Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Relation between Fundus Autofluorescence and Optical Coherence Tomography in Age Related Macular Degeneration
4246
4253
EN
Mohamed Nabil Mohamed
Sharaf
Ophthalmology Department, Faculty of medicine, Al-Azhar University
mohamednabil91@azhar.edu.eg
Hassan Mohamed
Hegazy
Ophthalmology Department, Faculty of medicine, Al-Azhar University
Mohamed Abdul Badiea
Rashed
Ophthalmology Department, Faculty of medicine, Al-Azhar University
10.21608/ejhm.2019.43803
Background: age-related macular degeneration (AMD) is a macular neurodegenerative disease that nowadays constitutes one of the main socioeconomical health issues worldwide, affecting the elderly population. The exponentially increasing prevalence of AMD is linked to progressive aging of the population, and it is the leading cause of legal blindness in the developed world. Objective: the study was designed to assess the relation between fundus autofluorescence (FAF) and Optical Coherence Tomography (OCT) in cases of age related macular degeneration. Patients and Methods: this study is prospective randomized, non-interventional uncontrolled cross-sectional study was conducted on thirty patients. These patients already diagnosed to have age related macular degeneration either dry or wet form by fundus examination. Results: it was found from this study fifty eyes of thirty patients having AMD, Sex distribution in female more than male, age distribution revealed that the age ranged from 50 to75 years, FAF and OCT cannot replace FFA in cases of CNV. Conclusion: FAF provides the opportunity to evaluate the retinal functional status. OCT obtains a detailed picture of the retinal anatomy
Age related macular degeneration,FAF,OCT
https://ejhm.journals.ekb.eg/article_43803.html
https://ejhm.journals.ekb.eg/article_43803_673aac47dd2a4d20a1763f036606d26d.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Effect of Carbon Tetrachloride (CCL4) on Liver in Adult Albino Rats: Histological study
4254
4261
EN
Haytham EL Sayed Ali
EL Sayed
Histology and Cell Biology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Lotfy EL Sayed
Morsy
Histology and Cell Biology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Tamer Mosad
Abo Emara
Histology and Cell Biology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Rania A.
Galhom
Human Anatomy and Embryology Department, Faculty of Medicine, Suez Canal University, Esmaillia, Egypt.
10.21608/ejhm.2019.43804
Background: The liver is a vital organ that plays a key role in the detoxification of endogenous and exogenous substances. Variety of pathological factors including viral hepatitis (especially hepatitis B and C), alcohol and drug abuse, metabolic diseases, autoimmune diseases and congenital abnormalities can cause hepatic injury. Chronic hepatic disease is quite common in daily clinical practice. Liver cirrhosis is the final stage of all chronic hepatic diseases. Liver transplantation is the treatment of choice for chronic liver failure, although, it faces several difficulties. Aim of the work: to evaluate the toxic effect of carbon tetrachloride (CCL4) on the liver structure. Materials and methods: Twenty male rats of average weight 200 grams and aged 6-8 weeks were included in this study. The Rats were divided into the following two groups: Group I (control group): ten male rats were subdivided into two subgroups, one of them acted as negative control and the other received the equivalent volume of the solvent olive oil. Group II (experimental group): ten male rats were injected intraperitoneally (IP) by CCL4 twice weekly for four weeks. Results: Histological examination of liver specimens showed that CCl4 caused patchy and variable pathological changes in the liver tissue along with significant increase in collagen fiber content. Conclusion: The induced liver fibrosis by CCL4 in rats showed markedly pathological effects on hepatic stroma and parenchyma.
Carbon Tetrachloride CCL4,Liver,albino rats
https://ejhm.journals.ekb.eg/article_43804.html
https://ejhm.journals.ekb.eg/article_43804_bf57645a3183e6bd74ebbaead3b11824.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Seroepidemiological Evaluation of Toxocariasis in Egyptian Children Suffering from Recurrent Urticaria
4262
4268
EN
Ahmed Mohamed
Bayoumy
Department of Medical Parasitology, Faculty of Medicine, Boys
drahmedbayoumy@azhar.edu.eg
Rabie Bedier
Atallah
Department of Dermatology, Faculty of Medicine, Al-Azhar University, Damietta
Khaled Abd El-Aziz
Mohamed
Department of Medical Parasitology, Faculty of Medicine, Damietta, Al-Azhar University
Tarek Khameis
Zaalouk
Department of Medical Parasitology, Faculty of Medicine, Boys
Mustafa El-Shahat
Ghazy
Department of Medical Parasitology, Faculty of Medicine, Damietta, Al-Azhar University
Mohamed Ahmed
El-Kenany
Department of Medical Parasitology, Faculty of Medicine, Damietta, Al-Azhar University
10.21608/ejhm.2019.43805
Background: human toxocariasis is one of the most common zoonotic helminthiases reported all over the world. Large spectrum of clinical diseases due to toxocariasis including cutaneous diseases particularly urticaria has been identified by recent diagnostic laboratory tests. Objective: it was to evaluate the Toxocara seroprevalence in children diagnosed with chronic urticaria (CU) and to identify its possible relationship with epidemiological, laboratory and clinical aspects, through a case–control study presented at the Dermatology Outpatient Clinic of Al-Azhar University Hospital in New Damietta City. Patients and Methods: seventy children diagnosed with CU and seventy healthy controls were included in the study. Sociodemographic risk factors for toxocariasis were analyzed based on a questionnaire collected from the children’s parents or guardians, then all of the children were subjected to thorough clinical examination, stool examination to exclude other parasites and blood samples were collected and tested for eosinophilic count by CBC as well as estimation of anti-Toxocara IgG antibodies by means of western blot (WB) test. Results: Toxocara IgG was positive in 18.5% (n=13). It was significantly higher than among the cross-matched 70 healthy controls (4.2%). This study confirmed the possibility of significant association between the seroprevalence of Toxocara and possible socioepidemiological factors as contact with pets or soil, geophagia as well as state of house. Regarding clinical manifestations and laboratory investigations, bronchial asthma, rhinitis and conjunctivitis were found to be significantly associated with Toxocara seroprevalence. Conclusion: Toxocara infection should be considered as an important cause of recurrent urticaria among children population in developing countries.
Chronic urticaria,Toxocariasis,children,IgG,seroprevalence
https://ejhm.journals.ekb.eg/article_43805.html
https://ejhm.journals.ekb.eg/article_43805_36a39ef97975fefb756e1855007cb36f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Comparative Study between Conservative Breast Surgery and Modified Radical Mastectomy in Triple Negative Cases
4269
4273
EN
Eid Rezk
El Gammal
Surgical Oncology Department, Faculty of Medicine, Al-Azhar University
Ayman Mohamad
Abdulmohaymen
Surgical Oncology Department, Faculty of Medicine, Al-Azhar University
Bashir Adel M. M.
Abdulmutaleb
Surgical Oncology Department, Faculty of Medicine, Al-Azhar University
bashher@gmail.com
10.21608/ejhm.2019.43806
Background: Breast cancer has a significant concern in modern researches due its mortality and associated psychological aspects. Aim of the Work: The aim of this work is to compare conservative breast surgery (CBS) and modified radical mastectomy (MRM) regarding oncologic and cosmetic outcomes in women with primary breast cancer negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 triple-negative breast cancer (TNBC). Patients and Methods: This retrospective study included 20 patients presented by breast cancer. All patients underwent surgery at Al-Azhar University Hospitals. 10 patients were treated by conservative breast surgery and 10 patients were treated by modified radical mastectomy. Results: We investigated Overall Survival in patients with TNBC treated with mastectomy compared with those receiving CBS. The analysis indicated that patients with CBS had better survival than patients with mastectomy in Overall Survival (P < 0.001). Conclusion: patients with CBS exhibited improved in TNBC may be associated with the baseline characteristics between two groups. Most patients in the CBS group presented with better survival than did patients in the mastectomy group. CBS was favored over mastectomy.
breast cancer,Conservative breast surgery,Modified Radical Mastectomy
https://ejhm.journals.ekb.eg/article_43806.html
https://ejhm.journals.ekb.eg/article_43806_24814722d09d6559144cdf7f3aa356c5.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Glycemic State of Type 2 Diabetic Chronic Kidney Disease Patients after Vitamin D Replacement Therapy
4274
4278
EN
Haitham
A.Azeem
Internal Medicine Department, Faculty of Medicine, Al-Azhar University
Ayman
Abdel Aziz
Internal Medicine Department, Faculty of Medicine, Al-Azhar University
Alaa Mohammed
Hashim
Clinical Pathology Department, Faculty of Medicine, Al-Azhar University
Mohammed
Ahmed
Internal Medicine Department, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.43807
Background: Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycaemia as a result of insulin deficiency, insulin resistance or both. Objective: To assess the impact of vitamin D replacement therapy on glycemic state in type 2 diabetic chronic kidney disease (CKD) patients. Patients and Methods: 70 patients previously diagnosed as type 2 DM (according to guidelines used by National Institute of Health USA) attending Al-Azhar Assuit University Hospital, internal medicine department and outpatient clinics was included in our study where vit. D was replaced in our groups and its impact on glycemic state was analyzed by bivariate and multivariate analyses. Results: Our study is a prospective study revealed a significant negative correlation between 25(OH)D levels and HbA1c values before and after vit. D replacement therapy. Conclusion: Vitamin D replacement therapy had a beneficial effect on glucose hemostasis via a significant reduction in HbA1c, this emphasizes the potential therapeutic implications of vitamin D supplementation as a promising preventative and therapeutic agent for improved glycemic control among type 2 DM patients with CKD
HbA1c,Type 2 DM,Chronic Kidney Disease,Vit. D replacement,Intervention study
https://ejhm.journals.ekb.eg/article_43807.html
https://ejhm.journals.ekb.eg/article_43807_f9cc4a936a109e02dd7c268efd8caba4.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Ipsilateral Femoral Neck and Shaft Fracture Management Single Implant versus Multiple Implants
4279
4284
EN
Ahmed AbdElhamid
Shamma
Department of Orthopedic Surgery, Faculty of Medicine, Al Azhar University, Egypt
Mohammed AbdElaziz
Hassan
Department of Orthopedic Surgery, Faculty of Medicine, Al Azhar University, Egypt
Ahmed Mohammed Saber
Agour
Department of Orthopedic Surgery, Elbajour General Hospital,Menoufia, Egypt
10.21608/ejhm.2019.43808
Introduction: Fracture of shaft and ipsilateral neck of femur is a challenging problem to orthopaedics surgeons. The treatment is often difficult, and there are many protocols for the management of these fractures. Objectives: To assess the efficiency of multiple implants method for management of ipsilateral fracture neck and shaft femur using plate and screws or retrograde nail for femoral shaft fractures and cannulated screws or sliding hip screw for femoral neck fracture, evaluate the efficiency of reconstruction nail as a single implant method for management of fracture both neck and shaft femur as well as to compare the results of two management methods. Material and Methods: A total of 20 adult patients with ipsilateral femoral neck and shaft fractures were included in our study. Standard radiographs were obtained. Patients were divided into single implant group (Group I; 10 patients) and multiple implants group (Group II; 10 patients). All patients were followed prospectively for a minimum of 1 year. Fracture union was confirmed radiologically, and functional evaluation was done as per Harris Score. Results: 70% of both groups achieved successful fracture union with the remaining 30% with either nonunion, malunion or necrosis of the femoral head but with non- significant difference between both groups. Conclusion: Upon comparing single versus multiple implants methods, equivalent results, were clinically and radiologically obtained with both techniques. However, it is difficult to draw a definite conclusion as the number of cases is relatively small. A study with a larger population scale probably gives a definite conclusion.
Ipsilateral Femoral Neck,Shaft Fracture,Single implant,Multiple implants
https://ejhm.journals.ekb.eg/article_43808.html
https://ejhm.journals.ekb.eg/article_43808_3bb3ff6913bdceb56148d3a9919af5f7.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Impact of Intrauterine Injection of Human Chorionic Gonadotropin at Embryo Transfer on Intra Cytoplasmic Sperm Injection Outcome
4285
4291
EN
Mona M.R.
Mourad
International Islamic Center for Population Studies and Research, Al-Azhar University
Yehia A.S.
Wafa
International Islamic Center for Population Studies and Research, Al-Azhar University
Shokry A.Z.
El Awady
International Islamic Center for Population Studies and Research, Al-Azhar University
Ahmed Abou
El Serour
International Islamic Center for Population Studies and Research, Al-Azhar University
10.21608/ejhm.2019.43809
Background: for successful embryonic implantation, a healthy embryo at blastocyst stage and a functional endometrium ready to receive it are basic requirements. There is growing research evidence that reveals the importance of embryonic endometrial synchrony for the accomplishment of a successful conception. Objectives: The aim of this research study is to assess the impact of hCG intrauterine injection procedure before embryonic transfer on enhancing pregnancy and implantation rates. Patients and methods: a prospective randomized clinical research trial that was conducted on 600 cases undergoing embryo transfer via an ICSI program at the ART unit of the International Islamic Centre for Population Studies and Research (IICPSR), Al Azhar University. Cases were categorised randomly into 2 research groups. In the first group (study research group), intrauterine of 500 IU HCG were injected before the embryonic transfer procedure. The second group (control research group), has gone through embryonic transfer without prior injection of hCG. Results: chemical and clinical pregnancy rates were statistically significantly more frequent among research study group (HCG intra uterine injection group).In addition multiple pregnancy was statistically significantly higher within research study group. Implantation Rate was statistically significantly higher among study group. Interestingly no statistical significant difference between study and control groups as regards early and late ovarian hyper-stimulation. Conclusion: there is a possible role of HCG in enhancing and improving endometrial receptivity and increasing implantation and pregnancy rates. Future research efforts should consider racial, ethnic and genetic differences in response to HCG intrauterine injection.
https://ejhm.journals.ekb.eg/article_43809.html
https://ejhm.journals.ekb.eg/article_43809_d34d94f3bb6b9562eed648b2716ecd6a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Inflammatory Markers in Obese Children
4292
4297
EN
Soheir Bahgat
Fayed
Department of Pediatric, Faculty of Medicine for Girls, Al-Azhar University
Ragaa Abdelsalam
Mohamed
Department of Pediatric, Faculty of Medicine for Girls, Al-Azhar University
Hala Mohamed Ali
Abdelsalam
Department of Pediatric, Faculty of Medicine for Girls, Al-Azhar University
Noha Helmy Mosaad Mohamed
El Fatairy
Department of Pediatric, Faculty of Medicine for Girls, Al-Azhar University
gamela.days@yahoo.com
10.21608/ejhm.2019.43810
Background: Childhood obesity has become a crucial problem in both developed and developing countries. In 2018, the World Health Organization estimated 41 million infants and children were obese. This number is predicted to increase to 70 million by 2025. Aim of the Work: To assess: Inflammatory markers: (tumor necrosis factor (TNF)-alpha- high sensitive CRP (HS- CRP) in obese children and the impact of obesity and inflammatory markers as risk factors for morbidity in obese children. Patients and Methods: This study was a cross-sectional comparative study. The study group comprised forty obese and thirty control Egyptian children who were recruited from pediatric outpatient’s clinic of Al-Zahra University Hospital and National Nutrition Institute. They were 24 females (60%) and 16 males (40%) obese children. Their ages ranged between 4-8 years. Results: We found that there was statistically significant increase in high birth weight, decreased physical activity, formula feeding, junk food, high serum of tumor necrosis factor –alpha (TNF-alpha) and high sensitive CRP (hs-CRP) in obese children than control group. Conclusion: Inflammatory mediators as hs-CRP and TNF –alpha are elevated in obese and overweight children more than healthy control group, which may indicate the presence of chronic inflammation.
Tumor necrosis factor-alpha,high-sensitivity C-reactive protein,Lipid profile
https://ejhm.journals.ekb.eg/article_43810.html
https://ejhm.journals.ekb.eg/article_43810_888a32987c92fb3af0f328308a3c33bd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
The Role of Procalcitonin As an Early Biomarker in Diagnosis of Sepsis
4298
4306
EN
Ekram Yasein
Ebid
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University
Sarah Younes
AbdelAziz
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University
Mai Abuzied Mohamed
Abuzied
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University
tarek.abuzaid24@gmail.com
10.21608/ejhm.2019.43811
Backgound: Sepsis is the systemic response to infection by microbial organisms. A differential diagnosis of infection caused by either bacteria or other microbial organisms is essential for effective treatment and prognostic assessment. Procalcitonin (PCT) is an accurate biomarker that is effective in identifying patients with sepsis and can be used in the diagnosis of bacterial infections. Objictive: The aim of the current study is to explore the utility of PCT in early diagnosis of sepsis and determine its prognostic role in assessment of treatment response. Patients and Methods: This study included patient group (40 patients with diagnosis of sepsis; 20 males and 20 females with ages ranged from 5-98 years) and 40 control group who matched well with patients as regard age and sex. Study groups was subjected to complete history taking, clinical examination for signs of sepsis, laboratory investigations as Complete Blood Count, C reactive protein, Blood culture, serum Procalcitonin level. Results: The PCT is significantly higher in patients more than the control group. When the CRP values are compared with those of PCT in patients, they both show similar effects in diagnosis of sepsis. PCT indicates an early response for patients to treatment (values were less than 105, reaching the normal level in serum) while CRP values were not indicating any treatment response. Conclusion: Procalcitonin is an important biomarker in the diagnosis of sepsis and it is a useful indicator for the effectiveness of treatment.
Procalcitonin,biomarkers for sepsis,C-reactive protein,Comparative study
https://ejhm.journals.ekb.eg/article_43811.html
https://ejhm.journals.ekb.eg/article_43811_2ca753dd4b48a1a7c4fdea426787a46c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Review of Spinal Pedicle Screws
4307
4311
EN
Bahaa Ali
Kornah
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Faisal Hasan
Zayed
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Ahmed Kotb Ahmed
Elkomy
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
anakonda100098@gmail.com
10.21608/ejhm.2019.43812
Background: Pedicle screws are medical implants which are implanted posteriorly into the vertebrae of the spine and longitudinally connected to a rod to form a construct which corrects spinal alignment or promotes stabilization. Pedicle screw fixation is considered to be the gold standard of spinal internal fixation due to its many benefits in a variety of debilitating spinal conditions. Objective: The aim of the work is to evaluate the use of spinal pedicle screws for different lesions in the past, in the present and in the future. Conclusion: Some successful applications of pedicle screws include surgical treatment of scoliosis reduction and stabilization of spondylolisthesis, stabilization of unstable spinal fractures, simple lumbar degenerative disc disease, primary or metastatic tumors of the lumbar spine, and surgical revision of symptomatic pseudoarthrodesis of the lumbar region.
spinal,Pedicle Screws
https://ejhm.journals.ekb.eg/article_43812.html
https://ejhm.journals.ekb.eg/article_43812_6c97ef6b0acfdf7fcf7d75e7c4ab0de4.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Impact of Adenoidectomy on Bronchial Asthma in Children
4312
4318
EN
EL-Sayed Attia
Siam
Departments of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University
Marwan Ahmed
Ibrahim
Departments of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University
Sameh Abdel-Aziz Ahmed
Mansour
Departments of Pediatrics and Neonatology, Faculty of Medicine, Al-Azhar University
Mahmoud Abu El-hamd Ali
Mahmoud
Departments of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University
mahmoud.abo.elhamd.ali@gmail.com
10.21608/ejhm.2019.43984
Backgoudn: asthma is one of the most prevalent chronic diseases of childhood, data from the American national health interview survey revealed the prevalence in children 14 years of age and younger to be 9.0%. Objictive: the aim of this work is to assess the effect of adenoidectomy on bronchial asthma. The conclusions of this study may aid in counseling patients and their families regarding the impact of surgical intervention on the modulation of asthma symptoms. Patients and Methods: this was a prospective case series study. Patients were selected from those attending asthma pediatric clinic at Al-Azhar University Hospitals (Sayed Galal and Al-Hussain hospitals). After exclusion and inclusion criteria were applied, 50 children with diagnosis of chronic adenotonsillitis associated with bronchial asthma were enrolled in the study. Results: there was a significant improvement of asthma control test and SN-5 questionnaire results in both urban and rural inhabitants comparing preoperative and postoperative state. There was a non-significant difference between urban and rural residence regarding improvement of bronchial asthma after. There was a significant improvement in both sexes regarding asthma control test and SN-5 questionnaire results comparing preoperative and postoperative state. On the other hand, there was a non-significant difference between male and female gender regarding such improvement after AT. Conclusion: adenotonsillectomy in asthmatic patients with chronic adenotonsillitis may lead to significant improvement in asthma symptoms control and most of the patients are able to eliminate their medications and improve quality of their life style.
Adenoidectomy,bronchial asthma,children
https://ejhm.journals.ekb.eg/article_43984.html
https://ejhm.journals.ekb.eg/article_43984_1a28592b92d21577d13cbc6b6403a1ba.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Comparative Study Between Total Intravenous Anesthesia Versus Volatile Induction and Maintenance Anesthesia with Sevoflurane for Bariatric Operations
4319
4324
EN
Anwar Mohamed Mostafa
Alhasanin
Anesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar University
Mostafa Mohamed Mohamed
El-Sayed
Anesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar University
Mohamed Abd El Nasser Zaki
Basiouny
Anesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar University
mohamedassassy@yahoo.com
10.21608/ejhm.2019.43986
Background: Morbid obesity is defined as a body weight 160% above the ideal weight for survival or 40 kg/m2 or >35 with serious comorbidity. Long-term surveys revealed that surgical intervention has been the only method to effectively sustain weight loss in these patients. Objectives: To compare total intravenous anesthesia applied with propofol-fentanyl to sevoflurane single breath and maintenance anesthesia. Patients and Methods: This prospective randomized clinical study was approved by the ethics committee in AlAzhar University and a written informed patient's consent was obtained. This study included 50 patients of both sexes, admitted for bariatric surgery carried out at Al-Azhar University Hospitals (El-Hussein and Bab El-Sharia). They were randomly allocated into two equal groups, TIVA group: 25 patients will receive total intravenous anesthesia applied with propofol-fentanyl. Group VIMA: sevoflurane single breath induction and maintenance group: 25 patients will receive - sevoflurane single breath induction and maintenance. Results: Total intravenous anesthesia using (fentanyl and propofol). Volatile induction and maintenance anesthesia (Inhalational anesthesia) using (fentanyl and sevoflurane). The following parameters were assessed between the 2 groups: Hemodynamics, SPo2 and ET Co2 were continuously monitored and recorded at 15 min interval. Conclusion: This study showed that both TIVA and VIMA were effective in bariatric surgeries. Regarding neuroendocrine stress response, TIVA group was provided suppressed hormone levels suggesting that there was suppression of stress response unlike VIMA group that showed even raised serum levels of those hormones.
total intravenous anesthesia,volatile induction,maintenance anesthesia,Sevoflurane,bariatric operations
https://ejhm.journals.ekb.eg/article_43986.html
https://ejhm.journals.ekb.eg/article_43986_c7f92cc94071c026d9a1b74646bf0683.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Value of 3D Speckle Tracking Echocardiography in Assessment of Left Ventricular Systolic Dysfunction in Hypertensive Patients
4325
4331
EN
Mohy E. Mansour
El-Abbady
Cardiology Department, Faculty of Medicine, Al-Azhar University
Taher Said
Abd El-Kareem
Cardiology Department, Islamic Cardiac Center, Al-Azhar University
Mohammed Naiem
Zidan
Cardiology Department, Islamic Cardiac Center, Al-Azhar University
10.21608/ejhm.2019.43987
Background: Hypertension is the most prevalent cardiovascular (CV) disorder, affecting 20–50% of the adult population in developed countries. Objectives: The aim of this study is to test the capability of real-time three-dimensional speckle tracking echocardiography (RT3D STE) in characterizing early abnormalities of left ventricular LV systolic dysfunction in hypertensive patients with normal LV systolic function by standard 2D echocardiography. Subjects & Methods: The study population included 150 consecutive hypertensive patients without complication and another age and sex matches 50 healthy controls. ECG, 2D and 4D echocardiography were performed for all cases. Results: There was evidence of ECG voltage criteria of LVH in about 72% of hypertensive patients which absent in healthy controls. By comparing both group there were no statistically significant difference regarding EF%, AO, ESD, EDD, EDV.ESV, while there were statistically higher significant value in the patients group regarding RWT, LVPWD, IVSD and LV mass with (P<0.001) compared to controls where there were low statistically significant higher value in the patients group regarding LA dimension and volume (P<0.05). Conclusion: 3D strain is an applicable technique; it can detect subtle or substantial changes of LV even with normal ejection fraction. The left ventricular strains (GAS, GLS and GRS) correlate negatively
Hypertension,left ventricular systolic dysfunction,eCG,Echocardiography
https://ejhm.journals.ekb.eg/article_43987.html
https://ejhm.journals.ekb.eg/article_43987_bdc16425337f8af30485bef2e197eb0f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Comparison between 2, 4 and 6 Minute Sitting Positions versus Immediately Lying Down on Hemodynamic Variables, Fluid and Ephedrine Requirement after Spinal Anesthesia in Elective Cesarean Section
4332
4339
EN
Gamal Farook Mohamed
Amer
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
El-Desoky Mohamed Ibraheem
Nouh
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
Ali Abdel El moteleb Ali
Ali
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.43988
Background: hypotension is one of the most common complications of spinal anesthesia in patients undergoing cesarean section. In this regard, the patient’s position may affect the incidence of hypotension. Objective: to compare the incidence of hypotension and ephedrine requirement after spinal anesthesia with variable time in sitting position before lying down. Patients and Methods: a total of 100 patients, scheduled for cesarean section under spinal anesthesia, with 10 mg of hyperbaric bupivacaine 0.5% (2 ml) mixed with 25 µg (0.5 ml) fentanyl, were randomly divided into 4 groups (25 patients per group). Groups M2, M4 and M6 remained in a sitting position for 2, 4 and 6 minutes after the induction of spinal anesthesia, respectively, while group M0 was immediately placed in a lying position. Results: there were highly significant differences between the four groups as regard the incidence of hypotension based on Chi-square test; **p-value <0.001 HS. The frequency of hypotension was higher in group M0 in comparison with other groups. There was high consumption of ephedrine and fluid in group M0 than other groups as the total dose used in group M0 was bigger than other groups while M6 had the smaller dose. Conclusion: the present study revealed that the patient’s position is an important factor, which affects the frequency of hypotension, ephedrine and fluid requirements, and the onset of sensory block during the administration of spinal anesthesia for cesarean section.
Systolic blood pressure,Spinal anesthesia,Ephedrine,Sitting position
https://ejhm.journals.ekb.eg/article_43988.html
https://ejhm.journals.ekb.eg/article_43988_27848c25f3feade04630214b5d04cbd4.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Uterine Artery Tourniquet Versus Vaginal Misoprostol to Decrease Blood Loss during Transabdominal Myomectomy
4340
4345
EN
Ali El-Shabrawy
Ali
Faculty of Medicine, Zagazig University, Department of Obstetrics & Gynecology, Sharkia Egypt
Manal Mohamed
Behairy
Faculty of Medicine, Zagazig University, Department of Obstetrics & Gynecology, Sharkia Egypt
Basem Mohamed
Hamed
Faculty of Medicine, Zagazig University, Department of Obstetrics & Gynecology, Sharkia Egypt
Eman El-Sayed
Abdel-Aziz
Faculty of Medicine, Zagazig University, Department of Obstetrics & Gynecology, Sharkia Egypt
ali_elnil@yahoo.com
10.21608/ejhm.2019.43989
Background: Uterine fibroids are tumor of the smooth muscles and the connective tissue of the uterus. They are considered to be the most common benign tumor of the pelvis. Conservative surgery remains the main approach for management of uterine myomas. Myomectomy is considered to be an important option for women who desire future childbearing or simply want to preserve their uterus. Objective: The aim of the study was to compare between the effect of pericervical uterine artery tourniquet (surgical) and perioperative vaginal misoprostol (medical) regarding their efficacy to decrease blood loss during trans- abdominal myomectomy. Methods: Prospective randomized controlled clinical trial. The study was approved by the Ethical Research Committee. The study was conducted in Obstetrics and Gynecology Department, Zagazig University Hospital. The study included 36 women with symptomatic myomas randomized into Group A included 18 patients who underwent uterine artery tourniquet and Group B included 18 patients who received single dose of 400 μg vaginal misoprostol one-hour before surgery. Results: The present study showed that there was statistically significant difference between both groups regarding intra-operative blood loss, operative time, the need for blood transfusion and amount of fluid within the post-operative drain. Conclusion: Pericervical mechanical tourniquet in comparison with pre-operative vaginal misoprostol is more effective method in; reducing both intra-operative and post-operative blood loss, and shortening of operative time during transa-bdominal myomectomy.
Uterine Artery Tourniquet,vaginal,misoprostol,blood loss,Transabdominal Myomectomy
https://ejhm.journals.ekb.eg/article_43989.html
https://ejhm.journals.ekb.eg/article_43989_0852f8e403a77b85ddcce5b29553b93c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Management of Postoperative Ventriculoperitoneal Shunt Complications in Pediatric Patients
4346
4352
EN
Abd Elkafy Sharaf Eldin
Ebrahim
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo
Usama Mohamed
El Shokhaiby
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo
Ahmed Aly
Alkholy
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo
ahmad.aly.alkholy@gmail.com
10.21608/ejhm.2019.43990
Background: Postoperative ventriculoperitoneal (VP) shunt complications in pediatric patients involves impaired absorption of CSF from the subarachnoid space to the venous circulation via the arachnoid villi. It also involves obstruction in flow of CSF from the ventricles to the subarachnoid space. Objective: To assess the proper management of postoperative shunt complications. Patients and Methods: Retrospective study conducted in the Neurosurgery Department of Al-Azhar University Hospitals and El-Sahel Teaching Hospital. Pediatric patients from both genders including infants and pediatric patients till 12 years old who were having postoperative ventriculoperitoneal shunt complications were assessed clinically and radiographically for the best management that include either surgical or medical ones or both .Results: The management of postoperative VP shunt malfunction is essential shunt revision of either proximal or distal catheters or the whole system if shunt disintegration is suspected. The most common organisms in shunt infection were gram positive organisms (coagulase negative staph. and staph. aureus). Conclusion: The most effective management plan is shunt revision. To prevent VP shunt malfunction, we have to make sure of intraoperative closed, sterile and functioning shunt system.
Cerebral spinal fluid,Ventriculoperitoneal shunt,Computed tomography
https://ejhm.journals.ekb.eg/article_43990.html
https://ejhm.journals.ekb.eg/article_43990_ea936b1d7b33b9b6e6c258d9f12297fa.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Mini- Laparoscopic Simple Nephrectomy Critical Assessment through A Randomized Trial
4353
4358
EN
Ahmed Y
Abo Alsaad
Urology Department; Al-Azhar University, Faculty of Medicine (Damietta)
aboelsaadurology@hotmail.com
10.21608/ejhm.2019.43991
Background: The conversion from open to laparoscopic simple nephrectomy was considered as an initial and most dramatic step toward progression, the second step is trying to miniaturization of the endoscope and instruments, in this study we aimed to evaluate miniaturization of laparoscopic simple nephrectomy looking for reduction perioperative morbidity and enhance cosmoses without significant operative disability. Patient and Methods: We prospectively reviewed 120 patients (60 in each group) who underwent trans-peritoneal conventional laparoscopy (CL) or mini laparoscopy (ML) simple nephrectomy between April 2015 and May 2018. The CL was done using 3 to 4 ports ranged from 5 to12 mm in diamond manner distribution. ML was done using same ports number and distribution ranged from 3- 5 mm except umbilical one was 10 mm. All operations were performed by same surgeon Results: However, ML experienced a significant longer operative time, significant more blood loss and insignificant increased conversion rate. The Post-operative data in the interest of ML were as follows; significantly lower pain scores, lower hospital stay, earlier return to activities and significant increase of cosmoses score of patients, Lastly, port site hernia was 6.7% in CL group and none in ML group (p = 0.042) Conclusion: ML trans-peritoneal simple nephrectomy is associated with lower post-operative pain, hospital stay, early return to normal activity, better cosmoses and less port site hernia. However operative time, blood loss and conversion rate are potentially more than CL.
Laparoscopy,simple nephrectomy,conventional laparoscopy,mini-laparoscopy
https://ejhm.journals.ekb.eg/article_43991.html
https://ejhm.journals.ekb.eg/article_43991_17c424c4125e001821ba25a5016deab6.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Role of Multidetector Computed Tomography in the Diagnosis of Congenital Thoracic Vascular Anomalies
4359
4366
EN
Ahmad Abdlfattah
Aborashed
Department of Radio-Diagnosis, Faculty of Medicine, Al-Azhar University
Mohamed Ismail
Hammad
Department of Radio-Diagnosis, Faculty of Medicine, Al-Azhar University
Mohamed Aldosokey Saad
Shaalan
Department of Radio-Diagnosis, Faculty of Medicine, Al-Azhar University
tantawy_wael@yahoo.com
10.21608/ejhm.2019.43992
Background: multidetector row computed tomography (MDCT) provides reliable diagnostic information on the normal anatomy of the aorta, pulmonary arteries & veins and vena cava, as well as congenital anomalies in pediatric and adult patients. Objective: in this study, we assess the role of multidetector CT scan in the evaluation and its ability to diagnose congenital thoracic vascular anomalies as well as it is importance to recognize these anomalies early for proper treatment and follow up, and also to prevent morbidities and mortalities. Patients and Methods: the study was done in National Heart Institute, Ministry of health Egypt. It included a total of 80 patients (50 males and 30 females, their age ranged between, 2 days to 64 years and the mean age was 11.6±18 years), who underwent MDCT (using GE 16/64- multislice CT) angiography from December 2018 to June 2019 and had diagnosed of congenital thoracic vascular anomalies, or asymptomatic (incidentally discovered). Results: a total of 80 patients had done 16/64-MDCT angiograms were considered to be of adequate diagnostic image quality. Twenty-seven patients diagnosed as systemic arterial (aortic) anomalies corresponding to 33.7% in all cases, the right aortic arch anomalies (9 cases) are represented the most frequent cases (11.2 %). Conclusion: The ability to diagnose congenital vascular thoracic anomalies has evolved tremendously in the past 20 years. Traditional methods of plain radiographs and barium swallow studies as well as invasive angiography have now been supplanted with MR imaging and MDCT, minimally invasive methods that provide superb resolution and a large field of view.
Multidetector Computed Tomography,Congenital Thoracic Vascular Anomalies
https://ejhm.journals.ekb.eg/article_43992.html
https://ejhm.journals.ekb.eg/article_43992_01283652ba9e560856c75f72f15bb40e.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Ranibizumab Versus Aflibercept for Treatment of Diabetic Macular Edema
4367
4374
EN
Attiat Mostafa
Elsayed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Mostafa Mahmoud
Mostafa
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Ashraf Abdul-Ati Abdul-Moati
Mohamed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
abdelatyashraf35@gmail.com
10.21608/ejhm.2019.43993
Background: Diabetic macular edema, a manifestation of diabetic retinopathy that impairs central vision, affects approximately 750,000 people in the United States and is a leading cause of vision loss. The increasing prevalence of diabetes worldwide highlights the importance of diabetic macular edema as a global health issue. Objective: The aim of this study is to compare the clinical effects and complications of intravitreal injection of Ranibizumab and aflibercept as anti-VGEFs for treatment of patients with diabetic macular edema. Patients and methods: This cross-sectional comparative study involved 40 eyes of 32 patients approved to have diabetic macular edema. All subjects had age and sex matched and they are collected from the Ophthalmology Department, Al-Agoza Police Hospital and Sayed Galal Hospital at the period of March 2017 to March 2019. Results: Comparison between both groups I and II as regard UCVA and BCVA shows a statistically non-significant difference (P>0.05). Visual acuities before and after 6 months of injection in both groups were compared and showed a statistically significant difference as regard VA change (P < 0.05) in Ranibizumab group (I) and highly statistically significant difference (P <0.01) in Aflibercept group (II). Although the effect of both groups in treatment seems to be comparable, significance of aflibercept was superior to ranibizumab as it showed more success in treatment of DME. Conclusion: Our findings suggest a possible benefit of aflibercept over ranibizumab for treating DME. This study equally suggests better efficacy of aflibercept compared to ranibizumab, in patients with worse levels of initial visual acuity.
ranibizumab,Aflibercept,Diabetic Macular Edema
https://ejhm.journals.ekb.eg/article_43993.html
https://ejhm.journals.ekb.eg/article_43993_0798fc7c2c7d2ce44e6669e670553879.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Single-Incision Mini Sling Compared with Transobturator Sling for Treating Stress Urinary Incontinence in Women
4375
4385
EN
Yahia Abd El Salam
Wafa
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Ahlam El Said
Kamel
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Mohammed Maghawry Maghawry
El Sayed
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
dr_maghwry777@yahoo.com
10.21608/ejhm.2019.43994
Background: Stress urinary incontinence (SUI) is a common disorder that affects a large number of women and their quality of life. It is defined as the involuntary leakage of urine on effort or exertion, or on sneezing or coughing according to the standardized terminology of the International Continence Society. Objective: The aim of this study was to compare both the efficacy and safety of the single-incision mini- sling (SIMS) against the traditional trans-obturator (TOT) sling for the surgical management of SUI in women including; objective and subjective cure rates, patient’s satisfaction, and complication rates. Patients and methods: This study was a prospective, double-blind clinical trial conducted on 100 women complaining of symptoms of stress urinary incontinence, with or without urge incontinence, based on patient complaint, cough stress test and ICIQ-SF score. Results: Regarding the cough stress test after one year follow up, the number of participants who reported negative results showed continuous progress in group (B) [42 women (89%)] after 38 (79.2%) in 6th month visit. On the other hand, group (A) women showed a little drop [44 women (91.7%)] after 46 (93.9%) in 6th month visit. Yet, the two groups showed insignificant difference at this follow up stage (P= 0.74). Conclusion: The 1-year follow-up results of this prospective trial indicate that both procedures appear to be equally effective for the treatment of SUI as regard the objective cure rates, whereas the SIMS procedure showed higher subjective cure rates than the TOT procedure.
Single-Incision Mini Sling,Transobturator Sling,Stress Urinary Incontinence,Women,clinical trial
https://ejhm.journals.ekb.eg/article_43994.html
https://ejhm.journals.ekb.eg/article_43994_d3abbc1528d8d5b18b7a8108230050db.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Laboratory Evaluation of Immunotherapy in Treatment of Allergic Airway Diseases
4386
4389
EN
Mohamed Saed
Elshorbagy
Immunology Unit of Clinical Pathology Department, Faculty of Medicine, Al-Azhar University
Ismael Abdelmonem
Atia
Chest Diseases Department,
Faculty of Medicine, Al-Azhar University
Nagah Mohamed
Abou-Mohamed
Immunology Unit of Clinical Pathology Department, Faculty of Medicine, Al-Azhar University
Abdelsalam Fathy Abdelsalam
Mohamed
Immunology Unit of Clinical Pathology Department, Faculty of Medicine, Al-Azhar University
dr_abdelsalam2000@yahoo.com
10.21608/ejhm.2019.43995
Background: Immunotherapy is a well-established therapeutic approach for treatment of IgE-mediated allergic diseases. It’s the only modality that targets the definite cause of allergy, blocks the pathophysiologic aspect of the disease and possibly prevents the development of a new sensitization. Objective: The aim of this work is evaluation of the response of allergic airway diseases to allergen specific immunotherapy. Patients and methods: We enrolled 50 patients with allergic airway diseasesreceiving subcutaneous immunotherapy (SCIT)shots and 30 control patients on pharmacotherapy. The study evaluated clinical assessment of allergic symptoms, medication used and laboratory markers (including specific and total IgE and eosinophil count) before and after 2 years of immunotherapy. Results: Our results showed that there was a significant decrease in total and specific IgE and eosinophil count after SCIT. Also, SCIT effectively reduced the allergic symptoms and the need for medication. Conclusion: Subcutaneous immunotherapy could alleviate allergic symptoms and reduce airway inflammation in allergic patients.
allergic airway diseases,allergy immunotherapy,allergy injections,subcutaneous immunotherapy,IgE
https://ejhm.journals.ekb.eg/article_43995.html
https://ejhm.journals.ekb.eg/article_43995_10ccbf419606a52c8c9a8789e56b66ca.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Efficacy of Intralesional Methotrexate in the Treatment of Plantar Warts
4390
4395
EN
Hamed Mohamed
Abdo
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University
Emad Mahmoud
Elrewiny
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University
Mohammed Shaban
Elkholy
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.43996
Background: Warts are tumors or growths caused by infection with Human Papilloma virus (HPV). Currently, over 170 HPV types have been identified. They are common presenting disease in children and adolescents which spread by direct contact or autoinoculation. Objective: The present work aimed to study the efficacy and safety of intralesional injection of methotrexate (MTX) for treatment of plantar warts and its possibility to be an alternative for the ordinary treatment. Patients and methods: sixty Egyptian patients presented with plantar warts were enrolled into our study. The patients were recruited from the Dermatology Outpatient Clinic of Al-Azhar University Hospital in the period from January 2019 to June 2019. Patients were classified into; control group (30 patients) that were Injected by normal saline and study group (30 patients) that were injected by MTX. Results: In intralesional MTX group, 2 patients (6.7%) showed complete improvement, 8 patients (26.7%) showed partial improvement and 20 patients (66.7%) showed no improvement. In intralesional saline group, 3 patients (10%) showed complete improvement, 4 patients (13.3%) showed partial improvement and 23 patients (76.7) showed no improvement. Conclusion: In this study, there was no statistically significant difference between the therapeutic responses to intralesional MTX injection and saline. Intralesional MTX injection was safe but less effective. No serious side effects were reported. Reported adverse events were local reactions in the form of swelling, pain and infection
Intralesional Methotrexate,Plantar warts
https://ejhm.journals.ekb.eg/article_43996.html
https://ejhm.journals.ekb.eg/article_43996_4b4453fbaf2101508cb6c446c42bff09.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Outcome Predictors of Augmentation Urethroplasty Using Dorsal Onlay Buccal Mucosal Graft
4396
4401
EN
Ahmed Mohammed
El-Shazly
Department of Urology, Faculty of Medicine, Al-Azhar University
intermedicalo@gmail.com
Hassan Abdelazim
Mohammed
Department of Urology, Faculty of Medicine, Al-Azhar University
Mamdouh Ahmed
Farid
Department of Urology, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.43997
Background: The incidence and timing of stricture recurrence and factors affecting urethroplasty outcomes remains incompletely characterized. Objective: To evaluate and determine the factors predicting the outcome of dorsal onlay buccal mucosal graft (BMG) urethroplasty. Patients and Methods: We analyzed the records of 115 patients underwent dorsal onlay BMG urethroplasty at Al-Azhar University Hospitals in Cairo, Egypt, from January 2015 to April 2018, with a minimum of 12 months of followup. The risk factors examined were patient age, stricture etiology, site, length, width, diabetes, hypertension, smoking, obesity, previous visual internal urethrotomy (VIU) and urethroplasty, early postoperative complications, extravasation at first periurethral ascending cystourethrogram (ACUG) and stricture width. Results: Average patients age was 38 years. Stricture free rate was 90.4% and mean followup period was 47.5 months (range 12 to 67). Average stricture length was 5.9 cm, average stricture width was 6.3 mm, 63.4% of patients were with previous VIU, and 9.5% were with previous urethroplasty. On univariate analysis, etiology, site of stricture, previous four or more times VIU, DM, obesity, stricture length, postoperative (post op.). wound infection and leakage at first periurethral ACUG were associated with stricture recurrence. On multivariate analysis panurethral stricture (HR 280.6, 95% CI 9.1-8622.8, p =0.001), traumatic stricture (HR 17.1, 95% CI 2.4-123.4, p =0.005) were independent predictors of stricture recurrence. Stricture width, previous urethroplasty, the number of failed endoscopic procedures less than 4 times, smoking, HTN and patient age did not affect the recurrent stricture rate. Conclusion: panurethral and traumatic strictures were independent predictors of stricture recurrence.
Dorsal onlay urethroplasty,predictors of urethroplasty failure,stricture length
https://ejhm.journals.ekb.eg/article_43997.html
https://ejhm.journals.ekb.eg/article_43997_f4eee36aacb0182824233270c7479c63.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Nasolabial cyst: Transnasal Marsupialization versus Sublabial Technique
4402
4405
EN
Ahmed M.
Abdelfattah
Otorhinolaryngology Department, Faculty of Medicine,
Cairo,
Al-Azhar University, Egypt
ahmedfatah10@hotmail.com
Ahmed Ibrahim
Zaghloul
Otorhinolaryngology Department, Faculty of Medicine,
Damietta,
Al-Azhar University, Egypt
10.21608/ejhm.2019.43998
Background: nasolabial cyst is relatively rare soft tissue lesion of nasal alar region. It is nonodontogenic in origin. Surgical sublabial excision is the treatment of choice for nasolabial cyst (NLC). However, it is associated with high complication rate. The transnasal marsupialization was introduced as an alternative modality of surgery. Aim of the work: to compare between both approaches to assess the intra-and post-operative outcome. Patients and Methods: twenty two patients presented by unilateral nasolabial cyst were included in the study and divided into two equal groups: endoscopic transnasal marsupialization (TM group; 11 patients) and sublabial surgical excision technique (SL group; 11 patients). For all patients, operative time, postoperative pain, postoperative complications and recurrence of the NLC were documented. Results: the operative time was significantly shorter in TM when compared to SL group (18.54±3.01 vs. 44.63±5.4 minutes respectively). Postoperative VAS was lower in TM when compared to SL group (3.09±0.83 vs. 6.09±1.13 respectively). The overall complications were significantly lower in TM group (18.2%) when compared to SL group (72.7%). Conclusion: the transnasal endoscopic marsupialization is preferred than conventional sublabial approach as it had shorter operative time, less postoperative pain and lower overall complications rate.
nasolabial cyst,sublabial,transnasal,marsupialization
https://ejhm.journals.ekb.eg/article_43998.html
https://ejhm.journals.ekb.eg/article_43998_a0f7bdd76f6a6916293ed50b21d143dd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Early High Frequency Oscillatory Ventilation in Prone Position in Pediatric Acute Respiratory Failure
4406
4416
EN
Mona Mohammed
Hamam
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
mona_hamam@yahoo.com
Khaled Talaat
Muhammad
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
Sahar Abd-Elazim
Abd-Elaziz
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
Ahmed Ibrahim
Harkan
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
10.21608/ejhm.2019.44525
Background: High frequency oscillatory ventilation (HFOV) is a form of nonconventional ventilatory support employed for severe respiratory failure in children. Aim of the study: Was to compare the impact of early high frequency oscillatory ventilation (within 24 hours of endotracheal intubation) versus pressure controlled mechanical ventilation (P-CMV) and /or late high frequency oscillatory ventilation in patient with acute respiratory failure in prone position. Patients and Methods: Thirty-nine pediatric patients (19 males and 20 females) aged (2 to 156 months) were admitted in pediatric intensive care unit (PICU), Tanta University Hospital. They were categorized into 3 groups: Group I; 15 patients were monitored on early HFOV (within 24 hours from intubation). Group II; 18 patients were monitored on P-CMV. Group III; 6 patients were monitored on late HFOV (24 hours after intubation). All patients were subjected to scoring systems for Pediatric Risk for Mortality (PRISM III) and Sequential Organ Failure Assessment (SOFA) they were also monitored for [pulse oximetry, blood pressure, oxygenation Index, oxygenation saturation index, lung mechanics (compliance and resistance), ventilation parameters (HFOV and P-CMV) and Trans-Esophageal Doppler. Results: PP had superiority over SP in improvement of oxygenation / ventilation parameters demonstrated by the increased (PaO2, SaO2,pH) /decreased PaCO2, OI, OSI, FiO2 without harmful affection on HD. PP improve lung mechanics demonstrated by increased lung compliance with decreased airway resistance. PP can be safely applied in pediatrics. Conclusion: Early HFOV had superiority over CMV/late HFOV showed by the improvement in Oxygenation/ventilation.
High Frequency Oscillatory Ventilation,Prone Position,Pediatric,Acute Respiratory Failure
https://ejhm.journals.ekb.eg/article_44525.html
https://ejhm.journals.ekb.eg/article_44525_edd904a70ec7a418ae689b879396cf14.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Prevalence and Risk Factors of Pneumothorax among Patients in Pediatric Intensive Care Unit
4417
4426
EN
Noha Hasab El Naby
Radwan
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
noha_radwan@yahoo.com
Khaled Talaat
Muhammad
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
Sahar Abd-Elazim
Abd-Elaziz
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
Ahmed Ibrahim
Harkan
Department of Pediatric Medicine, Faculty of Medicine, Tanta University, Egypt
10.21608/ejhm.2019.44527
Background: Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention. Aim of the work: was to study the prevalence and risk factors of pneumothorax among children in Tanta PICU. Subjects and Methods: Sixty pediatric patients aged from 2 to 180 months (29 males and 31 females) admitted to PICU, Tanta University Hospital and were divided into 3 groups: Group 1: 20 patients on PCMV. Group II: 20 patients on HFOV: Group III: 20 non-ventilated patients. Each group was further divided into two subgroups: Subgroup I (SGI): without pneumothorax, Subgroup II (SGII): with pneumothorax. All patients were subjected to scoring systems for Pediatric Risk for Mortality (PRISM III) and Sequential Organ Failure Assessment (SOFA). They were also monitored for [pulse oximetry, blood pressure, oxygenation index, oxygenation saturation index, lung mechanics (compliance and resistance), ventilation parameters (HFOV and P-CMV) and trans-esophageal Doppler]. Results: Incidence of pneumothorax in patients on P-CMV is higher than who on HFOV and non- ventilated group. The significant risk factors of pneumothorax were HR, RR, pH, PCO2, HCO3, PaO2, SaO2, OI, MAP, FIO2, PIP, CO, CI, SVRI, SOFA and PRISM III score. X-ray showed equal results to CT chest in the diagnosis of pneumothorax without the disadvantage of exposure to high radiation accompanied the use of CT. Conclusion: Pneumothorax in P-CMV patients occur with higher ventilatory settings. Most cases of pneumothorax have underlying lung disease as pneumonia and ARDS. Mortality rate is higher among patients with pneumothorax.
Pneumothorax,Pediatric,Intensive Care Unit,risk factors
https://ejhm.journals.ekb.eg/article_44527.html
https://ejhm.journals.ekb.eg/article_44527_0cba36954f224351bea86fe011b9699c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
A Comparison Between Bevacizumab and Mitomycin C in Treatment of Primary Pterygium
4427
4431
EN
Alaraby Abd Elghany
Nassar
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Abd Elmagid Mohamed
Tag Eldin
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Khalid Fathy Abd Elnaby
Ashour
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
intermedicalo@gmail.com
10.21608/ejhm.2019.44528
Background: A pterygium is a fleshy, wing-shaped growth from the conjunctiva, crossing over the limbus onto the cornea. The tissue is fibrovascular and can occur over the nasal or temporal cornea. It can be a bilateral process and asymmetric with one eye affected by a larger pterygium than the other. Objective: To compare between the effects of intraoperative subconjunctival injection of Bevacizumab (Avastin) and intraoperative topical Mitomycin C on the outcome of primary pterygium surgery as regard efficacy and complications. Methods: Prospective, randomized, comparative clinical study was done on twenty eyes of twenty patients complaining of primary pterygium of variable duration that were surgically treated by simple excision. In addition to surgical excision, postoperative subconjunctival injection of bevacizumab was done for 10 eyes (group A), and postoperative application of mitomycin C (MMC) was done for 10 eyes (group B). The postoperative outcome was followed clinically for a minimum of 6 months and the main outcome criteria were recurrence rate and postoperative complications. Results: A significant high recurrence rate was found in bevacizumab group (60%) in comparison to MMC group (10%). In group A subconjunctival hemorrhage was detected in 2 cases while no complications were detected in group B. Conclusion: A single intraoperative subconjunctival injection of bevacizumab had decreased the recurrence rate after primary pterygium excision which seems to be marginally superior to bare sclera excision alone, but does not give a more desirable recurrence rate with insignificant complications as subconjunctival hemorrhage which resolved within 2 weeks.
Pterygium,Bevacizumab,mitomycin c
https://ejhm.journals.ekb.eg/article_44528.html
https://ejhm.journals.ekb.eg/article_44528_e157761bba82b25be01e84ab724d8fab.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Study of Anxiety Symptoms in Mothers of ADHD Children
4432
4435
EN
Mahmoud Abd ELrahman
Hammoda
Department of Psychiatry, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ali Esmail
Abd ELrahman
Department of Psychiatry, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mahmoud Kamal Ahmed
Samada
Department of Psychiatry, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
mahmoudkamal1138@gmail.com
10.21608/ejhm.2019.44529
Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood onset psychiatric disorders that is characterized by inattention, hyperactivity and impulsivity. ADHD can affect social, cognitive and academic performance of children. All these impairments of psychosocial functioning can affect the quality of life of both patients and their families. Based on that, it is suggested that parents, especially mothers of ADHD children, display higher levels of depression and anxiety. Aim of the work: This study aimed to compare anxiety symptoms in the mothers with ADHD children with control group. Patients and Methods: Fifty mothers of the ADHD children as study group and fifty mothers with children without any psychiatric disorder as control group. All were evaluated with to a semi-structured interview and Taylor Manifest Anxiety Scale. Results: This study showed that 19 in mothers of study group (32%) had no anxiety symptoms while 31(68%) had anxiety symptoms and 13 (26%) had above sever anxiety. In the control group 35 (70%) had no anxiety and 15(30%) had anxiety symptoms while 3 (6%) had above sever anxiety. There was statistically significant difference between the two groups (p value = 0 .05). There was no significant relation between intensity of maternal anxiety and the intensity of ADHD symptoms in their children. Conclusion: The present study suggested that the presence and intensity of anxiety symptoms in mothers of ADHD children are higher than the control group and there was no significant association with ADHD symptoms in children.
Anxiety symptoms in mothers,Attention-deficit,hyperactivity disorder children
https://ejhm.journals.ekb.eg/article_44529.html
https://ejhm.journals.ekb.eg/article_44529_586e61addd45a01c5c989fdf682476b0.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Attenuation of Pneumoperitoneum-Induced Hypertension by Intraoperative Lidocaine Infusion in Laparoscopic Cholecystectomy
4436
4444
EN
Abdelazim Abdelhalim
Hegazy
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University
Mostafa Mohamed Mohamed
El-Sayed
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University
Ahmed Mohamed Mahmoud
Al Wakel
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University
ahmedalwakel207@gmail.com
10.21608/ejhm.2019.44530
Background: Laparoscopy has now become the standard technique and is considered gold standard for cholecystectomy but the intraoperative requirements of laparoscopic surgery produce significant physiological changes, which pose many challenges for the anesthesiologist. Objective: The aim of this work was to evaluate the effect of intraoperative IV lidocaine infusion for attenuation of pneumoperitoneum-induced hypertension. Patients and Methods: After approval of the Medical Ethical Committee at Al-Azhar University Hospitals, Department of Anesthesia, and after patient written consent, 90 patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for laparoscopic cholecystectomy were enrolled in this randomized, controlled, prospective, double-blind, clinical trial study. Results: Regarding the intraoperative and postoperative hemodynamics, in the present study it was observed that patients who received intravenous lidocaine (1.5 mg/kg bolus before skin incision and abdominal inflation followed by 1 mg/kg/h or 2 mg/kg/h and stopped immediately after abdominal deflation) were associated with a reduction in intraoperative BP and HR without any associated hemodynamic instability in comparison to patients who did not received lidocaine with no statistically significant difference between the two doses of lidocaine. Conclusion: This study showed that the intraoperative infusion of lidocaine of two different doses in patients undergoing laparoscopic cholecystectomy was associated with attenuation of blood pressure, heart rate, decreases the intensity of postoperative pain, and early recovery of bowel function without causing significant adverse effects, with more satisfaction for both patients and surgeons.
Pneumoperitoneum-induced hypertension,Intraoperative lidocaine infusion,Laparoscopic cholecystectomy
https://ejhm.journals.ekb.eg/article_44530.html
https://ejhm.journals.ekb.eg/article_44530_01b8139f88bead7c722d47b8bb5fe673.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
76
6
2019
07
01
Occupational Stress among Banking Employees at El Mansoura City
4445
4451
EN
Mohamed El-Hady Emam
Salim
Department of Community Medicine and Industrial Medicine, Faculty of Medicine, Al-Azhar University
Alaa Abdel Wahed Aboel Maged
Shams Eldine
Department of Community Medicine and Industrial Medicine, Faculty of Medicine, Al-Azhar University
Omar Omar
Zidan
Department of Community Medicine and Industrial Medicine, Faculty of Medicine, Al-Azhar University
Mohamed Mahmoud
Aboal Asaad
Department of Community Medicine and Industrial Medicine, Faculty of Medicine, Al-Azhar University
dr.aboalasaad84@gmail.com
10.21608/ejhm.2019.44526
Background: The International Labor Organization reported a number of worrying issues for workers in financial services; these included greater pressure on time, problems with ergonomics, conflicting roles, work demands, difficult relationships with customers, and a rising number of cases of stress and violence. Aim of the study: To assess the prevalence of occupational job stress among banking employees, to find out risk factors of occupational job stress and to recommend interventions that could prevent occupational stress among banking employees. Subject and methods: A study was conducted on 568 banking employees at El-Mansoura City. A cross sectional study using standardized questionnaire, and interventional study included application of stress management health education intervention program, were implemented. Evaluation was done six months after conduction of the intervention to measure the degree of success of the program. Results: the total number of the employees was 568; the majority of age group were between 25-45 years representing 79.1%. Among the studied participant 50.2% of them were working in national banks and 49.8% were working in private banks. 22.4% were manager while 57% were banker A and 20.6 were banker B. About 22.8% of national banks employees showed high stress level, while only 12% of private banking employees showed high stress level. Conclusions: this study showed statistical significance difference between national and private bank employees as regard the prevalence of health complaint. Age, gender, occupational degree and social relations at work among these study participants showed statistical significant difference between national and private banking employees.
Occupational stress,Banking employees,Stress management. Health education interventional program
https://ejhm.journals.ekb.eg/article_44526.html
https://ejhm.journals.ekb.eg/article_44526_76e19deb9681f29bd0f7d16d229df8dd.pdf