give it the quality of hysteresis. Corneal hysteresis is an important indicator of the biomechanical properties of the cornea. Aim: to compare the biomechanical properties of the cornea in patients having diabetes mellitus and age matched normal individuals as regards to corneal hysteresis (CH), corneal resistance factor (CRF), Corneal compensated IOP (IOPcc) and Goldman- correlated IOP (IOPg). Patients and Methods: A total of 200 eyes of 100 patients were enrolled in our study. Patients were selected from Ophthalmology outpatient clinics in Minia Health Insurance Hospital – Ophthalmology department. The type of our study is a case-control one. Patients were divided into two equal groups: Group A: included 50 patients (100 eyes) of age matched normal individuals. Group B: included 50 patients (100 eyes) having type 2 diabetes mellitus. Results: mean CH in control group was 9.8±1.3 mm Hg in comparison to mean CH in diabetic group which was 11.9±1.4 mm Hg, which was statistically significantly higher in diabetic patients when compared to control group, (P value = 0.<001). Conclusion: the corneal biomechanics in diabetic group are significantly higher compared with those of the control group.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101The Clinical Characteristics and Treatment Response of Patients with Low Grade Non-Hodgkin Lymphoma7897962435610.21608/ejhm.2019.24356ENAhmed Yosry El-AgamawiDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine,
Al-Azhar University, Cairo, EgyptMohammed El-Sayed Abd-El-FattahMansyDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine,
Al-Azhar University, Cairo, EgyptMohamed Omar AhmedDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine,
Al-Azhar University, Cairo, EgyptJournal Article20190114<strong>Background: </strong>as the histopathologic diagnosis of Non-Hodgkin Lymphoma (NHL) has become more sophisticated with the use of immunologic and genetic techniques, the understanding and treatment of many of the previously described pathologic subtypes have changed. <strong>Aim of the Work: </strong>was to <strong>r</strong>eview the clinicopathologic characteristics of the NHL patients, to assess the treatment response to the different treatment modalities available at our center and to analyze the correlation between patient’s characteristics, treatment modality and the achieved response.
<strong>Patients and Methods: </strong>the current work was a retrospective study reviewing the data of patients with pathologically confirmed diagnosis of low-grade NHL referred to Al Hussein university Hospital, Department of Clinical Oncology, Faculty of Medicine, Al-Azhar University during the period between January 2012 till December 2016.
<strong>Results: </strong>more than half the study group (57.2%) had the age between 41 and 60 years. Only 14.2% of the study group was younger than 40 years and 28.6% were older than 60 years. There was no difference between patients with CLL and patients with Low grade NHL as regards the age distribution. NHL in this study was equal among both males and females in both above 40 and below 40 age groups, unlike what was mentioned before which stated that NHL is more common in males than in females.
<strong>Conclusion: </strong>only 31 patients were evaluable for survival analysis with median follow up period of 15 months. Median disease-free survival (DFS) was 12 months (95% CI 0-72.9).Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101The Incidence and Predictors of Renal artery Stenosis in Patients Referred for Coronary Angiography7978012435710.21608/ejhm.2019.24357ENMohamed Osama Fathy KayedDepartment of Cardiology, Faculty of Medicine. Al-Azhar UniversityHaytham Mahmoud HassanDepartment of Community and occupational medicine, Faculty of Medicine. Al-Azhar UniversityMostafa Elsayed Abd ElGhanyDepartment of Cardiology, Faculty of Medicine. Al-Azhar UniversityAdham Mohamed Abd ElkaderDepartment of Cardiology, Matrouh Specialized Cardiothoracic and Interventional Catheterization Center, EgyptJournal Article20190114<strong>Background:</strong> Renal artery stenosis (RAS) and coronary artery disease (CAD) are two manifestations of a same pathogenesis which is atherosclerosis.. RAS is a leading factor of secondary hypertension, ischemic nephropathy and end stage renal disease (ESRD). <strong>Aim of work:</strong> This study was aimed to detect the incidence and predictors of renal artery stenosis in patients referred for elective coronary angiography. <strong>Patients and Methods:</strong> In this study we included 100 patients who underwent coronary and renal angiography.The mean age was 56.6 + 7.9 years, 60 males (60%), 40 females (40%), 60 diabetic (60%), 58 hypertensive (58%), 41 smokers (41%), 62 dyslipidemic (62%), 27 patients with family history of ischemic heart disease (27%), and patient with normal coronaries 12 (12 %). Our study consisted of 2 groups; 87 (87%) patients with normal renal arteries (group 1) and 13 (13%) patients with renal artery stenosis (group 2). <strong>Results: </strong>The incidence of RAS was 13% and the incidence of significant RAS (<span style="text-decoration: underline;">></span>50% stenosis) was 7%. The significant difference between the two groups was in the terms of hypertension (p-value 0.014), female gender (p-value 0.021), multivessel (<span style="text-decoration: underline;">></span> 2 vessels) coronary artery disease (p-value 0.046), normal coronaries had a significant negative association with RAS (p-value 0.027) and there was a significant relationship between atherosclerotic involvement of Left anterior descending artery (LAD), Diagonal, and right coronary artery (RCA) with RAS (p-value 0.037, 0.041 and 0.042). <strong>Conclusion: </strong>It could be concluded that predictors of RAS were hypertension, multivessel coronary artery disease (<span style="text-decoration: underline;">></span> 2 vessels) and female gender. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Awareness of heat-related illnesses in population of Saudi Arabia8028082435810.21608/ejhm.2019.24358ENMohammad AljumaanEmergency Department, Imam Abdulrahman Bin Faisal University, Eastern Provence, Saudi ArabiaFaisal AlhawajEmergency Department, Imam Abdulrahman Bin Faisal University, Eastern Provence, Saudi ArabiaSaleh AlkhalifaEmergency Department, Imam Abdulrahman Bin Faisal University, Eastern Provence, Saudi ArabiaNajebah AlhussainEmergency Department, Imam Abdulrahman Bin Faisal University, Eastern Provence, Saudi ArabiaAli AlhashimEmergency Department, Imam Abdulrahman Bin Faisal University, Eastern Provence, Saudi ArabiaLayan AlahmadiEmergency Department, Imam Abdulrahman Bin Faisal University, Eastern Provence, Saudi ArabiaFatimah AlkhunaiziEmergency Department, Imam Abdulrahman Bin Faisal University, Eastern Provence, Saudi ArabiaSaleh AljarudiEmergency Department, Imam Abdulrahman Bin Faisal University, Eastern Provence, Saudi ArabiaJournal Article20190114<strong>Background</strong>: heat stroke is a preventable severe condition of heat-related illnesses; it is an emergency condition affecting millions of people around the world. Heat related illnesses ranged from mild heat exhaustion to life-threatening heat stroke. Early detection and treatment of heat-related illnesses crucial to avoid mortality and morbidity. The aim of this study was to evaluate awareness of heat illnesses, its symptoms, treatment and prevention among the population of Saudi Arabia. <br /> <strong>Methodology<em>: </em></strong>a cross-sectional study carried out an online survey, Saudi Arabia, between, 1 November 2017 and 23 June 2018. Data were collected by using a valid multiple-choice question (MCQ). Survey questions included the possible thought causes and risk factors of both heat stroke and heat exhaustion.<br /> <strong>Result<em>: </em></strong>a total of 865 participants, the majority were Saudi citizens (806). Age and gender were almost equal. 281 were involved in the medical fields. <strong>Conclusion<em>:</em></strong> this study assessed the awareness of heat stroke and heat exhaustion among the health staff and medical students in different aspect of heat-related illness (Mainly heat stroke and heat exhaustion) and compared it to the level of awareness of general population in some aspect of heat-related illnesses. Almost, two third of medical personnel differentiate heat stroke definition when it was listed among other heat-related illnesses.in the other hand, knowledge of heat exhaustion definition was markedly lower among both health staff and non-health staff.44.6% of the participants chose all cooling methods as appropriate treatment of heat stroke. 71.1% knows that heat stroke had more devastating outcomes if not managed properly and rapidly than heat exhaustion.34% of the medical personnel thought avoiding hot spots was the best way to prevent heat-related illnesses; a similar number of the non-medical (31%) also thought the same. Awareness of heat-related illnesses and differentiation between them in relation to the definition, sign, symptoms, diagnosis, and treatment is not satisfactory.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Comparative Study between Submucosal Diathermy and Endoscopic Partial Turbinectomy in Hypertrophied Inferior Turbinate8098192435910.21608/ejhm.2019.24359ENWael Hassan AboulwafaOtolaryngology dept., Faculty of Medicine, AL-Azhar UniversityAbd Elaziz Kamal SaadOtolaryngology dept., Faculty of Medicine, AL-Azhar UniversityAyman Yehia AbbasOtolaryngology dept., Faculty of Medicine, AL-Azhar UniversityMohammed Abed ElewaOtolaryngology dept., Faculty of Medicine, AL-Azhar UniversityTarek Abd Elkarem EldahshanClinical Pathology dept., Faculty of Medicine, AL-Azhar UniversityJournal Article20190114<strong><em>Background:</em></strong>Chronic nasal obstruction is a common subjective complaint seen by otolaryngologists; turbinate hypertrophy is one of its causes. There are various treatment options for enlarged turbinates, the method of treatment depends on the size of the enlarged turbinates.
<strong><em>Objective:</em></strong>To evaluate the effectiveness of submucosal diathermy of inferior turbinate versus endoscopic partial turbinectomy in patients with inferior turbinate hypertrophy.
<strong><em>Patients and methods:</em></strong>A total of sixty patients of different age groups and both sexes were involved in the study. Patients were divided in two groups; group (I), which included 30 patients, had submucosal diathermy of both inferior turbinates and group (II); which included 30 patients had surgical endoscopic partial turbinectomy of both inferior turbinates. Patients were followed up for 6 months postoperatively and nasal obstruction was analyzed according to (NOSE) scale.
<strong><em>Results: </em></strong>there were no significant differences between both groups in nasal score mean at pre-operative, 1 week and 1 month (post-operative), however, group (II) had significantly (p<0.01) lower nasal score mean at 6 months compared to group (I),. In addition, there were a significant post-operative improvement in nasal obstruction in both used techniques at 1 week and 1 month. However, this significant improvement continued to 6 months in group II While, a type of recurrence was happened in group I at 6 months.
<strong><em>Conclusion: </em></strong>both of the used surgical techniques were found to be effective in reducing nasal obstruction but endoscopic partial turbinectomy was more effective in reducing nasal obstruction for longer duration. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101The outcome of Antegrade Cerebral Perfusion during Deep Hypothermic Circulatory Arrest in Pediatric Arch Surgery8208262436010.21608/ejhm.2019.24360ENHyam Refaat TantawiPediatric department , Ain Shams University, Faculty of Medicine –Cairo UniversityMohamed Abdel HafezCardiothoracic department, Faculty of Medicine –Cairo UniversityJournal Article20190114<strong>Background: </strong>Techniques for the surgical correction of aortic aneurysms have steadily improved since the first described successful repair, Despite these improvements, postoperative neurological complications remain a major factor in determining an adverse outcome.Complex aortic arch reconstruction in neonates and children is performed typically under deep hypothermic circulatory arrest. <strong>Aim</strong>: The study aimed at examining the effect of clinical impact, particularly neurologic complications, of deep hypothermic circulatory arrest in pediatric arch surgery and to summarize the early outcomes. <strong>Patients and method:</strong> One-handed and fourteen underwent full-term babies were enrolled in the present study .The maximum age was 20 weeks, arch surgery included Norwood, arch reconstruction for hypoplastic arch and interrupted aortic arch. Healthy neurological status preoperative was included between January 2011 and October 2015. The medical records were reviewed for preoperative diagnosis of patients which included age at the time of operation, sex and diagnosis of the patients. Operative details including type of the operation, duration of cross-clamp and deep hypothermic circulatory arrest timing were documented. The deep hypothermic circulatory arrest was conducted at 20 ℃. Postoperative outcomes, neurological complications including seizers, cerebral infarct, and duration of hospital stay were recorded. <strong>Results:</strong> The study noted that the incidence of postoperative complications such as seizure & bleeding was markedly 5.3%& 1.8% of the studied pediatric patients. <strong>Conclusion:</strong> The results concluded that the aortic arch reconstruction with Antegrade cerebral perfusion during the deep hypothermic circulatory arrest was accompanied by a lower risk of neurological complications. <strong>Recommendations: </strong>Long-term neurodevelopmental follow-up of these children is required to evaluate the late outcomes of Antegrade cerebral perfusion.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Health Needs of Patients with Cholelithiasis Undergoing Laparoscopic Cholecystectomy8278412526210.21608/ejhm.2019.25262ENSanaa Mohamed Alaa EldinMedical -Surgical Nursing Department, Faculty of Nursing, Alexandria University.Amna Yehia SaadMedical -Surgical Nursing Department, Faculty of Nursing, Alexandria University.Samira Saad Ali Abo El BakaMedical -Surgical Nursing Department, Faculty of Nursing, Alexandria University.Journal Article20190118<strong>Background: </strong>Laparoscopic cholecystectomy is standard procedure for management of gallbladder stone. Gallstones (cholelithiasis) are the most common cause of biliary tract disease in adults. The educative role of nurse is integral part of the care that is essential to patient satisfaction and positive outcomes.
<strong>Objective:</strong>Identify health needs of patients with cholelithiasis who were undergoing laparoscopic cholecystectomy<strong>.</strong>
<strong>Patients and Methods</strong><strong>:</strong><strong> </strong>A convenient sample of 100 adult patients with cholelithiasis who were undergoing laparoscopic cholecystectomy. Health needs of patients with cholelithiasis who were undergoing laparoscopic cholecystectomy included structured interview schedule was used to collect the data for the present study. It included two parts about socio-demographic and clinical data, knowledge related to nature of the disease, pre- operative preparation, post-operative care and self- care following discharge.
<strong>Results:</strong>the present study revealed that the majority of the studied patients had poor level of knowledge. There was statistically significant positive correlation between patients' level of knowledge and age, educational level, nurses as a source of knowledge and advices as well as physician and the nurse as a preferred source of knowledge.
<strong>Conclusion:</strong>It was concluded that the studied patients had poor level of knowledge regarding disease nature, pre-operative care, post-operative care and complications and self-care following discharge.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Transcranial Ultrasound in Comparison to MRI in Evaluation of Hypoxic Ischemic Injury in Neonates8428522526310.21608/ejhm.2019.25263ENAbd El-Aziz Kamal AunDepartment of Radiodiagnosis, Al-Azhar UniversityHassan Ali HassanDepartment of Radiodiagnosis, Al-Azhar UniversityWafik Ibrahim AliDepartment of Radiodiagnosis, Al-Azhar UniversityMaged Mohamed Ali AtakyDepartment of Radiodiagnosis, Al-Azhar UniversityJournal Article20190118<strong>Background:</strong> Hypoxic-ischemic injury is the most common cause of encephalopathy in newborns.
<strong>Objectives:</strong> The goal of our study was to demonstrate the role of transcranial ultrasound (TCUS) compared to MRI in assessment of neonatal encephalopathy.
<strong>Patients and methods:</strong> Consecutive thirty sex neonates with hypoxic-ischemic encephalopathy (HIE) were included. All cases had undergone MR imaging as well as transcranial ultrasound study of the brain. The study was conducted between May 2015 and September 2017. They were collected from the Neonatology Intensive Care Unit at Elsayed Galal and El-Demerdash University Hospitals.
<strong>Results:</strong> Our study found that stages I and II showed mild to moderate HIE presented with peripheral pattern and white matter injuries while stage III revealed severe HIE presented with central pattern of injury (BGT). In addition, our study reported that all patients with stage III of HIE showed severe central pattern on MRI.
<strong>Conclusion: </strong>MRI imaging is considered a sensitive technique in detecting different MR patterns of encephalopathy in newborns. MRI placed other imaging modalities in diagnostic assessment and early predictor of future development of neurological abnormalities in neonates with encephalopathy.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Conservative Treatment versus Elective Repair of Umbilical Hernia in Patients with Liver Cirrhosis and Ascites8538572526410.21608/ejhm.2019.25264ENAshraf Abdel El-hamid Abd El-monemDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityMohammed AbbasDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityMahmoud Ramadan Abdelaziz El-halawanyDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20190118<strong>Background: </strong>management of umbilical hernia in patients with liver cirrhosis remains controversial. The general surgical opinion is that umbilical hernia in patients with liver cirrhosis and ascites has high operative risks and high recurrence rates after elective repair. Conservative treatment, however, can also have severe complications resulting in emergency repair. In these patients such operations carry an even greater risk of complications than compared to elective operations.
<strong>Objective: </strong>Aiming at comparing between conservative treatment and elective repair of umbilical hernia in patients with liver cirrhosis and ascites.
<strong>Patients and Methods: </strong>a randomized prospective interventional study Our series was carried out on 40 consecutive patients at General Surgery department, Al-Azhar University hospital; Bab Elshaeria, Cairo, Egypt in the period from June 2017 till September 2018. The patients were divided into 20 patients (group A) undergo surgical repair and 20 patients (group B) undergo conservative treatment. Mean follow up was 6 months.
<strong>Results: </strong>elective repair of umbilical hernia in patients with liver cirrhosis and ascites had fewer complications than conservative treatment.
<strong>Conclusion: </strong>Our study showed that elective repair of umbilical hernia in cirrhotic and ascetic patients had less complication than conservative treatment.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Comparative study between fixed and flexible GnRH antagonist protocol versus GnRH agonist long protocol in polycystic ovarian disease patients treated with IVF8588662526510.21608/ejhm.2019.25265ENHany Maged Abd-ElaalObstetrics and Gynecology department, Faculty of Medicine, Al-Azhar UniversityFarid Ahmed KassabObstetrics and Gynecology department, Faculty of Medicine, Al-Azhar UniversityOsama DeifObstetrics and Gynecology department, Faculty of Medicine, Al-Azhar UniversityIsmael Abd-Elazeem MiraObstetrics and Gynecology department, Faculty of Medicine, Al-Azhar UniversityMohamed Mohamed Mohamed EssawyObstetrics and Gynecology Department, Beni-Suef General Hospital, Ministry of Health, Egypt.Journal Article20190118The objective of the present study was to compare and evaluate the effectiveness and safety of GnRH agonist long protocol compared with the GnRH antagonist (fixed and flexible) protocols in polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) cycles. This study was carried out on 60 patients with polycystic ovarian disease undergoing ICSI, their age ranged from (20 to 40 years). The cases were selected from The International Center for Population Study and Research (ICPS), Al-Azhar University. Eligible patients who accepted to take part in the study were randomized into 3 study group: Group A: 20 patients were included in agonist protocol, Group B: 20 patients were included in fixed antagonist protocol and Group C: 20 patients were included in flexible antagonist protocol. The results obtained from this study indicated no statistically significant differences regarding the pregnancy rates or regarding the developing of ovarian hyperstimulation syndrome (OHSS) complication in the studied population; so larger studies with larger sample size and longer duration are needed to clarify the roles of different IVF protocols.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Comparative Study between Single-Level Anterior Cervical Discectomy and Fusion using Cage and Plate or Cage Alone8678722526610.21608/ejhm.2019.25266ENYoussef BarakatDepartments of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityAlaa RashadDepartments of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityMokhtar RagabDepartments of Radiology, Faculty of Medicine, Al-Azhar UniversityMohamed Ibrahim Abd ElrahmanDepartments of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20190118<strong>Background: </strong>anterior cervical discectomy and interbody fusion (ACDF) is a well-accepted management option for the treatment of persistent cervical radiculopathy or myelopathy due to cervical disc prolapse. Typically a fusion is performed to stabilize the segment, maintain foraminal height.
<strong>Objective: </strong>to prospectively analyze the effect of one-level ACDF, comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes.
<strong>Patients and Methods: </strong>a total of 20 patients who underwent one-level for cervical disc disease and who completed 6 months of follow-up were included in this study. The patients were grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs: subsidence, adjacent disc space narrowing, clinical outcomes were assessed using the Odom's criteria.
<strong>Results: </strong>in the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, at the 3-and 6-months follow-up: Regarding the functional outcome in the plate group 6 (60%) patients had excellent outcome, 2 (20%) patients had good outcome, 1 (10%) had satisfactory and 1 (10%) had poor outcome, while in the cage group 7 (70%) patients had excellent outcome, 110%) had good outcome, 1 (10%) had satisfactory and 1 (10%) had poor outcome.
<strong>Conclusion: </strong>our results showed that for single-level cases, plate fixation had no additional benefit versus cage-only, although the cage-with-plate fixation group had a lower incidence of cage sinking than did the cage-only group. We conclude that physicians should be aware of these possible advantages and disadvantages associated with using cervical plates in one-level ACDF.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101The possible protective effect of vitamin E on adult albino rat’s testes exposed to electromagnetic field emitted from a conventional cellular phone8738842526710.21608/ejhm.2019.25267ENMahmoud Ibrahim EL-NaggarAnatomy and Embryology department, Faculty of Medicine, Al- Azhar UniversityAlaa EL-Din Sayed EL-SagheerAnatomy and Embryology department, Faculty of Medicine, Al- Azhar UniversityAshraf El- Sayed EbaidAnatomy and Embryology department, Faculty of Medicine, Al- Azhar UniversityJournal Article20190118<strong>Aim of the work</strong>: i to discuss the possible protective effect of vitamin E as a model of powerful antioxidant on the testes of adult albino rates exposed for electromagnetic field (EMF) emitted from cellular phone. This study also detected and described signs of morphological and behavior changes that can appear on the rats. <strong>Materials and Methods: </strong>The present study was carried out on 120 healthy adult albino rats. The rats were divided into 3 main groups. Group I (control group): consisted of 40 rats. These rats were kept in the animal house away from any source of EMF. Group II (radiation group): consisted of 40 rats that were exposed to EMF emitted from mobile phone for 60 days. Group III (radiation and vitamin group): consisted of 40 rats, those were exposed to EMF emitted from mobile phone for 60 days and simultaneously they received vitamin E, orally. <strong>Results: </strong>Electromagnetic field exposed rats showed testicular alterations, which were ameliorated by using vitamin E. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Assessment of Impact of Insight on Medication Adherence in Schizophrenic Patients8858892526810.21608/ejhm.2019.25268ENAbd Elhady E. HassanDepartments of Psychiatry and Neurology – Faculty of Medicine – Al-Azhar University.Ali Abd E. ElnabawyDepartments of Psychiatry and Neurology – Faculty of Medicine – Al-Azhar University.Mohamed M. A. EldeebDepartments of Psychiatry and Neurology – Faculty of Medicine – Al-Azhar University.Ahmed S. M. EssaDepartments of Psychiatry and Neurology – Faculty of Medicine – Al-Azhar University.Journal Article20190118<strong>BACKGROUND:</strong>Many patients with schizophrenia have impaired insight and low medication adherence. Poor adherence is one of the leading problems affecting the effectiveness of treatment in schizophrenia. It is an identified factor for relapse and hospitalizations with major social and economic consequences.
<strong>OBJECTIVE:</strong>The aim of this study was to study the relation between insight and medication adherence and other factors that may affect both of them.
<strong>SUBJECT AND METHODS:</strong>A total number of 50 schizophrenic outpatients “DSM 5” aged > 18 years old who were attending the hospital for regular follow up were included in this study. From the selected patients full medical history was obtained including: name, age, gender, occupation, educational status, history of the psychiatric disease, duration, medical treatment and times of hospitalization. Cultural and social standard and degree of family support was also collected. Patients’ insight was measured by the Schedule for Assessment of Insight-Expanded Version (<strong>SAI–E</strong>) translated into Arabic by Marwa Abdelgawad. The degree of medication adherence was measured by using Medication Adherence Rating Scale (<strong>MARS</strong>).
<strong>RESULTS:</strong>There was no significant correlation between patients’ insight and patients’ ages, duration of illness and hospitalization times with p-value: 0.69, 0.61 and 0.07 respectively. In addition, there was no significant association between medication adherence and age, duration of illness, number of hospitalization, gender, social level and family support with p-value: 0.575, 0.678, 0.566, 0.945, 0.091 and 0.360 respectively. Our results showed a strong positive correlation between insight and medication adherence with p-value: < 0.0001.
<strong>CONCLUSION:</strong> Insight and adherence were found to be closely related, low insight was associated with poor adherence in patients with schizophrenia. Moreover, these results should be used to establish a strategy for improving the prognosis of chronic schizophrenia.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Reproductive outcomes following Hysteroscopic Removal of endometrial polyps of different location, number, and size in patients with infertility8908982526910.21608/ejhm.2019.25269ENIsmaeel Mohammed Adb EL AzimMiraDepartment of Obstetrics and Gynecology, Faculty of Medicine - Al-Azhar UniversityAbdelmonsef Abdelhamed SedekDepartment of Obstetrics and Gynecology, Faculty of Medicine - Al-Azhar UniversityHazem Shaban EldesokyDepartment of Obstetrics and Gynecology, Faculty of Medicine - Al-Azhar UniversityJournal Article20190118<strong>Bɑсkgrouոd: </strong>Һystеrosсopiс rеsесtioո is ɑ rеlɑtivеly sɑfе ɑոd simplе proсеdurе wһiсһ еffесtivеly rеmovеs polyps; һowеvеr, еոdomеtriɑl polyps сɑո rесur. Studiеs һɑvе suggеstеd rесurrеոсе rɑtеs of up to 46%, ɑոd tһеrеforе it is importɑոt to idеոtify risk fɑсtors ɑssoсiɑtеd witһ rесurrеոсе.
<strong>Objесtivе: </strong>To ɑssеss tһе prеgոɑոсy rɑtе ɑftеr һystеrosсopiс polypесtomy iո iոfеrtility pɑtiеոts witһ еոdomеtriɑl polyps to сompɑrе prеgոɑոсy rɑtе ɑmoոg subgroups witһ polyps of diffеrеոt loсɑtioոs, ոumbеr ɑոd sizе.
<strong>Pɑtiеոts ɑոd Mеtһods: </strong>These Prospесtivе Сoһort Study oո 60 сɑsеs were сoոduсtеd ɑt tһе dеpɑrtmеոt of obstеtriсs & gyոесology Sɑyеd Gɑlɑl Uոivеrɑity һospitɑl bеtwееո Mɑy 2017 ɑոd ɑpril 2018. Pɑtiеոts witһ uոеxplɑiոеd iոfеrtility. two groups.
<strong>Rеsults: </strong>Iո our study wе сompɑrе tһе prеgոɑոсy rɑtе ɑссordiոg to polyp сһɑrɑсtеristiсs suсһ ɑs loсɑtioո, sizе ɑոd ոumbеr. ɑlso wе study tһе rеproduсtivе outсomе of һystеrosсopy iո two groups: 1st group witһout iոtrɑutеriոе lеsioո. 2 - 2ոd group witһ еոdomеtriɑl polyps. ɑոd wе fouոd tһɑt: tһеrе is ոo stɑtistiсɑlly dеfеrеոсе bеtwееո tһе two groups tһе p-vɑluе is 0.40654. Wе fouոd ɑ ոoո sigոifiсɑոt positivе сorrеlɑtioոs bеtwееո Prеgոɑոсy outсomе ɑոd ոumbеr of polyps witһ p-vɑluе 0.71, ɑ ոoո sigոifiсɑոt positivе сorrеlɑtioոs bеtwееո Prеgոɑոсy outсomе ɑոd sizе of polyps witһ p-vɑluе 0.456 ɑոd ɑ ոoո sigոifiсɑոt ոеgɑtivе сorrеlɑtioոs bеtwееո Prеgոɑոсy outсomе ɑոd sitе of polyps.
<strong>Conclusion: Wе</strong> fouոd tһɑt tһеrе is ոo stɑtisticɑlly dеfеrеոcе bеtwееո tһе two groups. Wе fouոd ɑ ոoո sigոificɑոt positivе corrеlɑtioոs bеtwееո Prеgոɑոcy outcomе ɑոd ոumbеr of polyps, , sizе of polyps ɑոd ,sitе of polypsPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Does Dopamine Agonist Hormonal Therapy for Macro-Prolactinoma Affect Future Surgery?8999042555610.21608/ejhm.2019.25556ENMohamed Raafat KandeelDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMagdy A. ElhawaryDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptOsama ElghannamDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190122<strong>Background: </strong>Controversy regarding first line therapy for macro-prolactinoma patients had been of debate for many decades. Several reports suggested that dopaminergic agents (DAs) medications are accused for prolactinoma fibrosis. Whether fibrosis has positive or negative influence on the management of prolactinomas is still unclear.
<strong>Aim of the work: </strong>was <strong>to</strong> compare the intraoperative tumor consistency, intraoperative difficulties and complications both pre- and post-operative between macro-prolactinoma patients who received DA medications and who did not receive prior to surgery.
<strong>Patients and Methods: </strong>Twenty-five macro-prolactinoma patients who underwent primary pituitary surgery, sub-labial trans-sphenoidal microscopic removal, of macro-prolactinoma grouped into two groups. Group 1 included patients who were treated by DA medication, combined therapy with Bromocreptine and Cabergoline, prior to surgery for at least 3 months. Group 2 included patients who didn’t receive any preoperative DA medications. We compared the intra-operative texture of the tumor, intraoperative and post-operative complications together with the extent of surgical excision and hormonal remission achieved.
<strong>Results: </strong>No significant statistical difference as regards intra-operative tumor consistency in relation to preoperative hormonal treatment. The rate of intra-operative and post-operative complications has no relation to the pre-operative hormonal therapy by DAs nor to the intraoperative tumor consistency. The only factor that affect the extent of surgical excision is the pre-operative tumor size graded by KNOSP classification and this extent of surgical excision has direct implication on the post-operative hormonal remission rate.
<strong>Conclusion: </strong>It could be concluded that there is no risk of more tumor fibrosis nor increase in the complication rate due to DA medication prior to surgery. So, using dopamine agonist as the primary treatment for prolactinoma while Surgical excision is deferred for cases of failure or intolerance of side effects of the the hormonal therapy.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Comparative study of total dose infusion of iron and intramuscular iron administration in treatment of severe iron deficiency anemia during pregnancy9059132555810.21608/ejhm.2019.25558ENFahd Abd El Aal Al OmdaDepartment of Obstetrics and Gynecology, Faculty of Medicine- Al-Azhar UniversityAbd El Raaof Abd El Raaof Abo NarDepartment of Clinical Pathology, Faculty of Medicine- Al-Azhar UniversityWaleed El Sayed Al NaggarDepartment of Obstetrics and Gynecology, Faculty of Medicine- Al-Azhar UniversityMohamed Abdullah Al Sayed Al-MorsiDepartment of Obstetrics and Gynecology, Faculty of Medicine- Al-Azhar UniversityJournal Article20190122<strong>Background: </strong>Iron deficiency anemia is the most common type of anemia among pregnant women, especially in developing countries. Indeed, a majority of women in the reproductive age group in the developing countries are anemic even before conception; pregnancy only tends to intensify it further.
<strong>Objective: </strong>to compare the effectiveness and safety of intramuscular and intravenous iron therapy in pregnant women with severe iron deficiency anemia.
<strong>Patients and Methods: </strong>This study is an interventional randomized study, comparing the effect of intravenous and intramuscular iron therapy on pregnant women with severe anemia. Allocation of patients in either group (I.V & I.M) was sealed and enveloped. The study was conducted at the Department of Obstetrics and Gynecology of General Helwan Hospital.
<strong>Results: </strong>The results of our study proved that the intravenous iron, showed high effectiveness in the treatment of iron deficiency anemia during pregnancy. Nearly no side effects were detected and thus, it can be considered as a useful and alternative formulation for the treatment of iron deficiency.
<strong>Conclusion: </strong>The present study proved that the severity of iron deficiency anemia affects the maternal outcome by increasing the risk of postpartum hemorrhage and also affects the fetal outcome by increasing the risk of preterm delivery and low birth weight.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Diabetic macular edema: posterior subtenons versus intravitreal injection of steroids9149232556010.21608/ejhm.2019.25560ENAshraf Mohammed Gad ElkareemOphthalmology department, Faculty of medicine, Al-Azhar University, Asyut Branch, Egypt.Journal Article20190122Background: Diabetic retinopathy (DR) with diabetic macular edema (DME) is one of the most common complications of diabetes and can lead to visual loss in young individuals. Purpose: to evaluate the efficacy of posterior subtenon versus intravitreal triamcinolone injection for treatment of diffuse diabetic macular edema. Patients and methods: seventy six eyes of 64 patients having diffuse diabetic macular edema were included and divided into two groups; Intravitreal triamcinolon acetonide group (IVTA group) included 40 eyes of 30 diabetic individuals, injected with 4 mg (0.1ml) IVTA. Posterior subtenon triamcinolon acetonide group (STTA group) consists of 36 eyes of 34 diabetic persons injected with 40 mg (1ml) in the posterior subtenon space. The central subfield macular thickness (CMT) measured with optical coherence tomography (OCT) before injection, 3 and 6 months post-injection was evaluated. Visual acuity as Log MAR, intraocular pressure (IOP) and any complications associated with both techniques ware assessed. Results: the baseline log MAR VA was significantly improved in both groups at one, three, and six months post-injection .The IVTA and STTA groups had significant reduction in CMT three and six months after steroid injection. The mean IOP was 16.6±1.3 mmHg and 15.4±1.1mmHg at the end of follow up in IVTA and STTA groups respectively. Conclusion: both intavitreal and subtenons routes of steroid injection are good alternatives for the treatment of diabetic macular edema, but the intravitreal route has a more pronounced effect while the subtenons route is safer.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Orthotopic ileal and sigmoid neobladder after radical cystectomy: functional results: A prospective study and retrospective study9249332556110.21608/ejhm.2019.25561ENSaied A.A. MostafaDepartments of Urology, Faculty of Medicine, Al-Azhar University, EgyptIsmail M. KhalafDepartments of Urology, Faculty of Medicine, Al-Azhar University, EgyptAli M.H. FaragDepartments of Urology, Faculty of Medicine, Al-Azhar University, EgyptHassan A. Abdel-BakyDepartments of Urology, Faculty of Medicine, Al-Azhar University, EgyptMostafa M.M. ShakweerDepartments of Radiology, Faculty of Medicine, Al-Azhar University, EgyptTarek M. OmranDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20190122<strong>Background: </strong>bladder cancer is common among genitourinary tract. Radical cystectomy with urinary diversion is the widely accepted treatment. However, no consensus exists regarding the best orthotopic neobladder creation intestinal segment.
<strong>Aim of the work: </strong>to evaluate functional and oncological outcome of ileal and sigmoid orthotopic urinary diversion.
<strong>Patients and methods:</strong> The study included two groups of 40 patients in each group (ileal and sigmoid groups). Each group was further divided in two twenty subgroups; prospective and retrospective. Ileal group operated in Urology and Nephrology centre (UNC) and Al-Azhar University hospital (Damietta), while patients in sigmoid group were operated in Al-Azhar University hospital (Cairo). All underwent full history taking, clinical examination, and laboratory investigations. Then, postoperatively, all were followed up for 6 months. In each postoperative follow up visit, patients were assessed clinical, radiological, urodynamic study and by laboratory investigations and patients’ quality of life were evaluated.
<strong>Results:</strong> In ileal orthotopic diversion, early postoperative complications were bleeding (2.5%), urine leakage (2.5%) and wound infection (25%). Diurnal continence was achieved in 90%, while nocturnal continence was achieved in 70%. The early postoperative complications were urine leakage (2.5%), obstruction (2.5%), and ileus (12.5%). The late complications were DVT (2.5%) and intestinal obstruction (5.0%). In addition, 2.5% were died from disease. Tumor recurrence was pelvic in 7.5%, distant (hepatic) in 2.5%. Only 25% of patients were potent and urine culture revealed E-coli in 40.0%. In the sigmoid orthotopic diversion group, the early postoperative complications were urine leakage (17.5%), obstruction (2.5%), ileus (7.5%), bleeding (2.5%), DVT (2.5%) and faecal leak (2.5%). Late complications were pouch stones (10.0%), stricture urethra (12.5%), ureterocolic stricture (7.5%), pouch stones plus stricture urethra in 5.0%, DVT (2.5%), intestinal obstruction (10.0%) and hematemesis in 2.5%. In addition, 12.5% were died. Tumor recurrence was pelvic in 25.0%. Only 7.5% of patients were potent and urine culture revealed E-coli in 35.0%. Diurnal continence was reported in 92.5%, while nocturnal continence was reported in 60%.
<strong>Conclusion: </strong>both sigmoid and ileal orthotopic neobladder provided a satisfactory outcome. Sigmoid neobladder was associated with lower rate of complications and better functional outcome. However, there were many late-term complications detected in this group. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Gestational Trophoblastic Neoplasia9349412556210.21608/ejhm.2019.25562ENMahmoud Ibrahim M. ShahinClinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Al-Azhar UniversityWael Helmy El SheshtawyClinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Al-Azhar UniversityMohsen Salah El-Din ZikriClinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20190122<strong>Background: </strong>gestational trophoblastic neoplasia forms a wide variety of rare conditions arising from abnormal proliferation of the trophoblastic cells in the placental microvilli. They consist of vesicular mole “partial and complete”, invasive mole, placental site trophoblastic tumor (PSTT), epithelioid trophoblastic tumor (ETT) and choriocarcinoma. They can be classified into premalignant forms which include vesicular mole and malignant forms which include the rest. <strong>Aim of the Work: </strong>this study aimed tostudy the epidemiological and clinical data, as well as treatment regimes and their outcome included response and related toxicity among patients with gestational trophoblastic neoplasia treated in this study.<strong>Patients and Methods: </strong>in this retrospective study, medical records of all patients with GTN presented to Oncology Department, Al-Hussein University Hospital in the period from January 2007 to June 2017 was retrieved from the archives and medical data was reviewed and analyzed. <strong>Results: </strong>median age of patient was 37.5 (Range 20-55), molar pregnancy was the most common pathological type (40%), followed by invasive mole (31.4%), while choriocarcinoma was diagnosed in 25.7% and only 2.9% of patients had placental site trophoblastic disease. According to FIGO score; 26 patients (74.3%) showed low risk and 9 patients (25.7%) showed high risk. In low risk patients, 30.8% of patients were kept under follow up while, (69.2%) received chemotherapy, 61.1% of them achieved complete remission on methotrexate as first line chemotherapy, while the rest 38.9% achieved complete response on EMA-CO or dactinomycin as 2<sup>nd</sup> line chemotherapy<strong>. </strong>Methotrexate wasn’t effective in high risk patients, while EMA-CO had much better response achieving (66.7%) complete response rate, with 2 cases of early death in those patients. <strong>Conclusion: </strong>this retrospective study represented a single center experience and had relatively small number of cases. A large multicenter prospective trial is recommended.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101Immunohistochemical expression of ERG and P63 in some prostatic lesions9429482556310.21608/ejhm.2019.25563ENAl-Sayed Mohamed IbrahimDepartment of Pathology, Faculty of Medicine, Al-Azhar UniversityHussein Abdel-Moneim HasanDepartment of Pathology, Faculty of Medicine, Al-Azhar UniversityAl-Moatazbellah Mahmoud El-SayedDepartment of Pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20190122<strong>Background</strong>: prostate cancer (PCa) ranks second among the most common types of solid tumors and the sixth among the leading causes of cancer deaths in men worldwide. In Egypt, prostatic cancer formed the majority of male genital cancer (60.7%) at the NCI in the last 10 years<strong><em>. </em>Aim of the work</strong>: the present study aimed to detect the immunohistochemical expression of ERG and p63 (as abasal cell marker) in benign prostatic lesions and prostatic carcinoma and to investigate the potential use of ERG and p63 expression levels to discriminate prostatic carcinoma from other lesions and to investigate the association of immunohistochemical expression of ERG with the other prognostic parameters of prostatic carcinoma such as age, plasma PSA level and pathological Gleason score. <strong>Methods:</strong> fifty prostate lesions, which were collected from the surgical files of the Pathology Department of Al-Azhar University Hospital and from a private lab. Clinicopathological and histological features were taken from patients files and confirmed by H&E examination. Immunohistochemical study was done by using two markers ERG and P63. <strong>Results: </strong>expression of ERG was restricted to malignant tissue (Prostatic carcinoma) and was negative in BPH and PIN specimens (P. <em>< </em>0.001<em>) </em>ERG is highly specific but less sensitive marker (40 % of PCa were negative). Expression of ERG revealed inverted significant correlation with Gleason grade and plasma PSA level (P < 0.05<em>).</em> P63 is highly specific and sensitive marker for non-carcinomatous prostatic lesions. <strong>Conclusion:</strong> ERG showed strong nuclear endothelial expression in all lesions. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274420190101The Role of Nuclear Factor Kappa B Rs28362491 Single Nucleotide Gene Polymorphism in Recurrent Embryo Implantation Failure9499562556510.21608/ejhm.2019.25565ENKhalid Tahseen Ahmed GabrDepartment of Medical Biochemistry, International Islamic Center for Population Studies and Research, Faculty of Medicine, Al-Azhar UniversityAbd EL-Mohsen Mousa ShaheenDepartment of Medical Biochemistry, International Islamic Center for Population Studies and Research, Faculty of Medicine, Al-Azhar UniversityAshraf Taha Abd-ElmouttalebDepartment of Assisted Reproductive Unit, International Islamic Center for Population Studies and Research, Faculty of Medicine, Al-Azhar UniversityAdel Elsayed IbrahimDepartment of Assisted Reproductive Unit, International Islamic Center for Population Studies and Research, Faculty of Medicine, Al-Azhar UniversityJournal Article20190122<strong>Background:</strong> Embryo implantation is a very intricate process, which is controlled by a number of complex molecules like hormones, cytokines, growth factors and their cross talk at feto-maternal interface. The transcription factor nuclear factor kappa B<strong> (</strong>NF-κB) induces the expression of various pro-inflammatory genes, including those encoding cytokines and chemokines, and also participates in inflammasome regulation. <strong>Aim of the present study:</strong>was to investigate the possible associations between NF-κB rs28362491 single nucleotide gene polymorphism and susceptibility to repeated implantation failure (RIF). <strong>Subjects and Methods:</strong> This study was conducted on 120 subjects subdivided into 2 groups<strong>: </strong>60 women with successful implantation asacontrol group (Group I), and 60 womendiagnosed withRIF(Group II). They were subjected to full history taking, clinical examination and investigated for molecular testing of the NF-κB -94 ins/del ATTG (rs28362491) polymorphism by lymphocyte separation and extraction of DNA for polymerase chain reaction (PCR) together with determination of serum concentration of day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol II (E2), prolactin and thyroid stimulating hormone (TSH) concentrations by an automated quantitative enzyme-linked fluorescent immunoassay (ELFA). <strong>Results:</strong> A significant difference in the genotype distribution of the NF-κB rs28362491 between those with RIF and controls. Specifically, subjects with RIF had a significantly higher frequency of the NF-κB rs28362491 del allele than that of controls. <strong>Conclusion:</strong> This study showed a significant association between rs28362491 in the promoter region of the NF-κB gene and RIF. NF-κB appears to be a triggering factor of orchestrated gene regulation during embryo implantation.