ORIGINAL_ARTICLE
Left Ventricular Function as An Independent Prognostic Factor for Coronary Artery Bypass Surgery
Background : Studies have suggested that patients with severe impairment of left ventricular function had a poor outcome following CABG surgery. Objectives: Evaluation of the role of pre-operative left ventricular function on the early post-operative mortality and morbidity following CABG. Patients and methods: This study was carried out from August 2016 to January 2017 including 40 patients undergoing CABG surgery. Patients were divided into two equal groups each containing 20 patients. Group A contained 20 patients with pre-operative ejection fraction > 50%, while group B contained 20 patients with pre-operative ejection fraction < 50%. Results: Mortality was 2 patients in group A (10%) compared to 5 patients in group B (25%) (P value = 0.031). The mean ICU stay in group A was 3.29 ± 1.49 days compared to 4.22 ± 1.98 days in group B (P value = 0.028). Pre-operative renal dysfunction improved in 2 patients (10%) from group A, compared to 1 patient (5%) in group B (P value = 0.555). Conclusion: Left ventricular function as an independent factor is a good prognostic factor regarding the early postoperative outcome in coronary artery bypass grafting including mortality, operative times, ICU stay and hospital stay
https://ejhm.journals.ekb.eg/article_30743_7545faf77690d5730ad51c8f9cbe5a31.pdf
2019-04-01
2325
2329
10.21608/ejhm.2019.30743
Coronary artery bypass grafting
Ejection fraction
Left Ventricular Function
Prognosis of coronary artery bypass grafting
Ahmed M.
El Ashkar
aelashkar@gmail.com
1
Cardiothoracic Surgery, Beni-suef University, Beni-suef
LEAD_AUTHOR
Ahmed N.
Khallaf
2
Cardiothoracic Surgery, Fayoum University, Fayoum, Egypt.
AUTHOR
ORIGINAL_ARTICLE
Patients Risk Factors as Predictors of Surgical Wound Infection Following Open Heart Surgery
Background: Median sternotomy wound infections are infrequent yet potentially fatal complication following cardiac surgery. The reported incidence of sternal infections ranges from 0.9 to 20%, and the incidence of mediastinitis is 1–2% in most studies. Several studies have examined and identified possible causes and risk factors associated with sternal infections. They include patient-related risk factors, and procedure-related factors. Aim of the study is the assessment of the patient’s risk factors related to incidence of infection. Patients and Methods: ninety-eight cardiac surgery patients operated via median sternotomy were included in the study and the role of patient related factors (age, gender, obesity and diabetes mellitus) in the incidence of postoperative superficial and deep sternal wound infection was accessed. Results: Sternal wound infection (SWI) developed in 18 patients (18.36%). 15 patients (15.3%) had superficial SWI while 3 patients (3.06%) had deep SWI. The most common causative organism in our study was staph. aureus especially MRSA. Conclusion: Patient-related risk factors such as age, gender, obesity and diabetes mellitus are important risk factors in the development sternal wound infection.
https://ejhm.journals.ekb.eg/article_30749_b5c3102e7d290da4730cd4bca9a75aa7.pdf
2019-04-01
2330
2333
10.21608/ejhm.2019.30749
Patient Risk Factors
superficial sternal wound infection
Deep sternal wound infection
Open heart surgery
mediastinitis
Ahmed M.
El Ashkar
aelashkar@gmail.com
1
Cardiothoracic Surgery Departments, Beni-suef University, Beni-Suef
LEAD_AUTHOR
Ahmed N.
Khallaf
2
Cardiothoracic Surgery Departments, Beni-Suef, Fayoum University, Fayoum, Egypt
AUTHOR
ORIGINAL_ARTICLE
Laparoscopy in Gastro- Intestinal Tumors
Background: Cancer is a major public health problem worldwide. Many studies have shown that the completion of adjuvant chemotherapy improves the survival rate. Objectives: The aim of the current study was to discuss the efficacy and role of diagnostic and therapeutic laparoscopy as a new trend in managing gastrointestinal tumors. Patients and Methods: This prospective study included a total of 50 patients, whom had gastro-intestinal tumor diagnosed by tissue biopsy and histopathology attending at General Surgery Department, Sayed Galaal Al-Azhar University Hospital. The hospital statistically significant data for the included 50 patients, pre and post diagnostic laparoscopy and surgical intervention were collected and analyzed. Results: A significant percentage of intra-abdominal cancers prove to be inoperable because of metastatic or locally advanced disease despite a preoperative workup suggesting a potentially resectable disease. Conclusion: It could be concluded that diagnostic laparoscopy is accurate staging tool for gastro intestinal tumors as staging method prior to surgery that can change plan to start neoadjuvant chemotherapy (CTR) instead of surgery. Laparoscopic surgery shows also short post- operative patient stay at hospital and early start of CTR.
https://ejhm.journals.ekb.eg/article_30750_6757ec85043346a5ad70ba0ae49f2c65.pdf
2019-04-01
2334
2338
10.21608/ejhm.2019.30750
Diagnostic Laparoscopy
Staging of abdominal malignancies
Staging Laparoscopy
Operability
Resectability
Ahmed Abd Elmawgoud
El-Tokhy
eltokhy81@gmail.com
1
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Drain or not After Repair of Ventral Hernia with Mesh
Background: Abdominal wall hernias are among the most common of all surgical problems. Ventral hernia repair (VHR) is a commonly performed operation, so hernia defect size affects operative time and surgical technique for repair of a ventral hernia. Incisional hernia is the most frequent postoperative complication following general surgery. Objectives: This study was done to review and assess the difference between insertion of wound drain and the use of abdominal binder and percutaneous aspiration after open repair of ventral hernias and its effect on postoperative outcome. Patients and methods: A total of 100 patients with non-complicated abdominal wall (ventral) hernia were enrolled to review and assess the difference between insertion of wound drain and the use of abdominal binder and percutaneous aspiration after open repair of ventral hernias and its effect on postoperative outcome. Patients were divided into two groups: Group (A) includes 50 patients with insertion of wound drain. Group (B) includes 50 patients with application of abdominal binder immediately postoperatively for 2 weeks. Results: This study showed distribution of patients according to age, ranging from 27 years to 70 years with mean age of 49.2 years (±11.6 years). 25% of patients below 39, 50% of patients below 50 and 75% of patients below 59.75. In our study, 60% of operations were carried out under spinal anesthesia and 40% of operations were carried out under general anesthesia. The hernial content of 100 patients was intestine in 28 cases, and omentum in 72 cases. There were developing of significant seroma in (30%) of patients as follow: (17%) at group A (with drain) and (13%) at group B (without drain). Significant seroma was not seen in (70%) of patients. Wound infection was developed in (18%) of patients as follow; (12%) for group A (with drain) and (6%) for group B (without drain). Wound infection not seen in (82%) of patients. As regard recurrence, (2%) of total count only showing early recurrence that present at group B. Of total count only (9%) complained of persistent postoperative pain as follows, 6 cases from group (A) and 3 cases from group (B). Conclusion: It could be concluded that combined abdominal binder and percutaneous aspiration for selected cases were superior to insertion of wound drains as regards seroma formation, wound infection and postoperative return to normal activity with no significant difference as regards hematoma, postoperative pain, hospital stay and patient satisfaction.
https://ejhm.journals.ekb.eg/article_30751_61defaba3982a102c055633605c5fdda.pdf
2019-04-01
2339
2345
10.21608/ejhm.2019.30751
wound drain
abdominal binder
percutaneous aspiration
Ventral hernia
polyprolene mesh
Ahmed Abd Elmawgoud.
El-Tokhy
eltokhy81@gmail.com
1
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Central Corneal Thickness and Intraocular Pressure in Type II Diabetes
Background: Diabetes is a rapidly-growing global health problem with a significant impact on morbidity and mortality due to diabetes-related complications. Objective: The purpose of this study was to assess the impact of type II diabetes on the central corneal thickness (CCT) and intraocular pressure (IOP). Patients and Methods: This prospective case-control study was performed at the ophthalmic department of Al-Zahraa University Hospital. It was conducted on 30 participants with type II diabetes and 10 healthy control (both eyes were included). Diabetics were categorized into 3 groups, diabetics without retinopathy, with non-proliferative diabetic retinopathy (NPDR) and with proliferative diabetic retinopathy (PDR).Each group contained 10 participants. Complete ophthalmic examination was done for all participants including, visual acuity, slitlamp, fundus examination, measurement of IOP and CCT. Fundus photography and measurement of glycosylated hemoglobin A1c (HbA1c) were done for diabetics. Results: Diabetics with PDR exhibited significantly higher IOP and CCT values compared to other groups. The IOP was significantly correlated with CCT and with the duration of diabetes. Conclusion: Diabetics with PDR had a significantly elevated IOP and thicker corneas than normal subjects. These data emphasize the importance of considering CCT measurements in diabetics for proper interpretation of IOP.
https://ejhm.journals.ekb.eg/article_30752_5de6940a43fa32d5391d22d0cb24cf2d.pdf
2019-04-01
2346
2352
10.21608/ejhm.2019.30752
Intraocular Pressure
Type II diabetes
Central Corneal Thickness
Eman Y.
Elsayed
emooyassin1@gmail.com
1
Department of Ophthalmology, Faculty of Medicine (For Girls), Al-Azhar University
LEAD_AUTHOR
Heba M.
Abdelrahman
hebaophtho@yahoo.com
2
Department of Ophthalmology, Faculty of Medicine (For Girls), Al-Azhar University
AUTHOR
Naglaa A.
Elkousy
3
Department of Ophthalmology, Faculty of Medicine (For Girls), Al-Azhar University
AUTHOR
ORIGINAL_ARTICLE
aIncisional Negative Pressure Wound Therapy (INPWT) for Coronary Artery Bypass Grafting Patients
Background: Surgical site infections are major complications of coronary artery bypass grafting using bilateral internal thoracic arteries. In this study we reviewed the results of using INPWT for high risk patients with coronary artery bypass grafting (CABG) using bilateral internal mammary arteries. Patients and methods: From January 2013 to December 2016, patients with coronary artery bypass grafting using bilateral mammary arteries were enrolled in this study. Patients were from Kasr El-Einy, Beni-Suef and Fayoum University Hospitals. The total number was 427 patients, where INPWT was used in 161 patient, and conventional sterilized dressing was done in 266 patients. 2 groups were matched for statistical analysis, the first group was the control and the second group was where INPWT was used. Results: The results related to sternal wound infections were similarly attributed to the conventional group (10.9%) and the INPWT group (10.2%) (P=1.00). Patients treated with INPWT had less rate of infection than those with conventional dressing (5.5% versus 10.2%, P= 0.210), this difference was not statistically significant. Interaction tests also showed comparable results for SSI (surgical site infections) among patients with or without significant co-morbidities. Conclusion: This study suggests that the use of INPWT did not decrease the incidence of sternal wound infections in patients who had CABG surgery using bilateral internal mammary harvesting (BIMA). A larger randomized study is needed to evaluate the efficacy of this technique.
https://ejhm.journals.ekb.eg/article_30753_d241e718ddd28e8c4db7891c4ca304b7.pdf
2019-04-01
2353
2357
10.21608/ejhm.2019.30753
Coronary artery bypass grafting
incisional negative pressure wound therapy
mediastinitis
Ahmed M.
El Ashkar
aelashkar@gmail.com
1
Cardiothoracic Surgery, Beni-suef University, Beni-suef
LEAD_AUTHOR
Ahmed N.
Khallaf
2
Cardiothoracic Surgery, Fayoum University, Fayoum, Egypt
AUTHOR
ORIGINAL_ARTICLE
Incidence of Human Cytomegalovirus in Breast Carcinoma Tissues is Associated with A Higher Expression of Growth Factor Receptor-Bound Protein 2
Background: female mammary carcinoma is the second most common cancer incidence among women and the fifth most common leading cause of cancer death worldwide. Premenopausal young women are more frequently targeted by inflammatory breast cancer (IBC), which is the most lethal form of breast cancer. The human cytomegalovirus (HCMV) has been identified as one of the viral infection with a higher frequency in carcinoma tissues of IBC than in non-IBC. The adaptor protein growth factor receptor-bound protein 2 (Grb2), was found to be upregulated in HCMV-infected cells and play as crucial role in cancer progression. Objective: this study aimed to assess the expression level of Grb2 in carcinoma tissues of IBC and non-IBC with HCMV infection. Patients and Methods: overall, 135 female diagnosed with breast carcinoma were enrolled in this study. Using conventional and real time polymerase chain reaction (PCR), we determined the incidence of HCMV and assessed the expression level of Grb2 mRNA in the breast cancer tissue samples. Results: Grb2 mRNA was significantly upregulated in HCMV+ IBC higher than in HCMV+ non-IBC. According to the molecular subtype, Grb2 mRNA was significantly higher upregulated in breast carcinoma tissues of HCMV+ hormonal positive (HP) than in triple negative (TN) counterparts. Conclusion: HCMV infection is associated with a high expression of Grb2 mRNA in IBC and that HP HCMV+ mammary carcinoma tissues confer upregulated Grb2 mRNA, suggesting a potential role of HCMV infection in enhancing of Grb2 mRNA expression in breast cancer with HP.
https://ejhm.journals.ekb.eg/article_30754_b8d84e5d384b134ccd109242869610c9.pdf
2019-04-01
2358
2365
10.21608/ejhm.2019.30754
Growth factor receptor-bound protein 2
human cytomegalovirus
inflammatory breast cancer
Mohamed
Fares
moh.fares@azhar.edu.eg
1
Department of Zoology, Faculty of Science, Al-Azhar University, Cairo
LEAD_AUTHOR
Hossam Taha
Mohamed
2
Faculty of Biotechnology, October University for Modern Sciences and Arts, Giza
AUTHOR
Sherif Abdelaziz
Ibrahim
3
Department of Zoology, Faculty of Science, Cairo University
AUTHOR
Mohamed
Hosney
4
Department of Zoology, Faculty of Science, Cairo University
AUTHOR
Mohamed I.
Rady
5
Department of Zoology, Faculty of Science, Al-Azhar University, Cairo
AUTHOR
Mohamed
El-Shinawi
6
Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
AUTHOR
Mona Mostafa
Mohamed
7
Department of Zoology, Faculty of Science, Cairo University
AUTHOR
ORIGINAL_ARTICLE
Comparative Study between Mini-incision and Conventional Surgical Approaches for Carpal Tunnel Release
Background: Conventional approach is an effective method for carpal tunnel release, however it causes scar discomfort, pillar pain and cosmetic complaints. Several mini-incision techniques were introduced to avoid such complications. Aim of the study The aim of this study is to compare the results of two surgical techniques, the conventional longitudinal incision over the transverse carpal ligament (TCL), and the mini-incision at the distal wrist crease and near the proximal border of the TCL for carpal tunnel release. Patients and Methods: This study included 20 patients with carpal tunnel syndrome. 10 were operated upon by classical open palmar incision (group A) and 10 through mini-incision technique at distal wrist crease (group B). Follow up was after 2 weeks, 1, 3 and 6 months. Incisional pain, pillar pain using Visual Analog Scale (VAS), Levine symptom and function severity scores were evaluated at 3rd and 6th months postoperatively. Patients’ satisfaction about surgery and cosmetic results were evaluated using Visual Analog Patient Satisfaction Scale (VAPSS). Patients graded their cosmetic results from poor to excellent. Results: There were no intraoperative complications. Group B showed significantly less incisional and pillar pain. Patients were significantly more satisfied about cosmetic results in group B. There was no significant difference between both groups regarding time taken to return to daily life activities. Conclusion: Conventional and mini-incision surgical approaches are both safe effective methods for carpal tunnel release. Mini-incision technique provided smaller and less painful scar, hidden in the wrist crease.
https://ejhm.journals.ekb.eg/article_30756_4204004f10a5096044dc8a1801c320fc.pdf
2019-04-01
2366
2373
10.21608/ejhm.2019.30756
Carpal tunnel syndrome
mini-incision technique
conventional approach
Ahmed Maged
Al-Mofty
1
Plastic, Reconstructive and Burn Surgery Department, Faculty of Medicine, Al-Azhar University
AUTHOR
Mostafa Sayed
Mekky
2
Plastic, Reconstructive and Burn Surgery Department, Faculty of Medicine, Al-Azhar University
AUTHOR
Eman Mohamed Ibrahim
Mostafa
prettyemmy2003@hotmail.com
3
Plastic, Reconstructive and Burn Surgery Department, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Laparoscopic Repair of Bilateral Inguinal Hernia Using Large Butterfly Mesh Without Fixation Versus Double Meshes with Stapler Fixation through TAPP Approach
Background: Inguinal hernia repair is one of the most frequent elective operations performed in general surgical practice. Approximately 20% to 30% of patients with inguinal hernia present with bilateral hernias at diagnosis. Objectives: The aim of this study was to demonstrate the outcome between using a single large butterfly mesh without fixation to Strengthen the posterior wall versus the use of two separate meshes with stapler fixation during laparoscopic repair of bilateral inguinal hernia with TAPP technique. Patients and Methods: A prospective randomized comparative study that was conducted in General Surgery Department, Al-Hussein University Hospital, Faculty of Medicine, Al-Azhar University from January 2017 to December 2018. A total of 40 patients with bilateral non-complicated inguinal hernias were included in this study. The patients were subsequently divided into two comparable groups. Group A: Twenty patients were scheduled for TAPP repair with double meshes and tacker fixation. Group B: Twenty patients were scheduled for TAPP repair with a single large mesh without fixation. Results: Average operating time was 102 minutes in group A, and 72 minutes in group B. Postoperative pain was less in group B. One patient had transient hematuria in group B. There was one recurrence in group A on the left side after 8 months and no recurrences were demonstrated in group B. Conclusion: laparoscopic TAPP using a single large butterfly mesh is safe, time saving and cost-effective approach for non-complicated bilateral inguinal hernias, especially in patients with direct hernia, large defect and low BMI.
https://ejhm.journals.ekb.eg/article_30758_a2ba506419a36f94032b2f7ed871ecd9.pdf
2019-04-01
2374
2380
10.21608/ejhm.2019.30758
Inguinal hernia
butterfly mesh
laparoscopic hernia repair
Mahmoud Elsayed
Nagaty
1
General Surgery, Faculty of Medicine, Al-Azhar university, Egypt
AUTHOR
ORIGINAL_ARTICLE
Vitamin B12 Status among Pregnant Women and Its Association with Obesity and Gestational Diabetes
Background: pregnant women in resource-poor areas are at risk of multiple micronutrient deficiencies, and diets that are low in animal products place women at increased risk of vitamin B12 deficiency. Aim of the Work: to investigate the vitamin B12 status of pregnant women in Egypt and its relationship with obesity and gestational diabetes mellitus (GDM). Patients and Methods: this clinical observational prospective study has been conducted at Bab Al-Shaaria University Hospital Obstetrics and Gynecological Department from April 2018 to January 2019. To assess vitamin B12 status among pregnant woman and its association with obesity and gestational diabetes. 80 pregnant women attended to out-patient clinic were included in the study. The evaluation included data collection through: history taking, examination, anthropometric measurement, maternal blood vitamin B12 level estimation at second and third trimester and blood glucose level. Results: vitamin B12 deficiency in pregnancy is common particularly in obese women and those with GDM. Conclusion: vitamin B12 deficiency is silent and common in general population. Causes of vitamin B12 deficiencies are multifactorial and associated with many health problems. Also, obesity is common and its prevalence is increasing in the world. Therefore, both health problems have gained importance in family medicine practice in the last decades.
https://ejhm.journals.ekb.eg/article_30759_5ac5a4e066e598d41ba26d3ecb8f186b.pdf
2019-04-01
2381
2388
10.21608/ejhm.2019.30759
Vitamin B12
Pregnant women
Obesity and Gestational Diabetes
Mohammed Mohammed
Gebril
1
Obstetrics and Gynecology Department, Faculty of Medicine, Al- Azhar University
AUTHOR
Tarek Ramadan
Abbas
2
Obstetrics and Gynecology Department, Faculty of Medicine, Al- Azhar University
AUTHOR
Mohammad Saad Eldeen
Radwan
3
Obstetrics and Gynecology Department, Faculty of Medicine, Al- Azhar University
AUTHOR
Mustafa Mohammed
Abd El-Kader
mustafamohd123123@gmail.com
4
Obstetrics and Gynecology Department, Faculty of Medicine, Al- Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Comparative Clinical Study between Preoperative Oral Administration of Paracetamol, Celecoxib and Pregabalin on Postoperative Pain in Gynecological Laparoscope
Background: Since the introduction of laparoscopic surgeries, postoperative pain has been generally reduced. However, it can still peak, especially during the early postoperative period and becomes the main cause of overnight hospital stay and prolonged convalescence after this day-case surgical procedure. Thus, optimizing postoperative pain relief, not only to sub-serve reduction of its intensity but to also enhance the recovery and shorten length of stay became the broader target of multimodal pain control regimens nowadays. That is why; searching for a drug that would be effective in reducing pain, safe from major adverse effects and can meanwhile possess an opioid-sparing potentiality would be a merit so as to improve the success rate of ambulatory day-care surgeries. Objective: To study the analgesic effects of preemptive single oral dose of paracetamol, celecoxib and pregabalin in patients undergoing gynecological laparoscope. Method: Preoperative evaluation, preparation and premedication was assessment, and routine laboratory investigations was done. Postoperative pain, Level of Sedation was measured. Results: There was statistical significant difference between the three groups regarding VAS. There was statistical significant difference between the three groups regarding the total pethidine consumption. Regarding postoperative level of sedation, blood glucose there was no statistical significant difference between the three groups. Conclusion: Oral pregabalin in a dose of 150 mg 2 hour before surgery, is significantly attenuating pain intensity and total meperidine consumption during the first 6 hours postoperatively.
https://ejhm.journals.ekb.eg/article_30760_d0e2ffda213e85e69c9cdfc1358d1bcd.pdf
2019-04-01
2389
2396
10.21608/ejhm.2019.30760
Preoperative
Paracetamol
Celecoxib
Pregabalin
Postoperative Pain
Gynecological Laparoscope
Sohair F.M.
Ali
1
Anesthesiology and Intensive Care Department, Faculty of Medicine Al-Azhar University
AUTHOR
Abd Allah M. A.
Alshiekh
2
Anesthesiology and Intensive Care Department, Faculty of Medicine Al-Azhar University
AUTHOR
Mohammed A.
Elhosiny
mo7amad_3liii@yahoo.com
3
Anesthesiology and Intensive Care Department, Faculty of Medicine Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Immunohistochemical Expression of Cyclooxygenase-2 (COX-2) in Breast Cancer
Background: breast cancer (BC) is the most common type of diagnosed cancers in women. It is still the second leading cause of cancer-related death among women after lung cancer all over the world. Breast cancer is the first of top ten cancers in Egypt. It ranks as the first malignancy affecting females, contributing 30% of all female cancers. It affects 1 in 14 women during their life time. Aim: This study investigated the association between cyclooxygenase-2 (COX-2) expression in female breast cancer versus the expression of ER, PR, as well as its association with other established prognostic indicators like age, tumor size, lymph nodal status, stage, grade, lymphovascular invasion, insitu component and histological subtype, and aims to validate the role of overexpression of COX-2 as a prognostic marker in female patients with breast cancer in Egypt. Results: High significant correlation was found between lymph node metastasis, negative ER and PR cases and COX-2 expression. No significant correlation could be detected between age, tumor size, site, histologic type, grade, insitu component, LVI and COX-2 expression. Conclusion: Cyclooxygenase-2 has poor prognostic parameter in breast cancer, as it is over expressed in majority of breast carcinoma, especially with lymph node metastasis, ER and PR negative hormone receptor.
https://ejhm.journals.ekb.eg/article_30955_959b5684ec5f10ba4205422d0942b836.pdf
2019-04-01
2397
2405
10.21608/ejhm.2019.30955
breast cancer
Cyclooxygenase-2
prognostic marker
immunohistochemistry (IHC)
ER\PR receptor
clincopathological data
Mahmoud Ismail Ahmed
Nassar
1
Department of Pathology, Faculty of Medicine, Assiut University
AUTHOR
Shaimaa M.M.
Bebars
2
Department of Pathology, Faculty of Medicine, Aswan University
AUTHOR
Rasha Mohamed Samir
Said
3
Department of Pathology, Faculty of Medicine, Aswan University
AUTHOR
Taghreed Mohammed Amin
Mustafa
taghreed.amin2020@gmail.com
4
Department of Pathology, Faculty of Medicine, Aswan University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Endovascular Managment for Intracranial Carotid Artery Aneurysms
Objective: To assess safety and effectiveness of endovascular management for different types of intracranial carotid artery aneurysms. Patients and Methods: prospective and retrospective review of intracranial carotid artery aneurysms treated by endovascular procedures in Al-Azhar University Endovascular Center and other centers. Twenty patients met inclusion criteria. Results: fourteen medium sized, nine small, four large and one giant aneurysm. Seventeen narrow necks, eleven wide-necks and seven have involved branches in neck. Twenty-three cases were treated with coiling, three cases were treated with stent-assisted coiling and two cases were treated with stenting as flow diverter. Conclusion: pre-procedural conscious patients with GCS15 or 14 associated with better outcome. PcomA, Ophthalmic and Choroidal aneurysms were associated with better outcome after endovascular procedures. Coiling of narrow neck aneurysms was associated with better outcome.
https://ejhm.journals.ekb.eg/article_30956_e8c747b0a9408c3632e7365893c45b7e.pdf
2019-04-01
2406
2417
10.21608/ejhm.2019.30956
cerebral aneurysm
endovascular techniques
wide-neck aneurysm
coiling
internal carotid artery aneurysms
Yousef Abdel El Gelel
Barakat
1
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University (Assiut)
AUTHOR
Mohamed Sayed Esmael
Al Shandawely
2
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University (Assiut)
AUTHOR
Ahmed
Al-Sherif
3
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University (Assiut)
AUTHOR
Salah Mohamed Mohamed
Meraka
salahmereka1@gmail.com
4
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University (Assiut)
LEAD_AUTHOR
ORIGINAL_ARTICLE
Two-Dimensional and Three-Dimensional Echocardiographic Assessment of Aortic Root Diameter in Patients with Coronary Ectasia
Background: Coronary artery ectasia (CAE) is a well-recognized but relatively uncommon finding encountered during diagnostic coronary angiography. It is commonly defined as in appropriate dilation of the coronary arteries exceeding the largest diameter of an adjacent normal vessel more than 1.5-fold. CAE is not an isolated and benign disease but a reflection of a generalized vascular media defect. Objective: The aim of this study was to compare 2D-TTEand 3D-TTE measurements of the aortic root diameter in patients with coronary artery ectasia to assess the presence of aortic root dilatation. Patients and methods: This prospective observational study included 50 consecutive patients came to the Department of Cardiology, Al-Azhar University Hospital, New Damietta for coronary angiography. The study was carried out from November 2017 until December 2018. Injection aortography was used as a gold standard and to assess the presence of ascending aorta dilatation in those patients. Results: The present study shows that there was a good correlation between 3D-TTE and aortography at the levels of aortic annulus, sinuses of Valsalva, sinotubular junction (r =0.98,0.95,0.98) but a rough correlation between 2D-TTE and aortography at these levels (r =0.49,0.48,0.46). The present study shows that there was increase prevalence of aortic root dilatation 13 patients (26%) and ascending aorta dilatation 9patients(18%) in patients with CAE. Conclusions: Accuracy of aortic root measurement by 3DTTE was superior to that by 2DTTE, because the values by 2DTTE were underestimated compared to those measured by 3DTTE and aortography. Increase prevalence of aortic root dilatation and ascending aorta dilatation in patients with coronary artery ectasia. Dilated Ascending aorta was associated with a higher prevalence of aortic root dilatation.
https://ejhm.journals.ekb.eg/article_30957_99bc18c3757cd501566b04f309952998.pdf
2019-04-01
2418
2425
10.21608/ejhm.2019.30957
Two Dimensional
Three Dimensional Echocardiographic
CAE
Mohammed Hesham Hassan
Ezzat
1
Department of Cardiology, Faculty of Medicine (Damietta), Al-Azhar University, Egypt
AUTHOR
Mohammed Adel
Attia
2
Department of Cardiology, Faculty of Medicine (Damietta), Al-Azhar University, Egypt
AUTHOR
Islam Ibrahim Ahmed Hassan
Abualwafa
ehab_abualwafa8878@yahoo.com
3
Department of Cardiology, Faculty of Medicine (Damietta), Al-Azhar University, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Recent Predictive Parameters for Successful Weaning from Mechanical Ventilation in Critically Ill Patients
Background: Removal of patients from mechanical ventilation (MV) has been termed liberation, discontinuation, withdrawal and most commonly weaning. Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Although weaning from MV is successful in most cases, the first attempt fails in 20% of patients. In addition, weaning accounts for over 40% of the total MV time, the proportion varying in function of the etiology of respiratory failure. Objective: The aim of this study was to evaluate the recent protocols of successful weaning from mechanical ventilation of critically ill patients, depending on central venous oxygen saturation, ultrasonographic assessment of diaphragmatic movement, and serial arterial blood gases to assess failure rate 48 hours after weaning. Patients and methods: This prospective randomized study included a total of 90 mechanically ventilated Egyptian patients of both sexes, ASA (I-II) attending at least for 48 hours at intensive care unit, AlAzhar University Hospitals. The included subjects were divided into three groups depending on method of monitoring; group A: serial arterial blood gases, group B: Central venous oxygen saturation and group C: Ultrasonographic assessment of diaphragmatic movement pre and post spontaneous breathing trial. All patients were subjected to daily monitoring of the following weaning parameters: static and dynamic compliances and inspiratory resistance, intrinsic positive end expiratory pressure (Auto PEEP) and Maximum inspiratory pressure (MIP). Results: There is highly statistically significant difference between patients as regard weaning outcome. As the group depended on normal ultrasonographic assessment of diaphragmatic movement, had the largest number of patients with successful weaning. Conclusion: Normal ultrasonographic assessment of diaphragmatic movement proved to be the most important criteria for successful weaning from mechanical ventilation.
https://ejhm.journals.ekb.eg/article_30958_e9418deee71d2d9baf0410f6a2d36e8b.pdf
2019-04-01
2426
2432
10.21608/ejhm.2019.30958
Weaning
Mechanical Ventilation
TTE
ICU
Osama Abdel-Hay
Kasem
1
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Ahmed Mohamed
Abdel-Galeel
2
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Mohamed Abdel-Gawad Abdel-Halim
Abo El-Suod
3
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Ahmed Hesham El-Sayed
Hemdan
ahmadelhalapy@gmail.com
4
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Assessment of the Prevalence of Abnormal Hysteroscopic Findings in Infertile Women Undergoing ART
Background: The endometrium plays an important role in implantation of good quality embryos in ART. Many studies have proved the negative impact of intra uterine pathologies on reproductive outcome whether spontaneous pregnancy or ART, because uterine anomalies may be associated with many obstetric complications such as miscarriage, preterm birth, premature rupture of membrane, malpresentation, postpartum bleeding and retained placenta. Aim of the work: This study aims to assess the prevalence of abnormal hysteroscopic findings among infertile women undergoing ART at Ain Shams Maternity University Hospital over the period from January 2007 to January 2017. Patients and Methods: This descriptive retrospective study was carried out on infertile couples planned for ART who were sent to ECDU for hysteroscopy in Early Cancer Detection Unit (ECDU), Ain Shams University Maternity Hospital. Case reports From January 2007 to January 2017 were reviewed. Results: The most prevalent congenital abnormality was endometrial polyp (18.4%) followed by uterine septum (6.9%). Conclusion: This study concluded that the most common uterine abnormality was endometrial polyp (18.4%), followed by uterine septum in 6.9% of patients. Also, thick endometrium was very common with a prevalence of 12.9%. Therefore, based on this high prevalence of abnormalities, this study is in agreement with the opinion that all women should be offered hysteroscopy, even if they have normal vaginal ultrasound and hysterosalpingography, because this is supposed to increase the detection rate of minor abnormalities, which theoretically will improve the reproductive outcome. Still, further interventional randomized controlled trials (RCT) are needed to verify the positive impact of routine use of hysteroscopy prior to ART.
https://ejhm.journals.ekb.eg/article_30959_4705061f3a8526aa3a88f3f8196567e4.pdf
2019-04-01
2433
2440
10.21608/ejhm.2019.30959
abnormal hysteroscopy
Infertility
art
Ahmed H
Farag
1
Department of Obstetrics and Gynecology, Ain shams university
AUTHOR
Mohamed H
Salama
2
Department of Obstetrics and Gynecology, Ain shams university
AUTHOR
Enas S
Badrous
enas.saad66@yahoo.com
3
Department of Obstetrics and Gynecology, Ain shams university
LEAD_AUTHOR
ORIGINAL_ARTICLE
Role of Breast Magnetic Resonance Imaging in Early Stage Breast Cancer
Background: globally, breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women. The surgical management of patients with early stage operable breast cancer is the main step of treatment and addresses both the primary tumor and regional lymphatics. Objectives: this study aims at highlighting the role of preoperative dynamic contrast enhanced breast MRI in early stage breast cancer and its impact on surgical management. Patients and Methods: this study was carried out over the period from March 2015 to October 2017 in Radiodiagnosis Department of Mansoura University Hospitals and Nasser Institute. The study was conducted on 29 female their ages ranging from 30 to 59 years old the study was approved by our Institution’s Ethics Committee, and all patients gave their informed consent before inclusion in the study. Results: in our study, MRI was requested for different causes varying between dense breast which may obscure lesions (51.7%), multifocal lobular carcinoma (13.7%), exclude multicentric lesion (10. 3%) and in (24%) of patients MRI was requested as preoperative routine check. In our study, we found that in 10 patients (34.5%), MRI revealed additional lesions that were not seen on conventional imaging by mammography and ultrasound.Six lesions (20.7%) of those additional occult lesions were identified as malignant and all were ipsilateral. Our study reported that six patients (20. 7%) who had unsuspected abnormalities identified on MRI had changes in treatment based on MRI findings. Conclusion: the results of this study confirm previous reports that preoperative MRI of the breast alters clinical management and detects otherwise occult carcinoma in a substantial number of patients with early breast cancer.
https://ejhm.journals.ekb.eg/article_30960_c21308b98f6b480a4a80af00e42d5b4b.pdf
2019-04-01
2441
2446
10.21608/ejhm.2019.30960
Breast Magnetic Resonance Imaging
Early Stage Breast Cancer
Rawhia Taha
Hasan
1
Radiodiagnosis Department, Faculty of Medicine for Girls, Al-Azhar University
AUTHOR
Hoda Mahmoud
Abdel-Wahab
2
Radiodiagnosis Department, Faculty of Medicine for Girls, Al-Azhar University
AUTHOR
Manar Ftouh Abbas
Khalil
mnarftouh@gmail.com
3
Radiodiagnosis Department, Faculty of Medicine for Girls, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Splinting after Carpal Tunnel Surgical Treatment: Does It Really Matter?
Background: Splinting of the wrist after carpal tunnel release (CTR) has been practiced by many surgeons especially in North America. The main reason wasto prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks) or too short (48 hours only). Objective: The aim of our study was to compare the effects of post-operative splinting for duration of one week with no splinting. Patients and Methods: All 20 of our patients underwent a standardized open CTR. Post operatively, they were randomized into a splinted (n=10) and a non-splinted (n=10) group. The splint was kept for 2 weeks. Patients were reviewed at regular intervals of one week, two weeks and three months. At each follow up, these patients were clinically assessed for outcome of the Boston questionnaire. Results: All patients presented with significant improvement in the post-operative evaluation within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up. Conclusion: We concluded that wrist splinting in the immediate post-operative period has no advantage when compared with the non-splinting wrist after a standard open carpal tunnel release.
https://ejhm.journals.ekb.eg/article_30961_061db74d8bebd68b7c525da2cc2df446.pdf
2019-04-01
2447
2450
10.21608/ejhm.2019.30961
Carpaltunnelsyndrome
carpaltunnelrelease
wristsplint
open carpal tunnel release
nerve compression
Mohamed Hazem
Mahmoud
1
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University
AUTHOR
Ali Tawfiq
El Alfy
2
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University
AUTHOR
El-Sayed Etewy Ahmed
Soudy
3
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University
AUTHOR
Ahmed Farid Ibrahim
el-Molla
ahmedfarid111@gmail.com
4
LEAD_AUTHOR
ORIGINAL_ARTICLE
Ultrasound Evaluation of Lower Uterine Segment in Pregnant Patient with History of Hysterotomy
Background: ultrasonography has been widely used in the field of obstetrics & gynecology. Development of more sophisticated technology in ultrasonography & the huge amount of studies & education by physicians makes ultrasonographic examination one of the most useful diagnostic techniques in obstetrics & gynecology. Objective: In this study we aimed to evaluate the gravid uterus in women with a history of previous, 1 or more hysterotomy, in all 3 trimesters by Trans-vaginal ultrasound (TVUS). Patients and Methods: This is a prospective, case-control, observational study. The study was carried out in a private Obstetrics & Gynaecology center Wally center in Fayoum city. The study was carried out in the period from December 2017 to December 2018. Initially, 100 patients were enrolled, but at the end of the study only 67 patients were involved in the study. Results: The distance between the leading edge of the placenta to the internal OS is the diagnostic accretion. This difference between the 5 groups regarding this distance was found to be highly significant (p-value= 0.001) across all 3 trimesters, which proves that repeated CS deliveries is a major risk factor for placenta praevia. There were 1 case, 3 cases & 2 cases of low-lying placenta found in groups 3, 4 & 5, respectively. Conclusion: Cesarean section scar pregnancy and rupture uterus are both rare events and were not found in the sample of this prospective study. However, they are both very important to diagnose as early as possible to prevent serious morbidity and even mortality.
https://ejhm.journals.ekb.eg/article_30962_892760c01fe94586fa80369aa5463e33.pdf
2019-04-01
2451
2460
10.21608/ejhm.2019.30962
TVUS
Lower uterine segment
CS
Hysterotomy
Emad Abd El Rahman
El-Tamamy
1
Department of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University
AUTHOR
Khaled Gaber
Sabaa
2
Department of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University
AUTHOR
Ahmed Khaled Wally
Momen
wallypopo90@gmail.com
3
Department of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
ORIGINAL_ARTICLE
The Effect of Vitamin D Supplementation on the Androgenic Profile in Patient with Polycystic Ovary Syndrome
Background: it is suggested that vitamin D status is associated with androgenic profile in women with PCOS. Although there are a lot of clinical trials known in this regard, the results were varying. Objective: This study aimed to evaluate the effect of Vitamin D supplementation on androgenic levels (including serum total testosterone, free testosterone and sex hormone binding globulins) in adult women with PCOS were established by the presence of hyperandrogenemia or clinical hyperandrogenism. Patents and Methods: in the present study, 50 outpatient clinic women were included and divided into two groups, first group consisted of 25 patients who received 4000 IU daily of Vitamin D3 for 6 months, and the other group consisted also of 25 patients who received placebo drug blindly. Results: the results showed significant difference between the two groups regarding different laboratory tests especially total testosterone level (decreased significantly after vit. D intake) and SHBG (elevated significantly after vit. D intake) and also significant difference in the hirsutism state after vitamin D administration. But in contrast, there was no significant difference between free testosterone level before and after vit. D administration. These results can help in the confirmation of the suggestion that vitamin D intake can help significantly in decreasing the androgenic profile in a woman patient with PCOS and also in decreasing hirsutism symptom. Conclusion: vitamin D intake can help significantly in decreasing the androgenic profile and hirsutism in a woman patient with PCOS and used as a proper treatment for them.
https://ejhm.journals.ekb.eg/article_30963_1952f548e2203e6d8c14e3029e937285.pdf
2019-04-01
2461
2466
10.21608/ejhm.2019.30963
Vitamin D
PCOs
Hirsutism
Fahd Abd El-Aal
Alomda
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Mahmmod Abd El-Latef
Hashish
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Waleed El-Sayed
El-Naggar
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Ahmed Mohammed Abd El-Rahman
Mosallam
dr.matrix_am@yahoo.com
4
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Strain/Strain Rate Imaging of Impaired Left Atrial Function in Patients with Metabolic Syndrome
Background: Metabolic syndrome (MS) predisposes to left ventricular dysfunction and heart failure, however, alterations in left atrial (LA) function in MS are unknown. Objectives: We aimed to use strain/strain rate (SR) imaging to investigate the effect of MS on LA function. Subjects and Methods: This prospective case control study included a total of 100 subjects divided in to 75 metabolic syndrome (MS) patients referred to Al-Azhar university hospital outpatient clinic for evaluation and treatment of hypertension and/or diabetes mellitus and 25 age and sex matched apparently healthy volunteers as a control group. All subjects underwent conventional echocardiographic examination and assessment of LA function by speckle tracking. Partial correlation and multiple stepwise regression analyses were used to determine the risk factors for impaired LA function. Results: Compared with the controls, the MS patients showed significantly lower levels of mean strain, mean peak systolic SR and mean peak early diastolic SR (P<0.05 for all), with no difference in the mean peak late diastolic SR. Central obesity, hypertension, dyslipidemia and uncontrolled diabetes were independent risk factors for impaired LA function. Conclusion: SR imaging is reliable in assessing LA function in MS patients.
https://ejhm.journals.ekb.eg/article_30964_8a852045d1f9a2c651a156e078a2a7c3.pdf
2019-04-01
2467
2474
10.21608/ejhm.2019.30964
Metabolic syndrome
Left atrial function
speckle tracking
Echocardiography
Sameh Refaat Hassan
Allam
1
Department of Cardiology, Al-Azhar University, Cairo, Egypt
AUTHOR
Abd El-Aziz Rezk Hassan
Sheredah
2
Department of Cardiology, Al-Azhar University, Cairo, Egypt
AUTHOR
Mohammad
Al-Deftar
3
Department of Cardiology, Al-Azhar University, Cairo, Egypt
AUTHOR
Ahmad Kamal Mohammad
Hashem
ahmad.binkamal@gmail.com
4
Department of Cardiology, Al-Azhar University, Cairo, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Comparative Study between Subinguinal Varicocelectomy and Laparoscopic Varicocelectomy
Background: surgical correction of varicocele is the corner stone of its therapy and varicocelectomy is the most commonly performed operation for the treatment of male infertility. Aim: to compare the outcome of the most common surgical approaches; sub-inguinal varicocelectomy and laparoscopic varicocelectomy as regards: operative difficulties & time, complications and efficiency. Patients and Methods: This randomized controlled study was conducted on 40 patients, divided into two groups: group I included 20 patients, were operated upon through the subinguinal approach and group II included 20 patients, were operated upon through the laparoscopic approach, and comparison between two groups as regard outcomes and complications. Results: It was found from this study that the operation time was relatively shorter with the laparoscopic technique (p<0.01), while the length of hospital stay and post-operative complications did not differ in both methods. Follow up of patients at 3 and 6 months showed a marked improvement in semen analysis in terms of concentration, the percentage of abnormal forms, movement, and also there was a marked improvement in testosterone hormone. Conclusion: In both methods, results were almost the same, but the sub inguinal approach is qualitatively better in terms of the lack of complications, but with delayed return to work compared with laparoscopic technique.
https://ejhm.journals.ekb.eg/article_30965_9173b2e5e1733aaf43a9e55a50ad8a4b.pdf
2019-04-01
2475
2480
10.21608/ejhm.2019.30965
Varicocele
varicocelectomy
sub-inguinal
Laparoscopy
male fertility
Ahmed Salah
Al-Gamal
surgeonahmed22@gmail.com
1
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
LEAD_AUTHOR
Abd El-Fattah Morsi
Saied
2
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Ashraf Abd El-Hameed
Abd El-Moneim
3
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
ORIGINAL_ARTICLE
Effect of Buspirone on the Histological and Immunohistochemical Alterations on Pancreas of Fetuses in Pregnant Rats
Aim of the work: Buspar drug(buspirone) is an antianxiety agent for the treatment of anxiety, and there are no adequate studies of Buspar in pregnant women which made this issue an exciting research area; so that our aim was to study the effects of buspirone on the structure of pancreatic tissue of the maternally treated rat fetuses. Material and methods: Buspirone hydrochloride tablets were obtained from Beecham, Haram, Giza, Egypt. Animals were divided into three groups (Ten pregnant rats in each group). Group I: (The control group) pregnant rats administrated orally distilled water only; Group II: pregnant rats were given oral dosages of buspirone hydrochloride at a dose level of 0.27 mg/ 100g b.w./day, daily for 15 days from the 6 th day to the 20 th day of gestation; Group III: pregnant rats were treated with the same manner with buspirone hydrochloride at a dose level of 0.41 mg/ 100g b.w./ day for 15 days from the 6 th to the 20 th day of gestation. Samples were taken from pregnant rats of all groups which sacrificed at 20 th day of gestation and fetuses were picked out for histological, histochemical and immunohistochemical studies for pancreatic anti-insulin and caspase-3 monoclonal antibody markers. Results: Treatment of pregnant rats with buspirone showed histopathological alterations in the pancreas of their fetuses; these alterations were well marked in the high dose maternally treated fetuses, and resulted in deformity in the pancreatic tissues. Conclusion: The present study showed that administration of buspirone may result in several histological and immunohistochemical deformity in the fetal pancreatic tissues.
https://ejhm.journals.ekb.eg/article_30966_4506fd18cd95f79c06932c9ff73856e0.pdf
2019-04-01
2481
2491
10.21608/ejhm.2019.30966
Buspar drug
Caspase-3
histopathology
Immunohistochemical and fetal pancreas
Nahla H.
El-Shaer
nhalshair@zu.edu.eg
1
Zoology Department, Faculty of Science, Zagazig University, Egypt
LEAD_AUTHOR
Asmaa M.
Abd El-Azez
2
Zoology Department, Faculty of Science, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Optical Coherence Tomography Study of Retinal and Choroidal Changes in Patients with Chronic Obstructive Pulmonary Disease
Background: Chronic obstructive pulmonary disease (COPD) has multi-systemic implications and comorbidities. Fine ocular structures are affected by hypoxia and systemic inflammation. Objective: To evaluate the changes in the retina and choroid in patients with chronic obstructive pulmonary disease using spectral-domain optical coherence tomography (SD-OCT). Patients and methods: This prospective case control study included a total of forty COPD patients and twenty ageand sex-matched healthy individuals as control group; both eyes were included. COPD patients were divided into two subgroups; a group with mild to moderate COPD and another group with severe to very severe COPD according to the Global Initiative for COPD guideline. COPD patients were subjected to spirometry. Arterial blood gas analysis was performed to determine hypoxic state. The subfoveal choroidal thickness (SFCT), macular thickness (MT) and retinal nerve fiber layer (RNFL) thickness were measured using SD-OCT and compared between groups. Results: There was no statistically significant difference between groups according to demographic data. Mean SFCT was statistically significantly thinner in COPD groupsthan in the control group; and this thinning was more pronounced with increase in the severity of COPD. As regard to MT, no statistically significant difference was observed between groups (p=0.691). Peripapillary RNFL was significantly thinner in COPD group than the control group in all quadrants except the superior one. Conclusion: Changes in the SFCT and RNFL thickness could be used as indicators for the severity of COPD
https://ejhm.journals.ekb.eg/article_30967_cc7a4b390801130c39d747ca44e9a13b.pdf
2019-04-01
2492
2498
10.21608/ejhm.2019.30967
chronic obstructive pulmonary disease
subfoveal choroidal thickness
Retinal nerve fiber layer thickness
Macular Thickness
Mai G.
Abd El-Naser
maigamal1289@gmail.com
1
Department of Ophthalmology, Faculty of Medicine (For Girls), Al-Azhar University
LEAD_AUTHOR
Heba M.
Abd El-Rahman
2
Department of Ophthalmology, Faculty of Medicine (For Girls), Al-Azhar University
AUTHOR
Zeinab R.
Adawy
3
Department of Chest, Faculty of Medicine (For Girls), Al-Azhar University
AUTHOR
Mona M.
Aly
4
Department of Ophthalmology, Faculty of Medicine (For Girls), Al-Azhar University
AUTHOR
ORIGINAL_ARTICLE
Low Pressure versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy
Background: the laparoscopic cholecystectomy (LC), one of the utmost commonly assumed operations in general surgery. Adequate working space inside the abdominal cavity is required. Carbon dioxide (CO2) is used with a definite pressure to establish this working space. Aim: our study was to compare the hemodynamic symptoms, post-operative shoulder-tip pain and the frequency of nausea and vomiting between standard and low-pressure CO2 pneumoperitoneum (PP) in patients undergoing LC. Patients and Methods: a prospective randomized study was done on 50 patients aged 18 to 75 years in Bab ElShaaria hospital, Al-Azhar University with symptomatic gallstones. Patients were allocated into two groups: standard pressure (Group A: 12-14 mmHg) and low-pressure (Group B: 8-10 mmHg). Hemodynamics were assessed pre insufflation and 15 min post insufflation and desufflation. The frequency of nausea and vomiting were assessed at 0, 8, 16, 24-hour post-operative. Post-operative shoulder- tip was assessed 1, 6, 12, 24-hour post-operative. Statistical analysis was postulated using SPSS V.25. Results: a noticeable difference between the two groups was observed with respect to the mean systolic blood pressure (p=0.003) and the mean heart rate (p=0.001). Furthermore, a significant difference as regard post-operative shouldertip pain, which was higher in the standard pressure group (p< 0.05). There were no major differences between the two groups concerning the frequency of nausea and vomiting. Conclusion: low-pressure PP can be used instead of standard pressure considering its low side effects without any effect on the working space and quality of the surgical procedure.
https://ejhm.journals.ekb.eg/article_31076_547f426ea9c5bdbc9544de4ac06ddca9.pdf
2019-04-01
2499
2504
10.21608/ejhm.2019.31076
cholethiasis
Laparoscopic cholecystectomy
low-pressure
pneumoperitoneum
Mahmoud
Kassem
kassem.16@outlook.com
1
General Surgery Department, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
Magdy Mahmoud
Emam
2
General Surgery Department, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohammad Arafat
Abd El-Maksoud
3
General Surgery Department, Faculty of Medicine, Al-Azhar University
AUTHOR
ORIGINAL_ARTICLE
Evaluation of Different Varieties of Brachioplasty
Background: There has been a renewed interest in upper arm contouring secondary to recent advances in plastic surgery that have made it safer and more appealing to both the plastic surgeon and the patient. Objectives: the aim of the work was to describe the aesthetic outcome of different techniques used for correction of arm ptosis to try to obtain a new treatment-based algorithm for management of brachioplasty. Patients and Methods: This prospective study included a total of 40 patients with different degrees of arm ptosis, requesting arm contouring attending at Al-Hussein and Bab Al-Shairia, Al-Azhar University Hospitals. Different techniques used for brachioplasty as liposuction or skin excision by different types of skin incision according to the degree of fat deposit, redundancy and skin ptosis, or both were used in this study. Results: Patient's satisfaction within clothes was 100% in all techniques used in brachioplasty while patients' satisfaction without wearing clothes or light clothes was 84.6% in surgical resection due to the presence of complications in the form of wound dehiscence in 5 patients (19%) and hypertrophic scar in 4 patients (15.4%) and it was 100% in liposuction patients and it was 83.3 in combined method patients due to the resent of wound dehiscence with ugly scar in 1 patient (16.7%). Conclusion: Brachioplasty operation whether liposuction alone or surgical excision or combined methods is a good method to treat patients with arm obesity or post massive weight loss skin ptosis. The proper method was selected according to the degree of fat deposit, redundancy and skin ptosis.
https://ejhm.journals.ekb.eg/article_31077_fa2954a9dba1097912e46ea901796ea7.pdf
2019-04-01
2505
2513
10.21608/ejhm.2019.31077
Brachioplasty
arm contour
arm ptosis
liposuction
Abdel Monem
Hota
1
Departments of Plastic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Moustafa
Meky
2
Departments of Plastic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Mahmoud
Nasef
3
Departments of Plastic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Mohammed
El Zoeiky
dr.zoeiky@gmail.com
4
Departments of Plastic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Comparison of the Microdose Flare Up GnRH Agonist and Antagonist Protocol in Assisted Reproduction with Poor Ovarian Response during Controlled Ovarian Stimulation Cycles
Background: Poor ovarian response presents a significant challenge in artificial reproductive treatment (ART). Poor responders are estimated to comprise approximately 9- 24% of IVF cycles patients. Recently, the development of GnRH antagonist protocol offered another approach for ovarian stimulation by blocking the pituitary receptors. There is evidence that application of GnRH antagonist protocol decreases the duration of ovulatory stimulus and reduce incidence of ovarian hyperstimulation syndrome (OHSS). Objectives: The aim of the current study was to evaluate the effect of the antagonist protocol to the microdose flare up GnRH agonist protocol for poor ovarian responders undergoing IVF/ICSl treatment. Patients and Methods: A total of sixty patients of IVF/ICSI assigned to be poor responders were randomized into two groups; group 1 Thirty patients received GnRH antagonist fixed protocol and group 2 thirty patients received a microdose flare up agonist protocol. Patients characteristics and treatment outcomes were statistically compared between groups. Results: Duration of stimulation was highly significantly lower in the antagonist group than that of the microdose flare up one (antagonist 8.60±1.63 versus microdose flare up 12.06±2.86; p=0.001). Number of ampoules of HMG was highly significantly lower in the antagonist group than that of the micro dose flare up agonist one (antagonist 23.53±7.33 versus micro dose agonist 71.97±9.35; p=0. 001). The number of oocytes retrieved in the antagonist group was not different from microdose flare agonist group (5.14±2.45 vs. 5.11±1.29; p=0.953), and the number of embryos transferred was similar in both groups (2.03±0.08 vs. 2.09 ± 1.05; p=0.674). No significant differences in pregnancy rates were reported. Conclusion: we offer using the "GnRH antagonist" as a patient friendly protocol in ART with poor ovarian response with Immediate mode of action, similar pregnancy rate, time saving, less duration of stimulation and number of ampoules for stimulation than microdose flare up protocol.
https://ejhm.journals.ekb.eg/article_31078_ff70b00027f536fe23ac974227faae46.pdf
2019-04-01
2514
2520
10.21608/ejhm.2019.31078
GnRH antagonist
ovarian hyperstimulation syndrome
poor ovarian response
IVF/ICSI
Mohamed Fakhry
Elebiary
elebiary.mohamed_obs@yahoo.com
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
LEAD_AUTHOR
Emad Abdelrahman
Eltemamy
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
Abdelmoneim Mohamed
Zakaria
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
AUTHOR
ORIGINAL_ARTICLE
Temporalis Fascia versus Tragal Mucoperichondrium Graft in Myringoplasty
Background: Chronic suppurative otitis media (CSOM) constitutes a major public health problem in children and adults in the developing world. It is an infection characterized by recurrent middle-ear discharge through a persistent tympanic membrane perforation. Objective: the aim of the present study is to compare the surgical and audiological results of temporalis fascia versus tragal perichondrium in myringoplasty Patient and Methods: a randomized prospective study concerned with 60 patients for whom myringoplasty was done. Patients were randomly assigned into two groups; in the first group temporalis fascia graft was used (30 patient) and tragal perichondrium graft was used in the second group (30 patients). Results: our study included 60 patients, 27 males and 33 females with a range from 19- 45 years. Surgical success rates for the first and second groups are 80% and 73.3%, respectively. There was 10.5 dB improvement in mean hearing threshold in fascia group, compared to 8.16 dB improvement in perichondrium group, giving an average of 9.33 dB improvement in mean hearing threshold of the total series. Conclusions: mean value of gain among temporalis fascia graft group was higher than tragal perichondrium graft group. There was statistically significant difference between the two groups regarding gain and no significant difference in surgical success rate between the two groups.
https://ejhm.journals.ekb.eg/article_31079_a7ca3a5475e52ef806efc921a649fca2.pdf
2019-04-01
2521
2526
10.21608/ejhm.2019.31079
Temporalis Fascia
Perichondrium Myringoplasty
Wael H.
Abo Elwafa
1
Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University
AUTHOR
Kamel S.
Hammad
2
Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University
AUTHOR
Ahmed S.
Gad
3
Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohamed K.
Ibrahium
4
Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohamed S.
Khalil
mohammed_alb2001@yahoo.com
5
Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University
AUTHOR
ORIGINAL_ARTICLE
Bowel Obstruction Following Lap Appendectomy and Open Appendectomy
Background: acute appendicitis is a common indication for abdominal surgery with a life-time incidence between 7 and 9% and appendectomy is one of the most common surgical procedures. Open appendectomy (OA) performed through the right lower quadrant incision was first described in 1894. It has become the standard treatment of choice for acute appendicitis, due to its efficacy and safety. Objective: the aim of the present study was to compare the frequency of readmissions due to bowel obstruction (BO) after open versus laparoscopic surgery performed for suspected acute appendicitis. Patients and Methods: this was performed in Aswan University hospital, on 100 patients from April 2015 to April 2017 who underwent laparoscopic and open appendectomy. The merits and drawbacks of LA and OA were explained to all of the patients with diagnosis of acute appendicitis. Results: a statistically significant difference was found when comparing the operative time of the LA and OA. The operating times in OA and LA were 16-37 min (mean 24.7) and 19-45 min (mean 33.1), respectively. The OA was shorter in duration, with a P value less than or equal to 0.05 (Mann-Whitney test). Conclusion: laparoscopic appendectomy is equally safe, and can provide less postoperative morbidity in experienced hands, as open appendectomy. Most cases of acute appendicitis can be treated laparoscopically. Laparoscopic appendectomy is a useful method for reducing hospital stay, complications and return to normal activity.
https://ejhm.journals.ekb.eg/article_31080_d9616cdccaf6f2c8336a3ec644591a3f.pdf
2019-04-01
2527
2530
10.21608/ejhm.2019.31080
Bowel obstruction
Appendectomy
Open appendectomy
Osama Abdullah
Abdul Raheem
osamaaloraby@yahoo.com
1
Department of General Surgery, Faculty of Medicine, Aswan University
LEAD_AUTHOR
Ehab Motawa
El Hussieny
2
Department of General Surgery, Faculty of Medicine, Aswan University
AUTHOR
ORIGINAL_ARTICLE
Contrast Sensitivity Affection: A Comparative Study between Photorefractive Keratectomy and Small Incision Lenticule Extraction Pre and Postoperative
Background: the cornea is a transparent dome shaped structure at the front of the eye separated from the iris and pupil by the anterior chamber. It is one of the main refractive media of the eye. Refractive surgery includes several types such as Photorefractive Refractive Keratectomy (PRK) and Small incision lenticule extraction (SMILE). Objective: contrast sensitivity affection in comparative study between patients undergoing photorefractive keratectomy (PRK) or small incision lenticule extraction (SMILE) surgery. Patients and Methods: twenty cases of different patients’ ages; 18-30 years old with myopia from -0.5 D to - 9.00 D were included in this comparative study. Patient with corneal infection, trauma, opacities, operation, ocular disease or congenital eye disease were excluded from our study. All the selected patients were submitted to full ophthalmological examination (visual acuity, fundus examination, pantacam, and assess contrast sensitivity degree before operation and one month after refractive surgery. Measurement of contrast sensitivity was done by Function Acuity Contrast Test (FACT) before and one month after refractive surgery through several spatial frequencies (1.5, 3, 6, 12 and 18). Results: we found that contrast sensitivity was affected one month after refractive surgery in both groups but it is affected in group 1 after PRK more than group 2 that had femto SMILE. Conclusion: contrast sensitivity was affected in both patients who had PRK or Femto SMILE after one month from operation but it is more stable after Femto SMILE.
https://ejhm.journals.ekb.eg/article_31081_25867086b26184686c7de2bcce54a671.pdf
2019-04-01
2531
2538
10.21608/ejhm.2019.31081
cornea
PRK
SMILE
LASIK
Abd Elmagid Mohammad
Tag Eldain
1
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
AUTHOR
Hosny Hassan Mohammad
Aly
2
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
AUTHOR
Mohammad Moustafa Abd Elhalem
Diab
mohamed6diab6@gmail.com
3
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR