@article { author = {Ali, Mohamed Abd Elaziz and Abd Elkhalek, Yasser Ibrahim and Elkomy, Amal Ghazy Ahmed}, title = {Role of MDCT in Assessment of Inflammatory Renal Disease}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1770-1777}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040602}, abstract = {Background: Renal inflammatory diseases range from mild to severe, acute to chronic and may be associated with predisposing risk factors like diabetes mellitus, human immunodeficiency virus (HIV), leukemia, vesicoureteric reflux and staghorn calculi. Ultrasound (US) is the initial screening modality and is used for guiding interventions as well. The role of intravenous urography (IVU) has diminished lately, however it still remains the best modality to diagnose calyceal irregularity of early tuberculosis, papillary necrosis and to evaluate congenital anomalies. Aim of Work: The study aim to highlight the value of multidetecter C.T imaging in assessment of renal inflammatory diseases. Conclusion: C.T has the ability to diagnose and assess renal infection site and extension of infection to pararenal fascia, renal infection unilateral or bilateral and infection focal or diffused. CT has important role in assessment of complication and follow up of patients. CT guided FNAB can be done to diagnose renal infection and differentiate between infection.}, keywords = {MDCT,HIV,Ultrasound,Intravenous urography,Inflammatory Renal Disease}, url = {https://ejhm.journals.ekb.eg/article_11714.html}, eprint = {https://ejhm.journals.ekb.eg/article_11714_e6f07182ae7cb4efbf798def9dea12d3.pdf} } @article { author = {Metwally, Eman Soliman and Abdul Rahim, Susan Adil Ali and Mazzohi, Husham Aklo}, title = {Role of Diffusion Weighted MRI in Characterization of Ovarian Tumors}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1778-1785}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040603}, abstract = {Background: Ovarian masses present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are currently used to evaluate ovarian tumors.Functional imaging by means of diffusion weighted magnetic resonance imaging (DW-MRI) is now part of the standard imaging protocols for evaluation of the female pelvis. DW-MRI is important MR imaging technique which enable the radiologist to move from morphological to functional assessment of diseases of the female pelvis. Aim of the Study: The aim of the current study is to evaluate the diffusion-weighted MR imaging in prediction of the nature of suspicious ovarian masses which are detected previously by conventional ultrasound. Patients and Methods: MRI Unit, radiodiagnosis department, Ain Shams University hospital. The study is prospective, included thirty women who presented with suspicious adnexal masses on previous ultrasound examination and referred for further assessment and characterization by DW-MRI. Patients with contraindications to MRI (e.g. claustrophobia, cardiac prosthesis and metallic plates) are excluded. Results: The study included 30 women ranging in age between 24 and 61 years with mean age 43.22±11.15. Out of 30 cases, 12 had of benign ovarian tumors while 18 had malignant tumors. Conclusion: Thus, combination of DWI and conventional MRI implies using a completely noninvasive technique with no radiation exposure. It is cost effective (no additional cost to MRI examination), and easily added to the MR study protocols with no marked lengthening of examination time. It improves the specificity of MRI and thus increasing radiologist’s confidence in image interpretation which will finally reflect on patient’s outcome and prognosis.     }, keywords = {diffusion weighted,MRI,CT,US,Ovarian tumors}, url = {https://ejhm.journals.ekb.eg/article_11715.html}, eprint = {https://ejhm.journals.ekb.eg/article_11715_a162a557a63faaa63a8277b5d6879a91.pdf} } @article { author = {Elmenyawi, Azza A. I. and Hassan, Ahmed and Said, Seham A. and Sawar, Sherif}, title = {Relationship Between Hepcidin, Ferritin and C-Reactive Protein in Hemodialysis Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1786-1793}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040604}, abstract = {Objective: Uremia is a state of heightened inflammatory activation. This might have an impact on several parameters including those used in the management of anemia as ferritin, serum iron, transferrin saturation, C-reactive protein (CRP) and hepcidin levels. In spite of this complexity the existing data indicate that hepcidin has an advantage over ferritin in guiding treatment of anemia in patients with chronic kidney disease (CKD) as it directly reflects iron availability and the status of iron homeostasis.                                                                                                                                          Aim of the study: was to determine serum hepcidin levels in maintenance haemodialysis (HD) patients and to investigate its relation to ferritin and markers of inflammation as C-reactive protein.     Subjects and methods: This study was conducted on 40 maintenance haemodialysis patients and 20 age-matched apparently healthy controls from October 2015 till February 2016 at the Haemodialysis Departement, National Institute of Urology and Nephrology (NIUN). Creatinine, albumin, hemoglobin, leucocytic count, CRP, hepcidin and ferritin were measured.                      Results: Serum ferritin and hepcidin  levels were significantly higher in HD patients compared with  controls (825.67 ± 956.52 ng/ml and 9.2 ± 4.2 ng/ml vs 85.1± 63.35 ng/ml and 0.75 ± 0.39 ng/ml respectively)  (p< 0.001).There was significant difference in CRP in HD patients compared with controls (4.28 ± 3.7mg/L vs 1.35±1.04mg/L respectively)(p<0.05).There were insignificant positive weak correlations between serum levels of hepcidin and ferritin (r = 0.05, P = 0.74).                   Conclusion:  Serum hepcidin levels are increased in HD patients and, hence, could be used in the evaluation of anemia in such patients. Serum hepcidin provides useful information about the level and availability of iron during inflammation as compared with traditional markers of iron status. Availability of the ELISA assay for serum hepcidin will facilitate the routine measurement of hepcidin in clinical practice.                         }, keywords = {hepcidin,ferritin,Hemodialysis,C-reactive protein}, url = {https://ejhm.journals.ekb.eg/article_11716.html}, eprint = {https://ejhm.journals.ekb.eg/article_11716_4b20c5c648dcce008f446c6dea08d994.pdf} } @article { author = {Nadim, Amr Abdel-Aziz Mahmoud and ElBohoty, Ahmad ElSayed Hassan and Ghanem, Reda Mokhtar Kamal and Mahmoud, Fatma Mohamed}, title = {Using of Magnesium Sulphate for Fetal Neuroprotection in Patients Presenting by Intrapartum Fetal Distress at Term: A Randomized Controlled Trial}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1794-1802}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040605}, abstract = {Background: labour is a stressful event for the fetus but is well tolerated by most fetuses. However, in some infants stress of labour in terms of metabolic acidosis can lead to Hypoxic Ischemic Encephalopathy (HIE). HIE around term remains a major cause of neonatal mortality and morbidity with lifelong chronic disabilities. Such insults are not limited to high risk pregnancies but can also occur in about 50% of low risk pregnancies. On current evidence, it is estimated that in about 10 of brain damaged infants, the cause is hypoxia during labour.There has been considerable interest in magnesium sulfate (MgSO4) because magnesium alleviates excitotoxic damage by binding to the magnesium site on the NMDA (N-methyl-D-aspartate) glutamate channel. Aim of the Work: magnesium sulphate (MgSo4) for fetal neuroprotection in patients presenting by intrapartum fetal distress at term. Patient and Methods:this is a randomized controlled trial (RCT). The current study was conducted to single term pregnant women who developed intrapartum fetal distress (as defined later) and need emergency CS (ceaseran section) according to Ain Shams protocol. This study was carried on 200 pregnant females, recruited from observation and labour wards of Ain Shams University Maternity Hospital. The current study was conducted to single term 200pregnant women who developed intrapartum fetal distress and needs emergency CS (cesarean section) according to Ain Shams protocoltoexaminethe effects of administered magnesium sulphate .patient were invited to participate in the study after providing clear explanation of the study and its expected values. Result: patients were invited to participate in this study after providing clear explanation of the study and its expected values. The demographic data of included women showed no significant difference between groups in the age and gestational age There was a significant difference in Apgar score at 5 min between MgSo4 and placebo.MgSo4 had significantly lower the risk of decrease Apgar score < 7 at 5min(p:0.029) .Mgso4 also had significantly lower seizure attacks (p:0.002) and had highly significantly reduce NICU admission rate (MgSo4 group 20(20%) and placebo group 43(43%)(p: 0.001)).In MgSo4 group, 23 women reported adverse reactions associated with procedure. Among them, 16 (16%) reported only flushing and 7 (7%) reported only nausea. In placebo group, were 8 (8%) reported flushing and 2 (2%) reported nausea. Conclusion and Recommendation: magnesium sulfate is effective in reducing risk of Apgar score <7 at 5min. Magnesium sulfate appear to be effective in reducing seizure and NICU admission. Magnesium sulphate is associated with maternal morbidity rather than non exposure in the form of nausea and flushing. The improvement in short-term outcomes without significant increase in side effects indicate the need for further trials to determine if there are long-term benefits of magnesium and to confirm its safety.  }, keywords = {Magnesium sulphate,Fetal Neuroprotection,Intrapartum Fetal Distress,cesarean section}, url = {https://ejhm.journals.ekb.eg/article_11717.html}, eprint = {https://ejhm.journals.ekb.eg/article_11717_594e29d143f432c9997694e2d446a987.pdf} } @article { author = {El- Sayed, Mahmoud Mohamed and Abo-Ali, Fawzia Hassan and Sheha, Dina Sayed and Eissa, Abeer Abdelhamid}, title = {Role of Vitamin D supplementation in Immunomodulation and improvement of symptoms of patients with Chronic Spontaneous Urticaria}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1803-1813}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040606}, abstract = {Background: Chronic Spontaneous Urticaria (CSU) is an allergic auto-immune disease with more than 6 weeks of continuous symptoms, it is known to trigger allergic wheal formations and angioedema. Vitamin D at optimal levels plays an important role in adjusting innate immunity thus People who has deficient or insufficient levels of serum vitamin D suffer from disturbance in immune system. Accordingly, studies have been established to explore the effect of vitamin D on CSU. Aim of the Study: To determine the effect of 12 weeks daily oral vitamin D supplementation [ high (4,000 IU/d) versus low (600 IU/d) dose of orally administered vitamin D3] on Urticaria activity score (UAS-7), quality of life (QOL) and medication burden in patients with chronic spontaneous urticaria, and to assess the relationship between vitamin D levels and CRP in these patients. Patients and methods: This single blind randomized prospective study conducted to 50 patients with CSU, admitted to Ain shams hospital, 50 patients were divided into 2 groups according to the dose of vitamin D orally administrated to these subjects, the first was group A , patients have received vitamin D orally in High dose 4000 IU/Day compared to group B , which included 25 cases received oral vitamin D in a low dose concentration 600 IU/d , Patients has been followed up in 3 times at baseline (0 week) , 6 weeks and 12 weeks intervals. Results:  Serum vitamin D levels in Group were higher than Group B (44.48 12.86 vs 34.45 5.43). Medication consumption was higher in group A compared to group B, thus favors orally low dose administration of vitamin D at first 6 weeks in the beginning of treatment course. UAS7 score in group A was better than Group B from baseline) to 6 weeks (P=0.009 vs 0.239) and from 6 weeks to 12 weeks. (P= 0.011 vs <0.0011). There was no significant difference in serum CRP between group A and group B as regards to CRP, furthermore there was no statistically correlation between 3 times intervals in group A and group B separately (12.71 1.47 vs 13.11 1.45). Conclusion: Improvement of both quality of life, and UAS7 score after receiving of High dose 4000 IU/d vitamin D orally in Group A, could benefit patients with CSU and decrease the complication of this disease. It was also found Serum Vitamin D level has no significant relation with C Reactive protein level, thus we couldn’t relay on evaluation the chronicity of urticarial by measuring its value in serum blood with patients suffering from chronic spontaneous idiopathic urticaria.  }, keywords = {Vitamin D,Urticaria,auto-immune diseases,Immunomodulation}, url = {https://ejhm.journals.ekb.eg/article_11718.html}, eprint = {https://ejhm.journals.ekb.eg/article_11718_42c3c9fbc1f5d34bfed0677a8aa60a3f.pdf} } @article { author = {Sammour, Hazem Mohamed and Abuelghar, Wessam Magdi and El-Salam, Nermine Essam El-Din Abd and Ahmed, Haitham Hassan}, title = {TSH and AMH in Infertile Women}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1814-1822}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040607}, abstract = {Introduction: Infertility is defined as the inability of a couple to achieve pregnancy over an average period of one year (in women under 35 years of age) or 6 months (in women above 35 years of age) of unprotected sexual intercourse. Infertility can be due to female, male reasons or both. It can be either primary or secondary. Aim of the work: The aim of this study is to evaluate the association between thyroid function and serum AMH levels. Methodology: Type of the study: this study was conducted a case control study. Study site: This study was carried out at Ain-Shams maternity hospital (outpatient infertility clinic). Duration of study: In the period between December 2015 and December 2016. Patients and study design: According to the sample size calculation by using the IBM© Sample Power© Software (IBM© Corp., Armonk, NY, USA), the study performed on 128 women divided into 2 equal groups as follows: Group “1” (study group): 64 infertile women at reproductive age (20-35) years. Group “2” (Control group): 64 normal fertile women aged (20– 35) years. Result: TSH and patient age that were strongly correlated with AMH levels in 26 post-matched infertile patients using multivariate logistic regression. Both TSH levels and patient age significantly impacted AMH levels in infertile patients. Conclusion: AMH levels were inversely correlated with TSH levels in infertile women of reproductive age. Recommendations: The study should be done using larger sample sizes in a multicenter trial including both urban and rural areas to validate results. Autoimmune thyroid antibodies (thyroglobulin antibody and thyroid peroxidase antibody) could be assessed with TSH, FT4, FT3 and AMH as there is a strong association between infertility and autoimmune thyroid antibodies.  }, keywords = {TSH and AMH,thyroid function,infertile women}, url = {https://ejhm.journals.ekb.eg/article_11719.html}, eprint = {https://ejhm.journals.ekb.eg/article_11719_7fe2ff6a1f7abc3c686e6cf654dcbec6.pdf} } @article { author = {Allam, Khalid E. and Shalaby, Mennatallah H. and Moulood, Israa A.}, title = {Role of Diffusion Weighted MRI Imaging in Detection of Liver Metakstases}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1823-1827}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040608}, abstract = {Background: diagnosis of liver metastases is of essential importance in the staging of patients with a known primary tumor. Aim of the work: The study aimed to evaluate role of DWI in diagnosis of liver metastasis. Patients and methods: twenty patients were included in this study. The cases were evaluated over 6 months at Ain Shams University Hospital with a 1.5 Tesla Phillips (MR System Achieva) whole body imager. Results: in the sample of the study which was composed of 20 patients there were two patients who presented with negative lesion in DW MRI with sensitivity 100%, specificity 90% and accuracy 95%. Conclusion: DWI alone performs equally well as Gd-MRI in the diagnosis of liver metastases. In cases where gadolinium injection is not allowed, dynamic contrast-enhanced imaging can be replaced by a protocol based on unenhanced T1- and T2-weighted imaging combined with DWI. Recommendations: Further studies on larger scale of patients are needed to confirm the results of the study.  }, keywords = {Diffusion,weighted MRI imaging,liver metastasis}, url = {https://ejhm.journals.ekb.eg/article_11720.html}, eprint = {https://ejhm.journals.ekb.eg/article_11720_20ff998e18bc2733ed545feacde6425d.pdf} } @article { author = {Elsayed, Heba Mahmoud Lotfy and Abd Elghany, Mohammed Mahmoud and Kamel, Cherry Reda}, title = {Effect of Serum Potassium Level on Hemodynamic Stability during the Hemodialysis Session}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1828-1831}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040609}, abstract = {Potassium is the major intracellular cation with concentrations reaching 120-150 mEq/L. On the contrary, the extracellular fluid potassium concentration is much lower and kept within very narrow levels between 3.5-5.0mEq/L (1). Aim of the work: this work aimed to assess serum potassium level in patients on regular hemodialysis and to determine its clinical impact on hemodynamic stability during the hemodialysis session. Patient and method: serum (K) level of 30 patients on regular hemodialysis was measured before and after dialysis and the results were correlated with electrocardiographic (ECG) changes. Results: there was no change in P wave, PR interval or QT interval in all the patients, while QRS was found to be shortened in 3 patients (10 %) in the post-dialysis ECG and elongated in one patient (3.3%) in the post dialysis ECG, T wave showed dynamic changes in the form of reduction in the amplitude of T wave in 11 patients (36.7%). Conclusion: the absence of electrocardiographic changes in hyperkalaemic haemodialysis patients should be interpreted with caution.  }, keywords = {Hemodialysis,potassium,hyperkalemia,Chronic Kidney Disease}, url = {https://ejhm.journals.ekb.eg/article_11721.html}, eprint = {https://ejhm.journals.ekb.eg/article_11721_a5399c0adea549d59eecc25f272f4697.pdf} } @article { author = {Alammari, Mohammed and Al-Qwizani, Abdulmalek Rshood and Alzayed, Abdullah Fahad and Sabbagh, Aminah Abdulghany and Alshadokhi, Omar Abdulmohsen and Hani M, Al Qahtany. Faisal and Aldossary, Faisal Hammad and Ghallab, Eyaad Talat and Alfalag, Tariq Hamid and Alrwithey, Faisal Abdullah and Mohammed, Alzahrani Rashad and Hamed, Hamed Ali}, title = {The Role of Radiology in Anterior Shoulder Dislocation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1832-1837}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040610}, abstract = {Glenohumeral bone defects are a typical finding in shoulder dislocation and they are intensely connected with the reappearance of dislocation and failure following arthroscopic Bankart repair. Advanced imaging assessment should subsequently be performed in order to recognize, quantify and portray the bone defects. Despite the fact that magnetic resonance has significant value in the appraisal of the glenoid labrum and rotator cuff, computed tomography scan is the examination of choice for studying bone defects. The imaging methodology selected for shoulder dislocation relies upon its accessibility and the treatment plan for a specific patient. Radiography is economical and is promptly accessible. It ought to be executed as the underlying imaging examination in patients giving a clinical issue identified with the shoulder. It complements the other advanced methods and gives an outline of the bony components of the shoulder joint. In few patients, radiography obviates additional imaging.  }, keywords = {Bone defect,Glenohumeral instability,imaging,Shoulder dislocation,Radiography,Bankart lesion}, url = {https://ejhm.journals.ekb.eg/article_11722.html}, eprint = {https://ejhm.journals.ekb.eg/article_11722_4e711311becadd2e65fd67eb4bb515aa.pdf} } @article { author = {Onsy, Ahmed Mohamed and Shehata, Mohamed Abd El-Samie and El Tawab, Adham Ahmed Abd and Khalil, Abd El Rahman Ali}, title = {The Relation Between Red Cell Distribution Width (RDW) And Coronary Artery Calcium Score(CACS) in The Diabetic Patients Undergoing Coronary CT Angiography}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1838-1848}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040611}, abstract = {Background: red cell distribution width is a marker associated with increased mortality and morbidity in cardiac patients, however it’s relation with coronary artery calcium score (CACS) is not well studied yet. Aim of the work:  this study aimed to assess the relation between red cell distribution width (RDW) and coronary artery calcium score (CACS) in the diabetic patients undergoing coronary CT angiography. Patients and methods: this study was conducted on 60 patients presented for assessment of coronary artery disease (CAD) by coronary CT angiography and they were categorized into 2 groups, group (A) diabetics(30 patients),group(B)non-diabetics (30 patients), All patients included in this study were subjected to: History Taking, complete physical examination, multi-slice CT coronary angiography (MSCT) including calcium score(CACS), laboratory investigations including complete blood count (CBC) including RDW(SD&CV), serum calcium level(total and ionized), erythrocyte sedimentation rate (ESR), lipid profile. Results: higher RDW(SD) was associated with the presence of greater coronary complexity of CAD and higher calcium score. In our study total serum calcium and RDW (SD) were found to be independent predictors of high Ca score more than 100, while ionized calcium and systolic blood pressure(SBP) were independent predictors of high Calcium score more than 400. Cut off value of RDW to predict high calcium score (more than 100) was RDW(CV) more than 13.45 & RDW(SD) more than44.45, while Cut off value of RDW to predict high calcium score (more than 400) was RDW(SD) more than 45.1. Conclusions: a greater baseline RDW(SD) value was independently associated with the presence of a greater coronary complexity of CAD and higher calcium score.    }, keywords = {MSCT,CACS,RDW (SD and CV),CA,OR,CI}, url = {https://ejhm.journals.ekb.eg/article_11723.html}, eprint = {https://ejhm.journals.ekb.eg/article_11723_e2aa930018f952d01351658d4b7172b5.pdf} } @article { author = {El Rashedy, Omnia F and Ahemad, Zainab N and Ahemad, Ahemad R and Ebraheem, Hameda E}, title = {Cerebrospinal Fluid Level of Glutamic Acid Decarboxylase (GAD) Antibody in Patients with Encephalitis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1849-1855}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040612}, abstract = {Background: Assaying the Glutamic Acid Decarboxylas( GAD) antibody in patients with encephalitis in cerebrospinal fluid and blood serum and its role in autoimmune encephalitis in children. Objective: This study Aimed at screening for GAD antibody in CSF of children presenting with acute encephalitis  with non bacterial  cause mostly autoimmune.Participants and methods: study is a pilot prospective study, conducted in the Pediatric department, Children’s Hospital, Ain Shams University.Fifty patients diagnosed with encephalitis exhibited at least one sign of parenchymatous brain dysfunction such as altered consciousness personality or behavior change, seizure, paresis, or ataxia. Encephalitis was defined as the presence of encephalopathy plus at least two of four findings: (1) fever (body temperature>38C); (2) abnormal cerebrospinal fluid examination (pleocytosis>5 white blood cells/mL and/or increased protein content>40 mg/dL) with negative cerebrospinal fluid culture; (3) abnormal electroencephalography findings compatible with encephalitis such as diffuse or focal slow activity, or periodic lateralized epileptiform discharges; and (4)abnormal results of neuroimaging, including computed tomography and magnetic resonance imaging (10), ,with  age ranged from 6-144 Months; followed up In the period from September 2014 till March 2016.Basic clinical evaluation and laboratory investigations were done, GAD antibody level was measured in CSF and blood serum. Results: GAD receptor antibody titer was done in CSF which range from (36 -368 ng/l) with median of 64.83 (57.93-74.48), while in serum it range from (42.76-900) ng/l) with median 89.5(58.62-154.5).It was found that 6/50 (12%) patients had high GAD receptor antibody titer were high in CSF. The other 44/50 (88%) patients had low GAD antibody titer. In serum samples of twinty patients we had 8/20 (40%) patients had high GAD antibody titer and the rest were low GAD antibody titer 12/20 (60%).Significant occurrence of DCL, hospitalization plus mechanical ventilation and long term sequel were detected in patients with high GAD antibody titer. EEG findings; Two patients showed generalized epileptogenic activity, one patient had diffuse cortical dysfunction and two patient had multifocal epileptiform discharge and the rest of patients had normal finding. Eighty six precent had normal MRI findings,While 7 patients (14%) had non specific findings;3 patients had transient cortical meningeal enhancment,2 patients had high intensity in medial temporal lobe,one had abnormal signal intensity in medial temporal lobe and one patient had global brain atrophy. Conclusion: GAD Abs are directed against an intracellular antigen. The proposed pathogenic mechanisms of neurological disease in patients with antibodies directed against intracellular proteins is not clear. The present study emphasizes the importance of studying the CSF of patients with encephalitis suspected to be mediated by GAD autoimmunity.Both serum and CSF level must be assessed simultaneously as CSF level may change rapidly with fluctuation of disease. There are great efforts to be done to define the role of these GAD antibodies and to determine how they affect central nervous system function. These studies must be carried out so that appropriate treatments can be provided for the growing number of patients with possible antibody-mediated conditions.  }, keywords = {GAD,CSF,EEG,MRI,Autoimmunity}, url = {https://ejhm.journals.ekb.eg/article_11724.html}, eprint = {https://ejhm.journals.ekb.eg/article_11724_3702cb6977996852fc59ecdafa877658.pdf} } @article { author = {Adly, Nermien Naim and Rohaiem, Shaimaa Nabil Mohammed and Amer, Moatassem Salah and Mancy, Walaa Hasan}, title = {Frailty and Cognitive Impairment}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1856-1859}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040613}, abstract = {Background: frailty is defined as a multifactorial syndrome leading to difficulties in maintaining homeostasis, and vulnerability to stressors. Depression shares many manifestations, risk factors and consequences with frailty. Some studies included cognitive assessment as a component to evaluate frailty.    Aim of the work: this study aimed to assess depression and cognition in frail elderly and to assess if depression could be underlying link between cognitive function and frailty. Patients and methods: this case control study included 102 males and females elderly living in geriatric homes in Cairo and excluded those who were bedridden or had sensory impairment interfering with communication, stroke, Parkinsonism, severe osteoarthritis, or dyspnea on ordinary exertion. All patients were subjected to comprehensive geriatric assessment. Frailty was diagnosed using a modified version of Fried criteria. We used the physical activity metric that was constructed by Avila-Funes. Conclusion: this study showed that cognitive impairment and depression did not differ between frail and non-frail subjects.    }, keywords = {Frailty,cognitive impairement,depression,Elderly,Geriatric homes}, url = {https://ejhm.journals.ekb.eg/article_11725.html}, eprint = {https://ejhm.journals.ekb.eg/article_11725_fc07b39c000ed4560bbc31ab5d71e866.pdf} } @article { author = {Mansour, Mona N.}, title = {Accuracy of The SRK/T Formula Using Partial Coherence Interferometer, AL-Scan after Phacoemulsification}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1860-1863}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040614}, abstract = {Purpose: To evaluate the accuracy of SRK/T formula used for IOL power calculation by partial coherence interferometer in patients undergoing phacoemulsification surgery. Patients and methods: A prospective interventional clinical study included 40 eyes of 34 patients who underwent uncomplicated phacoemulsification with IOL implantation from March 2015 to March 2017. Biometries were measured using ultrasound or AL-scan and intraocular lens power was calculated using the SRK-T formula. Patients were divided into 2 groups based on device used for IOL power calculation: AL-scan or ultrasound ; Axial length:  >=25 mm or < 25mm; or lens opacity:  Cataractous or clear lens. The mean error (ME) was calculated from the difference between the formula predicted refractive error and the actual post operative refractive error by the end of the followup (3 months postoperative). Results: Mean axial length measured preoperatively was 27.47 ± 316mm (21.55-34.05) mm. 60 percent of the patients were within 0.5 D of the predicted refractive error and 90 percent were within 1.0 D. There was no statistically significant difference in the overall performance of the SRK/T formula between the mean error when dividing the patients into 2 groups according to: device used for IOL power calculation (P= 0.274); Axial length (P= 0.46); or lens opacity (P= 0.18) in precision of predicting postoperative refraction. Conclusions : SRK/T formula helps in improvement of the accuracy of IOL power calculation and decreasing the postoperative refractive error. By using SRK/T formula, there was no statistically significant difference between the AL-scan or applanation ultrasound used in biometry.    }, keywords = {Partial Coherence Interferometer,Biometry,AL-scan,Ultrasound,IOL power,SRK/T formula}, url = {https://ejhm.journals.ekb.eg/article_11726.html}, eprint = {https://ejhm.journals.ekb.eg/article_11726_913071e127ba3ea1015e1eb4e023429e.pdf} } @article { author = {El Barbary, Mohamed Metwally and Zaki, Gamal Fouad Saleh and Mohamed, Mahmoud Hassan and Mahmoud, Noura Mohamed}, title = {Anesthetic considerations for Endo-Vascular Management of Intracranial Aneurysms}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1864-1873}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040615}, abstract = {      Intra cranial aneurysms are acquired lesions responsible for about 80% of non-traumatic sub arachnoid hemorrhage. Treatment of the condition in the past has relied on craniotomy and clipping of the aneurysm to prevent a recurrent hemorrhage. Nowadays endovascular coiling is the best primary treatment. The anesthesia in interventional radiology room has special arrangement and precautions. Intra operative management of endovascular cerebral aneurysm from the start including: arrangement of the room, monitoring, induction, maintenance and emergence of the patients. Post-operative care is very important and good management of potential perioperative complications like: aneurysm rupture, cerebral infarction, cerebral vasospasm, contrast reaction and nephropathy is mandatory. Aim of the Study: reviewing the current medical literature as regards the anesthetic considerations and problems of endo-vascular management of intracranial aneurysm. Conclusion: anesthesia in interventional radiology room should have special arrangements and precautions. Intra operative management of endovascular cerebral aneurysm from the start including: arrangement of the room, monitoring, induction, maintenance and emergence of the patients. Post-operative care plays a key role in mitigating potential perioperative complications like: aneurysm rupture, cerebral infarction, cerebral vasospasm, contrast reaction and nephropathy are mandatory.  }, keywords = {Anesthesia,Post-operative care,Intracranial Aneurysms}, url = {https://ejhm.journals.ekb.eg/article_11727.html}, eprint = {https://ejhm.journals.ekb.eg/article_11727_9b173b820f5eadd989c8ff225dbd78ef.pdf} } @article { author = {Abdallah, Mohammed AR. and Zuelfakkar, Nehal Mohamed and Elbana, Radwa Hasan}, title = {Comparative Study of Male and Female Sebum Production}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1874-1879}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040616}, abstract = {Background: Evidence is given that gender-related differences in skin physiological properties exist. The aim of this study was to evaluate the difference between male and female sebum production by measuring sebum production over ½ hour, 1 hour and 11/2 hours in both males and females. Subjects and Methods: The study included 200 healthy volunteers and was carried out in the Dermatology outpatient clinic- Ain-Shams University – during the period from January and February 2017 (as the sebum secretion is lower during this time of year). A total of 200 healthy male and female subjects (Fitzpatrick’s skin types I–IV) with their age ranged from 15-25years old participated in this clinical study after giving avocal informed consent. Participants were divided to 100 males and 100 females. Results: Among male participants, it was found that sebum production significantly increase with time; sebum production at 1 hour was significantly higher than that at 0.5 hour; furthermore, sebum production at 1.5 hour was significantly higher than that at 0.5 hour. Conclusion: Sex difference is a significant factor affecting the amount of sebum production; which is significantly higher among males in comparison to age matched females. Rate of casual sebum production significantly increase among both males and females over time. Recommendations More studies are recommended to determine the factors and mechanism; molecular and endocrinal, behind the strong relation between male gender and the increased amount of sebum production.  }, keywords = {sebum,males,Females,Dermatology}, url = {https://ejhm.journals.ekb.eg/article_11728.html}, eprint = {https://ejhm.journals.ekb.eg/article_11728_c8172806d1b914c9dc62b5389a902773.pdf} } @article { author = {Khairy, Hassan T. and Mohamed, Mohamed E. and Hussain, Sherif H. and Al-Refaie, Mohamed S.}, title = {Value of Glycosylated Hemoglobin at 34 Weeks Gestation in the Prediction of Adverse Neonatal Outcome}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1880-1888}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040617}, abstract = {Background: Gestational diabetes is diabetes, or high blood sugar levels, that develops during pregnancy.  It occurs in about 4% of all pregnancies. It is usually diagnosed in the later stages of pregnancy and often occurs in women who have no prior history of diabetes. Aim of the Work: To assess the predictive value of elevated glycosylated hemoglobin at 34 weeks’ gestation with adverse fetal outcome as regard fetal macrosomia and neonatal hypoglycemia. Patients and Methods: This prospective longitudinal cohort study included 98 pregnant women who were recruited from the obstetric outpatient clinic and department at Al-Galaa Teaching Hospital. Results:  HbA1c ≥7.9 has sensitivity of 88.1% and specificity of 66.1%, in prediction of macrosomia and a sensitivity of91.9% and specificity of 63.9% in prediction of Hypoglycemia. Conclusion: HbA1c ≥7.9 has moderate diagnostic characteristics in prediction ofmacrosomia, and hypoglycemia, low diagnostic characteristics in prediction of RDS and NICU. Recommendations: Use of HbA1C is recommended for patients with GDM for screening, follow up and prediction of adverse neonatal outcomes.  }, keywords = {Glycosylated Hemoglobin,gestation,adverse neonatal outcome,Fetal Macrosomia}, url = {https://ejhm.journals.ekb.eg/article_11729.html}, eprint = {https://ejhm.journals.ekb.eg/article_11729_6402504c87650b6a3ead65d8ce93e283.pdf} } @article { author = {Eisa, Hanan Mohammed and Gamal El Deen, Mostafa Mahmoud and Abdullah, Yosra Abdelzaher and Youssef, Ayda Aly and El Naggar, Tamer Farouk}, title = {Role of MRI in the Diagnosis of Different Bone Marrow Lesions in Pediatric Patients with Hematological Malignancies}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1889-1894}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040618}, abstract = {Background: hematological malignancies are one of the major causes of childhood morbidity;leukemia is the most common of pediatric cancers whereas lymphoma is the third most common childhood malignancy, NHL accounts for approximately 7% of cancers in children younger than 20 years. In patients with hematological malignancies the diagnosis of bone marrow involvement is important to determine prognosis and treatment protocols. MR imaging is the most sensitive imaging modality in the diagnosis of bone marrow infiltration and provides excellent details and additional accurate information about the extent of bone marrow involvement. Aim of the Work: this study aimed to evaluate the role of MRI in the diagnosis of different bone marrow lesions in pediatric patients with hematological malignancies with a trial to highlight the role of different recent modalities in the diagnosis, staging, monitoring management and in post treatment follow up of these patients. Patients and Methods: this study involved 63 patients (37 males and 26 females) with mean age of 9 years (range from 1.5 years: 16 years). They are cases of bone marrow biopsy proven hematological malignancy. They were categorized into two groups, group I: new cases who had bone marrow infiltration, they received no previous chemotherapy, group II: cases under follow up who have bone infarction, with history of chemotherapy or bone marrow transplantation (BMT). The MRI examinations were performed on a superconducting 1.5 T unit. Chi-square test was used to study the association between each 2 variables or comparison between 2 independent groups as regards the categorized data. The probability error at 0.05 was considered significant, while at 0.01and 0.001 were highly significant. Results: the different bone marrow lesions included in this study group of patients showed different MRI diagnostic criteria. A highly significant probability of errors was found in the relation between ADC values of bone infarction, bone marrow infiltration and red marrow.Conclusion: MRI provides an excellent imaging modality for the diagnosis of different bone marrow lesions is pediatric patients with hematological malignancies and can reliably differentiate between them based on the characteristic findings of each.    }, keywords = {Bone marrow,Leukemia,Lymphoma,Magnetic Resonance Imaging}, url = {https://ejhm.journals.ekb.eg/article_11730.html}, eprint = {https://ejhm.journals.ekb.eg/article_11730_190d6b13c33decd8d831abbc5d3b6c4e.pdf} } @article { author = {Nassif, Mohamed A. and Abdul Rahim, Susan A. and Hussien, Rana Z.}, title = {The Role of Diffusion-Weighted MRI in the Characterization of Musculoskeletal Soft Tissue Tumors}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1895-1900}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040619}, abstract = { Background:  magnetic resonance imaging (MRI) has an important role in characterization of soft tissue tumors, yet, it lacks specificity for differentiation between the benign and malignant lesions. Aim of the Work: this study aimed to evaluate the ability of DW MRI in detection and characterization of the musculoskeletal soft tissue tumors. Patients and methods: this prospective study included 30 patients (20 females and 10 males) referred to MRI unit Ain shams University Hospital for MRI evaluation of musculoskeletal soft tissue tumors. Results: from 30 cases, 12 cases were benign (40%), 18 cases malignant (60%). From 12 cases of the benign, 8 cases were ≤ 40 years and 4 cases were > 40. From 18 cases of the malignant, 7 cases were ≤ 40 and 11 cases > 40. Ranging of ADC value of benign tumors (1.72-2.58); mean ADC (2.21  ´ 10-3 mm2/sec). Ranging of ADC value of malignant tumors was 0.52-1.82. Mean ADC value was 0.90 ´ 10-3 mm2/sec. Cut-off ADC value ≤ 1.14 less than 1.14 was benign and more than 1.14 was malignant; sensitivity 94.4% and specificity 91.7%. Conclusion: DWI with ADC mapping and measurement of ADC value proved to be a valuable non –invasive tool in differentiating between benign and malignant musculoskeletal soft tissue tumors. Recommendations: a larger population for future studies is needed. Thus, histopathologic work up is required for reliable characterization of soft tissue tumors (4).  }, keywords = {Diffusion-weighted MRI,musculoskeletal,soft issue,Tumor}, url = {https://ejhm.journals.ekb.eg/article_11731.html}, eprint = {https://ejhm.journals.ekb.eg/article_11731_7af0b1b438d3428372f7bb399655bc62.pdf} } @article { author = {Fathy, Hesham M. and Makled, Ahmed K. and Sabaa, Haitham A. and Yonis, Mohamed A.}, title = {Incidence and Risk Factors That Predict Chronic Hypertension after Delivery in Women with Hypertensive Disorders of Pregnancy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1901-1907}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040620}, abstract = {Background: hypertensive disorders of pregnancy (HDP) are important disorders complicating 5% to 10% of all pregnancies and they are a leading cause of maternal and fetal morbidity and mortality and associated with subsequent development of chronic hypertension. Aim of the work: this study aimed to determine the incidence and risk factors that predict chronic hypertension after delivery in women with hypertensive disorders of pregnancy. Patients and Methods: this cohort prospective study was conducted at Ain Shams University, Maternity Hospital. This study included a sample of 207 pregnant women with hypertensive disorders of pregnancy, followed up for persistence of hypertension after 3 months postpartum. Results: the subjects were categorized into case group (n=25, 12.1%) included patients diagnosed as chronic hypertension at the postpartum period and the control group (n =182, 87.9%) included the rest of the study subjects. Clinical and demographic factors were evaluated. By multivariate regression analysis, age, gestational age at diagnosis, parity, preeclampsia and early onset hypertension with end-organ dysfunction were predictors of progression to chronic hypertension. Conclusion: 12.1% of women diagnosed with HDP continued with persistent hypertension after delivery and some clinical and demographic risk factors such as old maternal age at HDP, lower gestational age at diagnosis, multiparous women, preeclampsia and hypertension with end-organ dysfunction were predictors of progression to chronic hypertension. Recommendations: further studies on a larger scale of patients are needed to confirm the current results.  }, keywords = {risk factor,chronic hypertension,delivery,hypertensive disorders of pregnancy}, url = {https://ejhm.journals.ekb.eg/article_11732.html}, eprint = {https://ejhm.journals.ekb.eg/article_11732_9f7cc46ab684490bef66c0229ff03c3c.pdf} } @article { author = {Nassef, Hana Hamdy and Sheha, Aliaa Sayed and Radhi, Ali Abbass}, title = {The Role of Diffusion Weighted MR Imaging in Assessment of Hepatocellular Carcinoma after Radiofrequency Ablation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1908-1910}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040621}, abstract = {Background: hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Surgical resection and local ablative therapies represent the most frequent first lines therapies adopted when liver transplantation cannot be offered. Aim of the work:this study aimedto evaluate the feasibility of DWI and the corresponding ADC values to detect tumor response after radiofrequency ablation for hepatocellular carcinoma. Patients and methods: MR examinations were done for 20 HCC patients post-RFA. Pre and post gadolinium enhanced images as well as DW sequences were performed. ADC values of ablation zones and liver parenchyma were assessed. ADC values of ablation zones and adjacent signal alterations identified in DWI were analyzed. Results:residual or recurrent lesions were detected in 4 patients (20%). The mean ADC value of ablated zones differed significantly from that of normal liver parenchyma. The corresponding ADC values were significantly lower in patients with residual lesion than in patients without residual lesion. Conclusion: it can be concluded that DWI is a feasible follow-up tool for post ablation liver contributing in detection of residual lesion.    }, keywords = {MRI,carcinoma,Radiofrequency ablation,liver tumor}, url = {https://ejhm.journals.ekb.eg/article_11733.html}, eprint = {https://ejhm.journals.ekb.eg/article_11733_db1b9b2010d50330db857fe32d8e5334.pdf} } @article { author = {F, Mustafa G and R M, Abd El Rahman and M, Rozeik K}, title = {Closure Versus Non Closure of Subcutaneous Tissue in Cesarean Section in Diabetic Women: A Randomized Controlled Trial}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1911-1917}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040622}, abstract = {Background: caesarean section is one of the most commonly performed abdominal operations on women in most countries of the world. Its rate has increased markedly in recent years and is about 20–25% of all child-births in most developed countries. Aim of the work: this study aimed to assess the surgical site infection rate and patient satisfaction following closure of the subcutaneous tissue compared to non-closure of subcutaneous tissue in the diabetic women undergoing cesarean section. Patients and methods: this randomized prospective controlled study was conducted in Ain Shams University, Maternity Hospital. Elective cesarean section was done during the period from June 2016 to May 2017 to a sample of 88 pregnant women with diabetes mellitus. Results: there was no significant difference between closure and non –closure of the subcutaneous tissue in cesarean section in the diabetic women regarding SSI and wound complications. However, there was a significant difference between closure and non- closure of the subcutaneous tissue as regard the time needed for cesarean section closure which was in favor of non -closure of the subcutaneous tissue. Conclusion: closure of the subcutaneous tissue was superior to non-closure as regard patient satisfaction and cosmetic outcome. Recommendations: subcutaneous tissue closure can be used in diabetic patients undergoing cesarean section as long as it was not associated with significant increase in SSI, it had better cosmosis and patients’ satisfaction.  }, keywords = {closure,non-closure subcutaneous tissue,cesarean section,Diabetic women}, url = {https://ejhm.journals.ekb.eg/article_11734.html}, eprint = {https://ejhm.journals.ekb.eg/article_11734_db2ff6c12aabb85e9b99b1ded419e59d.pdf} } @article { author = {Elghazaly, Hesham A. and Salem, Dina A. and Gobran, Nagi S. and Hussien, Mariam M.}, title = {Hypofractionated Radiotherapy Versus Conventional Radiotherapy in Management of Patients with High Grade Gliomas Older Patients and Poor Performance State}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1918-1922}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040623}, abstract = {Background: as guidelines for glioblastoma treatment was based on trial included patients less 70 years old and good performance only. We did a randomised trial to assess the optimum palliative treatment in patients aged 60 years and older and poor performance patients. Patients and Methods: this study included 50 (elderly and/or frail patients) with high grade glioma who presented to the Clinical Oncology Department, Ain Shams University during the period of November 2013 to march 2016.Theywere categorized in two groups (25 in each group). Group A received standard conventional fractionation of 60 Gy in 30 fractions over 6 weeks.  Group B received 45 Gy in 15 fractions over 3 weeks. Results: progression free survival in conventional RTH group was 4.1 months, while in hypo fractionated group it was 4.2 with no statistically significant difference between the two groups. The median overall survival was 7.2 in the conventional group and 7.4 months in the hypo fractionated group with no statistically significant difference between the two groups. After age analysis patients≥ 70 years old median overall survival was 5.4 month and 6.8 month in patients ≥ 70 years received hypofractionation.it was statistically significant difference (P value = 0.047). Conclusion: this study showed that short course of radiotherapy has the same efficacy as slandered conventional radiotherapy in older patients and frail patients. And in patients over 70 years short course should be the slandered of care.  }, keywords = {Hypofractionation,Glioblastoma,Multiform,elderly patients}, url = {https://ejhm.journals.ekb.eg/article_11735.html}, eprint = {https://ejhm.journals.ekb.eg/article_11735_f2a13e7d962278f62d961a8110cf2669.pdf} } @article { author = {Abd El Alim, Manal and Abdel Halim, Rania M and Habib, Sara A}, title = {Comparison of Broth Micro Dilution and Disk Diffusion Methods for Susceptibility Testing of Dermatophytes}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1923-1930}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040624}, abstract = {Background: Dermatophytes are responsible for the majority of the fungal infections involving skin, hair and nails. There has been a remarkable increase in the number of fungal infections especially in those people whose immune system is compromised by aging, HIV infection, organ transplantation or cancer therapy. Objective: The aim of this study was to compare both broth microdilution method & disk diffusion method for in-vitro activity of some antifungal drugs (Terbinafine, Fluconazole, Itraconazole) against different species of dermatophytes. Patients and Method: This study was performed on 50 dermatophyte isolates recovered from various clinical specimens (skin, hair and nail) collected from dermatology outpatient clinic of Ain Shams University Hospital. All samples were cultured on sabarouds. Isolates recovered from SDA were subcultured on Potato Dextrose Agar (PDA) & incubated at 28°C for 7 days to enhance sporulation. The growth was harvested in sterile saline & the conidial and hyphal suspension was adjusted to 0.5 macfarland. Then antifungal susceptibility was done using: Disk diffusion (DD) method and Broth micro dilution (BMD) method. Results: There was a highly significant agreement between the antifungal susceptibility testing of fluconazole, itraconazole and terbinafine by disk diffusion method and Broth micro-dilution method. In our studyagreement between both methods for itraconazole was 1.00 (kappa), for terbinafine was 0.947, and for fluconazole was 0.878. The factors that may affect the results of BMD or DD are type and size of inoculum, composition of the media, temperature and duration of incubation and disc strength. Conclusion: There was a highly significant agreement between the antifungal susceptibility testing of fluconazole, }, keywords = {Dermatophytes,Disk diffusion,Broth micro-dilution}, url = {https://ejhm.journals.ekb.eg/article_11736.html}, eprint = {https://ejhm.journals.ekb.eg/article_11736_313b484a78a35ee8e1646b7d14531541.pdf} } @article { author = {Moussa, Manal Hassan and Elhusseiny, Rania Mahmoud and El-Fiky, Seif–Allah Mohamed Refaat and Ahmed, Sahar El-Sayed}, title = {Evaluation of the Response of Fractional Carbon Dioxide (CO2) Laser and Punch Elevation Technique in Treatment of Acne Scars: A Split-face Comparative Clinical, Histopathological, and Immune Histochemical Study}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1931-1940}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040625}, abstract = {Background: Acne is the most common skin disease affecting adolescents and young adults, with associated scarring and its sequelae. Treatment options are either lifting procedures raising scar base closer to normal skin surface, or resurfacing ones injuring epidermis and superficial dermis with neocollagenesis and epidermal repair. Punch elevation (PE) method is better for improving deep atrophic acne scars, that can be combined with depth resurfacing. CO2 laser stimulates new collagen formation, tightens skin and raises scar to surface. Aim of the Work: to assess efficacy and safety of combination of PE technique and fractional co2 laser (Fr co2 L) compared to fr co2 L alone. Subjects and Methods: 20 atrophic post acne scars patients were subjected to history taking, general and dermatological examinations, identifying scars types and grades. Treatment response at start, before each fr. co2 L session and 4 weeks after last laser session was clinically evaluated by Goodman and Baron scale, and recording patients’ photographs, satisfaction, and complications. Histopathological examination of scar skin biopsies before and 4 weeks after the last fr. co2 L session was done using H&E, Mallory trichome, sliver stain and immunohistochemical VEGF. Results: combined treatment with fr co2 L and PE was more effective in improving post acne scars than fr. co2 L resurfacing alone. Histopathological examination before combined fr. co2 L and PE treatment and 1 month after the last fr. co2 L session showed high significant increase in epidermal thickness (H&E), increase in collagen fiber type III (Mallory trichrome stain), decrease in collagen fiber type I (sliver stain) and increase in fibroblasts’ activity (VEGF). Conclusion: both PE technique and fr. co2 L resurfacing show promising efficacy and safety in treating atrophic post acne scars, complementing each other to improve skin texture and appearance, with excellent cosmetic outcomes.  }, keywords = {acne scar,Punch elevation,fractional CO2 laser,Efficacy,safety}, url = {https://ejhm.journals.ekb.eg/article_11737.html}, eprint = {https://ejhm.journals.ekb.eg/article_11737_3ba8b3f3d291c5d229a6b0193b0611e0.pdf} } @article { author = {Abdel Salam, Mona Hosny and Mohamed, Mohamed Mostafa and Kamel, Cherry Reda and Mahmoud, Abdelkhalek Fouad}, title = {Study of Vitamin D3 Supplementation on Chronic Kidney Disease (Mineral Bone Disease (CKD – MBD) Parameters in Patients with Chronic Kidney Disease Stage 3)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1941-1949}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040627}, abstract = {Background: Bone profile parameters are affected by decreased estimated GFR within chronic kidney disease  stage 3. We aimed to investigate if  bone  profile  parameters  response   to vitamin  D3 supplementation , within  this  stage , became  affected  by  the  presence or absence of  diabetic  state.  Materials and methods: 30 patients having chronic kidney disease (stage 3)   were  enrolled  in  the  study. 19 patients constituted non – diabetic group I and 11 patients constituted  diabetic  group II . All of them   have received vitamin D3  1000 IU  daily  for  3  months . For all patients the following measurements were  performed  before  and  after  vitamin  D3  use :CBC , ESR1 & ESR2 , blood urea , serum  creatinine , estimated  GFR , complete  urine  analysis  , serum Na , protein / creatinine  ratio , serum calcium , serum phosphorus , calcium – phosphorus  product , serum  albumin  , serum  alkaline phosphatase  ,  and  intact  serum  parathyroid  hormone. Results: Serum calcium levels have increased, while   intact parathyroid  hormone   has  decreased  within  both  groups  , with  a  more  obvious  response  within  the  diabetic  group . Serum alkaline phosphatase , serum  phosphorus , and  calcium – phosphorus  product   did  not  show  any significant   change, they were   within  their  level  after  vitamin  d3  use .ESR 1 and  ESR 2 levels were  higher  from the  start of  the study    within the  diabetic  group. Their mean  level  values   have significantly   decreased   in  a  highly  significant  way  within  this  group . Kidney function parameters  and  proteinuria  have  been  deteriorated  within  the  two  groups , being  worse  within  the  diabetic  group . Conclusion: Vitamin D3 use within stage 3 chronic renal disease patients  is  effective  for  patients  support  against  bone  mineral  disturbances  occurring  within  this  disease    .  }, keywords = {vitamin D3,CKD-MBD – Bone profile – Diabetes Mellitus – CKD stage 3}, url = {https://ejhm.journals.ekb.eg/article_11738.html}, eprint = {https://ejhm.journals.ekb.eg/article_11738_8a9a08d980a5afd4f247eae7a152d9bf.pdf} } @article { author = {Helal, Basma Abd Elfattah and Elshrbiny, Romysaa Ali and Shebl, Mohamed Mohamed and Mady, Nermen Mohamed}, title = {Study the Effect of Apocynin on Some Renal Functions in Ischemia/Reperfusion Injury in Male Albino Rats}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1950-1958}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040628}, abstract = {Background: Apocynin (4-hydroxy-3-methoxyacetophenone) which isolated from the traditional medicinal plant Picrorhiza kurroa, is a naturally occurring methoxy-substituted catechol, experimentally used as an inhibitor of NADPH oxidase and of the concomitant ROS production. Apocynin also proved to be a potent anti-inflammatory agent, based on the selective inhibition of the production of ROS by activated human PMNs. Aim of the Study: to explore the protective effect of Apocynin and the NADPH oxidase inhibitor on kidney damage induced by ischemia/reperfusion (I/R) in a rat model. Subjects and Methods: Fourty male albino rats were categorized into four equal groups of 10. Group 1: Sham operated control group, Group 2: Ischemia / reperfusion (I/R) group; which underwent bilateral renal ischemia for 1 hour followed by a 23 hour reperfusion, Group 3: 4-week Apocynin treated group in which rats received Apocynin with a  dose  o16 mg/kg /day for 4 weeks followed by bilateral renal ischemia for 1 hour then 23 hour reperfusion afterwards , and Group 4: 8-week Apocynin treated group in which rats received Apocynin with a  dose of 16 mg/kg /day for 8 weeks then bilateral renal ischemia for 1 hour followed by 23 hour reperfusion. After reperfusion, the animals were sacrificed, the blood samples were collected for determination of blood urea nitrogen, serum creatinine, 24 hour urine were collected for determination of creatinine clearance. Kidneys of all animals were harvested and evaluated biochemically through determination of tissue MDA, MPO, GPX and catalase level. Results: Kidney tissue MDA, MPO, serum BUN and Creatinine levels were found to be significantly higher in the I/R group. GPx level showed a significant decrease, while there was a slight decrease in Catalase level when compared with Sham operated group. Creatinine clearance was impaired in renal I/R group. Renal I/R injury has also induced an extensive tubular necrosis, glomerular damage, and apoptosis. Apocynin significantly reduced MDA and MPO and increased GPX and catalase in both treatment groups when compared to the I/R group (p< 0.001). The elevated BUN and creatinine levels were significantly reduced in treatment groups, also creatinine clearance was restored to around normal value. Conclusion: with accordance to the findings and outcome of the present study, Apocynin has exerted protective effects against ischemia/reperfusion injury by ameliorating the kidney damage induced by I/R injury to a significant extent. However, there was no significant difference in the outcome if the treatment was extended from 4 to 8 weeks.  }, keywords = {Apocynin,NADPH-oxidase,ischemia,Reperfusion injury}, url = {https://ejhm.journals.ekb.eg/article_11739.html}, eprint = {https://ejhm.journals.ekb.eg/article_11739_b2b6a258a71451ad7a61e0cdd1a9f24d.pdf} } @article { author = {Alluqmani, Maha Fahad and Aloufi, Abdulrahman Abdullah and Abdulwahab, Amnah Makki Al and alsharif, Abdullah Ismail Khalil and AlShathri, Abdullah Abdulaziz A and AlShehri, Mosab Shaher and aharbi, Samah Ali and Hawsawi, Samaher Ibrahim and Alshmmary, Nawal Ahmed and Alshammari, Bati Jassim I}, title = {Knowledge, Attitude and Practice of Mothers on Acute Respiratory Infection in Children under Five Years in Saudi Arabia, 2017}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1959-1963}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040629}, abstract = {Background: management and prevention of acute respiratory infections (ARI) is a worldwide problem especially in developing countries. Mothers are the caregivers of their children and thus their knowledge could be used as preventive measure for the disease. Objectives: assessing the knowledge, attitude and practice (KAP) of Saudi mothers toward ARI in children less than five years old in the Kingdom of Saudi Arabia. Methods: the study included 733 mothers admitted to a random sample of PHC from different districts of KSA. The mothers were interviewed and asked to fill up a predesigned questionnaire during the period from February 2017 to June 2017. The questionnaire comprised of 4 parts including the mothers’ demographics and KAP. Results: the mean age of mothers was 41.3 years old and the duration of marriage was from 10-20 years in most of mothers (41.9%). The majority of participants had college degree (53.9%) and 44% of subjects were working mothers. Most of subjects had good knowledge about that ARI is a disease of both upper and lower respiratory infection, pneumonia as a complication of ARI, the overuse of antibiotic and bacterial resistance and cough being the most common symptom of ARI. Poor knowledge was related to the use of antibiotics and consulting a physician if children had ARI. The knowledge score of mothers was good in 46% of subjects and 54% have insufficient knowledge. The attitude and practice of mothers was poor among more than half of the participants.Conclusion: most of Saudi mothers had inadequate, knowledge, attitude and practice toward ARI. The better understanding and sufficient knowledge was significantly correlated with young ages, short duration of marriage and higher education.  }, keywords = {KSA,KAP,Acute Respiratory Infections (ARI),primary health care}, url = {https://ejhm.journals.ekb.eg/article_11740.html}, eprint = {https://ejhm.journals.ekb.eg/article_11740_da181c02acf483ecb00a2fbafc790636.pdf} } @article { author = {Alandijani, Akram Adel and Alali, Samar Yousif and Alotaibi, Abdullah Saud and Alsulami, Aisha Abdulrahman and Alali, Rehab Abdulmohsen and Makkawi, Rabab Abdulrazaq and Alshehri, Waleed Ali and Ibrahim, Eman Mushabab and Alahmadi, Riyadh Awadhallah and Alshehri, Hassan Mohammed}, title = {Study of Knowledge, Attitude and Practice of Saudi Women towards Physical Activity, 2017}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1964-1967}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040630}, abstract = {Background: Physical activity is an effective component of health and prevention of disease. Increasing the general health knowledge about physical activity could prevent obesity and chronic diseases. Objectives: Study the knowledge, attitude and practice (KAP) of Saudi women regarding physical activity in Kingdom of Saudi Arabia (KSA). Methods: This was a community based survey study conducted among 800 Saudi adult females chosen randomly using a multistage random technique during the period from January to April 2017. The study included subjects were asked to fill up a predesigned questionnaire including questions about socio-demographics and assessing the KAP about physical activity. Results: Most of females (64%) had poor knowledge while 36% had good awareness about the physical activity. About 72.2% had poor practice pattern but 22.8% had good practice pattern of physical activity. The attitude toward physical activity was good in the majority of subjects (75.1%) and poor in (24.9%) of them. The overall general KAP of included females regarding physical activity was poor in 62% and good in 38%. Conclusion: The overall general KAP was low among the studied groups thus, there is a dispensable need for providing a good and safe environment for women for practicing routine physical activity. Also, more efforts should be carried out to increase the KAP of females toward physical activity through educational campaigns in internet, TV and health care facilities.}, keywords = {KAP,Physical activity,Women,KSA}, url = {https://ejhm.journals.ekb.eg/article_11741.html}, eprint = {https://ejhm.journals.ekb.eg/article_11741_6476269473ae171a448ac9c8aae63e16.pdf} } @article { author = {Aljohani, Maram Mohammed and Alakhmimi, Mai Khalid and Alalmaei, Abdulaziz Zaher and alturaigi, hamood sulaiman and Alshareef, Musab Shakir and Aldughaythir, Saad Saleh and Alenazi, Ahmed Abdullah Saleh and Alamri, Seba Ghaithan and Alsahafi, Rawan Ahmad and Alrajhi, Furat Mohammed}, title = {Evaluation of Parents Knowledge about the Dangerous Effect of Excessive Use of Antibiotics on Children with URTIs in Saudi Arabia, 2017}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1968-1972}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040631}, abstract = {Background: upper respiratory tract infections (URTIs) are highly encountered by children all over the world with repeating episodes from 6-8 times during the year.  However being of viral origin and a self-limited disease, many parents’ attitudes forces physician to use antibiotics thus resulting in antibiotic resistance. Objectives: to study the parental knowledge, attitude and practice (KAP) toward antibiotic use among children with URTIs in Kingdom of Saudi Arabia. Methods: a self-administered questionnaire was distributed among parents presented at a random sample of primary schools in KSA from February 2017 to June 2017. Results: a total of 547 parents were included from different parts of KSA, most of them were females, graduated from a college and received a moderate income. Overall, KAP toward using antibiotics in URTI for children was very low among 72% of subjects and was good in only 28% of subjects showing that there was inappropriate level of KAP among the studied population. Conclusion: Saudi parents have inadequate knowledge about antibiotic use in children for treating URTIs that showed incorrect answers for attitudes and practices. }, keywords = {KSA,KAP,Upper Respiratory Tract Infections (URTIs),Antibiotic resistance}, url = {https://ejhm.journals.ekb.eg/article_11742.html}, eprint = {https://ejhm.journals.ekb.eg/article_11742_b327c84a202a9d3ff236ce290d3075e4.pdf} } @article { author = {Wedhaya, Mohammad Abdulrhman and Abyadh, Dina Abdulkareem and Alhabi, Hatim Ali and Alrehaily, Sami Samran and Kurban, Mohammed Ahmad and Alzahrani, Ghaedaa Saad and Alshamrani, Ali Saleh R and Alqahtani, Amal Mohammed and Mansi, Mohammed Hamzah and Mofareh, Abdullah Saeed}, title = {Assessment of Knowledge, Attitude and Practice towards Hepatitis B among Healthy Population in Saudi Arabia, 2017}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {69}, number = {2}, pages = {1973-1977}, year = {2017}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.12816/0040632}, abstract = {Background: hepatitis Virus B is a major health problem in Kingdom of Saudi Arabia (KSA) as it is one of the most endemicity countries for being hepatitis B seropositive. Objectives: evaluation of the knowledge, attitude and practice (KAP) of Saudi population toward hepatitis B infection in KSA.        Methods: a descriptive cross sectional study was conducted among 890 Saudi subjects aged between 20-50 years old. All participants were interviewed during the period from February 2017 till June 2017 and filled-up a predesigned validated questionnaire that consisted of 4 parts including the demographics and KAP. Results: out of the 890 Saudi subjects, 69.3% were females, 48.3% were working, 77% had college degree and 50.9% of them aged from 20-30 years old. The prevalence of hepatitis B among the studied population sample showed that only 8% of subjects declared that they had hepatitis B infection. Most of the participants had good knowledge regarding the means of HB transmission, the definition, symptoms and effects of the disease. The attitude of subjects was good in 60% but the level of practice was poor among 66% of subjects as most of subjects hadn’t been screened or vaccinated for hepatitis B infection. Conclusion: the level of KAP toward hepatitis B was good in 56% of subjects with high scores of good knowledge and attitude but with poor practice levels among most of the subjects.}, keywords = {KAP,hepatitis B,Cross-Sectional,Adult,KSA}, url = {https://ejhm.journals.ekb.eg/article_11743.html}, eprint = {https://ejhm.journals.ekb.eg/article_11743_bccaf5f487d6923d4df9e3fcf2fb2317.pdf} }