Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Effect of Intravenous Immunoglobulin in Reducing Bilirubin Levels in Hemolytic Disease of Newborn
957
968
EN
Shaimaa Waheed Ibrahim
El Fekey
Departments of Pediatric Medicine, Faculty of Medicine, Tanta
University, Egypt
shaimaawaheed3@gmail.com
Hamed Mohammed
El-Sharkawy
Departments of Pediatric Medicine, Faculty of Medicine, Tanta
University, Egypt
Aisha Abd-Ellatif Elsaied
Ahmed
Departments of Clinical Pathology, Faculty of Medicine, Tanta
University, Egypt
Mohammed Abd-Ellatif
Nassar
Departments of Pediatric Medicine, Faculty of Medicine, Tanta
University, Egypt
Marwa Mohamed
Elgendy
Departments of Pediatric Medicine, Faculty of Medicine, Tanta
University, Egypt
10.21608/ejhm.2019.25779
Background: hemolytic disease of the newborn is an autoimmune haemolytic disease and caused by antibodies produced due to Rh and ABO incompatibilities. Neonatal jaundice is a common clinical problem encountered during the neonatal period. To avoid the associated neurological complications; exchange transfusion and phototherapy have been traditionally used. Aim of the work: was to assess the efficacy of intravenous immunoglobulins in neonates with Rh and/or ABO incompatibility in reducing the duration of phototherapy and the need for exchange transfusion and hospital stay. Subjects and Methods: in this clinical intervention study 40 patients diagnosed with hemolytic disease of newborn were grouped into group A and B. All neonates were treated with standard protocol for phototherapy and exchange transfusion. Group A patients received only phototherapy. Group B patients received intravenous immunoglobulins in a dose of 0.5 gm/kg of body weight single dose and phototherapy. Exchange transfusion was given to the patients of both groups if the bilirubin rose by 0.5 mg/dl per hour. Results: there was a significant decrease of bilirubin level in group B [that received phototherapy plus Intravenous Immunoglobulin (IVIG)] than group A [that received phototherapy only]. Hospital stay and duration of phototherapy decreased in group B than group A. Number of cases exchanged blood in group A was higher than cases of group B. Conclusion: addition of intravenous immunoglobulins for treatment of hemolytic disease of newborn significantly reduces bilirubin levels, duration of phototherapy, need for exchange transfusion and hospital stay.
Hemolytic Disease of Newborn,Bilirubin,Intravenous Immunoglobulin
https://ejhm.journals.ekb.eg/article_25779.html
https://ejhm.journals.ekb.eg/article_25779_86191fd613c865b8c635861a2cd9cc19.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
The Sacroiliac Joint Injection
969
977
EN
Hesham M.
Farhoud
Departments of Orthopedic Surgery, Faculty of Medicine (for girls), Al-Azhar University, Egypt
Ashraf M.
Enite
Departments of Radiology,
Faculty of Medicine (for girls), Al-Azhar University, Egypt
Abd Elkhalek
AlZalabany
Departments of Orthopedic Surgery, Faculty of Medicine (for girls), Al-Azhar University, Egypt
Tarek M.
Elatar
Departments of Orthopedic Surgery, Faculty of Medicine (for girls), Al-Azhar University, Egypt
tareeeek16@gmail.com
10.21608/ejhm.2019.25788
<strong>Background: </strong>the sacroiliac joint (SIJ) is the largest axial joint in the body, with an average surface area of 17.5 cm<sup>2</sup>, it is an accepted source of low back and/or buttock pain with or without lower extremity pain. Based upon history and physical examination findings, the prevalence of sacroiliac joint pain in chronic low back pain population has been shown to range from 22.5% to 62.8%. <strong>Aim of this work:</strong> to evaluate the therapeutic benefit of intra articular corticoid injections into the sacroiliac joints in a standardized fashion. <strong>Patients and Methods: </strong>This study included 20 adults with SIJ pain due to different reasons and who were scheduled to undergo SIJ injection of corticosteroids and local anesthetic. Demographic data to consider include sex, age, weight, occupation, affected side, co morbidity and suggested pathology of the examined SIJ. <strong>Results: </strong>there is a significant decrease of the inflammatory back pain in 85% of patients; on mean post 2.00±1.86 compared to pre 7.50±1.24 according to VAS of patients after 6 months follow up (<em>p-</em>value <0.001 HS). Its minimally invasive procedure & good result by single injection to all patients during 6 months follow up. <strong>Conclusion: </strong>CT guided sacroiliac joint minimally invasive, short time, very accurate and good results obtained. Intra articular SIJ injection is an effective method for alleviating pain in patients suffers from SIJ pain at least in short term.
Sacroiliac joint,intra articular injection
https://ejhm.journals.ekb.eg/article_25788.html
https://ejhm.journals.ekb.eg/article_25788_bf1f6a372de0b0582ff8611b096bcc0a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Alkaline phosphatase and haptoglobin as predictor of neonatal jaundice
978
987
EN
Hannan Mohamed
Abd Elmonem
Department of Pediatrics, Faculty of Medicine, Aswan University
Ahmed Ragab
Fakhr El-Din
Department of Pediatrics, Faculty of Medicine, Aswan University
Emad Farah
Kholeef
Department of Pediatrics, Faculty of Medicine, Aswan University
Shahenda
Nasr Eldin
Department of Pediatrics, Faculty of Medicine, Aswan University
drshahendanasr88@gmail.com
10.21608/ejhm.2019.25798
<strong>Background:</strong> The term kernicterus refers to the clinical features of bilirubin encephalopathy. Its risk is increased in term babies with very high bilirubin levels. Kernicterus is also known to occur at lower levels of bilirubin in term babies who have risk factors and in preterm babies.
<strong>Objective: </strong>The aim of the present study was to investigate whether serum alkaline phosphatse & haptoglobin (Hp) level could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns.
<strong>Methodology: </strong>The study is a prospective clinical study design, which was carried out in Pediatric Department, Faculty of Medicine, Aswan University Hospital. The study included 100 newborns with gestational age more than 35wk delivered in obstetric department.
<strong>Results: </strong>Our study showed no statistically significant difference between jaundiced and non- jaundiced cases regarding the mode of delivery, maternal gravidity and parity. As regards previous sibiling affected, we found a significant relation between clinically appearing jaundice and previous sibling affected with neonatal hyperbillirubinemia, which may reflect genetic susceptibility for hyperbillirubinemia. No significant relationship between gestational age and clinically appearing jaundice. When assessing the relationship between clinically appearing jaundice and birth weight, our results revealed no significant relationship.
<strong>Conclusion: </strong>The cord blood alkaline phosphatase level is not only a useful predictor for severe neonatal jaundice but also can predict the early onset of neonatal hyperbilirubinemia and expected methods of treatment in healthy newborns more than 35 weeks gestational age.
alkaline phosphatase,Haptoglobin,Neonatal Jaundice
https://ejhm.journals.ekb.eg/article_25798.html
https://ejhm.journals.ekb.eg/article_25798_b7c377238af7f9a92f7000e837fff4e9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Comparison between self-gripping mesh and sutured mesh in open inguinal hernia repair
988
993
EN
Mahmoud Mohamed
Abou El-Yazid
Department of General Surgery, Faculty of Medicine, Al-Azhar University
Mahmoud Mohammed
Mahran
Department of General Surgery, Faculty of Medicine, Al-Azhar University
Alaa Abdel Aty
Mahmoud
Department of General Surgery, Faculty of Medicine, Al-Azhar University
alaaabes2@gmail.com
10.21608/ejhm.2019.25804
<strong>Background: </strong>Inguinal hernias are one of the most common problems encountered by the surgeon, accounting for about 10-12% of all operations. Operations for the inguinal hernia are one of the most common procedures. Currently herniorrhaphy is the most performed surgical procedure in the world.
Aim: The aim of this study is to compare tissue adhesives and how it can reduce postoperative complications, especially chronic pain as well as recurrence rate in self-gripping mesh compared with sutured mesh in open inguinal hernia repair.
<strong>Methods: </strong>This study conducted on 30 cases of fresh inguinal hernia submitted to inguinal hernioplasty "mesh repair" 15 of them submitted to sutureless mesh "Group I" while the other 15 cases submitted to sutured mesh "Group II".
<strong>Results:</strong> Our results revealed that there was no statistical difference between both groups regarding the age. Also, there was no significant difference between both groups regarding gender. Our study revealed that the operative time was longer and blood loss was more during operation in sutured group than in sutureless group. In spite of increase incidence of complications sutured group than in sutureless in our study but there was no difference between both groups regarding complications.
<strong>Conclusion: </strong>From our study we can conclude that the use of self-grip (sutureless) meshes and sutured meshes in the management of groin hernias have nearly the same results in experienced hands.
Self-gripping mesh,Sutured mesh,Inguinal hernia
https://ejhm.journals.ekb.eg/article_25804.html
https://ejhm.journals.ekb.eg/article_25804_6ba90ec9fc68c9875bcd9aefe25cc274.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Assessment of complement (C2&C4) in patients with recurrent candidal infections
994
1002
EN
Rabie Bedir
Atallah
Dermatology, Venereology & Andrology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Osama Abd-Alazeem
Hashem
Dermatology, Venereology & Andrology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
osama.os129@gmail.com
Hesham Samir
Abd El-Samea
Dermatology, Venereology & Andrology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Hagar Ali Mokhtar
Abouzayed
M.B.B.Ch
10.21608/ejhm.2019.25812
<strong>Background: </strong>Over the past few decades, candidiasis is a disease of growing incidence that parallels the increasing number of immunocompromised people. The entity of recurrent candidal infections has been defined as at least four symptomatic episodes at the last year. Candida albicans pathogen acts as activating surface for complement deposition i.e., covalent binding of C3b. Opsonization is the process of deposition of complement fragments on the surface of pathogen that allows their recognition, ingestion, and destruction by macrophages, phagocytic cells, neutrophils, and monocytes. IgG antibodies and C3 fragments are the classical opsonins. Phagocytes express specific receptors for C3 fragments. Complement opsonization resulting from the direct activation of the alternative pathway on pathogen surface allows their elimination by phagocytes before the mounting of an adaptive immune response and the appearance of antibodies.<br /> <strong>Aim of the work:</strong> The aim of the present work is to clarify the relation between serum complement (C2&C4) and recurrent candidal infections.<br /> <strong>Patients and Methods:</strong> A case control study. Sera were obtained from 50 recurrent candidal infection patients and 30 healthy volunteers. C2 levels were measured using ELISA with standard kits from EIAab R&D Systems. C4 levels were measured using Automated Chemistry ELISA with standard kits from EIAab R&D Systems.<br /> <strong>Results:</strong> Serum complement C2 was significantly lower among the cases with recurrent candidal infection (65.63±48.35pg/ml) than in healthy volunteers 200.29± 358.43) with p-value= 0.01.<br /> <strong>Conclusion:</strong> Recurrent candidal infection can be caused by low (C2) level in patient's serum. There is significant alteration in complement (C2) level (P ≤ 0.01). There is no significant alteration in complement (C4) level (P ≥ 0.05). Serum complement (C2) level can be used as a laboratory investigation for patients with recurrent candidal infections especially those with associated systemic disease.
Recurrent candidal infections,Candida albicans,complementC2,complement C4
https://ejhm.journals.ekb.eg/article_25812.html
https://ejhm.journals.ekb.eg/article_25812_28441de324c21b8725b873c557d8df0f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Role of Pattern Electroretinogram in Early Detection of Glaucoma
1003
1007
EN
Mohamed Abdel-Monem
Mahdy
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Mohamed Mohamed-Aly
Ibrahim
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Mohamed Gamal Mostafa
Nasar
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
mgamal692255@gmail.com
10.21608/ejhm.2019.25820
<strong>Background: </strong>glaucoma is the most common cause of irreversible blindness. Primary open angle glaucoma (POAG) is the most commonly diagnosed form. Pattern electroretinogram emerged as a promising tool for diagnosing of early glaucoma. <strong>Aim of the work: </strong>the present study aimed to assess the role of pattern electroretinogram in differentiating between patients with early glaucoma and normal controls.<strong> Methodology: </strong>this study included 25 early glaucoma patients and 25 normal controls. They were undergone into careful history taking, complete ophthalmic examination and investigations by using PERG, SD- OCT and perimetry. <strong>Results: </strong>regarding the comparison we found reduction in amplitude of P50 and N95 between early glaucoma patients and normal controls.
pERG,POAG,SAP
https://ejhm.journals.ekb.eg/article_25820.html
https://ejhm.journals.ekb.eg/article_25820_51eb2029c80368d5b226f5fe1a761bbc.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Prognostic Significance of Systematic Lymphadenectomy as Part of Primary Debulking Surgery in Patients with Ovarian Cancer
1008
1015
EN
Saied Hosny
Bendary
Surgical Oncology Department, Faculty of Medicine, Al Azhar University
Mohamed Esmat
Abd Elghany
Surgical Oncology Department, Faculty of Medicine, Al Azhar University
Salama Saad
Abd Al Latif
Clinical Pathology Department, Faculty of Medicine, Al Azhar University
Mohamed Ahmed Abd Elrauf
Attia
Surgical Oncology Department, Faculty of Medicine, Al Azhar University
dr_mohamed_abdelrauf@yahoo.com
10.21608/ejhm.2019.25822
<strong>Background: </strong>worldwide, ovarian cancer is diagnosed in more than 200,000 women yearly and accounts for over 125,000 deaths. Unfortunately, about 70% of cases are diagnosed in an advanced-stage with evidence of upper abdominal spread in approximately half of these.
<strong>Aim of the Work:</strong> was to review the surgical management of female patients with ovarian cancer including intraperitoneal complete cytoreduction and systematic lymphadenectomy to show prognosis, post operative morbidities, recurrence and follow up.
<strong>Patients and Methods</strong><strong>: </strong>this study was conducted at Al-Azhar university hospitals and El Agousa police hospital – Ministry of interior - on 20 female patients who suffered from different stages of epithelial ovarian cancer with stage II, none bulky stage III, and only One patient with bilateral ovarian cancer stage Ic.
<strong>Results:</strong> This is study conducted on female patients with ovarian cancer the mean age of the studied patients was 51.35 years ranging from 37-64 years. 55% of patients represented with abdominal distension, 50% had abdominal pain, 40% abdominal discomfort,15% had abnormal bleeding ,65% had nonspecific GIT manifestation ,20% had urinary symptoms and 10% had back pain.
<strong>Conclusion:</strong> Although the relationship between the retroperitoneal spread of lymph nodes and patient prognosis has been demonstrated in several studies. lymphadenectomy, as a routine treatment procedure in ovarian cancer, remains controversial. Moreover, systematic lymphadenectomy often prolongs operation times, which may result in additional surgical complications such as lymphocele, lymphatic obstruction, lymphocysts and lymphedema, however these complications may be alleviated, and better outcome occurred by proper intra operative and post operative management by expert gynecological oncologist involvement and leveraging adequate instruments, which can eventually improve survival.
Systematic Lymphadenectomy,ovarian cancer,Primary Debulking Surgery
https://ejhm.journals.ekb.eg/article_25822.html
https://ejhm.journals.ekb.eg/article_25822_cd4629b8927fa3fea33c7f8df322fb2e.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Evaluating the role of OCT in optic disc analysis in glaucoma patients
1016
1022
EN
AbdElmongy E.
Ali
Department of Ophthalmology, Faculty of Medicine, Aswan University, Aswan, Egypt
Abdullah M.
EL-Amin
Department of Ophthalmology, Faculty of Medicine, Aswan University, Aswan, Egypt
TagEldin M.
Othman
Department of Ophthalmology, Faculty of Medicine, Aswan University, Aswan, Egypt
Ahmed F.
Gabr
Department of Ophthalmology, Faculty of Medicine, Aswan University, Aswan, Egypt
Nesma O.
Mohamed
Department of Ophthalmology, Faculty of Medicine, Aswan University, Aswan, Egypt
drnesoo@yahoo.com
10.21608/ejhm.2019.25823
<strong>Background: </strong>thirty patients underwent full ophthalmic examination, including a review of medical history, best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, gonioscopy, dilated fundoscopic examination, automated perimetry, and OCT at 1 month and after 6 months.
<strong>Objectives:</strong> the aim of the study was to assess RNFL thickness, ONH clinically and by OCT and correlate RNFL thickness by OCT with visual fields by standard automated perimetry in glaucoma patients, highlighting the usefulness of OCT in glaucoma patients where diagnosis by standard means were not confirmatory.
<strong>Patients and methods</strong>: All patients were scanned using SD-OCT (RS-3000; Nidek) after dilation with 1% tropicamide eye drop and the images were acquired by a single operator. Also, standard automated perimetry was conducted using the SITA 24-2 of the Humphrey Field Analyzer program (Carl Zeiss Meditec) with a Goldmann size III stimulus on a 31.5-apostilb background.
<strong>Results</strong>: There was a statistically significant difference between patients at 1 month and after 6 months as regards OCT (RNFL), on comparison between the four quadrants at 1 month the mean of the inferior quadrant was > superior > temporal > nasal respectively. After 6 months the mean of the four quadrants as well as the total RNFL thickness decreased but only the decrease in the temporal quadrant and total RNFL thickness was statistically significant (P=0.003, P=0.044 respectively).
<strong>Conclusion</strong>: An OCT would be significantly informative early in the disease course to diagnose a preperimetric glaucoma, to confirm on a visual field, and to follow up glaucoma progression.
Glaucoma,OCT
https://ejhm.journals.ekb.eg/article_25823.html
https://ejhm.journals.ekb.eg/article_25823_3faf634abe4c4d184abe70d544e9e7e3.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Esthetic evaluation of early rhinoplasty with complete unilateral cleft lip repair after nasoalveolar molding
1023
1030
EN
Mohammed
Ellithy
Pediatric surgery department, Al-Azhar university
Osama
Alshahat
Plastic surgery department Al-Azhar university
Refaat
Ibrahim
Pediatric surgery department, Al-Azhar university
Wael
Elmohandes
Dental surgery, Al-Azhar university
Sadek
Abdelrahman
General surgery department, Al-Azhar university
10.21608/ejhm.2019.26278
<strong> Background: </strong>The aesthetic outcome of primary rhinoplasty with complete unilateral cleft lip repair is a challenging due to nasal deformities, tissue deficiencies and alveolar ridge displacement. The aim of this study is aesthetic evaluation of primary rhinoplasty with complete unilateral cleft lip repair after nasoalveolar molding (NAM). <strong>Patient and methods:</strong> The study was applied on 30 patients with complete unilateral cleft lip, mean age at presentation was 89.17± 73.02 days (range 15-260 days). Presurgical nasoalveolar molding (PNAM) was done for all patients with mean duration of molding 78.48± 5.635 days (range 66-87 days). Measurements of nose and alveolar defect were taken by caliper before application of the device and after application of the device and after one month of operation and compared with each other’s. All patients were subjected to lip repair with Millard technique with primary closed rhinoplasty. Primary rhinoplasty with cleft lip repair becomes easier since NAM diminishes the tension over the soft tissues and reduces severity of deformity in the lower lateral alar cartilages. Postoperative nasal stent has a great role in improve the esthetic outcome of primary rhinoplasty. <strong>Results:</strong> There were significant improvement of nasal symmetry and reduction of alveolar gap width (AGW) after use of NAM. <strong>Conclusion:</strong> This study suggests that PNAM within 15 days post-delivery is effective at reducing alveolar gap width, alignment of cleft alveolar segments and improvement of nasal symmetry as long as the parents cooperate in placing and maintaining the NAM device in the newborn’s mouth and nose.
Nasoalveolar molding,Unilateral cleft lip,Esthetic evaluation,Early rhinoplasty,Primary closed rhinoplasty
https://ejhm.journals.ekb.eg/article_26278.html
https://ejhm.journals.ekb.eg/article_26278_57806e58c4e1089bdbf21eb675f8ba51.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Study of Patient Ventilator Dyssynchrony, Causes and Effect on Weaning in Mechanically Ventilated Patient in Respiratory Intensive Care Unit, Observational Study
1031
1035
EN
Moustafa Abd El Hafez
Zedan
Department of Chest disease, Faculty of Medicine, Al Azhar University, Cairo, Egypt
mostafa.zedan74@yahoo.com
Abdalla Soliman
Ayoub
Department of Chest disease, Faculty of Medicine, Al Azhar University, Cairo, Egypt
Ameen A
Hegazy
Department of Internal Medicine, Faculty of Medicine, Al Azhar University, Cairo, Egypt
10.21608/ejhm.2019.26350
Background: Obtaining the comfort in intensive care unit to patients is important. Patient-ventilator dyssynchrony is a big problem in respiratory ICU and when a chest physician facing it in ICU must be aware about causes and deleterious effects on the patients, so study of causes and its impact on weaning outcomes is very important.
<strong>Aim of the work:</strong> was to study patient ventilator dyssynchrony, causes and effect on weaning in mechanically ventilated patients in respiratory ICU.
<strong>Patients and Methods:</strong> Fifty patients were included in the study admitted at Sayed Galal, Al-Azhar University Hospital during period from May 2014 - December 2017 in RICU, all patients underwent the following ,Full history taking , Genral ,Local examinations, Monitoring for occurance of agitation, patient ventilator dyssynchrony, and duration of weaning, and observation for the cause of the problem. Exclusion criteria, shock patient with haemodynamic instability.
<strong>Results:</strong>The diagnosis of cases 18 COPD, 9 pneumonia, 8 bronchectasis, 4 Ild (interstitial lung disease), 6 OHS(obesity hypoventilation syndrome) and 5 pulmonary edema. Patients with dyssncrony have more duration of weaning 5.5455<span style="text-decoration: underline;">+</span> .90453 days than patients without dyssnchrony have duration of weaning 3.8125<span style="text-decoration: underline;">+</span>.83417 days with significant difference. And the dyssnchrony group have more duration of ICU stay time (days) with 9.8485<span style="text-decoration: underline;">+</span>1.03444 days than the patients without dyssnchrony have duration of weaning 8.0625<span style="text-decoration: underline;">+</span>.85391 days with significant difference .
<strong>Conclusion:</strong>Patient ventilator asynchrony occurs frequently, it is sensitive to ventilator settings and artificial airway problem, increased secretions, bronchospasm, alteration in body posture and seems to be associated with prolongation of weaning time.
Patient ventilator dyssnchrony,Weaning
https://ejhm.journals.ekb.eg/article_26350.html
https://ejhm.journals.ekb.eg/article_26350_c4d3983831d83fc0a866b037a7870747.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Evaluation of Serum Iron and Transferrin in Idiopathic Nephrotic Syndrome Patients Attending Al-Hussein Pediatric Nephrology Clinic
1036
1046
EN
Moftah Mohamed
Rabeea
Pediatric Department, Al-Azhar Faculty of Medicine
Nayera Mahmoud
Al-Akkad
Pediatric Department, Al-Azhar Faculty of Medicine
Gamal Zakariya
El-Morsi
Clinical Pathology Department, Al-Azhar Faculty of Medicine
Ahmed Elsayed
Darwish
Pediatric Department, Al-Azhar Faculty of Medicine
10.21608/ejhm.2019.26351
<strong><em>Background</em></strong><strong>:</strong> Nephrotic syndrome is characterized by excessive urinary excretion of albumin and other intermediated-size plasma proteins such as transferrin.. Excessive urinary losses of transferrin can produce low serum transferrin level that may lead to low plasma iron concentration and consequently the development of iron resistant microcytic hypochromic anemia. <strong>The aim of the work</strong> to evaluate changes in serum iron and transferrin and the relationship between the serum and urinary transferrin in the active and remission state of nephrotic syndrome
<strong><em>Patients and methods:</em></strong> The present work included fifty children with idiopathic nephrotic syndrome (INS), divided into 2 groups: group A (25 cases in activity) and group B (25 cases in remission). These two groups were age and sex matched with a mean age of (7.74 ± 2.45). All patients in this work were clinically evaluated together with routine laboratory investigations. Serum albumin and urinary alb. /creatinine were assessed. Levels of serum iron, serum ferritin, serum transferrin and urinary transferrin were measured.
<strong><em> Results</em></strong><strong><em>:</em></strong> This work shows that the level of hemoglobin, MCV, HCT were statistically significantly lower in the cases in active state than cases in remission. The mean serum iron, serum ferritin and serum transferrin were significantly lower in the cases in active state than in the cases in remission .The mean urinary transferrin was statistically significantly higher in the cases in active state than in the cases with remission.
<strong><em>Conclusion:</em></strong> Urinary transferrin can be considered a reliable parameter for early prediction of iron deficiency anemia in children with active nephrotic syndrome.
Hemoglobin (HG),Mean corpuscular volume (MCV) Albumin/creatinine ratio (alb. /creat) iron deficiency anemia,serum iron,transferrin
https://ejhm.journals.ekb.eg/article_26351.html
https://ejhm.journals.ekb.eg/article_26351_fd7b105994dfd711ba12ab1d8ff22b77.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Clinical characteristics of children with chronic rheumatic valvular heart disease in Cardiology Unit, Assiut University Children Hospital
1047
1052
EN
Lamiaa E.
Ali
Pediatrics Department, Faculty of Medicine, Assiut University, Assiut, Egypt
Farouk E.
Hassanein
Pediatrics Department, Faculty of Medicine, Assiut University, Assiut, Egypt
Faisal Alkhateeb A.
Abdullah
Pediatrics Department, Faculty of Medicine, Assiut University, Assiut, Egypt
10.21608/ejhm.2019.26352
<strong>Background: </strong>chronic rheumatic heart disease (RHD) is still common in developing countries and associated with major complications and high mortality. <strong>Aim: </strong>to describe clinical characteristics of children with chronic rheumatic valvular heart disease. <strong>Patients and Methods: </strong>the study included fifty patients with chronic rheumatic valvular heart disease attending Assiut University Children Hospital over six months. Full through history and clinical examinations were done to all cases. All cases have been subjected to chest X-ray, standard 12-lead ECG, and echocardiography. <strong>Results: </strong>female patients were slightly commoner than male patients. Mitral valve was the commonest valve affected followed by aortic valve. Regarding ECG, left atrial hypertrophy was the commonest finding and mitral regurge was the commonest valve lesion. While, left atrial hypertrophy was the commonest finding in chest X-ray. Respecting echocardiography, there was slightly increased in left ventricular end diastolic diameter and left atrium. Heart failure was the most common complication that occurs in RHD patients. Patients’ compliant with long acting penicillin (LAP) were more than non-compliant. <strong>Conclusion: </strong>echocardiography is the most important tool for evaluation of valvular heart disease. Left atrial hypertrophy is the commonest finding by ECG. There is increase in left ventricular end diastolic diameter and left atrium by echocardiography. Left atrial hypertrophy is the commonest finding in chest X-ray. Mitral valve is the commonest valve affected followed by aortic valve. Patients’ compliant with LAP are more than non-compliant patients.<strong> Recommendation: </strong>echocardiography must be used as a screening tool for early detection of subtle cases of RHD. Application of control programs with special emphasis on the regular use of secondary prophylaxis.
Rheumatic Heart Disease,Rheumatic fever,Long acting penicillin,secondary prevention
https://ejhm.journals.ekb.eg/article_26352.html
https://ejhm.journals.ekb.eg/article_26352_cd08a447ee7db5f75e8a5e87c8efe48d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Early Complete Response after Chemotherapy as A Prognostic Indicator for Final Outcome in High Grade Non-Hodgkin’s Lymphoma Patients
1053
1063
EN
Ahmed Yousery
EL Agamawy
Clinical Oncology And Nuclear Medicine Department, Faculty Of Medicine, Al-Azhar University
Mohsen Salah El Din
Zekry
Clinical Oncology And Nuclear Medicine Department, Faculty Of Medicine, Al-Azhar University
Hala Abd El Badie
Nayel
Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty Of Medicine, Cairo University, Cairo, Egypt
Eslam Mohamed
Mohamed
Clinical Oncology And Nuclear Medicine Department, Faculty Of Medicine, Al-Azhar University
eslamoncology2016@gmail.com
10.21608/ejhm.2019.26353
<strong>Background: </strong>In spite of progress in management of high-grade Non-Hodgkin’s Lymphoma (NHL), more than 30% will ultimately relapse after standard treatment.<strong> Aim of study</strong>: was to estimate early complete response (CR) as a prognostic factor for final outcome and benefit of early switching to second line chemotherapy for slow responders. <strong>Patients and Method:</strong> Newly diagnosed patients with high-grade NHL were randomized to either Group A or Group B. All patients received 3 cycles of CHOP/RCHOP while, only patients in the group B who didn't achieve early CR were shifted to second line chemotherapy. <strong>Results</strong>: The clinicopathological characteristics of patients included in the two groups were comparable. Assessment of treatment results after the 6<sup>th</sup> cycle showed that 10 patients achieved late CR, 4 patients in group A (40%-4/10) and 6 patients in group B (6/7–85.7%). This difference was statistically significant (p-value 0.04). Out of the early CR group (24 patients), one patient died and another developed CNS relapse thus, both mortality (1/24) and relapse rate (1/23) of early CR group is 4%. Two patients of late CR group relapse (2/10-20%). The difference between the relapse rates of early CR (4%) and late CR (20%) wasn't statistically significant. The remaining 22 patients (22/23-95.7%) achieved early CR and 8 achieved late CR (8/10-80%) were in maintained remission. Regarding toxicity profile, there was no significant difference between both groups.
<strong>Conclusion</strong>: Early shifting to second-line chemotherapy is tolerable and promising. However, studies with larger number of patients are mandatory to identify who may need this approach.
NHLs,early complete response and shifting to second line in NHLs
https://ejhm.journals.ekb.eg/article_26353.html
https://ejhm.journals.ekb.eg/article_26353_e40ab0d71ba2b7c8cc40550d9f74f644.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Functional Outcome of Humeral External Rotation Osteotomy in ERB’s Palsy
1064
1068
EN
Ahmed
Shamma
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Galal
Mansour
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mostafa Salah
Mohamed
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
must7088@yahoo.com
10.21608/ejhm.2019.26600
Background: Shoulder internal rotation contracture is the most common deformity affecting the shoulder in patients with Erb’s palsy. With progression of the deformity, the glenohumeral joint become more dysplastic which may lead to severe functional impairment of the affected limb. Aim of the Work: was to evaluate the functional outcome of external humeral rotational osteotomy. Patients and Methods: This is a prospective study on 10 patients with Erb's palsy who underwent external humeral rotational osteotomy. In this study the patients were evaluated for improvement of abduction and external rotation of shoulder after at least 6 months of operation. Results: The mean preoperative external rotation improved from -40° to 41° and the mean preoperative abduction improved from 135° to 150°. The mean mallet score for preoperative external rotation improved from 2.20 to 4 and the mean mallet score for preoperative abduction show no difference as all patients could raise their arms above 90 degree pre and postoperatively. Conclusion: External humeral rotational osteotomy improves shoulder function in patients with brachial plexus birth palsy suffering from internal rotation contracture associated with advanced glenohumeral joint deformity.
Humeral External Rotation,Osteotomy in ERB’s Palsy,Obstetric Brachial Plexus Palsy
https://ejhm.journals.ekb.eg/article_26600.html
https://ejhm.journals.ekb.eg/article_26600_eb977651f93ed64ba00ec6dd34917987.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Comparative Study for Serum Zinc and Copper Levels in Cases with Normal Pregnancy Versus Preeclampsia
1069
1074
EN
Ahmed Saied Sayed
Mohamed
Department of Gynecology and Obstetrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
ahmedbenny14@gmail.com
Fahd Abdelaal
El-Omda
Department of Gynecology and Obstetrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed Taha
Abdelfatah
Department of Gynecology and Obstetrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mahmoud Abdellatif
Hashish
Clinical Pathology, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
10.21608/ejhm.2019.26354
<strong>Background: </strong>Preeclampsiais a leading cause of both maternal and prenatal morbidity and mortality worldwide. Preeclampsia is more common in developing countries due to women’s low dietary intake of essential minerals and vitamins, micronutrients such as copper, zinc, magnesium, manganese and selenium.<br /> <strong>Aim of work: </strong>was to investigate the levels of serum zinc and copper in preeclamptic women versus normal pregnant women.<br /> <strong>Patients and Methods: </strong>This case-control prospective study included a total of 50 pregnant women attending the Antenatal Clinic, Department of Obstetrics and Gynecology, Al-Azhar University Hospital. Subjects were categorized into 2 groups. <strong>Group I:</strong>25 women with preeclampsia and <strong>Group II:</strong>25 normal pregnant women without preeclampsia who served as controls. Studied group women were subjected to the following investigations: Urine analysis for detection of albumin and measurement of the degree of proteinuria, CBC, liver function tests, renal function tests, coagulation profiles and serum zinc and copper estimation were done. <strong>Results: </strong>have showed that preeclamptic pregnant women have low serum concentration of zinc (Zn) and copper (Cu) comparing to the healthy pregnant women. Zinc levels in control group was 95.7 mg/dL and in preeclamptic group 60.8 mg/dL with highly significance statistical difference (p<0.001). Copper levels in control group was 96.7mg/dL and in preeclamptic group 62.9 mg/dL with highly significance statistical difference (p<0.001).<br /> <strong>Concusion: </strong>It could be concluded thatthere are certain circumstances where preeclamptic pregnant women have low serum concentration of zinc (Zn) and copper (Cu) than the healthy pregnant women. This suggests the possible involvement of depleted serum trace element in the pathogenesis of preeclampsia, but we could not tell if this decrease in serum levels of Zn and Cu was a cause or a result of preeclampsia.
zinc,copper,Normal pregnancy nutrition,preeclampsia
https://ejhm.journals.ekb.eg/article_26354.html
https://ejhm.journals.ekb.eg/article_26354_ec4420cdb4188532f4f30a5e8536da99.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Management of Lumbo-Peritoneal Shunt Complications in Patients with Idiopathic Intracranial Hypertension
1075
1078
EN
Ibrahim
Ewaiss
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University
Al-Sayed
Roshdy
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University
Samer
Magdy
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University
smmms2008@gmail.com
Mohamed
Rashid
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.26355
<strong>Background: </strong>lumboperitoneal (LP) shunt is one of the best surgical management in treatment of Idiopathic intracranial hypertension (IIH).<br /> <strong>Objective: </strong>to review the LP shunt complications and their management in IIH.<br /> <strong>Patients and Methods: </strong>a total of 20 patients who got complications after LP shunt and needed shunt revision were included. There were 18 females and 2 males treated at Al-Hussein university hospital and Al-Mataria teaching hospital during the period from December 2015 and June 2018.<br /> <strong>Results: </strong>there were 18 (90%) females and 2 (10%) males with age ranged from 18 to 48 years. Obstruction was the most common complication happened in 8 (40%) patients. Migration was the second common complication happened in 6 (30%) patients. Shunt infection is the one of the most dangerous complication and needs early intervention. There was one (5%) case of infection which required removal of the LP shunt. Tow (10%) patients had CSF leakage. One (5%) patient had symptoms of over drainage. One (5%) patient had radiculopathy. One (5%) patient had intestinal perforation.<br /> <strong>Conclusion:</strong> LP shunts for the treatment of IIH seems to be a safe procedure. Serious complications were rare. Only one case was deteriorated. Some patients need more than one shunt revision.
Lunboperitoneal shunt,Idiopathic intracranial hypertension,Complications
https://ejhm.journals.ekb.eg/article_26355.html
https://ejhm.journals.ekb.eg/article_26355_9743a8422c7331534d6b5b9909193e14.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
02
01
A Case Control Study on the Effect of Vitamin D on Childhood Cancer
1079
1087
EN
Salma B.
Galal
Department of Community and Occupational Medicine, Faculty of Medicine for Girls, Al-Azhar University.
Somaya M.
Lashin
Department of Community and Occupational Medicine, Faculty of Medicine for Girls, Al-Azhar University.
Hanaa
AbouElyazid
Department of Community and Occupational Medicine, Faculty of Medicine for Girls, Al-Azhar University.
Sahar A.
Khalil
Pediatric Oncology Department, National Cancer Institute, Cairo, Egypt
Doaa S.
Ahmed
Department of Community and Occupational Medicine, Faculty of Medicine for Girls, Al-Azhar University.
doaasadek55@yahoo.com
10.21608/ejhm.2019.26356
<strong>Background: </strong>Childhood cancer in Egypt is a growing concern for the society. The role of vitamin D as promising anticancer agent is evident. A limited number of studies have examined vitamin D status among pediatric oncology patients.
<strong>Aim of the Work: </strong>was to detect some risk factors of childhood cancer, to assess level of vitamin D and identify factors influencing its level in newly diagnosed cancer children and controls.
<strong>Subjects</strong><strong> and Methods: </strong>A case control study was designed including 160 children, aged 1 to 15 years. 80 children were randomly chosen from newly attendants of the National Cancer Institute in Cairo, while controls were recruited from healthy children accompanying parents in a polyclinic in Cairo. The questionnaire included, beside characteristics of parents, risk factors of childhood cancer. A subsample (40 cases, 40 controls) was investigated for serum vitamin D. SPSS 17 was used for statistical analysis.
<strong>Results: </strong>63.8% of the diagnosed cancer children were males compared to 55% of controls. Hematological tumor was the most predominant type. Significantly more cases than controls were of higher birth order , had older fathers, less educated mothers, positive family history of cancer, no folic acid supplementation of mothers during pregnancy, and low vitamin D level (p=0.000). In addition, they mentioned less frequent sun exposure days, incorrect timing of exposure, and lack of sport participation.
<strong>Conclusion: </strong>It is concluded that deficiency of vitamin D, family history of cancer and lack of maternal folic acid were detected as significant risk factors of childhood cancer.
childhood cancer,Vitamin D
https://ejhm.journals.ekb.eg/article_26356.html
https://ejhm.journals.ekb.eg/article_26356_d61d12a12d09f4a0791a9bde045ece12.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
02
01
Study the Relationship between Chronic Inflammation and DNA Changes in Children on Regular Hemodialysis
1088
1093
EN
Maha Zein
El-Abden
Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Manal
Abdel Salam
Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
manal24969@gmail.com
Soheir Saad
Korraa
Department of Molecular Biology, National Center for Radiation Research and Technology- Atomic Energy Authority, Cairo, Egypt
Heba Allah
Moawad
Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
10.21608/ejhm.2019.26357
<strong>Background and Aim of the Work:</strong> Inflammation is a common feature in chronic kidney disease (CKD), especially enhanced in end stage renal disease patients on hemodialysis (HD).Under inflammatory conditions, reactive oxygen species (ROS) and reactive nitrogen species (RNS) are generated from inflammatory and epithelial cells and result in DNA damage. In this study we assess DNA fragmentation in children with chronic kidney disease on regular hemodialysis sand detect its relation with some of the inflammatory markers.
<strong>Material and Methods: </strong>The study included 40 children with CKD on regular hemodialysis (HD), and they were selected from the hemodialysis unit of Al-Zahraa hospital, Al-Azhar University, during the period from April 2016 to January 2018. Another group of 40 apparently healthy children, matches age and sex with patients group as a controls. Serum level of C-reactive protein (CRP), tumor necrosis factor (TNF-α) and DNA fragmentation assay in the same line with routine investigations were assessed for both groups
<strong>Results: </strong>Children on regular hemodialysis have significantly higher CRP and TNF-α serum levels compared to their controls, it was (27.25±4.64 mg/L),(10.04±1.90 ng/ml) and (1.86±0.59 mg/L) (2.75±0.56 ng/ml) respectively, (P<0.001). There was a significant increase in DNA fragmentation in patients group (1.51±0.31) compared to the controls (0.54±0.21) with (P<0.001). DNA damage was present in (92%) of the study patients. There were significant positive correlations between DNA fragmentation and serum level of CRP, TNF-α, body mass index and dialysis duration.
<strong>Conclusion: </strong>Almost children on hemodialysis are exposed to DNA damage with significant association with inflammatory markers, duration of hemodialysis and BMI.
CKD,DNA damage,Hemodialysis,TNF-α
https://ejhm.journals.ekb.eg/article_26357.html
https://ejhm.journals.ekb.eg/article_26357_cb130ead6e7c87fdd9b20b7d7b0f2250.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
02
01
Compliance to short term antibiotics in rural and urban areas in Al-Ahsa-KSA
1094
1097
EN
Abdulrahman Abdulwahab
Alhulaybi
College of Medicine, king Faisal University, Alahsa, Saudi Arabia
Abdullah Saud
Almutairi
College of Medicine, king Faisal University, Alahsa, Saudi Arabia
Salem Ali
Almarri
College of Medicine, king Faisal University, Alahsa, Saudi Arabia
Amro khalid
Althwaiqub
College of Medicine, king Faisal University, Alahsa, Saudi Arabia
10.21608/ejhm.2019.26358
Background: non-adherence to medication is considered as one of the largest drug related issues in the medical field. It results in development of drug resistance besides other harmful effects on the health of individuals. Aim of the work: there is very little data about compliance in Saudi Arabia. So, we conducted this study to see the adherence to the antibiotics by the patients in Al-Ahsa comparing the urban and rural population. Methods: this was a cross sectional observational study in which 215 people were asked questions about the adherence to the antibiotics prescribed by physicians. A convenient sample of 215 people was selected due to the constraint of resources (Finance and time). A questionnaire was designed to include the questions about the adherence to the antibiotics prescribed besides demographic characteristics. Data were entered in SPSS statistic20 which was also used for analysis by using crosstab for the numeric data and chi-square was used to see if there was a relationship between variables. Results: the present results showed that 70.69% of the population was not adhering and 29.30% were adhering to the antibiotic course. In urban population, 38% of the people were adhering to the short term antibiotics compared to 22% in rural areas. Conclusion: there is a need for increasing the awareness about completing the antibiotic course among the people in general and in rural areas in particular.
https://ejhm.journals.ekb.eg/article_26358.html
https://ejhm.journals.ekb.eg/article_26358_1a82c448c370a3616bb508b24ac6d9f7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
02
01
Direct Cost Estimation of Infection Control Strategy in Pediatric Intensive Care Unit at Tanta University Hospital
1098
1110
EN
Mohammed Nagy Hammad
Elganiny
Department of Pediatric Medicine, Tanta University, Egypt
greeneyesnagy86@gmail.com
Ahmed Abd Elbasset
Abo Elezz
Department of Pediatric Medicine, Tanta University, Egypt
Enas Arafa
Elzimmrany
Department of Clinical Pathology, Tanta University, Egypt
Dina Hassan
Abd Elhady
Faculty of Medicine,
Department of Applied Statistics Faculty of Commerce, Tanta University, Egypt
10.21608/ejhm.2019.26359
Background: Hospital-acquired infections (HAIs) are a major complication of hospital care in adult and children. Estimating the cost of infection control is important because HAIs cost a lot by extending patient length of stay this is a major risk factor for HAI. Objectives: Estimation of the direct cost of medical infection control measures and the direct cost of hospitalization among patients with and without hospital-acquired infections in the Pediatric Intensive Care Unit at Tanta University Hospital. Subjects and Methods: fifty infants and children (with and without HAI) who were admitted to PICU were subjected to clinical examination and investigation to diagnose infection. The direct cost included feeding requirements, investigations, procedures, medications and infection control measures. Prices used according to the period from October 2016 to September 2017 for calculating patients cost. Results: The average total direct cost of hospitalization, for cases with HAI was 8940.45 EP, which was significantly higher than that for patients without HAI (2935.63 EP). There was a significant difference in the average cost per day between patients with and without HAI. The average total direct cost of management for cases with HAI was 7068.77 E.P, which was significantly higher than that for patients without HAI (2191.66 E.P). The average total infection control cost for cases with HAI was 1871.69 E.P, which was significantly higher than that for cases without HAI (743.96 E.P). The mean length of stay (LOS) in PICU was significantly longer for patients with HAI (19.08 days), while in patients without HAI was 7.44 days (range 4-11). Conclusion: The cost of infection control is much lower than the cost of hospital-acquired infections management that prolongs hospital stay causing financial losses to the health system.
Cost Estimation,Infection Control Strategy,pediatric intensive care unit
https://ejhm.journals.ekb.eg/article_26359.html
https://ejhm.journals.ekb.eg/article_26359_80080cbb1aa9cd746dbcc98445b79c8d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
The study of oxidative status in children with end stage renal disease on regular hemodialysis
1111
1122
EN
Ahmed Mohamed Mahmoud
Odima
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
ahmedodeama2000@gmail.com
Nagy Mohamed
Abo Elhana
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
Wesam Salah
Mohamed
Department of Clinical Pathology, Faculty of Medicine, Tanta
University, Egypt
Mohamed Abd Elaziz
Elgamsy
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
10.21608/ejhm.2019.26362
Background: Oxidative stress has long been demonstrated in haemodialysis patients. However, the factors influencing their oxidative status have not been characterized extensively in these patients. Despite heterogeneity in the oxidative stress levels in the CKD population, there has been little effort to measure patient oxidative stress levels before the use of any anti-oxidant therapies to optimize outcome. Objectives: Assessment of oxidative stress and the effects of using antioxidant medications on oxidative status in children with end stage renal disease under regular hemodialysis. Subjects and Methods: 70 children were included in this study and were categorized into 2 groups: Group (1): 35 children with ESRD on regular haemodialysis. Their ages ranged from 8 to 15 years old. They were 14 males and 21 females. All patients were undergoing haemodialysis three times per week, with each dialysis session lasting for three to four hours. Group (2): 35 healthy children with matched age and sex that were serving as control group. All patients were receiving antioxidant drugs regularly for 3 months. These antioxidant drugs were vitamin E in a dose of 5 mg/kg/day, vitamin C in a dose of 100-200 mg /day, N-Acetyl Cysteine in a dose of one sachet (200 mg) twice daily with meal. All children in both groups were subjected to: (a) complete history taking. (b) Full clinical examination. (c) Laboratory Investigations [Routine Investigations: CBC, blood urea, serum creatinine and BUN, PTH and PT, PTT and Bleeding Time. Specific Investigations: Measuring levels of 1-Interleukin-1β, tumor necrosis factor alpha, thiobarbituric acid reactive substances and malondialdehyde]. Results: There was an increase in markers of oxidative stress in children with end-stage renal disease on regular haemodialysis in the form of: 1) Increase serum level of interleukin 1β (IL-1β). 2) Increase serum level of tumor necrosis factor alpha (TNF-α). 3) Increase serum level of thiobarbituric acid reactive substances (TBARS). 4) Increase serum level of malondialdehyde (MDA). These levels were decreased with antioxidant drugs used in this study. Conclusion: The high levels of oxidative stress markers were decreased after regular therapy by antioxidant medications for 3 months in the form of vitamin E (5 mg/kg/day), vitamin C (100-200 mg /day) and N-Acetyl Cysteine (one sachet (200 mg) twice daily with meal).
Oxidative status: End stage renal disease,Hemodialysis
https://ejhm.journals.ekb.eg/article_26362.html
https://ejhm.journals.ekb.eg/article_26362_fd482432496febd470f76d953c65798a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Incidence, Prevention and Management of Post Tonsillectomy Hemorrhage
1123
1127
EN
Ali Abdallah
Abdel Rahman
Department of Otolaryngology, Faculty of medicine, Al-Azhar University
Mohammad Amin
Al-Morsy
Department of Otolaryngology, Faculty of medicine, Al-Azhar University
Mohamed Said
Hussein
Department of Otolaryngology, Faculty of medicine, Al-Azhar University
mohammedsaidhussien63@gmail.com
10.21608/ejhm.2019.26363
Background: Tonsillectomy is one of the most frequently performed operations in otolaryngology, especially in children. Basically, bleeding within 24 h has been classified as primary bleeding whereas bleeding occurring from the next day after surgery has been classified as secondary bleeding. Aim of the Work: Was to review the possibility of decreasing the incidence of post- tonsillectomy hemorrhage along with the associated complications. Methods: This is a prospective study enrolling one thousand and two hundred patients undergoing tonsillectomy (with or without adenoidectomy in Al- Azhar University Hospitals (El-Hussien – Sayed Jalal - AL Zahraa) from April 2018 till December 2018. We restricted the study to full time participants and resident staff so that complete records would be available. Results: The mean age of patients was 13.53 years, 47.62% of patients were male while 52.38% of patients were female. Primary bleeding occurred in 16 cases while secondary bleeding occurred in 32 cases. There are significant differences among studied groups as regard to control methods of post-tonsillectomy bleeding which could be conservative or operative. Conclusion: We concluded that patients with post-tonsillectomy bleeding should return for clinical evaluation as they may need conservative management or possible operation interference either for ligation or cautery of bloody tonsil, that trigger a need for external carotid artery ligation.
Bleeding,Cautery,Tonsillectomy,Sutures
https://ejhm.journals.ekb.eg/article_26363.html
https://ejhm.journals.ekb.eg/article_26363_96736481a6560dff8116ef12811a76cd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Day 3 embryo Transfer versus Day 5 Embryo Transferversus Day 6 Embryo Transfer in Cases of Intracytoplasmic Sperm Injection
1128
1136
EN
Hossam Eldin H.
Salem
Department of Obstetrics and Gynecology, Al-Azhar University
Assem A.
Mosa
Department of Obstetrics and Gynecology, Al-Azhar University
Emad Eldin R.
Matar
Department of Pathology, Faculty of Medicine, Al-Azhar University
Ahmed A.
Elsamanoudy
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
ahmed_elsamanoudy2005@yahoo.com
10.21608/ejhm.2019.26379
<strong>Background: </strong>IVF is becoming now the gold standard for solving the problem of infertility, nearly million IVF babies were born. The time of embryo transfer still rises a big question and is still a field of great debate whether to transfer it early as day 3 or wait till day 5 or day 6 to give a good chance for embryo selection. <strong>Aim of the work:</strong> to determine whether embryo transfer on day 3 versus day 5 versus day 6 shows a significant difference in implantation, clinical pregnancy, live birth, miscarriage and multiple pregnancy rates among women undergoing intracytoplasmic sperm injection. <strong>Results:</strong> Concerning multiple pregnancy rates day 3 embryo transfer was 7 (14%) in compared to 31 (31%) in day 5 embryo transfer in compared to 13 (26%) in day 6 embryo transfer which still shows significant difference between three groups. There was only slight difference between live birth in three groups, for day 3 we had (14%) 19 (5 twins and 9 single) living babies while for day 5 we had (44%) 70 (26 twins and 18 single) while for day 6 we had (20%) 31 (11 twins and 9 single). Using Pearson Chi-Square there was significant difference between the three groups regarding live birth. There was great difference in success rates and outcome of embryo transfer between three groups.<strong>Conclusion:</strong> From this study we can conclude that there is significant difference in either pregnancy or delivery rates between day 3 and day 5 and day 6 when patients are appropriately randomized. Delaying embryo transfer to day 5 or day 6 offers advantage to patients undergoing ICSI. Embryos that develop to the expanded blastocyst stage and are transferred on day 5 after retrieval are approximately as likely to implant compared to those for which expansion and transfer are delayed until day 6.
IVF,Intracytoplasmic Sperm Injection
https://ejhm.journals.ekb.eg/article_26379.html
https://ejhm.journals.ekb.eg/article_26379_186275927f5c01b23fc5e48b0e00363f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Study of Serum Leptin in Polytransfused Children with Beta Thalassemia Major
1137
1150
EN
Ahmed Mohamed Abd EL-Gawad
Asfour
Pediatric Department, Faculty of Medicine Al-Azhar University
drahmedasfour14@gmail.com
Ali Abd El-Latif
Afia
Pediatric Department, Faculty of Medicine Al-Azhar University
Mohamed Saeed
El-Shorbgy
Clinical pathology Department, Faculty of Medicine Al-Azhar University
Mohamed Abd El-kareim
Mohamed
Pediatric Department, Faculty of Medicine Al-Azhar University
10.21608/ejhm.2019.26380
<strong>Background: </strong>thalassemic patients with frequent blood transfusion can result in iron overload and increase serum ferritine level. Leptin is a polypeptide hormone that is mainly expressed in bone marrow and adipocytes and previous studies consumed that it is lower in thalassemic patients compared to healthy children as a result of hemsedrosis.
<strong>Objectives:</strong> The aim of this study was to evaluate leptin serum levels in patients with β- thalassemia major.
<strong>Patients and methods:</strong><strong> </strong>This case-control study was conducted on 50 children from 13 to 17 years old, at Al-Azhar university Hospitals (Sayed Galal & Al-Hussien hospitals). They were subdivided in two groups 30 patients (ß- thalassemia major) and 20 as control that were matched in age and sex. All Children were examined to be free from heart disease , iron deficiency anemia, kidney disease, diabetes, fever and systemic diseases were enrolled after taking informed consent of their parents. After collecting the samples, leptin and ferritin levels of the serum were measured in two groups by ELISA method. Then, the data were analyzed by the related statistical tests and SPSS 20 software.
<strong>Results: </strong>The mean of the serum levels of leptin and ferritin showed a significant difference in the case and control groups (P-value < 0.05). Levels of leptin in the case group showed no significant gender difference (P-value < 0.05).
<strong>Conclusion: </strong>Based on the results of this study, thalassemia major reduces serum levels of leptin regardless of age and body mass.
Beta-Thalassemia,Child, Ferritin, Leptin
https://ejhm.journals.ekb.eg/article_26380.html
https://ejhm.journals.ekb.eg/article_26380_6fd9a5969456489cd7c043f33ddba6f4.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Bacteremia Predictive Factors among Inpatients of Internal Medicine Department. A Prospective Cross- Sectional Survey in Aswan University Hospital
1151
1155
EN
Mohammed Zain Eldeen
Hafez
Departments of Internal Medicine, Faculty of Medicine, Aswan University,
Aswan, Egypt
Soumaia Ahmed
Kassem
Departments of Internal Medicine, Faculty of Medicine, Aswan University,
Aswan, Egypt
Wafaa Salah Eldin
Mohamed
Departments of Clinical Pathology, Faculty of Medicine, Aswan University,
Aswan, Egypt
Ahmed Yehia Araby
Youssif
Departments of Internal Medicine, Faculty of Medicine, Aswan University,
Aswan, Egypt
dr.ahmed_yehia@yahoo.com
10.21608/ejhm.2019.26693
Background: bacteremia is the presence of bacteria in the blood stream that are alive and capable of reproducing. It is a type of blood stream infection Aim of the Work: was to identify bacteremia predictive factors among inpatients at Internal Medicine Department in Aswan University Hospital and to improve the management and decrease mortality among inpatients through clinical parameters. Patients and Methods: we estimated blood cultures of one hundred patients at our department from April 2017 to April 2018. Results: The final diagnosis and univariate analysis have shown use of central venous line (p<0.001), high axillary body temperature (p<0.001), greater pulse rate (p<0.001), leucocytosis (p<0.001), neutrophilia (p<0.0001), and creatinine (p<0.002) were associated with bacteremia. Positive blood cultures patients have shown in our study that temp >38OC, leucocytosis, neutrophillia >85%, tachycardia>90 and serum creatinine >1.3% were independent risk factors of bacteremia. Conclusion: The presence of bacteremia can be highly predicted by fundamental clinical information such as high pulse rate, leucocytosis, high grade temperature and neutrophilia.
Bacteremia Predictive Factors
https://ejhm.journals.ekb.eg/article_26693.html
https://ejhm.journals.ekb.eg/article_26693_fc2782853938f784e93f6357a57e95af.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Influence of Sleeve Gastrectomy on Gastro-Esophageal Reflux Disease
1156
1164
EN
Ashraf Abd El-Hameed
Abd El-Moneim
Department of General surgery, Faculty of Medicine, Al-Azhar University
Abd El-Fattah
Morsi
Department of General surgery, Faculty of Medicine, Al-Azhar University
Tamer Abdu Mohammed
Megahed
Department of General surgery, Faculty of Medicine, Al-Azhar University
tamer.a.m390@gmail.com
10.21608/ejhm.2019.26381
<strong>Background: </strong>bariatric operations can induce reflux by affecting organs motor functions depending on the type of procedure performed. Laparoscopic sleeve gastrectomy (LSG) relatively new option of morbid obesity treatment, simpler to perform, short learning curve, and shorter duration (procedure time and hospital stay).
<strong>Objective</strong><strong>s</strong><strong>:</strong> The aim of this work was to evaluate upper gastrointestinal symptoms before and after sleeve gastrectomy on short term follow up period of 6 months post-operatively and to assess the relation between Gastro-Esophageal Reflux Disease and sleeve gastrectomy.
<strong>Patients and Methods:</strong> This follow up study included 50 morbidly obese patients treated with laparoscopic sleeve gastrectomy during the period from May 2018 to October 2018. Rome III Criteria and upper GI Endoscopy evaluation was done preoperatively then 6 months postoperatively concerning upper GI symptoms.
<strong>Results:</strong> Before LSG 60% asymptomatic, 40 % GERD, 6.7 % dyspepsia (PDS predominance). UGI endoscopy showed 40% no significant findings, 60% gastritis, 20% esophagitis, 13.3% duodenitis, DU 6.7%. 40% H-pylori positive and 60% negative. After 6 months follow-up, 93.3% complained of upper GI symptoms, 66.7 % prevalence of dyspepsia (p<0.001). GERD symptoms disappear in 83.3%. 20% increased Vomiting of all patients associated with GERD (p =0.030). 13.3% increased Dysphagia (p =0.125) associated with dyspepsia. 100% correlation between GERD and hiatus hernia (p<0.001) and 66.7% between vomiting and incompetent cardia (p=0.029).
<strong>Conclusion:</strong> Improvement of Gastro-Esophageal Reflux Disease after Sleeve Gastrectomy in patients complaining of GERD pre-operatively, although there is incidence of post-operative hiatus hernia and develop of gastrointestinal symptoms .
<strong>Recommendation: </strong>further studies have to be applied.
Obesity,Laparoscopic sleeve gastrectomy,upper gastrointestinal symptoms,GERD,Dyspepsia
https://ejhm.journals.ekb.eg/article_26381.html
https://ejhm.journals.ekb.eg/article_26381_2f0a6378a3c3b50d0ccbca9e6bf0e066.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Electrocardiography versus Echocardiography for assessment of left ventricular hypertrophy in ischemic heart disease patients with and without cardiovascular risk factors
1165
1173
EN
Mansour Mohammed
Moustafa
Department of Cardiology, Faculty of Medicine, Al-Azhar University
Abdel Aziz Rezk
Shredah
Department of Cardiology, Faculty of Medicine, Al-Azhar University
Kamal Ahmed
Marghany
Department of Cardiology, Faculty of Medicine, Al-Azhar University
Ahmed Yahya Sayed
Zakaria
Department of Cardiology, Faculty of Medicine, Al-Azhar University
cardiologist_yahya@yahoo.com
10.21608/ejhm.2019.26382
<strong>Background: </strong>it is well documented that left ventricular hypertrophy (LVH) detected by 12-lead electrocardiography or echocardiography is a major risk factor for cardiovascular morbidity and mortality in cohorts ranging from the general population to those with established cardiovascular disease, including coronary artery disease (CAD).
<strong>Objectives: </strong>aims of this study were to detect prevalence of LVH in CAD patients by standard echocardiography by measuring LVM indexed to body surface area and to test the sensitivity and specificity of new ECG criteria, Peugero-Lo Prosti criteria, for detection of left ventricular hypertrophy and comparing it with other ECG criteria to diagnose LVH.
<strong>Patients and Methods: </strong>This observational cross sectional study was conducted at El-Hussein University Hospital and Minia Health Insurance Hospital during the period from July 2016 to June 2017, the study involved 230 patients of either sex, and referred for Echocardiography department to perform 2D transthoracic echocardiography.
<strong>Results: </strong>In our study, we founded that firstly, the echo-LVH is prevalent in CAD patient (41.5%) regardless the presence of other cardiovascular risk factors. Moreover, our results showed that, the prevalence of echo-LVH is significantly higher in patients with CAD and hypertension, than in patients with CAD only (54% Vs. 32%). Secondly, the Peguero-Lo Prosti criteria has a higher sensitivity (61.4%) for detecting LVH among the patients with CAD than Sokolow-Lyon criteria (26.5%), Cornell voltage criteria (32.5%) and Romhilt Estes point score (41%) considering LVMI by echocardiography as reference standard.
<strong>Conclusion: </strong>the prevalence of echocardiographic LVH in CAD patient is high regardless the presence of other cardiovascular risk factors. Overall the present study shows that, Peguero-Lo Presti criteria has higher sensitivity and specificity in the ECG diagnosis of LVH compared to Sokolow-Lyon criteria, Cornell voltage criteria and Romhilt-Estes point score system considering LV mass index by 2D Echocardiography as reference standard.
Left ventricular hypertrophy,Coronary Artery Disease,eCG,ECHO
https://ejhm.journals.ekb.eg/article_26382.html
https://ejhm.journals.ekb.eg/article_26382_90414189a142404dc7d7ea292fde4504.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Pericardiectomy for Managing Constrictive Pericarditis. A Case Report of A 30-Years-Old Saudi Female
1174
1179
EN
Nora
Alsomali
College of Medicine, Alfaisal University
Afrah
Alsomali
College of Medicine, Alfaisal University
afrah.m@live.com
Aftab
Turi
King Faisal Specialist Hospital and Research center
aaftab1@gmail.com
Atli
Eyjolfsson
King Faisal Specialist Hospital and Research center
aeyjolfsson@kfshrc.edu.sa
10.21608/ejhm.2019.26597
<strong>Background: </strong> constrictive pericarditis (CP)is the final stage of a chronic inflammatory process that leads to the thickening and calcification of the heart’s pericardium, restricting its natural elasticity and diastolic filling. CP has nonspecific symptoms; hence, requires a high index of suspicion and complete investigations. <strong>Aim of the work</strong>: this is a case of a young Saudi female presented with a 3 years history of shortness of breath associated with abdominal distention<strong>. Patient and Methods</strong>: multimodal imaging, lab workup and cardiac catheterization were done to confirm the diagnosis of CP. <strong>Results</strong>: the patient was managed by total pericardiectomy; during which her calcification was found to be encasing the heart at its length dimension and invading deeply into the myocardium. The patient experienced complicated postoperative course; however, now is doing fine. <strong>Conclusion</strong>: to our knowledge there are no similar cases reported in the literature from Saudi Arabia. Therefore, the aim of this case was to highlight the importance of early diagnosis and management of CP for better prognosis.
constrictive,Pericarditis,pericardiectomy,calcification,Saudi Arabia
https://ejhm.journals.ekb.eg/article_26597.html
https://ejhm.journals.ekb.eg/article_26597_8e21ee9621f1c9a2b1cb1f8673b5938d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Pedicled thoracodorsal artery perforator flap for reconstruction of post burn contracted neck
1180
1185
EN
Osama
Alshahhat
Departments of Plastic Surgery, Faculty of Medicine, Al-Azhar University
Mohamed
Autifi
Anatomy and Emberyology, Faculty of Medicine, Al-Azhar University
Mohamed
Hosny
Departments of Plastic Surgery, Faculty of Medicine, Al-Azhar University
Mohamed
Osama
Departments of Plastic Surgery, Faculty of Medicine, Al-Azhar University
Mohamed
Farid
Departments of Plastic Surgery, Faculty of Medicine, Al-Azhar University
Moaaz
Moaty
Departments of Plastic Surgery, Faculty of Medicine, Al-Azhar University
moaazplastic@azhar.edu.eg
10.21608/ejhm.2019.26598
Background: The thin and pliable skin of the neck is a region with multidirectional activity, and postburn contractures forms there easily. Different methods of reconstruction were described. In our study the thoracodorsal artery perforator flap (TDAP) is used to reconstruct the post burn contracted (PBC) neck. Its main vascular supply is the thoracodorsal artery, and can be harvested as an island flap. Aim of the work: to evaluate the aesthetic and function outcome of TDAP flap as a new technique for reconstruction of PBC neck. Patients and Methods: this study included a total of 10 TDAP flaps. Were studied prospectively for their efficacy in reconstruction of PBC neck in 10 patients. Also donor site morbidity, patient satisfaction, and complications were evaluated. Between November of 2017 and January of 2019, this study was preceded by preserved cadaveric dissection. All were island flaps. The range of flap size was 18 ± 5 cm in length, and 9 ± 2 cm in width. Primary closure of donor site was performed in all cases. Results: 8 of the 10 flaps survived completely, two cases of distal necrosis not exceeding 2 cm (20%), and no total flap necrosis. Most of the patients were satisfied with both the functional and aesthetic results. Conclusion: PBC neck affects function, and appearance. In our view, the island TDAP flap is a good option for neck resurfacing regarding a wide arc of rotation, a relatively larger flap dimensions, a reliable pedicle length, and acceptable donor site morbidity
Thoracodorsal artery perforator flap,post-burn neck contracture,island flap,fasciocutaneous flap
https://ejhm.journals.ekb.eg/article_26598.html
https://ejhm.journals.ekb.eg/article_26598_053d4e8b44f4fb9b0d3e01f486b4bd49.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
74
5
2019
01
01
Breast-Conserving Surgery after Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer: Single Institute Experience
1186
1196
EN
Mohamed
Esmat
Department of General Surgery (Surgery Oncology Unit), Faculty of Medicine, Al-Azhar University, Cairo, Egypt
prof.mohamed.esmat@gmail.com
Wael
El-Sheshtawy
Department of Clinical Oncology
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
10.21608/ejhm.2019.26599
Background: from clinical and pathologic aspects, locally advanced breast cancer (LABC) can be considered a relatively heterogeneous group of tumors. Objective: we aimed to evaluate local control after breast-conserving surgery in patients with locally advanced breast cancer who received neoadjuvant chemotherapy for down staging. Patients and Methods: a retrospective study was performed to include patients with locally advanced breast cancer who underwent breast-conserving surgery after neoadjuvant chemotherapy (anthracylcine based regimen followed by taxans). The clinical, pathologic, and surgical factors that could contribute to locoregional recurrence were evaluated. Results: after neoadjuvant chemotherapy, 94 patients underwent breast-conserving surgery. The average tumor diameter was 5.3 cm, and 87.8% of patients achieved a size of up to 3 cm. Furthermore, 85.7% were at clinical stage III, 75.5% had T3-T4 tumors, 81.6% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic optimal response was achieved in 26.5% of the tumors, and all the samples had free margins. The 5- year overall survival rate was 81.6%, and the mean follow-up duration was 94.1 months. The rate of ipsilateral breast tumor recurrence was 10.2%, while the rate of locoregional recurrence was 16.3%. The regression analysis showed that multifocal morphology response was the only factor associated with ipsilateral breast tumor recurrence (p=0.04). The pathologic response evaluation criteria in solid tumors (RECIST) breast cutoff was the only factor associated with locoregional recurrence (p=0.01). Conclusion: breast-conserving surgery is a safe and effective therapeutic option for selected locally advanced breast tumors after receiving neoadjuvant chemotherapy.
Breast Neoplasms,neoadjuvant therapy,Drug Therapy Combination,Breast-conserving surgery,Recurrence,Disease-Free Survival
https://ejhm.journals.ekb.eg/article_26599.html
https://ejhm.journals.ekb.eg/article_26599_2d8ae729aa7dc93dd1327e67e438cd22.pdf