Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Plasma Hepcidin Level in Hemodialysis Patients and its Relationship to Anemia Therapy and Dialysis Efficiency
805
811
EN
Said M.
M
Al-Barshomy
0000-0003-4004-0931
Department of Internal Medicine & Nephrology,
Faculty of Medicine, Zagazig University, Egypt
saidbarshomy@yahoo.com
Amal
Zedan
Department of Clinical Pathology,
Faculty of Medicine, Zagazig University, Egypt
Mohammed Elsayed
Mostafa
Department of Internal Medicine & Nephrology,
Faculty of Medicine, Zagazig University, Egypt
10.21608/ejhm.2021.156448
<strong>Background:</strong> Hepcidin is a small peptide produced mainly by hepatocytes, macrophages and other cells. In addition to its antimicrobial effects, it is the primary regulator of iron metabolism as it controls both dietary iron absorption from the duodenum and the release of that iron by reticuloendothelial cells.
<strong>Objective:</strong> Study of plasma hepcidin level and its relationship to the parameters of iron status, anemia therapy, and parameters of dialysis efficiency in hemodialysis patient.
<strong>Patients and Methods: </strong>106 subjects were enrolled in our study. They were divided into two groups: <strong>Group 1 (control group)</strong> included10 healthy subjects. <strong>Group 2</strong> included96 end-stage renal disease (ESRD) patients on regular hemodialysis; they were subdivided into two groups according to the median plasma hepcidin level. full history, physical examination and detailed analysis of medical records to elucidate the cause of renal failure if present and duration of hemodialysis, estimation of glomerular filtration rate (eGFR) and calculating Kt/V. Laboratory investigations includingCBC, liver function tests, kidney function tests, serum iron, serum ferritin, total iron binding capacity (TIBC), transferrin saturation and plasma hepcidin level were measured. In addition to Pelvi-abdominal ultrasound was done.
<strong>Results:</strong> Plasma hepcidin levels were higher in maintenance hemodialysis patients than in healthy control subjects. Also, there was a significant and independent positive correlation between hepcidin and both serum ferritin levels and KT/V. While there was significant negative correlation between serum hepcidin levels & EPO dose.
<strong>Conclusion:</strong> High plasma hepcidin levels in HD patients depending on the magnitude of the inflammatory process and on rhEPO doses. Close interaction between hematological indices, iron status and plasma hepcidin levels.
renal failure,Anemia,iron,hepcidin
https://ejhm.journals.ekb.eg/article_156448.html
https://ejhm.journals.ekb.eg/article_156448_e9894ede5a41626485ddfce10015fa95.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Values of Application of Three Delays Model to Maternal Mortality Scenarios at Sohag Univeristy Hospital Bidirectional Cohort Study
812
816
EN
Magdy Mohamed
Amin
Department of Obstetrics and Gynecology, Faculty of Medicine - Sohag University
Mohamed Sabry
Ibrahim
Department of Obstetrics and Gynecology, Faculty of Medicine - Sohag University
Ahmed Elsayed
Ali
Department of Obstetrics and Gynecology, Faculty of Medicine - Sohag University
ahmedalsaid912@gmail.com
10.21608/ejhm.2021.156449
<strong>Background: </strong>Maternal mortality in Egypt is still relatively high so measuring maternal mortality and identifying its causes is essential and should be calculated regularly for the purpose of planning, monitoring and evaluation of provided maternal health care. <strong>Objective</strong>: Identifying the circumstances and causes of maternal mortality.
<strong>Patient and method:</strong> Data were collected from records of patients who were presented to and delivered at Sohag University Hospital in the period between 2017 and 2019. Only cases of maternal mortality were included in this study. In our study we found 20 maternal deaths occurred at our hospital between 2017 and 2019.
<strong>Results</strong>: In our study the most frequent one was the 1<sup>st</sup> delay that occurred in 10 women followed by 2<sup>nd</sup> delay in 4 women then combination of 1<sup>st</sup> and third in about 3 women and combination of 1<sup>st</sup> and 2<sup>nd</sup> in 2 cases and delay 2 in 1 case. Our study showed that the first cause of death was preeclampsia/eclampsia 55% followed by obstetric hemorrhage (placenta previa, postpartum hemorrhage, rupture uterus) 35%, caesarean section complications 5% and lastly medical condition associated with pregnancy 5%.
<strong>Conclusions</strong>: This study showed that the first delay is the most important delay in Sohag, especially in rural areas, and the most important cause of death was preeclampsia and ignorance about its complications which was due to lack of antenatal care.
Delays,health facilities,Maternal Mortality,preeclampsia,Postpartum Hemorrhage
https://ejhm.journals.ekb.eg/article_156449.html
https://ejhm.journals.ekb.eg/article_156449_fee7d6e89fae16e4616139f1522d8df8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Study of the relation between Plasma Transfusion and Clinical Outcome in Critically Ill Children at Pediatric Intensive Care Unit
817
823
EN
Tarek Abd El-Rahman
Atiyyah
Department of Pediatrics, Faculty of Medicine – Zagazig University, Zagazig, Sharkia, Egypt
Khalid Mohamed
Salah
Department of Pediatrics, Faculty of Medicine – Zagazig University, Zagazig, Sharkia, Egypt
Esraa Hassan Mohamed Hassan
El-Bahrawy
Department of Pediatrics, Faculty of Medicine – Zagazig University, Zagazig, Sharkia, Egypt
10.21608/ejhm.2021.156451
<strong>Background:</strong> Plasma transfusions are commonly used in adult and paediatric intensive care units. Latest data showed a correlation in adult trauma patients between plasma transfusions and worse clinical results. Plasma transfusions are frequently prescribed worldwide; the indications for their use remain unclear.
<strong>Objective: </strong>To identify signs of plasma transfusions and evaluation of the impact of plasma transfusions on coagulation studies.
<strong>Patients and Methods:</strong> This prospective cohort study was conducted at the Pediatric Intensive Care unit, Zagazig University Hospital between July 2019 and January 2020. Participants in the study had a full background of socio-demographic characteristics. Total clinical examination and the seriousness of the disease was measured at admission using the Sequential Organ Failure Assessment (SOFA) score as per Ferreira 2001. Patients have been checked for critical parameters.
<strong>Results:</strong> Our analysis found that 50 percent of plasma transfusions were attributed to bleeding, 40.7 percent to hypoalbuminemia, and 9.3 percent of plasma transfusions were due to surgical conceptions. The mortality rate in our study was 25.9 percent.
<strong>Conclusion:</strong> Plasma transfusion does not have a statistical effect on mortality, but there has been little improvement in mortality over predictive SOFA mortality. Approximately ten times, no bleeding or proposed bleeding-risk operations earned plasma, based on the physician's views and conceptions. Plasma transfusion was insufficient to correct minor coagulation irregularities. Major research evaluating effective plasma transfusion techniques are desperately needed.
Plasma transfusions,Blood component transfusion,plasma
https://ejhm.journals.ekb.eg/article_156451.html
https://ejhm.journals.ekb.eg/article_156451_e20b0b495015b625ecf394c59de2b1d7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Ameliorative Effect of Ginger Extract and Selenium in theThyroid Gland Toxicity Induced by Chlorpyrifos in Male Albino Rats
824
830
EN
Hanan I.
El-Kerdasy
Anatomy and Embryology Department, Faculty of Medicine, Benha University, Benha, Egypt
Abulmaaty M.
Elsayed
Anatomy and Embryology Department, Faculty of Medicine, Benha University, Benha, Egypt
Hend Ragab
Mousa
Anatomy and Embryology Department, Faculty of Medicine, Benha University, Benha, Egypt
10.21608/ejhm.2021.156452
<strong>Background: </strong>Chlorpyrifos CPF is one of the organophosphate insecticides that were interfered with the body’s hormones. Thyroid hormones are necessary to maintained normal metabolism, growth and development and the disturbance of their levels leads to adverse medical conditions. Ginger extract and selenium are effective anti- oxidants. <strong>Aim of the work:</strong> This study examined effect of CPF on the thyroid gland structure and function and the ameliorative effect of ginger extract and selenium.<strong> Material and Methods: </strong>forty rats were categorized into four groups. Control group I, group II: rats were given CPF at a dose of 6.7 mg/kg orally five days / week for six weeks, group III: rats were given CPF and ginger extract at a dose of 750 mg/kg orally, five days / week for six weeks. Group IV: rats were given CPF and sodium selenite 10 µg/Kg orally five days / week for six weeks, blood samples were taken for hormonal essay. Thyroid gland specimens were prepared for the histological and immunohistochemical studies. <strong>Results:</strong> chlorpyrifos induced functional toxic effect and destruction of the thyroid gland histological structures. There was a significant decrease in area % of the colloid and a significant increase in mean number of PCNA positive nuclei in comparison with the control group. Ginger extract and selenium eliminated the damage effect of CPF on the thyroid gland function and histological structure. <strong>Conclusion: </strong>CPF had adverse effects on the thyroid structure and function that could be eliminated by administration of ginger and selenium.
chlorpyrifos,selenium,Ginger extract,Thyroid gland
https://ejhm.journals.ekb.eg/article_156452.html
https://ejhm.journals.ekb.eg/article_156452_702807e10bdd6839526d2963d390188b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Study of Neck and Low Back Pains among Students
831
837
EN
Samah Mahmoud
Alian
Eman El-Dessoky
El-Shahawy
Hosnia Mohamed
Ragab
Mariam Al-batoul Mahmoud Mohamed
Yousof
mariamalbatoul66@gmail.com
10.21608/ejhm.2021.156454
<strong>Background:</strong> Neck pain (NP) is regarded as a chronic episodic condition characterized by persistent, recurrent, or fluctuating pain and disability. Low back pain (LBP) is social and economic health problem that affects population of all ages globally.
<strong>Objective: </strong>To evaluate the prevalence and associated risk factors of neck and low back pains among students at Faculty of Medicine, Zagazig University<strong>.</strong>
<strong>Patients and Methods:</strong> This was a cross sectional study that included 360 students at Faculty of Medicine, Zagazig University through the period from September 2018 to April 2019. Assessment of presence or absence of neck pain and back pain by Standardized Nordic Musculoskeletal questionnaire.
<strong>Results:</strong> 96 of the students were males (26.6%) and 264 were females (73.3%), their ages ranged from 18-25 years with a mean of 20.68 ± 1.92 years old, where 162 students of them ≤ 20 (45%) & 198 of them > 20 years old (55%). Prevalence of neck pain and/or low back pain among the studied group of students was 81.1%, while 18.9% of students were free from neck & low back pain. NP presented in 74.4% of students and LBP presented in 73.1% of all studied students. 66.4% of participants reported both NP & LBP. There was statistical significant association between reading hours (> 3 hours/ day) and NP & LBP.
<strong>Conclusion: </strong>High prevalence of NP and/or LBP 81.1% among medical students. Students complaining from NP and/or LBP had longer studying and reading time, presented mostly in clinical years in addition they had ergonomic problems and poor psychological studying environments.
prevalence,risk factors,Neck and low back pains
https://ejhm.journals.ekb.eg/article_156454.html
https://ejhm.journals.ekb.eg/article_156454_f90c663257b7aed03c498182ce332d4a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Assessment of CoMiSS among Children with Cow's Milk Allergy at Zagazig University Hospital
838
843
EN
Azza Ibrahim
El Desouky
Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Heba Gamal
Anany
Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Ibrahim Sobhy Ibrahim
Mohammed
Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
dr.ibrahim1986@gmail.com
10.21608/ejhm.2021.156455
<strong>Background:</strong> Cow’s milk protein allergy (CMPA): The topic of definition still causes confusion among physicians. Words such as “allergy,” “intolerance,” and “hypersensitivity” are used interchangeably. The accepted definition of allergy is “a hypersensitivity reaction triggered by specific immunologic mechanisms”. There is no such thing as “allergy to lactose” but rather lactose intolerance. The authors introduced the acronym “CoMiSS” (cow’s milk-related symptom score). <strong>Objective: </strong>To evaluate CoMiSS in children with cow's milk allergy at Pediatric Department, Faculty of Medicine, Zagazig University. <strong>Patients and Methods:</strong> This study was conducted during the period from December 2018 to May 2020. Cow’s milk-related symptom score was assessed.
<strong>Results:</strong> There was statistically significant increase in eosinophilic count among confirmed CMA than no CMA. There was statistically significant higher total score of CoMiSS among confirmed CMA than no CMA, and another one regarding each symptom of CoMiSS score. Accuracy of CoMiSS in diagnosis of CMA was 90.8%. The percentage was for sensitivity (86.4%), specificity (93.4%), positive predictive value (88.3%) when the score is >12 and negative predictive value (92.2%). <strong>Conclusion: </strong>CoMiSS is a simple, fast, and easy-to-use tool to raise awareness and help in early diagnosis of CMPA, but hard to handle with many of illiterate mothers. CoMiSS is a helpful tool and applicable method to screen for CMPA, though there may be risk of under-diagnosis when CoMiSS≥12 is used as the criterion for early pick-up of CMPA in Egyptian infants.
Assessment-CoMiSS,Cow's milk allergy in children
https://ejhm.journals.ekb.eg/article_156455.html
https://ejhm.journals.ekb.eg/article_156455_0b364f4cf9de63a83c334be77cecb955.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Comparison between General Pediatricians and Other Sub-Specialty of Pediatrics Regarding Knowledge of CMPA
844
850
EN
Hossam Fathi
El Saadany
Department of Pediatrics, Faculty of Medicine – Zagazig University, El-Sharkia, Egypt
Atef Mohammed
Khalil
Department of Pediatrics, Faculty of Medicine – Zagazig University, El-Sharkia, Egypt
Omnia Abd-Elhakim
Ismail
Department of Pediatrics, Faculty of Medicine – Zagazig University, El-Sharkia, Egypt
omniaelnaggar79@gmail.com
10.21608/ejhm.2021.156456
<strong>Background:</strong> Food allergy is an adverse health effect arising from a specific immune response that occurs reproducibly following exposure to a given food. The main cause of food allergies in children under three years old is Cow’s Milk Protein (CMP). The estimated prevalence of Cow’s Milk Protein Allergy (CMPA) is 2% to 3% in the first year of life. An observational study conducted in pediatricians’ offices revealed a gastroenterologist-diagnosed prevalence of 5% in the group of patients.
<strong>Objective:</strong> to compare between general pediatricians and other sub-specialty of pediatrician regarding awareness of cow’s milk protein allergy.
<strong>Patients and Methods:</strong> This study was conducted in El-Sharkia Governorate, Egypt. Pediatricians of both sexes of different subspecialties work in government facility with or without private facility and work in El-Sharkia Governorate. The sample size calculated using open Epi was 256 physicians.
<strong>Results:</strong> This study showed that general pediatricians were 78.1%, gastroenterologists were 3.2%, immunologists were 2.7% and pulmonologists were 3.9%. There was a low level of knowledge about CMA among the studied group.
<strong>Conclusion: </strong>Our findings revealed that there was a low knowledge about Cow’s Milk Protein Allergy among pediatricians. We found a huge variability in general pediatricians and other sub-specialty of pediatrics regarding CMPA.
General pediatricians,Sub-specialty of pediatrics,CMPA
https://ejhm.journals.ekb.eg/article_156456.html
https://ejhm.journals.ekb.eg/article_156456_f687747793a0bee46861d3ba316233a8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Evaluation of MIF as a Diagnostic Biomarker in Cases with Ankylosing Spondylitis
851
855
EN
Ibrahim Tharwat
Abdelal
Mirvat Abdel Hameed
Eltoukhy
Ahmed Mohammed
Baraka
Mohammed Abdelrahman
Ibrahim
10.21608/ejhm.2021.156457
<strong>Background:</strong> Ankylosing spondylitis (AS) has been afflicting humankind as far back as ancient Egypt. Macrophage migration inhibitory factor (MIF) appears to have the unique ability to drive both inflammation and new bone formation and could play an important role in the pathogenesis of AS.
<strong>Objective: </strong>The study aimed to evaluate MIF as a diagnostic biomarker in AS.
<strong>Patients and Methods:</strong> This study was conducted on 42 subjects; 21 AS cases and 21 controls. Patients were subjected to full medical history, general and musculoskeletal examinations, laboratory investigations including serum MIF level, sacroiliac X-ray, sacroiliac MRI with the Ankylosing Spondylitis Disease Activity Score (ASDAS) for disease activity.
<strong>Results:</strong> Regarding gender of the patients, the majority (71.4%) of patients were males; while (28.6 %) were females. We found that; the mean disease duration of AS patients was (15.05 ± 6.69) years; while the mean ASDAS score was (2.78 ± 0.68). We also found that, (71.4%) of AS patients received NSAIDs, (95.2%) received disease-modifying anti-rheumatic drugs (DMARDs), (57.1%) received tumour necrosis factor inhibitors (TNFi). Regarding imaging findings in our study, (61.9 %) of AS patients had sacroiliitis in sacroiliac X-ray while (100 %) of AS patients had sacroiliitis in sacroiliac MRI.
<strong>Conclusion: </strong>Serum MIF levels are elevated in AS patients. ROC-curve analysis showed that the best cutoff point of MIF was (>41.3) with area under curve (0.625), with fair accuracy (57.1%), sensitivity (80%) and specificity (50%).
Biomarker AS,Evaluation,MIF
https://ejhm.journals.ekb.eg/article_156457.html
https://ejhm.journals.ekb.eg/article_156457_d8ea4330a45ec7c64c4f3d2014b82fca.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Improvement of Outcome by Implementation of Enhanced Recovery Pathway in Gynecologic/ Oncology Surgery
856
861
EN
Abdel Magid Mahmoud
Sarhan
Hussein Mohammed Abdel
Dayem
Heba Mohamed Fathy
Abdelrahman
Radwa Atef Ameen
Elnaem
drradwaatef9025@yahoo.com
10.21608/ejhm.2021.156458
<strong>Background:</strong> Enhanced recovery programs (ERPs) are evidence-based protocols designed to improve functional rehabilitation after surgery. They lead to improvement in patient outcomes while reducing length of hospital stay.
<strong>Objective:</strong> This study aimed to compare surgical outcomes between women undergoing major gynecologic surgeries before and after implementation of enhanced recovery after surgery (ERAS) protocol.
<strong>Patients and</strong> <strong>Methods:</strong> This erective observational study was carried out on patients attending to Zagazig University Hospitals for Elective Gynecological Oncologic Surgeries in the period between August 2018 and August 2019.
<strong>Patients and methods: </strong>This study included 54 patients who were presenting for elective gynecological oncologic surgeries. They were classified into 2 groups. Group 1 include 27 patients who were exposed to the ERAS protocol regimen for the pre, intra and postoperative care. Group 2 include 27 patients who were exposed to the conventional care known in the literature. Clinical outcomes and compliance were obtained using the ERAS Interactive Audit System. <strong>Results:</strong> This study showed that the mean length of hospital stay was 38.29 ± 4.95 hours in group A and 68.44 ± 6.5 hours in group B with significant difference between the two groups. Postoperative complications rate was 7.4% in group A vs 11.1% in-group B with no significant difference between the two groups.
<strong>Conclusions:</strong> Systematic implementation of ERAS gynecologic oncology guidelines across a healthcare system improves patient outcomes and saves resources.
Enhanced recovery programs (ERPs),Improvement of outcome,Gynecologic oncology
https://ejhm.journals.ekb.eg/article_156458.html
https://ejhm.journals.ekb.eg/article_156458_912ae4bf3195853d936ec9a27ef343eb.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Effect of Isosorbide Mononitrate and Misoprostol for Cervical Ripening in Induction of Labor
862
868
EN
Moustafa Abbas
Ibrahim
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
Hussein Mohammed
Abdel Dayem
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
Amr Ahmed
Abdelrhman
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
Doaa Hamed
Abo El-Khir
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
doaahamed699@gamil.com
10.21608/ejhm.2021.156913
<strong>Background:</strong> Induction of labor has increased dramatically over the past two decades. Indications for induction of labor are either maternal (preeclampsia, pregnancy-induced hypertension) or fetal (post-term dates, growth retardation, ruptured membranes, diabetes). <strong>Objective:</strong> The purpose of this study was evaluation of the beneficial effect of isosorbide mononitrate and misoprostol for cervical ripening in induction of labor. <strong>Patients and </strong><strong>Methods:</strong> A randomized clinical trial was carried out on 120 full-term pregnant women who were admitted for induction of labor in Zagazig University Hospitals in the period of July 2017 to March 2018. Patients were divided into two groups: Group A included 60 full term pregnant females who received 25 μg misoprostol (Vagiprost tablet) and placebo tablet in the posterior vaginal fornix. Group B included 60 full-term pregnant females who received vaginal 25 μg misoprostol (Vagiprost tablet) plus 40 mg isosorbide mononitrate (Effox tablet) in the posterior vaginal fornix.<strong> Results: </strong>There was little difference between the effectiveness of vaginal 25 mg misoprostol vaginal inserts and 40 mg isosorbide mononitrate vaginal inserts in induction of labor. The safety profiles of both drugs were similar, but isosorbide mononitrate administration is considered a low-risk method of labour induction for pregnant women at full term.<strong> Conclusions:</strong> The combination of misoprostol and isosorbide mononitrate may be more safe and effective for induction of cervical ripening in full-term pregnancy in comparison to misoprostol alone.
Cervical ripening,induction of labor,Isosorbide,Mononitrate,misoprostol
https://ejhm.journals.ekb.eg/article_156913.html
https://ejhm.journals.ekb.eg/article_156913_cca82a7f3b481290c2f3f47db28127fc.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Ovarian Volume Measurement by Transvaginal Ultrasonography in Women with Postmenopausal Bleeding and Thickened Endometrium
869
875
EN
Ali El-Shabrawy
Ali
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.
Amr Kamel
El-Fayomy
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.
Bassem Mohamed
Hamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.
Samah Taha Abd El Rahman
Abd El Salam
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.
10.21608/ejhm.2021.156915
<strong>Background:</strong> Postmenopausal bleeding (PMB) is one of the most common reasons for referral to gynecology services. This is due to the concern of possible underlying malignancy, as approximately 10% of women with PMB will have endometrial carcinoma.
<strong>Objective:</strong> Early diagnosis of endometrial changes in women with postmenopausal bleeding and thickened endometrium.
<strong>Patients and Methods:</strong> A cross sectional study was conducted at Obstetrics and Gynecology Department, from December 2018 to January 2020 at Zagazig University Hospitals. The study included 56 women with post-menopausal bleeding and thickened endometrium (> 4 mm). They underwent vaginal sonography for endometrial thickness and ovarian volume measurement; endometrial sampling was done for definitive histologic diagnosis.
<strong>Results:</strong> There was statistically significant difference between normal, over weight and obese females as regards mean ovarian volume and endometrial thickness (p = 0.001and p = 0.01) respectively. Where, over weight and obese females had large mean ovarian volume (median = 1.80 and 2.350) respectively and larger endometrial thickness (median = 9.0 and 14.0) respectively compared to normal ones. We found that 51% of studied females were having hyperplasic lesions followed by 37.3% of them were having benign lesions then 11.8% of them were having malignant lesions. <strong>Conclusions:</strong> That enlarged ovaries in women with postmenopausal bleeding and thickened endometrium are associated with endometrial adenocarcinoma risk. Whereas obesity represents a marker of risk for that endometrial change.
transvaginal ultrasound,Ovarian volume measurement,Postmenopausal bleeding
https://ejhm.journals.ekb.eg/article_156915.html
https://ejhm.journals.ekb.eg/article_156915_246c4c4c502b3355f9ebe1f743e8811e.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
The Weight Assessment and its Relation to Hemophilia Joint Health Score in Hemophilic Patients
876
881
EN
Osama Roshdi
El-Safy
Department of Pediatrics, Faculty of Medicine – Zagazig University, Egypt
Ahmed Mohammed
Abdel Moneim
Department of Pediatrics, Faculty of Medicine – Zagazig University, Egypt
Nora Mohammed Ali
Mohammed
Department of Pediatrics, Faculty of Medicine – Zagazig University, Egypt
10.21608/ejhm.2021.156917
<strong>Background:</strong> Haemophilia is a group of hereditary disorders that impair the body's ability to control blood clotting or coagulation. Joint bleeding (hemarthrosis) results in synovial hypertrophy and damage of the cartilage, leading to joint destruction with recurrent bleeding episodes (hemophilic arthropathy).
<strong>Objective: </strong>To assess weight of hemophilic children and correlate the weight to Hemophilia Joint Health Score.
<strong>Methods:</strong> The sample size included was 66 patients with hemophilia in Zagazig city between October 2019 and March 2020. They were categorized according to presence of arthropathy or not [Two groups; one group with hemophilic arthropathy and the other group without hemophilic arthropathy]. All patients were subjected to full history taking including personal history, thorough clinical examination [assessment of vital signs and color, assessment of any bone deformity, pain or muscle weakness and Hemophilia Joint Health Score ] and weight assessment,
<strong>Results:</strong> Our case control study showing male predominance in both groups. In hemophilic arthropathy, 100% (10.68 ± 4.28) and without hemophilic arthropathy 97% (7.17 ± 4.12) and more prevalence of hemophilia A [factor V111 deficiency] in both groups (with H.A.97% & without H.A.78.8%). In addition, our study reported that most common site of bleeding in hemophilic patients rather than big joints affection; gum [18.2%] then gum & teeth [12.1%]. Increased weight was found more in hemophilia with arthropathy than in hemophilia without arthropathy.
<strong>Conclusion: </strong>Our case control study showing male predominance and more prevalence of hemophilia A than B in both hemophilic groups (with or without hemoarthropathy). Weight was significantly increased in hemophilia with arthropathy group than in hemophilia without arthropathy group.
Weight assessment,Hemophilia Joint Health Score,Hemophilic patients
https://ejhm.journals.ekb.eg/article_156917.html
https://ejhm.journals.ekb.eg/article_156917_7dc755f6a6530e0645325b6b0915ac9e.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Amiodarone and Magnesium Sulphate in Arrhythmia Prophylaxis in Pediatric Congenital Heart Diseases Patients Undergoing Cardiopulmonary Bypass
882
888
EN
Azza Ali Mohamed Ali
Khalil
Al Shaymaa Ahmed
Ali
Ali Mohamed Refat Ali
Soliman
Ehab Idris
Almahdoy
ehab.edris.mh@gmail.com
10.21608/ejhm.2021.158068
<strong>Background:</strong> Postoperative arrhythmias are an important cause of morbidity and mortality after cardiac surgery for congenital heart disease. In the early postoperative period, patients with congenital heart disease are especially vulnerable to rhythm disturbances. <strong>Objective:</strong> This study aimed to assess safety and efficacy of prophylactic amiodarone and magnesium sulphate in preventing cardiac arrhythmia especially junctional ectopic tachycardia (JET) in children with congenital heart disease (CHD) who undergo open heart surgery. <strong>Patients and Methods:</strong> This was a comparative clinical trial that was conducted on 48 cases at Cardiothoracic Department and Pediatric Cardiology Unit, Zagazig University Hospitals. The cases were divided into three groups according to received drug; Group (A): patients receiving placebo, Group (B): patients receiving magnesium sulfate and Group (C): patients receiving amiodarone.<strong> Results:</strong> There were highly statistically significant differences between groups as regard to Inotrope Score intraoperatively, heart rate and median arterial pressure postoperatively, postoperative Inotrope Score and drug complications where P<0.001.<strong> Conclusions:</strong> prophylactic of either amiodarone or magnesium sulfate are safe and relatively effective in preventing early postoperative arrhythmia in children after corrective heart surgery for CHD.
Amiodarone,Cardiopulmonary,Magnesium sulphate,Pediatric
https://ejhm.journals.ekb.eg/article_158068.html
https://ejhm.journals.ekb.eg/article_158068_8750d66ba09004bf34394c3042131805.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Platelet-Rich Plasma (PRP) in Obstetrics and Gynecology
889
894
EN
Mohammed Abd El Naser
Galal
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
mohammedabdelnaser12992@gmail.com
Ahmed Aly
Khalifa
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
Mohammed Yahya
Abd El Hafez
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
Ahmed Tag El Deen
Abd El Hafeez
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
Allam Mohammed
Abd El Moneem
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
10.21608/ejhm.2021.158074
<strong>Background: </strong>Platelet-rich plasma PRP is being used as a new therapeutic option for different pathologies in the field of dermatology, such as trichology, wound healing, and cosmetic medicine. Platelet-rich plasma is an exciting new technology that may have the potential to serve as an alternative or adjuvant treatment to surgery in many common injuries/conditions in sports medicine. The growth factors provided by platelets and plasma are essential to the tissue repair process. It could have its effect due to the microenvironment of the tissue. It is used within, the tissue’s specific processes for healing, or PRP’s possible ability to enchange stem cell proliferation, depending on its preparation, activation, and variable contents. Accordingly, it may be effective treatment for some gynecological and obstetrical conditions. <strong>Aim of the work: </strong>We conducted this essay to confirm PRP efficacy and safety in varous obstetric and gynecological disorders. <strong>Methodology: </strong>Relevant citations were extracted from Pubmed, Google scholar, Clinical key, Scopus, Med-line, Embase and Cochrane to identify studies investigating the uses of PRP in gynecology from 2010 to 2020.
<strong>Conclusion: </strong>PRP is an innovative therapeutic modality, as it is affordable, simple, easily performed, and effective. In the field of gynecology, the risks of PRP therapy as infection, bleeding, and nerve damage, appear to be minimal.
platelet-rich plasma,Obstetrics and Gynecology
https://ejhm.journals.ekb.eg/article_158074.html
https://ejhm.journals.ekb.eg/article_158074_69d0be0b7c376cc6d56acfa8269b0756.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Pregnancy Outcomes in Patients with Heart Valve Replacement: Sohag Perspective
895
902
EN
Ahmed Mohammed Ahmed
Mohammed
Mohammed Sabry
Ebrahem
Ayman Mohammed
Mohammed
Khaled Mohammed
Abdelal
Hazem Mohammed
Mohammed
Mostafa Abd Elkhalek
Abdellah
10.21608/ejhm.2021.158075
<span>Background: </span><span>Management of a pregnant woman with a prosthetic heart valve requires significant contemplations, particularly concerning looking after anticoagulation.<br /> </span><span>Objective: </span><span>We directed this observational study to notice maternal and fetal results in pregnant women with heart valve replacement in Sohag University Hospital.<br /> </span><span>Patients and methods: </span><span>An observational study was done in Sohag University Hospital, 20 cases recruited in Department of Obstetrics and Gynecology during the period from April 2019 to October 2019. All cases were exposed to finish history taking, total physical assessment (general and obstetrical), obstetric US and investigations as echocardiography, PT, PC and INR.<br /> </span><span>Results: </span><span>The mean age of the study group was around 28 years, with a range from 18 to 38 years. The vast majority of the cases had mitral valve replaced. CS was done for 40% of the cases, followed by vaginal delivery in 35% of them, evacuation in 20% and hysterotomy in one case (5%). Hemorrhagic complications were seen in 25% of the cases, followed by thrombosis and rapid AF (10% each), then heart failure and supraventricular arrhythmias (5% each). Miscarriage before the 24</span><span>th </span><span>week occurred in 30% of the cases and IUFD in one case (5%). Before 14 weeks of gestation, most of the cases used heparin either UFH or LMWH, with only 35% used vitamin K antagonists. Hemorrhage was more common with MVR.<br /> </span><span>Conclusion: </span><span>Patients with mechanical valves have more rate of fetal misfortunes and maternal complexities. Mitral valve replacement is related with more maternal hemorrhagic complications than aortic valve alone or double valve substitution.<br /></span>
pregnancy outcome,Heart Valve Replacement
https://ejhm.journals.ekb.eg/article_158075.html
https://ejhm.journals.ekb.eg/article_158075_ff91eed283d37bac94835f797a82b858.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Compliance and Efficacy of Oral Lactoferrin versus Ferrous Sulfate in Treatment of Nutritional Iron Deficiency Anemia during Second Trimester among Egyptian Ladies
903
909
EN
Karam M.
Bayoumy
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Egypt
Samar G.
Ragab
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Egypt
Nermeen A. M.
Elghareeb
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Egypt
nermeenelghareeb@med.asu.edu.eg
10.21608/ejhm.2021.158077
<strong>Background: </strong>Nutritional iron deficiency anemia is of a major concern in Egypt, especially during pregnancy.
The most commonly used treatment is oral iron mainly as ferrous sulfate. Unfortunately, ferrous sulfate has low efficacy with many adverse effects. Lactoferrin is a glycoprotein which belongs to proteins which have the ability to bind and transfer iron. This study was done to assess the compliance, efficacy and safety of lactoferrin in comparison to ferrous sulfate.
<strong>Methods: </strong>This randomized clinical trial was conducted in outpatient clinic under supervision of Department of Obstetrics and Gynecology, Faculty of medicine, Ain Shams University, Cairo, Egypt from August 2019 to February 2020. 140 women with iron deficiency anemia in second trimester were recruited and randomly assigned to either group. First group received lactoferrin 200 mg sachets once daily and second group received 100 mg of dried ferrous sulfate capsules twice daily for 4 consecutive weeks. Compliance to treatment, efficacy and side effects were recorded.
<strong> Results: </strong>Compliance is better in lactoferrin group in comparison to ferrous sulfate group. Maternal side effects were significantly less common in lactoferrin group than in ferrous sulfate group. The increase in hemoglobin was significantly higher in lactoferrin group. Number of cases achieved Hb level ≥10.5 was more frequent in lactoferrin group.
<strong>Conclusion: </strong>Oral lactoferrin is more tolerated and effective as compared to traditional treatment by ferrous sulfate.
nutritional iron deficiency anemia,Anemia in pregnancy,Lactoferrin,Ferrous Sulphate
https://ejhm.journals.ekb.eg/article_158077.html
https://ejhm.journals.ekb.eg/article_158077_80d4456861e63373d7d1fbc20a138ce3.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Impact of Long-Standing Diabetes Mellitus on Sexual Function in Upper Egyptian Women
910
915
EN
Mahmoud Ahmed
El-Amir
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
Magdy Abd El-Rahman
Mohammed
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
Mohammed Nour El-Dien
Salem
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
Yasser Ahmed
Helmy
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
10.21608/ejhm.2021.158078
Background: Sexuality is an important part of health, quality of life and general wellbeing. Diabetes has long been considered a major cause of impaired sexual function. Neuropathy, vascular impairment, and psychological complaints have been implicated in the pathogenesis of decreased libido, low arousability, decreased vaginal lubrication, orgasmic dysfunction and dyspareunia among diabetic women.<br />Objective: To investigate sexual dysfunction in diabetic females living at Sohag Governorate.<br />Patients and methods: This case–control hospital-based descriptive study was carried out at the Obstetrics and Gynecology Department, Sohag University Hospitals on two groups; the case (Diabetic) group and the control (Non-diabetic) group. Each group included 100 sexually active nonpregnant women between 20 to 40 years of age. Their sexual function was assessed using Female Sexual Function Index Questionnaire.<br />Results: The rate of feeling sexually aroused, level of sexual aroused, confidence about becoming sexually aroused during sexual life and rate of being satisfied with the arousal during sexual activity were significantly decreased in diabetic group than non-diabetic group. The difficulty of becoming lubricated “wet” during sexual activity and its maintaining until completion of sexual activity were significantly increased in diabetic group than non-diabetic group. The difficulty until reaching orgasm and satisfaction with the ability to reach orgasm were significantly decreased in diabetic group than non-diabetic group. Satisfaction with the amount of emotional closeness, the sexual relationship with the partner and the overall sexual life were significantly decreased in diabetic group than non-diabetic group.<br />Conclusion: The incidence of sexual dysfunction is higher in diabetic women.<br /><br />
Diabetes mellitus,sexual function,Upper Egyptian women
https://ejhm.journals.ekb.eg/article_158078.html
https://ejhm.journals.ekb.eg/article_158078_4c16b9bebaf2311f12b0337287857321.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Transcatheter Embolo-sclerotherapy of High Flow Arteriovenous Malformations
916
921
EN
Ehab Mohammed
Saad
Hossam Abdelhamid
Alwakeel
Tamer AbdelHay
Khafagy
Mohammed Magdy
ElRakhawy
Khaled Hassan Mohammed
Moussa
10.21608/ejhm.2021.158081
<strong>Background: </strong>Vascular malformations can be classified according to endothelial characteristics and flow dynamics of the lesions, on which the principles of treatment are based. Percutaneous injection of sclerosing agents such as ethanol or sodium tetradecyl sulfate is the mainstay treatment for the more prevalent low-flow or venous vascular malformations. In contrast, symptomatic high-flow arteriovenous malformation (AVM) generally requires transcatheter embolo-sclerotherapy with or without surgery to control the disease process.
<strong>Objective: </strong>To evaluate the safety and efficacy of endovascular management of high flow arteriovenous malformation by embolization and sclerotherapy.
<strong>Patients and methods: </strong>This study was conducted at Mansoura University Hospitals, we included a total of 18 cases diagnosed with high flow AVM. All cases were subjected to complete history taking, thorough physical examination, and routine laboratory investigations. Also, duplex ultrasound (US) and computed tomography (CT) angiography were ordered for all cases.
<strong>Results:</strong> The mean age of the included cases was (26.73 years (range, 8 – 60 years). Males represented 61.11% of these cases, while the remaining patients were females. As regard the clinical result, success was achieved in 16 cases (61.11%). Only two cases had poor clinical result (11.11%). Transient ischemia was encountered in 2 cases (11.11%). Other complications included ulceration (5.56%), foot gangrene (5.56%), hand ischemia with amputation (5.56%), contracture scar (5.56%), and necrosis with transient PE (6.7%). With a mean follow up period of 26 months (range, 6 – 36 months), 16 cases showed very good outcome (88.89%), one case had good outcome (5.56%), while the remaining case had poor outcome (5.56%).
<strong>Conclusion:</strong> Embolo-sclerotherapy appears to be safe and effective intervention for high flow arteriovenous malformations.
arteriovenous malformations,Embolo-sclerotherapy,Transcatheter
https://ejhm.journals.ekb.eg/article_158081.html
https://ejhm.journals.ekb.eg/article_158081_85c48650113eca672695aa7d0aa48ce9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Immunohistochemical Expression of Discoidin Domain Receptor1 (DDR1) in Non-Neoplastic Skin Disease: A Systematic Review
922
929
EN
Rehab Monir
Samaka
rehabsamaka@yahoo.com
Mohammed Ahmed
Basha
Reem Ahmed
Hassan
Walaa Sabry Mahmoud
Elkadi
10.21608/ejhm.2021.158082
Background: The discoidin domain receptor-1 (DDR1) is a non-integrin collagen receptor recently implicated in the collective cell migration of other cancer types.
Objective: To review the immunohistochemical expression of discoidin domain receptor1 (DDR1) in non-neoplastic skin disease. Data Sources: A systematic search of MEDLINE (PubMed, Medscape, Science Direct. EMF-Portal) and internet was conducted on all articles published from 2002 to 2021.
Study Selection: English-language reports of immunohistochemical expression of DDR1 on non-neoplastic skin disease. The initial search presented 90 articles where 30 studies had the inclusion criteria. Then, they were divided into 12 studies about immunopathogenesis of non-neoplastic skin disease, 9 studies about expression of discoidin domain receptor1 and 9 studies emphasized DDR1 expression in non-neoplastic skin disease.
Data Extraction: Articles not reporting on immunohistochemical expression of DDR1 in non-neoplastic skin disease in the title or abstract were not included. 9 independent investigators extracted data on methods.
Findings: Interaction of DDR1 with various receptors is important for the regulation of cell survival, migration, and differentiation in development and pathological conditions. The discovery of inhibitors of DDR1 kinase activity might be beneficial in several pathological conditions where DDR1 has been identified as a potential therapeutic target. Conclusion: Our review reported that the knowledge of the main cells and cytokines involved in the immunopathogenesis of non-neoplastic skin disease is essential for dermatologists to understand better the disease as well as the mechanism of action of the biologics, drugs that revolutionized the treatment of non-neoplastic skin disease in the last two decades.
Discoidin domain receptor1,Immunopathogenesis,Non-neoplastic skin disease,Treatment
https://ejhm.journals.ekb.eg/article_158082.html
https://ejhm.journals.ekb.eg/article_158082_1dd4c69a38ecf700cc51102aca53dc0d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Uterine Carcinosarcoma: A Plan for Treatment
930
934
EN
Sherif E.
Sayed
Departments of Surgical Oncology, Faculty of Medicine, Bany Swif University, Egypt
Anwar A.
El Shenawy
Department of Surgical Oncology, Faculty of Medicine, Aswan University, Egypt
Waleed M. Mohamed
Fadlalla
Department of Surgical Oncology National Cancer Institute, Cairo University, Egypt
10.21608/ejhm.2021.158083
<strong>Background: </strong>Uterine carcinosarcomas are very aggressive tumors in the womb that are associated with poor prognosis. They represent only less than 5% of uterine tumors and the incidence rate is less than 2 per 100,000 women per year.
<strong>Objective: </strong>We reviewed diagnosis and treatment of women with uterine carcinosarcoma. To determine if lymphadenectomy, chemotherapy and radiotherapy are associated with decreased recurrence and increased survival. To prove that multimodality therapy including surgery, chemotherapy and radiotherapy are the ideal treatment for this malignancy.
<strong>Patients and Methods</strong>: The rarity of the tumor made us depend on thirty cases done over 5 years mainly stage 1, 2 and 3 in University of Aswan between 2014 and 2018. We abstracted: histopathology results, survival outcomes from archived medical reports for the qualifying cases and patient demographics. Patient age at surgery and preoperative CA-125 for patient demographics. Histopathological results: cancer stage, depth of myometrial invasion, grade. Treatment data: Surgical details and use of postoperative adjuvant chemotherapy or radiotherapy or both.
<strong>Results: </strong>Most uterine carcinosarcoma (UCS) patients are candidates for adjuvant chemotherapy combination therapy, but in-depth testing has not been widely used. The high rate of recurrence and poor overall survival indicate an ongoing need for clinical trials specifically. Hazard of death and recurrence decreased with chemotherapy multiagent and vaginal brachytherapy with five years of higher survival and disease free survival. Also lymphadenectomy decreased recurrence and rate of death associated with.
<strong>Conclusion:</strong> Adjuvant chemotherapy with vaginal brachytherapy with lymphadenectomy were associated with increased survival and decreased recurrence of women with UCS.
Multimodality therapy,Plan for treatment,Uterine carcinosarcoma
https://ejhm.journals.ekb.eg/article_158083.html
https://ejhm.journals.ekb.eg/article_158083_16d265ee8746fec358380a9f620f7e38.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Fetal and Maternal Outcomes in Cases of Morbidly Adherent Placenta in Sohag University Hospital: Observational Study
935
939
EN
Omar Mohamed
Fahmy
Department of Obstetrics and Gynecology, Faculty of Medicine - Sohag University, Egypt
ofahmy237@gmail.com
Abdou Saeed
Aitallah
Department of Obstetrics and Gynecology, Faculty of Medicine - Sohag University, Egypt
Hazem Mohammed
Abdelghafar
Department of Obstetrics and Gynecology, Faculty of Medicine - Sohag University, Egypt
Mohamed Yahia
Abdelhafez
Department of Obstetrics and Gynecology, Faculty of Medicine - Sohag University, Egypt
Ahmed Aly
Khalifa
Department of Obstetrics and Gynecology, Faculty of Medicine - Sohag University, Egypt
10.21608/ejhm.2021.158084
<strong>Background</strong><strong>:</strong> Morbidly Adherent Placenta (MAP) is the greatest challenge in modern obstetrics. It is associated with massive obstetrical hemorrhage and high maternal mortality. Antenatal diagnosis and meticulous multidisciplinary planning at delivery is crucial for optimal outcome.
<strong>Objective:</strong> To study the maternal and fetal outcomes in cases of morbidly adherent placenta for better management of these cases and to know our local practices toward these cases in Sohag University Hospital<strong>.</strong>
<strong>Patients and Methods: </strong>132 cases of pregnant women who had placenta previa with previous cesarean section scar were studied. This observational study was conducted at a Tertiary Care Hospital at Sohag University Hospital, Obstetrics & Gynecology Department (Inpatient and Emergency Sectors) from September 2017 to September 2018. All cases were subjected to complete history taking, complete physical examination, complete investigations, obstetric 2D U.S, color Doppler and MRI in some cases. Elective delivery was planned at 37-38 weeks or earlier in case of any complication.
<strong>Results: </strong>3664 were delivered, 2138 cesarean deliveries (58.3%) were performed. The percentage of these cases found to be 3.6% of deliveries and 6.17% of cesareans. The frequency of MAP in our study is 1 in 27.8 deliveries. There was one mortality in our study.
<strong>Conclusion:</strong> High caesarean section (C.S) rate is the leading cause of MAP. Antenatal diagnosis of morbidly adherent placenta through color Doppler and MRI allows for multidisciplinary planning to minimize potential maternal or neonatal morbidity and mortality.
morbidly adherent placenta,Intensive Care Unit,cesarean section,Internal iliac artery,Intra-uterine catheter
https://ejhm.journals.ekb.eg/article_158084.html
https://ejhm.journals.ekb.eg/article_158084_b3ad8da820c616f50357716a4d5bbc7b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Effect of Implementing Discharge Plan on Health Outcomes of the Adult Congestive Heart Failure Patients
940
948
EN
Hend I.M.
Abd Elaty
Department of Medical Surgical Nursing - Faculty of Nursing, Alexandria University, Egypt.
Soheir Mostafa
Eweda
Department of Medical Surgical Nursing - Faculty of Nursing, Alexandria University, Egypt.
Thoraya Mohamed
Abdel Aziz
Department of Medical Surgical Nursing - Faculty of Nursing, Alexandria University, Egypt.
thoraied@yahoo.com
Samia Mohamed
Hafez
Department of Medical Surgical Nursing - Faculty of Nursing, Alexandria University, Egypt.
Mohamed Ibrahim
Sanhoury
Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
10.21608/ejhm.2021.158085
<span>Background: </span><span>Congestive heart failure (CHF) prompt discharge nursing planning is aimed to expand knowledge concerning CHF, promote self-care practices, improve clinical outcomes and minimize readmission.<br /> </span><span>Objective: </span><span>Determination of the effect of implementing discharge plan on health outcomes of the adult CHF patients.<br /> </span><span>Materials and Methods: </span><span>The study was conducted at the Inpatient Cardiology Department, Alexandria Main University Hospital and its affiliated Outpatient Cardiac Clinic. A convenience sample of seventy hospitalized CHF patients, who were sequentially divided into 2 equal groups; control group: exposed to routine hospital care and study group: received the discharge plan. Four tools were used; Tool I: Congestive Heart Failure Patie</span><span>nts’ </span><span>Nursing Assessment, Tool II: Atlanta Heart Failure Knowledge Test, Tool III: Congestive Heart Failure Health Outcome Indicators and Tool IV: Self-Care of Heart Failure Index.<br /> </span><span>Results: </span><span>There was significant difference between the two studied groups in relation to overall CHF knowledge mean scores after implementing the discharge plan. A statistical significant difference was noticed between the studied </span><span>group’s </span><span>patients in relation to overall mean scores of self-care maintenance scale, self-care management scale, and self-care confidence scale.<br /> </span><span>Conclusion: </span><span>Implementing the developed discharge plan has significantly improved the overall knowledge, self- care practice confidence of adult CHF patients.<br /></span>
Self-Care Practice,Health Outcomes,Knowledge,Discharge plan,Heart failure,Cardiology nursing
https://ejhm.journals.ekb.eg/article_158085.html
https://ejhm.journals.ekb.eg/article_158085_e33f02be8dd6fc9ff1bb77a006734fb7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Impact of Hemodialysis Time Prolongation on Blood Pressure Control
949
956
EN
Nahla Mohamed
Teama
Division of Nephrology Department of Internal Medicine, Ain Shams University, Faculty of Medicine, Cairo, Egypt.
Heba Soliman Mohammed
Soliman
Nephrology Department, Manshiet Elbakry Hospital, Cairo, Egypt.
Magdy
ElSharkawy
Division of Nephrology Department of Internal Medicine, Ain Shams University, Faculty of Medicine, Cairo, Egypt.
Reem Mohsen
El-Sharabasy
Division of Nephrology Department of Internal Medicine, Ain Shams University, Faculty of Medicine, Cairo, Egypt.
10.21608/ejhm.2021.158086
Introduction<strong>:</strong> Hypertension prevalence among end-stage renal disease (ESRD) patients range from 76% to 90%. Increasing the duration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours.
<strong>Objective: </strong>We aimed to study the effect of increasing hemodialysis session time on blood pressure control.
<strong>Methods: </strong>This observational study was conducted on 50 hypertensive prevalent HD patients on thrice-weekly maintenance HD. Patients were divided into 2 groups: (A) 25 patients who received longer hemodialysis session (4.5 hours) and (B) 25 patients HD who received the usual 4 hours session. They were followed up for a period of 6 months to assess changes of pre-dialysis blood pressure to monitor response.
<strong>Results:</strong> Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (p-value < 0.001 versus 0.523). Longer HD session time group was associated with highly significant decline in mean SBP, (p-value < 0.001). Moreover, longer HD session time group was associated with highly statistically significant decline in mean DBP, (p-value < 0.001). The decline in mean perdialysis SBP & DBP was -17.27 & -9 mmHg respectively and the rate of decline of postdialysis SBP & DBP was -6.45 & -12.38 mmHg respectively at 6<sup>th</sup> month compared to values in 1<sup>st</sup> month of follow up period.
<strong>Conclusion:</strong> Longer HD session duration is associated with better improvement in UF volume, mean SBP & DBP, pre-dialysis SBP & DBP and post-dialysis SBP & DBP as well.
Hemodialysis,Hypertension,ESRD
https://ejhm.journals.ekb.eg/article_158086.html
https://ejhm.journals.ekb.eg/article_158086_920e610e4d0e1d17218ceeef88c4784b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Evaluation of the Role of Hyaluronic Acid as A potential Biomarker for Diagnosis of Non-Alcoholic Fatty Liver Disease
957
963
EN
Ahmed Mohamed
ElGhandour
Gastroenterology, Hepatology and Internal Medicine Department, Ain Shams University, Egypt
ghandour80@hotmail.com
Emad Ahmad
Awad
Gastroenterology, Hepatology and Internal Medicine Department, Ain Shams University, Egypt
Riham Hamed Ahmed
Abdel-Hamid
Gastroenterology, Hepatology and Internal Medicine Department, Ain Shams University, Egypt
Ahmed M. F.
Mansour
Gastroenterology, Hepatology and Internal Medicine Department, Ain Shams University, Egypt
10.21608/ejhm.2021.158087
<strong><em>Background: </em></strong>Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, ranging from simple steatosis and non-alcoholic steatohepatitis (NASH) to cirrhosis, with its complications including hepatocellular carcinoma (HCC). The non-invasive diagnostic markers of NAFLD are gaining interest due to the invasive nature and potential side effects of liver biopsy, and are the current gold standard of diagnosis.
<strong><em>Objective:</em></strong> This study aimed to evaluate hyaluronic acid (HA) as a potential non-invasive biomarker for diagnosis and prognosis of NAFLD and to compare it with the traditional non-invasive techniques.
<strong><em>Patients and methods: </em></strong>This study included 63 subjects divided into 3 groups; including 21 patients with fatty liver, 21 patients with NASH, in addition to 21 healthy controls. Non-invasive assessment of liver fibrosis was done to all study subjects using aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 score (FIB4), in addition to measurement of HA serum levels.
<strong><em>Results:</em></strong> As regard assessment of liver fibrosis, there was a highly significant statistical difference between groups as regard APRI and Fib4 scores. As for HA there was a highly significant statistical difference between study groups. HA receiver operating characteristics curves (ROC) achieved excellent diagnostic performance for fatty liver with 100% sensitivity and specificity at cutoff of 25 ng/ml for fatty liver, versus a sensitivity of 95.2% and specificity of 85.7% for NASH at cutoff of 110 ng/ml.
<strong><em>Conclusion: </em></strong>HA can be used as an accurate and specific non-invasive biomarker for the diagnosis of NAFLD and staging of the severity of disease compared with the traditional known non-invasive scores.
biomarker,Hyaluronic acid,Non-alcoholic fatty liver disease
https://ejhm.journals.ekb.eg/article_158087.html
https://ejhm.journals.ekb.eg/article_158087_5043a8cdeb7869dd10a6db16842563e2.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Evaluation of Vomiting Among Children Admitted to Al-Azhar University Hospital in Assiut
964
968
EN
Abdelmagid Mohammad
Bayomi
Pediatrics Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Hosny
Abdel Kareem
Pediatrics Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Mohammad Ehab Saad
Zaghloul
Pediatrics Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
drmohammadoraby@gmail.com
10.21608/ejhm.2021.158088
<strong>Background: </strong>Vomiting is a common problem in children for which parents seek health care consultation. It has a varied etiology encompassing many organ systems, ranging from a benign physiological behavior to a life-threatening systemic disease. Most often, it is benign and self-limiting. Infections within and outside the gastrointestinal tract are the commonest causes. <strong> Objective:</strong> To evaluate the gastrointestinal and non-gastrointestinal causes of vomiting in children admitted to Al-Azhar University Hospital in Assiut from December 2019 to June 2020.<br /> <strong>Patients and Methods: </strong>This descriptive cross-sectional study included 105 children admitted to Al- Azhar University Hospital in Assiut during the period from December 2019 to June 2020 presenting with vomiting. Their ages varied from 2 to10 years old and included 64 males and 41 females.<strong> Results:</strong> Acute gastroenteritis was the leading cause of vomiting among all cases. It was observed that dehydration (86.0%) and weight loss (70.2%) were the most common clinical signs among GI causes of vomiting. Regarding laboratory results, anemia was presented in most of our cases, due to GI and non-GI causes of vomiting, representing (82.4%) and (70.8%) respectively. Abdominal U/S showed a high ability in diagnosing renal stones in (12.5%) of cases with non-GI causes of vomiting.<br /> <strong>Conclusion: </strong>The commonest GI cause of vomiting in children was gastroenteritis, followed by hepatitis A infection. The commonest non-GI cause of vomiting was lower respiratory tract infection. Weight loss was considered a golden standard in assessment of dehydration. Abdominal U/S was a useful tool for the diagnosis of renal stones.<br /> <strong> </strong>
Vomiting,H. Pylori infection,Acute gastritis,gastroenteritis
https://ejhm.journals.ekb.eg/article_158088.html
https://ejhm.journals.ekb.eg/article_158088_d54667a462d2aee4acd488f816458217.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Diagnostic Accuracy of Chest Ultrasound versus Plain Chest X-ray in Acute Assessment of Traumatic Hemothorax
969
973
EN
Samir Mohamed
Attia
Noureldin Noaman
Gwely
Mohamed El-Said
Ibrahim
Mahitab Galal El-Din Rashwan
Hefny
mahimosalam@yahoo.com
10.21608/ejhm.2021.158089
<strong>Background: </strong>Trauma is the leading cause of death in young adults, as well as a significant cause of morbidity and mortality in people of all ages. Ultrasonography (US) is a good first imaging modality because it is fast, repeatable, and noninvasive. It can also be achieved at the same time as other resuscitative steps, providing critical information without the time delay caused by radiograph or CT scan execution and interpretation.<br /> <strong>Objective:</strong> To compare the diagnostic accuracy of chest ultrasound with plain chest X-ray in acute assessment of traumatichemothorax at Emergency Hospital, Mansoura University.<br /> <strong>Patients and methods: </strong>This was a cross-sectional study included a total of 109 patients with polytrauma and conducted at Emergency Medicine Department, Mansoura University from November 2019 to October 2020. Emergency Hospital, Mansoura University is a level one trauma center with about 250,000 visit and 25,000 trauma cases per year. <strong>Results: </strong>The X-ray findings in the cases included in the study where fracture ribs was detected in 76 cases (69.7%), lung contusions in 28 cases (25.7%), obliteration of costophrenic angles in 17 cases (15.6%) and tension pneumothorax in 38 cases (34.9%). US showed 86.2% sensitivity, 100% specificity, PPV 100%, NPV 95.2% and 96.3% accuracy. X-ray showed 58.6% sensitivity, 100% specificity, PPV 100%, NPV 86.9% and 89% accuracy.<br /> <strong>Conclusion:</strong> Ultrasound has significant value in initial assessment of life-threatening conditions of trauma with acceptable sensitivity and high specificity.<br />
Chest Ultrasound,Plain Chest X-ray,Traumatic Hemothorax
https://ejhm.journals.ekb.eg/article_158089.html
https://ejhm.journals.ekb.eg/article_158089_b23b49cea61b451a748fb5e0fe36ebca.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Clinical Applications of Non-Invasive Multimodality Imaging in The Evaluation of Ocular Ischemic Syndrome: A Case Study
974
981
EN
Abdulhamid
Alghamdi
Faculty of Medicine, Department of Ophthalmology, Taif University
drghamdieye@hotmail.com
10.21608/ejhm.2021.158272
<strong>Background: </strong>A 74 years old lady presented with bilateral sudden deterioration of vision over a period of 3 weeks. She is a known diabetic and hypertensive for the past 25 years. The patient denied associated neurological symptoms. The patient underwent a comprehensive non-invasive neuroimaging and retinal imaging. <strong>Case Presentation:</strong> The case study is about right sided occipital lobe infarction and right sided internal carotid artery stenosis with complete right ophthalmic artery occlusion resulted in right Ocular ischemic syndrome (OIS). Ocular findings showed normal swinging light reflex. Right eye showed rubiosis iridis, neovascularization of the disc. Left eye showed moderate non-proliferative diabetic retinopathy. There was lack of cerebellar and/or cortical constitutional symptoms.<br /> Magnetic resonance angiography (MRA) imaging showed compromised right side internal carotid system and complete occlusion of the right ophthalmic artery. Magnetic resonance imaging (MRI) showed as well isolated right sided occipital lobe infarction. The patient received neurological and ocular treatment.<br /> <strong>Conclusion:</strong> Painless sudden bilateral visual disturbance in an elderly individual should draw the clinician attention to possible cortical etiology inspite the absence of neurological symptoms. Non-invasive imaging techniques had been shown to be effective in the evaluation of symptomatic Ocular ischemic syndrome (OIS), which should be considered if the gold standards imaging techniques are relatively or absolutely contraindicated.<br />
Magnetic resonance angiography,Non-invasive imaging,Occipital lobe infarction,Ocular ischemic syndrome,Swept-source optical coherence tomography
https://ejhm.journals.ekb.eg/article_158272.html
https://ejhm.journals.ekb.eg/article_158272_64756bf27ed0e907e0d39110c62cdfd7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Correlation between Doppler Indices as A Predictor of Neonatal Outcome in Normal and Preeclamptic Pregnant Women in The Third Trimester
982
987
EN
Abdel-Hamid E.
Shaheen
Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Mohamed A.
Elsayed
Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
m_atef_dr@yahoo.com
Ragab M.
Dawood
Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Hoda R.
Abbas
Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
hodaelsaqa@yahoo.com
10.21608/ejhm.2021.158274
<strong><span lang="EN-US">Background: </span></strong><span lang="EN-US">Doppler flow velocimetry of the umbilical artery and cerebral circulation is a non-invasive modality used for assessment of fetal wellbeing. Doppler studies are more specific and are potentially useful tool in prediction of adverse perinatal outcome in high risk patients. Aim of the current study was to evaluate the efficacy of middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), uterine artery pulsatility index (UAT-PI), and a cerebroplacental ratio (CPR) Doppler indices in assessment of fetal wellbeing. For documentation of the neonatal outcome in preeclamptic women with abnormalities of Doppler indices.</span><br /> <strong><span lang="EN-US">Objectives:</span></strong><span lang="EN-US"> Assessment of fetal wellbeing and prediction of neonatal outcome in normal pregnant women and woman with preeclampsia by using Doppler indices.</span><br /> <strong><span lang="EN-US">Patients and Methods</span></strong><span lang="EN-US">: the study isacase control study included 94 pregnant women (47 normal pregnancy and 47 preeclamptic patients) admitted in Obstetrics and Gynecology Department of Menoufia University during the period from August 2018 to November 2019. All included women underwent Doppler study and were followed up till delivery. <strong>Results: </strong>Doppler velocimetry studies of both placental and fetal circulation can provide important information as regard fetal wellbeing so can be used to improve fetal outcome.</span><br /> <strong><span lang="EN-US">Conclusions: </span></strong><span lang="EN-US">It was observed that all three parameters UAT-PI, MCA-PI and UA-PI when taken into consideration together are good parameters in predictions of perinatal outcome.</span><br />
Doppler,umbilical artery,preeclampsia
https://ejhm.journals.ekb.eg/article_158274.html
https://ejhm.journals.ekb.eg/article_158274_82e9ad184f9a7ae357b87a5a358df74b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Role of Ultrasound in the Assessment of Pediatric Non-Traumatic Gastrointestinal Emergencies
988
994
EN
Christine Milad
Banoub
Radio-diagnosis Department, Faculty of Medicine, Zagazig University, Egypt
christinemilad@yahoo.com
Tarek Mohamed
Sobhy
Radio-diagnosis Department, Faculty of Medicine, Zagazig University, Egypt
Ahmed Abd-Elaziz
Elsammak
Radio-diagnosis Department, Faculty of Medicine, Zagazig University, Egypt
Ahmed Mohamed
Alsowey
Radio-diagnosis Department, Faculty of Medicine, Zagazig University, Egypt
10.21608/ejhm.2021.159674
<strong>Background:</strong> Non-traumatic gastrointestinal emergencies in the children and neonatal patients and the presenting characteristics ultrasound features on the longitudinal and axial axes are a dilemma for the radiologist in the emergency room. The most frequent emergencies are appendicitis, intussusceptions, hypertrophic pyloric stenosis, and volvulus due to intestinal malrotation.
<strong>Objectives:</strong> this work aimed to assess the role of ultrasound in the assessment of pediatric non-traumatic gastrointestinal emergencies.
<strong>Patients and</strong> <strong>Methods:</strong> A retrospective analysis of 205 ultrasound examinations performed for neonatal and children patients with fever, abdominal pain, vomiting and diarrhea were evaluated. <strong>Results:</strong> Of 205 cases, 19 cases of intussusceptions, 49 cases of appendicitis, 2 cases associated with abscess, 1 gangrenous appendicitis with absence a color Doppler, 30 cases of perforated appendicitis and 3 cases of volvulus were found.
<strong>Conclusions:</strong> Acute abdominal pain is one of the most common complaints in childhood, and one that frequently requires rapid diagnosis and treatment in the emergency department. Although acute abdominal pain is typically self-limiting and benign, there are potentially life-threatening conditions that require urgent management, such as appendicitis, intussusception, or bowel obstruction. Meticulous history taking and repeated physical examinations are essential to determine the cause of acute abdominal pain and to identify children with surgical conditions.
Gastrointestinal pediatric emergencies,Intussusceptions,Appendicitis,Hypertrophic pyloric stenosis,volvulus
https://ejhm.journals.ekb.eg/article_159674.html
https://ejhm.journals.ekb.eg/article_159674_c78e53f0a97a9bbde38a70999236bc37.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Evaluation of Monocyte Chemoattractant Protein 1(MCP-1) as a Predictor of Complications in Type 2 Diabetes Mellitus in Zagazig University Hospital
995
1001
EN
Amira A.
Mahmoud
Mohamed Said
Soliman
Azza
Moustafa
10.21608/ejhm.2021.160038
ABSTRACT
<strong>Background: </strong>Monocyte chemoattractant protein-1 (MCP-1) is the first discovered and most extensively studied chemotactic cytokines (CC = chemokine). Many studies on its role in the etiologies of obesity- and diabetes-related diseases have been increased exponentially during the past two decades. MCP-1, a chemokine involved in monocyte chemotaxis can be consistently found at high levels in the patients with type 2 diabetes mellitus. MCP1 may be an early predictor of complications of diabetes.
<strong>Objective:</strong> Assessment of the levels of MCP-1 and other biochemical markers in diabetic subjects compared to a healthy group, which in turn can be beneficial to clarify the correlations of MCP-1 levels in diabetes mellitus with other clinical and biochemical parameters.
<strong>Patients and methods: </strong>Eighty-one participants including both male and female, of cross-matched ages ranging between 30 – 60 years old were included in this study. They were divided into three equal groups: group I (control group), group II (recently diagnosed T2DM) and group III (old diagnosed T2DM more than 10 years).
<strong>Results: </strong>The highest level of MCP-1 was found in the old diagnosed diabetic group while the lowest level was found in the non-diabetic control group. The LSD statistical analysis showed there was significant difference between all groups of the study. Our results showed that serum MCP-1 was elevated in cases of the group 3 (old diagnosed diabetic patients) who were suffering from diabetic nephropathy (9/27), diabetic retinopathy (9/27) and the last 9/27 were suffering of neuropathy.
<strong>Conclusion</strong>: The MCP-1 level is increased in type 2 Diabetic patients and significantly increased with the progression of diabetes complications as diabetic retinopathy, diabetic nephropathy and diabetic neuropathy.
MCP-1,T2DM
https://ejhm.journals.ekb.eg/article_160038.html
https://ejhm.journals.ekb.eg/article_160038_c16e9781762d0de28109562ec7ffc7b9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Study of Omentin-1 and Chemerin as Predictors of Coronary Artery Disease in Elderly Patients, with Retrospective Studying of their Relation to Diabetes Mellitus Type 2
995
1001
EN
Maher Borai
Mohammad
Departments of 1Clinical Pathology Faculty of Medicine, Zagazig University, Egypt
maherborai@yahoo.com
Ahmad Soliman
Sallam
Departments of 1Clinical Pathology Faculty of Medicine, Zagazig University, Egypt
Abeer Abdalla
Fekry
Departments of 1Clinical Pathology Faculty of Medicine, Zagazig University, Egypt
Mohammad Ibrahim
Amin
Departments of Cardiology, Faculty of Medicine, Zagazig University, Egypt.
10.21608/ejhm.2021.160044
Monocyte chemoattractant protein-1 (MCP-1) is the first discovered and most extensively studied chemotactic cytokines (CC = chemokine). Many studies on its role in the etiologies of obesity- and diabetes-related diseases have been increased exponentially during the past two decades. MCP-1, a chemokine involved in monocyte chemotaxis can be consistently found at high levels in the patients with type 2 diabetes mellitus. MCP1 may be an early predictor of complications of diabetes.<br /> <strong>Objective:</strong> Assessment of the levels of MCP-1 and other biochemical markers in diabetic subjects compared to a healthy group, which in turn can be beneficial to clarify the correlations of MCP-1 levels in diabetes mellitus with other clinical and biochemical parameters.<br /> <strong>Patients and methods: </strong>Eighty-one participants including both male and female, of cross-matched ages ranging between 30 – 60 years old were included in this study. They were divided into three equal groups: group I (control group), group II (recently diagnosed T2DM) and group III (old diagnosed T2DM more than 10 years).<br /> <strong>Results: </strong>The highest level of MCP-1 was found in the old diagnosed diabetic group while the lowest level was found in the non-diabetic control group. The LSD statistical analysis showed there was significant difference between all groups of the study. Our results showed that serum MCP-1 was elevated in cases of the group 3 (old diagnosed diabetic patients) who were suffering from diabetic nephropathy (9/27), diabetic retinopathy (9/27) and the last 9/27 were suffering of neuropathy.<br /> <strong>Conclusion</strong>: The MCP-1 level is increased in type 2 Diabetic patients and significantly increased with the progression of diabetes complications as diabetic retinopathy, diabetic nephropathy and diabetic neuropathy.<br />
MCP-1,T2DM
https://ejhm.journals.ekb.eg/article_160044.html
https://ejhm.journals.ekb.eg/article_160044_fb56e50f57fd3259ef774e46d72b1a9f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Comparative Study between Magnesium Sulphate Versus Dexmedetomedine as Additives to Levobupivacine in Ultra Sonographic Guided Supraclavicular Block in Patient Undergoing Forearm Surgeries
1010
1016
EN
Ahmed Hamody
Hassan
Department of Anesthesia, Faculty of Medicine, Sohag University, Egypt.
Ayman Mohamed
Abdelkareem
Department of Anesthesia, Faculty of Medicine, Sohag University, Egypt.
aymann8100@gmail.com
10.21608/ejhm.2021.160046
<strong>Background:</strong> Supraclavicular block provides alternative way to general anesthesia for upper limb surgeries. They produce complete muscular relaxation, maintaining hemodynamic stability intraoperatively and avoidance of the risks with general anesthesia. The most important target of anesthesia is to manage the patient's pain, as we can do the surgical procedures with no discomfort, and controlling of intraoperative and postoperative pain.
<strong>Objective:</strong> Our study aimed to detect how adding Mg sulphate or dexmedetomidine can improve the effect of local anesthetic in regional block (supra clavicular block).
<strong>Patient and Methods:</strong> 90 patients aged between 20–75 years old with ASA I– II who were scheduled for forearm surgeries under supraclavicular block anesthesia were enrolled in our study. This Study was conducted in Sohag University Hospitals from May 2019 to April 2020. Patients were divided into 3 equal groups.
<strong>Results:</strong> Magnesium sulphate had a more rapid onset of both sensory and motor block onset than dexmedetomedine and control groups. Dexmedetomidine had a longer duration of both motor and sensory block than magnesium sulphate group and control groups. Dexmedetomidine had a longer analgesic effect than magnesium sulphate group and control group. As regards rate of complications, there was no significant difference between the three groups.
<strong>Conclusion</strong>: The addition of 1 ml (100 μg) dexmedetomedine or 200 mg magnesium sulphate to supraclaviculary-injected levobupivacaine improved the onset, duration and postoperative analgesia of levobupivacain
Mg sulphate,Dexmedetomedine,Levobupivacine,Ultrasonographic guided,supraclavicular block
https://ejhm.journals.ekb.eg/article_160046.html
https://ejhm.journals.ekb.eg/article_160046_78ef85c7574f30f595973d3449076962.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Combined Midfoot Dislocation Involving the Naviculocuneiform and Calcaneocuboid Joints: A Case Report
1017
1020
EN
Ibrahim S.
Alayed
Department of Orthopedic Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
ibrahim.alayed@hotmail.com
10.21608/ejhm.2021.160051
<strong>Background:</strong> Midfoot injuries such as dislocation of the naviculocuneiform and calcaneocuboid joints are very rare. They mostly result from high energy crushing trauma, which leads to dislocation of the midfoot in a plantar direction.<br /> <strong>Objective: </strong>To study the outcome of open reduction and internal fixation with K-wires in naviculocuneiform and calcaneocuboid joint dislocations. <br /> <strong>Patients and methods: </strong>Our case report of a 27 years old male who sustained an isolated left foot injury after a road traffic accident, radiographs showed a dislocation of the naviculocuneiform joint and fracture-dislocation of the calcaneocuboid joint. This uncommon injury pattern required open reduction and internal fixation with K-wires.<br /> <strong>Results:</strong> K-wires were removed after 12 weeks. At the 12 months follow up, he achieved a complete range of motion of the left foot and ankle with good functional outcomes and with no complications. The goal in such dislocations is to achieve a stable congruent joint with gradual rehabilitation to reach a good functional outcome.<br /> <strong>Conclusion: </strong>Closed dislocations involving the naviculocuneiform and calcaneocuboid joints are very rare, and they occur following a high energy trauma in the majority of cases. The goal of treatment in such injuries is to achieve a stable congruent joint with gradual rehabilitation to maximize the functional outcomes.<br />
Calcaneocuboid,Naviculocuneiform,Midfoot injury,Chopart,Midtarsal Dislocation
https://ejhm.journals.ekb.eg/article_160051.html
https://ejhm.journals.ekb.eg/article_160051_11dadb18504ad419b2305540995550dc.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Clinical and Laboratory Predictors of No-reflow during Primary Percutaneous Coronary Intervention
1022
1029
EN
Hazem
Mansour
0000-0002-5366-3698
cardiology department, Faculty of Medicine, Ain shams university, Cairo-Egypt
hazemmansour79@gmail.com
Ali
Elabd
Department of Cardiology, Faculty of Medicine, Ain Shams University, Egypt
M.A.
Ghazy
Department of Cardiology, Faculty of Medicine, Ain Shams University, Egypt
Wafed
Sameer
Cardiology Department, Faculty of Medicine, Misr University for Science and Technology, Egypt
Ibrahem
Abdelhamid
Cardiology Department, Faculty of Medicine, Misr University for Science and Technology, Egypt
Ahmed
Tamara
Department of Cardiology, Faculty of Medicine, Ain Shams University, Egypt
10.21608/ejhm.2021.160052
<strong>Background: </strong>The phenomenon of no-reflow is defined as the occurrence of areas with very low tissue flow after the target vessel has reopened. Current knowledge suggests that the no-reflow phenomenon is caused by the damage to microvascular integrity established both during ischemia and during reperfusion. D-dimer is the end product of fibrin degradation by plasmin, as plasma concentrations increase in people with persistent or recent thrombosis. Its levels reflect the rate of fibrin turnover and give an indirect estimate of the size of the coagulant mass available for fibrinolysis and the severity of the hypercoagulable condition.<br /> <strong>Objective:</strong> To investigate the Clinical and laboratory predictors of no-reflowon admission afterprimary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients<strong><em>.</em></strong><br /> <strong>Patients and methods:</strong> A prospective single group observational study.A total of 100 patients presented with STEMI and eligible for primary PCI to the cardiology department in Ain Shams University hospital.<br /> <strong>Results: </strong>Coronary angiography showed that (74%) had normal flow while (26%) showed no re-flow. Renal impairment, DM and delayed reperfusion (> 4 hr) were significantly associated with no reflow(P-values = 0.018,0.023,0.005) respectively. ROC curve showed that the best cut off point for D-dimer to predict cases with no reflow was found ≥ 560 with sensitivity of 96.15%, specificity of 79.73% and area under curve (AUC) of 86.5% where as the best cut off point for CRP was > 41 with sensitivity of 76.92%, specificity of 64.86% and area under curve (AUC) of 69.8.<br /> <strong>Conclusion: </strong>Assessment ofD-dimer and CRP levels on admission in STEMI patients might independently predicts no-reflow after primary <span lang="EN-US">PCI.</span>
D-Dimer,CRP,No-reflow,STEMI,Primary PCI
https://ejhm.journals.ekb.eg/article_160052.html
https://ejhm.journals.ekb.eg/article_160052_72400ba730946b9b08e920bdcb2305ef.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Dietary Practice and Nutritional Status Among Pregnant Women
1030
1037
EN
Safa Hamdy
Alkalash
Family Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Nagwa Nashat
Hegazy
Family Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Rasha Tawakal
ELnady
Family Medicine Department, Trenna Family Health Unit Al Mahalla Al Kobra, Gharbia Governorate, Egypt
3Faculty of Home Economics, Department of Nutrition and Food Sciences, Menoufia University,
dr.rashaelnady2021@gmail.com
Nazeha A.
Khalil
Faculty of Home Economics, Department of Nutrition and Food Sciences, Menoufia University, Menoufia, Egypt
10.21608/ejhm.2021.160053
<strong>Background: </strong>Appropriate balanced maternal nutrition is the principal determinant for maternal and fetal wellbeing. Consequently, the dietary practice and nutritional status of pregnant ladies need to be addressed properly as it should follow the recommendations of the food pyramid. <strong>Objective</strong>: to assess dietary practice and nutritional status among pregnant women attending antenatal Care In the rural Family Health Unit<strong>. Methods: </strong>The study was a Facility-based cross-sectional study conducted in the Terrene family health unit, Gharbia Governorate on 350 pregnant ladies chosen by a simple random sample. Data were collected via face-to-face interviews using semi-structured questionnaires. Analyses were done using the statistical package of social science (SPSS version 20).
<strong>Results:</strong> In the current study the mean age of the enrolled pregnant women was about 24-year-old (Rang16-49 years old). Above two-thirty of them (65.14%) eat three times per day. Most of the studied pregnant women (73.43%) had varied favorite foods. About (46.57%) of them use animal fats for cooking. Most of them (72.57%) add average salt to their food. But (88.86%) of them prefer diverse foods. Multivariate logistic regression analysis revealed that age, women education, occupation, getting medical service, socio-economic status, previous delivery, presence of sickness, hemoglobin level, and daily meals frequency were significant predictors to nutritional status among pregnant women attending antenatal. <strong>Conclusion: </strong>The present study revealed that there is a burden of suboptimal dietary practice and undernutrition among these studied participants especially for low-income women.
Dietary practice,Meal intake,Nutritional Status,PHC,Pregnant women
https://ejhm.journals.ekb.eg/article_160053.html
https://ejhm.journals.ekb.eg/article_160053_1b5e1923c2e6b3f2ec8131fa986d59d3.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Non-invasive Methods in Diagnosis of Nonalcoholic Fatty Liver Disease
1038
1042
EN
Khaled
Hemida
Department of Gastroenterology, Faculty of Medicine, Ain Shams University, Egypt
Hany
Haroun
Department of Gastroenterology, Faculty of Medicine, Ain Shams University, Egypt
Inas Elkhedr
Mohamed
inas_elkhedr@yahoo.com
Mostafa
Mahmoud
El Sahel Hospital, Ministry of Health, Egypt
10.21608/ejhm.2021.160611
<strong>ABSTRACT</strong>
<strong>Background:</strong> Non-alcoholic fatty liver disease (NAFLD) is a risk factor for increased morbidity and mortality plus cardiovascular disease and malignancy. Despite all of these, most patients have good prognosis if diagnosed at early stages. <strong>Objective:</strong> The study was designed to evaluate different non-invasive methods as a diagnostic tool of non-alcoholic fatty liver disease among diabetic and non-diabetic patients. <strong>Patients and Methods: </strong>The study was done on 100 patients were divided into two groups of 50 diabetics and 50 non-diabetics with fatty liver disease on abdominal ultrasonography finding. These patients were assessed with transient elastography (TE) after lab tests and then scoring systems (Fib-4 and NAFLD fibrosis score) and liver stiffness scores were compared between the two groups. <strong>Results:</strong> There was statistically significant difference between the two groups as regard Fib-4 and NAFLD fibrosis score (p < 0.001), where Fib-4 and NAFLD fibrosis score were higher in group I (diabetic) than in group II (non-diabetic). A statistically significant difference between the two groups as regard liver stiffness (p < 0.001), where liver stiffness was higher in group I than in group II. Liver stiffness score and NAFLD fibrosis score were statistically significantly higher in those with (>F2) than those with (F2 or less) (p < 0.001). <strong>Conclusion:</strong> A combination of Fibroscan, Fib-4 and NAFLD fibrosis score provides a valuable non-invasive method in diagnosis of NAFLD patients, and this can eliminate the need for liver biopsy in patients without clear indication, especially diabetic patients that can help in early diagnosis of NAFLD before development of fibrosis.
FIB-4,FibroScan,NAFLD fibrosis score,Non-alcoholic fatty liver disease
https://ejhm.journals.ekb.eg/article_160611.html
https://ejhm.journals.ekb.eg/article_160611_40b98460f27c05ab0fbb8cb158c1881e.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Sodium Bicarbonate-Based Warm Saline Versus Warm Saline for Peritoneal Irrigation in Diagnostic Hysteroscopy-Laparoscopy: A Prospective Randomized Controlled Trial
1043
1049
EN
Mohamed
adel aboelela
Anesthesia and Surgical Intensive Care, Mansoura University.
10.21608/ejhm.2021.160613
<strong>ABSTRACT</strong>
<strong>Introduction:</strong> Diagnostic hysteroscopy-laparoscopy is an essential tool in management of infertility. Mainly, postoperative pain related to insufflated cold carbon dioxide (co<sub>2</sub>), as it creates acidic milieu causing mucosal, sub-diaphragmatic and phrenic nerve irritation. Sodium bicarbonate is an alkaline solution, neutralizing the acidic effects, hence reduces postoperative pain and irritation symptoms.
<strong>Objectives:</strong> This study aimed to assess the efficacy of adding sodium bicarbonate to washing warm saline in hysteroscopic-laparoscopic patients regarding incidence and intensity of postoperative pain and gastrointestinal irritation symptoms.
<strong>Patients and methods:</strong> 66 patients were enrolled, one was excluded due to ovarian bleeding. 33 patients in sodium bicarbonate (Na) group received 50 ml sodium bicarbonate 8.4% in 1000 ml warm saline as peritoneal irrigation solution. While 32 patients in saline (S) group the peritoneal irrigation solution was 1000 ml warm saline only.
<strong>Results:</strong> Patients’ demographic, hemodynamic data were comparable. Postoperative pain profile regarding shoulder tip pain, visual analogue score (VAS), and total pethidine consumption were lower in Na group. Also, postoperative nausea and vomiting (PONV) was lower in Na group.
<strong>Conclusion:</strong> Adding sodium bicarbonate to warm saline as a peritoneal washing solution during hysteroscopy-laparoscopy procedure resulted in better postoperative pain reduction specially shoulder tip pain and reduced the incidence of PONV. These results would improve patients’ recovery and experience towards operative practice.
<strong>ABSTRACT</strong>
<strong>Introduction:</strong> Diagnostic hysteroscopy-laparoscopy is an essential tool in management of infertility. Mainly, postoperative pain related to insufflated cold carbon dioxide (co<sub>2</sub>), as it creates acidic milieu causing mucosal, sub-diaphragmatic and phrenic nerve irritation. Sodium bicarbonate is an alkaline solution, neutralizing the acidic effects, hence reduces postoperative pain and irritation symptoms.
<strong>Objectives:</strong> This study aimed to assess the efficacy of adding sodium bicarbonate to washing warm saline in hysteroscopic-laparoscopic patients regarding incidence and intensity of postoperative pain and gastrointestinal irritation symptoms.
<strong>Patients and methods:</strong> 66 patients were enrolled, one was excluded due to ovarian bleeding. 33 patients in sodium bicarbonate (Na) group received 50 ml sodium bicarbonate 8.4% in 1000 ml warm saline as peritoneal irrigation solution. While 32 patients in saline (S) group the peritoneal irrigation solution was 1000 ml warm saline only.
<strong>Results:</strong> Patients’ demographic, hemodynamic data were comparable. Postoperative pain profile regarding shoulder tip pain, visual analogue score (VAS), and total pethidine consumption were lower in Na group. Also, postoperative nausea and vomiting (PONV) was lower in Na group.
<strong>Conclusion:</strong> Adding sodium bicarbonate to warm saline as a peritoneal washing solution during hysteroscopy-laparoscopy procedure resulted in better postoperative pain reduction specially shoulder tip pain and reduced the incidence of PONV. These results would improve patients’ recovery and experience towards operative practice.
<strong>Keywords: </strong>Laparoscopy, Pain, VAS, Sodium bicarbonate, PONV.
Laparoscopy,Pain,VAS,sodium bicarbonate,PONV
https://ejhm.journals.ekb.eg/article_160613.html
https://ejhm.journals.ekb.eg/article_160613_402cc6970b35a176168ed20366ae8b0e.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Association of 11beta-hydroxysteroid dehydrogenase type 1 (HSD11B1) gene polymorphism with Type 2 Diabetes Mellitus in a sample Egyptian Population
1050
1055
EN
Salah Hussein
Elhalawany
Department of internal Medicine, Endocrinology and Diabetes Unit,
salah.hussein@med.asu.du.eg
, Raef Malak
Botros
Department of internal Medicine, Endocrinology and Diabetes Unit,
Laila Mahmoud Ali
Hendawy
Department of internal Medicine, Endocrinology and Diabetes Unit,
Eman Mohamed Eman Mohamed
Fahmy
Department of of Internal Medicine, Endocrinology and Diabetes Unit,
Alaa Tarek
Younis
Department of of Internal Medicine, Endocrinology and Diabetes Unit,
10.21608/ejhm.2021.160614
<strong>Background:</strong> Recently, numerous studies have associated polymorphisms in 11beta-hydroxysteroid dehydrogenase type 1 (HSD11β1) gene and T2DM risk. However, there is still a lack in the published literature evaluating the association between HSD11β1gene polymorphism and the risk of T2DM.
<strong>Objective: </strong>The Aim of the study was to assess the association of HSD11β1gene polymorphism (rs846910) with Type 2 diabetes mellitus (T2DM) in a sample of the Egyptian population.
<strong>Patients and methods: </strong>Our study was conducted on 100 subjects; their mean age was 50.26 ± 9.1 years old. They were selected from Diabetes Outpatient Clinics of our institution for 6 months in the period from June 2019 to December 2019. They were divided into two groups: 60 type 2 diabetic obese patients with BMI > 25 kg/m<sup>2</sup> (Group I) and 40 age- and sex-matched controls (Group II).
<strong>Results:</strong> There was no statistically significant difference between cases and controls in terms of HSD11β1 polymorphism (rs846910). The regression analysis showed that the HSD11β1 polymorphism did not significantly increase the risk of diabetes mellitus (DM). Detection of HSD11β1 gene polymorphism in the study showed that homozygous GG genotype was more prevalent than GA genotype. However, there was no significant difference between GG and GA in terms of fasting and postprandial sugar and in terms of lipid profile.
<strong>Conclusion:</strong> The present study showed no significant association between HSD11β1 polymorphism (rs846910) and T2DM. Moreover, the HSD11β1polymorphism (rs846910) is not correlated with glycemic status or lipid profile.
HSD11B1 gene polymorphism,Single nucleotide polymorphism,T2DM,obese
https://ejhm.journals.ekb.eg/article_160614.html
https://ejhm.journals.ekb.eg/article_160614_b8686a0f17cdb6ade6d913c65aa90fe7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Changes in Sustained Treatment Response in Relapsed Chronic Hepatitis C Egyptian Patients on Directly Acting Antiviral Agents with Increased Insulin Resistance
1056
1061
EN
Inas Elkhedr
Mohamed
Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Egypt.
inas_elkhedr@yahoo.com
Yasser Omar
Abdel Rahman
Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Egypt.
Ramy Samir
Ghait
Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Egypt.
Alaa Lotfy
ElSayed
Kobri Alqoba Military Hospital, Egypt
10.21608/ejhm.2021.160616
<strong>Background: </strong>It is known that patients with high insulin resistance (IR) have a slower rate of decline in the viral load of HCV RNA compared to patients with low IR.
<strong>Objective:</strong> to evaluate relation between insulin resistance on sustained treatment response with direct oral antiviral drugs on relapsed Egyptian chronic HCV patients.
<strong>Patients and Methods: </strong>50 patients with chronic hepatitis C met inclusion criteria divided into Group I were non responders to treatment and achieved sustained virological response (SVR) at week 12 on retreatment and Group II were non responders to treatment and failed to attain SVR after 12 weeks of retreatment. All participants received the direct antiviral therapy (DAA) sofosbuvir and daclatasvir for 12 weeks. HOMA-IR was calculated and PCR was done before treatment, at end of treatment, 12 weeks and 3 months after end of treatment.
<strong>Results</strong>: there was a highly significant correlation between HOMA-IR and liver enzymes, lipid (P<0.01) and significant relation between HOMA-IR and BMI and waist circumference. After 6 months of treatment there was highly significant increase in insulin sensitivity and decrease in insulin resistance in patients after eradication of HCV (P<0.01). 12 cases of insulin resistance pretreatment and after 6 months: 3 cases HCV -ve became non-insulin resistant, 2 cases HCV -ve became insulin resistant, 2 cases of HCV -ve developed DM and 5 cases had no changes (still insulin resistant).
<strong>Conclusion</strong>: prevalence of insulin resistance and diabetes mellitus in patients with chronic hepatitis C was due to multiple causes and clearance of HCV infection improves insulin resistance; not directly related to DAA.
<strong> </strong>
Chronic hepatitis C,Directly acting antiviral agents,Insulin Resistance,SVR
https://ejhm.journals.ekb.eg/article_160616.html
https://ejhm.journals.ekb.eg/article_160616_1430cd539819ee3d823d5c2bf2e385ef.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Free Serum Testosterone Versus Total Testosterone/Estradiol Ratio in Low Sexual Desire in Old Men
1062
1067
EN
Ahmed SA
Abouroab
Departments of 1Andrology & STDs , Faculty of Medicine,
Mansoura University. Mansoura, Egypt
dr.ahmedsami2010@yahoo.con
Sherif Refaat
Ismail
Departments of 1Andrology & STDs , Faculty of Medicine,
Mansoura University. Mansoura, Egypt
Hamdy Foad Aly
Marzok
Clinical Pathology, Faculty of Medicine,
Mansoura University. Mansoura, Egypt
10.21608/ejhm.2021.160618
<strong>ABSTRACT</strong>
<strong>Background:</strong> Testosterone (T) and estradiol (E2) play a critical role in male sexual function being essential for modulating libido and erectile function. We hypothesized that an imbalance of T/E2 ratio may be an important factor leading to the development of low sexual desire in ageing men.
<strong>Objective:</strong> To evaluate the relationship between imbalance of T/E2 ratio and low sexual desire in ageing men.
<strong>Patients and Methods:</strong> This study was conducted on 50 low sexual desire old men and 40 healthy control men (mean age 59.8 years & range 55-69 years). These men were subjected to history taking, clinical examination, sexual desire score of IIEF and SDI-2 as well as estimation of serum sex hormones (total T, free T, E2, prolactin, and SBHG) using ELISA method.
<strong>Results:</strong> The sexual desire score of IIEF and SDI-2 were significantly lower in patients compared with the controls. The levels of TT, E2, TT/E2, FT and FT/E2 were significantly lower among study group compared with the controls. On the other hand, there were significant positive correlations between FT and FT/E2 ratio and both sexual desire score of IIEF and SDI-2. SHBG, E2, TT/E2 showed poor AUCs (AUC = 0.651, 0.626, 0.685 respectively). FT/E2 showed fair AUC (AUC = 0.727). Serum FT showed good AUC (AUC = 0.882), TT, combined T/E2 and FT and combined TT and E2 showed excellent AUC (AUC = 0.900, 0.903, 0.958 respectively).
<strong>Conclusion:</strong> Although older men with low sexual desire had significantly lower total and free T, our study failed to show significant correlations between total T, E2 or TT/E2 ratio and sexual desire score of IIEF and SDI-2. However, true androgen deficiency (FT) and true T/E2 imbalance (FT/E2 ratio) may have a role in discrimination between low and normal sexual desire in older men.
testosterone,Estradiol ratio,sexual desire,men,Elderly
https://ejhm.journals.ekb.eg/article_160618.html
https://ejhm.journals.ekb.eg/article_160618_9bb1e33c5860172a3432724c79f15a45.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Lactate Clearance Vs Revised Trauma Score
1068
1074
EN
Samir Mohamed
Attia
Rasha Rizk
Elzehery
Mohamed El-Said
Ahmed
Nourhan Hany Hassanien
Mohamed
nourhanhany314@gmail.com
10.21608/ejhm.2021.160874
<span>Background: </span><span>Trauma-related deaths are one of the top 10 causes of death. Resuscitation in trauma and critically ill patients are challenging. Clinical and laboratory parameters are used to verify the different measurements. Lactate is a diagnostic and prognostic biomarker in sepsis and trauma.<br /> </span><span>Objective: </span><span>The aim of the current work was to investigate lactate clearance in patients admitted to </span><span>emergency department (</span><span>ED) and </span><span>compare with the </span><span>revised trauma score to predict mortality rate in polytrauma patients. </span><span>Patients and methods: </span><span>This prospective case-control study included a total of 200 polytraumatic patients with availability of Blood sampling, admitted to Department of Emergency Medicine, Mansoura University Hospitals. This study was conducted over a period of 12 months. Serum lactate was collected in tubes before receiving any type of treatment. The analysis was performed within 1 h from blood collection and six hours.<br /> </span><span>Results: </span><span>Regarding association with mortality, Lactate first hour, Lactate after 6 hours and Lactate clearance demonstrated significant correlation with it (P<0.05), while the remaining factors were not correlated (P>0.05). Regarding association with incidence of discharge for ICU, type of injury and Revised trauma score were correlated with it (P<0.05).<br /> </span><span>Conclusion: </span><span>It could be concluded that serum lactate level and lactate clearance could be used as an independent predictor of mortality, incidence of discharge for ICU as well as admission to ICU with comparable efficacy to revised trauma score (RTS) in terms of Triage management.<br /></span>
Revised trauma score,lactate clearance,ICU
https://ejhm.journals.ekb.eg/article_160874.html
https://ejhm.journals.ekb.eg/article_160874_5a40ce386f566b20a52c2eab1d4a7f97.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Changes in Choroidal Thickness and Axial Length with Intraocular Pressure Changes After Trabeculectomy
1075
1081
EN
Adel G.
Zaky
Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Sara A.
Mohammed
Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
sarasaleh1234yasser@gmail.com
Hatem M.
Marey
Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Moataz F.
Elsway
Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
10.21608/ejhm.2021.160875
<strong>Background: </strong>Trabeculectomy is commonly performed in patients with chronic open angle glaucoma when medical therapy fails to control intraocular pressure (IOP).
<strong>Objective:</strong> The aim of the current work was to evaluate choroidal thickness (C.T) changes with Enhanced Depth Imaging-Optical Coherence Tomography (EDI-OCT) & axial length (AXL) with ophthalmic A-Scan ultrasound after reduction of intraocular pressure (IOP) following trabeculectomy.
<strong>Patients and Methods: </strong>The study was included 20 patients with open-angle glaucoma. The choroidal thickness was measured using enhanced depth imaging spectral domain optical coherence tomography (EDI-SD-OCT) and AXL of eye was measured using A-scan ultrasound before trabeculectomy and 1 month, 3 and 6 months postoperatively.
<strong>Results:</strong> The changes of choroidal thickness before and after 1, 3 and 6 months of the operation found to have high statistically significant increase in SFCT-V, SFCT-V, NCT, TCT, SCT and ICT in 1st month postoperative with mean (217.65±27.03, 218±21.09, 216.9±28.86, 190.35±34.3, 223.1±24.82 and 244.8 ± 23.77) respectively, then they decreased in the 3rd month with mean (198.85 ±27.8, 197.8±23.3, 200.15±27.5, 178.35 ±31.9, 208.75±23.3 and 233.5±21.05) respectively, but it was not less than preoperative, and continued in decreasing in the 6th month with mean (187.3 ± 29.02, 186.95 ± 25.82, 188.95±27.47, 166.45±26.38, 197.7± 23.05 and 223.5±22.66) respectively, but it was not also less than preoperative.
<strong>Conclusion:</strong> It could be concluded that intraocular pressure (IOP) reduction after trabeculectomy caused an increase in choroidal thickness (CT) this reduction of IOP was negatively correlated only with the increase in nasal, temporal, inferior and superior CT 3 mm away from the fovea<strong>.</strong>
Axial length,choroidal thickness,Intraocular Pressure Changes,Trabeculectomy
https://ejhm.journals.ekb.eg/article_160875.html
https://ejhm.journals.ekb.eg/article_160875_44d8e6f2aad5b27d1c288dc7d7713728.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Influence of Different Scrubbing Methods of Surgical Team on Surgical Site Infection in Cesarean Section
1082
1087
EN
Alaa Masoud
Abd Elgaied
Ahmed Mohamed Zaki
Nofal
Zeinab bdel Aziz
Kasemy
Mohamed Medhat
Abd Elaziz
Ibrahiem Ali
Saif El Nasr
10.21608/ejhm.2021.160876
<strong>Background: </strong>Cesarean section is the most performed major abdominal surgery. While cesarean delivery is usually an uncomplicated procedure, up to 20% of patients can experience a complication following cesarean delivery with infectious complications being the most common. Nosocomial infections represent one of the major sources of morbidity and mortality in hospitalized patients around the world.
<strong>Objective: </strong>The aim of the current work was to evaluate if the different scrubbing methods of surgical team before cesarean section by different materials change the rates of post-operative surgical site infection or not.
<strong>Patient and methods: </strong>This randomized controlled trial (RCT) study included a total of 278 pregnant women, attending at Departments of Obstetrics and Gynecology, Menouf General Hospital and Menoufia University Hospitals, during the period of September 2019 till August 2020.
<strong>Result: </strong>there was no statistically significant difference between the studied groups regarding their demographic and clinical data. There was no statistically significant difference between group A and group B regarding offensive odor at day 10 and 15 post-operatively. No offensive odor reported after day 25 or 30 postoperative (p> 0.05). Also, there was no statistically significant difference between group A and group B regarding approximation at day 10, 20, 25 and 30 post-operatively (p> 0.05. There was no statistically significant difference between group A and group B regarding hotness, redness, tenderness, swelling, discharge and offensive odor at day 10, 20, 25 and 30 post-operatively (p> 0.05).
<strong>Conclusion: </strong>It could be concluded that for the increasing rates of CS being performed without a clear medical indication; new practice protocols should be implemented to reduce the rate of cesarean deliveries as CS surgery has a 5–20 times higher risk of post-partum infection as compared to vaginal deliveries.
Betadine,cesarean section,Sterillium,Surgical wound Infection
https://ejhm.journals.ekb.eg/article_160876.html
https://ejhm.journals.ekb.eg/article_160876_cf47175dc034a6ab7c9113ad82b1df54.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Major in Hospital Complications and Duration of Hospital Stay in a Comparative Study between a Multimodal Analgesia Regimen Versus IV Morphine Analgesia after Open-Cardiac Surgeries
1088
1095
EN
Wesam Abd El Galil
Abu Elwafa
Departments of 1Anesthesia, Intensive Care and Pain Management Faculty of Medicine, Sohag University, Sohag, Egypt
Ahmed El Saied
Abd Ell Rahman
Departments of Anesthesia, Intensive Care and Pain Management Faculty of Medicine, Sohag University, Sohag, Egypt
Khaled Abdelfattah Mohamed
Abdelfattah
Departments of Anesthesia, Intensive Care and Pain Management Faculty of Medicine, Sohag University, Sohag, Egypt
Samar Thabet
Abu Bakre
Departments of 1Anesthesia, Intensive Care and Pain Management Faculty of Medicine, Sohag University, Sohag, Egypt
samarthabet@med.sohag.edu.eg
Ayman Mohammad Mohammad
Abdel Ghaffar
Departments of Cardiothoracic, Faculty of Medicine, Sohag University, Sohag, Egypt
10.21608/ejhm.2021.160877
<strong>Background:</strong> Pain after surgery decreases the quality of life and has also been reported as being the main source of concern for cardiac surgery patients. It was stated that patients with higher anxiety and depression levels after operation have higher requirements of analgesics for postoperative pain. Reduction of pain and anxiety after cardiac surgery is valuable for the healing process and improvement of the overall experience.
<strong>Objective:</strong> To determine if the multimodal regimen of dexamethasone, gabapentin, ibuprofen, ketorolac, and paracetamol was with less complications following open-cardiac surgeries compared to IV morphine.
<strong>Patients and Methods:</strong> Sixty patients were scheduled for sternotomy elective open-heart surgeries. The patients were randomized to one of two groups (ratio 1:1) utilizing sealed envelopes by the study coordinator.30 patients in each group. This prospective, randomized, and a controlled clinical trial was performed at Sohag University Hospital.
<strong>Results:</strong> Patients in the multimodal group suffered fewer major in-hospital complications than in the morphine group. Acute coronary syndrome had occurred in (one versus zero) patients with a percentage of (3.3%) in the morphine group. Cardiac tamponade had occurred in (two versus one) patients with a percentage of (6.7%) in the morphine group and was with a percentage of (3.3%) in the multimodal group with (p-value) of (0.554). The duration of hospital stays was with M± SD of (7±1.72) days among the multimodal group versus (11±1.6) days in the morphine group, with (a p-value) of (<0.001).
<strong>Conclusions:</strong> Patients in the multimodal group suffered less major in-hospital complications than in the morphine group after cardiac surgeries.
<strong> </strong>
Multimodal analgesia,Open-heart surgeries,morphine
https://ejhm.journals.ekb.eg/article_160877.html
https://ejhm.journals.ekb.eg/article_160877_70c0ee4411e313571e72e2583e33d5d3.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Clinical Correlation with Postoperative Computed Tomography Assessment of the Accuracy of Lumbar Pedicular Screws Insertion
1096
1100
EN
Samy Hassanin Mohammed
Salem
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
Atef Kelany
Abdelwanees
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
Mansour Abdelmageed
Makia
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
Mahmoud Hamed
Abdelkhalek
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
mahmoudabdelkhalek15889@gmail.com
10.21608/ejhm.2021.160878
<strong>Background: </strong>Pedicle screw instrumentation is widely used in the lumbar spine as a means of stabilization to enhance arthrodesis. For accuracy, pedicle screw instrumentation may be guided by anatomic landmarks, preoperative imaging, and intraoperative imaging tools such as plain radiography, fluoroscopy, and, more recently, image-guided technology. <strong>Objective:</strong> Improving accuracy of lumbar pedicular screws insertion and clinical outcome of patients undergoing lumbar pedicular fixation.
<strong>Patients and Methods: </strong>This cohort study was done at Neurosurgery Department at Alexandria Armed Forces Hospital and Neurosurgery Department in Zagazig University. Assuming that attendance rate of patients for lumbar pedicular fixation is 3 patients per month, the sample size was 36. All patients were taken as a comprehensive sample. Patients confirmed to have been underwent transpedicular lumbar fixation.
<strong>Results: </strong>In assessing 153 pedicle screws inserted in 36 patients. Out of 51 misplaced screws; lateral screw misplacement was observed in 28 screws (54.9 %) and medial pedicle wall violation in 22 screws (43.1 %) and inferior misplacement in one patient. The remaining 102 screws (67.55 %) were judged as correctly inserted. Of the 51 misplaced screws, 34 misplaced screws were classified as minor (cortical perforation ≤ 2 mm), 15 screws moderate (2–4 mm), and 2 screws severe penetration (> 4 mm).
<strong>Conclusion: </strong>Pedicle screw insertion carries risk of pedicular wall violation even in experienced hands even though intraoperative fluoroscopy is used. However; most violations are minimal with no clinical consequences and can be evaluated best by CT scan not plain X-ray.
CT,Lumbar Pedicular Screws Insertion,X-ray
https://ejhm.journals.ekb.eg/article_160878.html
https://ejhm.journals.ekb.eg/article_160878_3b5d19cc8cd95afebeb8fa7ca3c4df3f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Are Elderly Donors Good Alternatives for Kidney Transplantation While Kidney Transplant Waiting Lists Are Widening?
1101
1104
EN
Gulay
Yilmaz
. Acibadem International Hospital, Department of Nephrology and Transplantation, Istanbul, Turkey
Can
Sevinc
0000-0002-4069-9181
Ataturk University, Faculty of Medicine, Department of Internal Medicine and Nephrology, Erzurum, Turkey
dr_cansevinc@yahoo.com
10.21608/ejhm.2021.160879
<strong><span lang="TR">Background: </span></strong><span lang="TR">Kidney donors who are elderly, who have obesity, hypertension, previous malignancy, proteinuria and kidney stones are called complex living donors. Elderly donors have smaller kidney sizes, less glomerular filtration rate and more glomerulosclerosis. But the list of patients waiting for kidney transplantation is widening, so we need to use elderly donors for kidney transplantation.</span>
<strong><span lang="TR">Aim: </span></strong><span lang="TR">In this study we wanted to see the effect of donor age on graft function and we made a retrospective study including elderly donors in transplantation center. </span>
<strong><span lang="TR">Patients and Method:</span></strong><span lang="TR"> This randomized study included 104 adult kidney transplant recipients whose donors were older than 65 years old (Group I) and 95 adult kidney transplant recipients whose donors were younger than 65 years old (Group 2). Demographic features, delayed graft function rates, hospitilization days of donors and clinical parameters regarding levels of serum creatinine on 1, 30, 180 day, first year and second year of transplant were compared between the two groups. <strong>Results:</strong> Delayed graft function ratio of Group 1 was higher than Group 2 but it was not statistically significiant (p=0.554). 30<sup>th</sup>, 180<sup>th</sup> day, first year and second year creatinine level of Group 1 was significiantly higher than Group 2.</span>
<strong><span lang="TR">Conclusion: </span></strong><span lang="TR">In our study, the creatinine level of recipients of elderly donors were higher than recipients of younger donors, but there was no statistically significant difference in terms of delayed graft function between the two groups.</span>
<span lang="TR">Our data reveals that individuals over 65 years of age may be suitable donors after careful evaluation of kidney function.</span>
Creatinine levels,Elderly donors,Kidney transplantation
https://ejhm.journals.ekb.eg/article_160879.html
https://ejhm.journals.ekb.eg/article_160879_d99d762cbab6a77f1bfe598fbb8a0725.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Assessment of Quality of Life and Sexual Function in ladies with Pregnancy-Related Skin Changes
1105
1112
EN
Hesham Nabil Khalid
El Shamy
Department of Dermatology, Andrology & STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Samar Magdy Abdelhady
Hassan
Department of Dermatology, Andrology & STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
moramagdy93@gmail.com
Heba Allah saad Eldeen
Bazid
Department of Dermatology, Andrology & STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
10.21608/ejhm.2021.160881
<strong>Background: </strong>Pregnancy is characterized by immunologic, metabolic, endocrine, and vascular changes, which lead to skin changes, making pregnant women suffer from body image disorder, physical performance, and mental health affection which adversely affect their sexual activity and quality of life.
<strong>Objectives: </strong>To evaluate the impact of pregnancy and pregnancy-related changes on the quality of life and sexual function.
<strong>Patients and Methods: </strong>This case-control study involved 160 females divided into 4 groups: 40 pregnant females in the 1<sup>st</sup> trimester, 40 in the 2<sup>nd</sup> trimester, 40 in the 3<sup>rd</sup> trimester, and 40 nonpregnant females as the control group. Every participant filled out the Arabic version of the Female Sexual Dysfunction Index (FSDI) and Dermatology Life Quality Index (DLQI).
<strong>Results: </strong>There was a significant difference between the three trimesters regarding the types of skin changes (p=0.006). Acne vulgaris was the most common change in the 1<sup>st</sup>-trimester group. There was a significant difference between the studied groups as regards the female sexual function (p>0.001 regarding FSDI total score). There was no significant difference between females with skin changes compared to those without regard to their sexual function during 1<sup>st</sup>, 2<sup>nd</sup>, and 3<sup>rd</sup> trimesters (P=0.07,0.5,0.6 resp) regarding FSDI total score. Regarding the DLQI score, there was a significant difference between both the 2<sup>nd</sup> and 3<sup>rd</sup> trimesters and control groups (P2=0.01and P3=0.009 respectively) with higher mean values of the DLQI score among females with skin changes.
<strong>Conclusion: </strong>Pregnancy negatively affected female sexual function and quality of life. Skin changes during pregnancy significantly affected the quality of life of pregnant females.
Female sexual function,Pregnancy,quality of life
https://ejhm.journals.ekb.eg/article_160881.html
https://ejhm.journals.ekb.eg/article_160881_b86b76bedad9d4632d1f09b7f66a74dc.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Is There A Role for Dihydrotestosterone/ Estradiol Ratio in Premature Ejaculation?
1113
1119
EN
Mohamed Elsayed Abdelkhalik
Eldaraky
Mohammed Fawzy
Elkamel
Hamdy Fouad
Marzouk
10.21608/ejhm.2021.160883
Background: The association between endocrine control and ejaculatory reflex is still not completely elucidated. Serum dihydrotestosterone (DHT) concentrations have been reported to be lower in premature ejaculation (PE) patients. We hypothesized that homeostasis between testosterone (T) and their metabolites; dihydrotestosterone (DHT) and estradiol (E2); could be involved in orchestration of the ejaculatory process.
Aim: To test this hypothesis, we aimed to investigate any possible relationship between DHT/ E2 ratio and T/E2 ratio in a cohort of patients consulting for premature ejaculation (PE).
Methods: This prospective hospital-based cross-sectional case-control study has been carried on 104 PE patients (30 patients with primary lifelong PE and 74 patients with acquired PE) compared to 90 healthy men as controls.
Results: DHT levels were significantly higher in secondary PE compared to primary PE group (p = 0.011). Besides, serum E2 showed significant higher level among both primary and secondary PE groups compared to the control group (p=0.001). Moreover, both total testosterone (TT)/E2 and DHT/E2 ratios were significantly lower in both primary and secondary PE compared to the control group (p=0.001 for both). Furthermore, DHT/E2 ratio showed fair discriminating ability between PE and healthy controls (AUC = 0.749, p=0.001).
Conclusions: Both TT/E2 and DHT/E2 ratios were significantly lower in both primary and secondary PE subjects suggesting a role of hormonal imbalance in this context. Although this link seems likely, large-scale studies are needed to confirm these findings.
dihydrotestosterone,Dihydrotestosterone/estradiol ratio,estradiol,Premature Ejaculation,Testosterone/estradiol ratio
https://ejhm.journals.ekb.eg/article_160883.html
https://ejhm.journals.ekb.eg/article_160883_992e44b1c928e41cc4709196abd698e8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Comparative Study between Different Additives to Levobupivacaine in Caudal Block for Postoperative Pain Management in Pediatrics Undergoing Hypospadias Repair: Randomized Controlled Study
1120
1128
EN
Ahmed Hamody
Hassan
Islam A.
Amer
Ayman Mohamed
Abdelkareem
aymann8100@gmail.com
10.21608/ejhm.2021.160884
<strong>Background: </strong>For both children and their caregivers, postoperative pain is an irritating experience. Several approaches have been used to treat postoperative pain in pediatric patients improving sleep quality, and extending sedation time.
<strong>Objectives:</strong> This work aimed to compare the postoperative analgesic effect and any complications of addition of one of these drugs nalbuphine versus fentanyl versus dexamethasone to levobupivacaine in caudal block (CB) in pediatric patients undergoing hypospadias repair.
<strong>Patient and Methods:</strong> 90 ASA status I and II patients aged 2 to 9 years underwent hypospadias repair were prospectively involved in this study. Patients were randomized into three equal groups (Group N, Group F and Group D).
<strong>Result: </strong>There was no statistically significant difference between three groups as regards systolic blood pressure (SBP) except after 60 and 70 minutes after caudal block as there was a significant difference as SBP decreased in the group (N) more than in both groups (F and D). Also there was a significant deference between the three groups in SBP at 1, 1.5, 2 and 4 hours postoperatively. FLACC pain score between three groupsshowed a significant difference between three groups at 2, 6 and 8 hours postoperatively otherwise no significant difference
<strong>Conclusion: </strong>Adding a nalbuphine to levobupivacaine in caudal block had longer duration for postoperative analgesia and showed more sedation time than that of fentanyl and dexamethasone with more stability in hemodynamics.
Bupivacaine,Caudal analgesia,children,Fentanyl,nalbuphine,dexamethasone
https://ejhm.journals.ekb.eg/article_160884.html
https://ejhm.journals.ekb.eg/article_160884_550d57338d434973053a1f61264927e6.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Changes of Macular Vessel Density in Primary Open Angle Glaucoma
1129
1133
EN
Nesma Sayed
Mohammed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
nesma7@live.com
10.21608/ejhm.2021.160885
<strong>Background: </strong>Glaucoma is a known cause of irreversible blindness worldwide. Several techniques are used for its diagnosis and follow-up. Optical coherence tomography angiography (OCTA) is new technology that provides a quantitative assessment of the microcirculation of the retina and optic nerve in a rapid, noninvasive method.
<strong>Objective: </strong>To evaluate the changes at the macular vessel density (MVD) in primary open glaucoma patients (POAG) to correlate these changes with the changes of both ganglion cell complex (GCC) thickness and retinal nerve fiber layer (RNFL) thickness. <strong>Patients and Methods:</strong> Fifty healthy participants and fifty primary open angle glaucoma (POAG) subjects underwent visual field analysis, measurement of the whole image MVD, measurement of the average (RNFL) thickness, and measurement of the average thickness of (GCC). The area under the curve (AUC) was assessed for each parameter to differentiate POAG from healthy eyes.
<strong>Results: </strong>MVD was lower in POAG than in the control group. The glaucomatous group showed that MVD was 21.18 ± 2.6 at the fovea, while it was 39.5 ± 4.71 at the parafovea. There was a statistically significant positive correlation between MVD (foveal and parafoveal (especially at the superior quadrant) and the mean deviation (MD) (R+ve, P < 0.05). There was a statistically significant positive correlation between MVD and structural parameters. The ROC curves showed that the cut-off points were < 28.2 and < 48 for MVD at the fovea and parafoveal area respectively, at the superficial vascular plexus with 100% sensitivity & 100% specificity between the controls and POAG eyes<strong>.</strong>
<strong>Conclusions: </strong>MVD was reduced in cases with POAG compared to the control group. The assessment of macular vessel density by OCTA gave us good diagnostic abilities for diagnosis and management of glaucoma.
Macular vessel density,Ganglion cell complex,Optical coherence tomography angiography,Primary Open angle glaucoma
https://ejhm.journals.ekb.eg/article_160885.html
https://ejhm.journals.ekb.eg/article_160885_413df9fe5c5ebedce05c2e8b5fc17196.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Immunohistochemical Expression of Annexin A2 in Endometrial Carcinoma
1134
1141
EN
Marwa M.
Dawoud
Pathology Department, Faculty of Medicine, Menofia University, Egypt
Moshira M.
Abd El-Wahed
Pathology Department, Faculty of Medicine, Menofia University, Egypt
Ilaf M.A.
Gaber
Pathology Department, Faculty of Medicine, Menofia University, Egypt
Marwa M. Serag
El-Dien
Pathology Department, Faculty of Medicine, Menofia University, Egypt
10.21608/ejhm.2021.160886
<span>Background: </span><span>Endometrial carcinoma (EC) is second common gynecological cancer worldwide. It represents 2.83% of female genital malignancy and 72.37% of uterine corpus malignancy according to Egyptian National Cancer Institute (NCI). Distinction between endometrial atypical hyperplasia (EAH) and EC has been controversial, with clinical impact.<br /> </span><span>Objective: </span><span>Investigate immunohistochemical expression of Annexin A2 (ANXA2) in EC versus endometrial proliferative lesions and correlation with available clinicopathological parameters.<br /> </span><span>Materials and Methods: </span><span>This retrospective study included formalin-fixed, paraffin-embedded blocks of 66 specimens of endometrial tissue divided into four groups: EC, EAH, endometrial hyperplasia (EH) without atypia and proliferative endometrium. Immunohistochemical staining by ANXA2 antibody was done. Evaluation by semi- quantitative scores followed by correlation of results with clinicopathological data was applied.<br /> </span><span>Results: </span><span>Annexin A2 was positive in all cases without significant variations between groups. Analysis using ROC curve revealed that immunohistochemical expression of ANXA2 has weak power in differentiating type I- EC from EAH. Correlation between ANXA2 expression and clinicopathological parameters in type I- EC showed a significant negative association between ANXA2 immuno-reactivity score (IRS) and maximum tumor dimension (P=0.03). On other hand, in type II- EC, there was a significant positive linear correlation between ANXA2 H-score and both maximum tumor dimension (P= 0.02) and apoptotic count (P=0.008).<br /> </span><span>Conclusion: </span><span>Annexin A2 is essential for development of endometrial tissue beside carrying good features in type I- EC by its association with small tumor size. In type II- EC, ANXA2 has two opposing effects; increased tumor maximum dimension and apoptosis. Net result is in favor of increase tumor burden.<br /></span>
Annexin A2,Endometrial carcinoma,Endometrial hyperplasia,Immunohistochemistry
https://ejhm.journals.ekb.eg/article_160886.html
https://ejhm.journals.ekb.eg/article_160886_ea3f18eb5b89934577848c2a9bf684d2.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Does Glucose–Insulin–Potassium Infusion during on-pump Coronary Revascularization Affect Perioperative Inotropic Requirements?
1142
1148
EN
Essam Ezzat
Abd El-Hakeem
Ahmed Elsaied Abd Elrahman
Aly
Osama Salah El Din
Mahmoud
osamasalah@med.sohag.edu.eg
Eman Ebraheem
Darweesh
Ahmad Hamody
Hassan
10.21608/ejhm.2021.160888
<strong><span lang="EN-US">Background:</span></strong><span lang="EN-US"> During coronary artery bypass grafting (CABG), the myocardium is subjected to endure periods of ischemia and reperfusion, which may result in post-ischemic contractile dysfunction. That is a major contributor to early and late morbidity and mortality and increased requirement of pharmacologic and mechanical circulatory support.Glucose insulin potassium (GIK) infusion was thought to provide a cardioprotective effect.</span>
<strong><span lang="EN-US">Objective:</span></strong><span lang="EN-US"> To investigate whether the use of GIK solution in patients undergoing on-pump CABG affects requirements of inotropes.</span>
<strong><span lang="EN-US">Patients and Method:</span></strong><span lang="EN-US"> In this prospective, randomized placebo-controlled trial, 64 patients were assigned into two groups: the GIK group in which glucose-insulin and potassium infusion was given during CABG surgery, and the non-GIK group in which only saline infusion was given during the procedure.</span>
<strong><span lang="EN-US">Results: </span></strong><span lang="EN-US">In the GIK group, all patient needed not more than two inotropes with </span><span lang="EN-US">mean of 1.28 ± 0.46, while in the non-GIK group there were patients who need up to three inotropes with mean of 1.56 ± 0.56 (P. value of </span><span lang="EN-US">0.032)</span><span lang="EN-US">.</span>
<strong><span lang="EN-US">Conclusion: </span></strong><span lang="EN-US">GIK infusion during on-pump CABG reduces perioperative inotropic requirements.</span>
CABG,cardiac protection,Inotropic support,GIK
https://ejhm.journals.ekb.eg/article_160888.html
https://ejhm.journals.ekb.eg/article_160888_049f8e35f38ddd2fff5b390c2f0de1fd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Genotype Phenotype Correlation of FMF Cases in East Delta of Egypt: 2 Years of Follow-up
1149
1154
EN
Mohamed
Almalky
PID Unit, Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
drmohamedalmalkyped@yahoo.com
Rania
Amir
Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Egypt
Eman Gamal
Baz
PID Unit, Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
10.21608/ejhm.2021.161767
<strong>Introduction:</strong> Familial Mediterranean fever (FMF, MIM# 249100) is an autosomal genetic disease. FMF shows a marked ethnic distribution being most frequently observed in Turkish, Armenian, Jewish and Arabic communities. Since the cloning of the MEFV gene, about 280 mutations have been associated with FMF. M694V, V726A, E148Q, M694I, and M680I are the five most frequently encountered mutations.
<strong>Objective: </strong>The aim of this work was to correlate the clinical phenotypes of FMF patients to their gene mutation.
<strong>Patients and methods</strong>: The study was done on 55 patients with FMF who were diagnosed primarily clinically using Turkish pediatric criteria. Genetic identification of their gene mutation was performed and only patients with definite identified mutation in MEFV were included.
<strong>Results:</strong> Fever was the most prevalent manifestation in our patient as 96.3% of them experienced fever and the second most frequent symptom was abdominal pain 90.9% followed by chest pain 81.8%. Family history was positive in 61.8%. At diagnosis fifteen patients had amyloidosis at (27.3%) while forty patients did not have elevated amyloid (72.7%). Fifty one patient showed good response to colchicine (92.7%) while only four did not show response (7.3%). The severity of attacks were mild in 29 patients (52.7%) and moderate in 6 patients (10.9%) and severe in 20 patients (36.4%). M694V was the most prevalent mutation followed by M694I, V726A, M680I, R761H and K695R respectively.
<strong>Conclusion:</strong> In Egypt no significant difference between homozygous and heterozygous FMF patients regarding their clinical presentations but type of mutation affects the severity of clinical presentation.
East Delta of Egypt,Genotype Phenotype Correlation of FMF
https://ejhm.journals.ekb.eg/article_161767.html
https://ejhm.journals.ekb.eg/article_161767_8f480de77417fc8ae65c8f90407b6387.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Assessment of Serum Level of Claudin‐3 and Its Association with Disease Severity in Patients with Psoriasis Vulgaris
1155
1161
EN
Ahmed Abd-Elkhabir
Ahmed
Fatma Faisal
El Dakrory
Shimaa Rabea Abdel Qader
Hendawy
Nehad Mohamed
Shaaban
10.21608/ejhm.2021.161770
<strong>Background: </strong>Psoriasis is a common inflammatory disorder of the skin. Psoriasis is a disease of multifactorial origin where certain environmental factors acting on individuals with specific genetic predisposition leads to an immune dysregulation. Claudins are transmembrane proteins, which participate in the formation of tight junctions by binding to the actin cytoskeleton. Claudin‐3 present in the blood is considered as a useful biomarker of intestinal permeability.
<strong>Objective: </strong>To evaluate serum level of claudin-3 in patients with psoriasis in comparison to control group and correlate its levels with disease severity.
<strong>Patients and methods: </strong>Fifty-three patients (32 males and 21 females) with psoriasis and forty normal healthy control (23 males and 17 females) who matched the cases group as regard age and sex were included in this work. They were randomly selected from the Dermatology Department outpatient clinic in Mansoura University Hospital.
<strong>Results: </strong>Psoriasis group showed significantly higher level of claudin-3 when compared to control group (mean=58.3 versus 41.2; p < 0.001). Smoking was significantly associated with higher Claudin-3 level (p=0.031). In addition, claudin-3 level increased gradually with increased severity grades (p < 0.001). No significant associations were found regarding claudin-3 level according to gender, nutritional status, family history, in psoriasis group (p>0.05 for each). Higher BMI, smoking and higher claudin-3 level were associated with prediction of higher PASI score in univariate analysis. While multivariate analysis revealed that only smoking and higher claudin-3 level were considered independent predictor of more severe psoriasis cases.
<strong>Conclusion: </strong>Claudin-3 level was significantly higher in patients with psoriasis than healthy controls. PASI correlated with claudin-3 levels.
Claudin‐3,PASI score,Psoriasis
https://ejhm.journals.ekb.eg/article_161770.html
https://ejhm.journals.ekb.eg/article_161770_8d293f93e3b8c429fc1159e92db129cc.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Acute Myocradial Infarction, Primary Percutanious Coronary Intervention (PCI) in an Anticoagulated Patient for Mitalic Mitral Valve Replacement (MVR)
1162
1164
EN
Aeham
Rabadi
Cardiology Department, Queen Alia Heart Institute (QAHI), Royal Medical Services (RMS), Jordan
ayhamrabai84@gmail.com
Mohammad
Alsmadi
Gastroentrology Department, King Husain Medical City, Royal Medical Services (RMS), Jordan
Rayya
Almashagbeh
Cardiology Department, Queen Alia Heart Institute (QAHI), Royal Medical Services (RMS), Jordan
Yazan
Banihamad
Cardiology Department, Queen Alia Heart Institute (QAHI), Royal Medical Services (RMS), Jordan
Tareq
AL-Qudah
Cardiology Department, Queen Alia Heart Institute (QAHI), Royal Medical Services (RMS), Jordan
10.21608/ejhm.2021.161771
Valvular heart diseases and atrial fibrillation are ones of the most common indications for oral anticoagulation, in the same time they are known risk factors for coronary artery disease and presentation of acute coronary syndrome, which may need urgent management by primary percutaneous intervention.
Acute myocardial infarction is commonly seen in these patients with suboptimal anticoagulation, but it is almost seldomly seen when anticoagulation is in therapeutic range.
This is the first case reporting an acute myocardial infarction (MI) in a patient post mitral valve replacement (MVR) and high International Normalization Ratio (INR), which has not been reported before.
Acute myocardial infarction,Major bleeding,Percutaneouscoronary intervention,Warfarin
https://ejhm.journals.ekb.eg/article_161771.html
https://ejhm.journals.ekb.eg/article_161771_b1598a45f0253ab8240d6a1fd1da9952.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Incidence and Risk Factors of Venous Thromboembolism in Patients with Severe Traumatic Brain Injury in Emergency Hospital Mansoura University
1165
1172
EN
Samir Mohamed
Attia
Mohamed Farag
Selim
Mohamed Elsaied
Ibraheim
Mohamed Ibraheim Elsaied
Abdulfattah
mohamed.ibraheim100@yahoo.com
10.21608/ejhm.2021.161773
<strong>Background: </strong>Every year more than 10 million people are affected by traumatic brain injuries (TBIs). Despite efforts being made to improve TBI care, it remains a public health problem. Deep venous thrombosis (DVT) is common among trauma patients. If left untreated it may result in lethal pulmonary thromboembolism.
<strong>Objective: </strong>The aim of the current study was to determine the incidence and risk factors of venous thromboembolism in traumatic brain injury patients.
<strong>Patients and methods: </strong>This was a prospective study, which was conducted over 200 patients with severe traumatic brain injury admitted to Emergency Hospital Mansoura University over a year from January 2020 to January 2021. Emergency Hospital Mansoura University is a level one trauma center with about 250,000 visit and 25,000 trauma cases per year. <strong>Results:</strong> RTA and MCA were demonstrated to be the most common modes followed by FFH ad lastly direct trauma. The average Glasgow Coma Scale (GCS) was 6.12 ± 1.937 and 69.5% of the studied cases required intubation. There were no statistically significant differences among both groups (Non-VTE versus VTE) regarding GCS as well as the need for intubation. There were no statistically significant differences among both groups concerning EDH, SDH, ICH and brain contusion, while SAH and brain edema demonstrated significant increase in non-VTE cases compared to VTE cases.
<strong>Conclusion</strong><strong>:</strong> The current study demonstrated that, TBI is a life-threatening condition with a high mortality rate and seems to be associated with significant increase in the possibility of DVT development.
Incidence and risk factors of venous,Thromboembolism,Traumatic brain injury
https://ejhm.journals.ekb.eg/article_161773.html
https://ejhm.journals.ekb.eg/article_161773_7cb7d0c5fd9c4be0abde64b7fd7d99ad.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Vacuum Assisted Closure Versus Conventional Surgical Techniques in Treatment of Post-Sternotomy Mediastinitis
1173
1176
EN
Waleed Abbas
Kamel
Department of Cardiac Surgery, National Heart Institute, Egypt
Sherif Ahmed Kamal
Elhendawy
Department of Cardiac Surgery, National Heart Institute, Egypt
10.21608/ejhm.2021.162344
<strong>Background: </strong>In cardiac surgery patients, post-sternotomy mediastinitis, also known as deep sternal wound infection (DSWI), is a major cause of postoperative morbidity and mortality. Negative pressure wound therapy (NPWT), also known as vacuum assisted closure (VAC) dressing, is one therapeutic alternative that offers the following advantages: regulation of fluid drainage, reduction of local edema, and bacterial load reduction, and early development of granulation tissue by angiogenic stimulation. By acting topically with a low complication rate, offering greater comfort to the medical team and patient, and reducing hospitalization time, antibiotic usage, and dressing changes, this therapy has become an important and efficient method for fighting infection in complex wounds.
<strong>Objective: </strong>To evaluate the effectiveness and clinical outcome of vacuum‑assisted closure (VAC) therapy in the treatment of post-sternotomy mediastinitis in comparison with conventional treatment.
<strong>Patients and methods: </strong>This study was conducted in National Heart Institute (NHI), Egypt. Patients were hospitalized from March 2019 to March 2020. It included patients with post-sternotomy mediastinitis treated with conventional therapy and VAC divided in two groups each group contained 30 patients.
<strong>Results:</strong> The duration of VAC therapy was 7.42±2.23 days. Mean hospital stay after VAC therapy was 12.18±1.92 days. Twenty-two (92%) patients were treated successfully. At the end of VAC therapy, the mean reduction in wound size was 31.7%. The mean granulation tissue formation was 59%.
<strong>Conclusion: </strong>VAC is a safe, reliable, and relatively new option for the treatment of DSWI after cardiac surgery. VAC is an alternative to conventional treatment in wound healing strategy in post-sternotomy mediastinitis.
DWSI,Post-sternotomy mediastinitis,Conventional Treatment,VAC
https://ejhm.journals.ekb.eg/article_162344.html
https://ejhm.journals.ekb.eg/article_162344_5b88710cb5e2425dcf9a4f71619f3e4c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Management of Compound Depressed Fractures Over Major Cranial Venous Sinuses
1177
1182
EN
Mohamed A.
Abdelaal
Department of Neurosurgery, Faculty of Medicine, Sohag University
Ahmed Salah Eldin Mohammed
Saro
Department of Neurosurgery, Faculty of Medicine, Sohag University
Khaled Nasser
Fadl
Department of Neurosurgery, Faculty of Medicine, Sohag University
Abdelaleem Mohamed
Abdelrahman
Department of Neurosurgery, Faculty of Medicine, Sohag University
allomamohamed7777@gmail.com
10.21608/ejhm.2021.161776
<strong>Background: </strong>Incidence of trauma increased both in developing and developed countries especially in congested cities because of high traffic flow. This makes it a worldwide health and social issue. Furthermore, depressed skull fractures occur over venous sinuses in 11% –18% of cases, representing a fairly large proportion of these cases.
<strong>Objective: </strong>To characterize the demographic, clinical and radiological findings of patients with depressed fractures overlying cranial dural sinuses that we have faced in our institute at Sohag University Hospital.
<strong>Patients and Methods: </strong>This retrospective and prospective study was conducted on 50 patients with compound depressed fracture over venous sinuses, which were treated either surgically or conservative at Sohag University Hospitals.
<strong>Results: </strong>Despite surgical group included patients with neurological deficit and impaired level of consciousness compared to conservative group; surgical group had the same outcome as the conservative group. CNS infection was not recorded in both groups and the superficial infection was significantly higher in the conservative group. Mortality related to the treatment modality was not recorded in our study.
<strong>Conclusion:</strong> Both surgical and conservative treatment of compound depressed fracture over major cranial venous sinuses had a good outcome as regards morbidity and mortality. Risk of CNS infection is not high but surgical treatment can significantly decrease the risk of infection compared to the conservative treatment.
Depressed fractures overlying cranial dural sinuses,Sohag university
https://ejhm.journals.ekb.eg/article_161776.html
https://ejhm.journals.ekb.eg/article_161776_71a5dc094d9380c7873a33669069cff2.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Prevalence and Pattern of Coronary Artery Disease in Diabetic Patients with Cardiomyopathy
1183
1188
EN
Haitham Mohamed Ramadan
Tofaha
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
drhaithamh6@gmail.com
Mohamed Salah Elden
Abd Salam
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
Ahmed
EL Tayeb
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
10.21608/ejhm.2021.161777
<strong>Background: </strong>Coronary artery disease (CAD) is a group of diseases that includes stable angina, unstable angina, myocardial infarction and sudden cardiac death. It's the most commonly occurring type of cardiovascular diseases. Risk factors for CAD include hypertension, diabetes mellitus, smoking, alcohol ingestion, obesity, dyslipidemia, sedentary life and family history. The underlying mechanism involves atherosclerosis of the arteries of the heart
<strong>Objectives: </strong>The aim of the work was to assess the prevalence and pattern of coronary artery disease through invasive coronary angiography in diabetic patients with cardiomyopathy.
<strong>Patients and Methods: </strong>Fifty diabetic patient with echocardiographic evidence of cardiomyopathy were enrolled in this study, which conducted at Cardiology Department Azhar Assuit University Hospital during the period from November 2018 to March 2021. Informed consent was obtained from every patient after explanation of the procedure. Medical research and Ethics Committee approved the study.
<strong>Results: </strong>As regard HbA1c there was highly statistically significant (p-value < 0.001) positive correlation (r = 0.82) between HbA1c and duration of DM. Highly statistically significant (p-value < 0.001) positive correlation between (HbA1c and SYNTAX score) and (duration and SYNTAX score).
<strong>Conclusion: </strong>There was a correlation between HbA1c and SYNTAX score and duration of diabetes.
Diabetes mellitus,Coronary Artery Disease,cardiomyopathy,SYNTAX score
https://ejhm.journals.ekb.eg/article_161777.html
https://ejhm.journals.ekb.eg/article_161777_1217c4d31e73df7e9a0f73bf28dd0cd6.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Is it Possible to Predict Preeclampsia Early by Maternal Pregnancy Associated Plasma Protein-A and Uterine Artery Doppler? A Randomized-Controlled Trial
1189
1194
EN
Abeer
Elshabacy
000_0002_4481_2380
abear.elshabacy@gmail.com
Hala A.E.
Tabl
Sahar H.
Quashwa
10.21608/ejhm.2021.162345
<strong>Background: </strong>Hypertensive disorders in pregnancy, along with IUGR and low birth weight, are among the major causes of maternal mortality and morbidity. It is one of the most common pregnancy complications. Its incidence ranges between 10-12% of all pregnancies. Early detection of preeclampsia (PE) is of utmost importance to start early intervention that prevents maternal and fetal comorbidities and decreases maternal and fetal mortality.
<strong>Objectives:</strong> To predict the role of maternal serum pregnancy-associated plasma protein-A (PAPP-A) and uterine artery Doppler in females between 11-14 weeks of gestation for early detection of preeclampsia.
<strong>Patients and methods: </strong>This randomized-controlled trial was done at Benha Teaching Hospital Department of Obstetrics & Gynecology over 200 pregnant women with gestational ages of 11-14 weeks. Blood pressure was recorded, uterine artery Doppler was done, and a blood sample for PAPP-A was drawn.
<strong>Results: </strong>Uterine artery pulsatility index (PI) at 11-14 weeks of gestation is a good screening method for preeclampsia. The mean pulsatility index was more valid than PAPP-A. However, the combination of both in addition to patient history and blood pressure examination is more predictive.
<strong>Conclusion: </strong>Our study concluded that at 11-14 weeks of gestation, uterine artery Doppler and serum level of maternal PAPPA-A were good screening methods for early prediction of preeclampsia.
preeclampsia,PAPP-A,uterine artery Doppler
https://ejhm.journals.ekb.eg/article_162345.html
https://ejhm.journals.ekb.eg/article_162345_6c0e75530e829ed69a622660c69b449d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Outcomes of Instantaneous Wave-Free Ratio versus Fractional Flow Reserve Guided Strategies for Coronary Revascularization in Patients with Acute Myocardial Infarction
1195
1202
EN
Magdy Mohamed
Abdelsamei
Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mohyeldeen AbuElftouh
Eldeeb
Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Marwa Mohamed
Gad
Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mohamed Ali
Sallam
Cardiology Department, Gamal Abdulnaser Hospital, Public Authority for Health Insurance, Egypt.
10.21608/ejhm.2021.162848
<strong>Background:</strong> The instantaneous wave-free ratio (iFR) is non-hyperemic pressure-derived indices of the severity of stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking.
<strong>Objectives:</strong> To improve the outcomes of percutaneous coronary intervention (PCI) in patients presenting with ST segment elevation myocardial infarction (STEMI) and have multivessel coronary artery disease (CAD) through using a new technology of iFR in STEMI patients.
<strong>Subjects and methods:</strong> The present prospective cohort study was conducted by cooperation between Zagazig University Hospitals, Egypt and Chest Disease Hospital, Kuwait. During the period from April 2019 to April 2020. It included 188 patients presented with acute myocardial infarction (STEMI). Patients were divided into 2 groups each one enrolled 94 patients. Group I (iFR technique) and Group II (FFR technique), both were used to guide the decision as to whether percutaneous revascularization was appropriate.
<strong>Results:</strong> There was no statistically significant difference regarding lesion characteristics assessed among studied patients. 90.4% of IFR group were not suffering from chest discomfort during the procedure versus 29.8% of FFR group with a high statistically significant difference among both groups. Four patients (4.3%) out of total number of the first group had sustained non-fatal MI, however only three cases (3.2%) had non-fatal MI, the calculated p value was 0.71.
<strong>Conclusion: </strong>iFR-guided revascularization strategy was non-inferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac outcomes and was associated with less chest discomfort.
FFR,iFR,STEMI,PCI
https://ejhm.journals.ekb.eg/article_162848.html
https://ejhm.journals.ekb.eg/article_162848_3d119bf6003a188e09a2d75a99eed03d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Study of Subclinical Atherosclerosis in Patients with Type 2 Diabetes Mellitus
1203
1207
EN
Alhoussein Alsayed
AbdelAal
0000-0003-2333-476X
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
alhala1982@gmail.com
Alshabrawy M.
Abdelnabi
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
10.21608/ejhm.2021.162850
<strong>Background: </strong>Patients with type 2 diabetes mellitus (T2DM) are at increased risk of atherosclerosis. The early recognition of atherosclerosis at its subclinical stages can slow or prevent progression to atherosclerotic diseases, including coronary artery disease, cerebrovascular disease, and peripheral arterial disease.
<strong>Objective: </strong>Identification of the relationship between T2DM and subclinical atherosclerosis and to explore factors that can be associated with a high risk of subclinical atherosclerosis.
<strong>Patients and Methods:</strong> We recruited 75 participants among whom 50 T2DM while 25 were controls. Patients with T2DM were subdivided into two equal groups, well-controlled and uncontrolled. After complete history and examination, investigations including fasting and 2-hour postprandial blood glucose, high sensitive C–reactive protein (hs-CRP), and serum triglyceride (TG) levels were obtained. All participants underwent duplex ultrasound that was used to measure carotid intima-media thickness (cIMT) as a biomarker of subclinical atherosclerosis.
<strong>Results:</strong> Uncontrolled diabetics had increased cIMT than well-controlled diabetics and well-controlled diabetics had increased cIMT than non-diabetics. There was a highly significant positive correlation between cIMT and duration of diabetes in both well-controlled and uncontrolled diabetic groups. In the uncontrolled diabetic group only, there was a highly significant positive correlation between cIMT and each of hs-CRP and TG levels.
<strong>Conclusion:</strong> The risk of subclinical atherosclerosis is higher in type 2 diabetic patients especially in those with uncontrolled diabetes. In uncontrolled diabetics, subclinical atherosclerosis is associated with hypertriglyceridemia and elevated hs-CRP level.
Atherosclerosis,High Sensitive C – reactive,triglyceride,Type 2 diabetes mellitus
https://ejhm.journals.ekb.eg/article_162850.html
https://ejhm.journals.ekb.eg/article_162850_f521f0e7a2da89eb4aeaa7a8211520f7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Gross Motor Functioning in Children with Cerebral Palsy after Stem Cell Transplantation
1215
1217
EN
Reham S.
Tarkan
Faculty of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
rehamsabrey@chi.asu.edu.eg
Mohamed
Sedky
Faculty Of Medicine, Misr University For science and Technology
Khaled H.
Taman
Faculty of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
George S.
Kobinia
Stem Cell Therapy Group Vienna Medical University of Vienna –Austria
Maisa N.
Farid
Faculty of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
10.21608/ejhm.2021.162853
<strong>Background </strong>Cerebral palsy (CP) is a non-progressive motor disability that mostly results from perinatal complications. It demands extensive and multidisciplinary care, which poses a burden for patients and their families and a challenge to health systems. We aimed to evaluate the effect of stem cells transplantation on gross motor functioning of CP patients.<br /> <strong>Patients and Methods: </strong>It is a prospective study conducted on 20 children diagnosed with cerebral palsy with severe motor disability (GMFC 5) further classified into two groups according to age. The study was carried out from January 2018 to January 2020. Follow up of the patients was done before injection of stem cells and 3, 6, 9 and 12 months after injection of stem cells using Gross motor function classification scale (GMFC).<br /> <strong>Results: </strong>The study revealed that GMFC scores in pre-injection and 3,6,9and 12 months evaluations were not statistically significant when compared among the two groups while significant improvement was found in gross motor scale from pre-injection to final injection score in each group. Median GMFC changed from 5 to 2 among all cases.<br /> <strong>Conclusion: </strong>Gross motor function in children with CP remarkably improved after stem cell transplantation.
transplantation,stem cells,Gross Motor,Cerebral palsy
https://ejhm.journals.ekb.eg/article_162853.html
https://ejhm.journals.ekb.eg/article_162853_e4371d288b7c161ece4af247c2a09ce8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Comparison Study between Drugs (Orlistat and Chitocal) and Food Supplements (Green Tea and Apple Cider Vinegar) for Weight Loss and Hepatoprotection in Rats
1218
1223
EN
Hassan M.
Bukhari
Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, KSA
hmbukari@uqu.edu.sa
Seham E.
Zahran
El-Sayed H.
Bakr
Fayaz A.
Sahibzadah
Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, KSA
Eslam A.
Header
10.21608/ejhm.2021.165165
<strong>Background: </strong>Obesity is a major problem in Saudi Arabia. Pharmaceutical solutions were sought for treatment. Chemical formula might lead to major health side effects. Meanwhile, the use of herbal formula is alleged to be safe. Green tea and apple vinegar are some of these products.
<strong>Objective: </strong>The study aimed to measure the effect of green tea and apple vinegar on obesity and liver status compared to medical drugs.
<strong>Materials and methods: </strong>Thirty-six adult male albino rats were divided into normal control, and other five groups fed on high caloric and hyperlipidemic diets. They were control positive and the rest 4 groups were treated with different formula (green tea, apple cider vinegar, orlistat and chitocal).
<strong>Results: </strong>All treated groups showed significant decrease in body weight when compared to control positive. Rats administered with orlistat and chitocal showed the highest significant decrease in body weight gain (BWG) when compared to control positive. Moreover, all tested groups enhanced liver functions especially chitocal and apple cider vinegar groups which showed the highest effect in ALT. Orlistat and green tea groups came in second level.
<strong>Conclusion: </strong>Although, no poor effect of chemical drugs found, natural products can provide the positive effect with no risk. Apple cider vinegar was the best natural weight control formula.
apple cider vinegar,Chitocal,green tea,Obesity,Orlistat,Rats
https://ejhm.journals.ekb.eg/article_165165.html
https://ejhm.journals.ekb.eg/article_165165_b0ef6f37dd6da4740259d65e8c024d42.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Immunohistochemical Study of a Correlation between Pemphigus Vulgaris Activity Score and Stem Cell Control
1224
1229
EN
Heba A. S.
Bazid
Departments of 1Dermatology, Andrology & STDs Faculty of Medicine,
Menoufia University, Egypt
Iman
Seleit
Departments of 1Dermatology, Andrology & STDs Faculty of Medicine,
Menoufia University, Egypt
Samar Saeed Shaban
Abo Hegazy
Departments of 1Dermatology, Andrology & STDs Faculty of Medicine,
Menoufia University, Egypt
Rehab Monir
Samaka
Departments of STDs and Pathology, Faculty of Medicine,
Menoufia University, Egypt
rehabsamaka@yahoo.com
10.21608/ejhm.2021.165168
<strong>Background: </strong>Pemphigus vulgaris (PV) is a potentially life-threatening autoimmune blistering disease. PV autoantibodies disrupt desmosomal adhesion and cause acantholysis. Previous researches have shown that stem cells are indirectly involved as a result of desmoglein deficiency. Leucine-rich repeat-containing G protein-coupled receptor 5 (LGR5) as a follicular stem cell marker was evaluated in aim to correlate its intensity of expression with disease severity.
<strong>Objective: </strong>To correlate LGR5 intensity of expression with disease severity.
<strong>Patient and methods: </strong>This prospective cross sectional study was carried out on 20 PV patients. Patients were subjected to complete history taking, general, dermatological examination and assessment of disease severity by the Pemphigus Vulgaris Activity Score (PVAS), histopathological and immunohistochemical expression of LGR5 were done.
<strong>Results:</strong> All studied cases showed positive cytoplasmic basal LGR5 expression in patchy manner. 75% of cases had mild intensity of expression, 15% had moderate intensity and their Histo (H) score ranged from 50-130 with Mean ±SD 110±18.92. There were no significant correlation between PVAS scores ''skin, mucosa and total involvement'' and H score of LGR5 expression.
<strong>Conclusion:</strong> The current study could shed a new light on the disease and its correlation with stem cells, LGR5 as a stem cell marker could be related to the healing process in PV. However, it didn't correlate PVAS scores either in skin, mucosa or total involvement.
Lgr5,Pemphigus vulgaris,stem cells,skin,Autoimmune
https://ejhm.journals.ekb.eg/article_165168.html
https://ejhm.journals.ekb.eg/article_165168_3e0a3c8bb843402488cf4fab1aff2534.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Protective Role of Thyme Leave Extract on Methotrexate-Induced Histological and Immunohistochemical Changes in Testes of Rats
1230
1238
EN
Nahed
Omar
Department of Zoology, Faculty of Science, Domiat University, Egypt
Atta Allah
El-Kot
Department of Zoology, Faculty of Science, Domiat University, Egypt
Eman Ibrahim
Khalifa
Department of Zoology, Faculty of Science, Domiat University, Egypt
10.21608/ejhm.2021.165169
<strong>Background: </strong>Methotrexate (MTX) is an anticancer drug that induces testicular abnormalities but, thyme is antioxidant compound, which scavenges oxidative damage.
<strong>Objective:</strong> this study aimed to investigate the protective role of thyme leave extract on the histological and immunohistochemical testicular changes induced by MTX.
<strong>Material and Methods:</strong> forty adult male rats were used and categorized into 4 equal groups (10 rats/each); <strong>Group I: </strong>control rats group without treatment. <strong>Group ΙΙ: </strong>control rats administrated thyme only for a month, <strong>Group ΙΙΙ: </strong>rats injected (i.p) with MTX for four weeks, <strong>Group ΙV: </strong>rats injected with MTX and administrated thyme extract. <strong>Results: </strong>the control rat testes stained with H&E showed normal histological structure of testes; rats administrated thyme demonstrated normal structure similar to the normal control. Rats injected with MTX showed damaged testicular tissue but, rats co-treated with MTX and thyme demonstrated improvement in the testicular structure. The caspase-3 immunostain was expressed in the control and the thyme group as weak reaction in the spermatogonic cells. However, MTX group showed dense reaction for caspase-3 and group of MTX and thyme detected obviously reduction of caspase -3. Normal intense immunoreactive of PCNA was realized in the control and thyme groups. But, MTX group showed an obvious decrement of immunoreactivity and MTX and thyme group expressed more reduction in the immunoreactivity. <strong>Conclusion:</strong> thyme extract had the ability to ameliorate the abnormalities occurred in the testes of rats after MTX treatment.
<strong> </strong>
<strong> </strong>
testis rat,MTX,thyme,histological study,H&E,Immunohistochemical,caspase-3 and PCNA
https://ejhm.journals.ekb.eg/article_165169.html
https://ejhm.journals.ekb.eg/article_165169_24b86b1bf62fc03b3514ee2509623929.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Histological, Histochemical and Immunohistochemical Alterations Induced in Rat’s fetalskeletal Muscle Fibres and Skin Intoxicated Maternally with
1239
1249
EN
Hanaa A.
Abd El-Gawwad
Zoology Department, Faculty of Science, Al-Azhar University, Egypt
hanaa_khedr99@yahoo.com
Asmaa M.
Abd El-Azez
Zoology Department, Faculty of Science, Al-Azhar University, Egypt
10.21608/ejhm.2021.165171
<strong>Background: </strong>skeletal muscle relaxants contain a diverse mix of agents with different buildings and tools for achievement. These agents are classified as antispasmodics or antispasmodic agents, one of them is the drug carisoprodol.<strong>Objective</strong>: the current study aimed to investigate the possible effect of somadril compound on the skeletal muscle fibres and skin of fetuses maternally treated with carisoprodol.<strong>Material and methods</strong>: 30 pregnant female rats were categorized into 3 groups equal in number ten for each group, the first one (Control group ) ten pregnant female rats were administrated oral doses of distilled water; rats of the second group (S1) were administrated oral doses of carisoprodol in distilled water equivalent to 10.8 mg / 100 g body weight/ day and rats of the third group (S2) were administrated oral dose of carisoprodol in the distilled water equivalent to 21.6 mg /100g body weight/day. Rats of S1 and S2 were administrated oral dose of carisoprodol for 15 days from the 6<sup>th</sup> day to the 20<sup>th</sup> day of gestation. Many histological, histochemical and immunohistochemical studied were done to detect the alterations in the fetal skeletal muscles and skin<strong>. Results</strong>: fetal skin and skeletal muscle tissues of both treated groups showed many changes compared to the control group. C<strong>onclusion:</strong> treatment of the pregnant rats with carisoprodol led to numerous pathological changes in the fetal skin and skeletal muscle fibres.
carisoprodol,fetuses,Immunohistochemical,skin,histology,histochemical,skeletal musclefibres
https://ejhm.journals.ekb.eg/article_165171.html
https://ejhm.journals.ekb.eg/article_165171_d96ff92076be5507cd77beeb228bf046.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Assessment of INPP4B Expression Level in Acute Myeloid Leukemia Patients and Its Prognostic Significance. An Egyptian Study
1250
1258
EN
Nahla
Ibrahim
Zidan
Clinical Pathology Department, Faculty of Medicine, Zagazig university, Zagazig, Egypt
nahlaiz@yahoo.com
Weaam
Ismail
Departments of 1Clinical Pathology Faculty of Human Medicine, Zagazig University, Egypt
Doaa
AbdElmonem
Departments of 1Clinical Pathology Faculty of Human Medicine, Zagazig University, Egypt
doaametwaly2005@yahoo.com
Ahmed
Embaby
Clinical Hematology Unit of Internal Medicine, Faculty of Human Medicine, Zagazig University, Egypt
dr.embaby@yahoo.com
Walaa
Sarhan
Biochemistry, Faculty of Human Medicine, Zagazig University, Egypt
walaasarhan@hotmail.com
10.21608/ejhm.2021.165173
<strong>Background: </strong>Acute myeloid leukemia (AML) is a complex and heterogeneous hematopoietic tissue neoplasm caused by gene mutations, chromosomal rearrangement and deregulation of gene expression. Inositol polyphosphate 4-phosphatase type II (INPP4B) is a clinically relevant factor in the phosphoinositide 3 kinase (PI3K) pathway- associated cancers, has been found to have a bad prognostic role in AML. However, the exact mechanism is still unclear. <strong>Objective: </strong>We aimed in this study to investigate the prognostic role of INPP4B overexpression in Egyptian AML patients. <strong>Patients and methods:</strong> A total of 80 patients with newly diagnosed AML were included in the study. In addition, 40 apparently healthy, age and sex matched subjects served as control group. Immunophenotyping, cytogenetic analysis and quantitative assessment of INPP4B gene transcript were performed using real time PCR.<strong> Results:</strong> INPP4B overexpression was detected in 27.5 % of newly diagnosed AML patients. There was a statistically significant decrease in the probability of achieving complete remission (CR) with shorter overall survival (OS), event free survival (EFS) and disease-free survival (DFS) in the INPP4B high expression group compared with the low expression group (p=0.003, 0.03, 0.02 and <0.001; respectively).
<strong>Conclusion:</strong> We can conclude thatINPP4B overexpression is associated with poor response to therapy with poor outcome, and add prognostic value in patients with AML. INPP4B overexpression could be a valuable tool for making therapeutic decisions.
Acute Myeloid Leukemia,INPP4B expression,prognosis,Survival
https://ejhm.journals.ekb.eg/article_165173.html
https://ejhm.journals.ekb.eg/article_165173_822dd55a7f9b731d7bc20106c31e7cd4.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Adverse Effects of Two Kinds of Food Additives Mixtures (Fast green + Glycine, Fast green+ Sodium Nitrate and Sodium Nitrate + Glycine) on Some
1259
1264
EN
Asmaa A. H.
Mohamed
Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Egypt,
Eman
Helal
https://orcid.org/0
AlAzhar univ.
emanhelal@hotmail.com
Mohamed A.
Abdelaziz
Physiology Department, Faculty of Medicine, (Boys), Al –Azhar University, Egypt
10.21608/ejhm.2021.165175
<strong>ABSTRACT</strong>
<strong>Background:</strong> Food additives are substances used in food industry in order to improve the food's taste and appearance.
<strong>Objective: </strong>To investigate the adverse effects of mixing some food additives on the biochemical parameters in male albino rats. <strong>Materials and Methods:</strong> This study was conducted on twenty-four young male albino rats. Animals were divided into four groups (6 each). <strong>Group I:</strong> Control group < strong>, Group II:</strong> administered with fast green and glycine.<strong> Group III</strong><strong>:</strong> administered with fast green and sodium nitrate and <strong>Group IV:</strong> administered with sodium nitrate and glycine. After 30 days of treatment, blood samples were collected for biochemical parameters.
<strong>Results:</strong> body weight, total protein, albumin and testosterone hormone decreased in all treated groups. Glucose, insulin and HOMA-IR decreased in group received (fast green with glycine). Rats treated with sodium nitrate plus glycine showed a significant increase in glucose level. The liver enzymes and the kidney function tests increased in all treated groups. Rats treated with fast green plus glycine showed significant decrease in the TG and TC while HDL showed significant increase. Rats treated with sodium nitrate plus glycine showed a significant increase in the TG and TC while HDL showed significant decrease. T3 and T4 decreased in rats treated with the mixture of sodium nitrate and glycine while increased in rats treated with the mixture of fast green and glycine.
<strong>Conclusion:</strong> The use of these compounds must be limited as its use leads to real vehement disturbance in biochemical parameter.
Biochemical parameter,food additives,Sodium nitrate,thyroid hormones
https://ejhm.journals.ekb.eg/article_165175.html
https://ejhm.journals.ekb.eg/article_165175_87e0553fa463c273b8d734ecc8144c77.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Effect of Dialysis Modality on Bone Disease in Patient with End Stage Renal Disease
1265
1269
EN
Saeed
Abd Alwahab
Internal Medicine Department, Faculty of Medicine, Ain Shams University,Egypt
Waleed
Anwar
Internal Medicine Department, Faculty of Medicine, Ain Shams University,Egypt
Mostafa
Abd Elnasier
Internal Medicine Department, Faculty of Medicine, Ain Shams University,Egypt
Mohammed Elsaeed
Aboalfarh
Internal Medicine Department, Faculty of Medicine, Ain Shams University,Egypt
dr_mohammedelsaeed@yahoo.com
10.21608/ejhm.2021.165176
<strong>Background: </strong>The kidney has an important effect on minerals and bone metabolism in humans. Kidney is the target organ of many regulating hormones such as parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF-23), also it activates vitamin D. Abnormalities in phosphorus, calcium, vitamin D and parathyroid hormone are common in patients with chronic kidney disease (CKD).
<strong>Objective:</strong> To compare the effect of online hemodiafiltration (HDF) dialysis versus high flux hemodialysis on bone markers.
<strong>Patients and Methods</strong><strong>: </strong>The study was performed on 50 prevalent hemodialysis (HD) patients in Ain Shams University Specialized Hospital on high flux dialysis and were divided into 2 groups (group 1), 25 patients who continued hemodialysis with high flux dialyzer and (group 2), 25 patients who were shifted to online HDF<strong>. </strong>Bone specific alkaline phosphatase (BSAP), calcium, phosphorus, blood urea nitrogen (BUN), creatinine, sodium, potassium and blood hemoglobin were measured at the start of this study and after 4 months. Only Parathyroid hormone (PTH) was measured at the end of the study in both groups.
<strong>Results:</strong> there was significant increase BSAP and significant reduction of phosphorus levels after 4 months with online HDF compared to high flux HD; p value 0.036 and <0.001 respectively.
<strong>Conclusion: </strong>Online HDF has significant effect on bone markers and phosphorus clearance than high flux Hemodialysis but we need more prospective with longer durations studies to confirm this effects.
<strong> </strong>
Bone specific alkaline phosphatase,hemodiafiltration,Hemodialysis,parathormone,phosphorus
https://ejhm.journals.ekb.eg/article_165176.html
https://ejhm.journals.ekb.eg/article_165176_584ad1fd1ab51306bb08933d097fdda0.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
The Potential Benefit of Emergency Ultrasound Plus MDCT for The Diagnosis of Major Chest Trauma … A Diagnostic Test Accuracy Study
1270
1278
EN
Tarek Fawzy
Abd Ella
Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Shaheira Ahmed El-Sayed
Salem
Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Ashraf Anas
Zytoon
Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egyp
ashradio@gmail.com
10.21608/ejhm.2021.165178
<strong>Background:</strong> Multidetector computed tomography (MDCT) has established itselfas the preferred imaging modality for the evaluation of polytrauma patients owning to its significantly better ability in detecting tissue but patients are exposed to great amount of radiation during MDCT examination. Ultrasound has thebenefits of being reliable, dynamic, rapid, noninvasive technique and freed from radiation.
<strong>Objective: </strong>This study aims toascertain the role of transthoracic ultrasound for imaging blunt chest trauma patients and compared its sensitivity, specificity and accuracy to those of MDCT as a gold standard modality.
<strong>Patients and methods: </strong>This study was carried on 57 patients, 54 males (94.7%) and 3 were females (5.3%) and ages ranged from 5 to 60 years. All patients were exposed to major blunt chest trauma with or without associated polytrauma.
<strong>Results:</strong> With MDCT as the gold standard, the most common injury detected by ultrasound (US) was pleural in 89.5% of patients with 96% accuracy, chest wall lesions were found in 80.7% of patients with 95% diagnostic accuracy, parenchymal lesions were found in 64.9% of patients with 91% diagnostic accuracy and mediastinal lesions were detected in 3.5% with 91% diagnostic accuracy. The sensitivity and specificity of ultrasonography varied for detecting thesubsequent pathologies: rib fracture (89% and 100%) subcutaneous emphysema (87% and100 %), hemothorax (94% and 100%), pneumothorax (89% and 100%), hydropneumothorax (81% and 100%), pulmonary contusions (82% and 100%), lung collapse (93% and 100%), lung laceration (100% and 100%) and hemopericardium (100% and100%), respectively.
<strong>Conclusions:</strong> Chest US proved its value for diagnosis of blunt thoracic injuries with acceptable sensitivity and high specificity, particularly for pleural, pericardial and parenchymal lung injuries.
chest,blunt trauma,Ultrasound,Multidetector Computed Tomography
https://ejhm.journals.ekb.eg/article_165178.html
https://ejhm.journals.ekb.eg/article_165178_58a961d756e6a3e28db0069e8b44eed8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Association of Deep Retinal Capillary Plexus ischemia with Inner Segment/Outer Segment Disruption in Diabetic Macular Ischemia
1279
1283
EN
Nesma
S
Sayed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
nesma7@live.com
10.21608/ejhm.2021.165179
<strong>ABSTRACT</strong>
<strong>Background: </strong>Diabetic macular ischemia (DMI) is an important cause of visual impairment in patients with diabetic retinopathy. In some patients, it may lead to irreversible visual loss.
<strong>Purpose:</strong> The aim of the work was to assess the presence of outer retinal structural changes at the level of inner segment /outer segment (IS/OS) in relation to macular capillary non-perfusion at the level of deep capillary plexus (DCP) in diabetic retinopathy (DR).
<strong>Patients and Methods</strong>: A prospective observational study was carried on 250 eyes of 125 patients. They underwent scanning using Optical coherence tomography/ Optical coherence tomography angiography (OCT/OCTA) simultaneously.
<strong>Results</strong>: 250 of 125 diabetic patients were classified according to presence of capillary non perfusion (NP), into two groups (ischemic- non ischemic). The incidence of DCP NP was 100% in eyes with DMI while the incidence of superficial capillary plexus (SCP) NP was 71% . The incidence of foveal avascular zone (FAZ) irregularity, inner segment /outer segment (IS/OS) disruption was 100% and 95% respectively among eyes with DMI. DCP NP was more than SCP NP in eyes with FAZ irregularity, which make it the possible main cause of the structural changes in the retina during ischemia. There was a strong association between the presence of IS/OS disruption with duration, severity of DR and BCVA.
<strong>Conclusion</strong>: It could be concluded thatIS/OS disruption is associated with ischemia at DCP. It could be considered a reliable OCT findings that indicate an underling DMI and their presence can affect visual prognosis.
Diabetic macular ischemia,Optical coherence tomography angiography,Inner segment /outer segment disruption
https://ejhm.journals.ekb.eg/article_165179.html
https://ejhm.journals.ekb.eg/article_165179_eb7a5050efcfe8137647d8325c168427.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Immunoglobulin A and Immunoglobulin M and Their Relation to Treatment Response in Adult Egyptian Immune Thrombocytopenic Purpura Patients
1284
1289
EN
Rania A
Radwan
Department of Clinical Hematology and Bone Marrow Transplantation, Ain Shams University, Cairo, Egypt.
dr_raniaradwan@hotmail.com
Abdel Rahman A
Soliman
Department of Clinical Hematology and Bone Marrow Transplantation, Ain Shams University, Cairo, Egypt.
Aya
Adel
Department of Clinical Hematology and Bone Marrow Transplantation, Ain Shams University, Cairo, Egypt.
Haydi S
Mohamed
Department of Clinical Hematology and Bone Marrow Transplantation, Ain Shams University, Cairo, Egypt.
10.21608/ejhm.2021.165493
<strong>Background:</strong> Immune thrombocytopenia (ITP) is a disorder of antibody mediated destruction and inhibition of production of platelets. In general, this is an idiopathic disease, and it is unclear what are the immune factors related to disease predisposition, severity, and especially response to treatment.
<strong>Objective: </strong>The aim of the work was to measure the level of Immunoglobulins M (IgM) and A (IgA) in patients with immune thrombocytopenic purpura (ITP) and to detect their relation to treatment response.
<strong>Patients and Methods:</strong> The serum level of both IgA and IgM were measured by ELISA assay in 60 newly diagnosed ITP patients received standard treatment in the form of steroids. Patients were aged from 16 to 45 years.
<strong>Results:</strong> Median level of IgA was higher in ITP patients at presentation in comparison to average normal population which was of no statistical significance while ITP patients had lower median level of IgM at presentation in comparison to average normal population with no statistically significance. No significant correlation could be detected between level of IgA and IgM and platelets count in ITP patients after one month and 3 months of treatment. This study indicated that non responder patients had IgA level higher than that of responder patients but of no statistically significant difference. (P value=0.536).
<strong>Conclusion:</strong> It could be concluded that statistically significant difference between responder and non-responder ITP patients as regard the level of IgM denotes that patients who had IgM level below the median were more resistant to steroids which is the standard treatment in ITP.
ITP,IgA,IgM,Treatment response
https://ejhm.journals.ekb.eg/article_165493.html
https://ejhm.journals.ekb.eg/article_165493_667ce303e12b547741d23e838eaf3153.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Heparin Binding Protein as a Predictive Marker for Sepsis and Septic Shock in Critically Ill Patients: A Cross Sectional Study
1290
1296
EN
Mohamed Lotfy Mohamed
Elsayed
Department of Anesthesia and Surgical Intensive Care Zagazig University, Zagazig, Egypt
abolotfy.ml@gmail.com
Samia A.
El-Wakel
Department of Anesthesia and Surgical Intensive Care Zagazig University, Zagazig, Egypt
Mona Abdel
Hamid
Department of Anesthesia and Surgical Intensive Care Zagazig University, Zagazig, Egypt
Yasser Mohamed
Nasr
Department of Anesthesia and Surgical Intensive Care Zagazig University, Zagazig, Egypt
Amal Ahmed
Zidan
Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
10.21608/ejhm.2021.165497
<strong>Background</strong>: Sepsis is a serious inflammatory condition caused by infection, accompanied by high morbidity and mortality. An early effective diagnostic and predictive tool is needed to improve the management and prognosis of patients.<br /> <strong>Objectives</strong>: This study was aimed to assess the role of serum levels of Heparin Binding Proteinin early detection of sepsis and circulatory failure in critically ill patients, compared with the currently used biomarkers.<br /> <strong>Subjects and methods:</strong> This is a cross-sectional study of 66 patients with sepsis, carried out in emergency ICU and surgical ICU in Zagazig University Hospitals. Patients’ data were collected at admission, after 48 and 72 hours from medical records, bedside sheets, and radiographic reports. The concentration of heparin Binding Protein (HBP) is determined and compared to that of procalcitonin )PCT(, lactate, and total leucocytic count. <strong>Results:</strong> Median range level of HBP in sepsis (11.8, 9.8 and 8.083 ng/ml), septic shock (20, 22.6 and 19.25 ng/ml), and in uncomplicated infections (1.57, 0.9 and 7.3 ng/ml) on admission, after 48 and 72 hours respectively. HBP had 90.3% sensitivity, 62.9% specificity and 75.8% accuracy at cut of value ≥13.35 ng/ml AUC= 0.822, in diagnosis of septic shock on admission.<br /> <strong>Conclusion:</strong> serum heparin binding protein level is positively correlated with the severity of sepsis and septic shock and showed a good performance as an early diagnostic marker in patients with suspected sepsis and septic shock.<br />
Heparin Binding Protein,Sepsis,Septic shock,biomarker,Critically Ill
https://ejhm.journals.ekb.eg/article_165497.html
https://ejhm.journals.ekb.eg/article_165497_c398df5dfd8bdbb45b81a455dddd5327.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Diagnostic Value of Napsin A in Small Biopsy of Non-Small Cell Lung Carcinoma
1297
1301
EN
Rasha M.
Samir
0000-0002-5858-5094
Department of Pathology, Faculty of Medicine, Aswan University, Egypt
dr.rasha.samer@gmail.com
Ghada S.
Osman
Department of Pathology, Faculty of Medicine, South Valley University, Egypt
Mervat M.F.
El-Deftar
Department of Pathology, National Cancer Institute, Cairo University, Egypt
10.21608/ejhm.2021.165501
<strong>Background:</strong> Accurate sub-classification of non-small cell lung carcinoma (NSCLC) is crucial for the targeted therapy. In lung cancer most of tumors are un-respectable at diagnosis and small biopsy or cytological specimen is commonly the only available material for histopathology diagnosis. Although most of NSCLC can be diagnosed by routine stains, however diagnosis of poorly differentiated or undifferentiated tumors in small biopsy is challenging.
<strong>Objective:</strong> To evaluate the diagnostic value of Napsin A immunohistochemical (IHC) marker in NSCLC small biopsy<strong>.</strong>
<strong>Materials and Methods:</strong> Forty-six cases of primary NSCLC diagnosed by biopsy with subsequent resection were enrolled in this study. Subtyping of tumors was done according to 2015 World Health Organization criteria. IHC expression of Napsin A was assessed for all the cases. For large cell carcinoma (LCC) cases, Thyroid Transcription Factor 1 (TTF-1) and P63 expression were also tested. Markers expression was correlated with the histological diagnosis of the tumor. Sensitivity, specificity, positive, negative predictive values, and total accuracy of the markers were calculated.
<strong>Result:</strong> In NSCLC cases, the diagnostic sensitivity and specificity of Napsin A were 85.2% and 75% (respectively) with a PPV of 85.2%, NPV of 75.0% and 81.4% accuracy. In LCC cases TTF1 sensitivity was 57.1% and specificity 100%, PPV 100%, NPV 14.3%, accuracy 60.0%. In LCC P63 marker had a diagnostic sensitivity, specificity, PPV, NPV and accuracy of 100%, 85.7%, and 33.3%, 100.0% and 86.7% respectively. Expression of both Napsin A and TTF 1 in LCC cases raised the accuracy to 86.7%.
<strong>Conclusions:</strong> In small biopsy specimens Napsin A can subtype NSCLC with high sensitivity and moderate specificity. Additions of TTF-1/p63 IHC markers can further enhance the accuracy.
Non-small cell lung carcinoma (NSCLC),large cell carcinoma (LCC)
https://ejhm.journals.ekb.eg/article_165501.html
https://ejhm.journals.ekb.eg/article_165501_550aa172037182927110665f7a09f050.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Different Intraoperative Ventilatory Strategies for Prevention of Pulmonary Atelectasis in Obese Patients Undergoing Non-Bariatric Surgeries; Randomized Controlled Trial
1302
1311
EN
Mohamed Ezzat
Abd El-Fattah
Departments of Anesthesia and Surgical Intensive Care
Faculty of Medicine, Zagazig University, Egypt.
mohammedezzat2002@gmail.com
Doaa Mohamed
Faried
Departments of Anesthesia and Surgical Intensive Care Faculty of Medicine, Zagazig University, Egypt.
Essam Fathi
Abd-El Galel
Departments of Anesthesia and Surgical Intensive Care Faculty of Medicine, Zagazig University, Egypt.
Ayat Ahmed
Amer
Departments of Anesthesia and Surgical Intensive Care Faculty of Medicine, Zagazig University, Egypt.
Ahmed Abd El-Aziz
El-Sammak
Departments of Radiodiagnosis,
Faculty of Medicine, Zagazig University, Egypt.
10.21608/ejhm.2021.165505
<strong>Background:</strong> Upper abdominal surgeries have been reported to be associated with an increased incidence of postoperative atelectasis. Preventing atelectasis is important for all patients but is more important when caring for obese patients.
<strong>Objectives:</strong> To determine which of the following ventilatory strategies is better in prevention of pulmonary atelectasis in obese patients undergoing non-bariatric surgery: Volume control ventilation "VC", Pressure control Ventilation "PC", Volume control ventilation + Positive End Expiratory Pressure "PEEP", Volume control ventilation + Positive End Expiratory Pressure "PEEP" + lung recruitment maneuver.
<strong>Patients and methods:</strong> A randomized-controlled trial study was carried out in the operating room (OR) in Zagazig University Hospital including 92 patients. Patients were randomly allocated into four groups. G1: Volume control ventilation "VC", G2: Pressure control Ventilation "PC", G3: Volume control ventilation + Positive End Expiratory Pressure "PEEP", G4: as in G3 + lung recruitment maneuver.
<strong>Results:</strong> There was significant difference between the studied groups as regards PaO<sub>2</sub>/FiO<sub>2</sub> ratio as the 4<sup>th</sup> group was highly significant. There was also significant difference between the studied groups as regards atelectasis score with the least atelectasis score in group 4. There was a significant difference in group 4 than the other groups as regards length of stay in PACU, and need for 100% Fio2 in PACU.Finally,there was a significant difference between the studied groups as regards postoperative pulmonary complications with the 4<sup>th</sup> group has the least postoperative complication.
<strong>Conclusion:</strong> Our results suggest that volume control ventilation + Positive End Expiratory Pressure "PEEP" + lung recruitment maneuver had beneficial effects on oxygenation continued into the early recovery period and decrease pulmonary complications in the early post-operative period in obese patients undergoing non-bariatric upper abdominal surgeries.
atelectasis,obese,Ventilatory Strategies,Bariatric
https://ejhm.journals.ekb.eg/article_165505.html
https://ejhm.journals.ekb.eg/article_165505_dcc29fbd5be5f25060826878f7f00428.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Late presenting Congenital Diaphragmatic Hernia Mimicking Complicated Pneumonia with? an Air Leak - A Case Report
1312
1315
EN
Satam GH
Alshammari
Pediatric Pulmonologist,
Alyammamh Hospital, Pediatric Department Riyadh, Saudi Arabia.
d_satam@icloud.com
Saeed Rashid
Alzahrani
Pediatric Pulmonologist,
Alyammamh Hospital, Pediatric Department Riyadh, Saudi Arabia.
Tariq Jamal
Alanezi
Pediatric Intensivist, Pediatric Department,
Alyammamh Hospital, Riyadh, Saudi Arabia.
Razan Ebrahim
Alanfeesah
Pediatric Department, Pediatric Department,
Alyammamh Hospital, Riyadh, Saudi Arabia
Manar Jassem
Alshammari
Pediatric Department, Pediatric Department,
Alyammamh Hospital, Riyadh, Saudi Arabia
Abdullah
Al-Shamrani
Pediatric Pulmonologist and Sleep Physician,
Prince Sultan Medical Military City (PSMMC), Riyadh, Saudi Arabia
dr.alshamrani99@gmail.com
10.21608/ejhm.2021.165516
<strong> </strong>
<strong>Background:</strong> Congenital diaphragmatic hernia (CDH) is an anatomical defect of the diaphragm, which allows protrusion of abdominal viscera into the chest, causing serious pulmonary and cardiac complications in the neonate.
<strong>Objective:</strong> In this case report we aimed to present a rare case of late presentation of congenital diaphragmatic hernia.
<strong>Patient and method:</strong> We reported a late diagnosis of CDH at age of 3 months, who was referred to our center as a persistent left sided chest infection that needs necessarily intervention.
<strong>Result:</strong> At this late-presenting patient, which could be due to small defect in the diaphragm and could be missed antenatally or even in early postnatal period, it is expected to get worse when bowel distended, or patient stressed. Management of this condition was explored in detail, survival and prognostic factors were addressed.
<strong>Conclusion: </strong>CDHs are still a diagnostic challenge. Some are still missing in our community, and we need to improve medical services starting from antenatal visit. CDH should be kept in mind as a potential differential diagnosis in early infancy period for any patient presented with respiratory distress.
CDH,pneumonia,Post neonatal,postnatal,respiratory distress
https://ejhm.journals.ekb.eg/article_165516.html
https://ejhm.journals.ekb.eg/article_165516_9b3936642643cf66436794a8c794bc8f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Gender and Glaucoma: Findings from a Hospital-based Study in Upper Egypt
1316
1320
EN
Tageldin M.
Othman
Department of Ophthalmology, Faculty of Medicine – Aswan University, Egypt.
tageldin1973@gmail.com
Ahmed
Hewady
Department of Ophthalmology, Faculty of Medicine – Aswan University, Egypt.
Mohamed Ahmed
Abdel Hafez
Department of Ophthalmology, Faculty of Medicine – Fayoum University, Egypt.
10.21608/ejhm.2021.165520
<strong>Background: </strong>There is an increasing evidence globally on the presence of gender bias either in the prevalence or the uptake of eye care services between men and women.<br /> <strong>Objective</strong>: To detect the difference between men and women in the frequency and both demographic and clinical characteristics of glaucoma patients.<br /> <strong>Patients and methods: </strong>The current study adopts a retrospective study design, a total number of 1000 subjects were recruited in the current study on a multi-center approach. The sample was recruited from Aswan University Hospital, Aswan Ophthalmology Hospital, Aswan Eye Center, and Baladi Foundation Eye Clinic.<br /> <strong>Results: </strong>Among 1000 investigated subjects, the mean (±SD) age was 42.3 (±22.6) years, 455 (45.5%) were male and 545 (54.5%) female. Disaggregating data per gender showed that there were a statistically significant difference in laterality (p=0.038), best corrected affected vision (p < 0.0001), uncontrolled intraocular pressure (IOP) (P<0.0001), and accounting enlarged corneal diameter (p=0.044). Moreover, there was a significant difference in the type of primary and secondary glaucoma (P<0.0001) and (P=0.007), respectively. Multivariate analysis confirmed such findings.<br /> <strong>Conclusion: </strong>Gender bias in glaucoma is a critical issue in terms of both prevalence and service utilization. Women are more affected than men because of gender specific risk factors that may include laterality, severity (as surrogated by surgical uptake) in addition to acquiring some glaucoma subtypes specifically such as congenital, juvenile, pseudo-exfoliation (PXF), uveitic, neovascular and pigmentary glaucoma. Disaggregation of glaucoma data by gender should be applied as a routine in prevention of low vision and blindness research.<br /> <br />
Egypt,Gender,Glaucoma,Ocular Hypertension
https://ejhm.journals.ekb.eg/article_165520.html
https://ejhm.journals.ekb.eg/article_165520_7f842ee827f05a8fe64dce368d6d5383.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Clinical, Laboratory and Radiological Predictors of Unfavorable Hospital Admission Course for Diabetic Patients with COVID-19
1321
1329
EN
Mohamed
Sorour
Mohamed
0000-0002-5967-5315
Departments of Internal Medicine Faculty of Medicine, Zagazig University Hospital, Egypt.
doctor037@yahoo.com
Tamer M.
Gouda
Departments of Internal Medicine Faculty of Medicine, Zagazig University Hospital, Egypt.
Amr Shaaban
Hanafy
Departments of Internal Medicine Faculty of Medicine, Zagazig University Hospital, Egypt.
Hussein Mohammed
Hussein
Departments of Internal Medicine Faculty of Medicine, Zagazig University Hospital, Egypt.
Ali M.
Hassanin
Departments of Radiodiagnosis, Faculty of Medicine, Zagazig University Hospital, Egypt.
Nahla Ibrahim
Zidan
Departments of 3Clinical Pathology, Faculty of Medicine, Zagazig University Hospital, Egypt.
Walaa Sabry
Fouad
Departments of Family Medicine, Faculty of Medicine, Zagazig University Hospital, Egypt.
10.21608/ejhm.2021.165528
<strong>Background:</strong> Patients with diabetes mellitus infected with the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are at risk of high morbidity and mortality.
<strong>Objective:</strong> Our study aimed to address the clinical, laboratory and radiological predictors of hospital admission course for patients with diabetes mellitus with COVID19 infection at the time of admission.
<strong>Patients and Methods:</strong> This was a single center, retrospective study of patients with diabetes mellitus (DM) admitted with COVID-19 infection. Patients with unfavorable admission course were compared with those of favorable course regarding patient characteristics, clinical presentation, results of laboratory investigations and chest CT severity score. Univariate and multivariate analysis associated with the unfavorable course was performed.
<strong>Results:</strong> Among 141 patients with DM admitted with COVID19, 44 patients had unfavorable course. Those with the favorable course were significantly younger (53.3±16.4) vs (67.3 ±15.8) in the unfavorable course group, multivariate analysis revealed that age more than 65, presence of hypertension, CT severity scoring, high HBA1c, AST, IL6, oxygen saturation less than 93% and low lymphocyte count were the independent predictors of the unfavorable hospital admission course.
<strong>Conclusions: </strong>Our finding suggests that old age, presence of hypertension, hypoxia at presentation, in addition to high HBA1c, AST, IL6, CT severity scoring and low lymphocyte count were significant predictors of unfavorable admission course in COVID19 patients with diabetes.
Coronavirus,COVID19,Diabetes mellitus,predictors,prognosis
https://ejhm.journals.ekb.eg/article_165528.html
https://ejhm.journals.ekb.eg/article_165528_3fb6e8d0300ed9091d9fca2e04b6c43c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Efficacy of Adding Calcitonin to Methylprednisolone in Erector Spinae Plane Block for Thoracic Cancer Pain Management
1330
1337
EN
Medhat Mikhail
Messeha
Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
Ghada Fathy
Al-Rahmawy
Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
Mostafa Sayed Ahmed Mohammed
Elawady
Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
Esraa Yosri Lotfi
Kamel
Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
snowwhiteey.ey@gmail.com
10.21608/ejhm.2021.168246
<strong>ABSTRACT</strong>
<strong>Background:</strong> Pain continues to be a very prevalent symptom too often undertreated in cancer patients at all stages of their disease. It is difficult to manage, and patients often show a poor or limited response to analgesic medications or experience intolerable adverse effects.
<strong>Objective: </strong>The aim of the current work was to compare the effect of adding calcitonin to methylprednisolone versus methylprednisolone alone to local anesthetic in erector spinae plane block for patient suffering from thoracic cancer pain.
<strong>Patients and methods: </strong>A double-blind study was conducted from November 2019 until November 2020 at Outpatient Pain Clinic, Oncology Center, Mansoura University (OCMU). This study included thirty patients of both sexes and range of ages (30-70 years), with a history of chronic thoracic cancer pain ≥ 4 on a visual analogue scale (VAS) of 0 – 10 and Chronic pain for at least 3 months prior to study entry. Patients were divided into ywo groups, 15 each, Group (I) (methylprednisolone group) and Group (II) (calcitonin group).
<strong>Results:</strong> Any post block events like nausea, vomiting, respiratory depression (when SpO2 less than 92%) and pneumothorax were recorded. Consumption of analgesics (tramadol 1 – 1.5 mg / kg when needed) during first three months post procedure was measured. Patients of both groups gained benefits from the techniques. The two groups showed decline in the VAS scores and the total tramadol consumption. Calcitonin group has more prolonged duration of pain relief, significant reduction in pain scores, lower tramadol requirements, tolerable side effects.
<strong>Conclusion</strong>: Patients received calcitonin added to methylprednisolone and local anesthetics had significant reduction in pain scores, more prolonged duration of pain relief, less rescue analgesia (tramadol) consumed and was more satisfied with the treatment modality as compared to methylprednisolone and local anesthetics treated patients in 3 months follow up periods.
<strong> </strong>
Cancer Pain,Erector spinae plane block,visual analogue scale,Methylprednisolone,Calcitonin
https://ejhm.journals.ekb.eg/article_168246.html
https://ejhm.journals.ekb.eg/article_168246_e3aa1fa9da2c6760def46c6654117202.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Short Outcome Evaluation of Laparoscopic Ventral Hernia Repair Ahmed Saleh Mostafa Baghdady, Hussein Ali Mostafa,
1338
1334
EN
Ahmed Saleh Mostafa
Baghdady
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
asb1010@gmail.com
Hussein Ali
Mostafa
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
Abd El Aal Ali
Salem
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
Hassan Ahmed
Abdullah
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
Mohamed Rabie
Saad
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
10.21608/ejhm.2021.168248
<strong>Background: </strong>Ventral hernia is defined as primary anterior abdominal wall and incision hernia not including the groin. There are number of risk factors that lead to hernia to occur; like wound infection, morbid obesity, immunosuppression, previous operations, prostatism, and surgery for aneurysmal disease. Hernia defect can form within first 5 years of surgery but can occur late as well.
<strong>Objective: </strong>To evaluate the short-term outcome of laparoscopic ventral hernia repair as regard feasibility and safety, operative time and types of hernias.
<strong>Patients and methods: </strong>This study is a prospective nonrandomized study. It included forty out of sixty consecutive patients admitted at the Department of General Surgery, Aswan University, Aswan Egypt, with diagnosis of ventral and or incisional hernia in the period from July 2016 to December 2019.
<strong>Results:</strong> This study included 22 male and 18 female patients. 11 male patients had incisional hernia and 11 patients with ventral hernia. Types of hernias: Twenty-one cases had virgin abdomen with no previous surgeries while 19 cases had previous surgery done before; described as follows: midline laparotomy scar (11), caesarian section scar (5), port site scar (2) and appendectomy scar (1). Operative time: In first 20 operated cases the mean operative time was 120 min while in the last 20 cases with increasing learning curve the operative time starts to reduce markedly, and the mean time became 70 min.
<strong>Conclusion: </strong>Laparoscopic ventral hernia repair is an appropriate, safe and feasible approach for ventral hernia repair with short operative time.
Laparoscopic,Ventral hernia
https://ejhm.journals.ekb.eg/article_168248.html
https://ejhm.journals.ekb.eg/article_168248_7c8606bcc5c13c55076dcd6b6581c2a8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Effect of Low-Level Laser on Axillary Web Syndrome Post Mastectomy
1344
1349
EN
Eman
Shoukry
Department of Physical Therapy for surgery, Faculty of Physical Therapy ,National Cancer Institute, Cairo University, Cairo, Egypt.
emmashoukry@me.com
Wafaa Hussien
Borhan
Department of Physical Therapy for surgery, Faculty of Physical Therapy ,National Cancer Institute, Cairo University, Cairo, Egypt.
Marwa Mahmoud
Selim
Department of Physical Therapy for surgery, Faculty of Physical Therapy ,National Cancer Institute, Cairo University, Cairo, Egypt.
Hussein Gamal
Hussein
Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
10.21608/ejhm.2021.168250
<strong> </strong>
<strong>Background: </strong>Axillary Web Syndrome (AWS) is characterized by axillary pain radiating down the ipsilateral arm, shoulder range-of-motion limitation, and an axillary web of tissue most obvious on physical examination when the patient tries to abduct her arm. The use of laser as a non-surgical medical treatment modality for assisting the normal processes of healing has increased over the last few years. However, the efficacy of laser in reducing pain or promoting tissue repair remains controversial. <strong>Objective:</strong> This study was undertaken to determine the effect of low-level laser therapy on axillary web syndrome post mastectomy.<strong> Patients and Methods: </strong>This study included forty female patients who underwent mastectomy and received their treatment in Tagamoo branch of National Cancer Institute. Their ages ranged 40 to 55 years and body mass index ranged 25 to 30 (kg/m<sup>2</sup>). The patients were selected from Medical Oncology Department, National Cancer Institute, between January 2019 to June 2019.
<strong>Results: </strong>The results of this study revealed that Group A and Group B showed significant improvement in shoulder mobility (Flexion, Abduction and External rotation) and decrease of pain but by comparison between the two groups, group A showed greater improvement than Group B.
<strong>Conclusion: </strong>It could be concluded that low level laser in addition to traditional therapy and medical therapy can improve shoulder mobility and decrease pain more than using only traditional and medical therapy.The result of this study supported the expectation that Low Level Laser had a position effect on axillary web syndrome.
Low level laser therapy,Axillary Web Syndrome,mastectomy
https://ejhm.journals.ekb.eg/article_168250.html
https://ejhm.journals.ekb.eg/article_168250_00245b6bd908853d5f56fbfd1bd7515c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Short Term Results of Fixation of Unstable Thoracolumbar Fractures with and without Intermediate Screws: A Comparative Study
1357
1363
EN
Tarek
Farghaly
Orthopaedic Department, Alrazi Orthopaedic Hospital – Kuwait,
Ahmed
Moursi
Orthopaedic Department, Alrazi Orthopaedic Hospital – Kuwait,
Ahmed
Elattar
Orthopaedic Department, Alrazi Orthopaedic Hospital – Kuwait,
Moustafa
Elsayed
Orthopaedic Department, Sohag University Hospital, Sohag, Egypt
mostafa.ismael79@yahoo.com
Ahmed
Abdellatif
Orthopaedic Department, Aswan University Hospital, Aswan, Egypt
10.21608/ejhm.2021.168253
<strong>Background: </strong>Posterior short-segment pedicle screw fixation is widely used for unstable thoracolumbar (TL) fractures. Adding a pedicle screw at the fractured vertebrae could significantly improve the stability and decrease the stress on fixation construct.
<strong>Objective:</strong> Compare the efficacy of short segment pedicle screw fixation with and without intermediate screw in correction of the vertebral body height, local kyphosis and maintenance of the correction in the treatment of unstable thoracolumbar spine fractures.
<strong>Patients and Methods: </strong>This study was a prospective cohort study. 40 patients with unstable thoracolumbar fracture were divided randomly into 2 groups according to the surgical method used. In group B, 20 patients underwent fixation via short-segment pedicle screw instrumentation (1 level above and 1 level below the fractured level). In group A, 20 patients received additional screws at the fractured vertebrae.
<strong>Results: </strong>Both groups had significant correction in Cobb angle, anterior body height and local kyphotic angle. However group A had significantly higher correction achieved in Cobb angle (10.35 ± 6.02), anterior body height (1.15 ± 0.50) and local kyphotic angle (13.30 ± 7.54) than group B (3.45 ± 3.94), (0.40 ± 0.41) and (5.05 ± 4.36) respectively. Nevertheless, the differences in VAS score (p=0.759) and ODI (p=0.934) were not significant. Moreover, group A had a significantly lower loss of correction in Cobb angle (p=0.025) after twelve months of follow up.
<strong>Conclusion:</strong> The construct with intermediate screw was associated with not only better correction but also less correction loss after 12 months. However, this was not reflected on clinical outcome.
<strong> </strong>
Intermediate Screw,thoracolumbar fractures,pedicle screw
https://ejhm.journals.ekb.eg/article_168253.html
https://ejhm.journals.ekb.eg/article_168253_8d62fa32cccba5f8e9333221947081cd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Laparoscopic Totally Extra-peritoneal Hernioplasty versus Lichtenstein Open Tension Free Mesh Repair for Inguinal Hernia
1364
1369
EN
Sherif
Sayed
Department of Surgical Oncology, Faculty of Medicine, Beni Suef University, Egypt
sherifelprincesayed@yahoo.com
Ibrahim E.
Zayat
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
Haitham G.
Abd El Hady
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
Osama A.
Abdulraheem
Department of General Surgery, Faculty of Medicine, Sohag University, Egypt
10.21608/ejhm.2021.168254
<strong>Background</strong><strong>:</strong> Surgery for a groin hernia is the most common operation in general surgery. The recurrence rate in non-specialized centres is high, and postoperative pain and discomfort are common. The inguinal hernia repair has been a controversial area in surgical practice ever since it was associated with recurrence rates which have decreased because of the use of prosthetic mesh.
<strong>Objective:</strong> This study was aimed to evaluate the benefits and harms of the total extra-peritoneal technique compared with the Lichtenstein technique for inguinal hernia repair.
<strong>Patients and Material:</strong> This randomized controlled trial study included a total of 40 male patients aged between 14 and 60 years with unilateral or bilateral inguinal hernia, attending at Outpatient Clinic, Aswan University Hospital and followed up there. This study was conducted period from August 2017 to August 2018. They were randomly divided into two groups; Group A Open Lichtenstein hernioplasty and Group B; laparoscopic total extraperitoneal hernioplasty (TEP).
<strong>Results:</strong> There was a statistically significant difference between Groups A and B cases as regard operative time and hospital stay. There was no statistically significant difference between Group A and B cases as regard intra-operative/postoperative complications. Also, there was no s statistically significant difference as regard VAS, recurrence in either group during the follow- up period of 6 months.
<strong>Conclusions:</strong> It could be concluded that laparoscopic total extraperitoneal hernioplasty yielded better results regarding operative time and hospital stay. Yet, better results were found regarding complications, but the study could not detect statistical differences.
inguinal hernia surgery,TEP,Laparoscopic,Lichtenstein hernioplasty
https://ejhm.journals.ekb.eg/article_168254.html
https://ejhm.journals.ekb.eg/article_168254_dbed4e0dd8142fcb2cd76999e68adc3c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Role of Multidetector Computed Tomography in Evaluation of Renal Infections Hayam A. Abdellatif, Hager S. Sakr, El-Sayed M. El-Sayed
1370
1378
EN
Hayam A.
Abdellatif
Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
El-Sayed M.
El-Sayed
Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Hager S.
Sakr
Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
googalygogo@gmail.com
10.21608/ejhm.2021.168256
<strong>Background:</strong> Imaging plays a very important role in the diagnosis of renal infection. It assists diagnosis and differentiates between different types of renal infection. It also helps to detect and manage the associated complications through image-guided drainage and aspiration. Contrast-enhanced CT is the most useful study. A contrast-enhanced study is essential for a complete evaluation of patients with renal inflammatory disease to demonstrate alterations in the renal parenchymal perfusion and excretion of the contrast material, which occur as a result of the inflammatory process. <strong>Objective: </strong>To detect the role of multidetector CT in diagnosis of renal infection.
<strong>Materials and methods: </strong>This prospective study was conducted on sixty patients. The study was carried out at Diagnostic Radiology Departments of Menoufia University Hospital. The patients were presenting with fever (< 38°C) mainly and loin pain. <strong>Results: </strong>From 60 patients with renal infection, 18 cases were diagnosed as pyonephrosis, 16 cases were diagnosed as renal abscess, 12 cases were diagnosed as pyelonephritis, 4 cases were diagnosed as xanthogranulomatous pyelonephritis, 4 cases were diagnosed as perinephric abscess, 2 cases were diagnosed as emphysematous pyelonephritis, 2 cases were diagnosed as fungal ball, 2 cases were diagnosed as urinoma. The mean age was (39.4 ± 15.7).
<strong>Conclusion:</strong> Contrast enhanced computed tomography is a perfect diagnostic modality to assess the severity of inflammatory process and reaching the diagnosis of renal infection. It also helps to reach the cause, predisposing factors, associations, complications and the extent of the disease.
Abdominal computed tomography,Inflammation,Renal infection
https://ejhm.journals.ekb.eg/article_168256.html
https://ejhm.journals.ekb.eg/article_168256_809dd234d621232688d700b24657befd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Complications of Laparoscopic Ventral Hernia Repair
1379
1382
EN
Ahmed Saleh Mostafa
Baghdady
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
asb1010@gmail.com
Hussein Ali
Mostafa
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
Abd El Aal Ali
Salem
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
Hassan Ahmed
Abdullah
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
Mohamed Rabie
Saad
Department of General surgery, Faculty of Medicine, Aswan University, Egypt
10.21608/ejhm.2021.168258
<strong>Background: </strong>Laparoscopic techniques are being used increasingly in the repair of ventral hernias and offer the potential benefits of a shorter hospital stay, decreased wound complications, and possibly a lower recurrence rate. Despite good results from high-volume centers, significant complications may occur with this approach and the morbidity of incisional hernia repair may be underestimated.
<strong>Objective: </strong>To evaluate the outcome of laparoscopic ventral hernia repair as regard complications, post-operative pain, hospital stay, patient satisfaction and recurrence rate.
<strong>Patients and methods: </strong>This was a prospective non-randomized study. Forty consecutive patients admitted at the Department of General Surgery, Aswan University, Egypt, with diagnosis of ventral and or incisional hernia in the period from July 2016 to December 2019 were enrolled.
<strong>Results:</strong> Complication rate among the studied patients was found to be 30% (2 port site infection, 1 wound edge necrosis, 5 seroma, 3 ileus and 1 pneumonia). Mortality rate among our cases was found to be 0%. Recurrence rate showed that two cases developed recurrent hernia; one case after 6 months and the other case after 8 months. Success rate among this group was found to be 70 % of cases that passed without complications. Postoperative pain and patient satisfaction correlate significantly with clinical outcome. We found that patient satisfaction rate among our cases was 70%.
<strong>Conclusion: </strong>Laparoscopic ventral hernia repair main advantages being, with less postoperative pain, shorter hospital stays, lower recurrence rate and lower postoperative complications.
Laparoscopic ventral hernia,Complications,Post-operative pain
https://ejhm.journals.ekb.eg/article_168258.html
https://ejhm.journals.ekb.eg/article_168258_aff4f696dfcb408bc009c26aadb8ce72.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Role of Diffusion-Weighted Magnetic Resonance Imaging in Laryngeal and Hypopharyngeal Cancer in Comparison to Histopathological Finding
1392
1399
EN
Hagar A.
Abdel-Muttalib
Departments of 1Otorhinolaryngology National liver Institute, Menoufia University, Egypt
grgrhama511@gmail.com
Essam A.
Behairy
Departments of 1Otorhinolaryngology National liver Institute, Menoufia University, Egypt
Ahmad M.
Hamadan
Departments of 1Otorhinolaryngology National liver Institute, Menoufia University, Egypt
Naser M.
Abd El-Bary
Clinical Oncology, Faculty of Medicine, , National liver Institute, Menoufia University, Egypt
Mohammed E
Abd El-Samea
Department of Diagnostic Medical and Interventional Radiology, National liver Institute, Menoufia University, Egypt
10.21608/ejhm.2021.168261
<strong>Background</strong>: Diffusion-weighted magnetic resonance imaging (DW-MRI) has the ability of tissue characterization and can differentiate between benign and malignant tissues, including differentiation between benign post-radiotherapy changes and residual or recurrent malignancy.
<strong>Objective: </strong>This study aimed to assess the role of diffusion-weighted magnetic resonance imaging in the evaluation of laryngeal and hypopharyngeal cancer as an initial diagnosis and the post-treatment surveillance protocol.
<strong>Patients and methods:</strong> This study was a cross-sectional analytical study including twenty-five patients who presented with laryngeal or hypopharyngeal masses, thirteen cases were pretreatment cases, and twelve cases were post-treatment cases after completion of treatment. Seven cases had a hypopharyngeal origin, and eighteen cases had a laryngeal origin. The patients were assessed using history taking, a telescopic examination of the larynx and hypopharynx, computed tomography scanning, and diffusion-weighted magnetic resonance imaging on the neck. Direct laryngoscopic examination and biopsy taking from suspicious lesions were done. Biopsies were subjected to histopathological examination with a correlation between pathological and DW- MRI radiological results.
<strong>Results: </strong>DW-MRI had a 100% sensitivity, 82.4 % specificity, and 88% accuracy compared to histopathological findings of biopsies from the studied group. There was a non-significant difference between DW-MRI and biopsy findings for either pretreatment or post-treatment cases of both laryngeal and hypopharyngeal origin of the lesions (p-value > 0.05 for all).
<strong>Conclusion:</strong> DW-MRI is a sensitive tool for detecting laryngeal and hypopharyngeal cancers in new cases and excluding tumor residual after chemo-radiotherapy in cases with suspicious lesions after completion of treatment.
apparent diffusion coefficient,Chemotherapy,Diffusion-weighted MRI,Laryngeal cancer,Hypopharyngeal cancer,Radiotherapy
https://ejhm.journals.ekb.eg/article_168261.html
https://ejhm.journals.ekb.eg/article_168261_12ec2216ee42901a9fff2da5b62eb842.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Factors Improve Outcome of Penetrating Chest Trauma
1400
1405
EN
Bahaa A.
Elkhonezy
Department of Cardiovascular and Thoracic Surgery,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
bahaacts@gmail.com
Haytham M.
Abdelmoaty
Department of Cardiovascular and Thoracic Surgery,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ibrahim K.
Gamil
Department of Cardiovascular and Thoracic Surgery,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
10.21608/ejhm.2021.168262
<strong>Background:</strong> Penetrating chest trauma occurs internationally, and numerous studies on it have been found in the literature. Penetrating thoracic trauma (PTT) is a difficult problem, but fortunately most of these injuries can be treated without surgery.
<strong>Objective:</strong> The current work aimed to evaluate factors that improve outcome of patients of penetrating chest injuries in Al-Azhar University Hospitals.
<strong>Patients and Methods:</strong> A retrospective investigation conducted on (73) consecutive cases with penetrating chest trauma, mean age was (31.51±6.25) years, patients were divided into (13) patients presented with bullet injury and (60) patients presented with stab wound, Dissension of surgical intervention was done according to clinical examination, emergency laboratory and imaging investigations. Surgical approach depended on position, side, and type of trauma.
<strong>Results:</strong> Relation between hospital stay and demographic data showed highly statistically significant differences as regard to age, type of trauma, unconsciousness, shock, echo and surgical procedure. Younger patients needed ≤7 days to improve. Also the majority of patients with stab trauma (45 patients out of 60 patients) improved within 7 days. Most of patients with unconsciousness needed >7 days to improve and also patients with repair surgery needed >7 days to improve.
<strong>Conclusion:</strong> To improve outcome of patient with penetrating chest trauma, effort should be done for resuscitation of patient with early suspicion of danger of trauma with early laboratory and imaging investigation, to reduce the time from the trauma till operation with correction of any metabolic and laboratory abnormalities.
<strong> </strong>
Bullet injury,Cardiac injury,Penetrating chest trauma,Stab wound
https://ejhm.journals.ekb.eg/article_168262.html
https://ejhm.journals.ekb.eg/article_168262_827ca456452853db3eb20e4f3779bab3.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Incidence of Acute Kidney Injury in Hospitalized Patients with Coronavirus Disease 19 Infection
1404
1408
EN
Walid Ahmed Ragab
Abdelhamid
Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
10.21608/ejhm.2021.168265
<strong>Background:</strong> While the most important sequelae of coronavirus disease 2019 (COVID- 19) are alveolar injury and respiratory failure, other systems has also been involved, particularly the renal system. The occurrence of acute kidney injury (AKI) varies broadly among patients with COVID-19 infection in various studies. Nevertheless, there is a lack of information from Middle Eastern countries. <strong>Objective: </strong>To study the effects of COVID-19 infection on kidney function and determine the predictors of AKI in those patients. <strong>Patients and Methods:</strong> The research involved 66 patients with verified diagnosis of COVID-19 infection. They were classified into group 1 (55 subjects) who did not develop AKI and group 2 (15 subjects) who developed AKI. All study participants were subjected to detailed history taking, clinical data recording and serial laboratory investigations during the time of hospital admission.
<strong>Results:</strong> Both groups were sex-matched. Group 2 was significantly older than group 1 with a median age of 69 years and had lower diastolic blood pressure (DBP) than group 1. Group 2 had significantly higher acute inflammatory markers, higher serum creatinine, higher blood urea, lower serum total protein and lower estimated glomerular filtration rate (eGFR) at the time of presentation than group 1. <strong>Conclusion: </strong>AKI occurred in 22.7% of patients with verified COVID-19 infection in this study. The significant predictors of AKI in these patients were lower DBP, higher C-reactive protein level, higher serum lactate dehydrogenase level, and lower baseline eGFR.
COVID-19,Acute kidney injury,Glomerular Filtration Rate,Lactate dehydrogenase,Cytokine Release Syndrome
https://ejhm.journals.ekb.eg/article_168265.html
https://ejhm.journals.ekb.eg/article_168265_65bb6ace08f5728c0129bb09050f2dce.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Effect of Different Body Positions on Intraocular Pressure in Patients with Primary Open Angle Glaucoma
1411
1416
EN
Mohammed Sayed
Mostafa
Department of Ophthalmology, Faculty of Medicine, Aswan University, Egypt
dr_mido_elkuwaity@yahoo.com
Tag-Eldin Mohammed
Othman
Department of Ophthalmology, Faculty of Medicine, Aswan University, Egypt
Abdalla Mohamed El Amin
Abdalla
Department of Ophthalmology, Faculty of Medicine, Aswan University, Egypt
Ahmed Fathy
Gabr
Department of Ophthalmology, Faculty of Medicine, Aswan University, Egypt
10.21608/ejhm.2021.168266
<strong>Background:</strong> Primary open-angle glaucoma (POAG) is the most common type of glaucoma. Increasing age, elevated intraocular pressure (IOP), and a positive family history are risk factors for POAG incidence. Elevated IOP is a major risk factor for glaucoma development and progression. The mechanism for IOP changes with body position is not completely understood.
<strong>Objective: </strong>The present study was aimed to investigate the effects of different body positions on IOP in patients with primary open-angle glaucoma.
<strong>Patients and methods: </strong>This prospective study included a total of 60 glaucoma and glaucoma suspect patients and 30 normal subjects, attending at Aswan University Hospital. Subjects were divided into 3 groups (normal, glaucoma suspect and primary open angle glaucoma). Each subject underwent thorough ophthalmological evaluation including best corrected visual acuity, slit lamp biomicroscopy, tonometry, gonioscopy, and dilated fundus evaluation. The Perkin's tonometer was used to measure IOP in different sleeping positions (at zero <sup>o </sup>degree, at 30<sup>o </sup>degree and 45<sup>o</sup>) positions. In all these positions, baseline IOP as well as after 30 minutes IOP was measured.
<strong>Results:</strong> Comparison of both age and gender across different groups showed that there were no statistically significant differences among them. In terms of the IOP, comparing all of the three groups at baseline showed that there was a statistically significant difference across groups (p < 0.0001). There was a statistically significant reduction of IOP in 30 and 45 degree semi sitting positions compared to supine positions in all study groups<strong>.</strong>
<strong>Conclusion: </strong>It could be concluded that certain sleeping positions appear to be associated with changes in intraocular pressure. It is essential not to overlook these short term fluctuations particularly in patients with primary open angle glaucoma as they can affect progression of the disease.
Body positions,Intraocular Pressure,Primary Open angle glaucoma
https://ejhm.journals.ekb.eg/article_168266.html
https://ejhm.journals.ekb.eg/article_168266_e839c0276b55f4987a8e4670b4d12e15.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Comparative Study between Dexmedetomidine vs Midazolam-Fentanyl on Emergence Agitation in Children Undergoing Cochlear Implantation in Sohag University Hospital
1417
1423
EN
Ghada Abd El-gaber
Rezk
Department of Anesthesia, Faculty of Medicine, Sohag University, Egypt
drghadagaber@yahoo.com
Hala Mahmoud
Hashem
Department of Anesthesia, Faculty of Medicine, Sohag University, Egypt
Abd El Hady Ahmed
Helmy
Department of Anesthesia, Faculty of Medicine, Sohag University, Egypt
10.21608/ejhm.2021.168267
ABSTRACT
<strong>Background: </strong>Surgery of cochlear implantation is a great advance in otology for patients with deaf mutism, but it carries a great challenge to the anesthesiologist.
<strong>Objective: </strong>The aim of the current work was to compare effect of bolus Dexmedetomidine infusion versus bolus Midazolam- fentanyl infusion as regards; emergence agitation & recovery time, hemodynamics, postoperative pain and complication.
Patient and Methods: This study included a total of 40 pediatric patients (ASA I or II), undergoing cochlear implantation, attending at Sohag University Hospital. They were randomized divided into dexmedetomidine (D) group and midazolam (M) group.
Results: There was no significant difference between both groups as regard intraoperative mean blood pressure. There was a significant difference at discharge time. There was statistically insignificant decrease in heart rate (HR) in group D than M group. There was statistically significant difference at 1 min and discharge measurements. There was a highly significant difference between both groups as the time for recovery being more rapid in D group than in M group. Mask Acceptance Scale (MAS) was better within D group than M group without statistically significant difference. There was a no significant difference in emergence agitation between both groups. There was no significant difference between both groups as regard objective pain score. As regard nausea and vomiting, there was a highly significant difference between both groups.
Conclusion: It could be concluded that dexmedetomidine infusion in cochlear implantation in pediatric patients was equal as midazolam-fentanyl in inducing hypotension, emergence agitation and giving post-operative analgesia. However, dexmedetomidine infusion is better as regardrapid recovery without inducing nausea and vomiting.
Dexmedetomidine,Midazolam-Fentanyl,Undergoing Cochlear Implantation,children
https://ejhm.journals.ekb.eg/article_168267.html
https://ejhm.journals.ekb.eg/article_168267_07dce277f5b264fe561ab0215b7536d7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
The Effect of Different Induction Therapies on Graft Functions in Renal Transplantation
1424
1428
EN
Gulay
Yilmaz
Acıbadem International Hospital, Department of Nephrology and Transplantation, Istanbul, Turkey
Can
Sevinc
0000-0002-4069-9181
Ataturk University Faculty of Medicine Department of Internal Medicine and Nephrology, Erzurum, Turkey
dr_cansevinc@yahoo.com
10.21608/ejhm.2021.168268
<strong>Introduction:</strong> Rejection and delayed graft function (DGF) are frequent problems after renal transplant. The use of induction therapies increases graft survival and reduces acute rejection frequency. Here, we wanted to see one-year outcomes of patients who did not receive induction therapy and those who received basiliximab or anti-thymocyte globulin (rabbit) (rATG).
<strong>Patients and Methods:</strong> 741 renal transplant recipients were divided into 3 groups: 223 patients who received rATG, 213 who received basiliximab, and 305 patients who did not receive any induction therapy. Patients’ demographic characteristics, ischemia times, creatinine levels, presence of DGF and acute rejection were studied.
<strong>Results:</strong> 35.6% (n=264) of the patients were female and 64.4% (n=477) were male; their ages were 4 to 72 years. During follow-up, 27 (3.6%) patients had DGF and 152 (20.5%) had acute rejection. There was no difference in DGF and rejection between the 3 groups.
<strong>Conclusion:</strong> Although there wasn’t statistically difference in DGF, acute rejection, or 1- year creatinine levels between groups, the rATG group had higher hemodialysis rate, longer dialysis time, lower rate of preemptive transplantation, and lower mean age.
Delayed graft function,Induction,rejection,Renal transplantation
https://ejhm.journals.ekb.eg/article_168268.html
https://ejhm.journals.ekb.eg/article_168268_061c6d5beb7bfcfddea4b2eb74eef144.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Preemptive Ketamine in Abdominal Hysterectomy Patients, Does the Route of Administration Affect Analgesia and Hemodynamics? A Prospective Randomized Controlled Trial
1429
1435
EN
Mohamed Adel
Aboelela
0000-0001-8019-0243
Department of Anesthesia and Surgical Intensive Care, Mansoura University, Egypt.
aboelela_mohamed@yahoo.com
10.21608/ejhm.2021.168855
<strong>Introduction:</strong> Hysterectomy is a common procedure and postoperative pain is a considerable problem. Preemptive analgesia includes analgesic administration prior to surgical stimulus. Ketamine is a short acting anesthetic drug with analgesic and anti-inflammatory properties, reducing central sensitization of pain pathway and hyperalgesia.
<strong>Objectives:</strong> This study aimed to assess the efficacy of preemptive use of ketamine as an analgesic drug, either by intravenous route or by subcutaneous infiltration at the incisional site, regarding perioperative hemodynamics, postoperative pain and gastrointestinal irritation symptoms.
<strong>Patients and methods:</strong> 60 patients were enrolled in this study, divided into two equal groups (30 each) according to route of preemptive ketamine administration. Group (V) received 0.5 mg.kg<sup>-1 </sup>intravenously while group (S) received 0.5 mg.kg<sup>-1</sup> subcutaneously at incisional site. Postoperative pain assessment for 24 H. using visual analogue score (VAS) was adapted as primary outcome objective, while secondary outcomes included hemodynamic parameter and postoperative nausea and vomiting (PONV). <strong>Results:</strong> Data were analysed. VAS score showed significant difference among studied groups in early 2 postoperative hours. VAS<sup>0</sup> (V 2.40±0.62, S 1.96±0.92, P 0.038), VAS<sup>1</sup> (V 3.96±1.21, S 2.86±0.89, P 0.001), VAS<sup>2</sup> (V 4.00±0.94, S 3.33±0.88, P 0.007). Also, first time to pethidine intake (V 1.50±0.93 H, S 2.36±1.27 H, P 0.004). Other study objectives were comparable.
<strong>Conclusion:</strong> Preemptive use of ketamine with subcutaneous infiltration at incisional site in total abdominal hysterectomy patients provided better analgesia in early postoperative hours rather than intravenous route with comparable hemodynamic parameter and side effects.
hemodynamics,Hysterectomy,Pain,Preemptive ketamine,VAS
https://ejhm.journals.ekb.eg/article_168855.html
https://ejhm.journals.ekb.eg/article_168855_ff73ce52b2ee12959335674afa42e33f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Renal Transplants COVID-19 Infection with Different Presentations, Clinical Courses and Outcomes
1436
1442
EN
Ahmed H.
Elthakaby
Nephrology Departments National Institute of Urology and Nephrology,Cairo,Egypt
Azza Ali I.
Elmenyawi
Clinical Pathology2Departments National Institute of Urology and Nephrology,Cairo,Egypt
10.21608/ejhm.2021.170288
<strong>ABSTRACT</strong>
We report five cases with different clinical presentations of COVID-19 infection in renal transplant patients. Initially a typical clinical presentation, in the form of CNS manifestations (amnesia, behavior change followed by left sided paresis) for the 1<sup>st</sup> case, GIT manifestations for the 2<sup>nd</sup> case and chest and cardiac manifestations for the 3<sup>rd</sup> case. The other two cases similarly presented with chest manifestations but with different clinical courses. Our patients had a favorable outcome, which may provide a reference value for treating COVID-19 patients.
Clinical manifestation,COVID19 virus infection,Renal transplant recipient
https://ejhm.journals.ekb.eg/article_170288.html
https://ejhm.journals.ekb.eg/article_170288_27b9f633a0ba8e79ca60ce4597f9c9f8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Evaluation Of The Relationship between Serum Uric Acid and Bone Mineral Density In Rheumatoid Arthritis Male Patients
1443
1448
EN
maha
mohamed
salman
0000-0002-8102-4228
rheumatology and rehabilitation department faculty of medicine- Menofia university
mhasalman200@gmail.com
Eman A.
Galbat
Department of Physical Medicine, Rheumatology and Rehabilitation,
Faculty of Medicine, Menofia University, Egypt
10.21608/ejhm.2021.170289
<strong>Background:</strong> Hyperuricemia is a common risk factor for conditions associated with oxidative stress. Alternatively, there is increasing evidence that normal serum uric acid (UA) plays a protective role as an antioxidant. Osteoporosis was commonly attributed to oxidative stress and is a common complication of rheumatoid arthritis (RA).
<strong>Objectives:</strong> To study the relationship between serum UA and bone mineral density in male patients with rheumatoid arthritis.
<strong>Patients and methods:</strong> Fifty RA male patients were included in this study. Age, disease duration, and type of medication were recorded. Clinical examination for tender and swollen joints was done and disease activity score 28 was calculated. Body mass index, random blood glucose, erythrocyte sedimentation rate, C-reactive protein, serum UA, rheumatoid factor and anti-CCP were measured. Bone mineral density was measured using dual-energy X-ray absorptiometry at the lumbar spine, hip and radius.
<strong>Results:</strong> A highly significant positive correlation between serum UA and T scores in the lumbar spine and hip. However, serum UA was negatively correlated with disease activity, ESR and CRP (P < 0.001). There was significant (P < 0.001) association between serum UA and different therapeutic agents (levels of serum UA were higher in patients taking combined biological and conventional disease modifying anti-rheumatic drugs (DMARDs) than those who were taking biological or conventional DMARDs alone.
<strong>Conclusion:</strong> High normal serum UA level is protective against osteoporosis at both the lumbar spine and hip in male rheumatoid arthritis patients. Also, serum UA level is negatively correlated with RA disease activity and acute phase reactants in male patients with RA.
Rheumatoid Arthritis,Uric acid,DMARDs,DAS28,DEXA
https://ejhm.journals.ekb.eg/article_170289.html
https://ejhm.journals.ekb.eg/article_170289_43c8198f60ff16fe6f6e5aae9668db4c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Patterns of Angiogenic Factors (VEGF, Angiopoietin-1) in Patients with Benign Thyroid Lesions Before and After Surgery
1449
1455
EN
Ahmed Hamed
Horeya
Department of Endocrine Surgery Unit, Faculty of Medicine, Mansoura University, Egypt
ahoreya@hotmail.com
Ehab Mohamed
Khedr
Department of Endocrine Surgery Unit, Faculty of Medicine, Mansoura University, Egypt
Yasser Ali
Elsayed
Department of Endocrine Surgery Unit, Faculty of Medicine, Mansoura University, Egypt
Atef Mohamed
Abdel-Latif
Department of Endocrine Surgery Unit, Faculty of Medicine, Mansoura University, Egypt
Osama Elbaz
Elagroudy,
Department of Endocrine Surgery Unit, Faculty of Medicine, Mansoura University, Egypt
10.21608/ejhm.2021.170290
<strong>Background:</strong> Angiogenesis plays an important role in goiter development with endothelial cell proliferation occurring before increased proliferation of the thyroid follicular cells and increase in both vascular endothelial growth factor (VEGF) and Angiopoietin-1 (Ang-1) in the serum and intrathyroid tissue.
<strong>Objective: </strong>The aim of the current work was to measure the levels of VEGF and Ang-1 in patients with benign thyroid disorders before and after thyroidectomy and compare it to the normal control subjects.
<strong>Patients and Methods: </strong>This prospective study included a total of 80 patients provisionally diagnosed as benign thyroid disorders and 50 apparently healthy subjects served as a control group, attending at Outpatient Clinics of Endocrine Surgery Unit, Mansoura University Hospital. This study was conducted between February 2017 to February 2020. Of the 80 patients, 12 (15%) were male and 68 (85%) were female and their age ranged from 19 to 60 years (median = 40.41 years). On admission, careful history taking, clinical examinations and different investigations were done.
<strong>Results: </strong>Thirty patients had benign multinodular goiter, 20 had solitary follicular adenoma, 10 had diffuse toxic, 10 had nodular toxic goiter, and 10 had Hashimoto thyroiditis. In all patients, pre-operative circulating VEGF and Ang-1 levels were increased compared to controls (<em>P</em><0.001), and a decrease after thyroidectomy was observed in the levels of VEGF (<em>P</em><0.001) in all of them. This decrease was significant after total thyroidectomy compared to near total and hemi-thyroidectomy. Circulating Ang-1 were significantly increased (<em>P</em><0.001) after thyroidectomy in all patients.
<strong>Conclusion:</strong> It could be concluded that this study raise the potential for VEGF and Ang-1 factor to be used as biomarkers of the effectiveness of thyroidectomy in benign thyroid lesions. These results needs further investigations and may have potential prognostic implications.
Angiogenesis,Thyroidectomy,VEGF,Angiopoietin-1
https://ejhm.journals.ekb.eg/article_170290.html
https://ejhm.journals.ekb.eg/article_170290_d68044c513b9acc56bf4dd4a00fa384d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Study of the Outcome of Emergency Small Bowel Resections Regarding Morbidity and Mortality
1456
1461
EN
Hamza Hashem Awad
Mohammed
Department of General Surgery, Faculty of Medicine - Aswan University, Egypt
surgion.hamza@gmail.com
Mahmoud S
Ahmed
Department of General Surgery, Faculty of Medicine - Aswan University, Egypt
Mansour Mohammed
Kabbash
Department of General Surgery, Faculty of Medicine - Aswan University, Egypt
Abd-El Aal Ali
Saleem
Department of General Surgery, Faculty of Medicine - Sohag University, Egypt
10.21608/ejhm.2021.170291
<strong>Background: </strong>Management of small intestinal diseases in the emergency setting, imposes a challenge and is associated with incidence of perioperative mortality and morbidity. Many factors may contribute to this adverse outcome, it may be patient-related factors, associated colonic injuries or related to presenting derangement locally or systemically.
<strong>Objective</strong>: To rate the reported morbidity and mortality after small bowel emergencies with resections and re-anastomosis and the impact of preoperative, operative and postoperative factors on patients’ outcomes.
<strong>Patients and Methods: </strong>A total of 60 patients who underwent emergent small bowel resection were included in this study. This study was performed using data from patients of both sexes aged above 12 years old who presented with small bowel emergencies that needed emergency resection, which were managed in the General Surgery Department of Aswan University Hospital, during the period from March 2019 until February 2020.
<strong>Results: </strong>There was a statistically significant difference between them regarding age groups, the prevalence of comorbidities and previous abdominal surgeries. We found that associated injuries were associated with the most added risk of morbidity and time of presentation in the multivariate module, followed by hemodynamic instability. The two independent modifiable variables were the hemodynamic instability after initial resuscitation and the choice of simplest shortest appropriate operative option.
<strong>Conclusion:</strong> Regarding morbidity, there was significant effect of age and the presence of comorbidities. These results may aid the acute-care surgeons in identifying patients with a high-risk for postoperative complications and fatal outcomes.
Morbidity and Mortality,Small bowel emergency
https://ejhm.journals.ekb.eg/article_170291.html
https://ejhm.journals.ekb.eg/article_170291_72a2a51c745aa6a8c67f0747dc926ecc.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
The Role of Contrast Enhanced Digital Mammography in Evaluation of Breast Masses
1462
1471
EN
Hayam A.
Abdellatif
Department of Radiodiagnosis, Faculty of Medicine - Menofia University, Egypt
Shrouk M.
El Dalatony
Department of Radiodiagnosis, Faculty of Medicine - Menofia University, Egypt
shrouk.roka.sh@gmail.com
ElSayed E.
ElSayed
Department of Radiodiagnosis, Faculty of Medicine - Menofia University, Egypt
10.21608/ejhm.2021.170292
<strong>Background:</strong> A thorough clinical breast examination, imaging, and tissue sampling are needed for a definitive diagnosis of breast diseases. Contrast-enhanced digital mammography (CEDM) is the second type of advanced technology stemming from the digital platform (the first being tomosynthesis) that proved to be promising in this field. <strong>Objectives:</strong> The aim of this study was to evaluate the role of contrast enhanced digital mammography in diagnosis of breast masses. <strong>Patients and Methods:</strong> The study included 30 participants who visited the hospital for assessing their complaints of breast masses during the period from May 2019 to May 2020 after taking their consent. <strong>Results: </strong>The contrast enhanced digital mammography (CEDM) proved that 17 patients (56.7%) proved with malignant masses, 10 (33.3%) benign and 3 (10%) normal that was confirmed by final diagnosis of these cases. The sensitivity and specificity of the CEDM (100%, 92.86%) respectively, that expresses high levels of both parameters. <strong>Conclusion:</strong> CEDM has higher diagnostic value that can enhance the process of early cancer diagnosis, postoperative follow up, and treatment plans.
Breast Masses,CEDM,Mammography,sensitivity,specificity
https://ejhm.journals.ekb.eg/article_170292.html
https://ejhm.journals.ekb.eg/article_170292_629414d204b1fecc0ad26f3dccd66d1f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Multi Slice CT Cholangiography Using Minimum Intensity Projection in Evaluation of Patients with Biliary Obstruction: Comparison with Percutaneous Trans Hepatic Cholangiography
1472
1476
EN
Hayam Abdelmonsif
Abdellatif
Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Egypt
hayam_drar@yahoo.com
Mohammed Ramadan
Alkholy
Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Egypt
Hagar Said
Zidan
Department of Radiology, National Liver Institute Menoufia University, Egypt
Mohammed Shawky
Alwarrky
Department of Radiology, National Liver Institute Menoufia University, Egypt
10.21608/ejhm.2021.170508
<strong>ABSTRACT</strong>
<strong>Background:</strong> Evaluation of the diagnostic value of computed tomography (CT) cholangiography with minimum intensity projection (MinIP) in the work up of patients with obstructive biliary disease through correlation with percutaneous trans hepatic cholangiography (PTC) results.
<strong>Objective: </strong>In this study, we aimed to evaluate the diagnostic value of CT cholangiography with MinIP in the work up of patients with obstructive biliary disease through correlation with PTC results.
<strong>Patients and Method:</strong> The study included 36 patients (26 males and 10 females), with biliary obstruction. CT cholangiography was done to reach a definite diagnosis for the cause of obstruction and PTC was done during their management plan. Analysis of the image data with (MinIP) images was created on a separate workstation and compared to that of PTC. <strong>Results:</strong> The CT cholangiography using MinIP technique correctly diagnosed the cause of obstruction among all included cases. No significant difference was found between measurements of obstructing lesion size. We had a novel observation about that axial images are significantly better to reveal the obstructing biliary lesion if the cause of obstruction is intrahepatic; while coronal images are significantly better to reveal the obstructing biliary lesion if the cause of obstruction is extrahepatic.
<strong>Conclusion: </strong>CT cholangiography with MinIP is a complete noninvasive technique that provides projectional images similar to that of PTC without administration of oral specific contrast agents, requires no medications, less operator dependent and no complications were encountered in adequately screened patients.
Biliary obstruction,Biliary tract diseases,Cholangiography,CT,MinIP images,PTC
https://ejhm.journals.ekb.eg/article_170508.html
https://ejhm.journals.ekb.eg/article_170508_5ccec9fbe6684f17a0dde167fb6720f8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Solid Organs Injuries in Blunt Abdominal Trauma Patients
1477
1483
EN
Mokhtar Farid
Abo-Elhoda
Departments of General Surgery Faculty of Medicine – Mansoura University, Egypt
Samir Mohamed
Attia
Departments of Vascular Surgery, Faculty of Medicine – Mansoura University, Egypt
Mohamed Elsaid
Ahmed
Departments of Surgery, Critical Care Medicine and Faculty of Medicine – Mansoura University, Egypt
Khaled Abdelmoneim Elsayed
Abdeldaiem
Departments of Emergency Medicine and Traumatology, Faculty of Medicine – Mansoura University, Egypt
kabdeldaiem@gmail.com
10.21608/ejhm.2021.170510
<strong>Background: </strong>Trauma is a major public health problem worldwide, morbidity and mortality in solid organ injuries (SOIs) following blunt abdominal trauma are often related to the severity of associated injuries. The management of SOIs depends upon the hemodynamic status of the patients. Hemodynamically unstable patients often require surgical management. Nonoperative management (NOM) is preferred in hemodynamically stable patients.
<strong>Objective: </strong>This study was conducted to detect both incidence of solid organs injuries in blunt abdominal trauma patients and pattern of injuries as well as outcome in operative management comparing to non-operative management patients. <strong>Patients and methods: </strong>During the study period, total number of 6908 polytrauma patients presented to Mansoura University Emergency Hospital. Among them 685 (9.9%) presented by abdominal trauma. There were 173 cases with penetrating abdominal trauma and 512 cases with blunt abdominal trauma (BTA). Among the cases with BAT, 268 cases were excluded and the remaining 244 were included in the current study.
<strong>Results: </strong>The most common cause of trauma was road traffic accidents (RTA) (64.3%) of the cases. Solid organs were affected in (70.1%) of the cases, bowels and other abdominal organs were affected in (24.2%), combined solid organs and other abdominal injuries were detected in (5.7%) of the cases. Spleen was the most affected organ in 55.1% of the cases. Total operative management (OM) was required in 70 cases (37.8%) and total NOM was required in 115 cases (62.2%). The overall incidence of mortality was 5.4%. There was no statistically significant difference in the length of hospital stay between the cases according to management (operative or non-operative).
<strong>Conclusion: </strong>Hemodynamically stable blunt abdominal trauma with solid organ injury may be managed safely using a NOM approach.
Blunt Abdominal Trauma,NOM,Solid Organs Injuries
https://ejhm.journals.ekb.eg/article_170510.html
https://ejhm.journals.ekb.eg/article_170510_9c2e1102917fc39aa0f05c29b10aaba7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Relationship Between Serum Adipocyte Fatty Acid Binding Protein and Atherosclerosis in Type 2 Diabetes Patients
1484
1489
EN
said
M
Al-Barshomy
0000-0003-4004-0931
internal medicine, zagazig university, egypt
saidbarshomy@yahoo.com
Hala
Allam
Departments of 1Internal Medicine and Nephrology Faculty of Medicine, Zagazig University, Egypt
Hazem
Tantawi
Departments of Internal Medicine and Nephrology
Faculty of Medicine, Zagazig University, Egypt
10.21608/ejhm.2021.170511
<strong>Background:</strong> Atherosclerosis as a complication of diabetes, is considered to be a chronic inflammatory disease, developing over years and proceeding through many steps. Adiposity fatty acid–binding protein (A-FABP) is highly expressed in mature adipocytes and plays a central regulatory role in energy metabolism and inflammation<em>.</em> A-FABP mRNA expression in adipose tissues predicted coronary artery disease in homozygous subjects<em>.</em> A-FABP may also play a role in the development of atherosclerotic diseases in humans.
<strong>Objective: </strong>To detect the relationship between serum A-FABP level and carotid intima-media thickness (IMT) as indicator of atherosclerosis in patients with type 2 diabetes mellitus.
<strong>Patients and methods:</strong> 124 patients with type 2 diabetes (T2D), were divided into two groups: Group 1: 62 patients with T2D ≤ 5 years duration, and Group 2: 62 patients with T2D > 5 years duration. They were subjected to full history taking, clinical examination, and laboratory investigations in the form of CBC, LFT, KFT, HBA1c, fasting and postprandial blood sugar, A-FABP serum level, and carotid Doppler.
<strong>Results: </strong>Serum level A-FABP and carotid IMT was significantly higher in long standing diabetes group compared to short standing diabetes group.A-FABP cutoff was proven to have a high sensitivity 94.4%, specificity 100.0%, positive predictive value of 100.0%, negative predictive value of 97.7% and overall accuracy of 98.3% regarding the prediction of atherosclerosis<strong>.</strong>
<strong>Conclusions:</strong> A-FABP serum level have a high sensitivity, specificity<strong>, </strong>predictive value and overall accuracy regarding atherosclerosis, and should be recommended as a part of routine surveillance for atherosclerosis in patients with type 2 diabetes.
Adipocyte fatty acid protein,Carotid Doppler,diabetes
https://ejhm.journals.ekb.eg/article_170511.html
https://ejhm.journals.ekb.eg/article_170511_528e6f7501e0928c91f4707065ea1a14.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Pancreatic Exocrine Insufficiency among Diabetic Patients
1490
1495
EN
Mahmoud
Rizk
0000-0003-0916-3351
Internal Medicine Department, Gastroenterology and hepatology unit, Faculty of Medicine, Benha University, Egypt
mahmoudrizk70@yahoo.com
Ahmed Mohamed
Hussein
Departments of Internal Medicine Faculty of Medicine, Benha University, Egypt
Mohamed Abd Ellatif
Afifi
Departments of Internal Medicine Faculty of Medicine, Benha University, Egypt
Seham Gouda
Ameen
Departments of Clinical and Chemical Pathology,
Faculty of Medicine, Benha University, Egypt
El-Gazzarah
Ahmed Ragab
Department of Tropical Medicine, Faculty of Medicine, Menoufia University, Egypt
10.21608/ejhm.2021.170512
<strong>Background</strong>: Various studies have defined the existence of pancreatic exocrine insufficiency (PEI) in diabetic patients. The concentration of faecal elastase-1 (FE-1) has long been used as a screening method for exocrine pancreatic activity, with good results when compared to direct methods. The prevalence of pancreatic exocrine insufficiency in Egyptian diabetic patients measured by FE-1 concentration is still unknown.
<strong> Objective:</strong> To investigate the prevalence of PEI in Egyptian diabetic patients, and to examine its relationship with the degree of glycemic control and other metabolic parameters.
<strong> Patients and Methods:</strong> In this cross-sectional study, 180 diabetic patients, were divided into two equal groups. Group I: patients with type 1 diabetes mellitus (T1D) and Group II: patients with type 2 diabetes mellitus (T2D). Other 90 healthy subjects were enrolled in the study as a control group (Group III). All participants were evaluated for PEI by measuring the FE-1 concentration through the enzyme-linked immunosorbent assay (ELISA) method. Patients having FE-1 concentration < 200 µg/g of stool were diagnosed with PEI.
<strong> Results:</strong> The prevalence of PEI was 35.6% in T1D, 31.3% in T2D, and 7.8% in the control group (P < 0.001). A significant negative correlation was observed between FE-1 levels and both FBS and HbA1c in diabetic patients. There was also a significant positive correlation between body mass index (BMI) and FE-1 concentration for T1D and T2D groups.
<strong> Conclusion:</strong> Significant PEI was observed in Egyptian T1D and T2D patients assessed by the FE-1 concentration test.
Pancreatic exocrine insufficiency,diabetes,FE-1,Faecal elastase-1 concentration
https://ejhm.journals.ekb.eg/article_170512.html
https://ejhm.journals.ekb.eg/article_170512_53ab3d0d70e1586a9c0018cfc3113142.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Subclinical and Clinical Hypothyroidism in Proteinuric Nephropathies: Amelioration of Proteinuria and Preservation of Renal Function by Thyroid Hormone Replacement Therapy
1496
1503
EN
Saddam
A
Hassan
9, Saad Zaghloul, Kasr Alaini
saddam.ahmed@fmed.bu.edu.eg
El Metwally L.
El Shahawy
Internal Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt
Ashraf Talaat
Mahmoud
Internal Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt
Enas Mamdouh Mohamed
Ali
Internal Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt
Mohamed E.
Ibrahim
Internal Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt
10.21608/ejhm.2021.170514
<strong>Background</strong>: Emerging evidence shows a bi-directional talk between the kidney and thyroid; yet to date, sparse data exist as to the screening and treatment of hypothyroid states, whether Subclinical Hypothyroidism (SCH) or Clinical Hypothyroidism (CHT), in Chronic Kidney Disease (CKD) patients.
<strong>Objectives</strong>: The aim of the current study was to examine the association between thyroid hypofunction (whether subclinical or clinical) and proteinuric CKD (low eGFR and/or proteinuria), and to assess the impact of treating thyroid hypofunction on the progression of CKD.
<strong>Patients and methods</strong>: We conducted a prospective cohort study on 100 participants with baseline proteinuric CKD who were subcategorized according to their thyroid status into three groups: 20 euthyroid, 40 (SCH), 40 (CHT). All subjects were then followed up for 2 years after receiving Thyroid Hormone Replacement Therapy (THRT) according to their thyroid status.
<strong>Results</strong>: At baseline, we found a highly statistically significant association between SCH/CHT and low eGFR and proteinuria (P-value 0.001 for both) in univariate and multivariate analyses. After THRT, we found a statistically significant reduction in CKD progression as evidenced by preservation of mean eGFR and decrease in proteinuria in both groups with SCH and CHT (P-value 0.001 and 0.016 respectively) after the first 6 months of treatment that persisted over the remainder of 2-year follow-up period at a P-value 0.001.
<strong>Conclusion</strong>: The current study demonstrated a strong association between baseline proteinuric CKD and hypothyroid states and showed that THRT significantly halted CKD progression in hypothyroid patients who achieved euthyroid state.<br /><br />
Chronic Kidney Disease (CKD),Proteinuria,Subclinical Hypothyroidism (SCH),Thyroid Hormone Replacement Therapy (THRT)
https://ejhm.journals.ekb.eg/article_170514.html
https://ejhm.journals.ekb.eg/article_170514_501e2b4c979db8ce04a5847a7e660c16.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Transthoracic Echocardiography A Predictor of Complications in Patients with Severe Preeclampsia
1504
1508
EN
Ahmed M.A.
Ismail
Departments of Anesthesia, Intensive Care and Pain Management
Faculty of Medicine, Sohag University, Egypt
ahmed.aly25.aa@gmail.com
Hamza A.A.
Mahmoud
Departments of Anesthesia, Intensive Care and Pain Management
Faculty of Medicine, Sohag University, Egypt
Eman I.
Darweesh
Departments of Anesthesia, Intensive Care and Pain Management
Faculty of Medicine, Sohag University, Egypt
Abd El Rahman H.
Mohamed
Departments of Anesthesia, Intensive Care and Pain Management
Faculty of Medicine, Sohag University, Egypt
Mohamed A.W.
Ezaat
Departments of Internal Medicine,
Faculty of Medicine, Sohag University, Egypt
10.21608/ejhm.2021.170518
<strong> </strong>
<strong>Background: </strong>Severe preeclampsia (PE) and eclampsia are a hypertensive disease of pregnancy associated with significant morbidity and mortality and require special monitoring. Lung ultrasonography and transthoracic echocardiography are a novel monitoring and diagnostic tools in intensive care and are widely used nowadays.
<strong>Objective:</strong> To detect the role and value of transthoracic echocardiography (TTE) in postoperative monitoring in patients with severe PE.
<strong>Patients and Methods: </strong>This was a cross sectional study of 55 patients with severe preeclampsia, 35 patients with eclampsia and 60 healthy controls. Transthoracic echocardiography was done to evaluate diastolic function using E/A ratio with continuous wave Doppler, ejection fraction using M mode in long axis parasternal view and inferior vena cava (IVC) diameter in subcostal view. All measurements were done postoperatively.
<strong>Results: </strong>There was significant difference between the 3 groups regarding diastolic function (p value 0.0001). Abnormal diastolic function in severe PE, eclampsia and controls was 81.2%, 94.3% and 5% respectively. There was no difference between the 3 groups of the study as regard IVC diameter. There was significant difference between the 3 groups as regards EF (P=0.007), the mean of EF in severe PE, eclampsia and controls was 66.89 ± 5.54, 63.029 ± 8.45 and 66.43 ± 4.16 respectively. <strong>Conclusions:</strong> The use of transthoracic echocardiography is mandatory in postoperative monitoring in patients with severe PE and eclampsia as they can adjust management and detect complications. Restricted fluid therapy policy is indicated with the higher grades of diastolic dysfunction and lower ejection fraction (EF).
<strong> </strong>
Echocardiography,Eclampsia,lung ultrasonography,severe preeclampsia
https://ejhm.journals.ekb.eg/article_170518.html
https://ejhm.journals.ekb.eg/article_170518_614f179b61df3ce87c74763febf229f4.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Interleukin-35 Level in Acne Vulgaris
1509
1513
EN
Talal Ahmed
Abd El-Raheem
Department of Dermatology, STDs and Andrology, Faculty of Medicine, Fayoum University, Egypt
Mohamed Hassan
Mohamed
Department of Dermatology, STDs and Andrology, Faculty of Medicine, Fayoum University, Egypt
Olfat Gmeel
Shaker
Department of Biochemistry, Faculty of Medicine, Cairo University, Egypt
Haiba Ali
Mohamed
Department of Dermatology, STDs and Andrology, Faculty of Medicine, Fayoum University, Egypt
haibaaly@gmail.com
10.21608/ejhm.2021.170520
<strong><span lang="EN-US">Background: </span></strong><strong><span lang="EN-US">Acne vulgaris is a multifactorial disease affects the pilosebaceous follicle and results in inflammatory and non-inflammatory lesions with certain role of cytokines in its pathogenesis. Interleukin-35 (IL-35) cytokine has been shown to exhibit immunosuppressive activities, which are distinct from other members of IL-12 family. IL-35 is also unique in that it is expressed primarily by regulatory T- cells (Tregs) rather than by antigen-presenting cells (APCs).</span></strong>
<strong><span lang="EN-US">Objective: </span></strong><strong><span lang="EN-US">To investigate the role of IL-35 in the pathogenesis of acne vulgaris by assessing its levels in lesional skin and serum of patients with acne vulgaris compared with normal individuals.</span></strong>
<strong><span lang="EN-US">Patients and methods: </span></strong><strong><span lang="EN-US">44 subjects were divided into 2 groups: Group 1: It included measurement of serum and tissue level of interleukin 35 in 22 acne vulgaris patients with age group (15-30). All of them were subjected to detailed history taking, dermatological and general examination. Group 2: It included 22 healthy, age, and gender matched individuals as a control group.</span></strong>
<strong><span lang="EN-US">Result:</span></strong><strong><span lang="EN-US">Our results show a highly statistically significant difference between acne patient and control regarding IL-35 level in serum and tissue.</span></strong>
<strong><span lang="EN-US">Conclusion: </span></strong><strong><span lang="EN-US">Our study may provide evidence that serum and tissue IL-35 are important anti-inflammatory cytokines. They are actively expressed by the sebaceous glands. They have significant higher expression in acne patients. They are hypothesized to play a key role in acne cure at multiple points, through their anti-inflammatory action. This effect may be hindered in acne vulgaris by undiscovered obstacles.</span></strong>
Acne vulgaris and cytokines,IL-35 anti-inflammatory cytokine
https://ejhm.journals.ekb.eg/article_170520.html
https://ejhm.journals.ekb.eg/article_170520_768b1b374b7b09ae2869c8e64faa47ad.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Validation of the Patient-Doctor Relationship and Patient Satisfaction Questionnaire for An Arabic Adult Population in an Egyptian Sample
1514
1519
EN
Nagwa N.
Hegazy
Department of Family Medicine, Faculty of Medicine, Menoufia University, Egypt
Taghreed M.
Farahat
Department of Family Medicine, Faculty of Medicine, Menoufia University, Egypt
Asmaa
Magdy
Elakkad
Department of family medicine, faculty of medicine, Menoufia University, Egypt
alaslameia84@gmail.com
Marwa M.
Mohasseb
Department of Family Medicine, Faculty of Medicine, Menoufia University, Egypt
10.21608/ejhm.2021.170523
<strong>Background</strong>: Patient-doctor relationship and patient satisfaction are important engines that improve patient compliance and hence the health outcome. There are widely used instruments to measure patient-doctor relationship and patient satisfaction for primary health care purposes. Researchers lack a validated Arabic instrument that is tailored to the Arab population. So, it is important to translate and validate Patient-Doctor Relationship (PDRQ9) and patient satisfaction (PSQ 18) questionnaires into the Arabic language.
<strong>Objectives:</strong> Is therefore to develop, evaluate, and validate a self-reported measure of Patient-Doctor Relationship (PDRQ9) and patient satisfaction (PSQ 18).
<strong>Subject and Method: </strong>The Arabic version of PDRQ-9 and the PSQ-18 was translated from the English one with back to back translation. They were pilot tested statistically to ensure the psychometric properties (reliability and validity) and the appropriateness for the adult participants in the Arab countries. The Arabic questionnaires were administered to 434 adult participant attending primary health care facilities and hospitals in Suez Governorate, Egypt.
<strong>Results: </strong>Exploratory factor analysis suggested two factors, comprising of 27 items in total. Good model fit was demonstrated through confirmatory factor analysis, with measurement invariance analyses demonstrating equivalent factor structures across. Internal consistency for the PDRQ-9 ranged between (α= 0.981-0.975) for the total scores and that for PSQ-18 ranged between (α = 0.986-0.984).
<strong>Conclusion:</strong> Initial testing of the Arabic versions of the PDRQ-9 and PSQ-18 suggests that these questionnaires have satisfactory psychometric properties.
<strong> </strong>
<strong> </strong>
arabic version,Egypt,Patient-doctor relationship,patient satisfaction,Questionnaires
https://ejhm.journals.ekb.eg/article_170523.html
https://ejhm.journals.ekb.eg/article_170523_cd19813e35d60f949b17e0b21088bbb2.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Predictors of Remission in Lupus Nephritis Pati
1520
1526
EN
Emad Mohamed
El-Shebiney
Clinical Immunology and Rheumatology Unit, Internal Medicine Department, Menoufia University, Egypt
emanhamdiabdelatty@gmail.com
Enas Sobhy
Zahran
Clinical Immunology and Rheumatology Unit, Internal Medicine Department, Menoufia University, Egypt
Alaa Efat
Abd EL-Hamid
Hematology and BMT Unit, Internal Medicine Department, Menoufia University, Egypt
Eman Hamdi
Abdelatty
Nephrology and Dialysis Unit, Ahmad Maher Teaching Hospital
Samar
Tharwat
Rheumatology and Immunology Unit, Internal Medicine Department, Mansoura University, Egypt
10.21608/ejhm.2021.171397
<strong>Background:</strong> Lupus nephritis (LN) is a common and serious manifestation of SLE, occurring in more than half of patients with SLE during their course of illness, in 10–25% of such patients, kidney disorder progresses to end-stage renal disease (ESRD).
<strong>Objective:</strong> To determine the predictors of remission in patients with biopsy-proven lupus nephritis, and to assess the long-term renal remission rate in our lupus nephritis patients.
<strong>Patients and Methods:</strong> This is a retrospective observational study carried out at the Rheumatology and Nephrology Units, Internal Medicine Department, Menoufia and Mansoura Universities Hospitals, Egypt for a 1-year duration between 1 June 2019 and 1 June 2020. A total of 60 patients with biopsy-proven LN were studied.
<strong>Results:</strong> In the current study, after six months of follow-up, about two-thirds of patients achieved remission. The urinary protein creatinine ratio (UPCR) of 4.9 g/g, systemic lupus erythematosus disease activity index (SLEDAI) of 20 and Hb of 8.8 g/dl at the third month are valuable for predicting remission at the sixth month in active lupus nephritis. On multivariate analysis, serum creatinine (SCr) at the time of diagnosis is the only independent predictor of remission (complete or partial) at 6 months. According to the receiver operating characteristic curve, the cut-off value of SCr ≤ 2.9 mg/dL with 100% specificity and 98 % sensitivity was a predictor for renal remission.
<strong>Conclusion:</strong>The UPCR of 4.9 g/g, SLEDAI of 20 and Hb of 8.8 g/dl at the third month are valuable for predicting remission at the sixth month in active lupus nephritis. Serum creatinine level ≤2.9 mg/dL at the time of diagnosis was the only independent predictor of complete remission at 6 months.
Lupus nephritis,predictors,Remission
https://ejhm.journals.ekb.eg/article_171397.html
https://ejhm.journals.ekb.eg/article_171397_ce61d4eea377f46a5b0e0bb3b13a5149.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Expression of Homeobox A9 (HOXA9) in Non- Melanoma Skin Cancer: A Clinical and Immunohistochemical study
1527
1535
EN
Shimaa Kamel
Salama
Departments of Dermatology, Andrology and STDs Faculty of Medicine, Menoufia University, Egypt
shimaakamel2018@gmail.com
Mohamed A.
Shoeib
Departments of Dermatology, Andrology and STDs Faculty of Medicine, Menoufia University, Egypt
Wafaa Ahmed
Shehata
Departments of Dermatology, Andrology and STDs Faculty of Medicine, Menoufia University, Egypt
Aiat Shaban
Hemida
Departments of Pathology, Faculty of Medicine, Menoufia University, Egypt
10.21608/ejhm.2021.171399
<strong>Background:</strong> Homeobox A9 (HOXA9) has been implicated in acute myeloid leukemia and cancer breast but, little is known about HOXA9 expression in non- melanoma skin cancer (NMSC); basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). <strong>Objective: </strong>The aim of the current work was to study HOXA9 expression in NMSC by immunohistochemical method. <strong>Patients and Methods:</strong> This case-control study included a total of 45 cases with NMSC; 15 BCC and 30 SCC beside 45 age and sex-matched normal apparently healthy controls, selected from Dermatology, Andrology & Sexually transmitted diseases (STDs) Outpatient Clinic, Menoufia University Hospital, during the period December 2018 to June 2020. Clinical evaluation and histopathological evaluation confirmed the diagnosis of SCC and BCC. <strong>Results:</strong> Expression of HOXA9 in the overlying epidermis was positive in 83.3% of SCC cases with strong intensity in 68% and nucleocytoplasmic localization in 100%. HOXA9 was positive in 60% of BCC cases with mild intensity in 77.8% and nucleocytoplasmic localization in 100%. In control sections, HOXA9 was in all sections (100%) with strong intensity in 77.8%, and nucleocytoplasmic localization in all of them 100%. Regarding tumor islands; expression of HOXA9 was positive in 26 (86.7%) cases of SCC and was positive in 2 (13.3%) of BCC cases. There was significant higher HOXA9 H- score in control skin than NMSC (p < 0.001). <strong>Conclusions:</strong> It could be concluded that HOXA9 may be implicated in pathogenesis and may represent a target therapy for NMSC.
basal cell carcinoma,Squamous cell carcinoma,Homeobox A9
https://ejhm.journals.ekb.eg/article_171399.html
https://ejhm.journals.ekb.eg/article_171399_4b7e465b30e841753f0ea22b41dd8e41.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
The Possible Protective Effect of Melatonin and Coenzyme Q10 on Lung Injury Induced by Bleomycin in Adult Male Albino Rats
1536
1543
EN
Hanan
Elkerdasy
Department of Anatomy and Embryology Faculty of Medicine, Benha University
mhanan909@yahoo.com
Amal Mahmoud ElSafy
Elshazly
Department of Anatomy and Embryology Faculty of Medicine, Benha University
Bodour Qassim BadrEldeen
Baioumy
Department of Anatomy and Embryology Faculty of Medicine, Benha University
Yasmeen Mohammed Ismail
El Sayed
Department of Clinical Pharmacology, Faculty of Medicine, Benha University
Asmaa Y.A.
Hussein
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Benha University
10.21608/ejhm.2021.171400
<strong>Background: </strong>bleomycin-induced lung toxicity and oxidative damage by decreasing the deactivating enzyme, genetic vulnerability, and released cytokines of inflammation. Melatonin has a free radical detoxifying effect, coenzyme Q10 has a strong antioxidant effect. <strong>Aim of the study: </strong>this study aimed to evaluate the possible protective role of melatonin and coenzyme Q10 in bleomycin-induced lung injury in Albino rats. <strong>Material and Methods:</strong> forty male Albino rats were categorized into five groups; group I (control group), group II (bleomycin group): rats were given a single dose of bleomycin intra-tracheal for inducing lung injury, group III (melatonin group): rats were given melatonin for three weeks after intratracheal installation of bleomycin, group IV (coenzymeQ10 group): rats were given coenzymeQ10 for three weeks after intratracheal installation of bleomycin and group V (combined melatonin and Co Q10 group): rats were given a combination of melatonin and coenzyme Q10for three weeks after induction of bleomycin lung toxicity. Lung tissues were prepared for biochemical, histological and immunohistochemical studies.
<strong>Results: </strong>bleomycin produced a significant increase in the level of malondialdehyde and a significant reduction in glutathione peroxidase activity in lung tissues with loss of normal histological lung architecture, significant elevation in main area percent of collagen fibers deposition and caspase-3 immuno positive expression. In group III melatonin enhanced a significant improvement in the biochemical changes, moderate prevention of histopathological changes in lung tissue with a significant reduction in main area percent of collagen fibers deposition and caspase-3 immuno positive expression. While, in group IV co enzyme Q10 enhanced non significant improvement in the biochemical changes, mild prevention of histopathological changes and non-significant reduction in main area percent of collagen fibers deposition and caspase-3 immuno positive expression. Using a combination of both drugs in group V enhanced a significant improvement in the biochemical changes and almost preservation of normal histological architecture of the lung tissue. <strong>Conclusion:</strong> administration of both melatonin and coenzyme Q10 produced almost a complete recovery of bleomycin induced lung injury.
<strong> </strong>
bliomycin,Melatonin,Co enzyme Q10,lung toxicity
https://ejhm.journals.ekb.eg/article_171400.html
https://ejhm.journals.ekb.eg/article_171400_fa6132ec768e6fcf56592c346784d0c9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Maternal Serum C-Reactive Protein for Prediction of Maternal and Perinatal Morbidity in Premature Rupture of Membranes
1554
1552
EN
Ahmed Tawfiek
Shaaban
Departments of 1Obstetrics and Gynecology Menoufia University, Menoufia, Egypt
dr.a.tawfiek20@gmail.com
Amira Ahmed
Fathey
Departments of 1Obstetrics and Gynecology Menoufia University, Menoufia, Egypt
Alaa Masoud
Abdelgied
Departments of 1Obstetrics and Gynecology Menoufia University, Menoufia, Egypt
Ragab Mohamed
Dawood
Departments of 1Obstetrics and Gynecology Menoufia University, Menoufia, Egypt
Marwa Mohammed
Dawoud
Departments of Pathology, Faculty of Medicine,
Menoufia University, Menoufia, Egypt
10.21608/ejhm.2021.171401
<strong>Background</strong>: Premature rupture of membranes (PROM) is defined as spontaneous rupture of membranes before the onset of uterine contraction. If the rupture of the membranes occurs after 28 weeks but before 37 weeks of gestation it is termed as PPROM (Preterm Premature Rupture of Membranes).
<strong>Objective:</strong> To assess the role of the C- reactive protein (CRP) as a reliable predictor of chorioamnionitis in premature rupture of membranes (PROM).
<strong>Patients and methods:</strong> This is an observational prospective study that was conducted on 120 pregnant women admitted to Menoufia University Hospitals and Shebin EL-Kom Teaching Hospital during the period from October 2019 till December 2020.
<strong>Results</strong>: CRP level has sensitivity and specificity of (87.5% and 88.7%) respectively, at cutoff value >13 with area under curve of 0.915 with accuracy of 76.3% as the diagnostic tool in PPROM cases with histological chorioamnionitis (HCA). Also, C-reactive protein was significantly positively correlated with placental examination HCA, offensive discharge, ESR at 2<sup>nd</sup> hour, and TLC (p < 0.05). Also, C-reactive protein was significantly negatively correlated with amniotic fluid index (AFI), Apgar score at (5, 10 minutes) and fetal weight at delivery (p < 0.05). While, there was insignificant correlation between CRP with ESR at 1<sup>st</sup> hour among the studied patients (P>0.05).
<strong>Conclusion</strong>: CRP has a role for detection of maternal and perinatal morbidity with accuracy about 76% and can be used as an early predictor for morbidity in pregnant women with PPROM. Pregnant women with PPROM who had CRP level ≤13 mg/l should have expectant management if there are no other contraindications and those have CRP level >13 mg/l; termination of pregnancy should be taken in consideration in presence of signs of clinical chorioamnionitis.
<strong> </strong>
C-reactive protein,perinatal,Premature,PROM,rupture of membranes
https://ejhm.journals.ekb.eg/article_171401.html
https://ejhm.journals.ekb.eg/article_171401_d5233957aa776b55a86e0dfbde6d7e18.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
The Association of Gut Microbiota 16s RNA Target Region with Obesity
1553
1560
EN
Manal Gaber
Soliman
Internal Medicine Department, Faculty of Medicine, Menoufia University, Egypt
sedraanas@gmail.com
Sanaa Sayed
Gazareen
Internal Medicine Department, Faculty of Medicine, Menoufia University, Egypt
Walid
Shehab-Eldin
Internal Medicine Department, Faculty of Medicine, Menoufia University, Egypt
Eman EA
Badr
Internal Medicine Department, Faculty of Medicine, Menoufia University, Egypt
Shimaa Kamal
Zewain
Internal Medicine Department, Faculty of Medicine, Menoufia University, Egypt
10.21608/ejhm.2021.171402
<strong>Background: </strong>Gut dysbiosis is strongly associated with obesity and T2DM pathogenesis.
<strong>Objective:</strong>To study the possible associations of gut microbiota 16s RNA target region with obesity. <strong>Patients and Methods:</strong>A case-control study that was done on 60 subjects (20 obese subjects without diabetes, 20 obese diabetic patients, and 20 control normal subjects). This study was based on gut microbiota 16s rRNA detection by DNA extraction from fresh frozen stool samples of study groups. Gene amplification was done by PCR. Using gene sequencing to identify the gut microbiota species.
<strong>Results:</strong><strong> 2</strong> cases were positive for 16s RNA gene in control group, the sequence of this gene was belonging to Succinivibrio dextrinosolvens. <strong>3</strong> cases were positive for 16s RNA gene in obese without diabetes group; all were belonging to Prevotella copri. <strong>5</strong> cases were positive for 16s RNA gene in obese with diabetes group; <strong>3</strong> cases were belonging to Prevotella copri and <strong>2</strong> cases were belonging to Succinivibrio dextrinosolvens. Statistically there was no significant difference among the three study groups regarding the 16s RNA gene, nor abundant organism.Although there was a significant difference between obese without DM group & lean group regarding type of organism as 100% of obese without DM group had Prevotella copri compared to 0% in group A <strong>(P = 0.04)</strong>. However, there was no statistical difference between lean group and obese with DM group as <strong>(p = 0.20)</strong>. In addition, there was no difference between obese group and obese with DM group <strong>(P= 0.27)</strong> regarding type of organisms.
<strong>Conclusion</strong><strong>:</strong> Obesity is associated with microbial composition alteration using 16s rRNA sequences method.
<strong> </strong>
DNA extraction,16S rRNA target region,Gut microbiota species
https://ejhm.journals.ekb.eg/article_171402.html
https://ejhm.journals.ekb.eg/article_171402_aaed5f1a7ffa7673bf7cf43514f66b66.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Posterolateral Debridement and Anterior Reconstruction by Limited Spinal Shortening in Thoracic Spine Infections
1561
1568
EN
Mohamed E.
Abdel-Wanis
Department of Orthopedics, Faculty of Medicine, Sohag University, Egypt
wanis307@yahoo.com
Moustafa
Elsayed
Department of Orthopedics, Faculty of Medicine, Sohag University, Egypt
mostafa.ismael79@yahoo.com
Wael
Salama
Department of Orthopedics, Faculty of Medicine, Sohag University, Egypt
Mohamed A.
Mohamed
Department of Orthopedics, Faculty of Medicine, Sohag University, Egypt
badi388@gmail.com
10.21608/ejhm.2021.171403
<strong>Background:</strong> Spinal infection is a very dangerous type of skeletal infection as it may be complicated with spin neurological deficit or spinal deformity, so early diagnosis and treatment is very important.
<strong>Purpose</strong>: The aim of the current work was to evaluate the result of posterolateral debridement and anterior reconstruction by limited spinal shortening in thoracic spine infections.
<strong>Patients and Methods:</strong> This retrospective clinical study included a total of 10 patients, 5 men and 5 women with thoracic spinal infection, attending at Sohag University Hospital. This study was conducted between 2003 and 2009. All patients were operated in the prone position through a single posterior midline exposure. Posterior stabilization by transpedicular screw fixation was performed. Medial 3 centimeters of 1 or 2 ribs were excised unilaterally. Anterior circumspinal dissection enables debridement of the lesion and evacuation of any abscess. Then, reconstruction of the anterior column was performed by limited spinal shortening followed by posterior fusion.
<strong>Results:</strong> Causative organisms were TB in 8 patients, Staph aureus in 1 patient and bacteriologic testing of intraoperative samples did not find germs in 1 patient. Mean follow up was 90.3 months (range; 67- 150 months). No active infection occurred tell the end of follow up. Seven patients got neurological improvement. Two complications were encountered: kyphosis progression and temporary neurological deterioration.
<strong>Conclusion: </strong>In cases of thoracic spinal infections, single posterolateral exposure is sufficient to debride the infected material, decompress the neural elements, and reconstruct the spine. Limited spinal shortening allows anterior reconstruction without the need for bone grafting.
<strong> </strong>
Spinal infections,Spondylitis,Pott’s disease,spinal,Shortening,Spine reconstruction
https://ejhm.journals.ekb.eg/article_171403.html
https://ejhm.journals.ekb.eg/article_171403_f2a4dd0939944d231a4a1097784934e2.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Evaluation of Prognostic Factors and Middle Ear Risk Index in Type 1 Tympanoplasty
1569
1574
EN
Mohamed Modather
Abd ElNaem
Department of Otorhinolaryngology ENT, Faculty of Medicine, Assiut University, Egypt
m.aboshanif@aun.edu.eg
Ahmed Aboulwafa
Abdul Jaleel
Department of Otorhinolaryngology ENT, Faculty of Medicine, Assiut University, Egypt
Asmaa Nabil
Mohamed
Department of Otorhinolaryngology ENT, Faculty of Medicine, Assiut University, Egypt
10.21608/ejhm.2021.171404
<strong>Background: </strong>Chronic suppurative otitis media (CSOM) is a long-standing infection of middle ear cleft, characterized by ear discharge and permanent perforation of tympanic membrane. Surgical treatment of CSOM is still controversial. Recently many studies have been undertaken to evaluate the prognostic impact of various factors on the outcomes of tympanoplasty. Nonetheless, only few studies have assessed the clinical preoperative assessment method that allows for tympanoplasty outcome to be predicted.
<strong>Objective:</strong> To examine the role of the prognostic factors and middle ear risk index on the success of tympanoplasty.
<strong>Patients and methods:</strong> The medical records of 100 patients who underwent type 1 tympanoplasty between 2018 and 2020 were prospectively reviewed. Prognostic factors such as age, sex, presence of systemic diseases, location and size of perforation, duration of dry period, presence of myringosclerosis, presence of septal and conchal pathology, operation type, and status of the opposite ear were evaluated. Middle ear risk index (MERI) was calculated and its correlation with the rate of success of surgery was evaluated.
<strong>Results:</strong> It was noticed that experience of surgeon more than 5 years, absence of comorbidities and low middle ear risk score were significant predictors for success of tympanoplasty type 1 (P < 0.001, P < 0.001, P < 0.001 respectively).
<strong>Conclusion:</strong> We found that younger age, female gender, no comorbidities, and higher surgeon experience were associated with better outcome. In addition, patients with mild MERI score showed higher rate of success for tympanoplasty. The surgeon experience and MERI were independent predictors of successful procedure.
<strong> </strong>
Factors and Middle Ear Risk Index,Type 1 Tympanoplasty,CSOM
https://ejhm.journals.ekb.eg/article_171404.html
https://ejhm.journals.ekb.eg/article_171404_c03d4318122f2bb38811652870d846eb.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Ankle Brachial Index Screening for Peripheral Arterial Disease in Asymptomatic Diabetic Patients
1575
1581
EN
Heba A
. El-Malky
Department of Internal Medicine, Faculty of Medicine, Menoufia University, Egypt.
elmalkyheba549@gmail.com
Alaa El Deen
Dawood
Department of Internal Medicine, Faculty of Medicine, Menoufia University, Egypt.
Mahmoud S.
El-Desoky
Department of Internal Medicine, Faculty of Medicine, Menoufia University, Egypt.
Mai A.
Kamel
Department of Internal Medicine, Faculty of Medicine, Menoufia University, Egypt.
10.21608/ejhm.2021.171405
<strong>Background:</strong> Peripheral arterial disease (PAD) is a common macrovascular complication in diabetic patients related to atherosclerosis. Early diagnosis of PAD by ankle brachial index (ABI) is highly critical as this disease results in significant morbidity and mortality.
<strong>Objectives: </strong>Toscreen for PAD in asymptomatic diabetic patients by using ABI, determining its prevalence and associated risk factors.
<strong>Patients and Methods:</strong> This is a cross-sectional study conducted on 309 diabetic asymptomatic patients in Internal Medicine Department, Menoufia University Hospitals in the period between December 2018 and December 2020. Full history and biochemical profiles were obtained and ABI indices were measured to evaluate for PAD.
<strong>Results:</strong> The prevalence of PAD in this study was 36.2%. Advancing age, sedentary life, long duration of diabetes, smoking, poor glycemic control and dyslipidemia were identified as risk factors for PAD (p value <0.001)while, hypertension and body mass index were not significant among studied patients (p value 0.594 and 0.733 respectively).
<strong>Conclusion: </strong>PAD has a high prevalence in asymptomatic diabetic individuals. It is associated with multiple risk factors such as smoking, dyslipidemia, advancing age, atherosclerosis and prolonged uncontrolled hyperglycemia. Diabetic patients should be routinely examined by ABI to improve the outcome.
Peripheral Arterial Disease,diabetes,ankle brachial index
https://ejhm.journals.ekb.eg/article_171405.html
https://ejhm.journals.ekb.eg/article_171405_6aab88bf431f31934eac0aa172f5f11a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Effect of Contraceptive Methods on Female Sexual Function
1582
1588
EN
Amira AbdElgawad Abdelfattah
Tabal
Department and Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
amiratabal2011@gmail.com
Said Abd EL Aty
Saleh
Department and Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Dalia
Ibrahim
Department and Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Abd EL Hamid Essam
Shahin
Department and Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
10.21608/ejhm.2021.171406
<strong>Background</strong>: Female sexual function is the ability to achieve sexual arousal, lubrication, orgasm, and satisfaction, which results in a state of wellness and a life with good quality. Some women experience sexual dysfunction (SD), which is an important public health problem.
<strong>Objective:</strong> To study the effect of commonly used contraceptive methods on female sexual function.
<strong>Patients and methods:</strong> A cross sectional-controlled study on 314 female divided into two groups, study group of 164 females taking one of the common contraceptive methods and a control group of 150 females were not on any method. Each one answered the questions of the female sexual function index questionnaire (FSFI) and a female sexual dysfunction (FSD) was diagnosed when the FSFI total score was< 26.55.
<strong>Results</strong>: There was a statistically significant difference between FSFI scores of the study group (28.40±5.92) with that of the control group (31.34±4.83) in each domain except pain. And a significant lower FSFI scores among depomedroxy progesterone acetate (DMPA) and progestin only pills (POP) subgroups in comparison to controls and other subgroups. However, no significant difference was found between FSFI scores of the combined oral contraceptive (COC) subgroup and control group in each domain except for satisfaction, also no difference was found between the intrauterine contraceptive device (IUCD) subgroup scores and control group in each domain. Moreover, large percent of impaired sexual function (40%, 16.9%) was in DMPA and POP group. 53% of good sexual function cases had not any contraception and 15% were on IUCD. <strong>Conclusion</strong>: Progestin only contraceptives were associated with impairment of FSF; the injectable was worse than the POP while neither IUDs users nor participants on combined oral pills (COP) suffered from impaired sexual function.
contraceptive methods,Female sexual function,IUDs,lubrication,orgasm,progesterone
https://ejhm.journals.ekb.eg/article_171406.html
https://ejhm.journals.ekb.eg/article_171406_207ca2227a1ff2c9eae7c93c663c9945.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Predictors for Reintervention after Surgical Coarctation Repair through Left Thoracotomy
1589
1596
EN
Ayman R
Abdelrehim
Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
Rafik
Fekry Barsoom
Soliman
0000-0002-6931-4695
Cardiothoracic Surgery department, Faculty of medicine, Menoufia University
rafikfekry@hotmail.com
Luna S
Baangood
Pediatric Cardiology Department, Madina Cardiac Center, Madina, Saudi Arabia
Saad Q
Khoshhal
Pediatric Cardiology Department, Madina Cardiac Center, Madina, Saudi Arabia
10.21608/ejhm.2021.171409
<strong>Background: </strong>Recoarctationof the aorta may occur in infants after the primary surgical repair. Several risk factors were suggested in the literature, with controversial results among the studies.
<strong>Objective: </strong>This study was conducted to evaluate the predictors for reintervention after surgical coarctation repair by different techniques through left thoracotomy.
<strong>Patients and Methods:</strong> A retrospective analysis was performed for patients who underwent isolated surgical coarctation repair or with pulmonary artery band between Sep 2014 and December 2018. All primary intervention was through thoracotomy. Reintervention was defined as the need for balloon angioplasty or reoperation.
<strong>Results: </strong>A total of 47 patients with median age at repair of 7 days. The median duration of follow-up was 18 months (95% CI=14 to 22 months). Only 7 (14.9%) patients required reintervention. No mortality was recorded during the follow-up period. Cox proportional hazard analysis showed that only postoperative pressure gradient was an independent risk factor for reintervention. Receiver operating characteristic curve showed that postoperative pressure gradient was an excellent indicator (AUC = 0.948, 95% CI: 0.841 to 0.992, p < 0.001), with the optimal cut-off value >25, sensitivity of 100% and specificity of 80%.
<strong>Conclusions: </strong>Repair of aortic coarctation through thoracotomy has an overall good outcome. However, reintervention is required in some patients and elevated pressure gradient on echocardiographic assessment <25 can exclude recoarctation
Aortic coarctation,infant,Outcome,Recurrence,risk factors
https://ejhm.journals.ekb.eg/article_171409.html
https://ejhm.journals.ekb.eg/article_171409_fc2eed245ec8f5adb9960f6616bc00eb.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Laparoscopic Versus Subinguinal Varicocelectomy: Comparative Study
1597
1601
EN
Mahmoud Mohammed Ibrahim
Mohammed
Department of General Surgery, Faculty of Medicine, Aswan University, Egypt
mahmoudrayanrayan2017@gmail.com
Mansour Mohamed
Kabbash
Department of General Surgery, Faculty of Medicine, Aswan University, Egypt
Hassan Ahmed
Abd Allah
Department of General Surgery, Faculty of Medicine, Aswan University, Egypt
Abd-El Aal Ali
Saleem
Department of General Surgery, Faculty of Medicine, Sohag University, Egypt
10.21608/ejhm.2021.171411
<strong>Background: </strong>Varicocele is abnormal dilatation and tortuosity of the testicular vein within the spermatic cord. Laparoscopic varicocelectomy is a minimally invasive procedure that can easily be performed by simple instruments. Not only can the bilateral varicocele be easily dealt with through the same ports, but other procedures, such as hernia repair, can also be simultaneously performed. It is the best approach when recurrent disease and obesity are problems.
<strong>Objective: </strong>To assess and compare between the open and laparoscopic varicocelectomy approaches in treatment of varicocele as regards postoperative results, complications and efficacy of the technique.
<strong>Patients and methods: </strong>This prospective study was done on 30 patients with primary varicocele at Aswan University Hospital. They were classified into two equal groups. Group-A underwent open subinguinal varicocele repair. Group-B underwent laparoscopic varicocelectomy using the intraperitoneal approach.
<strong>Results: </strong>There were no significant differences between both groups as regard age and laterality. Postoperative pain was reported in 100% of patients in both groups. The open subinguinal procedure and laparoscopic varicocelectomy showed significant difference as regarding postoperative complications in favor of laparoscopic procedure, while both procedure showed no significant difference regarding improvement of semen parameters.
<strong>Conclusion: </strong>Laparoscopic varicocelectomy is better than open technique as regard operation time, postoperative complications (Wound erythema, wound infection, epididymitis, and recurrence) and postoperative hospital stay while other studies revealed that the microsurgical technique is the best of all.
<strong> </strong>
Laparoscopic,Varicocele. Laparoscopic,Varicocele. Laparoscopic,subinguinal varicocelectomy,Varicocele
https://ejhm.journals.ekb.eg/article_171411.html
https://ejhm.journals.ekb.eg/article_171411_4912c6398fc2a1edde5e39b1fc7eec4b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Mitral Valve Repair with Flexible Versus Rigid Annuloplasty Device in Degenerative Mitral Regurgitation
1602
1606
EN
Sameh
Elsayed
Saeed
Cardiothoracic surgery department ;Faculty of Medicine Zagazig University
samehcts87@gmail.com
Ahmed S
Fadaly
Departments of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt.
Nader A.
ElBoray
Departments of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt.
Ahmed M
Shafeek
Departments of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt.
10.21608/ejhm.2021.171414
<strong>Background </strong>the most common clinically presented valvular heart disease is mitral regurgitation (MR).Mitral valve repair is considered the surgery of choice for mitral regurgitation.
<strong>Objective:</strong> The aim of the current work was to evaluate the early result of mitral repair with flexible and rigid annuloplasty devices in degenerative mitral regurgitation.
<strong>Patients and Methods:</strong> This prospective study included a total of 64 patients with degenerative mitral regurgitation undergoing surgery for mitral valve repair with either a flexible or rigid annuloplasty device, attending at Department Cardiothoracic Surgery, Zagazig University Hospitals. This study was conducted between September 2017 and June 2020. We evaluated all patients after 6 months of surgery.
<strong>Results: </strong>According to early mortality there were 2 patients in flexible group, and 1 patient in rigid one with no significant differences. There were also no significant differences according to failure of repair.
<strong>Conclusion:</strong> It could be concluded thatin spite of type of annuloplasty devices used, the early outcomes of mitral valve repair with rigid or flexible device show good results in our prospective study, but there were statistical differences between both groups regarding postoperative left ventricular dimension and function.
<strong>Keywords:</strong>
<strong>Background </strong>the most common clinically presented valvular heart disease is mitral regurgitation (MR).Mitral valve repair is considered the surgery of choice for mitral regurgitation.
<strong>Objective:</strong> The aim of the current work was to evaluate the early result of mitral repair with flexible and rigid annuloplasty devices in degenerative mitral regurgitation.
<strong>Patients and Methods:</strong> This prospective study included a total of 64 patients with degenerative mitral regurgitation undergoing surgery for mitral valve repair with either a flexible or rigid annuloplasty device, attending at Department Cardiothoracic Surgery, Zagazig University Hospitals. This study was conducted between September 2017 and June 2020. We evaluated all patients after 6 months of surgery.
<strong>Results: </strong>According to early mortality there were 2 patients in flexible group, and 1 patient in rigid one with no significant differences. There were also no significant differences according to failure of repair.
<strong>Conclusion:</strong> It could be concluded thatin spite of type of annuloplasty devices used, the early outcomes of mitral valve repair with rigid or flexible device show good results in our prospective study, but there were statistical differences between both groups regarding postoperative left ventricular dimension and function.
<strong> </strong>
Mitral regurgitation,degenerative,Annuloplasty device and ventricular
https://ejhm.journals.ekb.eg/article_171414.html
https://ejhm.journals.ekb.eg/article_171414_d289aeb8c9c37a1df7c2feae838db9a8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Pattern and Outcome of Traumatic Brain Injury in Geriatric Population in Emergency Hospital Mansoura University
1607
1612
EN
Samir Mohamed
Attia
Departments of Vascular Surgery Faculty of Medicine, Mansoura University
Mustafa Mahmoud
Nabeeh
Departments of Neurosurgery,
Faculty of Medicine, Mansoura University
Hesham Khairy
Ismael
Departments of Critical Care Medicine,
Faculty of Medicine, Mansoura University
Mustafa Magdy Mohamed
Hamada
Departments of Emergency Medicine, Faculty of Medicine, Mansoura University
mostafahamada180@gmail.com
10.21608/ejhm.2021.175164
<strong>Background: </strong>Traumatic brain injury (TBI) is a critical public health and socioeconomic problem throughout the world, making epidemiological monitoring of incidence, prevalence and outcome of TBI necessary. In addition, TBI in elderly patients is a neglected global disease burden. The main cause is fall, followed by motor vehicle accidents. Severe trauma in elderly population imposes a significant health care burden and is associated with substantial morbidity and mortality.
<strong>Objective: </strong>To determine the pattern and outcome of traumatic brain injury in geriatric population in order to improve the management of geriatric trauma patients at Emergency Hospital Mansoura University.
<strong>Patients and methods:</strong> This was a prospective observational clinical study, which was conducted on 206 elderly trauma patients presented and admitted to Emergency Hospital Mansoura University (a level one trauma center with about 250,000 visit and 25,000 trauma cases per year) over a year from December 2019 to December 2020.
<strong>Results: </strong>Polytrauma was the commonest type with only 35% of the studied cases were isolated head injury. Most cases had multiple lesions (63.6%) with only 36.4% of which had single lesion. The majority of cases had no associated injuries, with few cases had scalp injury (16.5%) and free abdominal fluid of various degrees (27%). The average period of hospital stay was 10.42 ± 3.110, while the average period of ICU stay was 7.75 ± 4.538. The average GOS among the studied cases was 4.83 ± 2.965 and the majority of which (359%) died (grade 5).
<strong>Conclusion:</strong> The current study demonstrated that, TBI in elderly cases is a life threatening condition with a high mortality rate in which falling from height (FFH) was the predominant mode.
Emergency Hospital,Geriatric Population,Traumatic brain injury
https://ejhm.journals.ekb.eg/article_175164.html
https://ejhm.journals.ekb.eg/article_175164_d7b2401ac52c49925dae3963ed2816ad.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Correlation of Hepcidin to Other Markers of Iron Overload in Egyptian Thalassemia Patients
1613
1617
EN
Rania A.
Radwan
Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Hanan
Hamed
Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Mariam
Ahmed
Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Mostafa
El-Razzaz
Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
dr.mostafa_elrazzaz@med.asu.edu.eg
10.21608/ejhm.2021.175166
<strong>Background</strong>: Beta thalassemia is a disorder of hemoglobin leading to hemolytic anemia, ineffective erythropoiesis and iron overload that mediates much of the morbidity and mortality of the disease. Hepcidin is a peptide hormone that plays a crucial role in iron homeostasis. <strong>Objectives: </strong>Here we assessed the value of serum hepcidin level as a marker of iron overload in thalassemia patients. <strong>Patients and Methods</strong>: This case control study involved 30 thalassemia patients and 10 controls. The patients were selected from the Hematology Department of Ain Shams University Hospitals. We assessed the value of serum hepcidin level and see how it is correlated to values of serum ferritin along with MRI T2*on the liver and the heart in the same patients. <strong>Results</strong>: The median hepcidin level for cases was significantly lower than that for controls with P value (0.004), but serum hepcidin was not a statistically significant marker of iron overload when correlated with either serum ferritin or hepatic and/or cardiac MRI T2* findings of the patients. However, we found a significant correlation between hepcidin and gender, blood transfusion frequency and hepatitis C infection. <strong>Conclusion</strong>: hepcidin is not directly correlated to markers of iron overload in thalassemia patients. In these patients with anemia and iron overload, the erythropoietic drive is the dominant factor influencing hepcidin levels. Therefore, hepcidin is not a good marker of iron overload, but rather a good marker of erythropoietic drive.
hepcidin,iron overload,thalassemia
https://ejhm.journals.ekb.eg/article_175166.html
https://ejhm.journals.ekb.eg/article_175166_3ea1d686905e908c694883ef3310ed4d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Evaluation of The Best Surgical Margin for Basal Cell Carcinoma
1618
1628
EN
Adel Mohamed
Ismail
Department of Surgical Oncology, Ismailia Teaching Oncology Hospital, Egypt
Mai Mohamed
Abdelwabab
Departments of Pathology Faculty of Medicine, Zagazig University, Egypt
Mahmoud
abdou
yassin
Faculty of medicine , Zagazig university ,Egypt
mahmoudyassin42@yahoo.com
Said Mohamed
Negm
Departments of General Surgery, Faculty of Medicine, Zagazig University, Egypt
10.21608/ejhm.2021.175169
<strong>Background:</strong> Basal cell carcinoma (BCC) is one of the non-melanocytic malignancies of the skin, originating from the epidermal basal cells. It is considered the most common skin malignancy in humans. The treatment should remove the lesion with preserving the maximum level of healthy surrounding tissues. So, treatment is controversial between adequate safety margin and leaving satisfactory cosmetic results.
<strong>Objective:</strong> In this study, we aim to evaluate the intact safety margin for BCC post-operative, being regarded as 3 mm or more before surgery <em>(pathologically by routine and immunohistochemical staining using BerEP4).</em>
<strong>Patients and Methods:</strong> The study included 40 patients presented with basal cell carcinoma (BCC). All were assessed for the duration, size, type, and site of the lesion. The treatment of the primary lesion and recurrence time was reported for all cases. Different reconstructive types of local fascio-cutaneous flaps were performed. The excised specimens were referred to pathological verification of the diagnosis and evaluation of the boundaries, either free or infiltrated.
<strong>Results:</strong> There was a statistically significant association between recurrence and tumor size (p=0.001), deep facial invasion (p < 0.001), muscle invasion (p=0.001), ill-defined tumor borders (p < 0.001), positive surgical margins, and safety margins size (p < 0.001).
<strong>Conclusion:</strong> Excision of BCC with 3 mm or more as a safety margin is enough to preserve healthy tissues and avoid the requirement for difficult procedures of reconstruction. The use of BerEP4 is a highly specific marker for detecting BCC cells that, can be missed by routine H&E staining.
basal cell carcinoma,safety margin,Immunohistochemical,BerEP4,Fascio-cutaneous flaps
https://ejhm.journals.ekb.eg/article_175169.html
https://ejhm.journals.ekb.eg/article_175169_2092362ef34e56d7683e8eef4dbdc5ed.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
83
1
2021
04
01
Serum Soluble CD163 as a Predictor of Esophageal Varices and Variceal Bleeding in Cirrhotic Patients
1629
1637
EN
Mahmoud
Rizk
0000-0003-0916-3351
Internal Medicine Department, Gastroenterology and hepatology unit, Faculty of Medicine, Benha University, Egypt
mahmoudrizk70@yahoo.com
Ahmed Mohamed
Hussein
Department of Internal Medicine, Hepatology and Gastroenterology Unit, Benha University, Egypt
Mohamed Abd Ellatif
Afifi
Department of Internal Medicine, Hepatology and Gastroenterology Unit, Benha University, Egypt
Amany A.
Amer
Department of Tropical Medicines, Faculty of Medicine, Menoufia University, Egypt
10.21608/ejhm.2021.175171
<strong>ABSTRACT</strong>
<strong>Background:</strong> Bleeding of esophageal varices (OV) is also bearing elevated mortality in patients with liver cirrhosis (LC). The best standard diagnostic investigation for OV is upper gastrointestinal (GI) endoscopy. Patients and endoscopic units alike are burdened by the endoscopic screening of all patients with liver cirrhosis. The use of non-invasive OV detection reduces the need for endoscopic screening.
<strong>Objective:</strong> The aim of the current work was to test serum soluble CD 163(sCD163) as a predictor of the presence, and grade of OV and as non-invasive indicator of having severe variceal bleeding.
<strong>Patients and Methods:</strong> This cross-sectional study included a total of 70 cirrhotic patients, attending at the Hepatology and Gastroenterology Unit, Department of Internal Medicine, Benha University Hospital, Egypt. To detect OV, all patients underwent upper GI endoscopy, and serum sCD163 levels were assessed using an ELISA technique.
<strong>Results:</strong> Patients with OV had a higher mean value of sCD163 levels (8.71±8.42 ng/ml) than patients without OV (2.89±1.02 ng/ml), however this was not statistically significant (P=0.13). sCD163 level was significantly higher in large OV group (10.75±9.26 ng/ml) than small OV group (3.75±0.92 ng/ml), (P=0.001). The rate of significant variceal bleeding is closely linked to serum higher sCD163 levels more than (4.63 ng/ml).
<strong>Conclusion:</strong> It could be concluded that serum sCD163 could be a non-invasive indicator of the presence of OV in cirrhotic patients. It may also be used for the prediction of the size of OV and the probability of severe variceal bleeding.
<strong> </strong>
Serum soluble CD163,Esophageal varices,variceal bleeding,Cirrhotic Patients
https://ejhm.journals.ekb.eg/article_175171.html
https://ejhm.journals.ekb.eg/article_175171_4d075c785cbc9c8a1927ad8cbf07756d.pdf