eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
1
9
10.21608/ejhm.2019.22063
22063
Original Article
Corneal Endothelial Cells Changes after Phacoemulsification in Diabetic Patients
Emad Abdel Aal Saliem
emadophtha@yahoo.com
1
Ophthalmology Department, Al-Azher Faculty of Medicine, Assuit
Patients and Methods: The study included 40 eyes of 40 patients scheduled for cataract surgeryby phacoemulsification at Al-Azhar University Hospitals. The patients were assigned to 2 groups. Group 1: Twenty patients without diabetes were used as a control group. Group 2: Twenty patients diagnosed with diabetes based on medical history and all were on medical treatment. In this prospective randomized study, preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japa) were performed to evaluate endothelial cell count changes over 6 months. The main outcome measures were central corneal thickness (CCT), cell density (CD), coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). Results: In term of CCT, BCVA, HEX and CD, the differences between preoperative and postoperative values are statistically significant in both groups. On the other hand, in term of CV, the difference between preoperative and postoperative CV is statistically insignificant in both groups. Conclusion: The endothelium in diabetic subjects is more vulnerable to surgical traumaand has a lower capability in the process of repair.
https://ejhm.journals.ekb.eg/article_22063_cb6bf93309e0340ec8cf74c03fdbd73b.pdf
Phacoemulsification
endothelial cell loss
Central Corneal Thickness
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
10
16
10.21608/ejhm.2019.22064
22064
Original Article
Role of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Patients with Salivary Glands Tumors
Abdallah Mohammed AL-kheshen
1
Mohammed Salah EL-Feshawy
2
Mohammed Essmat Abd-ElGhani
3
Mahmoud Mohammed Abomosalam Ali
mabomosalam87@gmail.com
4
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
Background: The diffusion weighted imaging and ADC value give appreciable information about tumor cellularity with tissue contrast between the active and necrotic areas within the tumor. This would be valuable and could direct the beneficial site for interventional procedure and biopsy to be taken from the viable tumoral tissue especially in case with non-enhanced studies due to renal impairment.
Objective: The aim of this study was to investigate the capacity of Diffusion MRI to predict the benign and malignant Salivary gland tumors, using ADC value and DWI.
Patients and Methods: This study included 40 patients (24 male and 16 female). Sixteen patients had malignant lesions and twenty-four had benign ones. The DWI was obtained with b values including 0 and 800mm2/second. The Apparent Diffusion Coefficient (ADC) generated by measuring identical images at different b-values and represented as ADC map, from which the ADC value was calculated.
Results: The absolute ADC value of lesions was significantly different between benign and malignant salivary gland tumors (p<0.001). The sensitivity of ADC in differentiating benign from malignant lesions in our study was 93.7% indicating a high true positive rate. Hence, if the average ADC is below 0.85 x 10 -3 mm2/sec, there is high probability that the mass will be malignant with high specificity of 95.8 %. Results revealed that the mean ADC value of benign and malignant salivary gland tumors were 1.33±0.46x 10-3 mm2/s and 0.65±0.21 x 10-3 mm2/s, respectively. The mean ADC value of benign was significantly higher than that of malignant lesions.
Conclusion:Theuse of DWI and ADC values can provide better assessment of salivary gland tumors and predict the benign and malignant lesions.
https://ejhm.journals.ekb.eg/article_22064_204a1eb6245fa8e484e78a382824b4f0.pdf
ADC
MRI
DWI
Malignant Salivary Gland Tumors
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
17
22
10.21608/ejhm.2019.22065
22065
Original Article
Comparison between Transcerebellar Diameter, Biparietal Diameter and Femur length for Gestational Age Measurement Accuracy in Third Trimester of Pregnancy
Abdelmonaem Mohamed Zakaria
1
Ashraf Hamdy Mohamed
2
Ahmed Kamal Mohamed Eldarder
ahmedeldardery2016@yahoo.com
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: The provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality, independent of maternal characteristics. The use of ultrasonography has significantly improved the evaluation of fetal growth and development and has permitted prenatal diagnosis of a variety of congenital malformations.
Objective: The aim of this study was to detect an accurate method for assessment of gestational age in the third trimester of pregnancy comparing the transcerebellar diameter (TCD), biparietal diameter (BPD) and femur length (FL).
Patients and Methods: A total of 200 pregnant women in third trimester pregnancy were assessed in this randomized controlled study in Department of Obstetrics and Gynecology at Sohag General Hospital by two-dimensional ultrasound from January to June 2o18 to assess an accurate method for assessment of gestational age in third trimester of pregnancy.
Results: We found that out of 200 pregnant women, the TCD gave a correct assessment of gestational age within 3 days in 129 (64.5%) and within 1 week in 178 (89%). While the FL gave a correct assessment of gestational age within 3 days in 97 (48.5%) and within 1 week in 163 (81.5%). The least accurate was the BPD that gave a correct assessment of gestational age within 3 days in 65 (32.5%) and within 1 week in 123 (61.5%) pregnant women.
Conclusion: It could be concluded that TCD is the most accurate method for assessment of gestational age in the third trimester followed by FL, and the least accurate is the BPD.
https://ejhm.journals.ekb.eg/article_22065_83dcb2633bf18c21f06db9367450a61d.pdf
Transcerebellar Diameter
Biparietal Diameter
Gestational age
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
23
30
10.21608/ejhm.2019.22066
22066
Original Article
Comparative Study between Intrathecal and Caudal Epidural Anesthesia in Children for Lower Abdominal Surgery
Mostafa Mohammed Mahdy
1
Maamon Mohammed Ismail
2
Amr Soliman Hamrosh
3
Ahmed Elsayed Kamel Elfiky
magdi.arabicwolrd@gmail.com
4
Department of Anaesthesia and Intensive Care, Faculty of Medicine – Al Azhar University
Department of Anaesthesia and Intensive Care, Faculty of Medicine – Al Azhar University
Department of Anaesthesia and Intensive Care, Faculty of Medicine – Al Azhar University
Department of Anaesthesia and Intensive Care, Faculty of Medicine – Al Azhar University
Background: regional anaesthesia techniques are now established in the practice of pediatric anaesthesia. it is one of the most common techniques used for post-operative pain management in pediatric patients especially for urogenital, rectal, inguinal and lower extremity surgeries.
Objective: to compare caudal and spinal anaesthesia in paediatrics regarding haemodynamics, efficacy (sensory block characteristics, motor block characteristics) post operative analgesia, surgeon’s satisfaction, parents’ satisfaction and complications incidence.
Material and Methods: the present study was carried on100 patients, with age ranging from (6-12) and of ASA (american society of anaesthesia.) I, II classes undergoing infraubmliclal pediatric surgeries, patients in each group were randomly assigned to receive spinal or caudal epidural anaesthesia.
Results: the demographic data of patients as regard age, sex and ASA classification showed no statistical significant difference between the two groups, where the study was designed to compare between the effectiveness of spinal anaesthesia with bupivacaine 0.3mg/kg and caudal anaesthesia with bupivacaine 2mg/kg(1ml/kg vol.) as a sole anaesthetic technique adequate for infraumblical pediatric surgeries below T10 as regard the sensory and motor block characteristics, perioperative haemodynamic effects, pain assessment, analgesic requirements, and both the surgeon ad parents satisfaction was assessed.the results showed the superiority of subarachnoid on achieving rapid onset of sensory blockade, intense motor blockade, on the other hand the caudal epidural had the advantage of longer post operative analgesic effect and lower post operative analgesic consumption, furthermore both techniques gained good degree of parent and surgeon satisfaction.
Conclusion: if both techniques are correctly used and the anatomy of the patient is normal there is minimal risk of complications.
https://ejhm.journals.ekb.eg/article_22066_023cf0e12c0f34bbf2772b7c13e2cf03.pdf
intrathecal
caudal epidural
infraumblical
pediatric surgeries
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
31
35
10.21608/ejhm.2019.22067
22067
Original Article
Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome
M. Elmenawy
1
O. Elsherief
2
M. Abd Elaliem
3
Orthopedic Surgery Department, Faculty of Medicine (Damietta), Al-Azhar University
Orthopedic Surgery Department, Faculty of Medicine (Damietta), Al-Azhar University
Orthopedic Surgery Department, Faculty of Medicine (Damietta), Al-Azhar University
Background: ulnar impaction syndrome (UIS) is a common cause of ulnar-sided wrist pain. The differential diagnosis of ulnar-sided wrist pain is diverse due to the complex nature of the bony and soft tissue anatomy UIS may lead to degenerative lesions of the triquetrum, lunate, ulnar head cartilage or of the TFCC. Concomitantly the triquetrolunate ligaments may be disrupted. Associated factors of ulno-carpal joint space narrowing may include previous fracture (e.g. of the distal radius), premature physeal arrest of the distal radius or congenital ulna positive variance.
Aim of the work: this study aimed to evaluate the outcome of treating ulnar impaction syndrome with ulnar shortening osteotomy upon clinical and radiological.
Materials and Methods: in this study ten adult patients with ulnar impaction syndrome were selected from Orthopedic Outpatient Clinic of Faculty of Medicine (Damietta), Al-Azhar University Hospital from January 2018 to October 2018 and they were operated by ulnar shortening osteotomy and fixed by plating.Description of technique alongitudinal incision over the subcutaneous border of the ulna issued to expose the ulna between the distal and middle third of the ulna from the ulna styloid. Preoperative posteroanterior (PA) X-rays were reviewed to determine the amount of shortening required, with a goal of creating -2 mm variance postoperatively. A 6-hole dynamic compression plate was predrilled distally prior to performing two oblique osteotomies separated by the desired shortening length. The fragments were reduced and plated by using compression. Results: the mean disabilities of the arm, shoulder and hand (DASH) score was 9 postoperatively. Flexion, extension and supination were reduced compared to the contralateral unaffected extremity (84.6%, 85.3%, and 86.9% of normal). Patients received worker’s compensation 5 of 10 patients required hardware removal for plate irritation and 2 of 10 patients had a nonunion. Conclusion: we preferred our surgical technique ulnar shortening osteotomy for all cases of UIS. Pain was significantly improved in our Cases; however, smokers had less improvement in pain and higher disability scores.
https://ejhm.journals.ekb.eg/article_22067_17e2f5062364be03a5060d815cb49fb1.pdf
ulnar shortening osteotomy
ulnar impaction syndrome
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
36
49
10.21608/ejhm.2019.22068
22068
Original Article
Role of Recent Imaging Modalities in Diagnosis of Diabetic Foot
Mohamed Kamal Hamed Elsharkawy
1
Mokhtar Ragab Ramadan
2
Mostafa Mahrose Abd Elhamed
sheeekooo2030@gmail.com
3
Department of Radiodiagnosis, Faculty of Medicine, Alazhar University
Department of Radiodiagnosis, Faculty of Medicine, Alazhar University
Department of Radiodiagnosis, Faculty of Medicine, Alazhar University
Background: osteomyelitis and septic arthritis complicate up to one third of diabetic foot infections that require hospitalization and often result from contaminated soft tissues. Early diagnosis is difficult to achieve through noninvasive imaging studies. Nuclear medicine and radiologic imaging techniques, although commonly used, may lack accuracy. CT is used routinely because it is widely available, but it is of limited diagnostic value in early stages of acute osteomyelitis of the foot and in patients with diabetic osteoarthropathy. MRI, because of its high sensitivity and specificity, is considered the modality of choice for diagnosing osteomyelitis of the foot and for identifying associated soft-tissue abnormalities such as cellulitis, phlegmon, abscess, sinus tracts, and ulcers. Aim of the work: this study aimed to assess the role of recent imaging modalities such as high resolution ultrasound, CTA, MRI, MRA and PET/CT in the early detection and /or improving the prognosis of diabetic foot.
Conclusion: the major complication facing patients with diabetic foot is amputation that is why tight glycemic control is mandatory. In addition to routine screening for early detection of diabetic foot complications can be helpful. With advancement of radiological techniques, the prognosis of diabetic foot has improved.
https://ejhm.journals.ekb.eg/article_22068_ebebe66a3f397b743015b8b225596412.pdf
CTA
MRI
MRA
PET/CT
Diabetic foot
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
50
54
10.21608/ejhm.2019.22431
22431
Original Article
Pathological Fracture of Lower Limb in Children
Mohamed Salah AbdelHafeez
1
Mahmoud Seddik Hassan
2
Amr Mohamed Mahmoud Awad
dr.amrawad87@gmail.com
3
Department of Orthopaedics, Faculty of Medicine, AlAzhar University
Department of Orthopaedics, Faculty of Medicine, AlAzhar University
Department of Orthopaedics, Faculty of Medicine, AlAzhar University
Background: pathological fractures in children occur from many aetiology. The physician has to develop an individual strategy for management and rehabilitation, considering the biology of bone and the biomechanics at the fracture site to detect pathology of lesion and to reach perfect bone healing. Time-efficient protection and reconstruction of the child’s musculoskeletal system is the aim of the orthopaedic surgeon’s intervention. The whole strategy must be individualized to every situation.
Objective: The goals of managing a child’s pathological fracture are all based on establishing a diagnosis. Fracture management is then based on five points:(a) relief the pain; (b) achieve local control of the pathological lesion; (c) skeletal stabilization, preservation of growth, and maintain anatomical alignment; (d) fracture healing; and (e) restoration of function.
Patients and Methods: Our study was done over 20 cases of pathological fracture of lower limb in children in Al-Azhar University Hospitals (Al-Hossin and Saeid Galal hospitals) from January 2016 to December 2018. Imaging and radiology reports were used to determine fracture types. Complete fractures were classified to four major types: transverse, spiral, oblique and comminuted. In our study we use the Musculoskeletal Tumor Society (MSTS) scoring system to assess functional outcome for each patient. For lower extremity function, the MSTS used a 0-5 scale for the following variables: motion, pain, stability, deformity, strength, functional activity and emotional acceptance.
Results: According to our study no patients with fractures underwent amputation, affection of neurovascular structures, or tumour progression on therapy. Pathologic fracture was not an indication for any of the amputation procedures, only the tumour pathology in an indication. Two patients refused surgery. Only one patient had a local recurrence after limb salvage surgery, and underwent no further surgical intervention.
https://ejhm.journals.ekb.eg/article_22431_f7cf83341b494ea37f76e4c84bd5f92c.pdf
Pathological Fracture
lower limb
osteogenesis imperfecta
MSTS
Non-ossifying fibroma
Unicameral bone cyst
Aneurysmal bone cyst
simple bone cyst
tumour
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
55
62
10.21608/ejhm.2019.22432
22432
Original Article
Prevalence of female sexual dysfunction in Damietta governorate
Hassan Abou Khodair
1
Hany Othman Abo Al-Wafa
2
Salwa Mohamed Mostafa Rotab
msalwa788@gmail.com
3
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Dermatology Hospital, Damietta, Egypt
Aim: to assess the prevalence of female sexual dysfunction among women of Damietta governorate
Patients and methods: 500 randomly selected sexually active non-pregnant married women at age 18 – 45 years from outpatient clinics of Al-Azhar University Hospital were subjected to filling out the Arabic validated FSFI.
Results: The frequency of female sexual dysfunction among women of Damietta Governorate was 62% of participants. There was a statistically significant difference between women with female sexual dysfunction (FSD) and women without FSD in age, age of marriage and education level (P<.0001). Also, women not working were at higher risk to get FSD (P<.001) with the significant impact of socioeconomic level on having FSD.
Also, we reported a statistically significant difference between women with FSD and women without FSD in the mode of delivery and women used IUD &72.6% had a history of circumcision. There was a statistically significant difference between women with FSD vs women without in mean score of desire, arousal, lubrication, orgasm, satisfaction, and pain as women with FSD showed less score in all domains compared to women without the disease.
Conclusion: FSD was a significant health problem in Damietta that needs to be investigated more deeply and assessing associated risk factors. Low rate of overt complaints regarding sexual problems among Egyptian women does not indicate lack of sexual interest but reflects cultural factors such as shyness, embarrassment, reluctances of the women and lack of physicians’ awareness which lead to inadequate identification and management of such problems.
https://ejhm.journals.ekb.eg/article_22432_08ad6fcc03ead977dc00fb04a350694b.pdf
Circumcision
Damietta Governorate
Sexuality
sexual dysfunction
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
63
69
10.21608/ejhm.2019.22433
22433
Original Article
Effect of Metformin Only versus Effect of Metformin and Corticosteroids after Laparoscopic Ovarian Drilling on Ovulation in Women with Clomiphene Citrate Resistant Polycystic Ovary Syndrome
Ismail Talaat El-Garhi
1
Fahd Abdel Aal El-Omda
2
Gamal Zakaria El-Khatib
3
Ahmed Mohamed Fathy Awad
4
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
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Background: the syndrome of polycystic ovary syndrome (PCOS) is clinically and biochemically heterogeneous. Medical treatment of PCOS is tailored to the patient's goals. Broadly, these may be considered fewer than four categories: lowering of insulin levels, restoration of fertility, treatment of hirsutism acne and restoration of regular menstruation. Objective: this study aimed to study the effect of Metformin alone after laparoscopic ovarian drilling on ovulation in women with clomiphene citrate resistant polycystic ovary syndrome in comparison with studying the effect of Metformin with Dexamethasone after laparoscopic ovarian drilling on ovulation in women with clomiphene citrate resistant polycystic ovary syndrome. Methodology: in the present study, 60 patients with PCO were resistant to clomiphene citrate therapy had undergone ovarian drilling. Those patients had been classified into 2 groups according to the selected therapy. Two trails had been compared; group A received metformin (850 mg twice daily) plus dexamethasone (2mg daily from day 5 to day 14 monthly) for 3 months while group B had received metformin only (850 mg twice daily). Results: our study showed no significant correlation between serum progesterone level after therapy and different parameters in both study groups. Conclusion: we concluded that there was a good value of administration of Dexamethasone with Metformin after laparoscopic ovarian drilling in patients with clomiphene resistant polycystic ovarian disease especially those patients with normal DHEAS levels.
https://ejhm.journals.ekb.eg/article_22433_b6d3123cf0f0f0ab5012c99bc5ea0f19.pdf
Metformin
Corticosteroids
PCOs
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
70
73
10.21608/ejhm.2019.22434
22434
Original Article
Accuracy of Two-Dimensional Speckle Tracking Echocardiography in Detection of Myocardial viability in Patients with Ischaemic Cardiomyopathy
Mamdouh H. Altahhan
1
Attia M. Shokr
2
Mahmoud M. Gebali
drmahmoud07@gmail.com
3
Department of Cardiovascular Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Cardiovascular Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Cardiovascular Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: ischaemic cardiomyopathy isone of the common causes ofhigh mortality and increasing prevalence of heart failure. Because of the need to treat the cause of ischemic cardiomyopathy, testing of patients and detection of myocardial viability is much important and can help to identify viable segments of myocardium that have great chance of improving after revascularization. Noninvasive imaging are used for detection of viability and 2 dimensional speckle tracking echocardiography is under research for this.
Aim of the work: Detection of myocardial viability in ischemic cardiomyopathy using 2D speckle tracking Echocardiography versus myocardial perfusion imaging.
Patients and Methods: The ethical approval was obtained from the hospital ethical research committee and each patient entering the study signed an informed consent. Fifty patients included in this study with known ischemic cardiomyopathy. They were recruited from outpatient clinic at Al-Hussien Hospital during the period from October 2017 to July 2018. Myocardial perfusion imaging and 2D speckle tracking echocardiography with segmental longitudinal strain and global longitudinal strain were done to the fifty patients.
Results: 2D speckle tracking echocardiography with segmental longitudinal strain and global longitudinal strain when compared with myocardial perfusion imaging predicted cutoff point for viable segment from nonviable with detected sensitivity and specificity.
Conclusion: The new echocardiographically-derived myocardial deformation indices, which reflect structural changes assessed by transthoracic echocardiography can be used to detect myocardial viability.
https://ejhm.journals.ekb.eg/article_22434_739cea93b80a63bb709d18d7cdf401af.pdf
Echocardiography
myocardial viability
Myocardial Perfusion Imaging
Ischemic Cardiomyopathy
speckle tracking
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
74
79
10.21608/ejhm.2019.22435
22435
Original Article
Prospective Study to Evaluate Effect of Autologus Plasma Injection in the Wound Site immediately after Primary Wound Closure
Fawzy Ahmed Hamza
1
Ahmed Taha Sayed
2
Mohamed Mustafa Mohamed Mohamed Saeed
mhmd.saeed1988@gmail.com
3
Plastic surgery Department, Al-Azhar University
Plastic surgery Department, Al-Azhar University
Plastic surgery Department, Al-Azhar University
Background: Healing of wounds is considered as a complex and dynamic process, Platelets play an important role in the process of wound healing because it releases many growth factors that may be valuable in improving the results of the healing process.
Aim of the Work: The purpose of this study was to evaluate the effect of autologus plasma injection in the wound site immediately after wound closure on the process of wound healing.
Patients and Methods: The study was conducted on 60 patients having wounds at different sites of the body either post-traumatic or post-operative. They were grouped into two groups: Group A received autologus plasma injection in the wound site immediately after primary wound closure together with the usual wound care while the other group B received only the usual wound care without plasma injection. We have evaluated the wound healing process parameters as vascularity, pigmentation, pliability, pain, stiffness, the cosmetic results and development of complications using the Patient And Observer Scar Assessment Scale (POSAS) Score.
Results: We have found that the results of the wound healing process have improved much in group A which received autologus plasma injection than that was found in group B that didn't receive plasma injection regarding vascularity, pigmentation, pliability, pain, wound healing complications, cosmetic results and patients' satisfaction.
Conclusion: Autologus plasma injection in the wound site immediately after wound closure has enhanced the wound healing process, gave better cosmetic results and led to more patients' satisfacion because it contains abundant growth factors, cytokines and biologically active substances.
https://ejhm.journals.ekb.eg/article_22435_4e94f82617a4535089fe39cadf849a00.pdf
Wound healing
Autologus Plasma
platelet-rich plasma
Platelet-Poor Plasma
Cosmetic
growth factors
growth mediators
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
80
86
10.21608/ejhm.2019.22467
22467
Original Article
Clinical Audit on Management of Acute Poststreptococcal Glomerulonephritis in Children Admitted to Assiut University Children Hospital
Marwa A.M. Abuzeid
dmarwaa@yahoo.com
1
Ahlam Badawy Ali
2
Faida M.M. Mostafa
3
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
Background: acute poststreptococcal glomerulonephritis (APSGN) is the most common glomerulopathy among children in our community. Aim: to assess degree of adherence of medical physicians to Assiut University Children Hospital protocol for management of acute poststreptococcal glomerulonephritis. Patients and Methods: fifty eight patients with APSGN admitted to Assiut University Children Hospital were included in this study. The unit´s protocol wasfollowed for the management of these cases. Results: evaluation of the studied patients were done perfectly except for 12% of patients not asked about symptoms suggestive ofhypertension (HTN) and 14% not checked for oliguria and some laboratory investigations with less importance in diagnosis. Management was perfectly done except for general and supportive measures including daily weighting, calculating fluid input and output, which showed some defect. Putting patients on blood pressure percentiles was not done at all. Conclusion: evaluation of the APSGN patients includes taking proper history of nephritic symptoms and careful clinical examination. Main treatment includes monitoring fluid status and HTN, and proper management to avoid complications. Recommendation: stress on general and supportive measures including weighting patients daily, calculating fluid input and output, checking patients for oliguria, and follow up proper dietary measures especially for hypertensive and hyperkalemic patients. Stress in putting patients on blood pressure levels according to age and height percentiles for accurate detection of HTN.
https://ejhm.journals.ekb.eg/article_22467_b5a58cf538a6f47bf40f1ed82c53f4e1.pdf
Acute poststreptococcal glomerulonehpritis
Assiut University Children Hospital
Audit
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
87
93
10.21608/ejhm.2019.22471
22471
Original Article
Comparison between taans cerebellar diameter, biparietal diameter and femur length for gestational age measurement accuracy in the 3rd trimester
Alsaied Abdelmaksod Askr
1
Mahmoud Salah Mahmoud
2
Asmaa Ahmed Mahmoud Salloum
drasmaa822@gmail.com
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: the provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality and independent of maternal characteristics. Many patients in Egypt due to socio-economic reasons come for their first antenatal visit in the third trimester. Most of them are uneducated and come from remote areas. Also, many being lactating mothers are unsure of their LMP or have irregular cycles. Because of non-availability of any dating scans or earlier ultrasound and uncertainty in LMP, it becomes very difficult to calculate their due dates, so many pregnancies considered to be preterm or posterm were wrongly classified. The use of ultrasonography has significantly improved evaluation of fetal growth and development and had permitted prenatal diagnosis of a variety of congenital malformations. Ultrasonographic fetal biometry is highly reliable in the first and second trimester of pregnancy, but reliability of any ultrasound method greatly diminishes as gestational age advances, in the third trimester, reliability of any single ultrasound parameter alone is poor without correlation with other parameters. Objective: in our study, TCD was compared to FL and BPD in accuracy of assessment of gestational age in the third trimester of pregnancy. We correlated between the three parameters, Transcerebellar (TCD) and Biparietal diameter (BPD) and Femur length (FL), for accurate determination of gestational age in third trimester of pregnancy. Methods: a total of 200 pregnant women in the third trimester pregnancy were assessed in this observational study in Department of Obstetrics and Gynecology, Damietta Hospital, Al-Azhar University (Outpatient) by two-dimensional ultrasound to assess the accurate method for assessment of gestational age in the third trimester of pregnancy. Examinations were performed after a verbal consent from the patient with the patient lying in the dorsal supine position. Two dimensional ultrasounds were carried out. Fetal biometry and amniotic fluid volume were assessed. All women included in this study were subjected to history taking and clinical examination. Results: we found that out of 200 patients, TCD gave correct assessment of gestational age within 3 days in 118 patients (59%) and within 1 week in 180 patients (90%). While, FL gave correct assessment of gestational age within 3 days in 92 patients (46%) and within 1 week in 160 patients (80%). The least accurate was BPD that gave correct assessment of gestational age within 3 days in 59 patients (29.5%) and within 1 week in 120 patients (60%).
Conclusion: from this study, we concluded that TCD was the most accurate method for assessment of gestational age in the third trimester followed by FL and the least accurate was the BPD. Also, by combining accuracy of TCD (90%) and that of FL (80%) we can be near certain of gestational age in most of our patients even if they are unsure of their dates.
Recommendations: measuring TCD as routine in the third trimester as it has the same accuracy as the current fetal biometry (BPD and FL).
https://ejhm.journals.ekb.eg/article_22471_1c073c8e1483a381817e1acd5ba1690f.pdf
TCD
LMP
BPD
FL
GA
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
94
102
10.21608/ejhm.2019.22486
22486
Original Article
Relationship between Adenoidal Hypertrophy and Allergic Rhinitis in Children
Mohamed Abdel Monem Yonis
1
Marwan Ahmed Ibrahim
2
Farag Khalil Farag
3
Ahmed Mohamed El Shennawy
ahmed_mohmad_ahmed2012@yahoo.com
4
Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University (Cairo)
Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University (Cairo)
Internal Medicine Department, Faculty of Medicine, Al-Azhar University (Cairo), Egypt
Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University (Cairo)
Background: as a consequence of antigenic stimulation associated with chronic inflammation, the adenoids may enlarge so that they may almost fill the nasopharynx. Moreover, adenoid hypertrophy and allergic rhinitis can co-exist in the same patient and treating allergy may relieve patient's symptoms and thus avoid unnecessary surgery. Objective: this study aimed to determine the relationship between adenoid hypertrophy and allergic rhinitis in children based on clinical examination, nasal endoscopy and skin prick test. Methods: this was a prospective study included 50 children who were selected from many patients attended Otolaryngology Outpatient Clinic in Al-Azhar University Hospitals during the period from February 2018 to June 2018. All patients were signed an approved informed consent form before study enrollment. Results: the results of this study showed that there was no significant association between allergy and nasal obstruction neither measured by endoscopy, nor FRS. Furthermore, there was a significant negative correlation between allergy and adenoid volume measured only by endoscopy not by lateral X-ray nasopharynx. Supplementary, among all tested allergens, house dust and cotton dust allergy showed a significant negative association with the volume of adenoid. Moreover, all types of food and perennial allergens did not show significant correlations. Conclusion: this study showed that large adenoid may be associated with absence of allergy, whereas large turbinates may be associated with small adenoid. These findings may be helpful in clinical management of a child with nasal obstruction, so a detailed evaluation of the nose and nasopharynx is mandatory in each child with this complaint and it should be performed by nasal endoscopy. Consequently, the treatment should be geared toward the specific findings in that individual.
https://ejhm.journals.ekb.eg/article_22486_9d0f99b15a62dfd8abc8b6dff6e4d414.pdf
adenoid hypertrophy
Allergic Rhinitis
relationship
skin prick test
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
103
109
10.21608/ejhm.2019.22487
22487
Original Article
Evaluation of Gastro-Esophageal Reflux Disease after Sleeve Gastrectomy in Morbid Obese Patients
Mohammed Elsayed Radwan
1
Mohammed Arafat Abdel-Maksoud
2
Ashraf Abdo-Almonem Sayed Ahmad Abotaleb
3
Sobhy Rezk Ahmed Teama
sobhyteama2007@gmail.com
4
Department of General Surgery, Faculty of Medicine, Al-Azhar University
Department of General Surgery, Faculty of Medicine, Al-Azhar University
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University
Department of General Surgery, Faculty of Medicine, Al-Azhar University
Background: obesity is one of the major problems in the world and is associated with several comorbidities and disabling diseases e.g. cardiovascular disease, metabolic syndrome, type 2 diabetes mellitus (T2DM), infertility, certain tumor types, and GERD. Management consisted of conservative and surgical measures, conservative measures such as diet modifications physical exercise and pharmacological therapy. There was considerable evidence in the literature on the long-term positive impact of bariatric surgery as a primary therapy for the treatment of obesity and its co-morbidities.Objective: this study aimed to conclude that if gastroesophageal reflux disease develops after sleeve gastrectomy in morbidly obese patients or not. Patients and Methods: this prospective non-comparative study was conducted in Surgery Department, Al-Azhar University Hospitals in the period between October 2016 and October 2018. Study included 30 cases of morbidly obese patients (with BMI ≥ 40 Kg/m² or ≥35 Kg/m² associated with comorbidities) and they were submitted for laparoscopic sleeve gastrectomy and all of them had failed in trials of conservative management including dietary control and they are bulky eater but non-sweet eater. Results: the prevalence of gastroesophageal reflux disease (GERD) was markedly increased in morbid obese patients compared to the incidence in normal individuals, with a percentage of up to 70% of patients undergoing bariatric surgery. SG is associated with an increase in GERD prevalence. The measured increase in GERD prevalence ranged from 2.1% to 34.9% in the analyzed literature. There was marked heterogeneity between the studies in regard to a number of factors including preoperative BMI, method of evaluating GERD, exclusion criteria, length of follow-up and operative technique. Conclusion: only in a very special group of patients with BMI between 30 and 35 and comorbidities, SG plus other antireflux procedure or hiatal hernia repair is accepted.
https://ejhm.journals.ekb.eg/article_22487_984744c101649501e00e0f1685e5b311.pdf
central nervous system
gastro-esophageal reflux disease
Laparoscopic sleeve gastrectomy
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
110
116
10.21608/ejhm.2019.22637
22637
Original Article
Diagnostic Value of Electrocardiographic ST-T Wave Changes in Lead aVL in Patients with Chronic Stable Angina
Mohamad Osama Kayed
1
Aly Aly Ramzy
2
Ibrahim Yassin
3
Eslam Ismail Zakria Kotb
dreslamkotb222@gmail.com
4
Department of Cardiology, Faculty of Medicine, Alazhar University
Department of Cardiology, Faculty of Medicine, Alazhar University
Department of Cardiology, Faculty of Medicine, Alazhar University
Department of Cardiology, Faculty of Medicine, Alazhar University
Background: coronary artery diseases affect millions of patients in the world which cause a lot of complications up to death. by very simple non-invasive method like ECG we can predict and early diagnose and even localize very serious lesion in coronary angiograghy in patient with chronic stable angina and this is the target of our research. Aim of Work: this study aimed to detect the diagnostic value of ST segment and T wave changes in lead AVL in patient with chronic stable angina. Methods: this was a prospective observation study that was done from June 2017 to July 2018 and it included 200 patients presented to Alhussin University Hospital or referred to us from other secondary hospitals with chronic stable angina. All patients were subjected to full history, clinical examination, ECG and coronary angiograms with focusing on ST segment and T wave changes and analyses and localized the lesions in coronary angiograms and their relationship to previous ECG changes. Results: mean age in patients in our study was 55.89 years old with 77% males and 23% females. The most common risk factor was HTN. There was a relationship between ST-T wave changes in lead AVL in patient with chronic stable angina with a moderate agreement to mid LAD lesion 78% and to lesser degree LCX then RCA and LM. Conclusion: according to the previous results of our research, inverted T wave in lead AVL in chronic stable angina corresponds angiographically to tight mid left anterior descending coronary artery lesion.
https://ejhm.journals.ekb.eg/article_22637_5d5881ffed9f5d04296fb19f3bd2d31c.pdf
eCG
aVI
t wave
St segment chronic stable angina
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
117
119
10.21608/ejhm.2019.22638
22638
Original Article
Fournier gangrene as an atypical presentation of seminal vesicle abscess: a case report
Mohammed Alfozan
dr.masf@gmail.com
1
College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia
Background: seminal vesicle abscesses are usually misdiagnosed due to the rarity of this pathology and can be mistakenly diagnosed as an inguinal hernia or scrotal abscess even with the aid of computerized tomography of the abdomen and pelvis. We report a case where a pre-operative diagnosis was difficult owing to the atypical presentation with Fournier gangrene.
Aim of the work: To the best of our knowledge, our case is the first to report a seminal vesicle abscess presenting as Fournier's gangrene. We believe it can add to the scarce literature and help increase the index of suspicion for such rare urological condition.
Results: For our patient, the transurethral approach was successful without any complications and he was asymptomatic and able to void on the third day postoperative.
Conclusion: the transurethral drainage is a good alternative to transrectal drainage with comparable hospitalization period and symptoms relief. Also, it ensures complete drainage of the abscess cavity.
https://ejhm.journals.ekb.eg/article_22638_654accc3477e53d6c68a40dfe40bbd36.pdf
seminal vesicles
abscess
atypical presentation
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
120
125
10.21608/ejhm.2019.22640
22640
Original Article
The Comparative Preemptive Analgesic Efficacy of Addition of vitamin B Complex to Gabapentin versus Gabapentin alone in Orthopedic Surgery under Spinal Anesthesia
Ismael Abdel-Latif Shabayek
1
Saeed Mostafa Abdel-Hamid
2
Mohamed Mohsen Abdellatif Elbanna
dr.m_elbanna@yahoo.com
3
Anesthesia and Intensive Care Department, Faculty of Medicine, Al- Azhar University
Anesthesia and Intensive Care Department, Faculty of Medicine, Al- Azhar University
Anesthesia and Intensive Care Department, Faculty of Medicine, Al- Azhar University
Background: development of new multimodal analgesic regimens have led to substantial improvement in postoperative pain relief. Aim of the work: we designed this study to compare the effect of combined vitamin B complex-gabapentin versus gabapentin alone on postoperative pain in orthopedic surgery under spinal anesthesia. Methods: 80 patients who underwent elective orthopedic surgery under spinal anesthesia were randomized to receive orally 300 mg gabapentin (Group G) or 300 mg of gabapentin plus 2 vitamin B complex (Group GB) tablets 30 minutes before surgery. Postoperative pain intensity and total analgesic consumption during 12 hours after surgery, vomiting, and drowsiness during recovery were assessed. Results: the pain intensity in the gabapentin plus vitamin B complex group was lower than gabapentin group during 12 hours after surgery (p-value <0.001). Meanwhile, the total analgesic consumption in this group was less than gabapentin alone(p-value <0.05). The incidence of vomiting in patients who received combined gabapentin—vitamin B complex group was similar to gabapentin alone (p-value >0.05). Conclusion: the combination of vitamin B complex to gabapentin reduced intensity of postoperative pain and also the total amount of analgesic consumption within the first 12 hours postoperative following orthopedic surgery under spinal anesthesia.
https://ejhm.journals.ekb.eg/article_22640_8a5f9026c5f0979de81de8f07aebdd72.pdf
orthopedic surgery
Gabapentin
Pain
vitamin B complex
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
126
134
10.21608/ejhm.2019.22641
22641
Original Article
Posterior Lumbar Interbody Fusion in Degenerative Spondylolisthesis
Mohammed Bisar
1
Ahmed Akar
2
Ashraf Albasiony
basiony5527@gmail.com
3
Orthopedic Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Orthopedic Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Orthopedic Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: degenerative spondylolisthesis is one of causes of low back pain in older patients and it’s referring to a forward slippage of a lumbar, with an intact neural arch. Uncommon before the age of 50 years, it is more common in women and particularly in blacks, with a male: female ratio of 1:6. Posterior lumbar interbody fusion surgery is one of an effective surgery in treatment of patients with degenerative spondylolisthesis and can make significant relief in low back pain and disability. It has amore advantages more than other type of back surgery through restoring of vertebral height and restricts motion of the vertebral segment. Objective: this study aimed to evaluate the surgical treatment of degenerative spondylolisthesis by Posterior Lumber Interbody Fusion. Patients and Methods: this was a prospective study carried out at Al-Azhar University Hospitals on 15 patients with degenerative spondylolithesis operated by posterior lumber interbody fusion and assessment pre-operative, one day, three months and six months post-operative by oswestry disability index .also according to visual analogue scale pre and post-operative then assessment of the fusion according to lenke classification. Results: the mean preoperative ODI was (70.2%±5.5) one day Postoperative ODI was (10.93%±4.76), after 3 months was (10.67±7.97) and 6 months the mean post-operative was (12.76±14.25). According to VAS for back pain pre-operative was (6.9± 0.9) preoperative and show marked improvement and the main postoperative value according to VAS is (1.53±1.126) for leg pain The mean value Pre-operative according to VAS was :(9.06±0.7) and the mean value Post operativeis (2.0±1.41) the mean outcome was 87.24 % ranged from 38% to 94% the main complication noted the adjacent segment degenerative disease and Dural tear. Conclusion: posterior lumber interbody fusion in degenerative spondylolisthesis is a very good option.
https://ejhm.journals.ekb.eg/article_22641_4a1d0f630efb4778aaaa42c2411169d3.pdf
degenerative spondylolisthesis
interbody fusion
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
135
141
10.21608/ejhm.2019.22642
22642
Original Article
A Comparative Study between Bedside Chest Ultrasound and Traditional Chest Radiography in Critically Ill Patients
Omar M. Abo Shahba
1
Mohamed F. Agag
2
Badr I.
3
Shadi M. Yousef
shadi_magdi_1990@hotmail.com
4
Department of Anesthesia and ICU, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Anesthesia and ICU, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Anesthesia and ICU, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Anesthesia and ICU, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: Bedside chest ultrasound emerge a sensitive tool with much higher sensitivity than plain chest x-ray. It avoids the cost, risk of transportation to perform the CT chest and that of radiation exposure. Aim of the Study: was to evaluate the sensitivity and the specificity of bedside ultrasound in the detection and the evaluation of chest conditions of critically ill patients in comparison of CT chest as the gold standard tool. Patients and Methods: This prospective study was conducted on a registry of 80 patients with different chest pathology admitted to the Medical-Surgical Intensive Care Unit of Bab Al Shaeria Hospital between March and November 2018. Results: bedside chest ultrasound sensitivity in detection and evaluation of pneumothorax, pleural effusion, and consolidation and Interstitial lung disease in comparison to CT chest showed sensitivity around 93 % with little cost, without risk of radiation exposure and transportation of critically ill patients. Conclusion: Bedside chest ultrasound is a highly sensitive and specific tool in the detection and evaluation of many chest conditions that eliminates the risk of transportation of unstable patients and that of radiation exposure and is easily accessible in resource limited areas.
https://ejhm.journals.ekb.eg/article_22642_dc00f0f7750e0839983ba59ee92041df.pdf
bedside chest ultrasound
traditional chest radiography
Critically Ill Patients
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
142
146
10.21608/ejhm.2019.22643
22643
Original Article
A prospective Study of the Risk of Depression in Acne Patients Treated with Oral Isotretinoin
Rabie Bedir Atallahb
1
Hany Othman Abo Alwafa
2
Mohamed Abdel Fattah El Mahdy
3
Asmaa Elsayed Mahmoud
4
Dermatology, Venereology and Andrology Department
Dermatology, Venereology and Andrology Department
Psychatric Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Dermatology Department, Damanhour National Medical Institute
Background: depression showed up as potential side effect of isotretinoin in the summary of product characteristics. There have been numerous studies treating this issue yet as a rule not distinguishing any significant depression or suicide risk.
Aim of the Work: this study aimedto evaluate the risk of depression in acne patients treated with oral isotretinoin therapy. Methods: one hundred patients with moderate to severe acne were enrolled in non-controlled prospective study. The psychological condition was evaluated at the baseline and fourth month by the Hamilton Depression Rating Scale (HDRS) for all patients. Statistical analysis of HDRS scores was performed. Results: all patients completed the study. Before the treatment 18% of the patients had suffered from mild depressive symptoms. at end of 4 months The patient's scores remained below the subclinical level for depression except only 2 patients one was mildly depressed turned to moderately depressed after four months treatment with isotretinoin other was mildly depressed and still mildly depressed after four months treatment with isotretinoin. The incidence of depression was 1%. Symptoms of depression which occurred in two patients, in which case coexisting situational factors were found to be the cause. Conclusion: our results showed that the oral isotretinoin treatment for acne at the typical therapeutic dose caused significant reduction in depression scores with a depression incidence only 1%. These changes might be related to clinical effect of isotretinoin. Moreover, the treatment of acne improved symptoms of depression for most patients.
https://ejhm.journals.ekb.eg/article_22643_23ea95d023cd19e903b3e3c066c09fde.pdf
Acne valgaris
systemic isotretinoin
depression
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
147
155
10.21608/ejhm.2019.22644
22644
Original Article
Assessment of Routine Drainage in Elective Thyroid Surgery. A Prospective Randomized Study
Ayman Ibrahim
dr.aymanhelmy10@gmail.com
1
Department of General Surgery, Faculty of Medicine, Al-Azhar University
Background: At the end of thyroidectomy surgery, there was an area of some debate about insertion of closed suction drain before closure. The decision of routine use of drain depends on the surgeon’s training, experience, and personal preference. Many surgeons prefer to place drain to minimize dead space collection and to prevent or reduce the post-operative hematoma that may be life-threatening so, the insertion of drains was generally accepted, although there are many studies that show no difference in the rate of complication with or without drain insertion. Moreover drain insertion may be accompanied by many hazards such as more hospital stay and post-operative pain. So, the concept of routine use of drain should be revised in the light of recent reports that test the real need for its use. Aim of the study: this study aimed to assess if there was actual benefit from the use of drain in thyroid surgery and to evaluate the necessity of its use in thyroid surgery and to detect hazards of its use. Patients and methods: between June 2015 and July 2018, a prospective randomized study included 87 patients from those had elective thyroid surgery in Al-Hussien University Hospital for different indications. Patients had been categorized into 2 groups; group A (93 patients) for thyroidectomy without insertion of drain and group B (93 patients) for thyroidectomy with insertion of suction drain. In the study, results including: post-operative pain, hospital stay and complications (including wound infection, seromas, post-operative bleeding, hematoma, recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism) were documented. Follow up after patient discharge was done until healing of wounds to detect post-operative complications. Results: the overall postoperative complications rate in the study was low (13 patients) in the two groups. In the non-drained group, there were one case of hematoma ( 2.5 %), 2 cases of seroma ( 5.1 %), one case of RNL palsy ( 2.5 %), one case of transient hypoparathyroidism (2.5 %) and no cases of wound infection, whereas in the other group, there were 2 cases of hematoma ( 5.1 %), 3 cases of seroma ( 7.6 %), 2 case of RNL palsy ( 5.1 %), 2 case of transient hypoparathyroidism ( 5.1 %) and no cases of wound infection. There was no statistical significance between both groups as regard incidence of complications. In the non- drained group, 37 patients (94.8 %) were discharged at the next day after surgery while in the drained group 2 patients (5.1%) only were discharged in the next day and the remaining patients were discharged after removal of drain after 48 hours. The mean hospital stay for the non- drained group was 1.2±1 days and the mean hospital stay for the drained group was 2.1±1 days. Conclusion: in the study, use of drain in thyroid surgery did not have significant effect on the rate of incidence or prevention of postoperative complications. In serious postoperative bleeding, the drain which usually has small pores often become blocked be blood clots and become useless. On contrary, insertion of drain prolongs patient hospital stay and increases postoperative pain. So, routine use of drain in elective thyroid surgery should be prohibited.
https://ejhm.journals.ekb.eg/article_22644_1b92900708007ffcb8f8ce90fda02048.pdf
Drain
Thyroidectomy
post-oprative complications
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
156
161
10.21608/ejhm.2019.22645
22645
Original Article
Correlation between Serum Interleukin-31 Level and the Severity of Atopic Dermatitis in Children
Rabie Bedir Atallah
1
Ahmed Wahhed-Allah Amer
2
Hesham Samir Abd El-Samee
3
Reham Mahmoud Ibraheem
reham19885@gmail.com
4
Departments of Dermatology, Venereology & Andrology
Departments of Dermatology, Venereology & Andrology
Clinical pathology, New Damietta Faculty of Medicine, Al-Azhar University, Damietta
Departments of Dermatology, Desouk General Hospital, Egypt
Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease, characterized by intense itch, typical localization and a specific image of skin lesions. Pathogenesis of pruritus in AD is not fully understood, but recent studies emphasize the role of interleukin-31 (IL-31). This relatively recently described cytokine is considered to be a potential mediator inducing pruritus in AD. Aim of the Work: was to assess the correlation of serum IL-31 level and the disease severity in children with AD. Patients and Methods: a case control study. Sera were obtained from 50 AD children and 30 healthy volunteers. IL-31 levels were measured using ELISA with standard kits from EIAab R&D Systems. Serum IL-31 levels were correlated with AD disease activity. Disease severity in children with AD was assessed using the SCORAD (Severity scoringof atopic dermatitis) index. Results: Serum IL-31 level was significantly higher in AD children (Mean ± SD 99.73 ± 75.93) than in healthy children (Mean ± SD 54.01 ± 57.36), (p-value = 0.019). Serum IL-31 levels correlated positively with the calculated severity score (SCORAD index), (rs = 0.480, p- value <0.001) Conclusion: The results of this study confirm the importance of IL-31 in AD pathophysiology. Serum IL-31 level is an objective reliable marker of AD severity in children. It may represent a novel target for antipruritic drug development.
https://ejhm.journals.ekb.eg/article_22645_5250cc6e70822abe3ce7ff5f87efb8eb.pdf
atopic dermatitis
interleukin-31
severity SCORAD
pruritus
children
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
162
169
10.21608/ejhm.2019.22646
22646
Original Article
Detection of Subclinical Left Ventricular Systolic dysfunction by 2D Speckle Tracking Echocardiography in Patients with Peripheral Artery Disease
Mohammad S. Al-Baz
1
Wael Mohammad Attia
2
Hany A. Abd El-Fattah
3
Islam F. Abd Al-Gawad
dr.abonasab@gmail.com
4
Department of Cardiovascular Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Cardiovascular Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Cardiovascular Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: peripheral arterial disease (PAD) is estimated to affect 202 million people worldwide, with prevalence that is increasing over time. PAD represents a local manifestation of systemic atherosclerosis and portends a 2-6 fold increase in both cardiovascular and cerebrovascular events with an annual mortality rate of 4-6%(1,2) . Aim of the Work: the aim of this work was to detect left ventricular subclinical dysfunction using 2- dimensional speckle-tracking echocardiography (2D-STE) in patients with peripheral arterial disease. Patients and Methods: the ethical approval was obtained from the hospital Ethical Research Committee and each patient entering the study signed an informed consent. In a case-control study, 30 patients included was diagnosed with peripheral arterial disease and 20 control. They were recruited from Vascular department at Al-Hussein and Bab El-She'riya University Hospitals during the period from June 2018 to November 2018. Results: there was moderately strong significant correlation between ABI and left ventricle 2d speckle tracking echocardiography (2D-STE) (GLS% (p=0.003, r=0.52), AP4% (p=0.001, r=0.57), AP3% (p= 0.004, r=0.51) and AP2% (p=0.005, r=0.50)). This correlation was obvious according to limb affection (one limb vs. both limbs, GLS% p=0.025, AP4% p=0.038, AP3%=0.013 and AP2%=0.046) and severity (severe arterial disease vs. moderate arterial disease vs. some arterial disease subgroups GLS% p=0.003, AP4% p=0.001, AP3%=0.002 and AP2%=0.015). Also, there was moderately strong significant correlation of ABI with left ventricle systolic function (p=0.011, r=0.46) while other conventional echo parameters were of no significance with decline in ABI. Conclusion: peripheral arterial disease patients had lower global and segmental longitudinal strain than the healthy subjects and this was more prominent either with severity or limb affection. This study showed that even there is correlation between decline ABI and left ventricular systolic function EF% but LV GLS offer a better economic way to detect subclinical dysfunction in asymptomatic patient.
https://ejhm.journals.ekb.eg/article_22646_7cb04891af0de1b2a400440e7def5ea8.pdf
Echocardiography
Peripheral Arterial Disease
ankle brachial index and speckle tracking
global longitudinal strain
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
170
176
10.21608/ejhm.2019.22647
22647
Original Article
Assessment of the effects of frequent ventricular extra systoles on the left ventricle function using two-dimensional speckle tracking echocardiography in apparently normal hearts
Sameh R. Allam
1
Mohamed Sami
2
Muhammad I. Azzam
muhamedazzam02@gmail.com
3
Department of Cardiovascular, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Cardiovascular, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Cardiovascular, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: premature ventricular contractions are commonly seen within the general population and frequently observed during clinical practice. In recent years studies have shown that athough PVCs was considered as mostly benign, frequent PVCs without structural heart disease might lead to cardiac dysfunction and even cardiomyopathy, more recent work has revealed that PVCs can contribute to cardiomyopathy and heart failure and treating PVCs could lead to improved cardiac function.
Aim of the Work: the aim of this work was to assess the effect of ventricular extrasystoles (VESs) on LV function by using 2D-STE for early detection of subtle LV dysfunction in patients with apparently normal hearts and assess correlation between frequency of extrasystole and degree of impairment of LV dysfunction. Patients and Methods: the ethical approval was obtained from the hospital ethical research committee and each patient entering the study was signed an informed consent. Fifty patients were included in this study with asymptomatic frequent PVCs. All were without structural heart disease. Detailed history, physical examination, full labs, resting ECG, Holter monitoring for 24 hours, conventional ECHO assessment and finally strain imaging with measurement of LV-GLS were done. They were recruited from Cardiovascular Department at Sayed Galal University Hospitals during the period from December 2017 to November 2018. In this study we assessed speckle tracking of LV in apparently normal patients with frequent PVCs.
Results: early detection of subtle LV dysfunction was done by speckle tracking echocardiographic modalities other than conventional echocardiographic and showed a significant correlation with PVCs burden, focality, interpolated PVCs and duration of the complex of ectopic beat.Conclusion: frequent PVCs may produce LV dysfunction and cardiomyopathy independently of any pre-existing underlying cardiac disease and early detection of subtle LV dysfunction can be done by speckle tracking echocardiographic modalities even in asymptomatic patient.
https://ejhm.journals.ekb.eg/article_22647_fb22d4f266fa0519289c1963c0608d66.pdf
Echocardiography
premature ventricular contraction
interpolated PVCs
PVCs burden
Speckle tracking echocardiography
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
177
183
10.21608/ejhm.2019.22648
22648
Original Article
Prediction of Ipsilateral and Contralateral Cervical Lymph Node Metastasis in Unilateral Papillary Thyroid Carcinoma
El Sayed R. Ahmed
gogoseka1@gmail.com
1
Said H. Bendary
2
Mohamed Esmat
drmesmat67@hotmail.com
3
Ibrahim M. Hasan
4
Department of General Surgery, Faculty of Medicine, Al Azhar University
Department of General Surgery, Faculty of Medicine, Al Azhar University
Department of General Surgery, Faculty of Medicine, Al Azhar University
Department of General Surgery, Faculty of Medicine, Al Azhar University
Background: Surgical therapy is the cornerstone of treatment in patients with papillary thyroid cancer (PTC). Surgical therapy in PTC includes hemithyroidectomy or total thyroidectomy (TT) and, in cases of lymph node metastases, cervical lymph node dissection (CLND). The inclusion of prophylactic central compartment neck dissection (pCCND) as a new approach in the management of patients with PTC with clinically negative cervical lymph nodes raised controversies among the endocrine surgeons and predictive factors for central lymph node (CLN) metastasis in unilateral PTC cases not well defined.
Objectives: To investigate the risk factors associated with CLNM in clinical lateral cervical lymph node‑negative (cN0) and analyze the rate of ipsilateral and contralateral CLN metastasis in unilateral PTC casesin Al Azhar University Hospitals in the period from May 2016 tillJune 2018.
Patients and Methods: A prospective case-control descriptive study was performed to investigate the research questions during the period from the 1st of May 2016 till the end of June 2018 in Al-Azhar University Hospitals. A total of 40 selected patients suffering from papillary thyroid with clinically negative cervical lymph nodes who have received total thyroidectomy with bilateral CLND. The clinicopathological features of PTC patients with respect to sex, age, observation, tumor diameter, multifocality, extrathyroidal invasion, lymphovascular invasion and capsular invasion. The risk factors of CLNM were analyzed by Chi-squared test and multivariate logistic regression model.
Results: Ipsilateral CLN metastasis were present in 47.5% (19/40).Results analysis showed that males patients with tumor size (>1 cm) (P=0.027; OR, 2.153), age <45 years old (P=0.017; OR, 2.009) and capsular invasion (P= 0.018; OR= 0.730) were the predictors of ipsilateral CLN metastasis.Contralateral CLN metastasis were present in 17.5% (7/40) and prelaryngeal lymph node (LN) metastasis (P=0.008; OR, 13.333) and ipsilateral CLN metastasis (P=0.051; OR, 9.231), pretracheal lymph nodes (P=0.051; OR, 9.231), lymphovascular invasion (P=0.043; OR, 5.113) and ETE (P=0.05; OR, 4.901) independently predicted contralateral CLN metastasis.
Conclusion: For the high-risk PTC patients with CLNM, prophylactic CLND may be beneficial. Nevertheless, the present data was a single center prospective analysis, and the long-term prognostic factors including recurrence rate and mortality rate were lacking. Therefore, the results of this research may only serve as a tool in predicting CLNM.
https://ejhm.journals.ekb.eg/article_22648_d4e5767223968edaceeedfd41fdb1e8b.pdf
central lymph node
central lymph node metastasis
thyroid papillary carcinoma
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
184
192
10.21608/ejhm.2019.22649
22649
Original Article
Effect of Intramuscular Administration of Dexamethasone on Labour Outcome in Induction of Primigravida at Late-Term Pregnancy
Eslam Elsayed Shehata
eslamshehata65@yahoo.com
1
Mostafa Mohamed Zaitoun
2
Mohamed Naguib Azzam
3
Mohamed Elhussiney Radwan
4
Obstetrics & Gynecology department, Faculty of Medicine –Zagazig University, Egypt
Obstetrics & Gynecology department, Faculty of Medicine –Zagazig University, Egypt
Obstetrics & Gynecology department, Faculty of Medicine –Zagazig University, Egypt
Obstetrics & Gynecology department, Faculty of Medicine –Zagazig University, Egypt
Background: Induction of labour is common in clinical practice and is usually troublesome in primigravidas. Obestatricians are always in search of the best method of induction to ensure the best maternal and fetal outcome.
Objectives: to evaluate the effect of dexamethasone on labor outcome and to establish whether dexamethasone plays a role in shorting of the duration interval between initiation of labor induction and beginning of the active phase of labor in primigravida late-term pregnancy.
Patients and methods: Case control study included 120 primigravidae with late-term pregnancy classified into two groups: group I (cases) included 60 women assigned to receive a single 8-mg dose of dexamethasone intra-muscular and group II (control) included 60 women will not receive dexamethasone or any other cervical ripening agent.
Results: The interval between initiation of labor induction and beginning of active phase of labor was shorter in the dexamethasone group than in the control group (2.54 ± 0.94 hours vs. 3.59 ± 0.86 hours; p=0.001). Dexamethasone group showed shorter duration of active phase of labor than control group (4.82 ± 0.56 hrs. vs. 5.12 ± 0.58 hrs.). Dexamethasone group showed shorter duration of first stage of labor than control group (7.35 ± 1.15 hrs. vs. 8.69 ± 1.09 hrs.). Dexamethasone group showed faster rate of cervical dilatation than control group (1.37 ± 0.18 cm/hr. vs. 1.28 ± 0.17 cm/hr.). Dexamethasone group showed shorter duration of second stage of labor than control group (25.09 ± 12.99 minutes vs. 30.73 ± 12.96 minutes).
Conclusions: The administration of dexamethasone shortened labor duration with no significant difference between the two groups involving the duration of the third stage of labour, the neonatal outcome (meconium stained liquor, Apgar score at 1 minute and 5 minute birth weight, neonatal admission to neonatal intensive care unit and number of cases with fetal heart rate disturbance) and maternal complication.
https://ejhm.journals.ekb.eg/article_22649_f2e68ef41e2f2a84226db523c4aeabe0.pdf
dexamethasone
late-term pregnancy
induction of labor
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
193
207
10.21608/ejhm.2019.22711
22711
Original Article
Adjuvant Chemotherapy Treatment after Radical Cystectomy in Patients with Muscle Invasive Bladder Cancer
Hassan Khaled Hamdy
1
Mohsen Salah El-Din Zekry
2
Sabri Mahmoud Khaled
3
Sherif Mohammed Mustafa Azzam
sherifazzam24@yahoo.com
4
Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Urology and Andrology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: about 25% of patients newly diagnosed with bladder cancer have muscle-invasive bladder cancer (MIBC). Patients with MIBC have a worse prognosis than those with non-MIBC. Radical cystectomy with pelvic lymphadenectomy has been shown to be effective against MIBC. The pathologic stage of the primary tumor and regional lymph nodes status has been shown to be the most accurate predictors of disease recurrence after radical cystectomy.
Aim of the Work: to evaluate the toxicity profile related to the adjuvant chemotherapy cisplatin, gemcitabine when added to radical cystectomy as primary treatment, and to estimate disease free survival (DFS) and overall survival (OS).
Patients and Methods: during the period between December 2013 and October, 2017, a total number of 42 patients were included in this study at Clinical Oncology and Nuclear Medicine Department, Al-Hussein University Hospital with a provisional diagnosis of invasive type bladder cancer. The cutoff date for the analysis of overall survival was 31st April, 2018 corresponding to 6 months of follow-up for the last patient enrolled in the study. All patients were subjected to radical cystectomy and pelvic lymphadenectomy and received four cycles of adjuvant chemotherapy cisplatin 70mg/m2 D1, gemcitabine 1000mg/m2 D1,8, every three weeks.
Results: the most common grade 3 and 4 adverse events of hematological and non-hematological toxicities recorded during adjuvant chemotherapy were neutropenia (18.8%), grade 3 anemia (9.5%), grade 3 thrombocytopenia (2.3%), grade 3 nausea (28.5%), grade 3 and 4 vomiting (9.4%), grade 3 diarrhea (9.4%) while grade 3 renal toxicities observed in two patients (4.7%). As regard the survival analysis, the median disease-free survival (DFS) rate was not reached due to a relatively short follow up period and DFS was 82.9% at 1 year, 74% at 2 years, and 70.1% at 3 years. Concerning overall survival analysis, the median overall survival in our study was not reached due to a relatively short follow up period. Overall Survival rate at 1 year was 90.4%; at 2 years was 77.3% and 73.4% at 3 years.
Conclusion: for patients with bladder cancer who were not treated with neoadjuvant chemotherapy, we suggest not routinely administering chemotherapy following cystectomy. However, for patients with high-risk (T3 or higher, pathologic node involvement) urothelial carcinomas who are candidates for cisplatin -based combination chemotherapy and are willing to accept the risk for treatment-related toxicities in the absence of high level of evidence, adjuvant chemotherapy is a reasonable option. If administered, we prefer to use a cisplatin-based combination.
https://ejhm.journals.ekb.eg/article_22711_77ce0483def92c67e607156929dd6037.pdf
Chemotherapy
Radical cystectomy
Muscle Invasive Bladder
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
208
214
10.21608/ejhm.2019.22712
22712
Original Article
Clinical Outcome of Cervical Key-Hole Foraminotomy for Monolevel Cervical Radiculopathy
Samy Moussa Selim
samy_seliem@yahoo.com
1
Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
Background: Cervical degenerative disc disease is the most common cause of acquired disability in patients over the age of 50. C6-C7 and C5-C6 are the most common levels involved in it. Radiculopathy can be unilateral or bilateral and single level or multiple levels.
Objective: To know about the clinical outcome of cervical key-hole foraminotomy for monolevel radiculopathy.
Materials and methods: This cross sectional study was conducted in neurosurgery department, Al Qunfudah General Hospital, Saudi Arabia from January 2017 to December 2017. All admitted patients with mono level cervical radiculopathy due to posterolateral prolapsed intervertebral disc (PIVD) or bone spur who undergone key hole foraminotomy were included in this study, while patients with severe cervical degenerative diseases, myelopathy, instability, trauma, infection, tumors of cervical spine were excluded. Patients age, gender, level of cervical spine radiculopathy, pre-operative signs and symptoms, Pre and post-operative complications with post-operative variation in clinical status were recorded on a designed proforma. Minimum 1 month follow up was done.
Results: Total 20 patients were included in which there were 12 (60%) male and 8 (40 %) female with mean age 45 years (32-65 yrs.). The mean duration of complaint was 11 months (6-17 months). In all of these cases C6, C7 level involvement was the most common with total 8 (40%) patients. Complete recovery was found in 18 (90%) patients and partial in 2 (10%) patients while there was unintended durotomy in 1 (5%).
Conclusion: Minimally invasive posterior cervical foraminotomy for cervical radiculopathy is an effective option in well selected patients in postero-lateral foraminal stenosis due to prolapsed intervertebral disc and osteophytes formation.
https://ejhm.journals.ekb.eg/article_22712_009c1f6a005548dbaa517c609772c107.pdf
Cervical foraminotomy
Clinical Outcome
Monolevel cervical radiculopathy
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-01-01
74
1
215
218
10.21608/ejhm.2019.22713
22713
Original Article
Detection of Β -Human Chorionic Gonadotrophin in Vaginal Fluid For The Diagnosis of Preterm Premature Rupture of Membranes
Ahmed Hamza Awad
1
Mohamed Ibrahim El-Mohandes
2
Mahmoud Nahedd mushtaha
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Department of Obstetrics and Gynecology, El-Galaa Maternity Teaching Hospital, Cairo
Department of Obstetrics and Gynecology, El-Galaa Maternity Teaching Hospital, Cairo
Background: The purpose of the present study is to evaluate β-hCG in vaginal washing fluid for the diagnosis of preterm premature rupture of membranes (PROM).
Methods: This clinical trial was carried out at El-Galaa Maternity Teaching Hospital. The study included 100 women who were in their 3rd trimester of pregnancy. They were divided into 2 groups; group І (case group): Pregnant women with definite history of premature rupture of membranes confirmed by speculum examination as patients' (PROM) group. (n =50) and group ІІ (control group): Pregnant women with no history of rupture of membranes as control group. (n = 50)
Results: There was significant statistical difference in the prediction of PROM between the case group and the control group.
Conclusion: The presence of vaginal HCG is highly predictive of membranes rupture and is a more accurate diagnostic test than the amniotic fluid index (AFI) assessment in the diagnosis of ROM.
https://ejhm.journals.ekb.eg/article_22713_254059d2335bf86d6515960606d7b7f6.pdf
β-hCG
Premature Rupture of Membranes