eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4045
4047
10.21608/ejhm.2018.9113
9113
Original Article
Prevalence of Multinodular Goiter at Prince Mutaib Hospital in Sakaka Al-jouf
Faisal M. Alarjan
faisal_4957@hotmail.com
1
Jarid S. Aljarid
2
Ahmed M. Alruwaili
3
Atallah F. Alruwaili
4
Sultan M. Alshalan
5
College of medicine, Aljouf University
College of medicine, Aljouf University
College of medicine, Aljouf University
College of medicine, Aljouf University
College of medicine, Aljouf University
Background: Multinodular Goiter (MNG) is a diffuse multi-nodular enlargement of the thyroid gland in response to chronic TSH stimulation. Objective: The aim of this study was to find the prevalence of MNG among patient attending endocrinology outpatient department. Methods: This was a hospital-based study that included 324 patients who had visited the OPD in Prince Mutaib Hospital in Sakaka, Saudi Arabia, in a two months period (Dec 2014 and Jan 2015). Data analysis was looking for sex, age, marital status and number of children of those who have MNG. Data were analyzed using SPSS Version-17 and frequencies were obtained. Results: Files of 324 patients were examined in endocrinology section, 23 of them (age 18-42) were suffering from Goiter giving a prevalence rate of 10%. 11 of the patients were having Multinodular type of goiter giving a prevalence of 4.7%, while the rest have solitary type of goiter. Among those 11 patients who are married, 45% of them have MNG type. In addition, male to female ratio regarding MNG was 1.75: 1. Conclusion: In conclusion, the study showed that there is prevalence of MultiNodular Goiter of 5% among population of Aljouf.
https://ejhm.journals.ekb.eg/article_9113_8c33ddd15e6875d422881d6671553fd5.pdf
Multinodular Goiter
prevalence
Endocrinology
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4048
4053
10.21608/ejhm.2018.9114
9114
Original Article
Primary and Specialized Physicians’ Knowledge of and Attitudes Towards the Use of Complementary and Alternative Medicine in Medical Practice
Sarah Marie
1
Seba Almutairi
2
Maram Al Turki
3
Norah Alsabty
4
Hind Almodaimegh
5
King Saud Bin Abdulaziz University for Health Sciences
King Saud Bin Abdulaziz University for Health Sciences
King Saud Bin Abdulaziz University for Health Sciences
King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Department of Surgery
King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Pharmaceutical Care Department
Background: The use of complementary and alternative medicine (CAM) for treatment purposes in Saudi Arabia is a common practice by the public. Studies have found that using these products is not always a safe practice. Research has showed that many of CAM products could result in fatal adverse effects either when used alone or combined with conventional medicine. Health institutions are currently working on increasing the awareness of these adverse effects and the proper utilization of CAM, however addressing the knowledge gap among healthcare professionals is still an area of demand. Thus, this study aims to assess the knowledge and attitude of primary and specialized physicians at King Abdulaziz Medical City KAMC about CAM. Method: This is a cross sectional study based on an interview structured questionnaire that was validated through pilot testing and distributed among physicians in the following fields at KAMC; internal medicine, family medicine, Surgery, pediatrics, and obstetrics and gynecology. We included physicians from both genders, any nationality, and excluded all physicians who have not been practicing for more than one year. The minimum sample size required was 231. All the data were entered and analyzed by SPSS software version 21. A confidence interval of 95% was used and a P value less than or equal.05 is significant. Results: The research team was able to interview 220 physicians from different specialties and occupation with a response rate of 95.5%. The overall results were that the majority of participants (73.7%) had a poor knowledge about CAM. Also, it was found that there is no correlation between the level of knowledge and the specialty (P=0.26). Unlike Saudi physicians who believe in the beneficence of CAM, non-Saudis tend to have a more negative attitude toward this practice (P= 0.023). Resident and newly practicing medicine physicians had more positive attitude toward CAM compared to physicians with long history of practice (P=0.037). Almost 50% of our participants have obtained some knowledge about CAM from websites, books, and EBM articles. 81.1 % of the physicians insisted on the importance of receiving formal education about CAM. Conclusion: In conclusion we recommend that education about CAM to be given in the form of seminars, lectures, or part of the medical school curriculum. We also emphasize that this education should not be given to a certain medical specialties as our result showed that the knowledge and attitude toward CAM does not have a correlation with specialty.
https://ejhm.journals.ekb.eg/article_9114_5e8871251dcdb7130869d68dc2403de2.pdf
Physicians’ Knowledge
Complementary
alternative medicine
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4054
4059
10.21608/ejhm.2018.9115
9115
Original Article
Negative Pressure Wound Therapy Versus Conventional Dressing in Treatment of Diabetic Foot Wound
Abdullah Al-Mallah
poet.abdullah2009@gmail.com
1
Abdullah Al-Sayed
2
Atef Bayoumi
3
Vascular Surgery Department – Faculty of Medicine – Al-Azhar University – Cairo – Egypt
Vascular Surgery Department – Faculty of Medicine – Al-Azhar University – Cairo – Egypt
Vascular Surgery Department – Faculty of Medicine – Al-Azhar University – Cairo – Egypt
Background: Foot wounds in people with diabetes mellitus are a common and serious global health issue. Negative pressure wound therapy can be used to treat these wounds and a clear and current overview of current evidence is required to facilitate decision-making regarding its use. Aim of the Work: To compare the efficacy of negative pressure wound therapy with that of a control group using conventional moist wound dressings, in healing of diabetic foot ulcers, in terms of 1) Change in size of wound. 2) Rate of granulation tissue formation as percentage of ulcer surface area. 3) Period of hospital stay. 4) Cost of both modalities of treatment. And 5) Complications after treatment. Study Design: Prospective Randomized Controlled Trial. Place: This study was conducted in the vascular surgery department at Al-Azhar university hospitals. Methodology: The study included 50 patients randomized into two groups (25 patient for VAC therapy & 25 patient for conventional dressing) suffering from diabetic foot wounds. Results: In our study, 6 of 25 (24%) in the Conventional treatment group were females whereas 19 of 25 (76%) in the Conventional treatment group were males. 3 of 25 (12%) in the NPWT group were females and 22 of 25 (88%) were males. In the Conventional treatment group, 21 of 25 (84%) were above 60 years of age. 20 of 25 (80%) in the NPWT group were above 60 years of age. Wound bed showed signs of healing by granulation tissue formation in 19 among 25 patients (76%) compared to Conventional treatment, 7 showed granulation among 25 patients (28%) one week after initiation of treatment. (P=0.001). Granulation of the wounds was > 50% in 20 of the 25 patients underwent NPWT whereas only 3 of the 25 in the Conventional treatment had shown > 50% granulation. There was a highly statistically significant difference between average Granulation as % of ulcer area and it is significantly high in vacuum dressing. It was 51.92 ± 21.03 in Conventional treatment compared with 78.68 ± 18.12 in NPWT group (p- value < 0.05). Wound size was measured at initial presentation and then after treatment. Before treatment, the mean surface area of wounds in the NPWT group was 40.44 cm2, the Conventional treatment 38.52cm2. After wound management, mean surface area of the diabetic wounds was 36.08 ± 2.56 cm2 in the NPWT group and 37.63 ± 2.86 cm2 in the Conventional treatment. This represents a statistically significant difference (P=0.05). At the end of our study the incidence of secondary higher amputation in NPWT group was 5/25 (20%), the Conventional treatment 6/25 (24%). There was no significant difference between both groups (P=0.13). There is a statistically significant difference between average graft take-up and it is higher in vacuum dressing. It was 80.78 ± 14.54 in NPWT and 59.58±19.25 in control group. (P-value = 0.035). Daily mean cost in conventional dressing group was 67.43 ± 5.3 EP compared to 95.7 ± 10.2 EP in VAC group. A difference which is statistically different. Also, at the end of the study, total mean cost in conventional dressing group was 1976 ± 123 EP compared to 2275 ± 154 EP in VAC group. There was a difference in the total cost finally. Period of hospital stay till the wound was fully granulated and ready for skin grafting was 22.87 ± 7.62 in NPWT compared to 32.53 ± 10.17 in the conventional group. There is a highly statistically significant difference between average duration of hospital stay and it is reduced significantly in vacuum dressing. (p-value= 0.02). Conclusion: The rate of granulation tissue formation, wound surface area, overall graft survival was better in NPWT group as compared to conventional dressing group. Overall hospital stay and amputation rate were less in the NPWT group. Thus, NPWT can be considered as a superior option in the management of diabetic foot wounds. Cost of VAC therapy was higher than conventional dressing.
https://ejhm.journals.ekb.eg/article_9115_0a58ff59b25ab2ed22b705689947eaae.pdf
diabetes
foot ulcer
Vacuum Assisted Closure
Negative Pressure Wound Therapy
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4060
4063
10.21608/ejhm.2018.9116
9116
Original Article
Assessment of knowledge and Attitude and Practice of Parents towards Epilepsy among Children in Abha City
Asiri S. Hassan A
1
Alshehri S. Yahya M
2
Alqutub A. Tariq A
3
Alqutub Hussamaldin Tariq A
4
King Khalid University
King Khalid University
King Abdulaziz University
King Abdulaziz University
Background: Supporting information and high levels of awareness among parents could support the needs of the children and help in managing the outcomes of epilepsy. Objectives: Studying the knowledge, attitude and practice (KAP) of Saudi parents in Abha City regarding epilepsy, Kingdom of Saudi Arabia (KSA). Methods: It is a cross sectional study that was conducted during the period from February 2018 to May 2018 at Abha City, Saudi Arabia among 440 parents. The study tool was a questionnaire that consists of 20 questions regarding subject’s demographics, knowledge, attitude and practice pattern. Results: All the included parents rated the word epilepsy as common for them. Most of the subjects knows that epilepsy can be treated (84.3%), 90.9% knew that epilepsy is associated with hereditary and 52.5% recognized that epilepsy can be caused by trauma or stroke but only 21.1% only knew that epilepsy could be treated by surgery. The knowledge of most of the respondents was adequate among 68.2%. The attitude score was adequate among 76.4% of the parents. The practice score was adequate among 72.5% of the parents. Conclusion: Most of Saudi parents in Abha showed adequate awareness about epilepsy among children which showed adequate attitude and practice pattern. This is suggestive to increasing the chances of management of the disease and decreasing the risk factors and complications of misconceptions.
https://ejhm.journals.ekb.eg/article_9116_884b647ecb3b6a0c438104b6fd3bc4f6.pdf
Knowledge
Attitude
Practice
Epilepsy
parents Abha city
children
2018
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4064
4066
10.21608/ejhm.2018.9117
9117
Original Article
Systemic Review: Effect Of Weight Reduction On Decreasing Of BP
Abdulrahman F. Alaql
1
Waleed T. Alanezi
2
Othman M. Albalawi
3
Abdullah N. Alshahrani
4
Ali O. Alshargi
5
Imam Muhammad Ibn Saud Islamic University
Tabuk University
Tabuk University
Tabuk University
Ibn Sina National College For Medical Studies
Background: Lowering the blood pressure could decrease the risks of cardiovascular morbidity and mortality rates and showed an association between lowering the body weight and management of blood pressure levels in people with hypertension. This study aimed at reviewing the effects of weight loss on blood pressure and hypertension. Methods: 29 studies were included in this review. This systemic review showed that significant reduction in body weight either by dietary or non-dietary intervention could lower the blood pressure among hypertensive patients undergoing medications. However the extent effects are uncertain and have not been demonstrated on long term effects.
https://ejhm.journals.ekb.eg/article_9117_ed92a80d07068a098db8a5c3287446fc.pdf
Weight Reduction
blood pressure
prevention
Management
Hypertension
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4067
4074
10.21608/ejhm.2018.9118
9118
Original Article
Vitamin D Level in Non-Diabetic and Type II Diabetic Patients KFU Health Center: A Cross Sectional Study
Mohammed A. Al Hewishel,
1
Abdullah H. Al Huwaiyshil
2
Mustafa A. Alsubie
3
Abdullah A. Alhassan
4
Students Research Committee, Collage of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
Students Research Committee, Collage of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
Students Research Committee, Collage of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
Students Research Committee, Collage of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
Background: Widespread vitamin D deficiency all over the world has been documented by many previous studies including recent studies in KSA which revealed incidence reaching up to100%. Also, number of people with diabetes mellitus is increasing (7% of the world’s population in 2011, elevated to 9% in 2014). This number is expected to exceed 435 million by 2030. Compared to other areas of the world, diabetes prevalence was highest in Saudi Arabia (20.22%). In 2015, there were 3.4 million cases of diabetes in Saudi Arabia. Many studies showed high association between vitamin D deficiency and increased incidence of diabetes. Aim of the work: This study is planned to assess the incidence of vitamin D deficiency in non-diabetic and type II diabetic patients in KFU health center in Al-Ahsa region. Methods: Our study is a cross-sectional study done on 860 patients' data including plasma 25-hydroxy vitamin D3, fasting blood glucose and HbA1c levels. Results: Our results showed that 89.53% of the patients have vitamin D level below normal. There was higher incidence of vitamin D deficiency in females (81.67%) than in males (65.27%). The incidence of vitamin D deficiency was greater in Saudi (82.19%) than non-Saudi (68.40%) and in diabetics (89.68%) than non- diabetics (76.12%) patients. Within each group, the incidence of vitamin D deficiency was higher in females than in males. Incidence of vitamin D deficiency was highest in the 21 – 40 years group (86.19%) and lowest in the 1 – 20 years group (66.1%). The results showed inverse relationship between vitamin D level and both fasting blood glucose and HbA1c. The mean fasting glucose was higher in the deficiency group (165.55) as compared to the insufficiency group (118.67). Also, the mean HbA1c was higher in deficiency group (8.06) as compared to the insufficiency group (7.23). Conclusions: There is high incidence of vitamin D deficiency among KFU health center patients. Vitamin D level was inversely proportional to the level of fasting glucose and HbA1c. This is an evidence of the vitamin D role on glucose tolerance in diabetic patients.
https://ejhm.journals.ekb.eg/article_9118_5b8246166e4c4244bed71ddfbafad18d.pdf
Vitamin D
Diabetes type II
non-diabetic
KFU health center
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4075
4077
10.21608/ejhm.2018.9119
9119
Original Article
High Tracheal Bifurcation as a Cause of Left Main Bronchus Obstruction in Infant: A case report from Saudi Arabia
Gawahir M
jmukhtar@kfmc.med.sa
1
Khalid A M
2
Safa E
3
Wadha A
4
Pediatric Pulmonary division, King Fahad Medical City (KFMC)
Pediatric Pulmonary Division, King Khalid Hospital/ King Saud University
Pediatric Pulmonary division, King Fahad Medical City(KFMC)
Pediatric Pulmonary and Sleep Physician, Head of the Pulmonary Unit, KFMC, KSA
Background: Congenital short trachea (CST) an uncommon abnormality is defined as a reduction in the number of tracheal rings to 15 or less, compared to the average of 17 rings in normal infants. As a result, the carina is situated at a higher level than usual that lead the left main bronchus to course abnormally behind the arch of the aorta, making it prone to compression. CST is associated with a number of syndromes, including the Di George syndrome, several types of congenital heart disease, some skeletal dysplasias and meningomyelocoele. Case study: We report a case of one Saudi infant who presented with respiratory distress since birth and hyperinflation of left side of the lung secondary to extrinsic narrowing of proximal left main stem bronchus due to compression by arch of the aorta, and he underwent successful aortopexy of the aortic arch for this condition.
https://ejhm.journals.ekb.eg/article_9119_728d38dbd59bfb37f7511ee7da3b335f.pdf
High trachea bifurcation
children
Saudi Arabia
Case Report
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4078
4084
10.21608/ejhm.2018.9120
9120
Original Article
The Use of Levonorgestrel-Releasing System (Metraplant-E) in the Treatment of Abnormal Uterine Bleeding
Mohamed Ezz-Eldin A. Azzam
prof_m.azzam@outlook.com
1
Magd Eldin M. Mohamed
2
Laila A. Farid
3
Alshaimaa AA Mahmoud
4
Reem Abdelazeem Hussein
5
Alaa Rashid
6
Department of Obstetrics and Gynecology and Early Cancer Detection Unit, Ain Shams University, Cairo, Egypt.
Department of Obstetrics and Gynecology and Early Cancer Detection Unit, Ain Shams University, Cairo, Egypt.
Department of Obstetrics and Gynecology and Early Cancer Detection Unit, Ain Shams University, Cairo, Egypt.
Department of Obstetrics and Gynecology and Early Cancer Detection Unit, Ain Shams University, Cairo, Egypt.
Department of Obstetrics and Gynecology and Early Cancer Detection Unit, Ain Shams University, Cairo, Egypt.
Department of Obstetrics and Gynecology and Early Cancer Detection Unit, Ain Shams University, Cairo, Egypt.
Background: Dysfunctional uterine bleeding (DUB) is one of the commonest condition for which patient seeks out medical consultation. The prevalence increases with the increase of age peaking before menopause. Objectives: The aim of this work is to evaluate the effect of this new form of levonorgestrel-releasing IUD on the treatment of patients with abnormal uterine bleeding. Patients and Methods: A prospective age-specific comparative analysis of 61 peri-menopausal women presented with dysfunctional uterine bleeding who constituted the study group. They underwent hysteroscopy and endometrial sampling during an 18 months period from June 2014 to January 2016 at Ain Shams University Materity Hospital. Prior to metraplant-E application, all the patients in this study were in the age of 25-58 years old. Results: The role of Metraplant-E in the treatment of abnormal uterine bleeding (AUB) was evaluated. Sixty- one women with failed attempt(s) of medical treatment unwilling or unfit for hysterectomy were treated with Metaplant-E. Menstrual blood loss was assessed by pictoral bleeding assessment chart (PBAC), bleeding index (B.I) and total bleeding score (T.B.S/month). The bleeding patterns in the form of the mean menstrual blood loss estimated by bleeding index and the mean menstrual loss estimated by the total bleeding score/month and PBAC decreased significantly (p = 0.001). The quality of life scale (Likert scale) improved significantly (p = 0.001). All 15 cases who had endometrial sampling demonstrated progestational effect on histo-pathological examination. Conclusion: Metraplant-E was found to be effective in managing dysfunctional menorrhagia on both clinical and histopathological levels.
https://ejhm.journals.ekb.eg/article_9120_d4ed46856b6aba4358d60c5357201ea7.pdf
Metraplant-E
LNG-IUS
menorrhagia
contraceptives
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4085
4092
10.21608/ejhm.2018.9121
9121
Original Article
Immediate and Short-term Changes in Left Ventricular Function in Children Undergoing Percutaneous Closure of Patent Ductus Arteriosus by Echocardiography and Tissue Doppler
Ahmed M. Hassan
dr.ahmed.magdy@aol.com
1
Hebatallah M. Attia
2
Dina A.E. El Din
3
Department of Cardiology, Faculty of Medicine, Ain Shams University
Department of Cardiology, Faculty of Medicine, Ain Shams University
Department of Cardiology, Faculty of Medicine, Ain Shams University
Background: Patent ductus arteriosus accounts for 5–10% of all congenital heart diseases. Left-to-right shunting through the PDA results in pulmonary over-circulation and left heart volume overload. Transcatheter closure is the method of choice for PDA closure when suitable. Some previous studies have described an immediate deterioration of left ventricular functions after percutaneous closure of PDA, which is reversible and improves after few months. Purpose: This study aimed to determine the immediate and short-term changes in the left ventricular function in children with patent ductus arteriosus after percutaneous closure using 2D echocardiography and tissue doppler imaging. Patients and Methods: Thirty children with isolated PDA were treated by trans-catheter closure were studied. The LV dimensions, volumes and systolic function were assessed by two-dimensional echocardiography and tissue Doppler imaging before the PDA closure, on day 1 and after one month. Results: The median age of the patients was 4.25 years and mean BSA was 0.73 ± 0.31 m2, with the mean PDA diameter of 2.53 ± 0.60 mm. The LVEDD, LVESD, left atrium diameter, ejection fraction and LVEDV reduced significantly immediately after PDA closure (p < 0.001). After 1 month, LVEDD, LVESD and LAD continued to decrease, while ejection fraction improved significantly. All tissue Doppler velocities showed a significant decrease immediately after closure with significant increase of MPI (p < 0.001) and then were improved within 1 month. Conclusion: percutaneous closure of PDA was associated with reversible significant decrease in the left ventricular systolic and diastolic functions, which recovered after one month.
https://ejhm.journals.ekb.eg/article_9121_c7278b242850004e04df10a705f751e6.pdf
Left Ventricular Function
Echocardiography and tissue Doppler
patent ductus arteriosus
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4093
4099
10.21608/ejhm.2018.9122
9122
Original Article
Comparison between B-scan Ultrasonography and Optical Coherence Tomography in Evaluation of Macular Oedema
Amira S. Abd El Aziz
dr.meeero76@gmail.com
1
Hany M. El-Ibiary,
2
Lamia S. Elewa
3
Ahmed M. El-Bauomy
4
Department of Ophthalmology, Faculty of Medicine – Ain Shams University
Department of Ophthalmology, Faculty of Medicine – Ain Shams University
Department of Ophthalmology, Faculty of Medicine – Ain Shams University
Department of Ophthalmology, Faculty of Medicine – Ain Shams University
Background: Optical Coherence Tomography is a very sensitive modality for detection of even subclinical macular edema and provides both qualitative and quantitative results used in monitoring and follow up of patients before and after treatment of ME. However, B-Scan Ultrasonography is a non-Invasive diagnostic tool that has the advantage of reliably imaging the posterior segment regardless of the ocular media status and it is less dependent on patient cooperation. Aim of the Work: To report sensitivity and specificity of B-scan Ultrasonography in detection of macular edema. Patients and methods: This observational case series was conducted on Forty eyes of 20 patients examined at the ophthalmology clinic of Cairo Fatimic Hospital. They were asked to participate and were enrolled in this study in the period from December 2017 to March 2018. Results: There was high degree of agreement between clinical diagnosis and echographic findings of macular thickening. The sensitivity and positive predictive value (PPV) of B-scan ultrasonography to detect ME were 91.7% (22/24) and 84.6% (22/26) respectively. The specificity and negative predictive value (NPV) of B-scan ultrasonography to detect ME were 75% (12/16) and 85.7% (12/14), respectively. And consequently, the diagnostic accuracy of B-scan ultrasonography to diagnose ME was found to be 85% (34/40). Conclusion: Optical Coherence Tomography is the most sensitive method to diagnose macular edema both qualitatively and quantitatively, but in certain circumstances when performing OCT would be difficult or even impossible, B-Scan Ultrasonography provides an acceptable method to qualitatively detect macular edema.
https://ejhm.journals.ekb.eg/article_9122_f16221833674d1ae921bbc8c3fba2bea.pdf
Macular oedema
B-scan ultrasonography
Optical Coherence Tomography
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4100
4103
10.21608/ejhm.2018.9123
9123
Original Article
Assessment of Corneal Higher Order Aberrations Before and After Corneal Collagen Cross-Linking in Patients with Keratoconus
Mo’mena A.A.,
m.abd_elrazeik@yahoo.com
1
Moamen S.
2
Ahmed A.
3
Tamer E.M.
4
Rafeek E.G.
5
Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Purpose: This study aimed at assessing the shortterm effect of corneal collagen crosslinking on higher order aberrations of cornea in patients with keratoconus using corneal topography. Patients and Methods: The study was a prospective cohort study that was conducted in a private specialized eye hospital on 40 eyes of 28 keratoconus patients. Each patient was fully assessed preoperatively including doing corneal topography using Pentacam® HR. Transepithelial accelerated CXL was done to all patients. Postoperative corneal topography was done at six months and data was retrieved and analyzed. Results: RMS HOA recorded a higher mean value preoperatively, with a high statistically significant difference (p=0.00). All elements of HOAs showed lower postoperative values except for trefoil 30o. The difference was statistically significant in comma 0o, comma 90o, spherical aberrations and fifth order comma 90° (p=0.026, p= 0.003, p=0.005, and p=0.001 respectively). Conclusion: Transepithelial corneal collagen cross-linking improves corneal higher order aberrations. The maximum effect of the procedure is on comma 0o, comma 90o, spherical aberrations and fifth order comma 90° elements.
https://ejhm.journals.ekb.eg/article_9123_9fb271a49a31e6fb8933b87c4d47e389.pdf
Keratoconus
Corneal Collagen cross-linking
Higher order aberrations
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4104
4108
10.21608/ejhm.2018.9124
9124
Original Article
Assessment of Endovascular Treatment of Tibial Artery Occlusion in Diabetic Patients
Mohamed Abdel-Hamid Abdel-Rahman
1
Ahmed Saeed Daha
2
Mohamed Moukhtar Abdel-Fattah Elbanwany
3
Vascular Surgery Department, Faculty of Medicine, Al-Azhar University
Vascular Surgery Department, Faculty of Medicine, Al-Azhar University
Vascular Surgery Department, Faculty of Medicine, Al-Azhar University
Background: Globally, over 170 million people have diagnosed DM, and by the year 2030, the prevalence is estimated to raise 2.5-fold. Diabetes mellitus (DM) is one of the strongest predictors of peripheral arterial occlusive disease and a significant risk factor for progression of asymptomatic disease or claudication into critical limb ischaemia (CLI). Critical limb ischaemia is the most advanced stage of peripheral arterial occlusive disease. The prognosis is poor, with amputation rates up to been 30% and mortality up to 25 % after 1 year. Aim of the Work: The aim of this work is to evaluate the role of endovascular treatment of tibial artery occlusive disease in diabetic patients, as regard to efficacy, safety, as well as complications. Patients and Methods: This is prospective cohort study, diabetic patients with peripheral arterial occlusive disease (affecting tibial arteries), it is the study of 20 patients, Al-Azhar University Hospitals. Patients with Critical limb ischaemia (CLI) with Computerized Topographic Angiography (CTA) evidence of significant isolated tibial artery occlusive disease (anterior or posterior or both). Patients with generally adequate state of cardiac, respiratory and renal conditions that allow the procedure. Results: The present study was conducted on 20 diabetic patients, 11 males (55%) and 9 females (45%). Their age ranged between 50 years and 87 years with a mean age of 66.7 12.35. All 20 diabetic patients had tibial disease which ranges from segmental stenosis to total occlusion. The procedure time was estimated from the time of infiltration of local anaesthesia to the end of the procedure; It ranged from 45 min to 120 minutes with mean ± SD (88.920. min).The hospital stay ranged from 1 to 21 days with mean ± SD (5.5 ±6.8). Conclusion: Tibial angioplasty demonstrated its feasibility, safety and effectiveness in the treatment of diabetic patients with CLI. Limb salvage should be the main goal in patients with CLI due to infrapopliteal occlusive disease. With a prompt diagnosis, treatment can be started early and serious consequences may be avoided. Revascularisation that can prevent amputation is the ultimate treatment strategy.
https://ejhm.journals.ekb.eg/article_9124_f697e71afca8831ecd5393490fc577bc.pdf
Endovascular treatment
Revascularisation
Tibial Artery Occlusion
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4109
4112
10.21608/ejhm.2018.9125
9125
Original Article
Loop Knots Versus Harmonic Scalpel in Laparoscopic Appendectomy
Alsayed A. Hamdy, Mohamed F.L. Ayoup, Ashraf A.I. Elsayed
1
General Surgery Department, Faculty of Medicine, Al Azhar University
Background: Acute appendicitis is the most common indication for intra-abdominal emergency surgery, and appendectomy is one of the most commonly performed procedures in abdominal surgery. Although laparoscopic appendectomy (LA) has not yet achieved the status of a “Gold Standard” treatment, it is being progressively accepted as the treatment of choice for acute appendicitis. Numerous studies have shown many benefits of LA, including a faster recovery, less postoperative pain, reduced wound infections, shorter hospital stay and earlier return to work. Aim of the Work: To assess the feasibility of using the ultrasonic-activated device (harmonic) scalpel in sealing and division of the appendicular stump during laparoscopic appendectomy. Patients and Methods: This prospective study was carried out at the surgical department of Al Hussein University hospital during the period from June 2016 to April 2018. 40 patients diagnosed as acute appendicitis were included And divided into two groups: group 1 containing 20 patients using loop knots and group 2 containing 20 patients using harmonic scalpel (as a method of appendicular stump sealing. A comparative analysis was done for both techniques considering the post-operative leakage, the post-operative pain, hospital stay, surgery time, post-operative bleeding (if), and post-operative infection. Results: A total of 40 patients were included in this study, 20 in the loop knots group and 20 in the harmonic scalpel group. An analysis of the patients data showed that there was no significant difference between the first group and the second group with respect to difference in either age or gender. There was no mortality occurred in this study. There was no significant difference in the overall complication rates (10% in the LOOP group versus 10% in the harmonic group). Conclusion: Harmonic scalpel and loop knots tying are two promising techniques to secure the appendix stump in laparoscopic appendectomy with similar complication rates. Harmonic scalpel costs were higher than loop knots tying but has shorter operative times. Because of the simplicity of techniques, we highly recommend using of the harmonic scalpel especially by surgeons learning laparoscopic procedures.
https://ejhm.journals.ekb.eg/article_9125_a1ae4af973ff7d706785f3e933609471.pdf
Loop Knots
Harmonic Scalpel
Laparoscopic appendectomy
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4113
4119
10.21608/ejhm.2018.9126
9126
Original Article
Role of Recent MR Imaging Modalities in Diagnosis of Problematic Breast Lesions
Maged M.A. Ghanem, Mohamed S.T. El-Feshawy, Ahmed M.S. Abdelmaksoud
ahhhmed488@gmail.com
1
Department of Radiodiagnosis, Faculty of Medicine-Al-Azhar University
Background: Breast imaging reporting and data system (BIRADS) III and IV lesions are considered indeterminate breast lesions and an imaging dilemma. Contrast enhanced MRI shows high sensitivity in detecting these lesions but with low specificity leading to unnecessary biopsy in some of them and high false positive rate. So there was a need for new imaging techniques to raise the specificity of MRI. One of these new imaging techniques is MRS which can improve breast cancer diagnosis especially in indeterminate breast lesions. IT is a noninvasive method that can be added to the DCE–MRI of the breast increasing only the time of examination but allow better characterization of lesions depending on their chemical composition. Objective: To assess the diagnostic value of recent MR imaging modalities in diagnosis of problematic breast lesions categorized by mammography or sonomammography as (BIRADS III and IV) and correlation of these findings with available histopathological findings, clinical data or follow up. Patients and Methods: Study was carried out in the Radiology Department of Al-Azhar University Hospitals. The work took place during the period between May 2017 and June 2018. A total of 35 patients, presented with breast lesions for characterization, were included in the study. Results: We found that MRS measurement increased the specificity of the breast MRI in characterizing different breast lesions especially when it is combined with conventional dynamic MRI. Conclusion: MRS is a noninvasive scan that can be added easily to standard breast MRI protocols as an adjuvant tool. Detection of choline peak using choline SNR can accurately differentiate benign from malignant breast lesions especially indeterminate breast lesions with high sensitivity and specificity especially by adding its results with the results of the standard DCE- MRI scan.
https://ejhm.journals.ekb.eg/article_9126_f43052a70065e9f8b59ca50e34972fa7.pdf
Breast Imaging Reporting and Data System
Computed tomography
Dynamic contrast enhancement
Magnetic resonance
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4120
4125
10.21608/ejhm.2018.9127
9127
Original Article
Comparative Study between Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini Gastric Bypass in Control of Type 2 Diabetes Mellitus in Obese Patients
Ashraf Abd-Elhamid Abd-Elmonem1, Kamel Suliman Hamad2, Mohamed Noshi El-Alfi3, Abd El-Hafez Abd-El Aziz Selim1, Fouad Ebrahim Fouad Agwa*
foadagwa@gmail.com
1
1General Surgery Department, 2Clinical Pathology Department, 3Internal Medicine Department Faculty of Medicine, Al-Azhar University
Background: Among morbidly obese adult patients (body mass index (BMI) <40 kg/m2) those who are super obese (BMI < 60 kg/m2) present particular challenges for bariatric surgeons. Management of super obese (SO) patient has been associated with higher morbidity and mortality and increase surgical risk. The optimal surgical management of these patients is controversial. Aim: This work aimed to focus light on super obese patient. Considering the advantages, the disadvantages and determine long-term outcome of different plans of management regarding the recent guidelines for this group of patients. Patients and Methods: This study included 60 obese patients with type 2 diabetes mellitus (DM) and randomly divided using closed envelopment method into two groups: Group (1): (30 patients) treated by laparoscopic Sleeve gastrectomy (LSG), Group (2): (30 patients) treated by laparoscopic Mini-Gastric Bypass (MGB). Results: This study included 60 obese patients with type 2 D.M. As regard all sample patients (60 obese patients with type 2 D.M), the group age ranged between 22 -55 years with a mean ± SD of 37.88 ± 9.52 years. The group BMI ranged between 37 – 72 kg/m2 with a mean ± SD of 52.42 ± 9.45 kg/m2. Of the 60 patients, 38 patients (63.3%) were women and 22 patients (36.7%) were men. Conclusion: Bariatric surgery (LSG and MGB) is not only weight reducing surgery but a metabolic surgery which can cure most of the metabolic syndrome and they are considered the most effective long term treatment modality for type 2 diabetes in obese patients and with comparing between LSG and MGB, our study suggests that MGB has better and earlier effect than LSG in diabetes remission.
https://ejhm.journals.ekb.eg/article_9127_09e64723d8e54345e8a0e08239d7dbf1.pdf
Laparoscopic sleeve gastrectomy
Laparoscopic Mini Gastric Bypass
type2 diabetes mellitus
Obese Patients
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4126
4133
10.21608/ejhm.2018.9128
9128
Original Article
Role of CT Enterography in the Diagnosis of Crohn's Disease
Sherine K. Amine (1), Merhan A. Nasr (1), Ahmed M. Moustafa (2), Rania M. Abd El Rasool (1)
1
(1) Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University (2) Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
Background: Crohn's disease is a multifactorial chronic inflammatory disease characterized by non-caseating granuloma formation with a tendency toward remission and relapse, it affects any part of the GIT from mouth to anus with 80% small bowel involvement, most commonly the terminal ileum, with characteristic multiple discontinuous sites involvement (skip lesions) and transmural inflammation. Aim of the Work: The purpose of this study is to highlight the value of CT in diagnosis of (CD) and its ability to assess the degree of activity and its complications. Patients and Methods: This prospective study was conducted on 87 patients with GIT symptoms where CTE was performed to evaluate its possible impact on accurate diagnosis, detection of complications and consequent guidance for management planning. It was performed in radiological department of Ain –Shams University hospital: CT Unit in the period from “July 2017 to April 2018. The patients’ age ranged between (24 – 72 years) with a mean of 48 years. Results: Of the 87 patients with GIT symptoms that were highly suggestive of inflammatory bowel disease evaluated, 32 were UC, 21 were CD, 9 were other types of IBD and 25 were normal. Of the 21 CD patients evaluated, 7 were male and 14 were female. Conclusion: The role of MDCT in the diagnosis of Crohn’s disease and its complications is undeniable, with a proven efficacy in identifying the enteric and extra-enteric manifestations of the disease. However, advancements in CT E protocol design have allowed increasing accuracy in diagnosis, and the acquisition of studies at a much lower radiation dose. Recommendations: Further studies on a larger scale of patients are needed to confirm the results obtained by this study.
https://ejhm.journals.ekb.eg/article_9128_76f7470df88c08be9d7a142b55820dd2.pdf
CT enterography
small bowel
Crohn's disease (CD)
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4134
4142
10.21608/ejhm.2018.9129
9129
Original Article
Assessment of Early Left Ventricular Diastolic Dysfunction in Patients with Metabolic Syndrome by 2D Speckle Tracking Echocardiography
Mohammed Hesham Hassan, Mohammed Saad El-Gammal, Ahmed AL-HABBAA, Eslam Mubarak Ali*
1
Department of Cardiology -Al Azhar University, Cairo, Egypt
Background: Metabolic syndrome predisposes to left ventricular dysfunction and heart failure, early
detection of associated subclinical cardiac changes has important diagnostic and prognostic values. 2D strain and strain rate allow detection of subtle abnormalities of global and regional left ventricular systolic and diastolic functions.
Objectives: To detect early diastolic dysfunction in the left ventricle in patients with metabolic syndrome by 2D speckle tracking echocardiography based on global longitudinal isovolumic relaxation strain rate.
Subjects and Methods: This prospective study included a total of 100 subjects divided in to 75 metabolic syndrome (MS) patients referred to Al-Azhar university hospital outpatient clinic for evaluation and treatment of hypertension and/or diabetes mellitus and 25 age and sex matched healthy volunteers as a control group. All subjects underwent conventional echocardiographic examination and assessment of diastolic dysfunction by speckle tracking.
Results: There were no statistically significant differences between MS and controls in all traditional parameters of LV systolic function. On the other hand, significant differences were observed between MS and the control group in most of the parameters of GLS and SR IVR. Conclusion: Impairment of diastolic function detected by speckle tracking based on global longitudinal isovolumic relaxation strain rate in metabolic syndrome patients.
https://ejhm.journals.ekb.eg/article_9129_1f7b6198c309b1e35f7823fef864fb0b.pdf
Metabolic syndrome
Left ventricular diastole
speckle tracking
Echocardiography
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4143
4147
10.21608/ejhm.2018.9130
9130
Original Article
Evaluation of Prophylaxis and Management of Venous Thromboembolism in Surgical Cancer Patients
Omar Mokhtar Elhayeg, Abdelaziz Ahmed Abdelhafez, Mohamed Alaa Eldin Beshta
1
Department of Vascular Surgery, Faculty of Medicine - Alazhar University
Background: Deep venous thrombosis is considered to be one other challenges in medical practice because of silent nature in most of the cases and the complications that may end with death. It's very difficult to study its incidence. There is strong relation between malignancy and thrombosis. The incidence of deep venous thrombosis in malignancy differs according to the type of the tumor. There are many risk factors of deep venous thrombosis other than malignancy like surgery, history of previous attack, immobility, obesity, pregnancy, and contraceptives, and others. The incidence differs from one risk factor to another and also according to presence of other co-morbidities. Venous thrombosis occurs as a result of one or more three factors postulated by Virchow either abnormalities of blood flow, abnormalities of blood or vascular injury. Deep venous thrombosis in malignancy may be due to other causes like surgery, chemotherapy or central venous catheters. Objective: The aim of this work was to evaluate the efficacy of prophylactic measures before, during and after surgery in reducing the risk of developing venous thromboembolism in cancer patients undergoing surgery and how to mange the thromboembolic events if occurred after surgery in surgical cancer patients. Patients and Methods: This is a prospective study conducted on 20 patients presented to the Oncology surgery unit and Vascular surgery outpatient clinic of AL-Hussein University Hospital and Ahmed Maher Teaching Hospital between December, 2017 and June, 2018. Patients with operable tumors were included in this study while cancer patients with comorbidities interfering with surgical procedures were excluded. Data were recorded in predesigned sheet including age, sex, special habits, obesity, history of previous DVT and history of chronic illness. Duplex study was done pre and post operative to diagnose DVT .Time of operations were assessed. All included patients were assessed for the appropriate regimen of prophylaxis either mechanical or pharmacological or combination of both. Diagnosed patients with DVT after surgery were treated with heparin and oral anticoagulants. Results: Of the 20 patients, 9 (45%) were females and 11(55%) were males. The age of the patients ranged between 33 and 82 years with a mean age at presentation was 59.85 years. With the 20 patients who used preoperative prophylaxis regimens, the incidence of postoperative deep vein thrombosis was 10%; with average time of DVT development of (1.25 ± 0.35) months. In addition, the rate of bleeding was 5%; developed at 1-month duration. Conclusion: patients with cancer particularly those undergoing surgery are at risk of developing venous thromboembolic complications. Low molecular weight heparin (LMWH) and Unfractionated heparin (UFH) prophylaxis in patients undergoing cancer related surgery has proved to be effective and safe in reducing the risk of an acute event. Thromboprophylaxis with LMWH, UFH and mechanical methods should be considered for all patients with a malignancy who undergo surgery. Recommendation: Both pharmacological and mechanical thromoboprophylaxis measures are required to minimize the risk of developing deep vein thrombosis and its complications in surgical cancer patients (SCP).
https://ejhm.journals.ekb.eg/article_9130_11d89a5ab6f18a9d22780f5d0967bbbb.pdf
Venous Thromboembolism
Deep Vein Thrombosis
low-molecular-weight heparin
unfractionated heparin
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4148
4153
10.21608/ejhm.2018.9131
9131
Original Article
Evaluation of The Diagnostic Role of Non-Coding RNA and Exosomal Related Gene Association in Lung Cancer
Fawzia Khalil1, Hanan H. Shehata1, Nehad Osman2, Omar Abdel-Rahman3, Marwa Ali1 and Ghada Mohamed1
1
1 Medical Biochemistry and Molecular Biology Department, 2 Pulmonary Medicine Department, Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine –Ain Shams University
Background: Exosomes are microvesicles that are recently discovered in intercellular communication especially between tumor cells as lung cancer that are important for tumor development and progression. Objectives: Examine the diagnostic role of serum exosomal LncRNA in lung cancer among Egyptian population. Methods: Lung cancer characteristic exosomal RNA-based biomarker Lnc-RNA-RP11-510M2.10 was selected based on bioinformatic methods, followed by RT-qPCR validation of their expression in serum of 20 patients with lung cancer and 10 healthy volunteers. Results: serum exosomal Lnc-RNA-RP11-510M2.10 showed a significant negative association with lung cancer patients in comparison to patients with healthy persons (p<0.001). Conclusion: Lnc-RNA-RP11-510M2.10 could be used as diagnostic and prognostic biomarker tools for lung cancer.
https://ejhm.journals.ekb.eg/article_9131_5072de8d689c493976cb48576885c710.pdf
Lung Cancer
Exosomal RNA extraction
Lnc-RNA-RP11-510M2.10
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4154
4164
10.21608/ejhm.2018.9132
9132
Original Article
Prevalence of Glaucoma among High Myopia
Osama Abd El Kader Salem *, Amr Ismail El Awamry*, Yasser Abd El Maguid El Zanklony *, Omnia Mohammed Abd El-Fatah **
1
* Department of Ophthalmology, Faculty of Medicine, Ain Shams University ** Department of Ophthalmology, Faculty of Medicine, Cairo University
Background: Glaucoma is an optic neuropathy that is characterized by the selective loss of retinal ganglion cells and their axons, which manifests as the loss of the retinal nerve fiber layer (RNFL). Numerous studies have shown that the extent of RNFL damage correlates with the severity of functional deficit in the visual field (VF), and that RNFL measurement by optical coherence tomography (OCT) has good sensitivity for the detection of glaucoma. Purpose: To assess the prevalence of glaucoma among high myopic patients and the association between them using standard automated perimetry (SAP) and optical coherence tomography (OCT). Patients and Methods: A prospective observational randomized cross sectional study included a total of 80 eyes with high myopia, in the period from November 2017 to April 2018. Results: This cross sectional study included 44 subjects with 80 eyes regarding high myopia using the outpatient services of the Qlawoon Hospital, Cairo, who satisfied the inclusion and exclusion criteria between November 2017 and April 2018 aiming to determine the prevalence of glaucoma in high myopic patients. Conclusion: RNFL thickness mean is; for average thickness is 86.37, for superior thickness is 90.06 and for inferior thickness is 82.68 a highly significant P-value.
https://ejhm.journals.ekb.eg/article_9132_ca7442a382ce3a2830b40045b95300b5.pdf
Glaucoma
High myopia
Intraocular Pressure
myopic macular degenerations
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4165
4174
10.21608/ejhm.2018.9133
9133
Original Article
The Role of Diffusion Weighted Magnetic Resonance Imaging and Subtraction Magnetic Resonance imaging in Assessing Treatment Response of Hepatocellular Carcinoma After Transarterial Chemoembolization
Elhadi I. Ahmed
1
Mohammed S. Hassan
2
Mohammed G. Abdel-Mutaleb
3
Department of Radiology, Faculty of Medicine -Ain Shams University
Department of Radiology, Faculty of Medicine -Ain Shams University
Department of Radiology, Faculty of Medicine -Ain Shams University
Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and has a poor prognosis unless treated. Ablative therapies are promising treatment options for patients who are not eligible for surgery. Monitoring tumor response after transarterial chemoemolization (TACE) procedure is an important task in oncologic imaging. Early favorable response indicates effectiveness of therapy, while early treatment failure identification is also critical in patient management. In such cases further re-treatment will be mandatory. Aim of work: The aim of this study is to evaluate the efficiency of both diffusion weighted images and subtracted dynamic MRI technique in the detection of residual/ recurrent disease after TACE ablation of non resectable hepatocellular carcinoma (HCC) lesions. Accurate judgment of tumor viability will help diagnose the need for further treatment sessions. Patients and Methods: This study included 32 patients having 54 HCC lesions that underwent transarterial chemoembolization procedure over a period of 6 months (2017- 2018) were followed up 1-1.5 months by dynamic MRI. 12 patients of which underwent a second follow up within 3-4 months. Patients’ ages ranged between 59 to 73 years (mean age 53.1); 26 patients were males and 6 were females. All patients had liver cirrhosis related to chronic viral hepatitis. Results: In 1ry response and follow up findings post TACE, where good response was defied as disappearance of any intra tumoral arterial enhancement in treated lesions, residual disease was defined as at least 30% reduction in the sum of diameters of the viable enhancing lesion in the arterial phase, no response was less than 30% reduction in the enhancing lesion diameters. Progressive disease was defined as 20% increase in the sum of diameters of the enhancing lesions in comparison to the target lesion diameter at the start of treatment. Conclusion: MRI is a powerful tool in detection of residual tumor viability, quantifying tumor necrosis and detecting complications after TACE. Imaging protocol should include dynamic study combined with post processing subtraction images for better tissue characterization.
https://ejhm.journals.ekb.eg/article_9133_11f8f62772a47abd4e307ba0e2345c3d.pdf
DW MRI
subtraction MRI
Hepatocellular carcinoma
transarterial chemoembolization
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4175
4178
10.21608/ejhm.2018.9134
9134
Original Article
Role of Computed Tomography Perfusion Compared to Computed Tomography Triphasic Study in Assessment of Hepatic Focal Lesions
Abeer Muneer Ali Farag
abeer_muneer@hotmail.com
1
Sherif Abou Gamra
2
Mohamed Amin Nassef
3
Merhan Ahmed Nasr
4
Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Purpose of this study is: to evaluate the role of computed tomography perfusion and computed tomography triphasic in assessment of hepatic focal lesions. Methods: The study included 43 patients (between 30 to 60 years old) referred from radiodiagnosis department. Each patient included in the study was subjected to full history taking and availability of the previous studies. Results: The study showed that CT perfusion revealed more accurate results than CT triphasic. Conclusion: The current application of CT perfusion to patient with hepatic focal lesions showed that it enhanced our understanding of the disease diagnosis staging, prognostic evaluation and monitoring therapeutic response.
https://ejhm.journals.ekb.eg/article_9134_9ae7581d39f0a833415c3f13684dde96.pdf
ct perfusion – hepatic focal lesions
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4179
4184
10.21608/ejhm.2018.9135
9135
Original Article
Comparative Study between Ultra-Sound Guided Femoral Nerve Block and Adductor Canal Block in Postoperative Analgesia after Knee Arthroscopy
El-Feky A A
1
Abdel Karim U I
2
Ismael A M
3
Anesthesiology and Intensive care department, Faculty of Medicine, Al-Azhar University
Anesthesiology and Intensive care department, Faculty of Medicine, Al-Azhar University
Anesthesiology and Intensive care department, Faculty of Medicine, Al-Azhar University
Background : Analgesia after knee operations can be achieved by integrated multimodal analgesic protocols using two or more analgesic modalities that work by different mechanisms that will optimize the analgesia and minimize the potential risks and side effects. Objective: of this study was to evaluate the reliability of the postoperative pain control using adductor canal block (ACB) compared with that using the femoral nerve block (FNB) in patients undergoing knee arthroscopy. Patients and Methods: Eighty patients who had been scheduled to knee arthroscopy were included in this prospective, blinded study, and were randomly allocated into two groups (40 each); A group, had received ACB and F group, had received FNB. After 15 minutes; sensation, motor power and vital signs are assessed, then patients transferred to operating room where all patients had received general anesthesia. Total intraoperative fentanyl and vital signs are assessed. The postoperative pain (numeric rating scale [NRS]) and quadriceps power were assessed in the postoperative care at (1, 2, 4, 6, 8, 10, 12, 18 and 24) hours. The time to 1st pethidine and total pethidine requirements were also recorded. Results: Patients in group FNB had significantly less quadriceps power (at 6-8 h) postoperatively than those in groupACB. There were no significant differences between the two studied groups as regard NRS, time to 1st pethidine and total pethidine requirements in the 1st 24 h. Conclusion: In patients undergoing knee arthroscopy, the ACB can maintain a higher quadriceps power compared with the FNB and is efficient as FNB in control of postoperative pain.
https://ejhm.journals.ekb.eg/article_9135_3929250d31dfc790e13bf94b42941f39.pdf
Anesthetic techniques
adductor canal block
femoral nerve block
regional
Bupivacaine
knee arthroscopy
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4185
4188
10.21608/ejhm.2018.9136
9136
Original Article
Feasibility and Safety of Catheter Directed Foam Sclerotherapy Combined with Tumescent Local Anesthesia for Treatment of Axial Varicose Vein
Mohamed Atef Bayoumi
1
Mohamed Yahia Zakaria
2
Foad Mohamed Ahmed
3
Vascular Surgery Department, Faculty of Medicine, Al-Azhar University
Vascular Surgery Department, Faculty of Medicine, Al-Azhar University
Vascular Surgery Department, Faculty of Medicine, Al-Azhar University
Background: Varicose veins is a common health problem, with an estimated prevalence of greater than 20% (range 21.8% to 29.4%). Approximately 5% (range 3.6% to 8.6%) have venous oedema, skin changes or ulceration. Chronic venous disease (CVD) is the most common venous disorder. It is caused by venous hypertension due to either reflux, outflow obstruction or both. Aim of the Work: The aim of the work was to review the feasibility and efficacy of catheter-directed foam sclerotherapy in treatment of saphenous vein incompetence. Patients and Methods: This clinical trial was conducted at vascular surgery department at Al Azhar University Hospital. The study included 25 patients suffering from primary varicose vein. All patients were belonging to class C2 to C4 Ep as Pr according to CEAP classification. This mean: C2 to C4 clinically stage to stage venous disease in which there were uncomplicated, moderate to severe varicosities. Ep etiologically the disease was primary with well functioning deep system. Anatomically, the varicosities affected the superficial system mainly the great saphenous vein. Results: Between March 2017 and March 2018, 25 patients (25 limbs) were treated with CDFS at vascular department – Al-Azhar University hospitals. Demographic data and severity of venous disease are shown in Table below. Conclusion: The use of this catheter based technique facilitated foam sclerotherapy with a high primary and acceptable short-term occlusion rates, and low numbers of complications. Further studies are required to evaluate how the migration of foam into the common femoral vein can be diminished and whether the techniques used in this study of leg elevation and manual compression provide any advantage.
https://ejhm.journals.ekb.eg/article_9136_27360201b3adfbbda9eee136a5274d3f.pdf
Catheter Directed Foam Sclerotherapy
Tumescent Local Anesthesia
Axial Varicose Vein
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4189
4193
10.21608/ejhm.2018.9137
9137
Original Article
Low Dose Ketamine in Prevention of Propofol Injection Pain
Naglaa Mohammad Aly
1
Manal Mohamed Kamal
2
Dalia Ahmed Ibrahim
3
Alaa Ahmed Whied Mohamed
alaawhied@gmail.com
4
Department of Anesthesia, Intensive Care &Pain Management, Faculty of Medicine - Ain Shams University
Department of Anesthesia, Intensive Care &Pain Management, Faculty of Medicine - Ain Shams University
Department of Anesthesia, Intensive Care &Pain Management, Faculty of Medicine - Ain Shams University
Department of Anesthesia, Intensive Care &Pain Management, Faculty of Medicine - Ain Shams University
Background: Propofol is the most widely used intravenous anesthetic agent for induction and maintenance of anesthesia as well as for sedation inside and outside operation theatre. Propofol is almost an ideal intravenous (IV) anesthetic agent, but pain on its injection still remain a problem. Pain may not be a serious complication, but most patients remember it as one of the unpleasant encounters with anesthetists. In one survey pain on propofol injection stands seventh most important problem in the current practice of clinical anesthesia. Ketamine is (NMDA) receptor antagonist agent and a dissociative anesthetic with neurostimulatory side effect, multiple research trials suggest ketamine as a strong analgesic agent in sub anesthetic IV doses. Objective: The aim of the current study was to prove the effectiveness of low dose ketamine in preventing propofol injection pain. Methodology: Two groups each included 60 patients (middle age females who performed ovum pick up surgery: Ketamine group 60 patient received ketamine 0.2 mg/kg with propofol. Saline group 60 patient received normal saline 10 ml with propofol. Results: In the current study pain and hemodynamic changes (BP, pulse) were observed. Regarding pain: The incidence of propofol injection pain in the current study was reduced from 93.2% in saline group to 55% in ketamine group, the incidence of severe pain was completely abolished with ketamine. Regarding hemodynamics: There was no statistical significance between both groups regarding heart rate, regarding BP the degree of drop in BP in ketamine group was to less extent than in saline group that proves the role of ketamine in hemodynamic stability. Conclusion: Finally ketamine in low dose was effective in reduction of propofol injection pain.
https://ejhm.journals.ekb.eg/article_9137_9c7f1646893c0c07fa591a28bd0917b6.pdf
propofol
Intravenous – Blood pressure
N-methyl-D asparate
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4194
4199
10.21608/ejhm.2018.9138
9138
Original Article
Intracytoplasmic Sperm Injection Outcome in Patient at Risk of Poor Responder Using Mild Ovarian Stimulation Protocol versus Short Gonadotropin Releasing Hormone Agonist Protocol
Amr M. Elerasy
amroerasy@yahoo.com
1
Mohamed S. Hasanien
2
Shoukry A. Elawdy
3
Department of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar University
Department of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar University
Department of Obstetrics and Gynecology, Faculty of Medicine – Al-Azhar University
Background: Poor ovarian response to stimulation in IVF cycles is a challenging and frustrating condition for both clinician and patient, due to its poor prognosis in terms of pregnancies and live births. Although in the literature a large number of papers have been published in which many stimulation protocols suggested should be considered as the best for these women, however, no conclusive results have been reached. Aim of the Work: To evaluate ICSI outcome in patient at risk of poor responder using mild ovarian stimulation protocol versus short gonadotropins releasing hormone agonist protocol. Patients and Methods: This randomized controlled study was conducted on one hundred patients, complaining of infertility at risk of poor responders, patients with at least two of the criteria specific for poor responders at assisted reproductive technology unit, international Islamic center for population studies and research, Alazhar University, Cairo, Egypt, between august 2016 and august 2017. Results: Statistically significant differences were found in the Endometrial thickness, E2 at day of HCG, No. of dominant follicles at day of HCG, Number of retrieved oocyte, fertilization rate, Embryo number, Number of transferred embryos, Pregnancy rate and cost p-value 0.029, 0.036, 0.007, 0.027, 0.048, 0.019, 0.046, 0.044 ,0.001 respectively. Conclusion: ICSI outcome was evaluated in patients at risk of poor responders using short Gonadotropin releasing hormone agonist versus mild ovarian stimulation protocol (clomiphene citrate); showing that short Gonadotropin releasing hormone agonist should be preferred in these patients.
https://ejhm.journals.ekb.eg/article_9138_95e63d892b02d7210acae51fa5bc16ce.pdf
Sperm Injection Outcome
Poor Responder
Mild Ovarian Stimulation
Short Gonadotropin Releasing Hormone
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4200
4206
10.21608/ejhm.2018.9139
9139
Original Article
Management of Liver Metastasis of Colorectal Cancer
Mohammed Bassyoni
drmah.rabie2010@gmail.com
1
Magdy Hussain
2
Mahmmoud Abd El Aziz,
3
Department of General Surgery, Faculty of Medicine- AlAzhar University
Department of General Surgery, Faculty of Medicine- AlAzhar University
Department of General Surgery, Faculty of Medicine- AlAzhar University
Background: Globally, colorectal cancer is the third most common cancer among men and the second most common among women. Colorectal cancer is the fourth most frequently diagnosed cancer, but the second-leading cause of cancer deaths. Incidence of colorectal cancer has decreased significantly in recent decades, mortality rates have fallen as well. Those declining rates are largely attributed to earlier diagnosis through screening and more sophisticated and effective methods of treatment. Objective: That work represents colorectal cancer metastasis management, early detection and screening of colorectal cancer. Subjects and Methods: This observational study was conducted on 10 patients with liver metastasis admitted to GIT Surgery Unit, Cancer National Institute and postoperative follow up and observation at El-Haram Hospital and Cancer National Institute between April 2017 and December 2017. Results: This work is observational study. The patients in this study were divided into two (2) groups: group 1 and group 2. The included patients were prepared through studying the patient's condition, preoperative & intraoperative assessment. Choice of operation and how to manage synchronous metastases. The type of resection does not seem to influence the prognosis if a clear margin is obtained. The carcinoembrionic antigen (CEA) level is strongly correlated with recurrence-free survival. A free margin of at least 1 cm offers the best chance of avoiding recurrence. Conclusion: In this work observational study results preoperative, operative and postoperative results were recorded. Operative results (type of surgery, surgical technique), postoperative results (liver related complications, general complications, and postoperative morbidity and mortality of liver resection of colorectal cancer. Prognosis and follow up of patients of study and postoperative recurrence.
https://ejhm.journals.ekb.eg/article_9139_39b74d294e5680bfd44abe459172be09.pdf
Carcinoembryonic antigen
Colorectal carcinoma
Metastatic colorectal cancer
Colorectal liver Metastases
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4207
4217
10.21608/ejhm.2018.9140
9140
Original Article
Antibiotic Practicing Habits, Knowledge and Attitude toward Education about Antibiotics among Dentists in Jazan City
Nasser Ibrahim Zakri
1
Nasser Mohammed Alshehri1
2
Abdulrahman Nasser Shebli
3
Dentist General Practitioner, Faculty of medicine, Jazan university, Jazan
Dentist General Practitioner, Faculty of medicine, Jazan university, Jazan
Dentist General Practitioner, Faculty of medicine, Jazan university, Jazan
Introduction: Inappropriate use of antibiotics not only drives antibiotic resistance and misuses resources but also increases the risk of potentially fatal reactions and exposes people to unnecessary side effects and unfavorable outcomes ranging from gastrointestinal disturbances to fatal anaphylactic shock. In developed countries, surveys about general dental practitioners’ prescribing habits have raised awareness of the quality of prescriptions of antibiotics. Whilst some surveys have emphasized that dental prescriptions do not follow clinical guidelines, other authors have concluded that there is a lack of scientific information about appropriate and efficient prescription of proper antibiotic. Moreover, changes in the dental pharmacotherapeutic field have been so rapid in recent years that necessitate the constant updating of dental practitioners’ knowledge about new drugs, drug interactions, and useful therapeutic trends is necessary. Methods: We have conducted a descriptive cross-sectional study among dentists and dental trainee in Jazan city. The questionnaire required information about antibiotic prescription habits, knowledge about preventive majors of dental infection, and followed approaches in dental emergencies. Data collected through distribution of online filled questionnaire. The participants filled the questionnaire online then resent it again to the researcher. The distributed questionnaire was in Arabic language to overcome the language barrier. Collected data verified and coded before its entry to Statistical Package for the Social Science (SPSS). Results: Participants were classified into four categories by age: from 20 to 24 years (30.9%), from 25 to 30 years (53.9%), from 31 to 35 years (8.6%) and above 35 years (6.6%). More than half of participants were Dental graduates (56.4%%), (37%) were students and Interns, (6.2%) were with Master/ Diploma and only one of them with PhD (.4%).The majority of participants prescribed antibiotic for acute apical abscess (72.8%), on the other hand, less than half of participants (45.7%) prescribed antibiotics for acute apical abscess without systemic involvement, and nearly two thirds (65.4%) of participants prescribed antibiotic for medically compromised patient after tooth extraction. Conclusion: It is alarming that most dentists do not perform a proper microbial diagnosis before selecting an antibiotic as adjunct periodontal therapy. As a result, they tend to prescribe broad spectrum antibiotics depending on the probability and most likely diagnosis. Also, the misconception of indications for antibiotic prescription and low knowledge about antibiotics assist in the misuse and in proper use of antibiotics.Educational initiatives and continuous refreshment of knowledge may prevent unnecessary prescription in endodontic emergency treatments.
https://ejhm.journals.ekb.eg/article_9140_a7b40521422b9d000d9df8b083f476f4.pdf
Dental
Awareness
antibiotic
prescription
abscess
communication
education
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4218
4223
10.21608/ejhm.2018.9141
9141
Original Article
Evaluation of Fixation of Mastectomy Flaps in Reduction of Seroma Formation in Breast Cancer Patients
Ahmed M.
1
Nabil E.S.
2
Samy R.
3
Samy G.
4
Department of General surgery, Ain Shams University
Department of General surgery, Ain Shams University
Department of General surgery, Ain Shams University
Department of General surgery, Ain Shams University
Background: Seroma is the most common complication following modified radical mastectomy (MRM), as post mastectomy dead space left between skin and anterior chest wall where seroma is formed causing multiple health issues. Aim of the Work: Is to evaluate the feasibility and efficacy of fixation of skin flaps to anterior chest wall for closing postoperative space with drainage as an alternative to the classic form of mastectomy closure with closed suction drain for MRM for female patients with breast cancer. Patients and Methods: A total of 60 patients, admitted to the following hospitals: Sydnawy Insurance Hospital, and Ain Shames University Hospitals with a diagnosis of breast cancer and were treated by modified radical mastectomy. Patients were divided into 2 groups group A (n=30) were flap fixing group and group B (n=30) were non flap fixing group all patient were presented with breast cancer with age range of 32 to 75, postoperative patients were followed and their data were collected and compared. Results: All 60 patients were evaluated as we had no patients who were lost in follow up. Patients’ demographics were not different in the two groups. We reported less overall complication in group A than group B, also reduced total seroma volume in group A and reduced number of drain days in group A than B. Conclusions: Fixation of skin flaps to chest wall and closure of dead space post modified radical mastectomy actually reduce incidence of seroma formation
https://ejhm.journals.ekb.eg/article_9141_6038e72c39cb1afeb9c62980f35a944b.pdf
Modified Radical Mastectomy
seroma
Reducing seroma
Fixation of skin flaps
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
3
4224
4229
10.21608/ejhm.2018.9142
9142
Original Article
Effect of Intraperitoneal Ketamine as Postoperative Analgesia in Laparoscopic Cholecystectomy
Ahmed M. Shawky
1
Ali Essa
2
Ahmed Emam
3
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University
Background: Laparoscopic surgery is gaining popularity so different modalities of pain management should be used as patients experience postoperative pain of different sources especially from the abdomen, back and shoulder region which is severe especially in first postoperative hours. Objective: We aimed to evaluate effect of intraperitoneal instillation of ketamine and normal saline on post- operative pain and analgesic requirements after laparoscopic cholecystectomy. Patients and Methods: Forty patients undergoing laparoscopic cholecystectomy were randomly allocated and divided into two groups, The ketamine intraperitoneal (KIP) group (n=20 patients), in which 0.5 mg/kg ketamine diluted in 30 ml normal saline was instilled intraperitoneally,The saline intraperitoneal (SIP) group (n=20 patients), in which 30 ml of normal saline was instilled intraperitoneally. Patients receive these drugs as follow, 16 ml in gall bladder fossa while other 14 ml under copula of diaphragm on both sides while patients were placed in 15-20-degree trendelenburg position. This was done before patients recovered from anesthesia, then patients extubated and transferred to ward. Patients were evaluated according to VAS, time to first analgesic and total analgesic requirements during 24 hours post-operative. Results: Our results showed that usage of ketamine decreases postoperative pain and analgesic consumption in the first 24 hours after surgery along with longer pain free period compared to patients who were given bupivacaine after laparoscopic cholecystectomy. In our study ketamine 0.5mg/kg was safely used as we did not observe any sign of toxicity. Conclusion: Intraperitoneal instillation of local anesthetic is an easy, cheap and safe method which provides good analgesia in the immediate postoperative period after laparoscopic surgery. Ketamine is highly effective in postoperative pain control in laparoscopic cholecystectomy without any hazards on patients.
https://ejhm.journals.ekb.eg/article_9142_55a8124e7a9a066b79d95eba5bb3beab.pdf
Adverse drug reactions
visual analogue scale
N-methyl–D-aspartate
anesthesiologist