@article { author = {Abdelaal, Khaled Mohamed and Abdelghaffar, Ayman Mohammad and Abdel Bary, Mohamed and Helmy, Abdelhady Ahmad and Ahmad, Islam Mokhtar and Mohamed, Essam Elbadry Hashim}, title = {Missed Traumatic Diaphragmatic Hernia: Presentation and Outcome of Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {386-390}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146631}, abstract = {Background: Diaphragmatic insults are the most frequently overlooked injuries in trauma patients. Sometimes it is difficult for trauma physicians to detect diaphragmatic injuries because they are clinically silent. Nevertheless, the precise determination of this hernia is crucial, as missed traumatic diaphragmatic hernia (MTDH) may lead to serious complications. Objective: To comprehend MTDH more readily regarding the presentation and evaluation of surgical management outcomes. Methods: All patients diagnosed with MTDH admitted to the emergency department for surgery at the period from January 2010 to March 2018 were included in the study. We evaluated our cases as regard age, gender, clinical presentation, type of trauma, time since trauma, site of the hernia, surgical technique, complications, and mortality.                                                                                                                           Results: 25 patients with MTDH were included, 76% were males, mean age was 33.3 years. 92% were left-sided, while 8% were right-sided. 56% of cases were detected within 20 to 40 years of age. Penetrating trauma was the cause in 76 % of cases, blunt trauma in 16%. The stomach and colon were the commonest herniated organs in 64% and 56 % respectively. Dyspnea, abdominal pain, and vomiting were the commonest presentation. Thoracotomy was performed in all patients. Chest infection, pneumonia, ARDS, and empyema were the commonest complications. 3 (12%) cases of mortality in our study. Conclusion: every effort should be done to detect diaphragmatic injury in trauma patients, and surgeons should have a high index of suspicion, for early diagnosis, to prevent complications with subsequent high morbidity and mortality.}, keywords = {Diaphragmatic hernia,Trauma,Missed diagnosis}, url = {https://ejhm.journals.ekb.eg/article_146631.html}, eprint = {https://ejhm.journals.ekb.eg/article_146631_5029725f75d4896adb1fba3a6b3cc4f7.pdf} } @article { author = {Teama, Mohamed AbdElkader and Bessar, Hagar Awad and El-Sayed, Noha Mohamed and Mahmoud, Tawhed Mahmoud Ismail}, title = {Evaluation of Angiopoietin 2 Serum Level in Lichen Planus and Psoriasis Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {391-398}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146632}, abstract = {Background: Psoriasis and lichen planus (LP) are common chronic inflammatory skin diseases. The exact pathogenesis of these diseases until now is not fully determined. Angiogenesis is tightly regulated by a balance between pro- and anti-angiogenic mediators. Objective: To assess the relation of Ang-2 serum level with angiogenesis and inflammation that occurs in psoriasis and lichen planus. Patients and Methods: Thirty adult patients were included in this study. They were divided into 2 groups, 15 patients each, of psoriasis and lichen planus (8 patients with combined cutaneous and oral LP and 7 patients with cutaneous LP only). In addition to fifteen healthy subjects taken as control. The activity of the diseases was estimated at the time of examination using specific activity index for each disease. The serum level of angiopoietin 2 had been estimated by ELISA. Results: It was found that these diseases had significantly higher serum levels of angiopoietin 2 than the control group. The serum levels of angiopoietin 2 were higher in psoriasis compared to lichen planus, but the difference between psoriasis and lichen planus was not statistically significant. There was significant positive correlation between serum levels of angiopoietin 2 and the clinical severity of psoriasis. On the other hand, there was no correlation between serum level of angiopoietin 2 and the clinical severity of lichen planus. Conclusion: An important evidence on the importance of angiopoietin 2 serum level in pathogenesis of lichen planus as well as psoriasis. It elevated in serum of psoriasis and lichen planus patients that reflects its role in angiogenesis and inflammation that are important events in the development of these diseases.}, keywords = {Angiopoietin 2,lichen planus,Psoriasis,Evaluation}, url = {https://ejhm.journals.ekb.eg/article_146632.html}, eprint = {https://ejhm.journals.ekb.eg/article_146632_623cb344ca1457c906717c55308824f2.pdf} } @article { author = {Zakaria, Radwa Mohamed Mohamed and Elkeblawy, Mohamed Maher and Abdelmoneim, Abdelmoneim Ahmed and Mogahed, Hussein Gamal Hussein}, title = {Post Chemotherapy Balance Exercises in Children with Acute Lymphoblastic Leukemia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {399-403}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146634}, abstract = {Background: Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer; Children with this type of leukemia have poor postural balance, which is one of the side effects of chemotherapy. Objective: Toevaluate the therapeutic effect of static and dynamic balance exercises using both sides up (BOSU) ball on balance in children with acute lymphoblastic leukemia after completing their 6 months-chemotherapy treatment. Patients and methods: Thirty children patients of both sexes (18 boys and 12 girls) were participated in this study, who were selected from Benha Children Hospital with acute lymphoblastic leukaemia and had chemotherapy treatment for 6 months participated in this study. They were randomly assigned to 2 groups of an equal number, control group, 15 child patients who were 5-8 years of age (6.53 ± 1.13) that underwent gait training therapy and study groups, 15 child patients who were 5-8 years of age (6.67 ± 1.11), that underwent the same program in addition to static and dynamic balance training program by using BOSU ball. Results: There was a significant improvement of balance performance in study group more than control group. Conclusion: Balance exercises using BOSU ball can be used effectively in treating balance defect post chemotherapy in children with acute lymphoblastic leukemia.}, keywords = {Acute lymphoblastic leukemia,Balance Exercises,Post chemotherapy side effect}, url = {https://ejhm.journals.ekb.eg/article_146634.html}, eprint = {https://ejhm.journals.ekb.eg/article_146634_6c0f7f45354b7f79a44619043c83d03a.pdf} } @article { author = {Ali, Ahmed Elsaied Abd-Elrahman and Arafa, Sherif Kamal Hafez and Elsayed, Amir Abou Zkry and El Sharkawy, Mahmoud Fawzy Shehata}, title = {Comparative Study between Ultrasound-Guided Serratus Anterior Plane Block and Thoracic Epidural Analgesia for Breast Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {404-409}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146637}, abstract = {Background: Breast surgery is a 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. Objective: To compare the difference between the anesthetic effect of thoracic epidural versus serratus anterior plane block in breast surgery. Patients and methods: This study conducted on 60 adult patients scheduled for elective breast surgery divided into three groups. Each group contains twenty patients. Group A (n. 20) received general anesthesia only, Group B (n. 20) received combined general anesthesia and thoracic epidural analgesia, by receiving 6–8 ml of 0.25% bupivacaine and 0.05 mg fentanyl via the epidural catheter and Group C (n. 20) received serratus anterior plane block combined with general anesthesia. Results: The results of the present study demonstrated that SAP block caused hemodynamic stability, decreased the intensity of postoperative pain, reduced postoperative analgesic requirement, prolonged the time needed for the first request of analgesia, Therefore it can be considered as a safe procedure and effective for intraoperative and postoperative pain control in breast surgeries. Also, this study demonstrated that there is no difference between the groups according to nausea and vomiting. Conclusion: SAP block can produce excellent pain relief during the first six postoperative hours. It has a great promise due to its simplicity, easy-to-learn techniques, and relative lack of contraindications and complications.}, keywords = {Ultrasound,Serratus Anterior Plane Block,Thoracic epidural analgesia,Breast Surgery}, url = {https://ejhm.journals.ekb.eg/article_146637.html}, eprint = {https://ejhm.journals.ekb.eg/article_146637_f51b9e1000daf487b6553b63b40f4a14.pdf} } @article { author = {Samaka, Rehab Monir and Basha, Mohamed Ahmed and Mahmoud, Yara}, title = {Role of Myxovirus Resistance Protein 1 (MXA) in Psoriatic Skin}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {410-415}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146638}, abstract = {Background: Myxovirus-resistance protein 1 (MXA) is a key mediator of the interferon-induced antiviral response and is tightly regulated by type I IFNs. The expression of type I IFN signaling components is markedly increased in psoriasis skin lesions. The role of MXA in psoriasis pathogenesis is still poorly understood. Objective: The aim was to investigate the role of MXA in psoriatic skin. Material and Methods: Medline databases (PubMed, and Medscape) and all materials available in the internet were searched. The search was performed in December 2020. Study selection: The initial search presented 120 articles. The number of studies that met the inclusion criteria was 17. The articles included diagnosed patients with chronic plaque psoriasis of both genders. Data synthesis: Significant data were collected. Then a structured review was performed. Data extraction: If the studies did not fulfill the inclusion criteria, they were excluded. Data from each eligible study were independently abstracted in duplicate using a data collection form to capture information on study characteristics, interventions, and quantitative results reported for each outcome of interest. Finding: In total 9 potentially relevant publications were included; it was found that cytoplasmic localization of MXA in the keratinocytes of the psoriatic skin might play a private role in psoriasis pathogenesis. Conclusion: Cytoplasmic localization of MXA in the keratinocytes of the psoriatic skin might play a private role in psoriasis pathogenesis. This can open a new gate for a target therapy in psoriasis.  }, keywords = {Myxovirus resistance protein 1,Psoriasis,skin}, url = {https://ejhm.journals.ekb.eg/article_146638.html}, eprint = {https://ejhm.journals.ekb.eg/article_146638_5c7a6dcbdd181d38a988bab7f956b318.pdf} } @article { author = {Rashad, Nearmeen M. and Ahmed, Sherweet M. and Hussien, Marwa H.S. and Amer, Marwa G. and Ibrahim, Neveen F.}, title = {Association of Circulatory Long Non-Coding RNA AFAP1-AS1 with Risk and Progression of Hepatocellular Carcinoma in Egyptian Patients with Chronic Hepatitis C Virus Infection}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {416-425}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146640}, abstract = {Background: Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors worldwide. Long noncoding RNA (lncRNA) contribute to extensive biological processes and play oncogene or tumor suppressor roles in several diseases. Objective: To evaluate the expression levels of lncRNA AFAP1-AS1 in Egyptian patients with chronic hepatitis c virus infection (HCV) and to assess its relations with clinicopathological features of HCC. Patients and Methods: 60 chronic hepatitis C (CHC) patients in addition to 40 healthy subjects as a control group were enrolled in this study. CHC patients were divided into three groups, group I comprised 33 patients with chronic hepatitis C (CHC); group II comprised 15 patients with cirrhosis and 12 patients with HCC. lncRNA AFAP1-AS1 relative expression level was determined by RT-PCR. Results: lncRNA AFAP1-AS1 relative expression level was upregulated in CHC groups (4.28 ± 2.69) compared to controls [(2.56 ± 1.35), P < 0.001*]. Additionally, there was a significant difference between case groups as the highest relative expression level was in HCC patients (5.3 ± 2.28) compared to cirrhosis (4.28 ± 3.69) and CHC (3.93 ± 0.652). The lncRNA AFAP1-AS1 relative expression level was significantly positively correlated with clinicopathological features of HCC. Conclusions: lncRNA AFAP1-AS1 relative expression level was upregulated in CHC patients in particular patients with cirrhosis and HCC. Thus, circulatory lncRNA AFAP1-AS1 may be able to serve as a promising non-invasive diagnostic marker for cirrhosis and HCC.  }, keywords = {lncRNA,Chronic hepatitis C,Cirrhosis,AFAP1-AS1,HCC}, url = {https://ejhm.journals.ekb.eg/article_146640.html}, eprint = {https://ejhm.journals.ekb.eg/article_146640_7542dadd6d611d4f8ba2df0c9e3d845a.pdf} } @article { author = {El-Sayed, Youssef Abo Elwan and Mohamed, Mohamed El Sayed and Abdel Salam, Walid Abdallah and Soliman, Rana Ramadan Ibrahim}, title = {Assessment of Transcerebellar Diameter Accuracy in Detection of Gestational Age in Third Trimester in Cases of Intrauterine Growth Restriction}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {426-432}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146965}, abstract = {Background: Intrauterine Growth Restriction (IUGR) is defined as decreased fetal birth weight less than 10th percentile as regard to gestational age also diagnosed when there is a delay more than 2 weeks in a serial ultrasound monitoring of fetal gestational age. Objective: The aim of the work was to evaluate accuracy of transcerebellar diameter (TCD) in detection of gestational age in pregnancies with intrauterine growth restriction IUGR. Patients and Methods: Case-Control study was carried out on 52 women with normally progressing pregnancies during the third trimesters, with gestational ages between 27 and 37 weeks of gestation came to outpatient clinic of department of Obstetrics and Gynecology, Zagazig General Hospital and Zagazig University Hospital from June 2019 to March 2020, of them, 26 subjects were normal pregnancies and 26 subjects diagnosed as IUGR in 3rd trimester at gestational age (27week to 37 week). Trans-abdominal ultrasound was performed on all subjects; Fetal TCD was measured using the widest diameter of the cerebellum, measurement of fetal Bi-Parietal Diameter (BPD), Abdominal Circumference (AC), and Femur Length (FL). Results: There was statistically significant difference between gestational age (GA) by Last Menstrual Period (LMP) and sonar parameters at normal group but highest was TCD with P value 0.000 but in IUGR group only TCD, AC and FL were significantly positive correlated with GA; and TCD were highly significant. Conclusions: It could be concluded that the TCD measurement appears to be an accurate predictor of gestational age, even in the third trimester of pregnancy.}, keywords = {Transcerebellar Diameter,intrauterine growth restriction,Gestational age}, url = {https://ejhm.journals.ekb.eg/article_146965.html}, eprint = {https://ejhm.journals.ekb.eg/article_146965_5acc17354f85cdbeab6507f41b7120cf.pdf} } @article { author = {El-behiedy, Tarek Mohamed Abd El hamid and Soliman, Badeea Seliem and Ali, Fatma El Zahraa El Sayed and Ali, Mohamed Ramadan}, title = {Spontaneous Separation Versus Manual Removal of Placenta During Elective Cesarean Section Regarding Blood Loss}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {433-439}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146970}, abstract = {Background: Cesarean section (CS) rates have increased; this is especially concerning in developing countries. The mode of placental delivery contributes to morbidity associated with CS, and determines blood loss during CS. Objective: The aim of the work was to compare spontaneous placental delivery with cord traction and manual removal of placenta as regards amount of blood loss during elective cesarean section. Patients and Methods: This prospective Cohort study included a total of 48 Women prepared for elective cesarean section, attending at Zagazig University Hospitals and Zagazig General Hospital. This study was conducted between April 2019 to October 2019. The included subjects were divided into two groups (24 each) regarding methods of placental delivery. Group A; placenta was allowed to be separated spontaneously and removed by gentle cord traction. Group B; placenta was removed manually by the surgeon’s hand introduced into the uterine cavity and cleavage plane was created between the placenta and decidua basalis following which the placenta was grasped and removed. With the use of oxytocin by intravenous infusion 20 units after delivery of the baby in both groups. Results: Blood loss in spontaneous placental separation group was (881.67 ± 74.54) ml, but in manual placental separation group was (962.79 ± 116.11) ml, (p < 0.01).The preoperative hemoglobin (g/dl) in spontaneous separation group was (11.3 ± 1.07) and in manual separation group was (11.63 ± 1.11), postoperative hemoglobin in spontaneous separation group was (10.3 ± 0.83) and in manual separation group was (9.42 ± 0.74). Conclusion: Manual removal of placenta only seems to be superior in saving the time taken to extract out placenta. Manual removal of placenta adds to the post-operative complications in form of greater blood loss and infections.  }, keywords = {cesarean section,Manual placental removal,blood loss}, url = {https://ejhm.journals.ekb.eg/article_146970.html}, eprint = {https://ejhm.journals.ekb.eg/article_146970_a7c2aa74f68cd5f52bf765189306575c.pdf} } @article { author = {Osman, Mohammed Abdelrahman Abdelrahman and Attia, Samir Mohamed and Gomaa, Mohamed Said and Ismael, Hisham Khairy}, title = {Impact of Arterial Blood Pressure Management in Acute Ischemic Stroke on Short Term Outcome and Prognosis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {440-444}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146971}, abstract = {Background: Blood pressure (BP) is elevated in 75% or more of patients with acute stroke and is associated with poor outcomes. Whether to modulate BP in acute stroke has long been debated. With the loss of normal cerebral autoregulation, theoretical concerns are twofold: high BP can lead to cerebral edema, hematoma expansion or hemorrhagic transformation; and low BP can lead to increased cerebral infarction or perihematomal ischemia. Objective: To determine the impact of arterial blood pressure management in acute ischemic stroke on short term outcome and prognosis. Patients and methods: This study included 200 patients diagnosed with ischemic stroke and arrived to Emergency Hospital, Mansoura University over a year from June 2019 to June 2020. The cases were classified into 4 groups according to the systolic BP (SBP) of the cases; control group (SBP < 140 mmHg), group 2 (SBP 140-160 mmHg) group 3 (SBP 160-180 mmHg) and group 4 (SBP 180-200 mmHg). Results: The stroke score (follow up) according to blood pressure groups showed no statistically significant difference between the groups. Regarding the initial CT findings of the cases according to blood pressure groups, fourth group has more changes in CT brain, with a highly statistical significant difference observed between the groups. Conclusion: Elevated blood pressure in patients with stroke were associated with worse outcomes including ICU admission, mortality and duration of hospital admission. CT findings supported these findings as the percent of cases presented with initial infarction and cases who showed hemorrhagic transformation increased with elevation of BP.  }, keywords = {Arterial blood pressure,Acute ischemic stroke,CT,ICU}, url = {https://ejhm.journals.ekb.eg/article_146971.html}, eprint = {https://ejhm.journals.ekb.eg/article_146971_01495a0df657a85ddce30f7892222ac9.pdf} } @article { author = {Zaki, Mai Y. and Abdelmohsen, Soheir E. and Zamzam, Maha L. and Suliman, Marwa A.}, title = {Efficacy of Dexamethasone as A Prophylaxis for Radiation-Induced Pain Flare after Palliative Radiotherapy for Symptomatic Bone Metastases}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {445-454}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146995}, abstract = {Background: Bone is the most common site for metastases in cancer and may complicate a wide range of malignancies. Radiotherapy is a successful and efficient method for pain palliation and it can prevent the morbidity of bone metastases. Pain flare is a common event, occurring in almost 40% of the patients that receive palliative radiotherapy. Dexamethasone has shown possibility for prevention of such flare. Objective: This study aimed to investigate the efficacy of dexamethasone as prophylaxis for radiotherapy-induced pain flare in cases of painful bone metastases. Patients and Methods: Prospective randomized control trial was conducted at the Oncology and Nuclear Therapy Unit, Suez Canal University Hospital. The study involved 129 patients. Patients with painful bone metastases were divided into two groups, Study group received 8 mg dexamethasone first day of radiotherapy then for three days after finishing treatment, while control group received radiotherapy only. Results: The mean age in study group was 60.59 ± 7.64 years in comparison to 59.85 ± 7.02 years in control group. The most common primary sites were breast and prostate cancer. Incidence of pain flare was 8.8% of patients among study group while 19.7% of patients among control group. The difference between both groups was statistically non-significant. Conclusion: Dexamethasone does not play a significant role in reducing pain flare after palliative radiotherapy on painful bone metastases.}, keywords = {dexamethasone,Pain flare,Radiotherapy,Bone metastases}, url = {https://ejhm.journals.ekb.eg/article_146995.html}, eprint = {https://ejhm.journals.ekb.eg/article_146995_16be2d4dc23bbc3c5f0e4571f9f14ede.pdf} } @article { author = {Attia, Samir Mohamed and Nabeeh, Mostafa Mahmoud and Ahmed, Mohamed El-Said and Mohammed, Mohammed El-Atabani Abdel-Khalek}, title = {Role of Administration of Beta Receptor Blockers in the Management of Traumatic Brain Injury}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {455-460}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146975}, abstract = {Background: Severe traumatic brain injury (TBI) is associated with paroxysmal sympathetic hyperactivity (PSH), which is characterized by catecholamine surge. β-blockers can break this cycle by protecting β-receptor rich brain cells to decrease the cerebral oxygen demand, which may attenuate cerebral ischemia and secondary brain injury. In addition, β-blockers are beneficial to decrease hypermetabolism, lighten cardiac workload and ischemia, and lessen cerebral oxygen demand in head injury. Objective: The purpose of the study was to evaluate the effect of beta blockers (propranolol) on patients with acute TBI. Patients and methods: A total of 400 patients who were presented and admitted to Mansoura University Emergency Hospital (MUEH) surgical ICU with TBI were enrolled in this study. The enrolled patients were divided equally and randomly into 2 groups: Propranolol group (200 patients) who received IV propranolol and control group (200 patients) who received the standard medical and surgical care without propranolol. Results: The clinical outcome of the studied cases were obviously better in propranolol group (P <0.05). The neurologic examination; according to GCS; was improved in 34% vs. 27.5%. The cardiac examination; according to ECG showed changes in 12% vs. 26.5% in propranolol and control groups respectively. Also, the secondary outcome assessment parameters including ICU length of stay (LOS), ward LOS, mechanical ventilation, ventilation periods, survival rate and unfavorable GOS were better in propranolol group (P <0.05). Conclusion: Early propranolol administration is associated with post-head injury cardioprotective and neuroprotective effects, lower hospital resources use and better functional outcome.  }, keywords = {Beta Receptor Blockers,ICU,Traumatic brain injury}, url = {https://ejhm.journals.ekb.eg/article_146975.html}, eprint = {https://ejhm.journals.ekb.eg/article_146975_cb13c5c19a1953f313c8c9d761b86388.pdf} } @article { author = {Hegazy, Nagwa Nashat and Ragab, Seham Mohammed and El Hofey, Walaa Zaki}, title = {Environmental Risk Factors Associated with Children Autism Spectrum Disorders in, Menoufia Governorate}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {461-470}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146977}, abstract = {Background: Although no official statistics are available, some medical studies suggest that there are over 800,000 children with autism in Egypt. While, there is no cure for autism spectrum disorder, intensive, early treatment can make a big difference in the lives of many children. Objective: To explore environmental risk factors for autism spectrum disorders by using participants identified through broad ascertainment and reliable classification in Shebin El Kom city. Subjects and Methods: Our study was conducted at Psychiatric and Neurology Clinic, Pediatric Department, Menoufia University Hospital and centers for children with special needs in Shebin El Kom City.  A case control study enrolled 80 children, 40 of them diagnosed with autistic spectrum disorders by DSM-V-TR criteria with no another medical disease and another 40 apparently healthy children, from their brothers as a control group. All children attended to Psychiatric and Neurology Clinic, Pediatric Department, Menoufia University Hospital in Shebin El Kom City, Menoufia Governorate, Egypt during the period from April 2017 to January 2019. Results: There were significant differences between cases and control groups regarding gender, history of hypertension, diabetes mellitus, folic–iron, fever, bleeding, induced labor and precipitous labor, dental fillings, silver/mercury fillings in pregnancy and taking antibiotics during pregnancy or breast fed, born healthy > 4.5 kg, neonatal unit, breast fed, Jaundice, delayed sitting, delayed crawling, delayed walking and delayed speaking. Conclusions: From the current study, it was concluded that boys, high and moderate socioeconomic states and positive family history represented conditions associated with an increased risk for autism and ASDs in Egyptian population.  }, keywords = {autism,Fetal Factors,Maternal Factors,risk factors}, url = {https://ejhm.journals.ekb.eg/article_146977.html}, eprint = {https://ejhm.journals.ekb.eg/article_146977_909ed455daf683e33477ae1046159a39.pdf} } @article { author = {Rotab, Ola Abd elsamie Abd elsamie and Gwely, Nour Eldin Noaman and Atia, Samir Mohammed and Ismael, Hisham Khairy}, title = {Arterial Blood Gases as an Indicator of Early ICU Admission in Chest Trauma Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {471-478}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146978}, abstract = {Background: Trauma is injury to living tissue caused by an extrinsic agent. Trauma is a Greek word which means body injury. Blunt chest trauma causes 25% of traumatic deaths. It is commonly associated with multiple organ damage which leads to catastrophic patient outcome. Blunt chest trauma is more common than penetrating chest trauma. Arterial blood gas (ABG) studies report the degrees of acidemia, hypercarbia, and hypoxemia, which depend on cardiopulmonary status at the time of collection.  Objective: To determine the value of ABG measurements in patients with blunt chest trauma and its role in prognosis of different outcomes. Patients and Methods: This study included 100 patients arrived to Emergency Department (ED) in Emergency Hospital-Mansoura University during the period from 1-8-2019 to 1-8-2020. Patients were divided to subtypes according to ward or ICU admissions and presence or absence of lung injury. Length of hospital stay as outcome was also reported. Results: ABG and combined ABG measurements are strongly reflecting the clinical situation of chest trauma patients. It can predict longer length of hospital stay. PCO2 is more sensitive than HCO3- in prediction of ICU admission in chest trauma patients. SaO2, combined ABG analysis had higher sensitivity in prediction of ICU admission in chest trauma patients. HCO3- level and combined ABG were statistically significant in prediction of lung injury among studied patients with high specificity. Conclusion: ABG values and combined ABG values seemed to have a promising role in determination of patients admitted to ward versus others admitted in ICU.  }, keywords = {Advanced Trauma Life Support,Emergency medical system,Focused assessment with sonography for trauma}, url = {https://ejhm.journals.ekb.eg/article_146978.html}, eprint = {https://ejhm.journals.ekb.eg/article_146978_9e276a9684108388c8bdcf652dcd6aff.pdf} } @article { author = {Elsharkawy, Nagat Moaz Hamza Youssef and Abu Zeid, Mostafa Mohamed and Ahmed, Mohamed El Said and Attia, Samir Mohamed}, title = {Clinical Predictors of mortality in Acute Mesenteric Ischemia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {479-486}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146981}, abstract = {Background:  Acute mesenteric ischemia (AMI) is an emergency condition, which is accompanied by fatal complications. Clinical signs and symptoms are often unspecific. In addition, there is no single laboratory test to diagnose acute mesenteric ischemia. Early and accurate diagnosis of intestinal ischemia is important to provide rapid and correct treatment and reduce morbidity and mortality rates. Objective: To determine the clinical predictors of outcome in patients with acute mesenteric ischemia at Emergency Hospital, Mansoura University. Materials and Methods:  This was a prospective study, which was conducted on patients that were admitted to Emergency Hospital, Mansoura University over a year from December 2019 to December 2020. All patients above 18 years old with acute mesenteric ischemia were included while whom less than 18 years old were excluded. Results: this study had 50 patients (21 males and 29 females) with average age of 66 years old. The results showed that majority of the studied cases died, while only 42% (21 cases) of AMI cases survived. Hypercholesterolemia was considered the most frequently reported Co-morbidity followed by HTN, AF and lastly DM and cardiomegaly. There were statistically significant differences as regards co-morbidities (presence of 2 or more co-morbidities). Conclusion:  Acute Mesenteric Ischemia is a serious condition with high mortality rate especially in advanced age and in cases associated with comorbidities, presence of 2 or more co-morbidities, hypertension, hypercholesterolemia, past surgical history increase the incidence of death.  }, keywords = {Acute Mesenteric Ischemia,Hypercholesterolemia,Transmural necrosis,peritonitis}, url = {https://ejhm.journals.ekb.eg/article_146981.html}, eprint = {https://ejhm.journals.ekb.eg/article_146981_f35047224e38647ede9bba12c5753398.pdf} } @article { author = {Saleh, Ahmed Magdy and Zaher, Hosam Roshdy and Ibrahim, Mohamed El-Said and Attia, Samir Mohamed}, title = {Epidemiology of Vascular Neck Injury in Polytrauma Patients in Emergency Hospital Mansoura University, Egypt}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {487-490}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146988}, abstract = {Background: Trauma is considered to be the second most common cause of disability. Injuries to the neck can have significant morbidity and mortality that demand immediate attention and intervention. The most common clinical presentations for patients who reach trauma centers alive are shock, active bleeding, hematoma, and neurologic deficit. Objective: To determine the epidemiology of vascular neck injuries to patients admitted to Emergency Hospital, Mansoura University. Materials and Methods: This study was conducted on 96 cases admitted to Emergency Hospital, Mansoura University suffering from Neck Vascular Injuries. Assessment includes ABCDE approach, AMPLE history taking, full clinical examination, and radiological investigations that involve FAS, multislice CT brain, Duplex U/S, and CTA (computed tomographic angiography) in selective cases. Results: shock was the main presenting symptom. Neck zone II was the most commonly affected in 41 (42.7%) of cases. Operative treatment was performed in 68 (70.8%) cases while Conservative treatment was performed in 28 (29.2%) cases. AS regards Incidence of mortality, 44 (45.8%) of cases died compared with 52 (54.2%) of cases who were Survived. Conclusion: Neck injuries were relatively uncommon, found in 2.5% of all TQIP observations. Penetrating trauma was the predominant mode of trauma among the studied cases. Shock was considered the commonest presenting symptom followed by airway compromise. The main management was operative treatment.  }, keywords = {Trauma,neck,Operative,Shock,penetrating}, url = {https://ejhm.journals.ekb.eg/article_146988.html}, eprint = {https://ejhm.journals.ekb.eg/article_146988_2a6eb41dfea4a279e8515a0cfda0d994.pdf} } @article { author = {Bahaa Eldin, Ahmed Mohamed and Hosny, Salwa Seddik and Adly, Nahla Nader}, title = {Assessment of TNF Alpha in Type 2 Diabetic Patients with Lactobacillus Acidophilus}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {496-501}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146989}, abstract = {Background: Lactobacillus acidophilus is a probiotic strain that is widely used in traditional foods such as dairy products and nutritional supplements. It has been shown that L. acidophilus interacts with immune system cells and increases intestinal integrity with a beneficial effect on glucose balance as it has been found to delay the onset of glucose intolerance, hyperglycemia, dyslipidemia and oxidative stress in diet-induced diabetic rats. Objectives: To assess the level of TNF alpha in type 2 diabetic patients with lactobacillus acidophilus. Patients and methods: This study is a case control study that was conducted on 100 type 2 diabetic patients diagnosed according to the American diabetes association diagnostic criteria. They were recruited from the Outpatient Clinic of Internal Medicine and Endocrinology Department Unit of Ain Shams University Hospitals during the period from February 2019 to November 2019. They were divided into 2 groups, group 1 that included 50 type 2 diabetic patients with atherosclerosis and group 2, which included 50 type 2 diabetic patients without atherosclerosis. Results: There was a statistically significant positive correlation between PCR cut-off threshold and HbA1c (p-value = 0.026), 2hr pp (p-value = 0.013) and intimal media thickness (p-value = 0.031) and there was a statistically significant positive correlation between TNF alpha level and HbA1c (p-value = 0.015), LDL cholesterol (p-value = 0.024) and intimal media thickness (IMT) (p-value = 0.033). In addition, there was highly statistically significant positive relation found between TNF alpha level and PCR cut-off threshold (p-value < 0.001). Conclusions: Lactobacillus acidophilus has been found to delay the onset of glucose intolerance, hyperglycemia, dyslipidemia and oxidative stress in patients with type 2 diabetes mellitus.  }, keywords = {Lactobacillus acidophilus,Type 2 diabetes mellitus,TNF alpha}, url = {https://ejhm.journals.ekb.eg/article_146989.html}, eprint = {https://ejhm.journals.ekb.eg/article_146989_e6afea633104d9d9e508a5e7be85ce46.pdf} } @article { author = {Gad, Said Abdelbaky and Elagrody, Ahmed I.}, title = {Are Diabetes Mellitus and Diabetic Nephropathy Good Predictors of Osteoporosis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {497-501}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146992}, abstract = {Background: Osteoporosis is a metabolic bone disorder with a tendency for fracture and diabetes mellitus (DM) has a close relation to osteoporosis. Objective: Is to study the role of diabetes mellitus (DM) and diabetic nephropathy in the acceleration and production of osteoporosis. Patient and Methods: This study included 88 cases which were divided into 2 groups; 44 patients with DM and 44 patients as a control group with no sex predilection. Both groups were exposed to full history taking, bone mineral density (BMD) measurement, fasting blood sugar, urinary albumin, postprandial blood sugar, HA1C, creatinine, urea, HOMA- IR. Result: There is a strong and positive correlation between DM, diabetic nephropathy, and incidence of osteoporosis as BMD was -0.59 (-5.0:1.0) and -0.08 (-3.0:1) for cases and control respectively and 36.4% of diabetic cases had osteoporosis and only 11.4% of control had osteoporosis. Conclusions: Osteoporosis (OP) is a more complication in patients with DM. Increased risk of OP present in older age group, and female sex. Diabetic patients on long-term insulin therapy are at high risk of OP. due to high bone turnover and low bone formation.  }, keywords = {DM,diabetic nephropathy,Osteoporosis}, url = {https://ejhm.journals.ekb.eg/article_146992.html}, eprint = {https://ejhm.journals.ekb.eg/article_146992_98d9029f86f066ba5e21392f285a331d.pdf} } @article { author = {Ahmed, Salwa Sabry and Abdelmonem, Allam Mohamed and Ibrahim, Mohamed Sabry and Ali, Eman Hassan}, title = {Different Timing of Intrauterine Insemination and Pregnancy Outcome in Patients with Unexplained Infertility: A Randomized Controlled Study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {502-505}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.146994}, abstract = {Background: In this era of rapid advancements in assisted reproductive technologies, intrauterine insemination (IUI) is still widely offered to subfertile couples, as a cheaper and less invasive treatment option before proceeding to IVF. Objective: To determine the most suitable timing of hCG administration prior to intrauterine insemination for optimizing pregnancy outcome and success rate. Patients and methods: A randomized controlled study conducted in Obstetrics and Gynecology Department, Sohag University from 30 June 2018 to 30 June 2019 and included couples with unexplained infertility. A total of 110 patients were recruited in our study, 30 patients dropped out; where 20 patients were due to inadequate stimulation, bad endometrium or more than 3 follicles were present, 6 patients did not show up for folliculometry after being given treatment and 4 patients did not show up for the procedure after being given the hCG trigger. Results: This study showed an improved pregnancy rate when IUI was performed with a time interval of 24–36 h (13 case with positive pregnancy test). Conclusion: IUI after ovulation induction can be done any time between 24 and 48 h after hCG injection without significant differences in pregnancy rates.  }, keywords = {Intrauterine insemination,Ovarian induction,Unexplained infertility}, url = {https://ejhm.journals.ekb.eg/article_146994.html}, eprint = {https://ejhm.journals.ekb.eg/article_146994_4d6a3dbf7c54a7e9165c4117c48a4582.pdf} } @article { author = {Bakouri, Mohammed Abobaker Mohammed and El-Soufy, Mohamed Abd Allah and El-Hewala, Tarek Abd ELSamad and Fahmy, Fahmy Samir}, title = {Fixation of Distal Ulna Fractures by Distal Ulnar Locked Hook Plate}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {506-513}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.147000}, abstract = {Background: Distal ulna fractures are often found in conjunction with distal radius fractures, and the complexity of the interaction of the distal ulna with the radio-ulnar joint and triangular fibrocartilage complex makes understanding and treatment of distal ulna fractures challenging. Objective: To determine the efficacy and analyze the results of Locking Compression Distal Ulna Hook Plate (LC-DUP) in patients suffering from distal ulnar fracture (either isolated or associated with distal radius fractures). Patients and methods: This prospective clinical trial study included 18 patients. The age of the studied group ranged from 22 to 58 years; half of the group had age ranged from 30 to 40 years. They were suffering from distal ulna fractures and were treated by locked compression distal ulnar hook plates during the period from November 2019 to July 2020. Results: All patients eventually achieved full union. Only two of them had delayed union. The radiological and clinical assessment of fracture site and DRUJ was promising.  More than three quarters of patients had excellent outcome, while the rest quarter; half of them had good, and the other half had satisfactory outcome according to the Modified MAYO Score, which had mean of 90.5 ± 14.6. While, the mean of the Quick DASH score was 9.8 ± 5.8. Conclusion: The good outcomes achieved in this study suggest that the use of the distal ulna hook plate could be an alternative treatment method for intra-articular ulna neck or head fractures, as well as basal oblique ulnar styloid fractures.  }, keywords = {Distal Ulna Fractures,Distal Ulnar Locked Hook Plate}, url = {https://ejhm.journals.ekb.eg/article_147000.html}, eprint = {https://ejhm.journals.ekb.eg/article_147000_67607977a1bcfebb420edc580bd13dc2.pdf} } @article { author = {Abdelmaksoud, Shaimaa Reda and Khashaba, Rana Atef and Eldesouky, Rasha Shaker and Assar, Effat}, title = {Pediatric COVID-19 Infection: Do Clinical Features and Hematological Parameters Predict the Need for ICU Admission?}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {514-518}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148528}, abstract = {Background: The world is facing the new pandemic caused by SARS-COV2. The confrontation of this new pandemic necessitates study and analysis of the clinical and laboratory finding in such entity. Objectives: To discuss the clinical and hematological findings in pediatric patients with SARS-CoV-2 infection and to correlate these characters with the need for ICU admission. Patients and methods: This was a hospital record-based study, in which the clinical features and laboratory findings of 29 pediatric patients with confirmed COVID-19 infection were obtained from the medical records of admitted pediatric patients. Results: This study included 29 pediatric patients with confirmed COVID-19 infection. Six cases (20.7%) were admitted to pediatric ICU. The most common presenting symptoms were cough in 23 cases (79.3%) and fever in 19 cases (65.5%). There was a significant association between tachypnea and ICU admission; as 5 out of 6 ICU cases (83.3%) had tachypnea compared to none 0/23 (0.0%) of the non ICU patients (P < 0.001). The frequencies of lymphopenia and thrombocytopenia were higher among ICU patients (100.0% and 50.0% respectively) than the non ICU ones (39.1% and 8.7% respectively) (P < 0.05 for both). The median values of lymphocytes and platelets counts were significantly lower in ICU patients than those of non ICU patients (P=0.002 and 0.007 respectively). CRP values were higher in ICU patients compared to non ICU patients (P=0.011). Conclusion: Decreased lymphocyte count, thrombocytopenia and elevated CRP can be stood out as discriminative laboratory indices for early ICU admission.  }, keywords = {CLINICAL FEATURES,hematological,lymphopenia,Pediatric COVID-19}, url = {https://ejhm.journals.ekb.eg/article_148528.html}, eprint = {https://ejhm.journals.ekb.eg/article_148528_b22baa11dd22094d1e6385999026e2b0.pdf} } @article { author = {Wagdy, Reham and Al-Ostaz, Sameer and Al-ghamdi, Omar and Kanaa, Ahmad and Al-Shareef, Saleh and Al-Mazidii, Mohammad and Albokhari, Ensaf and Al-Attas, Maha}, title = {Evaluation of Hypertension and Pre-Hypertension among Obese Children Living in Saudi Arabia by National and International Guidelines of Hypertension}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {519-530}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148529}, abstract = {Background: Pediatrics hypertension is a major public health concern. The burden of hypertension among children has increased especially in high-income countries due to the surge in obesity prevalence. Objective: The current study aimed to evaluate the differences and similarities in the prevalence of hypertension and prehypertension among obese students living in Jeddah estimated by the updated Saudi guidelines and the guidelines of American Academy of Pediatrics for hypertension. Patients and Methods:  This cross-sectional study included a total of 107 students having BMI >18.5 and 192 students having BMI <18.5, served as a control, matched in age and gender. They were collected from national and international schools and from out-patient clinics of Hospitals of Ministry of Health . This study was done between October 2019 and March 2020. The participants were subjected to blood pressure measurements, classified based on updated Saudi & American guidelines of hypertension 2017. Results: Among overweight/obese students’ systolic hypertension was significantly higher and was 2.344 more likely to occur than among normal students (95% CI:1.283 – 4.285. <0.001), the prevalence of systolic hypertension grade I was significantly higher by Saudi guidelines compared to that recorded by American among overweight/obese group (21.5% versus 12.1, P=0.004). The prevalence of elevated systolic blood pressure by American guidelines was significantly higher among overweight/obese group above 13 year when compared to its similar by Saudi guidelines (37.4% versus 25.2%, P=0.004). Conclusion: It could be concluded that overweight/obese students are at least two times more susceptible for hypertension than normal body weight students. A fixed threshold for hypertension of the updated American guidelines for teenager could be the cause of a down-estimation of prevalence of hypertension to prehypertension state.}, keywords = {Hypertension,Pre-hypertension,Obesity,Saudi guidelines of hypertension}, url = {https://ejhm.journals.ekb.eg/article_148529.html}, eprint = {https://ejhm.journals.ekb.eg/article_148529_8349585a15b46b15e6fab710b621c0f7.pdf} } @article { author = {Sleem, Ahmed and Mohamed, Mohamed A. and Khalifa, Abdelrahman H. and Abdelatif, Ahmed R. and Marzouk, Ashraf}, title = {Prospective Randomized Comparative Study between Tension Band and Intramedullary Screw Fixation for Olecranon Fractures}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {531-535}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148532}, abstract = {Background: Controversy exists regarding the best technique for treating displaced transverse olecranon fractures with advocates for three techniques: (1) intramedullary (IM) screw, (2) locking plate, and (3) tension band. Objectives: The aim of this study was to seek which method of fixation fits best according to olecranon fracture type and postoperative outcome. Two methods were used: K-wire with tension band and intramedullary screw. Patients and methods: A prospective randomized comparative study included 20 patients with displaced transverse or oblique fracture of the olecranon, treated at Department of Orthopedics, Sohag University Hospital. The patients were randomly divided into two groups of equal number where patients with odd numbers were treated using AO tension band wiring (Group I) and those with even numbers by intramedullary screw (Group II). Results: Patients’ characteristics were insignificantly different between both groups. The range of motion was significantly higher in group II than group I. Mayo Elbow Performance score (MEPS) was significantly higher at 4 weeks, 3month and 6 months in group II compared to group I but with an insignificant difference at 2 weeks between both groups. Visual analogue score (VAS) was significantly lower at 6 months in group II compared to group I but with an insignificant difference at 2 weeks, 4weeks and 3month between both groups. Conclusion: It could be concluded that olecranon fracture fixation with intramedullary screw is superior to K-wire with tension band in transverse or oblique non comminuted fractures with more range of motion, lower VAS, and higher MEPS.}, keywords = {Tension Band,Intramedullary Screw Fixation,Olecranon Fractures}, url = {https://ejhm.journals.ekb.eg/article_148532.html}, eprint = {https://ejhm.journals.ekb.eg/article_148532_866c0b45de74b5481e61037f2b098f05.pdf} } @article { author = {Hammoda, Rasha Mahmoud and Moussa, Salwa G. and Hassan, Rasha M.}, title = {Prevalence of Obesity in A Cohort of Egyptian Rheumatoid Arthritis Patients and Its Implication on Disease Activity}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {536-541}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148536}, abstract = {Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease with articular and extra-articular manifestations, several factors can affect disease outcome. Objective: To assess the prevalence of obesity in a cohort of Egyptian rheumatoid arthritis patients and study its relation to disease activity and extra-articular manifestations. Patients and methods: The study included 200 RA patients. Detailed medical history, disease activity score (DAS28), VAS, HAQ, were carefully recorded. High-resolution computed tomography (HRCT) was done and to detect lung affection. BMI was calculated and patients were sub-grouped accordingly into underweight, normal BMI, over-weight and obese patients. Results: Patients were 172 females and 28 males with a mean age of 45.1±14.2 years. According to BMI, 32% of patients were overweight, 35% were obese, 20% with normal BMI and 13% were underweight. Overweight and obese patients were significantly older (p ˂ 0.001), had longer disease duration (p ˂ 0.001), had higher ESR, CRP, DAS, HAQ, VAS (p ˂ 0.001), had more frequent arthritis (p˂0.001), had joint deformity, had rheumatoid nodules (p = 0.007) and ILD (p ˂ 0.001). Conclusion: overweight and obesity were frequent among Egyptian RA patients. It was associated with high disease activity and extra-articular manifestations. In turn, patients’ weight reduction can help in improvement of patients’ outcome and disease activity control.  }, keywords = {Obesity,Rheumatoid Arthritis,Extra-articular}, url = {https://ejhm.journals.ekb.eg/article_148536.html}, eprint = {https://ejhm.journals.ekb.eg/article_148536_c156ae38fe764e159e357f1ecc0ad901.pdf} } @article { author = {Ibrahim, Ayman Mohammed and Shokry, Wessam Sherin and Ebrahim, Hanan Ebrahim Mousa}, title = {Recent Advances of TIRADS Classification of Thyroid Nodules by Ultrasound}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {542-550}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148538}, abstract = {Background: Thyroid nodules are abnormal growths of thyroid tissue which commonly arise within an otherwise normal thyroid gland. They may be hyperplasia or a thyroid neoplasm, but only a small percentage of the latter are thyroid cancers. Objectives: To improve the management of the patients and to reduce cost-effectiveness by decreasing number of unnecessary fine needle aspiration cytology (FNAC). Patients and Methods: This study was conducted on 50 patients known or clinically suspected to have solitary thyroid nodule or multiple nodules, referred to Radiodiagnosis Department, Ain Shams University Hospitals. The cases included 33 females and 17 males (age between 41-50 years). Results: All the nodules with TIRADS 1 were benign. In TIRADS 2 there were 10 benign and 1 malignant nodules. In TIRADS 3 there were 4 benign and 1 malignant nodules. In TIRADS 4 there were 2 benign nodules and 4 benign nodules while in TIRADS 5 there were 2 benign and 4 malignant nodules. There was a statistically significant difference between the two groups. There was a statistically significant difference between the two groups with benign and malignant nodules regarding the texture of the nodules. Solid texture was higher in the malignant nodules and spongiform texture was common in the benign nodules while the cystic and mixed texture were comparable between the two groups. Conclusion: The major ultrasound features seen associated with malignancy were microcalcifications, taller than wider shape of the nodule, hypoechoic and marked hypoechoic echopattern of the nodule, irregular borders and presence of suspicious cervical lymph nodes.}, keywords = {Thyroid nodules,TIRADS Classification,Ultrasound}, url = {https://ejhm.journals.ekb.eg/article_148538.html}, eprint = {https://ejhm.journals.ekb.eg/article_148538_8afdd56a4c377cca6359a6aec852e822.pdf} } @article { author = {Ahmed, Khaled El-ghoneimy Said and Ibraheem, Asmaa Mohamed and Sayed, Nahla Saad Mohamed}, title = {Comparison between the Foveal Avascular Zone and Macular Capillary Network Density in Diabetic Retinopathy and Normal Retina}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {551-557}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148540}, abstract = {Background: Diabetic retinopathy (DR) is mostly a vascular disease where the development of macular oedema and proliferative retinopathy are major causes of visual impairment. Enlargement of the foveal avascular zone (FAZ) is associated with visual deterioration in patients with diabetic retinopathy. Objective: To evaluate the foveal avascular zone (FAZ) and perifoveal capillary network density in the superficial retinal layer (SRL) and deep retinal layer (DRL) in patients with varying severities of diabetic retinopathy (DR). Patients and methods: This is a prospective comparative randomized case-control study consisting of 77 eyes divided into two groups, each group underwent imaging using OCT-A device. Group one: 37 healthy control eyes, and group two: 40 eyes with DM of different degrees of diabetic retinopathy. Subjects were imaged between September 2019 and February 2020 at Kasr El-Ainy Teaching Hospital.  Results: The FAZ area at the levels of the superficial and deep vascular networks of eyes with DR were found to be larger compared with those of age-matched healthy controls, and as would be expected, control eyes had higher vascular density in both networks compared with the diabetic eyes. Furthermore, eyes with worse DR stage showed larger FAZ area and lower vascular density values. This study also showed that angiographic parameters, namely FAZ area and vessel density (VD) correlated with best corrected visual acuity. Conclusion: Our study revealed that vascular density and FAZ area can be quantified in DR eyes in a rapid, automated, and noninvasive manner with OCTA. Also foveal avascular zone area and vascular density as measures of DMI correlate with visual acuity in patients with DR.}, keywords = {diabetic retinopathy,FAZ,Macular Capillary Network Density,OCTA}, url = {https://ejhm.journals.ekb.eg/article_148540.html}, eprint = {https://ejhm.journals.ekb.eg/article_148540_83c995b337f4b2dc9547366ee97b91ec.pdf} } @article { author = {Abdelhameid, Azza Abdel Mageid and Helal, Khaled Fathy and Abohashem, Mohamed Fathy and Al Minshawy, Mohamed Abdel-Moneim}, title = {Effects of Metformin on Pregnancy Outcomes in Women with Polycystic Ovary Syndrome during First Trimester}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {558-564}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148557}, abstract = {Background: Polycystic ovary syndrome is a hormonal disorder commonly found in women of reproductive age affecting about 15% of them and is considered the most common cause of anovulatory infertility. Administration of metformin to these anovulatory women increase ovulation rate and continuing in first trimester improves the pregnancy outcome. Objective: To assess pregnancy outcome in women with polycystic ovary syndrome who continue metformin during first trimester with its co-morbidity and mortality. Patients and Methods: This prospective intervention study was conducted on 44 pregnant polycystic ovary syndrome women who were attending for antenatal care at Outpatient Clinic, Obstetric and Gynaecological Department, Zagazig University Hospital. These 44 women took metformin before pregnancy and was followed up by indication of ovulation and metformin (1000-1500 mg/day) until they got pregnant. Then they were divided into two group: group 1 (22) continuous metformin dose during first trimester and group 2 (22) who discontinued metformin therapy once pregnancy diagnosed. The 2 groups followed up by fasting blood glucose and fasting serum insulin at their first visit and at 28 weeks of gestation. Results: group 1 who continued (1000_1500mg /day) metformin in first trimester had good pregnancy outcomes (significantly lower weight gain, lower gastrointestinal diabetes mellitus and lower spontaneous miscarriage) than group 2 who discontinued metformin (p value: 0.001). Conclusions: good maternal outcomes in women with polycystic ovary syndrome who continued metformin during first trimester including decrease incidence of spontaneous miscarriage and gastrointestinal diabetes mellitus.}, keywords = {polycystic ovary syndrome (PCOS),Metformin,spontaneous abortion}, url = {https://ejhm.journals.ekb.eg/article_148557.html}, eprint = {https://ejhm.journals.ekb.eg/article_148557_c86c3c04b0882717297833bd9cc253a0.pdf} } @article { author = {Mansour, Nermin Maher and Aboelnour, Nancy Hassan and Faltaous, Fady Samy and Elkabalawy, Mohamed Maher}, title = {Effect of Vinica Alkaloids Iontophoresis on Post-Mastectomy Shoulder Pain}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {562-566}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148559}, abstract = {Background: Iontophoresis is a non-invasive technique used to increase the penetration of substances through the skin through the dermal layer (epidermis, dermis and parenchyma) in a controlled manner. Technological advances in recent decades have lowered the cost of equipment for implementation, which allowed for the expansion of this technique. Objective: To evaluate effect of vinica alkaloids iontophoresis on post-mastectomy shoulder pain. Patients and Methods: A randomized controlled study that was carried out on thirty females with age ranging from 35 to 50 years and suffering from post-mastectomy shoulder pain. The patients were randomly divided into two equal groups, each one included 15 patients. Patients in group A (Study group < /span>) received 45-60 minutes of vincristine iontophoresis (20 ml vincristine) 3 times/week in addition to conventional medical care, for eight weeks. While, patients in group B (Control group) received placebo 45-60 minutes of only 20 ml saline iontophoresis (3 times/week), in addition to conventional medical care, for eight weeks. Results: Significant improvements in VAS and shoulder range of motion (ROM) were reported in the study group compared to the control group (p > 0.001). In the study group, the percents of improvement of shoulder flexion, abduction, internal and external rotation were 22.9%, 24.62%, 35.85%, and 39.97% respectively. While, in the control group, they were 0.5%, 0.67%, 2.8%, and 3.35% respectively. VAS scores achieved higher percentage of improvement (54.05%) compared to control group (10.15%). Conclusion: Vinica alkaloids iontophoresis achieved significant improvements in shoulder pain and ROM following mastectomy. }, keywords = {Vinica alkaloids,Iontophoresis,mastectomy,rom,VAS}, url = {https://ejhm.journals.ekb.eg/article_148559.html}, eprint = {https://ejhm.journals.ekb.eg/article_148559_04a67a837b418b302275c247528851d3.pdf} } @article { author = {Omara, Mohammed Abd El Ghany and El Khouly, Nabih Ibrahim and Salama, Hend Talaat and Solyman, Ayman El-Sayed}, title = {Extended Use of Clomiphene Citrate in Induction of Ovulation in Polycystic Ovary Syndrome with Clomiphene Citrate Resistance}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {567-573}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148562}, abstract = {Background: Clomiphene citrate (CC) is still holding its place as the first-line treatment for induction of ovulation in polycystic ovary syndrome (PCOS) patients.  Objective: to assess the effect of extended clomiphene citrate on pregnancy outcomes of clomiphene resistant PCOS. Patients and methods: this study was conducted on 48 PCO patients with CC resistance attended to the Obstetrics and Gynecology Outpatient Clinic at Menoufia University and Al-Bajour General Hospitals, from April 2018 to February 2020.  Patients were treated with an extended CC administration (150 mg for 10 days) to overcome anovulation. Result: There was highly significant change in follicle-stimulating hormone (FSH), luteinizing hormone (LH) and FSH/LH after extended CC treatment (p < 0.001). Also, serum progesterone and number of follicles were significantly increased after treatment compared to before treatment. Conclusion: CC extended is a safe, effective with minimal side effect, but low pregnancy rate was observed. Therefore, further studies with large number of PCO patients with CC resistant with addition of other drugs are required to investigate the improvement of the pregnancy rate.}, keywords = {Clomiphene citrate resistance,Extended use,Rotterdam criteria}, url = {https://ejhm.journals.ekb.eg/article_148562.html}, eprint = {https://ejhm.journals.ekb.eg/article_148562_9182fa137f4f3d4bfa80ec5685821883.pdf} } @article { author = {Mohamed, Samy Hassanin and Essa, Waleed Mohamed El-Hady and Abd El-Azeem, Sherif Abdel-Raouf and Belassy, Mohamed Ramadan Ibrahim}, title = {Unilateral Fenestration versus Open Laminectomy in Treatment of Degenerative Stenosis of Lumbar Spine}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {574-580}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148564}, abstract = {Background: The syndrome of degenerative lumbar canal stenosis accounts for a large percentage of causes of low back pain in the elderly worldwide. Surgical management has demonstrated better clinical and radiological results than conservative treatment. It allows for adequate decompression of the thecal sac and the compressed nerve roots. However, aggressive laminectomy with facetectomy has been linked with many postoperative complications including instability. Hence, new less invasive modalities have been introduced such as fenestration and endoscopic laminotomy. Objective: This study aimed at comparing the safety and outcome of conventional laminectomy to unilateral fenestration in cases of lumbar canal stenosis. Patients and methods: It took place at the Neurosurgery Department at Zagazig University and included thirty six patients with lumbar canal stenosis; eighteen patients were treated by conventional laminectomy and eighteen patients were treated by unilateral fenestration. Results: Decompression led to an intense decrease of total pain in both groups. Matched with that experience in group I, but, with more remaining back and leg pain was found in group II, 6.58±0.99 and 6.75±0.96, respectively, compared with 2.16±0.57 and 2.75±0.86 , respectively, at the 12 weeks follow-up assessment (p < 0.001). The most obvious symptom of lumbar stenosis, neurogenic claudication improved in 91% of patients in group I compared to 83% in Group II. Patient satisfaction was higher in Group I, as the patients who underwent unilateral fenestration showed more decrease in total pain with 12 weeks postoperatively. Conclusion: Unilateral fenestration allows acceptable and safe decompression of the spinal canal in patients with degenerative lumbar stenosis.}, keywords = {Degenerative Stenosis,lumbar spine,Open Laminectomy,Unilateral Fenestration}, url = {https://ejhm.journals.ekb.eg/article_148564.html}, eprint = {https://ejhm.journals.ekb.eg/article_148564_65068a096d7e7d357032745de9829001.pdf} } @article { author = {Juwayli, Rabeea Mifath Mohammed and Farag, Adel Abdel Razik and Shalaby, Adel Abd El-Azim and Sharf El-Deen, Sherif Mohammed}, title = {Correlation between Refractive Errors and Intraocular Pressure after Adjusting by Central Corneal Thickness}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {82}, number = {3}, pages = {581-586}, year = {2021}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2021.148570}, abstract = {Background: There is a significant correlation between myopia and intraocular pressure as an increase in the intraocular pressure (IOP) was on a higher side in high and moderate myopias in comparison to emmetropic and low myopic patients indicating higher degrees of myopia as an important risk factor for ocular hypertension. Objective: To investigate the correlation between refractive status and intraocular pressure after adjusting for central corneal thickness. Patients and Methods: This study was conducted in the Ophthalmology Department at Zagazig University Hospitals on patients with refractive errors within 20-40 years with no detectable systemic or ocular pathologies that could affect the outcome of the study. The spherical equivalent of refractive errors ranges in myopia from -1 to -6 and in hypermetropia from +1 to +6. The sample was (50) eyes to be divided into two groups. It was calculated using Open Epi Program with a Confidence level of 95% and power of 80%  Results: The mean CCT of the studied myopic group was 544.68 ± 29.62, while among the studied hypermetropic group it was 548.9 ± 32.5, there was no statistically significant difference between both groups regarding central corneal thickness. The mean IOP of the studied myopic group was 17.44 ± 2.41.  While among the studied hypermetropic group it was 13.92 ± 1.8, there was a highly statistically significant difference between both groups regarding IOP. Conclusion: There was a statistically significant correlation between intraocular pressure and myopia with intraocular pressure being higher in the moderate myopic patient than in low myopia, thereby increasing the risk of glaucoma in these patients.  }, keywords = {Central Corneal Thickness,Intraocular Pressure,Spherical equivalent refractive error}, url = {https://ejhm.journals.ekb.eg/article_148570.html}, eprint = {https://ejhm.journals.ekb.eg/article_148570_3fe78945ebac5ebaaadfc23038870aa1.pdf} }