@article { author = {Chyad, Maysaa A. and Azab, Enas A. and Shalaby, Mennatallah H. and Aly, Ahmad A.}, title = {The Role of Uterine Artery Doppler Sonography in Predicting Pre-eclampsia at 14-20 Weeks of Gestation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7850-7859}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20598}, abstract = {Background: the introduction of Doppler technology has proved the first opportunity for repetitive, noninvasive hemodynamic monitoring in human pregnancy compared to other methods of maternal and fetal monitoring. Aim of the Work: this study aimed to predict usefulness of uterine artery Doppler in predicting pre-eclampsia and to study uterine artery Doppler waveforms at 14-20 weeks of gestation. Patients and Methods: this prospective study was carried out in the Radiodiagnosis Department Ain Shams University. This study included 33 pregnant women (between 14 to 20 weeks of pregnancy); they were chosen randomly from patients referred from maternal clinics, all were primigravida, single pregnancy during the period from June 2017 to December 2017. Results: regarding our results when RI index was used, sensitivity, specificity were 90.0%, 87.0% and when PI index was used sensitivity, specificity were 60.0%, 87.0%. Conclusion: we can conclude that uterine artery Doppler between 14- 20 weeks of gestation is a simple rapid non-invasive procedure and it can be used as a reliable indicator for prediction of preeclampsia to use it as a screening test. Recommendations: we recommend other studies with a wide scale of population (large number) in more than one center; this will lead to increased surveillance and delivery in a well-equipped setup in high risk detected patient which is necessary to reduce the maternal and fetal complications}, keywords = {uterine,artery,Doppler,solography,Pre-eclampsia,gestation}, url = {https://ejhm.journals.ekb.eg/article_20598.html}, eprint = {https://ejhm.journals.ekb.eg/article_20598_2275ed5c0a5145988159b83698ba3ee4.pdf} } @article { author = {Abdelkhalik, Ahmed M. and Agha, Mohamed M. and Zaki, Ahmed M. and Tahoun, Ahmed Tahoun}, title = {Clinical and Lab-Assessed Antibiotic Resistance Pattern of Uropathogens among Women with Acute Uncomplicated Cystitis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7860-7868}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20600}, abstract = {Background: acute uncomplicated cystitis (AUC) in females is among the most frequent infections in community. Treatment of AUC in Egypt usually based on empirical therapy. Objectives: To determine the most common uropathogens and their pattern of resistance to commonly used antimicrobials aiming at finding a proper antibiotic which can be used as effective empirical therapy in AUC. Patients and Methods: Observational, hospital based, cross sectional study was performed. Three hundred and twelve female patients were recruited for the study with positive urine culture and clinical symptoms correlate with AUC during the period from December 2017 to August 2018. Results: Eight organisms were isolated. E. coli was the most common uropathogen and was isolated from 231 cases (74%). The next most common was Pseudomonas which was detected in 41 cases (13.1%). Other organisms include MRSA (6.1%), Klebsiella (2.2%), Enterococcus spp. (1.9%), proteus (1.3%), Acinetobacter and Staph. aureus (0.6%) each. Isolated uropathogens in this study were least resistant to Nitrofurantoin (47.1%). The highest resistance rate was to TMP/SMZ (87.8%). Resistance pattern to quinolones were 64.1%, 67% and 60.6% to Ciprofloxacin, Norfloxacinand and Levofloxacin respectively. Conclusion: The most common cause of community acquired AUC was E. coli. Nitrofurantoin can be used as a first line empirical therapy for AUC as it showed the least resistance pattern (47.1%). Antimicrobial resistance is a crucial issue which evolves continuously and thus more studies must be carried out in different regions and constanttime intervals.}, keywords = {Urinary tract infection,Acute uncomplicated cystitis,Antibiotic Resistance Pattern}, url = {https://ejhm.journals.ekb.eg/article_20600.html}, eprint = {https://ejhm.journals.ekb.eg/article_20600_e9021f7337e6eecf425ab27d2fde6d83.pdf} } @article { author = {Elsharkawy, Mohamed Kamal Hamed and Ramadan, Mokhtar Ragab and Abd Elhamed, Mostafa Mahrose}, title = {Role of Recent Imaging Modalities in Diagnosis of Diabetic Foot}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7869-7882}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20601}, abstract = {Background: osteomyelitis and septic arthritis complicate up to one third of diabetic foot infections that require hospitalization and often result from contaminated soft tissues. Early diagnosis is difficult to achieve through noninvasive imaging studies. Nuclear medicine and radiologic imaging techniques, although commonly used, may lack accuracy. CT is used routinely because it is widely available, but it is of limited diagnostic value in early stages of acute osteomyelitis of the foot and in patients with diabetic osteoarthropathy. MRI, because of its high sensitivity and specificity, is considered the modality of choice for diagnosing osteomyelitis of the foot and for identifying associated soft-tissue abnormalities such as cellulitis, phlegmon, abscess, sinus tracts and ulcers. Aim of the work: this study aimed to assess the role of recent imaging modalities such as high resolution ultrasound, CTA, MRI, MRA and PET/CT in the early detection and /or improving the prognosis of diabetic foot. Conclusion: the major complication facing patients with diabetic foot is amputation that is why tight glycemic control is mandatory. In addition to routine screening for early detection of diabetic foot complications can be helpful. With advancement of radiological techniques, the prognosis of diabetic foot has improved.}, keywords = {CTA,MRI,MRA,PET/CT,Diabetic foot}, url = {https://ejhm.journals.ekb.eg/article_20601.html}, eprint = {https://ejhm.journals.ekb.eg/article_20601_3795b84b7cb6f023ead04253a40d7f49.pdf} } @article { author = {Baaleis, Manal Ali Saleh and Ali, Sayed Ibrahim}, title = {Impact of Usage of Different Coping Strategies on Academic Performance of Female Students in College of Medicine, Al-Ahsa}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7883-7891}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20857}, abstract = {Background: academic stress can be prescribed as mental distress with respect to some anticipated frustration associated with academic failure or even awareness of the possibility of such failure. Medicine in specific is one of the most stressful fields of education because of its highly demanding professional and academic requirements, highly extensive medical curricula, repeated difficult exams and fear of failure all are causes of persistent stress and anxiety for medical students. Student’s ability to handle these increasing demands of medical school can affect their academic success and emotional health. Experiencing stress and anxiety is beneficial to some extent as it can enhance the academic performance. In the other hand, increasing levels of stress that students exposed may have a negative effect on their cognitive functioning and learning abilities in the medical school. Coping is an important key point of dealing with stress and preventing psychological problems. Aim of the work: this studyexplored the impact of usage of different coping strategies on academic performance of students of College of Medicine in Al-Ahsa, 2018 and which type they use more than the other and which of these different strategies comprise more satisfaction than the others do. Methods: this wasa cross sectional study was carried out among female students in college of medicine in king Feisal University in the academic year 2017-2018. Data had been collected by electronic and paper survey, which contained demographics, educational level, family income, GPA, studying hours and the Lazarus's ways of coping framework, which was a widely accepted model containing 66 points that distinguishes between distinct active and emotion based coping methods. Results: 73 students were completed the survey, 58.9% of them reported being upset\sad for significant amount in 2 weeks period, and 49.3% of students report that they feel they need psychiatric consultation. No significant association was noticed between GPA and each of coping strategies addressed in this study. Positive reappraisal was the most used strategy by 76.86%, while confrontive coping was the least to use by 55.83%. Conclusion: medical students were more vulnerable to academic stress due to highly demanding professional and academic requirements. To overcome this, students used different coping strategies.According to our study, there was no significant impact on the GPA or difference between these strategies.}, keywords = {Coping strategies,Academic Performance,Female Students,College of Medicine,Al-Ahsa}, url = {https://ejhm.journals.ekb.eg/article_20857.html}, eprint = {https://ejhm.journals.ekb.eg/article_20857_a1fdb5d1bee6410d4520a0ff13c938ce.pdf} } @article { author = {Hassan, Farid I. and El Sheikh, Walid A. and Hablas, Wael R. and Abou Shama, Doaa E.}, title = {Comparative Study of Anti-Mullerian Hormone, inhibin-B, and Three-Dimensional Ultrasound Determinants of Ovarian Reserve in Patients Undergoing ICSI}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7892-7901}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20869}, abstract = {Background: Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected into an oocyte. Objective: Aim of the Work:   Comparing three-dimensional ultrasound parameters, with anti-Mullerian hormone (AMH) and other conventional endocrine markers for the prediction of ovarian response in patients undergoing intracytoplasmic sperm injection cycles. Methods: This observational prospective study was conducted at Alexandria Armed Military Hospital, on a sample of 100 women aged between 25 and 35 years, enrolled for intracytoplasmic sperm injection (ICSI). Results: a good correlation between inhibin B and other numerical variables. There was a strong positive correlation between inhibin B and AMH, strong negative correlation between inhibin B and both FSH and LH. Inhibin B correlated moderately negatively with age and moderately positively with AFC, number of collected oocytes. Inhibin B correlated positively with the number of oocytes and number of grade 1 embryos. As regard pregnancy rate, the good-response group had significantly higher chemical and clinical pregnancy rates, as there was no chemical or clinical pregnancy occurred in poor responders. Conclusion: AFC, AMH and Inhibin B are effective in predicting the ovarian reserve as well as the response to induction, and both AFC and AMH are the most significant predictors of response to ovarian stimulation during ICSI. Recommendations: Larger scale studies including higher number of patients are needed to verify the validity of this parameter as a marker of ovarian reserve in patients undergoing ICSI. }, keywords = {Anti-Mullerian hormone,inhibin B,three dimensional ultrasound,ovarian reserve,ICSI}, url = {https://ejhm.journals.ekb.eg/article_20869.html}, eprint = {https://ejhm.journals.ekb.eg/article_20869_6f25a9e87e45faa83f7a18a317904aa9.pdf} } @article { author = {Al Amin, Ali Mohammed and Hassan, Mohammed Hisham and Mohammed, Yehia El Maadawy and Abd Elfattah, Ashraf Al-Amir and Mostafa, Mostafa Tarek}, title = {Assessment of normal values of Area Strain by using Three-dimensional speckle-tracking Echocardiography}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7902-7907}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20870}, abstract = {Background: area strain (AS) has become a parameter of increasing concern. AS is a parameter that combines both the longitudinal and the circumferential deformations and it is acquired using three-dimensional speckle tracking echocardiography (3D STE). This parameter should be used to detect pathological changes as it is more sensitive than the conventional parameters in evaluating left ventricular (LV) systolic function. Aim: The present study aimed to estimate the maximum normal systolic reference value of Area Strain in a sample of healthy subjects. Subjects and Methods: the study conducted 180 healthy subjects (33.4±9.7yrs, 94.4% males, 5.6% females). The subjects were volunteers without heart-related diseases or other diseases. They were classified into three different age groups: Group I is between the ages of 20-30, Group II is between the ages of 30-40 and Group III is between the ages of 40- 50. Results: the study showed that the mean global area strain at group I, group II and group III were -28.40 ± 2.48 %, -28.57 ± 2.73% and -28.53 ± 2.81% respectively. The mean maximum systolic global area strain of all the studied subjects was -28.50 ± 2.66%. The difference between the three groups was statistically insignificant. Conclusion: the study concluded that global area strain obtained from 3D STE may be used clinically as an additional diagnostic method since Area Strain can provide a more global and comprehensive assessment of LV systolic function than traditional parameters.}, keywords = {Area Strain (AS),three dimensional (3D),speckle tracking echocardiography (STE)}, url = {https://ejhm.journals.ekb.eg/article_20870.html}, eprint = {https://ejhm.journals.ekb.eg/article_20870_55ba3e047f3fbef6673dff1360b0c8ac.pdf} } @article { author = {Saad Allah, Horaya A. and ElEmary, A.Tarek H. and Mohammed, Jihan A. and Gamal, Asmaa M.}, title = {Evaluation of choroidal thickness in different stages of diabetic retinopathy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7908-7916}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20871}, abstract = {Purpose: to assess changes of choroidal thickness (CT) in diabetic patients in different stages of diabetic retinopathy and diabetic macular edema using spectral domain optical coherence tomography. Patients and methods: One hundred and sixty three subjects were enrolled: 113 diabetic patients (186 eyes) and 50 normal individuals as controls. Eyes were divided into two groups according to age; group A from 35 to 50 years and group B from 51 to 65 years. Both groups classified according to retinopathy grade: DR1 (no DR), DR2 (mild- moderate nonproliferative diabetic retinopathy (NPDR)), DR3 (severe NPDR), DR4 (untreated proliferative diabetic retinopathy (PDR)) and DR5 (previously treated PDR). All participants underwent full ophthalmic examination, stereoscopic color fundus photography, and spectral domain optical coherence tomography (RS-3000; Nidek). Spectral domain optical coherence tomography examination consisted of linear scans, 6 mm in length, centered onto the fovea, and macula multi scans. Choroidal thickness was measured manually at the fovea and at 500, 1000, and 1500 um distance along all scans in the macula. Results: Mean age was not significantly different between patients with diabetes and controls. In the macular area, CT was significantly lower in the nasal quadrant versus all other quadrants (P, 0.0001), in both groups. No significant CT difference was found between controls and diabetic eyes without detectable DR. Diabetic macular edema did not influence CT. In early NPDR (mild and moderate) and treated PDR the mean choroidal thickness was significantly decreased than control. In severe NPDR and treated PDR, the mean subfoveal choroidal thickness was not different than control. There was a statistically significant increase in choroidal thickness in PDR when compared with the mild NPDR group (P=0.027). DME was associated with a non-statistically significant increase in choroidal thickness compared with eyes without DME (P=0.13). Conclusion: Choroidal thickness is reduced in diabetic eyes. Subfoveal choroidal thickness increased with the severity of diabetic retinopathy but showed no statistically significant association with the presence of DME. Spectral domain optical coherence tomography clearly confirms in vivo previously reported histopathologic observations. The role of choroid in the pathophysiology of DR needs to be adequately investigated.}, keywords = {diabetic retinopathy,choroid,choroidal thickness,OCT}, url = {https://ejhm.journals.ekb.eg/article_20871.html}, eprint = {https://ejhm.journals.ekb.eg/article_20871_867ad9a9afdb78bc611041994c797c3f.pdf} } @article { author = {Alhosainy, Abdulhafez M. and El-Sawy, Ahmed G. and Abd-Elhamed, Islam S.}, title = {Clinical Comparative study between subcutaneous Continuous Analgesia versus continuous transversus abdominis plane block post caesarian section}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7917-7924}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20876}, abstract = {Background: post cesarean section pain is associated with a variety of unfavorable post-operative consequences; affect both mother and the newborn, especially the first 48 h after delivery. The pain can be improbable, disrupting mother/child bonding and also affects mental, chest, heart problems, and prolong the hospital stays. Aim of the Work: to compare the efficacy and safety of bilateral continuous transversus abdominis plane (TAP) block versus continuous wound infiltration for pain relief after surgery. Patients and Methods: this study was conducted on forty patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for elective CS were enrolled in this controlled study. Information about the study was explained comprehensively both orally and in written form to the patients. All patients gave written informed consents prior to their inclusion in the study. Results: there was no difference between TAP block & CWI as regarding pain during rest but TAP block was more effective during movement than CWI, opioid consumption was much less in TAP group than in CWI group and the time of first analgesia request was earlier in CWI group than in TAP group. Conclusion: both TAP block & CWI provided post-operative analgesia but USG TAP block increased the time to first analgesic request, reduces the total pethidine consumption with hemodynamic stability and decreases the incidence of adverse effects in patient undergoing caesarian section compared to continuous wound infiltration.}, keywords = {subcutaneous Continuous Analgesia,continuous transversus abdominis plane block,Caesarian Section}, url = {https://ejhm.journals.ekb.eg/article_20876.html}, eprint = {https://ejhm.journals.ekb.eg/article_20876_9bb388ca3cf00a9857ea303ce5dc9d1c.pdf} } @article { author = {Akl, Mabrouk and Albaghdady, Ayman and Elshazly, Ahmed and Fouad, Hala and Embaby, Hany and Keriakos, Mary and Elshahawy, Mahmoud and Eldeeb, Diaa and Elshafey, Mohamed and Elsabaa, Abdelrahman}, title = {Non operative conservative management of blunt trauma to the spleen in Children: A Single Tertiary Hospital Experience}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7925-7931}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20878}, abstract = {Background: Splenic injury is the leading cause of major bleeding in the patients of blunt abdominal trauma. In earlier medical practice, the blunt splenic injury was managed surgically in most cases, but the increased understanding of the splenic function in the immunological process and the identification of post-splenectomy complications have led physicians to prefer the non-operative management . Material and methods: A retrospective study of the patients with blunt trauma to the spleen in the pediatric age group between the year 2015 and 2018. The study was conducted in (Nasser Institute Hospital for research and treatment). Management of the patients was done using hypovolemic resuscitation and serial follow up. Abdominal ultrasound, complete blood picture and Abdominal CT were done. Data was tabled and analyzed. Results: A total of 123 blunt splenic trauma patients were identified. Traffic-related accident and falling from height were the main mechanisms of injury. Splenic contusion and hematoma were the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen, blush, and devascularization. Non-operative management failed in 6 patients who underwent splenectomy. (95.12%) of the patients managed successfully using hypovolemic resuscitation without need for surgical interference. Discussion: Non-operative management is considered for patients with low-grade splenic injuries, unless operated upon for other associated injuries. In fact, higher-grade injuries could also be managed non-operatively. Splenic angioembolization of bleeding vessels increased the success rate of non-operative management in hemodynamically stable patients. In our study, although we didn`t use splenic angioembolization we were able to reach high rates of success. In comparison with the operative management of blunt splenic trauma, the nonoperative management has the added benefit of preserving the splenic functions. Conclusions: Most blunt splenic trauma patients were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan.}, keywords = {spleen,Pediatric,injury,Non-operative management,NOM}, url = {https://ejhm.journals.ekb.eg/article_20878.html}, eprint = {https://ejhm.journals.ekb.eg/article_20878_260e79fe18e76e426fd6b20e3af50970.pdf} } @article { author = {Mostafa, Mansour M. and Al-Deftar, Mohammad I. and Mohamed, Mohamed S.}, title = {Two-dimensional speckle tracking echocardiography for assessment of both atria functions in patients with atrial septal defect}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7932-7938}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20879}, abstract = {Background: of all the types of congenital heart disease, ASDs represent the second most common and account for 7% to 10% of all congenital heart defects. The most common type of atrial septal communication is an ostium secundum defect, representing 80% of all ASDs. In unaffected individuals, the chambers of the left side of the heart are under higher pressure than the chambers of the right side. In the case of ASD, which may result in a clinically remarkable left-to-right shunt, blood shunts from the left atrium to the right atrium. This extra blood from the left atrium may cause a volume overload of the right side. Aim of the Work: The aim of this work was to assess feasibility of using 2-dimensional speckletracking echocardiography (2D-STE) for evaluation of left and right atrial function in patients with unrepaired atrial septal defect, to compare both LA & RA function in patients with unrepaired atrial septal defect with those apparently healthy individuals, and to correlate both LA & RA function with the size of inter-atrial shunting. Patients and Methods: The ethical approval was obtained from the hospital Ethical Research Committee and each patient entering the study signed an informed consent. Thirty patients included in this study with secundum atrial septal defect. All were under the age of sixteen at time of diagnosis. They were recruited from cardiovascular department at Sayed Galal University Hospitals during the period from December 2016 to November 2018. Results: Speckle tracking echo of both atria showed a significant correlation with QP/QS, ASD maximal size, ASD minimal size, RA to LA area ratio and pulmonary pressure. Patients with PH were older (33.4+/-14.6 vs. 23.8 +/- 12.2 years; p<0.06) and had larger defects (17.8+/4.6 mm vs. 14.5.1+/- 5.0 mm; p<0.08). The proportion of women was nearly similar in both groups (55% in patients with PH vs. 63% in those without; p=NS). Most patients with PH had ASDs with more complex shapes on echocardiography. However, some patients with simpler and smaller defects, such as central ASD with a diameter of <5 mm, also developed PH. Conclusion: The new echocardiographically-derived myocardial deformation indexes, which reflect structural changes assessed by transthoracic echocardiography, can be used to detect abnormalities in atrial function before clinical deterioration}, keywords = {Echocardiography,Atrial Septal Defect,right atrium,left atrium,speckle and pulmonary hypertension}, url = {https://ejhm.journals.ekb.eg/article_20879.html}, eprint = {https://ejhm.journals.ekb.eg/article_20879_ba11213287e0986a75ead680fb9499af.pdf} } @article { author = {Alrayes, Mona H. and Hammad, Reham H.M. and Radwan, Enas M. and Abd El-Hamid, Samar M.}, title = {Role of CD11a and CD18 in Diagnosis of Acute Promyelocytic Leukemia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7939-7950}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20881}, abstract = {Background: Acute promyelocytic leukemia (APL) is an aggressive subtype of acute myeloid leukemia (AML) that requires rapid diagnosis and early intervention. Previous studies spotted light on APL being negative for members of β2 integrin family CD11a and CD18. The aim of this work: was to study the value of absence of CD11a and CD18 molecules in screening and its relation to prognosis of APL cases. Patients and methods: This cross sectional study was conducted on seventy adult (>18 years) patients with de novo AML, recruited from National Cancer Institute, Cairo University. They were divided in to 2 groups; group 1 of APL cases (n= 35) and group 2 of AML-Non APL cases (n= 35) as a comparative group. Both groups were investigated by flow cytometry for the expression of CD11a and CD18 molecules on leukemic cells. Results: Comparison between group 1 and group 2 illustrated significant reduction in % of cells expressing CD11a (p= 0.014), CD18 (p=0.008) and % of cells co-expressing CD11a /CD18 (p=0.007) in group 1 compared to group 2. There was significant positive correlation between % of cells expressing CD18 and TLC (r=0.411, p=0.014). There was significant positive correlation between CD11a MFI and hepatomegaly (r=0.390, p=0.021) in AML-Non APL group. Regarding the output data of ROC curve for discriminative percentage of leukemic cells expressing CD11a and CD18 between APL and Non-APL groups, at cut off 78.95% and 23.5% respectively, the specificity for both was 60% and 68.6%, respectively. While sensitivity was 77.1% and 68.6%, respectively, with Area Under Curve (AUC) of 0.671 and 0.686 and p value of 0.014, and 0.008 for leukemic cells expressing CD11a and CD18, respectively. Conclusion: [1] There is significant reduction in % of cells expressing CD11a and CD18 in APL patients, but they were neither sensitive nor specific to be used as single markers in diagnosis of APL patients. [2] Positive correlation seen between the most important prognostic factor, TLC and both CD18 MFI and percentage of cells expressing CD18 could throw light on the potentiality of CD18 as a prognostic factor. [3] Significant positive correlation between CD11a MFI and hepatomegaly in Non-APL cases might suggest a role of CD11a in migration of leukemic cells.}, keywords = {APL,AML,CD11a,CD18}, url = {https://ejhm.journals.ekb.eg/article_20881.html}, eprint = {https://ejhm.journals.ekb.eg/article_20881_e561b1d02745284029ab7f0220ff5e5c.pdf} } @article { author = {Mohammad, Ahmed Mohammad Ahmed and Radwan, Mohammad Elsayed and Abdel-Maksoud, Mohammad Arafat}, title = {Surgical Treatment of Ingrown Toenail by Nail Fold Resection without Matricectomy}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7951-7962}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20882}, abstract = {Background: ingrown toenail is a common condition. Although many methods for treatment are available, there is no consensus on the optimal treatment. Aim of the study: to evaluate surgical correction of ingrown toenails via soft-tissue excision of the nail folds with preservation of the nail and its matrix. Patients and Methods: This study includes one hundred (100) patients suffering from ingrowing toenail; these patients were enrolled in a combined prospective study and had a retrospectively gathered outcome analysis at the department of surgery, AL-Azhar University Hospital from October 2017 to October 2018. Results: significantly short operative time was recorded. Postoperative wound complications occurred in 15.7%% of patients. All cases presented in grade I (33 cases), only one case, symptoms and signs of grade I recurred 1 month after operation (recurrence rate 0.9%). The 27 cases presented in grade II ingrown toenails, symptoms and signs recurred in 7 cases (recurrence rate 6.5%). The 48 cases presented in grade III, symptoms and signs recurred in 10 cases (recurrence rate 9.2%). The recurrence rate in all cases was 18 cases (16.66%). Conclusion: nail fold excision of ingrowing toenail without matrisectomy is considered as an effective and safe method for ingrown nail treatment.}, keywords = {matrisectomy,ingrowing toenail}, url = {https://ejhm.journals.ekb.eg/article_20882.html}, eprint = {https://ejhm.journals.ekb.eg/article_20882_edf01ef44a234f92d00eefb9e7b8c836.pdf} } @article { author = {Alshahhat, Osama A. and Amin, Mahmoud A. and Safwat, Ahmed M.}, title = {Early Versus Late Fixation of Mandibular Fractures in Adults}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7963-7967}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20995}, abstract = {Background: facial fractures occur most commonly in males in the third decade of life. The most frequent causes of facial fractures are road traffic accident, interpersonal violence, falls, and sportsrelated accidents. Mandible fractures are one of the common facial fractures in the adult population. However, the timing of treatment of mandible fractures remains a source of debate. Aim of the work: the aim of the study was to evaluate the effectiveness of early versus late treatment of isolated mandibular fractures in adults upon healing and postoperative complications. Patients and Methods: the present study included 20 patients who were presented by isolated mandibular fractures. They were divided into two groups according to the time utilized from injury to operative intervention: Group 1: included 11 patients who were treated within 72 hours. Group 2: included 9 patients who were treated after 72 hours up to 14 days. All included patients were underwent full history taking, examinations (general and local) done in a systematic manner, laboratory and radiological examination. Outcome was documented for all patients. Results: both groups were comparable as regard to age and sex (no females). The most common cause of trauma in studied patients was road traffic accident. Operative time extended from 110 to 192 minutes with no significant difference between absorbable and non-absorbable groups (150.07±23.99 vs 160.06±20.54 minutes respectively). There were a total of 20 males and no females in the study group with a mean age of 23.3±6.3 (range 18to 38 years) in the immediate group and 26.6±8.1 (range 18 to 39 years) in the delayed group. The most common fracture types in both groups were parasymphyseal and angle fractures with RTA as the most common etiology. In the immediate group, there were one patient with temporomandibular joint pain after surgery, five patients with numbness, and one patient with malocclusion. In the delayed group, no patients with TMJ pain, seven patients with numbness, and two patients with malocclusion. Conclusion: our study did not reveal a statistically significant difference in the development of postoperative complications after mandible fracture repair between the early and late treatment groups.}, keywords = {Complications,delayed treatment,Mandibular fracture}, url = {https://ejhm.journals.ekb.eg/article_20995.html}, eprint = {https://ejhm.journals.ekb.eg/article_20995_7fdb8a8140bbb22ee5e6eb06f0e3511c.pdf} } @article { author = {Hudieb, Ahmad El-Sayed}, title = {Effect of three Intravitreal Injections of Aflibercept on the CNV Guided by Optical Coherence Tomography Angiography in Wet Age-Related Macular Degeneration}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7968-7974}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20996}, abstract = {Background: Age-related Macular Degeneration (AMD) is a progressive, degenerative disease that affects the macula and it is one of the most common leading causes of irreversible vision loss in old patients with age more than fifty. Optical coherence tomography angiography (OCTA) can detect the presence of choroidal neovascularization (CNV), structural changes in AMD; moreover, changes in choroidal blood vessel flow. Aim: to assess and compare structural retinal changes in patients with neovascular age-related macular degeneration (AMD) treated with 2mg/0.1ml intravitreal aflibercept three times with an interval of one month each. Patients and methods: twenty eyes of non-diabetic non-hypertensive ARMD patients were included. They received 2mg/0.1ml intravitreal aflibercept three times with an interval of one month each. OCTA was done before the first injection and was repeated one month after the third injection. Results: the area size and the GLD of the CNV had highly statistically significantly improved after 2mg/0.1ml three intravitreal aflibercept injections. Conclusion: aflibercept is an effective treatment in AMD; it can decrease the area size, GLD, and thickness of the CNV. OCTA is an effective tool that can provide a noninvasive method in the diagnosis and follow up of the activity and anatomical changes in AMD.}, keywords = {Optical coherence tomography angiography,Aflibercept,Wet Age-Related Macular Degeneration,CNV,Macular Thickness}, url = {https://ejhm.journals.ekb.eg/article_20996.html}, eprint = {https://ejhm.journals.ekb.eg/article_20996_d8774dee7d5d3da00516a31236d68666.pdf} } @article { author = {Saleh, Mahmoud M and Abdelhalim, Nour Elden A}, title = {Comparison Between Temporal Versus Nasal Anterior Transposition of the Inferior Oblique Muscle for Management of Dissociated Vertical Deviation with Inferior Oblique over Action: Two Years Follow Up}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7975-7981}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.20997}, abstract = {Background: anterior nasal transposition (ANT) is a relatively new procedure which can be used to eliminate inferior oblique over action. An advantage of this procedure over temporal anterior transposition is that it avoids ante-elevation syndrome. Objective: to compare anterior temporal transposition (ATIO) of the inferior oblique muscles versus anterior nasal transposition (ANT) in management dissociated vertical deviation (DVD) with inferior oblique muscle over action (IOOA). Patients and Methods: The study included 50 eyes of 28 patients with DVD of at least 10 prism dioptres ∆ in the eye involved. The patients were divided into two groups. Group A (25 eyes of 15 patients) managed by temporal anterior transposition (ATIO) of the inferior oblique muscles and Group B (25 eyes of 13 patients) managed by nasal anterior transposition (ANT) of the inferior oblique muscles. All patients were followed for at least 24 months postoperatively. The size of preoperative and postoperative angle of DVD, grade of IOOA preoperative and postoperative, need for repeated surgeries and complications were recorded and evaluated. Results: In group A the mean DVD angle was decreased in primary positions from 21.11±4.32 ∆ to 9.5 ±4.7 ∆ (P<0.001) and from 19.5±4.6 ∆ to 5.51 ±2.65∆ (P<0.001) in group B mean IOOA grade was decreased from +2.0 ±0.7 to +0.18±0.4 in group A (P<0.001) and from +2.5 ±0.7 to +0.1±0.5 (P<0.001) in group B. In group B, two patients developed hypotropia of 5 and 6 PD. Persistent IOOA (+1) was observed postoperatively in two eyes in each group. Limited elevations in abduction developed in 3 patients in group A, the incidence of recurrence rate after 24 months was 2 eyes 10% in group A and one eye 5% in group B. Conclusion: Anterior transpositions either temporal or nasal of the inferior oblique muscles are safe and effective in management of DVD with inferior oblique muscle over action. Anterior nasal transposition (ANT) is more effective in correction of DVD with less incidence of antielevation syndrome and recurrence of DVD, however may induce persistent hypotropia.}, keywords = {DVD,IOOA,ATIO and ANT}, url = {https://ejhm.journals.ekb.eg/article_20997.html}, eprint = {https://ejhm.journals.ekb.eg/article_20997_26c498172ecef01a8cde64eafe0dff53.pdf} } @article { author = {Ayad, Waleed A.}, title = {Assessment of uterine cavity after hystroscopic removal of sub- mucous fibroids by morcellation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7982-7987}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21717}, abstract = {Study Objective: sub- mucous fibroid can be removed hystroscopically by different techniques , hystoscopic shaver represent one of the most recent treatment of intra cavitary fibroids, althought its usage is simple and has a good result for removal of fibroid, it may be complicated by formation of intra uterine adhesions. Study Objective: to determine the incidence and types of uterine syechia following hystroscopic myomectomy by morcellation. Design: prospective observational study. Patients and methods: Setting: Al- Azhar University hospital (New Damietta) during the period from August 2016 to March 2018. Patients: fifty women who had hystroscopic myomectomy by intra uterine Bigatti shaver (IBS).for different reasons (abnormal uterine bleeding, infertility, recurrent pregnancy loss). Interventions: office hysteroscopy after 2 months from hystroscopic myomectomy by Bigatti shaver. Measurements and Main Results: Evaluation of uterine cavity especially formation of adhesions is observed. The incidence of adhesions was 8%. The development of adhesion was usually associated with multiple myomas present in posterior position who need long resection time and usually the resection is incomplete. The adhesions were usually mild (75%) and there was no complications were reported after hysteroscopic myomectomy. Conclusion: the IBS proves to be an effective and safe new instrument for the removal of submucous fibroids, however such procedure may be followed by formation of intra uterine adhesions however most adhesions are filmy and its incidence is less than conventional hystroscopic methods as reviewed in literature.}, keywords = {Hysteroscopy,Myomectomy,Uterine adhesions,synechiae,Integrated Bigatti Shaver}, url = {https://ejhm.journals.ekb.eg/article_21717.html}, eprint = {https://ejhm.journals.ekb.eg/article_21717_53c0c67467a6121776b327c6bff15e61.pdf} } @article { author = {Massoud, Abd Elhakim Abd Allah and Fouaad, Amro Ahmed and Abdelkareem, Mohamed M and El Baqary, Ahmed Mohamed Ali}, title = {Evaluation of the Accuracy of Trigger Finger Injection Using Ultrasound}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7988-7996}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21718}, abstract = {Background: Trigger finger is a common cause of disability and pain in the hand and The lines of management of this disease start by conservative treatment as rest, NSAID, local corticosteroid injection under the tendon sheath either blind or by musculoskeletal ultrasound guidance and surgery may indicated in recurrent cases. Aim of the study: The aim of the present study was to evaluate the musculoskeletal ultrasound accuracy to guide the injection of corticosteroid in trigger finger management. Material and methods: 50 cases that complaint from symptoms of trigger digit in this randomized, prospective control study were recorded. All the cases were injected by 1 ml corticosteroid 1ml of 2% lidocaine at the level of the A1 pulley under the tendon sheath. The injection done under control of musculoskeletal ultrasound after a blinded needle insertion. Comorbidities and associated diseases were recorded. Follow up examinations at the 2 week and 6 months, no complications were recorded. The results were assessed according to the green’s grading. The pain was assessed according to visual analogue scale. Results: The cases in the present study were assessed according to age, associated diseases and hand dominance. The female patients were more than male patients in the present study. The injection under control of musculoskeletal ultrasound accurate more than a blinded injection even when an expert physician who did it. And It showed the same efficacy according to green’s grading at the period of follow up examinations when compared with the pre-injection status. No complications were seen during the period of the follow up. Conclusion: A different technique of injection using musculoskeletal ultrasound guidance all of which gave excellent accuracy superior to a blinded injection even when it is done by expert physician. However, the post injection result was similar to that of a blinded injection. Level one of evidence (randomized prospective study).}, keywords = {Ultrasound,Trigger finger- Corticosteroid injection}, url = {https://ejhm.journals.ekb.eg/article_21718.html}, eprint = {https://ejhm.journals.ekb.eg/article_21718_d29d7061bd4405af7c2bb67eac8c1446.pdf} } @article { author = {Wahib, Ali Ahmed and Seif El-Nasr, Mohamed Safwat and Ismail, Mahmoud Bastawy and Eltiby, Diaa Mohammad and Sayed, Sayed Abd-Elrehim and Soliman, Moataz Yousry}, title = {Diagnostic Value of Plasma M2-Pyruvate Kinase in Egyptian Patients with Colorectal Cancer}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {7997-8006}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21719}, abstract = {Background: M2-pyruvate kinase (M2-PK) is a tumor growth key regulator and plays a crucial role in tumor metabolism and can dynamically regulate aerobic glycolsis. Notwithstanding, the colonoscopy is the gold standard for early detection of colorectal cancer (CRC), the acceptance of this invasive technique is low. Aim of the work: to assess the diagnostic value of plasma M2-PK in Egyptian patients with CRC. Methods: we measured the plasma M2-PK using Enzyme-linked immunosorbent assay in CRC patients and comparing these levels with those obtained from patients with functional bowel disorders (FBD), inflammatory bowel disease (IBD),colorectal polyp and apparently healthy individuals and to detect its sensitivity and specificity. Results: the value of plasma M2-PK level was higher in CRC patients, 15.22 U/ml than other groups. Average plasma M2-PK was 6.78, 5.28, 2.25 and 2.1 U/ml among colorectal polyp, IBD, FBD patients and normal individuals respectively. The plasma M2-PK can be used in differentiating between CRC and normal individual with  83.33% sensitivity, 100% specificity at area under the curve (AUC) 0.949  with cut-off >6U/ml. Also, it can be used to discriminate between colorectal polyp and CRC patients at cut-off level of >10.6 U/mL with 75.5% sensitivity and 87.5% specificity and to differentiate between FBD and organic colonic lesions at cut-off level >3 U/ml with 81.94% sensitivity and 83.3% specificity. Conclusion: plasma M2-PK was considerably elevated in CRC patients and may be used as non-invasive biomarker for CRC. Recommendation: future researches including a large and long-term follow-up studies are recommended.}, keywords = {colorectal cancer,M2-pyruvate kinase,Functional bowel disorders,IBD,colorectal polyp}, url = {https://ejhm.journals.ekb.eg/article_21719.html}, eprint = {https://ejhm.journals.ekb.eg/article_21719_88e8fe032d08e49c1def0fa0fc8402af.pdf} } @article { author = {Elsokary, Amira Nasr and Attiah, Samah Mohamed and Ghannam, Bahaa Bedair}, title = {Immunohistochemical Study of CDK5 and Ki-67 in Cervical Precancerous Lesion and Carcinoma}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8015-8021}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21810}, abstract = {Background: cervical carcinoma is one of the commonest female tumors worldwide arises from cervical intraepithelial neoplasia. Cervical cancer is a multifactorial process and infection with some types of human papilloma virus (HPV) has been suggested as the most important risk factor. The genesis of cancer was correlated with abnormal regulation of DNA damage and repair. A research proved that CDK5 was mandatory for the DNA damage response in cancer cells. Ki-67 is a nuclear protein that is associated with RNA transcription and cell cycle progression. Aim of the work: the purpose of this study was to evaluate the expression of CDK5 in cervical precancerous lesions and carcinoma to clarify its role in carcinogenesis and progression of cervical cancer, as well as the expression of Ki-67. Material and Method:  specimens included (55 cases) consisted of precancerous lesions (15), SCC (30), adenocarcinoma (10). All specimens were formalin-fixed and embedded in paraffin blocks. Multiple serial 5-microne thick sections were cut from the paraffin blocks of the specimens; one was stained by Hematoxylin and Eosin for histopathological examination, Other Sections were immunostained with antibodies to CDK5 and K-i67. Results: high tumor grade and high FIGO stage were positively correlated with CDK5 IHC expression (P-value=0.012 and 0.042) and with Ki67 IHC expression (p-value= 0.01 7and 0.044) respectively. Conclusion: there is a direct positive correlation of both CDK5 and Ki-67 expression with high tumor grade and high FIGO stage of cervical carcinoma. }, keywords = {precancerous,SCC,Adenocarcinoma,CDK5,Ki-67}, url = {https://ejhm.journals.ekb.eg/article_21810.html}, eprint = {https://ejhm.journals.ekb.eg/article_21810_7478495f79d38e390b6d48774ecdb3b7.pdf} } @article { author = {Salah, Eman Mohamed and Ibrahim, Reham R. and Hussien, Ahmed and Salem, Khadega and Gonaid, Mariam H. and Soliman, Hesham S. M.}, title = {Phytochemical screening and insecticidal activity of different extracts of Acacia modesta Wall. on adult Culex pipiens mosquito.}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8022-8030}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21811}, abstract = {Background: Insect-transmitted diseases remain a major source of illness and death worldwide. Mosquitoes alone transmit diseases in more than 700 million people annually. The aim of the work: is to perform phytochemical screening tests and to investigate the insecticidal effects of different extracts of the aerial parts of Acacia modesta (A. modesta)   Wall. on adult Culex pipiens (Cx. pipiens) mosquito. Materials and methods: Different A. modesta Wall. extracts were bioassayed against adult Cx. Pipiens mosquito to estimate their insecticidal effects. Three different extracts of A. modesta Wall. aerial parts were prepared (distilled water, ethanol and acetone extracts). Different concentration for each prepared extract were tested for their insecticidal activity as well as different duration of exposure e.g. one hour, 24 hours, 48 hours and 72 hours were also performed. Results: The efficacy of these extracts varies according to type of solvent used, concentration of extract and duration of exposure. With continuous exposure for 24 hrs; efficacy of A. modesta Wall. extract was elevated from 62–91% in the same manner. Expanding the exposure for 48 hrs; show continuous elevation up to 90–100 %. Meanwhile, the highest concentration of the tested plant extracted in acetone is one third (100 mg/ml) compared to other solvents (300 mg/ml), results showed that using acetone as a solvent is better than either distilled water or ethanol for its insecticidal activity. Conclusion: It was evident from the results that the plant is a potential source of botanical insecticides against adult Cx. pipiens mosquitoes and their toxic effects are time and concentration dependent. Moreover, phytochemical screening for the aerial parts of A. modesta Wall. resulted in the identification of carbohydrates and/or glycosides, tannins, flavonoids , unsaturated sterols and/or triterpens  as well as saponins.}, keywords = {Acacia modesta Wall,Culex pipiens,insecticides and phytochemical screening}, url = {https://ejhm.journals.ekb.eg/article_21811.html}, eprint = {https://ejhm.journals.ekb.eg/article_21811_8954a203410661fd679c7f627b97b225.pdf} } @article { author = {Soliman, Ahmed S. and El Awady, Shokry A. and Wahab, Haitham M.}, title = {Effect of Maternal Body Mass Index in Relation to Embryo Quality and Clinical Outcomes in Couples underlying ICSI.}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8031-8038}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21812}, abstract = {Background: The rising incidence of obesity coupled with its detrimental effects on fertility led to greater numbers of overweight and obese women utilizing assisted reproduction technologies (ART), such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Aim of the Work: To evaluate the impact of body mass index on embryo quality and clinical outcomes in couples underlying ICSI. Patients and methods: a retrospective observational comparative study was conducted on 400 Women at ART Unit, International Islamic Centre for Population Studies and Research (IICPSR), Al-Azhar University. Data were recruited from the patient`s files who did ICSI trial in IICPSR  from December 2015 to December 2017, after exclusion of cycles in which the body mass index  (BMI) was not recorded. After approval of the local ethics committee, all pregnant women were briefed about the nature of the study and informed consent was obtained from them before inclusion in the study. Results: The duration of infertility was progressively higher as BMI increased. Basal luteinizing hormone, follicle-stimulating hormone, and estradiol levels were higher in group 2 than in group 1. Higher total doses of gonadotropin were required in group 2 to obtain equivalent ovarian response than in group 1. No significant difference was observed on ovarian response and embryonic parameters. Serum estradiol level on ovulation triggering day was significantly higher in group 2. Ovarian hyperstimulation and cycle outcome were not significantly different between both groups. Conclusion: Overweight and obesity appear to have independent adverse effects on ovarian response to stimulation and outcomes in women undergoing ICSI.}, keywords = {Body Mass Index,Embryo Quality,Clinical Outcomes Couples underlying ICSI}, url = {https://ejhm.journals.ekb.eg/article_21812.html}, eprint = {https://ejhm.journals.ekb.eg/article_21812_5d6c4435d6e4357c961f78d633a4e510.pdf} } @article { author = {Mahdy, Mostafa Mohammed and Ismail, Maamon Mohammed and Hamrosh, Amr Soliman and Elfiky, Ahmed Elsayed Kamel}, title = {Comparative Stud‌y between Intrathecal and Caudal Epidural Anesthesia in Children for Lower Abdominal Surgery}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8039-8046}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21813}, abstract = {Background: regional anaesthesia techniques are now established in the practice of pediatric anaesthesia. It is one of the most common techniques used for post-operative pain management in pediatric patients especially for urogenital, rectal, inguinal and lower extremity surgeries. Objective: to compare caudal and spinal anaesthesia in paediatrics regarding haemodynamics, efficacy (sensory block characteristics, motor block characteristics) post-operative analgesia, surgeon’s satisfaction, parents’ satisfaction and complications incidence. Material and Methods: the present study was carried on100 patients, with age ranging from (6-12) and of ASA(american society of anaesthesia.) I, II classes undergoing infraubmliclal pediatric surgeries, patients in each group were randomly assigned to receive spinal or caudal epidural anaesthesia.   Results: the demographic data of patients as regard age, sex and ASA classification showed no statistical significant difference between the two groups, where the study was designed to compare between the effectiveness of spinal anaesthesia with bupivacaine 0.3mg/kg and caudal anaesthesia with bupivacaine 2mg/kg(1ml/kg vol.) as a sole anaesthetic technique adequate for infraumblical pediatric surgeries below T10 as regard the sensory and motor block characteristics, perioperative haemodynamic effects, pain assessment, analgesic requirements, and both the surgeon ad parents satisfaction was assessed.the results showed the superiority of subarachnoid on achieving rapid onset of sensory blockade, intense motor blockade, on the other hand the caudal epidural had the advantage of longer post-operative analgesic effect and lower post-operative analgesic consumption, furthermore both techniques gained good degree of parent and surgeon satisfaction. Conclusion: if both techniques are correctly used and the anatomy of the patient is normal there is minimal risk of complications.}, keywords = {intrathecal,caudal epidural,infraumblical,pediatric surgeries}, url = {https://ejhm.journals.ekb.eg/article_21813.html}, eprint = {https://ejhm.journals.ekb.eg/article_21813_53137f5b4484546e991041524893d98a.pdf} } @article { author = {Barrak, Abd El Monem M. and Lashin, Hesham E. and Metwally, Mahmoud M. and Abd El-Rahman, Nabil I.}, title = {Ficolin-2 a newmarker for severity of liver inflammation in patients with chronic hepatitis C}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8047-8053}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21914}, abstract = {Background: ficolin-2 is a kind of human serum complement lectin with a structure similar to mannan-binding lectin (MBL) and it has been implicated in innate immunity. Recent studies have shown that complement pathway activation may contribute to hepatitis. However, the relationship between ficolin-2 and viral hepatitis remains largely elusive. Aim of the work: this study aimed to determine the dynamics of ficolin-2 in patients with chronic hepatitis C. Patients and Methods: Thirty patients who had not yet received therapy and twenty normal control subjects were included in this study. A sandwich enzyme-linked immunosorbent assay (ELISA) was used to measure the ficolin-2 concentrations in all serum samples of patients and 20 healthy donors. Results: we found that the concentrations of ficolin-2 were significantly higher in chronic hepatitis C patients with abnormal ALT values than in chronic hepatitis C patients with normal ALT values and healthy controls. Ficolin-2 concentrations in chronic hepatitis C patients with abnormal ALT values were positively correlated with ALT levels (*P <0.05). Then, we found ficolin-2 concentrations in rapid viral response (RVR) group decreased significantly (*P <0.05), while in non-RVR group, ficolin-2 decreased slightly (P >0.05). Conclusion: our findings suggested that early increased ficolin-2 is highly correlated with hepatic inflammation and rapid viral response.}, keywords = {ficolin-2,Liver inflammation,Chronic HCV}, url = {https://ejhm.journals.ekb.eg/article_21914.html}, eprint = {https://ejhm.journals.ekb.eg/article_21914_8839be521965dcb5e73357f0a866e5db.pdf} } @article { author = {El Kattan, Osama Abbas and Abd El Salam, Ahmed Abd El Mawgod and Mohamed, Ahmed El Sayed Fathy}, title = {Management of Infected Mesh Following Ventral Hernia Repair}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8054-8060}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21917}, abstract = {Background: abdominal hernia represents a major health care burden. With over 350,000 repairs performed annually in the United States, millions of dollars are consumed with results that are often far from ideal. The use of the prosthesis in the abdominal wall hernia repair (AWHR) has introduced new problems. Although mesh has reduced hernia recurrence rates, it has its own set of complications. So, mesh infection is one of the most devastating complications after the implantation of any mesh. Objective: this work aimed to focus on management of infected mesh after ventral hernia repair. Patients and Methods: this study was conducted in the Department of Surgery, Faculty of Medicine, Al-Azhar University Hospitals from September 2016 until March 2018. The study included 40 patients with surgical mesh infections after the repair of the ventral hernia. Results: cases with laparoscopic hernia repair, minor infections and a patient unfit for surgery were excluded for any medical reason. And after taking the history of the disease and clinical examination and the necessary investigations and the most important is to take a sample of infected fluid over the mesh to determine the type of infection caused by this or doing fistulogram if the fistula connected to the intestine small or large. Conclusion: research of best practices in surgical technique, preoperative care, and mesh materials is ongoing, and much remains to be learned on the prevention and management of this complex and potentially devastating complication.}, keywords = {abdominal wall hernia repair,partial removal of mesh,Complete mesh removal}, url = {https://ejhm.journals.ekb.eg/article_21917.html}, eprint = {https://ejhm.journals.ekb.eg/article_21917_8bd76f39915af2e96615df239e6c7c1e.pdf} } @article { author = {Sweilam, Mohammad A. and Attia, Mohammad A. and El-Saadany, Hanan M. and Ibrahim, Asmaa S.}, title = {Study the role of serum cartilage oligomericmatrix protein (COMP) in the diagnosis of rheumatoid arthritis patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8061-8073}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21920}, abstract = {Background: rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology. Cartilage oligomeric matrix protein (COMP) is one of markers used for early predicting joint destruction and disease activity in RA disease. Objective: in the present study we evaluated the role of COMP as diagnostic marker in RA patients in comparison with other traditional markers and its correlation with disease activity parameters. Patients and Methods: blood samples were collected from 50 patients newly diagnosed with rheumatoid arthritis (Group I) and also from 30 healthy subjectsas a control group (Group II).Serum level of COMP was measured by enzyme-linked immunosorbent assay (ELISA). Results: there was a high significant difference between the RA patients group and the control group regardingserum COMP level. Also, there was a significant correlation between serum COMP level with clinical and laboratory data of active RA patients. Conclusions: serum COMP could be useful for early diagnosis of rheumatoid arthritis and also could be used as a marker of disease activity and joint destruction.}, keywords = {serum cartilage oligomeric matrix protein,Rheumatoid Arthritis}, url = {https://ejhm.journals.ekb.eg/article_21920.html}, eprint = {https://ejhm.journals.ekb.eg/article_21920_5fb5aa743de2bb19877ce5361df5888a.pdf} } @article { author = {Salama, F. and Elshoura, S. and Mandour, I.}, title = {Treatment of Fracture Head Radius in Children with Closed Reduction and Elastic Nail}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8074-8076}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21921}, abstract = {Background: radial head fractures represent 5-10% of traumatic injuries of the elbow in children and 1% of all pediatric fractures. They result from a fall on the outstretched arm, with the elbow extended and the forearm supinated. Objective: this study aimed to assess the results of treatment of fracture head radius in children with closed reduction and fixation with elastic nail. The results were assessed clinically and radiologically. Methods: this study included 20 patients with fracture head radius in children who were treated with closed reduction and elastic nail in the Department of Orthopedic at New Damietta Al-Azhar University Hospital from Jan 2018 to September 2018. Results: this study was carried out on twenty patients with epiphyseal fractures of head radius treated with elastic nail from Jan 2018 to Oct 2018 and follow up for (1-10) months, 16 case excellent, 2 cases good, one case fair and one case bad. Conclusion: we were convinced by the versatility of the Titanium Nancy nailing as it provides a solution to fracture head radius that would have been exposed to open reduction, with no wasting time during operation, less infection rate, less blood loss and improved rehabilitation program.}, keywords = {fracture head radius in children with closed reduction and elastic nail}, url = {https://ejhm.journals.ekb.eg/article_21921.html}, eprint = {https://ejhm.journals.ekb.eg/article_21921_f49ea64fd0407a74616404b6b8d38f3d.pdf} } @article { author = {Farag, Ali Mohamed and Abo-Elsaad, Ahmed Youssef and Ahmed, Yasser Ali and Azzam, Ahmed Saber Mohamed}, title = {Laparoscopic varicocelectomy initial experience at Al_Azhar Hospital (Demietta)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8077-8083}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21923}, abstract = {Background: Varicocele is a collection of dilated veins in the pampiniform plexus that drain the testicle and may contribute to male infertility. A variety of surgical & non-surgical approaches have been advocated for varicocele treatment. Objective:  Evaluate laparoscopic varicocelectomy with regard to intra and post-operative parameters. Patients and Methods: At Departments of urology of Al_azhar University Hospitals (Damietta). Prospective randomized study was performed about laparoscopic varicocelectomy during the period from June 2016 to December 2017 after obtaining informed consent. The group included patients with clinically palpable varicocele confirmed by U/S complaining of infertility (primary, secondary) or chronic testicular pain. Results: The range operative bilateral Laparoscopic Varicocelectomy time was 60-90 minutes. There were no intra operative complications in the study group. The average hospital stay was 24-36 hours. Post-operative analgesics (2-3) doses, daily activities initiation usually started after 4-5days. Hydrocele formation was seen in (11.1%) patients recurrence was seen in (5.6%) patient. None of the patient has developed an atrophic testis as a result of the laparoscopic procedure. Patients had improvement of the seminal fluid parameters during follow up period and pregnancy rate was (25%). CONCLUSION: Laparoscopic varicocele ligation is a simple and safe technique causing minimal morbidity and enabling rapid return to normal activity.}, keywords = {Varicocele,Laparoscopy,Infertility}, url = {https://ejhm.journals.ekb.eg/article_21923.html}, eprint = {https://ejhm.journals.ekb.eg/article_21923_e8057cf5585afa6ecbe8a1b1eaa078a3.pdf} } @article { author = {Mekky, Abdullah Ahmed Abdullah and Gabr, Amgad Ahmed Moshref and Kamal, Mohamed Ahmed Lotfy and Hamouda, Mohamed Mahmoud and Khalil, Ahmed Said Abd El Khalik}, title = {Study of the Effect of Repetitive Transcranial Magnetic Stimulation on a Sample of Children with Attention-Deficit/Hyperactivity Disorder}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8084-8090}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21925}, abstract = {Background: attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric disorder that affects children and young adults and cause significant functional impairment. Although there are effective medications and psychobehavioural therapies that help with management of ADHD, the medications can have significant side effects, which limit their use. There is need to explore other treatment options. transcranial magnetic stimulation (TMS) and repetitive transcranial magnetic stimulation (rTMS) are recent safe and non-invasive investigative and therapeutic tools. Aim of the work: to study the effect of repetitive transcranial magnetic stimulation on a sample of children with Attention-Deficit/Hyperactivity Disorder. Methods: the sample was consisted of (35) child; their ages were ranged from 6 to 12 years old after diagnosed clinically according to DSM-5 through a designed semi structured interview and through application of Conner’s teacher-28 and parent-48 rating scalesas ADHD combined type. Females were (11) children with percentage 31.4%, while males were (24) children with percentage 68.6%. All patients on the sample were not receiving any medical or behavioral therapy for ADHD. Results: means scores of inattention, hyperactivity and impulsivity were reduced significantly in the post 5 days and 2 weeks follow up (P-values > 0.001(, started to rise again in its evaluation after 4 weeks but not reaching its values before rTMS sessions. the percentage of severe cases in each scale category was dramatically decreased immediately and 2 weeks after rTMS sessions and started to rise again in its evaluation after 4 weeks but to lower percent than before rTMS sessions (70%, 100% and 60% had severe inattention, hyperactivity and impulsivity respectively before rTMS, reduced to 0%, 0%, 10% immediately and 2 weeks after rTMS but increased to (20%, 40% and 40%) after 4 weeks. no patient experienced any significant adverse effects during the study, except 3 children reported mild headache that resolved spontaneously within an hour without medication. Conclusion: this study concluded that r TMS over left dorso-lateral prefrontal cortex may be safe and effective way of providing relatively lasting relief of ADHD symptoms especially in children with severe symptoms.}, keywords = {ADHD – neurobiology – TMS – rTMS}, url = {https://ejhm.journals.ekb.eg/article_21925.html}, eprint = {https://ejhm.journals.ekb.eg/article_21925_bb434064b592f7aa032feb39a5e46fda.pdf} } @article { author = {Eid, F. A. and Abu Elnaga, N.A. and Sarhan, M. and Mansour, H.}, title = {Effect of monosodium glutamate on liver of pregnant rats and their fetuses (Histological and histochemical studies)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {73}, number = {11}, pages = {8091-8098}, year = {2018}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2018.21951}, abstract = {Background: monosodium glutamate (MSG) is a widely used flavor enhancer and stabilizer in readymade or packaged foods. The excessive use of MSG increases the oxidative stress in the different body systems and causes teratogenic effects on fetuses of mothers treated with it in the gestational periods. Aim of the work: this study investigated effects of MSG on maternal and fetal liver tissue. Material and Methods: the present work was carried out on fifty mature pregnant Albino rats (Weight 200 ± 20 g) and six male rats in the reproductive age (Older than 60 days). The first group was served as the control group. The remnant pregnant rats were categorized into two sub- groups. Animals of the 1st sub group were dissected on day 15th of gestation (C15) and the second was dissected on day 19th (C19) of gestation. The second group was administrated monosodium glutamate daily with the dose of 7 g/10mL/kg body weight from the 9th to 14th of gestation. Then the pregnant mothers were categorized into two sub- groups, the first was dissected on the 15th day (G15) and the second on the 19th day (G19) of gestation. The pregnant mothers were dissected after anesthesia which was performed by Halothane produced by Pharco. Comp. The uterine horns were removed from the surrounding fats then fetuses were removed from the surrounding amniotic membranes.  Histopathological and histochemical studies were done on the   maternal and fetal liver tissue through hematoxylin-eosin stain and Feulgen reaction. Results: numerous degenerative changes were detected in both maternal and fetal liver tissues of G15 and G19 groups. These changes included: vacuolation in hepatocytes, degenerative and necrotic areas and atrophied size of hepatocytes with pyknotic nuclei. These changes were observed in the centrolobular zones and the portal zones. Conclusions: This study showed that short-term MSG exposure in the gestational periods caused several histological and histochemical changes in the maternal and fetal liver tissues. These findings should be re-evaluated in additional long-term studies.}, keywords = {}, url = {https://ejhm.journals.ekb.eg/article_21951.html}, eprint = {https://ejhm.journals.ekb.eg/article_21951_7fa5c5dd0dc0fa3840dda044b6aa426a.pdf} }