Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Tolerance and Effectiveness of Oral Direct Acting Antivirals in Treatment of HCV Egyptian patients with Decompensated Liver Cirrhosis
5293
5297
EN
Magdy
Aldahshan
Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo – Egypt
Samy
Zaki
Tropical Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo – Egypt
Ramadan
Eldamarawy
Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo – Egypt
10.21608/ejhm.2019.55616
Background: Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV-related decompensated cirrhosis. Objective: The current study aimed to evaluate the efficacy and safety of DAAs in managing HCV patients with decompensated cirrhosis and the impact of achieving sustained virological response on improving the quality of life, short term survival and if viral eradication would step down CTP score. Patients and Methods: The study included a treatment group I (n = 25) composed of HCV patients with decompensated cirrhosis Child B and group II (n = 22) with decompensated cirrhosis Child C. both groups received DAAs (sofosbuvir 400 mg, daclatasvir 60 mg) plus ribavirin as tolerated for 3 months and follow-up was done for 6 months. Results: In both treated groups, there were improvements in platelet count, albumin, Child-Torcout-Pugh (CTP) (p = 0.001) and a significant reduction in the frequency of hepatic encephalopathy (HE). Also, there was improvement in quality of life of both treated groups. Conclusion: Treatment of HCV with decompensated cirrhosis with DAAS had improved CTP score, quality of life and survival.
Direct acting antivirals,HCV,Decompensated Liver Cirrhosis
https://ejhm.journals.ekb.eg/article_55616.html
https://ejhm.journals.ekb.eg/article_55616_4ca85d2f7c773df3dbc685f0a75e7671.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Diagnosis of Placenta Accreta by Uterine Artery Doppler Velicometry in Patients with Placenta Previa
5298
5306
EN
Ibrahim Mahrous
Kandil
Obstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar University, Egypt
Mohamed Ali
Mohamed
Obstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar University, Egypt
Ahmed Mohamed
Taha
Obstetrics &Gynecology Department, Beni-Suef General Hospital, Ministry of Health, Egypt
10.21608/ejhm.2019.55617
Background: Placenta accreta occurs in the complete or partial absence of the decidua basalis. Women with previous cesarean delivery or placenta previa are known to be at greater risk of placenta accreta. Objectives: to evaluate ultrasound accuracy in diagnosing placenta accreta and its variants and to detect the potential value of uterine artery Doppler in diagnosing placenta accreta and to assess the impact of antenatal diagnosis in Egyptian population. Patients and Methods: This prospective study was conducted on (100) pregnant women diagnosed as placenta previa by ultrasonography and were candidates for either emergency or elective repeated CS or hysterectomy (if the diagnosis of placenta accreta is confirmed). All these patients were randomly selected from the Obstetrics Clinic at Beni-Suef General Hospital during their 3rd trimester. The study was approved by the medical ethics committee of Al-Azhar University academic and ethical committee and a written informed consent was obtained from all patients. Results: The results obtained from this study indicated no statistically significant differences regarding the mean values of uterine artery Doppler PI and RI between cases of placenta accreta and non accreta (p value =.078 & 0.58 respectively) in correlation with histopathological assessment. Our results showed no statistically significant correlation regarding mean values of uterine artery Doppler PI and RI between cases of placenta accreta and placenta non accreta (p values = 0.341, 0.953 respectively) in correlation with intra-operative assessment. Conclusion: Several ultrasound criteria can be used in diagnosis of placenta accreta, as this study showed their high accuracy. They include loss of retroplacental clear zone, presence of abnormal placental lacunae, myometrial thinning and utero-vesical hypervascularity. On the other hand, both loss of retroplacental clear zone, abnormal placental lacunae can predict which patient will mostly have CS hysterectomy.
uterine artery Doppler,placenta accreta
https://ejhm.journals.ekb.eg/article_55617.html
https://ejhm.journals.ekb.eg/article_55617_4b769a570c7272b25ced460d796a6451.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
The Impact of Repeated Cesarean Sections on Perioperative Maternal Morbidity
5307
5312
EN
Ibrahim Mahrous
Kandil
Obstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar University, Egypt.
Abdelsattar Mohamad
Farhan
Obstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar University, Egypt.
Montaser Mostafa
Shaker
Obstetrics & Gynecology Department, Beni-Suef General Hospital, Ministry of Health, Egypt.
10.21608/ejhm.2019.55618
Background: Rates of cesarean delivery vary internationally, but generally, it has shown a worldwide increase. Repeated cesarean deliveries was found to be associated with increased maternal morbidity, including placenta previa, placenta accreta, hysterectomy, adhesions, bladder injury, postoperative hemoglobin deficit and need for blood transfusion. Objective: In our study, we evaluated the outcome of emergency cesarean deliveries conducted at Bani Suef General Hospital and the impact of repeated cesarean deliveries on that outcome. Patients and methods: We recruited 300 patients admitted at the Casualty Department. The patients were divided equally into 3 groups (100 patients in each group) as follows: group 1: Patients with previous one cesarean delivery, group 2: Patients with previous two cesarean delivery and group 3: Patients with previous three or more cesarean deliveries. Results: The operative duration was statistically significantly longer in patients with previous three or more cesarean deliveries (group 3) than patients with previous one cesarean delivery (group 1) or previous two cesarean delivery (group 2) [74.4, 44.4, 56.4 min respectively, p < 0.001]. The estimated blood loss was found to be higher in group three than one and two attributed to higher incidence of placenta previa and placenta accrete in group three. The incidence of adhesions (omental and bladder) was significantly higher in group three, but the incidence of bowel adhesion was the same in group three and two (which was statistically not significant). Conclusion: The rate of complications was higher in group three (bladder and bowel injuries, scar dehiscence, placenta previa, placenta accreta, hysterectomy and post-operative ICU admission).
Repeated,Cesarean delivery,morbidity
https://ejhm.journals.ekb.eg/article_55618.html
https://ejhm.journals.ekb.eg/article_55618_70679c9da15ab0f3bf4d810fec42cd18.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Effect of Conditioned and Co Culture Media from The Umbilical Cord Mesenchymal Stem Cells on Heptoma Cell Line (Huh7)
5313
5321
EN
Marwa. M.
Hussein
0000-0002-7843-4445
Department of Zoology, Faculty of Science- Ain Shams University
marwasoada@yahoo.com
H. H
Swelim
Department of Zoology, Faculty of Science- Ain Shams University
Hanaa A.
Amer
Department of Zoology, Faculty of Science- Ain Shams University
Fatma A.
Abu Zahra
Department of Zoology, Faculty of Science- Ain Shams University
Mourad M.
Hadier
Department of Zoology, Faculty of Science- Ain Shams University
10.21608/ejhm.2019.55619
Background: this study aimed to detect a new way for cancer control. Hepatoma cell line HuH7 was the model for cancer and was treated with two types of the media. The first was the conditioned media (in which mesenchymal stem cells were cultured), the second media was co-culture media in which mesenchymal stem cells and HuH7 cells were cultured. Objective: this work was designed to evaluate the efficiency of using the media in which mesenchymal stem cells alone (Conditioned media) or co-culture with HuH7 (Co-cultured media) were housed on controlling the viability, growth and mortality of HuH7, by applying different techniques. Result: at specified times (0, 48,72,96 hours) after incubation in each medium cells were tested. The morphological study showed that in both conditioned and co-culture media, HuH7 cells were suffered from damage and this was directly proportional with increase of time. (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide) tetrazolium reduction assay (MTT) showed that there was a significant difference between the four groups in conditioned and co-culture media. In the biochemical study for conditioned and co-culture media, there was a significant difference between the four groups in αFP and GOT, but there was a non-significant difference between the four groups in albumin, GPT, ALP and γ –GT. Conclusion: the conditioned and co-culture media from mesenchymal stem cells alone or co-culture with HuH7 proved to be efficient in control of cancer cell survival.
hepatoma cell line (HuH7),Umbilical cord Mesenchymal Stem Cell (UMSC),proliferating cell nuclear antigen (PCNA) and Vascular Endothelial Growth Factor (VEGF)
https://ejhm.journals.ekb.eg/article_55619.html
https://ejhm.journals.ekb.eg/article_55619_cdce6b04bb9b04c11d14e53193052f8c.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
A Study on Intestinal Parasitic Infections Among Immunocompetent Egyptian Children Attending Al-Hussein University Hospital, Cairo
5322
5337
EN
Morsy R.
Geneidy
Medical Parasitology Department, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt
10.21608/ejhm.2019.55822
Background: Parasitic infections are still a dangerous public health problem in the world, especially in developing countries including Egypt representing a major cause of morbidity and mortality mainly among children. Methods: This cross-sectional study included 400 randomly chosen immunocompetent children of both sexes. Their ages ranged from 6 months up to 12 years old. All children were subjected to a structured questionnaire sheet, stool examination using: Direct smear and concentration techniques (formol ether sedimentation and Modified Ziehl–Neelsen stain). The study was approved by the medical ethics committee of Al-Azhar University Hospitals and a written informed consent was obtained from all children's parents or gardeners. Results: Among the examined individuals, parasites were detected in only 139 ones (34.75%) mainly in the first two years of age and more common among males 35% than females 34%. By species, the parasitic prevalence rate was, G.lamblia 49 (12.25%), E.vermicularis 35 (8.75%), E. coli 22 (5.5%), E. histolytica/dispar 7 (1.75%), H. nana 4 (1.0%) and mixed infections 22 (5.5%). Positive results are more common among rural children 38% and low social classes. Low level of parent's education, low family income, high crowding index, and bad hand hygiene were considered highrisk factors of parasitic infections. Conclusion: Rural residency, bad hygiene, and low social class, as well as crowdedness, were the most significant risk factors associated with parasitic infections among children
Immunocompetent children,Intestinal parasites,Egypt
https://ejhm.journals.ekb.eg/article_55822.html
https://ejhm.journals.ekb.eg/article_55822_edbb366e7744f578efb48587f2fbc355.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Assessment of Heart Rate Variability in Heart Failure Patients
5338
5344
EN
Abdelaziz Rizk
Hassan
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mohamed Sami
Abdelsamea
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Hany Khamees Rashed
Elhelw
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
hanyelhelw27@gmail.com
10.21608/ejhm.2019.56657
Background: Heart rate variability (HRV) depicts the functional status of the autonomic nervous system and its effects on sinus node. Objective: The aim of the study was to analyze heart rate variability (HRV) parameters in patients with heart failure with reduced ejection fraction (HFrEF) and to assess correlation between HRV parameters and functional capacity of the study group (assessed by NYHA class and 6 MWT). Subjects and Methods: This study included a total of 80 patients with chronic heart failure with reduced ejection fraction, attending at the Outpatient Clinic, Department of Cardiology, Al-Azhar (Al-Hussein) University Hospital. This study was conducted between December 2018 to October 2019. Patients were divided into four groups according to New York Heart association functional classification (NYHA). All patients were subjected to cardiac tests mainly ECGs, Echocardiography and 24 hours Holter monitoring. Results: High statistically significant difference was found between the four groups regarding HRV parameters (SDNN rMSSD, pNN50 and LF/HF ratio) and 6MWT duration. There was positive correlation between premature ventricular contractions (PVCs) burden and ANS indices (LF/HF). Conclusion: Disturbed cardiac autonomic function was found in patients with heart failure with reduced ejection fraction (HFrEF). HRV parameters have strong positive correlation with NYHA functional class and with 6MWT distance in patients with HF. Impaired autonomic function was associated with higher PVCs burden even in patients with same NYHA class.
Heart Rate Variability,Heart Failure Patients
https://ejhm.journals.ekb.eg/article_56657.html
https://ejhm.journals.ekb.eg/article_56657_df129dc08c32801903faa2ad6578ed10.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Endoscopic Treatment of Sessile Colorectal Polyp
5350
5354
EN
Fawzy. M.
Mustafa
Department of General Surgery, Faculty of Medicine - Al-Azhar University
Cairo – Egypt
fawzymetwallymustafa@gmail.com
10.21608/ejhm.2019.56659
Background: Endoscopic resection of sessile colonic polyps’ presents a number of unique challenges. Large sessile polyps are associated with the greatest risk of postpolypectomy bleeding, perforation and polyp recurrence, with massive submucosal scarring making subsequent attempts at endoscopic resection problematic. Objective: This study aimed to evaluate feasibility, safety, and the effectiveness of endoscopic treatment of colorectal benign-appearing polyps. Patients and methods: This prospective study was carried out on forty (40) consecutive patients at General Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between January 2014 and August 2016. All patients were subjected to clinical evaluation including history taking, general examination, abdominal and per-rectal examinations. Results: Of the 40 cases with removed polyps, 10 cases were excised by cold biopsy forceps, 4 cases were excised by cold snare, 12 cases were excised by hot snare and 14 cases were excised by EMR with mucosal lifting according to the size of the polyp. Complications included nonspecific abdominal pain in 5 patients (12.5%) that were treated conservatively and bleeding in 3 (7.5%), two cases during procedure while 1 case presented 7 th day post procedure. One case transferred into open surgery due to perforation. All cases were treated endoscopically. Post-polypectomy surveillance permitted the detection and treatment of recurrent polyps in 3 cases that treated endoscopically with piece meal excision. Conclusion: This study showed that polypectomy of benign sessile colorectal polyps performed by an expert endoscopist is feasible, effective, and safe, even on an outpatient basis.
Endoscope Polypectomy sessile polyps EMR (Endoscopic Mucosal Resection)
https://ejhm.journals.ekb.eg/article_56659.html
https://ejhm.journals.ekb.eg/article_56659_74db17c5816040dd08d4f28740306a6b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Optical Coherence Tomography Assessment of Macular and Choroidal Thickness in Patients with Proliferative Diabetic Retinopathy in Relation to Hemoglobin A1C
5355
5366
EN
Abdullah Hussain
Hamed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Hassan Metwally
Bayoumi
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Abdulmonem Mohammad
Abdulmonem
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
drabdelmonem2020@gmail.com
10.21608/ejhm.2019.56919
Background: Diabetic retinopathy affects up to 80 % of all patients who have had diabetes for 10 years or more. Despite these intimidating statistics, research indicates that at least 90% of these new cases could be reduced if there were proper treatment and monitoring of the eyes blindness. Objective: To evaluate the relation of macular and choroidal thickness to HbA1c in patients with proliferative diabetic retinopathy. Patients and methods: This study included 40 eyes of 33 patients with a diagnosis of proliferative diabetic retinopathy (PDR). Patients were recruited from Retinal Clinic in Imbaba Eye Hospital and they were asked to participate in this study. This study was designed as an observational, cross-sectional and non-coherent study in the period from 5/2018 to 4/2019. Results: the results showed that the macular thickness was higher and the choroidal thickness was lower in uncontrolled HbA1c group than controlled HbA1c group. We assumed that increase level of glycosylated hemoglobin lead to increase macular thickness and decrease choroidal thickness and increase incidence of diabetic macular edema and choroidal atrophy. Conclusion: Optical coherence tomography is a sensitive and noninvasive diagnostic tool in the evaluation of macular and choroidal thickness. Hypertension is also an important risk factor in the development of diabetic retinopathy, diabetic macular edema and diabetic choroidopathy.
Optical Coherence Tomography,Macular and Choroidal Thickness,proliferative diabetic retinopathy,Hemoglobin A1C
https://ejhm.journals.ekb.eg/article_56919.html
https://ejhm.journals.ekb.eg/article_56919_a49e6666246dc7367b0a37a2c5d6fc64.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Evaluation of QT Dispersion and Tp-e interval in Children with Hypothyroidism
5367
5372
EN
Mohamed Hesham Hassan
Ezzat
Department of Cardiology, Faculty of Medicine. Al-Azhar University
Mohamed Samy
Abdel-Samae
Department of Cardiology, Faculty of Medicine. Al-Azhar University
Mohamed Basiony
Taha
Department of Cardiology, Matrouh
Specialized Cardiothoracic and Interventional Catheterization Center, Egypt
dr.mohamedbasiony@gmail.com
10.21608/ejhm.2019.56920
Background: Several studies in adults, showed increased dispersion of QT and corrected QT (QTc), peak-to-end interval of the T wave (Tp-e), Tp-e/QT ratio and Tp-e/QTc ratio in hypothyroidism. However, there were few studies in children with hypothyroidism. Objective: This study aimed to evaluate the relationship between hypothyroidism in children and increased QTd, QTc, Tp-e, Tp-e/QT ratio and Tp-e/QTc ratio. zPatients and methods: In this study we compared 50 hypothyroid children with 30 healthy children in respect of serum thyroid stimulating hormone (TSH), serum level of free triiodothyronine (fT3) and level of free thyroxine (fT4). Hypothyroidism diagnosed with TSH above the laboratory accepted upper limit and normal or decreased fT4 values. The patient and control group data were compared by calculating the QT interval, corrected QT(QTc), QT dispersion (QTd), QTc dispersion (QTcd), Tp-e, Tp-e/QT ratio and Tp-e/QTc ratio on 12-lead surface electrocardiogram (ECG). Results: In the hypothyroid group, the mean age was 10.36 ± 4.18 years old (ranged from 1-17 years). Regarding the control group, the mean age was 9.09 ± 4.58 years old (ranged from 1-17 years). The QT max, QTc max, QTd, QTcd, Tp-e, Tp-e/QT and Tp-e/QTc values were determined to be significantly higher in hypothyroid children than the control children (p=0.03, p=0.026, p< 0.001, p=0.004, p=0.003, p=0.034 and p=0.027 respectively). QT max, QTc max, QTd and QTcd in the hypothyroid group were 330 ± 38 ms, 406 ± 26 ms, 37 ± 17 ms and 39 ± 17 ms respectively. While in the control group, they were 315 ± 23 ms, 393 ± 26 ms, 18± 13 and 27 ± 16 respectively. Conclusion: It could be concluded that there was a significant increase in QTd, QTcd, Tp-e, Tp-e/QT ratio and Tp-e/QTc ratio values in children with hypothyroidism similar to that seen in adults. The use of 12- lead ECG for the measurements of QTd, QTcd and Tp-e can be considered necessary for the monitoring of children with hypothyroidism and in the evaluation of the risk of cardiovascular disease.
hypothyroidism,QT dispersion,thyroid stimulating hormone,children
https://ejhm.journals.ekb.eg/article_56920.html
https://ejhm.journals.ekb.eg/article_56920_d1f75281081c4b7dfde8d5365c47b6fd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
A Comparative Study between Use of Propofol-Ketamine and Propofol-Fentanyl in Total Intravenous Anesthesia for Laparoscopic Surgeries
5373
5379
EN
AL-Sayed Mostafa
Stohy
Department of Anesthesiology and Intensive Care, Faculty of Medicine - Al-Azhar University
Abd El-Wahab Abd El-Sattar
Saleh
Department of Anesthesiology and Intensive Care, Faculty of Medicine - Al-Azhar University
Ahmed Salah El-deen Mohamed
Zahakna
Department of Anesthesiology and Intensive Care, Faculty of Medicine - Al-Azhar University
10.21608/ejhm.2019.57351
Background: Total intravenous anesthesia has advantages over traditional inhalational anesthesia. It has the advantages of hemodynamic stability, ease of titration using targeted control infusion systems, less organ toxicity, preservation of hypoxic pulmonary vasoconstriction, and reduction of intra- cerebral pressure, risk reduction of postoperative nausea and vomiting, less atmospheric pollution and more economic. Propofol as a strong anesthetic but has no property of internal analgesia; so, a quick action opioid like fentanyl is usually used for helping in analgesia. Aim of the work: The aim of this study was to compare between propofol-ketamine and propofolfentanyl as a drug combination used for total intravenous anesthesia in laparoscopic surgeries as regarding hemodynamic state, intraoperative analgesia, recovery time, postoperative analgesia, nausea and vomiting as well as emergence reactions. Patients and Methods: This comparative study was conducted between July 2017 and June 2019 at Sayed Galal University Hospital on 40 adult patients with sex and age matched. Their age ranged between 20-50 years old. They were randomly divided into two equal groups depending on drug combination used, Propofol-Ketamine Group (I) and Propofol-Fentanyl Group (II). The study was approved by the medical ethics committee of Al-Azhar University Hospitals and a written informed consent was obtained from all patients. Results: The mean intraoperative blood pressure in Group (I) was higher than Group (II) with statistically significant difference between both groups p˂0.001. The comparison between the mean of pain (VAS) score, sedation (Ramsay’s score) and recovery time of patients in both groups shows that means were higher in PropofolKetamine Group than Propofol-Fentanyl Group and there was statistically significant difference between them p˂0.05. In this study, nausea/vomiting were more common in Group (I) than Group (II) with statistically significant difference between them (p˂0.05). Emergence reaction (unpleasant dreams or hallucinations) were more evident in Group (I) with statistically significant difference. Conclusion: There was no significant difference in the average number of heart beats and peripheral oxygen saturation. The combination of Propofol-Ketamine leads to more hemodynamic stability. The combination of Propofol-Fentanyl leads to faster recovery than the combination of Propofol-Ketamine for procedural sedation and analgesia in patients undergoing laparoscopy. Nausea/vomiting were more common significantly in group (I). Emergence reaction was more evident in group (I) and was statistically significant.
Anesthesia,propofol,Ketamine,Propofol-Fentanyl,Laparoscopic Surgeries
https://ejhm.journals.ekb.eg/article_57351.html
https://ejhm.journals.ekb.eg/article_57351_16a7271c1c488df589c4b9f2100cd3fe.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Assessment of Left Ventricular Diastolic Dysfunction by 2D Speckle Tracking in Hemodialysis Patients
5380
5385
EN
Abd El Mohsen Mostafa
Abdo
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Attia Morsy
Shokr
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed Mohamed
El Ashkr
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mohamed Safwat
Helmy
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
dr.91mido@gmail.com
10.21608/ejhm.2019.57352
Background: Diastolic dysfunction is widespread among patients on dialysis and is associated with increased morbidity and mortality. Echocardiographic speckle tracking strain rate analysis may allow assessment of left ventricular diastolic function. Objectives: The purpose of this study was aimed to test the capability of speckle tracking diastolic strain rate to assess the clinical and subclinical left ventricular diastolic dysfunction in end stage renal disease patients who are on dialysis. Subjects and Methods: This prospective study included a total of 45 subjects, 30 of them were on dialysis, attending at the Outpatient Clinic, Department of Cardiology, Faculty of Medicine, Al-Azhar University Hospital and Nasr City Police Hospital. The included subjects were divided into three groups; Group (A) included fifteen healthy control subjects, Group (B) included fifteen patients with dialysis with normal diastolic function and Group (C) included fifteen patients with dialysis with diastolic dysfunction. Results: No significant differences were observed between control subjects and study population as regard age, sex, DM, smoking and Dyslipidemia. In the current study, comparison between the three groups revealed statistically significant difference in mean values of HTN. Comparison between the three groups revealed highly statistically significant differences in echocardiographic parameters that included E/A, E/e, LA volume, TR velocity and speckle tracking diastolic strain rate used in evaluation of Diastolic function “ P value 0.001 ”. Conclusion: Two-dimensional speckle tracking could be used in assessment of diastolic dysfunction among people on dialysis dependent on speckle tracking diastolic strain rate.
Left Ventricular Diastolic Dysfunction,Two-Dimensional Speckle Tracking Echocardiography,dialysis patients
https://ejhm.journals.ekb.eg/article_57352.html
https://ejhm.journals.ekb.eg/article_57352_1456dc4dc6f869e40616b8f961681eb8.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Partial Resection Versus Complete Resection of Costal Cartilage in Breast Reconstruction by DIEP Flap
5386
5391
EN
Mohamed M.
El-Ghor
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar University
Abdelhady
Omar
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar University
Tarek M.
El-Banouby
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar University
Ahmed
Taha
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar University
Abdelfatah
El-Shekh
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.57353
Background: Breast reconstruction is a vital component of the overall treatment plan of breast cancer patients. Surgical breast reconstruction is not only desired by most patients, but is recommended by law in many countries. Aim of the Work is to compare between partial resection and complete resection of costal cartilage in breast reconstruction by DIEP flap as regard postoperative pain mainly and other factors as operative time, blood loss, blood transfusion, and hospital stay. Patient and Methods: Forty patients were recruited in this study and were divided into 2 groups, 20 patients underwent breast reconstruction by DIEP flap with partial resection of costal cartilage and 20 patients underwent breast reconstruction by DIEP flap with complete resection of costal cartilage. Results: DIEP flap with partial resection of costal cartilage does in fact cause less postoperative pain than DIEP flap with complete resection of costal cartilage. Conclusion: The DIEP flap is an excellent choice for breast reconstruction, and is usually the first choice of flap for breast reconstruction in our practice. Over the past 3 years in our practice it has shown to be safe and reliable and provide a breast reconstruction with a superior long-term result with minimal donor site morbidity.
Costal Cartilage,Breast Reconstruction,DIEP Flap,blood loss,Blood transfusion
https://ejhm.journals.ekb.eg/article_57353.html
https://ejhm.journals.ekb.eg/article_57353_27355dcc083752f83cd3287a2dd6d6c9.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Surgical Reconstruction after Excision of Pilonidal Sinus with Modified Limberg Transposition Flap
5392
5398
EN
Ahmed Shawky
Abd El-Aziz
General Surgery Department, Faculty of Medicine, Al-Azhar University
Mohammed Abd El-Aal
Nafea
General Surgery Department, Faculty of Medicine, Al-Azhar University
Abd El-Hafiz Hosny
Abd El-Hafiz
General Surgery Department, Faculty of Medicine, Al-Azhar University
islamhosny91@gmail.com
10.21608/ejhm.2019.58014
Background: Pilonidal sinus is a common infectious process which occurs in buttocks and sacral area which involves a wide range of symptoms that are different from an asymptomatic sinus to acute and chronic sinus track. Aim of the work: The aim of the study was to evaluate the outcome of modified Limberg transposition flap in surgical reconstruction after excision of pilonidal sinus. Patients and Methods: This prospective study was conducted at the Department of General Surgery, Al-Azhar University Hospitals (Al-Hussin & Sayed Galal hospitals). This study was carried out on 30 consecutive patients with primary non recurrent sacrococcygeal pilonidal sinus from 11/2018 to 6/2019 to allow a minimum follow-up period of at least 5 months for the last case operated upon. Results: Operative time and postoperative pain with mean operative time 47.37 ± 5.67, postoperative pain: 18 patients (60%) with mid pain, 10 patients (33.3%) with moderate pain, only 2 (6.7%) with severe pain. The complications among study group were 4 patients (13.3%) with wound seroma, 3 patients (10%) with wound hematoma, 3 patients (10%) with wound infection, 2 patients (6.7%) with wound gapping, only one patient (3.3%) with flap necrosis. The mean time for wound healing is 20.57 ± 5.72, 17 patients (56.7%) less than 20 days and 13 patients (43.3 %) more than 20 days, mean hospital stay is 3.63 ± 0.85, 17 patients (56.7%) = 3 days hospital stay and 13 patients (43.3%) more than 3 days hospital stay. Conclusion: Surgical reconstruction after excision of pilonidal sinus with modified Limberg transposition flap is an effective method for the management of pilonidal disease, especially when dealing with recurrent pilonidal sinus.
Surgical Reconstruction,Excision,Pilonidal Sinus,Limberg Transposition Flap
https://ejhm.journals.ekb.eg/article_58014.html
https://ejhm.journals.ekb.eg/article_58014_776d6f262d3a9fff72267c040d2c4b3a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Correlation Between Audiological, Clinical and Radiological Findings in Patients with Microtia
5399
5404
EN
Gehan Abdel-Rahman
El- Zarea
Audio Vestibular Medicine Unit, Department of Otorhinolaryngology, Faculty of
Medicine, Al-Azhar University
Ali Khalaf
Mahrous
Audio Vestibular Medicine Unit, Department of Otorhinolaryngology, Faculty of
Medicine, Al-Azhar University
Abd Ellah Nazeer
Yaseen
Department of Radiodiagnosis, Faculty of
Medicine, Al-Azhar University
Ahmed Taha
Mohamed
Audio Vestibular Medicine Unit, Department of Otorhinolaryngology, Faculty of
Medicine, Al-Azhar University
10.21608/ejhm.2019.58016
Background: Microtia is a congenital abnormality of the auricle. The main problems of patients with microtia are hearing loss and cosmetic abnormalities of the affected ear. Most patients with microtia have normally formed inner ears and have no sensorineural hearing loss. High resolution computed tomography (HRCT) scan and hearing assessment are important for evaluation of patient with microtia. Objective: The aim of the current work was to evaluate the relation between audiological, clinical and radiological findings in patients with microtia. Patients and Methods: This is a descriptive cross-sectional study of 30 patients with microtia, who were selected from outpatient clinic of El-Hussein University Hospital, Cairo, Egypt, from August 2018 to September 2019. All subjects were subjected to full history taking, Otological examination, general examination, basic audiological evaluation, and radiological evaluation. Relations were evaluated between hearing level, clinical degree of microtia according to Marx et al. (1) classification and CT scoring as assessed by the CT scoring system of Jahrsdoerfer et al. (2) . Results: The hearing level correlated significantly with severity of microtia. However, there was no significant association between degree of microtia and CT scoring as assessed by the CT scoring. Also, no significant correlation between hearing level and the total CT scoring. Conclusion: The principle “The better developed the external ear, the better the hearing level” has been proved in Egyptian cases with microtia. It may not be possible to predict external and middle ear abnormalities based on microtia grades. Therefore, both audiology testing and radiology investigation are two independent evaluations before hearing reconstruction surgery.
Microtia,external auditory canal,middle ear anomalies,temporal bone,atresia,hearing,high-resolution computed tomography,pure tone audiometry
https://ejhm.journals.ekb.eg/article_58016.html
https://ejhm.journals.ekb.eg/article_58016_8ceed1eeebe0366f8fba776f34c9dbf1.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Role of Early Pharmacoinvasive Strategy in Management of Patients with Acute ST Elevation Myocardial Infarction
5405
5412
EN
Mansour
Mustafa
Department of Cardiology, Faculty of Medicine - Al-Azhar University
Khaled
Naguib
Department of Cardiology, Faculty of Medicine - Al-Azhar University
Abdelaziz Rizk
Hassan
Department of Cardiology, Faculty of Medicine - Al-Azhar University
Hisham Mohammed
Abd-Elhamid
Department of Cardiology, Faculty of Medicine - Al-Azhar University
hisham.buda@gmail.com
10.21608/ejhm.2019.58017
Background: Myocardial reperfusion with rapid recanalization of infarct-related artery is the key to success in the management of ST-elevation myocardial infarction (STEMI). Timely reperfusion is crucial for minimization of infarct size and thereby for preservation of left ventricular function and reduction in mortality in STEMI patients. Objective: The aim of this study was to determine the effectiveness of early routine percutaneous coronary intervention (PCI) post-fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to baseline risk status (assessed by GRACE score). Patients and methods: Our study was conducted on 120 patients presented with ST-elevation myocardial infarction who presented within 12 hours after the onset of symptoms to our hospital and were eligible for firbrinolytic therapy. Results: In general pharmaco-invasive strategy was associated with reduction of death, reinfarction, revascularization and composite MACE at 1 & 6 months follow up. In the subgroup analysis of the high risk patients who underwent routine early PCI, the reduction in improvement was associated with using BMS. Moreover, patients treated with BMS showed higher rate of revascularization than those treated with conservative strategy. The patients treated with DES showed reduction in re-infarction, revascularization and composite MACE within 6 months. The using of BMS versus DES in the non-high risk group didn’t show significant difference on 6 months follow up. Conclusion: The baseline risk stratification will add advantage in choosing the strategy of reperfusion and even the type of stent used during PCI.
PCI,STEMI,GRACE,MACE
https://ejhm.journals.ekb.eg/article_58017.html
https://ejhm.journals.ekb.eg/article_58017_aa36ace52085d959c2cb6169b00aad08.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Relationship between LA Strain by 2D Speckle Tracking and LV Diastolic Function in Patient with Different Grades of LV Diastolic Dysfunction
5413
5420
EN
Wael Mohammed
Attia
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Alsayed Ali Abdou
Almarghany
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mahmoud Abd El salam
Ahmed
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
mahmoud_cardio5800@yahoo.com
10.21608/ejhm.2019.58019
Background: Diastolic function assessment is complex and multipara metric because most conventional parameters do not follow the progression of diastolic dysfunction (DD). Strain imaging is an emerging index of LA function, with recent data demonstrating that LA strain is diminished in diastolic heart failure. However, LA strain is not part of the standard assessment of diastolic function. We hypothesized that LA strain decreases with worsening DD in a stepwise fashion and could thus be useful in evaluating DD. Objectives: The aim of the current work was to observe the relationship between left atrial (LA) strain and left ventricular diastolic function. In addition to determine whether LA strain could be used to detect diastolic dysfunction (DD) and classify its degree when present. Patients and Methods: This prospective study included a total of 60 patients with diastolic dysfunction and 20 healthy control individuals, attending at outpatient clinic and Echocardiography Laboratory, Cardiology Department, Al-Hussein University Hospital. They were subjected to detailed echocardiographic examinations of the LV systolic and diastolic function and Lt atrial strain by 2D speckle tracking. Results: There were statistically highly significant differences between the four groups as regard results of GLS strain (P value=0.001) and peak LA strain (P value=0.001). Conclusions: It could be concluded that LA strain measurements are feasible and allow accurate categorization of DD, because unlike the traditional parameters, it changes progressively with severity of DD. LA strain may become a useful tool for diastolic assessment in future clinical practice.
Two-Dimensional Speckle Tracking Echocardiography,Left atrial strain,Diastolic Dysfunction
https://ejhm.journals.ekb.eg/article_58019.html
https://ejhm.journals.ekb.eg/article_58019_9dc3dc5bec49b8011b23a8e65d9cca45.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Intravitreal Ranibizumab Monotherapy or Combined with Laser for Diabetic Macular Edema (OCT guided study)
5421
5426
EN
Hassan Mohammed
Higazy
Department of Ophthalmology, Faculty of Medicine- Aswan University
Abdalla Mohamed Alamine
Abdalla
Department of Ophthalmology, Faculty of Medicine- Aswan University
Mahmoud Abd Elhaleem
Ali
Department of Ophthalmology, Faculty of Medicine- Aswan University
mahmoud.abdelhalim@aswu.edu.eg
10.21608/ejhm.2019.58022
Background: Diabetic retinopathy (DR) is the most frequent ocular complication of diabetes mellitus and the leading cause of blindness in the working age population in developing countries. Objective: The aim of this study was to compare central macular thickness using optical coherence tomography (OCT) between Ranibizumab 0.5 mg monotherapy over Ranibizumab 0.5 mg combined with laser based on mean average change in best-corrected visual acuity (BCVA) over 6 months in diabetic macular edema (DME). Patients and methods: The study was carried out on forty eyes of patients aged 30-75 years old, with type 1 or 2 diabetes mellitus and have visual impairment due to DME. The patients were selected from the Outpatient Ophthalmology Clinic of Aswan University Hospital. Results: Both groups achieved improvement of visual acuity and reduction of the macular thickness but the effect was more pronounced and long lasting in the combined therapy group. Conclusion: The use of more than one line of treatment in combination for patients with diffuse DME could provide more sustained results with the need for less frequent injections and decreasing the recurrence or persistence rate of DME.
Intravitreal Ranibizumab Monotherapy,Diabetic Macular Edema,BCVA,OCT
https://ejhm.journals.ekb.eg/article_58022.html
https://ejhm.journals.ekb.eg/article_58022_e7c923d948cb58de41075085afbce13b.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Sensitivity and Specificity of Computerized Tomography Coronary Angiography for Evaluation of Coronary Stents of Variable Sizes and Sites
5427
5433
EN
Islam Shawky
Abdelaziz
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Egypt
Ahmed Abdelraouf
Mahdy
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Egypt
Hamed Mohamed Hamed
Abdelhafez
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Egypt
10.21608/ejhm.2019.58024
Background: Coronary artery stenting has become the most important non-surgical treatment for symptomatic coronary artery disease. However, in-stent restenosis occurs at a relatively high rate and this problem has led to the routine use of invasive angiography for assessing stent patency. Objective: The aim of the study is to determine sensitivity and specificity of Computerized Topography Coronary Angiography (CTCA) for evaluation of coronary stent patency regarding its different sites and sizes. Patients and methods: The study population consisted of 40 patients presented for follow up after previous coronary stent implantation within at least 6 months regardless presence or absence of symptoms suggestive of in-stent restenosis. It was carried out at Nasr City Police Hospital in the span of one year from June 2018 to June 2019. The study was approved by the medical ethics committee of Al-Azhar University Hospitals and a written informed consent was obtained from all patients. Results: The current study revealed a good diagnostic accuracy of the MSCT coronary angiography (91.2%). Sensitivity, specificity, PPV and NPV were 88.2%, 92%, 83.3% and 94.3% respectively. We also concluded the higher diagnostic accuracy of ISR in LAD compared to other vessels as well as higher diagnostic accuracy of ISR of proximal stents and stents of diameter > 3mm. Conclusion: It was concluded that the 320-slice CT coronary angiography is a robust test that can be used confidently to diagnose patients with coronary stents and more importantly to rule out significant coronary instent restenosis in patients with high likelihood of having significant ISR.
sensitivity,specificity,Computerized tomography,Coronary angiography,coronary stents
https://ejhm.journals.ekb.eg/article_58024.html
https://ejhm.journals.ekb.eg/article_58024_6969bc858eafa7edd288df58cf9c9c14.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Study of Interferon-γ-Inducible Protein 10 (IP 10) Level as a Diagnostic and Prognostic Marker in Patients on Sofosbuvir and Daclatasvir as Antiviral Therapy of Chronic Hepatitis C.
5434
5441
EN
Mostafa Yousef
ELmishad
Department of Microbiology and Immunology, Faculty of Medicine, Al-Azhar University
Alsayed Ahmed
Gouda
Department of Microbiology and Immunology, Faculty of Medicine, Al-Azhar University
Ali Saad Elden
Nada
Department of Hepatology, National Hepatology Institute Al- Menofia University
Ahmed Hussin
Al-Dehna
Department of Microbiology and Immunology, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.58025
Background: Hepatitis C virus (HCV) belongs to the family Flaviviridae. Elevated plasma levels of the interferonγ-inducible protein 10 (IP 10) is common in HCV infection. Objective: study of IP 10 level as a diagnostic and prognostic marker in patients on sofosbuvir and daclatasvir as antiviral therapy of chronic HCV in comparison with HCV RNA level estimated by PCR. Patients and methods: ELISA estimation of IP 10 serum level and quantitative PCR for hepatitis C RNA virus done for 40 chronic HCV patient before , within and after undergoing antiviral therapy in the form of Sofosbuvir and Daclatasvir ± Ribavirin. In addition, ELISA estimation of IP 10 serum level was done to 20 apparently healthy individuals as a control group. Results: IP 10 serum concentrations were significantly higher in patients than in control group. Sofosbuvir and daclatasvir significantly decreased IP 10 serum level concentrations and this change in concentrations was statistically highly significant. HCV PCR mean were 39×104 ± 78×104 log IU/ml) before start of treatment then declined to undetectable level after one month of treatment till 3 months after the end of treatment. This change in concentrations was statistically significant. Conclusions: IP 10 may be used as a prognostic but not diagnostic marker for treatment efficacy in chronic HCV infected patients subjected to sofosbuvir/daclatasvir combination therapy.
Interferon-γ-Inducible Protein 10,IP 10,Chronic hepatitis C,direct acting antiviral therapy,Sofosbuvir,Daclatasvir
https://ejhm.journals.ekb.eg/article_58025.html
https://ejhm.journals.ekb.eg/article_58025_7f5e7808874e84ad7d006335905c4f36.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema
5442
5447
EN
Hassan Mohammed
Higazy
Department of Ophthalmology, Faculty of Medicine- Aswan University
Abdalla Mohamed Alamine
Abdalla
Department of Ophthalmology, Faculty of Medicine- Aswan University
Mahmoud Abd Elhaleem
Ali
Department of Ophthalmology, Faculty of Medicine- Aswan University
mahmoud.abdelhalim@aswu.edu.eg
10.21608/ejhm.2019.58027
Background: Diabetic macular oedema can occur at any stage of retinopathy and is typically characterized by retinal thickening and leakage of extracellular fluid, which are linked with hypoxia and up regulation of vascular endothelial growth factor (VEGF). Objective: The aim of this study was to compare central macular thickness using optical coherence tomography (OCT) between Ranibizumab 0.5 mg monotherapy vs Ranibizumab 0.5 mg combined with laser based on mean average change in best-corrected visual acuity (BCVA) over 6 months in diabetic macular edema (DME). Patients and methods: The study was carried out on forty eyes of patients aged 30-75 years old, with type 1 or 2 diabetes mellitus and have visual impairment due to DME. The patients were selected from the Outpatient Ophthalmology Clinic of Aswan University Hospital. Results: Visual acuity measured as log MAR values in Group A, when comparing the baseline visual acuity with that at the end of follow-up period, there was a significant improvement in vision. Some patients achieved improvement of two lines at the end of six months. In Group B, there was a significant improvement in vision when comparing the baseline reading with the six months reading with an average gain in visual acuity of two or more lines. The central macular thickness improved in both groups without statistically significant difference between them in the first three months post-injection. However, the combined group achieved the highest reduction in the macular thickness at the end of follow-up period. Conclusion: Ranibizumab monotherapy provided significantly superior benefit over standard-of-care laser in patients with visual impairment due to DME being rapidly improved and sustained BCVA over the 6-month treatment period.
Ranibizumab Monotherapy,Diabetic Macular Edema,BCVA,OCT
https://ejhm.journals.ekb.eg/article_58027.html
https://ejhm.journals.ekb.eg/article_58027_5a4365dfcaffe74e5808396470fd735f.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Total Knee Replacement in Severe Varus Knees
5448
5454
EN
Mohammed Salah Aldin
Abd El Hafeez
Orthopaedic Surgery Department, Faculty of Medicine, Al- Azhar University
Mahmoud Sedek
Hassan
Orthopaedic Surgery Department, Faculty of Medicine, Al- Azhar University
Mohamed AbdElaziz
Hassan
Orthopaedic Surgery Department, Faculty of Medicine, Al- Azhar University
Anass Abd El Halim
Salim
Orthopaedic Surgery Department, Faculty of Medicine, Al- Azhar University
arnolld.mr32@yahoo.com
10.21608/ejhm.2019.58030
Background: Varus deformity is predominantly the commonest deformity in candidates for total knee arthroplasty. Obtaining a well-positioned and stable prosthetic construct with restoration of the normal mechanical axes of the limb and joint line have been shown to have an important bearing on the final outcome of knee replacement operations. Objective: The aim of this work is to study the results and outcome of total knee replacement in severe varus knees and how to manage the ligamentous laxity and bone defect to improve the alignment of the limb. Patients and methods: This study was carried out in the period between January, 2016 and July, 2019. A prospective study was conducted involving 32 patients with 40 knees with a severe varus deformity, indicated for total knee arthroplasty. The implants used for these cases are total knee, however PCL sacrificing or CCK were used, according to the knee problem, the condition of the ligaments and the bone defect. Results: The results of our study showed that the average knee society score (KSS) showed a highly significant increase postoperatively to be 93.0±4.5 in compared with average preoperative KSS of 30.2±15.0. The average knee function score at the last follow up was 75.3+10.0 (range from 65 to 80) compared with average preoperative knee 25.7+20.1 (range from 5 to 40). Conclusion: Sequential medial soft tissue release must be performed to provide adequate stability without over releasing. PCL must be released in severe fixed varus deformity especially if accompanied by flexion deformity.
Total knee replacement,Severe varus knees,Arthroplasty
https://ejhm.journals.ekb.eg/article_58030.html
https://ejhm.journals.ekb.eg/article_58030_2c8151ead515a91ecbbf0c3714410116.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
MR Spectroscopy of the Brain in Cases of Carotid Artery Stenosis
5461
5464
EN
Ali Abd El-Hady
El-Sayed
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed Muhammad
Mostafa
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Islam Abdullah Muhammed
Roshdy
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
islamriad2016@gmail.com
10.21608/ejhm.2019.59176
Background: stenosis or occlusion of the internal carotid artery (ICA) causes a reduction in arterial pressure distal to the stenosis or occlusion. This reduction leads to hypoperfusion which causes chemical changes in the brain and can be detected by proton magnetic resonance spectroscopy (1H-MRS). Objective: The aim of the current study was to explore the value of proton magnetic resonance spectroscopy imaging in patients with internal carotid artery stenosis or occlusion. Patients and Methods: This study included a total of 30 non infarcted patients with stenosis or occlusion of unilateral internal carotid artery, attending at the Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University (AlHussein) Hospital. Patients underwent MR spectroscopy to detect metabolic changes of the brain. Results: In 30 noninfarcted patients, there was decreasing in N-acetylaspartate (NAA) and increasing in choline in the hemisphere compared with the contralateral side. In addition, there was lactate peaks which found only in 8 patients. Conclusion: 1H-MRSI can reveal abnormal metabolic changes which occur in cerebral tissues with no infarction. However, internal carotid artery may show stenosis or occlusion at an initial stage, which in turn may help guide management decisions and preoperative assessment.
H-MRS, MRI, Carotid artery stenosis, Stroke, ICA, Cerebral ischemia, Transaxial,Semiovale, VOIs
https://ejhm.journals.ekb.eg/article_59176.html
https://ejhm.journals.ekb.eg/article_59176_b59101d603d63f21986db26499d727dd.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Effect of Pretreatment with Transdermal Testosterone on Controlled Ovarian Stimulation and Outcome in Poor Ovarian Responders Undergoing ICSI
5465
5496
EN
Yehia
Wafa
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Abdelaal
Elghandour
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmad Elsayed
Abdelaal
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
dr_ahmedelsayed@hotmail.com
10.21608/ejhm.2019.59177
Background: Controlled ovarian stimulation (COS) has contributed to improving the pregnancy rate of women who undergo in vitro fertilization (IVF) by increasing the number of developing follicles and oocytes. Poor ovarian response to controlled ovarian stimulation (COS) remains a major problem in assisted reproduction. Objective: To investigate the effectiveness of treatment with transdermal testosterone gel (TTG) before controlled ovarian stimulation (COS) in low responders undergoing intracytoplasmic sperm injection (ICSI). Patients and Methods: A total of 300 patients who were defined as poor responders using BOLOGNA criteria were randomized into TTG pretreatment group and control group. For TTG pretreatment group, 10 g of TTG (5 % testosterone) for 15–20 days with a 5 mg/d nominal delivery rate of testosterone were applied daily for 15-20 days in the cycle preceding COS for IVF. Main Outcome Measure(s): COS results and IVF outcome. Result(s): There were no differences in patients’ characteristics between the two groups. Total dose and days of human menopausal gonadotrophins (HMG) used were significantly lower in the TTG pretreatment group than in the control group. The numbers of oocytes retrieved, mature oocytes, fertilized oocytes, and good-quality embryos were similar in both groups. Embryo implantation rate, clinical pregnancy rate per cycle and live birth rate did not show any statistically significant difference between the two groups. Conclusion: Transdermal testosterone pretreatment did not significantly increase the number of retrieved oocytes, clinical pregnancy rate or live birth rate in poor responders undergoing ICSI trials, however it reduces the total dose and number of days of HMG administration.
Transdermal testosterone gel,controlled ovarian stimulation,IVF,low responders,ICSI
https://ejhm.journals.ekb.eg/article_59177.html
https://ejhm.journals.ekb.eg/article_59177_10b773ce07a6ea1686e07be6218f6f05.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Role of Diffusion Weighted MRI in Assessment of Renal Lesions
5470
5481
EN
Sayed Ahmed
Ghoneim
Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed Abd Elfattah
Abo Rashid
Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Hytham Mahmoud
Nafady
Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mahmoud Mamdouh Mahgoub
Aziz Eldin
Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
hewany234@gmail.com
10.21608/ejhm.2019.59179
Background: Renal lesions are being discovered with increasing frequency due to rapid development and advances in cross-sectional imaging studies being applied in clinical practice. Objective: The aim of the current work was to evaluate the ability of MRI with diffusion images and ADC values in assessment, characterization of renal lesions and its ability to differentiate benign from malignant lesions. Patients and Methods: This prospective study included a total of thirty patients with suspected renal lesions, referred from Urology and Internal Medicine Departments of Suez Canal authority hospital. This study was conducted between January 2019 and July 2019. Patients were examined by MRI with diffusion images and ADC values. Results: The mean apparent diffusion coefficient (ADC) value of normal renal parenchyma was higher than the mean ADC values of benign and malignant lesions. The mean ADC value of all benign lesions was higher than that of malignant lesions. However, there was overlap between ADC values of inflammatory, solid benign lesions and ADC values of malignant lesions. Conclusion: There is overlap between ADC values of inflammatory, solid benign lesions and ADC values of malignant lesions. Using of ADC value alone may lead to inaccurate assessment of renal lesions. The combination of conventional MRI and ADC value in the diagnosis of renal lesions can increase the diagnostic accuracy.
Diffusion,MRI,renal lesions,parenchyma
https://ejhm.journals.ekb.eg/article_59179.html
https://ejhm.journals.ekb.eg/article_59179_370de8e1472d778977484845cec317a0.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Effectiveness and Safety of Silodosin in Treatment of Premature Ejaculation: Placebo Double Blind Control Study
5482
5487
EN
Yahya Mohamed Ibrahim
Hodeeb
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University
Mohamed Saeed Mohamed
Hasan
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University
Mohammed Abdelhafez Beyali
Abdelhafez
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.60256
Background: Premature ejaculation (PE) is a common sexual problem, many epidemiological reports have shown that approximately 20–30% of men have complaints of PE. Objective: The aim of this study was to evaluate the effectiveness of silodosin 4mg in treatment of premature ejaculation. Patients and methods: This study was conducted on 160 subjects with premature ejaculation. The patients were recruited from Dermatology and Andrology Outpatient Clinics in Al-Azhar University Hospitals . Results: According to our results, there is highly statistically significant difference (p-value < 0.001) between patient group (559.3 ± 159.9) and control group (248.4 ± 83.7) as regard intravaginal ejaculatory latency time (IVELT) post-treatment (p-value < 0.001). Also, we found highly statistically significant difference (p-value < 0.001) between premature ejaculation profile questionnaire (PEPQ) pre- and post-treatment in patients' group. As silodosin caused improvement of control over ejaculation, satisfaction with sexual intercourse, personal distress related to ejaculation and interpersonal difficulty. At the end of the study only 11 (13.75%) patients reported that they had a decreased semen volume as a side effect of silodosin, which disappeared completely after discontinuation of the drug. Conclusion: we found that, silodosin 4 mg is a promising idea in treatment of premature ejaculation, as it is effective, cheap, safe and available in Egyptian market. We recommend administration silodosin 4mg 2 hours before sexual intercourse for treatment of premature ejaculation.
Silodosin,Premature Ejaculation
https://ejhm.journals.ekb.eg/article_60256.html
https://ejhm.journals.ekb.eg/article_60256_9c57d5f39eb7c100284b7f23e45ef40a.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Association of Significant Coronary Arterial Disease, Coronary Calcification and Carotid Intima Media Thickness with Glycosylated Hemoglobin Levels in Patients without History of Diabetes Mellitus Sent for Coronary CT Angiography
5488
5496
EN
Ahmed Adel Saber
Taha
Cardiology Department, Faculty of Medicine, Ain Shams University
ahmed.adel28989@gmail.com
10.21608/ejhm.2019.60257
Background: Diabetes mellitus (DM) is a risk factor for the development of the coronary heart disease (CHD), and individuals with DM have more extensive atherosclerosis, more cardiac events, and higher prevalence of silent ischemia as compared with individuals without DM. Objective: The aim of the study is to assess the association of significant coronary arterial disease, coronary calcification and carotid intima media thickness with glycosylated hemoglobin levels in patients without history of diabetes mellitus sent for coronary CT angiography. Patients and methods: This prospective study included 39 patients who underwent 320 Multi-slice CT coronary angiography (Aquilion ONE 320 MSCT) at (Nasr-City Police Hospital) through the period from May 2017 to April 2018. They divided into 3 equal groups according to HbA1c (G1, non-diabetic, G2, pre-diabetic and G3 diabetic). The study was approved by Ain Shams University academic and ethical committee and an informed written consent was obtained from all patients. Results: At level of multi-slice CT coronary, CCS was significantly higher in Group C than in Group A and B. But no significant difference could be picked in subgroup analysis between Group A and Group B. There were no significant differences among groups as regarding significant coronary artery stenosis. But there was a trend towards significance in Group C; however, it failed to reach significance mostly because of the small sample size. At level of carotid Doppler US, there were significant differences between groups as regarding bilateral CIMT. But this significance was mainly between Group C and the other groups in subgroup analysis. As regarding correlation, age and HbAlc had a positive strong correlation with CCS, LT CIMT, and RT CIMT. Conclusion: HbAlc positively correlates with coronary and carotid atherosclerosis and patients with mild elevation of HbAlc has significantly more CIMT than individuals with normal HbAlc.
DM,CAD,CHD,CT angiography,CIMT,HbAlc
https://ejhm.journals.ekb.eg/article_60257.html
https://ejhm.journals.ekb.eg/article_60257_c8be5ab1826c13db46ef09fc90094208.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
The Impact of Type II DM on the Left Ventricular Function after Early Invasive Management in Middle Aged Patients with Non-St-Segment Elevation Myocardial Infarction
5497
5506
EN
Mohsen Ali Mahmoud
Salama
Department of Cardiology, Faculty of Medicine, Al-Azhar University
Kamal Ahmed
Marghany
Department of Cardiology, Faculty of Medicine, Al-Azhar University
Amany Mohamed
Seddik
Department of Cardiology, Faculty of Medicine, Al-Azhar University
Sherif Mohamed Ibrahim
Halawa
Department of Cardiology, Faculty of Medicine, Al-Azhar University
10.21608/ejhm.2019.60259
Background: Cardiovascular diseases are presently the leading causes of death in industrialized countries and expected to become so in emerging countries by 2020. Among these, coronary artery disease (CAD) is the most prevalent manifestation and is associated with high mortality and morbidity. Objective: The aim of this study was to assess the impact of Type II DM on the left ventricular function measured by 2D Speckle tracking Echocardiography in middle aged patients presenting with NSTEMI who will undergo PCI. Patients and methods: This study was carried on sixty middle aged patients (according to WHO, it should be 55 years of age) admitted with NSTEMI who undergoing (PCI) during their admission at Al-Hussein University Hospital, Mostafa Kamel Military Hospital and the International Cardiac Center (ICC) at Alexandria. They divided into two equal groups (Diabetic group and Non-diabetic control group). Results: The result showed that diabetes had a bigger effect on the initial systolic function but with early intervention.The difference in systolic function in both study groups was insignificant though it was a bit better in non-diabetics. Regarding to the site of significant LAD lesion, statistical difference was found in osteal LAD lesions (more in diabetics) and mid LAD lesions (more in non-diabetics). Conclusion: Early intervention in diabetic patients lessens the effect of CAD on the myocardium even if the disease tends to be stronger than non-diabetics early on. The 2D speckle tracking echocardiography is a promising, feasible, and non-invasive modality to evaluate myocardial deformation.
Type II DM,Left Ventricular Function,Early Invasive Management,Non-St-Segment Elevation Myocardial Infarction,CAD
https://ejhm.journals.ekb.eg/article_60259.html
https://ejhm.journals.ekb.eg/article_60259_488b437332d6d5bcbb10f38a026e60bf.pdf
Pan Arab League of Continuous Medical Education
The Egyptian Journal of Hospital Medicine
1687-2002
2090-7125
77
4
2019
10
01
Role of Cardiac MR Imaging in Evaluation of Left Ventricular Diastolic Function in Ischemic Heart Disease
5507
5513
EN
Ali Abd Elhady
Elsayed
Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University
Mamdouh Helmi
Eltahan
Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University
Ahmed Mohamed
Abou Elfotouh
Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University
Mahmoud Mohamed Abou
Mandour
Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University
dr.mandour1985@gmail.com
10.21608/ejhm.2019.60260
Background: Diastolic dysfunction and coronary artery disease (CAD) are interrelated. The complications of CAD, myocardial ischemia or infarction, are major causes of diastolic dysfunction. Objective: The aim of this study was to determine the accuracy of CMR in assessment of left ventricular diastolic function in ischemic heart disease patients by using a combination of left atrium size measurement and phase-contrast evaluation of transmitral flow. Also, to evaluate the extent of myocardial scarring in these patients and to correlate between the degree of myocardial scarring and the degree of left ventricular diastolic dysfunction. Patients and methods: In the current study a total number of 22 patients with known ischemic heart disease were enrolled for contrast enhanced CMR examination between January 2019 and October 2019. All patients underwent CMR and echocardiography. Two of the 22 patients were excluded from the study because of technical difficulties or failure of data acquisition (patient did not hear or did not obey breathing instructions). So, 20 patients were included in the present study. Results: our study showed feasibility of routinely performing evaluation of MV flow to assess diastolic function using CMR. We were able to obtain clinical variables including E:A ratios and deceleration times, which agreed with those obtained using TTE. Conclusion: In patients with CAD, extent of myocardial scarring reliably predicts the degree of diastolic dysfunction. LGE-CMR provides a powerful means to noninvasively assess the degree of myocardial scarring.
Cardiac MR imaging,Left ventricular diastolic function,Ischemic heart disease,CAD,CMR
https://ejhm.journals.ekb.eg/article_60260.html
https://ejhm.journals.ekb.eg/article_60260_140beb35ced6044021c28aa47665fb19.pdf