Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Evaluation of the Protective Roles of Synthetic Zeolite on Some Physiological and Biochemical Parameters after Cadmium Toxicity of Crayfish (Procambarus Clarkii)551755261145810.21608/ejhm.2018.11458ENMohamed M.A. ShahatDepartment of Zoology, Faculty of Science, Al-Azhar University (Assiut – Egypt) Department of biology, Jazan University, Jazan, Kingdom Saudi ArabiaMaged M.A. FoudaDepartment of Zoology, Faculty of Science, Al-Azhar University (Assiut – Egypt) Department of Biology, Jouf University, Sakaka, Kingdom Saudi ArabiaHussein A. A. SultanDepartment of Zoology, Faculty of Science, Al-Azhar University (Assiut – Egypt)Ibrahim O. AliChemistry Department, Faculty of Science,
Al-Azhar University (Cairo– Egypt)Department of Biology, Jouf University, Sakaka, Kingdom Saudi ArabiaJournal Article20180823<strong>Background: </strong>the release of heavy metals into the environment through industrial effluents is a major concern, worldwide and removal of such pollutants has been a great concern during the last decades. Heavy metals are not biodegradable and tend to be accumulated in organisms and cause numerous diseases and disorders.<strong> Aim of the Work: </strong>this study evaluated the protective role of synthetic zeolite against cadmium toxicity of freshwater crayfish <em>(Procambarus clarkii)</em>.<strong> Patients and Methods: </strong>the crayfish was divided into six groups (36 individual in each group), the first group was used as a control group, the second group was exposed to a dose of (50 μg/L) cadmium chloride for 45 days, the third group exposed to a dose of (50 μg/L) cadmium chloride for 45 days and then added zeolite (1 mg/L) for 45 days. The fourth group was exposed to a dose of (50 μg/L) cadmium chloride for 45 days and then added zeolite (5 mg / L) for 45 days, the fifth group was exposed to a dose of (50 μg/L) cadmium chloride plus (1 mg/L) zeolite for 45 days. The sixth group was exposed to a dose of (50 μg/L) cadmium chloride plus (5 mg/L) zeolite for 45 days. After the experimental periods, the crayfish were weighted and hemolymph was collected to measure the biochemical parameters (Glucose, total protein, albumin, globulin, A/G ratio, cholesterol, triglyceride, LDL, HDL, Na+, K+, Cu+2, Ca+2and Mg+2). <strong>Results:</strong> in G2 the concentration of total protein, albumin, globulin, HDL, Na+, K+, Cu+2 and Ca+2 were significantly decreased (p< 0.05) compared with the control group, while glucose, A/G ratio, cholesterol, triglyceride, LDL and Mg+2 were significantly increased (p< 0.05) compared with the control group. The addition of the ion-exchanging agent, zeolite (1 mg/L and 5 mg/L) to cadmium exposed group (G2) caused improvement in weight and all hemolymph biochemical parameters in G3, G4, G5 and G6. <strong> Conclusion:</strong> the synthetic zeolite was able to protect crayfish against cadmium toxicity by reducing the transfer of cadmium from polluted water into crayfish tissue and reducing the chance for metal uptake by interacting in the experimental medium which in evidently improves the physiological and biochemical functions.https://ejhm.journals.ekb.eg/article_11458_c3ebcecca1222a00fa95c41ecb19482e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Effect of Different Lung Ventilatory Patterns during and After Cardiopulmonary Bypass on Oxygenation Parameters after Cardiac Surgery in Adults: A Comparative Study552755331145910.21608/ejhm.2018.11459ENEslam Reda Abdelhay HassanFaculty of Medicine - Ain Shams University in Anesthesia DepartmentSamia Ibrahim SharafFaculty of Medicine - Ain Shams University in Anesthesia DepartmentEman Mohamed Kamal AboseifFaculty of Medicine - Ain Shams University in Anesthesia DepartmentMarwa Mostafa MohamedFaculty of Medicine - Ain Shams University in Anesthesia DepartmentJournal Article20180823<strong>Background:</strong> pulmonary complications after cardiac surgery recorded incidence of 25% of all cardiac surgeries. Ventilation strategies before and after CPB also cause problems. Alveolar over-distention and reduced lung recruitment are involved in lung injury during general anesthesia in cardiac surgeries. Protective lung ventilation is a common practice during general anesthesia and includes positive end expiratory pressure (PEEP), recruitment maneuvers and the use of FiO2 levels not greater than 80%.<strong> Aim of the Work:</strong> the aim of the study was to compare the effect of application of continuous positive airway pressure (C-PAP) ventilation during cardiopulmonary bypass and application of positive end expiratory pressure (PEEP) after cardiopulmonary bypass (CPB) per se or followed by lung recruitment (RM) in the intensive care unit (ICU) on arterial oxygenation after cardiopulmonary bypass.<strong> Patients and Methods:</strong> after obtaining approval from the medical ethical committee, this study was conducted at Cardiothoracic Academy of Ain Shams University and Ain Shams University specialized hospitals. The study included 66 patients divided into three equal groups.<strong> Conclusion:</strong> the application of alveolar recruitment strategy showed short term improvement in the arterial oxygenation and ventilation perfusion mismatch in patients undergoing CABG using CPB. Further studies are needed to determine if this beneficial effect of recruitment maneuvers could be further prolonged and produce more lasting clinical effects.https://ejhm.journals.ekb.eg/article_11459_a4fe04033a29843f5078c25a7c3da0c7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Study of Hand Hygiene Awareness among Doctors and Nurses in King Abdulaziz Specialist Hospital553455391146010.21608/ejhm.2018.11460ENWijdan Abdulmohsen AlzahraniCollege of Medicine, Aljouf University, Sakaka, Saudi ArabiaMalak Khalid AlkuwaykibiCollege of Medicine, Aljouf University, Sakaka, Saudi ArabiaAthir Athallah AlruwiliCollege of Medicine, Aljouf University, Sakaka, Saudi ArabiaAbeer Zaid AlmaziadCollege of Medicine, Aljouf University, Sakaka, Saudi ArabiaShaimaa Mohamed Abd Elfattah HasnCollege of Medicine, Aljouf University, Sakaka, Saudi ArabiaJournal Article20180823<strong>Background:</strong> hand hygiene is now regarded as one of the most important element of infection control activities. It is an effective strategy to prevent health care-associated infections (HCAIs). It is a required practice for all health care providers. It is done by using manually antibiotics jelly or washing hands by soap and tap water. Hand hygiene before and after examination of the patient is the first line of protection against infection as hand is considered the primary carrier of infections.<strong> Aim of the Work:</strong> was to assess the knowledge, attitudes and practice of doctors and nurses in King Abdulaziz Specialist Hospital.<strong> Patients and Methods:</strong> this descriptive cross-sectional study was conducted on the 110 of doctors and nurses in King Abdulaziz Specialist Hospital, who were interviewed between 3rd March 2017 and 9thApril 2017. Data were collected and analyzed using SPSS version 16.<strong> Results:</strong> out of 110 respondents, 57.3% were female and the nurses constituted the highest cadre (61.8%). Hand hygiene knowledge was highest in the Emergency Room (29.1%) and lowest among diabetes center staff (3.6%).<strong> Conclusion:</strong> hand hygiene is crucial for doctors and nurses and hence the need to improve their attitude, practice and knowledge. The presence of significant differences between doctors and nurses in our study indicated the need for qualified doctors who have enough information and knowledge about the importance of hand hygiene to assure control of infections as well as all hygienic affairs during working with patients enrolled in hospitals.https://ejhm.journals.ekb.eg/article_11460_458f5c05f6f396fb6e9b7ce4192e3356.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Effect of Intramuscular Administration of Dexamethasone on the Duration of Labor Induction554055461146110.21608/ejhm.2018.11461ENMohammed Abd-Allah ElmaraghyDepartment of Obstetrics and Gynaecology, Faculty of Medicine - Ain Shams UniversityTamer El RefaieDepartment of Obstetrics and Gynaecology, Faculty of Medicine - Ain Shams UniversityKareem Mohamed LabibDepartment of Obstetrics and Gynaecology, Faculty of Medicine - Ain Shams UniversityMarwa Gamal MohamedDepartment of Obstetrics and Gynaecology, Faculty of Medicine - Ain Shams UniversityJournal Article20180823<strong>Background:</strong> induction of labor is a common obstetric procedure which is performed for a variety of medical and non-medical indications. If the cervix is unfavourable, prior ripening of the cervix makes induction of labor easier and more succeful. There are different methods for ripening of the cervix and making it ready for induction. These methods included medical methods such as the administration of prostaglandins, and mechanical methods such as extra amniotic saline infusion, traction on the cervix with Foley catheter and laminaria.<strong> Aim of the Work:</strong> the aim of the study is to evaluate the efficacy of intramuscular dexamethazone injection prior to induction in improving progression and duration of labour phases.<strong> Patients and Methods:</strong> this study started with 100 Nulliparous Pregnant women who were conducted at the labor wards of Ain Shams Maternity Hospital. The studied subjects were randomized into two groups: Dexamethasone group: This group included 50 Nulliparous women (N=50), called A group. Control group: This group included 50 Nulliparous woman (N=50), called B group.<strong> Results:</strong> in this study the duration of active and second stages was decreased without change on mode of delivery. The study no significant statistical differences between the two studied groups as regards fetal heart rate. The duration of second stage in dexamethasone group was shorter than in the control group. Dexamethasone intramuscularly prior to induction significantly shortens duration of normal labor in normal parturants with minimal complications.<strong> Conclusion:</strong> an intramuscular injection of dexamethasone before labor induction is found to shorten the duration of labor induction by decreasing the interval between the initiation of induction and the beginning of the active phase, duration of active phase and duration of second stage of labor with no observed maternal or neonatal complications.https://ejhm.journals.ekb.eg/article_11461_a7d2980f26dbf92ffd02b6ab69ffdabe.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701The Role of Dynamic MRI with Diffusion Weighted Images in Evaluation of Portal Vein Thrombosis in Hepatic Patients554755511146210.21608/ejhm.2018.11462ENSuzan Bahig AliDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityAsmaa Magdy SalamaDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityMostafa Farag ElshafieDepartment of Radiology, Theodore Bilharz Research InstituteMartina Fares Fayez ShogryDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityJournal Article20180823<strong>Background:</strong> hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide and its incidence is increasing especially in western nations. HCC may be associated with portal vein thrombosis which could be either benign or malignant. <strong>Aim of the Work:</strong> to detect the role of diffusion MR imaging in the differentiation between benign and malignant portal vein thrombosis in patients with HCC.<strong> Materials and Methods:</strong> prospective study carried on 30 patients with liver cirrhosis with pathological or radiological proof of HCC, associated with visible portal vein thrombosis. Dynamic MRI examination and diffusion weighted imaging were performed for all patients. ADC values and ratios were calculated for both HCC and thrombus. Definite accepted radiological criteria were used as a standard of reference to detect the nature of the thrombus and discriminate between bland ones and neoplastic ones.<strong> Results:</strong> we found that the ratio between the ADC of the thrombus and ADC of the HCC was significantly different between the malignant and bland cohorts and a cutoff value of 1.25 for the ADC ratio helped in differentiation between malignant and benign portal vein thrombi with 85% sensitivity and 81% specificity. There was also obvious statistical significant difference between the ADC values of the bland and neoplastic thrombi.<strong> Conclusion:</strong> diffusion weighted MR imaging has a great role in differentiation between the benign and malignant portal vein thrombosis by measuring the ADC ratio between the thrombus and HCC.https://ejhm.journals.ekb.eg/article_11462_133bd3e6dd3b03fb3263f2ab4c837621.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Role of Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) in Assessment of Urinary Bladder Carcinoma556155701146410.21608/ejhm.2018.11464ENHanaa Abdel Qader Abdel HameedDiagnostic Radiology Department; Faculty of Medicine, Ain Shams UniversityMona Ali Mohamed Ali NagiDiagnostic Radiology Department; Faculty of Medicine, Ain Shams UniversityDhurgham Hayder WaliDhi-Qar University - College of Medicine – IraqJournal Article20180823<strong>Background:</strong> bladder cancer is the fourth most common cancer in males and the tenth most common cancer in females. Urinary bladder cancer occurs three to four times more frequently in men than in women and has a high recurrence rate, necessitating long-term surveillance after initial therapy. Patients with bladder cancer survive longer than those with most other common cancers. For the radiological evaluation of the urinary bladder and prostate gland, magnetic resonance imaging (MRI) is a valuable imaging modality due to high tissue contrast, multiplanar imaging capabilities, and the possibility of tissue characterization. Diffusion-weighted imaging (DWI) has emerged as a diagnostic technique in the evaluation of various abdominal lesions.<strong> Aim of the Work:</strong> to evaluate the role of diffusion weighted magnetic resonance imaging (MRI-DWI) in the diagnosis of urinary bladder carcinoma, with pathological diagnosis was taken as the reference.<strong> Patients and Methods:</strong> this is a retrospective study that included 20 patients in whom bladder cancer had been suspected either clinically or by U/S and confirmed by biopsy and 20 patients in whom bladder cancer had been not suspected and MRI was done because of other pelvic diseases as a control group. The study was conducted in El-Demerdash hospital. The patients will be referred to the radiology department from the urology department for further MRI evaluation with DWIs.<strong> Results:</strong> in this study, 20 patients suspected to have bladder cancer were scheduled for MR imaging. All patients were scheduled for different MR sequences including T2WIs, DWIs and post contrast T1WIs. Regarding the detection of urinary bladder carcinoma the sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using T2 images alone and combined use of T2 and DW images were 62.5%, 66.7%, 63.2% and 100%, 100%, 100% respectively. The sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using post contrast MR images alone and combined use of post contrast MR images and DW images were 92.3%, 100%, 93.3% and 100%, 100%, 100% respectively.<strong> Conclusion:</strong> we assume that DW-MRI is a safe and confident method in detection and local staging of urinary bladder carcinoma. In addition, DW images may predict the histological grade of the tumor. Hence DWI may be added to routine imaging protocols of urinary bladder tumors.https://ejhm.journals.ekb.eg/article_11464_ddf37c6c8828b492451a1c89237bb082.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Effect of Sildenafil Citrate on Fetal Color Doppler Study and Biophysical Profile in Cases of Intrauterine Growth Restriction (IUGR) in Third Trimester557155741149410.21608/ejhm.2018.11494ENMohamed Hesham Hasan AnwarObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityMorad Kamel HasaninObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityBassem Ragab AbdelazizObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityOmar Abd El Mageed Ismail HamdObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20180823<strong>Background:</strong> fetal growth restriction is an important cause of perinatal morbidity and mortality. The accurate assessment of fetal growth during pregnancy is difficult, but recent advances have improved this important aspect of obstetric care with positive implications for antenatal patients and their babies.<strong> Aim of the Work:</strong> to assess the effect of sildenafil citrate on color Doppler flow parameters in umbilical artery, Middle cerebral artery and Biophysical Profile in case of fetal growth restriction.<strong> Patients and Methods:</strong> this is a prospective cohort study of 100 pregnant females presenting for routine antenatal care at 28 + 0 weeks till delivery. A cohort of 100 pregnant females attending the antenatal care clinics at Al-Hussein university hospital and Bab El-Sharia university hospital during a period of 2 years from May 2016 to May 2018.<strong> Results:</strong> this study excluded the patients with undetermined gestational age, intrauterine infection, high risk for aneuploidy (e.g. maternal age >40 years, detected congenital fetal anomalies in the current or previous pregnancies). All cases were followed regularly twice monthly during the seventh and eighth month and then once weekly till delivery, after the administration of 20mg of sildenafil citrate every 12 hourly starting from the 28 weeks of gestation until delivery.<strong> Conclusion:</strong> the current study conclude that, administration of Sildenafil 20 mg every 12 hourly in pregnant females with fetal growth restriction (FGR) improved the feto-placental Doppler indices (pulsatility index and resistance index) of umbilical artery, middle cerebral artery.https://ejhm.journals.ekb.eg/article_11494_00cf1ca6e72eae32446e65d8ae427f56.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Role of PET/CT in Assessment of Colorectal Carcinoma557555771151210.21608/ejhm.2018.11512ENWaleed Mohamed Abd-Elhamid HettaDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityAhmed Hassan SolimanDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityAhmed Mohamed RabieDepartment of Radiology, Faculty of Medicine, Ain Shams UniversityJournal Article20180825<strong>Background:</strong> colorectal cancer is the second most common cause of cancer in women (9.2% of diagnoses) and the third most common in men (10.0%), it is the fourth most common cause of cancer death after lung, stomach, and liver cancer.<strong> Aim of the Work:</strong> the goal of this study was to elucidate the role of 18F-FDG PET-CT in evaluation of colorectal cancer.<strong> Patients and Methods:</strong> twenty five patients with histopathologically proven colorectal primary malignancy were evaluated for suspected local recurrence and metastasis. No age predilection and both sexes were included, clinical history, image follow-up, tumor markers, and pathological reports were reviewed for gold standard.<strong> Results:</strong> the final diagnosis of distant metastasis and/or local recurrence in post-therapeutic cancer colon was evident in 70% of our patient population with PET/CT sensitivity of 95.6%, specificity of 91.4%, (NPV) of 88.9%, (PPV) of 96.7%, and diagnostic efficacy of 94.4% and CT sensitivity of 62.6%, specificity of 48.6, (NPV) of 33.3% (PPV) of 76.0%, and diagnostic efficacy of 58%.<strong> Conclusion:</strong> PET/CT is a better method to evaluate post-therapeutic colorectal cancer patients.https://ejhm.journals.ekb.eg/article_11512_e3824ef9ce2e4bed361c811572abe6cb.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Role of Transarterial Chemoembolization (TACE) in Down Staging of Hepatocellular Carcinoma (HCC) before Liver Transplantation557855831151310.21608/ejhm.2018.11513ENAbdallah Lutfy Farouk AhmedRadiology Departments, Faculty of Medicine, Ain Shams UniversityHaytham Mohamed NasserRadiology Departments, Faculty of Medicine, Ain Shams UniversityMohamed El-Gharieb Abo-ElmaatyRadiology Departments, Faculty of Medicine, Ain Shams UniversityIman Fawzy MontasserRadiology Departments, Faculty of Medicine, Ain Shams UniversityJournal Article20180825<strong>Background:</strong> liver transplantation (LT) has emerged as the optimal treatment for cirrhotic patients with Hepatocellular carcinoma (HCC) because it cures both tumor and underlying cirrhosis. HCC could be downstaged or controlled by various anticancer therapies, which might bring them chance of undergoing a curative treatment such as LT.<strong> Aim of the Work:</strong> it was to evaluate the outcomes of HCC downstaged patients using transarterial hepatic chemoembolization (TACE) therapy to allow eligibility for liver transplantation.<strong> Patients and Methods:</strong> the study included all the cirrhotic patients who underwent TACE for downstaging of HCC to become eligible for liver transplantation at the period from 2008 to 2017 in Ain Shams Specialized Hospital. Al the patients underwent TACE to meet the Milan criteria for liver transplantation.<strong> Results:</strong> the etiology of cirrhosis and HCC in our patients was primarily Hepatitis C virus which is endemic in our country. All the cases were not eligible for liver transplantation because they were out of Milan criteria, therefore all the cases underwent TACE for downstaging of the tumor to be within the Milan criteria to become fit for liver transplantation. After undergoing TACE for downstaging, Patients underwent living donor liver transplantation, then they were followed up for detection of recurrence on the transplanted liver. Four of the twenty seven patients had recurrent HCC (14.8 %).<strong> Conclusion:</strong> successful down-staging of HCC by TACE can be achieved in the majority of carefully selected patients and is associated with excellent posttransplantation outcome.https://ejhm.journals.ekb.eg/article_11513_d7561b0342c96dd15e23981f6339bc62.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Correlation between Peptidyl Arginine Deiminase Type 4 Polymorphism and Disease Activity in Polyarticular Juvenile Idiopathic Arthritis in Egyptian Patients558455881151410.21608/ejhm.2018.11514ENMohsen M. AliDepartment of Physical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Ahmed A. Abdel-AzizDepartment of Rheumatology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptKamel S. HammadDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed A. HanafyDepartment of Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Journal Article20180825<strong>Background:</strong> juvenile idiopathic arthritis (JIA) is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age affecting one or more joints, lasting for at least 6 weeks. PADI4 is one member of PADI gene family. The PADI gene region is located at chromosome 1p36. It codes for enzymes responsible for the posttranslational conversion of arginine residues into citrulline. There are likely to be different genetic risk factors for JIA in different ethnic groups. Therefore, here we sought an influence of HLA-SE and PADI4 on JIA susceptibility in Japanese, because both HLA-SE and PADI4 were reported as significant genetic risk factors for RA independent of ethnicity. Recently, association of PADI4 gene polymorphisms with ACPA positivity and disease activity in polyarticular JIA. <strong>Aim of the Work:</strong> the aim of this work is to investigate PADI polymorphism rs2240340 to determine whether this polymorphism could be a marker of susceptibility to JIA in Egyptian children and adolescents and whether this single nucleotide polymorphism (SNP) is correlated with clinical parameters in JIA.<strong> Patients and Methods:</strong> the ethical approval was obtained from the hospital ethical research committee and each patient entering the study will sign an informed consent. Thirty patients included in this study with polyarticular types of juvenile idiopathic arthritis and all of them fulfilled ILAR classification criteria (2004). All were under the age of sixteen at time of diagnosis. They were recruited from Physical Medicine, Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from January 2018 to June 2018. In this study we measure PADI4 polymorphism and correlate with disease activity in polyarticular JIA in Egyptian patients.<strong> Results:</strong> association of PADI4 gene polymorphisms with ACPA positivity and disease activity in polyarticular JIA and PADI4 gene polymorphism can be used as a marker of susceptibility to polyarticular JIA.<strong> Conclusion:</strong> PADI4 gene polymorphism became a marker of susceptibility to polyarticular JIA and gene polymorphism correlated with disease activity in ACPA positivity in polyarticular positive JIA.https://ejhm.journals.ekb.eg/article_11514_8b6d8c98ba2c8b851bc9476d63785e2a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group558955941151510.21608/ejhm.2018.11515ENMohamed Esmat Abo GareebUrology Department, Faculty of Medicine, Ain Shams UniversityAhmed Tawfick HassanUrology Department, Faculty of Medicine, Ain Shams UniversityWaleed Fawzy AbdelsamiUrology Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180825<strong>Background: </strong>pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades.<strong> Aim of the Work:</strong> determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group.<strong> Patients and Methods</strong>: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy.<strong> Results:</strong> there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group.<strong> Conclusion:</strong> flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.https://ejhm.journals.ekb.eg/article_11515_401d73aa798cfe5ac3e83dad72738065.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Cognitive Functions in Recipients of Liver Transplantation: Prospective Comparative Study559555991151610.21608/ejhm.2018.11516ENAhmad Saad MohamedDepartment of Neuropsychiatry, Faculty of Medicine-Ain Shams UniversityMahmoud Ahmed ElmeteiniDean of Faculty of Medicine, Director of Ain Shams Center for Organ Transplant, Professor of Surgery-Ain Shams UniversityGhada Abd Elrazek MohamedDepartment of Neuropsychiatry, Faculty of Medicine-Ain Shams UniversityDoha Mostafa ElserafyDepartment of Neuropsychiatry, Faculty of Medicine-Ain Shams UniversityReem Elsayed HashemDepartment of Neuropsychiatry, Faculty of Medicine-Ain Shams UniversityAlaa Adel ElmadaniDepartment of Neuropsychiatry, Faculty of Medicine-Ain Shams UniversityJournal Article20180825<strong>Background:</strong> cognitive control refers to the ability to regulate, coordinate, and sequence thoughts/actions in accordance with the current task goals. It comprises a set of components including task switching, updating and response inhibition and coordinating multiple simultaneous operations. The fronto parietal network has been suggested as a neural basis for cognitive control. Liver transplantation is one of the most dynamic fields in modern medicine and is a lifesaving option for patients with end stage liver disease. Since the first successful transplantation in 1967, liver transplantation has been performed in many centers worldwide saving thousands of liver failure patients.<strong> Aim of the Work:</strong> based on that, our study aimed to assess cognitive functions, depression, and anxiety in patients with end stage liver disease before and after liver transplantation, then compare between both<strong>. Patients and Methods:</strong> the study involved convenience sample of 44 recipients with ESLD prepared for liver transplant, 30 of which completed the study and 14 cases dropped out.<strong> Results:</strong> all data were recorded and statistical analysis was done using the Statistical Package for Social Science SPSS- 20th version. The results were tabulated, grouped and statistically analyzed using the suitable statistical parameters. For description analysis.<strong> Conclusion:</strong> more liver impairment as estimated by Child Pugh score and MELD score associated with more impairment in cognitive tasks. In the current study the presence or absence of hepatic encephalopathy had no relation to cognitive function.https://ejhm.journals.ekb.eg/article_11516_50afd2561d9bbfd6e0248f5a40ef9928.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Evaluation of Knowledge regarding Shaken Baby Syndrome among Parents in Tabuk City560056031151710.21608/ejhm.2018.11517ENAbdullah Nasser AlshahraniFaculty of Medicine Tabuk University, Tabuk UniversityMohammed Nasser AlshahraniFaculty of Applied Medical Sciences, Tabuk UniversityAli Bani AhmedFaculty of Applied Medical Sciences, Tabuk UniversityJournal Article20180825<strong>Background:</strong> abusive head trauma (AHT) or shaken baby syndrome (or SBS), is an injury to a child's brain as a result of abuse. SBS can be caused by direct blows to the head, dropping, throwing or shaking a child. The prevalence of SBS has been reported to be 14–33.8/100 000 in children aged below one year. With a mortality rate of approximately 25%, a great portion of the survivors continue their lives with functional disorders including learning difficulty, behavior problems, advanced cognitive and developmental retardation, stroke and blindness. Shaking frequently occurs as a result of getting angry of a caregiver of a baby who cries in an unspecifiable way. Therefore, caregivers of babies should be aware of their level of stress and learn how to cope with stress. Shaken baby syndrome is a preventable problem. However, we have limited knowledge about how educated of caregivers about SBS especially in less urbanized regions such as Northern Borders including Tabuk city.<strong> Aim of the Work:</strong> to evaluate parents' knowledge regarding shaking baby syndrome in Tabuk city.<strong> Patients and Methods:</strong> The target population of this research are parents who have children up to one year old in Tabuk city. A questionnaire was administered to parents who have children from birth up to one year old. The participants were consented and then the questionnaires were distributed to them. The questionnaires involved questions regarding some demographics including age, educational level, nationality, how many children. Questions regarding Level of knowledge about SBS included: incidents of shaking their baby during the first year of life, awareness about the risk of shaking your child in first year, knowledge about the term shaking baby syndrome. All data obtained with questionnaire were analyzed using the Statistical Package for the Social Sciences (SPSS) version 23. The chi square statistics were used to test our hypotheses and the distributions of categorical variables. Results: The total sample size was 92 participants. Descriptive statistics showed that 88% were Saudi, 60% were below the age of 40. Regarding education, 12% were illiterate. Regarding the knowledge about SBS, 57.61 % reported shaking the baby to make them quite within the 1st year of life. 67.39 % reported said they had no idea about the risks of shaken the baby during the 1st year of life. Moreover, about 70% reported they have never heard about what is called SBS.<strong> Conclusion:</strong> Majority of parents have never heard about SBS. Only 32% of the surveyed understood the connection of shaking with risks on the child’s life during the 1st year and thereafter. Perception, knowledge of and attitudes towards SBS must be addressed by applying Shaken Baby Syndrome educational and Prevention Programs especially in less urbanized regions such as Northern Borders including Tabuk city.https://ejhm.journals.ekb.eg/article_11517_64a5a7d912485569809e03df82155a04.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Cortical Lesions in a Sample of Egyptian Multiple Sclerosis Patients560456081151810.21608/ejhm.2018.11518ENIsmail A. MontaserDepartment of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Mohamed H. RashadDepartment of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Mohamed A. Abd El-AzizDepartment of Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Alaa G. MashaalDepartment of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Journal Article20180825<strong>Background:</strong> multiple sclerosis is an inflammatory demyelinating disease with a neurodegenerative component mainly characterized by progressive accumulation of focal white matter (WM) lesions. The degree of cortical damage at baseline was associated with the progression of disability. Cognitive deficits could be better explained by cortical lesions (CLs) than by WM lesions. Fatigue in MS could be due to damage to the cortico striato thalamo cortical circuit. <strong>Aim of the Work:</strong> to detect (CLs) in MS patients and correlate these lesions with physical disability, cognitive dysfunction and fatigue.<strong> Subjects and Methods:</strong> a case-control study on 64 subjects including 44 known multiple sclerosis patients diagnosed according to revised McDonald's criteria 2017.<strong> Results:</strong> we observed a statistically significant difference between MS patients and healthy controls as regard number of (CLs), Symbol Digit Modality Test (SDMT), Fatigue Severity Scale (FSS) and P300 wave latencies and amplitudes. Secondary progressive (SPMS) subgroup was affected more than relapsing remitting (RRMS) subgroup. (CLs) were located mainly in temporal lobes.<strong> Conclusion:</strong> This study suggested that cortical affection is directly associated with physical and cognitive disability progression.https://ejhm.journals.ekb.eg/article_11518_8d903b469caf62bf87b92471185242a4.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Systemic Versus Intratympanic Corticosteroid Therapy for Idiopathic Sudden Sensorineural Hearing Loss; A Meta-analytical Study560956151151910.21608/ejhm.2018.11519ENOssama Ibrahim MansourDepartment of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine - Ain Shams UniversityWaleed Farag Abd El Aziz EzzatDepartment of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine - Ain Shams UniversityTarek Abd El Hamid HamdyDepartment of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine - Ain Shams UniversityBeshoy Nadhy Habib ShehataDepartment of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine - Ain Shams UniversityJournal Article20180825<strong>Background:</strong> idiopathic sudden sensorineural hearing loss (ISSHL) is one of the most controversial issues in otology. There have been countless publications and debates concerning ISSHL over the last decades. ISSHL can be defined as a sensorineural hearing loss of sudden onset or one that happens in minutes, hours or even in a few days. The hearing impairment varies as far as intensity and sound frequency are concerned, some specifically say it is a 30dB hearing loss minimum, in at least three continuous frequencies with all known causes have to be ruled out previously.<strong> Aim of the Work:</strong> the aim of this study was to evaluate the treatment outcomes of ITS treatment and SST based on meta-analysis, and to provide an alternative modality for clinical practice.<strong> Materials and Methods:</strong> the current meta-analysis assessed the therapeutic effectiveness of intra-tympanic (IT) steroid protocol as first and single drug method compared to a systemic steroid protocol. In the current meta-analysis study we applied 2 parameters to compare between ITS group and SST group which were : recovery rate and hearing improvement. <strong>Results: </strong>the results of this study showed that regarding both; recovery rate and hearing improvement, there was no significant difference between intra-tympanic steroid (ITS) and systemic steroid therapy (SST). Second both SST and ITS alone were an effective treatment in ISSNHL patients as they significantly improved PTA and also the recovery rate. Third, if patient has any systemic condition that make the use of systemic steroid risky or lead to side effect, then the option of intra-tympanic steroid was, not only justified but mandatory.<strong> Conclusion:</strong> the conclusion from our meta-analysis was shown as follows: first, according to the current study, ITS treatment produced no significant difference in both aspects PTA improvements and recovery rate than SST in ISSHL patients. Second both SST and ITS alone were an effective treatments in ISSNHL patients as they significantly improved PTA and also the recovery rate.https://ejhm.journals.ekb.eg/article_11519_5f07ef5c73e890a7d00af379787943e8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Prevalence of Rheumatic Heart Disease and its Risk Factors among Cardiac Patients in Taif City, KSA.561656221152010.21608/ejhm.2018.11520ENAbdulelah S AlgethamiDepartment of Internal Medicine, Faculty of Medicine, Taif UniversityOmar Mohammed A AlthobaitiDepartment of Internal Medicine, Faculty of Medicine, Taif UniversityIbrahim H AlthomaliDepartment of Internal Medicine, Faculty of Medicine, Taif UniversityGamal M ElnemrDepartment of Internal Medicine, Faculty of Medicine, Taif UniversityDepartment of Medical and Radiological Researches,
Nuclear Materials Authority, EgyptMashael A AlzahraniDepartment of Internal Medicine, King Faisal Hospital , KSASultan M AlthobaitiDepartment of Pharmacology, Taif University, KSAJournal Article20180825<strong>Background:</strong> exposure of the body’s connective tissue to group A β-hemolytic streptococci, after an infection, causes an inflammatory response called Rheumatic fever (RF). When the heart’s connective tissue is affected, the condition is called Rheumatic heart disease (RDH).<strong> Aim of the Work:</strong> we aimed at discovering the prevalence of RDH among cardiac patients and to determine factors that played a role in its development. Also, the study was conducted to find out the causal relationship between early treatment of RF and the occurrence of RHD.<strong> Patients and Methods:</strong> faisal Hospital’s cardiac outpatient clinics, in Taif, KSA, who filled a designed questionnaire after training. To screen the population for the prevalence of RDH among cardiac patients and to determine factors that played a role in its development. Also, it was conducted to find the causal relationship between early treatment of RF and the occurrence of RHD. The ages were from 18 to 70 years old.<strong> Results:</strong> the overall prevalence of RHD among cardiac patients was 8%. The difference in prevalence of RHD was statistically significant (p=0.021) between patients whose family sizes exceeded 10 individuals (37.5%) compared to those whose family sizes was 10 individuals or less (62.5%). Also, the difference in prevalence of RHD was statistically significant (p=0.044) between patients who had little (37.5%) or no knowledge (37.5%) about symptoms of RHD compared to those who had moderate (25%) or good knowledge (0%) about symptoms of RHD. The effect of RF management on RHD was studies and it was found that irregular and incomplete antibiotic therapy in case of tonsillitis (p=0.006) and irregular oral hygiene (p=0.027) were associated with higher prevalence rates of the disease.<strong> Conclusion: </strong>The that efficient management of rheumatic fever and acute tonsillitis in terms of adequate antibiotic therapy, good oral hygiene and awareness about the symptoms of RHD are very import aspects to protect against RHD.https://ejhm.journals.ekb.eg/article_11520_243e8b8f0f87012b094977d3982f49ad.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701A Study of Sexual Dysfunction in a Sample of Medicated and non Medicated Egyptian Female Patients with Schizophrenia562356271152110.21608/ejhm.2018.11521ENAhmed Saad AliDepartment of Neuropsychiatry, Faculty of Medicine- Ain Shams UniversityGihan Medhat El NahasDepartment of Neuropsychiatry, Faculty of Medicine- Ain Shams UniversityMona Mahmoud El SheikhDepartment of Neuropsychiatry, Faculty of Medicine- Ain Shams UniversityMahmoud Mamdouh El HabibyDepartment of Neuropsychiatry, Faculty of Medicine- Ain Shams UniversityHussein Ahmed ElkholyDepartment of Neuropsychiatry, Faculty of Medicine- Ain Shams UniversityPhoebe Fayez GhobrialDepartment of Neuropsychiatry, Faculty of Medicine- Ain Shams UniversityJournal Article20180825<strong>Background:</strong> the relationship between sexuality and schizophrenia is complex. It may be related to both the psychopathology and the pharmacotherapy, as the sexual functions may be affected by symptoms itself, living with a severe chronic mental health illness, and the adverse effects of antipsychotics or other medications. Systematic studies have revealed that sexual dysfunction is highly prevalent in both untreated and treated schizophrenia patients, affecting 30–80% of women and 45–80% of men. The prevalence of sexual dysfunction may be higher in patients with schizophrenia than in patients treated for other mental disorders.<strong> Aim of the Work:</strong> to compare a group of females with Schizophrenia to healthy female control group regarding frequency and type of sexual dysfunction. <strong>Patients and Methods:</strong> this study was sought to extend our knowledge about the association of schizophrenia and its treatment with sexuality problems. It was done at Institute of Psychiatry, Faculty of Medicine, Ain Shams University to determine the rate of occurrence of sexual dysfunctions in married females with schizophrenia in comparison to control group. It included 90 females diagnosed as schizophrenia (divided into 3 groups of 30s 1-untreated patients 2-patients treated with typical anti psychotics 3- patients treated with Atypical antipsychotics) and 30 females as a control group.<strong> Results:</strong> the study revealed high prevalence of sexual dysfunction among all patients group yet it was highest among the drug naive group as 100% of them had sexual dysfunction.<strong> Conclusion:</strong> the relation between schizophrenia and female sexuality is complex it could be the result of side effect of antipsychotic medications yet the high prevalence of sexual dysfunction among drug naïve patients, suggest that sexual dysfunction is an integral part of the disease. https://ejhm.journals.ekb.eg/article_11521_f3b69ac21b8c8a51284d70bd8955e997.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Relationship between Oxytocin Level and Major Depressive Disorder562856331152210.21608/ejhm.2018.11522ENAbd El Nasr M. OmarInstitute of Psychiatry, Faculty of Medicine – Ain Shams UniversityHeba H. AlshahawyInstitute of Psychiatry, Faculty of Medicine – Ain Shams UniversityDoaa H. HewediInstitute of Psychiatry, Faculty of Medicine – Ain Shams UniversityReem E. HashemInstitute of Psychiatry, Faculty of Medicine – Ain Shams UniversityFairouz A. TawfikInstitute of Psychiatry, Faculty of Medicine – Ain Shams UniversityJournal Article20180825<strong>Background:</strong> major depressive disorder is one of the most common medical disorders worldwide, having huge impact on physical and mental health in the society and is considered an extended life-threatening psychiatric disorder. Abnormalities in the neurohypophyseal system, neuroendocrine, and immune systems have been reported in depression.<strong> Aim of the Work:</strong> this study was carried out to identify the relationship between plasma oxytocin level and the severity of major depressive disorder.<strong> Patients and Methods:</strong> this case control observational study was started from July 2016 till March 2018. The subjects were selected from inpatient and outpatient clinics of Institute of Psychiatry, Faculty of medicine, Ain Shams University. Twenty two female patients were enrolled and fourteen female healthy subjects were considered as controls. Both groups were subjected to Arabic version of Structured Clinical Interview for DSM-IV-TR Axis I Disorders and sampling of serum Oxytocin. Moreover the female patients were subjected to Hamilton rating scale for depression and state trait anxiety inventory to assess the presence of anxiety symptoms.<strong> Results:</strong> our study revealed reduced serum oxytocin levels in depressed female patients with cutoff point ≤25.6 denoting that below this level shows probability for major depressive disorder in females.<strong> Conclusion:</strong> our study revealed reduced serum oxytocin levels in depressed female patients. Consistently with the hypothesis of dysregulated OXT biology may serve as a biomarker for major depression.https://ejhm.journals.ekb.eg/article_11522_e444145f7eeccf571910916d82cb5607.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Clinical Patterns of Facial Aging among Egyptian Females563456391152310.21608/ejhm.2018.11523ENHanan Mohamed El KahkyDermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams UniversityHeba Mahmoud DiabDermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams UniversityAmany Abdelaziz AliDermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180825<strong>Background:</strong> the skin displays the most visible manifestations of aging. Research interest in aging process has grown and people are becoming obsessed with looking young. The face has received most of the attention and generated most of the studies related to beauty and aging because it is the most expressive part of human body.<strong> Aim of the Work:</strong> to assess the different clinical patterns of facial wrinkles and signs of skin aging among different age categories of Egyptian females.<strong> Subjects and Methods:</strong> this cross-sectional study was carried out in the Dermatology, Venereology and Andrology department of Ain Shams University Hospitals after Institutional Review Board approval. The study included included 100 adult females ranged from 20-60 years old.<strong> Results:</strong> the mean age was (38.570±11.634) with a range of 20-60 years. Skin phototype was Fitzpatrick Type III in 8 patients (8%), IV in 55 females (55%) and V in 37 females (37%). Glogau classification for severity of skin aging signs was type I in 39 cases (39%), Type II in 20 (20%), Type III in 26 (26%) and type VI in 15 (15%). All patients reported history of excessive sun exposure for extended hours; 32 cases reported sunscreen use but not regular, while 68 cases didn’t use sunscreen.<strong> Conclusion:</strong> skin Type IV showed more wrinkles indentation index, roughness, melanin concentration, melanin heterogeneity and HGB heterogeneity. There was a significant correlation between the sunscreen use and average melanin concentration, where cases that used sunscreen showed lower average melanin concentration. The relation between sun screen use and severity of wrinkles (Indentation index) was non-significant.https://ejhm.journals.ekb.eg/article_11523_38133df925d8aefa7bf126e0c92c26dd.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Abnormal Ocular Findings in Chronic Renal Failure Patients on Hemodialysis564056461154010.21608/ejhm.2018.11540ENDina E. MansourDepartment of Ophthalmology, Faculty of Medicine, Ain-Shams UniversityAhmed M. El-BayomiDepartment of Ophthalmology, Faculty of Medicine, Ain-Shams UniversityAml M. El-AzabDepartment of Ophthalmology, Faculty of Medicine, Ain-Shams UniversityJournal Article20180826<strong>Background:</strong> chronic kidney disease (CKD) is a global public health problem and diabetes is a leading cause for it. Those patients with end-stage renal disease (ESRD) are generally treated using hemodialysis (HD). HD causes numerous metabolic changes which in turn induce osmotic changes in blood and extracellular fluids including the aqueous and vitreous humor, so there are many ocular abnormalities in ESRD patients either due to common pathophysiological mechanisms and risk factors between eye and kidney diseases or due to hemodialysis itself.<strong> Aim of the Work:</strong> the aim of this study is to evaluate ocular findings in CKD patients on hemodialysis, including the best-corrected visual acuity (BCVA), measurement of intraocular pressure (IOP), corneal, conjunctival, tear film changes, lens and fundus changes.<strong> Patients and Methods:</strong> this cross sectional observational study was carried out on twenty three patients (6 males and 17 females) with 44 eyes, with chronic kidney disease on chronic hemodialysis for 2-10 years in the Dialysis Unit at Agouza Specialized Hospital in the period from November 2017 to April 2018. The hemodialysis duration was approximately four hours three times per week.<strong> Results:</strong> forty three percent of total 44 eyes had BCVA > 6/18. As regard anterior segment, we found yellow sclera was the commonest finding (75%), cataract (61.4%), lid edema (56.8%), dry eye (43.2%), conjunctival congestion (47.7%), and pterygium (13.6%). As regard posterior segment; Diabetic retinopathy was the commonest finding (38.6%), hypertensive retinopathy (4.5%), AMD (2.3%), macular hemorrhage (2.3%). Regarding OCT findings, there was statistically significant difference between eyes of diabetic, hypertensive and other patients as regard central foveal thickness.<strong> Conclusion: </strong>our results demonstrate high prevalence of abnormal ocular findings in chronic renal failure patients on hemodialysis. So those patients should be evaluated regularly by the ophthalmologist.https://ejhm.journals.ekb.eg/article_11540_adfc0253655b0c4944b65d7ee7aa8c87.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-20027211201807013-Nitro-Tyrosine as a Biomarker of Minimal Hepatic Encephalopathy in Patients with Liver Cirrhosis564756511154110.21608/ejhm.2018.11541ENEmad Ahmed AwadDepartment of Internal Medicine and Gastroenterology and Hepatology, Faculty of Medicine, Ain Shams UniversityMansour Nassef MohammedDepartment of Internal Medicine and Gastroenterology and Hepatology, Faculty of Medicine, Ain Shams UniversityMoataz Mohammed SayyedDepartment of Internal Medicine and Gastroenterology and Hepatology, Faculty of Medicine, Ain Shams UniversityAhmed El-Saady El-KhayalDepartment of Internal Medicine and Gastroenterology and Hepatology, Faculty of Medicine, Ain Shams UniversityMohamed Ahmed Saad AhmedDepartment of Internal Medicine and Gastroenterology and Hepatology, Faculty of Medicine, Ain Shams UniversityJournal Article20180826<strong>Background:</strong> hepatic encephalopathy (HE) is a common complication in patient with liver cirrhosis. It comprises of a broad spectrum of neuropsychiatric abnormalities of varying severity, and affected patients usually suffer from psychomotor, cognitive, emotional, behavioural, and motor coordination dysfunctions. Patients with minimal HE (MHE), a subclinical form of HE, usually have a normal mental and neurological status upon routine clinical examination. The subtle deficits in patients with MHE can only be elicited by specialized neuropsychological tests.<strong> Aim of the Work:</strong> the aim of this study was to evaluate the role of 3-Nitro-Tyrosine as a biomarker of Minimal Hepatic Encephalopathy in patients with liver cirrhosis.<strong> Patients and Methods:</strong> our conducted study was a prospective case control study carried on 60 adult patients and 30 age matched controls. All were recruited from Internal Medicine and Hepatology and Gastroenterology Department at Ain Shams University Hospitals in the period between September 2016 and June 2018. All patients enrolled in the study were subjected to detailed history taking, full physical examination, laboratory investigations, psychometric tests for detection of MHE using specially digit symbol test (DST), Trail making test A (TMT A), Trail making test B (TMT B), serial dotting test (SDT) and 3-Nitro-Tyrosine level (3NT).<strong> Results:</strong> our study found that the serum levels of 3-nitro-tyrosine are a good predictor of the presence of MHE in patients with liver cirrhosis, with good sensitivity (90%) and specificity (93.33%) and positive and negative predictive values were 93.1% and 90.3% respectively at a cutoff of 14.8 ng.<strong> Conclusion:</strong> determination of 3-nitro-tyrosine in serum is easy and is not time consuming. It only requires taking a serum sample from the patient and determining 3-nitro-tyrosine concentration. This procedure can be therefore easily added to the routine clinical determinations in patients with liver cirrhosis. This would also allow extending the diagnosis of MHE to most clinical settings, helping to identify patients with MHE.https://ejhm.journals.ekb.eg/article_11541_42e93d61f38a990c5bb0b3e08865c26d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701A Comparative Study of the Diagnostic and Prognostic Value of Squamous Cell Carcinoma Antigen and Alfa-foeto Protien in Hepatocellular Carcinoma Before and After Therapeutic Intervention565256571154210.21608/ejhm.2018.11542ENTarek Maged Al SaktyInternal Medicine Department, Faculty of Medicine, Ain Shams UniversityHesham Hamdy RadwanInternal Medicine Department, Faculty of Medicine, Ain Shams UniversityMohamed El Gharib Abou El MaatyRadiology Department, Faculty of Medicine, Ain Shams UniversityAhmed Samir AllamInternal Medicine Department, Faculty of Medicine, Ain Shams UniversityRamy Samir Abd El HamidMohamed Gamal YousefInternal Medicine Department, Faculty of Medicine, Ain Shams University,Journal Article20180826<strong>Background: </strong>hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and it is one of the major causes of death, because of its high frequency and poor prognosis. Hepatocellular carcinoma is now a common malignancy in Egypt which usually develops on top of liver cirrhosis secondary to viral infection, as hepatitis C viruses increased the risk of HCC in the Egyptian patients. <strong>Aim of the Work: </strong>was to verify the possibility of using the plasma squamous cell carcinoma antigen level as a tumor marker for hepatocellular carcinoma and to evaluate its prognostic value in management of HCC.<strong> Patients and Methods: </strong>the study included 60 subjects divided into three groups: group I was 30 patients with hepatocellular carcinomas, group II was 15 patients with liver cirrhosis and group III was 15 normal subjects serving as a control group.<strong> Results: </strong>the plasma SCCA level was significantly higher in group I patients (with HCC), than in the group II patients (cirrhosis) and control group. SCCA showed direct significant correlation with the most of laboratory data specially AST, INR, number and size of lesion.<strong> Conclusion: </strong>plasma SCCA is a sensitive and specific serum marker for the diagnosis of HCC and combination of AFP and SCCA in screening and diagnosis of HCC yielded a better sensitivity in diagnosis of HCC.https://ejhm.journals.ekb.eg/article_11542_c092857c344ce2773586fb5aa1677bd8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Discontinuation Rates among Copper Intrauterine Device Users in Primary Healthcare Unit and University Clinic. Is There a Difference?565856651154310.21608/ejhm.2018.11543ENNoha Mohamed Abd El Hafeez AhmedObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityRania Hassan MostafaObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityWessam AbuelgharObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityGasser ElbishryObstetrics and Gynecology Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180826<strong>Background: </strong>in Egypt, despite the high percentage of women using IUD according to Demographic and Health Surveys (DHS) 2014 (52.9%) of total women using contraceptive methods, the discontinuation rates among Cu-IUD users (within 12 months of use) reaches 14.3% in 2014. <strong>Aim of the Work:</strong> the aim of the study was to compare between primary health care unit and university family planning clinic in discontinuation rate among copper IUD users. <strong>Patients and Method:</strong> study design: prospective analytical observational study. Study setting: This study was conducted at Family planning Outpatient clinic of Ain Shams Maternity Hospital and El-Zahraa primary health care unit for a year. This study included 260 women whom attending family planning clinic for Cu- IUD insertion. Total 100 subjects was enrolled from each clinic. Rest of subjects was lost on follow up either after 6 months or 12 months. Some others refused to participate or gave wrong personal contacts. <strong>Results:</strong> preliminary results of the study revealed that there is no statistically significant difference between discontinuation rate among Copper IUD users in university clinic and primary healthcare clinic (p-value = 0.095). <strong>Conclusion:</strong> in our Study, analysis of data revealed that age, parity and previous usage of IUD may affect discontinuation rate after 12 months of IUD use. The mean cause of IUD discontinuation was bleeding and Anemia was present in 66.6% of patients complaining from bleeding.https://ejhm.journals.ekb.eg/article_11543_96ec09455b93f79f8e2cb1ed4766770b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Role of Surgery in Management of Discitis566656721154510.21608/ejhm.2018.11545ENAmr Hasan YousefDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityAhmed M El-SherifDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityYousef. A. BarakatDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20180826<strong>Background:</strong> discitis is an inflammation of the vertebral disc space which may spontaneous or post spinal surgery; that is often diagnosed late. With good response to conservative treatment and in some condition the plan of management is surgical.<strong> Aim of the Work: </strong>to assess the role of surgery in management of discitis and which approach is appropriate, with comparison between conservative and surgical management and the relationship between risk factors and outcome.<strong> Patients and Methods:</strong> this prospective and retrospective study was conducted on 25 patients of specific criteria confirmed to have discitis by clinical presentation, radiological findings and laboratory investigations.<strong> Results:</strong> discitis is more common in old age that occurred in lumbar more that dorsal or cervical disc space with risk factors such as failed spinal surgery (40%), DM (36%), HCV +ve (8%), TB (8%), Brucella (4%) and addiction (4%) of past history with affect the outcome. There was a statistically significant relation between location of discitis and pre modified ranking scale, while modified ranking scale pre and post management were statistically highly significant in each cervical, dorsal and lumbar.<strong> Conclusion: </strong>both conservative and surgical management have good outcome. But we observed that the risk factors like DM and addiction worsened the prognosis. We also observed that the shorter surgical maneuver the better is the outcome.https://ejhm.journals.ekb.eg/article_11545_3388f0228a956d899b45c116eed692d9.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Comparison of Smoking Cessation Practices among Smoker and Non-smoker Health Care Providers: A KAP Study in Northern Saudi Arabia567356781154710.21608/ejhm.2018.11547ENAbdullah Saud AlsaqryAl-Jouf UniversityUmer Farooq DarAl-Jouf UniversityAltaf Hussain BandayAl-Jouf UniversityTalal Mohammed AlsharariAl-Jouf UniversityAyman Khalil AlrushaydanAl-Jouf UniversityJournal Article20180826<strong>Background and objectives:</strong> health care Providers (HCPs) are epicenters for counseling the smokers to quit smoking and adopt healthy lifestyle based on informed decisions. The effects of smoking status of HCPs on cessation practices are contradictory in published literature. The northern Saudi Arabia has high smoking prevalence so is the need for cessation interventions. We carried out the KAP study to determine the difference in knowledge, attitude and practices between smoker and non-smoker HCPs.<strong> Materials and Methods:</strong> using non-probability consecutive sampling, 268 HCPs including physicians, dentists, pharmacists, nurses, and paramedical staff were included from governmental Hospitals and primary health centers of Aljouf region. A self-administered questionnaire containing Global Adult Tobacco Survey and standard practice <em>guidelines</em> for smoking cessation intervention in Hospitals and primary care centers was used for data collection.<strong> Results:</strong> we found that HCPs (14.92%) were current smokers, 2.6% were former smokers. Among female HCPs, there was no reported active smoking but 48.94% reported passive smoking. Knowledge of hazards of smoking among HCPs was up to standard. In addition, there was obvious misbelieve that Certain Types of Cigarettes Can Be Less Harmful Than Other among all HCPs (Smokers and non-smoker HCPs significantly differed in advising smoking cessation (p value < 0.01). Among other variables, increasing taxes on tobacco sale (p value < 0.01) and applying standard guidelines for smoking cessation intervention (p value < 0.01) were significantly different between groups. Lacking skills and facilities e.g. medical supply were the most frequency reasons for not starting smoking cessation intervention.<strong> Conclusion:</strong> because of high prevalence of smoking among HCPs and its negative effects on patient counseling, we suggested that there should be systematic and quality mechanism intact for quitting smoking independent of personal attitude of health care providers and initiate training center along with providing pharmacological supply for smoking cessation intervention in Aljouf region.https://ejhm.journals.ekb.eg/article_11547_55dcc1b96f6d284afbccdffff7980c03.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Local Wound Infiltration for Post Operative Analgesia in Patients Undergoing Inguinal Hernia or Infra Umbilical Incisional Hernia567956871154910.21608/ejhm.2018.11549ENZakria Abdel-Aziz Moustafa SanadDepartment of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams UniversityAdel Mohamed Meselhi El-AnsaryDepartment of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams UniversityMohamed Mourad Mohsen Mohamed AliDepartment of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams UniversityMohamed Sabry Abdel-Badei IsmaelDepartment of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams UniversityJournal Article20180826<strong>Background: </strong>since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post operative analgesia. The proper management of post operative pain ensures early ambulation of patients and obviates many postoperative complications. <strong>Aim of the Work: </strong>to compare the efficacy of transversus abdominis plane (TAP) block versus wound infiltration with local anesthetic agent as regarding postoperative analgesia, its effect on hemodynamic changes (HR, BP) during rest, opioid (pethidine) consumption. The patients included in this study were either of inguinal hernia or infra umbilical incisional hernia.<strong> Patients and Methods</strong><strong>: </strong>after obtaining approval from the medical ethical committee in Ain Shams University, this prospective randomized clinical trial study was conducted in Ain Shams University Hospital. It included fifty adult undergoing inguinal hernia or infra umbilical incisional hernia repair.<strong> Results: </strong>patients were assigned randomly into two equal groups: Group A: (n = 25) TAP Block: patients received general anesthesia followed by Tap block at the end of the operation. Group B: (n=25) Local Wound Infiltration: patients received general anesthesia followed by local wound infiltration at the end of the operation.<strong> Conclusion: </strong>bilateral TAP block was effective in reducing postoperative pain scores at rest and movement for 8-12 hours and lower total 24-h postoperative opioid and analgesic consumption after inguinal hernia or infra umbilical incisional hernia repair under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.https://ejhm.journals.ekb.eg/article_11549_c43b792442ab858a3d552ea069a0491c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Study of the Bronchoreversibility and Outcomes in Patients with Chronic Obstructive Pulmonary Disease (COPD)568856941155010.21608/ejhm.2018.11550ENEmam Abdelkader Mahmoud Al-ShareifPulmonary Diseases Department, Faculty of Medicine, Al-Azhar UniversityKhaled Mohamad Ibrahim HalemaPulmonary Diseases Department, Faculty of Medicine, Al-Azhar UniversityMohamad Al-Sayed Abdulatif NasrPulmonary Diseases Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20180826<strong>Background:</strong> acute bronchial reversibility after inhalation of short acting Beta2 agonists (SABA) has been traditionally used to differentiate asthma from chronic obstructive pulmonary disease. However, it is clear that a positive reversibility test does not exclude the diagnosis of chronic obstructive pulmonary disease. About 24% of patients with COPD met the criteria for reversibility.<strong> Aim of the Work:</strong> assessment of airflow reversibility & outcomes in patients with COPD.<strong> Patients and Methods:</strong> this study was conducted at Chest Department, Al-Hussein Hospital, Al-Azhar University and the Chest Hospital in Addakahliah Governorate in the period between January & December 2017. The study included 30 patients with COPD; diagnosed and classified according to [Global initiative for chronic Obstructive Lung Disease (GOLD), 2017].<strong> Results:</strong> mean PFT (FEV1, FEV1 / Pred. FVC % and PEFR) showed no statistically difference pre and post BDT. There was highly statistically significant difference in PFTs (FEV1, FEV1 / Pred. FVC % and PEFR) at 4, 6 and 8 weeks compared to Pre BDT. A highly statistically significant improvement in ABG (PaO2, PaCO2 and pH) was found through weeks of study compared to baseline ABG. CAT test results showed highly significant improvement after 8 weeks compared to 0 week.<strong> Conclusion:</strong> bronchoreversibility is not determined from the first session of nebulizer. Moreover, mostly there is no difference in pulmonary functions mainly forced expiratory volume in the first second between pre and post bronchodilator inhalation. To judge if there is airflow reversibility or not, we must give the patient complete course of treatment for at least one month. Therefore, the lack of acute response to short acting Beta2 agonists does not preclude the beneficial long-term response maintenance bronchodilator treatment.https://ejhm.journals.ekb.eg/article_11550_3384cb8fd12c7b9a6f00dbdff07531fb.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Comparative Study between Intravenous and Intraperitoneal Magnesium Sulphate as Adjuvant to General Anesthesia for Pain Management in Laparoscopic Cholecystectomy569557041155310.21608/ejhm.2018.11553ENMohamed Ahmed Mohamed ElfikyDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAlsayed Mostafa StohyDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityWael Mohmed El Mahdy IbrahimDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAhmed Khedr Tolba IbrahimDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityJournal Article20180826<strong>Background:</strong> numerous researches have proved the benefits of laparoscopic cholecystectomy compared to the open method, mainly because of less metabolic response to stress, maintenance of diaphragm and pulmonary function, less postoperative complications, lower incidence of postoperative ileus, early mobilization, shorter hospital stay, and a more cosmetic. The main presentation of postoperative pain is somatic, whereas visceral pain is less present, and thus the pain is less in the patients operated by laparoscopic method.<strong> Aim of the Work:</strong> to compare intravenous Magnesium Sulphate with intra peritoneal Magnesium Sulphate as adjuvant to general anesthesia for pain management in laparoscopic cholecystectomy.<strong> Patients and Methods:</strong> this prospective randomized double blind clinical study using closed envelopes method was carried out on 100 adult patients, Undergoing laparoscopic cholecyctectomy in Bab-Alshaeria University Hospital, faculty of medicine, Al-Azhar University. After approval by the Institutional Ethical Committee, and informed written consent obtained from the patients, we randomly divided the patients into two groups 50 patients each.<strong> Results:</strong> the pain scores of group II (intra-peritoneal group) were significantly lower than group I (intravenous group), the total opioid consumption postoperatively in group II(intra-peritoneal group) was highly significant lower than group I (intravenous group). Also there was a significant reduction in opioid-related side effects such as postoperative nausea and vomiting.<strong> Conclusion:</strong> the intraperitoneal administration of magnesium sulphate is a safe and effective method in the management of acute postoperative pain after laparoscopic cholecystectomy more than intravenous administration of magnesium sulphate.https://ejhm.journals.ekb.eg/article_11553_21bd5103e4f9e654c0b0e5407c9cb9d6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-2002721120180701Impact of Increased Maternal Body Mass Index on Pregnancy Outcomes570557081165910.21608/ejhm.2018.11659ENIsmail Talaat El GarhyObstetrics & Gynecology, Faculty of Medicine, Alazhar UniversityAshraf Hamdy MohamedObstetrics & Gynecology, Faculty of Medicine, Alazhar UniversityHazem Sayed ShabbanObstetrics & Gynecology, Faculty of Medicine, Alazhar UniversityEl-Hussien Mohamed AbdoObstetrics & Gynecology, Police Authority hospitalsJournal Article20180826<strong>Background:</strong> in the last decade, the prevalence of obesity has significantly increased in populations worldwide and becomes epidemic. Obesity has been documented by World Health Organization (WHO) as "a pandemic nutritional disorder. Egypt had the highest average Body Mass Index (BMI) and obesity in the world.<strong> Aim of the Work:</strong> evaluation of the possible effects of increased body mass index on pregnancy and measure its maternal, fetal and neonatal outcomes.<strong> Patients and Methods:</strong> the present study was approved from alazhar research ethical committee. The present study was carried out in Obstetrics and gynecology out-patient, Nasr city police hospital and El-hussien university hospital. Three hundred (300) pregnant women were included in the study; they were divided into3 groups: Group I 150 pregnant women with normal weight (BMI = 18.5 – 24.9 kg/m2). Group II: 75 pregnant women who are overweight (BMI = 25 – 29.9 kg/m2). Group III: 75 pregnant women who are obese (BMI >= 30 kg/m2). Groups were subjected to full history taking, clinical examination, obstetric palpation, ultrasound, investigations, antenatal care, post natal care and neonatal assessment.<strong> Results:</strong> statistical significant relationship between increased BMI and incidence of gestational hypertension, diabetes, postpartum hemorrhage and macrosomia. No Statistical significant relationship was found between increased BMI and incidence of cesarean rate, wound infection and intra uterine fetal retardation (IUGR). <strong>Conclusion:</strong> maternal obesity carries significant risks for the mother and fetus, including maternal outcomes as increased incidence of hypertension, gestational diabetes, cesarean rates, and postpartum hemorrhage. Fetal outcomes as macrosomia.https://ejhm.journals.ekb.eg/article_11659_5543d71617a656013ff8f96063219f13.pdf