eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4881
4888
10.21608/ejhm.2019.47452
47452
Original Article
Autologus Hair Transplantation Vs Skin Expansion in Management of Cicatricial Alopecia; A Comparative Study
Mohamed Hassan Mohamed Abdel-Aal
1
Ahmed Abo Hashem Azab
2
Amr Mohamed Mohamed Adss
amrads92@gmail.com
3
Department of General Surgery, Faculty of Medicine, Zagazig University
Department of General Surgery, Faculty of Medicine, Zagazig University
Department of General Surgery, Faculty of Medicine, Zagazig University
Background: The bad impact of cicatricial alopecia among population lead to increase the desire of correction of that type of hair loss. Although, there are many methods of hair restoration but the efficacy of each, indications and possible hazards has not yet been clearly identified. Objective: To compare between hair transplantation using follicular unit extraction and skin expansion surgeries in the field of hair restoration in secondary cicatricial alopecia regarding aesthetic outcome, operative duration, optimum patient selection and complications of both techniques. Subjects and methods: Twenty four patients suffering from alopecia were involved in this study 15 males (62.5%) and 9 females (37.5%). Patient’s age ranged from 7 to 26 years old. Patients were divided into two groups according to the procedure done. Group (A) 12 patients done hair transplantation surgeries. Group (B) 12 patients done scalp expansion surgeries. Results: There was a non-significant difference between both groups regarding the mean age or the mean operation duration (P > 0.05). The mean values of the surface area of alopecia, in tissue expander group (B) was significantly larger than that of hair transplantation in group (A) (P < 0.001). However the time since exposure to the causative injury was significantly longer in group (A) than that of group (B) (P < 0.01). Hair transplantation tends to have less recovery time highly indicated in adults with smaller non-dependent areas of alopecia, while expanders with long recovery period solve bigger problems of alopecia in younger patients. Conclusion: Multiple factors interfere with the surgical plan age, gender, occupation, size and site of alopecia and time since injury. Both hair transplantation and skin expansion are very useful in the field of cicatricial alopecia treatment. While hair transplantation has less hazards during anesthesia, less post-operative scars and less recovery time, skin expansion is a good solution for bigger problems like big area of alopecia or younger patients.
https://ejhm.journals.ekb.eg/article_47452_24555d52ff60f1fa6eb3c869f94ffdf1.pdf
Alopecia
hair transplantation
skin expansion and hair restorative surgeries
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4889
4893
10.21608/ejhm.2019.47453
47453
Original Article
Association of Retinal Nerve Fiber Layer Thickness and Degree of Myopia Using Spectral Domain Optical Coherence Tomography
Attiat Mostafa El-Sayed Mostafa
1
Mahmoud Mohamed Saleh
2
Ismail Mostafa Belal Mahfouz
imahfouz@yahoo.com
3
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Background: High myopia is defined as refractive error above -6.0 D and axial length above 26 mm. High myopia and its complications are considered to be one of the most significant causes of blindness and visual impairment in young people. Objective: To evaluate the effect of the degree of myopia on the peripapillary retinal nerve fiber layer (RNFL) thickness by spectral-domain optical coherence tomography (OCT). Patients and Methods: The study had been carried out in Embaba Ophthalmic Hospital during the period of June 2018 to February 2019. The study included 60 eyes, divided equally into 3 groups: Group A: Mild myopia (spherical equivalent between −0.5 and −3.0 D). Group B: Moderate myopia (spherical equivalent between −3.1 and −5.99 D). Group C: High myopia (spherical equivalent more than −6.0 D). Results: This study showed that RNFL thickness was lower in the high and moderate myopic eyes compared with low myopic eyes in all quadrants except in temporal quadrant. A highly significant positive correlation was evident between spherical equivalent and RNFL thickness in each quadrant. A highly significant negative correlation between axial length and RNFL thickness was found in each quadrant. Conclusion: High myopia should be considered in the interpretation of OCT data because of thinning of RNFL thickness and normative database corrected for refractive error and axial length should be incorporated. It is difficult for OCT to discriminate between high myopes with and without glaucoma. Therefore, clinical signs of glaucomatous nerve fiber damage are very important.
https://ejhm.journals.ekb.eg/article_47453_47bc5c33995742ddf1c347469730d791.pdf
Myopia
Retinal Nerve
Fiber Layer Thickness
Optical Coherence Tomography
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4894
4898
10.21608/ejhm.2019.47454
47454
Original Article
The Relation between Helicobacter Pylori Seropositivity and Hyperemesis Gravidarum in Pregnant Women during First Trimester
Emad Abdel rahman El tamamy
1
Ahmed Taha Abdel Fattah
2
Mohamed Hemdan Aboelfotoh Ibrahim Hemdan
m.hemdan88@gmail.com
3
Department of obstetrics & gynecology Faculty of Medicine Al-Azhar University Cairo, Egypt
Department of obstetrics & gynecology Faculty of Medicine Al-Azhar University Cairo, Egypt
Department of obstetrics & gynecology Faculty of Medicine Al-Azhar University Cairo, Egypt
Background: Nausea and vomiting during pregnancy are the most common conditions affecting pregnancy, occurring in about 80% of all pregnancies and the condition always disappears on the 16th to 18th weeks of gestation. This may be mild and does not affect the general condition of the pregnant women (the condition is called emesis gravidarum), or it may be severe enough to affect the patient physically and psychologically, causing intractable vomiting, weight loss (0.5%), electrolyte imbalance, dehydration and impairment of liver and kidney functions. Helicobacter pylori (HP) is one of the most common bacterium affecting humans. It is gram-negative and helix-shaped microaerophilic bacterium transmitted by the oro-oral or feco-oral route. It is more prevalent in developing countries and affects young children. Acute infection manifests as acute gastritis and stomach pain, whereas chronic infection causes chronic gastritis and peptic ulcer, 2% of which may develop into stomach cancer. Aim: The aim of our study was to investigate the association between H pylori infection and hyperemesis gravidarum. Methods: Forty five pregnant women with hyperemesis gravidarum and 45 asymptomatic pregnant women in a prospective study were enrolled. Serum immunoglobulin G for Helicobacter pylori was assayed in the sera of the two groups. Results: Regarding maternal age, gestational age and socioeconomic status, there was no statistical difference between both groups. There was a marked statistical difference between both groups in terms of Helicobacter pylori seropositivity. Conclusions: There is a powerful correlation between H pylori and hyperemesis gravidarum.
https://ejhm.journals.ekb.eg/article_47454_0770cf0bebf0e230afdb424b425417dc.pdf
Helicobacter pylori
Hyperemesis gravidarum
human chorionic gonadotropin
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4899
4905
10.21608/ejhm.2019.47456
47456
Original Article
Prevalence of Obesity and Overweight among Primary Schools Children in Qena, Egypt
Amira M.M. Hamed
1
Alaa-Eldin A. Hassan
2
Mohammed Mahmoud Sayed Younis
3
Al-Mostafa Mohammed Kamal
almostafa.kamal99@gmail.com
4
Faculty of Medicine, Department of Pediatrics, Al-Azhar University, Assuit branch, Egypt
Faculty of Medicine, Department of Pediatrics, Al-Azhar University, Assuit branch, Egypt
Faculty of Medicine, Department of Pediatrics, Al-Azhar University, Assuit branch, Egypt
Qeft Teaching Hospital, Ministry of Health, Qena, Egypt
Background: Obesity is a significant public health concern affecting more than half a billion people worldwide giving rise to a range of health problems. This is due to its various and serious health hazards on one side and its preventable nature on the other side. Objective: This study aimed at identification of prevalence of overweight and obesity and its risk factors among children between 6 - 12 years of age in Qena, Egypt. Methods and populations: A cross sectional study was conducted on 1000 students were chosen randomly from all grades of primary schools (6 -12 years) in the period from January, 2019 to June, 2019. Results: The overall prevalence of obesity and overweight was 13.9% and 16.2% respectively. Girls were more obese than boys, (OR= 7.26, 95% CI: 4.6-10.19). Current study revealed that 71.2% of the obese and 66.7 of overweight children were from urban areas (OR= 0.172, 95 % CI: 0.115- 0.257) and 38.5% of the overweight children and 97.2% of the obese children had an obese parent (OR = 134.4, 95% CI: 47.06 - 372.6). There was a statistical significant association between prevalence of overweight and obesity in school children and education of the mother (OR = 10.2, 95% CI: 6.2- 16.6). Conclusion: About one out of seven of 6-12 year-old-children in Qena city were obese. Locality of residence, gender, guardian education, obese guardian, feeding formula in early life, bad dietary habit (fast food consumption and missed breakfast) and lack of physical activity were likely to be the predictors of this alarming issue.
https://ejhm.journals.ekb.eg/article_47456_97b25d6c7de5038f04362a5224d15690.pdf
childhood
overweight
Obesity
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4906
4912
10.21608/ejhm.2019.47457
47457
Original Article
The Role of Umbilical Cord Thickness and Glycated Hemoglobin (HbA1c) Levels for Prediction of Fetal Macrosomia in Patients with Gestational Diabetes Mellitus
Osama Elsaeed Ali Ismail
1
Ibrahim Ramadan Alsawy Rady
2
Mahmoud Fayez Mohamed Fathi
mahmoud.fayez66@gmail.com
3
Department of Obstetrics and Gynaecology, Faculty of Medicine, El-Azhar University
Department of Obstetrics and Gynaecology, Faculty of Medicine, El-Azhar University
Department of Obstetrics and Gynaecology, Faculty of Medicine, El-Azhar University
Background: Diabetes with pregnancy is a known clinical risk factor associated with fetal macrosomia. The rationale for performing an elective cesarean section includes a potential reduction in perinatal complications, especially those related to macrosomia. Objective: This study aimed to assess the accuracy of HbA1c and umbilical cord thickness in prediction of fetal macrosomia in diabetic pregnant women. Patients and Methods: The study included 100 diabetic pregnant, 27 - 28 weeks gestation, gathered from Inpatients and Obstetric Outpatient Clinic of Bab Alshariya University Hospital attending for routine antenatal care. Results: At a criterion of > 211 mm2 , the umbilical cord area measured at 27 – 28 weeks of gestation was able to predict high birth weight (macrosomia), with a sensitivity of 90.5% and a specificity of 91.7%. The area under the curve for the ROC was 0.9294, with a 95% confidence interval of 0.8608 to 0.9702, which was found to be statistically highly significant (p = 0.0001). When compared the ROC curves of both the umbilical cord area and the glycated hemoglobin, it was found that umbilical cord area is more reliable in predicting fetal macrosomia at the right criterion, the difference between the predictive efficiency for both parameters was found to be statistically highly significant. Conclusion: Macrosomia is a cause of the worst of obstetric emergencies such as shoulder dystocia, birth asphyxia and postpartum haemorrhage. Shoulder dystocia cannot always be predicted accurately. However, predicting macrosomia can help to identify the population at risk of such complications.
https://ejhm.journals.ekb.eg/article_47457_a6ea82fa951d97d5c8f3c9465521fc00.pdf
Umbilical cord thickness
Glycated hemoglobin (HbA1c)
Macrosomia
Gestational diabetes mellitus
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4913
4919
10.21608/ejhm.2019.47460
47460
Original Article
Carbetocin Versus Misoprostol in Prevention of Postpartum Hemorrhage in High Risk Patients
Ismail Abd El Mobdy Ismail
1
Mohamed Salah El Deen Fahmy
2
Hany Ahmed Farouk
3
Ismail Abd El Mobdy Ismail
dr_oml2015@yahoo.com
4
Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University
Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University
Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University
Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University
Background: Postpartum hemorrhage (PPH) is a significant problem and a major cause of maternal mortality and morbidity, resulting in up to 28% of maternal deaths. It is a potentially life-threatening complication of both vaginal and cesarean delivery, the prevalence of PPH is approximately 6% of all deliveries. Objective: The aim of this study is to compare the effectiveness and safety of carbetocin and misoprostol for the prevention of atonic postpartum hemorrhage in high risk patients. Patients and Methods: this study is a prospective clinical study which was conducted at the Department of Obstetrics and Gynecology, Aswan University Hospital, in the period from September 2017 till September 2018. One hundred cases were involved in the study and divided into 2 equal groups. The study was approved by the medical ethics committee of Aswan University Hospital and a written informed consent is obtained from all patients. Results: Significant difference was found between the two studied groups as regard mean volume of blood loss. Carbetocin group showed the lowest volume of blood loss. As regard uterine tone after treatment, carbetocin group showed the highest tone compared to misoprostol groups. Significant difference was found between the two groups as regard need for additional uterotonics. The results demonstrated an increased use of additional oxytocics in the misoprostol group (32% of cases) VS (12% of cases) in carbetocin group. Conclusion: According to the results of this study, it's concluded that carbetocin is more effective in controlling the amount of blood loss during delivery and eventually help in the prevention of postpartum hemorrhage in high risk patients.
https://ejhm.journals.ekb.eg/article_47460_4efbc5244ed4b0d92c6c978f32dfe8d2.pdf
carbetocin
misoprostol
Postpartum Hemorrhage
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4920
4924
10.21608/ejhm.2019.47601
47601
Original Article
Laparoscopic Cholecystectomy with Low Tension Pneumoperitoneum under Spinal Anesthesia with Sedation
Mahmoud Abo Amra Mahmoud
1
Emad Adham Ibrahim
2
Tareq Sobhey El-Naggar
3
Mohammed Shaban Mohammed
medo_m18@ymail.com
4
Departments of General Surgery, Faculty of Medicine Al-Azhar University (Assiut)
Departments of General Surgery, Faculty of Medicine Al-Azhar University (Assiut)
Department of Anesthesiology, Faculty of Medicine Al-Azhar University (Assiut)
Departments of General Surgery, Faculty of Medicine Al-Azhar University (Assiut)
Introduction: Cholecystectomy is the commonest operation of the biliary tract. It is known that open upper surgery under spinal anesthesia and laparoscopic cholecystectomy under general anesthesia. Objective: In the present study study we performed laparoscopic cholecystectomy under spinal anesthesia with low tension pneumoperitoneum with sedation to evaluate, analyze and document whether laparoscopic cholecystectomy could be performed under spinal anesthesia and to assess the benefits and harms of low-tension pneumoperitoneum. The study was approved by the medical ethics committee of Al-Azhar University Hospital in Assiut and a written informed consent was obtained from all patients. Materials and Methods: A prospective observational study with symptoms of cholelithiasis who underwent laparoscopic cholecystectomy under spinal anesthesia with low tension pneumoperitoneum (7-9 mmHg) was conducted on 40 patients in Surgery Department of Al-Azhar University Hospital in Assiut from December 2018 to June 2019. Results: We successfully performed the operations in 27 patients without major complications. Only 13 patients (32.5%) who converted to general anesthesia due to anxiety despite using sedation. The operation was converted to open cholecystectomy in one case only (2.5%) due to disturbed anatomy and adhesions. Mean age was 45 years (range 21-57years). BMI was ≤ 32. All patients were satisfied on follow up. Conclusion: Laparoscopic cholecystectomy under spinal anesthesia with low-tension pneumoperitoneum with sedation by experienced surgeons is safe, cost-effective, feasible, associated with minimal postoperative pain and smooth recovery
https://ejhm.journals.ekb.eg/article_47601_28b19973fe532f028c4703ea66e0fc9c.pdf
Cholecystectomy
Laparoscopic cholecystectomy
Laparoscopy
Low tension pneumoperitoneum
Spinal anesthesia
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4925
4932
10.21608/ejhm.2019.47602
47602
Original Article
Circulating Angiogenic microRNA-27b and Thrombospondin-1 (TSP-1) Level in Patients with Diabetic Retinopathy
Samia Souka Moustafa
1
Maisa Nour El-Din Shawkey
2
Aida Ahmed Abd Elhameed
3
Mohamed Maher EL Hefny
4
Raghda Abd-Elsalam Nagaty Hanady
5
Department of Chemical Pathology, Faculty of Medicine, Al-Azhar University
Department of Chemical Pathology, Faculty of Medicine, Al-Azhar University
Department of Chemical Pathology, Faculty of Medicine, Al-Azhar University
Department of Ophthalmology, Research Institute of Ophthalmology-Ministry of Scientific Research
Department of Chemical Pathology, Faculty of Medicine, Al-Azhar University
Background: Diabetes mellitus (DM) is a chronic disease characterized by insulin deficiency or its peripheral resistance resulting in hyperglycemia and non-enzymatic glycation of protein.The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. MicroRNAs (miRNAs) are a class of highly conserved 19–25 nucleotide noncoding RNAs that regulate gene expression. Objective:This study aimed to assess plasma miR-27b expression in diabetic retinopathy patients as an early diagnostic parameter in both proliferative and non-proliferative and to assess the correlation between plasma levels of miR-27b with the clinico-pathological parameters of diabetic patients as well as determination of the level of thrombospondin-1 (TSP1). Patients and Methods: This study was conducted on 60 diabetic retinopathy Egyptian patients that were recruited from the Research Institute of Ophthalmology - RIO (Medical Retina Clinics) during their routine screening for diabetic retinopathy. Results: Micro RNA 27b shows a highly significant difference (increase) among PDR compared to non-PDR & control groups (P value: 0.001) and shows a moderately significant increase in expression in PDR group compared to control group (P value: 0.01). This significant increase in microRNA between PDR group and control group has the ability of being a non-invasive biomarker for diagnosis of PDR versus control group, as miRNA-27b expression showed AUC = 0.889 with (95% CI 0.744–1.000). The best cut-off point of miRNA-27b is 1.95 with 88.9% sensitivity & 100% specificity and the p value <0.001(highly significant). Conclusion: TSP-1 can act as a predictor for transformation of non-retinopathy stage to PDR stage. miRNA-27b has the ability to differentiate between the PDR and control group and could be considered a non invasive biomarker.
https://ejhm.journals.ekb.eg/article_47602_cdf2e04ca4395cbc223fabaa4006a9e4.pdf
Diabetes mellitus
microRNA-27b
Thrombospondin-1
diabetic retinopathy
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4933
4937
10.21608/ejhm.2019.47603
47603
Original Article
Prevalence of Cardiovascular Disease Risk Factors in Shaqra, Saudi Arabia
Feras Mansour Almarshad
feras-mmm@hotmail.com
1
Abdulaziz Abdulrahman Alrashed
2
Khalid Ibrahim Aljammaz
3
Ali Mohammed Alduhayshi
4
Jaber Saleh Alhadlaq
5
Department of Internal Medicine, Shaqra University, Shaqra, Saudi Arabia
Medical Student, College of Medicine, Shaqra University, Shaqra, Saudi Arabia
Medical Student, College of Medicine, Shaqra University, Shaqra, Saudi Arabia
Medical Student, College of Medicine, Shaqra University, Shaqra, Saudi Arabia
Medical Student, College of Medicine, Shaqra University, Shaqra, Saudi Arabia
Background: According to the report of World Health Organization (WHO), cardiovascular diseases (CVDs) accounted for most noncommunicable disease (NCD) deaths (17.5 million NCD deaths) during 2012 worldwide. Surveillance of CVD risk factors is a key strategy for effective CVD prevention. Aim: To identify the extent of CVD risk factors of developing cardiovascular disease events among Shaqra population of Saudi Arabia. Method: This community-based cross-sectional study was conducted on a total of 369 participants including 267 (72.3%) males and 102 (27.6%) females aged 18-45 years from Shaqra City of Saudi Arabia. Blood Pressure, BMI, blood glucose, smoking status and family history of CVD risk factors were estimated. Results: Prevalence of hypertension was 10.3% and diabetes 1.6%. Tobacco consumption was 24.8%. Obesity was 23.30%. Family history of HTN and DM was 50.09%. Conclusion: High prevalence of hypertension, obesity and tobacco consumption was seen in Shaqra population which will predispose to CVD risk. Campaigns to raise the awareness of CVD risk factors will boost the quality of life of the peoples and will add years to live.
https://ejhm.journals.ekb.eg/article_47603_88cc064b20530980735115b5416163a3.pdf
Cardiovascular disease
Hypertension
Diabetes mellitus
Smoking
Obesity
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4938
4946
10.21608/ejhm.2019.47811
47811
Original Article
Standard versus Accelerated Collagen Cross-Linking in Treatment of Keratoconus: Visual, Refractive, and Topographic Outcomes
Ibrahim M. Amer
1
Asaad Nooreldin
asaad_nooreldin@yahoo.com
2
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
Background: collagen cross-linking (CXL) is an effective, safe and rapidly progressive treatment modality for treatment of mild to moderate keratoconus not only in hindering the progression of the disease but also in improving the visual, refractive and topographic results. Objective: the study aims to compare the outcomes of standard and accelerated cross-linking in treatment of keratoconus. Patients and Methods: the present prospective study evaluated 99 eyes of 52 patients with keratoconus. They were classified into two groups; group (1) included 50 eyes (received standard CXL; 3Mw/cm2 , 30 min) (SCXL group) and group (2) 49 eyes (treated by accelerated CXL; 9Mw/cm2 , 10 min) (ACXL group). Spherical equivalent, uncorrected visual acuity, best-corrected visual acuity, and topographical analysis of the cornea were assessed at baseline and within 3 years postoperative. Simulated keratometry was measured in terms of Sim K-1, Sim K-2, K-max, cylindrical value, thickness of the cornea (at the thinnest point) and Q-value were evaluated. Results: postoperative uncorrected distance visual acuity and corrected distance visual acuity didn’t significantly changed in both groups. Postoperative spherical equivalent significantly decreased in standard CXL compared to accelerated CXL. Standard CXL had a greater effect in decreasing Simk-1, Simk-2, k-max and k-mean. K-max decreased from 52.33±5.55 to 50.35±5.14; P=0.07 and in accelerated group from 54.58±4.35 to 52.74±4.41; P=0.04. Also, postoperative corneal pachymetery (at thinnest location) was found to be more stable in standard CLX group. Conclusion: both standard and accelerated CXL are effective in early keratoconus management with better results in standard CXL procedure.
https://ejhm.journals.ekb.eg/article_47811_cdb2fc4dc9e163f75f013550690368f5.pdf
standard
Accelerated
Collagen Cross-Linking
Keratoconus
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4947
4951
10.21608/ejhm.2019.47978
47978
Original Article
Evaluation of the Effect of Intracameral Injection of Bevacizumab in the Treatment of Neovascular Glaucoma
Salim Mohamed Osemy
drsalim2017@gmail.com
1
Mahmoud Abd El-Badie Mohamed
2
Emad Abd eI-Aal Saleem
3
Ophthalmology department, Faculty of Medicine, Al-Azhar University (Assuit), Egypt
Ophthalmology department, Faculty of Medicine, Al-Azhar University (Assuit), Egypt
Ophthalmology department, Faculty of Medicine, Al-Azhar University (Assuit), Egypt
Background: neovascular glaucoma (NVG) is a severe condition resulting from ischemia caused by conditions such as central retinal vein occlusion (CRVO), diabetic retinopathy (DR) and chronic uveitis. In NVG, there is neovascularization of the iris (NVI) and anterior chamber angle (NVA) mediated by vascular endothelial growth factor (VEGF) leads to elevation in the intraocular pressure (IOP). Intracameral injection of Bevacizumab show good result in regression of iris neovascularization. Objective: it was to determine the effect of intracameral injection of bevacizumab on the neo-vessels over the iris, and on the IOP in patients with NVG. Patients and Methods: this research is a comparative, prospective, non-randomized study. Fifteen patients of neovascular glaucoma (NVG) (≥21mmHg) (with rubeosis iridis) were divided into four groups. Group 1 had peripupillary vessel dilatations, group 2 had early neovascularization mainly in the chamber angle plus to peripupillary vessel dilatations, group 3 had prominent rubeosis with/without neovascular glaucoma, group 4 had most advanced rubeosis and injected with a single intracamerlar bevacizumab (0.05 ml at the limbus in the upper temporal quadrant) at Al-Azhar University hospital between March 2017-March 2018. Results: after six months of following up the 15 patients, only group 1 showed complete regression of iris neovascularization; group 2, group 3 showed partial regression at first but finally there was recurrence of iris neovascularization; and group 4 didnot show response at all to the treatment. Conclusion: regression of iris neovascularization was inversely proportional to the pre-injection grade. Lower grades were associated with a better response.
https://ejhm.journals.ekb.eg/article_47978_08835721c12a970707799c4bd70c75d2.pdf
Neovascular glaucoma
Central Retinal vein occlusion
diabetic retinopathy
Bevacizumab
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4952
4955
10.21608/ejhm.2019.47981
47981
Original Article
Subconjunctival Bevacizumab versus Mitomycin C Adjunctive to Subscleral Trabeculectomy
Ekram R. Abdallah
ekramragababdallah@gmail.com
1
Mahmoud Abd El-badie Mohamed
2
Hossam Eldeen Saad Abou Saif
3
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University (Assuit), Egypt
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University (Assuit), Egypt
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University (Assuit), Egypt
Background: trabeculectomy was considered gold standard procedure for glaucoma treatment. Mitomycin C (MMC) and bevacizumab (BVZ) has been used to increase trabeculectomy success rates. Objective: to compare the outcome of subscleral trabeculectomy with subconjunctival injection of BVZ with that of trabeculectomy with MMC. Patients and Methods: a prospective, non-randomized, comparative study design was used. Thirty eyes from thirty patients with uncontrolled glaucoma were enrolled. Fifteen eyes underwent subscleral trabeculectomy with intraoperative use of MMC (0.2mg/ml for 3 minutes) (group I) and 15 eyes underwent subscleral trabeculectomy with subconjunctival bevacizumab injection (1.25mg/0.1ml) (group II). The outcome measures were the best-corrected visual acuity, intraocular pressure (IOP), number of IOP-lowering medications, complications, and bleb morphologic features (based on the Indiana Bleb Appearance Grading Scale). Results: thirty eyes of thirty patients fulfilled inclusion criteria and assigned to one of two study groups. Each study group included fifteen eyes of fifteen patients. Participants were 14 males and 16 females. Mean ages of patients assigned to MMC and BVZ were 54.0±7.33 and5.7±6.9 years respectively. The difference in mean age was statistically insignificant among treatment groups (p=0.740). Mean number of pre-operative anti-glaucoma medications used by MMC and BVZ treatment groups were 2.47±0.52 and 2.47±0.52 with no significant difference among treatment groups (p=1.00). Conclusions: adjunctive subconjunctival bevacizumab with trabeculectomy is effective in controlling the IOP profile and the post-operative IOP reduction showed no statistically significant different in both group at all postoperative visits. Comparable success rates were achieved in the two groups.
https://ejhm.journals.ekb.eg/article_47981_659debfe4330ee18c82c5d8bfc2aa179.pdf
subscleral trabeculectomy
Bevacizumab
mitomycin c
Intraocular Pressure
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4956
4963
10.21608/ejhm.2019.47982
47982
Original Article
Impact of Temporal Lobe Epilepsy on Central Auditory Processing in Children
Naema Mohammed Ismail
1
Amany Ahmed Shalaby
2
Ghada Saed Abdel Azim
3
Eman Ismail Abd-Ellatif
4
Department of ENT, Audiology unit, Faculty of Medicine (for Girls), Al-Azhar University
Department of ENT, Audiology unit, Faculty of Medicine, Ain Shams University
Department of Neurology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
Department of ENT, Audiology unit, Faculty of Medicine (for Girls), Al-Azhar University
Background: Anatomical and functional integrity of the auditory pathways, from peripheral to central structures, is essential for proper processing of auditory stimuli and a satisfactory development of language, speech, and learning. Neurological disorders, such as epilepsy, are one of the possible causes of central auditory disorders. Objective: The aim of the current work was to study the effect of temporal lobe epilepsy on auditory temporal resolution ability in children. Patients and methods: Thirty children suffering from temporal lobe epilepsy, with age ranged from 12 to 16 years, were included in this study. Also, 10 apparently healthy children with age and gender matched with the study group were taken as a control group. All children were subjected to full history taking, clinical examination, cognitive and basic audiological evaluation. Also, questionnaire for central auditory processing disorders in children was applied and assessment of temporal resolution ability using Gaps In Noise (GIN) test. Results: Children with temporal lobe epilepsy had significantly increased gap detection threshold (GDTh) values, and lower percentage of correct gap detection than control group. 86.7% of epileptic children demonstrated abnormal scores for approximate GIN threshold (gap detection threshold above 6 msec, with sensitivity and specificity of 80% and 100% for right ear and 86% and 100% for left ear. Conclusion: Temporal resolution deficit is a comorbidity in children with temporal lobe epilepsy and is increased with longer duration of epilepsy. Impairment was not affected by age, gender, medications or duration of treatment. Also, there was no significant difference between both ears in GIN test, reflecting no laterality effect.
https://ejhm.journals.ekb.eg/article_47982_95a344699a6d0ca7d0ee2a2a20fdf015.pdf
Temporal lope Epilepsy
Auditory Temporal Resolution
Gaps in Noise Test
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4963
4969
10.21608/ejhm.2019.47983
47983
Original Article
In Vitro Evaluation of Antiviral / Virucidal Activity of Naja Nubiae (Elapidae) Venom Against Rift Valley Fever and Herpes Simplex Virus Type -1 (HSV-1) Using Cell Culture
Kareem A. Yonys
karemyonys1990@gmail.com
1
Samy A. Saber
2
Abir A. El-Fiky
3
Aly F. Mohamed
4
Department of Zoology, Faculty of Science (Boys branch), Al-Azhar University
Department of Zoology, Faculty of Science (Boys branch), Al-Azhar University
ANDI COE in Antivenom Research
R&D Sector VACSERA
Background: Venoms are pretentious products secreted by snake, invertebrates and scorpions. Venoms composed of different proteins, toxic fractions, enzymes and hormones. Some fractions proved bioactivity including anticoagulation. antimicrobial and anticancer activity. Objective: The aim of the current study was to in vitro evaluate the Antiviral / virucidal activity of Naja nubia (Elapidae) venom against Rift Valley Fever (RVFv) and Herpes simplex virus type -1 (HSV-1) using cell culture. Materials and methods: Toxicity of tested venom was performed using cell culture to determine the safe concentration using MTT assay. Antiviral activity was conducted by precultured cell treatment with safe concentration of snake venom for 24 hr. then virus was dispensed as 0.1 ml / well in quadrate for each dilution. TCID50s of snake venom safe concentration treated and untreated cells were determined. The difference is the antiviral activity. Virucidal was conducted by mixing one part of virus models with nine parts of the safe concentration of snake venom at 37oC. The infectivity titer / time interval was determined according to Reed and Menuch equation. Result: Data record revealed that the cell viability was concentration dependent recording an IC50 of 9.3 µg/ ml. Also, venom showed a very limited antiviral activity but the virucidal activity was time dependent and showed a depletion rate in the order of 0.72 log (10) and 0.94 log (10) /hr. for RVFV and HSV-1 respectively indicating that RVFv was moderately sensitive than HSV-1. Conclusion: It could be concluded that Naja Nubiae venom is a potentially virucidal agent than antiviral one with persistent inactivation potential.
https://ejhm.journals.ekb.eg/article_47983_e14b87bbaec2d25ba66831eb968c4e42.pdf
Naja nubiae
Antiviral
Virucidal
Rift valley forever virus
Herpes simplex type 1
cell culture
MTT
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4970
4975
10.21608/ejhm.2019.47984
47984
Original Article
Comparative Study between Efficacy of Two Quadruple DAAs Therapy in Treatment of HCV Relapsers
Amgad A. Elzahaby
1
Kamel S. Hammad
2
Waleed M. Mousa
3
Ahmed S. Elkhapaty
drahmeds3d.as@gmail.com
4
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Al-Azhar University, Cairo
Department of Clinical pathology, Faculty of Medicine, Al-Azhar University, Cairo
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Al-Azhar University, Cairo
Kafr-Elsheikh Liver Research Center of Hepatology
Background: Chronic hepatitis C virus (HCV) is considered as a major cause of liver diseases. The standard treatment of HCV infection is a combination of direct-acting antiviral agents (DAAs). Relapse is defined where HCV RNA remained undetectable at the end of therapy but rebounded to pretreatment levels once DAA therapy was discontinued. Aim of the study: This study was performed to compare efficacy and safety of two quadruple DAAs regimens (Sofosbuvir/Daclatasvir/Simeprevir and Ribavirin Vs. Sofosbuvir/Ombitasvir/ Paritaprevir/ ritonavir - Ribavirin) in treatment of HCV relapsers. Patients and Methods: Retrospective cross-sectional study of 90 experienced patients previously treated with Sofosbuvir and Daclatasvir ± Ribavirin for 3 months and relapsed. The patients were divided into two groups, each group included 45 patients: Group I treated with (Sofosbuvir and Daclatasvir -simeprevir—Ribavirin) while Group II treated with (Sofosbuvir-Ombitasvir/Paritaprevir/ritonavir - Ribavirin). Results: The study showed an excellent response to both regimens of treatment. In group I; the sustained virologic response rates at 24th week were 44/45 (97.8%); 100% (29/29) in non-cirrhotic and 93.8% (15/16) in cirrhotic patients. while group II SVR 24 rates were 93.3% (44/45); 92.9% (26/28) of non-cirrhotic patients, and 94.1% (16/17) of cirrhotic patients. while group II SVR 24 93.3% (44/45) of overall patients, 92.9% (26/28) of non-cirrhotic patients, and 94.1% (16/17) of cirrhotic patients. Additionally, the most common adverse events reported were easy fatiguability, headache, nausea, generalized weakness, photosensitivity - in group I only. Conclusion: It could be concluded that the current combination regimen is well tolerated and achieved excellent SVR rates.
https://ejhm.journals.ekb.eg/article_47984_c4b80136f4165a20b2e50b5fceb4edc0.pdf
two quadruple DAAs therapy
HCV relapsers
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4976
4981
10.21608/ejhm.2019.47985
47985
Original Article
Sutureless Phacovitrectomy in Vitreoretinal Diseases of Presbyopic Patients with Clear Crystalline Lens
Ahmed Hassan Abdel Wahab
1
Mostafa Mahmoud Mostafa
2
Ahmed Salah Abdel-Rehim
dr.hasan.wahab@live.com
3
Department of Ophthalmology, Faculty of Medicin, Al-Azhar University
Department of Ophthalmology, Faculty of Medicin, Al-Azhar University
Department of Ophthalmology, Faculty of Medicin, Al-Azhar University
Background: Patients with vitroreinal diseases require surgical intervention frequently have coexisting lens opacification. Cataracts increase in prevalence with age, as do vitreoretinal pathologies such as macular holes, epiretinal membranes, and retinal detachments. Diabetes is another contributing factor that results in the development of both retinal disease and cataracts. In addition, vitrectomy itself causes cataracts to progress. Objective: The aim of the work to review the results and complications of combined phacoemulsification and vitrectomy in presbyopic patients with clear crystalline lens and compare it with the results and complications of separate surgeries. Patients and methods: This study carried on 40 presbyopic patients with clear lens having complex vitreoretinal disease in which vitrectomy is essentially required such as primary rhegmatogenous retinal detachement, recurrent rhegmatogenous retinal detachement, full thickness macular hole Stages 3,4,5, idiopathic epiretinal membrane, proliferative diabetic retinopathy and vitreous hemorrhage. Result: There is no difference between the groups regarding sex, diagnosis, used material, VA, and IOP. VA showed improvement in both groups at the same degree post operatively. But there is no change in the IOP postoperatively compared to the preoperative measurement in both groups. The only complication that showed significant difference between the two groups is the visually significant PCO which occurred in 2 cases (9.5%) in the Combined Phaco Vitrectomy compared to 10 cases of PSC in the PPV alone group (43.5%). Conclusion: Our study provides evidence that combing phaco and vitrectomy has more efficacy vitrectomy alone then phaco regarding visual acuity improvement with lower incidence of complications.
https://ejhm.journals.ekb.eg/article_47985_6580fa86c09c17ea0b4a8bcdb238f0ac.pdf
Sutureless Phacovitrectomy
Vitreoretinal Diseases
Presbyopic Patients
Clear Crystalline Lens
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4982
4986
10.21608/ejhm.2019.47986
47986
Original Article
Evaluation of Meibomian Glands Dysfunction in Type Two Diabetic Patients
Nada N. El Sawy
dr.nadaelsawy@yahoo.com
1
Doaa A. Mahmoud
doaamahmoud75@gmail.com
2
Wafaa A. Madbouly
3
Department of Ophthalmology, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt.
Department of Ophthalmology, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt.
Department of Ophthalmology, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt.
Background: Diabetes Mellitus is one of the most common leading causes of blindness. Cataract and retinopathy are wellknown as ocular complications of diabetes, problems involving the ocular surface; dry eyes in particular, have been reported in diabetic patients. Aim of the Work: to evaluate Meibomian glands function in patients with type 2 diabetes Mellitus. Materials and Methods: this prospective observational study compared changes in Meibomian glands and tear film function in type 2 diabetic patients with non-diabetic patients. It included 20 eyes of 11 patients with type two diabetes mellitus and 20 eyes of 11 healthy non-diabetic controls. Meibomian glands function was evaluated by grading of Meibomian gland loss by meibography. Tear film function was assessed by dry eye questionnaire, measuring tear breakup time (TBUT), the Schirmer I test & corneal and Conjunctival fluorescein staining. Results: dry eye questionnaire results were significantly higher scoring in diabetic group comparing with non-diabetic. TBUT was significantly lower in diabetic, especially with longer diabetic duration, comparing with normal control. Schirmer 1 test, corneal and conjunctival fluorescein staining, was significantly higher in diabetic patients compared with normal control. Meibography showed significant high scoring in diabetic patients that represent significant decrease in Meibomian gland number compared with controls. Conclusion: our data suggest that type 2 diabetes predisposes to various changes on the ocular surface Meibomian gland dysfunction (MGD) in type 2 diabetic patients is more severe compared with nondiabetic patients. It should be noted at an early stage and treated appropriately in order to prevent more severe eye complications. Therefore, close attention should be paid to the ocular surface, especially in long-term diabetes mellitus. Further studies are needed to increase the sample size and include fluctuations in blood sugar as a key factor in studying the ocular surface.
https://ejhm.journals.ekb.eg/article_47986_94af1186fbda816dac37e21a888e4bd6.pdf
Meibomian Glands Dysfunction
Type Two Diabetic Patients
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4987
4992
10.21608/ejhm.2019.48134
48134
Original Article
Magnesium Sulfate versus Fentanyl as Adjuvant to Epidural Levobupivacaine in Surgeries below Umbilicus
Osama Helal Ahmed
1
Waheed Mohamed Ali
2
Yasser Mamdouh Kamel
yasser.kamel13@yahoo.com
3
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Background: Epidural anesthesia is performed to provide anesthesia for surgical procedures carried on lower abdomen, pelvis, and lower limbs. It offers superior pain relief and early mobilization especially when local anesthetic is combined with an adjuvant. Noxious impulses from damaged tissue evoke long lasting alterations in the central nervous system. Objective: The aim of the current study was to evaluate and compare between the effectiveness of adding magnesium sulphate versus addition of fentanyl to epidural levobupivacaine in onset of sensory and motor block, duration of analgesia , quality of block , intraoperative hemodynamics, post-operative pain control and post-operative side effects. Patients and Methods: The present study is a prospective randomized double blind controlled comparative study conducted for patients scheduled to undergo elective surgeries below umbilicus in Al-Azhar University Hospital in Assiut. After obtaining Institutional Ethics Committee approval and written informed consent, 90 patients ASA I/II were enrolled into the study. Results: this study demonstrated that magnesium, and fentanyl are effective as useful adjuvants to local anesthetic for epidural anesthesia. Magnesium sulphate is associated with a shorter onset of action of the epidural block with less nausea, vomiting and pruritis incidence, fentanyl have a prolonged duration but more incidence for those side effects. Conclusion: It could be concluded that magnesium sulfate and fentanyl are good adjuvants to local anesthetics when given epidurally, fentanyl provides more duration of analgesia but with more incidence of nausea vomiting and pruritis when compared to magnesium sulfate, but magnesium sulfate show more incidence of pain with injection.
https://ejhm.journals.ekb.eg/article_48134_3245b35dc2505d5b186520b45f33f482.pdf
magnesium sulfate
Fentanyl
Epidural Levobupivacaine
Surgeries Below Umbilicus
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
4993
5001
10.21608/ejhm.2019.48136
48136
Original Article
Sutureless Glueless Conjunctival Autograft for Primary Pterygium Surgery
Abd Allah Alhusseiny Abdel Gawad
1
Riad Alzaher Hassan
2
Ahmed Mostafa Ismail
optic.chiasma@yahoo.com
3
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Background: Pterygium is a fibrovascular growth of an abnormal conjunctival tissue that progressively encroaches the limbus and then onto the cornea invading its superficial layers. It is a common ophthalmic condition seen mostly in dry, dusty areas. Objective: The aim of the current study was to evaluate the sutureless glueless conjunctival autograft for primary pterygium surgery as regard technique, complications and success rate. Patients and methods: This prospective study included a total of 30 patients with primary nasal pterygium, attending at Outpatient Clinic of Ophthalmology Department, Al-Azhar University, Damietta. This study was conducted between March 2017 to March 2018. Results: When comparing post-operative values at the end of third month with the first month we have found no difference in corneal state for all patients. The patient with corneal opacity was as the first month and had no difference in corneal state or BCVA. We detected one patient (3.3%) having recurrent pterygium. Finally when comparing post-operative values at the sixth month with the third month, we have found another patient who was reported with recurrent pterygium. Thus, the recurrence rate was 2 patients (6.7%) among all studied patients and the other values were approximately the same. Conclusion: This study suggests that sutureless glueless conjunctival autograft technique is a safe, simple, easy of performance, has less surgical time and very effective for the management of primary pterygium.
https://ejhm.journals.ekb.eg/article_48136_aae2c058c102ac0b36fd891108d89b19.pdf
Sutureless Glueless Conjunctival Autograft
Pterygium
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5002
5007
10.21608/ejhm.2019.48507
48507
Original Article
Effect of Diabetic Retinopathy on Retinal Nerve Fiber Layer Thickness
Mohamed Tarek Abdelmoneim
1
Abdulla Mohamed Elamin
2
Alaa Abdelmongy Sadaka
3
Hossam Abdelfattah Husein
dr.hossamhmmad@yahoo.com
4
Department of Ophthalmology, Faculty of Medicine Aswan University
Department of Ophthalmology, Faculty of Medicine Aswan University
Department of Ophthalmology, Faculty of Medicine Aswan University
Department of Ophthalmology, Faculty of Medicine Aswan University
Background: Diabetic retinopathy is one of the most common causes of vision loss in developed countries. Objective: The objective of this study was to assess the effect of diabetic retinopathy (DR) on the retinal nerve fiber layer (RNFL) thickness. Patients and methods: This study was carried out on 55 eyes of 35 patients designed as a prospective, interventional case series at Sohag Hospital from January, 2016 to December, 2016. A complete ophthalmologic examination was performed including best-corrected visual acuity (BCVA) using the ETDRS charts, intraocular pressure (IOP) measurement, slit-lamp biomicroscopic examination, fundus examination and fluorescein angiography. Results: The RNFL (inferior and total) thickness at each follow-up was increased significantly from baseline to 1 month and 6 months post-PRP then decreased significantly from 1 month to 6 months follow up (p < 0.001). The superior RNFL was increased significantly from baseline to 1 month post-PRP and then decreased at 6 month follow up (p < 0.001). While no significant change from 1 month to 6 months follow up (p > 0.05). Conclusion: Increase in the macular Ganglion cell (GC) thickness and RNFL at 1 month of follow-up that may be related to laser induced intraretinal inflammation which triggers increased capillary permeability and ensuing axonal edema due to the cytokine release.
https://ejhm.journals.ekb.eg/article_48507_59f379ea9bea06630999687bdb0d71cf.pdf
diabetic retinopathy
Retinal nerve fiber layer thickness
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5008
5015
10.21608/ejhm.2019.48509
48509
Original Article
Carbetocin Versus Oxytocin in Prevention of Atonic Postpartum Hemorrhage
Esmael Mohamed Talaat Elgarhy
1
Ashraf Hamdy Mohamed
2
Mohamed Mahmoud Mohamed Abdelfatah
dr.mzayed2020@gmail.com
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: Death due to pregnancy remains an important cause of premature mortality of women worldwide. An estimated 500,000 women die from this cause every year with up to quarter of deaths occur due to hemorrhage. Objective: The aim of this study was to compare the effectiveness and safety of carbetocin versus oxytocin in the prevention of atonic postpartum Hemorrhage (PPH) after vaginal deliveries and cesarean sections. Patient and Methods: This computerized random cross sectional prospective comparative study included a total of 400 pregnant women who were going to deliver, attending at Obstetric and Gynecological Department at El-Mataria Teaching Hospital in Corporation with Obstetric and Gynecological Department, Faculty of Medicine, Al-Azhar University. This study was conducted between October 2017 to October 2018. Results: Carbetocin was proved statistically to be more effective in preventing uterus atony and thereby PPH in comparison with oxytocin. Conclusion: It could be concluded that carbetocin is a better uterotonic agent in comparison with Oxytocin in the management of atonic postpartum hemorrhage after delivery either vaginal or cesarean section as it decreases incidence of occurrence of PPH and post-partum blood loss.
https://ejhm.journals.ekb.eg/article_48509_347279f74fa14118bfe4c0292f2a6fca.pdf
carbetocin
oxytocin
Atonic Postpartum Hemorrhage
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5016
5025
10.21608/ejhm.2019.48512
48512
Original Article
Mustardé Versus Incisionless Otoplasty for Protruding Ear
Mohamed Hassan Abdel-Aal
1
Mohammad Reda Ahmad
2
Mansour Mohamed Morsy
3
Mohamed Elsayed Mohamed Abdel-Wahed
mohamed.abdelwahed.1989@gmail.com
4
Department of General Surgery – Faculty of Medicine, Zagazig University
Department of General Surgery – Faculty of Medicine, Zagazig University
Department of General Surgery – Faculty of Medicine, Zagazig University
Department of General Surgery – Faculty of Medicine, Zagazig University
Background: Prominent ear is one of the most common facial deformities affecting children. The aesthetic and psychosocial concerns surrounding an ear deformity serve as a catalyst for parents to seek correction, thereby propagating the strong desire for otoplasty at an early age. Objective: is to assess the role of Mustardé technique and incisionless otoplasty technique regarding aesthetic outcome in surgical treatment of protruding ear, complications and postoperative care. Subjects and methods: 24 patients (18 males and 6 females) suffering from prominent ear deformity (4 unilateral and 20 bilateral) were included in the present study. The reconstructive procedures were done for 44 ears divided by the procedure done into 2 groups. Group A: Mustardé procedure (21 ears, 8 patients with bilateral prominent ear and 2 patients with unilateral prominent ear); and group B: Incision-less procedure (23 ears, 9 patients with bilateral prominent ear and 2 patients with unilateral prominent ear). An approval of the study was obtained from Zagazig University academic and ethical committee and an informed written consent was obtained from each patient for acceptance of the operation. Results: The mean values of the duration of operation in Mustardé procedure (group A) was significantly longer than that of Incision-less procedure (P < 0.001). The follow up period (months) revealed non-significant difference between both groups (P> 0.05). Mustardé procedure (group A) has a significant high percentage of reduction in auriculocephalic distance (P < 0.01), when compared with that of incision-less procedure, the percentage of reduction of the auriculo-temporal distance, and auriculo-mastoid distance of Mustardé procedure (group A) had a non-significant high values when compared with those of incision-less procedure (P> 0.05). Conclusion: Both Mustarde and the incision-less suture techniques provide satisfactory results; however, the incisionless suture technique appears to be easier with less surgical time.
https://ejhm.journals.ekb.eg/article_48512_dd603de3460b3c7b3b55dcaa85c59b6d.pdf
Mustarde
Incisionless otoplasty
Protruding ear
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5026
5031
10.21608/ejhm.2019.48688
48688
Original Article
Association between Colonization with Group B Streptococcus and Preterm Delivery
Yahia Abd El Salam Wafaa
1
Muhammad Hesham Hassan
2
Mohamed Ibrahim Mostafa
3
Nagham Abed Mohamed Elameer
4
Amr Ahmed Sayed Ali Mohammed
amr.aa.mohammed@gmail.com
5
Department of Obstetrics and Gynaecology, Faculty of Medicine, Al-Azhar University
Department of Obstetrics and Gynaecology, Faculty of Medicine, Al-Azhar University
Department of Obstetrics and Gynaecology, Faculty of Medicine, Al-Azhar University
Clinical Pathology, Al-Galaa Maternity Teaching Hospital
Department of Obstetrics and Gynaecology, Faculty of Medicine, Al-Azhar University
Background: Despite major advances in perinatal care, preterm delivery (PTL) is still the predominant cause of perinatal mortality and a major cause of neurological morbidity in surviving infants. Objective: the objective of this study is to find any association between maternal group B streptococcus (GBS) colonization and preterm delivery. Patients and Method: This study is a prospective study including 100 pregnant women between 28 – 36 weeks of gestation from those who attended the Emergency Department at Al-Galaa Maternity Teaching Hospital from April 2015 to August 2015. All patients were tested for genital colonization with Group B streptococcus (GBS) by taking low vaginal swab that was sent for microbiological examination. Results: In this study there was a significant difference between positive and negative cases as regard obstetric data. As regard preterm labor, 80% of positive swab cases had preterm labor compared to 46.2% of negative swab cases and this was statistically significant. Positive vaginal swab cases are at 7 times higher risk to have preterm labor compared to negative cases. Conclusion: GBS vaginal colonization was associated with premature labour in the studied population. Women with GBS vaginal colonization qualify for intrapartum chemoprophylaxis. The study results suggest that the early prenatal screening for GBS may identify pregnant women at risk of PTL.
https://ejhm.journals.ekb.eg/article_48688_226399d44971777d3e2e95f7e8dcb599.pdf
Group B Streptococcus
Preterm Delivery
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5032
5039
10.21608/ejhm.2019.48690
48690
Original Article
Optical Coherence Tomography Evaluation of Retinal Nerve Fiber Layer and Ganglion Cell Layer Thickness before and after Argon Laser in Treatment of Diabetic Retinopathy
Mohamed Tarek Abdelmoneim
1
Abdulla Mohamed Elamin
2
Alaa Abdelmongy Sadaka
3
Hossam Abdelfattah Husein
dr.hossamhmmad@yahoo.com
4
Department of Ophthalmology, Faculty of Medicine, Aswan University
Department of Ophthalmology, Faculty of Medicine, Aswan University
Department of Ophthalmology, Faculty of Medicine, Aswan University
Department of Ophthalmology, Faculty of Medicine, Aswan University
Background: Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes with the potential to cause severe vision loss and blindness and a devastating effect on quality of life. Objective: Discuss the macular ganglion cell and retinal nerve fiber layer (RNFL) changes after laser treatment as a management of diabetic retinopathy. Patients and Methods: This study was carried out on 55 eyes of 35 patients designed as a prospective, interventional case series at Sohag Ophthalmic Diagnostic Laser Unit between January 2016 and March 2017. A complete ophthalmologic examination was performed, including best-corrected visual acuity (BCVA) using the ETDRS charts, intraocular pressure (IOP) measurement, slit-lamp biomicroscopic examination, fundus examination, fluorescein angiography, and 3D optical coherence tomography (OCT) 2000. Results: The value of RNFL (superior and total) in the GRID group is more than in the pan-retinal photocoagulation (PRP) group which increased at 1 month post laser (not significant) then significantly decreased at 6 month follow up. The value of RNFL (inferior) in the GRID group is more than in the PRP group which significantly increased at 1 month post laser then decreased at 6 month follow up table 4. Conclusion: Significant ganglion cell (GC) and RNLF decrease at the sixth month of follow-up can be attributed to axonal loss secondary to direct or indirect effects of PRP treatment. SD OCT is a very valuable tool to document the RNFL thickness changes following the argon laser photocoagulation.
https://ejhm.journals.ekb.eg/article_48690_47a702f0df9e30c15785bbc2b499074f.pdf
Optical Coherence Tomography
Retinal nerve fiber layer
Argon laser in treatment
diabetic retinopathy
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5040
5048
10.21608/ejhm.2019.48863
48863
Original Article
Identification of Silicone Oil Maculopathy by OCT after Vitrectomy for Rhegmatogenous Retinal Detachment
Ibrahim M. Amer
1
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
Background: silicone oil (SO) is used as a vitreous replacement and has been shown to be effective in repairing complicated retinal detachment. Its use, however, may have several disadvantages. Aim: to study the macular changes after SO injection as tamponade in vitrectomy for rhegmatogenous retinal detachment (RRD). Patients and Methods: a prospective, interventional and non-randomized study was performed on 75 eyes (75 patients) of RRD. The patients underwent primary vitrectomy with SO tamponade. All the patients were examined at baseline and postoperatively at day one, one week, one month, and three months. Each visit examination included best corrected visual acuity (BCVA), indirect ophthalmoscopy slit-lamp biomicroscopy, fundus examination by binocular indirect slit-lamp biomicroscopy, measurement of intraocular pressure, and optical coherent tomography (OCT) at 1,3 months postoperatively. Results: 71 of the 75 eyes, had a successful vitrectomy with reattached retina under SO tamponade and 4 eyes were excluded. The patients’ mean age was 48±4.5 years. Preoperatively, the macula was on in 41(57.75%) eyes and off in 30(42.25%) while retinal detachment (RD) was total in 18(25.35%) eyes and subtotal in 53(74.65%) eyes. Central macular thickness (CMT) was 177-850 microns. Three months after vitrectomy, CMT was 154-708 microns. While no statistical significant difference was detected between 1 month to 3 months after vitrectomy (P=0.175). Postoperative OCT changes include attenuated IS/OS junction in 16(22.54%) eyes, macular edema in 15(21.13%) eyes, epiretinal membrane in 13(18.31%) eyes. Conclusions: OCT is a beneficial tool for identification of silicone oil maculopathy even in clinically normal maculae.
https://ejhm.journals.ekb.eg/article_48863_58a2d3f5387e9e160ca25bdc6e8b892e.pdf
Silicone Oil
maculopathy
OCT
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5049
5055
10.21608/ejhm.2019.48880
48880
Original Article
Assessment of Nutrition State in Children with Heart Diseases
Hanan M. Abdelmoneim
1
Bahaa Elamir Hawary
2
Alaa Magdi Eldoctour Soliman
alaa.kroosh@gmail.com
3
Department of Pediatrics, Faculty of Medicine Aswan University
Department of Pediatrics, Faculty of Medicine Aswan University
Department of Pediatrics, Faculty of Medicine Aswan University
Background: It is well- known that children with congenital heart diseases (CHD) are at high risk for nutrition and growth restrictions. Objective: The purpose of this study was to assess growth restriction in infants and young children with heart disease and investigate the relationship between poor growth, feeding difficulties, cardiac classification, and nutrition intervention on outcomes. Materials and Methods: This study was performed on 100 children, 50 of them with symptomatic CHD (patient group). They were recruited from the Pediatric Cardiology Outpatient Clinic at Aswan Heart Center from March to August, 2016. A group of 50 apparently healthy children matched in age and sex represented our control group. CHD was diagnosed or excluded by clinical findings and echocardiographic and other routine tests. Results: We found there was some growth restriction in children with CHD compared to normal children in same age group. The growth deficiency was wasting rather than stunting and it was found to be the most common type of malnutrition in our study. No relationship between cardiac complexity, classification (cyanotic vs. acyanotic) and variables including growth parameters. Close nutritional monitoring should be included routinely for all children with CHD regardless of cardiac classification. Age at time of corrective surgery affects the potential for nutritional recovery and catch-up growth. Conclusion: Children with CHD require unique nutritional challenges. It is important to start dealing with nutrition status in congenital heart diseases as a preventable association rather than common consequence. Nutritional screening for diagnosed CHD cases will help in early detection of growth faltering, consequently it will provide access to early nutrition intervention and improve patient outcomes.
https://ejhm.journals.ekb.eg/article_48880_26a5de02c8b5b6fdd85eafda06c9fc21.pdf
Congenital heart disease
Malnutrition
Immunonutrition
Nutrition in CHD
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5056
5059
10.21608/ejhm.2019.49260
49260
Original Article
Endovascular Treatment of Cerebral Aneurysms Not Presented by Classic Subarachnoid Hemorrhage (First Year Experience by Neurologist)
Eman M Khedr
1
Ahmed Bassiony
2
Hany Zaky-Eldin
3
Bastawy Fawal
4
Ahmed Shoyb
ahmed.shoyb@yahoo.com
5
Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Assuit, Egypt and the Academic Director of Neuropsychiatry Department, Faculty of Medicine, Aswan University, Aswan
Department of Neuropsychiatry, Faculty of Medicine, Ain shams University, Cairo
Department of Neuropsychiatry, Faculty of Medicine, Ain shams University, Cairo
Department of Neuropsychiatry, Faculty of Medicine, Aswan University, Aswan, Egypt
Department of Neuropsychiatry, Faculty of Medicine, Aswan University, Aswan, Egypt
Saccular intracranial aneurysms are localized enlargement lesions of the vasculature, most commonly sited at bifurcation points in the circle of Willis. Often they will stay asymptomatic during the life. Its common presentation is rupture that leads to subarachnoid hemorrhage (SAH) but had other presentation as ischemic stroke or compressive symptoms. Material and Methods: we recruited 16 patients with intracranial aneurysm that had presentations other than subarachnoid hemorrhage and was treated by endovascular intervention and evaluated clinically and angiographically before procedure and 3-6 months after procedure Results: the mean age of patients was 5.75±11.1 ranging between 23 – 69 years. 10 patients were females and 6 were males. 7 patients (43.8 %) were hypertensive which was the commonest risk factor in those patients. 6 patients (37.5%) had ICA aneurysm. Conclusion: endovascular therapy of intracranial aneurysms is a safe and effective method of therapy with less morbidity and mortality rates.
https://ejhm.journals.ekb.eg/article_49260_2c0faec6aa30e3a53e7c287b6f8228ff.pdf
Subarachnoid Hemorrhage
rupture aneurysm
coiling
Ethical approval no: ASU 44-1-16
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5060
5067
10.21608/ejhm.2019.49263
49263
Original Article
Effect of Specific Nutritional Program on Patients with Chronic Renal Failure on Hemodialysis on El-keman Village Luxor Governorate
Mona Mostafa Aboserea
1
Hala Ahmed El-Maghawry
2
Mostafa Saad Ahmed Mohamed
drsafysaad@yahoo.com
3
Department of Public health & Community Medicine, Faculty of Medicine, Zagazig University
Department of Public health & Community Medicine, Faculty of Medicine, Zagazig University
Department of Family Medicine, Faculty of Medicine, Zagazig University
Background: Chronic renal failure is a universal community health problem. It is important to the patient to be on a specific healthy diet program. Objective: The present study was conducted to evaluate the effect of a specified nutritional program on the health status of renal patients on hemodialysis. Patients and methods: This was an interventional study that was conducted in the renal dialysis unit in El-keman village, Luxor Governorate. It included 60 patients with chronic renal failure on hemodialysis. An educational nutritional program was designed for the studied group. The patients were assessed pre- and post-intervention. The collected data were analyzed by using SPSS program version 19 with considering statistical significance when P value < 0.05. Results: The mean age of the studied participants was 46 years with age ranging from 20-60 years old. Nearly 56.7% of the patients were males and 51.7% of them were of low social class. Regarding the Mini Nutritional Assessment (MNA), there was highly statistically significant difference in MNA score before and after intervention (25.07 versus 22.45 respectively) and there was marked significant reduction in malnutrition percentage after the intervention. Creatinine, urea, AST, ALT and cholesterol significantly decreased after intervention compared to the levels before it. There was highly statistically significant improvement in hemoglobin level after intervention. Conclusion: It can be concluded that proper nutrition is important for patients on hemodialysis as good nutritional status of the patients affects greatly their quality of life and health status.
https://ejhm.journals.ekb.eg/article_49263_b9d242b3759cee40b6a586be4059301c.pdf
Specific Nutritional Program / Chronic Renal Failure / Hemodialysis
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5068
5073
10.21608/ejhm.2019.49264
49264
Original Article
Efficacy and Safety of Eltrombopag for the Treatment of Chronic Idiopathic Thrombocytopenic Purpura in Children and Adolescents
Tamer Hasan Hassan
1
Marwa Zakaria Mohamed
2
Sameh Nabil Khalil Nada
merna.emad.roshdy@gmail.com
3
Department of Pediatrics, Faculty of Medicine, Zagazig University
Department of Pediatrics, Faculty of Medicine, Zagazig University
Department of Pediatrics, Faculty of Medicine, Zagazig University
Background: Chronic ITP is a very common disease in children. Most treatment options have focused on slowing platelet destruction like corticosteroids and IVIG. These treatments are not always effective, or have only a transient effect, and treatment related adverse events often restrict further use. Impaired platelet production has been evolved as a potential disease mechanism for ITP. As a result, growth factor and growth factor analogue stimulation of megakaryopoiesis has also been investigated. Objective: is to evaluate the efficacy and safety of eltrombopag for the treatment of children and adolescents with chronic ITP. Subjects and methods: It was a prospective cohort study which was conducted on forty patients (22 males and 18 females) with chronic ITP. They were treated with eltrombopag for a period ranged from 6 months to 2 years after failure of first line of treatment (steroids, IVIG or both). Patients started eltrombopag with mean initial platelet count 14.4 X 103 / uL and were evaluated after at least 6 months of therapy. The study was approved by the academic and medical ethics committee of Zagazig University and a written informed consent was obtained from all patients. Results: Thirty patients (75%) responded to eltrombopag with a mean platelet count of 100.9 X103/ uL while 10 patients (25%) did not respond to the drug. Mean platelet count was significantly higher after eltrombopag therapy (100.9 ± 65.97 versus 14.4 ± 8.87, P < 0.001). The longer the duration of treatment, the higher the mean platelet count after treatment (r = 0.4, P < 0.001). Only 43.3% of responders received combined treatment with IVIG and steroids versus 20% of non-responders (p = 0.006). Conclusion: Eltrombopag is an effective, well tolerated and safe drug to restore platelet counts at levels high enough to prevent bleeding events in children with chronic ITP.
https://ejhm.journals.ekb.eg/article_49264_b9e0262c2d6c821191978c1a1074da57.pdf
Eltrombobag
Chronic ITP
Treatment
children
Efficacy
safety
eng
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
2019-10-01
77
2
5074
5080
10.21608/ejhm.2019.49265
49265
Original Article
The Value of Iron Metabolism Dynamic Changes in Response to Direct Anti-Viral Agents among Egyptian Chronic HCV Patients
Assem El-Sherif
1
Fathy G. Abd El-Razek
2
Mohammed S. Hussein
3
Mohammed El Shorbagy
4
Ahmed Eliwa
ahmedmahereliwa@yahoo.com
5
Mohamed El Kassas
6
Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
Background: Like other viruses, hepatitis C virus (HCV) needs constituents of host cells to proliferate and iron is considered as one of the most important constituents. So, chronic HCV often appears to be associated with disturbances in iron homeostasis. Objective: The aim of this study was to evaluate the iron metabolism dynamic changes in response to direct antiviral agents (DAAs) among Egyptian chronic HCV patients. Patients and Methods: This prospective cohort study was conducted on 180 subjects, 150 of them had chronic HCV whom received different DAAs regimens at one of the specialized HCV treatment facilities (Group A), as well as another 30 healthy volunteers (Group B), in the period from January 2017 to September 2018. The study was approved by the medical ethics committee of Al-Azhar University Hospitals and a written informed consent was obtained from all patients. Result: Before treatment, serum iron, ferritin, transferrin saturation and triglycerides were significantly higher among HCV patients when compared to controls (p<0.001), while serum TIBC, transferrin, hepcidin, hepcidin/Ferritin ration, cholesterol were significantly lower in HCV patients in comparison with controls (p<0.001). Following treatment with DAAs, serum iron, ferritin, transferrin saturation and triglycerides were significantly decreased. On the other hand, serum TIBC, transferrin, hepcidin, hepcidin/Ferritin ration and serum cholesterol were significantly increased. The improvement of HbA1c was associated with an improvement in iron overload parameters. Conclusion: Rapid decrease in serum ferritin during IFN/RBV free treatment may reflect a quick regression of inflammation after inhibition of viral replication. The improvement in the iron parameters associated with improvement in triglyceride and glucose metabolism may also suggest an improvement of metabolic functions of the liver following HCV eradication.
https://ejhm.journals.ekb.eg/article_49265_1af5dfb67a45adc2defec04d9f61721e.pdf
HCV
hepcidin
iron
Lipid
DAAs