@article { author = {Ebeid, Mai Ahmed and Aboul-Fotouh, Sawsan and Abdel-tawab, Ahmed Mohyeldin and El-Kharashi, Omnyah Aly and Abd Al-khalek, Hadwa Ali}, title = {Study of Behavioral Deficits Elicited by Exposure to Lipopolysacaride /Chronic Mild Stress in Male Wistar Rats}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5137-5143}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10732}, abstract = {Background: depression may be considered "the disease of the modern era". With a high prevalence worldwide causing significant morbidity and mortality and constituting a heavy burden on social and economic welfare. Despite decades-long research the exact pathogenesis of depression is still not fully understood. Aims: to investigate the behvioral deficits elicited by exposure to the combined model of lipopolysaccharide (LPS) then chronic mild stress (CMS) in male Wistar rats and to investigate the putative role of inflammatory cytokine production induced lipopolysaccharide exposure together with chronic stress in the pathogenesis of depressive like behaviour. Materials and Methods: Sixty five Male Wistar rats were divided into two groups; Control group (n=29): naïve rats left undisturbed, not exposed to stress and LPS/CMS exposed group (n=27). Results: exposure to LPS/CMS model induced a depressive-like behavior manifested by a decline in body weight gain, alongside an increase in immobility time in FST and a decrease in time of active interaction in SIT. Conclusion: this work highlights the depressive like behaviour induced by exposure to the combined model of lipopolysaccharide and chronic mild stress. This work also underscores the putative role of lipopolysaccharide exposure in modulating the stress-induced neuroinflammation which is thought to be crucial, not only for the pathogenesis of depression, but also for a wide array of neurological diseases. }, keywords = {depression,chronic mild stress,lipopolysaccharide,forced swimming test,open field test,social interaction test}, url = {https://ejhm.journals.ekb.eg/article_10732.html}, eprint = {https://ejhm.journals.ekb.eg/article_10732_c7dbf6a8ca14a9c09131d27eb0315aa0.pdf} } @article { author = {Mahfouz, Sayed A. and Khalil, Mahmoud M. and Elbahr, Mohammed A.}, title = {Adjunctive Intravitreal Bevacizumab with Vitrectomy for Diabetic Vitreous Hemorrhage}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5144-5152}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10733}, abstract = {Background: Postoperative vitreous hemorrhage (VH) following pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) is a common event, with a reported incidence of 29% to 75%.This complication delays visual rehabilitation, interferes with fundus examination, and may necessitate additional surgical procedures. Vascular endothelial growth factor (VEGF) is an angiogenic mitogen, and the involvement of VEGF in PDR has been suggested by studies that have demonstrated that VEGF concentrations were markedly elevated in both vitreous and aqueous fluids of patients with active PDR compared with samples from patients without diabetes, with NPDR, or with quiescent PDR. Bevacizumab (Avastin®, Genentech, Inc., South San Francisco, CA) is a full-length recombinant humanized monoclonal antibody that binds to all isoforms of VEGF. Aim of the Work: to evaluate the safety and efficacy of intravitreal bevacizumab (IVB) at the end of vitrectomy operation for prevention of postoperative rebleeding in patients with diabetic vitreous hemorrhage. Patients and Methods: The study included 20 eyes of 20 patients undergoing PPV for severe non-clearing vitreous hemorrhage for more than 1 month. Eligible eyes were randomly assigned to one of two groups: Group A (10 eyes) did not receive any intravitreal injection and Group B (10 eyes) received 1.25 mg IVB injection at the end of surgery. All patients were subjected to complete history taking and full ophthalmic examination including best-corrected visual acuity, anterior segment examination, fundus examination and B-scan ultrasonography was performed. All patients underwent three-port pars plana vitrectomy using 23-gauge instrumentation under local anesthesia. At the end of surgery, fluid-air exchange was performed and the intraocular air is left as tamponade in selected cases. The follow up period occurred over 1 week, 1 month and 3 months. The main outcome measures were occurrence of vitreous hemorrhage and BCVA. Results: At 1 month after surgery, the incidence of early postoperative VH was 30% and 20% in Group A and B, respectively (p = 0.641). Mild vitreous hemorrhage (grade 1) was the major component of early VH at 1 month (20% of 30% and 10% of 20%, in Group A and B, respectively). Analysis of changes in the mean BCVA at 1 month after surgery showed significant improvement from the preoperative BCVA in all study groups, the mean differences between pre-BCVA (Log MAR) and post BCVA (Log MAR) among the studied groups was 0.865 ± 0.351 with statistically significant difference between the two groups (p = 0.000).the mean differences between pre-BCVA (Log MAR) and post BCVA (Log MAR) among the studied groups was 0.865 ± 0.351 with statistically significant difference between the two groups (p = 0.000). At 3 months after surgery, the incidence of late postoperative VH was 20.0% and 0.00% in Group A and B, respectively, with no significant difference between the two groups(P=0. 237). Again, analysis of changes in the mean BCVA at 3 months after surgery showed significant improvement to 1.080 ± 0.2098 and 0.870 ± 0.17767 in Group A and B, respectively, with statistically significant difference between the two groups (p >0.027). Conclusion: The incidence of late postoperative vitreous hemorrhage is lower than that of early postoperative vitreous hemorrhage and is not affected by intraoperative intravitreal bevacizumab injection and Adjunctive use of intravitreal bevacizumab with pars plana vitrectomy for complications of PDR is safe and well-tolerated with no serious ocular or systemic adverse events.}, keywords = {Diabetic Vitreous Hemorrhage,Intravitreal Bevacizumab,Pars Plana Vitrectomy}, url = {https://ejhm.journals.ekb.eg/article_10733.html}, eprint = {https://ejhm.journals.ekb.eg/article_10733_4cbe1e03ce138da86ddadf9417d8a8de.pdf} } @article { author = {Nasif, Hana Hamdy and Abdelmaksoud, Mohamed Hosni Kamel and Shalaby, Mennatallah Hatem and Elsakka, Ahmed Salama Hussein Mohamed}, title = {Role of Interventional Radiology in the Management of Postoperative Biliary Complications}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5153-5160}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10734}, abstract = {Background: Biliary postoperative complications include biliary stenoses, biliary leaks, fistulas and collection or abscess formation. These complications usually occur due to injury after laparoscopic cholecystectomy, gastric or hepatic resection, bilio-enteric anastomosis and after liver transplantation. In most of the cases a new surgical intervention is not possible. Endoscopic intervention is usually the optimal initial management of these complications; however, in patients with altered enteric passage, tight low biliary stricture, high up obstruction or leakage endoscopic approach becomes impossible. Therefore, the percutaneous trans-hepatic approach is of extreme importance in the diagnosis and treatment of the problem especially in complex cases Objective: This study aimed to highlight the spectrum of percutaneous cholangiographic findings and methods of treatment of postoperative benign biliary stenoses, biliary leaks and to detect its significance in management of these problems. Patients and Methods: This study was conducted in Theodor bilharz research institute (TBRI), Egypt from February 2013 to June 2018. 17 patients with benign postoperative biliary complications (stricture and leak) were treated with a percutaneous transhepatic procedure. Only adult patients (age >18 years) were included in the study.    Results: All patients had cholestasis and/or bile leak according to clinical and biologic findings (i.e., jaundice or an episode of cholangitis). Biliary obstruction and/or leak was confirmed by abdominal ultrasonography (US), multidetector computed tomography, and/or magnetic resonance (MR) cholangiography when US results were not conclusive and confirmation of the site & extension of  the stricture and/or leak  was needed. The results of the present study demonstrated that treatment of post-operative biliary complications (stricture and/or leak) by percutaneous transhepatic procedures was an effective option with acceptable rate of complication. Conclusion: We concluded that the percutaneous treatment of post- operative biliary complications is an effective alternative to surgery. This method should certainly be preferred when the local conditions were not favorable to a surgical repair, failure of endoscopic approach or when a recurrence was observed after an unsuccessful previous repair. Its advantages compared with surgery were its minimally invasive nature, reduced risk of complications, and the fact that all options remain open in case of failure. }, keywords = {Ultrasonography,Magnetic resonance,Percutaneous transhepatic biliary drainage}, url = {https://ejhm.journals.ekb.eg/article_10734.html}, eprint = {https://ejhm.journals.ekb.eg/article_10734_6d4af54cc4772decab87b8e09882de0e.pdf} } @article { author = {El Fiky, Alia Abd Allah and Elia, Remon Zaher and Louka, Amir Louis and Aneis, Doaa Sobhy}, title = {Evaluation of Calcaneal Fractures by Multi Detector CT and Its Significant Effect on the Surgical Management Planning}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5161-5165}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10735}, abstract = {Background: Familiarity with the normal calcaneal anatomy is important for understanding fracture mechanisms and classification schemes. Clinical presentation at the time of evaluation generally includes (a) a history of a fall from a height, and (b) certain signs that aid the physician in identifying possible calcaneal fractures. Purpose: To look at the role played by the multi detector computed tomography (MDCT) in assessing calcaneus fractures and delineate the fracture fragment which help in decision making in the management of extra and intra articular fractures of the calcaneum and pre-operative planning. Patients and Methods: This study will be conducted on patients with calcaneal fractures suspected clinically or by x ray diagnosis. The patient will be referred from orthopaedic department at Ain Shams University Hospitals; the patient will be investigated using MDCT. Results: This study included 44 feet of 41 patients (three bilateral); 35 males and 6 females, representing 85.4% and 14.6% of all patients respectively, their mean age was 34.22 years, we observed that calcaneal fractures commonly occur in male than female. Conclusion: Multi detector CT is the best method of assessing calcaneus fracture in order to decide management. It delineates the fracture fragments and help in making the pre-operative planning of the fracture.}, keywords = {Computed tomography,calcaneal fracture,Sanders classification,musculoskeletal}, url = {https://ejhm.journals.ekb.eg/article_10735.html}, eprint = {https://ejhm.journals.ekb.eg/article_10735_9ab0c658730d636e4b9840fa717c9e46.pdf} } @article { author = {Zaghloul, Mohamed A. and El-Sebaie, Samir A. and Abd Al-Alim, Azza A. and El-Sotouhy, Abdel Rahman M.}, title = {Comparison between volume-controlled and pressure-controlled ventilation in COPD patients undergoing laparoscopic cholecystectomy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5166-5172}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10736}, abstract = {Background: Chronic obstructive pulmonary disease (COPD) is a well-known independent risk factor for the development of postoperative pulmonary complications. Managing ventilation and oxygenation during laparoscopic cholecystectomy (with creation of pneumoperitoneum) in these patients presents many challenges. Aim of this study: was to compare between volume-controlled and pressure-controlled ventilation in COPD patients undergoing laparoscopic cholecystectomy. Methods: A case control study was conducted on 60 participants aged between 18 and 60 years, diagnosed with COPD and scheduled for laparoscopic cholecystectomy. To start with, all patients received volume-controlled ventilation (VCV). Fifteen minutes after creation of pneumoperitoneum, they were randomized to receive either VCV (Group A) or pressure-controlled ventilation; PCV (Group B). Hemodynamics, ventilatory parameters, arterial blood gas analyses were noted. All data were analyzed statistically. Results: There was no significant difference between study groups as regards hemodynamic variables. Peak airway pressure was significantly lower in PCV group compared with VCV group. Mean airway pressure was significantly higher in PCV group compared with VCV group. As regards arterial blood gas analyses, there was no significant difference between study groups as regards PaO2 and SpO2. Patients in PCV group had higher PaCO2 (yet not clinically significant) at 35 min, compared with patients in VCV group. Conclusion: PCV and VCV were generally effective in maintaining adequate ventilation, oxygenation and hemodynamic stability. Peak airway pressure was significantly lower in PCV group compared with VCV group, thus decreasing the risk of barotrauma. PCV may be a better choice than VCV in COPD patients undergoing laparoscopic cholecystectomy.}, keywords = {Laparoscopic cholecystectomy,chronic obstructive pulmonary disease,Pressure-Controlled Ventilation,Volume-Controlled Ventilation}, url = {https://ejhm.journals.ekb.eg/article_10736.html}, eprint = {https://ejhm.journals.ekb.eg/article_10736_f987844dcfaa0dd057bca72ab007defc.pdf} } @article { author = {AlKuwaity, Khalid Waleed and Mohammad, Tasneem Noor and Hussain, Malik Azhar and Alkhanani, Annas Jamal and Ali, Abdulla Mohamed Bakr}, title = {Prevalence and Determinant Factors of Osteoarthritis of the Knee Joint among Elderly in Arar, KSA}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5173-5177}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10737}, abstract = {Background: Osteoarthritis of the knee, the disease of knee joint dysfunction and pain caused by joint degeneration, it is the commonest joint disease. In most cases of joint degeneration there is no clear identifiable cause, but increasing age, excessive joint loading, and joint abnormalities and trauma increase the risk of OA. It has significant effects on human health and quality of life (QoL). Objective: This study was carried out aimed to determine the prevalence and determinant factors of osteoarthritis of the knee among elderly population in Arar, KSA. Methods: The present cross sectional community based study was conducted in Arar city, the capital of Northern Borders Governorate on 238 elderly people of age 60 years and more. Data was collected through personal interviews with the sampled population and filling a predesigned questionnaire. It included questions regarding the already previously diagnosed osteoarthritis of the knee joint and its determinants. Results: the mean age (± SD) was 70.4 (±9.3) years, male to female ratio was 48.3 to 51.7. The overall prevalence rate of osteoarthritis of the knee joint was 24.5%.Osteoarthritis was almost equal in females and males (26.8% and 26.1%, respectively), it was insignificantly associated with increasing age, female sex, hypertension and diabetes (P>0.05), while significantly associated with the BMI. Conclusion: Osteoarthritis of the knee joint is common among elderly population in Arar, KSA. It was almost equal in females and males. }, keywords = {osteoarthritis,Knee joint,Elderly,Arar,KSA,determinants,prevalence}, url = {https://ejhm.journals.ekb.eg/article_10737.html}, eprint = {https://ejhm.journals.ekb.eg/article_10737_183804f10f4269f22a05be30a5cb0b5e.pdf} } @article { author = {Alruwaili, Ashwaq Arar S and Abo El-fetoh, Nagah Mohamed and Alruwaili, Thmer Arar S and Alanazi, Waad Alazri S and Alhazmi, Hala Hamdan R and Alanazi, Noor Awad B and Alshammari, Hibah Abtan B and Alshammari, Arwa Ahmed A and Alrwaili, Ahlam Hussein}, title = {Knowledge, Attitude and Practice of the Parents Regarding Child Vaccinations in Arar, Northern Saudi Arabia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5178-5182}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10738}, abstract = {Background: Parental decisions regarding vaccination are very vital for increasing the vaccination rate and parent compliance to the immunization schedule.  Worldwide studies show that besides other factors, parental knowledge and beliefs have major influence on starting and continuing of child vaccination. Objective: The study aim to assess knowledge, attitude and practice of the parents regarding child vaccinations in Arar, Northern Saudi Arabia. Methods: A cross-sectional community based study carried out during the period from 1st January to 30th July 2018. A systematic random sampling technique was used; 367 participants was included.  Data collected using a pre-designed online questionnaire distributed among parents of children and adolescents to be self-administered. Results: the majority (40.1%) of children aged less than 6 years old, 58.9% were males, fathers' education was university or more in 47.7% of participants and mothers' education was secondary school 75.5%. Most (88.3%) of parents were sure that the vaccinations are important for their children, 68.4% think vaccination reduces the probability of death or illness of a child, 85.6% think that vaccinations reduces the number of infectious diseases, 89.6% think that the vaccinations have a role in the child health, 6.8% were aware that some vaccinations are accompanied with side effects such as fever and 83.1% were aware that even healthy child needs vaccination. 70.1% of parents gave their child all mandatory vaccines, 77.9% follow the child's compulsory immunization, 76.6% of parents feel secure after vaccination of their children. Conclusion: knowledge and acceptance of childhood vaccinations, perceptions of vaccine-related health benefits is good among parents in Arar, Northern Saudi Arabia.}, keywords = {children,cross sectional,Immunization,parents,Arar, Northern Saudi Arabia,vaccine}, url = {https://ejhm.journals.ekb.eg/article_10738.html}, eprint = {https://ejhm.journals.ekb.eg/article_10738_f3ffed9073bdf55bba2e34bafc1d5e67.pdf} } @article { author = {Akl, Sherif Abd AlKhalek and ElMekkawi, Sherif Fathi and El-Kotb, Ahmed M. and Okily, Adel Sayed}, title = {Swabbing of Subcutaneous Tissues with Betadine for Prevention of Surgical Site Infection after Caesarian Section}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5183-5188}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10739}, abstract = {Background: The progressive increase in the incidence of caesarean birth has been a notable feature of contemporary obstetric practice and caesarean delivery is now the most frequent major surgical procedure performed in obstetrics and gynecology. In Egypt the rate of cesarean delivery is 51, 8 % of all deliveries. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. Aim of the Work: To assess the efficacy of subcutaneous swabbing of cesarean section wounds with povidone iodine to prevent postoperative wound infection. Patients and Methods: The study population was randomized into 2 groups: Povidone-Iodine Group: Included 275 women who underwent elective caesarian section with subcutaneous tissue irrigation with Povidone iodine 1% solution and control Group: Included 275 women who underwent elective caesarian section without subcutaneous tissue irrigation. Results: Incidence of SSI didn’t differ significantly between the Povidone-Iodine group and the Control group (6.11% vs 8.54%, p = 0.37). No significant differences were found between both groups regarding the severity of SSI based on required treatment or incidence of postoperative pyrexia. Conclusion: There was no benefit of subcutaneous tissue swabbing with povidone iodine in decreasing wound infection following cesarean section.}, keywords = {Subcutaneous Tissues,Betadine,Surgical Site Infection,Caesarian Section}, url = {https://ejhm.journals.ekb.eg/article_10739.html}, eprint = {https://ejhm.journals.ekb.eg/article_10739_0a33d284f911df3eccd195f604d6f8d3.pdf} } @article { author = {Hussein, Hossam El-Din Hassan and Mortada, Ahmed Elnabil and Elmaleh, Haitham Mostafa and Abbas, Ahmed Adel and Iskandar, Amir Nagui Abdalla}, title = {Revisional Laparoscopic Mini-Gastric Bypass for Weight Loss Failure after Restrictive Procedures}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5189-5194}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10740}, abstract = {Background: bariatric surgery has proven its effectiveness in achieving and maintaining weight loss and improving obesity-related co-morbidities, quality of life, and survival. As demand for bariatric surgery increases, so too will the need for revisional surgeries. The revision rate following primary bariatric surgery is reported to be between 10% and 25%. To facilitate weight loss surgically, many different types of bariatric procedures have been developed and established. Objectives: to assess the effectiveness of revisional laparoscopic mini-gastric bypass for management of inadequate weight loss after different restrictive procedures. Patients and Methods: the present study is a prospective study that was conducted at Ain Shams University Hospitals in Egypt, between July 2016 and July 2018. It included Forty (40) patients who underwent a restrictive bariatric procedure 2 years ago or more with inadequate weight loss. Operative time, intraoperative complications, rate of conversion. Postoperative pain, consumption of analgesics, length of hospital stay, start of oral feeding. Results: the patients series involved 40 patients, 12 of which were male patients (40%) whereas, 24 were female patients (60%). The patients’ age at the time of revisional surgery ranged from 23 to 57 years old with a mean ± SD of 38.50 ± 8.42 years. The preoperative BMI ranged from 31.25 to 52.62 kg/m2 with a mean ± SD of 41.59 ± 4.99 kg/m2 with an excess weight ranging from 19.79 to 86 kg with a mean ± SD of 46.51 ± 14.27 kg. The mean time interval between the initial restrictive surgery and the revisional LMGB was 41.63 ± 16.92 months. 18 patients (45%) had a VBG as their primary restrictive surgery, 10 patients (25%) had LAGB, 8 patients (20%) had LSG and 4 patients (10%) had LGCP. 28 patients (70%) underwent LMGB for IWL compared to 12 patients (30%) for WR. Conclusion: the revisional Laparoscopic Mini-Gastric Bypass (r-LMGB) appears to be a feasible and safe option after failed restrictive bariatric surgery. However, additional studies with larger population and longer follow up period are required to evaluate longer-term success.}, keywords = {Revisional Laparoscopic Mini-Gastric,Weight Loss Failure,Restrictive Procedures}, url = {https://ejhm.journals.ekb.eg/article_10740.html}, eprint = {https://ejhm.journals.ekb.eg/article_10740_bca17e5914d49871278127faab0cfbf4.pdf} } @article { author = {Almutairi, Mada Bejad G. and Alsulaimi, Salem Muaedh and Alghamdi, Rayan Ali I and Alrehaili, Khalid Abdullah and Habhab, Sohaib Aziz and Althagafi, Abdulrahman Mohsen and Alghamdi, Faisal Ali and Meighrbl, Naif Abdulaziz and Alsuhaymi, Waleed Mohammed and AlYahya, Mohammed Saeed}, title = {Evaluation of GERD Diagnosis, Management, and Outcomes}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5195-5202}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10741}, abstract = {Background: Gastroesophageal Reflux Disease (GERD) is a condition which develops when the reflux of gastric content causes troublesome symptoms or complications. GERD is arguably the most common disease encountered by the gastroenterologist. It is equally likely that the primary care providers will find that complaints related to reflux disease constitute a large proportion of their practice.(1) GERD condition can present with different presentations and the response to the intervention significantly differs from patient to patient. As a result reviewing the new literatures done in this field will help in providing a better outcomes for the patients. Objective: Treating patients with GERD is difficult and needs different approaches. In this paper, we reviewed the major and the latest studies regarding GERD symptomatology, risk factors, diagnosis and management. Method: A comprehensive search was done using biomedical databases; Medline, and PubMed, for studies concerned with assessment of GERD. Keywords used in our search through the databases were as; “GERD Pathophysiology”, “GERD Classification”, and “GERD Management”. Conclusion: GERD is a condition which develops when the reflux of gastric content causes troublesome symptoms such as heartburn, regurgitation, and sleep disturbance. GERD can be diagnosed by various measures such as GERD Questionnaire, PH Monitoring, and Upper Endoscopy. Initially GERD can be managed by simple life modification measures, then physicians can add Protons Pump Inhibitors (PPIs), and Histamine 2 Receptor Blocker (H2RBs). In case of PPIs and H2RBs failure in reliving GERD symptoms physicians may go for anti-reflux surgical interventions. }, keywords = {GERD,Diagnosis,Management,outcomes}, url = {https://ejhm.journals.ekb.eg/article_10741.html}, eprint = {https://ejhm.journals.ekb.eg/article_10741_61d37e8b3e909db0088436f671ea84ab.pdf} } @article { author = {El-Tonsy, Taimor Mohammed Khalifa and Mohammed, Mamdouh Attia and Hamed, Yasser Abou El-Ela and Tawfik, Samah Hamdy}, title = {Bacteriological study of Acne Vulgaris in Cairo Egypt}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5203-5209}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10742}, abstract = {Background: acne vulgaris is chronic inflammatory dermatosis of the pilosebaceous units which is characterized by open and/or closed comedones (blackheads and whiteheads) and inflammatory lesions including papules, pustules, or nodules, in some cases, is accompanied by scarring. Acne is multifactorial disease including increased sebum production, hypercornification of pilosebaceous duct, an abnormality of microbial flora especially colonization of the duct with propionibacterium acne and the production of inflammation. P.acne has been implicated in the pathogenesis of acne for more than 100 years.  Objective: the present work was done to determine bacteria involved in acne vulgaris among Egyptian acne patients. Patients and Methods: this study was conducted on one hundred patients with inflammatory acne vulgaris recruited from the Dermatology outpatient clinic of Al-Hussien hospital. Results: in this study, S.epidermidis was higher in normal skin than in acne lesion. But P.acne was higher in acne lesion than in normal skin with significant statistical difference. There was a significant relation between type of organisms isolated and severity of acne lesions in both aerobic and anaerobic state. There was a significant relation between positive acne family history and liability for post acne scar. Even though there was no significant relation between hermonal therapy and severity of acne lesions. We noticed that the majority of female patients with POP history had moderate acne lesions. In this study, the high percentage of S.epidermidis was observed in moderate acne lesion and in normal skin in aeorobic state but high percentage of P.acne was found in moderate acne lesions in anaerobic state. However, P.acne can not be solely held responsible for the initiation of inflammation in inflamed acne lesions or for the variation in its severity. Conclusion: the high percentage of no growth result in this study directs us that the antibiotic treatments are not the most useful treatment for acne and there are other effective methods for treatment whether topical as retenoids or ablative as Lasers. Patient with family history of acne lesion especially first relative (mother) we must keep in mind that they are more susceptible for post acne scar so we should start with the perfect treatment as early as possible to prevent the post acne sequels.}, keywords = {1,25 dihydroxy vitamin D3,dihydrotestosterone,Propionibacterium acnes,Pilosebaceous units}, url = {https://ejhm.journals.ekb.eg/article_10742.html}, eprint = {https://ejhm.journals.ekb.eg/article_10742_e12e7ec58f3fa9f40b6e84abc504ce17.pdf} } @article { author = {Nashed, Sherif W. and Elshebieny, Ahmed A. and Maarouf, Mohammed M. and Nawar, Nancy R.}, title = {The Utility of Fibrinogen/C-reactive protein Ratio versus D-dimer and Fibrin Degradation Product in Diagnosis of Overt Disseminated Intravascular Coagulation in Intensive Care Unit patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5210-5214}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10743}, abstract = {Background: Coagulopathies in ICU are one of the most common complications in ICU. DIC is one of the most threatening coagulopathies in ICU.It is accompanied with high mortality rates in ICU.Early diagnosis of DIC is very important for early intervention for better prognosis.DIC is caused by several pathologies like sepsis, trauma, obstetric causes and malignancies. Aim of the Work: to compare between the sensitivity between fibrinogen/CRP ratio and FDP and D-dimer. Patients and Methods: After obtaining approval from the medical ethical committee at Ain Shams University, this observational prospective study was conducted at Ain Shams University Intensive Care Units. The study included 70 patients in Demerdash ICU after including patients with ISTH score ≥5.  2 samples were collected from each patient. Results: The results were in favor to the classical parameters of diagnosis of overt DIC in comparison with the new parameter of DIC. It showed that D-dimer and FDPs together were more sensitive than fibrinogen/CRP ratio. Conclusion: The D-dimer and FDP tests offered the best test panel in the diagnosis of DIC especially in overt DIC due to their high sensitivity.}, keywords = {Fibrinogen,C-reactive protein,D-Dimer,fibrin degradation product,overt disseminated intravascular coagulation,ICU}, url = {https://ejhm.journals.ekb.eg/article_10743.html}, eprint = {https://ejhm.journals.ekb.eg/article_10743_a43b4224418beda1061c9d05e5e3563b.pdf} } @article { author = {Elewah, El-Sayed M and Ahmed, Abd-Elmoez H and Ali, Abdel-Mongy El and Ebrahim, Anas M}, title = {A Comparison between Pulled and Pushed Monocanalicular Silicone Intubation in Management of Congenital Nasolacrimal Duct Obstruction}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5215-5220}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10744}, abstract = {Background: Congenital nasolacrimal duct obstruction (CNLDO) is usually caused by a membranous block at the valve of Hasner. Symptoms of CNLOD include epiphora, mucous discharge, or mucopurulent discharge. Many CNLDOs can resolve spontaneously by the first year of life. Children who ultimately have unsuccessful responses to canalization will undergo invasive procedures for CNLDO, including probing, silicone intubation, balloon dacryocystoplasty and dacryocystorhinostomy. There are two types of lacrimal intubation, monocanalicular and bicanalicular. Pushed monocanalicular stent is characterized by the probe guide actually placed inside the silicone tube, rather than attached at the end as in conventional ‘‘pulled’’ intubations stents. Aim of the work: was to compare the success rate of pulled monocanalicular (MCI) versus pushed monocanalicular silicone intubation (PMCI) of the nasolacrimal duct for congenital nasolacrimal duct obstruction. Patients and methods: In a prospective randomized clinical trial 67 eyes of 67 patients with CNLDO underwent either pulled monocanalicular silicone intubation (MCI) (=32 eyes) or PMCI ( =35 eyes).      Cases were considered successful if reached grade 0 or 1 in fluorescein dye disappearance test -complete or partial resolution of symptoms - after two months after tube removal. Results: This study included only patients with simple obstruction at the level of the Hasner valve and diagnosed intraoperative during the initial probing thus, the surgical outcome was assessed in 30 eyes of 30 patients in the MCI groups. 15 eyes received MCI in the upper punctum and 15 eyes received MCI in the lower punctum. The other 30 eyes 30 patients did PMCI with Masterka tube. 15 eyes received PMCI in the upper punctum and 15 eyes received PMCI in the lower punctum. 33 females (55%) & 27 males (45%) with age ranged from 12 to 46 months with mean of 26 ± 11 months. Follow-up of the patients was done at 1 week, 1 month, 2 and 3 months post-operative. Tube removal was done 3 months post operatively in both types of tube. The overall success rate in the MCI intubation groups was 86.7%, whereas in the PMCI intubation groups was 80%. However, the difference in the success rates between the two groups was statistically insignificant (P= 0.4884) using Chi-square test. Conclusion: Results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.}, keywords = {lacrimal drainage system,congenital nasolacrimal duct obstruction,silicone intubation}, url = {https://ejhm.journals.ekb.eg/article_10744.html}, eprint = {https://ejhm.journals.ekb.eg/article_10744_124ef14ac9795fe93e31019902142f34.pdf} } @article { author = {Zakaria, Abd El Moneim Mohamed and Sedek, Abd El Monsef Abd El Hamid and Soliman, Ahmed Sayed Saleh}, title = {Assessment of Different Methods of Ovulation Induction on Endometrial and Ovarian Blood Flow by Three Dimension Transvaginal Ultrasound & Doppler Indices}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5221-5226}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10745}, abstract = {Background: the study was performed in a prospective randomized fashion in order to compare the value of tansvaginal ultrasound, and the value of combined colour Doppler imaging of uterine, ovarian blood flow and transvaginal folliculometry in assessment of ovulation induction of infertile women. Objectives: Ovulation rate was taken as the gold standard for assessment of ovulation induction result. Patients and Methods: Analysis of the results provided the following information: A) Better sensitivity & specificity of colour Doppler indices in detection of ovulation. B) Better timing of human chorionic gonadotrophin administration & better ovulation rate when colour Doppler was used in cycle monitoring. Results: It can be concluded from the results of this study that combined use of transvaginal sonography & colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. Conclusion: combined use of transvaginal sonography & colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. The study opens a new field of ongoing research on the valuable application of colour Doppler studies in the management of gynecologic infertility due to ovarian cause.}, keywords = {transvaginal ultrasound,colour Doppler,ovulation induction clomiphene citrate}, url = {https://ejhm.journals.ekb.eg/article_10745.html}, eprint = {https://ejhm.journals.ekb.eg/article_10745_b508ca34c6836a22a7f6e635e7ce5f45.pdf} } @article { author = {EL Zahaby, Hany Mohamed Mohamed and El Henawy, Ahmed Mohamed El Sayed and Youssef, Ahmed Monier Ahmed and Ghallab, Eslam Kandil Abd El Moaty}, title = {Comparative Study between Femoral Arterial Doppler and Echocardiography in fluid responsiveness assessment in Septic Shock Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5227-5232}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10746}, abstract = {Background: Fluid replacement is considered the cornerstone of resuscitation in critically ill patients especially in patients with septic shock. However, only about 50% of critically ill hemodynamically unstable patients are responsive to fluids. Furthermore, both under resuscitation and overzealous fluid administration adversely affect the outcome. Consequently, the resuscitation of critically ill patients requires an accurate assessment of the patients’ intravascular volume status and their volume responsiveness. Aim of the Study: The aim of this study is to compare between the femoral arterial doppler and Echocardiography in fluid responsiveness assessment in septic shock patients. Methodology: The study was conducted on 30 adult male and female patients admitted to Critical Care Department in Ain shams University Hospitals with the diagnosis septic shock. All patients in this study have the Criteria of Septic shock. Echocardiographic examination and femoral Doppler were done for all included patients. Velocity time integral on left ventricle outflow tract and Velocity time integral on femoral artery were measured before and after fluid resuscitation, after infusion of 30 ml/kg over 3 hours, Results:  These results show that there were 23 patients were responded clinically to fluid resuscitation from all total number of 30 patients. From all total number of patients whom clinically responded, 22 patients responded to fluid resuscitation by transthoracic echocardiography and 23 patients responded by femoral Doppler.  Conclusion: These results showed that femoral Doppler parameters were a reliable predictor to fluid responsiveness in patients with severe sepsis and septic shock as well as transthoracic echocardiography in dynamic monitoring of the change in stroke volume after a maneuver that increases or decreases venous return (preload). However femoral Doppler seems to be easier and rapid tools to be used by junior staff.}, keywords = {Femoral Arterial Doppler,Echocardiography,Septic Shock Patients}, url = {https://ejhm.journals.ekb.eg/article_10746.html}, eprint = {https://ejhm.journals.ekb.eg/article_10746_7a9a7e9e1b47c271f3c8764d648620e5.pdf} } @article { author = {}, title = {Surgical Management of Lobar Intracerebral Hemorrhage}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5233-5240}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10861}, abstract = {Aim of work: We conducted a case study to evaluate the surgical management of lobar intracerebral hemorrhage. Patients and Methods: This study included 20 patients who were diagnosed with Lobar ICH between January 2017 and December 2017, All cases were managed surgically. ICH is a neurological emergency and medical care should starts rapidly with stabilization of airway, breathing functions, circulation and other associated pathologies as fits and elevated blood pressure. CT scan was the standard diagnostic tool in the 1ry management of the cases. A routine preoperative investigation as CBC, PT was done. Cases admitted to a postoperative ICU for at least 48 hours and a follow up CT scan was done. Results: We observed all survivors for at least 2 months and asses our outcome using Glasgow Outcome Scale. Conclusion: Care of such cases and rehabilitation plays an important role to have a good prognosis.}, keywords = {Lobar intracerebral haemorrhage,Traumatic,Spontaneous,results,Discussion}, url = {https://ejhm.journals.ekb.eg/article_10861.html}, eprint = {https://ejhm.journals.ekb.eg/article_10861_7ddfa60b67cbb97942d4ae6456687c50.pdf} } @article { author = {Kamal, Sanaa Moharam and Abdelhakam, Sara Mahmoud and Massoud, Yasmine Mahmoud and Abd El Hafeez, Kareem Abd El Aziz and Kamal, Hazem Ahmed}, title = {Clinical Profile of patients with Ascitic Fluid Infection at Ain Shams University Hospitals}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5241-5250}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10862}, abstract = {Background: Ascites is a common problem in patients with chronic liver disease. About 60% of patients with cirrhosis will develop ascites. Patients with chronic liver disease and cirrhosis frequently develop infections of the ascitic fluid. Aim: The aim of this study is to assess the clinical profile of patients with ascetic fluid infection admitted to Tropical Medicine department at Ain Shams University hospitals. Patients and Methods: The current Cross-sectional study was conducted at The Tropical Medicine Department, Ain Shams University on 87 Egyptian patients with chronic liver disease and ascites during the 12-months period from June 2017 to May 2018 by collecting their clinical, laboratory and radiological data. Results: The frequency of infected ascites among the studied patients with chronic liver disease and ascites was 31%. The main presenting symptom of infected ascites was abdominal pain (37%) and the most common clinical sign was lower limb edema (81%). The most frequently isolated micro-organism was E.coli that was detected in 7% of patients with infected ascites. Among the 27 patients with infected ascites, 12 patients responded to the third generation cephalosporins, nine patients responded to Meropenem. Conclusion: Infection of the ascitic fluid is frequent among patients with chronic liver disease and cirrhosis admitted to Ain Shams University Hospitals. Almost one third of the ascitic patients developed at least one attack of spontaneous bacterial peritonitis or bacterascites. Monomicrobialbacterascites is more frequent than polymicrobialbacterascites and E coli is the most common isolated organism. Third-generation, broad-spectrum cephalosporins remain a good initial therapy for patients who do not have allergy to cephalosporins. Alternative antibiotics such as Meropenem and pipercillin-tazobactam should be considered for patients for patients who fail to improve on traditional antibiotic regimens.}, keywords = {ascites,Spontaneous Bacterial Peritonitis,Ascitic fluid infection}, url = {https://ejhm.journals.ekb.eg/article_10862.html}, eprint = {https://ejhm.journals.ekb.eg/article_10862_0919a6ab25736aec8c6693ddc57ddceb.pdf} } @article { author = {Basiouny, Reem H. and Hendy, Arwa A. and Khattab, Rasha T.}, title = {Diffusion weighted Image MRI in Assessment of Patients with Multiple Myeloma}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5251-5258}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11163}, abstract = {Background: Recent developments in diagnostic imaging techniques have magnified the role and potential of MRI in patients with multiple myeloma. Quantitative diffusion-weighted imaging of the bone marrow is adjunct tool for the diagnosis of a diffuse MR imaging pattern in patients with multiple myeloma. Aim of the Work: This study aimed to evaluate the apparent diffusion coefficients (ADCs) of magnetic resonance (MR) imaging patterns in the bone marrow of patients with multiple myeloma (MM) and to determine a threshold ADC that may help distinguish a diffuse from a normal pattern with high accuracy Patients and Methods: This study was carried out in Radiology Department of Ain Shams University Hospitals. This study included 30 patients newly diagnosed, untreated MM and 16 healthy control subjects underwent spinal MR imaging including diffusion-weighted imaging, and bone marrow ADCs were calculated. Pattern assignment was based on visual assessment of conventional MR images. Results: Mean ADCs 6 standard deviation in patients with MM for the normal, focal, and diffuse MR imaging patterns were 0.360 x 10-3 mm2/sec +/- 0.110, 1.046 x 10-3 mm2/sec +/- 0.232, and 0.770 x 10-3 mm2/sec +/- 0.135, respectively. There were significant differences in ADCs between diffuse and normal (P .001), diffuse and focal (P.001), and focal and normal (P.001) patterns. Patients with a diffuse pattern had more features of advanced disease, higher international staging system score, increased incidence of high-risk cytogenetics, and higher revised international staging system score. ADCs greater than 0.548 x 10-3 mm2/sec showed 100% sensitivity (9 of 9) and 98% specificity (10 of 11) for the diagnosis of a diffuse (vs normal) MR imaging pattern, whereas an ADC greater than 0.597 x 10-3 mm2/sec showed 100% sensitivity (9 of 9) and 100% specificity. Conclusion: ADCs of MR imaging patterns in patients with MM differ significantly. A diffuse MR imaging pattern can be distinguished more objectively from a normal MR imaging pattern by adding quantitative diffusion-weighted imaging to standard MR imaging protocols.}, keywords = {Multiple myeloma,DW MRI}, url = {https://ejhm.journals.ekb.eg/article_11163.html}, eprint = {https://ejhm.journals.ekb.eg/article_11163_140aa77cb10618a26f6abe84eda4786e.pdf} } @article { author = {El Khadrawy, Shehab Mohamed and Ellabbad, Mohamed Ahmed and Alzebak, Ahmed Mohamed}, title = {Role of Neuroendoscopy in Management of Intraventricular Lesions}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5259-5269}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.10866}, abstract = {Objective: Intraventricular (IV) lesions are easily being approached with the endoscope through the ventricular system, because intraventricular tumors often cause cerebrospinal fluid (CSF) pathway obstruction and hydrocephalus. The aims of endoscopy in intraventricular tumors are usually the restoration of CSF pathway obstruction, clarification of the histology, and if possible, a complete tumor removal. Methods: Twenty five consecutive cases with IV lesions were removed or biopsied with or without ETV and septum pellucidostomy. Patient information was retrospective entered into a database. Outcomes were evaluated by life table analysis. Results: Twenty five patients had completed with ETV in 16 cases; six cases by cyst fenestration, seven cases tumor biopsy 10 cases cyst removal, two cases hematoma were evacuated. 16 cases improved post-operative (clinical and radiological), three cases needed VP shunt, Three cases with same clinical as pre-operative, One case presented with paresis, Two cases operated microscopically after one year. Conclusions: The advantages of the endoscopic approach are minimal dissection and brain retraction. Reach to the target is rapid. The method of choice for removal of colloid cysts, arachnoid cysts and restore CSF pass way obstructed by lesions at the same operation.}, keywords = {Arteriovenous malformation,Cerebrospinal Fluid,Endoscopic third ventriculostomy,External ventricular drain,Intra cranial pressure,Intraventricular hemorrhage,Ventriculoperitoneal,Aqueduct of Salvias}, url = {https://ejhm.journals.ekb.eg/article_10866.html}, eprint = {https://ejhm.journals.ekb.eg/article_10866_ea62c590cf38d7ad4ee98d95629b1300.pdf} } @article { author = {Ibrahim, Ahmed Samir and Abdel-Dayem, Emad Hamid and Hassan, Hossam Mohsen}, title = {An Egyptian study for standardization of myocardial T1 mapping values on a 3 Tesla MRI machine}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5270-5277}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11029}, abstract = {Objective: of this study is to set standard values for the native T1 values in both normal and diseased myocardium on a 3 tesla MRI machine. Methodology: this study was carried out in Misr Radiology Center. 31 patients were divided into normal group (control) including 10 patients and diseased group including 21 patients. Result: The native T1 values on the healthy myocardium ranged from 1110 to 1300 msec, with ECV values ranging from 25 to 33 % with variable elevations of the native T1 and ECV values according to the pathology affecting the myocardium. We concluded that the above values are the reference values for the 3 T MRI machine.}, keywords = {Cardiovascular Magnetic Resonance (CMR),Extra-cellular Volume (ECV),Late Gadolinium Enhancement (LGE)}, url = {https://ejhm.journals.ekb.eg/article_11029.html}, eprint = {https://ejhm.journals.ekb.eg/article_11029_32b3e12606c5aa08ff32a9d5b946dcdd.pdf} } @article { author = {Aljabri, Nibras Khaled and Al-Qahtani, Ashaq Mubarak and Alahmari, Ali Mohammed and Alyamani, Feras Ali and Almutawah, Mohammed Ahmed and Alsaif, Malak Abdulaziz and Almaghrabi, Bashir Adel and Alshareef, Elaf Fahad}, title = {Epidemiology outcomes of proximal humerus fractures in Saudi Arabia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5278-5283}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11030}, abstract = {Background: Proximal humerus fractures (PHF) are osteoporotic fractures that affect women over 70 years of age. Like fractures of the femoral neck they have become a public health concern. As the population ages there is an increase in the number of people in poor general condition with an increased risk of falls on fragile bones. The incidence of these fractures has increased by 15% per year. Methods: All patients managed for PHF in Saudi Arabia in the past year were included in this prospective study (prospective cohort study; level 2). Three hundred and twenty-five patients were included with 329 fractures. Results: There was a ratio of two women to one man. At the final follow-up 50 patients had died (15%) and 25 patients were lost to follow-up. The mean age was 70 years old. There were two types of risk factors. The first was fragile bones, and the second was patient specific risk of falls. The severity of the fracture increased with the age of the population. Hospitalization was necessary in 43% of the cases in our study. Surgical management was necessary in 21%. This lack of relationship between the percentage of displaced fractures (58%) and the percentage of surgically treated fractures is a sign of the difficulties of managing this population, which is usually in poor general condition. Conclusion: Proximal humerus fractures (PHF) is frequent and its prevalence is increasing. The ageing population is the cause, resulting in a population that is in poor general condition with an increased risk of falling on increasingly fragile bone. Measures must be taken in this growing population to prevent the risk factors of PHF because management of these fractures may become another source of dependency in the elderly population.}, keywords = {Epidemiology,fracture,Proximal humerus,prevalence,Osteoporosis}, url = {https://ejhm.journals.ekb.eg/article_11030.html}, eprint = {https://ejhm.journals.ekb.eg/article_11030_827473e9f80ad8c29ed5cb628fb0f399.pdf} } @article { author = {}, title = {Complications Following Inhaled Anesthetics Administration: A Systematic Review of Current Literature}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5284-5289}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11164}, abstract = {Background: anesthesia and sedation are an essential part of surgical operations and treatment in the intensive care unit. Sedation in the ICU is essential to keep patients well while they are intubated, mechanically ventilated, or agitated. It is also a cornerstone when they undergo any kind of invasive procedures. Most patients who require anesthesia are in generally bad health condition, such as failed kidney or liver, putting them at a greater danger of the complication of anesthesia itself. Newer agents, however, are trying to overcome these challenges. Aim of the Work: our aim in this study is to understand the mechanism of action of inhaled anesthesia, study their common adverse effects and complication and explore how to prevent them. Material and Methods: we conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1987, through March 2017. The following search terms were used: anesthesia, complication of anesthesia, inhaled anesthesia, overcoming challenges in surgery Conclusion: inhaled anesthetics are a basis in both surgical operations and sedation within the intensive care unit and are used for sedation or anesthesia. Most patients who require the use of anesthetics are critically ill, and may have renal dysfunction, hepatic dysfunction, or both. Therefore, the administration of safe anesthetic agent is essential to prevent the occurrence of severe adverse events. Newer agents have been reported to be safer.}, keywords = {Anesthesia,Complication of Anesthesia,Inhaled Anesthesia,Overcoming Challenges in Surgery}, url = {https://ejhm.journals.ekb.eg/article_11164.html}, eprint = {https://ejhm.journals.ekb.eg/article_11164_c850289dedb4ef1ba9239de11de6e2b5.pdf} } @article { author = {Nassar, Elaraby A and Othman, Adel A and Mohamed, Mohamed K and Sakr, Ahmed M}, title = {Retropupillary Fixation of Iris-Claw Intraocular Lens versus Trans-Scleral Suturing Fixation for Aphakic Eyes without Capsular Support}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5290-5297}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11165}, abstract = {Background: many reasons can lead to an aphakia without sufficient capsular support for a posterior chamber intraocular lens, such as intraoperative complications during phacoemulsification, intracapsular cataract extraction, ocular trauma and lens dislocation caused by various reasons. Aim of the Work: was to compare retropupillary fixation of an iris-claw IOL (artisan aphakia lens) with transscleral suturing fixation of aposterior chamber IOL for aphakic eyes without sufficient capsular support as regards safety, visual recovery and complications of the procedure. Material and Methods: this a prospective interventional case series study included a total of 45 eyes of 42 patients of the age group 13-60 years, selected from those attending the Ophthalmology Department at Al-Azhar University Hospitals according to the inclusion and exclusion criteria. Results: in group A, the duration ranged from 15 to 45 min with a mean of 30.30±6.06min, in group B, the duration ranged from 35 to 85 min with a mean 60.60±12.41min. The P-Value was< 0. 001. The IOP showed at day 1 postoperative was higher in group B 20.06±4 than group A A16.40±3.9 p value was 0.012, however IOP was nearly at the same level at the end of the follow up period 15.23±3.63 in group A and 15.23±3.63 in group B with p value 0.713. Conclusion: the results of our study indicated that IC-IOL and SF-PCIOL implantations are both satisfactory in correcting aphakia without sufficient capsular support to hold an IOL in the posterior capsule.}, keywords = {Aphakia,Iris Claw Intraocular Lenses}, url = {https://ejhm.journals.ekb.eg/article_11165.html}, eprint = {https://ejhm.journals.ekb.eg/article_11165_711de9cdeb5da087f1972982263c4f68.pdf} } @article { author = {Elkady, Mohammad Sabry and Refaat, Ghada and Elsayed, Zeinab and Farag, Kyrillus}, title = {Prognostic Value of Platelet to Lymphocyte Ratio in Patients with Non-Small Cell Lung Cancer}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5298-5303}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11166}, abstract = {Background: The prognostic value of Platelet-to-lymphocyte ratio (PLR) in patients with non-small-cell lung cancer (NSCLC) is still indistinct. We conducted this study to assess the prognostic significance of pretreatment PLR in patients with unresectable NSCLC. Aim of the Work: to assess the prognostic significance of pre-treatment PLR in patients with NSCLC. Material and Methods: we retrospectively reviewed 130 patients treated for NSCLC with definitive/palliative chemotherapy and/or radiotherapy in Ain-Shams University hospital, Clinical Oncology department between January 2014 and December 2016. Pre-treatment CBC was available for the 130 patients to calculate PLR by dividing the absolute platelet count by the absolute lymphocytic count. Results: Out of 130 patients with available pre-treatment complete blood picture, population age ranged from 23 to 87 years. Male to female ratio was 4.8:1. Adenocarcinoma presents 51% of cases. Unresectable stage II and stage III present 2% and 27% respectively, while Stage IV presents 69%. Using a cut-off value of 150, high PLR>150 was significantly associated with poor overall survival (OS) (median OS: 10.33 months; 95% CI: 6.23-14.42), compared to patients with PLR<150; (median OS: 24.63 months, 95% CI: 11.5-37.76, p=0.008), but not PFS. In multivariate analysis, PLR>150 was an independent poor prognostic factor for OS; (HR=1.9, 95% CI; 1.092-3.3, p=0.023).     Conclusion: High PLR is associated with poor OS in patients with unresectable NSCLC.}, keywords = {Platelet to Lymphocyte ratio,Non-Small Cell Lung Cancer,prognostic factor}, url = {https://ejhm.journals.ekb.eg/article_11166.html}, eprint = {https://ejhm.journals.ekb.eg/article_11166_4481d651d67becaef8eb5e67b5703afc.pdf} } @article { author = {Abdel-Mo`men, Magdy Ahmed and Elkhateeb, Saad Eldein Mahmoud and Abdel-Ra`oof, Hesham Said and Mohamed, Mohamed Ahmed Elbadawy}, title = {Comparative study between Ultrasound guided Pectoral nerves block and Thoracic epidural as analgesia in breast surgeries}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5304-5312}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11167}, abstract = {Background: Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Acute postoperative pain due to insufficient or ineffective pain control is a major risk factor for the development of chronic pain after breast surgery. This condition includes paresthesia, intercostobrachial neuralgia and phantom breast pain. Aim of the Work: we aimed at comparing the analgesic effectiveness and safety of pectoral (Pecs) block versus thoracic epidural in breast surgeries. Material and Methods: The present study was conducted to compare the efficacy and safety of the Pecs II block with thoracic epidural (TE) on sixty female patients ASA I-II, their ages ranged from 18- 65 years old scheduled for unilateral breast surgery. The patients were allocated randomly into two groups (n=30) according to type of regional anesthesia administrated. (Pecs block or TE). Results: The results of the present study demonstrated that, Pecs block caused hemodynamic stability, decreased the intensity of post-operative pain, reduced post-operative analgesic requirement, prolonged the time needed for first request of analgesia, decreased PONV. Therefore it can be considered as quite safe procedure and effective as well for intraoperative and postoperative pain control in breast surgeries. Conclusion: Whether it is more superior to thoracic epidural depends on the type and extent of surgery. For surgeries involving the axilla, Pecs block is required as part of axillary compartment block but for medial breast incisions, thoracic epidural offers denervation of anterior branches of the intercostal nerves, which Pecs block does not confer.}, keywords = {Pecs,thoracic epidural,breast surgeries}, url = {https://ejhm.journals.ekb.eg/article_11167.html}, eprint = {https://ejhm.journals.ekb.eg/article_11167_99e9002fa4459a2e335265de3f668300.pdf} } @article { author = {Alhumaidi, Rakan Awadh and Yousef, Khaled Hamdi Bin}, title = {Impact of Using Contact Lenses with Hygiene Rules in Saudi Arabia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5313-5320}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11168}, abstract = {Background and Objectives: this study aimed at assessing the level of compliance among contact lens wearers with hygiene rules, the prevalence of associated eye complaints, to determine the demographic factors of compliance and eye complications. Material and Methods: this is cross-sectional study on 500 subjects’ contact lens wearers at three ophthalmology clinics in Saudi Arabia (King Abdul-Aziz University Hospital in Jeddah, King Khalid University Hospital in Riyadh and King Fahad University Hospital in Khobar) during the period between July 2017 and March 2018. A semi-structured questionnaire was administered to investigate 10 items with a compliance score (0-10) was calculated as the number of rules to which the participant is fully compliant. Socio-demographic data were analyzed as factors for compliance and correlation of compliance scores with the presence and number of ocular complaints. Results: contact lenses were used for cosmetic purpose (47.8%), and for refractive errors (38.6%); and most frequent lens type was monthly (42.6%). Results showed that 22.6% of participants changed sterile solution daily; 15.8% changed the lens box monthly, 81.2% washed their hands before, 89.6% washed lens before and 33.2% after wearing the lenses, and 37.2% followed the correct washing method. The mean (SD) compliance score was 4.67 (1.60) and females had a moderately higher score than men. The majority of participants (93.0%) reported eye complaints and 73.6% had two or more concomitant symptoms. Conclusion: contact lens wearers have poor compliance with several hygiene rules resulting in the high prevalence of eye complaints. Therefore, it is important to teach contact lens wearers the specific hygienic rules of the target population to prevent serious eye complications.}, keywords = {Compliance,Hygiene Rules,Contact Lenses Wearers}, url = {https://ejhm.journals.ekb.eg/article_11168.html}, eprint = {https://ejhm.journals.ekb.eg/article_11168_d67c38d8052f00aed59487ce97f6808f.pdf} } @article { author = {Hejazi, Ahmed Saleh and Alzahrani, Abdulelah and Alshehri, Abdullah Ali and Aldhafiri, Fahd M. and Aljefri, Hasan and M. Aldhafiri, Fawaz}, title = {Etiologies and In-Hospital Outcomes of Nonhemolytic Jaundice among Infants at King Abdulaziz University Hospital (KAUH)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5321-5325}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11169}, abstract = {Background: most of articles addressed the underlying causes and management of Neonatal Nonhemolytic Jaundice, however only a few have investigated nonhemolytic jaundice among infancy which can turn fatal in severe case, however can be prevented by early diagnosis. Aim of the Work: was to investigate the most common etiologies of nonhemolytic jaundice among infants presented to at King Abdulaziz University Hospital (KAUH) which may help pediatricians to rearrange their differential diagnosis about nonhemolytic jaundice in infants. Material and Methods: this is a retrospective observational study of all infants aged between 1-12 months, conducted at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia from January 2016 to November 2017. Data collection was done using Microsoft Excel while data analysis was done using SPSS version 21. Chi -square test was used to test if associations would be appropriate. Results: out of total 105 patients enrolled in this study, complete data set was available for 88 only patients during 2012. The mean age at presentation in months was 2.73 (± SD 2.21) range from 1 to 12 months. Among the sample, the final outcome was as follows ; 59 (67%) jaundice-free, 14 (15.9%) still diseased and 15 (17%) dead. Sepsis was the most common cause of jaundice with 33 cases (37.5%), followed by biliary atresia 10 cases (11.4%) and congenital hypertrophic pyloric stenosis 7 cases (8%). On the other hand, the least common causes were rare diseases like wolman syndrome, crigler-najjar syndrome and autoimmune hepatitis and each of them represents 1 case. The overall number of deaths in our study was 15 (17%). Seven of them were due to sepsis and 2 were due to biliary atresia. Conclusion: we hope to help the local physicians in Jeddah to arrange their differential diagnosis of nonhemolytic jaundice among infants and deal with it seriously, due to the high incidence of critical illness and death.}, keywords = {Nonhemolytic Jaundice,Hyperbilirubinemia,Infant jaundice,KAUH}, url = {https://ejhm.journals.ekb.eg/article_11169.html}, eprint = {https://ejhm.journals.ekb.eg/article_11169_4378486a46aa02e51d06c55b03d17fcd.pdf} } @article { author = {Osman, Mahmoud Abd El Megid and Elsaeid, Kadrey Mohamed and Mosa, Neveen Ibrahim and Saleh, Shereen Abou Bakr and Mansouer, Khaled Amro Zaky and Zaky, Mohammed Fathy Sayed Mohammed}, title = {Comparison between Different Lines of Antiviral Combination Therapies against Hepatitis C Virus Genotype 4 in Egyptian Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5326-5333}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11170}, abstract = {Background: hepatitis C virus (HCV) infection in one of worldwide chief causes chronic liver illness. The extended effect of it is highly inconstant, ranging from least histological changes to broad fibrosis and cirrhosis with possibility of hepatocellular carcinoma (HCC). The morbidity and mortality of this global infection are growing. The estimated worldwide prevalence of HCV is a by the World Health Organization (WHO) affecting >170 million people worldwide. There is a varied distribution of HCV infection with about 23 million people likely to have it in the countries of Eastern Mediterranean Region. This is nearly number of infected people in both Americas and Europe. Egypt is considered to have highest prevalence worldwide with an expected 14.7% of total population seropositive for HCV. Aim of the Work: to compare the different new lines of antiviral combination therapies against hepatitis C virus genotype 4 in Egyptian patients as regards efficacy and safety. Material and Methods: an open label, single-center, parallel-groups, randomized controlled clinical study, comparing the different lines of antiviral combination therapies against hepatitis C virus in Egyptian patients as regards efficacy reflected by the sustained virological response and safety through reporting adverse effects occur with each drug combination. This study was conducted on confirmed HCV chronically infected patients with diagnosis based on HCV-RNA PCR. The cases were collected from viral hepatitis treatment unit in Electricity hospital, one of the centers of National Committee for Control of Viral Hepatitis (NCCVH). All cases in this study were assessed and managed according to updated guidelines by NCCVH in parallel with the European Association for Study of Liver (EASL) and the American European Association for Study of Liver (AASLD). Results: this study was conducted on 1000 patients with confirmed diagnosis of chronic HCV with positive serum HCV RNA by PCR technique. The cases were collected for this study had chronic hepatitis either without cirrhosis or with compensated cirrhosis differentiated by using the FIB-4 score. They could be INF-naïve or INF-experienced. The antiviral regimens used were SOF/SIM, SOF/LDV±RBV, SOF/DCV±RBV, PAR/OMB/RBV, and IFN/SOF/RBV. Out of 1737 patients who underwent initial evaluation, 531 patients were not eligible for therapy due to the presence of one or more exclusion criteria. The main causes for treatment exclusion were advanced liver decompensation, inadequately controlled diabetes and HBV co-infection. The total number of patients enrolled and eligible for antiviral treatment was 1206, 1000 of them started the treatment course, while 206 patients did not start it due to receiving treatment in other centres or died before starting the treatment. Conclusion: 1000 patients started antiviral therapy for HCV, they showed good adherence to treatment and high SVR rates compared to other recently published real-life studies. We used seven different treatment regimens, all of which proved to be efficacious and safe with no clear preference for each over others.}, keywords = {Antiviral Combination Therapies,Hepatitis C Virus Genotype 4}, url = {https://ejhm.journals.ekb.eg/article_11170.html}, eprint = {https://ejhm.journals.ekb.eg/article_11170_4be667a59c13cf85efe9744029583e0b.pdf} } @article { author = {AlSinety, Abdel Fattah Mohamed Al Sayed and Mousa, Asem Anwar Abdo and Amer, Ahmed Samy Soliman and Fata, Ahmed Mohamed Kamal and Abozeid, Hagagy AbdAlatif Ahmed}, title = {The Impact of Antithyroid Antibodies on Pregnancy Outcome following Intracytoplasmic Sperm Injection (ICSI) cycle}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5338-5344}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11171}, abstract = {Background: the presence of antithyroid antibodies (ATA) are frequently encountered in general population and approximately 1/5 of childbearing age women are positive for the antithyroid peroxidase antibody (TPO-Ab) or antithyroglobulin antibody (TG-Ab). Autoimmune thyroid diseases are rather frequent in women in the childbearing age, affecting 5-20% of them. They are characterized by the presence of antithyroglobulin and antithyroperoxidase antibodies, grouped under the definition of ATA. ATA are often detected in subjects complaining of hypo- or hyperthyroidism, but are no rarely found in patients without any sign of thyroid dysfunction. Aim of the Work: to investigate the impact of antithyroid antibodies on pregnancy outcome in cases of one or two failure of Intracytoplasmic Sperm Injection (ICSI) cycle. Patients and Methods: the present study is a prospective study. This study was conducted at Ahmed Oraby IVF center (private center), and was approved by the Medical Ethical Committee of Al-Azhar University. Informed consent was obtained from every patient according to Hospital Ethics Committee. Age of patients, diseases status and previous treatments were recorded. This study was done on 50 patients complaining of infertility with history of one or two failure of ICSI cycle and patients divided into two groups, in the ATA positive group, 25 women were positive for TG-Ab and/or TPO-Ab, 25 women negative for TG-Ab and/or TPO-Ab served as controls. All patients did not receive any adjuvant treatment, such as glucocorticoids, anticoagulants, or other adjuvants. Patients with other autoimmune diseases, or positive for anticardiolipin antibody, antinuclear antibody, lupus anticoagulant, or rheumatoid factor were excluded from this study. Results: there were no significant differences in age, BMI, basal LH, FSH levels, cause of infertility and duration of infertility between two main groups. No significant differences in terms of the days of ovarian stimulation, estradiol level, total gonadotropins dose, number of oocytes retrieved, available embryos and blactocysts number neither of embryos transferred nor in rates of fertilization, implantation and clinical pregnancy between two main groups were found. The only statistically significant among the ATA positive group increase the abortion rate was found p value 0.02.    Conclusion: patients with anti-TPO antibodies showed no significant differences in fertilization, implantation, pregnancy rates, live birth rates but higher risk for miscarriage following intracytoplasmatic sperm injection-ICSI and embryo transfer when compared with those negative for anti-thyroid antibodies.}, keywords = {Antithyroid Antibodies,Intracytoplasmic Sperm Injection,Antithyroglobulin,Antithyroid Peroxidase Antibody}, url = {https://ejhm.journals.ekb.eg/article_11171.html}, eprint = {https://ejhm.journals.ekb.eg/article_11171_b1bb1f2dff2db9c1c146dd68c7f008b9.pdf} } @article { author = {Sallam, Abd Alla Abd Alhamid and Salama, Mostafa Mahmoud and Alshaer, Hamada Mohamed Fahmy}, title = {Role of Layer by Layer Irrigation by Povidone Iodine during Closure of Potentially Contaminated Wounds in Reduction of Surgical Site Infection}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {72}, number = {9}, pages = {5345-5350}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.11172}, abstract = {Background: surgical site infection (SSI) is the infections occurring up to 30 days after surgery that affect the incision, deep tissue at the operation site or involve the organs or body space. Infection at the surgical site remains the second most common adverse event occurring to hospitalized patients and a major source of morbidity following surgical procedures. Aim of the Work: this study was done to assess the role of irrigation of partially contaminated wounds by povidone iodine in reduction of surgical site infection. Patients and Methods: this descriptive prospective study was carried out on 100 patients of potentially contaminated wounds at El-Hussein University Hospital and others, Patients divided into two groups A&B each group consisted of fifty patients, Group A: their wounds irrigated layer by layer with povidone iodine during closure, Group B: their wounds closed without irrigation with povidone iodine. Results: total number of cases with SSI in our study is twenty cases 20% of the total count. In group A there was nine cases two of them showed pus formation. While, in group B there was eleven cases eight of them undergo pus formation. Conclusion: from our study we concluded that The irrigation of the subcuta­neous tissue during closure of potentially (clean) contaminated wounds layer by layer by povidone-iodine 10% solution did not significantly reduces the surgical site infection percentage but significantly reduced the forma­tion of pus within the infected wound cavity and thus reducing the severity of surgical site infection.}, keywords = {Surgical site infection (SSI),Potentially (clean) contaminated wound,Povidone-iodine (PVI),Irrigation}, url = {https://ejhm.journals.ekb.eg/article_11172.html}, eprint = {https://ejhm.journals.ekb.eg/article_11172_9fc540c844d3698f840e43c9cc4db862.pdf} }