eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5351
5355
10.21608/ejhm.2018.11273
11273
Original Article
The Efficacy of Transobturator Tape (TOT) in Treatment of Mixed Urinary Incontinence in Females
Amr Mohammed Elsadek Nowier
1
Ahmed Alsaghir Atallah Soliman
drahmedatalla2014@gmail.com
2
Urology Department, Faculty of Medicine, Ain Shams University
Urology Department, Faculty of Medicine, Ain Shams University
Background: mixed urinary incontinence (MUI) is defined as the complaint of involuntary loss of urine, associated with urgency and also with effort. Urodynamic studies (UDS) are widely considered the gold standard investigation for determining the type of incontinence.
Aim of the Work: It evaluates the safety and efficacy of transobturator tape (TOT) procedure in treatment of women with mixed urinary incontinence.
Patients and Methods: this study was carried out at Ain Shams Urology Department and National institute of urology and nephrology in the period from October 2017 to may 2018. This Study included 20 female patients with MUI who failed to respond to medical treatment and other forms of conservative methods. Post operative evaluation was carried out at 2 weeks, 3, and 6 months following operation.
Results: Our study showed statistically significant cure rate for urge component 12 cases (60%), and also significant cure rate for stress component 17 cases (85%), no statistically significant difference in the cure rate depending on the age factor by dividing the patients into two groups group below forty (11 cases) and group above forty (9 cases).
Conclusion: our study showed statistically significant cure rate for urge component 12 cases (60%), and also significant cure rate for stress component 17 cases (85%). The limitations in our study were small number of patients and short time of postoperative follow-up. We advocate that the TOT procedure should always be tried in the management of mixed urinary incontinence in female population as it is an effective and simple procedure.
https://ejhm.journals.ekb.eg/article_11273_ac95e520a7200d1bec705a4830adace2.pdf
Transobturator Tape
Mixed Urinary Incontinence
Urodynamic studies
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5356
5361
10.21608/ejhm.2018.11275
11275
Original Article
Correlation between Clinical and Urodynamic Improvement in Patients with Overactive Bladder Syndrome on Anticholinergic Drugs
Mahmoud Ezzat Ibrahim
1
Ahmed Mohamed Tawfeek
2
Sherief Saad Mohamed
ahsd0307@gmail.com
3
Urology Department, Faculty of Medicine, Ain Shams University
Urology Department, Faculty of Medicine, Ain Shams University
Urology Department, Faculty of Medicine, Ain Shams University
Background: The International Continence Society (ICS) defined overactive bladder syndrome (OAB) as urinary urgency with or without urge incontinence, often accompanied by frequency and nocturia in absence of infection. Urinary urgency is the complaint of a sudden compelling desire to void which is difficult to defer with patients often suffering from anxiety due to fear of leakage. Urge urinary incontinence is defined as involuntary leakage of urine, accompanied or immediately preceded by urgency. Overactive bladder syndrome is a symptomatic diagnosis. On the other hand, detrusor overactivity (DO) is a urodynamic finding, characterized by involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked. These terms aren't interchangeable, as overactive bladder syndrome patients may not have detrusor activity on urodynamic testing. Aim of the Work: to determine the relation between clinical improvement and urodynamic based improvement in patients with overactive bladder syndrome receiving anticholinergic drugs. Patients and Methods: this study included thirty-eight patients, who presented to the Outpatient Urology Clinic at Ahmed Maher Teaching Hospital with symptoms of OAB syndrome. This study design was prospective. Patients clinical histories were taken, they were examined thoroughly, and completed an IPSS questionnaire. This was followed by a urinalysis, free uroflowmetry and a pelvi-abdominal ultrasound. Results: this study included thirty-eight patients who were divided into two groups. Group A included twenty-one patients, fifteen females and six males with mean age of 48.2 years old (21-60), who did not have detrusor overactivity in the first urodynamic study. On the other hand, group B included seventeen patients, ten females and seven males with mean age of 43.7 years old (18-58), who had detrusor overactivity in the initial urodynamic study. Patients in both groups received Solifenacin 10 mg once daily for twelve weeks before completing another IPSS questionnaire and undergoing a follow up urodynamic study. Conclusion: in this study, we concluded that there was strong correlation between urodynamic and clinical improvement in OAB patients after Solifenacin treatment as patients who were improved urodynamicaly reported improvement of their symptoms while those with poor urodynamic response reported that their symptoms were either the same as before treatment or worse. We also concluded that Solifenacin 10 mg once daily led to significant improvement in IPSS results of OAB patients with significant increase in volume to first desire and maximum cystometric capacity.
https://ejhm.journals.ekb.eg/article_11275_ee0b605d7913aded7ed17a14f08db8c4.pdf
Urodynamic Improvement
Overactive Bladder Syndrome
Anticholinergic Drugs
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5362
5366
10.21608/ejhm.2018.11277
11277
Original Article
Recent Advances in Management of Postoperative Vomiting for Laparoscopic Bariatric Surgeries
Alaa Abbass Moustafa
1
Mohammed Abd El Monem Marzouk
2
Mina Ezzat Almaz Nesem
minaezat91@gmail.com
3
General Surgery Department, Faculty of Medicine, Ain Shams University
General Surgery Department, Faculty of Medicine, Ain Shams University
General Surgery Department, Faculty of Medicine, Ain Shams University
Background and Objectives: obesity continues to be a leading public health concern associated with many comorbidities that significantly decrease life expectancy. Surgery remains the only effective treatment modality for morbid obesity, resulting in long-term weight loss and sustained improvement in weight-related comorbidities. Vomiting is considered as a possible postoperative complication in all bariatric procedures. Anastomotic leak is one of the most serious complications following bariatric laparoscopic Roux-en-Y gastric bypass (LRYGB) and associated with high morbidity rates and prolonged hospital stay. Timely management is of utmost importance for the clinical outcome. This study evaluated the approach to suspected leakage in a high-volume bariatric surgery unit. Patients and Methods: the study has been conducted on 100 Patients with morbid obesity. Observational checklist including: Age at the time of operation, body mass index (BMI), preoperative gastroesophageal reflux disease (GERD) and newly developed postoperative upper gastrointestinal symptoms. Invasive manoeuvres as gastrographin swallow and meal, virtual gastroscopy and upper gastroIntestinal endoscopy were done upon patients who developed post-operative vomiting after LBS for two months. Go to: Results: 100 Patients who underwent LBS included 85% women, 42 ± 10 years old, body mass index 43,8 ± 5,4 kg/m2, sleeve gastrectomy 71%, minigastric bypass surgery 24%, Roux-en-Y gastric bypass 5%. During the first 48 post-operative hours, 39% of patients developed postoperative vomiting which was controlled with medical treatment (Aprepitant). 4% of them suffered from recurrent episodes of vomiting over a period of two months were surgically complicated (stenosis, kinking, or obstruction). Endoscopic treatment was successful for 3 of the 4 patients (75%) after balloon dilatation or insertion of a stent. One of the 4 patients (25%) required conversion to Roux-en-Y gastric bypass. Conclusion: post-operative vomiting after Laparoscopic Bariatric Surgeries (LBS) is a common complication which responds well to centrally acting antiemetic (Aprepitant) during the first 48 post-operative hours. While invasive maneuvers (Balloon dilatation or insertion of a stent) or even surgical correction might be needed.
https://ejhm.journals.ekb.eg/article_11277_c4535afd929dcdee2c68ca7b0ec4db3c.pdf
Laparoscopic Bariatric Surgeries
Obesity
Vomiting
Aprepitant
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5367
5370
10.21608/ejhm.2018.11278
11278
Original Article
The Crosstalk between Interferon and Transforming Growth Factor Beta Signaling Pathways in Hepatitis C Patients
Noha Mohamed Hany M. Elzeiny
nohaelzeiny@gmail.com
1
Abd-El-Rahman M. A. Hammouda
2
Enas Samir Nabih
3
Sherif Monier Mohamed
4
Medical Biochemistry and Molecular Biology departement, Faculty of Medicine, Ain Shams University
Medical Biochemistry and Molecular Biology departement, Faculty of Medicine, Ain Shams University
Medical Biochemistry and Molecular Biology departement, Faculty of Medicine, Ain Shams University
Internal Medicine and Gastroenterology Department, Faculty of Medicine, Ain Shams University
Background: there is an increasing interest in using microRNAs (miRNAs) as biomarkers in liver disease. Diagnostic biomarkers in hepatitis C serve as a great benefit for the early treatment of HCV. Aim of the Work: the aim of this study was to evaluate the expression of miRNA-16 in Egyptian patients infected with HCV and their relation to different biochemical and clinicopathological parameters. Patients and Methods: twenty-five subjects were chosen, 16 HCV infected and 9 healthy controls. Collection, processing and storage of serum for evaluation of miRNA16 using RT-qPCR was done. We evaluated the power of miRNA as a diagnostic tool using ROC curve analysis. The prognostic significance of the investigated parameters in HCV patients was explored. Results: there is a highly significant difference of miRNA 16 expression between HCV patients and healthy controls. miRNA 16 has great sensitivity and specificity for differentiating between patients with HCV and healthy controls. Conclusion: miRNA 16 can be used as a potential diagnostic biomarker for HCV. In addition, it could be used for staging of the disease.
https://ejhm.journals.ekb.eg/article_11278_f6ed61bb5b90eb20dfa7fa59adb7cd80.pdf
HCV
miRNA
miRNA 16
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5371
5374
10.21608/ejhm.2018.11282
11282
Knowledge and Awareness of Diabetic Foot Complications in Diabetic Patients
Sarah Naif Aldawish
sara-naif1993@hotmail.com
1
Ahmad Hassan Alsomali
2
Abeer Jalawi alotaibi
3
Abdulwhab Abdulhaq Alkhars
4
Almaarefa University, Saudi Arabia
Almaarefa University, Saudi Arabia
Almaarefa University, Saudi Arabia
Almaarefa University, Saudi Arabia
Background: diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes.
Aim of the Work: to assess the level of awareness of Diabetic foot disease amongst patients with type 2 diabetes mellitus aim. To measure the knowledge of diabetic about sign and symptoms of diabetic foot. To measure the knowledge of risk factors of diabetic foot in diabetic patients.
Patients and Methods: this is a questionnaire-based cross-sectional study enrolling a total of 100 randomly selected diabetic foot Saudi adults ensuring diversity in age range and educational stages. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS) 23. Awareness levels for DF were calculated as absolute frequencies and were reported as overall percentages.
Results: a number of 99 participants with type 2 Diabetes Mellitus participated in the study, 91% of the participants were either overweight or obese, 92% of participants had concomitant hypertension, (57.5%), dyslipidemia and (26.7%) eye problems. Also 76% of the specimen reported altered sensation in their lower limbs, and 90% reported having no previous diabetic foot disease education. Only 22.2% of participants reported having examined their feet, but only when they experienced a problem. A number of participants achieved mediocre scores for knowledge (mean 4.45, standard deviation (s.d.) 2.201, confidence interval (CI) 4.2–4.7) and practice (mean 11.09, s.d. 2.233, CI 10.8–11.5) on diabetic foot care (DFC). Those who had a higher level of education and who were less than 65 years old had a significantly better score for previous foot care education (p <0.05).
Conclusion: The study demonstrated that awareness of DFD was suboptimal, based on current DFC guidelines. To minimize the burden of DFD, improved screening and prevention programs as well as patient education should be provided to T2DM patients, whilst maintaining an aggressive approach to risk factor modifications, footwear and identifying the at-risk foot.
https://ejhm.journals.ekb.eg/article_11282_1fe8bcb0149c791319643018e2e6b3e1.pdf
diabetes
Diabetic foot
type-II diabetes
sequella
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5375
5384
10.21608/ejhm.2018.11283
11283
Original Article
Correlation between Central Venous Pressure and the Diameter of Inferior Vena Cava by using Ultrasonography for the Assessment of the Fluid Status in Intensive Care Unit Patients
Mostafa Ibrahim Mostafa Shalaby
1
Hussein Montasser Roshdy
2
Wael Mohamed Elmahdy
3
Anas Ezzat Fathy El Mezayen
anasezzat1990@gmail.com
4
Departments of Anesthesia and Intensive Care Unit, Faculty of Medicine – Al Azhar University
Diagnostic Radiology, Faculty of Medicine – Al Azhar University
Departments of Anesthesia and Intensive Care Unit, Faculty of Medicine – Al Azhar University
Departments of Anesthesia and Intensive Care Unit, Faculty of Medicine – Al Azhar University
Background: decisions regarding fluid therapy, whether in the operating theatre, intensive care unit, emergency department, are among the most challenging and important tasks that clinicians face on a daily basis. Specifically, almost all clinicians would agree that both hypovolaemia and volume overload increase the morbidity and mortality of patients. The therapeutic goal of fluid administration is to increase preload, or the stressed venous volume, leading to an increased stroke volume and cardiac output. However, studies of patients with acute illness or hypotensive patients in the intensive care unit consistently demonstrate that approximately 50% of fluid boluses fail to achieve the intended effect of increasing cardiac output. Aim of the Work: this study was done to evaluate the correlation between central venous pressure (CVP) measurements and ultrasound measurements of the inferior vena cava diameter, and collapsibility index. The secondary aim was to evaluate the value of ultrasound as a noninvasive tool in assessment of intravascular volume status and fluid responsiveness in critically ill intensive care unit patients. Patients and Methods: after obtaining the approval of the Al-Azhar University Ethical Committee and written informed consent, 50 patients aged 30-60 years of either sex, ASA I-III admitted in the ICU of Al-Azhar teaching hospitals who had a functioning central venous catheter inserted for any clinical indication, were involved in this single blinded correlational study. Hemodynamic parameters were monitored continuously including heart rate and non-invasive mean arterial blood pressure. CVP measurements were taken with the patient in the supine position. Clinical assessment was done for signs of hypovolemia like hypotension, tachycardia, prolongation of capillary refill: >3 seconds, acidosis, increased serum lactate more than 2 mmol/L or loss of skin turgor. Results: in our study, there was a significant correlation between CVP and the two studied ultrasound parameters, IVC CI and IVCdmax. Analysis of the receiver operating characteristic curve ROC showed that inferior vena cava collapsibility index (IVC CI) had the most favorable performance of the two ultrasound parameters in predicting CVP < 10 cm H2O. As regards prediction of fluid responsiveness, analysis of the ROC showed a better diagnostic accuracy of IVC collapsibility index and IVC diameter for predicting fluid responsiveness. Conclusion: ultrasound of the inferior vena cava may be used as a feasible non-invasive, rapid and simple adjuvant method to assess the intravascular volume and guide fluid responsiveness in critically ill intensive care unit patients, inferior vena cava collapsibility index may be used to predict low central venous pressure and predict fluid responsiveness.
https://ejhm.journals.ekb.eg/article_11283_29dfdafaa8fe18162792f656c7e34164.pdf
Central venous pressure
diameter of inferior vena cava
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5385
5390
10.21608/ejhm.2018.11284
11284
Original Article
Comparison between the effect of Two Regimens for Hepatitis C Treatment (Qurevo and Ribavirin) and (Sofosbuvir, Daclatsvir and Ribavirin) on Patients above and below the Age of 60 Years
Mahmoud Abd El Majeed Othman
1
Motaz Mohamed Saied Abd EL Mawjood
2
Mohamed Osama Aly Aly
3
Aya Ahmed Morsy El Ghamry
drayaahmed@yahoo.com
4
Department of Internal Medicine, Faculty of Medicine, AinShams University
Department of Internal Medicine, Faculty of Medicine, AinShams University
Department of Internal Medicine, Faculty of Medicine, AinShams University
Department of Internal Medicine, Faculty of Medicine, AinShams University
Background: the goal of antiviral treatment is to prevent complications of the disease, mainly cirrhosis and HCC. New therapy options, known as direct acting antiviral (DAA) regimens, offer the promise of increased success rates complimented by shorter treatment durations, improve side effect profiles, and simplified treatment monitoring.
Aim of the Work: to compare between the effect of oral antiviral treatment especially (Quervo and Ribavirin) and (Sofosbuvir, Daclatasvir and Ribavirin) between elderly patients above 60 years and young people below this age as regard: Response to treatment, Development of complication.
Patients and Methods: the study was conducted on 100 Egyptian patients they were divided into 2 groups each one received one of the two treatment regimens then each group divided into 2 subgroups, subgroup A include patients below 60 years and subgroup B include patients above 60 years. The selected patients were subjected to History taking, Complete physical examination, Pelviabdominal ultrasound, Laboratory investigations: complete blood count, bilirubin and liver enzymes before and after treatment, INR, creatinine, albumin, HBs Ag, HIV antibodies and Alpha feto proteins, HCV RNA.
Results: there is no significant difference between two treatment regimens. Both regimens show cure rate about 94%, 96% achieved SVR with (sofosbuvir daclatasvir and ribavirin regimen), (quervo and ribavirin regimen) respectively. Both regimens are effective in elderly patients above 60 years as young patients below this age in both regimens, response of treatment in both regimens in elderly patients above 60 years is 96%. Gender doesn't affect treatment outcome. Anemia develop in 34% of patients receiving sofosbuvir, daclatasvir and ribavirin regimen, and in 58% of patients receiving quervo and ribavirin regimen. Females developed anemia more frequent than males in both regimens. Both regimens developed hepatobiliary complication, 12%, 18% developed hyperbilirubinemia with (sofosbuvir daclatasvir and ribavirin regimen), (quervo and ribavirin regimen) respectively.
Conclusion: treatment with (sofosbuvir daclatasvir and ribavirin regimen) or (quervo and ribavirin regimen) is highly effective with little differences between them; also age and gender have no role in achieving SVR. Complications such as anemia and hyperbilirubinemia occur in treatment with both regimens and more frequent with (quervo and ribavirin regimen).
https://ejhm.journals.ekb.eg/article_11284_1db1c9f47261504b0dae1d5459c05c26.pdf
Sofosbuvir
Daclatasvir
Quervo
Ribavirin
SVR
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5391
5395
10.21608/ejhm.2018.11285
11285
Original Article
Study of Vitamin D Level in Cirrhotic HCV Patients before and after Transplantation
Amira Ahmed Salem
1
Wael Ahmed Yousry
2
Ghada Abd El-Rahman Ahmed
3
Hussein Salah Eldin Ibrahim Omar
hussein.salaheldin@yahoo.com
4
Internal Medicine Department, Faculty of Medicine, Ain Shams University
Internal Medicine Department, Faculty of Medicine, Ain Shams University
Internal Medicine Department, Faculty of Medicine, Ain Shams University
Internal Medicine Department, Faculty of Medicine, Ain Shams University
Background: chronic hepatitis C is a common condition. Transfusion of blood or blood-related products was one of the main routes of HCV transmission. Furthermore, nosocomial infections represent a key source of infection, particularly in some of the high-prevalence countries (such as Egypt, Pakistan and Eastern Europe). In general, prevalence increases with increasing age until peak prevalence at 55–64 years in most regions. At least six HCV genotypes are known, Genotype 4 frequency is the highest from Central Africa to the Middle East. Worldwide people infected with HCV are at an increased risk of developing serious hepatic complications including cirrhosis and hepatocellular carcinoma.
Aim of the Work: the aim of this work is to study vitamin D level in post HCV liver cirrhosis patients before and six months after liver transplantation in addition to chronic HCV patients without cirrhosis.
Patients and Methods: this prospective case control study was conducted on 25 patients. 15 of them with liver cirrhosis due to chronic hepatitis C virus evaluated before and six months after liver transplantation in addition to 10 chronic HCV patients without cirrhosis as control group. Liver cirrhosis or transplantation patients were recruited from Ain Shams specialized hospital liver transplantation unit and chronic HCV patients without cirrhosis were recruited from hepatology outpatient clinic of Ain Shams university hospital in the period from February 2017 to November 2017. Symptoms suggestive of liver disease (e.g. jaundice, bleeding tendency, increased abdominal girth).
Results: this study was conducted on 25 patients. 15 of them with liver cirrhosis due to chronic hepatitis C virus evaluated before and six months after liver transplantation in addition to 10 chronic HCV patients without cirrhosis as control group. Group I: Consists of 15 (60%) patients with post HCV liver cirrhosis before liver transplantation. They were 13 males (86.6%) & 2 females (13.3%). Their mean age was 50.53 ± 4.52. Group IΙ: Consists of the same patients of group I evaluated six months post liver transplantation. Group III: Consists of 10 (40%) patients with chronic HCV without cirrhosis. They were 6 males (60%) & 4 females (40%). Their mean age was 53.0 ± 8.46.
Conclusion: this study concluded that vitamin D deficiency is prevalent among patients with liver cirrhosis. Liver transplantation improves vitamin D level but not to the recommended normal level i.e. vitamin D deficiency or insufficiency can persist after transplantation.
https://ejhm.journals.ekb.eg/article_11285_3051ffea8d434414a853b2f65ad04a2a.pdf
Vitamin D Level
Cirrhotic HCV Patients
Endoscopic Retrograde Cholangio Pancreatography
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5396
5397
10.21608/ejhm.2018.11295
11295
Original Article
Thymopharyngeal Duct Cyst: A Form of Cervical Thymus
Reyof Saeed Alharthi
reyofsaeedalharthi@gmail.com
1
Alaa Bakheet A. Alzahrani
2
Sultanah Naser Alshreef
3
Bashaer Beshr Alnahdi
4
Taif University, Taif City, Saudi Arabia.
Taif University, Taif City, Saudi Arabia.
Taif University, Taif City, Saudi Arabia.
King Abdullaziz University, Jeddah City, Saudi Arabia.
Background: a rare case of a cystic thymopharyngeal duct presented as a rare case of the cervical thymus. The embryology of normal cervical descent of the thymus is reviewed. The preoperative diagnosis of thymopharyngeal duct cyst is rare to be established, however, histopathology is the definitive diagnosis. Thymopharyngeal duct cysts are rare lesions commonly been one of differential diagnosis in childhood neck masses.
Patients and Methods: asymptomatic thymopharyngeal duct cyst in a 7 years old boy caused by the remnants of the thymopharyngeal duct. A consent form was taken from the parent. The study approved by the ethical Committee of the Faculty of Medicine, UmmAl-QuraUniversity that follows the international rules of research. The study not sponsored by any agency.
Results: the patient undergoes surgery under general anesthesia followed by transverse incision, the cystic lesion was found on the sternocleidomastoid muscle. There were no postoperative complications. Histopathologic evaluation confirms the presence of thymopharyngeal duct cysts.
Conclusion: thymopharyngeal duct cysts can cause a diagnostic challenge to the surgeon evaluating of neck swelling. Also its importance of considering thymopharyngeal duct cysts in the differential diagnosis of any child who presents with a neck swelling.
https://ejhm.journals.ekb.eg/article_11295_bef3a7459baa1034c0cf57d5fe0b8f5c.pdf
Thymopharyngeal cyst
Cystic lesion
Duct Cyst
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5398
5402
10.21608/ejhm.2018.11296
11296
Original Article
The Role of Susceptibility Weighted Imaging (SWI) in Evaluation of Acute Stroke
Maha Abdelhamed El Nouby
mahaelnoby@yahoo.com
1
Eman Ahmed Fouad Darwish
2
Eman Ahmed Shawky Geneidi
3
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Background and Objectives: SWI provides information about blood oxygenation levels in intracranial vessels. Prior reports have shown that SWI focusing on venous drainage can provide noninvasive information about the degree of brain perfusion in arterialischemic stroke. We aimed to evaluate the influence of the SWI venous signal pattern in predicting stroke evolution.
Materials and Methods: a semiquantitative analysis of venous signal intensity on SWI and diffusion characteristics on DTI was performed in 2o adult patients with acute stroke of MCA vascular territories. The mismatch between areas with SWI-hypointense venous signal and restricted diffusion was correlated with stroke progression on follow-up.
Results: we included 2O patients with a confirmed diagnosis of arterial ischemic stroke. Follow-up images were available for. MCA stroke progression on follow-up was observed in 11/12 patient with DWI -SWI mismatch. Initial SWI hypointense venous signal and areas of restricted diffusion on DTI. This mismatch showed a statistically significant association (P _ 0.00188) for infarct progression.
Conclusion: SWI-DWI mismatch predicts stroke progression in arterial ischemic stroke.
https://ejhm.journals.ekb.eg/article_11296_e09b18628ab0d6af22c1372a2a875c04.pdf
stroke
MRI
Susceptibility weighted imaging (SWI)
(PWI)
DWI
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5403
5408
10.21608/ejhm.2018.11297
11297
Original Article
Reliability of Diffusion Weighted MRI for the Diagnosis of Residual and Recurrent Cholesteatoma
Medany Mahmoud Medany
1
Reda Mohammed Sabra
2
Ehab Kamal Hakim
3
Ahmed Mohammed Medhat Elshafei
ahmedmedhats2006@gmail.com
4
Amr Mohammed Ismaeel Sadawy
5
Departments Otorhinolaryngology, Faculty of Medicine, Ain Shams University
Departments Otorhinolaryngology, Faculty of Medicine, Ain Shams University
Departments Otorhinolaryngology, Faculty of Medicine, Ain Shams University
Departments Otorhinolaryngology, Faculty of Medicine, Ain Shams University
Departments Radiodiagnosis, Faculty of Medicine, Ain Shams University
Background: olesteatoma is defined as the presence of collections of kertatinized squamous epithelium within a sac in temporal bone & skull base, commonly involve the middle ear cavity & mastoid cavities. Congenital cholesteatomas compose only 2% of middle ear cholesteatomas.
Aim of the Work: to evaluate the role of DWMRI in detecting residual and/or recurrent cholesteatoma and to compare it to the intra-operative findings.
Patients and Methods: this study was conducted on patients with recurrent or residual cholesteatoma suspected clinically or by CT examination at Ain Shams University hospitals or Hearing and Speech Institute. The patients were referred from the department of Otolaryngology, Ain Shams University hospitals, Hearing and Speech Institute and also from other private clinics.
Results: from the 30 cases we examined, 19 cases (63%) showed areas of DWI restriction within the middle ear denoting primary or recurrent cholesteatoma. The smallest size of cholesteatoma detected was 4.5 mm. All 19 cases that showed evidence of recurrent cholesteatoma on MS-EPI DWI MRI images underwent second look mastoid surgery will all cases (100%) showing intra-operative evidence of cholesteatoma. Of the 11 cases that were negative for cholesteatoma on DWIs, 9 of these cases underwent second look mastoid surgery with 4 cases (44%) showing small cholesteatomas measuring less than 4 mm while the other 5 cases (56%).
Conclusion: DWI is a beneficial tool in the evaluation of recurrent cholesteatoma with excellent specificity that reduces the need of second look surgeries in multiple cases.
https://ejhm.journals.ekb.eg/article_11297_181ab47cf5e2aea2756d46c3c2f153ed.pdf
Diffusion Weighted MRI
Residual
Recurrent Cholesteatoma
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5409
5415
10.21608/ejhm.2018.11350
11350
Original Article
Effect of Immediate versus Early Oral Hydration on Caesarean Section Postoperative Outcomes: A Randomized Controlled Trial
Heba A. Ahmed
a.h_hoba@hotmail.com
1
Ahmed A. El-Shahawy
2
Hazem M. Sammour
3
Department of Obstetrics and Gynecology,Faculty of Medicine, Ain Shams University
Department of Obstetrics and Gynecology,Faculty of Medicine, Ain Shams University
Department of Obstetrics and Gynecology,Faculty of Medicine, Ain Shams University
Background: caesarean sections performed every year are increasing in number dramatically all over the world. So, it became very important to give more attention for their postoperative care.
Aim of the Work: to evaluate the effect of immediate oral hydration initiated within 2 hours after uncomplicated caesarean section on the following post-operative outcomes: post-operative vomiting and abdominal distention, post-operative nausea and abdominal pain, the return of intestinal movements, duration of intravenous fluid administration, duration of hospital stay and participant satisfaction.
Patients and Methods: this randomized controlled study was conducted at Ain Shams University Maternity Hospital. It was carried during the period from July 2016 to July 2017. 140 women, all of them underwent uncomplicated cesarean section under regional anesthesia were randomly assigned into two groups. In the immediate group: oral hydration was received in the first 2 hours postoperatively, and in the early group: oral hydration was received after 8 hours postoperatively.
Results: all the results of the postoperative outcomes of both groups had non-significant differences except for the psychological satisfaction which was significantly higher in the immediate group with a (p<0.001).
Conclusion: immediate oral hydration group showed non-significant differences comparing with early oral hydration group regarding most of the postoperative outcomes, but the results were relatively better towards the immediate group. Also, immediate hydration is significantly better than early hydration regarding psychological satisfaction of women, allowing them to be more able to breastfeed their kids and to spend a less stressful time in the hospital.
https://ejhm.journals.ekb.eg/article_11350_6210f985ff6320bac67515db619c7012.pdf
Immediate/Early Oral Hydration
cesarean section
postoperative outcomes
Vomiting
Nausea
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5416
5420
10.21608/ejhm.2018.11351
11351
Original Article
Prevalence and Determinant Factors of Chronic Calculous Cholecystitis among Senile Population Arar, KSA
Maha Mukhlef R Alanazi
1
Abdalla Mohamed Bakr Ali
apdo3332008@gmail.com
2
Waad Salamah Alaleimi
3
Asem Matrouk Z Alrowaili
4
Sultan Majed M Alshammari
5
Saud Rteamy R Alanazi
6
Abrar Asaad M Alanazi
7
Waad Alazri S Alanazi
8
Jawaher Naif M Althayidi
9
Alaa Ali S Alanazi
10
Zain Amer L Alruwily
11
Dnya Saleh Affat Alanaziy
12
Zaid Qati F Alshammari
13
Mashail Rasheed M Alshammari
14
Fatimah Awadh A Alrasheedi
15
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Sohag University, Egypt
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Faculty of Medicine, Northern Border University, KSA
Background: chronic calculous cholecystitis is an inflammatory disease which affects the gallbladder wall and causes motoric-tonic dysfunctions of the biliary system accompanied by gallstones in the lumen of the gallbladder and biliary pain. Among aging study groups, the prevalence of gallstone disease is likely to increase.
Aim of the Work: to determine the prevalence and determinant factors of chronic calculous cholecystitis among senile population in Arar, KSA.
Patients and Methods: the present cross sectional community based study was conducted in Arar city, Northern Border Province, KSA on 217 adult people aged 50 years and more. Data were collected through personal interviews with the study population and filling the questionnaire which guided us to the data of socio-demographic status, smoking, chronic diseases, already previously diagnosed with chronic calculous cholecystitis, after ensuring the diagnosis by reviewing the accompanied health reports and/or prescriptions and asking the accompanied caregivers about the case.
Results: the mean age of the participants (± SD) was 69.9 (±9.3) years; male to female ratio was 43.8 to 56.2. The overall prevalence rate of chronic calculus cholecystitis found in this study was 6.9%. There was a relationship between chronic calculus cholecystitis and age group, sex, DM, BMI group, Thyroid disease and Hypertension. The prevalence of chronic calculus cholecystitis was more in females compared to males (9.0% vs. 4.2%).
Conclusion: female gender, diabetes and obesity are significantly associated factors in the development of gallstones. Thus, understanding the gallstones pathogenesis would result in life style modifications and weight loss which would decrease the rates of the disease.
https://ejhm.journals.ekb.eg/article_11351_e5d214a8da6ac487a5af246ec5e5b7e3.pdf
Chronic Calculous Cholecystitis
prevalence
determinants
Senile Population
Arar
KSA
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5421
5426
10.21608/ejhm.2018.11352
11352
Original Article
Bronchial Asthma among Medical students in Saudi Arabia
Aishah Mohammad Alkhaldi
1
Mohammed Ali Almesned
2
Fawziah Abdulrahman Roublah
3
Ahmad Mohedeen Aldawalibi
4
Talal Mohammed Saeed Alshahrani
5
Azzam Arshad Shaikh
6
Khalid Jubran Idris
7
Faculty of Medicine, Northern Border University
Faculty of Medicine, Qaseeim University
Faculty of Medicine, King Abdul-Aziz University
Faculty of Medicine, King Saud University
Faculty of Medicine, King khalid University
Faculty of Medicine, Umm Al-Qura University
Faculty of Medicine, Umm Al-Qura University
Background: bronchial asthma is a common chronic respiratory disease affecting adolescents and young adults nationality and worldwide and its prevalence has increased in developed and developing countries over the last three decades.
Aim of the Work: to establish the prevalence of bronchial asthma among medical students in Saudi Arabia and the relationship between asthma and some associated risk factors.
Patients and Methods: a descriptive cross-sectional study. Data were collected from randomly selected undergraduate medical students of 6 universities, during the academic year 2017-2018. A predesigned questionnaire was disseminated to the targeted population to complete it.
Results: the prevalence of physician-diagnosed bronchial asthma in our participants was 19.2%. Males reported insignificant higher prevalence of bronchial asthma compared to females (P= 0.195). Bronchial asthma was significantly associated with skin allergy 32.9% (P= 0.001), allergic rhinitis 61.6% (P=0.001), hay fever 12.3 %( P=0.001) and obesity 28.8% (P0.009). While it was insignificantly associated with smoking (P=0.428), passive smoking (P=0.561), diabetes (P=0.254) and performing muscular exercise (P=0.322). Precipitating factors to bronchospasm was dust in 43.8%, certain foods in 1.4%, hot weather in 2.7% and multiple factors in 52.1%. Herbal treatment was tried in 34.2%; desensitization in 6.8% and 68.5% needed emergency treatment. Response to medical treatment was good in 89.1% of cases.
Conclusion: the prevalence of physician-diagnosed bronchial asthma in our participants was 19.2%. Males reported insignificant higher prevalence of bronchial asthma than females. Bronchial asthma was significantly associated with skin allergy, allergic rhinitis, hay fever and obesity. While it was insignificantly associated with active smoking or passive smoking.
https://ejhm.journals.ekb.eg/article_11352_f2dfd6d3a5ff466ff4e79a8e18fb34cd.pdf
prevalence
Physician-diagnosed asthma
Associated symptoms
Medical students
Saudi Arabia
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5427
5432
10.21608/ejhm.2018.11353
11353
Original Article
Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy in Uterine Tumors
Mohamad Fathy
1
Hamed Al-Azony
2
Ehab Hasanen
3
Nader Abd-Elhamid
naderzaid1969@yahoo.com
4
Surgical Oncology Unit, Faculty of Medicine, Al-Azhar University, Cairo
Surgical Oncology Unit, Faculty of Medicine, Al-Azhar University, Cairo
Gynecology and Obstetrics Department Faculty of Medicine, Al-Azhar University, Cairo
Surgical Oncology Unit, Faculty of Medicine, Al-Azhar University, Cairo
Background: laparoscopic hysterectomy (LH) rates have increased but abdominal hysterectomy (AH) still high and often the first choice for many surgeons even with most of studies reported that the minimal access method offers significant patient benefit over open surgery.
Aim of the Work: we aimed to compare the outcome of total laparoscopic hysterectomy as regard the result and safety compared to total open abdominal hysterectomy in cases of uterine tumors.
Patients and Methods: this prospective randomized controlled study performed on 25 patients who underwent LH (group 1) compared to 25 patients who underwent AH (group 2). The mean age of the cases, body mass index (BMI), duration of operation, estimated blood loss (EBL), rate of complications, post-operative hospital stay and convalescence time were compared for two groups.
Results: LH was associated with a significantly longer operating time (139.96±22.66 minutes vs. 106.54±21.8 minutes P 0.001). As regard intraoperative complications and estimated blood loss there was no difference in both groups. In LH group the pain score and analgesia requirements in post-operative period were significantly less with fewer requiring opioid analgesia. There was a highly significant difference between groups in postoperative wound infection which was higher in AH group. LH was also associated with a significantly shorter inpatient hospital stay (2.22 days vs. 5.52 days P= 0.022) and earlier returned to normal life (7.5 days vs. 20.6 days P<0.001).
Conclusion: total laparoscopic hysterectomy is safe and feasible procedure in treatment of uterine tumors with accepted peri-operative morbidity and good improvement of quality of life post-operative.
https://ejhm.journals.ekb.eg/article_11353_45afb5ec7c38053e72575772e259e7d2.pdf
Total laparoscopic hysterectomy
Total Abdominal Hysterectomy
uterine tumors
outcomes and complications
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5433
5437
10.21608/ejhm.2018.11354
11354
Original Article
Posterior Corneal Astigmatism Changes in Cases with Keratoconus
Mohammed Elsaid AbdElaziz Mahmoud
1
Ismael Ebraheem Hamza
2
Ahmed Hassan Assaf
drmai.m.zaki@gmail.com
3
Tamer Fahmy Eliwa
drmohammed1244@gmail.com
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: keratoconus is bilateral (usually asymmetrical), progressive, non inflammatory, cone like anterior protrusion of the cornea involving the central and the inferior para central areas that results in corneal ectasia, astigmatism and diminution of vision. It usually seen after puberty, with incidence of 1 in 2000 of general population, the major benefit of corneal tomography is the measurement of the posterior corneal surface, because the posterior surface contributes minimally to the overall refractive power of the eye (due to the minimal difference between the index of refraction of the cornea and aqueous) it was considered less important both diagnostically and therapeutically. The posterior cornea, however, is an earlier indicator of ectatic change or ectasia susceptibility.
Aim of the Work: to determine the changes of posterior corneal astigmatism in cases with keratoconus.
Patients and Methods: one hundred eyes of 50 patients were included in this retrospective, case control study which adhered to the tenets of the Declaration of Helsinki and was approved by the Ethics Committees of the Ain Shams University Hospitals. All patients included in the study provided informed consent, these cases were divided into: 1- Keratoconus group: comprised 50 eyes of 25 patients with keratoconus diagnosed on the basis of clinical and topographic signs and 2- Control group comprised 50 eyes of 25 normal candidates for refractive surgery.
Results: the mean magnitudes posterior corneal astigmatism(PCA) were approximately 1 D, and The PCA values were significantly associated with the severity ofKeratoconus(KC), the posterior corneal surface was more affected in the early stages of KC.
Conclusion: we found that the mean magnitudes PCA were approximately 1 D, and The PCA values were significantly associated with the severity of KC, the posterior corneal surface was more affected in the early stages of KC.
https://ejhm.journals.ekb.eg/article_11354_131f0fd198265d2a6d02fb52853a179c.pdf
Keratoconus
Corneal tomography
posterior astigmatism
pentacam
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5438
5443
10.21608/ejhm.2018.11355
11355
Original Article
Anal Abscesses and Different Methods of its Surgical Management
Mana Ali Mueidh Al Hajlan
1
Mohammed Hundur Alasmari
2
Abdullah Salem Al Haider
3
Abdulaziz Abdullah Alhazmi
4
Nasser Naji Mohsen Al harthi
5
Yaqoub Mubarak Ali Alhamami
6
Faculty of Medicine, Najran University, KSA
Faculty of Medicine, Najran University, KSA
Faculty of Medicine, Najran University, KSA
Faculty of Medicine, Najran University, KSA
Faculty of Medicine, Najran University, KSA
Faculty of Medicine, Najran University, KSA
Background and Objectives: in this review wed discuss background of anal abscess and fistula, as well focused on different surgical approaches for dealing with anal abscess, their effectiveness and difficulties after surgery.
Patients and Methods: We conducted narrative review by searching published literatures in the following databases: MEDLINE/PubMed, and Embase, for all studies concerning with types of Anal abscesses and diagnosis in addition to surgical management approaches “June, 2018”.
Results: Anorectal abscesses are one of the commonest anorectal problems encountered by surgeons. They are usually cryptoglandular in origin and are associated with an anal fistula in 30% – 70% of cases. When the incriminating gland originates from the posterior midline and traverses the conjoint longitudinal muscle into the deep postanal space, a deep postanal abscess results. Further extension of this infective process into the unilateral or bilateral ischiorectal fossa leads to a horseshoe abscess. This type of abscess accounts for about 15% – 20% of anorectal abscesses and its management remains challenging to surgeons.
Conclusion: Anorectal abscesses are common anorectal problems, early management is mandatory, almost always require surgical drainage, even if they have spontaneously discharged.
https://ejhm.journals.ekb.eg/article_11355_9db6fa8a2db6fdf69fe7ffdeb658d46d.pdf
Anal abscesses
Surgery
perianal abscesses
postanal abscess
surgical management
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5444
5449
10.21608/ejhm.2018.11356
11356
Original Article
Evaluation of Stress Ulcer Prophylaxis Benefits and Outcomes: A Simple Literature Review
Mohammed Yaan Allah M Alghamdi
1
Abdulelah Hassan Alluhaybi
2
Abdullah Abdulaziz Alzahid
3
Murad Abdullah Akkur
4
Mohammed Abdulaziz A Alshenaiber
5
Riyadh Othman Abdullah Shati
6
Wed Ziyad Alnajjar
7
Sanaa Mahmoud Anbarserri
8
Reem Awad Alqahtani
9
Lamees Hassan Alzahrani
10
Al-Baha University
Umm Al-Qura University
Imam Abdulrahman Bin Faisal University
Jazan University
Misr University for Science and Technology
King Abdulaziz University
King Abdulaziz University
Taibah University
King Khalid University
Ibn Sina National College
Background: One of the commonest complications in critically ill patients is stress related mucosal disease (SRMD). It can be associated with increase in the risk of development of overt gastrointestinal bleeding. As a result, a lot of literatures have been done to evaluate the pathogenesis that stands behind its development, and assessment of the measures that can be used to lower the risk of its 'occurrence.
Aim of the Work: In this review we aimed at discussing the pathogenesis that stands behind stress ulcer development, Also, discussing the role of anta- acid as a prophylaxis against harms and benefits. In addition to providing an intensive study that analyzed the recent literatures considered this field of study.
Methodology: A comprehensive search was done using biomedical databases; Medline, and Pubmed, for studies concerned with assessment of stress ulcer prophylaxis. Keywords used in our search through the databases were as; “stress ulcer”, “stress ulcer prophylaxis”, “stress ulcer in ICU patients”.
Conclusion: Stress related mucosal disease is associated with increase in the risk of clinically overt gastrointestinal bleeding. As a result, patients who require mechanically ventilation for more than 48 h and those with a manifest of coagulopathy are highly recommended for having stress ulcer prophylaxis (SUP). Anta- acid such as Proton Pump Inhibitors (PPIs) and histamine 2 receptor antagonists (H2RA) help in prevention of gastrointestinal bleeding, but did not have any effect on mortality risk reduction. Still further prospective randomizes trials needs to be done to evaluate our scientific research survey to guide the physicians in making a decision about the use of SUP in ICU patients.
https://ejhm.journals.ekb.eg/article_11356_6a785c71396a383f1d7d8087ecfafa86.pdf
Stress
ulcer
Prophylaxis
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5450
5454
10.21608/ejhm.2018.11357
11357
Original Article
Prevalence of Right Ventricular Dysfunction in relation to Type of Vascular Access in Chronic Hemodialysis Patients: Monocentric Study
Mohamed Osama Mahmoud
1
Bichari Walid Ahmed
2
Rezk Khaled Mohamed
3
Abdel-Dayem Mohamed Mahmoud
mohamednephro9856@yahoo.com
4
Department of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Background: chronic renal failure (CRF) is associated with significantly increased morbidity and mortality. Chronic renal failure affects almost every system of the body and results in various functional and structural abnormalities. Life-sustaining haemodialysis (HD) requires durable vascular access (VA) to the circulatory system. An arteriovenous fistula is currently considered the gold standard access for hemodialysis, as it has lower risk for infection, lower tendency to thrombotic occlusion, greater blood flow, reduced treatment time and is less expensive to maintain than alternative vascular access methodologies. Patients on hemodialysis have several risk factors for developing PH: LV systolic and diastolic dysfunction, volume overload, endothelial dysfunction and sleep-discorded breathing. Aim of the Work: The aim of the current study was the prevalence of right ventricular dysfunction in relation to type of the vascular access in chronic hemodialysis patients. Patients and Methods: this cross-sectional study was carried out on 100 subjects on regular hemodialysis more than six months duration, 62 males (62%) and 38 females (38%). The patients' age ranged between 24 and 76 years. They were selected from dialysis unit in Aswan health insurance hospital. All patients were subjected to the following: full history taking and clinical examination, vascular access examination (Types and patency), laboratory investigations. ECG for arrhythmias "AF, PVCs, Ischemic changes, LVH" and Echo parameters findings "RT. Vent. Systolic pressure, Rt. Vent. diastolic dysfunction, Rt. vent. dimensions, PHT & LVH). Results: percentage of right ventricular diastolic dysfunction was higher in patients of A-V fistula [47.5%] than [42.4 %] in cases of A-V graft and [33.3%] in patients with permanent catheter and there was significant statistical difference between right ventricular diastolic dysfunction and types of vascular access (p=0.043). The percentage of Rt. Ventricular diastolic dysfunction was higher in patients with low flux dialyzer membrane [83.3%] than in patients with high flux dialyzer [16.7%] but without significant statistical difference. There was no statistical difference between types of vascular access and attacks of recurrent of hypotension during dialysis session among chronic hemodialysis patients in the study. The percentage of Rt. Ventricular diastolic dysfunction was higher in patients with low flux dialyzer membrane [83.3%] than in patients with high flux dialyzer [16.7%] but without significant statistical difference. Conclusion: this study concluded a significant ventricular diastolicdysfunction in relation to type of vascular access in chronic hemodialysis patients. Vascular access type has a significant relationship to theincidence of pulmonary hypertension and Right ventricular systolic pressure (RVSP) in chronic hemodialysis patients.
https://ejhm.journals.ekb.eg/article_11357_4c71f229ef798efe7ae0fb76c917d8ff.pdf
Rt.vent. dysfunction
AVF- hemodialysis-vascular access type- pulmonary Hypertension
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5455
5560
10.21608/ejhm.2018.11358
11358
Original Article
Formal Abdominoplasty versus Mini-Abdominoplasty Post Laparoscopic Sleeve Gastrectomy
Mohamed Ahmed Mohamed Aamer
1
Moheb Shoraby Eskandaros
2
Bishoy Nagy Gerges
doctorbishoy@gmail.com
3
Department of General Surgery, Faculty of Medicine Ain-Shams University
Department of General Surgery, Faculty of Medicine Ain-Shams University
Department of General Surgery, Faculty of Medicine Ain-Shams University
Background: obesity nowadays is associated with comorbidities that double folded the mortality as cancer, cardiovascular disease, and diabetes. And weight loss by dietary changes and exercise usually does not achieve the desired weight loss goals. As such, bariatric surgery has become the treatment of choice for obesity and co-morbidities. Body contouring and specially abdominoplasty after bariatric surgery is a component in the treatment of the obese patient and is well accepted by patients, despite the extensive scarring with all of the surgical procedures. There is evidence that post–bariatric surgery patients who have subsequent body contouring surgery maintain their weight loss. Aim of the Work: to compare between formal and modern mini-abdominoplasty after laparocopic sleeve gastrectomy. Patients and Methods: this comparative study included two groups of thirty patients each, group I consisted of patients with redundancy at the ventral part of the abdomen after weight loss stabilization at BMI 30 for more than 6 months post laparoscopic sleeve gastrectomy, where formal, traditional, abdominoplasty was done to them. While group II consisted of patients with redundancy at the ventral part of the abdomen after weight loss stabilization at BMI 30 for more than 6 months post laparoscopic sleeve gastrectomy, where modern mini-abdominoplasty was done to them. Results: as regarding Flank fullness post Abdominoplasty Group I resolved the flank fullness except for 10 while Group II 20 cases still with flank fullness, therefore there was statistical significant difference between the two groups as (p value) = 0.009823. As regarding upper abdominal wall bulge condition resolved successfully in 27 cases from group I and only 10 from Group II, therefore there was statistical significant difference between the two groups as (p value) = 0.000006. Conclusion: abdominoplasty gives the patient seeking weight loss the encouragement and well to lose more weight and improve his psychological state, traditional abdominoplasty provide a comprehensive treatment of abdominal wall redundancy, even in the most severe cases, the patients get both functioning and cosmetic improvement. Mini-abdominoplasty is less effective, not appropriate method to treat patients with lipodystrophy of the trunk and fullness of the flanks post laparoscopic sleeve gastrectomy and bariatric surgeries.
https://ejhm.journals.ekb.eg/article_11358_20a4d9b0e51cc508479d7721fd7bb622.pdf
Study and compare formal
traditional
abdominoplasty and mini
abdominoplasty post laparoscopic sleeve gastrectomy
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5461
5465
10.21608/ejhm.2018.11359
11359
Original Article
A Comparative Study between Magnesium Sulphate and Nitroglycerin with Propranolol in Controlled Hypotensive Anaesthesia during Middle Ear Surgeries
Hoda Omar Mahmoud
1
Manal Kamal Shams
2
Adel Alaa El-din Habib
3
Amr Abdel Monem Al Sayed Ali
amrmenem1990@gmail.com
4
Department of Anesthesia, Intensive care and Pain Management, Faculty of Medicine, Ain Shams University
Department of Anesthesia, Intensive care and Pain Management, Faculty of Medicine, Ain Shams University
Department of Anesthesia, Intensive care and Pain Management, Faculty of Medicine, Ain Shams University
Department of Anesthesia, Intensive care and Pain Management, Faculty of Medicine, Ain Shams University
Background: controlled hypotension is performed in order to reduce blood loss and the need for transfusion during the surgery and to improve visibility of the surgical site by decreasing the arterial pressure until hypotension is reached. Aim of the Work: to compare magnesium sulphate and nitroglycerin with propranolol during middle ear surgery in terms of regarding their efficiency in inducing deliberate hypotension and providing a better surgical field exposure during middle ear surgery. It also compared the influence of their use of postoperative pain and recovery time. Patients and Methods: forty adult patients undergoing middle ear surgery were included. Patients were randomly divided into two equal groups. Patients were assigned to receive magnesium sulphate (M group) and nitroglycerin with propranolol (N group) from the period of Jan 2018 to August 2018. ASA physical status I, age group ranged from 18 to 60. Results: the current study shows the ability of magnesium sulphate and nitroglycerin with propranolol to induce deliberate hypotension in patients undergoing middle ear surgery. Mean arterial pressure was successfully reduced to the target values in both groups. All drugs were equally successful to produce satisfactory surgical field. Conclusion: this study included forty adult patients age ranged 18 to 60 undergoing middle ear surgery was included. Patients were randomly divided into two equal groups. Patients were received magnesium sulphate (M group), or nitroglycerin and propranolol (N group).
https://ejhm.journals.ekb.eg/article_11359_5977d1a57b6f4e24980594860f2c7937.pdf
Mean arterial pressure
post anesthetic care unit
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-08-18
72
10
5466
5469
10.21608/ejhm.2018.11360
11360
Original Article
Predictive and Prognostic Impact of Tumor-Infiltrating Lymphocytes (CD8+) In Breast Cancer Treated With Neoadjuvant Chemotherapy
Zeinab Mohammed Abdel-Hafeez Elsayed
1
Mohammad Sabry Elkady
2
Waleed Abd Elmmonem Biomy
3
Mai Mohamed Ali Ezz El Din
4
Manal Mohamed El Mahdy
5
Tag Ibrahim Omran
6
Radwa Mohamed Sabra
radwahamed7@gmail.com
7
Department of Clinical Oncology and Nuclear Medicine, Ain Shams University
Department of Clinical Oncology and Nuclear Medicine, Ain Shams University
Department of Clinical Oncology and Nuclear Medicine, Ain Shams University
Department of Clinical Oncology and Nuclear Medicine, Ain Shams University
Department of Clinical Pathology Faculty of Medicine, Ain Shams University
Maadi Armed Forces Medical Compound
Maadi Armed Forces Medical Compound
Background and Objectives: the use of neoadjuvant chemotherapy (NAC) in breast cancer induces a pCR in only 30–35% of patients. We can’t depend only on clinical and pathological factors to distinguish the patients who have no chance of a pCR or not. Moreover, the NAC scenario is the perfect setting to study possible changes in TIL levels. Tumor-infiltrating lymphocytes (TIL) (CD) 8+ are essential components of tumor-specific cellular adaptive immunity. However, only few studies have addressed the significance of (CD8+) TIL in patients with breast cancer. Patients and Methods: we assessed the stromal and intratumral TIL, CD+8 in pretreatment core biopsy by immuohistochemistry (IHC) in 45 patients with breast cancer received neoadjuvant anthracyclin and docetaxel chemotherapy. CD8 classified into high or low according to the inter quartile range. Tumors with ≥ 50% intratumoral or stromal lymphocytes were designated lymphocyte predominant breast cancer (LPBC). Results: we found statistically significant correlation with high CD8 and DFS and smaller tumor residual (95% CI, 18.6-22.9; P= 0.01) and (p=0.003) respectively. But there was no significant difference regarding pCR or OS between high and low groups. Conclusion: this study confirmed that the CD8 TIL is an important prognostic and predictive factor in breast cancer.
https://ejhm.journals.ekb.eg/article_11360_2e8e84560891fbb08caeb69f2b441af2.pdf
breast cancer
CD8
Tumor infiltrating lymphocytes
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5470
5478
10.21608/ejhm.2018.11361
11361
Original Article
Validation of AFP Model as a Predictor of Response, Recurrence and Survival in HCC Patients Underwent Locoregional Treatment
Mohamed Kamal Shaker
1
Heba Mohamed Abdella
2
Mohamed Mahmoud Mahmoud El Tabbakh
3
Mohamed Atef Abu Hashima
midoatif.2014@gmail.com
4
Department of Tropical Medicine, Faculty of Medicine, Ain Shams University
Department of Tropical Medicine, Faculty of Medicine, Ain Shams University
Department of Tropical Medicine, Faculty of Medicine, Ain Shams University
Department of Tropical Medicine, Faculty of Medicine, Ain Shams University
Background: incidence of hepatocellular carcinoma (HCC) has rapidly increased worldwide. HCC is the sixth most common malignancy and the third most common cause of cancer related death. Since HCC usually develops in a damaged liver, the prognosis of HCC depends not only on tumor progression but also on the degree of liver dysfunction. In Egypt, HCC constitutes 70.48% of all liver tumors among Egyptians. Aim of the Work: to validate the use of AFP model as a predictor of response, recurrence and survival in hepatocellular carcinoma patients after locoregional treatment. Patients and Methods: this study was conducted at Tropical Medicine department and HCC clinic, Ain Shams University Hospitals. The study was approved by the Research and Ethics Committee of Ain Shams University, Cairo, Egypt in accordance with local research governance requirements. Results: according to this classification 130 patients are for RFA and 70 patients are for TACE but actually 132 patients underwent TACE and 68 patients underwent RFA this could be explained by the facts that some lesions are large in size (>4cm) and others are located near main bile duct, intestinal loop or blood vessel so RFA couldn’t be done. Conclusion: AFP model may be a predictor of response, recurrence and survival in HCC patients undergoing locoregional treatment (TACE or RFA) but more studies with larger sample size are needed to validate its use.
https://ejhm.journals.ekb.eg/article_11361_a9cd9b45dbbff06b293849ec7e98f47e.pdf
Hepatocellular carcinoma
Locoregional treatment
Alpha fetoprotein
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5479
5484
10.21608/ejhm.2018.11362
11362
Original Article
Dexamethasone versus Ondansetron in Prevention of Postoperative Nausea and Vomiting After Laparoscopic Surgery
Raafat A. Hammad
1
Abeer M. Eldeek
2
Rania M. Hussien
3
Ahmed A. Shendy
drahmedanwer0@gmail.com
4
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Background: postoperative nausea and vomiting (PONV) are a common distressing symptoms in patients undergoing laparoscopic surgery and can contribute to anxiety, dehydration, metabolic abnormality, wound disruption, delayed recovery and other issues. The incidence of PONV varies from 20 to 80 % of all surgeries, and it is an economic and social burden. Aim of the Work: was to assess whether dexamethasone is a cost-effective alternative to ondansetron in the prevention of PONV in patients undergoing laparoscopic surgery. Patients and Methods: A study was conducted at Ain Shams University Hospitals between November 2017 and April 2018, after obtaining approval of research ethical committee and patients’ informed consents. 80 Patients were included in the study and underwent elective laparoscopic surgery and received general anesthesia. Results: The study showed a statistically significant difference between groups regarding PO nausea and other postoperative complications. Conclusion: Dexamethasone 8 mg was as effective as ondansetron 4 mg. Dexamethasone provided a simple, safe, cheap, and effective postoperative nausea and emesis prevention method with the advantage of being cheaper decreasing the economic burden.
https://ejhm.journals.ekb.eg/article_11362_dce18e5b934ec30abcd38b2b35eb22bc.pdf
dexamethasone
Ondansetron
Postoperative Nausea
Vomiting
laparoscopic surgery
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5485
5489
10.21608/ejhm.2018.11383
11383
Original Article
A Comparison between Post-Operative Analgesia after Intrathecal Injection of Nalbuphine versus Fentanyl as an Adjuvent to Bupivacaine after Cesarean Section
Azza Youssef Ibrahim
1
Kareem Youssef Kamal
2
Hany Magdy Fahim
3
Ahmed Nasser Ahmed
ahmednasser_91@hotmail.com
4
Department of Anesthesiology, I.C.U and Pain Management, Faculty of Medicine, Ain Shams University
Department of Anesthesiology, I.C.U and Pain Management, Faculty of Medicine, Ain Shams University
Department of Anesthesiology, I.C.U and Pain Management, Faculty of Medicine, Ain Shams University
Department of Anesthesiology, I.C.U and Pain Management, Faculty of Medicine, Ain Shams University
Background: one of the primary aims of anesthesia is to alleviate the patient’s pain and agony, by permitting the performance of surgical procedures without any discomfort. Relief of postoperative pain has gained real importance in recent years considering the central, peripheral and immunological stress response to tissue injury. Any expertise acquired in this field should be extended into the postoperative period, which is the period of severe, intolerable pain requiring attention. So there is a need for extended analgesia without any side effects to achieve this goal. The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Aim of the Work: the purpose of this study was to assess the postoperative analgesic requirements and the spinally mediated analgesic effects of intrathecal nalbuphine as an adjunct to intrathecal bupivacaine after cesarean section in comparison to intrathecal bupivacaine plus fentanyl. Patients and Methods: eighty female patients came to Demerdash Hospital for cesarean delivery, they were randomly allocated into two equal groups (40 patients) group F and group N. Group F: Bupivacaine-Fentanyl: Patients received an intrathecal injection of 2 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (25 µg) fentanyl. Group N: Bupivacaine-Nalbuphine: Patients received an intrathecal injection of 2 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (0.8 mg) Nalbuphine. Results: the addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia moderately prolonged the time of postoperative analgesia, while the duration of analgesia was more prolonged and the adverse effects were minimal with the group of nalbuphine, our result shows no significant difference, but shows significant difference in the More rapid onset of sensory block with Fentanyl than with Naluphine, more rapid Regression time to S1 dermatome with Fentanyl than with Naluphine, the duration of motor block is shorter with Fentanyl than with Naluphine, patients receive rescue analgesia 6 h postoperatively is fewer with Nalpuphine than Fentanyl. Conclusion: more rapid onset of motor block in fentanyl group than in nalbuphine group, more rapid onset of sensory block with Fentanyl than with Naluphine, more rapid regression time to S1 dermatome with Fentanyl than with Naluphine.
https://ejhm.journals.ekb.eg/article_11383_2dd138147b64a6debec07258074d8621.pdf
Bupivacaine
Fentany
intrathecal
ACTH
PDPH
Intra-thecal
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5490
5494
10.21608/ejhm.2018.11384
11384
Original Article
The Role of Ultrasound in Evaluation of Meniscal Injury
Nada Sayed Mahdy
nada.sayedmahdy@yahoo.com
1
Hossam Mousa Sakr
2
Allam Elsayed Allam
3
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Background: meniscal tear is one of the most common injuries of knee joint , MRI is considered to be 1st choice to diagnose meniscal tear. The Question of the study is if we can use U/S as screening tool for Meniscal injuries before MRI. Aim of the Work: to determine the clinical usefulness of ultrasonography for diagnosis of meniscal pathology in patients with acute knee pain and compare its diagnostic accuracy to MRI in a clinical setting. Patients and Methods: this study was carried out in Radiology department, Ain Shams University hospitals. 15 patients with MRI proven Meniscal tear underwent knee ultrasound examination. Results: the overall sensitivity of ultrasound examination for meniscal tears was 77%. Conclusion: ultrasound appears to be useful for the screening of meniscal tears but detection of the morphology of meniscal tears seems insufficient.
https://ejhm.journals.ekb.eg/article_11384_a4da78de457fd75a370fdb65872934e3.pdf
Meniscal Tear
Magnetic Resonance Imaging
Musculoskeletal ultrasound
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5495
5498
10.21608/ejhm.2018.11385
11385
Original Article
Change in Left Ventricular End Diastolic Pressure (LVEDP) as apredictor of Adverse Effect in Patients undergoing Primary PCI
Osama Abd El Hamed
osamaamin130@yahoo.com
1
Akram Abdelbary
2
Ahmed Battah
3
Tarek Elgohary
4
Critical Care Department, Faculty of Medicine, Cairo University.
Critical Care Department, Faculty of Medicine, Cairo University.
Critical Care Department, Faculty of Medicine, Cairo University.
Critical Care Department, Faculty of Medicine, Cairo University.
Background: in acute myocardial infarction (MI), decreasing compliance of the left ventricle is directly associated with prognosis. Patients and Methods: 30 patients presented with acute ST segment elevation MI Who underwent primary PCI within 12 hours of presentation. All patients were subjected to full history taking, physical examination, serial ECG, cardiac enzymes and measurement of LVEDP just before and after Primary PCI using end hole catheter. Results: post revascularization left ventricular end diastolic pressure (LVEDP) decreased. There is significant correlation between LVEDP change and left ventricular dysfunction (p value:0.014). Significant correlation between LVEDP and mortality are present. Conclusion: change in LVEDP measured just pre and post primary PCI are significantly correlated with adverse clinical outcome in patients with acute STEMI.
https://ejhm.journals.ekb.eg/article_11385_d93a772d2ad9cfeaebebedadd0e3484b.pdf
LVEDP
STEMI
Primary PCI
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5499
5504
10.21608/ejhm.2018.11386
11386
Original Article
Relation of Cord Cortisol Level and Respiratory Distress Syndrome in Preterm
Salah Abd-Rabbou Elsayed
1
Mohamed Abdel Salam Zannoun
m_zannoun@yahoo.com
2
Tarek Mostafa Emran
3
Amany Mostafa Elzalabany
4
Pediatrics Department, New Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Pediatrics Department, New Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Pediatrics Department, New Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Pediatrics Department, New Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Background: numerous studies have shown that severity of respiratory distress syndrome may affect the endogenous cortisol secretion in preterm infants. Aim of the Work: assess the relationship between Cortisol level in umbilical cord in first and third day after delivery & Respiratory distress syndrome in preterm. Patients and Methods: a case control study that includes 90 preterm infant. Each included infant was submitted to history taking, complete clinical examination and laboratory investigations including complete blood count, arterial blood gases, level of cortisol in day one and day three. Results: in the present work, there was no significant difference between cases and controls as regard age, gender, weight, gestational age, as regards the serum cortisol levels in the studied groups,this study revealed that mean level of serum cortisol in 1stday of life among the three groups showed elevation and showed no significant statistical difference between the three groups (P-value = 0.107) Regarding mean level of serum cortisol in 3rd day of life showed high significant difference between the three groups (P-value = 0.001). group I (without RDS) marked lower than both groups II&III (with RDS), and comparison between group II and III regarding the same value, showed that group III had significant higher level than group II (P-value = 0.001). Conclusion: preterm infants respond to the stress at delivery and cortisol production continues in infants with RDS than those without RDS.
https://ejhm.journals.ekb.eg/article_11386_04c354214ad6aa114aad456aa78487b4.pdf
Cord Cortisol
Preterm
respiratory distress
Stress response
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5505
5512
10.21608/ejhm.2018.11387
11387
Original Article
Role of MRI in Diagnosis of Endometrial Cancer
Lobna Abdelmonem Habib
1
Mona Mohamed Salaheldin Alhawary
m16mona@yahoo.com
2
Emad Hamed Abd Eldayem
3
Ahmed Fathy Abd Alghany
4
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Background: the role of MRI in female pelvic imaging has been magnified nowadays by the aid of diffusion weighted magnetic resonance imaging (DW-MRI) and contrast enhanced imaging for better assessment of endometrial cancer. Aim of the Work: this study aimed to show MRI role in diagnosis of female patients with endometrial cancer for better evaluation, prognosis and treatment strategies according to preoperative MRI staging. Patients and Methods: this study carried out in Radiology Department of Ain Shams University Hospitals. This study included 25 patients. All patients were subjected to careful history taking, histologic diagnosis of endometrial carcinoma and pelvic MRI was done. Results: the diagnosis capability of the MRI in comparison to histopathology in patients with endometrial carcinoma was significant. Conclusion: MR imaging with the aid of contrast enhanced images, diffusion weighted images and ADC mapping, had a great role in diagnosis of endometrial cancer as part of pre-operative assessment for lesion characterization and staging of the disease, that improve overall survival rate of patients by choosing better treatment plan.
https://ejhm.journals.ekb.eg/article_11387_85c642c8a3ad13dc73dd21163f60bac4.pdf
Endometrial carcinoma
MRI
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2018-07-01
72
10
5513
5516
10.21608/ejhm.2018.11388
11388
Original Article
Comparison between Hypertonic Saline (3%) and Normal Saline (0.9%) as a Preload before Spinal Anaesthesia in Caesarean Section
Fahmy Saad Latif
1
Dalia Ahmed Ibraheem
2
Amin Mohammed Alansary
3
Mariam Gamal Motawashleh Salama
gmariam488@gmail.com
4
Department of Anaesthesiology, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University
Department of Anaesthesiology, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University
Department of Anaesthesiology, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University
Department of Anaesthesiology, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University
Background: spinal anesthesia is frequently used for cesarean delivery because of its rapid onset, a dense neural block, little risk of local anesthetic toxicity and minimal transfer of drug to the fetus. General anesthesia is preferred in emergency obstetric situations, such as cord prolapse, in which there is a need for reliable induction, and also bleeding placenta previa. Unfortunately it is frequently accompanied by hypotension, which may be defined in absolute terms as a systolic blood pressure (SBP) of 90 or 100 mmHg or in relative terms as a percentage (20% fall from baseline). Aim of the Work: the aim of this study is to compare hypertonic saline (3%)and normal saline (0.9%) in preventing spinal induced hypotension. Patients and Methods: in our study, 40 patients were randomly divided into 2 equal groups: Group A: received hypertonic saline (3%) (4ml/kg) . Group B: received normal saline (0.9%)(13ml/kg). Results: our study showed that hypertonic saline (3%) was more effective than normal saline to prevent spinal induced hypotension and it did not affect the neonatal outcome. Conclusion: neonatal outcome was excellent with the use of either hypertonic saline (3%) or normal saline (0.9%) as a preload for the parturient who received spinal anesthesia before cesarean section.
https://ejhm.journals.ekb.eg/article_11388_a0ffcc59db99e98075f12109a26e3ec8.pdf
blood pressure
Diastolic Blood Pressure
Gestational age
Systolic blood pressure