Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Occurrence and Recurrence of Hepatocellular Carcinoma after Direct Acting Antivirals in Compensated Chronic Hepatitis (C) Cirrhotic Egyptian Patients
356
361
EN
10.21608/ejhm.2020.77446
Background: Egypt had been vexed by the highest load of chronic hepatitis C in the world. It represents a vast market of the new direct-acting anti-viral drugs (DAAs); effectively treating chronic hepatitis C virus (HCV) infection. Objectives: The aim of this study is to detect the occurrence and recurrence of hepatocellular carcinoma (HCC) during the follow-up after antiviral treatment with direct acting antiviral therapy in patients with chronic HCV infection and in patient with chronic HCV prior history of treated hepatocellular carcinoma who achieved complete response. Subjects and methods: This was prospective study including 150 patients with compensated chronic hepatitis C virus infection and 150 patients with compensated chronic hepatitis C virus infection prior history of treated hepatocellular carcinoma. The patients were attending Aswan university hospital and viral hepatitis unit in addition to Viral Hepatitis Unit and were prospectively collected at the end of December 2019. The patients were divided into two groups: Group (A): patients with chronic HCV infection who were treated with direct acting antivirals. Group (B): patients with chronic HCV infection prior history of treated hepatocellular carcinoma who were treated with direct acting antivirals. Results: The results of the study revealed that there was no significant difference between the studied groups as regard time needed for HCC to occur after DAA. Conclusion: Surveillance programs should be widely endorsed during and after DAAs therapy for patients at HCC risk, even for those who had been achieved HCV cure.
Chronic hepatitis C,Direct acting antiviral,Egypt,Hepatocellular carcinoma
https://ejhm.journals.ekb.eg/article_77446.html
https://ejhm.journals.ekb.eg/article_77446_9a6efb57e866f509314307d280fd920c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Effect of Treating Chronic Hepatitis C Infection with Direct-Acting Antivirals on The Risk of Recurrence Hepatocellular Carcinoma
362
368
EN
10.21608/ejhm.2020.77447
Background: Hepatitis C virus (HCV) is a major global healthcare problem. The WHO estimates that up to 3% of the world's population has been infected with the virus, equating to more than 170 million individuals worldwide, with significant associated morbidity and mortality. Objective: The aim of this study was to detect effect of treating chronic hepatitis C infection with direct-acting antivirals on the risk of recurrence hepatocellular carcinoma. Subjects and methods: This prospective study included a total of 150 patients with compensated chronic hepatitis C virus infection and 150 patients with compensated chronic hepatitis C virus infection with prior history of treated hepatocellular carcinoma by ablation, resection, chemoembolization or liver transplantation, attending at Viral Hepatitis Units, Departments of Internal Medicine, Assiut and Aswan University Hospitals. This study was conducted between December 2017 and December 2019. Results: The present study shows that 33.3% of HCC had history of treatment with surgical resection, 46.7% had history of Radiofrequency ablation (RFA), 13.3% of Transarterial Chemoembolization (TACE) and 6.7% with liver transplantation. There were highly significant differences between the two studied groups as regard ALT, total bilirubin, creatinine and AFP levels. There were no significant differences between the two studied groups as regard albumin, INR, platelets, total protein and WBCs. There were no significant differences between the studied groups as regard Hepatocellular carcinoma "occurrence or recurrence" and time needed for HCC to occur after direct-acting antiviral agents (DAAs). Conclusion: It could be concluded that antiviral treatment should not be delayed in hepatocellular carcinoma patients in order to avoid further liver deterioration and extrahepatic complications of HCV.
HCV,HCC,DAA,SVR,Hepatocellular carcinoma
https://ejhm.journals.ekb.eg/article_77447.html
https://ejhm.journals.ekb.eg/article_77447_728012e1af2e83895905d94f295837cf.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Prediction of Spontaneous Abortion Risk by the Use of First Trimester Ultrasound Measurements and Maternal Serum Progesterone Level
369
373
EN
10.21608/ejhm.2020.77448
Background: Prompt diagnosis of early pregnancy failure is a difficult dilemma. There is no single test currently available which immediately differentiates continuing from non-continuing intrauterine or tubal pregnancy. First-trimester ultrasonography is routinely performed to confirm pregnancy location and assess viability. Objective: The aim of this study was early detection of spontaneous abortion risk. Material and methods: This study was conducted in the Department of Obstetrics and Gynecology, Zagzaig University. Sample size was 40 patients. Assuming that mean difference between Group (A) who miscarried and group (B) who continued pregnancy after 20th week in the mean gestational sac diameter 17.9 ± 3.3 and 20.7 ± 3 respectively. Results: 40 patients with mean age 27.55 ± 3.77 years old ranging from 21 to 37 years. All group were in 7th week of pregnancy. Parity was distributed as 25% were primigravida (PG) and about two third were 1-2 and only 10% had parity >2. MSD, CRL, MSD-CRL and FHR parameters were distributed as 19.98 ± 4.97, 8.42 ± 1.71, 11.56 ± 3.5 and 135.6 ± 15.13 respectively. Women in the abortion group had significantly lower MGSD, CRL, MGSD-CRL ratio and FHR values in comparison with women in the non-abortion group (12.9 ± 2.4 vs. 22.4 ± 2.9, 6.1 ± 0.91 vs. 9.2 ± 1.1, 6.8 ±1.6 vs. 13.1 ± 2.3 and 115.0 ± 8.2 vs. 142.0 ± 9.6 respectively) with p-value: < 0.001. Conclusion: Measuring serum progesterone, and first-trimester ultrasound measurements of MGSD, CRL, MGSD/CRL ratio and FHR were good predictors of early pregnancy failure and can be used as a risk assessment model that can predict the risk of early spontaneous abortion
Spontaneous abortion risk,First Trimester Ultrasound,Maternal Serum Progesterone Level
https://ejhm.journals.ekb.eg/article_77448.html
https://ejhm.journals.ekb.eg/article_77448_a63240b417abd65f1de3ed04f14d6428.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Role of Nuclear Medicine in Renal Transplantation
374
380
EN
10.21608/ejhm.2020.77449
Background: Precise diagnosis of renal transplant complications is very important as many complications are potentially treatable if detected early. CT, MR imaging, and nuclear medicine studies play a complimentary role. Nuclear medicine renal scans (using radioactive 99mTc DTPA or 51Cr-EDTA) are considered the gold standard for the evaluation of kidney function because of their accuracy Objective: To spotlight on the important role of nuclear medicine on the preparation of both donor and recipient, follow up and early detection of any abnormality in the transplanted kidney with smooth noninvasive techniques. Conclusion: Renal scintigraphy (RS) has its merits for the evaluation of complications after kidney transplantation, especially for urological and/or vascular complications. Early diagnosis of vascular and urological complications can contribute to a more specific surgical intervention and better post-transplant outcomes. RS should be used in case of non-acute complications, and if the ultrasound (US) provides insufficient results. Radionuclide imaging has the unique advantage of relating perfusion to function. Comparative studies between renal scintigraphy and Doppler sonography seem to have similar performance in the evaluation of renal transplant perfusion.
Nuclear medicine,Renal transplantation
https://ejhm.journals.ekb.eg/article_77449.html
https://ejhm.journals.ekb.eg/article_77449_50cb3c6c466b9573833931d5592c0107.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Endoscopic Resection of a Granular Cell Tumor: A Case Report
381
383
EN
Omar Ahmed
AL Omair
Internal Medicine Department, College of Medicine, King Faisal University, Saudi Arabia
10.21608/ejhm.2020.78328
Background: Granular cell tumors (GCTs) are benign soft tissue tumors that are thought to originate from Schwann cells. They are relatively rare, and presentation in the gastrointestinal tract is even more uncommon. Case report: In this paper, we present a 26-year-old female patient who was incidentally diagnosed with an esophageal GCT. The tumor was initially detected by endoscopy, evaluated by endoscopic ultrasonography (EUS), then resected using an endoscopic mucosal resection technique
Endoscopic,Granular Cell Tumor
https://ejhm.journals.ekb.eg/article_78328.html
https://ejhm.journals.ekb.eg/article_78328_97d19b30b5e68b1aeeb2f92b14d63e4f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Laparoscopic Mini- Gastric Bypass in Management of Morbid Obesity A Prospective Study
384
391
EN
Hussein Ali Mostafa
Abd Al-Motalib
Department of General and laparoscopic surgery, Faculty of medicine – Aswan University
Osama Yassin Mostafa
Taha
Department of Plastic and Bariatric surgery, Faculty of Medicine – Assiut University
Abdel Aal Ali
Sleem
Department of General surgery, Faculty of Medicine - Sohag University
Ahmed Mostafa Maghraby
Mohamed
Department of General and laparoscopic surgery, Faculty of medicine – Aswan University
ahmedmmahraby@yahoo.com
10.21608/ejhm.2020.78329
Background: In recent years, a surgical technique known as single-anastomosis gastric bypass (SAGB) or minigastric bypass (MGB) has been developed. Its frequency of performance has increased considerably in the current decade. This procedure proposes a simplification of Roux-en-Y bypass by performing a single anastomosis, with a significant reduction of technical complexity, shorter operative time and a potential reduction in morbidity and mortality. Objective: This study aimed to evaluate if laparoscopic mini gastric bypass operation is safe and effective for treatment of different cases with morbid obesity and its associated comorbidities Material and methods: This was a prospective study of 100 patients with morbid obesity submitted to laparoscopic MGB from March 2018 to January 2019. This study was conducted in the Bariatric Surgery Unit, at Assuit university hospital and Osama Taha group clinic. Demographic and clinical data were prospectively collected from the preoperative evaluations. Results: The most important findings of this study were the safety and the high efficacy, which were translated into no mortality, very acceptable complications (early complication rate 4% and late complication rate 6 %). High excess weight loss (EWL) 72.26 ± 5.18 % and remission rate 92% of patients who had diabetes, as 100.0% of patients who had fatty liver, 96.0% of patients who had hyperlipidemia, 95.0% of patients who had sleep apnea and 94.0% of patients who had hypertension. Conclusion: MGB/ one-anastomosis gastric bypass (OAGB) is a simple, safe, effective, easy to learn and easy to reverse procedure. It has acceptable complications and mortality rates.
MGB,EWL,Morbid Obesity
https://ejhm.journals.ekb.eg/article_78329.html
https://ejhm.journals.ekb.eg/article_78329_5a3183b3f225d341f80baba19c924dc8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Management of Inflammatory Pancreatic Fluid Collections and Walled-off Pancreatic Necrosis: A Retrospective Study Over Five Years
392
399
EN
Mahmoud
Khairallah
Department of General Surgery, Alexandria University, National Research Centre, Egypt
Ahmed
Khairallah
0000-0002-4701-1714
Department of Internal Medicine,
National Research Centre, Egypt
ahmed.abdo.khairallah@gmail.com
Mohamed Ibrahim
Kassem
Department of General Surgery, Alexandria University, National Research Centre, Egypt
Ahmed El Sayed
Shaaban
Department of General Surgery, Alexandria University, National Research Centre, Egypt
Mostafa Refaie
El Keleny
Department of General Surgery, Alexandria University, National Research Centre, Egypt
10.21608/ejhm.2020.78330
Background and objective: Acute pancreatitis (AP) is an inflammatory process of the pancreas, with variable involvement of peri-pancreatic tissues and remote organ systems. In this study we discuss surgical and conservative management of acute pancreatitis and its local complication. Methods: This retrospective study was carried out on 128 patients, who were admitted to Gastrointestinal Surgery Unit, Main Alexandria University Hospital, Alexandria University, and who were complaining of acute pancreatitis with fluid collections and sequels (PP, ANC and walled-off pancreatic necrosis (WOPN). Medical information was retrieved retrospectively from patient’s files recorded in Main Alexandria University Hospital and from computerized data system in Gastrointestinal Surgery Department, between October 2013 – October 2018. Results: Forty-five patients with acute edematous pancreatitis with free collection were managed conservatively successfully. Thirty-two patients with PP underwent drainage, endoscopic (n=17), or open (n=15) approach. Twentythree patients with WON underwent drainage and debridement whether by open (n=11), endoscopic (n=9), or PCD (n=3) approaches. Twenty-eight patients with necrotizing pancreatitis, 16 patients were managed conservatively, 12 patients needed intervention either, PCD (n=9) or open surgical necrosectomy (n=3). Conclusions: The operative management of acute pancreatitis is focused on managing the acute complications, and the long-term sequelae. However, the evolution of videoscopic and endoscopic techniques have greatly expanded the tools available.
Acute pancreatitis,Necrotizing pancreatitis,Pseudo pancreatic cyst,Walled off necrosis
https://ejhm.journals.ekb.eg/article_78330.html
https://ejhm.journals.ekb.eg/article_78330_512f8b47b4a1e6785a24e84f8f4246ce.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Outcome of Single Anastomosis Gastric Bypass in 100 Obese Diabetic Patients, A Prospective Study
400
405
EN
Hussein Ali Mostafa
Abd Al-Motalib
Department of General and Laparoscopic Surgery, Faculty of medicine, Aswan University
Osama Yassin Mostafa
Taha
Department of Plastic and Bariatric surgery, Faculty of Medicine, Assiut University
Abdel Aal Ali
Sleem
Department of General surgery, Faculty of Medicine, Sohag University
Ahmed Mostafa Maghraby
Mohamed
Department of General and Laparoscopic Surgery, Faculty of medicine, Aswan University
ahmedmmahraby@yahoo.com
10.21608/ejhm.2020.78331
Background: Type 2 diabetes mellitus ((T2DM) is one of the most challenging health problems of the twenty-first century. A further 318 million adults are estimated to have impaired glucose tolerance, which puts them at high risk of developing the disease. (T2DM remission has been reported to varying degrees after all current bariatric operations. Objective: The aim of this study was to evaluate if laparoscopic mini gastric bypass (MGB) operation is effective for treatment of (T2DM associated with morbid obesity. Material and methods: This prospective study included a total of 100 patients with morbid obesity submitted to Laparoscopic MGB from March 2018 to January 2019. This comprises the initial part of our series, and data was analyzed after all patients completed a follow up of 1 year. This study was conducted in the Bariatric Surgery Unit, at Assuit university hospital and Osama Taha group clinic. Demographic and clinical data were prospectively collected from the preoperative evaluations. Results: Diabetic patients showed significant decrease in random blood sugar (RBS) and HA1c in 1 year follow up after surgery. The mean RBS preoperative was 294.40±57.13 while after 1 year follow up was 182.38±4.71 and significant decrease in HA1C from mean 8.24±1.91 to 5.61±1.20 1 year after surgery. Remission was achieved in 92% with (86.0%) of patients have complete remission, and (6.0%) of patients have partial remission. In this study The DM complete remission rates for those with disease duration < 2years, 2-5 years and > 5 years were 93.02%, 66.67% and 25% respectively. Conclusion: It could be concluded that one-Anastomosis Gastric Bypass (OAGB) can be an excellent alternative to Roux-en-Y Gastric Bypass (RYGB) for the treatment of diabetes and obesity. Pre-operative medications and duration of disease may be used to predict postoperative diabetes remission.
Anastomosis,Gastric bypass,Obese diabetic patients
https://ejhm.journals.ekb.eg/article_78331.html
https://ejhm.journals.ekb.eg/article_78331_b3a2724c030fa71a3f85eb2c2b2da677.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Ultrasound Guided Pectoral Nerve Block Versus Ultrasound Guided Thoracic Paravertebral Block to Supplement General Anesthesia in Simple Mastectomy
407
411
EN
Mona R.
Salem
Department of Anesthesia, International Nozha Hospital, Cairo,
Nadia G.
El-Sharkawi
Department of Anesthesia, Intensive Care
and Pain Management, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
Inas
El-Shazly
Department of Anesthesia, Intensive Care
and Pain Management, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
elshazly_inas@gmail.com
Mohamed A.
Mansour
Department of Anesthesia, Intensive Care
and Pain Management, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
mohamed.a.mansour77@gmail.com
10.21608/ejhm.2020.78332
Background: Breast surgery, can be associated with significant postoperative pain. Objectives: This study was conducted to compare pectoral nerve block (PECS) and thoracic paravertebral block (TPVB) as supplements to general anesthesia for alleviation of patients’ postoperative pain after breast surgery. Patients and Methods: This prospective cohort study included 60 female patients with ASA I-III, and body mass index< 30 kg/m2 undergoing mastectomy. Patients were allocated into two equal groups (PECS and TPVB groups). Both types of nerve block were ultrasound-guided. After 30 minutes, general anesthesia was induced. When the mean arterial pressure (MAP) or heart rate (HR) exceeded 20% of the preoperative value, increments of fentanyl 25 µg were given intravenously at 5 minutes intervals. Paracetamol and ketorolac were used for postoperative analgesia. Postoperative pain intensity was measured using visual analogue scale (VAS). The measured parameters included time to the first call for analgesia, intraoperative and postoperative MAP and HR, intraoperative fentanyl consumption, the amount of analgesics used in the first 24 postoperative hours and patients’ satisfaction and complications. Results: The PECS Group showed significantly lower intraoperative fentanyl consumption, longer duration before the first postoperative call for analgesia, lower VAS till 18 hours postoperatively, lower postoperative consumption of both paracetamol and ketorolac, and higher satisfaction score as compared to TPVB group. There were no complications in both groups. Conclusions: Pectoral nerve block was superior to thoracic paravertebral block in terms of intraoperative analgesic consumption, duration of analgesia, postoperative pain score, postoperative analgesic consumption, and patients’ satisfaction.
Ultrasound,pectoral,block,paravertebral,mastectomy
https://ejhm.journals.ekb.eg/article_78332.html
https://ejhm.journals.ekb.eg/article_78332_e64beba97adf9eca700920db0812f561.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Prevalence of Neck Pain Among Otolaryngologists
412
416
EN
Nawal Abd El-Raouf
Abou-Shady
Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University
Rasha M.
El Rewainy
Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University
Walaa E. El-Den Mohamed
Mustafa
Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University
Ibrahim M.
Hamoda
Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Kafr El-Sheikh University
10.21608/ejhm.2020.78333
Background: otolaryngologists spend their workdays in performing markedly precise procedures in small works places i.e. the patients’ ear, nose and throat. Due to this, they frequently adopt awkward neck, back and shoulder postures while using devices like otoscope, endoscope and microscope. So, the otolaryngologists’ job profile puts them at high risk for musculoskeletal disorders like neck pain. Purpose: of the study was to investigate the prevalence of work-related neck pain among otolaryngologists - head and neck surgeons. Patients and Methods: specific questionnaire based on Visual Analog Scale and Neck Disability Index was given to one hundred otolaryngologists, head and neck surgeons of both gender, age from 30 to 40 years selected from ENT Departments in Hospitals of Ministry of Health. Results: The statistical analysis revealed that the prevalence of work-related neck pain among otolaryngologists was (69%). Regarding the severity of pain, (80%) reported pain as mild pain while (20%) reported pain as moderate. Conclusion: It could be concluded that work related neck pain is common among Egyptian Otolaryngologists, making otolaryngologists at a high-risk group. There is a need to improve ergonomics in the clinical and operative room settings and to educate otolaryngologists on ergonomic principles.
Neck pain,Otolaryngologists,Musculoskeletal disorders
https://ejhm.journals.ekb.eg/article_78333.html
https://ejhm.journals.ekb.eg/article_78333_c17d238a8d9cfebfad83c08bc9424a0b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Rare Occurrence of Chemotherapy-Induced Regression of Focal Nodular Hyperplasia: A Case Report and Literature Review
417
422
EN
Johara
AlMulhim
Department of Radiology, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
dr.johara1988@gmail.com
10.21608/ejhm.2020.78334
Background: Chemotherapy exerts a multitude of effects on all organ systems including the liver. Chemotherapyinduced liver changes are widely discussed in the literature and include hepatitis, hepatic steatosis, cholestasis, nodular hyperplasia, and veno-occlusive disease among others. The exact mechanism of which nodular hyperplasia is affected by chemotherapy is controversial but some experts suggest an alteration in blood supply might lead to exaggerated focal regeneration. Objectives: This study aimed to discuss an unusual effect of chemotherapeutic agents on pre-existing focal nodular hyperplasia with a short literature review. Patient and methods: A case report of 67 years old bedridden male patient presenting to the hospital with a 1- month history of gross hematuria who was treated with chemotherapy. Results: Our case showed an interval size reduction of a pre-treatment documented FNH in a patient with muscleinvasive urinary bladder cancer who was treated with a chemotherapy regimen of GemCarbo. This report also emphasizes the importance of enhanced MRI with hepatobiliary contrast agents in the evaluation of equivocal liver lesions in cancer patients to avoid misdiagnosis of distant metastasis. Conclusion: FNH is a common focal hepatic lesion and frequently seen in oncology patients during either initial evaluation or at follow up. Diagnostic radiologists should be aware of the expected imaging findings of various types of hepatic lesions and the effect of the medications the patient is receiving to avoid over-staging oncology patients.
Chemotherapy,FNH,MRI
https://ejhm.journals.ekb.eg/article_78334.html
https://ejhm.journals.ekb.eg/article_78334_0e2f567ad19c32106364b6a3e458b80f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
A Short Review on Progressed Hepatocellular Carcinoma: Radiological Findings and Histopathological Diagnosis
423
428
EN
Khalid Suliman
AlJoqiman
Department of Radiology, College of Medicine, King Faisal University, Al-Ahsa
Johara
AlMulhim
Department of Radiology, College of Medicine, King Faisal University, Al-Ahsa
dr.johara1988@gmail.com
Mohammed Abdulrahman
AlTuriqy
Department of Radiology,
College of Medicine, Majmaah University, Saudi Arabia
10.21608/ejhm.2020.79269
Background: Hepatocellular carcinoma (HCC) is, by far, the most common liver malignancy. The risk factors for the development of HCC are numerous with liver cirrhosis, chronic hepatitis B and C viral infections and alcohol abuse on top of the list. Several studies were devoted to evaluate the complex radiological appearance of HCC and its correlation with histopathologic grade/stage as well as possible mimickers of HCC, all of which have a significant impact on diagnosis and management of patients with HCC. Objectives: Evaluation of the radiological findings of HCC and its correlation with histopathologic grade/stage as well as mimickers of HCC. Methods: This is a review article of some of the existing literature regarding radiological findings and histopathologic diagnosis of progressed hepatocellular carcinoma. Conclusion: Imaging findings of progressed HCCs are complex and different from the standard findings of welldifferentiated HCCs. Evaluation of enhancement and washout patterns, as well as the possibility of the presence of microvascular invasion, should be undertaken by the reporting radiologist and delivered comprehensively to the treating multidisciplinary team for proper management.
Radiology,HCC,CT,MRI,Liver
https://ejhm.journals.ekb.eg/article_79269.html
https://ejhm.journals.ekb.eg/article_79269_f46674e8926f22dff334f628a205ac28.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Unusual Cause of Transient Unilateral Fixed Dilated Pupil in Infant with Bronchiolitis: A Case Report
429
430
EN
Abdullah
Al-Shamrani
Prince Sultan Medical Military City (PSMMC)
dr.alshamrani99@gmail.com
Reham M.
Babiker
Dr. Sulaiman Al-Habib Medical City-Rayan Hospital
Waleed A.
Okash
Dr. Sulaiman Al-Habib Medical City-Rayan Hospital
Naif I.
Al-Oudah
Dr. Sulaiman Al-Habib Medical City-Rayan Hospital
Rola A.
Sleiman
Dr. Sulaiman Al-Habib Medical City-Rayan Hospital
10.21608/ejhm.2020.79270
Background: Unilateral anisocoria has a variety of causes, some of which could be life-threatening. Mydriasis can represent a serious neurological finding in intensive care units. Bronchiolitis is the most common cause of intensive care in the infancy period. Ipratropium bromide is anticholinergic and commonly used in the intensive care unit (ICU). Anisocoria is due to the overactivation of the sympathetic nervous system or hypoactivity of the parasympathetic nervous system. Objectives: Assessment of cases of anisocoria in infants with bronchiolitis under ipratropium bromide therapy. Patient and methods: A case report study of a 9-month-old infant with a fixed dilated pupil. He was admitted into the ICU and given ipratropium bromide. Results: Ultimately, the patient’s symptoms of pupillary dilation resolved over 24 hours with the discontinuation of ipratropium bromide, with a complete recovery. The case presented here is typical of anticholinergic side effects, and the evidence of this benefit is even more limited, which might lead to frustrating observations among patients and health care providers. Conclusion: Anisocoria is not an uncommon finding in patients receiving ipratropium bromide. Paediatricians should follow the Saudi Bronchiolitis Guideline recently published in 2018, in which no indication of ipratropium bromide in bronchiolitis was clearly stated.
Anisocoria,pupil,bronchiolitis,ipratropium bromide,mydriasis
https://ejhm.journals.ekb.eg/article_79270.html
https://ejhm.journals.ekb.eg/article_79270_b4480e7656950f3e2232c42bffa330c9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Renal Resistive Index as One of The Predictors of Cardiac Diastolic Dysfunction in Type 2 Diabetic Patients
431
434
EN
Hend M.
Abdelhakam
Department of
Internal Medicine, SVU, Qena
hendhakam@gmail.com
Ehab M.
Moussa
Department of Radiology, Assiut University, Assiut
Salah
Argoon
Department of Internal Medicine (Endocrinology Unit), Assiut University, Assiut
argoons@yahoo.com
Mahmoud
Ashry
Department of Internal Medicine (Cardiology and Critical Care Unit), Assiut University, Assiut, Egypt
mamashry57@yahoo.com
10.21608/ejhm.2020.79352
Background: Renal resistive index (RRI) is markedly affected by renal and systemic conditions. Aortic stiffness with affected pulse pressure in type 2 diabetic patients is associated with backward overload effect on the heart. This had led to consider RRI as a preferred marker for prediction of an increased total cardiovascular risk. Aim: This study interested in detecting the relationship between the renal resistive index and the cardiac diastolic dysfunction in individuals with type 2 diabetes. Patients and methods: A hospital based, cross-sectional study was conducted on 79 type 2 diabetic patients with no symptoms of cardiovascular involvement. They were subjected to echocardiographic evaluation of diastolic dysfunction and renal duplex for measurement of RRI. Results: The results of the current study revealed a significant relationship between renal resistive index and diastolic dysfunction (p < 0.001). Conclusion: Worsening indices of diastolic function in subjects with type 2 diabetes paralleled increases in RRI, which was detected as one of the independent predictors of diastolic dysfunction in these results.
Diastolic Dysfunction,Renal Resistive Index,Type 2 DM
https://ejhm.journals.ekb.eg/article_79352.html
https://ejhm.journals.ekb.eg/article_79352_c1d968eebd5eb4097ca15df21a2a13a1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Evaluation of QT Intervals in Compensated and Decompensated Chronic Hepatitis C Cirrhotic Patients
435
441
EN
Osama Ahmed
Khalil
Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig Egypt
Mohamed Samy
Fawzy
Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Ashraf Khalifa
EL-Naggar
Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig Egypt
Entesar Kamel
Sayed
Internal Medicine Department, Ahmed Maher Teaching Hospital, Egypt
drayaahmed@yahoo.com
10.21608/ejhm.2020.80836
Background: Cirrhotic cardiomyopathy is chronic cardiac dysfunction in cirrhotic patients with no previous structural heart disease. QT prolongation is one of the most important cardiac alterations related to cirrhosis. Objective: This study was aimed to evaluate QT interval duration among compensated and decompensated chronic Hepatitis C (Ch HCV) cirrhotic patients and to detect its relation to biochemical changes in cirrhosis and its effect on patients’ outcome. Patients and Methods: A cross sectional study was conducted on 52 Ch HCV patients divided into two groups according to presence of signs of decompensation. Patients underwent clinical, laboratory and electrocardiographic evaluation. Cirrhosis severity was classified according to the Child-Pugh score. The QT interval in lead II (QTII), maximum QT (QTmax), heart rate corrected QTmax (msillisecond) obtained manually using by a 12-lead electrocardiogram. Results: Decompensated patients had non-significantly lower values of QTII and QT max. There was significant difference between both groups regarding QT maxc. 80.8% versus 38.5% of decompensated and compensated patients had prolonged QTC. There was significant relation between child class and QT parameters. There was significant relation between QT maxc prolongation and serum Albumin, sodium, ammonia, Urea, AFP and APACHE-II. There was significant relation between outcome and both QT max and QT maxc. Cutoff of QT max n predicting mortality was≥435 with sensitivity 80% and specificity 69%. QT maxc cutoff ≥508 predicted mortality with sensitivity 80% and specificity 84%. Conclusion: A prolonged QT maxc was prevalent among cirrhotic patients and this positively correlated with disease severity and high mortality.
Cirrhosis,prolongation,cardiomyopathy
https://ejhm.journals.ekb.eg/article_80836.html
https://ejhm.journals.ekb.eg/article_80836_8d3f6d03cf2745d0ee3da936a394c1c1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Role of Laparoscopy in Diagnosis and Treatment of Acute Abdominal Pain
442
445
EN
Mohammed Fathi
Sharaf
Department of General and Laparoscopic Surgery, El-Hussein University Hospitals,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Eslam Taha
Ghalwash
Department of General and Laparoscopic Surgery, El-Hussein University Hospitals,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Abd Al Rahman Mohammed
Ali
Department of General and Laparoscopic Surgery, El-Hussein University Hospitals,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
drabdom2020@gmail.com
10.21608/ejhm.2020.80838
Background: Abdominal pain is a common presentation at the surgical department. Emergency laparoscopy in patients with "acute abdomen" is a part of common surgical practice. Aim: Evaluation of the role of laparoscopy in management of acute abdominal pain Methods: 100 patients with acute abdominal pain presented to the Department of Surgery, Al-Azhar University, El-Hussein and El Minia Health Insurance Hospitals were included in the study during the period from April 2018 to April 2019. They were divided into two groups: known preoperative diagnosis (therapeutic n= 67 patients) and unknown (diagnostic and therapeutic n= 33 patients). Their ages ranged between 12 and 60 years old (35 patients were males and 65 patients were females). Laparoscopy was performed for all patients under general anesthesia. Results: The definitive diagnosis was established in 99 % of cases. 64 % of those cases were managed successfully by use of laparoscopy and conversion rate was 33 %. Time required for each operation varied according to the procedure, intraoperative morbidity was 7 %, post-operative complications were 11 %. The mortality of study was 1%. Conclusions: laparoscopic intervention for abdominal emergencies is as safe, feasible and effective. It results in minor trauma, has a rapid postoperative recovery, and reduces morbidity. Laparoscopy can help to avoid unnecessary non- therapeutic laparotomies. It can also help to guide the operating surgeon for choosing the proper targeted incision.
Acute abdomen,Emergency,Laparoscopy
https://ejhm.journals.ekb.eg/article_80838.html
https://ejhm.journals.ekb.eg/article_80838_af56fd6abc733d7d7142d9e02ac4652c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Cancer Oral Tongue: A Retrospective Epidemiological, Pathological and Clinical Analysis with Correlation to Treatment Outcome
446
456
EN
Hesham Mahmoud
El Wakiel
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University
Amro Lofty
Farag
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University
Ahmed Hassan
Abdel Aziz
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University
Ahmed Gamal Ali
El Sayed
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University
ahmedgamal4me@hotmail.com
10.21608/ejhm.2020.80840
Background: early cancers are managed by single modality treatment (surgical excision of the primary tumor or radiotherapy (3DCRT, IMRT or brachytherapy)) with or without elective neck dissection. While locally advanced resectable disease is managed by surgery (excision of the primary tumor with modified radical neck dissection) followed by postoperative radiotherapy with or without chemotherapy. This should be considered for cases with adverse pathological features. Purpose: this is a retrospective study to analyze the epidemiological, pathological and clinical factors in cancer oral tongue and correlate them to clinical outcomes [response to treatment and survival rates (disease free survival, progression free survival and overall survival)] to explore best options of care for the patients. Patients and Methods: at the Department of Clinical Oncology and Nuclear Medicine, Ain Shams University Hospitals and Nasser Institute, Cancer Center; patients with a histologically confirmed diagnosis of oral tongue cancer were included in this retrospective analysis. The study included 40 cases from Nasser Institute, Cancer Center and 18 cases from Ain Shams University Hospitals. The study period was 6 years from January 2011 to December 2016. Results: fifty eight recorded cases were included in the study and subsequent descriptive analysis was performed. One patient who didn’t receive any treatment was omitted from the study. Conclusion: as regard treatment; most of the patients underwent surgery followed by adjuvant concurrent chemo radiotherapy especially in patients with close or positive surgical margins or patients who didn’t undergo LN dissection. This affected DFS.
Cancer Oral Tongue,Lymph nodes,Liver Function Test,Kristen Rat Sarcoma virus
https://ejhm.journals.ekb.eg/article_80840.html
https://ejhm.journals.ekb.eg/article_80840_112710921a2db3298d094fe0fcdb3f17.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Effect of Dexamethasone as A Local Anesthetic Adjuvant for Peribulbar Block in Vitreoretinal Eye Surgeries
457
461
EN
Dalia S.
Tawfik
Department of Anesthesia, Research Institute of Ophthalmology, Cairo, Egypt
Sara R.
Mahmoud
Department of Anesthesia, Research Institute of Ophthalmology, Cairo, Egypt
Noha A.
Osama
Department of Anesthesia, Research Institute of Ophthalmology, Cairo, Egypt
noha.a.osama22@gmail.com
10.21608/ejhm.2020.81283
Background: Off label use of dexamethasone as an adjuvant to local anesthesia has been utilized to prolong single injection techniques. Objectives: To assess the beneficial effect of dexamethasone on peribulbar block in vitreoretinal surgeries. Patients and Methods: Patients undergoing vitreoretinal surgeries were randomized into 2 groups (10 patients each). They were given peribulbar block in the form of single medial canthus injection in a mixture of 8-10 ml of lidocaine 2% and bupivacaine 0.5% added to hyaluronidase 30 IU given by 25G, 1" needle. Group 1 received the block in addition to 4 ml dexamethasone. All patients got preoperative sedation in the form of 20 mic fentanyl, 1 mg midazolam and 20 mg propofol. Primary outcomes were onset of the block, pain during injection according to the visual analog scale (VAS) score, the need to supplement the block or sedation during surgery. Secondary outcomes were hemodynamics (heart rate, mean arterial blood pressure, oxygen saturation), patient satisfaction and surgeon satisfaction. Results: The mean onset of sensory and motor block in group 1 was significantly less (6.2+1.9) than group 2 (9.9+0.3 minutes). The pain score in group 1 was significantly lower (4+0.8) than group 2 (6+0.9), and the need for supplementation of the block or sedation during surgery differed significantly between the groups in favor for group 1 where the need for both was much less. Conclusions: Addition of dexamethasone to peribulbar block in vitreoretinal surgery speeds up the onset of the block and adds to its efficacy.
dexamethasone,peribulbar,vitreoretinal
https://ejhm.journals.ekb.eg/article_81283.html
https://ejhm.journals.ekb.eg/article_81283_a307a85b818ae08e4626ac69de2e17f9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Fetuin-A as a Marker of Insulin Resistance in Type 2 Diabetic Patients in Zagazig University
462
468
EN
Fawzy Abdelfatah
El-Messallamy
Department of Internal Medicine, Faculty of Medicine, Zagazig University,
Sharkia
Jehan Saeed Abdo
Soliman
Department of Biochemistry, Faculty of Medicine, Zagazig University,
Sharkia
Sally Mahmoud Saeed
Shalaby
Department of Internal Medicine, Faculty of Medicine, Banha University, Qaluobya, Egypt
Heba Abdel-Rahman Kamel
Abdel-Rahman
Department of Internal Medicine, Faculty of Medicine, Banha University, Qaluobya, Egypt
lwjywlarawkarma@gmail.com
10.21608/ejhm.2020.81284
Background: Fetuin-A is responsible for instigating insulin resistance by inhibiting tyrosine kinase receptors. Objective: To investigate the relationship of fetuin-A with and insulin resistance in type- II diabetics either obese or non-obese of Zagazig University, Shatkia Governorate, Egypt. Patients and Methods: This is a case-control study that was conducted at the Internal Medicine Department of Zagazig University. Seventy-five participants were divided into three groups. Group-A (n =25) normal healthy individual, Group-B (n =25) non-obese type 2 diabetic patients and Group C (n=25) obese type 2 diabetic patients. Type 2 diabetic patients with no morbidities. Serum fetuin-A and insulin levels were performed by ELISA kits while fasting blood glucose (FBG), 2HPP and HA1C were determined by the enzymatic kit method. A comparison of groups was done and correlation was achieved by using Spearman correlation. Results: The results demonstrated a significant difference in mean values of fetuin-A, BMI, WHR, fasting blood glucose (FBG), 2HPP, HA1C, insulin level and Homoeostasis Model Assessment of Insulin resistance (HOMAIR) in type-II diabetics when compared to normal healthy individuals and obese type-II diabetics (p<0.01). The fetuin-A level was higher in obese more than non-obese type II diabetics. Conclusion: The study concluded that fetuin-A might be accountable for insulin resistance in type-II diabetes mellitus either obese or non-obese. So the high levels of Fetuin-A responsible for insulin resistance.
Fetuin-A,Insulin Resistance,Type-II Diabetes Mellitus,Obesity,HOMA-IR
https://ejhm.journals.ekb.eg/article_81284.html
https://ejhm.journals.ekb.eg/article_81284_ff757896845b21592b16927e92d58705.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Value of Multi-Slice Computed Tomography in The Evaluation of Postoperative Complications After Laparoscopic Sleeve Gastrectomy
469
480
EN
Amgad S.
Abdel-Rahman
Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt,
dr_amjadsami@yahoo.com
Fatma M. M.
Salama
Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt,
Sayed H. M.
Mohamed
Department of Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt.
10.21608/ejhm.2020.81761
Background: Obesity is a medical condition that have an adverse effect on health. Bariatric surgery is considered nowadays as one of the most effective treatment for obesity. CT is one of the best modalities that is performed after a bariatric procedure to assess for complications. Purpose: The aim of this work was to highlight CT radiological features of postoperative surgical complications after laparoscopic sleeve gastrectomy (LSG) using abdominal multi-slice computed tomography (MSCT), and 3D volumetric rendering if needed. Patients and Methods: 182 patients with post sleeve gastrectomy suspected complications were subjected to CT of the abdomen and pelvis. Post-processing was performed with multi-planner reformation generating coronal and sagittal images together with the raw axial images for assessment of the integrity of the sleeved stomach and detection of any encountered complication with 3D reconstruction if needed to asses gastric pouch volume. Results: CT detected complications in 43 patients (23.6%) out of the 182 patients who underwent laparoscopic sleeve gastrectomy. The complications reported in our study were hematoma occurred in 13 patients (7.1%), leakage occurred in 10 patients (5.5%), abscess formation occurred in 6 cases (3.3%), splenic infarction occurred in 5 patients (2.7%), solid organ injury occurred in 2 patient (1%), Porto-mesenteric thrombosis occurred in 7 patients (3.8%), intestinal obstruction occurred in 2 cases (1%), port site ventral hernia occurred in 3 cases (1.6%), abdominal wall hematoma occurred in 3 cases (1.6%), enlarged gastric pouch occurred in 4 cases (2.2%), hiatus hernia occurred in 2 cases (1%). Conclusion: It could be concluded that sleeve gastrectomy became an increasingly popular surgery for obesity, so the radiologists must recognize and identify the normal postoperative anatomy as well as the possible complications of this procedure. MSCT with the 3D volumetric study is an important imaging tool to diagnose accurately the complications of sleeve gastrectomy.
Laparoscopic sleeve gastrectomy (LSG),Multi-slice CT (MSCT),Body mass index (BMI)
https://ejhm.journals.ekb.eg/article_81761.html
https://ejhm.journals.ekb.eg/article_81761_15715594d2bf06be3a084ce7830f2487.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
The Effect of High Flux versus Low Flux Dialyzers on Serum Fibroblast Growth Factor-23 (FGF-23) and Its Cardiovascular Implications in Prevalent Hemodialysis Patients
481
488
EN
Walid Ahmed
Bichari
Department of Internal Medicine, Faculty of Medicine, Ain Shams University
Mariam Gamal
Aabed
Department of Internal Medicine, Faculty of Medicine, Ain Shams University
Ashraf Hassan
Abdelmobdy
Department of Internal Medicine, Faculty of Medicine, Ain Shams University
ashrafnephro@yahoo.com
10.21608/ejhm.2020.81762
Background: Cardiovascular disease is the main cause of death in patients with end stage renal disease. Fibroblastic growth factor- 23 (FGF-23) is a novel phosphaturic hormone produced in the osteocyte. Patients with kidney disease complain of elevated levels of FGF-23 in response to hyperphosphatemia. Patients and Methods: This was a cross-over prospective study conducted on 30 patients on regular hemodialysis. The study period was 6 months, laboratory investigations for FGF-23, complete blood picture, s. urea (pre-dialysis and post-dialysis), serum albumin, serum electrolytes (Ca++ & PO4), alkaline phosphatase, PTH, serum ferritin, and lipid profile as well as echocardiography were obtained in the start of the study, after 3 months on maintained lowflux hemodialysis and 3 months after switching the patients to high-flux hemodialysis. Results: There was a highly significant reduction of FGF-23 level with high-flux dialyzers than with low-flux dialyzers. The adjusted difference in the absolute change in FGF-23 levels between the three months period of lowflux dialysis and the three months period of high-flux dialysis showed a highly significant reduction with high-flux than with low-flux (p= 0.000). There was a significant reduction of serum levels of PTH, calcium, phosphorus levels with high-flux dialyzers than with low-flux dialyzers, the adjusted difference was (p= 0.022), (p= 0.000), and (p= 0.006) respectively. Conclusion: FGF-23 levels were significantly higher in hemodialysis patients than in normal population. FGF-23 was better eliminated by high-flux dialyzers than low-flux dialyzers and high FGF-23 levels were associated with increased incidence of cardiac valve calcification. FGF-23 positively correlated with right ventricular systolic pressure.
Cardiovascular,Low-flux,High-flux,FGF-23,Hemodialysis patients
https://ejhm.journals.ekb.eg/article_81762.html
https://ejhm.journals.ekb.eg/article_81762_1c69e7ba91896a46b333650d073145f6.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Evaluation of the Corneal Thickness and Endothelial Changes Following Uncomplicated Phacoemulsification in Diabetic and Non-Diabetic Patients by Pentacam and Specular Microscopy
489
496
EN
Motaz Bellah Abdel Hameed
Erfan
Department of Ophthalmology, Faculty of Medicine, Misr University for Science and Technology
Hossam El-Den Mohamed
Khalil
Department of Ophthalmology, Faculty of Medicine, Beni-Suef University
Hazem Effat
Haroun
Department of Ophthalmology, Faculty of Medicine, Beni-Suef University
Ahmed
Tharwat
Department of Ophthalmology, Faculty of Medicine, Misr University for Science and Technology
a.teyeclinic@yahoo.com
10.21608/ejhm.2020.82462
Background: Diabetes mellitus (DM) is an important health problem that induces unrestful complications. It causes significant morbidity owing to specific microvascular complications such as diabetic retinopathy, diabetic cataract, diabetic keratopathy, and diabetic optic nerve diseases. Patients and Methods: This is a prospective, comparative case series study assessing the corneal endothelial status in 20 diabetics and 20 non diabetics before, after 1 day, 1 week and 1 month of uneventful phacoemulsification using phaco-chop technique. Central corneal thickness (CCT), as well as endothelial cell density (ECD), coefficient of variation (CV) and percentage of polymegathism or hexagonality were measured by specular microscopy. The corneal thickness at 0, 2 and 4 mm from center of the cornea and corneal volume at 3, 5 and 7 mm from the center of the cornea. Changes were compared between both groups using pentacam in the same follow up period. Results: Preoperative CCT was found to be significantly higher in diabetic than in non-diabetic group. ECD and CV were insignificantly higher in diabetics in contrast with the percentage of hexagonality, which was found to be insignificantly lower preoperatively. Diabetics showed insignificant higher loss in endothelial cell count as compared to non-diabetics. Furthermore, the diabetics showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the CV%. Postoperative CCT measurements demonstrated no significant variations between groups evidenced by specular microscopy as well as changes in corneal thickness and volume evidenced by pentacam. Conclusion: The present study revealed no significant differences between preoperative and postoperative values neither in terms of mean ECD values, nor in corneal thickness and corneal volume between diabetic patients and nondiabetic patients undergoing phacoemulsification employing phaco-chop technique.
cataract surgery,Corneal Thickness,Endothelial changes,Specular microscopy,pentacam,Diabetes mellitus
https://ejhm.journals.ekb.eg/article_82462.html
https://ejhm.journals.ekb.eg/article_82462_e2605d6435810fb48ee176527aab9c09.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
The Diagnostic Value of Cervicovaginal and Serum Ferritin in Relation to Spontaneous Preterm Birth: Observational Study
497
502
EN
Ibrahim Saif
Elnasr
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
ibrahimalisaifelnasr@gmail.com
Hesham
Ammar
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
amar_hesham@yahoo.co.uk
10.21608/ejhm.2020.84072
Background: Preterm labor is a major cause of neonatal complications. Some researchers have demonstrated that increased serum ferritin level and cervicovaginal ferritin concentrations is associated with preterm labor. Objective: The aim of the current work was to detect the role of serum and cervicovaginal ferritin concentrations in mid gestation in predicting preterm labor in patients with no well-known risk factors for preterm delivery. Patients and methods: This prospective cohort observational study included a total of 100 pregnant women with singleton pregnancies between 20 and 24 gestational weeks, attending at the Department of Obstetrics and Gynecology, Menoufia University Hospital between March 2017 to March 2019. Cases were distributed between 2 groups; Group 1 delivered full-term and group 2 delivered preterm. Cervicovaginal and serum ferritin was measured for them. All cases were followed up till delivery. Results: There is a strong relation between spontaneous preterm delivery and increased levels of serum and cervicovaginal ferritin when measured at gestational age 20–24 weeks. Serum ferritin level ≥110.5 ng/mL gave sensitivity 86.7% and specificity 94.1% in preterm delivery prediction. Cervicovaginal ferritin level ≥25.5 ng/mL gave sensitivity 86.7 % and specificity 64.7% in preterm delivery prediction. Conclusion: It could be concluded that increased serum and cervicovaginal ferritin concentrations in mid gestation are dependable markers for predicting preterm delivery
cervicovaginal ferritin,Preterm Delivery,serum ferritin,spontaneous preterm delivery
https://ejhm.journals.ekb.eg/article_84072.html
https://ejhm.journals.ekb.eg/article_84072_b805e36f0a46cde2f5567e53cdaa46fc.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Incidence of Acute Kidney Injury in HCV Infected Patients Receiving Direct-Acting Antivirals
503
508
EN
Hayam
Aref
Department of Internal Medicine and Nephrology, Ain Shams University, Cairo, Egypt
drhiam_aref@med.asu.edu.eg
Mostafa
Ahmed
Kobry El Kobba Military Hospital, Cairo, Egypt
mostafashaban2009@gmail.com
Ahmed Abdelmoniem
Emara
Department of Internal Medicine and Nephrology, Ain Shams University, Cairo, Egypt
ahmed_emara@med.asu.edu.eg
Salma Fathy
Rezk
Department of Internal Medicine and Nephrology, Ain Shams University, Cairo, Egypt
Haitham Ezzat
Abdelaziz
Department of Internal Medicine and Nephrology, Ain Shams University, Cairo, Egypt
10.21608/ejhm.2020.84074
Background: Egypt had high burden of HCV infection worldwide. The new direct-acting antivirals (DAAs) can target almost all steps of HCV life cycle. Objective: Study of the incidence of acute kidney injury (AKI) in HCV infected patients receiving DAAs. Patients and methods: A prospective study that was conducted in the Virology Clinic in Kobry El-Koba Military Hospital on 63 male patients who were eligible to treatment by DAAs, who received treatment with sofosbuvir, daclatasvir and ribavirin combination. They were divided into Group A: 33 patients with eGFR > 90 ml/min and Group B: 30 patients with chronic kidney disease (CKD) stage II-III (eGFR<90 and >30 mL/min). The fluctuations in serum creatinine and eGFR were measured while on-therapy and for 3 months follow up after end of treatment. Results: total of 63 male patients, treatment-naive were included. Group A (33 patients) with eGFR > 90 mL/min. Group B (30 patients) with eGFR < 90 mL/min. There was a significant difference between different readings of serum creatinine in both groups on therapy and on follow up during the next 3 months after the end of therapy. The incidence of AKI was more observed in patients with eGFR > 90 ml/min in comparison with those with eGFR < 90 ml/min and >45 ml/min, but with no statistical significance. Conclusion: AKI events during and after end of therapy with DAAs were observed especially in patients with normal baseline serum creatinine. Patients with CKD stage II-III experienced improvement in their kidney functions during and after end of therapy.
Hepatitis C virus,Direct acting new antiviral drugs,Acute kidney injury
https://ejhm.journals.ekb.eg/article_84074.html
https://ejhm.journals.ekb.eg/article_84074_64dd5f9142c15367f6945f02beddf8c6.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Effect of Venous Congestion on Worsening Renal Function in Decompensated Heart Failure Patients
509
518
EN
Abdelbassit
ElShaarawy
Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Adel Gamal
Hassan
Department of Cardiology,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
Ahmed Abdelmoniem
Emara
Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
ahmed_emara@med.asu.edu.eg
Haitham Ezzat
Abdelaziz
Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
10.21608/ejhm.2020.84077
Background: Cardiorenalsyndrome has been defined as the simultaneous dysfunction of both the heart and the kidney. In this setting, worsening renal function (WRF) is a common finding. Objective: The aim of work was to determine whether venous congestion, rather than impairment of cardiac output, is associated with the development of WRF in patients with decompensated heart failure (DHF). Patients and Methods: This observational prospective study included a total of 30 adult Egyptians patients with DHF, attending at Ain Shams University Hospitals. Inclusion criteria: 1. Left ventricular ejection fraction < 50%. 2. CVP > 10 mmHg. 3. Right ventricular systolic pressure > 40 mmHg. ECHO was done for all subjects. Follow up of s. creatinine, GFR with MDRD equation, CVP, MABP and body weight were done daily for a week. Results: At follow up, 11 (36.7%) subjects developed WRF and 19 (63.3%) did not. that there was an incremental risk in WRF with increasing baseline CVP, as it appears to be a near linear relationship, because if the baseline CVP reached >19 or > 24 mmHg, we observed a sharp increase in the incidence of WRF approaching 51% and 71%, respectively. Furthermore, the mean baseline CVP was higher in subjects who developed WRF (26.2±3.3 mmHg) versus those who did not (18.1±1.9 mmHg) ( p<0.001).We have also noticed that baseline EF was significantly lower in subjects who developed WRF .We also noticed that Subjects who developed WRF had lower eGFR at baseline. Conclusions: It could be concluded that in the setting of DHF, venous congestion (high CVP) may be the most important driving factor of WRF rather than low COP.
Heart failure,renal function,kidney,hemodynamic,Venous congestion
https://ejhm.journals.ekb.eg/article_84077.html
https://ejhm.journals.ekb.eg/article_84077_c122f24047d05d848519c859187c8034.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Histological and Histochemical Studies on Kidneys of the Pregnant Rats and Their Foetuses under the Effect of Buspirone Hydrochloride
519
531
EN
Hanaa A.
Abd El-Gawwad
Zoology Department, Faculty of Science, AL-Azhar University, Egypt
10.21608/ejhm.2020.84078
Background: anxiety is a powerful central nervous system depression that can slow normal brain function. Buspirone is often prescribed to reduce the feelings of tension; this drug is also known as sedative drug. Aim of the work: this study aimed to detect the effect of buspirone hydrochloride on kidney of the pregnant rats and their foetuses (histological and histochemical studies). Material and methods: the current study was applied on thirty pregnant female rats that were categorized into three groups (ten pregnant rats in each group): Group1 (the control pregnant rats that were orally administrated with distilled water, group II (pregnant rats were given oral dosage of buspirone hydrochloride at dose level of 0.27 mg /100 g body weight /day daily for 15 days from the 6 th day to the 20th day of gestation and group III (pregnant rats were treated with buspirone hydrochloride at a dose level of 0.41 mg/100 gm body weight/day for 15 days from the 6 th to the 20th day of gestation. Kidney tissues were taken from pregnant rats and picked out from their foetuses of all groups which killed on the 20th day of gestation for the histological and histochemical studies. Results: maternal and foetal kidney tissues of both treated groups showed numerous changes post-treatment with buspirone that well-marked at the high concentration dose. Conclusion: the present study showed that administration of Buspirone drug resulted in several histological and histochemical alterations in the kidney tissues.
Pregnant,Foetuses,Buspirone,Histological and Histochemical Changes,kidney
https://ejhm.journals.ekb.eg/article_84078.html
https://ejhm.journals.ekb.eg/article_84078_a5e7e466b019e01cc29a076ed1ac687d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Evaluation of Nutritional Status of Children with Acute Lower Respiratory Tract Infection
532
537
EN
Mohammad Nagieb
AboElfotoh
Departments of Pediatric, Faculty of Medicine, Zagazig University
Ehab Mahmoud
Rasheed
Departments of Pediatric, Faculty of Medicine, Zagazig University
Samar Mahmoud
Sharaf
Departments of Clinical Pathology - Faculty of Medicine, Zagazig University
Noha Abdel Baset
Tohamy
Departments of Pediatric, Faculty of Medicine, Zagazig University
bodytota2020@yahoo.com
10.21608/ejhm.2020.85233
Background: Pediatric respiratory disease remains an important cause of morbidity in both developing and developed world. Several risk factors are associated with acute respiratory infection (ARIs), some of them are un-modifiable (e.g. age and sex of the child), while others are modifiable and these include nutritional and environmental modifiable risk factors (e.g. lack of breastfeeding and severe malnutrition). Objective: This study was designed to evaluate nutritional status of children with acute lower respiratory tract infection. Patients and methods: This study included 40 children, aged from 1 to 5 years suffering from acute lower respiratory tract infection (ALRI). The children were subjected to complete history, clinical examination and laboratory investigation as estimation of serum level of zinc and pre-albumin. Results: In children with ALRI, there was non-significant difference between children with pneumonia, bronchitis and bronchopneumonia as regard breast feeding, supplementation, MAC, Zinc and pre-albumin, however, the difference between them was significant as regarding BMI and nutritional status. Conclusion: The results of this study concluded that there is positive relation between nutritional status of child and acute LRTI. There was significant decrease in mortality and morbidity due to RTI after improvement of nutritional status of children. The level of zinc and pre-albumin were affected by nutritional status of children.
zinc,Prealbumin,Nutritional Status,children,LRTI
https://ejhm.journals.ekb.eg/article_85233.html
https://ejhm.journals.ekb.eg/article_85233_2e12c92ff2aeee6e9456db4a013c9668.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Association between Vitamin D Deficiency and Recurrent Acute Diarrhea in Children
538
543
EN
Azza Ibrahim
El- Desouky
Department of Pediatrics, Faculty of Medicine, Zagazig University
Mona Mohammed
El Shaffi
Department of Pediatrics, Faculty of Medicine, Zagazig University
Samar Mahmoud
Sharaf
Department of Clinical Pathology, Faculty of Medicine, Zagazig University
Heba Ibrahim Salem
Mohammed
Department of Pediatrics, Faculty of Medicine, Zagazig University
hebasalem184@gmail.com
10.21608/ejhm.2020.85234
Background: Vitamin D deficiency is highly prevalent among children worldwide. It causes impairment of the immune response to infection and decreased activity of gut antimicrobial peptides. The impact of vitamin D deficiency on the severity of acute diarrhea among children may be helpful for diarrheal management. Objective: To assess vitamin D deficiency and its correlation with recurrent acute diarrhea in children. Subjects and Methods: This study included 60 children, (1 to 5 years old) suffering from recurrent acute diarrhea more than 6 times per last year. They were subjected to complete history, clinical examination laboratory investigation and supplementation of vitamin D for three months for children who had vitamin D deficiency or insufficiency. Results: Vitamin D deficiency was found in 56.7%, insufficient in 21.7%, and sufficient in 21.7% in children with recurrent acute diarrhea. There was a statistical difference as regards the number of acute diarrhea attacks and vitamin D deficiency. Hemoglobin level was decreased below normal in (55%) of children with deficiency. Stool examination detected Enterobius vermicularis, Giardia lamblia, Entamoeba histolytica, and Ascaris lumbricoides in (26.7%, 8.3%and 3.3%, and 1.7%) respectively. Seventy-five percent of the studied children were supplemented with vitamin D which significantly decreases the number of diarrheal attacks. Conclusion: This study pay attention to the role of vitamin D in the susceptibility to infection-related illness in children. There is a positive correlation between vitamin D deficiency and iron-deficiency anemia. A significant decrease in the number of attacks of acute diarrhea after vitamin D supplementation was noted.
Vitamin D,Recurrent Acute Diarrhea,children
https://ejhm.journals.ekb.eg/article_85234.html
https://ejhm.journals.ekb.eg/article_85234_ab8a74bb864f07d7ff08a6fb9e16ee62.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
The Effectiveness of Ultrasound-Guided Percutaneous Aspiration of Simple Renal Cysts in Hospitals of Aljouf Region, Saudi Arabia
544
547
EN
Mohammed Jayed S.
Alenzi
Department of Surgery, College of Medicine, Jouf University
10.21608/ejhm.2020.85701
Background: Percutaneous renal cyst aspiration and sclero-therapy are considered as single, a safe and minimally invasive procedure currently practicing by numerous uro-surgeons currently in the treatment of simple symptomatic cysts. Objectives: This study was designed to assess the effectiveness and complications of ultrasound (US) guided percutaneous aspiration of renal cysts with 99% ethanol as sclerosing material in the treatment of simple symptomatic renal cysts. Methodology: This observational prospective study was done among 42 patients who had a total of 47 symptomatic simple renal cysts. It was carried out during the period from 2014 to 2017 in the Outpatient Clinic of MOH. The patients’ age ranged between 23-62 years including male (19) and females (23). An US guided ablation of renal cyst was done under local anesthesia. After that, an equal volume of contrast medium was injected through the needle into the cyst cavity to delineate the cyst wall. The sterile 99% ethanol, with one fourth of total cyst volume was injected into the cyst after complete aspiration of the contrast medium. After that, the ethanol was aspirated, and volume was measured. Results: The complications were minimum including, hematuria in 8 patients (17%), low-grade fever in 7 patients (14.8%) and mild flank pain in 5 (10.6%) patients were observed. During the follow-up after the sclerotherapy, out of 47 cysts, 20 (42.5%) cysts with different sizes showed statistically significant (P < 0.05) complete resolution and not appeared again during the later follow-up sessions. The overall success rate in the current study procedure was 100%. Conclusion: Percutaneous aspiration with a single injection of 99% ethanol sclerotherapy gave a high success rate in the treatment of simple renal cysts with good optimization of sclerosing material and effective aspiration skill of uro-surgeon.
Renal cyst,percutaneous aspiration,sclerotherapy
https://ejhm.journals.ekb.eg/article_85701.html
https://ejhm.journals.ekb.eg/article_85701_71f33d90fc55f5f578877a68d2f47980.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
79
1
2020
04
01
Effect of HCV Eradication on Glycemic Control of Type 2 Diabetes Mellitus
548
552
EN
Islam Ahmed Mohamed
Sayed
Internal Medicine Department, AlAhrar Teaching Hospital
islamshalaby651@gmail.com
Faried Fawzy
Abd-elHafez
Internal Medicine Department,
Faculty of Medicine, Zagazig University, Egypt
Hatem Mahmoud
Salem
Internal Medicine Department,
Faculty of Medicine, Zagazig University, Egypt
10.21608/ejhm.2020.86702
Background: Hepatitis C virus (HCV) is a major cause of chronic liver disease, including cirrhosis and liver cancer. Type 2 diabetes mellitus (T2DM) is a common comorbid condition in approximately one-third of individuals with chronic HCV infection. Objective: This study aimed at assessing the effect of the new direct acting antiviral drugs (DAAs) for chronic hepatitis C (HCV) on glycemic control of type 2 DM. Patients and method: This prospective cohort study was done on 32 diabetic patients with hepatitis C in the Internal Medicine Department, Al-Ahrar Teaching Hospital. The patients underwent history taking, clinical examination and laboratory studies including routine investigations and fasting blood glucose and glycosylated hemoglobin before and after treatment with direct antiviral agents (DDAs). Results: This study comprised 32 patients with diabetes. Their mean age was 57.65 ± 7.67 years. The females constituted (62.5%). There was statistically non-significant difference change before and after treatment regarding TLC, total bilirubin, HcvAb or HBSAG. There was statistically significant change between before and after treatment regarding hemoglobin, platelet count, prothrombin time (all of them increased after treatment), INR, s.creatinine, ALT and AST (all of them decreased after treatment). There was statistically significant difference between PCR1 and PCR 2 before and after treatment. All patients had negative PCR after treatment with complete response to DDAs. There was statistically significant decrease between FBG after treatment while there is significant decrease in HbA1c after treatment. Conclusion: HCV eradication leads to a statistically significant reduction in fasting glucose and HbA1c in patients with type 2 diabetes, which is an indirect indicator of improvement of insulin sensitivity in patients with T2DM.
HCV,DAAs,Glycemic,Diabetes mellitus
https://ejhm.journals.ekb.eg/article_86702.html
https://ejhm.journals.ekb.eg/article_86702_46c1fd593f4fe4e4febfb7a15429b680.pdf