@article { author = {Wafa, Yehia Abd El Salam and Mohamed, Ashraf Hamdy and Abd Allah, Alsaied Ahmed Abo El Kamal}, title = {The Effect of Threatened Abortion on Fetal Growth and Premature Rupture of Membrane}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5766-5770}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.63376}, abstract = {Background: The diagnosis of threatened abortion is frequently made in clinical practice as a result of taking a history of vaginal spotting and the finding of a closed cervix at subsequent vaginal examination in first 20 weeks of gestation. Objective: This study was conducted to evaluate the incidence and relation between threatened miscarriage and preterm premature rupture of membranes (PROM) and also its effect on fetal growth. Patients and methods: The current study was conducted during a period of 8 months starting from 1st June 2019 till 31st August 2019. The patients were divided into two groups. First group: Included one hundred women presenting with threatened abortion at or below 20 weeks of gestation (case group). Second group: Included one hundred women who didn't have any symptoms of threatened abortion (control group). All patients were recruited from the Outpatient Clinics and Casualties of the Obstetrics and Gynecology Department, Al-Hussein and Bab Al-Sharia, Al-Azhar University Hospitals. Results: Our study showed that there were significant differences regarding abortion, preterm labor and intrauterine growth restriction in the case group compared to the control group. There was a relative increase in the incidence of premature rupture of membranes, hypertensive disorders, placenta previa and the rate of cesarean section in the case group compared to the control group. Conclusion: There was a relation between threatened abortion and adverse pregnancy outcomes.}, keywords = {threatened miscarriage,Fetal Growth and Premature Rupture of Membranes}, url = {https://ejhm.journals.ekb.eg/article_63376.html}, eprint = {https://ejhm.journals.ekb.eg/article_63376_c58afbae57be17bfb1975b40f2695eb6.pdf} } @article { author = {Abokifa, Amin M. and El Badawy, Refaat I. and Anwar, Hesham W. and El Sagheer, Yahia E.}, title = {Disorders of Sexual Development in Proximal Hypospadias in Children}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5771-5775}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.63574}, abstract = {Background: Hypospadias is seen in around one in 300 live births, making it the most prevalent congenital penile abnormality. Objective: to evaluate of the incidence and diagnosis of disorders of sexual development in proximal hypospadias. Patients and Methods: This prospective study was conducted on 44 children attending the Pediatric Surgery Department, Al-Azhar University Hospitals during the period from Dec 2018 to Nov 2019. Detailed history taking; including complete physical examination, examination with special focus on external genitalia and gonads; routine and specific laboratory investigation as genetic karyotyping, serum testosterone (T), dihydrotestosterone, dehydroandrostenedione,17 OH progesterone, HCG stimulation test, serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), Adrenal hormones “serum cortisol & plasma adrenocorticotropic hormone (ACTH) “to exclude congenital adrenal hyperplasia. Ultrasound abdomen and pelvis was routinely done to assess the internal genital organs " uterus, fallopian tubes " and gonads " testis, ovaries ". Results: there are (5) patients diagnosed as DSD: Three cases (6.8 %) have Karyotyping (46, XX), diagnosed as CAH. One case (2.2%) has Karyotyping (46XY (70%)/45X (30) sex chromosome DSD (45, X/46, XY PGD) or “mixed gonadal dysgenesis”. One case (2.2%) has Karyotyping (46, xy), diagnosed as complete Androgen insensitivity syndrome. Conclusion: Patients presenting with proximal hypospadias and one or more of the co-existing anomalies of micro penis, undescended/impalpable testes, and penoscrotal transposition/bifid scrotum should warrant DSD evaluation. Presence of bilaterally descended testes in scrotum does not preclude the possibility of DSD.}, keywords = {DSD,Proximal Hypospadias,children}, url = {https://ejhm.journals.ekb.eg/article_63574.html}, eprint = {https://ejhm.journals.ekb.eg/article_63574_a9164c881410525ebf8b695683998f85.pdf} } @article { author = {El Beialy, Adel Abbas and Elabd, Hemmat Ahmed and Abd El-Rahman, Asmaa Fouad Ibrahim}, title = {Serum Level of Matrix Metalloproteinase 3 and Hydroxyproline in Patients with Early Rheumatoid Arthritis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5776-5783}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.63575}, abstract = {Background: Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. Objective: The aim of this study wasto estimate serum level of Matrix metalloproteinase 3 and hydroxyproline in early rheumatoid arthritis. Patients and methods: This study included a total of 40 patients with early RA (disease duration < 3 yrs.) and 20 normal volunteers of matched age and sex served as the control group, attending at Department of Physical Medicine, Rheumatology and Rehabilitation, Al-Hussein University hospital. A disease evaluation was done by DAS 28 for all subjects. Results: In this study, there was a significant positive correlation between matrix metalloproteinase 3 (MMPs) with all studied parameters of disease activity (MS, SJC, GH, ESR, DAS 28) p-value <0.05 and a significant positive correlation between MMP3 and TJC p-value <0.001. There was also a significant positive correlation between hydroxyproline with (TJC, SJC, DAS28) p-value <0.05. Results showed a significant positive correlation between matrix metalloproteinase 3 and hydroxyproline. (P-value <0.001). Conclusion: It could be concluded that in RA there is an evidence of elevated serum MMP3 and HP levels that reflects disease activity and could be used as a specific marker for joint damage.}, keywords = {Metalloproteinase 3,hydroxyproline,Rheumatoid Arthritis}, url = {https://ejhm.journals.ekb.eg/article_63575.html}, eprint = {https://ejhm.journals.ekb.eg/article_63575_77224c43bd96e9f0418bfe63a82aad02.pdf} } @article { author = {Abdu EL- Aal, Hanan Elsayed Ali and Mohamed, Mervet Abdelfatah and Saad, Amna Yehia}, title = {Adherence of Patients with Insulin Dependent Diabetes to Therapeutic Regimen}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5784-5794}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.63576}, abstract = {Background: Diabetes mellitus is a metabolic disorder with varied etiologies characterized by chronic hyperglycemia and carbohydrate, fat and protein metabolism disorders caused by insulin secretion defect, insulin action or both. People with diabetes also have an increased risk of other diseases, including heart, peripheral, arterial and cerebrovascular disease. Objective: This study aimed to identify adherence of patients with insulin-dependent diabetes to therapeutic regimen. Patients and methods: A descriptive research design was used to accomplish the aim of the present study. A convenience sample of 150 adult patients who were admitted to the study. The study was conducted at the DiabeticOutpatient Clinic at Shark El Madina Hospital in Alexandria. Outpatient clinic was working 6 days per week from Saturday to Thursday from 9 am to 1 pm. Results: There was a highly statistical significant relation between patient's age, sex, level of education, monthly income and overall adherence to therapeutic regimen (p < 0.05). The highest percentage of the studied patients who had good adherence to therapeutic regimen were aged 40 -50 years old, female patients, university educated and had enough income (63.9%, 52.7%, 62.1%, and 75% respectively). Overall adherence barriers were moderate in the patient's age group of 50-60, male, manual occupation, divorced, secondary educated and who hadn't have enough income (65.4%, 55.9%, 71.1%, 71.4%, 70% and 63% respectively). Conclusion: Based on the study findings, it can be concluded that, more than half of the studied patients were fair adherent to diabetic diet, and more than two thirds of them were good adherent to medication.}, keywords = {Adherence of Patients,Diabetes mellitus,Insulin,Congestive heart disease}, url = {https://ejhm.journals.ekb.eg/article_63576.html}, eprint = {https://ejhm.journals.ekb.eg/article_63576_98069d1649b6d08cc223727800da3cf6.pdf} } @article { author = {Ellithy, Mohamed Mohamed and Abdelmonem, Ashraf Abdelhameed and Helal, Ahmed Abdelghaffar Hamed and El Gohary, Ibrahim Abu Zeid Ibrahim}, title = {Study of Central Venous Cut-Down Versus Percutaneous Central Venous Catheterization in Neonates and Infants}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5795-5803}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.63577}, abstract = {Background: Several more access routes of have been described. Umbilical artery catheters (UACs), and umbilical vein catheters (UVCs). CVCs can be placed in numerous sites, including the internal jugular vein (IJV), the subclavian vein, the femoral vein, peripheral veins leading to central access, and other surgical access sites. Objective: To compare central venous cut-down catheterization versus percutaneous central venous catheterization in neonates and infants regarding technical feasibility, indications, operative time and complications. Patients and Methods: This is a prospective study on two different methods for central line insertion in neonates and infants. This study was done at Al-Azhar University Hospitals, in Pediatric Surgery Department, Neonatal Intensive Care Unit and Pediatric Intensive Care Unit. One hundred patients who required central venous catheterization were included in this study, during period between December 2018 and October 2019. Results: The present study reported that the ultrasound guided CVC was more useful in placement of CVC in infants and neonates, and decreasing complications. The ultrasound technique not only clarified the relative position of the vein and its surrounding structures but also helped in identifying the course of the central vein and its caliber and provide confidence to the operator Conclusion: The present study reported that the ultrasound guided CVC was more useful in placement of CVC in infants and neonates, and decreasing complications. Cost is one of the limiting factors in the availability of ultrasound device in many clinical applications.}, keywords = {Central Venous Cut-Down,Percutaneous Central Venous Catheterization,Neonates and Infants}, url = {https://ejhm.journals.ekb.eg/article_63577.html}, eprint = {https://ejhm.journals.ekb.eg/article_63577_02f2b8d7cd2231a0a9afc31c647c6669.pdf} } @article { author = {Saber, Samy A. and Mohamed, Aly F. and El-Fiky, Abir A. and Eldaly, Hossam. H.}, title = {In Vitro Evaluation of Antibacterial Potential of Cerastes Vipera Venom against Gram-Positive and Gram-Negative Bacterial Strains}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5804-5816}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.63748}, abstract = {Background: Venoms of the family Viperidae in particular are complex mixture of many substances. They include many different proteins that possess significant bactericidal inhibition. Objectives: The aim of the current work was to investigate the antibacterial profile of Sahara sand viper (Cerastes vipera) snake venom against both gram negative Pseudomonas aeruginosa and gram-positive bacteria Bacillus cereus. Materials and Methods: 1. Identification of the venom was performed using assessment of total protein, determination of the venom protein by SDS-PAGE electrophoresis and determination of the half lethal dose (LD50) of venom. 2. Antibacterial activities of Cerastes vipera venom was examined by using disc diffusion method. Microdilution method was used to determine the venom's minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC). 3. The interaction between venom and bacteria was examined by Electron microscope. Results: The total protein of the venom was 1.047±0.1 mg/ml. The SDS electrophoresis showed there were four clear bands of protein nearly at 25, 35, 48, 63 Kds and another band between 25, and 35 Kds. The LD50 was 18.3 μg/mouse (0.915 mg/kg body weight). Concerning the antibacterial effect of tested venom, disc diffusion test showed a ring of inhibition zone of about 12 mm in the case of Pseudomonas aeruginosa and of about 0.8 mm in the case of Bacillus cereus. The Microdilution test showed that the MIC of the venom for Pseudomonas aeruginosa was 12.5 mg/ml and that for Bacillus cereus was 25 mg/ml. The electron microscopic examination supported the two previous tests, as it observed the presence of elongated, malformed, melted, no-membranous and lysed bacterial cells when treated by the venom. Conclusion: It could be concluded that Cerastes vipera venom is a potentially weak bactericidal, but can inhibit antibiotic-resistant bacteria as Pseudomonas aeruginosa. }, keywords = {Cerastes vipera venom,bactericidal,Bacillus cereus,Pseudomonas aeruginosa,MIC,MBC,Electron microscopic examination}, url = {https://ejhm.journals.ekb.eg/article_63748.html}, eprint = {https://ejhm.journals.ekb.eg/article_63748_ebdaa5467fc75fd26e4ce64f588f1f29.pdf} } @article { author = {Abdelsalam, Habiba Ahmed and Fayed, Soheir Bahgat and Mohamed, Amal Gaber}, title = {Homeostasis Model Assessment of Insulin Resistance in Obese Children as A Predictor for Metabolic Syndrome}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5817-5824}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.63753}, abstract = {Background: Obesity has emerged as one of the most serious public health concerns in the 21st century. HOMAIR scores are useful indicators of insulin resistance for research purposes. Objectives: This study was aimed to evaluate HOMA-IR for insulin resistance in obese children, to correlate between HOMA-IR and metabolic syndrome in obese children and also to assess relation between insulin resistance and morbidity. Subjects and Methods: This cross-sectional study included a total of ninety overweight and obese children, aged 4-8 years, attending at El-Zahraa University Hospital and National Institute of Nutrition. This study was conducted between from January 2018 to January 2019. All studied children were subjected to anthropometric measurement, blood pressure measuring, skin finding as acanthosis nigricans. Lab investigations including measurement of HBA1C, fasting serum glucose, total cholesterol, HDL-C, LDL-C, triglycerides and insulin were done. Results: Mean and median values of HOMA-IR were significantly higher among patients with large birth weight than low and average birth weight and among patients with positive family history of obesity than negative ones. Participants illustrated a significant positive correlations between HOMA-IR and weight and BMI, SBP, DBP and serum cholesterol Conclusion: It could be concluded that homeostasis model assessment of insulin resistance index HOMA-IR in obese children is increased with increased body mass index, waist circumference systolic, diastolic blood pressure, serum cholesterol, LDL-C, large birth weight, patients with positive family history of obesity and among patients with acanthosis nigricans.}, keywords = {HOMA,Insulin Resistance,Overweight and Obese children}, url = {https://ejhm.journals.ekb.eg/article_63753.html}, eprint = {https://ejhm.journals.ekb.eg/article_63753_656092cb46c85a1954517d6ea7bf4d81.pdf} } @article { author = {Solyman, Mohammad Tharwat Mahmoud and Ait-Allah, Abdou Saeed and Mohammad, Mohammad Alaa Alsaid and Alam-Edeen, Mohammad Hasan and Amin, Yasser Abdel-kareem}, title = {Role of Magnetic Resonance Imaging (MRI) In Abnormal Uterine Bleeding}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5825-5833}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64082}, abstract = {Background: Abnormal uterine bleeding (AUB) is not always reported by women experiencing symptoms. Because of this, 3% to 35% of women worldwide may have abnormal uterine bleeding. Objective: MRI examination of women with AUB to detect any organic cause not detected with transvaginal ultrasonographic examination and if MRI add any advantage more than transvaginal ultrasound. Patients and methods: This study had been conducted at the department of diagnostic radiology-Sohag University Hospital at the period from September 2016 to September 2018. 50 women with abnormal uterine bleeding were referred from the Department of Obstetrics and Gynecology or from the Outpatient Clinic for this study. Results: Our study revealed a sensitivity of transvaginal ultrasonography (TVS) was 100% and specificity was 95.56% in detecting uterine pathology. For uterine myoma; the current study showed that MRI had a sensitivity of 100%, specificity 100%, PPV 90.9% NPV 100% and accuracy 98%. Our MRI sensitivity and specificity for endometrial carcinoma were high may be because endometrial carcinoma was one case only and we used DW image for her diagnosis. The need for histopathological evaluation of endometrial lesion couldn't be totally excluded. In our study TVS had a sensitivity for endometrial carcinoma 100% and specificity 100% Conclusion: Role of MRI in abnormal uterine bleeding as equal as that of (TVUS) but still TVUS has the upper hand as the first imaging choice, real time imaging}, keywords = {MRI,Abnormal Uterine Bleeding,DWI,TVUS}, url = {https://ejhm.journals.ekb.eg/article_64082.html}, eprint = {https://ejhm.journals.ekb.eg/article_64082_a593abe70374c53e0c0941669117fb4d.pdf} } @article { author = {Solyman, Mohammad Tharwat Mahmoud and Ait-Allah, Abdou Saeed and Mohammad, Mohammad Alaa Alsaid and Alam-Edeen, Mohammad Hasan and Amin, Yasser Abdel-kareem}, title = {Management of MR Imaging in Abnormal Uterine Bleeding}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5834-5840}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64083}, abstract = {Background: Abnormal uterine bleeding (AUB) is a common condition that leads to increased health care costs and decreased quality of life. A systematic approach to AUB evaluation can simplify management and enhance women’s well-being. Objective: Management of MRI in women with AUB to detect any organic cause not detected with transvaginal ultrasonographic examination and if MRI add any advantage more than transvaginal ultrasound. Patients and methods: Fifty women with abnormal uterine bleeding were referred from the outpatient clinic and inpatients of OB/GYN Department at Sohag University Hospital was subject for this study. Results: MRI results in the diagnosis of fibroid had a sensitivity and specificity of 100% and the 2D TVS had a sensitivity of 80% and specificity 100 %. The falsely positive MRI was focal type adenomyosis miss diagnosed as interstitial fibroid. The sensitivity of the MRI for the adenomyosis in our results was 100% with specificity was 95%. Our results of adenomyosis using 2D transvaginal ultrasound had sensitivity 80% and specificity 97.5%. Our results using MRI had a sensitivity of 100% in endometrial polyp detection with specificity 90.47%. TVS had a sensitivity of 50% with specificity 100%. Conclusion: Management of MRI in abnormal uterine bleeding as equal as that of TVS but still TVS has the upper hand as the first imaging choice, real time imaging. patients also preferred TVS than MRI.}, keywords = {Management of MR Imaging,Abnormal Uterine Bleeding,TVUS,FIGO,quality of life}, url = {https://ejhm.journals.ekb.eg/article_64083.html}, eprint = {https://ejhm.journals.ekb.eg/article_64083_35d2d43a221c05fde0f98d49cc87a110.pdf} } @article { author = {Rafat, Mohamed Nabil and Berengy, Mahmoud Saad and Abd alsamie, Hesham Samir and Ramadan, Sallam El-sayed}, title = {Evaluation Of The Relationship Between Neutrophil-Lymphocyte Ratio and Insulin Resistance In Newly Diagnosed Type 2 Diabetes Mellitus Patients}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5841-5846}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64084}, abstract = {Background: Newly diagnosed type 2 diabetes mellitus (DM) is associated with insulin resistance (IR). This insulin resistance is related to state of chronic inflammation and inflammatory marker such as neutrophil lymphocyte ratio, which can be used as a predictor inflammatory marker for insulin resistance. Objectives: The aim of this study was to evaluate the relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus in New Demitta Hospital patients. Patients and methods: This study is a prospective one that was carried out on thirty (30) populations and sixty (60) patients newly diagnosed type 2 diabetes mellitus attending to Outpatient Clinic and Inpatient Department of Internal Medicine at Al-Azhar University Hospital, Damietta. All were subjected to full history and clinical examination, laboratory tests include, HOMA IR, HbA1c, serum fasting insulin, CBC, Fasting blood sugar, post prandial glucose level, ALT, AST, serum albumin, bilirubin, GGT, creatinine, urea, uric acid, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, high sensitive C-reactive proteins, ESR, BMI and urine analysis. Results: Our study showed that there was statistically significant increased neutrophil-lymphocyte ratio and serum triglycerides in group newly diagnosed type 2 diabetes mellitus with IR (BI) in comparison with newly diagnosed type 2 diabetes mellitus without IR group (BII) and controlled group (A).The study showed a significant positive correlation of NLR with HOMA-IR and showed the risk predictors of IR including NLR, TG and HbA1c. Conclusion: The results of this study showed that in newly diagnosed type 2 DM with IR having increased NLR which can be considered as early predictor for IR in those patients.}, keywords = {Neutrophil-lymphocyte ratio (NLR),Insulin resistance (IR),Inflammation,Type 2 diabetes mellitus}, url = {https://ejhm.journals.ekb.eg/article_64084.html}, eprint = {https://ejhm.journals.ekb.eg/article_64084_e41bc2f1c513f68f8a25f74a8af74a7c.pdf} } @article { author = {Sabra, Amira Ibrahim and Eldeeb, Ali Eid and Salama, Alsiagy Ali and Elsayed, Salwa Elmorsy}, title = {Role of Diagnostic Musculoskeletal Ultrasound in Assessment of Gouty Arthritis}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5847-5852}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64085}, abstract = {Background: Gout is a chronic heterogeneous disorder of urate metabolism results in deposition of monosodium urate crystals in the joints and soft tissues, with accompanying inflammation and degenerative consequences. Aim of work: Assessment of the role of musculoskeletal ultrasound (MSUS) in detecting changes in gouty arthritis patients under anti hyperuricimic treatment. Patients and methods: 30 patients with gouty arthritis treated with febuxostat 80 mg once daily for 3 months and 20 (age, sex & body mass index “BMI”) matched controls were included. Patients were assessed by clinical examination, pain by visual analogue scale (VAS), tenderness by Ritchie index, functionally assessed using lower extremity functional scale & examination of joint effusion and tophi by palpation. MSUS findings in knee and first metatarsophalangeal “1st MTP” joints of patients and controls were reported before and 3 months after treatment. Results: BMI mean in patients group was 28.18 ± 1.49 (25-31) and in controls was 27.67 ± 1.56 (25-31). VAS, tenderness & lower extremity functional scale in patients before treatment in knee & 1 stMTP joints significantly improved after treatment (p < 0.001). There was a significant improvement in ESR, CRP, serum uric acid, double contour sign & knee effusion in patients after treatment compared to before treatment. Conclusion: Ultrasonography can detect changes related to treatment of gout with febuxostat. Febuxostat is a safe and efficient anti hyperurecemic drug and is effective in treatment of gouty arthritis. Ultrasound is more sensitive in detecting findings & changes of disease than clinical examination.}, keywords = {Gout,Ultrasonography,gouty arthritis,double contour sign,tophi,febuxostat}, url = {https://ejhm.journals.ekb.eg/article_64085.html}, eprint = {https://ejhm.journals.ekb.eg/article_64085_466d5348035131910a90b370587d924c.pdf} } @article { author = {Rafat, Mohamed Nabil and Alsayyad, Mohammad Mossaad and El Ghannam, Magdy Zaky and Rafat, Mahmoud El Sherif}, title = {Study of Serum Uric Acid level in Thyroid Disorders}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5853-5857}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64086}, abstract = {Background: Thyroid dysfunction affects hundreds of millions globally, serum uric acid (UA) elevation has been found to be related to thyroid dysfunction according to some studies. Thyroid dysfunction affects the purine nucleotide metabolism that may increase uric acid concentration, which is the end-product of purine metabolism and is a primary risk factor for development of gout. AIM OF THE WORK: The aim of this study was to estimate the frequency of hyperuricemia in patients with thyroid dysfunction whether hypothyroid or hyperthyroid. Patients and methods: This is a case control clinical study that was conducted in Internal Medicine Outpatient Clinic and Inpatient Department of Internal Medicine at Al-Azhar University Hospital, Damietta. The population of the study were classified into 50 hypothyroid patients (group I), 50 hyperthyroid patients (group II) and 50 normal as control (group III). All were subjected to full history, clinical examination and laboratory tests including, complete blood count, serum urea, serum creatinine, estimated glomerular filtration rate, lipid profile, thyroid stimulating hormone, free triiodothyronine and free thyroxine. Investigations included echocardiography, electrocardiography and thyroid ultrasound. Results: There was significant elevation of body mass index, blood urea, createnine, VLDL, TG, cholesterol, Uric Acid, TSH in group I as compared to group II & III. Additionaly, there was statistically significant elevation of estimated glomerular filteration rate, FT4, FT3 in group II in comparison with groups I & III. Also, there was significant increase in IHD, pericardial effusion, in group I and statistically significant increase in pulmonary HTN in group II. Conclusion: The uric acid level was elevated in both hypothyroidism and hyperthyroidism, the elevation was more in hypothyroidism concomitant with the elevation of other parameters that characterize chronic kidney disease such as creatinine, estimated glomerular filtration rate and blood urea indicating that the decreased excretion of uric acid was the leading pathogenesis to this elevation in hypothyroidism}, keywords = {Hyperuricemia,Thyroid dysfunction,Gout,VAI}, url = {https://ejhm.journals.ekb.eg/article_64086.html}, eprint = {https://ejhm.journals.ekb.eg/article_64086_28ec2c30fe85558ecc3af1bead90249f.pdf} } @article { author = {Ali, Mohammed Ali Abd Elhamid and Yehya, Mohamed Ahmed and Elsherief, Faisal Ahmed Hashem}, title = {Management of Football Players Injuries at Dakahlia Governorate "Analytical Study"}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5858-5865}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64087}, abstract = {Background: No research on the medical specialty of soccer injuries in Egypt, despite its importance for injury prevention designing in a country with restricted football medicine resources. The aim of this study was to evaluate the incidence and pattern of injuries in soccer players. Objective: The aim of this analytical study is to evaluate the incidence, severity and pattern of injuries and follow up of outcome results of the management procedures done for football players at Dakahlia Governorate season 2017 -2018. Patients and Method: A prospective study was conducted during season 2017-2018 which a complete of 154 players with associating age vary of 18–35 years. Physiotherapists recorded team exposure and injuries. Participants: Five teams of 2nd Egyptian league at Dakahlia. Results: A total of 350 injuries occurred during season 2017-2018 giving an injury incidence of 9.4 injuries/1,000 hours, on average 31 players per team. The average player participated in33 ± 4 matches and had 170 ±15 training sessions each season. Of all included injuries 250 (71.4%) were acute injuries, where as 100 (28,6%) were overuse injuries, with 212 (60.6%) occurring during matches and 138(39.4%) during training. On average, a player sustained 2.3 injuries per season. The single most common injury subtype was hamstring strain, representing 14.8% of all injuries, severe injuries constituted 12%, ankle injuries represent 10.9%, fractures represent 2.8%, dislocations represent 1.7%, ACL injury represent 1.2%, medial meniscal injury represent 2.3% and tendon Achilles rupture represent 0.6%, concussion accounted for 1.7% of all injuries. Re-injuries constituted 9% of all injuries. Conclusions: The overall incidence of injuries among players in Egypt is high because of lack of medical personnel and medical care, lack in documentation of injuries and there is no rules or programs for injury prevention provided by Egyptian Football Association. a lot of studies are required to completely perceive the pattern of injuries and establish prevention programs.}, keywords = {Football Injuries,Dakahlia Governorate,Sport injuries}, url = {https://ejhm.journals.ekb.eg/article_64087.html}, eprint = {https://ejhm.journals.ekb.eg/article_64087_7ba39cfebae69e49ca8bf9e11e2c922f.pdf} } @article { author = {Hafez, Mohammed Zein Eldeen and Abd Elaziz, Wael Abd El Gwad and Moustafa, Walaa Shazly}, title = {Can Hyponatremia Play a Role in Morbidity and Mortality in Chronic Hepatic Patients in ICU at Aswan University?}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5866-5872}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64632}, abstract = {Background: Hyponatremia is a frequent complication of advanced chronic liver diseases related to an impairment in the renal capacity to eliminate solute-free water that causes a retention of water that is disproportionate to the retention of sodium, thus causing a reduction in serum sodium concentration and hypoosmolality. Objective: The aim of this study is to evaluate the role of hyponatremia on morbidity and mortality in chronic liver diseased patient in ICU unit at Aswan University Hospital. Matients and methods: This study included 90 patients who were suffering of hyponatremia with chronic liver disease and selected from patients in Aswan University Hospital. The patients were 61 males (67.78%) and 29 females (32.22%). Results: About (40%) of patients were discharged and (60%) of patients died. First group: patients with mild hyponatremia about (67.71%) were discharged and about (35.29%) died. Second group: patients with moderate hyponatremia about (65.7%) were discharged and about (34.21%) died. Third group: all patients with severe hyponatremia (100 %) died. Conclusion: hyponatremia play important role in mortality rate of patients with chronic liver disease.}, keywords = {Hyponatremia,Morbidity and Mortality,Chronic Hepatic diseases,ICU}, url = {https://ejhm.journals.ekb.eg/article_64632.html}, eprint = {https://ejhm.journals.ekb.eg/article_64632_2e3848a526eff14192e6fd9dfa3a34b6.pdf} } @article { author = {El Hamedi, Mahmoud A. and Salem, Hesham A.}, title = {Platelet Rich Plasma in Repeated Implantation Failure in Women with Thin Endometrium Thickness}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5873-5875}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64633}, abstract = {Background: repeated implantation failure (RIF) is a major challenge in reproductive medicine. Platelet rich plasma (PRP) was able to promote the endometrial growth and improve pregnancy outcome of patients with thin endometrium. Aim of the study: it was to evaluate the effectiveness of intrauterine infusion of PRP in treatment of thin endometrium in frozen-thawed embryo (FTE) transfer. Patients and Methods: the study included 10 infertile patients with thin endometrium (<7mm) in Frozen Embryo Transfer (FET) program. Estradiol valerate 12 mg/d was started on day 3 of menstrual cycle. PRP was prepared from autologous blood and infused into the uterine cavity. Endometrial thickness was re-assessed and if the endometrial thickness wasn’t satisfactory infusion of PRP was repeated 2-4 times. Cleavage stage embryos were transferred on the 3 rd day after progesterone administration, and blastocysts were transferred on the 5th day after progesterone administration. Results: the endometrial thickness increased after PRP infusion in all the patients, and reached >7mm on the day of progesterone administration. Sixty percent of the patients became pregnant; 83.3% continued pregnancy and 16.7% experienced missed abortion. Conclusion: intrauterine PRP may be effective in promoting endometrial growth, endometrial thickness, and improving pregnancy out come in repeated implantation failure.}, keywords = {platelet rich plasma,Repeated,Implantation Failure,Endometrial Thickness}, url = {https://ejhm.journals.ekb.eg/article_64633.html}, eprint = {https://ejhm.journals.ekb.eg/article_64633_a5ba51e7c770c4975c96e10a2268493e.pdf} } @article { author = {Abo-Elwafa, Wael Hassan and Alawady, Mohammed Kamel Ibrahem and Esam, Hossam Mohammed}, title = {Comparative Study between Endoscopic Transcanal Myringoplasty Versus Microscopic Myringoplasty in middle age group (20-40 years)}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5876-5882}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64826}, abstract = {Background: The surgical goals of myringoplasty are the closure of the tympanic membrane perforation and improvement of the hearing levels. Aim of the work: To compare the results, advantages and disadvantages between endoscope and microscope in myringoplasty. PATIENTS AND METHODS: This study was carried out in the Otorhinolaryngology Department at Alhussin and Bab-Alsharia University Hospitals. The study included 40 patients with a diagnosis of chronic suppurative otitis media of tubo-tympanic type, divided into two groups and each group contained 20 patients. All patients were operated by one surgeon. Results: The difference in age, sex, side of diseased ear and size of perforation between the two groups was not significant. In group (A) the circumference of the perforation was clearly visualized in all patients (100%). While, in group (B) the circumference of the perforation could not be visualized in 7 patients (35%), 5 patients (25%) required external auditory canal curettage and 2 patients (10%) required endoscope-assisted microscopic myringoplasty to evaluate the ossicular chain. The difference between the 2 groups was significant (P.value = 0.004). In group (A) the graft was uptaken in 85% of patients while in group (B) the graft was uptaken in 80% of patients with no significant difference between the two groups (p = 0.677). Conclusion: The ability to easily negotiate through EAC, Panoramic, wide angle, and magnified view provided by the endoscope and uninterrupted picture overcomes most of the disadvantage of the microscope.}, keywords = {chronic suppurative otitis media,endoscope – microscope}, url = {https://ejhm.journals.ekb.eg/article_64826.html}, eprint = {https://ejhm.journals.ekb.eg/article_64826_53efbbec103261a1629da8216692dc31.pdf} } @article { author = {Abd El-Moniem, Samah R. and Abou El-Enin, Ahmed I. and Rashwan, Afaf H.}, title = {Effect of Monocular Intravitreal Anti-Vascular Endothelial Growth Factor Injection on the Fellow Eye}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5883-5892}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64850}, abstract = {Background: The contralateral effect of intravitreal Anti-Vascular Endothelial Growth Factor (anti- VEGF) on the fellow eye is still controversial. Objectives: The aim of the current work was to evaluate the contralateral effect of anti-VEGF injection on the fellow eye in patients with bilateral diabetic macular edema (DME). Patients and Methods: This prospective interventional study included a total of 30 female patients with bilateral DME aged from 30 to 70 years, attending at Department of Ophthalmology, International Medical Center, Armed Forces. This study was conducted to assess the effect of unilateral intravitreal injection of anti-VEGF on the fellow eye. It was conducted between 2018 to 2019. Results: The mean age ± SD was 61.0 ± 7.8 years and duration of DM was 17.50 ± 9.797 years. All patients were obese with mean body mass index (BMI) 37.3 ± 3.5. 21 cases were hypertensive, 2 patients had albuminuria. Statistically significant decrease in central retinal thickness (CRT) in both eyes were found with mean ± SD reduction 83.07 ± 31.67 µm in injected eye and 11.30 ± 12.78 µm in the untreated eye from baseline, no significant improvement in best corrected visual acuity (BCVA). There was no significance correlation between hypertension and improvement in CRT, while the patients with albuminuria showed worsening in CRT in untreated eye. Conclusion: It could be concluded that ranibizumab can escape into the systemic circulation and reduce contralateral CRT and the systemic condition could affect the outcome of the treatment.}, keywords = {DME,anti-VEGF,fellow eye}, url = {https://ejhm.journals.ekb.eg/article_64850.html}, eprint = {https://ejhm.journals.ekb.eg/article_64850_240561f26a919ef8ca01962315158442.pdf} } @article { author = {Nosseir, Youssef Fathy and El Arousy, Mahmoud Hassan Taha and Mohey El Din, Mohamed Moanes Mohamed and Mahmoud, Muhammad Mahmoud Sameh Muhammad}, title = {Effect of Aging on Left Ventricular Function by Real Time Three-Dimensional Speckle Tracking Echocardiography}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5893-5899}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64852}, abstract = {Background: Three-dimensional echocardiography (3D-Echo) has been incorporated into routine clinical practice in many echocardiography laboratories, as it provides many advantages in the evaluation and study of heart diseases. Objective: To estimate the maximum normal systolic reference value of AS in a sample of healthy subjects. Patients and methods: This study was conducted in the Islamic Cardiology Centre in Al Azhar University, Real Time 3D Speckle Tracking Echo data set was acquired over 24 months in 90 healthy subjects divided into 3 main groups according to their age: 1- First Group 16-30 years old, 2- Second Group 31-50 years old and 3-Third Group 51-65 years old. Results: II and age group III were -22.07 ± 1.48%, -19.40 ± 1.98% and -17.67 ± 1.52% respectively. Our study showed that the mean Global Longitudinal Strain at age group I, age group II and age group III were -19.2 ± 1.52%, -18.9 ± 1.96% and -17 ± 0.99% respectively. The present study showed that the mean Global Area Strain at age group I, age group II and age group III were -29. 1±1.31%, -28.5 ± 1.76% and -28.1 ± 1.65% respectively. Our present study showed excellent intraobserver reproducibility of the results and an overall acceptable interobserver reproducibility of strain measurements. Conclusion: Global area strain derived from three-dimensional speckle-tracking may be applied clinically as a supplementary diagnostic method since strain imaging can identify LV dysfunction earlier than conventional methods. This opens a new perspective in heart failure prophylaxis and primary prevention with institution of therapeutic measures before the patients develop symptoms and irreversible myocardial dysfunction.}, keywords = {aging,Left Ventricular Function,Real Time Three-Dimensional Speckle,Tracking Echocardiography}, url = {https://ejhm.journals.ekb.eg/article_64852.html}, eprint = {https://ejhm.journals.ekb.eg/article_64852_c81d8a871d602edd815f4e089a9882e0.pdf} } @article { author = {Hamed, Amira Mohammed Mohammed and Abdelmeguid, Mona Mohamed and Omar, Shehab Ahmed Abdel Maksoud}, title = {The Effect of Probiotics on Reducing Duration of Hospitalization in Infants with Indirect Hyperbilirubinemia}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5900-5905}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.64968}, abstract = {Background: In recent years, the tendency to use drugs has been increasing in the treatment of neonatal jaundice. Several drugs have been used since then, but the effect of probiotics on serum bilirubin level (SBL) is not so clear. This study was conducted to evaluate the effect of probiotics on SBL and the duration of phototherapy in term neonates with hyperbilirubinemia. Objective: The aim of this study was to evaluate effects of probiotics on neonatal jaundice in reducing hospitalization duration. Patients and Methods: In this randomized clinical trial, we studied 100 term neonate with jaundice hospitalized for phototherapy in AL Azhar Hospital, during August 2017 till January 2018. Eligible neonates were randomly divided into two groups; probiotic group and control group. Both groups received standard conventional phototherapy, but the intervention group received sachet on 10 ml of probiotic containing formula until hospital discharge. The outcome variables were SBL and the duration of phototherapy. Results: The 1st group had a significantly lower hospitalization stay in comparison to the 2nd group. The first group showed 3.34 ± 0.70 days and the second group showed 3.7 ± 0.74. Conclusion: Oral probiotics in neonates with jaundice have significant effect on SBL and the duration of phototherapy. Further studies are needed with longer time follow up.}, keywords = {Bilirubin,Jaundice,Newborn,phototherapy,probiotic}, url = {https://ejhm.journals.ekb.eg/article_64968.html}, eprint = {https://ejhm.journals.ekb.eg/article_64968_e841367f0de564a5fbe8c6d32b94fbb9.pdf} } @article { author = {Kabbash, Mansour Mohamed and Abdallah, Hassan Ahmed and El Shenawy, Anwar A. and Mohamed, Mostafa Mohamed Sayed}, title = {The Prevalence of Thyroid Cancer in Patients with Multinodular Goiter}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5906-5910}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.65255}, abstract = {Background: Thyroid cancer is the most common endocrine carcinoma, as it accounts for almost 90% of all endocrine malignancies. The incidence of thyroid carcinoma is about 1-3 cases in every 100,000 population. During the last 30 years, the rate of thyroid cancer incidence has increased worldwide. Objective: The aim of this work was to determine the frequency of thyroid carcinoma in multinodular goiter in patients undergoing thyroidectomy to make a strategy to perform total thyroidectomy (TT) as a rule of treatment. Patients and methods: This retrospective study included the medical charts and surgical data of a total of 50 patients who underwent surgery for goiter at General Surgery Department, Aswan University Hospital between 2015 and 2018. Results: The present study showed that the frequency of papillary carcinoma was 6% of all thyroid diseases (from 50 patients), 60% of incidental thyroid carcinoma as the frequency was high in the 4th decade of life. The present study showed that the frequency of follicular carcinoma was 2% of all thyroid diseases (one case), 20% of ITC. Patient was in the 4th decade. The present study showed that the frequency of undifferentiated thyroid cancer was 2% of all thyroid diseases. Conclusion: It could be concluded that, according to the finding of this study, total thyroidectomy is the preferred method in benign thyroid disease for which surgery is indicated. The advantages of TT include reduction of recurrence rate, achieves a permanent cure of thyroid disorders.}, keywords = {Thyroid Cancer,Multinodular Goiter,CT,MRI,PET scan}, url = {https://ejhm.journals.ekb.eg/article_65255.html}, eprint = {https://ejhm.journals.ekb.eg/article_65255_776a98344aeabb47bba14daa5c8754c6.pdf} } @article { author = {El-Houseini, Ehab Motawa Eisa and Abdelmoteleb, Hussein Ali and Ahmed, Mahmoud S.}, title = {Is Laparoscopic Appendicectomy an Acceptable Approach in Management of Patients with Acute Appendicitis?}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5911-5921}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.65256}, abstract = {Background: Appendicitis is the most common cause of acute abdomen and appendectomy is the most frequent surgical procedure performed in the world in recent times. In the last few years the number of laparoscopic appendectomies performed around the world has dramatically increased. Objective: The aim of the work is to study the acceptance and satisfaction of the patients as regards the laparoscopic approach for management of acute appendicitis and evaluation the results. Patients and methods: It was a comparative study included 100 consecutive patients with acute appendicitis. They were given the options to accept the approach for appendectomy whether open or laparoscopic after discussion the advantages and disadvantages of each approach and the last decision were left to the patient. The study was approved by the medical ethics committee of Aswan University Hospital and a written informed consent was obtained from all patients. Results: The consecutive patients of age ranging from 15-45 years with features suggestive of acute appendicitis were divided into laparoscopic appendectomy group (LA) 70 cases and open appendectomy group (OA) 30 cases, after taking informed consent. LA was done with the help of three trocar/cannulae creating pneumoperitoneum with CO2 whereas OA was performed by McBurney incision. The operating times in OA and LA were 20-70 minutes (mean 30) and 25-95 minutes (mean 55) respectively. Increased doses of analgesics, antibiotics and antiemetics were required in OA, as compared to LA. The mean postoperative hospital stay in LA group was 1.4 days (range 1-3 days) whereas it was in OA group, it was 3.5 days (range 2- 6 days). Conclusion: LA is safe and has major benefits like less postoperative pain, decreased wound infection, early hospital discharged, early return to work and a better cosmetic scar than OA.}, keywords = {Appendicitis,Appendectomy,Laparoscopic appendectomy}, url = {https://ejhm.journals.ekb.eg/article_65256.html}, eprint = {https://ejhm.journals.ekb.eg/article_65256_de923c4245ddf5a4f585ec58f2cd2642.pdf} } @article { author = {Helal, Eman G.E. and Zaki, Dina Alsayed and Abdelaziz, Mohamed A. and Zakaria, Abeer}, title = {Effect of Both Bisphenol - A and Liquorice on Some Sexual Hormones in Male Albino Rats and Illustration of the Effect of Stem Cell Enhancer on Their Actions}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5922-5929}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.65257}, abstract = {Background: Xenoestrogens are a type of xenohormone that imitates estrogen. They can be either synthetic or natural chemical compounds. Synthetic xenoestrogens include some widely used industrial compounds, such as PCBs, bisphenol A (BPA) and phthalates. "Dietary estrogen" is also called phytoestrogen, which is a plantderived xenoestrogen not generated within the endocrine system, but consumed by eating phytoestrogenic plants. Stem cell enhancer (SCE) (StemEnhance®) is a novel mobilizer of bone marrow adult stem cells that was shown to increase the number of circulating stem cells. Objectives: The aim of the current work was to clarify the effect of both BPA and liquorice together on some sexual hormones and illustration of the effect of stem cell enhancer on their actions. Materials and methods: Thirty male albino rats were used and were divided into three groups: Group I: control (untreated group), group II: rats treated with BPA and liquorice and group III: rats treated with BPA and anise oil in addition to stem cell enhancer. Blood samples were collected for different biochemical investigations. Results: There was a highly significant increase (p < 0.01) in the level of ALT and AST activities, urea, creatinine, FSH, prolactin, total cholesterol, triglycerides, LDL-C, VLDL, LDL/HDL and TC/HDL. While, there was highly significant decrease (p < 0.01) in HDL-C, total protein, albumin, globulin, testosterone and LH. These results turned back to the normal values after receiving the SCE as compared to normal group. Conclusion: It could be concluded that phytoestrogen and xenoeostrogen have undesirable effects and it is recommended to minimize the utilization of these compounds to protect people from its hazardous effects.}, keywords = {BPA,Liquorice,Stem Cell Enhancer,Hormonal assay,biochemical parameters}, url = {https://ejhm.journals.ekb.eg/article_65257.html}, eprint = {https://ejhm.journals.ekb.eg/article_65257_9532471071ae11256fcd0696bcded7cb.pdf} } @article { author = {El Gharabawy, Gamal S. and Abd Allah, Ezz El-Dein E. and Amr, Ibrahim M. and Elmitwalli, Mohammed}, title = {Histological and Immunohistochemical Study of The Effect of Cyclophosphamide on Testis of Male Adult Albino Rats and The Possible Protective Role of Vitamin E}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5930-5946}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.65258}, abstract = {Background: cyclophosphamide is not only used as anticancer chemotherapeutic drug in adult and childhood malignancies, but also used as an immunosuppressive agent for organ transplantation. Aim of the work: this work was planned to evaluate the histological, immunohistochemical and ultrastractural changes in the testis of adult male Albino rats after administration of cyclophosamide and the possible role of vitamin E supplementation and drug withdrawal were explored. Materials and Methods: 50 healthy male Albino rats weighted 200gm were categorized into 5 groups, (ten rats each group). At the end of the experiment, the animals of all groups were anaesthetized by ether inhalation. Their testes were dissected out carefully and processed for light and electron microscope examination. The testes were immediately dissected out and the samples for light microscope were fixed in 10% neutral buffered formaldehyde (pH 7.2) for 24-72 hours. Sections (5um thick) were obtained and stained with H&E, Mallory's trichrome, PAS stains and immunohistochemicaly for detecting bcl-2 protein were used. Minute specimens were double fixed in glutaraldehyde and processed to obtain semithin sections stained with toluidine blue and ultrathin sections (70nm) for TEM. Results: testes of the cyclophosphamide-treated adult rats and cyclophosphamide withdrawal group revealed thick tunica albuginea, distorted and shrunken seminiferous tubules with wide interstitium in between. These tubules had marked reduction in the thickness of the germinal epithelium which appeared detached from irregular thick basement membrane and wide empty lumina were devoid of spermatozoa. The germinal epithelium in these tubules appeared degenerated with vacuolated cytoplasm and pyknotic nucle; the interstitium showed acidophilic hyaline material, congested thickened blood vessels and numerous interstitial Leydig cells with pyknotic nuclei. Cross sections of the middle and principle pieces of sperms showed disturbed axoneme. Cross sections in the sperms detected the middle, principle and end pieces. In the middle pieces, the axoneme was surrounded by fibrous and abnormal mitochondrial sheaths. The mitochondria in their sheath showed mild swelling, vacuolization and distortion. Leydig cells had large oval euchromatic nuclei with widened perinuclear space. The cytoplasm contained numerous mitochondria and dilated SER. using vitamin E with cyclophosphamide relatively improved the testicular tissue. Conclusions: cyclophosphamide treatment produced marked changes in the histological structure of the testes especially the germinal epithelium and sperms. This may lead to serious problems such as infertility or even sterility. The histological affection of cyclophosphamide on testis persisted after stoppage of treatment which is an indication of its cumulative effect. Supplementation of vitamin E with cyclophosphamide relatively improved the testicular tissue. So, administration of vitamin E in patient received cyclophosphamide is mandatory to reduce its side effects.}, keywords = {Histological,Immunohistochemical,clophosphamide,albino,testis,Ultrastructure}, url = {https://ejhm.journals.ekb.eg/article_65258.html}, eprint = {https://ejhm.journals.ekb.eg/article_65258_efd2b2c55c4268454f96f56b5958f01d.pdf} } @article { author = {Hasan, Asmaa Ahmed Ali and Mohamed, Nessren Mohamed Baha El Deen}, title = {Real Time 3-D Echocardiography for Evaluation of Left Ventricular Systolic Function in Patients with Liver Cirrhosis Caused by Hepatitis C Virus}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5947-5953}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.65606}, abstract = {Background: Cardiovascular changes are associated with Liver cirrhosis so, it is important to assess its function in cirrhotic patients. Child-Pugh scoring system is the simplest clinical method used for classifying liver cirrhosis. 3D echo and 2D speckle tracking echocardiography (2D-STE) are the most recent imaging modalities able to evaluate LV systolic function accurately. Aim: To assess LV systolic function in patients with chronic liver cirrhosis caused by HCV by different echocardiographic modalities including 3D and STE and correlation of the results with the severity of cirrhosis based on Child-Pugh score. Material and methods: A prospective study was done in Cardiology Department, AlZahraa University Hospital including a total of 75 subjects; 45 cirrhotic patients and 30 subjects as a control. 2D, 3D LV volumes and EF and 2D-STE of the LV were measured. Then, the patients’ group was divided into 3 subgroups according to Child Pugh score then LV systolic function were assessed with different echo modalities (2D, 3D and MM, TDI (Sm) and, 2D STE). Results: The LVEF increased significantly in patient group by M-mode and 2D but decreased by TDI, 3D echo and STE. Increased systolic velocity (Sa) by TDI in group III of cirrhosis but lowered systolic function by using STE. Also, there was a significant correlation between severity of liver cirrhosis and LVEF by 2D STE, 3D and 2D. Conclusions: The recent noninvasive 3D echo and 2-D STE techniques are a promising methods for early detection of LV systolic dysfunction in asymptomatic patients with viral liver cirrhosis. Also, the LV systolic dysfunction is related to the extent of severity of liver cirrhosis.}, keywords = {Liver cirrhosis – real time 3D,Ventricular function,Speckle tracking echocardiography- Child pugh score}, url = {https://ejhm.journals.ekb.eg/article_65606.html}, eprint = {https://ejhm.journals.ekb.eg/article_65606_b9b4b2ed482899ce19f46aa31e27377f.pdf} } @article { author = {Kabbash, Mansour Mohamed and Saleem, Abd.El-Aal Ali and Abdel Rheem, Osama Abdallah and Abd El-Rahman, Mohammed Abdel Raouf Adly}, title = {Surgical Intervention in Adhesive Intestinal Obstruction}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5954-5957}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.65607}, abstract = {Background: Adhesive small bowel obstruction (ASBO) is a common cause for admission to surgical wards in developed countries, particularly following colorectal and pelvic surgery. Despite advances in diagnosis and treatment, the operative intervention rate is between 15 and 30%, the recurrence rate is up to 30% following surgery and the mortality is between 2 and 8%. Objective: The aim of current study was to report the time of surgical intervention of patient with adhesive intestinal obstruction. Patients and Methods: This study included a total of 50 patients with clinical diagnosis of adhesive SBO, attending at Surgical Department, Aswan University Hospital. This study was conducted between January 2018 to December 2018. After clinical and radiological diagnosis of adhesive SBO, all patients were promptly hydrated with Ringer lactate solution and their electrolytes and acid base imbalances were corrected. Results: Successful conservative treatment was noted in 28 patients (66%) with discontinuation of nasogastric decompression within an average period of 2 days followed by discharge on fourth day of admission. 22 Patients (44%) underwent surgery, safe conservative management needed the pre- requisite of having ruled out any possibility if strangulation of the bowel as the first step of management. As for hospital stay patients who underwent conservative therapy have less durations of hospital stay (3-6 days) than those who underwent surgical intervention (7-14 days). Conclusion: ABO remains a common clinical problem. Patients presenting with symptoms and signs consistent with ASBO should undergo plain abdominal X-ray. If this confirms the diagnosis, and there is no clinical suspicion of strangulation, a water soluble contrast agent should be administered by Nasogastric tube.}, keywords = {surgical,Adhesive Intestinal Obstruction,Management}, url = {https://ejhm.journals.ekb.eg/article_65607.html}, eprint = {https://ejhm.journals.ekb.eg/article_65607_c3a8f81ca0bd8a311502526669f55f4e.pdf} } @article { author = {Kabbash, Mansour Mohamed and Abdel Reheem, Osama Abdallah and Hussein, Abd El Rahman Mohamed}, title = {Laparoscopic versus Open Repair of Perforated Peptic Ulcer}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5958-5964}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.65608}, abstract = {Background: H. pylori infection and nonsteroidal anti-inflammatory drug (NSAID) usage contribute to a great majority of cases. Thus, non-operative management of the disease is indicated in nearly all cases, with the exceptions of hemorrhage, perforation, obstruction, and refractory disease. Objective: Comparison between laparoscopic and open repair of perforated peptic ulcer as regards postoperative advantage and complication. Patients and methods: 279 identified published observational studies (randomized control trials and clinical control trials) after search strategy. Participants were patients that had done repairing of perforated peptic ulcer. Laparoscopic versus open repair of perforated peptic ulcer. Results: There was no significant difference in the operating time between the two groups (p Z 0.618). Overall, the laparoscopic group had fewer complications compared to the open group (14.3% vs. 36.8%, p Z 0.005). When reviewing specific complications, only the incidence of surgical site infection was statistically significant (laparoscopic 0.0% vs. open 13.2%, p Z 0.003). The other parameters were not statistically significant. Although total hospital costs were similar (P = .465), the median intraoperative costs were greater for LR than for OR patients, at U6772 and U5626, respectively (P < .001). The median cost of ward stay tended to be U865 less in the LR group but was not statistically relevant. Conclusion: Laparoscopic surgery had upper hand over open procedure because of less intraoperative blood loss and postoperative pain, less postoperative complications, shorter hospital stay, surgical site infection rate, shorter nasogastric tube duration.}, keywords = {Laparoscopic,Open repair,Perforated peptic ulcer,H. pylori}, url = {https://ejhm.journals.ekb.eg/article_65608.html}, eprint = {https://ejhm.journals.ekb.eg/article_65608_95d2e6687b3bebe159ceb307a669254e.pdf} } @article { author = {Saied, Hany Zaki and Mahmoud, Wael Shaaban and Arafa, Kareem Samir}, title = {Treatment of Open Comminuted Diaphyseal Fracture of the Tibia by Ilizarov}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5965-5972}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.65980}, abstract = {Background: Management of open diaphyseal tibial shaft fractures can be comminuted due to lack of soft tissue coverage and blood supply of the tibial shaft. Open reduction and internal fixation [ORIF] with plates and screws achieves stability, allows joint mobilization but does not allow early weight bearing which as a stimulus is a must for early union. Closed reduction and intramedullary fixation compromise the intramedullary blood supply and increases the risk of infection in open fractures. Ilizarov is considered safe in treating these open injuries, at the same time it has the advantages of easy application, minimal invasive, and convenient subsequent soft tissue repair. Objective: The aim of current study was to evaluate treatment of open comminuted diaphyseal tibial fracture by ilizarov external fixator; its effective, availability, outcomes and complications. Patients and Methods: This prospective study included a total of 10 patients with comminuted tibial diaphyseal fractures managed with early Ilizarov external fixator, attending at Alharam Hospital. This study was conducted between Feb 2018 and July 2019. General assessment indicators included pain, complete union, deformity in comparison to healthy limb, infection, leg limb discrepancy, stiffness and activity of the patients were analysed. Results: Follow-up of all participants for analysis was done. The follow-up time was 17 months. Three cases developed ankle stiffness. The average total range of knee motion in our cases was 130.5 (range 125-140). A significant limp occurred only in 3 cases. NO persistent limp persisted in our cases. Fifteen patients had minimal pain at the site of fracture. Signicant pain occurred in three cases. Pin site infection occurred in 7 patients. All the patients achieved full union and activity. Excellent results were obtained in 4 cases (40%). Good results were obtained in 3 cases (30%) with overall good to excellent results were about (70%). Fair results were obtained in 3 cases (30%). Conclusion: It could be concluded that the Ilizarov external fixator is a golden horse for orthopedic surgeons. It holds wonderful promise in the management of open diaphyseal tibial shaft fractures.}, keywords = {open diaphyseal tibia,Ilizarov tibia comminuted fractures}, url = {https://ejhm.journals.ekb.eg/article_65980.html}, eprint = {https://ejhm.journals.ekb.eg/article_65980_160243139811d0edb3855418d97da381.pdf} } @article { author = {Mofied, Esraa A. and El-Belbasy, Reda M. and Abo Al-Hassan, Hanaa}, title = {Knowledge and Attitude Assessment of Medical and Nursing Female Students at Al-Azhar University in Cairo; For their Anticipated Breastfeeding Support}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5973-5982}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.66690}, abstract = {Background: Breastfeeding is a critical first step on a child’s path to a healthy future. Despite its benefits, breastfeeding is no longer a norm in many communities. Inadequate support and lack of information by healthcare professionals were risk factors affecting breastfeeding failure. Although many studies identified knowledge and attitudes towards breastfeeding among mothers, little is known about knowledge and attitudes towards breastfeeding among medical and nursing students in Egypt. Aim: This study is aiming to assess knowledge, attitude and anticipated practices of medical and nursing female students at Al-Azhar University to provide breastfeeding support. Participants and methods: A cross sectional study, conducted at Al-Azhar University in Cairo during the academic year (2018-2019) on a sample of 440 female students from faculty of medicine and faculty of nursing. Results: Regarding knowledge, the finding of the study revealed very good level of knowledge (mean percent score of knowledge was 75.23%±7.37) and most of studied groups had neutral attitude (78.4%). Mean score of anticipated practices among them was 63.97±6.64 indicating average level. Conclusion and recommendation: This study reflects very good level of knowledge, neutral attitude and average anticipated practices level among undergraduate female students in medical and nursing faculties at Al-Azhar University. So, it is crucial to focus on students’ education and training as a fundamental aspect in improving future health care providers’ knowledge, skills and experience needed in clinical practice. This will affect students’ attitudes towards breastfeeding and will reflect on their anticipated practices.}, keywords = {breastfeeding,Medical students,Nursing students,Knowledge,attitude and practices}, url = {https://ejhm.journals.ekb.eg/article_66690.html}, eprint = {https://ejhm.journals.ekb.eg/article_66690_d8c411f299d0c7809a1cad9535f963dc.pdf} } @article { author = {Rayea, Mohammed M. Farid and Amer, Medhat Kamel and Mousa, Ahmed Abdelhady and Farghaly, Mohammed Gamal}, title = {Comparative Study between Slow Conventional Freezing and Cryoprotectant-Free Vitrification of Human Spermatozoa in Large Volume}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5983-5988}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.66691}, abstract = {Background: Cryopreservation is the collection, freezing, and long term storage of sperm, and is a highly effective method of protecting male fertility. Cryopreservation of semen has been widely used as a vital method for fertility preservation of male patients before undergoing chemotherapy, radiotherapy, and/or surgery that may lead to testicular failure or ejaculatory dysfunction. Objective: The aim of this study was to compare the aseptic technology of cryoprotectant-free vitrification of human spermatozoa in large volume, to conventional freezing protocol as regards post thawing motility, vitality and sperm DNA fragmentation. Patients and methods: This study included a total of 20 male patients seeking seminal fluid analysis, attending at the andrology laboratory of a specialized IVF center (ADAM International Hospital for Fertility and Sterility, Giza, Egypt. Patients were presented with the diagnoses of normozoospermia, oligozoospermia (either isolated or combined with asthenozoospermia or teratozoospermia). Results: Motility of (in a large volume (300 µl) in the absence of permeable cryoprotectants displayed significant statistically lower levels as compared to conventional Sperm Freezing. It was shown in different groups at different times (post thawing and 1-hour and 24-hour) of assessment that motility of vitrified spermatozoa decreases in comparison with slow conventional freezing as we go from the baseline. DNA fragmentation of vitrified spermatozoa showed higher levels as compared to conventional slow freezing but there is no significant statistical difference between vitrification and conventional slow freezing in DNA fragmentation. Conclusion: It could be concluded that vitrification technique was quite far away from comparison with slow conventional freezing protocol, and still need for further modifications and wide scale of study to achieve the good results.}, keywords = {Slow Conventional Freezing,Cryoprotectant-Free Vitrification,Human Spermatozoa in Large Volume}, url = {https://ejhm.journals.ekb.eg/article_66691.html}, eprint = {https://ejhm.journals.ekb.eg/article_66691_c5a20c0b9fc2617fc1bd8949b8256f40.pdf} } @article { author = {}, title = {Oxidative Stress and Apoptosis Biomarkers in Neonate Rats’ Brain Exposed to Diquat during Lactation}, journal = {The Egyptian Journal of Hospital Medicine}, volume = {77}, number = {6}, pages = {5989-5994}, year = {2019}, publisher = {Pan Arab League of Continuous Medical Education}, issn = {1687-2002}, eissn = {2090-7125}, doi = {10.21608/ejhm.2019.67316}, abstract = {Background: Toxic chemicals compete with biological macromocules and other small molecules that construct brain structure in their natural function. Interruptions in development of the brain caused by toxic compounds, both before and after birth, can lead to defects that occur quickly after exposure, or much later in life. Objectives: This study aimed to throw light on the effect of diquat (DIQ) on the development of neonates, brain by determination of oxidative stress and apoptosis markers during lactation period. Materials and methods: Twenty pregnant female rats from the breeding facility of the Mammalian Toxicology Department, the Central Agricultural Pesticides Laboratory, Agriculture Research Center were included in this study. The lactating dams and their pups were constructed into two experimental groups (10 dams each). The first saved as a control group and received distilled water daily during the breast-feeding period. The second group was intubated with 5.12 mg/kg DIQ as 1/80 of LD50 (according to preliminary trails) from the 1st postnatal day (PND1) to the 10th postnatal day (PND10) and served as treated (study) group. Brain samples of neonates were collected after treated period and the 21th postnatal day (PND 21). The oxidative stress biomarkers (SOD, GPx, GST, GSH and Protein carbonyl) and gene expression of BAX and BCL2 as apoptosis markers were estimated. Results: The results indicated disruption in both oxidative stress and apoptosis biomarkers as evidenced by increased in GST, GPx activities, gene expression of BAX and protein carbonyl level. Also, results showed a decline in SOD activity, BCL-2 gene expression and GSH content declined. Conclusion: The results of this study showed that exposure to DIQ increases the generation of free radicals and can cause oxidative stress and induce neuronal programed cell death}, keywords = {Diquat,Oxidative Stress,apoptosis,Gene expression,lactation,Neonates}, url = {https://ejhm.journals.ekb.eg/article_67316.html}, eprint = {https://ejhm.journals.ekb.eg/article_67316_2bea4caa5c93007774fd4dbbfee04093.pdf} }