Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Knowledge and Preventive Behavior Regarding COVID-19 among School-children in Saudi Arabia: A Regional Survey22802287235889ENAisha AlmutairiDepartment of Pediatrics, College of Medicine, Qassim University, Buraidah, Saudi ArabiaJournal Article20220105<strong>Introduction: </strong>COVID-19 is the fastest spreading viral infection because it is highly contagious in nature and asymptomatic carriers, therefore individuals of all age groups are at risk. Most of the children who got infected have mild symptoms or are asymptomatic but still can spread the infection to others.<br /> <strong>Aim: </strong>This study aimed to assess the knowledge and adoption of preventive behavioral practices regarding COVID 19 among school children in Saudi Arabia.<br /> <strong>Subjects and methods: </strong>This is a cross-sectional study conducted among 336 school children (66.7% girls vs 33.3% boys) aging 7-12 years old in the Qassim region, Saudi Arabia. A self-administered questionnaire was distributed to the targeted students of primary schools. The questionnaire includes basic demographic data, knowledge of the potential sources of transmission and risk factors for infection, and preventive behavioral practices toward COVID-19. <strong>Results: </strong>The knowledge of the students regarding the potential sources of transmission and risk factors for infection were average, high, and low among 59.2%, 29.5%, and 11.3%, respectively. The level of preventive behavioral practices was high, average, and low among 48.5%, 38.4%, and 13.1%, respectively. The factor associated with increased knowledge was being aged 9 – 10 years old while the factor associated with increased preventive behavioral practices was being a female student.<br /> <strong>Conclusion: </strong>Most of the school children were knowledgeable about the mode of transmission and risk factors of COVID-19 infection. They are even more aware of the preventive behavior necessary to control the spread of the disease. Continuous awareness about COVID-19 prevention is necessary to control the transmission of infection.https://ejhm.journals.ekb.eg/article_235889_0a3cd9fffc8b450a90840f8f80e34c22.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220508Association between Serum Zinc level and Febrile Seizures2288229223589110.21608/ejhm.2022.235891ENAbdullatif Mohammed AmneenahAssociate Professor of Pediatrics, Derna University, Consultant Pediatrician,Hamad Ali Hamad AlqataniHead of Pediatrics Department- Al Wahda Hospital (Derna), LibyaJournal Article20211108<strong>Background</strong>: The febrile seizure is the commonest form of seizure in children. Several hypotheses propose that neurotransmitters and trace elements have a role in the beginning of a febrile seizure. Inhibitory pathways in the central nervous system (CNS) can be affected by zinc, an essential component of many enzymes.
<strong>Aim and objectives: </strong>Thisstudyaimed to determine the relation between serum zinc level and febrile seizures.
<strong>Subjects and methods: </strong>This prospective case control study was carried in Al -Wahda hospital- pediatrics department in Derna city in the north-eastern part of Libya in the period between March 2019 to March 2020. This study comprised 120 children aged between 2 months and 6 years. They were divided to 3 groups: 40 children with febrile seizures, 40 children with fever and no seizures, and 40 healthy children.
<strong>Results: </strong>Zinc levels varied significantly amongst the three groups investigated. The differences between the groups with and without febrile seizures, as well as between febrile seizure groups and the controls, are also notable. The seizure-free group and the controls, on the other hand, showed no considerable differences.
<strong>Conclusion:</strong> According to the current findings, serum levels of zinc were lower in children with febrile seizures. Seizures in febrile children may be facilitated by zinc deficiency.https://ejhm.journals.ekb.eg/article_235891_4342b9fd5b3e88bfbf4684a4a05bacd0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220508The Diagnostic Yield of Capsule Endoscopy in Egyptian Patients with Obscure Gastrointestinal Tract Bleeding2293229623589210.21608/ejhm.2022.235892ENSoha Saoud AbdelmoneimDepartment of Tropical Medicine and Gastroenterology, Assiut UniversityShereen A. SalehDepartment of Internal Medicine, Gastroenterology and Hepatology Unit, Ain Shams UniversityMohamed Zakaria Ali Abu RahmaDepartment of Tropical Medicine and Gastroenterology, Assiut UniversityAhmed MonisDepartment of Internal Medicine, Gastroenterology and Hepatology Unit, Ain Shams University2Ehab MiKhael NaieemDepartment of Tropical Medicine and Gastroenterology, Assiut UniversityReginia Nabil Mikhail GuirguisDepartment of Internal Medicine, Gastroenterology and Hepatology Unit, Ain Shams University20000-0003-3442-3629Journal Article20220116<strong>Background: </strong>Obscure gastrointestinal bleeding (OGB) is defined as a gastrointestinal (GI) bleeding of unknown aetiology that persists despite conventional assessment. OGB accounts for about 5% of all GI bleeding and is a real issue for doctors.
<strong>Objective: </strong>The major goal of this study was to see how effective capsule endoscopy (CE) was at diagnosing Egyptian patients with gastrointestinal (GI) bleeding, whether it was occult or overt.
<strong>Patients and methods:</strong> This is a prospective observational single center study. 32 patients with OGIB (overt or occult) were referred for capsule endoscopy during the 30-month period (from June 2017 to December 2019) to the Endoscopy Unit at Hospital of Ain Shams University. Follow up patients after performing capsule endoscopy was done, some of them were recommended to do enteroscopy, and the others were referred for either surgery, radiological intervention or just medical treatment according to the pathology detected by the capsule.
<strong>Results: </strong>In the current study, capsule endoscopy was able to detect accurate findings in all studied cases (twenty five) with exception of seven cases (22%) with overall diagnostic accuracy were 78%
<strong>Conclusion: </strong>Capsule endoscopy is an excellent tool in evaluation of obscure gastrointestinal bleeding (both overt and occult) with relative safety and high diagnostic yield, which helps guiding therapeutic management.https://ejhm.journals.ekb.eg/article_235892_265d2a33c67418bea604500473047485.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220508Measurement of The Fetal Occiput-Spine Angle during The First Stage of Labor as A Predictor of The Progress and Outcome of Labor2297230323589310.21608/ejhm.2022.235893ENMohamed Mahmoud Ahmed SalmanDepartment of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, EgyptMohamed Ibrahim Mohamed AmerDepartment of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, EgyptHanan Khalaf Matloob AlmatloobDepartment of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, EgyptAliaa Mohammed MaatyDepartment of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20211206<strong>Background:</strong> Spontaneous vaginal delivery without intervention is the ideal route for most pregnancies. Failure of progression in some women may need interventions including Caesarian section or instrumental delivery.
<strong>Objective:</strong> To assess the accuracy of the fetal occiput-spine angle measured through transabdominal ultrasound during the first stage of labor on the prediction of progress and outcome of labor.
<strong>Patients and Methods:</strong> The study included (65) cases recruited from the prelabour unit in Ain Shams University hospital who was in labor. The fetal OSA is measured by abdominal ultrasound during the first stage of labor to assess its effect on the progress of labor, mode of delivery, and postnatal events.
<strong>Results: </strong>It was found that there is a significant relationship between occiput-spinal angle with both mode of delivery and duration of the first and second stage of labor, Cut off was more than (118) degrees. Which had a high negative predictive value in predicting caesarian section at the present age of 97.7% while less than or equal to (118) degrees had a positive predictive value for caesarian section and instrumental delivery of 52.6% only, at the same time it was found that there was a positive correlation between the fetal occiput-spinal angle with advanced gestational age, the angle increased with advanced gestational age we did not have any obvious explanation for it.
<strong>Conclusion:</strong> OSA equal to or less than (118) degrees correlates with a significant increase in the rate of cesarean delivery and prolongation of the active and second stage of labor. There is no correlation between the angle and maternal or fetal complications.https://ejhm.journals.ekb.eg/article_235893_094c84c64ecd1ec41c07ce7863a7a5c0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Outcome and Survival of Severe to Critical COVID-19 Patients Admitted at Zagazig University Hospitals2304231023595310.21608/ejhm.2022.235953ENMohamed El-Shabrawy MahmoudyDepartment of Chest Diseases, Faculty of Medicine, Zagazig University, EgyptWaheed M. ShoumanDepartment of Chest Diseases, Faculty of Medicine, Zagazig University, EgyptAbdul Moneam MansorDepartment of Chest Diseases, Faculty of Medicine, Zagazig University, EgyptDalia Anas IbrahimDepartment of Chest Diseases, Faculty of Medicine, Zagazig University, EgyptJournal Article20220105<strong>Background: </strong>More than 356 million people have been infected with the new coronavirus (SARS-CoV-2) that causes COVID-19.<strong>Objective: </strong>to assess outcomes and survival of COVID-19 patients admitted at Zigzag University Hospitals. <strong>Patients and methods:</strong> Retrospective cohort study was conducted at COVID isolation Sednawy Hospital, Zagazig University during the period from Jan 2021 to Dec 2021 including 900 cases as a comprehensive sample, were selected as severe to critical COVID patients according to the criteria of Egyptian protocol for management of COVID-19 patients. All patients had real-time polymerase chain reaction (RT-PCR) in respiratory tract materials.
<strong>Results:</strong> There was significant relation between severity and overall survival, which was significantly higher in those with severe disease. There was significant relation between comorbidity and overall survival, which was significantly higher in those without comorbidity and overall survival, death was 40.9% of all cases; 84.9% of critical and 12% of severe (P 0.001). Survival was highest in 3<sup>rd</sup> group 72.8%, while lowest in 1<sup>st</sup> group 42.3% (P 0.001). Remdesivir was used in 58.4% of critical and 45% in severe cases, while non-used antiviral was in 29% of critical and 27% of severe cases. CRP, IL6, Albumin/IL6 ratio, neutrophil/lymphocytes ratio were all statistically different between critical and severe cases, while PCT and CRP were insignificantly different.
<strong>Conclusion: </strong>Outcome improving over different groups with time, this means improvement in medical care, different comorbidities, change in the level of acute phase reactant and anti-inflammatory drugs may affect the survival of severe and critically ill COVID 19 patients. https://ejhm.journals.ekb.eg/article_235953_34171f08f798177dea73595aeac7cefa.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Serum Level of Adipocyte Fatty Acid Binding Protein in Patients with Psoriasis Vulgaris before and after Treatment with Acitretin2311231823595410.21608/ejhm.2022.235954ENNora Mostafa DarwishDepartments of 1Dermatology, Andrology &STDsFatma Faisal El DakroryDepartments of 1Dermatology, Andrology &STDsShimaa Rabea Abdel Qader Hendawy2Clinical Pathology, Faculty of Medicine - Mansoura University, EgyptJournal Article20220510<strong>Background: </strong>Psoriasis is a common immune mediated and chronic inflammatory skin disorder portrayed as hyperproliferation and maturation impairment of keratinocytes, increased immune cells infiltration and blood vessel formation, and accumulation in proinflammatory cytokines. Psoriasis is now considered a systemic disease where it is associated with psychological, metabolic, arthritic, and cardiovascular comorbidities. Lifespan is reduced as a consequence.
<strong>Objective: </strong>The aim of this study was to evaluate serum level of adipocyte fatty acid-binding protein (FABP4) in patients with psoriasis vulgaris and to compare it with its level in healthy control.
<strong>Patients and methods:</strong> Seventy-four were included in this study. They were chosen from the Out-patient Clinic of Dermatology, Andrology & STDs Department, Mansoura University Hospitals. A case study group of 37 patients with psoriasis vulgaris and 37 of healthy people age- and sex-matched were used as a control group.
<strong>Results: </strong>ROC curve for detection of FABP4 before acitretin validity in differentiating studied cases illustrated excellent area under curve of 0.728 (p < 0.001)* with the best detected cut off point was 2.7 yielding sensitivity of 75%, specificity of 81.1% and total accuracy of 78.1%. So, the present study demonstrated that; detection of FABP4 level before acitretin therapy could be used as reliable indicator in differentiating studied cases with high sensitivity and specificity.
<strong>Conclusions:</strong> Serum FABP4 levels were significantly increased in patients with psoriasis, indicating that this protein may be a potential marker of psoriasis and an independent predictor for the risk of comorbidities or complications in psoriatic patients. Additionally, it could be used also as a reliable indicator of acitretin therapy.https://ejhm.journals.ekb.eg/article_235954_151aed29eccd7ff75aba5bb3b91dc8cf.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prediction and Prevention of Pre-eclampsia by Measuring Mean Platelet Volume and Uterine Artery Doppler Indices in High-Risk Pregnant Women2319232423595510.21608/ejhm.2022.235955ENAli El-Shabrawy AliDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, EgyptYoussef Abo Elwan ElsayedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, EgyptHana Matoog Dawo SaadDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, EgyptAhmed Metwally ElkatawayDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, EgyptJournal Article20211207<strong>Background:</strong> Pre-eclampsia (PE) is a multisystem disorder of unknown cause that is unique to human pregnancy.<br /> <strong>Objective:</strong> This work aimed to evaluate platelet volume and its significance in the prediction of preeclampsia.<br /> <strong>Methods:</strong> This is a prospective cohort study that was carried out in the Obstetrics and Gynecology Department (High-risk unit) at Zagazig University Hospitals. Sixty high-risk pregnant women were involved during the period from July 2021 to February 2022. Ultrasound scanning was done to evaluate fetal biometric parameters according to fetal morphology and localization of the placenta. The uterine arteries were identified, and the pulsatility index and resistive index were measured bilaterally. Ultrasound examinations were performed by one observer only.<br /> <strong>Results:</strong> Platelet (PLT) was significantly higher among control and unaffected groups at all times but MPV and PDW were significantly higher among cases at all times. The first, second, third, fourth, and fifth visits were at 12, 14, 16, 18, and 20 weeks gestation respectively<br /> <strong>Conclusions</strong> Abnormal platelet indices and uterine artery Doppler indices can be considered as an early, economical, and rapid procedure for the assessment of PE. https://ejhm.journals.ekb.eg/article_235955_ca1e0ab4a4bde819460c89a138ea69d1.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Internet Addiction in Relation to Mental Health among Medical Students, Menoufia University, Egypt2325233123595610.21608/ejhm.2022.235956ENReda Abdel LatifIbrahempublic health and community medicine department, faculty of medicine, Menoufia university0000-0003-1224-7695Amr S. Shalaby2Neuropsychiatry DepartmentNagwa N. Hegazy3Family Medicine Department, Faculty of Medicine, Menoufia University, EgyptJournal Article20211202<strong>Background:</strong> Use of the Internet, computers, smartphones, and other electronic devices has dramatically increased over recent years, and this increase is associated not only with tremendous benefits to the users but also with documented cases of excessive use, which has negative health consequences. In many countries, the problem has reached the magnitude of a significant public health concern.
<strong>Objective: </strong>This study aimed at estimating the prevalence of Internet addiction among Egyptian medical students and its relation to their depression, anxiety and stress.
<strong>Results:</strong> Across sectional study including 678 medical students. Their age ranged from 17 – 24 years, 41.4% of them were males. The participants were subjected to a self-administered questionnaire that included personal data, family history and their previous year academic degree, compulsive Internet use scale (CIUS) was used, and also Depression Anxiety Stress Scale-21 (DASS -21) was used for assessing anxiety, depression, and stress. Problematic Internet use (PIU) among the participant students was 68.3%, PIU was significantly associated with increased family income, depression, anxiety and stress were also associated with PIU with odds ratio [1.57 (1.11 – 2.22), 1.65 (1.11 – 2.43), 1.48 (1.03 – 2.12)] respectively.
<strong>Conclusion: </strong>The high prevalence of problematic internet use (PIU) among medical students in Menoufia University is a matter of concern that is also associated with stress, anxiety, and depression as well as its negative impact on their academic achievement. It is important to plan comprehensive programs to raise public awareness about the hazards and introducing awareness and treatment services in primary health care facilities.https://ejhm.journals.ekb.eg/article_235956_ac8460c161c883ca286bc44e5252ce70.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220510Evaluation of Thyroid Functions in Patients with Diabetic Ketoacidosis2332233623595810.21608/ejhm.2022.235958ENMohammad O. Abdel AzizDepartments of 1Internal Medicine and Critical CareAmr Mahmoud Abdel Wahab2Internal Medicine and EndocrinologyEman Alsayed3Clinical PathologyAli O. Abdel Aziz4Chest, Faculty of Medicine, Minia University, EgyptHend M. Monees3Clinical Pathology and ChemistryAhmed Amin Ibrahim5Internal Medicine, Faculty of Medicine, Beni-Suef University, EgyptJournal Article20211208<strong>Background:</strong> Diabetic ketoacidosis (DKA) is an acute life-threatening complication of diabetes. It is not only a sign of acute absolute insulin deficiency in type 1 diabetes mellitus (T1DM) but also increasingly seen in patients with type 2 diabetes mellitus. DKA can affect the function of the hypothalamus-pituitary- thyroid axis directly or indirectly due to various factors such as relatively insufficient insulin secretion and metabolic disorders.
<strong>Subjects and Methods: </strong>This study was performed in the ICU of Minia University Hospital and Beni-Suef University Hospital. It included 90 patients admitted in ICU of both Hospitals who had diabetic ketoacidosis and 30 normal individuals as control group. The thyroid function of patients group and control group, impact of Ketoacidosis on thyroid function of patients group and its correlation with the clinical features and laboratory findings at diagnosis were evaluated.
<strong>Results: </strong>Asregard thyroid profile TSH, FT3 and FT4 were significantly lower in patients compared to control groups (p <0.001). The mean reverse T3 was 780.1±55.6 in DKA patients, which was significantly higher than control group (325±62.5) with p value p < 0.001. The mean TSH was (1.9±0.4) in DKA patients, which was significantly lower than control group (2.6±0.6) with p value p < 0.001. The mean FT3 was (3±0.4) in DKA patients, which was significantly lower than control group (3±0.4) with p value p < 0.001. The mean FT4 was (12.9±1.3) in DKA patients, which was significantly lower than control group (13.8±1.4) with p value p < 0.013. There was significant negative association between rT3 and pH (r= -0.610, p < 0.001).
<strong>Conclusions:</strong>Our study demonstrated that thyroid profile TSH, FT3 and FT4 were significantly lower in patients with DKA, while the mean reverse T3 was significantly higher in DKA patients. This dysfunction was correlated with severity of ketoacidosis. Findings of our study may have important therapeutic applications.https://ejhm.journals.ekb.eg/article_235958_3d2a82ed8cd6cca2ce8b0f0f31c6f3b6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220510Closed Treatment of Displaced Fracture Neck of Radius in Children by Metaizeau Technique2337234323595910.21608/ejhm.2022.235959ENKhaled Edris Abdelrahman GhonimDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, EgyptAdel Abdelazem Ahmed SalemDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, EgyptMahmoud Elsayed Albadawy ThabetDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, EgyptFuad Khallefah AliDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, EgyptJournal Article20211202<strong>Background:</strong> Radial neck fractures in the pediatric population represent up to 1% of all pediatric fractures. Judet type III and IV radial neck fractures represent difficulties in closed and open reduction. The Metaizeau technique has been used as a tool to reduce these.<br /> <strong>Objective:</strong> This study aimed to evaluate the clinical and radiological outcomes following Metaizeau technique for displaced radial neck fracture in children.<br /> <strong>Patients and methods: </strong>A prospective operation clinical study of 18 patients, with fracture radial neck, who underwent closed reduction and internal fixation with Métaizeau technique. Follow up Clinical and radiological evaluation was performed and any complications were recorded.<br /> <strong>Results:</strong> The function of elbow according to Mayo elbow performance score was excellent and good in 22.2% and 77.8% respectively. Also, the radiological results were excellent and good in 22.2% and 77.8% respectively. No complications were noted.<br /> <strong>Conclusion:</strong> We have managed to achieve stable fixation of the reduction without any loss of position and consequently, better outcomes with no complications.https://ejhm.journals.ekb.eg/article_235959_05c8c97b7df93dcd285b55880d2f4058.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Central Auditory Processing Impairment and Cognitive Profiles in Children with Specific Learning Disabilities2280228723609610.21608/ejhm.2022.236096ENSoha Abdelraouf MekkiEman Hassan ELsafyWafaa Hosney GhannamNahla Hassan GadJournal Article20220510<strong>Background:</strong> Specific learning disabilities (SLDs) are a significant factor in children's academic underachievement. Around 46% of SLDs children have comorbid auditory processing disorder (APD). Cognitive functions are the ability to think and plan. Consequently, learning and academic progress are significantly affected by these disabilities.
<strong>Objective:</strong> Our study sought to evaluate whether children with SLDs have both central auditory processing (CAP) and cognitive abnormalities.
<strong>Patients and methods:</strong> A case-control study was conducted on 36 children from different schools of Zagazig city, Alsharquia government, Egypt, allocated into 2 groups, 18 with SLDs and academic underachievement (study group I) and 18 without SLDs (control group II). Medical history, otological evaluation, basic audiological examination, central screening tests (speech in noise (SPIN), dichotic digit (DDT), and pitch pattern sequence (PPS)), test for temporal resolution (Gaps in noise, (GIN)), IQ, and visuomotor ability evaluation were used to collect data.
<strong>Results:</strong> The SLDs group had lower DDT, PPS, total score and percent of GIN test versus the control groups. At the same time, the approximate threshold of GIN test in the SLDs group was significantly greater relative to the normal group. Regarding Bender-Gestalt test (BGT) test, there was highly statically significant increase scores on copy and recall phases among control group. A significant positive relationship was detected between the BGT copy and recall phases and PPS on both sides.
<strong>Conclusion:</strong> Our findings endorsed our hypothesis that most children with SLDs had subnormal scores on CAP abilities and cognitive function. The most severely affected CAP were temporal resolution and temporal ordering. Most SLDs children had visuomotor affection.https://ejhm.journals.ekb.eg/article_236096_f8eafc7fc4ebcf0d3729943dcbafcfcd.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of Result of Percutaneous Fixation Proximal Humerus Fracture in Adults in Zagazig University Hospitals2351235623609910.21608/ejhm.2022.236099ENMohammed Saad Amer DawAbdelsalam EidOsam Mohamed MetwallyHany Mohamed Abdelfattah BakrJournal Article20220510<strong>Background: </strong>Percutaneous pinning is a minimally invasive treatment with a limited number of applications for fractures of the proximal humerus.<br /> <strong>Objective: </strong>to assesswhether closed reduction with percutaneous pinning gives sufficient stability to allow early active range of motion and eventual bone healing in the proximal humerus.<br /> <strong>Patients and Methods</strong>: 18 patients with age above 18 years with closed proximal humeral fracture in adults at Zagazig University Hospital by closed reduction and percutaneous pinning by K-wire were the subject of our study. Percutaneous K-wire fixation was used to treat the patients. We followed up patients and evaluated our results at 1, 3 then 6 months according to constant score (CS).<br /> <strong>Results:</strong> The radiographic union of all but one of the patients occurred by 12 weeks. Intraoperatively, there were no serious issues, eighteen patients had superficial (mild) pin tract infection (100%), One patient had delayed union (5.6%), the last patient had pin loosening (5.6%), and no patient had nonunion or avascular necrosis (AVN). The average Constant-Murley score was 81.<br /> <strong>Conclusion</strong>: By using a closed reduction with percutaneous pinning (CRP) to stabilise fractures of two and three parts, the advantages of minimum soft tissue invasiveness and less blood loss can be achieved.<br /> <strong> </strong><br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_236099_af5d95c5a402680ad2ea15700c4e7e71.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Reconstruction of Posterior Meatal Wall After Canal Wall Down Mastoidectomy: Cartilage versus Bone Graft2357236423610210.21608/ejhm.2022.236102ENAhmed Solieman RamadanAmr Hasan El SenbawySherif Mohammad AskarMohamed Salah Abd El Azeem El SayedJournal Article20220510<strong>Background:</strong> Acquired middle ear cholesteatoma remains a common problem nowadays. The mainstay of treatment is surgery. Surgeries for cholesteatoma are usually classified as canal wall down (CWD) or canal wall up (CWU) procedures. The concept of canal wall reconstruction (CWR) mastoidectomy has been shown up in an attempt to combine the advantages of both CWD and CWU techniques. In this procedure, the posterior meatal wall (PMW) is removed, providing exposure to the entire attic and middle ear, helping to ensure complete disease eradication. Hence, the recurrence rate is as low as 2% for this procedure.
<strong>Objective: </strong>This study aimed to assess the results of the reconstruction of the posterior meatal wall with bone and cartilage graft. <strong>Patients and Methods:</strong> This study was carried out on 24 ears of 24 patients in the Department of Otorhinolaryngology, Head and Neck Surgery, Zagazig University Hospitals during the period from September 2019 to September 2021. Twenty-four subjects were divided into two groups, group A (treated by canal wall down mastoidectomy with the reconstruction of the posterior meatal wall with cartilage from conchal cartilage), and group B (treated by canal wall down mastoidectomy with the reconstruction of the posterior meatal wall with bone from cortical bone). <strong>Results</strong>: There was a statistically insignificant difference between the cartilage graft group and bone graft group regarding post-operative complications. There was a decreased median of PTA-AC at post-operative cartilage graft compared to pre-operative; the difference was statistically significant with a percent of improvement of 31.36%.
<strong>Conclusions: </strong>We concluded that CWDM eradicates disease in the middle ear and epitympanum by direct visualization and prevents common complications of the traditional CWDM technique.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236102_28bfab096db32e108b1bea5169a59b81.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Ultrasonographic Measurement of Optic Nerve Sheath Diameter for Detection of Increased Intracranial Pressure in Patients Scheduled for Elective Tumor Craniotomy2365237223610510.21608/ejhm.2022.236105ENHowaydh Ahmed OthmanAhmed Mohamed Mahmoud MohamedEkram Fawzy SayouhNahla Mohamed AminJournal Article20220510<strong>Background</strong>: Elevated intracranial pressure (EICP) is a serious neurological condition. The diameter of the optic nerve sheath can be determined by means of ultrasonography as a non-invasive method of detecting EICP.<br /> <strong>Objective:</strong> The aim of the current work was to evaluate the accuracy of bedside optic nerve sheath diameter (ONSD) by ultrasound (US) as a non-invasive method of detecting increased intracranial pressure (ICP) in patients underwent elective tumor craniotomy in comparison to clinical and radiological computed tomography (CT) findings of EICP.<br /> <strong>Patients and Methods:</strong> From January 2020 to May 2020, this prospective observational study was conducted on seventy-one patients underwent elective tumor craniotomy at Zagazig University Hospitals. ONSD measurements were done and compared with clinical and radiographic features on CT brain suggesting increase in ICP pre and post-operatively.<br /> <strong>Results:</strong> There were good relation between ONSD and clinical signs of EICP. it was found that there were increase in preoperative mean ONSD among cases had nausea (4.94±0.57 mm), vomiting (4.97±0.55) mm and headache (4.87±0.6 mm), disturbed conscious level (4.9±0.62 mm) and visual field affection (5±0.46 mm). also, there was increase in postoperative mean ONSD among cases with nausea (4.81±0.67 mm), vomiting (4.81±0.62 mm), headache (4.83±0.63 mm). The cut-off value of ONSD for diagnosing increased ICP was >4.8 mm with sensitivity 78.9%, specificity 63.6% and accuracy 71.8%.<br /> <strong>Conclusion</strong>: It could be concluded that bedside ultrasonographic measurement of ONSD is a reliable technique for prediction of elevated intracranial pressure.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_236105_3825c768bafc6a44ec9bceab6004a1c8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Impact of Left Atrium Function on In-hospital Course in Patient with ST-segment Elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention2373238123610710.21608/ejhm.2022.236107ENAya Elsayed AboziedRagab Abdelsalam MahfouzEkhlas Mohamed HusseinMohamed Safwat AbdeldayemJournal Article20220510<strong>Background:</strong> Left atrial (LA) volumetric assessment by echocardiography remains a simple, non-invasive technique for left atrial functional assessment.<br /> <strong>Objective</strong>: The aim of the current work was to assess the left atrial function and its relation to the severity of the lesion in-hospital course in patients with ST-segment Elevation Myocardial Infarction(STEMI) undergoing Primary Percutaneous coronary intervention (PCI). <br /> <strong>Patients and Methods: </strong>This cross-sectional study included a total of 135 patients with acute STEMI, attending at Department of Cardiology, Zagazig University Hospitals. The included subjects were categorized into two groups; <strong>Group 1 </strong>included those, who developed adverse events. (31 patients “23%”), and <strong>Group 2:</strong> included patients with benign course. (104 patients “77%”). Coronary angioplasty as well as Echocardiography were done to all patients.<br /> <strong>Results:</strong> Regarding the echocardiographic parameters, there were significant differences between both study groups as regards Wall motion score index, left atrium volume index, Left atrium expansion index, LA total ejection fraction and E/e′ ratio. There was no significant difference between the two groups regarding LVEF. There was a high significant correlation between left atrial volume index and Wall Motion Score Index, Syntax score, Left atrium expansion index, LA total ejection fraction and E/e′ ratio. On a multivariate model for independent predictors for hospital adverse events were High syntax score, Left atrium volume index and Left atrium expansion index.<br /> <strong>Conclusion:</strong> It could be concluded that LA functions has high significant correlated with the severity of the lesion and a good prog<br /> nostic factor in hospital course of STEMI patients undergoing primary PCI.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_236107_f7b3ae714e63acb86b8f9c0edb70ffac.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Comparison of Dexmedetomidine Versus Dexamethasone as Adjuvants to Intrathecal Bupivacaine in Emergency Orthopedic Lower Limb Operations2382238723611210.21608/ejhm.2022.236112ENMohamed E. ElshahawyHani I. TamanMostafa S. ElawadyAhmed M. FaridJournal Article20220510<strong>Background:</strong>Various adjuvants were added to intrathecal anesthetics to improve quality of the block and postoperative analgesia.
<strong>Objective: </strong>The aim of the current work was to compare the efficacy of adding dexmedetomidine versus dexamethasone as adjuvants to intrathecal bupivacaine in emergency orthopedic lower limb surgery.
<strong>Patients and Methods:</strong>This prospective comparative double blinded study included a total of 90 patients with lower limb trauma requiring surgery, attending at Mansoura University emergency Hospital. Cases were randomly divided into three groups; each consisted of 30 cases. <strong>Group A</strong> received dexmedetomidine as an adjuvant to bupivacaine, <strong>Group B</strong> received dexamethasone as an adjuvant, and <strong>Group C </strong>received spinal bupivacaine plus 1 cm of normal saline. Sensory and motor blocks as well as post-operative VAS score in addition to need for analgesics were assessed.
<strong>Results:</strong>Demographic data did not differ between the three study groups (p > 0.05). Group A showed a significantly earlier onset of sensory block (p =0.005), motor block (p = 0.009), as well as late regression to L1 sensory level (p <0.001). Additionally, longer analgesia (p < 0.05) and longer time before the first call for analgesics (p = 0.005) was associated with group A. However, complications encountered did not differ between the three study groups (p > 0.05).
<strong>Conclusion:</strong> It could be concluded that intrathecal dexmedetomidine is superior to both dexamethasone and bupivacaine alone regarding duration of analgesia and pain severity. Moreover, it has more rapid onset and longer duration of sensory blockade. No significant side effects were noted when compared to the remaining groups.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236112_f2fc5b3c132386927ff2bfa33272a6b6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Clinical and Radiological Diagnosis of Talar Fractures: Review Article2388239323611510.21608/ejhm.2022.236115ENAli Adyaab Ali AdyaabMohamed Abdelaziz Mohamed GaithJournal Article20220510<strong>Background:</strong> Less than one percent of all foot and ankle fractures are caused by talar neck fractures. Arthritis, osteonecrosis, and fractures due to malunion were also common. High suspicion is needed to identify talar process fractures, especially in the context of ankle sprain-like processes including inversion and/or eversion, as these injuries are difficult to detect on routinely radiographs.<br /> <strong>Objective:</strong> This review article aimed to characterize talus neck fractures and their clinical and radiological diagnosis.<br /> <strong>Methods:</strong> These databases were searched for articles published in English in 3 data bases [PubMed – Google scholar- science direct] and Boolean operators (and, OR, not) had been used such as [Talar fractures, foot & ankle fractures] and in peer-reviewed articles between May 1977 and January 2021, no language limitations, and filtered in selected data basis. However, the range of time interval for researches was wide as there was scarcity of data on the particular reviewed, accurate and depth in the retrieved literature. Documents in a language apart from English had been excluded as sources for interpretation. Papers apart from main scientific studies had been excluded (documents unavailable as total written text, conversation, conference abstract papers and dissertations).<br /> <strong>Conclusion:</strong> In some cases, talar fractures are accompanied by soft tissue envelope damage (A common link between open talus fractures). Talar body extrusion and deltoid ligament encirclement are two distinct features of Hawkins type III fracture dislocations. It is typically possible to detect talar neck or body fractures by taking routine ankle radiographs.<br /> <strong> </strong><br /> https://ejhm.journals.ekb.eg/article_236115_d9583840777d21c7ce474447e71e8870.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of the Ideal Time Interval between Repeated Shock Wave Lithotripsy Sessions for Renal Stones2394239923611710.21608/ejhm.2022.236117ENAbdulrahman Abubaker AlzubirAref Mohamed MaaroufMaged Mohamed AliMahmoud Mohamed MalekJournal Article20220510<strong>Background</strong>: An extracorporeal shock wave lithotripsy (ESWL) procedure is frequently used to treat upper urinary tract urolithiasis.<br /> <strong>Objective: </strong>Determining the optimal interval between repeated sessions of shock wave lithotripsy for renal stones.<br /> <strong>Patients and Methods:</strong> Between June 2021 and February 2022, three groups of thirty-six patients underwent elective outpatient lithotripsy for renal stones. Patients who required many SWL sessions were studied and classified into 3 groups, 12 patients each. The first group's SWL sessions were separated by three days, while the second group's sessions were separated by one week. Those in the third group, sessions were repeated after two weeks. Three groups were compared on the VAS scores they recorded during and after the ESWL.<br /> <strong>Results:</strong> Stone clearance rates were 83.3%, 75.0%, and 91.7% (P= 0.54) for groups 1, 2, and 3. There was no significant difference between three groups as regard laboratory parameter (B2-microglobulinuria and Microalbuminuria) after 1<sup>st</sup> session, after 2<sup>nd</sup> session the laboratory parameter was significantly higher in group 1 with no significant difference between groups 2 and 3. All groups increased after 2<sup>nd</sup> session then decreased after one month. Steinstrasse was insignificantly associated with group 3 (8.33%, P =0.51).<br /> <strong>Conclusion: </strong>Our findings support the transient effect of ESWL through measurement and follow up the laboratory parameters and possible complications. We concluded using SWL to treat renal stones is safe and effective, and short-interval treatments do not raise the risk of complications.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_236117_a3aeabdd983f2bd020ae9942f7c557f3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Role of Computed Tomography Volumetry in Preoperative Evaluation of Liver Volume in Living Donor Liver Transplantation2400240523612010.21608/ejhm.2022.236120ENMohamed Ibrahim TaemaMohamed Mohsen Tolba FawzAya Mohamed Abd El-Rhim AliMohamed Moataz Al-FawalJournal Article20220510<strong>Background</strong>: It has been frequently utilized in liver transplantation surgeries to determine the liver's preoperative computed tomography volumetry (CTV) to avoid issues that may arise from graft size and residual liver volume. <strong>Objective:</strong> Liver transplantation in Zagazig University Hospitals was studied to determine the accuracy of the estimation of graft size using manual and automated interactive software. <strong>Patients and Methods: </strong>Eighteen patients; with age range from 21 to 42 years (mean age 30.4 years) and gender distribution of 6 females (33.3%) and 12 males (66.7%). The outpatient clinic of liver transplantation at the National Hepatology and Tropical Medicine Research Institute in Cairo, Egypt, directed all patients to the Radiology Department. All patients had computed tomography volumetry.<strong> Results:</strong> Differences in graft size between preoperative and actual graft measurements had an average volume of 21.7+33.65 cm<sup>3</sup> and between the pre-op and actual graft volumes, the mean difference was 51.96+33.65 cm<sup>3</sup> (range 4-131 cm<sup>3</sup>). Mean estimated graft-to-recipient weight ratio (GRWR) was (1.1±.2) and mean actual GRWR was (1.1±.3). Correlation between estimated GRWR and actual GRWR was statistically significant. A significant association was found between mean preoperative volume and total volume of the graft. The findings were statistically significant. <strong>Conclusion:</strong> For determining the volume of preoperative grafts, CT volumetry is a reliable method that was found to be highly correlated with the actual graft volume.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_236120_bc2d288d84d653476a7c54e1984bc17f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment and Validation of Ultrasound liver Imaging Reporting and Data System Version 2017 (US-LI-RADS V 2017) in Patients at High Risk of Hepatocellular Carcinoma2406241123680110.21608/ejhm.2022.236801ENRana Akram AwadMohamed Zakaria ElazazyFarida Mohammed ElfawalSameh Saber BaiomyJournal Article20220513<strong>Background</strong>: Improvement of patient-centered outcomes through standardization of ultrasound reporting in patients at high risk of developing Hepatocellular Carcinoma (HCC).
<strong>Objective</strong>: To assess the role of US-LI-RADS in the detection of HCC in high-risk patients.
<strong>Patients and Methods</strong>: Fifty patients of both sexes referred from Tropical and Internal Medicine Departments with cirrhosis due to chronic viral hepatitis (C&B) with a mean age of 58 years were included in this comprehensive study, at the Radiodiagnosis Department, Faculty of Medicine, Zagazig University Hospital. All patients were subjected to conventional B-mode ultrasound. <strong>Results:</strong> Out of the 50 cirrhotic patients, 13 patients (26%) had positive findings by the US. Using US-3 as a positive finding had a high specificity and negative predictive value (100 percent). Instead of being high, the sensitivity and positive predictive value (PPV) were poor when a positive observation was classified as US-3 (43.3 percent). <strong>Conclusion:</strong> It was found that the LI-RADS US-3 category had a high specificity for hepatocellular carcinoma diagnoses, however, it had a low sensitivity.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236801_b264acb60eb71204556518c829c802cd.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Erythrocyte Glutathione Transferase is A Sensitive Marker of Hemodialysis Adequacy2412241623680210.21608/ejhm.2022.236802ENGamal E. MadyTamer W. ElsaidGhada M. AbdelazimShaimaa Z. AbdelmegiedJournal Article20220513<strong>Background:</strong> Erythrocyte glutathione transferase (e-GST) is a non-dialyzable dimeric protein in red cells. It binds and sequesters a variety of small or large toxic compounds.
<strong>Objective: </strong>This study verifies whether e-GST can assess hemodialysis (HD) adequacy in different techniques or is complementary to the Kt/V urea parameter.
<strong>Patients and Methods:</strong> This is a pilot cross-sectional study included 20 end-stage renal diseases (ESRD) patients on conventional HD, 20 ESRD patients on hemodiafiltration (HDF) for at least 6 months, and 20 healthy controls. Serum e-GST was measured for all patients and controls.
<strong>Results:</strong> Serum e-GST can predict inadequate dialysis at cut off value >14 ng/ml with area under curve (AUC) 0.871, sensitivity 95%, specificity 60%, PPV 70.4% and NPV 92.3%. e-GST was significantly high in patients on conventional HD and HDF (mean ±SD 18.35±5.61 ng/ml, 15.20±4.40 ng/ml) respectively compared with control subjects (mean ±SD 2.80±1.36 ng/ml) P-value <0.0001. Post hoc analysis showed a significant difference between control and both conventional HD and HDF patients (P <0.0001, 0.0001) respectively while no significant differences between conventional HD and HDF patients' P-value (0.061). Patients were redistributed according to kt/v. Patients with kt/v ≤1.3 have significantly higher e-GST (mean ±SD 20.05±4.35 ng/ml) compared with kt/v >1.3 (mean ±SD 13.5±3.82 ng/ml) p-value 0.0001. The patients who have elevated e-GST have increased odds of inadequate dialysis (odds ratio: 28.5). In Conventional HD and HDF, e-GST was negatively correlated with kt/v and URR (P<0.0001).
<strong>Conclusion:</strong> Erythrocyte glutathione transferase is a highly sensitive marker for hemodialysis adequacy in different modalities and didn't need any calculations for interpretation.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236802_732417644dbf2856e6098669428509ab.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Is the Treatment with Direct Acting Antiviral Agents (DAAs) Affecting Glomerular Filtration Rate (GFR)?2417242123680310.21608/ejhm.2022.236803ENIman Ibrahem SarhanReem Mohsen ElsharabasyMohamed Hassan Abdel Gawad MohamedFatma Abdelrahman AhmedJournal Article20220513<strong>Background:</strong> The kidney is a major component of extrahepatic manifestations of hepatitis C virus (HCV) clinical syndrome and the risk of chronic kidney disease (CKD) is more than 20% higher in patients with HCV infection than in seronegative individuals. Introduction ofdirect acting antivirals (DAA) represented a transforming point in the treatment of HCV.
<strong>Patients and Method:</strong> Retrospective cohort study of 118 adult HCV infected patients with normal baseline kidney functions and eGFR >60 ml/min were included. Patients coinfected with HBV and those with impaired kidney functions at beginning of treatment were excluded. Patients were divided into 3 groups according to their DAA-combination treatment regimen. Patients’ eGFR were measured at baseline, at the end of treatment and one year later.
<strong>Results:</strong> Our results showed that patients who received sofosbuvir/daclatasvir/ribavirin, their pre-treatment eGFR mean±SD was (86.156±16.37). Post treatment eGFR showed an insignificant change after end of treatment (84.736± 17.41) and 1 year after treatment (82.06± 18.07). Those who received sofosbuvir/daclatasvir, their pretreatment eGFR mean ±SD was (94.606 ±19.32). Post treatment eGFR showed an insignificant change after end of treatment (89.396 ±18.39) and 1 year after treatment (89.176±20.27). As for patients who received sofosbuvir/simeprevir, their pretreatment eGFR mean ± SD was (92.716 ± 15.11). Post treatment eGFR showed an insignificant change after end of treatment (88.366 ±16.27) and 1 year after treatment (89.016± 15.72).
<strong>Conclusion:</strong> The new direct antiviral agents like sofosbuvir, daclatasvir and simeprevir are safe regarding glomerular filtration rate in patients with normal renal function. However, the treated patients need careful monitoring of kidney function tests during the period of treatment.https://ejhm.journals.ekb.eg/article_236803_d40e6ec3d1a4000a3c0d1454b2922fe3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Functional Assessment of Anorexia/Cachexia Therapy among Egyptian Children with Cancer Disease after Nutritional Management2422242923680410.21608/ejhm.2022.236804ENHesham Sami AbdelmegedMahmoud Almahdi OmarGhada Mohammed AbdellatifJournal Article20220513<strong>Background:</strong> Nutrition plays a deciding role and a key factor in children with cancer and can influence their outcome. It is essential for appropriate growth and development and a critical component in the optimization of clinical outcomes. <strong>Objective:</strong> This study aimed to improve the nutritional status of children and evaluate the impact of nutritional counseling and support for these children with cancer.
<strong>Patients and Methods</strong>: This interventional study was performed in the Oncology Pediatric Department, at the Zagazig University Children's Hospital for the period from February to August 2021. The study included 54 pediatric cancer patients who will start chemotherapy.<strong> Results</strong>: there were no statistically significant differences between the studied groups according to the Patient-Generated Subjective Global Assessment (PG-SGA) scale at a baseline or 45<sup>th</sup> day but there was a statistically significant increase in the frequency of type A among the interventional group and a statistically significant increase in C and D type among the control group at 90<sup>th</sup> day. The interventional group showed a statistically significant increase in type A at 90<sup>th</sup> day compared to baseline. There was a statistically significant increase in the mean physical, social, functional domain, anorexia/cachexia subscale (A/CS), and total FAACT scores among the interventional group compared to the control group.
<strong>Conclusion</strong>: nutritional intervention is mandatory for cancer patients to prevent cachexia and improve their physical and social state. Functional assessment of anorexia/cachexia therapy (FAACT) scale and anorexia/cachexia subscale (A/CS) have good content validity and can be used for characterizing the effect of nutritional intervention and treatment of anorexia symptoms and/or anorexia-related concerns in patients with cancer.
https://ejhm.journals.ekb.eg/article_236804_a18672fbd39f3a3178196c17d9c84d14.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of Distal Radius Fractures in Adults Using Kirschner Wires among Zagazig University Hospitals2430243523680510.21608/ejhm.2022.236805ENAbdulbari Sulayman Al MabroukHossam Fathi MahmoudMohamed Abdallah M. AbdelsalamRiad Mansour MegahedJournal Article20220513<strong>Background</strong>: The use of closed reduction and percutaneous K-wires, with or without external fixation, is a common surgical solution for patients with an unstable distal radius fracture. <strong>Objective:</strong> To detect effectiveness of K-wiring as an efficient method for treating distal radius fractures in adults and elderly in Zagazig University Hospitals. <strong>Patients and Methods: </strong>At Orthopedic Departments of Zagazig University Hospitals, 24 cases with distal radius fractures were treated by percutaneous K-wiring with six months follow-up. <strong>Results:</strong> Most of the participants met the Mayo wrist score criteria in 13 of the cases where they were evaluated clinically as outstanding. One patient had Sudeck atrophy, seven patients had superficial skin infection, and two patients had stiffness. <strong>Conclusion:</strong> In adults and the elderly, distal radius fractures can be effectively treated by percutaneous K-wiring. The surgery is safe, has a low rate of complications, and requires only a brief stay in the hospital. By sticking to the fundamental principles and technical features, most of the complications can be avoided.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236805_88f840229540a0fc982e7b344c05bb96.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Study of the Accuracy of Ultrasonography in Predication of Fetal Growth Restriction at Thirty-two versus Thirty-six weeks of Gestation2436244223680610.21608/ejhm.2022.236806ENHend Salah Abdo SalehMahmoud Attia SeksakaHanan Hamid Mohammed AqeelahAbd Elrazik Elsayed Abd ElrazikJournal Article20220513<strong>Background</strong>: In some countries, third-trimester ultrasound monitoring of foetal growth is a standard practice, increasing detection rates to 40-80%.
<strong>Objective:</strong> Evaluation of the effectiveness of standard third-trimester ultrasound examinations at 36 weeks' gestation with those at 32 weeks' gestation for detecting fetal growth restriction (FGR).
<strong>Patients and Methods: </strong>132 women who meet the inclusion criteria. Biparietal diameter, head and abdominal circumferences, and length of the femur were used to calculate the estimated fetal weight (EFW). It was determined that an immediate Doppler assessment of the umbilical artery pulsatility index from a free-floating umbilical cord section was necessary when EFW was less than 10th centile by local standard. Automated pulse Doppler measurements were made. After delivery, neonates were assessed by pediatrician to assess fetal growth.
<strong>Results:</strong> There was a statistical significance increase in EFW at 36 weeks of gestation compared to values at week 32. All US parameters had significant validity in predication of fetal growth restriction (FGR) but with higher accuracy in differentiation than that assessed at 32 weeks of gestation, the most precise was abdominal circumference (AC with) 59.1% accuracy, 65.9% sensitivity and 48.3% specificity for negative cases, then 55.7% and 51.5% for FL and BPD respectively.
<strong>Conclusion</strong>: Detection of FGR and related perinatal and neonatal outcomes was more accurate when ultrasound was performed at 36 weeks' gestation than when it was performed at 32 weeks' gestation.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236806_9000887f01e4fbf4652bd493f290b582.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Outcomes of Headless Intramedullary Screws versus K-wires Fixation in Metacarpal Fractures2443245123680710.21608/ejhm.2022.236807ENMohammed Almukhtar DougdougAdel Mohammad SalamaAmr Mohamed El AdawyAhmed Mashhour GaberJournal Article20220513<strong>Background</strong>: In metacarpal fractures of the hand, intramedullary screw fixation (IMS) has been recognized as an alternate treatment option. <strong> Objective</strong>: This study aimed to compare hand function restoration and pain reduction at postoperative follow-up between intramedullary versus K-wire fixation. <strong>Patients and Methods: </strong>18 consecutive patients presented by a total of 20 metacarpal fractures were managed by two methods of surgical fixation; percutaneous pinning (PCP), and intramedullary headless compression screws (IMHS). They were followed up for a mean period of 12-24 weeks with an average period of 18 weeks. The study was conducted at Orthopedic Departments, Zagazig University Hospital (ZUH), and Alkhadra Hospital Tripoli (Libya).<strong> Results:</strong> Follow up (months), duration physiotherapy (weeks) and period to return work (days) were significantly shorter in IMHS group. Also, the same group significantly associated with no splint. Favorable outcome was associated more with IMHS group but non-significant (may be due to low number of study groups). <strong> Conclusion</strong>: It's possible to safely and efficiently treat metacarpal fractures with intramedullary screw fixation because of its reduced risk of complications and superior prognosis after surgery. The screws required less casting and allowed workers to return to work more quickly than previously.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236807_ebab7407091bf06e63ba04b42b087c83.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Cost effectiveness analysis of adopting Gene-Xpert® (GX) for the Diagnosis of Tuberculosis in Egypt2452245823680810.21608/ejhm.2022.236808ENAmal SamirSedrakPublic Health and Community Medicine Department, Faculty of Medicine, Cairo University0000-0002-6742-5295Amany Ahmed SalemTarek Tawfik AminWagdy AminJournal Article20220513<strong>Background:</strong> Tuberculosis is one of the most devastating infectious diseases worldwide. It constitutes a major global health problem infecting millions of people each year, with a particular heavier burden on the developing world.
<strong>Objective</strong>: evaluating the cost effectiveness of incorporating Gene Xpert to sputum microscopy compared to sputum microscopy and culture for diagnosis of tuberculosis and multidrug-resistant (MDR) tuberculosis in low- to middle-prevalence settings like Egypt.
<strong>Design</strong>: An economic evaluation study was conducted using a decision analysis model representing the diagnostic process starting with tuberculosis suspects, continuing to tuberculosis cases, and ending with treatment. The model outcome was the incremental cost per incremental DALYs (Disability Adjusted Live Years) averted between the new GX algorithms incorporated with smear microscopy versus the standard algorithm for detection of suspect TB case.
<strong>Results</strong>: Xpert testing is estimated to result in additional costs (EGP 2,320) per each
DALY averted compared to sputum microscopy and culture.
<strong>Conclusion</strong>: The results of this study advocate that GXpert is a cost-effective method of TB diagnosis, compared to a base case of smear microscopy and clinical diagnosis with its ability to substantial increase in case finding. It has also important potential for improving tuberculosis diagnosis and disease control.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236808_037a0a7ea36dea3fd148dec131449360.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Impact of Hysteroscopy on Patients with Secondary Infertility2459245323680910.21608/ejhm.2022.236809ENAbd El-monsef Abdelghaffar MoustafaJournal Article20220513<strong>Background:</strong> decreased rates of gestation are detected in cases with uterine space irregularities. The correction of these irregularities was accompanying with better rates of gestation. Diagnostic hysteroscopy could be accomplished with negligeable distress and higher sensitivity and specificity in assessment of the uterine space.
<strong>Objective: </strong>This study aimedto assess the role of hysteroscopy in diagnosing the abnormalities of the uterine space among females having secondary infertility.
<strong>Subjects and methods:</strong> This work was conducted on138 cases having secondary infertility with no suspected uterine defect at the Gynecological Outpatient Clinic in Al-Hussein University Hospital, Al-Azhar University.
<strong>Result:</strong> The majority of the patients had hysteroscopy as part of their infertility treatment (77.5 percent ). Among the patients investigated, there was a statistically significant difference between pre-hysteroscopic diagnostic and hysteroscopy findings. There were also 76 females with normal hysterography and US, and 18 females with abnormal hysteroscopy results, resulting in an NPV of 86.8% for both ultrasonography and hysterography.
<strong>Conclusion: </strong>hysteroscopy was the most precise diagnostic examination for lesions in comparison with ultra-sonography. The technique was of limited usage in the diagnosing of intra-uterine adhesions and some uterine deformities, while its global consequences in diagnosis of uterine deformities were better than those attained by ultrasonography.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236809_cf3e94e799b1bbf18ecbba4f1e4dc6cc.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Value of Non-Invasive Scores and Modalities in Predicting the Presence of Esophageal Varices in Patients with Liver Cirrhosis2464247123681010.21608/ejhm.2022.236810ENHeba A. FaheemInternal medicine department , Gastroenterology and hepatology unit, Faculty of Medicine, ain shams University, Cairo, Egypt0000-0002-2163-3339Marwa Ahmed MohamedEngy Ezzat EidNouran Mohamed SaidJournal Article20220513<strong> </strong>
<strong>Background</strong>: Esophageal varices (EVs) represent the main complication of portal hypertension and carry a significant risk of morbidity and mortality. Esophagogastroduodenoscopy (EGD) is the gold standard test for screening of esophageal varices in patients with cirrhosis, but many studies explored noninvasive modalities in order to overcome its cost and invasiveness.
<strong>Objective</strong>: The aim of the current work was to assess the potential role of five non-invasive scoring systems/modalities (AST to platelet ratio index {APRI} score, ALT/AST ratio {AAR}, fibrosis – 4 {FIB-4} index, King’s score, and platelet count/ spleen diameter {PC/SD ratio}) in detection of esophageal varices in patients with liver cirrhosis.
<strong>Patients and Methods</strong>: This prospective cohort study included a total of 120 cirrhotic patients, attending at Hepatology Outpatient Clinic, Endoscopy Unit and Radiodiagnosis Department, El-Demerdash Hospital, Ain Shams University. Patients were classified according to presence of esophageal varices (EVs) detected by esophagogastroduodenoscopy (EGD) into two groups; <strong>Group 1 </strong>consisted of 9 patients with no EVs, and <strong>Group 2 </strong>consisted of 111 patients with EVs. group II were further subdivided according to the grade of esophageal varices (EVs) into three subgroups. The following noninvasive scores and indices were calculated for all patients: APRIscore, AAR, FIB-4 index, King’s score, and PC/SD ratio.<strong>Results</strong>: Among the five scores studied, AAR at a cut off value >0.88 showed the greatest sensitivity (86.49%) and accuracy (92.8 %), followed by PC/SD ratio at a cut off value <668.97 with an 86.49% sensitivity and 90.1% accuracy and FIB-4 index at a cut off value >5.1 with an 83.78% sensitivity and 90.1% accuracy. While the least sensitive scores were APRI and King’s score with a 70.27% and 67.57% sensitivity respectively.
<strong>Conclusion</strong>: It could be concluded that AAR and PC/SD ratio are the most sensitive scores that can predict the presence of esophageal varices (EVs) in cirrhotic patients with acceptable accuracy. Being cheap and applicable they could be used as an initial screening tests to detect esophageal varices in patients with liver cirrhosis.
<strong> </strong>https://ejhm.journals.ekb.eg/article_236810_c9a2a332e1d720e0b0306ab2cf750fc6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701An Insight of Platelet Rich Plasma (PRP) Role in Dermatology: Review Article2472247423681110.21608/ejhm.2022.236811ENEman Abdelkarim AbdelgawadHowyda Mohamed IbrahimMai Ahmed SamirJournal Article20220513<strong>Background</strong>: Platelet-rich plasma (PRP) is a plasma concentrate containing platelets from a patient's own blood. Safety, rapid release of platelet-derived growth factors, autologous preparation, and avoidance of disease transmission from animal to human are some of the benefits that PRP's biological approach may offer. While PRP has been evaluated and proved to be beneficial in a range of orthopedic and maxillofacial injury repair treatments, such as bone grafting and orthopedic surgery, it has also been found to be useful in the treatment of skin conditions.
<strong>Objective</strong>: To characterize platelet rich plasma role in dermatological diseases.
<strong>Methods:</strong> PubMed, Google Scholar and ScienceDirect were searched using the following keywords: Platelet Rich Plasma, PRP, Treatment of skin conditions and Application of PRP in dermatology. The authors also screened references from the relevant literature, between January 1997 and November 2021, including all the identified studies and reviews, only the most recent or complete study was included. Documents in a language apart from English have been excluded as sources for interpretation was not found. Papers apart from main scientific studies had been excluded: documents unavailable as total written text, conversation, conference abstract papers and dissertations.
<strong>Conclusion</strong>: Using higher concentrations of platelets and growth factors, platelet-rich plasma aids in wound healing and tissue regeneration. The number of dermatologists using PRP is steadily rising.
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<strong> </strong>https://ejhm.journals.ekb.eg/article_236811_11832a62da70b1a9bb455c1df71c134e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Utility of Serum Anti-C1q Autoantibodies as a Biomarker of Lupus Nephritis in Children2475247923837410.21608/ejhm.2022.238374ENHany ElsayedAhmed Ibrahim Bayoumi ImamHasan EL-Banna KhedrNaglaa Ali KhalifaJournal Article20220520<strong>Background</strong>: Deficiencies in anti-C1q antibodies were substantially linked to the development of lupus nephritis. <strong>Objective</strong>: To investigate the diagnostic value of serum anti-C1q auto antibodies used as a reliable marker for diagnosis of lupus nephritis in children.
<strong>Patients and Methods: </strong>at Zagazig University Children’s Hospitalseventy-two child included in the study were classified into 3 groups: Group (A): 18 children diagnosed with lupus nephritis flare at time of study. Group (B): 18 children diagnosed with lupus nephritis quiescence stage at time of study, and Group (C): 36 healthy children. Serum anti-C1q autoantibodies was assessed in all participants.
<strong>Results:</strong> Anti C1q at cutoff point 35 in Group (A) 15 (83.3%) had anti C1q value more than or equal 35.1 (5.56%) had anti C1q value between 9 – 35 and 2 (11.1%) had anti C1q value less than 9 while in Group (B) 14 (77.8%) had anti C1q value between 9 – 35 and 4 (22.3%) had anti C1q value less than 9 and in group (C) all children had anti C1q value less than 9. Lupus nephritis had a superior positive prognostic marker in the form of anti-C1Q, which had a sensitivities of 100 and specificities of 81.82. Lupus nephritis activity was associated with anti-C1q antibodies, suggesting that they could be beneficial in forming predictions regarding the disease and in assessing its activity. <strong>Conclusion</strong>: Anti-C1q antibodies can be considered a reliable, sensitive, and specific biomarker for the diagnosis of nephritis flares in pediatric and Egyptian SLE patients, in addition to and possibly replacing other proven disease activity indices.
<strong> </strong>https://ejhm.journals.ekb.eg/article_238374_b22dc7cf6ae191e2ce9fc172799fa98a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Nickel Allergic Reaction post-Transcatheter Atrial Septal Defect Device Closure: A Case Report2480248523837510.21608/ejhm.2022.238375ENFatma Aboalsoud TahaJournal Article20220520<strong>Background: </strong>Although transcatheter device closure of atrial septal defect (ASD) is a common, safe, and effective interventional cardiac procedure, some adverse effects have been reported including device migration, cardiac erosion, and nickel allergic hypersensitivity reaction.
<strong>Objective: </strong>Here we report on an eleven-year-old boy who experienced a nickel allergic reaction after transcatheter ASD device closure, and we report on how we managed this critical situation.
<strong>Case Report: </strong>Here we report on an eleven-year-old boy who experienced a nickel allergic reaction after transcatheter device closure of a large ostium secundum ASD with a 34-mm Hyperion™ ASD occluder (Comed, Netherlands). Ten days post-procedure, the patient complained of fever, severe allergic reaction; dermatitis, and pruritic rash on his face, arms, trunk, and genital area. Dug allergic reaction and infective endocarditis was excluded. Immediately the patient was managed as a case of device-induced nickel allergic reaction. All manifestations were resolved completely after one week with high doses of dexamethasone and clopidogrel 75 mg orally for 6 months. Subsequent follow-up for 6-month post-procedure showed that the device was properly seated with no recurrence of the nickel allergic symptoms.
<strong>Conclusions: </strong>Nickel allergy and device allergic syndrome must be considered during transcatheter device closure. Despite still controversial, confirmation of a nickel allergy pre-procedure with the patch testing or with the device itself may be useful. Nickel-avoidance strategies using modified devices could be considered a treatment option for patients with nickel allergy.
<strong> </strong>https://ejhm.journals.ekb.eg/article_238375_4aa4fe665fda53e2ac170253021d49aa.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Thyroid Dysfunction in Children with Trisomy 21 and Cardiac Abnormalities2486249023837610.21608/ejhm.2022.238376ENAlshimaa Arafa AbdouAmr Megahed MohammedBasher Abd Allah HassanHanan Samir AhmedJournal Article20220520<strong>Background:</strong> Developmental difficulties, muscle hypotonia, small stature, unique facial traits, and congenital abnormalities, notably cardiac, are all phenotypic aspects of Down syndrome. <strong>Aim and objectives: </strong>to assess thyroid function abnormalities in children with Down syndrome and congenital heart disease. <strong>Subjects and methods</strong>: The study was conducted at Cardiology Unit of Pediatric and Neonatology Department at Zagazig University Hospitals as a cross-sectional study on 50 subjects, Patients were evaluated for congenital heart disease using plain chest X-ray, electrocardiography, two-dimensional echocardiography and Doppler studies. Thyroid function parameters were also performed including plasma TSH, FT3 and FT4. <strong>Results: </strong>Highly significant differences were found between the studied groups as regard TSH, FT4 and FT3 levels, but no statistically significant differences between them as regard age or gender. In addition, there was no significant relation between genetic types of Down syndrome and thyroid function. <strong>Conclusion:</strong> Thyroid dysfunctions, most commonly subclinical hypothyroidism, are frequent in children with Down syndrome, with no relation of length, weight, maternal age or gender to the thyroid function.
<strong> </strong>
https://ejhm.journals.ekb.eg/article_238376_a1704790e3f4fcf10db3339e1b6a80f8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Right Mini-Thoracotomy Aortic Valve Replacement Versus Full Sternotomy Approach2491249523837710.21608/ejhm.2022.238377ENKhaled M. AwadallaAhmed SultanMina WahbaJournal Article20220520<strong>Background: </strong>For a long time, full median sternotomy was the standard approach for heart surgery. With the advancement of the new technology there is a trend for minimal invasion in all types of surgeries including heart surgery aiming to avoiding and minimizing surgical trauma and morbidity.<strong> Objective:</strong> The aim of the current work was to compare the outcome of right mini-thoracotomy aortic valve replacement versus full sternotomy. <strong>Patients and Methods: </strong>A retrospective study that was done in multicentre in in Cairo University and Beni-Suef University. Between June 2015 to October 2021, 219 patients had aortic valve replacement for aortic valve disease of them 124 had the surgery through full sternotomy and 95 patients had it through right mini thoracotomy. We collected their clinical data and compared their inpatient course and outcome.<strong> Results:</strong> Right mini-thoracotomy was associated with more aortic cross clamp, total bypass and total surgery time, but less mechanical ventilation, blood loss, blood transfusion, ICU stay, re-exploration for bleeding than the full sternotomy group. Also, it was associated with less wound complications with no significant difference in mortalities in both groups. In addition, it had shorter hospital stay that was 6.9 ± 0.8 days (mean ±SD) in comparison to 8.2 ± 1.1 days (mean ±SD) in the full sternotomy group with a p value of 0.02. Also, right mini-thoracotomy showed more patient satisfaction and shorter wound than the full sternotomy group.<strong>Conclusion:</strong> It could be concluded that right Mini-thoracotomy aortic valve replacement is safe alternative to full sternotomy with shorter MV, ICU and inpatient stay, less wound infection, smaller wound and more patient satisfaction but with longer cross clamp, bypass and surgery time.
<strong> </strong>https://ejhm.journals.ekb.eg/article_238377_fbdb4b94c62ef1eb3fe3b599947b09c6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prognostic Value of HER2 in Metastatic Colorectal Cancer: A Single Institutional Experience2496250223837810.21608/ejhm.2022.238378ENMai Ezz El DinRadwa Abd El-Azeem YassinMohamed Mohamed El BassiounyManal Mohamed El-MahdyMohamed Yassin MostafaJournal Article20220520<strong>Background:</strong> HER2 (Human epidermal growth factor receptor 2) activation has been associated with poor prognosis in a number of tumours as breast, gastric and lung cancers, but the prognostic role of HER2 in colorectal cancer (CRC) remains unclear.
<strong>Objective:</strong> The aim of the current work was to detect the incidence and prognostic impact of HER2 overexpression in metastatic CRC patients in relation to clinico-pathologic features and outcome.
<strong>Patients and Methods:</strong> Data of metastatic CRC patients treated from January 2012 to end of December 2016 in a tertiary referral university hospital were collected. Eligible patients had their paraffin block tested for HER2.
<strong>Results: </strong>Clinico-pathologic features of 70 patients were available for analysis. Age ranged 20-73 years, at a median of 39.5 years. Fifty (71.4%) of these cases were left sided. Male to female ratio was 3:4. Mucinous variant was present in 27.1 %( 19 cases). Synchronous metastasis constituted 61.4%. HER2 incidence was found in 8.57% (6 cases). Her2 positivity was significantly associated with a shorter time to progression on both first line of therapy, PFS1 (mPFS1 3 vs. 6 months, p=0.045) and PFS2 (mPFS2 4 vs.6 months, p=0.036). No significant relation to clinico-pathological characteristics or OS were detected.
<strong>Conclusion: </strong>HER2 positivity was not associated with clinico-pathologic features but was related to outcome with a shorter PFS but not OS in metastatic CRC. Further prospective data sets are required to confirm its prognostic role.https://ejhm.journals.ekb.eg/article_238378_47c31bb3c851c3a20bf7a8d982fd9ade.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Potential Prediction of Myocardial Viability Using Strain/Strain Rate at Low-Dobutamine Stress Echocardiography on a Segment-by-segment Basis2503251123837910.21608/ejhm.2022.238379ENAmr HanafyAml SolimanSaud Mohamed ElsaughierHossam-Eldein MansourMohamed Kamal SalamaSoliman GharibNaggeh Mohamed MahmoudJournal Article20220520<strong>Background:</strong> It is crucial to determine if the myocardium with highly impaired function is irreversibly harmed or reversibly dysfunctional in acute myocardial infarction. Although dobutamine-induced wall motion improvement is suitable for assessing viability, it is vulnerable to significant inter- and intra-observer variability because it is subjective.
<strong>Objectives: </strong>It was determined whether peak longitudinal strain (PLS) and peak longitudinal strain rate (PLSR) in individual myocardial segments with low dose dobutamine stress echocardiography (LDDSE) could diagnose myocardial viability in patients with acute ST segment elevation myocardial infarction using delayed contrast-enhanced cardiac magnetic resonance (DE-CMR) as a reference (STEMI).
<strong>Patients and Methods:</strong> This study included 60 individuals who had been in the hospital for at least three months after acute myocardial infarction. LDDSE with delayed contrast-enhanced cardiac magnetic resonance and offline deformation indices analysis was performed on all patients.
<strong>Results:</strong> There were 268 segments having significant resting wall motion anomalies available for the final analysis. Dobutamine-induced peak longitudinal strain was greater in viable than non-viable segments in all investigated individual myocardial segments (< 0.001 for mid inferoseptum, p=0.001 for mid inferolateral, and < 0.001 for all other segments). Furthermore, dobutamine-induced peak longitudinal strain rate was significantly lower in non-viable segments compared to viable segments within the studied individual myocardial segments (p < 0.001 for basal antro-septum, < 0.001 for apical inferior, <0.001 for mid inferolateral, < 0.001 for mid antrolateral, <0.001 for mid inferoseptum, <0.001 basal anterior, <0.001 for basal inferolateral, <0.001 basal inferoseptum, and < 0.001 for all other segments).
<strong>Conclusion: </strong>Dobutamine-induced peak longitudinal strain and strain rate could predict myocardial viability segment by segment in those suffering from acute ST segment elevation myocardial infarction.
<strong> </strong>https://ejhm.journals.ekb.eg/article_238379_7d3896ae0100d67a04cf583024ddf184.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Interleukin 27 Serum Levels and Echocardiographic Parameters in Children and Adolescents with Type 1 Diabetes Mellitus2512251923838010.21608/ejhm.2022.238380ENGhada Mohamed AbdellatifSahar Abdelraof ElsharawyWeaam Ibrahim IsmailMaha MetwaliHamza Mohammed Ali OunDoaa Mohammed AbdelrahmanJournal Article20220520<strong>Background</strong>: New treatment methods for cardiovascular and autoimmune illnesses take advantage of (IL-27) pro- and anti-inflammatory properties. <strong>Objective</strong>: To assess the level of IL-27 level and echocardiographic parameters in children, and adolescents with type 1 diabetes mellitus (T1DM).
<strong>Patients and Methods: </strong>at Department of Pediatrics, Diabetes Outpatient and Echocardiography Cardiology Unit, Zagazig University Hospitals, we conducted this case-control study on 30 children diagnosed with T1DM and 30 healthy age- and sex-matched subjects who were selected as non-diabetic group (controls). Serum lipid and IL-27 measurements in addition to echocardiography were done.
<strong>Results:</strong> There was significant higher value of following echocardiography measures: LVIDs, LVIDd, LVId, LVIsd, PWD S, PWD D, RWT, LVMI, LVM both of bad and good control diabetic children compared to healthy control. While there was no significant difference regarding EF and FS between studied groups. There was significant higher value of serum interleukin 27 of bad control diabetic children compared to both; good control diabetic children and healthy children. But there was no significant difference, of good control diabetes children and healthy control children regarding serum interleukin 27. There was significant positive relation between serum interleukin 27 and disease duration of bad control type1 diabetic children.
<strong>Conclusion</strong>: T1DM is connected with rise of IL-27 levels and lipid profile. This link is particularly evident in poorly managed patients demonstrating a relevant involvement of IL- 27 and dyslipidemia on the etiology of the condition.
https://ejhm.journals.ekb.eg/article_238380_872fc88353be2ff80ccca42a3036f439.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Comparative Study between Implantation of an Empty Polyethylethylketone Cage versus Cage with Bone Graft in Anterior Cervical Discectomy and Fusion2520252623838110.21608/ejhm.2022.238381ENYasser Ahmed MashalMohamed Ahmed SamirAhmed Ali MorsyHosny Hassan SalamaJournal Article20220520<strong>Background:</strong> Cervical spondylosis is a chronic degenerative process of the cervical spine that affects the vertebral bodies and intervertebral discs of the neck and may progress into disc herniation, bone spur formation, compression of the spinal cord. The majority of cervical spine disorders are self-limited and may be treated non-operatively.
<strong>Objective:</strong> To compare implantation of empty polyethylethylketone cage versus cage with bone graft in Anterior cervical discectomy and fusion regarding clinical improvement & radiological fusion rate and cage subsidence.
<strong>Patients and Methods:</strong> 48 patients suffering from 2 levels or more cervical degenerative disc disease who were unresponsive to medical treatment were divided into 2 groups: Group A: Included 17 patients who underwent ACDF with an empty cage. Group B: Included 15 patients who underwent the same procedure with cages with bone grafts.
<strong>Results:</strong> The mean operative time in our study in group A was 128.3±11.63 while in group B was 125.77±14.16 with no significant difference between the 2 groups (p=0.00**). The mean amount of blood loss in group A was 178.11±11.63 while in group B was 172.77±14.16 with no significant difference between the 2 groups (p=0.00**). The mean VAS of neck pain improved in group A from 6.71±0.78 preoperatively to 2.2±0.7 postoperatively, and also improved in group B from 5.11±0.78 preoperatively to 0.77±0.62 postoperatively, there was a significant improvement in both groups. <strong>Conclusion:</strong> Interbody cage-based fusion with or without plate fixation in two levels or more cervical discectomies achieved good stability and neurological outcome.
<strong> </strong>https://ejhm.journals.ekb.eg/article_238381_3de6de47a70e22b0c8d164555789b4bf.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Study of Forkhead Box p3 Gene Polymorphism in Asthmatic Children2527253423838210.21608/ejhm.2022.238382ENDina Tawfeek SarhanMarwa Abd Elmonem Abd El RehiemKhalid Mohamed SalahAhmad Mohammed BarakaJournal Article20220520<strong>Background:</strong> One of the heterogenous chronic diseases affecting the lungs is asthma. Etiology of asthma could be attributed to altered functions of forkhead box p3 Gene (FOXP3) through epigenetic mechanism and genetic polymorphism.
<strong>Objective:</strong> To assess the frequency of two FOXP3 polymorphism rs3761548 and rs2232365 among asthmatic children in comparison with healthy children.
<strong>Patients and methods:</strong> A total of 202 Egyptian children were recruited and divided into 2 separate groups, 1<sup>st</sup> one of asthmatic contained 101 children with asthma and a control group of 101 non-asthmatic apparently healthy children.
<strong>Results:</strong> We found a statistically significant difference in FVC, FEV1 concerning degree of asthma. The lowest values were reported among sever asthmatic cases. The genotype analysis of patients and controls revealed non-statistical significant difference was found in patients when compared to control concerning foxp3 polymorphism for 2 different single nucleotide polymorphisms (SNPs) rs 3761548 and rs 2232365. The AC genotype of rs3761548 and the GG genotype of rs2232365 polymorphisms were the most frequent genotypes among the studied children. The rs3761548 C allele carriers could be more susceptible to have asthma since it could be considered a bronchial asthma allele risk factor.
<strong>Conclusion:</strong> We investigated the association between FOXP3 polymorphism in (rs 3761548 and rs2232365) and occurrence of asthma in Egyptian children. The AC genotype of rs3761548 and the GG genotype of rs2232365 polymorphisms were the most frequent genotypes among the studied children. The rs3761548 C allele carriers could be more susceptible to have asthma since it could be considered a bronchial asthma allele risk factor.
<strong> </strong>https://ejhm.journals.ekb.eg/article_238382_fec04328e4463392ce4b03b065352b10.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Role of Triphasic Computed Tomography for Detection of Hepatitis C Virus Consequences: Review Article2535253823838310.21608/ejhm.2022.238383ENHeba Fathy TantawyStefany Adel AbdElMalakAdel Mohamed SanoorMaha Ibrahim MetwallyJournal Article20220520<strong>Background</strong>: Chronic hepatitis-C, a necroinflammatory disease of the liver that leads to liver cirrhosis in roughly 20% to 30% of patients, is caused by hepatitis C virus (HCV) infection. Liver cancer occurs at an average of 3.5 percent every year when cirrhosis has been formed in the liver. Nowadays, computed tomography (CT) scan is considered as a promising screening tools. Triphasic CT often shows enhanced contrast enhancement of the focal lesion during the arterial phase of the test (wash-in) and contrast wash-out during the portal/venous and late equilibrium phases for hepatocellular carcinoma (HCC) radiology.
<strong>Objective</strong>: To assess possible role of triphasic computed tomography for detection of hepatitis C virus consequences.
<strong>Methods:</strong> PubMed, Google scholar and Science direct were searched using the following keywords: Triphasic Computed Tomography, Hepatitis C virus and Hepatocellular Carcinoma. The authors also screened references from the relevant literature, including all the identified studies and reviews, only the most recent or complete study between January 2003 and February 2021 was included. Documents in a language apart from English have been excluded as sources for interpretation was not found. Papers apart from main scientific studies had been excluded: documents unavailable as total written text, conversation, conference abstract papers and dissertations.
<strong>Conclusion:</strong> Using of triphasic CT has been considered as a golden diagnostic imaging technique to detect the incidence of hepatocellular carcinoma as well as its possible complications.
<strong> </strong>https://ejhm.journals.ekb.eg/article_238383_915d2faed74411fbb609686157c28897.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Correlation between Gastrointestinal Symptoms Questionnaire and Findings of Upper Gastrointestinal Endoscopy in Gastrointestinal Disorders2339254823918010.21608/ejhm.2022.239180ENKhaled Mohamed RaafatKhaled Hamdy Abd El MajeedAsmaa Ibrahim AhmedAhmed Samir AllamJournal Article20220525<strong>Background: </strong>Gastrointestinal diseases are among the most common problems in tropical countries and commonly manifest as diarrhea, abdominal pain, abdominal distention, gastrointestinal bleeding, intestinal obstruction, malabsorption, or malnutrition.
<strong>Objective:</strong> The aim of this work was to compare the efficacy of gastrointestinal symptoms questionnaire and results of upper gastrointestinal endoscopy to create an optimally reliable tool for measuring the presence and severity of GI symptoms and to measure the symptomatic response to treatment more objectively.
<strong>Subjects and Methods: </strong>This study has been conducted on 100 patients complaining of gastrointestinal symptoms attending the Gastrointestinal Endoscopy Unit in Faculty of Medicine, Ain Shams University Hospital. All patients have been evaluated by upper GI endoscopy to measure the correlation between gastrointestinal symptoms questionnaire and upper GI endoscopy.
<strong>Results:</strong> There was significant correlation between gastrointestinal symptoms questionnaire and results of upper gastrointestinal disorders.
<strong>Conclusion: </strong>Gastrointestinal symptoms questionnaire is an easy used tool, which can be used to measure the presence, severity of gastrointestinal symptoms and the symptomatic response to treatment more objectively.
<strong> </strong>https://ejhm.journals.ekb.eg/article_239180_f287e65957dac87d9b6769fdfe62ef21.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Study of the Relation between Il-6, Insulin Resistance, and Blood Pressure in Essential Hypertensive Patients2549255323918310.21608/ejhm.2022.239183ENAmira M. ElsayedWalaa M. LbrahimSayed A. GraweshAyman M. ElbadawyJournal Article20220525<strong>Background:</strong> One of the most important cardiovascular risk factors is essential hypertension, a disease that affects a large percentage of the population.
<strong>Objective:</strong> The purpose of this study was to establish a probable relationship between IL-6 levels and both insulin resistance and essential hypertension.
<strong>Methods</strong>: This is a case-control study. Ninety participants were involved: sixty essential hypertensive patients and thirty healthy control who were matched for age and gender. The fasting and two-hour postprandial plasma glucose, serum fasting insulin, HOMA-IR, and serum IL6 levels of all patients and control group were all examined.
<strong>Results:</strong> In comparison to the control group, fasting insulin and the HOMA-IR values in the hypertension group were considerably higher. The median level of IL-6 in the hypertensive group (5.85 pg /ml) was substantially greater than in the control group (1.49 pg /ml). Overall fasting insulin, fasting blood glucose, and HOMA-IR showed positive correlation with IL-6, which is an indicator of insulin resistance.
<strong>Conclusion:</strong> Screening of IL-6 may be an indicator of insulin resistance in hypertensive patient. Further research into the processes underlying these connections is required.
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<strong> </strong>https://ejhm.journals.ekb.eg/article_239183_748ad0fab814d80b59e6de8b1ab74824.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of the Effect of Combination Chemotherapy with Five-day Infusion of Fluorouracil plus Vinorelbine in Pretreated Metastatic Breast Cancer Patients2554256023918910.21608/ejhm.2022.239189ENMai Ezz El DinRasha SalahTarek KamelAhmed NagyJournal Article20220525<strong>Background: </strong>Continuous infusion (CI) of 5-fluorouracil (5FU) and vinorelbine, individually and in combination, has been proven in several studies to be active and well tolerated for advanced pretreated breast cancer.
<strong>Objective: </strong>This study sought to evaluate the clinical activity and side effects of their combination in pretreated metastatic breast cancer patients.
<strong>Patients and Methods:</strong> This retrospective study collected and analysed the medical records of fifty-four patients who attended El-Salam Oncology Center and Ain Shams University Hospitals, Department of Clinical Oncology during the period from July 2013 to June 2018. Combination chemotherapy received was 5FU 600 mg/m<sup>2</sup>/d for 5 consecutive days as a CI and vinorelbine 25 mg/m<sup>2 </sup>on days 1 and 5 as a short intravenous (IV) infusion every 3 weeks.
<strong>Results:</strong> Eleven (20.4%) complete responses, 20 (37%) partial responses and 14 (25.9%) stable disease were documented, accounting for a clinical benefit rate of 83.3%. The median progression free survival was 6.8 months. The median overall survival (mOS) was 25.8 months. Treatment was well tolerated, with grade 3 anemia, febrile neutropenia and stomatitis in 9.3%, 5.6% and 1.9% respectively as the main adverse reactions.
<strong>Conclusions:</strong> This drug combination is active in metastatic previously treated breast cancer patients with an acceptable toxicity profile and continues to be present in the treatment armamentarium in this setting.
<strong> </strong>https://ejhm.journals.ekb.eg/article_239189_00a75b91d49c41fce24aafb992f871ef.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Endoscopic Inferior Turbinoplasty Versus Radiofrequency Ablation for Treatment of Inferior Turbinate Hypertrophy2561256723919110.21608/ejhm.2022.239191ENRuwaydah Husayn AmhimmidWaleed Mohamed Basha AminSaid Abdel Monem MohamedAshraf Elhussiny OdabashaJournal Article20220525<strong>Background:</strong> A variety of methods can be used to treat inferior turbinate hypertrophy that has not improved with the medical treatment including turbinectomy, laser and turbinoplasty as well as radiofrequency ablation.
<strong>Objectives: </strong>This study aimed to compare the results and outcome of radiofrequency ablation with that of endoscopic turbinoplasty in cases of inferior turbinate hypertrophy that are resistant to the medical treatment.
<strong>Patients and methods: </strong>Thirty-four patients having refractory inferior turbinate hypertrophy have been divided randomly into two groups. Group (A) included patients who underwent endoscopic inferior turbinoplasty, while group (B) contained patients who underwent radiofrequency ablation.
<strong>Results:</strong> Three-months postoperatively, within each group, there was a statistically significant decrease in the inferior turbinate hypertrophy grading, but with no statistically significant difference between the two groups. As well, there was a statistically significant improvement of the nasal symptoms VAS in each group. However, there was a statistically significant more improvement of the postoperative nasal obstruction VAS in the radiofrequency group than in the endoscopic turbinoplasty group. Whilst, there was a statistically significant more improvement of the postoperative sneezing VAS in the endoscopic turbinoplasty group than in the radiofrequency group.
<strong>Conclusion: </strong>Both techniques are effective for inferior turbinate reduction. Radiofrequency ablation is a minimally invasive technique and more effective than endoscopic turbinoplasty in relieving nasal obstruction.
<strong> </strong>https://ejhm.journals.ekb.eg/article_239191_e6b26a630cf147bd554d73b548065922.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701An Overview of Post Mastectomy Seroma and Treatment Options: Review Article2568257023919210.21608/ejhm.2022.239192ENWael Elsayed LotfyOsama Abdel Aziz MohamedLoay Mohamed ElhadyMaryam Asmaeil AbuojaylahJournal Article20220525<strong>Background: </strong>Among women, breast cancer is the most common kind of diagnosis, the main cause of cancer-related death, and the leading source of lost life years due to disability-adjusted for global mortality. Breast-conserving surgery or mastectomy is common in the treatment of the disease which was relied on for many years. Seroma is a common side effect after mastectomy. Some surgeons view it as a necessary evil that must be endured after surgery. Seroma formation following breast surgery can occur anywhere from 3% to 85% of the time.
<strong>Objective: </strong>This review aims to give an overview of seroma formation after mastectomy surgeries and the possible treatment options.
<strong>Methods:</strong> The databases were searched for articles published on 3 databases [PubMed -Google scholar-science direct] and Boolean operators (and, or, not) had been used such as [Post Mastectomy Seroma, Breast cancer surgery and Treatment for breast cancer] and in peer-reviewed articles between January 2009 and June 2021.
<strong>Conclusion</strong>: Although post-mastectomy seroma occurs in the vast majority of individuals, tightening the flap after surgery may help avoid its development.
<strong> </strong>https://ejhm.journals.ekb.eg/article_239192_46b8ef3dd76e490eb7e40a40bd33c9ff.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Accuracy Of Multi-Detector Computed Tomography in Assessment of Lower Limb Peripheral Arterial Diseases in Diabetic Patients2571257723919510.21608/ejhm.2022.239195ENMisbah Salim AliAyman Fathi ZiedAhmed Abdelhamid MohammedAhmed Gamil Ibrahim AbdelmegidJournal Article20220525<strong>Background:</strong> The risk of peripheral arterial disease is significantly increased among diabetic individuals, as presented through multidetector computed tomography angiography (MDCT). There are numerous benefits to choosing this path.
<strong> Objective</strong>: To evaluate the lower limb arteries by multidetector computed tomography angiography.
<strong>Patients and methods:</strong> MDCT examinations were performed on 24 diabetic patients who presented with signs and symptoms of lower limb ischemia; MDCT will be performed with PHILIPS ingenuity 128 slice CT scanner. For stenosis, occlusion, calcification, plaque structure, collaterals, transverse, maximum intensity projection, multi-planar, and volume-rendering images were used.
<strong>Results:</strong> At least 22 segments had severe stenosis, defined as luminal narrowing of more than 50% and PSV ratio of more than 2, Fifty segments were occluded, eight had no distal collateral refilling, and five had nonsignificant stenosis (luminal constriction lower than 50% of arterial diameter and PSV lower than ratio 2).
<strong>Conclusion:</strong> MDCT for evaluation of lower limb ischemia should be considered as the investigation of choice for pre-operative assessment & follow-up; being less invasive and provides angiography-like high-resolution images which are familiar to vascular surgeons.
<strong> </strong>https://ejhm.journals.ekb.eg/article_239195_ffeeb75a861838eda9dfe9d8447819b2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Clinico-Epidemiological Study of Maxillary Squamous Cell Carcinoma Cases with Infiltration of The Base of The Skull and/or The Orbit2578258123920210.21608/ejhm.2022.239202ENElham H. El-BanaShimaa E. AttiaEngy AboelnagaAlaa M MariaAmal HalimJournal Article20220525Background: The most common site of sinonasal and paranasal carcinoma is the maxillary sinus, which accounts for 60-70 percent of all cases. Squamous cell carcinoma (SCC) is the most common histopathological type, accounting for 60–75% . Infiltration of the skull base and/or orbit is one of the complications of such tumours which can have a negative impact on one's quality of life.Objective: The study looked at the epidemiological characteristics and treatment outcomes of patients with maxillary sinus squamous cell carcinoma (MxSSCC) with skull base and/or orbital invasion who were admitted to Mansoura Clinical Oncology and Nuclear Medicine Department and Tanta Clinical Oncology and Nuclear Medicine Department for treatment between January 2000 and December 2018.
Patients and methods: This is a retrospective study. Thirteen patient records fulfilled the eligibility criteria of our study. Females were slightly more in number (7 patients (53.8%). The majority of the cases were of age between 40-69 years (N= 11 patients representing 84.6%). Radiotherapy (RT) was the main line of treatment. It was used as the definitive line in ten patients (76.9%) and surgery with postoperative radiotherapy (PORT) was used in (N=3, 23.1%) patients. Results: 5-years overall survival (OAS) of patients with skull base and/or orbital invasion was 15.4% while 2-years progression-free survival (PFS) was 30.8%.Conclusion: This study highlights the effect of the skull base and/or orbital invasion on OAS and PFS of patients with MxSSCC.
https://ejhm.journals.ekb.eg/article_239202_a7f36b5a59be3e8ec3dc4415c15c45ce.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Impact of Laxative Drops on The Bowel Motility and Post Caesarean Section Recovery2582258723920510.21608/ejhm.2022.239205ENHeba Farag Mohamed SalamaMahy N. EgizAmira Ahmed FathyJournal Article20220525<strong>Background: </strong>Enhanced recovery after surgery (ERAS) has been considered as a widely dependable paradigm to increase the goodness of patient care by better management of surgical patients in the perioperative period. There is no specific method has been established yet to prevent and treat postoperative ileus but different strategies were used, however the efficacy of them were unclear.
<strong>Purpose</strong>: To determine the effectiveness of stimulant laxative on the resumption of intestinal motility and its reflection on the post caesarean section recovery.
<strong>Patients and methods</strong>: A prospective cohort study, included 120 women who had caesarean section (CS) in Menoufia University Hospital, from June 2021 till October 2021. They were divided into case group (A) which included 60 patients who drank a cup of anise added to it 15 drops of picolax 4 hours after CS and control group (B) included 60 patients who just drank a cup of anise only 4 hours after surgery. Resumption of intestinal sound, first flatus and motion were compared between the two group.
<strong>Results</strong>: Case group which used laxative showed significantly shorter time for first intestinal sounds (Mean ± SD 6.87 ± 1.38), time to first flatus (Mean ± SD 16.78 ± 4.46) and mean time to first bowel movement (Mean ± SD 20.65 ± 5.81) (p < 0.05).
<strong>Conclusion</strong>: Usage of stimulant laxative 4 hours after CS enhance the intestinal motility and improved the CS recovery.
<strong> </strong>https://ejhm.journals.ekb.eg/article_239205_e4b359cbb5d6b2e9e5d57c079ba9ec1f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of T-Regulatory Cell in Children with Chronic Immune Thrombocytopenia2588259223920710.21608/ejhm.2022.239207ENLaila M. SheriefHeba Allah Elsayed BdelrhmanSaleem Emran Ali AbeadShereif Mohammed ElgebalyJournal Article20220525<strong>Background:</strong> Immune thrombocytopenia (ITP) is an autoimmune disease characterized by isolated thrombocytopenia and increase risk of bleeding. The initial event leading to anti-platelet autoimmunity remains unclear.
<strong>Objective:</strong> The aim of this study was to assess the role of T-regulatory cells in chronic ITP.
<strong>Patients and methods:</strong> This cohort study was carried on 34 children with chronic immune thrombocytopenia who presented to the Pediatric Hematology Unit and Outpatient Clinic of Zagazig University Hospitals during the period from June 2020 up to march 2021 to assess the role of T-regulatory cells in children with chronic immune thrombocytopenia.
<strong>Results:</strong> ITP patients were 20 females (58.8%), while 14 were males (41.2%). Consanguinity was reported in 6 patient (17.6%) while similar condition was found only in one patient (2.9 %). Patients were presented initially with purpura (44%) and ecchymosis (73.5%) while hematuria was detected in 5.9% and epistaxis in 38.2%. After six months significant improvement was detected in purpura (17.6%), ecchymosis (47%) and epistaxis (17.6%). The T regulatory cells were significantly increased after six months of follow up and there was significant positive correlation between platelet count and T regulatory cell level after six month of therapy.
<strong>Conclusion: </strong>T- regulatory cells may play role in pathogenesis of chronic immune thrombocytopenia. Thus, T regulatory cells may play a role in modifying immune responses in these patients, resulting in new strategies of treatment and monitoring of disease activity.
<strong> </strong>https://ejhm.journals.ekb.eg/article_239207_7536aa5efdf7e3efc69834b62652a77d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Comparison of Intralesional Vitamin D3 Injection, 5% Koh Cream and Their Combination in Treatment of Cutaneous Warts2593259823921210.21608/ejhm.2022.239212ENAhlam Abdulsalam AlmabroukGamal Ahmed DuwebJournal Article20220525<strong>Background:</strong> Warts are a common skin condition that affects people all over the world. This ailment affects 2–20% of students in primary school. A well-known keratolytic agent, potassium hydroxide (KOH), has many dermatological uses. Vitamin D is important in the proliferation and differentiation of keratinocytes.
<strong>Objective:</strong> The aim of the current work was to compare the efficacy and safety of intralesional vitamin D3 injections and 5% KOH cream separately and in combination with each other in the treatment of warts.
<strong>Patients and Methods:</strong> This study was carried out at the private outpatient Al- Ahlam Center of Dermatology and Cosmetology in Gharyan, Libya from 1<sup>st</sup> of Sep to last of Dec 2021. 45 patients with warts were included in the study. They were classified into 3 groups according to method of treatment into Vitamin D3 group, 5% KOH cream group, and combination group.
<strong>Results</strong>: The mean age of patients was 27.04 ± 11.7 years. 31 patients completed the study. Complete response was seen in 12 patients with vitamin D injection after period of 4 months, 9 patients with 5% KOH cream after period 2-3 months, and 10 patients with combination both treatment after a period of 1 month<strong>.</strong>
<strong>Conclusions: </strong>It could be concluded that intralesional vitamin D with 5% KOH cream is safe, effective, and inexpensive treatment option for recalcitrant palmoplantar and periungual warts.
<strong> </strong>https://ejhm.journals.ekb.eg/article_239212_48bf9c36c71b446cd681698548b4c26d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220601Knowledge and Self-Care Management Practice Among Asthmatic Children (6-12 Years): An Educational Intervention Study2599260524087110.21608/ejhm.2022.240871ENHala Mostafa Elhady HashimDepartment of Community, Environmental, and Occupational Medicine,
Faculty of Medicine, Benha University, EgyptAhmady Mohammed IsmailDepartment of Community, Environmental, and Occupational Medicine,
Faculty of Medicine, Benha University, EgyptMarwa Salah El Dien Abd ElraoufDepartment of Community, Environmental, and Occupational Medicine,
Faculty of Medicine, Benha University, EgyptMai Magdy Anwer SaberDepartment of Community, Environmental, and Occupational Medicine,
Faculty of Medicine, Benha University, EgyptHala Ali Abed HassanDepartment of Community, Environmental, and Occupational Medicine,
Faculty of Medicine, Benha University, EgyptJournal Article20211226<strong>Background</strong>: Asthma is a highly prevalent chronic respiratory disease which has been increasing worldwide. Education to support self-management is an integral part of asthma care that improves disease control, reduces exacerbations and admissions, and improves quality of life of asthmatic children and their caregivers.<br /> <strong>Objective:</strong> The aim of the current work was to assess factors affecting knowledge and self-care management practice of asthmatics and their care givers and to evaluate the effect of implementing an asthma educational intervention.<br /> <strong>Patients and Method</strong>: An interventional study (pre and post comparison study design) was conducted that compared the change in knowledge and self-care practices among participants before and after implementing a health educational program. <strong>Results</strong>: Asthma educational intervention significantly increased asthma symptoms control and pediatric asthma quality of life among studied asthmatic children, asthma knowledge and pediatric asthma caregivers quality of life among caregivers of the studied asthmatic children after the application of the educational program (P<0.001).<br /> <strong>Conclusions:</strong> It is postulated that children with asthma who receive an interactive, comprehensive educational program would improve their quality of life, asthma management and asthma control compared with children receiving usual care.https://ejhm.journals.ekb.eg/article_240871_0d7bc312edd779c2154487fd532e5fbf.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Sirtuin 1 Gene Expression in Non-alcoholic Fatty Liver Disease and Its Correlation with Biochemical and Clinical Features2606261224088110.21608/ejhm.2022.240881ENShadi SulaymanDepartments of 1Internal MedicineEmad Fawzi HamedDepartments of 1Internal MedicineSamia Hussein Ali2Medical Biochemistry, Faculty of Medicine, Zagazig University, EgyptTarek M. H. IbrahimDepartments of 1Internal MedicineJournal Article20211227<strong>Background</strong>: Silent information regulator 1 [sirt1] is a protein that is widely expressed and has a crucial function in the prevention of oxidative stress, which is implicated in the development of a number of chronic disorders, such as fatty liver disease.<br /> <strong>Objective</strong>: The aim of the current work was to investigate SIRT1 gene expression in non-alcoholic fatty liver disease and it is emerging role in pathogenesis of non-alcoholic fatty liver disease. <strong>Subjects and Methods: </strong>This case-control study included a total of twenty cases of Non-Alcoholic Fatty Liver Disease; NAFLD (<strong>Group A)</strong> and ten individuals as a control<strong> (Group B)</strong>, attending at Departments of Internal Medicine and Medical Biochemistry, Zagazig University Hospitals. They were assessed clinically by lab investigations and quantitative real time polymerase chain reaction (RT-PCR) to assess Sirt1 gene fold expression.<br /> <strong>Results:</strong> There was a significant lowering of sirt1 gene expression p=0.0001 for patient with NAFLD compared to healthy controls. There was significant association between SIRT1 and BMI, as well as hyperlipidemia in NAFLD compared to healthy group. We found a significant association between SIRT1 and NAFLD patients with mild fibrosis and those without fibrosis. Cut off value ≤0.61 had 80.0% sensitivity and 80.0% specificity, positive predictive value 57.0%, negative predictive value 92.0% and accuracy was 80.0%.<br /> <strong>Conclusion</strong>: It could be concluded that the significant correlation between SIRT1 gene expression and non-alcoholic fatty liver disease helps to differentiate patients with nonalcoholic fatty liver diseases and healthy ones.https://ejhm.journals.ekb.eg/article_240881_dca735dc5d4ac9afef430f9c66e9ef0b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Anxiety in Hearing Impairment Subjects26132616240886DOI:10.21608/EJHM.2022.240886ENNashwa Mohamed RefaatAudiology Department, ORL, Shebein Elkoom Teaching Hospital, EgyptJournal Article20211230<strong>Purpose: </strong>With an increasing incidence for hearing impairment, it is necessary to search for the psychological impact on patients. Anxiety prevalence may be raised in people with hearing impairment. This study aimed to evaluate the prevalence of anxiety in hearing loss patients.<br /> <strong>Methods </strong>A case control study included 100 subjects: 50 controls and 50 subjects diagnosed with hearing loss of variable types, degree, and causes. They underwent audiological and Modified Arabic Beck anxiety inventory questionnaire evaluation. First Pure-Tone Audiometry (PTA) was performed in all frequencies to determine the type and level of hearing impairment, then Beck anxiety inventory questionnaire (Modified Arabic form) was done.<br /> <strong>Results </strong>The sample collected showed results of 42% single sided hearing loss while<strong>, </strong>58% was bilaterally affected<strong>. </strong>Anxiety was estimated in 68% of hearing impairment patient with a percentage of 41% male and 59% females.<br /> <strong>Conclusion</strong> Anxiety is a very prevalent problem facing not only subjects with hearing impairment, but also affects a noticeable ratio of apparently normal subjects. So, the psychological assessment and support are needed to be in mind.https://ejhm.journals.ekb.eg/article_240886_1b19e16b8e13607f05c95f431ff424ac.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Role of Posterior Pericardiotomy on The Incidence of Atrial Fibrillation and Pericardial Effusion after Coronary Revascularization2619262424089010.21608/ejhm.2022.240890ENMohamed Abd El-Wahab1Department of Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Fayoum, EgyptEhab El-Shihy2Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, EgyptAhmed Sayed2Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, EgyptAbdullah Osama Mahfouz1Department of Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Fayoum, EgyptJournal Article20220103<strong>Background: </strong>The most common type of arrhythmia following coronary artery bypass grafting (CABG) is atrial fibrillation (AF) with an incidence rate of 20-30%. Even though postoperative atrial fibrillation (POAF) can be self-limited, it may be complicated by lack of hemodynamic stability, increased hospital stay, home mortality, stroke, thrombotic complications, embolus, extra drug therapy, and consequently increased hospital expenses.
<strong>Objective:</strong> This prospective and retrospective study aims to demonstrate the effectiveness of posterior pericardiotomy in reducing the incidence of pericardial effusions and consequently reducing the related atrial fibrillation and development of delayed posterior cardiac effusions.
<strong>Patients and Methods</strong>: This prospective and retrospective randomized study was carried out on 100 patients undergoing coronary artery bypass grafting at Kasr El Ainy Hospital, Cairo University, and at Fayoum University Hospital, Department of Cardiothoracic Surgery between May 2017 and January 2018. One hundred patients were divided into two groups; each group included 50 patients. A 4-cm longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in the posterior pericardiotomy group (group A). Posterior pericardiotomy was not performed in the conventional group (group B).
<strong>Results:</strong> Atrial fibrillation developed in five patients (10%) in group (A) and in 12 patients (24%) in group B (P =0.118). Early pericardial effusion developed in 6 patients (12%) in group A and 18 patients (36%) in group B (P =0.022), but no late pericardial effusion developed in group A despite six (12%) late pericardial effusions developing in group B (P=0.027).
<strong>Conclusion:</strong> Posterior pericardiotomy is a simple, safe, and effective technique for reducing not only the prevalence of early pericardial effusion but also delayed posterior pericardial effusion and tamponade without significant reduction in post-operative atrial fibrillation (POAF). https://ejhm.journals.ekb.eg/article_240890_ffdbac7ee6cda9687befa6448b910451.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Recording of Complications of Treatment of Hypoxic Ischemic Neonates by Passive Whole-Body Cooling: A Study in Neonatal Intensive Care Unit of Mataria Teaching Hospital2625263324089410.21608/ejhm.2022.240894ENSohaila Ali Abd El-HalimDepartment of Pediatrics, Mataria Teaching Hospital, EgyptJournal Article20211230<strong>Background:</strong> Hypoxic-Ischemic Encephalopathy (HIE) is a type of neonatal encephalopathy where mortality rate is estimated by 11.2%, globally. The only known management for HIE is therapeutic hypothermia. However, many drawbacks have been associated with therapeutic hypothermia including death.
<strong>Objective:</strong> Recording complications of treatment of hypoxic ischemic neonates using therapeutic hypothermia (TH) for improvement of the results of the management using TH.
<strong>Patients and Methods:</strong> In this case-series study, which was conducted at the Neonatal Intensive Care Unit (NICU) of Mataria Teaching Hospital (MTH), Cairo, Egypt. The study was conducted from January 2018 to December 2019. All medical files of fourteen neonates presented with HIE and treated with hypothermia were reviewed.
<strong>Results:</strong> Among the 14 neonates with HIE, survivor cases were 71.6%. They were discharged on single oral anticonvulsant and was weaned off after one month and all were on full oral feeding. One case died on second day of hypothermia due to severe pulmonary hypertension and uncontrolled hypotension (7.1%) and 21.3% had sepsis and 7.1% had early onset and died on 4<sup>th</sup> day with maternal history of chorioamnionitis and 14.3% died from late onset sepsis.
<strong>Conclusion:</strong> Although therapeutic hypothermia is a well-established treatment to neonates with hypoxic ischemic disease, their short-term effects can be easily controlled but low incidence of devastating complication can occur. Further controlled studies are needed to detect the factors associated with the elevated risk of such consequences.https://ejhm.journals.ekb.eg/article_240894_e9b0eee68be5ee56bd30d9811cbcec40.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Can Dual-Energy Contrast-Enhanced Digital Mammography Change The Final BI-RADS Category of Equivocal Breast Lesions Characterized by Sonomammography in Women with Dense Breast?2634264224089810.21608/ejhm.2022.240898ENMai M. K. BarakatRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptSherif N. A. HegazyRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptNoha M. TahaRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20220103<strong>Background: </strong>Equivocal and indeterminate breast lesions which are detected on sonomammography should be further evaluated by either biopsy or follow-up. Contrast-enhanced digital mammography can act as a problem-solving tool to avoid biopsies of some problematic breast lesions and help clinicians to take a proper decision about these lesions in the same setting. <strong>Objective:</strong> This study aimed to evaluate the complementary role of contrast-enhanced digital mammography (CEDM) to characterize indeterminate and equivocal breast lesions detected on sonomammography and its role to downgrade or upgrade the final BI-RADS category of these lesions.
<strong>Patients and Methods:</strong> This prospective study included 35 females with mean age of 48.26 years. Ladies were referred from the clinic for screening mammograms during the period from august 2020 to September 2021.
<strong>Results: </strong>Contrast-enhanced digital mammography showed higher specificity (86.4%), PPV (80.0%), NPV (95.0%), and accuracy (88.6%). While sonomammography revealed specificity of 63.6%, PPV of 60.0%, NPV of 93.3%, and accuracy of 74.29%. However, both showed a comparable sensitivity of about 92.3%. Fourteen lesions (40%) were downgraded by CEDM and proved to be benign lesions and five lesions (14.2%) were upgraded and proved to be malignant lesions.
<strong>Conclusion:</strong> Contrast-enhanced digital mammography is a promising technique in the characterization of equivocal and indeterminate breast lesions (BI-RADS 3 and 4). It can be utilized to help in the final assessment of these findings in the same setting and offer assistance in avoiding biopsies in numerous patients with more prominent specificity and precision than sonomammography.https://ejhm.journals.ekb.eg/article_240898_9ca3a0f7fce23e27f76372116aca8514.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prognostic Value of Asymmetric Dimethylarginine in Patients with Acute Coronary Syndrome2643264724090610.21608/ejhm.2022.240906ENSameh Attia Amin AminDepartment of Cardiology, Faculty of Medicine, Ain Shams University, EgyptReem Ali IbrahimDepartment of Cardiology, Faculty of Medicine, Ain Shams University, EgyptMohsen Mahmoud MahdyDepartment of Cardiology, Faculty of Medicine, Ain Shams University, EgyptAhmed Mohamed OnsyDepartment of Cardiology, Faculty of Medicine, Ain Shams University, EgyptJournal Article20220129<strong>Background: </strong>Evidence has accumulated that asymmetric dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthase. Nitricoxide reduction is considered the hallmark of endothelial dysfunction. <strong>Objective: </strong>The study aimed to determine the value of the asymmetric dimethylarginine in patients with acute coronary syndrome as a predictor of major adverse cardiac events (MACE) and mortality during hospitalization and up to 6 months.
<strong>Patients and Methods: </strong>This study included 80 patients who were admitted to the critical care unit (CCU) with acute coronary syndrome. Serum ADMA marker was obtained within 24 hours of admission. Depending on ADMA value, patients were divided into three groups; Group A included patients with ADMA values up to 1.2 micromole/liter, Group B included those with ADMA values of more than 1.2 and up to 1.56 micromole/liter, and Group C comprised patients with ADMA value of more than 1.56 micromole/liter. During hospitalization and up to 6 months after discharge, patients were subjected to clinical follow-up to detect the occurrence of MACE including re-infarction, heart failure, re-intervention, and stroke or mortality.
<strong>Results:</strong> Significant correlation was detected between ADMA value and patients’ prognosis (i.e. as the ADMA value increased, the prognosis was worsened) with a significantcorrelation between patients’ groups and prognosis with a P-value of 0.001.
<strong>Conclusion: </strong>ADMA level had a prognostic value in patients with acute coronary syndrome with a cut-off value >1.2 micromole/liter, whereas patients with higher levels of ADMA were associated with a higher incidence of MACE and higher mortality than patients with lower levels of ADMA.https://ejhm.journals.ekb.eg/article_240906_439e097f9f40f424ebc061703370de5e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Cerebrovascular and Cognitive Changes in Chronic Hepatitis C Patients2648265224091110.21608/ejhm.2022.240911ENElham Ahmed Hassan1Department of Gastroenterology and Tropical Medicine, 2Department of NeurologyNoha A. Masoud1Department of Gastroenterology and Tropical Medicine, 2Department of NeurologyAbeer S. Abdel Rehim1Department of Gastroenterology and Tropical Medicine, 2Department of NeurologyGhaydaa A. Shehata2Department of NeurologySaad Z. Mahmoud1Department of Gastroenterology and Tropical MedicineGehan S. Seifeldein3Department of Radiology, Faculty of Medicine, Assiut University, Assiut, EgyptKhaled O. Aboshaera2Department of NeurologyAhmed M. Abu-Elfatth1Department of Gastroenterology and Tropical MedicineJournal Article20220103<strong>Background: </strong>Hepatitis C viral (HCV) infection is associated with systemic inflammation and metabolic complications that might predispose patients to cerebrovascular atherosclerosis and may report neurocognitive complaints.
<strong>Objective:</strong> This case-control study aimed to assess cerebrovascular and cognitive changes in patients with chronic hepatitis C (CHC) infection.
<strong>Patients and methods: </strong>Transcranial color Doppler assessment of cerebrovascular reactivity and cognitive abilities screening instruments (CASI) was conducted in 100 CHC patients and 100 healthy controls. All enrolled patients were evaluated by Fibroscan and the current study employed a cut-off of ≤12.5 kPa for excluding cirrhosis.
<strong>Results: </strong>Compared to controls, CHC patients had significantly lower scores on CASI and its components. Patients had significantly lower-middle carotid artery (MCA) intimal media thickening (IMT), peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean flow velocity (MEV) than controls. Additionally, the total CASI score significantly correlated with PSV and EDV of MCA and negatively correlated with IMT, pulsatility index (PI), and resistance index (RI).
<strong>Conclusion: </strong>CHC patients have impaired cognitive function that may be associated with cerebrovascular affection in absence of cirrhosis. Future multi-center studies with the evaluation of the effect of antiviral on cerebrovascular reactivity and cognitive function in such patients are warranted.https://ejhm.journals.ekb.eg/article_240911_c5aece6c5f4ad27d638abc6e905e796c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Different Radioactive Iodine Ablation Strategies in Intermediate and High Risk Papillary Thyroid Cancer2653266024091410.21608/ejhm.2022.240914ENHend Ahmed El-HadaadDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, EgyptMohamed Farouk AklDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, EgyptAbd El-Monem Mohamed YoussefDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, EgyptMohamed Ali Abo El-khierDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, EgyptJournal Article20220106<strong>Background: </strong>Papillary thyroid cancer (PTC) represents most of cases of differentiated thyroid cancers. Thyroidectomy followed by radioactive iodine (RAI) remnant ablation represent the cornerstone management of many intermediate and high-risk patients according to American Thyroid Association (ATA).
<strong>Objective: </strong>This study aimed to evaluate the outcome of different used I<sup>131</sup> ablation doses (80, 100 and 120 mCi) in intermediate and high-risk patients in our hospital and to analyze the predictors affecting RAI failure. Besides, survival analysis was conducted as a secondary objective of the study.
<strong>Patients and Methods: </strong>This was a retrospective study conducted on 63 patients diagnosed as PTC at our hospital from January 2015 till February 2020. Our study involved only PTC pathology, mean age of 40.6 ± 13.4 years at diagnosis, and intermediate- and high-risk patients according to ATA initial risk stratification system, 2015.
<strong>Results: </strong>Among the 63 patients included in this study (17 males and 46 females), 41 were classified as intermediate-risk, while 22 were classified as high-risk based on the ATA guideline. Overall RAI ablation success, in both groups, was observed in 43/63 (68.25%) patients. Moreover, it was achieved in 31/41 (75.6%) of intermediate-risk patients and in 12/22 (54.5%) high-risk patients. Pre-ablation stimulated Tg >1ng/ml was statistically significant negative predictor of ablation failure [P-value < 0.001, odd`s ratio 61.5, 95% CI (10.8-51.5)].
<strong>Conclusion: </strong>There was no statistically significant difference between success rates of I<sup>131 </sup>doses in intermediate- and high-risk groups. However, the failure rates were more after 120 mCi due to the associated more aggressive underlying disease, especially higher-risk patients so higher RAI activities are recommended for this risk group.https://ejhm.journals.ekb.eg/article_240914_2f5745b50de46806122e5fe390e39f0c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Role of Renal Doppler Ultrasound in Early Detection of Acute Kidney Injury in Critically Ill Patients2661266724091610.21608/ejhm.2022.240916ENMarwa K. KhairallahDepartments of 1Internal Medicine, Nephrology UnitAbdalla KellaniDepartments of 1Internal Medicine, Nephrology UnitHamdy M. Ibrahim2Radiology, Faculty of Medicine, Assiut UniversityManar Salah AhmedDepartments of 1Internal Medicine, Nephrology UnitMohammad Hassan MostafaDepartments of 1Internal Medicine, Nephrology UnitJournal Article20220106<strong>Background:</strong> Acute kidney injury is a potentially fatal condition with high mortality rate, treatment cost and poor outcome. The most crucial end-point in forecasting AKI is monitoring microcirculation parameters. Renal resistive index has been proposed as a new tool in intensive care unit (ICU) patient’s microcirculation monitoring.
<strong>Objective: </strong>The research study aimed to determine if there is a relation between change in renal resistive index (RRI) and acute kidney injury (AKI) in the first week of ICU admission.
<strong>Patients and Methods:</strong> This was an observational prospective study of ICU patients. All participants underwent history taking, clinical examination with calculation of sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE II) score. RRI was calculated using Doppler ultrasound with the following formula: (peak systolic velocity – end diastolic velocity)/ peak systolic velocity.
<strong>Results:</strong> Patients with AKI had significantly higher peak-systolic velocity, end-diastolic velocity and renal resistive index (P< 0.001). Patients with stage III AKI had significant higher RRI in comparison with stage I and stage II (p value < 0.001). RRI had 75% sensitivity, 87% specificity for prediction of stage II and III AKI with over all accuracy was 83%.
<strong>Conclusions:</strong> Assessment of RRI in the first 24 hours of ICU admissions was valuable in predicting the development of AKI especially in the stage II, III and persistent AKI. It is recommended to evaluate it early to prevent AKI development in ICU patients.https://ejhm.journals.ekb.eg/article_240916_dfdd96481aa420d98cc159376dbc6640.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Impact of Quarantine Restrictive Measures on Gifted Students’ Academic Achievement and Behavior During COVID-19 Outbreak, in Saudi Arabia: Educational and Psychological Aspects2668267624111410.21608/ejhm.2022.241114ENAhmed O. AlsabihRim M. BougatfaAhmed A.MorsiFayoum University, Faculty Of Medicine, Histology Department0000-0001-7911-0795Abdulaziz Q. AliHussian H. AlsafwaniSaleh A. AlatiyaAhmad K. AlzaaliayAdeeb H. AlsaqrAhmed M. AbdelmoneimAhmed H. AhmedEzat A. MersalJournal Article20220602<strong>Background: </strong>Quarantine is used worldwide to interfere with COVID-19 transmission. It had a negative effect on the scholastic performance and behavior of regular students.
<strong>Objective:</strong> The study strived to investigate such parameters on gifted students.
<strong>Methods: </strong>A self-administered questionnaire was distributed to the parents of 378 gifted students all over Saudi Arabia, through their schools. These students were represented by Mawhiba Foundation, Saudi Arabia.
<strong>Results</strong>: The findings showed that 70.4 % of the gifted students had an increase in their academic achievement at the end of the second semester. Moreover, 50.3% of the participants had experienced major behavioral changes during quarantine. Also, 56.9% of students suffered from annoying dreams and difficult sleeping. More than half of the participants faced distant learning problems. The correlation analysis indicated a significant and positive correlation between gifted students’ academic achievement, entertainment hours, and parenteral help, while it was significant and negative between the academic achievement and the number of sleeping hours.
<strong>Conclusion: </strong>Quarantine had a great psychological burden on the parents of the gifted students that was reflected on their behavior. However, most students faced different problems during the online distance learning, but their academic achievement had increased that might explain their unique mental ability.
https://ejhm.journals.ekb.eg/article_241114_5870330c8b3c7541d273e2b01088ad14.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Study of Some Predictors of Neonatal Mortality among Preterm Newborn at Zagazig University Hospital2677268224111610.21608/ejhm.2022.241116ENAmr Mgahed Abo El NagaMohammed Othman HafezEhab Abdelmonem El BanaAya Mohammed Ibrahim ShehataJournal Article20220602<strong>Background:</strong> Birth before the 37<sup>th</sup> week (259<sup>th</sup> day) of pregnancy, measured from the first day of the last menstrual cycle, is referred to as preterm.
<strong>Objective:</strong> Early prediction of neonatal outcome in preterm neonate.
<strong>Patients and Methods:</strong> This was a prospective cohort study carried out in Neonatal Intensive Care Unit in Zagazig University Children Hospitals for 6 months. The estimated sample was 58 neonates.
<strong>Results: </strong>About65.5% died and 34.5% were discharged alive. There was statistically significant relation between outcome and maternal age. Singleton pregnancy represented 92.1% and 95% of those died and discharged respectively. There was statistically significant relation between outcome and order in family. Mortality was significantly higher among those with first order (42.1% and 15% within who died and discharged respectively). There was statistically significant relation between outcome and Apgar score at 1 minute, at 5 minutes and at 10 minutes. The best cutoff of Apgar at 1 minute in prediction of mortality was ≤6.5 with area under curve 0.961, sensitivity 92.1%, and specificity 90%. The best cutoff of Apgar at 5 minutes in prediction of mortality was ≤7.5 with area under curve 0.944, sensitivity 84.2%, and specificity 95%. The best cutoff of Apgar at 10 minutes in prediction of mortality was ≤8.5 with area under curve 0.914, with sensitivity 84.2%, and specificity 90%<strong>.</strong>
<strong>Conclusion:</strong> Premature infants with a low Apgar score have a higher mortality rate.
<strong> </strong>https://ejhm.journals.ekb.eg/article_241116_002ad226d4f6b5281615e49896287673.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Wide-Angle Digital Breast Tomosynthesis Might Be Used for The Early Detection and Grading of Breast Cancer during Screening Campaigns2683269624111710.21608/ejhm.2022.241117ENYasmin HosnyHemedaDiagnostic Radiology, Faculty of medicine, Menofia University000-0002-2272-3416Emad Abdel HafezJournal Article20220602<strong>Background: </strong>Digital breast tomosynthesis (DBT) is a new imaging modality for improving breast cancer detection because it allowed for better detection of abnormalities, especially in females with dense breasts, and the diagnosis of benign lesions, which resulted in fewer recalled cases and negative biopsies, as well as assessing therapeutic efficacy.
<strong>Objectives: </strong>Evaluation of the diagnostic validity of 3D wide-angle Digital Breast Tomosynthesis (WA-DBT) during screening programs for breast cancer (BC).
<strong>Patients and Methods: </strong>449 women with breast lesions who attended the screening campaign were examined by Full-field Digital Mammography (DMG) and WA-DBT using Hologic™ Selenia® Dimensions® 3D Performance System and ultrasound (US) imaging using GE LOGIQ P7® linear probe (7-12 MHz). Then, a surgical biopsy was obtained from women who had lesions of BI-RADS grade 4 or 5 and examined pathologically, the pathological diagnosis was used as the gold standard for comparison of radiological diagnoses.
<strong>Results: </strong>Pathological diagnosis defined30 malignant and 9 benign lesions. The performance characteristics of WA-DBT imaging were superior to that of DMG and US and the agreement of diagnoses obtained by WA-DBT and both DMG and US was moderate and substantial with κ coefficient of 0.421 and 0.726, respectively. ROC curve analysis defined WA-DBT as the best diagnostic test with a significantly higher area under the curve (AUC) in relation to the reference AUC as a discriminative diagnostic modality for breast lumps of BI-RADS grade 5 and as the most sensitive modality for differentiation between masses that are probably benign (BI-RADS grade 3) and that suspicious of malignancy (BI-RADS grade 4).
<strong>Conclusion: </strong>WA-DBT is a valuable radiologic modality for screening women with breast lesions especially those in dense/extremely dense breasts. Also, WA-DBT can precisely identify microcalcifications obscuring very small-to-small breast lesions thus allowing early detection of BC.
<strong> </strong>https://ejhm.journals.ekb.eg/article_241117_77852ba6a7fd7f11bf97119adfeee4c9.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701High Flux Versus Low Flux Dialysis: Impact on Intradialytic Hypertension and Adequacy of Dialysis2697270324111910.21608/ejhm.2022.241119ENAhmed MohamedTawfikInternal medicine - Nephrology department Faculty of medicine Ain Shams University0000-0001-7406-3061Ahmed M. ElgendyHisham A. Abou El LeilGamal E. MadyJournal Article20220602<strong>Background: </strong>Intradialytic hypertension is an underrecognized complication in hemodialysis patients, increasing cardiovascular morbidity, mortality, and hospitalization.
<strong>Objective</strong><strong>:</strong> The aim of the current work was to detect the incidence of intradialytic hypertension in hemodialysis patients and to compare the effect of high flux versus low flux dialysis on intradialytic hypertension and adequacy of dialysis.
<strong>Patients and Methods: </strong>The study was conducted on 200 patients on regular hemodialysis in Beheira governorate. The patients were divided into: <strong>Group 1 </strong>including 100 patients on hemodialysis with high flux dialyzers and<strong> Group 2</strong> including100 patients on hemodialysis with low flux dialyzers.
<strong>Results: </strong>The incidence of intradialytic hypertension in hemodialysis patients was 23.5 % at the start, 21% after one month and 13% after three months duration. There was a significant reduction in number of intradialytic hypertension patients after one month duration and after three months in both groups. Adequacy of dialysis in the form of Kt/V and urea reduction ratio showed highly significant improvement by the end of the study in the high flux group. Kidney function tests, serum parathyroid hormone levels and serum hemoglobin levels showed significant improvement at the end of the study in high flux group compared to low flux group.
<strong>Conclusion: </strong>It could be concluded that the current study has not demonstrated a significant difference between both groups regarding the effect on intradialytic hypertension, but adequacy of dialysis in the form of Kt/V and urea reduction ratio improved significantly by the end our study in the high flux group.https://ejhm.journals.ekb.eg/article_241119_f44dadd3624f5e96fe2a66d1a4b330f6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Serum Osteopontin Level as Biomarker in the Diagnosis of Pediatric Bronchial Asthma in Different Age Groups2704270924112110.21608/ejhm.2022.241121ENMohammed Sanad NagiubEhab Mahmoud RasheedAtef Goda HusseinAhmed Ibraheem Abd El Hameed AtyaJournal Article20220602<strong>Background:</strong> Bronchial asthma is chronic inflammatory disease of the respiratory tract, in which many cells of innate and adaptive immune system in combination with epithelial cells are involved causing the main clinical typical criteria for the disease. Osteopontin (OPN) is identified in many cell types in the immune system. OPN is a protein expressed during the inflammatory processes related to Th2 lymphocyte activity.
<strong>Objective:</strong> The aim of the current study was to evaluate serum osteopontin level as biomarker in the diagnosis of bronchial asthma in different age groups.<strong> Patients and Methods:</strong> This prospective case-control study was carried out at the Pediatric Department, Zagazig University Hospitals from May 2019 till December 2019. All patients were subjected to full history taking and laboratory investigations including measurement of Human Osteopontin (OPN).
<strong>Results:</strong> There was high significant positive correlation between osteopontin and S. IgE and AEC. Also, there was high significant negative correlation between osteopontin and forced expiratory volume 1 (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF) in both age groups. There was significant difference between <5 years severe asthma and 5-12 years severe asthma as regard Osteopontin level.
<strong>Conclusion:</strong> It could be concluded that there is strong association between OPN concentration and disease severity. OPN shows high significant difference between asthmatic and control group. Serum OPN is a good biomarker in the diagnosis of bronchial asthma at different age groups.https://ejhm.journals.ekb.eg/article_241121_f40e7aa51a4673ff1ad1a9ac81144ecd.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Genotyping of Rotavirus RNA by Sequencing among Children with Diarrhea at Zagazig University Hospital2710271524112310.21608/ejhm.2022.241123ENElhamy Rifky AbdelkhalikMohamed Abdelkader Adallah AlmalkyRania Mohamed Mohamed Ebrahim AmerHazem Ali Abd ElraoufJournal Article20220602<strong>Background:</strong> Worldwide, rotavirus (RV) is the most common cause of severe gastroenteritis among infants and young children. While diarrhea is the second most common cause of fatal childhood illness. RV can be detected in high concentrations in the stool of children suffering from gastroenteritis.
<strong>Objectives:</strong> To determine rotavirus genotyping among diarrheic children at Sharkia Governorate.
<strong>Patients and Methods:</strong> For one-year surveillance, the data and the stool samples were gathered from January 2015 to January 2016. A total of 140 stool specimens were collected from the inpatients diagnosed with acute diarrhea in the Pediatric Department, Zagazig University Hospitals.
<strong>Results:</strong> Our results showed that there was a statistically significant difference between positive and negative rotavirus infection cases in Veslkari score of severity and hospital stay. 12.5% of the study group had G3 genotype and 33.6% of the study group had strain P8. By comparing clinical data between G3 and non-typeable genotyping in the studied group, there was a statistically significant difference between G3 and non-typeable genotyping in the Veslkari score of severity. There was a highly statistically significant negative correlation between the Veslkari score of severity and weight. On the other side, there was a statistically significant positive correlation between the Veslkari score of severity and age.
<strong>Conclusion:</strong> We concluded that rotavirus represents a high percentage of hospitalized cases of GE in Zagazig University Hospital with a significant difference in severity and complications between positive and negative rota cases.
<strong> </strong>
https://ejhm.journals.ekb.eg/article_241123_14bde692e8da085347fac504606c281a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Mitral Valve Replacement Through Standard Median Sternotomy Versus Minimally Invasive Approach (Anterolateral Thoracotomy) with Short-Term Results2716272124112410.21608/ejhm.2022.241124ENAhmed Eid Ahmed HusseinKhalid Hassan AbdelBaryMostafa Abdel Sattar MohamedAhmed Samy FadalyJournal Article20220602<strong>Background:</strong> When it comes to mitral valve repair, minimally invasive procedures are safe, have low post-operative morbidity, and have a low recurrence rate.
<strong>Objective:</strong> This aimed to compare procedure & early outcomes of patients who met the inclusion criteria for mitral valve surgery to those who do not need surgery using the standard method.
<strong>Patients and methods:</strong> Mitral valve surgery was performed on 40 individuals with mitral valve disease (MVD) who were selected at random. The study was conducted in Zagazig University Hospital and El-Maadi, El-galaa, and Kobri El-Koba military hospitals. A standard sternotomy was used to perform mitral valve surgery on 20 patients in group A, whereas a level I less invasive procedure, involving a Rt. anterolateral minithoracotomy under direct vision and femoral artery and vein cannulation, was performed on the other 20 patients in group B.
<strong>Results:</strong> In group (A), postoperative discomfort was much less than in group (B). Compared to group (B), group (A) spent less time in the hospital overall. No statistical significance could be found in the number of complex patients between groups A and B, despite the fact that complications in group A were less severe. The minimally invasive mitral valve surgery (MIMVS) procedure was more affordable than sternotomy surgery.
<strong>Conclusion:</strong> Primary mitral valve surgery can be performed with this technique, which is nearly as safe as a median sternotomy. Using this method, extra incisions in the groin can be avoided while still getting outstanding cosmetic outcomes.
<strong> </strong>https://ejhm.journals.ekb.eg/article_241124_095ca34b2c073ddda100ef70ae7d6f48.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Analysis of Risk Factors for Hepatic Decompensation Post Trans Arterial Chemo Embolization (TACE) for Hepatocellular Carcinoma (HCC) on Top of Cirrhotic Liver2722272624112610.21608/ejhm.2022.241126ENMuhammad Abbas El-MasryFatema Abu-Bakr Abdel-MoezMoustafa Hashem Mahmoud OthmanAbdelmajeed M. MoussaAmr Abdel-Rady Ismaiel MohammedJournal Article20220602<strong>Background:</strong> Trans Arterial Chemo-Embolization (TACE) is usually employed for unresectable hepatocellular carcinoma (HCC) and is largely considered to be palliative, but may be curative depending upon the stage of HCC. A common complication of TACE is decompensation of cirrhosis. The development of complications may depend upon various risk factors related to the liver disease, the patient and to the procedure itself.
<strong>Objective:</strong> To identify the incidence and analyze the risk factors for of hepatic decompensation following TACE.
<strong>Patients and methods: </strong>Retrospective descriptive study was conducted in Al-Rajhy Liver University Hospital, and Assiut University Hospitals. This study included 50 cases with HCC on top of liver cirrhosis, evaluation of liver function and proper staging of the tumour were done prior to TACE.
<strong>Results:</strong> Basal Child and MELD score, initial tumor size and basal albumin level were statistically significantly (p < 0.005) correlated with decompensation following TACE.
<strong>Conclusion:</strong> Proper selection of patients is essential for a better outcome and lower risk of hepatic decompensation after TACE. Serum albumin and tumour size were the independent predictors of decompensation.
https://ejhm.journals.ekb.eg/article_241126_6d63ccab28cfcf70a8a23131ef17567c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Left Ventricular Remodeling and Myocardial Reperfusion among Diabetics Treated with Primary Coronary Intervention for Acute Myocardial Infarction2727273224112810.21608/ejhm.2022.241128ENMohey Eldeen Abo Elftouh EldeebKamal Saad MansourAhmed Abo Amer Ibrahim MansourMohamed Mohsen MohamedJournal Article20220602<strong>Background:</strong> Left ventricle (LV) remodeling and poor myocardial reperfusion have been linked in various investigations, particularly in diabetics.
<strong>Objective:</strong> The aim of this study was to assess the influence of diabetes mellitus on both left ventricular systolic function recovery as well as myocardial reperfusion following primary percutaneous coronary intervention (PCI).
<strong>Patients and methods:</strong> One hundred primary percutaneous coronary intervention of (IRA) alone was used in 50 diabetic and 50 nondiabetic individuals who had their first STEMI attack, underwent echocardiography (conventional TTE) and coronary catheterization to determine effect of diabetes on LV remodeling and myocardial reperfusion.
<strong>Results:</strong> ST elevation after 1ry PCI in diabetics differed significantly compared to non-diabetics. Left ventricular end-systolic diameter (<em>LVESD</em>), wall motion score index (WMSI) and incidence of remodeling after 3 months follow up was significantly higher in diabetic group compared to non- diabetics. Follow up beyond 3 months indicated positive significant correlation between ejection fraction (EF) by m-mode and myocardial blush grade (MBG), negative correlation between LVEDV and MBG, positive significant correlation between E/A ratio and MBG negative significant correlation between WMSI and MBG.
<strong>Conclusion:</strong> It could be concluded that diabetes has a negative impact on cardiac reperfusion in STEMI patients. Patients with diabetes are more likely to experience remodeling than those without diabetes.
<strong> </strong>https://ejhm.journals.ekb.eg/article_241128_325b0daab6701c221de5c52a306828ae.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701An Overview of Zinc and its Intralesional Role in Treatment of Multiple Recalcitrant Warts: Review Article2733273524112910.21608/ejhm.2022.241129ENNada Mohamed Ali Abd ElkareemFawzia Farag MostafaDoaa HosnyJournal Article20220602<strong>Background: </strong>Human papilloma virus (HPV) causes viral warts, which affect around 10% of the population. HPV types 1, 2, and 57 are frequently implicated as etiological factors in the majority of cases. It's more difficult to diagnose and cure HPV 4 and 7 because of their rarity. It is possible to combine several treatments for viral warts because treatment might be time-consuming in some circumstances, even when various options are accessible. In spite of reports of successful systemic acitretin therapy for viral warts resistant to previous treatments, oral acitretin therapy has only been used in a limited number of cases.
<strong>Objective: </strong>Assessment of role ofintralesional zinc sulphate 2% in the treatment of multiple recalcitrant warts.
<strong>Methods:</strong> Warts, Zinc sulphate, Recalcitrant warts, and the Human Papillomavirus were all looked for in PubMed, Google scholar, and Science direct. References from relevant literature were also evaluated by the authors, but only the most recent or complete study from January 2000 to January 2022 was included. Due to the lack of sources for translation, documents in languages other than English have been ruled out. Papers that did not fall under the purview of major scientific investigations, such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations, were omitted.
<strong>Conclusion</strong>: Warts can also be cleared with intralesional 2 percent zinc sulphate. Children may benefit from using topical or oral zinc as an alternative to harsh manual treatments for warts.
<strong> </strong>https://ejhm.journals.ekb.eg/article_241129_a4963075169e0324c1369fca47d7e8f6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Interleukin-23 and its Receptor Expression (IL-23R) in Psoriatic and Psoriatic Arthritis Patients2736274124113010.21608/ejhm.2022.241130ENMohamed Saad SerriaEman HamzaNessma A. NosserMarwa ZohdyFatma Azzahraa HishamJournal Article20220602<strong>Introduction: </strong>Psoriasis (Ps) is a systemic autoimmune disorder that develops under the influence of environmental factors in a genetically susceptible person. The IL-23/IL-17 axis is the primary signalling pathway for cellular and molecular alterations in Ps.<br /> <strong>Objective:</strong> The aim of the study was to investigate the levels of interleukin 23 (IL-23) in serum and its receptor expression (ILR23) in blood of patients with Ps and psoriatic arthritis (PsA), as well as to evaluate the possibility of using (IL23R) in blood as a marker for susceptibility of Psoriasis.<br /> <strong>Patients and Methods</strong>: Medical data and clinical evaluation were done and blood samples from patients and control groups were collected. Serum IL-23 concentration was measured using enzyme-linked immunosorbent assay (ELISA) and the Expression of IL-23R in human peripheral blood mononuclear cells (PBMCs) was determined using Western blotting.<br /> <strong>Results:</strong> Serum IL-23 concentration was significantly higher among Ps cases than in controls and it was significantly different between PsA and Ps groups. The protein expression of IL-23R was significantly greater in Ps group than in control group with no significant difference between Ps and PsA groups. Receiver operating characteristics (ROC) curve showed a diagnostic value for the increased blood IL-23R with a sensitivity of 83.3% and a specificity of 73.3% for psoriasis. Also, (ROC) curve showed a diagnostic value for the increased blood IL-23 with a sensitivity of 80% and a specificity of 73.3% for the diagnosis of psoriasis.<br /> <strong>Conclusion:</strong> Serum IL-23 and its receptor expression measurements are helpful tools in the diagnosis of Ps as well as in the prediction of PsA. We hypothesized that there is a link between IL-23 and IL-23R and the risk of Ps in addition to PsA, with evidence that the expression of IL-23R is linked to a significantly greater risk of psoriasis.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_241130_416e27ab3a230ab16afbcf72462c1df0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Total Serum Bilirubin Level for Neonatal Jaundice after Intensive Phototherapy2742274524113110.21608/ejhm.2022.241131ENHeba Elsayed GabrMoustafa Gamal Amin GhonemWael Husseiny Soliman BakirJournal Article20220602<strong>Background:</strong> Intensive phototherapy in neonatal hyperbilirubinemia rapidly decreases serum total bilirubin (STB) below the threshold for treatment. Intensive phototherapy implies the use of high levels of irradiance to as much of infant's surface area as possible.
<strong>Objectives: </strong>This study aimed to assess the total serum bilirubin level for neonatal jaundice after intensive phototherapy.
<strong>Patients and Methods: </strong>This study was conducted on 200 newborns with neonatal jaundice who were admitted to the NICU of Benha Teaching Hospital, Egypt, requiring double surface, and intensive phototherapy treatment during the period of the study from March 2020 till December 2020.
<strong>Results:</strong> Among the 200 neonates with hyperbilirubinemia, the mean STB measurement at presentation was 12.12 ± 4.6 mg/dl, after phototherapy the mean of STB was 8.4 ± 3.39 mg/dl. After stoppage of phototherapy by 24± 6 hours the mean was 11.34 ± 3.17 mg/dl. The mean STB after phototherapywas 8.4 ± 3.39 mg/dl, while after stoppage by 24 ± 6 hours the mean was 11.34 ± 3.17 mg/dl. There was significant difference between the three measurements regarding present serum total bilirubin, after phototherapy & after stoppage by 24 ± 6 hours (with P < 0.001).
<strong>Conclusion:</strong> Intensive phototherapy in neonatal hyperbilirubinemia rapidly decreases serum total bilirubin (STB) below the threshold for treatment. However, underlying alteration in bilirubin production and excretion may persist and cause bilirubin rebound after stopping phototherapy.
<strong> </strong>
https://ejhm.journals.ekb.eg/article_241131_e66381da187a163c7229c69925ab2d16.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Assessment of Cord Blood Selenium Level in Preterm and Full-Term Neonates2746275024171210.21608/ejhm.2022.241712ENWael Husseiny Soliman BakirDepartment of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, EgyptMoustafa Gamal Amin GhonemDepartment of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, EgyptHeba Elsayed GabrDepartment of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, EgyptJournal Article20220111Background: Low selenium concentrations in the mother or her fetus can affect on infection risk, a major cause of preterm birth. Selenium status is also important in the group of hospitalized neonates and infants.
Objective: This study aimed to measure cord blood selenium levels in full term and preterm neonates.
Subjects and Methods: A total of 120 full and preterm neonates and their mothers included in this study. They were admitted to delivery room, Pediatric Department at Benha Teaching Hospital, Egypt. The study was conducted through the period from February 2020 to December 2020. They were subjected to full history taking, routine, physical examination and cord blood selenium was measured.
Results: Full-term neonates had significantly higher GA, Wt., Lt and selenium levels than pre-term neonates. Also, there was no significant differences between full-term neonates and pre-term neonates regarding CRP, TLC and PLT. Also, selenium supplementation didn’t show any significant effect on several clinical parameters as gestational age, weight, height, circumference, mother age, C-reactive protein, TLC and PLT among full-term neonates. On contrast, selenium supplementation showed a significant improved serum selenium level among preterm and full-term neonates.
Conclusions: Full-term neonates had significantly higher selenium levels than pre-term neonates. Selenium concentrations are reduced in neonates, especially in those with lower gestational age and birth weight. Supplementation significantly affected serum selenium levels as compared to non- supplemented.https://ejhm.journals.ekb.eg/article_241712_0db1255b41fc883ae05e705330a97ebb.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Association between Interleukin 6 Serum Level and Severity of Disease among Pediatrics with Covid-192751275724171410.21608/ejhm.2022.241714ENMoustafa Gamal Amin GhonemDepartment of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, EgyptWael BakirDepartment of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, EgyptHeba GabrDepartment of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, EgyptJournal Article20220604<strong>Background: </strong>Most studies quantify IL-6 only at patient admission, a strategy that may not be appropriate to accurately predict the outcome or to guide treatment due to the dynamic inflammatory process occurring during infection with SARS-CoV-2.
<strong>Objective: </strong>This study aimed to investigate the association between interleukin-6 serum level and severity of disease among pediatrics with covid-19.
<strong>Patients and methods:</strong> A cross-sectional study was conducted on 130 children with COVID-19. All children were divided into4 groups according to WHO criteria as asymptomatic, which included 20 children, mild included that 60 cases, moderate that included 40 cases and severe, which included 10 cases. All cases were admitted to Benha Teaching Hospital, with a diagnosis of COVID-19 during the period study from February 2020 to December 2020.
<strong>Results:</strong> Interleukin-6 serum level was significantly increased with severe than other severity features groups. ROC curve analysis showed that procalcitonin and interleukin-6 were the best markers for early prediction of severity of disuses among children with covid-19. The sensitivity of interleukin-6 was 87.9% and specificity was 63.5%, at AUC of 0.640 with cut-off of 7.41.
<strong>Conclusion:</strong> Children at any age seem to be susceptible to COVID-19, and even though their symptoms are milder, they still present a diverse range of clinical presentations. Interleukin-6 was the best marker for determining the severity of disease among pediatrics with covid-19.https://ejhm.journals.ekb.eg/article_241714_aaa9981ffe21cda6cb1fa93a5b84829c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Role of High-Resolution Multidetector Computed Tomography in Characterization of Pulmonary Ground Glass Opacity2758276524171610.21608/ejhm.2022.241716ENRasha Shawky ZakiDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, Sharkia, EgyptOsama Abdallah DawoudDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, Sharkia, EgyptAyman Fathy AhmedDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, Sharkia, EgyptAhmed Fekry SalemDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, Sharkia, EgyptJournal Article20220604<strong>Background:</strong> Multislice computed tomography not only improves the detection and characterization of parenchymal abnormalities but also increases the accuracy of diagnosis.
<strong>Objective:</strong> To study and differentiate multidetector computed tomography findings and the pathologic characteristics in different pulmonary ground-glass opacity causes.
<strong>Patients and methods:</strong> Thirty patients referred from the Chest Department, Zagazig University Hospital to the Radiology Department during the period from November 2018 to December 2019, were included in this cross-sectional trial. Diagnosis of GGO is based on careful history taking and clinical data, restrictive or obstructive pulmonary defect, and conclusive radiographic as well as histopathologic findings.
<strong> Results</strong>: parenchymal lung diseases were predominant as seen in 24 patients accounting for 80 % of such patients while vascular diseases were responsible for ground-glass attenuation were only 6 patients accounting for 20%. The commonest diagnosis for the diffuse pattern of ground-glass opacity was interstitial lung diseases (16.7%), followed by pulmonary fibrosis (13.3%), cardiogenic pulmonary edema (10%), then pulmonary hemorrhage (6.7%), and lastly pulmonary hypertension with (3.3%). In the patchy pattern of ground glass, the commonest diagnosis was infectious pneumonia (10%), followed by post-irradiation and post patchy and diffuse patterns showing restrictive dysfunction (high FEV1/FVC and FVC is reduced) and the nodular pattern shows mixed dysfunction (low FEV1and low FVC).
<strong>Conclusion:</strong> we offer a diagnostic approach for the evaluation of ground-glass patterns in HRCT of the chest based on all previous consensus data. It could help to narrow the list of differential diagnosis and reach the most accurate onehttps://ejhm.journals.ekb.eg/article_241716_38c2191b79bec09233243c4c6d16d62b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Effects of the Anti-obesity Drugs Vita Slim and Green Tea on Certain Biochemical and Physiological Indices of Obese Adult Male Albino Rats2767277124172010.21608/ejhm.2022.241720ENEman G. E. Helal1Department of Zoology, Faculty of Science (Girls), Al-Azhar UniversityNora A. Aljalaud2Biology Department, College of Science, Imam Abdulrahman Bin Faisal University, Saudi ArabiaAshraf M. M. Algendy3Department of Physiology, Faculty of Medicine (Boys), Al-Azhar University, EgyptSuzan S. Elpasty1Department of Zoology, Faculty of Science (Girls), Al-Azhar UniversityJournal Article20220110<strong>Background:</strong> Because obesity is linked to an increased risk of diabetes and heart disease, the ideal anti-obesity medication would have weight loss that was long-lasting and had few side effects.
<strong>Objective: </strong>To detect if the weight-loss drugs; green tea and Vita slim negatively affect several biochemical and physiological markers.
<strong>Materials and Methods</strong>: Three groups consisted of 21 mature obese male albino rats (with a body weight of 220 ±20 gram): In Group one: control (vehicle treatment), in group two: for a period of 30 days, rats were given Vita slim (0.1mg/kg/day), and in group three:for 30 days, rats were given green tea (0.1 mg/kg/day).
<strong>Results</strong>: Significant changes were observed in the weight of the treated groups, in serum levels of AST/ALT, albumin, triglycerides, low-density lipoproteins (LDL), LDL/HDL ratio, urea, creatinine, as well as triiodothyronine (T3) as compared with the control group.
<strong>Conclusion:</strong> Several physiological and biochemical markers, including kidney and liver functions, have been shown to be negatively impacted by Vita slim and green tea after 30 days of ingestion.https://ejhm.journals.ekb.eg/article_241720_3c28f0c95b0abd80d59fd30311d0e34b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Combined CTP-IGF-1 Score: A New Score for Assessment of Disease Severity in Patients With HCV- Related Liver Cirrhosis2772277624172210.21608/ejhm.2022.241722ENElsayed GhoneemDepartments of 1Internal Medicine, Hepatology & Gastroenterology UnitAhmed MarwanDepartments of 1Internal Medicine, Hepatology & Gastroenterology UnitMervat El-Sayed Mashaly2Clinical PathologyMohamed Mofreh Salem2Clinical PathologyAbeer Saad El Zekred3Biochemistry, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, EgyptAhmed SalehDepartments of 1Internal Medicine, Hepatology & Gastroenterology UnitJournal Article20220112<strong>Background:</strong> Liver is the largest endocrine organ in the body. It is the key organ in insulin mediated metabolism, growth hormone and insulin like growth factors (IGF) pathway. Liver cirrhosis is the end result of many chronic diseases including hepatitis C virus infection. Child-Turcotte-Pugh (CTP) score is the standard used in assessment of hepatic reserve but it has its drawbacks in the form of subjective variables, hepatic encephalopathy and ascites.
<strong>Objective:</strong> The work aimed to assess IGF-1 in patients with liver cirrhosis and its correlation with CTP score and to assess the value of modified combined CTP-IGF-1 score.
<strong>Patients and methods</strong><strong>:</strong> This was a case-control study that enrolled 170 patients with chronic liver disease (CLD) and 72 healthy controls. CLD (liver cirrhosis) in the study group was caused by chronic hepatitis C virus (HCV) infection. Liver cirrhosis was identified by clinical assessment, abdominal ultrasonography (US), and laboratory assessment.
<strong>Results:</strong> IGF1 showed highly significant low values in the study group compared to controls (42.15 ± 27.976 and 66.31 ± 33.084 ng/ml respectively, p <0.001). The combined CTP-IGF-1 score in comparison with the classic CTP score showed improved area under curve (0.848 and 0.854), sensitivity (71.2% and 88%), negative predictive value (41.7% and 53.7%), false negative results (49 and 19) and accuracy (75.73% and 83.98%) but decreased specificity (97.22% and 61.1%), positive predictive value (99.2% and 91.5%) and higher false positive results (1 and 14) respectively.
<strong>Conclusion:</strong> IGF-1 showed progressive decrements with progression of liver cirrhosis and is negatively correlated with CTP score. Addition of IGF-1 to CTP score to formulate combined score improves the AUC, negative predictive value, sensitivity, and the accuracy of CTP score and decreases the false negative results.https://ejhm.journals.ekb.eg/article_241722_46e1248cb65fb49ff334da8e77a62b47.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701An Updated Overview of Keratoconus Management: Review Article2777278024195110.21608/ejhm.2022.241951ENMohamed Magdy Ibrahim MahmoudDepartment of Ophthalmology, Faculty of Medicine, Zagazig University, EgyptAlaa Mohamed HamdyDepartment of Ophthalmology, Faculty of Medicine, Zagazig University, EgyptAshraf Bor'i MohamedDepartment of Ophthalmology, Faculty of Medicine, Zagazig University, EgyptYasmine Ahmed Diaa El DinDepartment of Ophthalmology, Faculty of Medicine, Zagazig University, EgyptJournal Article20220605<strong>Background: </strong>Non-inflammatory corneal stromal thinness causes the central or paracentral region of the cornea to thin and protrude anteriorly, leading to myopia, irregular astigmatism, and vision impairment with keratoconus (KC). About 90% of the time, it is bilateral, but the severity and progression are asymmetrical. It normally begins around the time of puberty and continues until the third or fourth decade of life before stopping. The severity of the condition, the degree of visual impairment, and the benefits and drawbacks of each treatment option all play a role in determining the best course of medical or surgical treatment.
<strong>Objective: </strong>review article aimed to assess the new modalities of keratoconus management.
<strong>Methods:</strong> PubMed, Google scholar and Science direct were searched using the following keywords: Keratoconus, keratoconus management, corneal cross linking and intrastromal corneal ring segments. The authors also screened references from the relevant literature, including all the identified studies and reviews, only the most recent or complete study was included between March 2009 and January 2022. Documents in a language apart from English have been excluded as sources for interpretation. Papers apart from main scientific studies (documents unavailable as total written text, conversation, conference abstract papers and dissertations) were excluded.
<strong>Conclusion:</strong> It is possible to conduct corneal cross linking and intrastromal corneal ring segments methods simultaneously or in a sequential order, which has a beneficial effect on KC treatment. Several other methods with promising outcomes have been described in the literature.https://ejhm.journals.ekb.eg/article_241951_2d809cde2ce20a4eb92544178a72c940.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Uric Acid as a Predictor of Peripheral Arterial Disease as Indicated by Ankle Brachial Index2781278724195210.21608/ejhm.2022.241952ENHazem MansourDepartments of 1Cardiology and 2Vascular Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt0000-0002-5366-3698Sameh ShahenDepartments of 1Cardiology and 2Vascular Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptHeba SultanDepartments of 1Cardiology and 2Vascular Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptHamdy AbdelAzeem AboElNeelDepartments of 1Cardiology and 2Vascular Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptHassen ShehataDepartments of 1Cardiology and 2Vascular Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20220112<strong>Background:</strong> Peripheral arterial disease (PAD) is a chronic atherosclerotic progressive disorder that affects the arterial tree especially those of the lower limb which can be screened by the ankle-brachial index (ABI). Generally, uric acid (UA) has been accused of the initiation and progression of atherosclerosis in various arterial segments however, it is a less studied risk factor in PAD.
<strong>Objective:</strong> Our study aimed to evaluate the correlation between increased serum uric acid levels and PAD as indicated by ABI and whether there is a cut-off value for UA to predict PAD.
<strong>Patients and methods:</strong> A case-control study compared 100 patients with PAD as indicated by ABI with 100 cross-matched controls as regards serum UA levels and other risk factors. Moreover, the receiver operating characteristic curve (ROC) was plotted to determine the best cut-off point for UA to detect PAD as indicated by ABI.
<strong> Results</strong>: The BMI, DM, and dyslipidemia were highly significant among the patient's group (P- value= 0.001). Moreover, UA was significantly correlated to low ABI (P- value=0.003). Besides, UA cut-off value > 6.5 exhibited a specificity of 90% and a positive predictive value of 80% to diagnose PAD.
<strong>Conclusion:</strong> Low ABI was significantly associated with UA denoting its probable relation with lower limb atherosclerosis, with a good positive predictive value to predict it.https://ejhm.journals.ekb.eg/article_241952_b490298355a81b63c11ce4310dae2a57.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Childhood Psychological Trauma and Psychiatric Comorbidity in Patients with Breast Cancer2788279424195410.21608/ejhm.2022.241954ENNashaat A. Abdel-FadeelDepartment of Neurology and Psychiatry, Faculty of Medicine, Minia University, EgyptMervat M. ZanatyNashaat A. Abdel-Fadeel*, Mervat M. Zanaty, Ahmed M. Kamal, Maha A. Hassan, Mohamed TahaAhmed M. KamalDepartment of Neurology and Psychiatry, Faculty of Medicine, Minia University, EgyptMaha A. HassanDepartment of Neurology and Psychiatry, Faculty of Medicine, Minia University, EgyptMohamed TahaDepartment of Neurology and Psychiatry, Faculty of Medicine, Minia University, EgyptJournal Article20220113increase the risk of depression and anxiety with subsequent adverse effect on compliance to cancer treatment. In patients with breast cancer, childhood trauma is associated with higher levels of fatigue, stress and psychological distress and has a significant impact on patients’ reaction and adjustment to cancer diagnosis.
<strong>Objective: </strong>The aim of this study was to detect psychiatric comorbidity and impact of childhood trauma in patients with breast cancer and study their relations with tumor grading and histopathological characteristics.
<strong>Patients and Methods</strong>: In this cross-sectional study, we recruited 150 patients diagnosed with breast cancer. Participants were females aged 18 years or older. Patients with history of another cancer, comorbid serious medical condition, in their investigation phase of cancer diagnosis or those who refused to participate in the study were excluded. The tools applied to participants were the Symptom Checklist 90 Revised and Childhood Trauma Questionnaire.
<strong>R</strong><strong>esults:</strong> 113 patients (75.3%) had psychiatric comorbidity; somatization was the most common psychiatric comorbidity (58.7%) followed by depression (40.7%). Patients reported severe to extreme childhood trauma in domains of physical neglect (28%), physical abuse (22.7%), emotional neglect (7.3%), emotional abuse (18%) and sexual abuse (2%). Patients with psychiatric comorbidity had more grade III and IV in tumor grading. Patients with grade IV breast cancer had more severe psychiatric symptoms.
<strong>Conclusions</strong>: Psychiatric comorbidity and childhood trauma are common in patients with breast cancer. Patients with psychiatric comorbidity have more grades III and IV tumor grading. Patients with grade IV breast cancer have more severe psychiatric symptoms.https://ejhm.journals.ekb.eg/article_241954_f60aebbbb9059585cdf195022bd75869.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Cancer Cervix and Human Papilloma Virus (HPV) among Women Attending Gynecological Out Clinic Patients Al-Azhar University Hospitals: Newly Screening Technique2795279724195510.21608/ejhm.2022.241955ENYousef Mohamed El-MazzallyDepartments of 1Community and Industrial MedicineSaged Mohamed El-Mazzally2Obstetrics and Gynecology,
Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220605<strong>Background:</strong> Most incidences of cervical cancer are caused by the human papillomavirus (HPV), which can be prevented with a vaccination. In around 90% of cases, HPV infections have no symptoms and disappear on their own within two years. In certain situations, however, an HPV infection might remain and cause warts or precancerous lesions. HPV causes nearly all cervical cancer cases; two strains, HPV16 and HPV18, accounting for 70% of cases.
<strong>Objectives:</strong> The study was designed to re-assess the prevalence of HPV infection among womenattending the GynecologicalOutpatient Clinic Al-Azhar University Hospitals using the new liquid-based cytology technique and our results provide important information for public health authorities considering HPV prevention in Egypt.
<strong>Subjects and methods:</strong> Our study was conducted on 1000 gynecological patients attending Al-Azhar University Hospitals between March 2021 and December 2021. Their ages ranged from 35 - 70 years old. Cervical samples were collected by a gynecologist using a cytobrush and placed in a liquid-based cytology medium (using the DC LBC from GZLBP) for the presence of HPV DNA using Linear Array HPV genotyping at Cytolab Laboratory, Cairo, Egypt.
<strong>Results</strong> Among 1000 women who underwent the LBC test, 97 women were positive for HPV DNA findings (9.7%), while the rest of women 903 were test free (90.3%). 57 cases (58.7%) of positive women showed different degrees of cervical intra-epithelial neoplasia CIN.
<strong>Conclusion: </strong>The essential need for a proper screening system for cervical pathologies and further multi-central randomized studies are strongly recommended through our study.https://ejhm.journals.ekb.eg/article_241955_ed0d15c8f2eaabe5838bac7026b501bc.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Body Dysmorphic Disorder in Females Seeking Aesthetic Dermatology Minimally Invasive Cosmetic Procedures2798280424196110.21608/ejhm.2022.241961ENMohamed A. El-khayyatDepartments of 1Dermatology, Andrology and STDsHassan M. El-FakahanyDepartments of 1Dermatology, Andrology and STDsFatma A. LatifDepartments of 1Dermatology, Andrology and STDsNashaat A. Abdel-Fadeel2Neurology and Psychiatry,
Faculty of Medicine, Minia University, EgyptJournal Article20220116<strong>Background:</strong> Body image is defined as the internal representation of person’s external appearance and it plays a significant role in quality of life and self-esteem of individuals. Body Dysmorphic Disorder (BDD) affects 1-2% of general population. Patients with BDD report significant dissatisfaction with their external appearance and represent about 5-15% of individuals seeking aesthetic interventions.
<strong>Objective: </strong>The aim of this study was to estimate rates of BDD in females seeking aesthetic dermatology services in Egyptian culture in a step to raise awareness about BDD in dermatology practice.
<strong>Patients and Methods</strong>: we recruited 150 female subjects from those seeking different aesthetic dermatology interventions from dermatology clinics in Minia governorate. Our study is a cross sectional study that involved collecting data about sociodemographic and illness related characteristics, history taking and clinical examination. The tools applied to participants were the Body Dysmorphic Disorder Questionnaire, the Body Dysmorphic Disorder modification for Yale-Brown Obsessive-Compulsive Scale (Adult version) and the Body Dysmorphic Disorder modification for Yale-Brown Obsessive Compulsive Scale (Adolescent version).
<strong>R</strong><strong>esults:</strong> The most common age group was 25-35 years representing 42.7% of the sample. Based on BDD-YBOCS results, 62% of our sample screened positive for BDD while lower rates of BDD were found based on Body Dysmorphic Disorder Questionnaire (BDD-Q).
<strong>Conclusions</strong>: Patients with BDD frequently present to aesthetic dermatology settings. Rates of BDD in aesthetic dermatology seekers are high reaching up to 62%. It is important to screen all persons seeking aesthetic interventions for BDD.https://ejhm.journals.ekb.eg/article_241961_ef70ce02319d50d81016d52413f593ac.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220606Comparative Study between Primary Percutaneous Coronary Intervention, Pharmacoinvasive Strategy and Pharmacological Reperfusion Strategy in Acute Myocardial Infarction. A Long-Term Follow-Up Analysis2805281124226910.21608/ejhm.2022.242269ENAhmed Shafie AmmarDepartment of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, EgyptAhmed Fathy Ahmed El SayedDepartment of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, EgyptMohammad Gouda MohammadDepartment of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, EgyptMostafa Fathy MohammedDepartment of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, EgyptJournal Article20220113<strong>Background: </strong>Until now there is no clear evidence to support the superiority of one strategy over the others to treat STEMI patients.Serial B‐type natriuretic peptide (BNP) measurements accurately predict the risk of death or congestive heart failure in STEMI patients.
<strong>Objective: </strong>The aim of the study was to determine which strategy is the best strategy to treat acute STEMI and if BNP give an incremental prognostic value in treated STEMI patients.Patients presented with acute STEMI were enrolled in the present study.
<strong>Patients and methods: </strong>Only 93 patients were followed up with us for 6 months and divided to 3 groups according to the treatment strategy. All patient underwent BNP analysis, echocardiography and treated with either received only thrombolytic therapy (Group I), primary PCI (Group II) or received thrombolytic therapy then went to catheterization (Group III).
<strong>Results:</strong> Regarding BNP level change was higher in Group I and in Group III had high BNP level higher than Group II but this difference doesn`t reach level for statistically significant correlation between BNP levels and type of reperfusion in the three groups. Regarding LV systolic function, there was no statistically difference between the percent change in LV systolic function in Group I and Group III (P-value = 0.854, 0.152 respectively) but there was statistically significant difference between the percent change in LV systolic function in Group II (P-value=0.031)<strong>.</strong>
<strong>Conclusion: </strong>The best way for treatment of acute STEMI patients, is a primary PCI the most significant predictive methods are recovery of EF% and reduction of BNP, however pharmacoinavsive strategy like PCI strategy has good follow up prognosis and better than thrombolytic alone therapy.https://ejhm.journals.ekb.eg/article_242269_10c66890389cf1ba218d6d2561a9795b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220606Computed Tomography Imaging in Orbital Complications of Acute Inflammatory Paranasal Sinuses Diseases2812281924227410.21608/ejhm.2022.242274ENSherin Wagdy MohamedDepartment of Radiodiagnosis, Faculty of Medicine Zagazig University, EgyptIbrahim Abdelaziz LibdaDepartment of Radiodiagnosis, Faculty of Medicine Zagazig University, EgyptHanan Abdel Hameed IsmailDepartment of Radiodiagnosis, Faculty of Medicine Zagazig University, EgyptMahmoud Mohamed Ibrahim GabalDepartment of Radiodiagnosis, Faculty of Medicine Zagazig University, EgyptJournal Article20220119<strong>Background:</strong> When it comes for identifying paranasal sinus disease (PSD) problems, CT scans are frequently the go-to imaging modality.
<strong>Objective:</strong> To diagnose orbital complications of acute inflammatory paranasal sinuses diseases by computed tomography.
<strong>Patients and methods:</strong> Thirty patients with orbital complications as pain, edema, and visual acuity disorders were referred from Ophthalmology Department to Radiology Unit at Zagazig University Hospitals. All patients were included in this comprehensive sample trial and were subjected to thorough history and clinical evaluation as well as multi detector CT examinations.
<strong>Results:</strong> 40% had opacity in maxillary ethmoid bone (erosion), 30% had opacity in Max sphenoid ethmoid, 20% had opacity in maxillary ethmoid and 10% had maxillary opacity. Majority were invasive fungal (40%), allergic fungal (30%), acute bacterial with 20% and mucocale (10%). Significant association and agreement between Opacity in Max, sphenoid ethmoid and allergic fungal also between opacity in maxillary with mucocele and between opacity in maxillary ethmoid and acute bacterial also between opacity in maxillary ethmoid bone erosion and invasive fungal.
<strong>Conclusion:</strong> CT has important role in diagnosis of orbital complications resulting from acute inflammatory paranasal sinuses diseases, as it can detect cause, site of lesion, erosion of bone, and it can give feedback about response to treatment or need for surgical interference and success rate of surgery. CT could be with contrast or without contrast for better evaluation of lesion extension and invasion to surrounding structures.https://ejhm.journals.ekb.eg/article_242274_e6929dc56df28f8ada1b56187f91122d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220606Role of Suction Pipelle in Diagnosis of Endometrial Lesions in Patients with Perimenopausal Bleeding2820282524227610.21608/ejhm.2022.242276ENAmna Elsayed Ismail Abdel-MageedDepartments 1Obstetrics & GynecologyYousif Abou-Elwan ElsayedDepartments 1Obstetrics & GynecologyManal El-BehieryDepartments 1Obstetrics & GynecologyOla Abd Elraouf Ahmed Harb2Pathology, Faculty of Medicine - Zagazig,
Faculty of Medicine - Zagazig UniversityHala Sherif ElsayedDepartments 1Obstetrics & GynecologyJournal Article20220120<strong>Background:</strong> Suction pipelle helps for taking endometrial samples for detection of abnormal uterine bleeding.
<strong>Objective:</strong> To determine if suction pipelle can be used instead of traditional dilatation and curettage (D & C) for detection of endometrial lesions among perimenopausal bleeding patients.
<strong>Subjects and Methods: </strong>We conducted our cross-sectional study, at Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University Hospitals, and Matrouh Maternity Hospital on sixty patients with abnormal uterine bleeding (AUB). Two samples were taken from women complaining of perimenopausal bleeding, one by pipelle device without need to anesthesia and the other by D & C after general anesthesia, then comparing the findings of histological analysis of both, with D & C, which is the gold standard approach for endometrial sampling.
<strong>Results:</strong> When it came to detecting secretory and hormone-dependent endometrium, atypical hyperplasia and EEC grade 1 with both methods, there was a perfect match. Some cases of proliferative endometrium and simple hyperplasia were correctly diagnosed using the pipelle after D & C failed to do so (20% and 16.6% by pipelle versus 16.6% and 13.3% by D & C respectively). Endometrial polyps and disorganised proliferative hyperplasia were among the conditions that the pipelle failed to detect, and this is disappointing.
<strong>Conclusion:</strong> EEC grade 1 and simple endometrial hyperplasia, as well as secretory endometrium, hormone-dependent endometrium, and simple hyperplasia were all easily diagnosed using pipelle's high sensitivity and specificity. Endometrial polyp and disorganized endometrial hyperplasia were difficult to detect with this test because of its limited sensitivity.https://ejhm.journals.ekb.eg/article_242276_c547e0c90774cb051a8a6850940c02b0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220606Correlation between Radiological and Total Nasal Symptom Severity Score Effect of Montelukast in Patient with Allergic Rhinitis Associated with Inferior Turbinate Hypertrophy2826282924227810.21608/ejhm.2022.242278ENAyat A. Awwad AwwadDepartments of 1OtorhinolaryngologyMohamed Fekry Farag2Department of Medical Physiology, Armed Force Faculty of Medicine, Cairo, EgyptSaid Sharaf Mohammed Mohammed El Sayed3Department of Medical Physiology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptFayez Mohammed Abd Elfattah Elbayoumy4Anatomy & EmbryologyMosaad Mohmed Ibrrahim5Medical Biochemistry, ART Unit, International Islamic Center for Population Studies & ResearchHusseini Fathi Husseini Mohamed El Boraey6Radiodiagnosis, Faculty of Medicine, Al-Azhar University, New Damyetta, EgyptJournal Article20220117<strong>Background:</strong> Allergic rhinitis (AR) is immunoglobulin E (IgE)-mediated inflammation of the nasal mucosa on exposure to allergens. Hypertrophic rhinitis (HR) is a common complication for AR, and often need turbinate surgery. Montelukast was evidenced to have an effective role in treatment in AR.<strong> Objective:</strong> The aim of the current work was to correlate between radiological and total nasal symptom severity score (TNSSS) effect of montelukast in patient with allergic rhinitis associated with inferior turbinate hypertrophy.<strong> Patients and methods:</strong> This prospective comparative case control study included a total of 100 allergic patients suffering from nasal obstruction due to inferior turbinate hypertrophy (study group) and 100 non-allergic patients (control group), attending at Outpatient Clinics, ENT Department, Al-Azhar University Hospitals, Egypt. The effect Montelukast was assessed by (TNSSS), radiologically by (CT) scan. Serum levels of IgE, TGF-β and IL13 were measured.<strong> Result:</strong> Montelukast showed improvement of all nasal symptoms score with highly significant improvement TNSSS (P=0.003) and significant reduction on inferior turbinate size (p=0.001) compared to control. In addition to, significant reduction in serum levels of IgE, TGF-<em>β</em> and IL13.<strong> Conclusion:</strong> Montelukast could be effective alternative treatment for inferior turbinate hypertrophy.https://ejhm.journals.ekb.eg/article_242278_4522889d75ba20dac10eed0dd68e9fec.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220606Combined Albumin-Bilirubin Grade and Platelets (ALBI-PLT) Score and Albumin-Bilirubin Score (ALBI) as Simple Noninvasive Laboratory Markers for Prediction of Esophageal Varices in Cirrhotic Patients2830283724227910.21608/ejhm.2022.242279ENHatem S. AlegailyDepartments of 1Hepatology, Gastroenterology and infectious DiseasesMedhat A. Khalil2Internal MedicineAida Thabet3Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Benha, EgyptBadawy A. AbdulazizDepartments of 1Hepatology, Gastroenterology and infectious DiseasesJournal Article20220117<strong>Background:</strong> Esophageal varices (OVs) are common side effects of liver cirrhosis that can be life-threatening. Esophago-gastroduodenoscopy (EGD) is the gold standard for detecting OVs. In spite of this, it is intrusive and expensive.
<strong>Objective: </strong>The aim of the current work was to evaluate albumin-Bilirubin Score (ALBI), AST/ALT ratio, aspartate to platelet count ratio index (APRI), Child-Pugh Score, albumin-bilirubin grade, platelets (ALBI-PLT score) and platelet count/spleen diameter ratio as noninvasive laboratory markers for prediction of OVs in cirrhotic patients.
<strong>Patients and Methods: </strong>Two hundred and sixty patients with liver cirrhosis were screened for OVs.
CBC, liver and kidney profiles and abdominal ultrasonography were done, ALBI, ALBI-PLT score, AST/ALT ratio, APRI, a Child-Pugh Score and platelet count/spleen diameter ratio were measured for all patients. Also, EGDs were performed by one professional endoscopist for all patients.
<strong>Results</strong>: ALBI, ALBI-PLT, Platelet count/spleen diameter ratio and Child-Pugh Score were reliable indicators of esophageal varices. The best one was ALBI-PLT where at cut-off >2, may predict OVs with sensitivity 96.48 and specificity 87.76 (P< 0.001). Using ALBI at a cutoff >-2.6. may predict OVs with sensitivity of 83.77% and specificity of 53.26% (P = 0.001). Also, these noninvasive markers could help in detecting OV's size (P <0.001).
<strong>Conclusion:</strong> It could be concluded that the combined albumin-bilirubin and platelet grade (ALBI-PLT) and the albumin-bilirubin ratio (ALBI), Platelet count/spleen diameter ratio and Child-Pugh Score could be used as noninvasive markers for detecting esophageal varices and grading them.https://ejhm.journals.ekb.eg/article_242279_b79118a7cef13afa54e6f83943b36bef.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220607Relationship of Transcription Factor 7-Like-2 (TCF7L2) Gene Polymorphism rs12255372 and Glycemic Control in Type 2 Diabetes Mellitus2838284424253410.21608/ejhm.2022.242534ENSomia Abd El-Hamid Bawadyepartments of 1Clinical Pathology and 2Internal Medicine, Faculty of Medicine, Ain Shams University, EgyptNermine Helmy MahmoudDepartments of 1Clinical Pathology and 2Internal Medicine, Faculty of Medicine, Ain Shams University, EgyptManar Hassan Farouk AlzayetDepartments of 1Clinical Pathology and 2Internal Medicine, Faculty of Medicine, Ain Shams University, EgyptRania A. RadwanDepartments of 1Clinical Pathology and 2Internal Medicine, Faculty of Medicine, Ain Shams University, EgyptMarwa Ali Abdel-WahedDepartments of 1Clinical Pathology and 2Internal Medicine, Faculty of Medicine, Ain Shams University, EgyptJournal Article20220116<strong>Background: </strong>Diabetes mellitus is a collection of metabolic illnesses defined by hyperglycemia caused by an insulin secretion deficiency and/or enhanced insulin cellular resistance. TCF7L2 (Transcription Factor 7-like 2) is a transcription factor that has been linked to blood glucose control. <strong>Objective:</strong> Our study aimed to assess the association of TCF7L2 rs12255372 gene polymorphism with T2DM and to evaluate the impact of TCF7L2 rs12255372 polymorphism on glycemic control in type 2 diabetic patients. <strong>Patients and Methods: </strong>The study was conducted on forty-seven (47) diabetic patients who were collected from the out-patient clinic and in-patient of Department of Internal Medicine and Endocrinology at Ain Shams University Hospitals; in addition, twenty-three (23) age- and sex- matched healthy subjects taken as healthy control group. Assay of TCF7L2 rs12255372 gene polymorphism was performed by real-time PCR analysis. <strong>Results: </strong>The study had showed that there was no significant association between TCF7L2 rs12255372 G>T gene polymorphism and T2DM. However, there was significant association between the concordance of this polymorphism and higher level of post treatment HbA1c and higher level of serum lipids among patients’ group.<br /> <strong>Conclusion:</strong> TCF7L2 rs12255372 G>T gene polymorphismis associated withpoor therapeutic response to oral antidiabetic agents and occurrence of dyslipidemia.https://ejhm.journals.ekb.eg/article_242534_ac155636bf1a0b580194db7f5b12ff0e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220607Assessment of Immune Response to Pneumococcal Conjugate Vaccine in Hemodialysis Children after One Year2845285124253610.21608/ejhm.2022.242536ENMayy Abd-Alfattah Neemat-AllahDepartments of 1PediatricsJawdah Abduljalil Abd Alraheem AzqeerDepartments of 1PediatricsUsama Mahmoud AlKholyDepartments of 1PediatricsMai Mahmoud Sami IbrahimClinical Pathology, Faculty of Medicine, Zagazig University, EgyptJournal Article20220117<strong>Background:</strong> Pediatric patients with impaired immune systems, including those with chronic renal failure, should receive pneumococcal vaccinations which have a great role in prevention of chest infections.
<strong>Objective:</strong> The aim of the current work was to evaluate immune response for Pneumococcal Conjugate Vaccine 13 (PCV13) in Hemodialysis (HD) children after 3 months 1 year and 2 years of vaccination.
<strong>Patients and methods:</strong> Thirty-six children and adolescent on regular HD were included in this trial. All patients were not previously vaccinated by PCV13. We had determined pneumococcal immunoglobulin (IgG) antibodies 3 months, 1 year and 2 years after vaccination by PCV13. This study was carried out in Dialysis Nephrology Unit at Zagazig University Hospital of Children.
<strong>Results:</strong> As regard frequency of chest infection after PCV13, there was a statistically significant decrease in frequency for patients who developed chest infections after PCV vaccinations from 75% to 16.7%. Chest infections and antibody titers were statistically linked at three months, one year, and two years. The best cutoff of serum antibody titer at 2 years≥0.03825 for prediction of absence of infection with area under curve 0.917, sensitivity 90%, specificity 83.3%, positive predictive value 96.4% and negative predictive value 62.5% and accuracy 91.7% (p < 0.05).
<strong>Conclusion:</strong> It is possible for patients with end-stage renal disease (ESRD) and dialysis to produce enough antibodies against the PCV13 vaccine to reduce their risk of developing chest infections. Adequate protective concentration of antibody post PCV13 which is higher than 0.35ug/ml was maintained for most of cases at 1 year.https://ejhm.journals.ekb.eg/article_242536_19277f275452313202e06f0f20a59490.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220607General Insight about Male Infertility: Review Article2852285524254210.21608/ejhm.2022.242542ENAbdulrahman AlhusaynDepartment of Urology and Andrology, Faculty of Medicine Zagazig University. EgyptAhmed Ragab AliDepartment of Urology and Andrology, Faculty of Medicine Zagazig University. EgyptMohamed Mahmoud SeleemDepartment of Urology and Andrology, Faculty of Medicine Zagazig University. EgyptMahmoud Mohamed MalekDepartment of Urology and Andrology, Faculty of Medicine Zagazig University. EgyptJournal Article20220118<strong>Background</strong>: Failure to get pregnant after 12 months of unprotected sexual intercourse is described as infertility. Infertility affects 15 percent of the world's population, and in 50 percent of cases, a male component, such as poor sperm quality, is involved. Male infertility is now a mystery, with many theories as to what causes it. Semen analysis abnormality is usually invariably a sign of male infertility, but other male variables may still play a role even if the semen analysis is normal. Infertility in males can be caused by varicocele, genital infections, endocrine disruptors, genetic and immunological and systemic illnesses as well as environmental causes.
<strong>Objective:</strong> To discuss overview of male infertility causes, risk factors, diagnosis with special care of semen analysis.
<strong>Methods:</strong> PubMed, Google scholar and Science direct were searched using the following keywords: Male Infertility, Semen analysis and Risk factors of infertility. The authors also screened references from the relevant literature, including all the identified studies and reviews, only the most recent or complete study was included between May 2012 and July 2021. Documents in a language apart from English have been excluded as sources for interpretation was not found. Papers apart from main scientific studies had been excluded: documents unavailable as total written text, conversation, conference abstract papers and dissertations.
<strong>Conclusion:</strong> Male infertility accounts for over 20% of all causes of infertility in couples, and semen analysis is the only test that can reliably diagnose 9 out of 10 men who have a real issue with male infertility, with a sensitivity of 89.6%.https://ejhm.journals.ekb.eg/article_242542_18c55ac680b636d85e9dbc2f3ceab89b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220607Study on The Relationship between Thyroid Function and Frailty in Elderly2856286024254610.21608/ejhm.2022.242546ENNany Hasan El GayarDepartments of 1GeriatricsMohamed Ahmed MehanaDepartments of 1GeriatricsRasha Mohamed ZakiDepartments of 1GeriatricsAbeer Shawky El-Hadedy2Clinical and chemical pathology,
Faculty of Medicine, Alexandria University, Alexandria, EgyptJournal Article20220117<strong>Background</strong>: Frailty arises from the "physiologic triad" of sarcopenia, immune and neuroendocrine dysregulation. With aging, serum levels of thyroid hormones show marked changes.
<strong>Objectives:</strong> To study the circulating thyroid hormones (TSH, FT3, and FT4) and determine the relationship between circulating thyroid hormones and frailty in the Elderly.
<strong>Methods</strong>: This cross-sectional observational descriptive study included 50 subjects who were attending the outpatient geriatric clinic and geriatric unit at Alexandria Main University Hospital and were divided into; group A: 30 frail subjects aged ≥65 years (case group) and group B: 20 healthy subjects aged <65 years (control group) during the period from March till October 2019. Frailty assessment was done using Frail Questionnaire as well as thyroid function tests (TSH, FT3, and FT4) and other routine laboratory investigations. Anthropometric measurements were taken, including weight, height, and BMI (body mass index).
<strong>Results</strong>: No statistically significant variation between the studied candidates as regards gender (p=0.729), BMI (p=0.144), or TSH levels (p=0.401) but T3 and T4 were significantly lower in group A. with noting of weak non-significance positive results parallel between age and TSH levels (r=0.150, p=0.298), high significant moderate negative correspondence in-between age and serum FT3 levels (r=-0.530, p < 0.001) and non-significant weak negative correlation between age and FT4(r=-0.246, p=0.085). TSH levels in group A were: (3.3%) low, (66.7%) normal, (30%) high. Level of FT3 was: (46.7%) low, and (53.3%) normal while FT4 level was: (26.7%) low, (66.7%) normal and (6.7%) high.
<strong>Conclusion: </strong>Aging and frailty are associated with changes in thyroid functions in the form of significantly decreased hormonal levels including FT3 and FT4, with a non-significant change in TSH levels<strong>.</strong>https://ejhm.journals.ekb.eg/article_242546_1b1b32e76a52ceb54857546f995110d8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220607Magnesium Sulphate, Lidocaine or Nitroglycerin for Controlled Hypotension and Quality of the Surgical Field in Patients Undergoing Tympanoplasty2861287024254910.21608/ejhm.2022.242549ENAhmed Yousry Nour EldeenAnesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, EgyptZaki Taha SalehAnesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, EgyptHala ElattarAnesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, EgyptReham Mohamed AamerAnesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20220120<strong>Background:</strong> Intraoperative bleeding impairs surgical field visibility during tympanoplasty; several methods have been used to decrease blood loss and improve the quality of the surgical field, one of them is usage of hypotensive anesthetic agents.
<strong>Objective: </strong>This study aimed to compare the effect of magnesium sulphate, lidocaine or nitroglycerin for controlled hypotension on hemodynamics, quality of the surgical field and blood loss in patients undergoing tympanoplasty.
<strong>Patients and methods:</strong> A prospective double blind randomized clinical study included 45 patients of both genders, ASA I&II undergoing tympanoplasty were allocated into Three groups ( 15 patients each ) group (<strong>M</strong>) received magnesium sulphate by giving loading dose 40 mg/kg then the maintenance dose 15 mg/kg/hr, group (<strong>L</strong>) received lidocaine by giving an infusion dose of 2 mg/kg/hr and group (<strong>N</strong>) received nitroglycerin by giving an infusion dose of 5-10 μg/kg/min. For each group ( mean arterial blood pressure "MABP", heart rate "HR", quality of the surgical field, total IV fluids given, total blood loss, intraoperative complications, duration of the surgery and the extubation time) were recorded.
<strong>Results:</strong> The studied doses of the drugs achieved the target mean arterial pressure (50–65 mmHg) with superior hemodynamic stability in the lidocaine group. Group L showed a statistically significant decrease in blood loss (p < 0.05) , a statistically significant better quality of the surgical field (p < 0.05) and a statistically significant less complications (p < 0.05) compared to the other studied groups<strong>. </strong>
<strong>Conclusion:</strong> It was showed that using any of these three drugs can be effective for controlled hypotension in patients undergoing tympanoplasty but lidocaine has the priority for the achieving stablility of the hemodynamics, the best quality of the surgical field and the least blood loss.https://ejhm.journals.ekb.eg/article_242549_b6333a0693ce5eaaf2af371c4f10bb5a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220608Assessment of Outcomes of Closed Reduction and Percutaneous Fixation of Lisfranc's Injuries of The Foot2871287724275610.21608/ejhm.2022.242756ENAbduraouf Mosbah Ramadan El-AjnafOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptMohammed Othman MohammedOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptAshraf Abd Eldayem MohamedOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptSami Ibrahim Sadek AliOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20220120<strong>Background:</strong> An early surgical intervention for metatarsal joint injuries (Lisfranc injury) is essential to prevent or treat any foot compartmental syndrome that is the most common outcomes.
<strong>Objective:</strong> to manage outcomes of percutaneous fixation with closed reduction in managing foot Lisfranc's injuries.
<strong>Patients and Methods: </strong>At Orthopedic Departments, Zagazig University Hospital, 18 patients with displaced Lisfranc injury were studied in prospective research. Closed reduction and percutaneous fixation of the Lisfranc injuries by k-wires or screw were done to all patients. All patients were periodically monitored clinically and radiographically for a week, then every 2, 4, 6, and 12 weeks after the index procedure.
<strong>Results:</strong> Favorable outcome were majority with 88.9% (16 cases) (11 patients excellent and 5 good) and unfavorable 11.1% (2 patients) (1 fair and 1 poor). The current study estimated the complication as overall with 4 cases and we found superficial infection in 22.2%, stiffness in only one case (5.6%) and delayed union in 1 case also no case of compartment syndrome of foot in our series.
<strong>Conclusion:</strong> Lisfranc injuries treated with k-wire or screw percutaneous reduction and fixation could be treated efficiently, quickly and simply surgically with predictable and dependable consequences without routine removal of hardware.https://ejhm.journals.ekb.eg/article_242756_24457d2f7e61dd0257b574797a60393e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220608Uterine Packing with Gauze Versus Bakri Balloon for Arresting Atonic Postpartum Hemorrhage after Cesarean Delivery2878288224276310.21608/ejhm.2022.242763ENElsayed Elshamy¹Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, Egypt.
2Department of Obstetrics and Gynecology, Rabia Hospital, Riyadh, Saudi Arabia.Wael Gaber¹Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, EgyptAbd-Elhamid Shaheen¹Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, EgyptJournal Article20220119<strong>Background: </strong>There is no adequately sufficient evidence to determine the effectiveness and safety of mechanical and surgical interventions for treating primary postpartum hemorrhage (PPH).
<strong>Objective:</strong> To assess the safety, efficacy and acceptability of uterine packing with gauze compared to Bakri balloon tamponade for treatment of atonic PPH after cesarean section.
<strong>Patients and Methods: </strong>A prospective observational study. A total of 176 patients with atonic PPH after cesarean section were treated either with uterine packing with gauze (n=84) or Bakri balloon tamponade (n=92). The success rate together with early and late complications were recorded and statistically analyzed.
<strong>Results:</strong> 90.4 percent of individuals with uterine packing were able to cease their active bleeding compared to 75 percent of those with the Bakri balloons (p < 0.05). The uterine packing group's surgery took longer time, and the Bakri Balloon group's requirement for further vascular ligation was much higher, indicating a significant difference in procedure duration and need for further intervention (p < 0.05). There were no significant differences in other operational and postoperative statistics between the two groups of patients. Uterine packing patients were more likely to be accepted by the patients (p < 0.05), more satisfied with the surgery (p < 0.001), and more likely to recommend it to others (p < 0.001).
<strong>Conclusion:</strong> Although uterine packing with gauze may require longer time to insert with similar safety to Bakri balloon, yet it is more effective and more acceptable, less costly and readily available.https://ejhm.journals.ekb.eg/article_242763_003b5e3c428685e179e9e93998eac063.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220608Prevalence and Antibiotic Resistance Profiles of Carbapenem-Resistant Klebsiella Pneumoniae Isolated from Tertiary Care Hospital, Egypt2883289024276510.21608/ejhm.2022.242765ENAya A. Al-BazDepartments of 1Medical Microbiology and ImmunologyAref MaaroufUrology, Faculty of Medicine, Zagazig University, EgyptAyman MareiDepartments of 1Medical Microbiology and ImmunologyAlshimaa L. AbdallahDepartments of 1Medical Microbiology and ImmunologyJournal Article20220123<strong>Background: </strong>Carbapenem-resistant <em>Klebsiella pneumoniae</em>(CR-Kp) dissemination is a major healthcare problem due to its limited treatment options.<br /> <strong>Objective:</strong> This study aimed to determine the prevalence and antimicrobial resistance profile of hospital infections caused by CR-Kp in Al-Ahrar Teaching Hospital. The study was conducted through the period from January 1, 2021 to December 31, 2021.<br /> <strong>Patients and Methods:</strong> 650 clinical samples were collected from different ICU departments.<em>Klebsiella pneumoniae </em>isolates were identified by conventional methods. Susceptibility to carbapenems and other antibiotics was determined by disk diffusion method.<br /> <strong>Results: </strong>Out of 650 clinical specimens, 142 <em>K. pneumoniae </em>were isolated with an isolation rate of 21.8%. <em>K. pneumoniae</em> showed that the majority (60.6%) of isolates were extensively-drug resistant (XDR), while 30.3% were multidrug resistant (MDR) and only 9.2% were susceptible. By disk diffusion method, the incidence of CR-Kp was 25.4% (36/142). Antibiotic susceptibility test showed that 100% of CR-Kp isolates were resistant to Amoxicillin/Clavulanic acid, Ampicillin/Sulbactam, Pipracillin/Tazobactam, cefepime, ceftriaxone, cefotaxime, cefoxitin, ceftazidime and nitrofurantoin. High rate of resistance was also evident to aztreonam, norfloxacin (88.9%, for each) and amikacin (61.1%). Levofloxacin owned the lowest resistance rate (30.6%), followed by ciprofloxacin (44.4%) and gentamycin (47.2%). Antibiotic resistance pattern of isolated CR-Kpshowed that the majority of the isolates (97.2%) were XDR, while only 2.8% were MDR.<br /> <strong>Conclusion: </strong>Aboutquarter of <em>K. pneumoniae</em> isolates were carbapenem-resistant with predominance of XDR isolates whichrepresents a warning sign for which application of antibiotic stewardship is mandatory as well as strict infection control policies for prevention of development of pan-drug resistant bacteria.https://ejhm.journals.ekb.eg/article_242765_7bb4512ba9ccc76fa31a5ea4f0597eee.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220601The Results of Fragment-Specific Fixation for Treatment of Intra-Articular Distal Radius Fractures2891289624276810.21608/ejhm.2022.242768ENMohammed Raafat KhalilOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptAbdelsalam Eid Abdelsalam,Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptMohamed Mansour ElzohairyOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptAhmed Mashhour GaberOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20220123<strong>Background:</strong> Distal radius and ulna fractures are the most common fracture in adults representing 44% of all fractures. Fragment-specific fixation can be a useful tool in treating distal radius fractures. <br /> <strong>Objective:</strong> The aim of the present study was to evaluate the results of treating intra-articular distal radius fractures with fragment-specific fixation to provide good functional outcome.<br /> <strong>Patients and methods:</strong> This prospective study included 36 patients with distal radial fractures. They were admitted and operated in the Casualty Unit of the Orthopedic Department, Zagazig University Hospitals. The average time of follow up period of the cases was 9 months. <strong>Results:</strong> Age was distributed as 39.5 ± 9.17 years, male were 61.1% and dominant right were in 88.9%. Mayo score distribution at different time among studied group was significant increase from 6 weeks to 3 months and to 6 months. There was significant increase in range of motion distribution from 6 weeks & 3 months to 6 months. There was significant increase in grip strength distribution from 6 weeks & 3 months to 6 months. Overall complicated cases were 6 cases. Complicated cases were significantly associated with longer union time and significant delayed return to work. <strong>Conclusion:</strong> Fragment-specific fixation is a valuable technique for intra articular distal radius fractures in well planned and selected patients. As it achieves a high rate of union and good functional outcome on follow up and it allows excellent grip strength and range of motion of wrist joint.https://ejhm.journals.ekb.eg/article_242768_0699ec1072956e4f96e61ed3ad9af0ba.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220608Alopecia Areata: An Overview of the Disease and its Genetic Basis: Review Article2897290324277110.21608/ejhm.2022.242771ENRaghda Atef Abd ElshafyDepartments of 1Dermatology, Venereology, and AndrologyNaglaa Ali Khalifa2Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkia, EgyptRasha Mohamed BesherDepartment of 3Dermatology, Al-Ahrar Teaching Hospital, Sharkia, EgyptMahmoud Yousry M. Abdel MawlaDepartments of 1Dermatology, Venereology, and AndrologyJournal Article20220123<strong>Background</strong>: Alopecia areata (AA) is a frequent, reversible kind of hair loss. It is commonly seen as patchy regions of full hair loss on the scalp and other body parts that might lead to complete loss of all body hair. The condition is characterized by localized inflammatory lesions with perifollicular T-cell infiltrates, demonstrating the importance of local cytokine generation in the formation of patchy hair loss. IL-1β is a major inhibitor of hair development in vitro. Its impact is blocked by the interleukin-1 receptor antagonist, IL-1ra.<br /> <strong>Objective</strong>: To review the epidemiology, clinical characteristics, pathogenesis, and associated genetic factors and the emerging therapeutics for AA in this review article. Greater knowledge of the disease pathophysiology may contribute to establishing novel medicines that are more targeted and effective against AA. <br /> <strong>Methodology</strong>: The databases were searched for articles published in English in 3 databases [PubMed – Google scholar science direct] and Boolean operators (AND, OR, NOT) had been used such as [Alopecia Areata AND Genetic Polymorphisms OR Overview] and in peer-reviewed articles between January 2001 and May 2022.<br /> <strong>Conclusion</strong>: Comprehensive understanding of the genetic basis of AA may mediate an efficient therapeutic approach for managing and treating this life quality affecting condition.https://ejhm.journals.ekb.eg/article_242771_dc43e164382ee0f74fedb741bed73222.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Evaluation of Anatomical Characteristics of Cesarean Scar Niche by Sonohysterography and Diagnostic Hysteroscopy in Women with Secondary Infertility2904290924299310.21608/ejhm.2022.242993ENUsama Helmy AlmarzukiObstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Sharkia, EgyptTaha Abdel Fattah AhmedObstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Sharkia, EgyptTarek Mohamed AlBehedyObstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Sharkia, EgyptHussein Mohamed Abdel DayemObstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Sharkia, EgyptJournal Article20220123<strong>Background:</strong> Cesarean section complications are becoming more common as cesarean scar defects.<br /> <strong>Objective:</strong> This study aimed to evaluate the anatomical characteristics of cesarean scar niche by diagnostic hysteroscopy and sonohysterography in women with unexplained secondary infertility.<br /> <strong>Patients and methods:</strong> This observational cross-sectional study included 100 women who attended our outpatient clinic, complaining of unexplained secondary infertility with a history of at least one CS and showing scar niche in office hysteroscopy followed by re-assessment by saline infusion sonohysterography with the evaluation of scar depth, width, and shape in both methods.<br /> <strong>Results: </strong>The present work revealed that 45 cases had unhealthy (fibrotic) scars, 41 cases had collected blood in the niche, 24 cases had infected scars, 5 cases had endometritis, and 4 cases had a small submucosal polyp, as well as one case, had a small uterine septum. There were 32 cases with post-menstrualspotting, the mean duration of post-menstrualspotting was 2.5 days (±0.9 SD), 19 cases had chronicpelvic pain, 15 cases had both post-menstrualspotting and chronic pelvic pain, 12 cases had dyspareunia. There were 25, 31, and 44 cases that had 2ry infertility ≥ 1, ≥ 2, and ≥ 3 years respectively. There was a non-significant correlation between features of the niche through diagnostic hysteroscopy and correlated symptoms.<br /> <strong>Conclusion:</strong> Cesarean scar may play an intermediate role in fertility. Hysteroscopy is considered the golden standard tool for the diagnosis of different intrauterine lesions, however; the procedure of sonohysterography is well-tolerated, cost-effective, and can be performed in an office-based gynecological practice, and doesn’t require special training.https://ejhm.journals.ekb.eg/article_242993_d3206d00ac3c4b898882ae9749c78eff.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Anatomical Repair Versus Intra Peritoneal Mesh Repair of Umbilical and Paraumbilical Hernia in Ascitic Patients: Randomized Controlled Study2910291624299410.21608/ejhm.2022.242994ENAbdel-Rahman AlbahyDepartments of 1General SurgeryMohamed ElsaidDepartments of 1General SurgeryAhmed NegmDepartments of 1General SurgeryAbdel-Rahman Mokhtar2Hepatology and Gastroentrology,
Faculty of Medicine, Mansoura University, EgyptAbdelAzim ElGanshDepartments of 1General SurgeryMohamed ShetewyDepartments of 1General SurgeryJournal Article20220127<strong>Background:</strong> Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites, having a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, mesh repair is associated with lower recurrence rate, but with higher surgical site infection when compared to conventional fascial suture. Intraperitoneal mesh repair has advantages of avoiding recurrence, decreasing ascetic leak and wound infection.<br /> <strong>Objective:</strong> The purpose of this study was to compare the safety and effectiveness of surgical management of umbilical and paraumbilical hernia via anatomical repair and intraperitoneal mesh repair in relation to conservative treatment in ascetic patients.<br /> <strong>Patients and methods:</strong> This randomized controlled study included 94 patients presented with umbilical and paraumbilical hernia with ascites. The study was conducted in Mansoura University Hospitals through the period from 2016 to 2018. The patients were divided randomly into 3 groups; Conservative treatment group (28 cases), anatomical repair group (36 cases) and intraperitoneal mesh repair via composite mesh group (30 cases). Comparison was done for effectiveness and complications.<br /> <strong>Results: </strong>Conservative treatment had high rate of complications (60%) and deterioration of hepatic condition (18%), elective surgical correction appeared more safe, intraperitoneal composite mesh repair decreased leak and significantly reduced recurrence and associated complications compared to anatomical repair (17% versus 3%).<br /> <strong>Conclusion:</strong> Both elective anatomical repair and intraperitoneal mesh repair of umbilical and paraumbilical hernia in ascetic patients were safer and better than conservative treatment. Intraperitoneal mesh repair has advantages of avoiding recurrence and decreasing ascetic leak.https://ejhm.journals.ekb.eg/article_242994_dfc7a916e4cbed51ae5283014f13f2e6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Relationship between Monocyte to High Density Lipoprotein Cholesterol Ratio and Coronary Artery Tortuosity2917292224299510.21608/ejhm.2022.242995ENTarek Ahmed NaguibDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptEl Sayed Mohamad FaragDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptMohammad Abd Allah El TahlawiDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptAhmed Fathy ShawkyDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptJournal Article20220124<strong>Background:</strong> Coronary artery tortuosity (CorT) is a prevalent angiographic finding commonly associated with aging, hypertension, atherosclerosis and other cardiovascular conditions. It has been suggested that coronary artery tortuosity causes alteration in blood flow and reduction in coronary artery pressure distal to the tortuous segment and can thus lead to ischemia.<br /> <strong>Objective:</strong> This study aimed to find the relationship between monocytes to high density lipoprotein cholesterol ratio (MHR) and isolated coronary artery tortuosity (CorT) without obstructive coronary artery disease (CAD). <strong>Patients and Methods:</strong> This study is an observational retrospective case control study that was performed in National Heart Institute and Zagazig University Hospital between January 2018 and January 2020 for patients with stable coronary artery disease that underwent coronary angiography. In this study 60 patients with chronic stable angina were enrolled, 30 patients showed Cor-T without obstructive CAD (cases) on coronary angiography, while the other 30 patients showed normal coronaries (Control).<br /> <strong>Results</strong>: The most two predictable factors for the detection of Cor-T are MHR and C-reactive protein (CRP). In Cor-T group there was a significant positive correlation between the number of tortuous vessels and the MHR with P-value <0.001, the more number of tortuous vessels the higher MHR. <br /> <strong>Conclusions: </strong>The relationships between the noninvasive laboratory index MHR and coronary artery tortuosity is significant. These findings consider MHR as an accurate, quantitative, non-invasive, highly available and non-expensive parameter for the prediction and detection of Cor-T and may be useful for risk stratification.https://ejhm.journals.ekb.eg/article_242995_83808ce38371f2053d211e1c463f6632.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Reno Protective Effect of Sodium Glucose Cotransporter-2 Inhibitor (Dapagliflozin) in Type 2 Diabetic Patients2923292924299610.21608/ejhm.2022.242996ENRasha O. AbdelmoniemDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptMarwa S. ShaalanDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptM. ShawkyDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptWalaa M. LbrahimDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptAyman M. ElbadawyDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptJournal Article20220609<strong>Background: </strong>Many studies reported a renal protection by sodium glucose cotransporter-2 inhibitor (SGLT2i) using in Type 2 diabetes mellitus (T2DM). <strong>Objective:</strong> Our study was designed to evaluate the renal benefit offered by SGLT2 inhibitor (dapagliflozin) in type 2 diabetic patients.<strong> Patients and Methods</strong>: 100 diabetic patients, 50 treated by dapagliflozin 10 mg once daily for 12 months and 50 treated by placebo for the same period. Patients were recruited from those attending Endocrinology Unit in Benha University Hospital. Clinical and laboratory data were performed to patients who were followed up every 3 months for 1 year.<strong> Results:</strong> No significant difference among the two groups regarding age, sex, residence, and the common adverse effects. Urinary albumin/creatinine ratio was statistically lower in SGLT2i group compared to placebo group at the end of the study but was non-significant at base line. Estimated glomerular filtration rate (eGFR) was statistically higher in SGLT2i group compared to placebo group at the end of the study although there was non-significant difference at base line. No significant difference between the two groups regarding HbA1c at base line, 3 and 6 months later but was statistically lower in SGLT2i group after 9 months and 1 year. BMI, SBP and DBP were statistically lower in SGLT2i group at the end of the study but there was non-significant difference at base line.<strong> Conclusion</strong>: We found reno protective properties by using sodium glucose cotransporter-2 inhibitor (dapagliflozin) in type 2 diabetic patients, a great impact on glycemic control and other pleiotropic effects without significant differences regarding common adverse effects.https://ejhm.journals.ekb.eg/article_242996_2c772584325056af3dca97a61cb9af8f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Outcomes of Two Surgical Techniques for Mid-Shaft Clavicle Fractures Fixation2930293624299710.21608/ejhm.2022.242997ENHusayn Jamal Ahseen AbraydahDepartment of Orthopedics, Faculty of Medicine, Zagazig University, EgyptAdel Mohammed SalamaDepartment of Orthopedics, Faculty of Medicine, Zagazig University, EgyptMohamed AbdAlla M. AbdelsalamDepartment of Orthopedics, Faculty of Medicine, Zagazig University, EgyptAhmed Hatem Farhan ImamDepartment of Orthopedics, Faculty of Medicine, Zagazig University, EgyptJournal Article20220124<strong>Background:</strong> Fractures of the clavicle account for 44% of injuries around the shoulder girdle, several techniques of fixation have been described in literature, including the use of plates, Kirschner wires, Steinman pins, external fixators and even plaster constructs.<br /> <strong>Objective: </strong>The purpose of this prospective cohort study was to compare the outcomes of intra-medullary fixation and plating in the treatment of mid-shaft clavicle fractures.<br /> <strong>Patients and Methods:</strong> In this study, 24 patients ranging in age from 18 to 60 were enrolled. They were split into two groups and given intra-medullary nailing or plating as their treatment options. Comparison of the two groups' outcomes and complications was done.<br /> <strong>Results: </strong>The nail group's union time was markedly reduced. In terms of the functional outcome, as measured by the Quick DASH Score, there was no significant difference between groups. A higher rate of infection and nonunion was found in those who used plates, although there was no statistically significant difference between the groups. The nail group had much more skin irritation (hardware prominence) than the control group. When compared to the plate group, patient dissatisfaction was much higher due to scar development.<br /> <strong>Conclusion: </strong>It is possible to employ intra-medullary fixation in the treatment of mid-shaft clavicle fractures as a viable alternative to plate fixation since it is a minimally invasive procedure with fewer risks, faster healing, and better cosmetic and functional outcomes.https://ejhm.journals.ekb.eg/article_242997_54e361bf440a024467c0b0745be95066.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Incidence of Hyperammonemia among High-Risk Infants Admitted to Pediatric Intensive Care Unit2936294124299810.21608/ejhm.2022.242998ENMohamed Mamdouh GaafarPediatrics Department, Faculty of Medicine, Zagazig University, EgyptAli Ahmed MohammedPediatrics Department, Faculty of Medicine, Zagazig University, EgyptWesam A. MokhtarPediatrics Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20220109<strong>Introduction: </strong>Severe liver failure and inborn metabolic abnormalities produce hyperammonemia in children. Because of the pre-analytical challenges that must be properly controlled, achieving valid plasma ammonia levels in acute instances might be difficult.<br /> <strong>Objective: </strong>The aim of the present study was to estimate the prevalence of plasma ammonia levels among high risk infants admitted to pediatric intensive care unit (PICU).<br /> <strong>Patients and Methods: </strong>A cross-sectional study was carried out at NICU in Pediatric Department at Zagazig University Children Hospital. This study involved 60 neonates and children who were subjected to full medical history, thorough clinical examination and laboratory investigations. Frequency of suspected and confirmed inborn errors of metabolism (IEMs) cases was assessed.<br /> <strong>Results:</strong>The mean age was 2.15±1.89 years and weight was 8.95±6.56, 50.0% were male, regarding mode of delivery in 66.7% was cesarean section (CS). 48.3% had consanguinity. The main complaints for patients were respiratory distress (51.7%), convulsion (33.3%) and encephalopathy (10%) and the hyperammonemia was detected in 25% of the studied group. The hyperammonemia was detected in 66.7% of the confirmed IEM cases. About 16 cases (26.7%) of the studied group, unfortunately, died while 73.3% survived.<br /> <strong>Conclusion: </strong>Hyperammonemia represented a one of the main significant cause of sick infants' admission to PICU. Hyperammonemia must be rapidly suspected in case of neurologic symptoms in pediatrics. An adequate management should start rapidly as coma duration and ammonia peak level.https://ejhm.journals.ekb.eg/article_242998_847be75ffabb6c8b8e27ff99d914766e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Efficacy of Ezetimibe as Monotherapy in Hypercholesterolemic Patients with and without Diabetes: A Randomized Controlled Clinical Trial2942294724299910.21608/ejhm.2022.242999ENYasmine Farouk ShamseldinDepartment of 1Clinical Pharmacy, Faculty of Pharmacy, Misr University for Science and Technology, Giza, EgyptAmal Kamal HusseinDepartments of 2Pharmaceutics andEman Mohamed Sadek3Clinical Pharmacy, Faculty of Pharmacy, Minia University, EgyptHassan ShalabyDepartments of 4Gastroenterology and EndoscopyHoussam Mowafi5Critical Care, Faculty of Medicine, Misr University for Science and Technology, EgyptJournal Article20220130<strong>Background: </strong>Hyperlipidemia, hypertension, and diabetes are common diseases in the elderly. They are the main factor of cardiovascular disease and thus increase the risk of mortality. Recently, the death rate caused by COVID-19 is not predictable but has been increased by many factors, including age, hyperlipidemia, diabetes mellitus, obesity, and cardiovascular disorders.<br /> <strong>Objective: </strong>Since many patients with these conditions are under lipid-lowering therapy, we carried out this study to evaluate the effect of ezetimibe on hyperlipidemia in patients with type 2 diabetes mellitus, non-diabetic, and COVID-19.<br /> <strong>Patients and methods: </strong>In this study, 13 hypercholesterolemic patients were categorized per disease suffering from (Diabetes, non-diabetic and COVID-19). All patients were administered 10 mg of ezetimibe each day for 90 days. Afterward, their lipid profile was measured at baseline and then after 30, 60, and 90 days. Plasma total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL), and very-low-density lipoprotein (VLDL) were measured.<br /> <strong>Results: </strong>HDL increased in diabetic and hypertensive patients by 24% and 6.2 % but decreased in the COVID patients by 1.29 %, in response to ezetimibe. Total Cholesterol and LDL decreased by 39.64 %, 30.32 % & 58.58% and 38.4 %, 25.33%, & 54.93 %, respectively. Results showed a considerable increase in triglyceride concentration by 13.5% and 23 % at 30 and 90 days of treatment in COVID-19 patients.<br /> <strong>Conclusion: </strong>These findings reveal that ezetimibe was an effective treatment of hyperlipidemia among diabetic patients. In addition Sars-CoV-2 might be a factor interacting with hyperlipidemia-reducing therapy and lower ezetimibe efficacy. However, larger cohort studies are required to confirm these findings.https://ejhm.journals.ekb.eg/article_242999_87ea51d5470af77ee81d50276aaeffb8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Non-Traditional Predictors for Occurrence and Severity of Premature Atherosclerosis in Acute Coronary Syndrome2948295424300110.21608/ejhm.2022.243001ENRehab Rashad IbrahimDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptKhalid Tammam, Salwa Mohammed GhoneimDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptSalwa Mohammed GhoneimDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptEl Sayed Mohammed FaragDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptAlaa Elsayed SalamaDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptJournal Article20220127<strong>Background: </strong>Several non-traditional factors are associated with increased risk of atherosclerosis among patients with acute coronary syndrome (ACS). <strong>Objective:</strong> This study aimed to detect predictors for the premature atherosclerosis in patients less or equal than 45 years old in men and less than 55 years old in female and severity of premature atherosclerosis in acute coronary syndrome. <strong>Patients and methods:</strong> This cross-sectional study included 105 patients with acute coronary syndrome attended for angiography at Cardiology Department, Zagazig University Hospitals. Patients were divided equally into: Group (I) included young patient having traditional risk factors only with acute coronary syndrome, group (II) included young patients having nontraditional risk factors only such as Apo A-I and Apo B and increased lymphocyte to monocyte ratio with acute coronary syndrome and group (III) that included young patient having both traditional and non-traditional risk factors such as ApoA-I, m Apo B and increased lymphocyte to monocyte ratio with acute coronary syndrome. In all groups severity of atherosclerosis was assessed by Gensini score system.<br /> <strong>Results:</strong> About 2/3 of acute coronary syndrome with traditional risk factors group (62.9%) had severe atherosclerosis, with high statistically significant difference between the 3 groups. Hypertension was the only significant traditional factor in relation to severity of atherosclerosis. Also, obese patients had severe atherosclerosis 5 times more than non-obese. Odds of having severe atherosclerosis was 2.66 times more among males than females. <strong>Conclusion:</strong> A variety of significant non-traditional risk factors place patients at higher risk for ACS. We recommend taking these factors in consideration as regards assessment of occurrence and severity of premature atherosclerosis and ACS.https://ejhm.journals.ekb.eg/article_243001_df2077da6ecd7c038bc25099e39eb523.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Results of Closure of Patent Ductus Arteriosus in Adult Population Using Cardiopulmonary Bypass2955295724300310.21608/ejhm.2022.243003ENAhmad AbdelAleem ElDerieDepartment of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Dakahlia EgyptHatem Abdelmoneim ElsorogyDepartment of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Dakahlia EgyptMohammed Abdel-Fattah SanadDepartment of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Dakahlia EgyptGehad Ibrahim AwadDepartment of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Dakahlia EgyptJournal Article20220201<strong>Background: </strong>Surgical repair of patent ductus arteriosus (PDA) in adults is more challenging compared to children. This study was conducted to report our experience using cardiopulmonary bypass (CPB) in adult cases with PDA.<br /> <strong>Aim of the work: </strong>The objective of this study is to evaluate the safety and efficacy of the usage of the cardiopulmonary bypass in management of PDA in the adult population, not suitable for trans-catheter closure.<br /> <strong>Patients and methods: </strong>This is a retrospective study that included all adult cases with PDA who had surgical closure for 5 years <strong>(</strong>July 2014 to July 2019) at the Cardiothoracic Surgery Department at Mansoura University, Egypt. All demographic, clinical, and Echo-derived data were collected, <strong>New York Heart Association</strong> (NYHA) class was calculated for all cases before operation. All cases underwent PDA repair using CBP. Postoperatively, clinical and radiological assessments were performed 6 months after surgery.<br /> <strong>Results:</strong> The study included a total of 10 cases (7 males and 3 females). Their mean age was 32.2 years. Eight cases of them had NYHA class II, and the remaining cases had NYHA class III. Direct closure was performed in 6 cases (60%), and the other 4 cases had patch closure. The mean CBP and aortic clamping times were 97 and 45.5 minutes respectively. The mean esophageal temperature was 30.50 ºC. Neither mortality nor reoperation was encountered in the current study. Six months after the operation, pulmonary artery pressure decreased from 43.6 mmHg down to 25 mmHg and NYHA class I was present in 8 cases while the other 2 cases had NYHA class II. <strong>Conclusions:</strong> A cardiopulmonary bypass is a safe option for adult cases with patent ductus arteriosus unsuitable for percutaneous or minimally invasive closure.https://ejhm.journals.ekb.eg/article_243003_33b51bc69d1d0237ed22a588ad1af3c6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Difference between Oral Isosorbide Mononitrate & Sildenafil Citrate Therapy in Reducing Umbilical Artery Doppler Indices in Pregnancies with Fetal Growth Restriction; A Prospective Randomized Control Trial2958296324300410.21608/ejhm.2022.243004ENPaul NaseefObstetrics and Gynaecology Department, Faculty of Medicine, Ain shams University, Cairo, EgyptAhmed TharwatObstetrics and Gynaecology Department, Faculty of Medicine, Ain shams University, Cairo, EgyptMortada El SayedObstetrics and Gynaecology Department, Faculty of Medicine, Ain shams University, Cairo, EgyptIhab Abd El FatahObstetrics and Gynaecology Department, Faculty of Medicine, Ain shams University, Cairo, EgyptJournal Article20220130<strong>Background:</strong> Fetal growth restriction (FGR) occurs when a fetus does not attain its genetically assigned expected growth rate. An estimated fetal weight (EFW) or abdominal circumference (AC) below the 10th percentile for gestational age is the ideal definition of this condition.<br /> <strong>Objectives:</strong> This study aimed to compare isosorbide mononitrate and sildenafil citrate therapies in the context of pregnancies complicated by FGR regarding the magnitude of reduction in umbilical artery (UA) Doppler resistance index (RI) in a randomized fashion.<br /> <strong>Patients and Methods:</strong> This research was carried out in the Maternity Hospital of Ain Shams University during the period from March to September 2020. 64 pregnant women with FGR, were recruited from the antenatal clinic. They were subdivided into 2 groups according to a randomization table (Isosorbide mononitrate group versus sildenafil citrate group).<br /> <strong>Results:</strong> The administration of isosorbide mononitrate 30 mg twice daily is as effective as sildenafil citrate 50 mg twice daily in reducing umbilical artery Doppler resistance index (RI), thereby enhancing fetal growth in pregnancies with FGR and in turn reducing the overall perinatal morbidity and mortality caused by iatrogenic prematurity or FGR itself.<br /> <strong>Conclusion:</strong> We recommend the use of isosorbide mononitrate as a therapeutic agent in pregnancies with FGR caused by placental insufficiency.https://ejhm.journals.ekb.eg/article_243004_b1d3f9bd49459f10642bcad22714c8fe.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Role of Tetracycline in Management of Seroma Post-operative in Native Access for Hemodialysis, Post Appendicectomy and Post Mastectomy2964296624300510.21608/ejhm.2022.243005ENMichael Samuel AyadVascular surgery DepartmentMina Makram HendyGeneral Surgery Department, Faculty of Medicine, Minia University, EgyptJournal Article20220118<strong>Background:</strong> Seroma is a frequent surgical complication. Complications include compression of other tissues, infection, and abscesses. Patients with mastectomy, appendicectomy and native access had 4.3%-63% seromas. Seroma commonly occurs after lymphatic channel injury. Tetracycline (TCN) is an antibiotic used to treat illnesses such as acne, cholera, brucellosis, plague, malaria, and syphilis. It is an effective topical sclerosing agent.<br /> <strong>Objective: </strong>The present study aimed to determine the role of tetracycline in management of post-operative seroma in native access for haemodialysis, post-appendicectomy and post-mastectomy.<br /> <strong>Methods:</strong> This was a prospective cross-sectional study conducted on 104 patients with post-operative seroma at Minya University Hospital and The Good Shepherd Hospital. All patients provided their demographic information. Locally administered tetracycline to a wound. The patients were monitored for post-operative wound problems and seroma healing.<br /> <strong>Results: </strong>Native access patients were 44. Mean age was 45.59 ± 16.75 years. 47.7% were females and 52.3% were males. Diabetes prevalence reached 68.2% and HTN prevalence reached 56.8%. Post-appendicectomy patients were 29. Mean Age was 28.5 ± 7.53 years. 41% were females and 46% were males. 33% of patients had diabetes. Appendicular abscess was recognized in 36% of patients. Post-mastectomy patients were 30. Mean age was 56.6 ± 9.49 years. 96.67% were females. 50% of participants had diabetes.<br /> <strong>Conclusion:</strong> Tetracycline was effective in seroma treatment in most patients with complete improvement in less than 10 days. Only post-mastectomy patients that showed resolve days more than other patients.https://ejhm.journals.ekb.eg/article_243005_0fdae09b68a8f47c48fa8880e37a8799.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Perinatal Outcomes of Pregnancies with Preterm Premature Rupture of Membranes after 34 Weeks of Gestation2967297524300610.21608/ejhm.2022.243006ENWael NossairDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptYoussef Abo Elwan El-SayedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptYasmin Ali El-ShabrawyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptSafaa Abdel-Salam IbrahimDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptJournal Article20220127<strong>Background:</strong> Preterm premature rupture of the membranes (PPROM) is an important contributor to perinatal mortality and morbidity. Neonatal complications are related primarily to the gestational age at rupture of membranes.<br /> <strong>Objective:</strong> The aim of the present study was to improve the perinatal maternal and fetal/neonatal outcomes in cases with preterm premature rupture of membranes between 34 -37 weeks of gestations.<br /> <strong>Patients and methods:</strong> This prospective case control study included 82 women comprised 41 with PPROM (group I) and 41 without ROM as matched controls (group II). All women were presented to maternity unit of Obstetrics and Gynecology Department over 8 months period, at Zagazig University Hospitals.<br /> <strong>Results:</strong> In this study (73.2%) with PPROM were below the age of 30 years. Urinary tract infection was 17.1% versus 12.2 %, cervicitis 4.9% versus 0% in patients with PPROM versus controls respectively. Maternal outcome in this study was evaluated; there were 82.9% of patients with PPROM versus 95.1% discharged from hospital within 4 days after delivery with no bad outcomes. Good Apgar score was (68.3%) in patients with PPROM and 82.9% in control group. In PPROM group; 7 fetuses were diagnosed as fetal distress and only 2 (4.9%) cases had clinical chorioamnionitis. Regarding neonatal morbidity in patients with PPROM, the results showed that respiratory distress syndrome (RDS) was diagnosed in 4 neonates, 7 with tachypnea, 6 with jaundice, and 3 with sepsis and no case of perinatal mortality.<br /> <strong>Conclusion: </strong>With appropriate care, the maternal risks of expectant management after 34 weeks of gestation are generally accepted to be minimal and a clear neonatal advantage exists by reducing risks of neonatal respiratory problems, admission for neonatal intensive care, and cesarean section.https://ejhm.journals.ekb.eg/article_243006_97ec62f2c5bf39ba8da7f7b31bd7d654.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Frequency of Hepatitis C Virus in Pregnancy and Pregnancy Outcome at Al-Ahrar Teaching Hospital, Zagazig, Egypt2976298124300710.21608/ejhm.2022.243007ENAhmed Mohamed AtefDepartment of Obstetrics and Gynecology, Al-Ahrar Teaching Hospital, Zagazig, EgyptSabah Mohamed SaadaDepartment of Obstetrics and Gynecology, Al-Ahrar Teaching Hospital, Zagazig, EgyptDiana Nageeb SalamaDepartment of Obstetrics and Gynecology, Al-Ahrar Teaching Hospital, Zagazig, EgyptAlaa Hassieb ElsadekDepartment of Obstetrics and Gynecology, Al-Ahrar Teaching Hospital, Zagazig, EgyptLoay Mohamed AbdallahDepartment of Obstetrics and Gynecology, Al-Ahrar Teaching Hospital, Zagazig, EgyptJournal Article20220126function in a case of severe liver disease.<br /> <strong>Objective</strong>: The aim of the current work was to assess the frequency of HCV in parturient women and their pregnancy outcome at Al-Ahrar Teaching Hospital.<br /> <strong>Patients and Methods: </strong>This cross-sectional prospective study included a total of 1,135 pregnant women, attending at Obstetrics and Gynecology Department, Al-Ahrar Teaching Hospital, Zagazig. Pregnant women were admitted between 28- and 42-weeks’ gestation. They were tested for HCV+ antibodies using the Rapid Test Technique.<br /> <strong>Results:</strong> The frequency of HCV in pregnant women tested was 7.7%. There were statistically high significant relationships between HCV and occupation, history of blood transfusion, history of HCV treatment, type of previous delivery and laboratory findings among the study cases.<br /> <strong>Conclusion</strong>: It could be concluded that history of HCV treatment, previous operations, risky occupations, blood transfusion and family history of HCV are risk factors for HCV infection.https://ejhm.journals.ekb.eg/article_243007_df1e7da524087447ef062c5b4d116d7f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609The Metabolic Syndrome in Survivors of Acute Lymphoblastic Leukemia of Pediatrics Patients at Zagazig University Hospitals2982298924300810.21608/ejhm.2022.243008ENAbeer Atef MohamedDepartments of 1PediatricsElhamy Rifky AbdelkhalekDepartments of 1PediatricsMohamed Refaat BeshirDepartments of 1PediatricsThoraya Hosny2Clinical Pathology, Faculty of Medicine, Zagazig University, EgyptJournal Article20220126<strong>Background:</strong> Insulin resistance is considered to be of the major causes of the metabolic syndrome. There is a growing body of evidence showing that treatment for Acute Lymphoblastic Leukemia (ALL) has side effects.<br /> <strong>Objective:</strong> The aim of the current work was to detect the prevalence of metabolic syndrome in survivors of childhood ALL to determine the relationship between metabolic syndrome and growth parameters in ALL survivors.<br /> <strong>Patients and methods:</strong> This cross-sectional study included a total of twenty-four ALL survivors, attending at Pediatrics Hematology and Oncology Unit, Faculty of Medicine, Zagazig University Hospitals. Full clinical examination as well as laboratory investigations including estimation of serum insulin, total cholesterol, triglycerides, HDLc, LDLc, fasting plasma glucose were done for all patients.<br /> <strong>Results:</strong> Obesity was significantly higher among metabolic syndrome (MS) cases. Patients with metabolic syndrome in ALL showed greater systolic and diastolic blood pressure than those without metabolic syndrome. It was found that children with metabolic syndrome had higher fasting plasma insulin levels and fasting plasma glucose levels than those without the syndrome. ALL patients who had metabolic syndrome had higher triglyceride levels than those without MS.<br /> <strong>Conclusion:</strong> It could be concluded that ALL survivors are at an elevated risk for metabolic syndrome, as the increased risk for obesity and disturbed lipid profile in those patients.https://ejhm.journals.ekb.eg/article_243008_be21cbd1c4fa154f3ab2be47b118ce81.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Comparison between Transabdominal Preperitoneal Approach and the Totally Extraperitoneal Approach for Inguinal Hernia Repair on the Effect on Testicular Blood Flow2990299524301010.21608/ejhm.2022.243010ENAbdel-Rahman AlbahyDepartments of 1General SurgeryMohamed Abu SheashaDepartments of 1General SurgeryAhmed ElghriebDepartments of 1General SurgeryMohamed El-Adalany2Diagnostic Radiology, Faculty of Medicine, Mansoura University, EgyptMagdy BeshirDepartments of 1General SurgeryJournal Article20220125<strong>Background</strong>: Inguinal hernia repairs are one of the most common procedures performed in general surgery departments. Various techniques have been used to repair inguinal hernias. But now only 3 methods are generally accepted as the best evidence-based treatment options for inguinal hernia repair: the Shouldice technique, Lichtenstein tension-free repair and laparoscopic repair either via the transabdominal preperitoneal (TAPP) approach or the totally extraperitoneal (TEP) approach. There is limited number of studies that have compared the effects of both techniques on the spermatic cord and testicular functions in long term. <strong>Objective:</strong> The aim of the current work was to compare the effect of laparoscopic inguinal hernioplasty either totally extraperitoneal (TEP) approach or transabdominal preperitoneal (TAPP) approach on testicular blood flow and volume on the same side of the hernia repair.<br /> <strong>Patients and methods</strong>: This prospective study was performed on <strong>47 </strong>male patients admitted to general surgery ward at Mansoura University Hospital between February 2019 and February 2020 with clinically diagnosed inguinal hernias and fulfilling the eligibility criteria. The study population was distributed into 2 groups by computer generating program; Group A that included <strong>28</strong> patients with inguinal hernia who were operated by laparoscopic techniques (TAPP) approach and group <strong>B</strong> that included <strong>19</strong> patients with inguinal hernia who were operated laparoscopically by (TEP) approach.<br /> <strong>Results:</strong> There is non-statistically significant higher improvement in resistive index (RI) in TEP group than TAPP at levels of Testicular and Capsular Artery but the same percentage of improvement at the level of intratesticular artery.<br /> <strong>Conclusion: </strong>It could be concluded that laparoscopic inguinal hernioplasty either TAPP or TEP approaches are safe regarding testicular blood flow but also, they improve it.https://ejhm.journals.ekb.eg/article_243010_cb28eb97032ee5511305ef21c05efa19.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220609Spacers versus Nebulizers in Treatment of Acute Asthma A Prospective Randomized Study in Preschool Children2996299924301210.21608/ejhm.2022.243012ENMohamed B. Hamza1Pediatric pulmonology DepartmentAhmed Ibrahim Harkan2Pediatric ICU Department, Faculty of Medicine, Tanta University, EgyptJournal Article20220101<strong>Background:</strong> Asthma affects approximately 14 million adult Americans and is responsible for over 450,000 hospitalizations each year. Every year, approximately 1.8 million asthma patients visit the emergency department. Aerosol delivery to mechanically ventilated patients utilizing nebulizers or metered dose inhalers (MDI) with spacers has been shown to be feasible and beneficial. <strong> Aim and Objectives:</strong> The goal of this study was to analyse MDI aerosol administration with spacer delivery and nebulizer among preschool kids.<br /> <strong>Material and Methods:</strong> A randomized, double-blind medical experiment involving 200 preschool children were divided into 2 groups received active drug either by nebulizer (group 1=100 patients) or MDI-spacer (group 2=100 patients). Assessment was done including clinical history, medications history, height, weight and BMI. All of the following parameters were measured: heart rate, respiratory rate, and arterial oxygen saturation while the children were awake and breathing room air. FEV1 was calculated using a portable spirometer. These clinical and laboratory tests were performed 10, 20, and 40 minutes after using the nebulizer. <strong>Results:</strong> The mean age in months was 25.4 ± 12.7 among group 1 and 26.6 ± 11.6 among group 2. Group 1 included 43% males and 57% females while group 2 included 52% males and 48% females. The mean BMI for age z score in group 1 was 0.31 & 0.97 and 0.32 & 0.89 in group 2. There was a statistically substantial variation between the two groups in terms of FEV1. In terms of heart rate, respiratory rate oxygen saturation, or hospital stay duration, there was no statistically substantial variation between the two groups.<br /> <strong>Conclusion:</strong> The MDI-spacer and the nebulizer both delivered salbutamol equally well aerosol therapy to preschool children suffering from wheezes and acute asthma exacerbations. The spacer had higher effect on FEV1 than nebulizer but there was no difference regarding oxygen saturation and hospital stay duration.https://ejhm.journals.ekb.eg/article_243012_270d525f5d18fcd7e22ef4a2a8bf6654.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Patterns and Outcome of Autoimmune Chronic Liver Diseases in Assiut University Hospital: A Retrospective Study3000300424452810.21608/ejhm.2022.244528ENAdnan Ahmed MohamedMohammed Abd El Sabour Mohamed MekkyYomna Hammam Abo El-WafaAhmed Abu-ElfatthDepartment of Gastroenterology and Tropical Medicine, Assiut University, Assiut, EgyptJournal Article20220617<strong>Background& aim: </strong>Autoimmune liver diseases (AILD) are relatively low diseases but their pattern and outcome are still unclear. It includes primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH). The current study was conducted to assess pattern of AILDs in our locality<br /> <strong>Methods: </strong>This retrospective study was conducted between 2016 and 2019 in Tropical Medicine and Gastroenterology Department, Assiut University Hospitals. In addition to characteristics of patients, types and outcome of AILDs were registered.<br /> <strong>Results:</strong> A total of 1750 patients with various chronic liver diseases were identified only 2.9% of those patients had different types of AILDs, as follows: 40 patients had AIH, 6 patients had PSC, and 4 patients had PBC, 80% of them were females. <strong>Conclusion:</strong> AILDs are still underappreciated in our community. Patients with unexplained abnormalities in liver functions should be suspected of having such diseases. Future multi-center studies on this topic are necessary.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244528_eb69bbb1307db1b694abba88a9c0080b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Protective Effect of Hesperidin on Kidneys and Testes of Adult Male Rats Exposed to Bisphenol A3005301324452910.21608/ejhm.2022.244529ENSara E. KasemAmira A. AbdelnabyPalqees A. MohammedShimaa B. HemdanRasha M. Z. Abd El-FattahReda M. ElsayedJournal Article20220617<strong>Background: </strong>Bisphenol A, a global environmental pollutant, has been reported to induce organs toxicity. Hesperidin is a flavanone glycoside which is found in citrus fruits. It has antioxidant properties; so it can protect cells from oxidative stress. <strong>Objectives</strong>: The current study aimed to investigate the toxic effects of bisphenol A on the kidneys and testes after repeated oral dose and evaluate the possible protective effect of hesperidin when co-administered with it.<br /> <strong>Materials and Methods: </strong>Forty-two adult male albino rats were divided into four groups: Group I (Control group), Group II (Hesperidin only group) received hesperidin orally at the dose of 200 mg /kg /day. Group III (Bisphenol only group) treated orally with bisphenol A at dose 160 mg /kg /day. Group IV (Bisphenol& hesperidin group) received bisphenol A and hesperidin. After two months, all animals were sacrificed, and blood was collected for analysis (kidney functions and hormones level). The kidneys and testes were preserved for histopathological examination.<br /> <strong>Results: </strong>Repeated oral administration ofbisphenol A induced statistically significant increase inthe level of urea and creatinine, statistically significant decrease in serum level of FSH, LH and testosterone. Histopathological examination of kidneys and testesrevealed multiple histopathological changes. These toxic effects declined markedly when hesperidin was co-administered with bisphenol A.<br /> <strong>Conclusion: </strong>The present study concluded that bisphenol A has many toxic effects on kidneys and testes both structurally and functionally and hesperidin has a protective role against such harmful effects.<br /> <br /> <strong> </strong><br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244529_a3f9deedbcbc19864f790a380d87abc8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Treatment of Open Femoral Fracture with Bone Loss: Review Article3014302124453010.21608/ejhm.2022.244530ENAhmed El-Sayed Soliman MohamedMohamed Ahmed Abdallah Mohamed GharibWael Mansour AbdElsamiae AbdallahMohamed Soliman HamedMohamed Aly Abdelraouf AmmarJournal Article20220617<strong>Background: </strong>Attempting limb reconstruction in the presence of critical bone loss usually involves surgery which had technically difficult, time-consuming, physically, and psychologically demanding for the case, with no guarantee of a satisfactory outcome. The function of the salvaged limb might be disappointing due to residual pain, joint stiffness, and neurovascular deficit. The case might require a secondary amputation due to refractory disease or non-union. Thus, the correct initial decision as to whether to embark upon limb reconstruction or to perform a primary amputation had important but difficult.<br /> <strong>Objective: </strong>The aim of this essay had to evaluate various treatment options for open femoral fracture with bone loss regarding, different methods to compensate for bone loss, and the complications of each one.<br /> <strong>Methods:</strong> PubMed, Google Scholar, and Science Direct were searched using the following keywords: Treatment of open femoral fracture, Bone loss, and Bone loss and complications. The authors also screened references from the relevant literature, including all the identified studies and reviews, only the most recent or complete study was included between June 2000 and December 2020. Documents in a language apart from English have been excluded as sources for interpretation were not found. Papers apart from main scientific studies had been excluded: documents unavailable as total written text, conversation, conference abstract papers, and dissertations.<br /> <strong>Conclusion: </strong>Bone loss had a relatively uncommon problem encountered in the treatment of open fractures, and usually occurs in the femur and tibia. The majority of defects had small and could be managed with standard methods of fixation, and autogenous bone grafting. Larger defects with complex soft-tissue problems could be managed by shortening, fixation with later lengthening.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244530_a042467b65624beed09eb8609b9b02ed.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Sonography Assessment of Amniotic Fluid Volume as a Predictor of Fetal Outcome in Low-Risk Pregnancy3022302824453110.21608/ejhm.2022.244531ENAlaa Hassieb ElsadekAhmed Mohamed AtefDiana Nageeb SalamaLoay Mohamed AbdallahSabah Mohamed SaadaJournal Article20220617<strong>Background</strong>: An essential component of the amniotic sac, amniotic fluid (AF) aids in the growth of the developing fetus. The volume of amniotic fluid (AFV) can be measured using a variety of methods. <strong>Objective</strong>: To determine which is better in assessment of amniotic fluid volume, amniotic fluid index technique (AFI) or single deepest vertical pocket technique (SDVP) for prediction of fetal outcome in low-risk pregnancies.<br /> <strong>Patients and Methods: </strong>This work is a randomized comparative trial done at Zagazig University Hospitals on 240 pregnant women. Group (A): (Amniotic fluid index group); 120 women. Group (B): (Single deepest pocket group); 120 women. Ultrasound was used to measure amniotic fluid either by AFI or SDP methods. Cardiotocography (CTG) was used to observe fetus intrapartum and Apgar score was used to assess infant post-partum.<br /> <strong>Results:</strong> mean AFI was 8.8 cm in group A, mean SDP was 3.8 in group B. There was high statistically significant difference between study groups in amniotic fluid assessment. A group had significantly more oligohydramnios than B group. There was high statistically significant difference between study groups in CTG assessment of oligohydramnios cases. Oligohydramnios cases in A group had significantly more reassuring CTG than oligohydramnios cases in B group. In the A group, the difference between normal and abnormal AF was highly statistically significant.<br /> <strong>Conclusion</strong>: Oligohydramnios and labour inductions for oligohydramnios were increased by using the AFI method, however perinatal outcomes did not improve. Therefore, the SDP approach is the best way for determining amniotic fluid volume.<br /> <strong> </strong><br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244531_db8d539d352edc68ac8fce61eedf3baf.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Effect of Correction of Metabolic Acidosis on Serum Interleukin 10 Levels in Chronic Hemodialysis Patients3029303224453210.21608/ejhm.2022.244532ENMohamed Sary GharibFawzia Hassan Ahmed Abo AliHeba William AdlyHossam Moustafa ElkadyJournal Article20220617<strong>Background:</strong> Metabolic acidosis is a common complication in chronic hemodialysis (HD) patients and can cause loss of lean body mass. Interleukin 10 (IL-10) also is increased in chronic HD patients and has a prognostic value.<br /> <strong>Objectives:</strong> The aim of this study was to evaluate the effect of correction of metabolic acidosis on serum IL-10 levels in chronic hemodialysis patients.<br /> <strong>Patients and Methods:</strong> Forty chronic hemodialysis patients with predialysis bicarbonate levels <strong>Results:</strong> Bicarbonate levels significantly increased at end of study (22.83±0.71 vs 18.85±1.12 mEq/l, p < 0.001). Serum IL-10 levels significantly decreased after correction of metabolic acidosis (19.91±6.68 vs 25.89±10.64 pg/ml, p < 0.001) and the change of IL-10 was significantly correlated with the change in bicarbonate (r = - 0.436, p = 0.005).<br /> <strong>Conclusions:</strong> Correction of metabolic acidosis in chronic hemodialysis patients was associated with decrease in serum IL-10.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244532_07e5b718dfd5efe58a36eeb10e99f1ab.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Cementless Total Hip Arthroplasty in Drug-Induced Osteonecrosis3033303724453310.21608/ejhm.2022.244533ENMohamed Aly Abdelraouf AmmarAhmed El-Sayed Soliman MohamedMohamed Ahmed Abdallah Mohamed GharibAhmed Hamdy ElsayedWael Mansour AbdElsamiae AbdallahMohamed Soliman HamedJournal Article20220617<strong>Background:</strong> Osteonecrosis is a debilitating disease that may progress to collapse the subchondral bone and the articular cartilage of the joint.<br /> <strong>Objective:</strong> This study aimed to document the clinical and radiographic results of cementless total hip replacement (THA) in patients with osteonecrosis of the femoral head.<br /> <strong>Patients and Methods</strong>: This prospective clinical trial study was conducted on eighteen patients diagnosed with steroid-induced osteonecrosis of the femoral head at the Orthopedic Department, Zagazig University Hospitals during the period from August 2020 to the end of January 2021. All patients were subjected to Pre and post-operative clinical evaluation, special radiological assessment was applied.<br /> <strong>Results</strong> We assessed the clinical signs and symptoms using a modified Harris hip score pre and post-operatively. MHHS of 90 points or more was categorized as an excellent result; 80-89 points were good; 70-79 points were fair; less than 70 points were poor results.<br /> <strong>Conclusion</strong>: Advancements in surgical technique and better designs have greatly improved the long-term survival of cementless implants in young patients with osteonecrosis of the femoral head.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244533_bd9cc675862ba792b38445738a4e377a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Recurrence of Hepatocellular Carcinoma in Hepatitis (C) Virus Related Cirrhosis Treated with Direct Acting Antiviral Therapy3038304424453410.21608/ejhm.2022.244534ENSalama Mohammed El-GhoneimyRashed Mohammed HassanElsayed Saad Abd ElbaserEman Mohammed Elsaid DiefJournal Article20220617<strong>Background:</strong> Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world. Its appearance is mainly linked to the presence of liver cirrhosis, hepatitis viruses (HCV and HBV) are major etiological factors of chronic hepatitis and fibrosis. The infection with HCV is still risk factor for HCC.<br /> <strong>Objective:</strong> The aim of this work was to estimate recurrence rate of HCC in patients with HCV related cirrhosis after direct-acting antivirals (DAAs) in (Sharkia Governorate).<br /> <strong>Patients and</strong> <strong>Methods:</strong> This prospective cohort study was conducted in Tropical Medicine Department, Zagazig University Hospitals, during the period between December 2017 and May 2018. This study included 120 patients with cirrhosis caused by chronic HCV infection. Group A: included 60 patients with HCC treated with different modality of intervention (ethanol alcohol injection, radiofrequency ablation and trans-arterial chemo-embolisation) showing complete radiologic response and had HCV related cirrhosis and treated with DAAs. While Group B: included 60 patients with HCV related cirrhosis without development of HCC and treated with DAAs.<br /> <strong>Results:</strong> There was no significant difference between the two groups regarding age, sex or any other demographic data. Incidence of HCC was 33% in group A while 30% in group B 6 months after DAAs.<br /> <strong>Conclusion:</strong> Recurrence of hepatocellular carcinoma in hepatitis (C) virus related cirrhosis treated with direct acting antiviral therapy was common.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244534_3ae467115d3f9fbe1c733fe4ccd02d5a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Urinary PGF- 2α and Carotid intima Media Thickness in Simple Obese Children: a Cross-sectional Study3045305024453510.21608/ejhm.2022.244535ENNoura Mohammed Ibrahim El BakryAyat Mostafa Mohamed AhmedJournal Article20220617<strong>Background:</strong> Obese children of all ages show signs of low-grade chronic inflammation. Circulating acute phase reactants (CPR) and urinary PGF-2α are used to determine the severity of inflammation. Childhood obesity-related inflammation seems to have a key role in the advancement of atherosclerosis. Obesity is a key contributor in the evolution of metabolic disorder and collection of cardiovascular risk variables that may lead to heart illness and stroke. Doppler ultrasound estimations of the intima media thickness (IMT) are a practical, direct, and noninvasive method for evaluating and detecting preclinical artery wall diseases. It was connected to cardiovascular risk variables and was able to foresee the likelihood of future cardio-cerebrovascular disease.<br /> <strong>Objectives:</strong> The aim of this research was to look into inflammatory status as measured by serum highly sensitive acute phase reactants (hs-CPR), oxidative stress as measured by urinary PGF-2α, early arterial wall anomalies as measured by IMT, and associations between the above studied parameters, clinical, and anthropometric measurements.<br /> <strong>Methods:</strong> The research included 40 obese children aged 4 to 12 years who were chosen from The Outpatient Clinic of Children University Hospital, Faculty of Medicine, Minia University. A control group of 25 age and sex matched seemingly healthy youngsters was also recruited. Patients and controls had a comprehensive clinical assessment and had their serum hs-CRP and urine PGF-2α levels analyzed. High-resolution B-mode ultrasonography was used to assess IMT in the right and left carotid arteries.<br /> <strong>Results:</strong> Serum hs-CRP and PGF-2α levels in obese children were considerably greater than in controls. Obese juvenile patients had considerably greater median values of the left and right carotid arteries than controls.<br /> <strong>Conclusion:</strong> Serum CRP and Urinary PGF- 2α were the most important and statistically significant factors affecting IMT and can predict CVD risk in obese children.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244535_5b74930e53a4b4da2964ccaabcd322f5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Relation between Admission Troponin Level and TIMI Flow, Myocardial Tissue Perfusion and Clinical Outcomes after Primary Percutaneous Coronary Intervention3051305724453610.21608/ejhm.2022.244536ENKamal Saad MansourMohammad Moustafa Al-daydamonyMahmoud Korashy Mahmoud KhidewyEkhlas HusseinJournal Article20220617<strong>Background:</strong> Cardiac troponin is a structural protein within the cardiac myocytes and is a highly sensitive and specific marker to diagnose cardiac cells injury and damage.<br /> <strong>Objective:</strong> This study aimed to detect the effect of troponin level assessed on admission on the angiographic and clinical outcome post primary PCI.<br /> <strong>Patients and Methods:</strong> We conducted a cohort study to assess the prognostic relation between rise of first troponin on presentation and primary PCI success and post-primary PCI clinical outcome either during the hospital stay or during the follow up period after discharge. This study was conducted on forty-four patients presented to the Emergency Department with STEMI and underwent primary PCI.<br /> <strong>Results:</strong> The TIMI flow grade post PCI was (I) in 5 patients (11.4%), (II) in 7 patients (15.9%) and (III) in 32 patients (72.7%). For the 32 patients who had TIMI III flow, we went for further analysis of reperfusion by assessing the myocardial blush by evaluating the TMPG. It was found that 3 patients (9.4%) had TMPG (I), 4 patients (12.5%) had TMPG (II) and 25 patients (78.1%) had TMPG (III). No patients were recorded to have major flow limiting dissection that ended with complications or coronary perforation. The in-hospital outcome was assessed and the total number of patients who had complications during hospitalization was 12 patients (27.3%).<br /> <strong>Conclusions:</strong> This study findings support that a single measurement of hs-cTnT provides significant incremental information to risk stratification after STEMI.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244536_2d158d7ccc76b899f0f1670b96e66d77.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Management of Pulmonary Alveolar Proteinosis Using Whole Lung Lavage, Recent Update3058306224453910.21608/ejhm.2022.244539ENWaleed AdelAlaa OmarMahmoud EldegwyJournal Article20220617<strong>Background</strong>: Alveolar proteinosis is mainly autoimmune disease in which lipoproteins accumulate inside alveoli. In severe cases it presents with dyspnea, tachypnea and cough. Lung lavage is the treatment of choice in symptomatic cases. <strong>Objective</strong>: The aim of this study was to illustrate two different techniques of management of pulmonary alveolar proteinosis (PAP) whether unilateral or bilateral whole lung lavage (WLL), analysis of indications, superiority and the efficacy of the two techniques. <strong>Patients and Methods</strong>: This is a retrospective analytical study that included 31 patients; all were done in Kasr Alainy Teaching Hospitals in the period between 2012 and 2021. All of our patients had progressive severe respiratory symptoms. Pre-procedural, intra-procedural, and post-procedural data were recorded as well as postoperative mortality, complications, ICU stay, relapses, and the need for recurrent settings of WLL.<strong> Results</strong>: The median time from diagnosis of PAP to treatment was 10.6 months (range from 1 to 40 months). The median age was 39.7 years (ranging from 19 to 70 years). Male patients were 22 (71%), while female patients were 9 (29%). Unilateral WLL was utilized in 21 patients (67.7%) and bilateral WLL in 10 patients (32.3%). Marked improvement occurred in 13 patients (41.9%), 12 patients showed partial improved (38.7%), 3 patients were stationary (9.7%), and unfortunately, 3 patients (9.7%) worsened post lavage. Single relapse occurred in 9 patients, while multiple relapses occurred in 5 patients. <strong>Conclusion</strong>: Bilateral WLL was found to be a good alternative to unilateral WLL, which is cost-effective, less time consuming and even may decrease the incidence of relapses (single or multiple) with no significant difference in the incidence of complications.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244539_46589e1764838ea916e59145301e6cbc.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Association of Vitamin D with Inflammatory Bowel Diseases Activity in Pediatric Patients3063306824454110.21608/ejhm.2022.244541ENHatem Mohammed HussienMotasim Mustafa Mohammed SalimHeba Gamal Anany EmamJournal Article20220617<strong>Background: </strong>Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract and is divided into Crohn's disease and ulcerative colitis.<br /> <strong>Objective:</strong> This study aimed to find the correlation between vitamin D deficiency and IBD activity in pediatric patients.<br /> <strong>Patients and</strong> <strong>Methods</strong>: A case-control study was conducted at the Gastroenterology Clinic, Pediatric Department, Zagazig University Hospital performed on 36 subjects divided into two equal groups; (group A) was a comprehensive sample, and (group B) contained apparently healthy participants as a control group of the same age, sex, and ethnically matched to the cases in the period between March 2021 to September 2021.<br /> <strong>Results</strong>: The Mean 1,25 dihydroxycholecalciferol (ng/l) levels in the remission and active phases were 28.18 ± 3.42 and 14.06 ± 3.92 respectively and the fecal calprotectin ranged from 50 to 257 with a mean of 118.28 ± 55.06. There was a non-statically significant correlation between Vit D and 1,25 dihydroxycholecalciferol levels in the remission and active phases. <strong>Conclusion</strong>: This study found that 1, 25 dihydroxycholecalciferol level was lower in patients with IBD than in healthy people.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244541_282cfacc75c551815c9efc4c9afa40bf.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Characterization of 42 Egyptian Children with Lysosomal Storage Disorders3069307724454210.21608/ejhm.2022.244542ENEman M. FahmyElsayed AbdelkreemOsama E. MohamedMostafa M. AbosderaAbdelrahim A. SadekJournal Article20220617<strong>Background: </strong>Lysosomal storage disorders (LSDs) are a heterogeneous family of genetic diseases with a broad phenotypic spectrum. There is a paucity of data on LSDs from developing countries.<br /> <strong>Objective: </strong>We aimed to study the pattern, relative frequency, and phenotypic spectrum of LSDs in children at an Egyptian medical center.<br /> <strong>Patients and Methods:</strong> This study included children < 18 years with LSDs diagnosed and followed up at an Egyptian medical center from January 2018 to December 2021. Data were collected on patients’ demographics, clinical features, characteristic metabolites, specific enzyme assay, and genetic testing.<br /> <strong>Results: </strong>Forty-two children (62% males, 74% parental consanguinity and 26% positive family history) were diagnosed with 10 different LSDs, representing 14% of all cases with inborn errors of metabolism (IEMs). The most frequent LSDs groups were mucopolysaccharidosis (MPS) (52.4%) and sphingolipidosis (40.8%). The most common individual diseases were MPS I (26.2%), Gaucher disease (23.8), MPS III (16.7%), and acid sphingomyelinase deficiency (11.9%). The median age at presentation was two years with a median diagnostic delay of 12 months. The most common clinical manifestations were delayed development, intellectual disability, visceromegaly, coarse facial features, and skeletal abnormalities. Finally, genetic data were available for only 12 patients (8 Gaucher disease, 3 MPS-III, and 1 MPS-VI).<br /> <strong>Conclusion:</strong> LSDs (most commonly MPS and Gaucher disease) represent an important part of IEMs at our medical center, and the diagnosis seems challenging and often delayed.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244542_89d5ff0b06a08f4dd625ceb14491938c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Valvular Calcification in Hemodialysis Cases: Relation to Functional Deficiency of Vitamin K and 25-Hydroxyvit-D Serum Level3078308224454410.21608/ejhm.2022.244544ENSherif El Sayed MansourGhada Mohamed Hasan ElkanishyTarek Medhat AbbasAhmed Bahy Eldeen IbrahimJournal Article20220617<strong>Background: </strong>Elevated incidence of death in hemodialysis (HD) cases is frequently accompanying with quicker atherosclerosis and increased vascular calcification.<br /> <strong>Objective: </strong>The current study aimed to determine the relation between valvular calcification in HD cases and functional vitamin-K (Vit-K) as presented by serum level of uncarboxylated matrix Gla protein (ucMGP) and 25(OH) vitamin-D (Vit-D) levels.<br /> <strong>Patients and Methods</strong><strong>: </strong>This work was conducted over six months and included 90 HD cases and 20 apparently healthy adults with normal kidney function (to establish normal range of ucMGP); age and gender matched to the HD cases.<br /> <strong>Results: </strong>About one-third of the patients (41.1%) had calcifications on the aortic valve, and about one-quarter had calcifications on the mitral valve (27.8%). Non-significant association was noted between MGP and vit-D (P = 0.439).<br /> <strong>Conclusion: </strong>We suggested that the end-stage renal disease (ESRD) in HD is accompanied by a shortage levels of vit-K and vit-D built in present work. The most important result of the present work was the significant difference in MGP between patients and controls, suggesting a correlation between MGP level and aortic valve calcifications.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244544_f129ff8c3f317d846b6d0d80853584fb.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prediction of Atopic Asthma in Children with Asthma in Early Life3083308824454510.21608/ejhm.2022.244545ENRehab Goda Mohamed Abd ElkaderRasha Faisel Abd El Alim Abu El DahabJournal Article20220617<strong>Background:</strong> Childhood asthma is the most frequent chronic non-communicable condition. Preschool and early childhood wheeze is common for many children. Asthma can be a lifelong problem for some children. Atopic asthma is the commonest based on gene–environment interactions identified by international research over the past 20 years.<br /> <strong>Objective: </strong>This study aimed to predict atopic bronchial asthma in children at risk.<br /> <strong>Methods:</strong> The present cross-sectional study was carried out on 50 asthmatic patients (29 males and 21 females). Apparently normal 20 children of comparable age, sex and socioeconomic status were taken as a control group. The patients were recruited from Otorhinolaryngology Clinics. They were suspected of atopic asthma with allergic rhinitis or repeated attacks of common cold or other risk factors. The study was conducted through the period from May 2021 to December 2021.<strong> Results:</strong> Asthma was more prevalent in males in 2 groups with significant difference. There were significant differences between asthmatic groups regarding family history of atopic diseases, seasonal variations, serum IgE titer but non-significant regarding parasitic infestations, chest X-ray abnormalities and studied variables. There was significant positive correlation between serum IgE titer and attacks severity, history of atopy and eosinophilia but not with seasonal and diurnal variation.<strong> Conclusion:</strong> The presence of atopic diseases, family history of atopic diseases, high serum eosinophilic count and high serum IgE titer in children with asthma in early life was found to be predictive to the development of persistent asthma in adulthood. <br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244545_92886823f0c4b3efbed5f34ab1aefa18.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Clinical Outcomes for Patients with Acute Myeloid Leukemia Harboring IDH1 Mutation After Intensive Chemotherapy3089309324454610.21608/ejhm.2022.244546ENNour El Hoda H. AbMohamed O. AzzaziWalaa A. El SalakawyJohn A. SawerisJournal Article20220617<strong>Background: </strong>Acute myeloid leukemia (AML) is heterogeneous myeloid disorder with multifactorial pathogenic mechanisms and a broad range of prognosis. AML is characterized by clonal proliferation of poorly differentiated cells of the myeloid lineage.<br /> <strong>Objective:</strong> This study aimed to detect Isocitrate Dehydrogenase 1 (IDH1) mutation in adult Egyptian AML patients and to find correlation between the mutation and prognosis & survival in those patients after intensive chemotherapy.<br /> <strong>Patients and Methods: </strong>Our study included 98 subjects with newly diagnosed AML. They all presented to Ain Shams University Hospital (Hematology Unit). All Patients included in the study were subjected to: History taking and clinical examination, laboratory investigations including routine investigations and cytogenetic studies for detection of IDH 1 mutation. All patients were followed up for their response to treatment for a period of 6 months.<br /> <strong>Results: </strong>IDH1 mutation occurs in a considerable percentage of Egyptian AML patients that shows independent bad prognostic impact on the clinical outcome.<br /> <strong>Conclusion:</strong> IDH1 mutation occurred in a considerable percentage of Egyptian AML patients that showed independent bad prognostic impact on the clinical outcome.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244546_881c305711b5a772d0002208ba2b1f5e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Frequency of Penile and Scrotal Abnormalities in Early Childhood Boys Attending Pediatric Mansoura University Hospital3094310024454710.21608/ejhm.2022.244547ENIbrahim Abo Bakr Abdel-HamidNanees Abd El-Badie SalemAhmed Fathy StateAmir Yahia Abdel-Raheem Abdel-Aal LeilaJournal Article20220617<strong>Background: </strong>Scrotal and penile anomalies are among the common lesions in children, and some have no gross functional or morphological import on the patient. But many of them can be corrected by surgical operation at the earliest possible period, preferably when less than 2–3 years of age.<br /> <strong>Objective:</strong> To determine the frequency of penile and scrotal abnormalities among boys (between 1-7 years of age) attending Pediatric Mansoura University Hospital.<br /> <strong>Patients and methods:</strong> This was an observational cross-sectional study which set in the Mansoura University Children Hospital over a period of one year (February 2020 to January 2021). The study was undertaken on 5005 boys aged from 1-7 years.<br /> <strong>Results: </strong>0.2 % of the studied boys have phimosis, 0.3% hooded prepuce, 1.2% concealed penis, 0.8% penile torsion, 0.1% webbed penis and 0.1 % trapped penis. Chordee was detected among 0.4% of the studied cases, 0.4% hypospadias and 0.1 % penile epidermoid inclusion cysts. 0.4% have bifid scrotum, 0.2% scrotal pigmentation and 0.1% of the cases have scrotal hypoplasia. Mean anogenital distance was 4.186 cm ranging from 2.9 and 6.2 cm. Hydrocele and undescended testis (1.2% and 1% respectively). Inguinoscrotal hernia was detected among 1.5%. Highest mean stretched penile length among boys aged from 64 to 86 months (5.92 cm) followed by boys aged 38 to 63 months (5.5 cm) and the least for group aged 12 to 37 months (4.7 cm).<br /> <strong>Conclusion:</strong> External genitalia abnormalities are common in boys. Careful screenings of children are mandatory to avoid the further complications.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_244547_7512d757ad18cd9c3ef103fb2931e689.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Lower Respiratory Conditions in Down Syndrome: Review Article3101310424690210.21608/ejhm.2022.246902ENNasser SAlharbi1. Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2. Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia0000-0001-9623-7093Journal Article20220630<strong>Background</strong>: Down syndrome (DS) is by far the most common chromosomal abnormality, manifested clinically with distinctive dysmorphism, functional and anatomical defects compromising multiple body systems with greater impact on respiratory system. <strong>Objective:</strong> This review aim to review and summarize reported lower respiratory conditions that exceeded the general population prevalence and their clinical outcomes in DS.<br /> <strong>Methods</strong>: The databases were searched for articles published on 2 databases [PubMed and Google scholar] and Boolean operators (and, or, not) had been used such as [Down syndrome, trismomy21, respiratory, pulmonary] and in peer-reviewed articles between January 2005 and June 2022.<br /> <strong>Conclusion</strong>: The spectrum of lower respiratory conditions in Down syndrome is wide. Multiple conditions confirmed to be higher in individuals with DS compared to normal population. In this article we reviewed the prevalence and outcomes of lower respiratory infections, recurrent wheezing, airways anomalies, pulmonary artery hypertension (PHN), Morgagni hernia and subpleural cysts. The rarity and the non-specific clinical presentation of some conditions lead to delayed diagnosis and intervention, warranting a need for awareness efforts targeting general practitioners and general pediatricians.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246902_17689ba462e7053f7d3cf6c81e13965a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Pneumonia in Children with Acute Bronchiolitis Using Lung Ultrasound3105311124690310.21608/ejhm.2022.246903ENAhmed Taleb Mohamed LemineHassan Albana Mohammed SalimKhalid Mohammed Salah AbdelmegedSameh Saber BayoumiJournal Article20220630<strong>Background:</strong> Bronchiolitis is a lower respiratory tract infection (LRTI), resulting from the inhalation of virus-containing droplets. Chest ultrasound is not considered in the diagnostic algorithm for assessment of pneumonia in children with acute bronchiolitis even though its usefulness has been tested in several studies in the last years as an emerging diagnostic tool. <strong>Objective:</strong> The aim of the present study was to assess the diagnostic accuracy of lung ultrasound (LUS) for the detection of pneumonia in children with acute bronchiolitis.<br /> <strong>Patients and methods:</strong> This cross-sectional study included children from birth to 24 months of age admitted to Pulmonology and Allergy Unit, Pediatric Hospital of Zagazig University. Children were diagnosed with bronchiolitis according to the American Academy of Pediatrics guideline. All patients underwent posteroanterior chest X-ray (CXR) because of clinical suspicion of concomitant bacterial pneumonia, persistent oxygen saturation (SatO<sub>2</sub>) < 90%, and asymmetric breath sounds on auscultation.<br /> <strong>Results:</strong> The mean age of the studied cases was 4.19 months and 86.7% of them were from 1 to 6 months. The most common clinical findings among the studied group was wheezes (96.7%) followed by fever (60%). 63.3% of the studied group had moderate respiratory distress, 26.7% had mild and 10% had severe. Abnormal findings of X-ray were peri-bronchial thickening, lung consolidation and hyperinflation (13.3%, 13.3% and 10% respectively). Abnormal findings of ultrasound were compact B line, subpleural lung consolidation and irregular pleural lines (53.3%, 26.7% and 3.3% respectively).<br /> <strong>Conclusion:</strong> Lung ultrasonography is more accurate and sensitive than chest X-ray to diagnose suspected cases of pneumonia in the pediatric age group. LUS is a sensitive and highly specific diagnostic tool in children with community-acquired pneumonia (CAP).<br /> https://ejhm.journals.ekb.eg/article_246903_575cfd4940a805a963b648b7064af861.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Vaginal Misoprostol Safety and Efficacy in Second Trimester Pregnancy Termination in Women with a Previous Cesarean Section3112311624690410.21608/ejhm.2022.246904ENNadia Khairy Fathi Abou ElelaJournal Article20220630<strong>Background:</strong> In patients who have already undergone a cesarean section, there is increasing use of medications to terminate the pregnancy due to fetal death or fetal anomalies.<br /> <strong>Objectives: </strong>To study the safety and efficacy ofpregnancy termination using vaginal misoprostol in women undergone a single lower segment cesarean section.<br /> <strong>Patients and methods: </strong>This clinical trial study included 100 women (attending the Department of Gynecology and Obstetrics, Benha University hospitals) with one previous lower segment cesarean section who were advised to terminate their pregnancy (after 13-26 weeks) due to intrauterine fetal death or fetal structural anomalies. They were divided into two equal groups Group I (cases) who had uterine scars, while Group II (control) without scars. History, clinical examination, and ultrasound imaging were performed on all patients. There were 72 hours in which the patient was given misoprostol every four hours via the vaginal route.<br /> <strong>Results: </strong>It was found that the induction-to-abortion period was much shorter in the control group than in the cases group despite no significant differences in age, parity, gestational age, or doses required to induce abortion between the two groups. There were non-significant differences between patient group I with uterine scar and control group II without uterine scar regarding doses needed, except for 1-4 doses and 9-12 doses which exhibited significant differences.<br /> <strong>Conclusion:</strong> In women who have had a previous cesarean section, the vaginal route of misoprostol in a dose of 50 µg /4 hours is safe and successful for inducing a second-trimester abortion.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246904_b97a65598ddbe9d8f3e34a2ac57c2ef6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Study of Circulating Apelin in Type 1 Diabetic Patients and its Association with Glycemic Control in a Group of Egyptian Population3117312324690510.21608/ejhm.2022.246905ENHanan Mohammed Ali AmerMaram Mohammed Maher MahdyDoaa Abd Ellatif Ahmed TahaDina Ahmed Marawan MarawanJournal Article20220630<strong>Background: </strong>Type 1 diabetes mellitus (T1DM) is a common chronic and metabolic disease characterized by hyperglycemia as a cardinal metabolic feature. Chronic hyperglycemia proved to cause macro and microvascular complications. Studies proved that TIDM is associated with metabolic abnormalities and alteration of adipose tissue hormones (adipokines)<strong>. </strong>Adipose tissue yields many adipocytokines that modulate insulin sensitivity and play essential role in the pathogenesis of diabetes. apelin is a multifunction neuropeptide, involved in the regulation of food intake, cell proliferation and angiogenesis.<br /> <strong>Objectives: </strong>The aim of this study was to evaluate the level of serum apelin in type 1 diabetic patients and to its correlation with glycemic control.<br /> <strong>Patients and Methods: </strong>This cross-sectional study was conducted on 100 Egyptian subjects including 60 type 1 diabetic patients admitted to Endocrinology and Diabetes inpatient and outpatient clinics, Ain Shams University Hospitals and 40 healthy control subjects, during the period from June 2019 to January 2020.<br /> <strong>Results: </strong>plasma apelin levels were significantly higher in diabetic group when compared to controls. Significant negative correlation was found between the apelin level and HbA1c. The best cut off value of apelin between diabetic and control is > 180 with 99.7% accuracy. Serum apelin ≥180 (ng/L) had sensitivity of 96.6 %, moderate specificity of 97.5%, positive predictive value of 98.3% and Negative Predictive value of 95.1%.<br /> <strong>Conclusion: </strong>Increased levels of serum apelin in T1DM patients could be considered as promising adipokine for the development of diabetic complications.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246905_53778261e24386451d978315112d7539.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Growth among Preparatory School Students in Menia El-Kamh –Sharkia Governorate3124312824690710.21608/ejhm.2022.246907ENHisham Sami Abdel HamidHosnia Mohamed RagabAshgan Abdallah AlghobashyEngy El-Sayed Abdel HamidJournal Article20220630<strong>Background:</strong> Normal growth is essential for development and general health of children. Height and weight measurements are therefore the most important clinical findings in child development. In fact, short stature is a common problem for children. It should not be neglected because the underlying medical conditions must be detected and treated before satisfactory catch-up growth can be demonstrated.<br /> <strong>Objective:</strong> This study was aimed to improve health status of the preparatory school children in Sharkia Governorate, and to find the impairment factors associated with growth.<br /> <strong>Patients and Methods:</strong> This cross-sectional study included a total of 538 students aged 12-15 years selected from preparatory schools in Menia El-Kamh Sharkia governorate. This study was conducted between July 2017 to March 2018.<br /> <strong>Results:</strong> The overall prevalence of short stature (SS), underweight, overweight, and obesity were 7.1%, 2.4%, 24.5%, and 11.7% respectively.<br /> <strong>Conclusion:</strong> The importance of assessment of Anthropometric measurement in children. Prevelance of overweight and obesity in Preparatory School students was common. Obesity was common among females than males in our study.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246907_2a5afa4dcbc03ebc44ad0eb23b417ef7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701KFU Medical Students’ Perceptions of Medical Professionalism3129313424690810.21608/ejhm.2022.246908ENLatteefah Alnaeemking faisal university university0000-0002-3677-2454Sarah AlomarJournal Article20220630<strong>Background:</strong> Transformation of medical students into medical professionals is a core competency required for physicians since training and practice of medicine focus upon character, personal integrity, academic and technical skills. Professionalism is associated with better clinical outcomes.Evidence shows that professionalism affects decision-making, medical errors, patient interactions, patient satisfaction, and health outcomes.<sup> </sup>Professionalism is taught at the Medical College in King Faisal University (KFU), but the importance is unclear for learners.<br /> <strong>Aim:</strong> To understand if there is a difference between pre-clinical and clinical students' perception of professionalism among students at the College of Medicine, King Faisal University.<br /> <strong>Method:</strong> A cross-sectional study was conducted at King Faisal University, College of Medicine. Data were collected through a Google electronic questionnaire involving 296 medical students. Data were analyzed using SPSS version 21.<br /> Result: Of all pre-clinical-year, 97.1% of students had a good perception of personal characteristics that reflect professionalism compared to 85.5% of students during the clinical years. The internal motivation was the most essential characteristic of the personal characteristics at 77.3%, while personal appearance was ranked lowest at 48.6%. 90.9% of respondents rated professionalism regarding respect interactions with patients as extremely important, followed by confidentiality at 87.5%. Moreover, 83.8% of students considered respecting other team members is significant, while 51% agree that dishonesty should be reported.<br /> Conclusion: The results of the analysis showed an increased insight of professionalism among students when it comes to treating members or working with colleagues during a clinical setting.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246908_174cec7aac6d7935bb62ef0887e04a13.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Value of Longitudinal Strain in Assessment of Patients with Suspected Acute Coronary Syndrome and No Wall Motion Abnormalities3135314224691010.21608/ejhm.2022.246910ENMagdy Mohamad AbdelsamieAhmed Abd Elfattah ElzayatWaleed Salem ElawadyBosy Hamed MohamedMoataz ElsananJournal Article20220630<strong>Background</strong><strong>:</strong> Echocardiography is a first simple technique for the evaluation of coronary artery disease (CAD), which is useful in the diagnostic and prognostic workup of these syndromes. The clinical work-up of patients presenting with chest pain is a diagnostic challenge.<br /> <strong>Objective:</strong> We inspected the diagnostic performance of global (GLS) and territorial (TLS) longitudinal strain to predict CAD in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) but apparent normal global and regional systolic function.<br /> <strong>Patients And Method: </strong>A cross sectional study included 90 patients with suspected NSTE-ACS with normal left ventricular ejection fraction (LVEF) (≥50%) and wall motion score index (WMSI) (=1). Speckle-tracking echocardiography was performed to all patients on admission then patients underwent coronary angiography or noninvasive test according to their risk stratification. Patients were classified to 2 groups (CAD and No CAD).<br /> <strong>Results:</strong> There was significant sensitivity and specificity of cardiac enzymes, GRACE score, Global longitudinal strain and territorial longitudinal strain in identifying CAD. However there was no statistically significant difference in conventional echocardiographic data between both studied groups. A cutoff value of GLS -17.1, TLS-LAD cutoff level >-17.15, TLS-LCX cutoff level >-16.9 and TLS-RCA cutoff level >-16.3. GLS as a predictor for the number of affected vessels, cutoff point of ≥ -15.4 can be used. A predictor for the presence of proximal lesions, cutoff point of TLS LAD ≥ -15.1 and TLS LCX ≥-15.3 can be used.<br /> <strong>Conclusions: </strong>Global longitudinal strain and territorial longitudinal strain can be used for early detection of the presence of coronary artery occlusion to identify patients who may benefit from early reperfusion. GLS also can predict multivessel disease and TLS can be used as a predictor for the presence of proximal lesions.<br /> https://ejhm.journals.ekb.eg/article_246910_c384d0c732d95c0f7703936fe8754cc3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Screening of Charcot Foot and associated Risk Factors in Assiut Diabetic Foot Care Clinic3143314724691210.21608/ejhm.2022.246912ENHeba Abdel HafezInternal Medicine Department, Assiut UniversityMohamed Hossam Eldin Hassan MaghrabyWalaa Anwar KhalifaJournal Article20220630<strong>Background: </strong>Charcot foot is considered the most serious complications of poorly controlled diabetes mellitus. Till now, there is paucity in assessment of frequent and risk factors of such complications in our locality.<br /> <strong>Objective:</strong> This study aimed to estimate the percentage of Charcot foot in patients attending Diabetic Foot Care Clinic and to evaluate the risk factors for its development.<br /> <strong>Patients and methods:</strong> A cross-sectional study was conducted at Diabetic Foot Care Clinic over one-year duration between 2015 and 2016. The study enrolled a total of 720 diabetic patient came for evaluation for diabetic foot. All patients were subjected to history taking and physical evaluation especially foot examination. Characteristics of any foot lesion was recorded with neurological evaluation of the affected foot.<br /> <strong>Results:</strong> Out of 720 patients came to the clinic with diabetic foot, 100 (13.8%) patients were diagnosed to have Charcot foot. Patients with Charcot foot had significantly higher age, frequency of male sex, type 2 diabetes that is poorly controlled. Predictors for Charcot foot in the current study were old age, presence of hypertension, use of oral hypoglycaemic agents, low albumin level, poorly controlled diabetes mellitus and hyperlipidemia<br /> <strong>Conclusion:</strong> Diabetic Charcot arthropathy is associated with multifactorial risk factors and requires a concerted effort from multidisciplinary teams. Special scrutiny, foot care and education are imperative, especially in chronic diabetic patients with micro- and macro-vascular complications. Further prospective research with matched peripheral neuropathy groups should be conducted.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246912_6195e8d85fc1a3d078be3d6637af9e71.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Effectiveness of Transvaginal Sonoelastography in Differentiation between Normal Cervix, Cervical Intraepithelial Neoplasia and Cancer Cervix3148315424691610.21608/ejhm.2022.246916ENMohamed Fathy Abo HashimMohamed Lotfy Al SayedAhmed Nashat Fatah AllahMohamed Ibrahem AminJournal Article20220630<strong>Background:</strong> Early cervical cancer is mainly treated with surgery, whereas middle- and late-stage of cervical intraepithelial neoplasia (CIN) is mainly treated with radiotherapy. Therefore, accurate preoperative diagnosis and staging of cervical lesions are crucial to patients with cervical lesions.<br /> <em><strong>Objective:</strong></em><em> The present study aimed to assess transvaginal sonoelastography in differentiation between normal cervix, CIN and cancer cervix.</em> <strong>Patients and methods:</strong> A Case-control study carried out in Departments of Obstetrics & Gynecology and Radiology, Zagazig University Hospitals. Women were classified into three groups: Group A: 20 cases with normal cervix, group B: 10 cases with CIN and group C: 10 cases with cancer cervix.<br /> <strong>Results: </strong>There was non-significant difference between studied groups as regards age and smoking. While there was significant difference regarding family history, weakened immune system, endometrial thickness and strain ratio<strong>.</strong><br /> <strong>Conclusion:</strong> Real time elastography (RTE) strain ratio (SR) of the uterine cervix, performed with a silicone ED as a reference material, seems a reliable method for distinguishing between a normal cervix and malignancy. The technique also showed promising results as a complementary investigation in diagnosing CIN.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246916_ce614da3e6189e6d1c533f1d70278ac1.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Comparative Study among Gabapentin, Midazolam and Granisetron for Prevention of Postoperative Nausea and Vomiting after Middle Ear Surgery3155316224691810.21608/ejhm.2022.246918ENAhmed Mohamed Salama Al-NajjarDalal El-Sayed Mohammad SoudHaitham Nuri Farg HassanNermeen Mohammad Ali MohammedJournal Article20220630<strong>Background:</strong> Postoperative nausea and vomiting (PONV) is the one of the most unpleasant complications. PONV is more distressing for patients than pain.<br /> <strong>Objective:</strong> The aim of the present study was to prevent PONV after middle ear surgery by comparing one hour preinduction use of oral gabapentin, intravenous Midazolam or Granisetron.<br /> <strong>Patients and methods:</strong> This was a prospective double-blinded randomized placebo controlled clinical study that was conducted in Anesthesia, Intensive Care and Pain Management Department in Zagazig University Hospitals. The study was carried out within 6 months on 108 adult patients between the ages of 21 and 65 years planned for middle ear surgery. The study included 46 men and 62 women. The patients were divided into four groups: Control (C) group, Gabapentin (G) group, Midazolam (M) group and Granisetron (GR) group (27 patients in each). Patients were followed-up 24 hours postoperatively for the incidence and severity of PONV, hemodynamic changes, side effects of these drugs and the need for rescue antiemetics.<br /> <strong>Results:</strong> Vomiting and nausea was considerably higher in Group C. Moreover, nausea was noticeably associated with Group G, It was reduced from 14.3% at 8-16 hr interval to 9.5% at 16-24 hr interval in M group. There was no significant difference among studied groups regarding side effects. Only one patient in G group felt dizziness, one patient suffered from extra pyramidal symptoms and one patient complained from vertigo. One patient in C group felt vertigo and 2 patients in GR group felt headache.<br /> <strong>Conclusions</strong>: Using oral Gabapentin 300 mg, intravenous Midazolam 0.075 mg/kg or Granisetron 3 mg one hour before induction of anesthesia in middle ear surgeries, surely causes a substantial reduction in occurrence of PONV.https://ejhm.journals.ekb.eg/article_246918_9d8d6801ca01b2f6b787525f539e4173.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Results of Open Reduction and Internal Fixation of Proximal Third Both Bones of Forearm Fractures in Adults3163316924692110.21608/ejhm.2022.246921ENSalah Eldeen Ali Muftah Abdul-Azizorthopedic department of zagazig universityAhmed Hashim AminAhmed Mohamed NahlaMohamed Nagy ElalfyJournal Article20220630<strong>Background</strong>: For displaced proximal fractures of the forearm in the adult, open reduction and internal fixation with plating is usually considered as the best therapeutic option.<br /> <strong>Objective</strong>: Improving functional outcome of patients with proximal third both bones forearm fracture in adults.<br /> <strong>Patients and Methods: </strong>At Orthopedic Department of Zagazig University Hospital 12 patients with proximal third both bones of forearm fractures in adults were studied in prospective research. Open reduction and internal fixation through dynamic compression plate were done to all patients.<br /> <strong>Results:</strong> the average operation time among the studied group were (59.8±6.8) minutes ranged from 30 to 95 minutes. Only one case, which had infection, had delayed union (19 weeks), which was treated by antibiotics, otherwise the average union time for all cases was (13.7±2.5) weeks and there was no un-union. Most of the studied group (66.7%) had excellent Mayo elbow performance index followed by (16.7%) had good score then fair and poor (8.3%) for each. There was statistically significant higher AO classification among poor and fair outcome than excellent and good outcome as (100.0%) of poor and fair outcome were A2.<br /> <strong>Conclusion</strong>: Open reduction and internal fixation (ORIF) is appropriate treatment of both bones forearm fracture. Plate fixation was safe and effective treatment option for proximal both bones forearm fracture because it provided good function outcomes.<br /> <strong> </strong><br /> https://ejhm.journals.ekb.eg/article_246921_59d6a2fa6142ab698b511122d07306e3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Study of Heel Pain in Rheumatic Diseases3170317324692210.21608/ejhm.2022.246922ENAhmed Mohamed Ahmed MohamedDepartment of Internal Medicine, Assiut UniversityAhmad Farrag ThabetJournal Article20220630<strong>Background: </strong>The differential diagnosis of heel and foot pain is extensive, but the most common is mechanical etiology. The anatomic location of the pain can aid in diagnosis. Plantar fasciitis is the most common diagnosis, resulting in medial plantar heel pain, particularly with the first weight-bearing steps after rest.<br /> <strong>Objective: </strong>We tried to describe most common causes of non-traumatic heel pain in our locality.<br /> <strong>Patients and methods:</strong> The current study was prospectively conducted between May 2019 and May 2020. The study enrolled 100 patients who were complaining of heel pain. Full history evaluation and clinical assessment were done in all patients<br /> <strong>Results:</strong> Mean age of enrolled patients was 39.92 ± 14.49 years with range between 18 and 68 years. The majority (52%) of enrolled patients were females and 48 (48%) patients were males. Based on clinical, laboratory and radiological findings of enrolled patients; 45 (45%) had planter fasciitis, 32 (32%) had heel spur and 23 (23%) had Achilles tendinitis.<br /> <strong>Conclusion:</strong> Non-traumatic heel pain is a common issue in the clinical practice. Planter fasciitis is considered the most frequent etiology of such pain in our setting. Comparative studies between different available modalities for management of heel pain are warranted.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246922_4501678ef2a0b995241d9dd9d47b15ed.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Laparoscopic Versus Open Surgery for Suspected Appendicitis3174317924692410.21608/ejhm.2022.246924ENMohamed Mahmoud EltaweelJournal Article20220630<strong>Background:</strong> Laparoscopic appendectomy has mostly replaced open surgery. Appendectomy, or surgical removal of the appendix, is one of the most common operations performed by a specialized surgeon and is used to teach the fundamentals of laparoscopy - first by observing and then performing the procedure independently.<br /> <strong>Aim of the work:</strong> This study compared laparoscopic and open surgery for suspected appendicitis.<br /> <strong>Methods:</strong> A total of 200 individuals with probable appendicitis participated in this prospective randomized clinical study. All patients over the age of 18 who had a clinical diagnosis of appendicitis were randomly randomized to either open appendectomy (OA) or laparoscopic appendectomy (LA). First prophylactic antimicrobial treatment was administered intravenously. Supine posture and general anesthesia were provided to all patients. After the operation, we followed up for complications and survival. <strong>Results:</strong> The operating time in laparoscopic patients was significantly greater. However, blood loss was substantially lower. The need for analgesics was substantially reduced in the laparoscopic group. There was a substantial difference between included patients in both groups in terms of postoperative stay length, time to return to work/normal activities, and the incidence of postoperative complications. In terms of survival time or complication incidence, there was no significant difference between the two groups.<br /> <strong>Conclusion:</strong> Despite the longer operational time, LA has a favorable hands-on OA in terms of blood loss, length of postoperative stay, time to return to work/normal activities, and the incidence of postoperative problems. In terms of survival time and complication incidence, there was no significant difference.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246924_6614b184137f873d4f81cf7649ec4773.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Association of Diabetes Mellitus and Inflammatory Bowel Disease3180318424692610.21608/ejhm.2022.246926ENFatema AboBakr AbdEl-MoezLobna Abdel- WahidMario MedhatFaragresident doctor in internal medicine department of assiut universityMohamed Abozaid Ali AbozaidJournal Article20220630<strong>Background and aim:</strong> Inflammatory Bowel Disease (IBD) and Diabetes mellitus (DM) etiology are still unclear, but both have genetic basis and share several complications. So we aimed to search for whether the two diseases are associated with each other and whether there are risk factors that increase the incidence of diabetes mellitus in inflammatory bowel disease patients.<br /> <strong>Methods:</strong> This study was conducted on 130 inflammatory bowel disease patients who were diagnosed by colonoscopy and biopsy from EL-Raghy Assiut University Hospital and were not known to have DM before the study in the period from October 2019 to June 2021.<br />These patients underwent a full history, a thorough clinical examination, and routine lab investigation, especially fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1c).<br /> <strong>Results:</strong>Out of 130 patients; 26 (20%) were found to be diabetics and the other 104 (80%) were non-diabetics. The mean age of the studied patients was 32.45 ± 9.05 years, majority (78.5%) of them were males. And we found that patients with DM were significantly younger than those without DM. The family history of DM was higher among those patients with DM. The susceptibility of DM is increasing with the lengthening of IBD duration. No significant difference was present between both groups of patients as regards the type of treatment for IBD.<br /> <strong>Conclusion: </strong>Diabetes mellitus risk increases in patients with IBD who are younger than 30 years old, have a positive family history of diabetes mellitus, and have had IBD for more than 3 years.<br /> https://ejhm.journals.ekb.eg/article_246926_907132ce29ceffcb4ca636d30457f643.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Bariatric Surgeries: A Randomized Controlled Trial3185319124692710.21608/ejhm.2022.246927ENYasser M. NasrSalwa H. WalyWael Elsayed Lotfy MokhtarJournal Article20220630<strong>Background: </strong>Pain after laparoscopic bariatric surgeries has negative effects on patients' recovery.<br /> <strong>Objective</strong>: To evaluate efficacy and safety of adding intraperitoneal dexamethasone to bupivacaine for postoperative pain relief after laparoscopic bariatric surgeries.<br /> <strong>Patients and Methods:</strong> Sixty patients were randomly allocated into 3 groups as follows:Group B (n=20): bupivacaine 100 ml 0.25% + 5 ml normal saline. Group BD4 (n=20): bupivacaine 100 ml 0.25% + 4 mg dexamethasone (1 ml) + saline 4 ml, and Group BD8: (n=20) bupivacaine 100 ml 0.25% + 8 mg dexamethasone (2 ml) + saline 3 ml. Postoperatively ketorolac IV 30 mg/6 hours + Paracetamol IV 1 g/8 hours were given± nalbuphine.<br /> <strong>Results:</strong>Pain was lower in Group BD8. Sedation was deeper in Group B. Time to first supplementary analgesia was longer in Group BD8 than Groups B or BD4, and longer in Group BD4 compared to Group B. Patients requiring supplementary analgesia were less in Group BD8 than Groups B or BD4. Total postoperative consumption of nalbuphine in the firstpostoperative day (POD 1) was less in Group BD8 than Groups B or BD4, and less in Group BD4 than Group B. Time for independent ambulation was shorter in Group BD8 than Groups B or BD4, and shorter in Group BD4 than Group B. Postoperative nausea and vomiting (PONV) was higher in Group B compared to other groups.<br /> <strong>Conclusion: </strong>Intraperitoneal administration of either 4 mg or 8 mg dexamethasone to bupivacaine (0.25%) resulted in better recovery and pain relief after bariatric surgeries. Dexamethasone 8 mg is superior to 4 mg.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246927_7ca7803ebbcae28f9d38b45f5e1794c3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Association of Systemic Inflammatory Response syndrome with Serum Creatinine, Albumin, and C-Reactive Protein in Acute Pancreatitis Patients3192319624692810.21608/ejhm.2022.246928ENSoha MohammadNagebinternal medicine, faculty of medicine, Assiut, EgyptMostafa Abd-Allah HarediMuhammad Abbas El-MasryGhada M. EzzatJournal Article20220630<strong>Background and aim:</strong> Acute pancreatitis (AP) is one of the leading causes of hospital admission from gastrointestinal diseases, with approximately 300,000 emergency department visits each year. Outcomes from acute pancreatitis are influenced by risk stratification, fluid and nutritional management, follow-up care, and risk-reduction strategies.<br /> <strong>Objective: </strong>The current work aimed to assess the pattern and outcome of acute pancreatitis.<br /> <strong>Patients and methods:</strong> A total of 70 patients with acute pancreatitis were enrolled. Those patients were subjected to history and clinical evaluation. All baseline laboratory and radiological data were recorded.<br /> <strong>Results:</strong> Serum albumin was negatively correlated with the length of hospitalization. Severe inflammatory response syndrome was associated with higher C-reactive protein and serum albumin level, in the Contrast-enhanced CT (CECT) scan and systemic inflammatory response syndrome (SIRS) in the first 48 hours were significantly associated with severe inflammation and necrosis.<br /> <strong>Conclusion:</strong> Acute pancreatitis is a challenging condition, which vary in severity and duration. Early diagnosis and severity classification have substantial impact on proper care. A more complicated disease is associated with the early onset of systemic inflammatory response syndrome.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246928_8cbfd67567345a7b732c19d1d0d66133.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Thoracic Epidural versus Surgically placed Rectus Sheath Catheters for Postoperative Analgesia after Midline Laparotomies: A Randomized clinical Trial3197320524693010.21608/ejhm.2022.246930ENSalwa H. WalyYasser M. NasrWael Elsayed Lotfy MokhtarJournal Article20220630<strong>Background: </strong>Midline laparotomies are accompanied by severe postoperative pain that is mainly related to abdominal wall incision. <strong>Objective:</strong> This study aimed to find if the analgesia provided through rectus sheath catheters can be safe and effective as thoracic epidural analgesia for early postoperative pain relief after midline laparotomies.<br /> <strong>Patients and Method: </strong>50 patients were randomly allocated into 2 groups:<strong> Group TEA</strong> (n=25): on wound closure 20 mL of 0.25% bupivacaine + 40 μg fentanyl were injected into epidural catheter. Thereafter, every 6 h, 20 mL 0.125% bupivacaine + 40 μg Fentanyl for 48 h were injected into the catheter. <strong>Group RSB</strong> (n=25): bilateral rectus sheaths catheters were surgically placed during wound closure. On each side, 20 mL bupivacaine 0.125% + 20 μg fentanyl were injected. Then, every 6 h, 10 mL 0.125% bupivacaine + 20 μg fentanyl were given through each catheter for 48 h. <strong>In both groups</strong>, IV 1 gm paracetamol/8h was given. If visual analogue scale (VAS) score became ≥ 4. Also, IV fentanyl was given. <strong>Results: </strong>intraoperative and postoperative fentanyl consumption, time to first analgesia, VAS and sedation levels were comparable between groups. Time for first oral intake was shorter in group TEA. Time for independent ambulation was shorter in group RSB. Post-operative nausea and vomiting (PONV) and pruritus were higher in group TEA. Patients' satisfaction was higher in group RSB.<br /> <strong>Conclusion:</strong> Analgesia through surgically placed rectus sheath catheters is a safe and effective alternative to thoracic epidural analgesia in midline laparotomies. Clinical trials registration number: NCT04262622.<br /> https://ejhm.journals.ekb.eg/article_246930_97e702cf307c3bb2cebd471d87fa61c1.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Utilization of Pelvic Ultrasonography and CA125 Level to Diagnose Uterine Myoma and Adenomyosis3206321224693210.21608/ejhm.2022.246932ENNadia Khairy Fathi Abou ElelaMohamed Mohamed Abd Alsalam SulimanDina Mohamed Gamal Eldin SolimanSara Atef ZakiRagab Alsayed Amin IbrahimMostafa Gamal Abdelhaleem MohammedJournal Article20220630<strong>Background:</strong> Preoperative diagnosis of adenomyosis and uterine myoma can be aided by pelvic ultrasonography and cancer antigen 125 (CA125). <strong>Objective:</strong> This study aimed to evaluate the usefulness of CA125 level and transvaginal ultrasonography in diagnosis of uterine myoma and adenomyosis and to differentiate both lesion.<br /> <strong>Patients and Methods: </strong>One hundred patients complaining of abnormal uterine bleeding were included in this study. They were attending the Obstetrics and Gynecology Departments at Zagazig University Hospitals and Al-Ahrar Teaching Hospital for hysterectomy. Transvaginal ultrasonography (TVS) was done for all selected cases to examine the pelvis for detecting any pathology. CA 125 level was measured. Hysterectomy specimens were histopathologically examined. <strong>Results:</strong> The combination of serum CA125 level and TVS showed that it was useful in adenomyosis group as CA125 level increased the accuracy of TVS from 77% to 80.2%, while in myoma group the combination was not useful as CA 125 decreased the accuracy of TVS from 100% to 83.3%. <strong>Conclusion:</strong> Transvaginal ultrasonography is the most sensitive for myoma (100%) & CA125 level is the most specific (77%) for adenomyosis. CA125 level had the highest sensitivity (87.5%) for adenomyosis than transvaginal ultrasonography (80.1%). Combining both TVS and CA125 level increased the accuracy for detection of adenomyosis to 80.2% but decreased it to 83.3% in detection of uterine myoma.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_246932_1d4e007d957695c2e783731119448792.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Role of Serum Procalcitonin in Monitoring the Response to Treatment of Pediatric Bacterial Meningitis3213321624712810.21608/ejhm.2022.247128ENMaha ZakariyaMohammedDepartment of pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt0000-0002-6098-561XEman ElhaddadRania ShatlaJournal Article20220701<span>Background: </span><span>Early diagnosis and appropriate management are important to reduce the complications of acute bacterial meningitis (ABM). Serum procalcitonin (PCT) is one of the most sensitive and specific markers for identification of ABM. </span><span>Objective: </span><span>This study was done to evaluate serum PCT as a marker to confirm ABM especially after oral antibiotics intake or when cerebrospinal fluid (CSF) culture is negative and to assess its correlation with outcome of ABM in children. </span><span>Methods: </span><span>This is a prospective cohort study that included 38 children with suspected ABM who presented to Ain Shams University Children Hospital over a period of 6 months. The PCT levels were measured on admission and 72 hours (h) after treatment. </span><span>Results: </span><span>Sixteen cases received oral antibiotics before admission, out of which only 6 (38%) patients showed growth in CSF bacterial culture. All the 38 cases showed elevated levels of PCT on admission. There was a significant drop in the mean of PCT level after 72 h of treatment compared to level on admission (7.1±6.5 vs. 11.4±3.7, p=0.001) respectively. There was a significant difference in the mean of PCT level between cases with good versus poor outcome, on admission (7.2±2.8 vs. 13.2±4.4, p < 0.001) and 72 h after treatment (4.2±3.5 vs. 12.9±5.3, p < 0.001) respectively. </span><span>Conclusion: </span><span>Serum PCT levels were high in all patients with suspected ABM, including those who received oral antimicrobials for 1-3 days before admission. The decline in PCT levels after treatment was associated with favorable outcome in our cohort.<br /> </span><span><br /></span>https://ejhm.journals.ekb.eg/article_247128_4eac7477db4c6d342dd058f5913e1843.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Microbiological Decontamination of Aflatoxin B1 in Peanuts by Backer’s Yeast3217322224712910.21608/ejhm.2022.247129ENAmany K. ShahatHasnaa S. Abd El HamidMysa S. MostafaJournal Article20220701<span>Background: </span><span>Peanuts are one of the commonly consumed snacks but with poor storage practices and handling can make them prone to food borne infections.<br /> </span><span>Objective: </span><span>The study aimed to measure the level of aflatoxin B1 in peanuts, which are contaminated with Aspergillus flavus before and after decontamination by yeast to detect the effect of biological decontamination of aflatoxin B1 in peanuts by yeast in selected locations in Qalubia Governorate in Egypt.<br /> </span><span>Materials and Methods</span><span>: This study was carried out on 30 peanut samples from 3 different cities.Fungal Counts was determined by the dilution plate technique, Isolation of Fungi was done by direct plating method on SDA and incubated at 25 and 30°C, for 7 days, suspected aflatoxigenic fungi (A. flavus) that identified from peanuts were taken for aflatoxin analysis using Aflatoxin B1 ELISA Assay Kit then decontamination of peanuts by baker's yeast for 6 h and 24 h at 37 °c then requantitation of aflatoxin B1 after 6 h and 24 h by ELIZA method.<br /> </span><span>Results</span><span>: There was significant strong positive correlation between fungal count and aflatoxin concentration with the </span><span>samples from “Qalub” had the highest fungal count (30 ×103 cfu/g) while “Benha” had the lowest count of (5 ×103 </span><span>cfu/g). Also we found that the aflatoxin concentration in </span><span>“Benha” and “Kaha” less than the concentrations in “Qalub”. </span><span>The aflatoxin B1 concentration is decreased after microbiological decontamination with prolonged contact with backer's yeast.<br /> </span><span>Conclusion: </span><span>This study showed that the peanuts were contaminated with toxigenic fungi, and we observed that yeasts have a huge potential application in aflatoxin degradation in foodstuffs.<br /> </span><span><br /></span>https://ejhm.journals.ekb.eg/article_247129_4caa8d084ec0a124ab0a9ecc85002c50.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Early Bedside Predictors of Cardiac Involvement in COVID-193222322924713010.21608/ejhm.2022.247130ENAmr SetouhiGamal FathyTarek AbdelrahmanKhaled MahmoudJournal Article20220701<strong>Background: </strong>COVID-19 could lead to severe acute respiratory syndrome leading to myocardial injury. It is associated with high morbidity and mortality. COVID-19 progression severity can be predicted by cardiac signs. Biomarkers can be used for early detection of cardiac injury and damage and prediction of severe prognosis ultimately. Echocardiography is used for therapeutic management and diagnostic procedures for COVID-19 patients. Detection of subtle cardiac damage early allows for providing efficient treatment.<br /> <strong>Objective: </strong>The aim of the current study was to predict early cardiac involvement in COVID-19 depending on different laboratory and echocardiographic parameters.<br /> <strong>Patients and methods:</strong> This prospective analytical observational study included a total of 100 patients diagnosed as positive COVID-19, depending on polymerase chain reaction ‘PCR’ of nasopharyngeal swabs. Patients underwent full echocardiographic assessment, electrocardiogram (ECG) and laboratory investigations just upon admission. Further grouping of patients according to clinical deterioration was done to detect the prognostic value of investigations.<br /> <strong>Results: </strong>Group I of clinically deteriorated patients had more lymphopenia (mean ±SD: 954.2± 6.5x10<sup>9</sup> /l), higher neutrophils-lymphocytic ratio (mean ±SD: 3.9± 0.2), less TAPSE (tricuspid annular plane systolic excursion) (mean ±SD: 14.85 ± 3.29mm) and more basal RV (right ventricle) diameter (mean ±SD: 39.93 ± 3.08 mm) in comparison with clinically stable patients. Deterioration of TAPSE (p value = 0.017) & basal RV diameter (p value = 0.044) were found to have significant relation with grading of respiratory failure using PO2/FiO2 ratio which had significant positive correlation with RV diameter (p value= <strong>Conclusions:</strong> TAPSE & basal RV diameter can early predict cardiac involvement in COVID 19 disease and have the prognostic ability to predict the degree of respiratory failure in deteriorated patients.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_247130_61238fecba2937f6178542a4f157a04d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of Thyroid Function Tests in Patients with Type 2 diabetes at Mansoura Specialized Medical Hospital and Its Relation to Cardiovascular Risk Factors3231323624713110.21608/ejhm.2022.247131ENMohamed GweeqNagy ShaabanOsama Saad SalamaAhmed AlbehairyJournal Article20220701<strong>Background</strong>: The two most common endocrinopathies are diabetes mellitus (DM) and thyroid diseases (TD), which frequently coexist and influence each other. Thyroid dysfunction in type 2 diabetic patients can help clinicians to provide the best treatment for metabolic disorders, as thyroid abnormalities like hypothyroidism can make achieving glucose targets and other comorbidities difficult.<br /> <strong>Objective:</strong> The aim of the current work was to detect prevalence of thyroid dysfunction in patients with type 2 diabetes attending diabetes outpatient clinic at Mansoura Medical Specialized Hospital and their association with cardiovascular risk factors.<br /> <strong>Patients and methods</strong>: This cross-sectional study included a total of 100 type 2 diabetic patients aged 35-55years, attending at Mansoura Specialized Medical Hospital (SMH) and 50 normal healthy controls. The included subjects were divided into two groups; <strong>Group 1 (diabetics) </strong>consisted of 100 patients, and <strong>Group 2 (control) </strong>consisted of 50 normal healthy individuals matched in age, sex with group 1.<br /> <strong>Results</strong>: There was a statistically significant increase in the mean BMI, SBP and W/H ratio in (Group 1) compared to (Group 2). The median duration of diabetes mellitus in the group 1 was 9 years (1-25). There was a statistically significant increase in the mean serum triacylglycerols (TG), serum LDL and serum cholesterol levels in (Group 1) compared to (Group 2). There was a significant difference between studied groups with higher percentage of normal thyroid among group 2 (90% versus 71%) (P < 0.05) .and significant higher percentage of subclinical hypothyroidism in (Group 1) as compared to (Group 2).<br /> <strong>Conclusion</strong>: It could be concluded that thyroid dysfunction is frequently developed among patients with type 2 diabetes mellitus. Screening for the thyroid functions among diabetic patients is needed to prevent cardiovascular risks.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_247131_0bc8dbdb7116f3243a1f998cdf6b7203.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of Functional Outcome of Rectal Cancer Management in Two Specialized Centers in the Last Three Years3237324324713210.21608/ejhm.2022.247132ENAli Helmy El-ShewyAhmed M. SallamMohammed Ahmed IbrahimMohammed AlgazarJournal Article20220701<strong>Background</strong>: Rectal cancer surgery had achieved remarkable evolution over the past years. Thanks to the adoption of total mesorectal excision and neoadjuvant chemoradiation, local recurrence rates dropped significantly down to 5%.<br /> <strong>Objective:</strong> This study was aimed to evaluate the functional and oncological outcome of rectal cancer management in specialized two centers.<br /> <strong>Patients and methods</strong>: This retrospective study included a total of 30 patients operated for rectal cancer, attending at Zagazig University Hospitals and Meet Ghamer Oncology Center. This study was conducted between 2017 to 2019. <strong>Results</strong>: This study included 30 cases, 16 were males and 14 were females, operative time ranged from 120-140 minutes with mean 130 minutes. Blood loss ranged between 250-600 cc. Only one case was converted to open surgery. No intraoperative complications like ureteric or bowel injuries were recorded. Postoperative complications were noted in 7 patients, of them 4 patients developed perineal wound infection and they improved with conservative management, one case developed chest infection who was improved with medical treatment, 1 patient developed stoma and sunken refashioning was successfully done, and 1 patient complained of postoperative urinary incontinence and impotence.<strong> Conclusion</strong>: It could be concluded that laparoscopic surgery improves oncologic and functional outcome better than open because of good visualization of pelvic anatomy.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_247132_f1a10b34d08f961fd263822f1ad54b86.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Dobutamine-Stress Echocardiography as a Predictor of Cardiac Function after Surgery for Aortic Valve Regurgitation with Poor Function3244324924713310.21608/ejhm.2022.247133ENAhmad ElDerieDepartment of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, EgyptMohammed SanadHatem BeshirMohammed AdelAmr AboelfotohGehad AwadJournal Article20220701<strong><span lang="EN-US">Background: </span></strong><span lang="EN-US">Patients with aortic valve regurgitation (AR) present at a late stage with impaired function. Some may not show improved function after surgery.</span><br /> <strong><span lang="EN-US">Aim of the work:</span></strong><span lang="EN-US"> To evaluate the functional outcome in patients with and without poor left ventricular (LV) function and to evaluate the role of dobutamine echocardiography in predicting persistent dysfunction after surgery.</span><br /> <strong><span lang="EN-US">Patients and Methods: </span></strong><span lang="EN-US">Patients with severe AR (71) who underwent valve replacement (AVR) were divided into 2 groups based on the ejection fraction (EF); Group I: patients</span><span lang="EN-US"> with EF <50% and Group II: patients with EF >50%. Group I was subdivided into 2 subgroups according to the response to dobutamine-stress echocardiography (DSE): Group Ia: patients</span><span lang="EN-US"> whose EF increased to >50%, and Group Ib: patients whose EF remained <50%. Six months postoperatively, echocardiography was performed to assess the cardiac function and volumes.</span><br /> <strong><span lang="EN-US">Results: </span></strong><span lang="EN-US">Seventy one patients were included in the study: 39(54.9%) in Group I, 32(45.1%) in Group II, 21(29.6%) in Group Ia and 18(25.4%) in Group Ib. Preoperative criteria was not significantly different between the 2 groups apart from the intensive care unit (ICU) stay which was longer in group I (p = 0.006). In group Ia, EF raised on DSE (p < 0.001) and after surgery (p < 0.001). In group II, EF showed significant change on DSE (p < 0.001), but not after surgery (p = 0.203).</span><br /> <strong><span lang="IT">Conclusions: </span></strong><span lang="EN-US">Preoperative DSE can predict improvement of LV function after AVR in cases with severe AR with ventricular dysfunction.</span><br /> <strong><span lang="EN-US"> </span></strong>https://ejhm.journals.ekb.eg/article_247133_e423578db6f794d1d5beb0a4d0919eb3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Antenatal Steroid in Preterm Infants with Respiratory Distress Syndrome3249325424713410.21608/ejhm.2022.247134ENHeba Elsayed GabrMariam Adel FouadJournal Article20220701<strong>Background</strong>: Respiratory distress syndrome (RDS) remains the most important determinant of increasing neonatal morbidity in preterm infants<strong>.</strong> A low secretory capacity of the adrenal cortex may cause a diminished stress response during the acute illness in preterm infants and could lead to increased morbidity in these infants.<br /> <strong>Objective:</strong> To evaluate the levels of antenatal steroid (cortisol) in the 1<sup>st</sup> and 3<sup>rd</sup> days of life in preterm neonates with respiratory distress syndrome.<br /> <strong>Patients and methods: </strong>This study was carried out in neonatal intensive care unit (NICU) of Benha University Hospital from June, 2020 to January, 2022. The study included 45 preterm neonates (23 females and 22 males), with gestational age ranged from 30 to 36 weeks, and their weights ranged between 1.100 kg to 2.700 kg (all of them were appropriate for gestational age (AGA) with mean weight 1.800 <span style="text-decoration: underline;">+</span> 0.300 kg).<br /> <strong>Results:</strong> In the current study, in ROC curve and area under the curve shows that 3<sup>rd</sup> day serum cortisol significantly could be used as a predictive measure in cases prognosis with probability of 71% that the assay result for a randomly chosen positive case will exceed the result for a randomly chosen negative case. Among respiratory distress groups (2 and 3) 3<sup>rd</sup> day serum cortisol level of 485.5 (nmol/l) was chosen as a cutoff point below which cases with respiratory distress tend to show improvement in prognosis with sensitivity of 80% and specificity of 80%.<br /> <strong>Conclusion: </strong>Preterm infants with severe RDS (mechanically ventilated) release more cortisol, which could be the result of severe stress associated with respiratory distress and positive pressure ventilation. Increased incidence and severity of RDS were noticed more in cesarean section (CS) than in vaginal delivery (VD). Antenatal steroids have effective role in decreasing incidence and severity of RDS.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_247134_2b9da06564c47920414b4d46ca35cace.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prevalence of Bronchial Asthma among Primary School Children3256326124713510.21608/ejhm.2022.247135ENMoustafa Gamal Amin GhonemJournal Article20220701<strong>Background: </strong>Asthma the most common chronic condition among children is operationally defined as "recurrent wheezing and or persistent coughing in a setting where asthma is likely and other rare condition have been excluded. Bronchial asthma is prevalent worldwide, especially in developed countries where its prevalence is increasing to epidemic proportions.<br /> <strong>Objectives: </strong>This study aimed to assess the prevalence of bronchial asthma among primary school children.<br /> <strong>Patients and Methods:</strong> This study was carried out on 2763 children that consisted of a representative sample of children attending eight primary schools in El Menoufiya Governorate. Four schools of them are located inside Shebin El Koum city the capital of the governorate. The other four schools are located in villages around the capital. Children were screened for chest symptoms by a questionnaire. <strong>Results: </strong>Clinical presentation of asthmatic children as cough, wheezes, dyspnea and chest tightness were the most common presenting symptoms. Also, rhinitis was the most common allergic condition that was associated with asthmatic children. Viral upper respiratory tract infection and environmental changes were the most common exacerbating factors while drugs and emotion were the least ones.<br /> <strong>Conclusion:</strong> This work highlighted on the prevalence of childhood bronchial asthma among primary school children in El-Menoufia governorate, with overall point prevalence of 6.5 %, which showed significant increase during the last 20 years as by comparing the result of our study to the result of same study in 20 years ago, which reported that the prevalence of bronchial asthma in primary school children in Menoufiya governorate was 2.2 % , as the prevalence increased by 4.3 % (Triple times) during this period. This explain the magnitude of the problem of bronchial asthma in our community.<br /> <strong> </strong><br /> https://ejhm.journals.ekb.eg/article_247135_f70f7af1b442e38103b583a02bb268d4.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Impact of Bronchial Asthma on the Child's Quality of Life3261326624713610.21608/ejhm.2022.247136ENMoustafa Gamal Amin GhonemJournal Article20220701<strong>Background:</strong> Asthma is a complex respiratory disease characterized by inflammation and reversible obstruction of the airways that can lead to diverse symptoms such as wheeze, breathlessness, chest tightness, and cough. Asthma affects approximately 350 million people from all age groups worldwide.<br /> <strong>Objectives:</strong> This study aimed to assess the impact of bronchial asthma on the quality of life among children.<br /> <strong>Patients and Methods:</strong> This study was carried out on 2763 child as a representative sample of children attending eight primary schools in El Menoufiya Governorate. Four schools of them are located inside Shebin El Koum city the capital of governorate and the other four schools are located in villages around the capital. Children were screened for chest symptoms by a questionnaire.<br /> <strong>Results: </strong>there was significant relationship between asthma severity and eosinophilia. In intermittent asthma, 21.3 of children had eosinophilia, in mild persistent asthma, 50.9% of children had asthma, in moderate persistent, 70.3% of children had asthma and in sever persistent asthma 90% of children had asthma. The same occurred with increased bronchovascular markings in x-ray as 0% 0f children with intermittent asthma had bronchovascular markings. This percentage increased to reach 100% in children with severe persistent asthma.<br /> <strong>Conclusion:</strong> pediatric asthma is considered a one of the most common chronic pediatric chest problems, which has its impact on a child's quality of life. By providing the necessary knowledge and skills, patients and family are encouraged to effectively manage the disease process and improve their quality of life.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_247136_493ea80470fda3ca76bd7328b3a3b68a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Correlation between Ultrasound Measurements of Internal Jugular Venous Diameter and Central Venous Pressure Measurements as a Follow up Tool in Severe Sepsis3267327124713710.21608/ejhm.2022.247137ENShaimaa AtefSalemAnesthesia ,Surgical ICU and pain management departement , Faculty of Medicine ,Mansoura university ,Egypt0000-0003-4019-0892Amal Rashad RyadEnas Aly AbdelmotlebTamer Elmetwally FarahatJournal Article20220701<strong>Background: </strong>Sepsis is one of the primary causes of death among intensive care unit (ICU) patients. Proper and controlled fluid administration is needed in septic patients to overcome generalized vasodilatation and capillary leak that worsen septic patients. <strong>Objective:</strong> Current study aimed to evaluate ultrasonographic measurements of internal jugular vein (IJV) as a predictor for volume status and to define its role in improvement of haemodynamic, urine output and mortality rate among septic patients.<br /> <strong>Patients and Methods:</strong> Fifty-one adult septic patients were enrolled from ICU of Mansoura University Hospitals who already inserted central venous catheter (CVC) for appropriate indication took part in an observational study. Continuous monitoring of hemodynamic parameters was carried out. Ultrasound guided IJV diameter was assessed when patients were lying down, then central venous pressure (CVP) measurements were taken. Signs of hypovolemia, such as tachycardia, hypotension, and acidosis were assessed clinically.<br /> <strong>Results:</strong> Data from 51 septic patients who were spontaneously breathing were evaluated. There was significant positive correlation between CVP and both width and height (at admission, 3h or 24 hours following the admission). Systolic blood pressure (SBP) demonstrated statistically significant positive correlation at admission (width and height) and after 24 hours of admission with width. Diastolic blood pressure (DBP) and mean arterial pressure (MAP) demonstrated statistically significant positive correlation at admission (width and height) and after 3 hours of admission with height.<br /> <strong>Conclusions:</strong> Ultrasonographic measurement of the IJV is a good predictor of fluid response in septic patients.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_247137_3ce864d5bd7432e1e6fa47ee7d4a4f96.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of Outcomes of Ligation of Intersphincteric Fistula Tract in Treatment of Transsphincteric Perianal Fistula3272327724713810.21608/ejhm.2022.247138ENRihan Abdulhafid Emhamed BoukarMuhammad Ali BaghdadiMohamed Mahmoud Mokhtar MohamedAbdelhafez ElshewailJournal Article20220701<strong>Background: </strong>The intersphincteric fistulous tract ligation treatment has been presented as a new sphincter-saving procedure with high success rates and excellent continence preservation.<br /> <strong>Objective:</strong> To assess the efficacy and outcomes of intersphincteric fistula tract (LIFT) ligation in the treatment of transsphincteric perianal fistula.<br /> <strong>Patients and Methods: </strong>At the General Surgery Department (GIT Unit) at Zagazig University Hospitals, 18 patients who were treated with the LIFT technique were involved in this cohort clinical study. All patients were followed up for three months to assess recovery, complications, discomfort, incontinence, and recurrence after surgery.<br /> <strong>Results:</strong> all cases had restored a good function through the three months according to the Wexner score post-operative. There was a statistically significant association between age, DM, Quality of life, time of operation, healing time, and recurrence where recurrence was associated with the highest mean age of cases, diabetic patients, the longest stay in the hospital, and the longest healing time. Also, the quality of life of all recurrent cases was not good.<br /> <strong>Conclusion</strong>: Long-term control of uncomplicated trans-sphincteric perianal fistula can be achieved with little complications using the sphincter-preserving approach of LIFT. It is a safe procedure for patients with simple trans-sphincteric perianal fistula with good healing rates at short-term follow-up.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_247138_8abe55d571963344a4020894f6dbd403.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Endothelin 1 As A Predictor Marker for Bronchopulmonary Dysplasia in Preterm Neonates with Respiratory Distress Syndrome3278328324713910.21608/ejhm.2022.247139ENHanaa Abd Elftah MohamedYousef Mohamed YosefNoha Abd Elhaleem MohamedAmal Abdo Ahmed AlsyedJournal Article20220701<strong>Background:</strong> Bronchopulmonary dysplasia (BPD) is usually defined as a need for supplemental oxygen at 36 weeks after conception. Functional data on endothelin-1 action suggests that endothelin-1 is not only a marker but also a mediator of respiratory disease in newborn infants including BPD.<br /> <strong>Objective: </strong>The aim of this study was to evaluate the value of endothiline-1 as a biomarker that predicts early diagnosis of bronchopulmonary dysplasia in preterm neonates with respiratory distress syndrome (RDS).<br /> <strong>Patients and Methods:</strong> This study was conducted as prospective study in Neonatal Intensive Care Unit, Zagazig University Hospital, Zagazig, Egypt in the period between April 2018 and October 2018. The study included 39 preterm neonates, (22 males and 17 females) with gestational age of 28-35 weeks who were diagnosed as having respiratory distress syndrome based on clinical and radiological findings.<br /> <strong>Results:</strong> In the present study, cases group had significant lower gestational age 30.22 ± 1.81 week & birth weight 1.35 ± 0.22 Kg compared to the control group 34.58 ± 2.19 weeks & 1.69 ± 0.38 Kg respectively. In the present study, there was no significant difference between study and control groups as regards Apgar score at 1 & 5 minutes, gender and mode of delivery. Also, serum endothelin-1 level was done at day 3 of postnatal life and it was significantly higher in neonates who developed BPD later in life (435.29 ± 172.83 ng/l) compared to the control group with no BPD (304.32 ± 54.46 ng/l). Neutrophil count on day 3 of life was positively correlated with level of endothelin-1.<br /> <strong>Conclusion:</strong> Our findings indicated that high serum levels of endothelin-1 at day 3 of life was associated with later development of bronchopulmonary dysplasia.<br /> <strong> </strong><br /> https://ejhm.journals.ekb.eg/article_247139_c5015e290522d2eb879454c726896965.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Role of Time of Hemodialysis Shifts on Quality of Life: A Comparative Study between Morning versus Evening Conventional Hemodialysis at Nephrology & Urology Unit, Minia University Hospital3284329224714010.21608/ejhm.2022.247140ENBasma FathyAhmed Mohamed Saad Eldin SalamaMohamed Abd Elmoniem Hassan KhalilNermein Abd El Rahman IbraheimJournal Article20220701<strong>Background:</strong> End-stage renal failure (ESRF) is a prevalent problem at national and global levels. It’s a public health concern. Quality of life (QOL) conception had evolved over time but still emerging in Egypt. Reduced QOL of hemodialysis (HD) patients has been linked to non-compliance to treatment, a surge in hospital admissions, hemodialysis complications, and mortality.<br /> <strong>Objective: </strong>It was to evaluate QOL of the hemodialysis patients in Minia, Egypt.<br /> <strong>Patients and Methods: </strong>A cross-sectional study was carried out at Nephrology and Urology Unit, Minia University Hospital on 60 patients. A validated questionnaire was utilized.<br /> <strong>Results:</strong> The study revealed that the patients aged 33.5-60 years and most (56.7%) of them were males. There were significant differences between patients at morning and night shift regarding kidney disease effect, disease burden, cognitive function, and sleep (p-values = 0.001, 0.027, 0.002, and 0.001; respectively). There was a significant negative correlation between hemoglobin level and the effect and burden of kidney disease, cognitive function as well as social function (p= 0.035, 0.033, 0.02, and 0.031; respectively). Nevertheless, there was no correlation between total and ionized calcium, phosphorus, PTH, URR, KT/V, or S. albumin and QOL<strong>. </strong><br /> <strong>Conclusions</strong> Time of hemodialysis, either morning or night shift, has an impact on QOL of HD patients as the morning shift was significantly associated with better QOL in contrast to the night shift in our study in terms of kidney disease effect, kidney disease burden, cognitive function, and sleep.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_247140_c39e9ab53d986735f930576c9e801021.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prevalence And Impact of Hyponatremia in Chronic Kidney Disease Patients with Coronavirus Disease 20193293329824811010.21608/ejhm.2022.248110ENWalid Ahmed RagabAbdelhamidInternal medicine department, faculty of medicine, Zagazig University, Zagazig, Egypt0000-0001-6146-9775Michael Edwar0000-0003-0149-9336Usama Ragab0000-0001-5411-1943Journal Article20220705<strong>Background</strong><strong>: </strong>Coronavirus disease 2019 (COVID-19) is frequently associated with hyponatremia. Individuals with history of chronic kidney disease (CKD) are more likely to experience critical complications related to COVID-19.<br /> <strong>Objective: </strong>This study aimed to identify the prevalence and outcomes of admittance of hyponatremia in COVID-19 patients with history of CKD.<br /> <strong>Patients and Methods:</strong> The study involved admitted CKD patients with COVID-19 between January 2021 and April 2021. It was performed at Zagazig University hospital. Subjects were divided according to admittance serum sodium into group 1 with hyponatremia (80 subjects) and group 2 with normonatremia (68 subjects). Hypernatremic patients were excluded. Clinical and laboratory data were collected from all subjects. Patients were observed for the occurrence of acute respiratory failure, and acute renal failure. Additionally, mortality rates were recorded.<br /> <strong>Results:</strong> Patients in group 1 stayed longer in the hospital than in group 2 (<em>p </em>= 0.034). Additionally, they had higher systolic blood pressure records (<em>p < /em> < 0.001). Group 1 had significantly shorter survival and higher incidence rates of acute kidney injury (AKI) than group 2. Finally, multivariate analysis revealed that the significant risk factors for in-hospital mortality in group 1 were older age, longer hospital stay, higher serum potassium, and higher LDH.<br /> <strong>Conclusion:</strong> In our study, hyponatremia affected 54% of CKD patients with COVID-19 and was attributed to higher rates of AKI and in-hospital mortality.<br /> </em>https://ejhm.journals.ekb.eg/article_248110_edb6b2ff6f48ce094c1820b858219b4b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Combined Use of Misoprostol Plus Oxytocin versus Oxytocin Alone to Reduce Blood Loss during Cesarean Section3299330324811310.21608/ejhm.2022.248113ENRagab Alsayed Amin IbrahimObstetrics & Gynecology Department, Alahrar Teaching Hospital. Zagazig Al Sharqia, EgyptJournal Article20220705<strong>Background:</strong> One of the most important complications of Type 2 diabetes mellitus (T2DM) is atherosclerotic cardiovascular disorders (ASCVD), a disease that affects a large percentage of the population and considered a healthcare burden. <strong>Objective: </strong>Our aimto establish a probable relationship between lipoprotein (a) [Lp (a)] and T2DM and to demonstrate it as a marker of (ASCVD).<br /> <strong>Patients and Methods</strong>: This case-control study included 200 subjects; 150 diabetic patients and 50 age and gender matched healthy subjects. Thorough history taking of T2DM with assessment of vascular diabetic complications was done. The fasting plasma glucose, HbA1c, lipid profile, s. creatinine and Lp (a) level were performed to all participants. <br /> <strong>Results:</strong> Lp (a) levels were significantly low in diabetic patients (19.8 ± 13.4 mg/dl) compared to control group (32.6 ± 20.8 mg/dl) (p <0.001). Lp (a) level was significantly higher in diabetics with macro-vascular complications (22.7 ± 14.4 mg/dl) than diabetics with micro-vascular complications (11.7 ± 6.5 mg/dl). Lp (a) level among diabetics with macro-vascular complications was insignificant higher than diabetics without vascular complications (p= 0.08).<br /> <strong>Conclusion:</strong> Lp (a) is strongly associated with T2DM and its vascular complicationsthat needs further research especially genetic study.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248113_4feeae246be15a21453c0bf2b1c4dda0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220705Serum Homocysteine, Folic Acid and Vitamin B12 Levels in Patients with Psoriasis Vulgaris3304330924819510.21608/ejhm.2022.248195ENEl Shahat Farag Ahmed SharafDepartments of 1Dermatology, Andrology & STDsBothina Mahrous GhanemDepartments of 1Dermatology, Andrology & STDsHamdy Fouad Marzouk2Clinical Pathology,
Faculty of Medicine - Mansura University, EgyptYasmin Elsayed Mohamed Abd El AzizDepartments of 1Dermatology, Andrology & STDsJournal Article20220303Hyperhomocysteinaemia might account for the increased susceptibility to CV diseases in psoriasis patients. Homocysteine metabolism is dependent in part on folate and vitamin B12 so deficiency of these vitamins may lead to hyperhomocysteinaemia.<br /> <strong>Objective:</strong> This study aimed to investigate the association between homocysteine, folic acid and vitamin B12 levels and psoriasis vulgaris and to evaluate the correlation between homocysteine, folic acid and vitamin B12 levels and the severity of psoriasis vulgaris.<br /> <strong>Patients and methods:</strong> This case control study included 80 subjects who were distributed into two groups; Cases group (Group A): included 50 patients with chronic plaque psoriasis vulgaris, and Control group (Group B): included 30 non psoriatic healthy, age and sex matched, subjects.<br /> <strong>Results: </strong>The mean folic acid level in the psoriasis group was 3.69 (SD 0.96) nmol/l which was statistically significantly lower as compared with the control group (5.67 ± 1.31 nmol/l) (p < 0.001). The mean vitamin B12 level in the psoriasis group was 186.94 (SD 64.90) pmol/l which was statistically significantly lower as compared with the control group (353.73 ± 76.76 pmol/l) (p < 0.001). The mean homocysteine level in the psoriasis group was 18.54 (SD 4.18) nmol/mL which was statistically significantly higher as compared with the control group (11.09 ± 1.78 nmol/mL) (p < 0.001).<br /> <strong>Conclusion:</strong> hyperhomocysteinaemia, decreased serum folate levels, and decreased serum B12 levels are common in patients with psoriasis. Serum homocysteine level was negatively correlated with serum folate level. No significant correlation was found between psoriasis severity (as measured by psoriasis area and severity index) and serum levels of homocysteine, folic acid, or vitamin B12.https://ejhm.journals.ekb.eg/article_248195_424a4e427acba33ae9a5435bbbaa29c2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220705Relation Between Paraclival Carotid Canal and Sphenoid Sinus Pneumatization Pattern: A New Classification3310331824819610.21608/ejhm.2022.248196ENMohamad Hasan Alam-EldeenDepartments of 1 RadiologyKhaled Nasser FadleNeurosurgeryMohammed Elrabie Ahmad Mohammed3Otorhinolaryngology-Head & Neck SurgeryAbeer Fareed Abd El-NaeemHuman Anatomy& Embryology, Faculty of Medicine, Sohag University, Sohag, EgyptMohammed HazemDepartments of 1 RadiologyJournal Article20220216<strong>Background: </strong>Many neurovascular structures are in critical proximity to the sphenoid sinus margins. The purpose of the study is to establish a simple classification for the relation of the paraclival carotid canal to sinus margins using computed tomography to minimize surgical risks.<br /> <strong>Methods:</strong> This retrospective study included 168 patients who were referred to the Diagnostic Radiology Department for computed tomography scans on paranasal sinuses from June 2019 to June 2020. We evaluated the sphenoid sinus pneumatization pattern, the relation of the paraclival internal carotid artery canal to its margins, and the variations of the intersinus septum. <br /> <strong>Results: </strong>Type 2 canal was the commonest in the midsellar pattern, type 3 canal was the commonest in the sellar pattern whereas type 4 canal was absent in conchal, presellar, and midsellar patterns. We found a highly significant association between type 4 canal and sellar and postsellar patterns of pneumatization on both sides (p <.001).<br /> <strong>Conclusion: </strong>The establishment of a simple and applicable standard classification for the types of paraclival internal carotid artery by computed tomography can help to minimize vital surgical complications.https://ejhm.journals.ekb.eg/article_248196_4973a6ce5e6f346a9771ece40995005b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220705Prevalence of Developmental Dysplastic Hip in Zagazig University Hospitals; Ultra-Sound Study3319332424819710.21608/ejhm.2022.248197ENMohamed Moataz El FawalDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, EgyptDoaa Mohamed Elsayed MohamedDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, EgyptFathi Ahmed TantawyDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, EgyptAhmed Abd El-Hamid MohamedDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, EgyptJournal Article20220301<strong>Background:</strong> Developmental Dysplastic Hip (DDH) is common impaired development in newborns. Ultrasound (US) is the gold standard for assessing hip development in infants younger than six months.<br /> <strong>Objective:</strong> This study aimed to detect diagnostic accuracy of ultrasound examination for hip joint in neonates and to detect possible risk factors related with prevalence of DDH.<br /> <strong>Patients and methods: </strong>A total of 525 infants were referred to the Radiology Section at Zagazig University Hospitals after showing indicators of hip instability during their neonatal examinations. They were included in this cross-sectional trial. All patients were subjected to thorough history and clinical evaluation as well as US modality.<br /> <strong>Results:</strong> Of the 5,360 hip joints analyzed, 89.57% were categorized as type Ia or Ib by Graf, 10.19% as type IIa, and 0.24% as types IIc to IV. There was significant differences between clinical and sonographic assessments. A greater birth weight was found to have a negative impact on the α-angles in univariate regression analysis, as was a later delivery (by weeks) beyond the due date. Birth weight, female gender, and a family history of DDH were found to significantly affect α-angles-angles by multiple regression analysis (p < 0.0001, p < 0.0001, p=0.005 successively).<br /> <strong>Conclusion:</strong> There were significant differences between clinical and sonographic assessments. We also detected some possible risk factors related with prevalence of DDH. In comparison to 2D ultrasound, DDH detection with 3D ultrasound took less time and had higher inter-rater reliability.https://ejhm.journals.ekb.eg/article_248197_797345513b6f5a63b966779e24ccd6bb.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220705Hepatitis C Seropositivity and Short -Term Clinical Outcome of Acute Heart Failure Patients3325333124819910.21608/ejhm.2022.248199ENShady Hussein Mahmoud BarhamDepartment of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, EgyptEssam Mohammed El-Sayed MahfouzDepartment of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, EgyptJane Nader Ramadan AbouleneinDepartment of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, EgyptJournal Article20220301<strong>Background: </strong>Heart failure (HF) is a major public health problem affecting around 37.7 million people globally with frequent hospital admissions, reduced quality of life and shortened life expectancy.<br /> <strong>Objective: </strong>The aim of this study is to compare between the short-term clinical outcome of hepatitis C seropositive acute heart failure patient’s vs the seronegative acute heart failure patients.<br /> <strong>Patients and Methods: </strong>The study is a prospective cohort study that included 150 patients admitted at cardiovascular department in Specialized Medical Hospital (Mansoura University), presented by symptoms and signs of acute heart failure. Patients of the study were classified to two groups; hepatitis C seropositive acute heart failure patient’s vs the seronegative acute heart failure patients.<br /> <strong>Results: </strong>High prevalence of abnormal liver function tests (LFTs) was found in our patients with acute heart failure reaching 77.5% of the study population. Abnormal LFTs were higher in hepatitis C virus (HCV) positive compared to HCV negative. In our study, statistically significant correlation was found between cardiovascular mortality and major adverse cardiovascular events (MACE) with chronic kidney disease (CKD) and albumin as regarding HCV positive patient. However, no statistically significant correlation was found between cardiovascular mortality and MACE with any of liver function, CBC, CKD as regarding HCV negative patient.<br /> <strong>Conclusion: </strong>The higher prevalence of abnormal liver function tests in our study in comparison with other studies may be explained by more aggressive HF exacerbation in our patients associated subclinical hepatitis C affection in our patients with HF. Our patients with acute heart failure had younger age than other studies. The present controversy results need large long-term study in the future.https://ejhm.journals.ekb.eg/article_248199_6daf2d688fd457042bde6f8f000e8f5e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220705Lipoprotein (A) In Type 2 Diabetes Mellitus as A Marker of Atherosclerotic Cardiovascular Disease3332333724820210.21608/ejhm.2022.248202ENAmira M. ElsayedDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptRasha O. AbdelmoniemDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptHend R. AboelfotouhDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptWalaa M. LbrahimDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptJournal Article20220303<strong>Background:</strong> One of the most important complications of Type 2 diabetes mellitus (T2DM) is atherosclerotic cardiovascular disorders (ASCVD), a disease that affects a large percentage of the population and considered a healthcare burden. <strong>Objective: </strong>Our aimto establish a probable relationship between lipoprotein (a) [Lp (a)] and T2DM and to demonstrate it as a marker of (ASCVD).<br /> <strong>Patients and Methods</strong>: This case-control study included 200 subjects; 150 diabetic patients and 50 age and gender matched healthy subjects. Thorough history taking of T2DM with assessment of vascular diabetic complications was done. The fasting plasma glucose, HbA1c, lipid profile, s. creatinine and Lp (a) level were performed to all participants. <br /> <strong>Results:</strong> Lp (a) levels were significantly low in diabetic patients (19.8 ± 13.4 mg/dl) compared to control group (32.6 ± 20.8 mg/dl) (p <0.001). Lp (a) level was significantly higher in diabetics with macro-vascular complications (22.7 ± 14.4 mg/dl) than diabetics with micro-vascular complications (11.7 ± 6.5 mg/dl). Lp (a) level among diabetics with macro-vascular complications was insignificant higher than diabetics without vascular complications (p= 0.08).<br /> <strong>Conclusion:</strong> Lp (a) is strongly associated with T2DM and its vascular complicationsthat needs further research especially genetic study.https://ejhm.journals.ekb.eg/article_248202_41e6869575b98fb8dcd7a4eac24a14a7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Association between Serum Cortisol in the 1st and 3rd Days of Life in Neonates with Respiratory Distress Syndrome3338334524811410.21608/ejhm.2022.248114ENHeba Elsayed GabrMariam Adel FouadJournal Article20220705<strong>Background</strong>: Numerous studies have shown that severity of respiratory distress syndrome may affect the endogenous cortisol secretion in preterm infants.<br /> <strong>Objective: </strong>Is to evaluate the levels of serum cortisol in the 1<sup>st</sup> and 3<sup>rd</sup> days of life in preterm neonates with respiratory distress syndrome.<br /> <strong>Patients and methods:</strong> This study was carried out in neonatal intensive care unit (NICU) of Benha University Hospital during the period from 2019 till 2020. The study included 45 preterm neonates (23 females and 22 males). The neonates included in the study were divided into three groups: Group I: Preterm neonates without RDS as control (n =15). Group II: Preterm neonates with mild to moderate respiratory distress syndrome, were on continuous positive airway pressure (CPAP) (n =15). Group III: Preterm neonates with severe respiratory distress syndrome, were mechanically ventilated (n=15).<br /> <strong>Results:</strong> In cases received antenatal steroids there was no significant difference between 1<sup>st</sup> and 3<sup>rd</sup> day’s serum cortisol levels.In cases didn't receive antenatal steroids there was highly significant difference between 1<sup>st</sup> and 3<sup>rd</sup> day’s serum cortisol levels.There was significant difference between 1<sup>st</sup> day serum cortisol levels and highly significant difference between 3<sup>rd</sup> day serum cortisol levels regarding antenatal steroids.<br /> <strong>Conclusion:</strong> Preterm infants respond to the stress at delivery and cortisol production continues in infants with RDS than those without RDS; may be in order to cope with poor pulmonary function and to enhance lung maturity. Antenatal steroids have effective role in decreasing incidence and severity of RDS. <br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248114_dbdd565e0ee03da5c6739edeb89716b8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Perceived Barriers to Healthy Eating Among Mothers of Preparatory School Girl Students in an Egyptian City: A Qualitative Study3346335124811710.21608/ejhm.2022.248117ENDalia Mohamed Atef ShehataIsmaildepartment of public health and community medicine, faculty of medicine, Assiut university, EguptDalia G. MahranFarag M. MoftahMirette M. AzizJournal Article20220705<strong>Background:</strong> parents face many barriers in feeding their children in a healthy way, and these perceived barriers may affect children's eating habits.<br /> <strong>Aim:</strong> this study aimed to investigate the existing barriers perceived by mothers in relation to the eating behaviors of their preparatory school children.<br /> <strong>Participants and Methods</strong>: four focus groups were conducted with mothers of students (N=30) at 3 preparatory girl schools in Assiut city. Focus group discussions (FGD) were conducted using a FGD guide. Analysis was conducted using Nvivo11 software.<br /> <strong>Results</strong>: the reported barriers to healthy eating among Egyptian population included personal barriers, family barriers, social barrier peer pressure, and community settings barrier. Family barriers included parents’ dietary habits and taste preferences, mother's knowledge about healthy diet, mothers' working status and house chore commitment, and family socioeconomic conditions. Personal barriers included taste preferences, psychological changes of adolescence and sense of independence, adolescents’ denial of the unhealthy nature of their preferred food, and culture and values.<br /> <strong>Conclusion</strong>: family and personal barriers were the main barriers to healthy eating behaviors perceived by mothers.<br /> <strong>Recommendation</strong>: the reported barriers to healthy eating from the mothers' perspective should be taken in consideration during construction of nutritional education program to improve its success.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248117_63068344eb6bc5af8baf4e1efc009b0d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Subscapularis Calcific Tendonitis: Case Report3352335524811910.21608/ejhm.2022.248119ENJalal AhmedAl-Qahtani MuathAl-Masri MamdouhJournal Article20220705<strong><span lang="EN-US">Background: </span></strong><span lang="EN-US">Calcium deposits in the rotator cuff tendon are a defining feature of calcific tendinitis, affects the supraspinatus tendon the most frequently, then the infraspinatus, the teres minor, and sometimes the subscapularis. The actual cause of a painful shoulder problem is yet unknown.</span><br /> <strong><span lang="EN-US">Objective: </span></strong><span lang="EN-US">The aim of this case report was to highlight to subscapular calcific tendonitis applied to our hospitals that was managed by arthroscopic treatment.</span><br /> <strong><span lang="EN-US">Case report:</span></strong><span lang="EN-US"> A 52-year-old, male patient, live in Jeddah, work as teacher, right hand dominant, non-smoker, presented to our clinic complaining of right shoulder pain for 2 years. Pain localized lateral and anterior side of right shoulder, sudden onset, dull in nature, radiate to arm, aggravating by overhead activity, relived by analgesia and rest, associated with weakness, got worse in last 2 months, with night pain. No history of trauma. Patient did 6 sessions of physiotherapy without improvement.</span><br /> <strong><span lang="EN-US">Conclusion: </span></strong><span lang="EN-US">Arthroscopic treatment of calcific tendonitis refractory to conservative measures has been shown to be effective and safety.</span><br /> <strong><span lang="EN-US"> </span></strong>https://ejhm.journals.ekb.eg/article_248119_34fa0cd674dab1e45b4b984b8f0d65b3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Ascitic Fluid Calprotectin Level as a Diagnostic Marker of Spontaneous Bacterial Peritonitis in Cirrhotic Patients3356336224812010.21608/ejhm.2022.248120ENMohamed Abd Ellatif AfifiAmira Mohamed Noureldin AbdelrahmanMaha Mamdouh OsmanFathy Mohamed Fathy KasemJournal Article20220705<strong><span lang="EN-US">Background</span></strong><strong><span lang="EN-US">:</span></strong><span lang="EN-US">Spontaneous bacterial peritonitis (SBP) is the infection of pre-existing ascitic fluid without evidence of a secondary infection. </span><strong><span lang="EN-US">Objective: </span></strong><span lang="EN-US">To evaluate ascitic fluid calprotectin as a diagnostic marker of spontaneous bacterial peritonitis in cirrhotic patients. </span><br /> <strong><span lang="EN-US">Patients and Methods:</span></strong><span lang="EN-US"> This study was conducted on 50 cirrhotic patients with ascites. Patients were divided into 2 groups: Group (I):Included40 cirrhotic patients with SBP on the basis of polymorphonuclear leukocytes (PMN) count in the ascitic fluid ≥250 cells/μL</span><span lang="EN-US">in the absence of secondary peritonitis, irrespective of ascitic fluid culture results</span><span lang="EN-US">, Group (II):Included10 cirrhotic patients with ascites but without SBP (control group).</span><br /> <strong><span lang="EN-US">Results:</span></strong><span lang="EN-US"> There was a statistically significant difference between the two studied groups regarding hemoglobin (Hb) (P=0.006), white blood cells (WBCs) (P=0.015), platelet count (P>0.001), C-reactive protein (CRP) (P=0.001) and bilirubin (P=0.013). There was also significant difference between the two studied groups regarding ascitic fluid analysis parameters; as ascitic lactate dehydrogenase (LDH) and PMN count were significantly higher in SBP group (P<0.001, for both). Ascitic fluid calprotectin was significantly higher in SBP group compared to non-SBP group (26.3 ng/ml (6.5 – 75) vs. 15 ng/ml (6.5-33); P=0.013). Ascitic calprotectin was significant at a cutoff level of 18 ng/ml with a sensitivity of 90% and 70% specificity for diagnosing SBP with an area under the curve (AUC) = 0.835).</span><br /> <strong><span lang="IT">Conclusion:</span></strong><span lang="EN-US"> Ascitic fluid calprotectin could be used to serve as a convenient reliable diagnostic marker for SBP in cirrhotic patients with ascites.</span><br /> <strong><span lang="EN-US"> </span></strong>https://ejhm.journals.ekb.eg/article_248120_03f872eaa34588c8044fe2e1ea647b44.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Effect of Oral Propranolol plus Oxytocin Versus Oxytocin alone on Induction and Outcome of Labor3363336824812310.21608/ejhm.2022.248123ENMohamed SobhyDepartment of Obstetrics & Gynecology at Zagazig General Hospital.Ali El Shabrawy AliMostafa Abdo AhmedMai Mostafa ZaitounJournal Article20220705<strong>Background: </strong>Labor is a state of uterine contractions having adequate frequency, duration, and strength resulting in cervical effacement and dilatation. Prolonged labor could cause maternal and neonatal medical issues and these unfavorable labor clinical outcomes are elevated in prolonged gestations in comparison with term pregnancies.The present study aimed to evaluate the effect of oral propranolol supplementary agent to oxytocin on Induction and Outcome of Labor and compare it with the control group (oxytocin alone).<br /> <strong>Patients and methods: </strong>This was a Randomized Controlled Clinical Trial which was conducted in Zagazig University Hospital and Zagazig General Hospital in the period between January 2021 and December 2021 to compare the efficacy of propranolol and oxytocin vs. oxytocin alone for induction of labor at 38-41 week gestational age. The study was conducted on 106 pregnant women; divided into two groups each group contain 53 pregnant women.<br /> <strong>Results: </strong>Duration of Latent Phase and Duration of 3<sup>rd</sup> stage was significantly shorter among study group but there was no significance difference in duration of active phase and 2<sup>nd</sup> stage between two groups. Dose of Oxytocin at which sufficient contractions occurred (3 contractions per 10 minutes) was significantly lower among the study group than the control group. Normal vaginal delivery was more frequent among the study group than among the control group: 41 cases (77.4%) versus 32 controls (60.4%). Cesarean section mode was less in the study group than the control group (p>0.05). <strong> </strong><br /> <strong>Conclusion:</strong> Administration of oral propranolol combined with oxytocin during latent phase of labor is an effective agent in shortening the labor duration and decreasing the rate of cesarean section with no considerable side effects neither to the mother nor to her newborn has been recorded during the study.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248123_0e8b6f5cb23a85a6d212975dab95298f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Could ICD10 reflect the effect of Anxiety and Depression on Systemic Lupus Erythematosus Disease Burden?3369337324812510.21608/ejhm.2022.248125ENAhmed LotfiAlyaa Diaa ElmoghazyAhmed Mustafa KamalAmal Ali HassanMona Hamdy NasrJournal Article20220705<strong>Background: </strong>Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that may affect multiple organ systems, including the central nervous system. Psychiatric symptoms, present in the majority of patients with SLE, may have severe consequences for the patients. The aim of the study was to assess the relation between psychological factors (anxiety and depression) and disease activity parameters in SLE patients.<br /> <strong>Patients and Methods:</strong> This was a matched hospital-based case control study. The study consecutively enrolled 25 patients with SLE who fulfilled the 2012 systemic lupus international collaborating clinics (SLICC) classification criteria for SLE and 25 healthy individuals, matched for age and sex, who served as a control group. Both case and control groups were subjected to clinical and laboratory evaluation of disease activity and psychological assessment according to The International Classification of Mental and Behavioral Disorders tenth revision (ICD-10).<br /> <strong>Results:</strong> About 52% of patients had depression and 48% had anxiety symptoms, while only 8% of controls reported mild depression and 8% had anxiety symptoms (p values 0.008 and 0.001 respectively). Data also showed highly significant correlation between disease activity measured by SLE disease activity index (SLEDAI) and both depression and anxiety (p < 0.01).<br /> <strong>Conclusions:</strong> Psychiatric manifestations are common in SLE, and they positively correlated with the disease activity. Using ICD-10 as a standardized tool for assessment of anxiety and depression in SLE patients is valuable for future comparisons with other studies on SLE patients.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248125_e17470e963be9900f421d47123361994.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Postoperative Analgesic Effect of Using Bupivacaine Versus Bupivacaine with Dexmedetomidine or Ketamine in Cesarean Section Operations3374337924812710.21608/ejhm.2022.248127ENRana Sobhi Ismail RizkMohamed Anwar RefkyHala Ibrahim ZanfalyAhmed Mostafa IbraheamJournal Article20220705<strong>Background</strong>: Indeed, local anesthetic infiltration of surgical wounds is a straightforward, effective, and inexpensive approach of providing excellent postoperative analgesia for a wide range of surgical operations with minimal risk of adverse consequences.<br /> <strong>Objective</strong>: The purpose of this study was to evaluate the efficacy of bupivacaine, bupivacaine combined with dexmedetomidine, or ketamine for post-operative analgesia following caesarean delivery.<br /> <strong>Subjects and Methods:</strong>A total of 90 pregnant womenscheduled for elective cesarean section, were equally divided into 3 equal groups (thirty each); <strong>control (C) group:</strong> received local wound infiltration with 40 mL of 0.25% bupivacaine (20 ml bupivacaine 0.5 %- and 20-ml saline) in two divided doses; <strong>dexmedetomidine (D) group:</strong> received local wound infiltration with a volume of forty mL of 0.25% bupivacaine plus 2 ug/kg dexmedetomidine; and <strong>ketamine (K) group:</strong> Patients had volume-specific local wound infiltration with forty ml of 0.25% bupivacaine plus 2 mg/kg ketamine.<br /> <strong>Results:</strong> When compared to the other two groups, the ketamine group had a significantly longer duration before they needed analgesia (P < 0.001). Morphine consumption in the ketamine group was much lower than in the other two groups. (<em>P</em> < 0.001). The ketamine group had the most satisfied patients compared to the other two (P < 0.001).<br /> <strong>Conclusion</strong>: It could be concluded that adding ketamine with bupivacaine in wound infiltration has a better effect than adding dexmedetomidine as regards hemodynamics stability, the time to the first analgesic request, patients’ satisfaction, and the total dose of morphine consumption during the 24 hours post operatively.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248127_34b2b6fccfe68b21899b42687988eec0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Visual Disturbances Due to Use of Different Synthetic Drugs for the Ovulation Induction among Females with Infertility Issues3380338324812910.21608/ejhm.2022.248129ENSara A. AttiaAhmed Tharwat Abo DakikaJournal Article20220705<strong>Background:</strong>Different types of drugs are used for the stimulation of ovulation. These drugs include "Follicle-stimulating (FSH) drugs” and “Modulating-ovulation drugs.<br /> <strong>Objectives: </strong>The present study was aimed to assess the association of visual disturbances that might occur in infertile women who receive different types of ovarian induction drugs.<br /> <strong>Materials and Methods: </strong>This study included a total of 300 patients with primary infertility due to anovulation, aged 20 - 40 years, recruited from the Obstetrics and Gynecology Outpatient Clinic, Menoufia University Hospital. This study was conducted between January 2019 to June 2020. The participants were categorized into three groups (100 each) based on the use of one of three different drugs, namely, Gonal F, Clomid, and HMG groups, The number of follicles, results of pregnancy tests, and ocular clinical condition were assessed.<br /> <strong>Results: </strong>The study showed that the average number of follicles per cycle was significantly lower in the Clomid group, and the visual disturbances were met in 3% of the participants in the Clomid group.<br /> <strong>Conclusion: </strong>It could be concluded that clomid might be associated with visual disturbance. It is recommended that gynaecologists advise women receiving different types of ovarian induction drugs to closely visit an ophthalmologist before suggesting these drugs to assess their risk of developing visual disturbances<strong>.</strong><br /> https://ejhm.journals.ekb.eg/article_248129_d38ca311436a9637a29060e2f8c9adf8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Ultrasound Guided TAP Block Efficacy Compared to Patient-Controlled Analgesia in Women Undergoing Caesarean Section3384338824813010.21608/ejhm.2022.248130ENAhmed TharwatAbudakikaFaculty of medicine menofia universityAbdelhassib Salah SaadAhmed Mohamed ElshafieJournal Article20220705<strong>Background:</strong> Ultrasound-Guided Transversus Abdominis Plane (USG-guided TAP) block is now utilized as an auxiliary analgesic to reduce the usage of opioids during surgery and to reduce the use of systemic analgesics for postoperative pain management. <strong>Objective:</strong> The aim of the current work was to compare USG-guided TAP block efficacy and patient-controlled analgesia in women undergo caesarean section.<br /> <strong>Patients and Methods:</strong> This study conducted on 60 pregnant women aged 19-40 years who were scheduled to undergo caesarean section under general anaesthesia, attended at Department of Obstetrics and Gynaecology, Faculty of Medicine, Menoufia University.<br /> <strong>Results: </strong>Both groups' VAS values declined considerably over time (p=0.05) in the within-group comparison. The SpO2 values did not show any significant difference between the study groups and in the within-group comparison. While, they were considerably higher in Group 1 patients at the postoperative 30<sup>th</sup> minute and 1<sup>st</sup>, 2<sup>nd</sup>, 3<sup>rd</sup>, 6<sup>th</sup>, 12<sup>th</sup>, and 24<sup>th</sup> hours (p=0.003) in the between-groups comparison. In the between-groups comparison, there were no significant differences in VAS values<strong>. </strong>Nausea-vomiting were significantly increased among patients of group II (2.0 ±0.7) than group I (1.2±0.4) at 30<sup>th</sup> minute (p=0.015). On contrast, Nausea-vomiting did not show any significant differences among group I and II after, 1, 2, 3, 6, 12 and 24 hours postoperatively.<br /> <strong>Conclusion: </strong>TAP block could be considered a more desirable approach than intravenous patient-controlled analgesia (PCA) since it avoids the systemic effects of morphine used in PCA and its analgesic impact begins sooner.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248130_de06809cb68505a7efc8f089336c1769.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Plasma Concentration of Osteopontin as A Predictor of Vascular Calcification in Patients with Diabetic Nephropathy3389339524813110.21608/ejhm.2022.248131ENNashwa Mostafa A. AzozMohamad A. SobhAhmed AhmedInternal Medicine Department, Assiut UniversityRanda A. El ZohneJournal Article20220705<strong>Background: </strong>Vascular calcification (VC) is a common health problem in patients with diabetic nephropathy (DN). Early recognition of vascular calcification has a great effect on the outcome.<br /> <strong>Objective</strong>: We aimed to assess the efficacy of serum osteopontin (OPN) in the early prediction of VC in patients with diabetic nephropathy.<br /> <strong>Patients and Methods:</strong> A total of 70 patients with type 2 diabetes mellitus were divided into equal two groups. Group (A): included 35 patients with diabetic nephropathy with chronic kidney disease (CKD) stage I-IV and group (B): included 35 patients with DN with CKD stage V on hemodialysis. Another 30 healthy subjects were recruited as a control group. Carotid Doppler and echocardiography were done in patients’ groups only while serum OPN was measured in all groups.<br /> <strong>Results: </strong>Osteopontin was found to be higher in group B in comparison to other groups and also higher in group A in comparison control group. A total of 31 (44.3%) patients had VC. Patients with VC had higher OPN in comparison to those without VC. Predictors for VC in patients with CKD were OPN, intima thickness and CKD stage V. OPN at cutoff point > 144 ng/ml had 93% overall accuracy for the prediction of VC in patients with CKD, and the area under the curve was 0.966.<br /> <strong>Conclusion:</strong> We concluded that (1) OPN level was significantly higher in hemodialysis patients with diabetic nephropathy stages V than those diabetic patients with chronic kidney disease stage I-IV. (2) OPN level was significantly higher in patients with vascular calcification than in those without. So, OPN can be used as an early marker for the detection of vascular calcification.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248131_af2400b036c50a0f26650790a112938e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701PCR Versus Toxigenic Culture in Diagnosis of Antibiotic-Associated Diarrhea Due to Clostridium Difficile Infection3396340024813210.21608/ejhm.2022.248132ENMysa S. MostafaHasnaa S. Abd El HamidJournal Article20220705<strong>Background: </strong>Clostridium difficile infection (CDI) is a leading cause of healthcare-associated infections accounting for significant disease burden and mortality. The clinical spectrum of C difficile ranges from asymptomatic colonization to toxic megacolon and fulminant colitis. <strong>Objective:</strong> The present study aimed to evaluate the sensitivity and specificity of PCR in comparison with toxigenic culture for diagnosis of antibiotic-associated diarrhea due to Cl difficile infection. <strong>Materials and methods:</strong> This comparative study was conducted on 80 patients with antibiotic associated diarrhea (AAD). Toxigenic culture (TC) was done for detection of toxigenic Cl difficile and, PCR assay was done for detection of tcdA and tcdB genes and results of both methods were compared. <strong>Results: </strong>Out of 80 diarrhea patients included in the study, 12 (15%) were positive and 68 (85%) were negative for toxigenic culture. Out of 80 diarrhea patients included in the study, 32 (40%) were positive and 48 (60%) were negative for PCR. The sensitivity, specificity, PPV and NPV of PCR in diagnosis of Cl difficile infection were 100%, 70%, 61.5% and 100% respectively. Also, there was a highly significant difference between positive and negative results as detected by PCR.<strong> Conclusion: </strong>we can conclude that PCR is a highly sensitive method (100% sensitivity) as compared to TC in diagnosis of antibiotic-associated diarrhea due Cl difficile infection.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248132_dc8ac08375353f9195d4660f705c0891.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Early Haemodynamic Outcomes of Pulmonary Thrombo-endarterectomy: Experience of a Tertiary Referral Center in Egypt3401340724813610.21608/ejhm.2022.248136ENAbdullah Osama MahfouzKerellos MaxTarek MohsenTamer Eid FoudaJournal Article20220705<strong>Background:</strong> Chronic thromboembolic pulmonary hypertension is a potentially curable condition via pulmonary thromboendarterectomy (PTE) which involves surgical removal of the thromboembolic material through endarterectomy. This is a technically demanding surgery and better results could be achieved only in experienced centers worldwide. The present study aimed to document the hemodynamic outcomes of PTE focusing on the degree of improvement in exercise capacity and hemodynamic parameters after surgery.<br /> <strong>Subjects and Methods:</strong> an interventional prospective and retrospective study was undertaken in the Cardiothoracic Surgery Department at Kasr El-Aini University Hospitals, including 20 patients who underwent PTE. <br /> <strong>Results:</strong> After excluding the 3 mortality cases, all the 15 cases with preoperative NYHA-FC III and IV improved to a better FC while the 2 cases with preoperative NYHA-FC II remained unchanged. Mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) decreased by 33.5 (range 35.6 - 31.3) mmHg and 542.6 (range 604 - 481.1) dyn.sec.cm<sup>-5</sup> respectively.<br /> <strong>Conclusion:</strong> PTE results in a dramatic improvement in the hemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension.<br /> https://ejhm.journals.ekb.eg/article_248136_1c5dc9cc3a3c78468557004fcbd1831c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Screening of Opioid Abuse in Toxicology Unit and Laboratory at Mansoura University with A Comparison of Two Detection Methods: Clinical and Legal Issues3408341124813710.21608/ejhm.2022.248137ENMohamed Moharram BadawyMohammad Abd-El-Same'e El-KattanShaaban Abd El Fattah El-MosallamyJournal Article20220705<strong>Background: </strong>Drug abuse is a critical concern worldwide. Urine drug screening is a common practice applied for the detection of common drugs of abuse for both clinical and legal issues. <strong>Objective: </strong>This study was performed to screen for opioid abuse in urine samples collected from adult subjects (aged > 18 years) at the toxicology laboratory and toxicology unit, Emergency Hospital, Mansoura University, and to compare enzyme-multiplied immunoassay (EMIT) with thin layer chromatography (TLC) techniques for confirmation of opiate in samples.<br /> <strong>Patients and Methods: </strong>A total of 500 urine samples were randomly collected and screened with immunochromatographic (rapid) test strips for opiates. The positive urine samples obtained by the rapid test were further analyzed by EMIT and TLC techniques.<br /> <strong>Results: </strong>A total of 80 samples (16%) were positive for opiate by the rapid test. By analyzing these positive samples usingEMIT, only 68 samples were positive (68/80; 85%). Only 66 samples (66/80; 82.5%) revealed positive results (opiate spot) meaning that TLC was able to confirm 2 false-positive results by EMIT. This might be due to drug interactions.<br /> <strong>Conclusion: </strong>Opioid abuse seems to be a problem among the Egyptian adult population. Despite the high sensitivity of EMIT (100%), TLC is more specific when compared with it. Indeed, EMIT can be a relatively accurate alternative for TLC, but, whenever positive results need to be re-checked, it is recommended to use the cheap and widely available TLC technique or ideally use the High-performance liquid chromatography (HPLC), particularly for legal purposes.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248137_4b7b86a695e876615777cccd3157d40f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220708Laser versus Ligation as Sphincter Preserving Techniques in the Management of Intersphincteric Perianal Fistula3412341624871810.21608/ejhm.2022.248718ENWesam Mohammad Amr1General Surgery Department, Zagazig University Hospital, EgyptHatem Mohammad1General Surgery Department, Zagazig University Hospital, Egypt.Mahmoud Sobhi Abdultawwab2Department of General Surgery, Al Ahrar Zagazig Teaching Hospital, EgyptMahmoud Abdou Yassin1General Surgery Department, Zagazig University Hospital, EgyptJournal Article20220327<strong>Background: </strong>Fistula tract Laser closure (FiLaC) and Ligation of intersphincteric Fistula Tract (LIFT) are feasible and safe techniques with low postoperative pain and minimal incontinence.<br /> <strong>Objectives:</strong> Our study aimed to preserve the anal sphincter and decrease the rate of incontinence and recurrence of the fistula during the management of intersphincteric perianal fistula.<br /> <strong>Patients and Method: </strong>This was a prospective observational study for 6 months at Department of General Surgery, Zagazig University Hospitals. Two groups of 56 patients were formed. Group A underwent fistula tract laser closure and group B ligation of intersphincteric fistula tract. Patients were followed for 6 months for postoperative pain, recurrence, and complication.<br /> <strong>Results: </strong>In our analysis, the average operating time was 19.3 minutes (min), while in the LIFT group it was 48.6 min with a statistically significantly higher mean operation time in the LIFT group. The mean hospital stay time postoperatively in the FiLac group was 8.1 hours, which was significantly lower than in the LIFT group (17.1 hours). In the FiLaC group, the mean time of healing was 16.4 days while in LIFT the mean healing time was 32 days, which was statistically higher than the FilaC group. Postoperative pain was statistically wrose in the LIFT group than the FiLaC group. There was no substantial difference between the two groups after a considerable period of follow-up.<br /> <strong>Conclusion: </strong>Our research found that both approaches are promising techniques, with higher healing rates and a lower risk of incontinence or recurrence after surgery. However, LIFT was quite significantly better for healing rate and recurrence, while fistula tract laser closure was slightly significantly better for postoperative pain and incontinence.https://ejhm.journals.ekb.eg/article_248718_3954b83189aa963e2ff3999f44a317b3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220708Evaluation of Obstructive Sleep Apnea in Metabolic Syndrome3417342224871910.21608/ejhm.2022.248719ENMedhat Fahmy NegmDepartments of 1Chest DiseaseMohammad Hussein KamelDepartments of 1Chest DiseaseWalaa Mohammad Ebrahim2Internal Medicine, Faculty of Medicine, Benha University, EgyptZeinab Gaber Nor-EldeinDepartments of 1Chest DiseaseShaimaa Magdy AboYoussefDepartments of 1Chest DiseaseJournal Article20220308<strong>Background: </strong>There is bidirectional relationship between obstructive sleep apnea and metabolic disease. Sleep apnea results in intermittent hypoxia and sleep fragmentation, which lead to and exacerbate obesity and type 2 diabetes by increasing sympathetic activity, oxidative stress, inflammation and lipolysis. Moreover, metabolic disease can lead to or exacerbate sleep apnea through weight-dependent and physiology-dependent mechanisms.<br /> <strong>Objective: </strong>The studyaimed toexplore the association between metabolic syndrome and obstructive sleep apnea (OSA).<br /> <strong>Patients and Methods:</strong> This study was conducted at Sleep Unit of Chest Department Benha University Hospitals. This study enrolled 100 patients that were divided into two groups: Group A, which included 80 patients with metabolic syndrome as cases and group B that included 20 patients without metabolic syndrome as control group. All patients included in this study were subjected to lipid profile, HbA1c, overnight polysomnography (PSG).<br /> <strong>Results:</strong> There was highly statistically significant positive correlation between apnea hypopnea index (AHI) and waist circumference, TG, HbA<sub>1</sub>C, systolic blood pressure, diastolic blood pressure and sum all night desaturation. There was highly statistically significant negative correlation between AHI and HDL and minimal SPO<sub>2</sub>. TG, HDL, Hb A1C and systolic and diastolic blood pressure were significant predictors for increase AHI and increase OSA severity.<br /> <strong>Conclusion</strong><strong>:</strong> OSA was highly prevalent in patients with metabolic syndrome, which is associated with increasing severity of OSA. Also, it is associated with poorer control of diabetes, hypertension, and dyslipidemia, which are all components of metabolic syndrome.https://ejhm.journals.ekb.eg/article_248719_92532002efed8aa7f11f049ebfae54e4.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Angiomatoid Fibrous Histiocytoma: Case Report3423342624872010.21608/ejhm.2022.248720ENAlghamdi Mohammed TalalDivision of oncology, Orthopedic Department, Soliman Fakeeh Hospital, Jeddah, Saudi ArabiaJournal Article20220301<strong>Background: </strong>Angiomatoid Fibrous Histiocytoma (AFH) is a rare soft tissue tumor that occurs most often in children, teenagers and young adults. In clinical and radiographic terms, the lesion is easily mistaken for hematoma, soft tissue hemangioma or malignant fibrous histiocytoma. While the lesion is rare, because of the potential for local recurrence and metastasis, this lesion must be accounted for in the differential diagnosis of a soft tissue mass.<br /> <strong>Objective:</strong> A case report of angiomatoid fibrous histiocytoma; the clinical, radiological and pathological outcomes.<br /> <strong>Case Report:</strong> Our case report of a 30 years old female who presented with left knee soft tissue mass anterior to the patella, which was discomforting, painful mass. X-ray and MRI of the left knee showed a soft tissue mass in the adipose tissue not attached to the underlying musculature. Wide margin resection was done,<br /> <strong>Result:</strong> Histopathology report findings were consistent with angiomatoid fibrous histiocytoma. CT staging done postoperatively with no sign of metastatic lesion. Follow up MRI left knee done showed no sign of recurrence.<br /> <strong>Conclusion:</strong> Angiomatoid fibrous histiocytoma is a rare soft tissue tumor with intermediate malignant potential. Although non-specific, a mass with MRI characteristics, including cystic areas, a fibrous pseudocapsule and internal blood spots on the extremity of a child, adolescent or young adult, AFH must be considered as part of the differential diagnosis. A wide surgical excision with clear margins and post-excision follow-up is required.https://ejhm.journals.ekb.eg/article_248720_48ac4ede4aea8c6d2e2c057087b484c0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Serum Levels of Intercellular Adhesion Molecule-1 and TNF- in Patients with COVID-19 and Its Relation to Disease Severity3426343224872110.21608/ejhm.2022.248721ENAmira E. RamadanDepartments of 1Medical Microbiology and ImmunologyMarwa S. AzabDepartments of 1Medical Microbiology and ImmunologyAbeer E. Abdelmaksoud2Community MedicineEtemad A. Mohammad3Chest DiseasesNashwa A. Amin3Chest DiseasesAmira H. Allam3Chest DiseasesSamah M. Eldsouky4Otolaryngology, Faculty of Medicine, Benha University, EgyptAmany K. ShahatDepartments of 1Medical Microbiology and ImmunologyJournal Article20220708<strong>Background:</strong> Coronavirus disease 2019 (COVID-19) is a major health concern and can be devastating, especially for the elderly. It causes a systemic inflammatory response, involving dysregulation and misexpression of many inflammatory cytokines.<br /> <strong>Objectives</strong>: To assess the cytokine profile in COVID-19 patients and detect its relation with disease severity.<br /> <strong>Patients and methods</strong>: This study included 50 COVID-19 patients confirmed by reverse transcription–polymerase chain reaction (RT-PCR), of whom 20 with severe pneumonia, 20 with moderate and 10 with mild disease, and 50 healthy control. Quantitative ELISA tests were performed for tumour necrosis factor alfa (TNF-α) and intercellular adhesion molecule1 (ICAM-1).<br /> <strong>Results:</strong> Level of ICAM-1 is higher in cases of COVID-19 than healthy controls (median for cases = 420 ng/ml). Also TNF-α level is higher in cases with a median of 165 both levels were higher in CORADS 6 and positively correlated with CT findings.<br /> <strong>Conclusion: </strong>Patients with severe COVID-19 might have a cytokine storm syndrome and increased expression of endothelial cell adhesion molecules as ICAM-1, which is related to COVID-19 and disease severity and may contribute to coagulation dysfunction. Levels of ICAM 1 were associated with more severe CT findings and longer hospital stay, also ICAM 1 and TNF can be used as diagnostic measures as they have a higher sensitivity specificity and predictive values.https://ejhm.journals.ekb.eg/article_248721_252a510b4a8ec54551eb8e6283ae7dc3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Magnesium Sulphate Versus Dexmedetomidine for Prevention of Emergence Agitation (EA) after Sevoflurane in Adult Patients Undergoing Percutaneous Nephrolithotomy3434343824872210.21608/ejhm.2022.248722ENAbbady Abdellah AhmedDepartments of 1Anaesthesia and Surgical ICUMohammed Hussam El-din MohammedDepartments of 1Anaesthesia and Surgical ICUGamal A. Alsagheer2Urology, Faculty of Medicine,
South Valley University, Qena, Egypt.Mahmoud Mohammed Ahmed IsmailDepartments of 1Anaesthesia and Surgical ICUJournal Article20220708<strong>Background: </strong>The utilization of sevoflurane as inhalational agent may cause emergence agitation (EA)during recovery from general anesthesia. EA has also been specified to emergence delirium, and sometimes it is accompanied with negative postoperative behaviors. The aim of this study was to compare the effect of magnesium sulphate and dexmedetomidine infusion on prevention of EA after sevoflurane anesthesia in adult patients undergoing percutaneous nephrolithotomy (PCNL).<br /> <strong>Patients and methods</strong>: This study was carried out at Anaesthesia, Intensive Care Unit and Pain Management Department, Qena university Hospital on 50 adult patients undergoing PCNL under general anesthesia using sevoflurane as inhalational agent. Participants were divided into two groups: group I (25 patients) received initial intravenous magnesium sulphate and group II (25 patients) received dexmedetomidine infusion.<br /> <strong>Results: </strong>There was statistically significant difference between both groups regarding Richmond Agitation Sedation Scale (RASS). The mean VAS was 7.2 (SD 1.9) and 2.6 (SD 0.9) among groups 1 and 2, respectively. There was statistically significant difference between both groups regarding VAS and hemodynamics<br /> <strong>Conclusion</strong>: Intraoperative infusion of either dexmedetomidine or magnesium sulfate after sevoflurane in adult patients undergoing PCNL decreased postoperative agitation and pain intensity with the superiority of dexmedetomidine. However, the magnesium sulfate gives more hemodynamic stability, so it was preferred for patients with severe comorbidities.https://ejhm.journals.ekb.eg/article_248722_8332e5883e03c70f752659e6697f3e91.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Clinical and Radiological Evaluation of Minimal Invasive Fixation of Sander's Type II, III Calcaneal Fracture3439344524878110.21608/ejhm.2022.248781ENAhmed El-sayed El-MaltOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptAli Tawfiq El-AlfiOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptMohamed Magdy M. El-sayedOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptAhmed Mohamed NahlaOrthopedic Surgery Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20220309<strong>Background:</strong> Calcaneal fractures continue to be one of the most complicated injuries of the lower extremity. The aim of the present study was to evaluate the clinical and radiological results of minimal invasive fixation in management of sanders type II, III calcaneal fractures.<br /> <strong>Patients and methods:</strong> This study was carried out in Zagazig University Hospital and Damietta Specialized Hospital. Eighteen cases were included as a comprehensive sample with sander's type II, III closed fracture.<br /> <strong>Results:</strong> The mean age of the studied cases is 45.33 (SD 9.8) years; 83.3% are males, 83.3% are working and 50% are smokers<strong>.</strong> About 66.7% of the included cases have fracture due to fall from height, 16.7% road traffic accidents and 16.7% direct trauma. Of the studied cases, 66.7% have right side fracture. About 66.7% of the cases have joint depression by Essex classification, 33.3% Sanders classification III, and 66.7% Sanders classification II. Only 33.3% of the cases have positive subtalar arthritis. The mean range of movement is 85.83 (ranged from 70 to 100), and mean AOFOS score is 87.83 (ranged from 77 to 95). The American Orthopaedic Foot & Ankle Society (AOFAS) score shows statistically significant positive correlation with PIFA pre-treatment, PIFA post treatment and negative correlation with HT pre and post treatment.<br /> <strong>Conclusion:</strong> Treatment of calcaneal fractures using a minimally invasive internal fixation method with a thin plate and bone grafting can provide excellent or good clinical outcomes with few soft tissue complications.https://ejhm.journals.ekb.eg/article_248781_e45c89ec25914042e084634962cd2361.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Changes in Liver Fibrosis and Stiffness, Lipid Profile and Insulin Resistance in Patients with Chronic Hepatitis C Viral Infection Who Received Direct Acting Antiviral Therapy3446345124878210.21608/ejhm.2022.248782ENEssam AbdelmohsenDepartments of 1Internal MedicineAlshimaa H. B. AbotalebDepartments of 1Internal Medicine andRanda A. El Zohne2Clinical Pathology, Assiut University Hospital, Assiut, EgyptHossam Mahmoud AbdelwahabDepartments of 1Internal MedicineHossam MaghrabyDepartments of 1Internal MedicineJournal Article20220309<strong>Background:</strong> With introduction of direct acting antivirals (DAAs) in the management of chronic hepatitis C viral (HCV) infection, this leads to high frequency of sustained viral response (SVR). Effect of these agents on liver stiffness and lipid isn’t well studied.<br /> <strong>Objective:</strong> We tried to assess changes in liver stiffness, insulin resistance (IR) and lipid profile after achievement of SVR with DAAs.<br /> <strong>Patients and methods:</strong> A total of 80 patients with chronic HCV infection were recruited in the study. All patients received dual therapy of sofosbuvir and daclatasvir either without ribavirin (in case of chronic hepatitis) or with ribavirin (in case of liver cirrhosis). Liver stiffness, lipid profile and IR were assessed at baseline and at the end of therapy.<br /> <strong>Results:</strong> All patients achieved SVR. Majority (58.8%) of patients were males. There was significant improvement in liver transaminases after therapy. There was significant reduction in frequency of IR after therapy (42.5% vs. 68.7%; <em>p < /em>= 0.04) with percentage of decrease was 16.11%. Also, there was significant decrease in degree of fibrosis as assessed by fibroScan with percentage of decrease was 48.2%. Predictors for persistence IR after DAAs therapy were only body mass index and advanced fibrosis. Cholesterol, low density lipoproteins and triglycerides showed significant increase after therapy.<br /> <strong>Conclusion:</strong> Sofosbuvir and daclatasvir with or without ribavirin are effective and tolerable agents in management of chronic HCV infection. Degree of liver fibrosis and insulin resistance would be reduced after DAAs therapy. Future multi centers are warranted to confirm these findings.</em>https://ejhm.journals.ekb.eg/article_248782_f21cfd4ce647f93c87f76582e864105c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Epidemiology of Bacterial Infections in Pediatrics Intensive Care Unit (PICU) at Zagazig University3452345624878310.21608/ejhm.2022.248783ENAlaa ZidanDepartments of 1PediatricsNehad Ahmed KaramDepartments of 1PediatricsAmal Hassan Atta2Microbiology and Immunology, Faculty of Medicine – Zagazig University, EgyptAhmed Hussieny AwadDepartments of 1PediatricsJournal Article20220313<strong>Background:</strong> Infections are one of the commonest causes of mortality in the pediatric intensive care unit (PICU), with a mortality of up to 50%, depending on the origin of the infection. At our study death rate was 35.8% and survival was 64.2%. <strong>Objective:</strong> This study aimed to identify the most common bacterial infections in pediatric intensive care unit (PICU) at Zagazig University and to describe their epidemiologic and microbiologic characteristics, and determine other risk factors for developing bacteremia.<br /> <strong>Patients and Methods:</strong> This cross-sectional study was conducted over a period of 6 months from June 2017 to November 2017; it included 240 pediatric patients admitted at Pediatric Intensive Care Unit (PICU), Faculty of Medicine, Zagazig University Hospitals.<br /> <strong>Results:</strong> Prolonged hospital stay, urinary catheter (UC) non-significantly increased risk of infection. On the other hand, central venous catheter (CVC), mechanical ventilation (MV) significantly increased risk of infection. There was statistically non-significant relation between outcome and type of organism.<br /> <strong>Conclusion:</strong> MV and UC were significantly associated with healthcare-associated infections (HAIs). Patients with HAIs had significantly longer length of stay (LOS).Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Immune Response to the COVID-19 Vaccination in Egyptian Patients Undergoing Maintenance Hemodialysis3457346324878410.21608/ejhm.2022.248784ENMohammed Fouad AhmedFouad AhmedDepartment of Internal Medicine, Faculty of Medicine, Zagazig University, Sharkia, EgyptAli Omar AhmedDepartment of Internal Medicine, Faculty of Medicine, Zagazig University, Sharkia, EgyptAhmed Mokhtar AhmedDepartment of Internal Medicine, Faculty of Medicine, Zagazig University, Sharkia, EgyptAyman Riyadh Abd El-HameedDepartment of Internal Medicine, Faculty of Medicine, Zagazig University, Sharkia, EgyptJournal Article20220308<strong>Background: </strong>COVID-19 is a global health crisis caused by SARS-CoV-2 and associated with higher morbidity and mortality in patients on maintenance Haemodialysis (HD). Patients with chronic kidney disease (CKD), but especially those with End-stage renal disease (ESRD), treated with maintenance HD tend to have a reduced immune response to infection or vaccination.<br /> <strong>Objective: </strong>The present study aimed to evaluate the immune response following vaccination with the COVID-19 vaccines in patients with maintenance HD and the factors associated with it.<br /> <strong>Patients and methods: </strong>This prospective observational comparative study included 44 patients with ESRD on maintenance HD had been done in the Internal Medicine and Clinical Pathology Departments, Zagazig University Hospital. Another 20 vaccinated non-renal patients were considered controls. SARS-COV2 IgG was estimated using an ELISA assay.<br /> <strong>Results: </strong>There is a lower significant value of SARS COVID igG in renal dialysis patients compared to the control group regarding sex, smoking habit, and obesity. Also, there is a lower significant value of SARS COVID IgG in renal dialysis patients compared to the control group regarding the history of COVID19 infection before vaccination and occurrence of post-vaccine adverse effects. There is a higher significant SARS COVID igG value for males and smokers in the control group.<br /> <strong>Conclusion: </strong>Hemodialysis patients demonstrate a hyporesponsiveness to vaccination against COVID-19. Although most patients on maintenance hemodialysis developed a substantial humoral response following the COVID vaccine, it was significantly lower than controls.https://ejhm.journals.ekb.eg/article_248784_f6b91fb2d0075e921dd088f3e7e473f6.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Comparative Study between Ligasure and Conventional Vessel Ligation in Thyroidectomy “Randomized-Controlled Study “3464346924878510.21608/ejhm.2022.248785ENAmmar S A1General SurgeryMoataz Ahmed AltaybPediatric Surgery, Faculty of Medicine - Assuit UniversityAshraf Ahmed Helmy1General SurgeryAbadeer Rafaat Marsis1General SurgeryJournal Article20220310<strong>Background: </strong> Remarkable increase in incidence of thyroid cancer over previous decade has resulted in increased need for thyroid surgery.<br /> <strong>Aim and objectives: </strong>Goal of research was to evaluate safety and efficacy of using vessel sealing device ligasure (COVIDIEN®) in terms of intraoperative and postoperative complications, comparing to standard vascular ligation in open thyroid surgery.<br /> <strong>Patients and methods: </strong>A randomized-controlled trials that was conducted at Department of General Surgery of Assiut University Hospitals. A total of 80 patients were scheduled for thyroidectomy participated in the research. Those patients were randomly subdivided into 2 categories. Category 1 included cases who underwent conventional vessel ligation (n= 40 patient) and category 2 included cases who underwent ligasure vessel sealing (n=40 patients). The study was conducted in the period between 2019 and 2021.<br /> <strong>Results:</strong> Both groups had insignificant difference regarding overall recorded complications (8 (20%) vs. 7 (17.5%); <em>p < /em>= 0.51). One patient in each group developed hoarseness while recurrent transient laryngeal nerve damage was recorded in two patients in each category. The most frequent complication was transient hypocalcaemia (12.5% of conventional ligation and 10% of ligasure sealing group).<br /> <strong>Conclusion:</strong> Ligature was superior to conventional approach in terms of lowering operation time, perioperative and postoperative blood loss, and parathyroid damage. RLN injuries, on the other hand, were comparable in both categories. Although shorter operative periods led to lower operating room occupancy expenses, overall cost of surgery was considerably greater in ligasure category.</em>https://ejhm.journals.ekb.eg/article_248785_2ae285c10b204c7556e48bc5f00cfd1a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Frequency and Risk Factors of Nocturnal Enuresis among Primary School Children in Sharkia Governorate3470347624881810.21608/ejhm.2022.248818ENSafaa Mohammed El-Sayed AhmedDepartments of 1Family Medicine, Tal Moftah Family Health Center, Abo Hammad District,Soad Abdel Salam Shedeed2PediatricsReem Abbas Abbas Morsy3Occupational & Environmental Medicine,Hanaa Salah Said4Family Medicine, Faculty of Medicine, Zagazig University, Sharkia, EgyptJournal Article20220313<strong>Background:</strong> nocturnal enuresis (NE) has a negative impact on children’s health and imposes a long-term burden on families. With increasing the awareness and improving the cultural conditions more attention was given to NE.<br /> <strong>Objective:</strong> To assess the frequency and associated risk factors of NE in a sample of primary school children in the Sharkia Governorate.<br /> <strong>Patients and methods: </strong>The study was carried out in two randomly selected schools (Al Salam primary school and Tal Moftah primary school) in Abo Hammad district, Sharkia Governorate. The sample included children who had monosymptomatic, primary, or secondary nocturnal enuresis including 454 children ages 6–12 years.<br /> <strong>Results: </strong>The frequency of NE was (8.8%). Children experienced more NE if they drank beverages containing caffeine during the day (12.2%). About 42.9% and 43.3% of children had constipation and urinary tract infection respectively suffering from NE. All children with social problems were belonging to the nocturnal enuresis group.<br /> <strong>Conclusion:</strong> Nocturnal enuresis was a common problem in children. Most of its risk factors were preventable and treatable.https://ejhm.journals.ekb.eg/article_248818_3e2b2cf2118badf552bf58ea1ec853d8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Alveolar Capillary Dysplasia in a Tertiary Center: A Case Report3477348024881910.21608/ejhm.2022.248819ENElaf Junainah1Department of Pediatric Pulmonary Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, KSAEla Alturkistani1Department of Pediatric Pulmonary Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, KSATalal Almaghamsi1Department of Pediatric Pulmonary Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, KSAMohammed Zuhdi Alimam1Department of Pediatric Pulmonary Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, KSAHamdi Alsufiani2Department of Pediatric Pulmonary Medicine, Children Hospital at King Salman Medical City,
Al-Madinah Al-Monawarah, KSAMohammed Junainah3Department of Pediatric Pulmonary Medicine, King Abdulazziz Hospital, Jeddah, KSAAhmed Jamal3Department of Pediatric Pulmonary Medicine, King Abdulazziz Hospital, Jeddah, KSARotana Hammad4Department of Pediatric Pulmonary Medicine, King Fahd Armed Forces Hospital, Jeddah, KSAJournal Article20220310<strong>Background: </strong>Alveolar Capillary Dysplasia (ACD) is an exceedingly rare fatal and lethal developmental lung disorder mainly involving the major pulmonary vasculature, with a dismal prognosis. It usually presents in full term infants who develop respiratory distress on their first days of life as persistent pulmonary hypertension of the newborn (PPHN) that is unresponsive to treatment, and produces respiratory failure early in life. The majority of reported cases were found to be associated with other systemic anomalies, more frequently involving gastrointestinal system, as well as cardiovascular, urogenital, musculoskeletal, and right-left laterality anomalies. Since its first description, significant achievements in research have led to better understanding of the underlying molecular mechanism of ACD, and genetic studies have identified association with genomic alteration in the locus of the transcription factor FOXF1.<br /> <strong>Objective: </strong>Here we present a case of female newborn who was referred to our tertiary center at the age of 5 months due to chronic hypoxia and failure to gain weight. Eventually, she was diagnosed as ACD.<br /> <strong>Conclusion: </strong>ACD/MPV is a rare and lethal developmental disorder. Patients suffer from sever hypoxemia that progresses over time, although awareness is growing among physicians it can still be confused with idiopathic pulmonary hypertension as the presentation can be similar. This usually delays the diagnosis and leads to unnecessary suffering of patients and waist of hospitals resources. As soon as the diagnosis is suspected. Genetic testing should be done or histological exam should be performed, ideally before ECMO or even surgeries for CO occurring anomalies.https://ejhm.journals.ekb.eg/article_248819_1170341ad801842a63224fffe9a06609.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Accuracy of Naked Eye Visual Inspection in Early Detection of Cervical Intraepithelial Neoplasia at Zagazig University Hospitals3481348724882010.21608/ejhm.2022.248820ENAmal Abd Aziz El Sayed NouhDepartments of 1Obstetrics and GynecologyEman Taher Nour El Din2Pathology, Faculty of Medicine – Zagazig University, EgyptAbd El-Razik Elsayed Abd El-RazikDepartments of 1Obstetrics and GynecologyKholoud Elsayed Ali AhmedDepartments of 1Obstetrics and GynecologyJournal Article20220313<strong>Background:</strong> Cervical cancer is a major contributor to mortality and morbidity among women in low- and middle-income countries. Unlike other cancers, cervical cancer is preceded by a spectrum of cytomorphological changes called cervical intraepithelial neoplasia (CIN) for many years before developing into a frank malignancy.<br /> <strong>Objective:</strong> We aimed to detect the accuracy of naked eye (NE) visual inspection in early detection of cervical intraepithelial neoplasia.<br /> <strong>Patients and Methods:</strong> This<strong> c</strong>ross sectional studywas conducted atObstetrics and Gynecology Outpatients Clinic and Pathology Department, Zagazig University Hospitals on 206 patients during the period from January 2021 to June 2021. <strong>Results:</strong> About 81% of patients had normal appearance cervix on NE examination. Visual naked eye inspection with acetic acid staining was negative in 41.3%, low threshold positive in 36.4% and high threshold positive occurred in 22.3%. There was significant association between presence or intensity of visual inspection with acetic acid (VIA) and nature of lesion. Within normal/benign lesion, 49.1%, 39.3% and 11.7% had negative, low threshold positive and high threshold positive respectively. Within CIN-1, 42.9%, 14.3% and 42.9% had negative, low threshold positive and high threshold positive respectively. Within CIN-2, 50% and 50% had low threshold positive and high threshold positive respectively. Within CIN -3, 35.7% and 64.3% had low threshold positive and high threshold positive respectively. <strong>Conclusion:</strong> Visual inspection with acetic acid (VIA) can be used as cervical cancer screening test especially in low-resource settings.https://ejhm.journals.ekb.eg/article_248820_54bf15da558ec6c248653034080c12e5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Comparison between Rapid Rhino® Pack and Gloved Nasal Pack as Middle Meatal Spacers after Endoscopic Sinus Surgery3488349524882110.21608/ejhm.2022.248821ENHamzah Faraj Alhamri MohammedDepartment of Oto-Rhino-Laryngology, Faculty of Medicine, Zagazig University, EgyptMagdy Ibrahem GoudaDepartment of Oto-Rhino-Laryngology, Faculty of Medicine, Zagazig University, EgyptIslam Roshdy HerzallahDepartment of Oto-Rhino-Laryngology, Faculty of Medicine, Zagazig University, EgyptAhmed Fouad ElgoharyDepartment of Oto-Rhino-Laryngology, Faculty of Medicine, Zagazig University, EgyptJournal Article20220314<strong>Background</strong><strong>:</strong> Rapid Rhino® nasal pack was used to minimize bleeding and to relieve postoperative pain after endoscopic sinus procedures (ESS), while different nasal packs have been employed in various sinonasal surgeries throughout the last decades. The aim of the study was to compare the effectiveness of Rapid Rhino® Pack and Gloved Nasal Pack as Middle Meatal Spacers after ESS for reducing postoperative adhesion in-patient undergoing ESS and reducing the pain during pack removal.<br /> <strong>Patients and Methods: </strong>We conducted a prospective, randomized controlled clinical trial, at ENT Department, Faculty of Medicine, at Zagazig University Hospitals on 44 cases. Patients were randomized to receive Rapid Rhino® pack the in one middle meatus (right or left), and the Gloved Nasal pack in the contra-lateral middle meatus intra-operatively.<br /> <strong>Results:</strong> Sino-nasal Outcome Test (SNOT-22) chart significantly decreased from a pre-operative mean of 52.59 (SD13.17) to 34.18 (SD 8.79) at 3 months post-operatively. Visual Analogue Scale (VAS) for pain significantly decreased in the Rapid Rhino pack groups compared with gloved nasal pack. Bleeding was more in gloved nasal pack side with statistically significant difference among both groups (p=0.007). Endoscopic evaluation of our cases revealed no significant difference between both groups regarding edema, discharge and both groups were significantly improved while significant differences were found regarding while scarring and crusting.<br /> <strong>Conclusion</strong>: We concluded that whether packs are always necessary following endoscopic sinus surgery. Rapid Rhino® Pack fulfils their primary purpose of hemostasis and is well tolerated. It has also been shown to cause little pain on removal and may prevent adhesion formation.https://ejhm.journals.ekb.eg/article_248821_eb3685697ae478b4f695489a9b83ff4a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of Diaphragmatic Dysfunction Associated with Ventilator Weaning Failure in Neonates by Diaphragmatic Ultrasound3495350424882210.21608/ejhm.2022.248822ENSohaila Ali Abd El-HalimDepartments of 1PediatricsTamer Aly AlKassas2Radiodiagnosis, Mataria Teaching Hospital, EgyptJournal Article20220315<strong>Background:</strong> Mechanical ventilation is extensively used in neonatal intensive care units. However, many risk factors are associated with mortality rates in neonates on mechanical ventilation. Various techniques have been introduced to assess the weaning time from mechanical ventilation with least risks including diaphragmatic ultrasound. This study aimedat evaluating the role of diaphragmatic ultrasound in predicting failure of weaning from mechanical ventilation in both Full Term (FT) and Preterm (PT) neonates by measuring diaphragmatic excursion before extubation using and determines a cut off value for diaphragmatic excursion for expecting weaning failure.<br /> <strong>Patients and Methods: </strong>A prospective cohort study was performed in the neonatal intensive care unit (NICU) of Mataria Teaching Hospital (MTH) from June 2018 to May 2019. All full and pre-term neonates who need mechanical ventilation from first day of admission were included major congenital anomalies, need surgical intervention, congenital diaphragmatic hernia, weaned before 72 hours, pleural effusion, hepato-splenomegaly were excluded.<br /> <strong>Results:</strong> Neonates with low gestational age, presence of respiratory distress, longer period on mechanical ventilation and higher ventilator setting were more prone to weaning failure. Additionally, excellent sensitivity and specificity of diaphragmatic ultrasound in prediction of weaning failure in neonates especially in full term whether using excursion of right and left hemidiaphragm. <strong>Conclusion:</strong> Bedside ultrasound can predict weaning failure through measuring right or left diaphragmatic excursion in full term and preterm neonates.https://ejhm.journals.ekb.eg/article_248822_7d33ef46a7ef89c09d204b1e12b91423.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Migraine Prevalence among Al-Azhar University Students in Zagazig3505351124882710.21608/ejhm.2022.248827ENAbdullh Almaamoun SarhanAsmaa Sobhy AbdelhadyHanan Salah MohamedBothina Mohamed RamadanJournal Article20220710<strong>Background: </strong>As a neurological disorder, migraine is a major public health issue.<br /> <strong>Objective</strong>: To determine the prevalence of migraine headache among all grades of Al-Azhar University students in Zagazig.<br /> <strong>Patients and Methods</strong>: The study was observational descriptive questionnaire-based cross sectional design that was conducted on the population of students of the Faculty of Islamic Studies and Arabic Language for Girls and Faculty of Fundamentals of Religion for Boys, Al-Azhar University in Zagazig. The targeted students were from 1<sup>st</sup> to 4<sup>th</sup> year for the age group (18-22) from both genders.<br /> <strong>Results: </strong>There was a significant difference between students suffering from headache and other group without headache regarding age, residence, smoking and family history of headache or other neuropsychiatric illness. Regarding characters of headache, 47.02 % of our students had frequency of 2-4 attack of headache per month. 38.2% of them had long duration of headache that last for > 12 hours. Nausea and vomiting was a common symptom in 41.1 % of students. 68.9 of them reported a pulsating headache with moderate severity in 56.8 %, bilateral in 65.3% with visual disturbance in 26.7%, always worse by effort in 45.6 and always sensitive to light in 34.6% and noise in 30.4%<strong>.</strong><br /> <strong>Conclusion</strong>: Headache was uncommon complaint among students of the Faculty of Islamic Studies and Arabic Language for Girls and Faculty of Fundamentals of Religion for Boys, Al-Azhar University in Zagazig, Sharkia Governorate similar to what had been obtained elsewhere. Also, migraine forms a major health problem among our students, which might impose an enormous burden on individual sufferers.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248827_e222fde86f2343837542ee6a1d298a41.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of The Role of 3D Power Doppler in Predicting the Viability of The Endometrium to Receive Embryos for ICSI Patients3512351724882810.21608/ejhm.2022.248828ENAbd El-monsef Abdelghaffar MoustafaJournal Article20220710<strong>Background:</strong> Embryo implantation is an important event in both natural and assisted human reproduction. The benefit of 3D power Doppler is that it can measure endometrial blood flow and endometrial volume (EV) at the same time. We wanted to check whether 3D power Doppler characteristics might be utilized to predict pregnancy and implantation on the day of HCG injection during an intracytoplasmic sperm injection (ICSI) and embryo transfer procedure.<br /> <strong>Methods:</strong> This was a cross-sectional study done on 100 women EVF unit. Study was conducted in Al-Hussein University Hospital, Al-Azhar University, between May 2021 and February 2022. Before the conduction of the study, the Local Ethical Committee approved the work. All women gave consent to participate in the work.<br /> <strong>Results: </strong>There was significant increase in endometrial VI, FI, VFI and thickness in injection day in cases became pregnant compared to those who did not fulfill pregnancy. PI and RI were significantly decreased in pregnant group. No significant difference between pregnant and non-pregnant groups concerning endometrial volume. <br /> <strong>Conclusion:</strong> 3D power Doppler is a useful noninvasive predictor for predicting the viability of the endometrium to receive embryos for ICSI patients.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248828_9e1a041430e6f6c3b77909ce5653a39d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Endovascular Embolization of Ruptured Intracranial Arteriovenous Malformation: A Retrospective Analytic Study3518352224883110.21608/ejhm.2022.248831ENAdel Saad IsmaeilAhmed Mohamed AlawamryMohamed Salah MohamedAbdulaziz Salim SultanMohamed Ezzat AlsayedJournal Article20220710<strong>Background:</strong> Endovascular embolization is one of the main modalities in the treatment of ruptured intracranial arteriovenous malformations (AVMs). The endovascular approach to AVM using different embolizing agents is a well-established treatment strategy.<br /> <strong>Objective:</strong> This study aimed at evaluating of the efficacy of endovascular embolization of AVM using detachable-tip microcatheters and Onyx 18®.<br /> <strong>Patients and methods:</strong> This retrospective study was conducted at the Department of Neurosurgery Zagazig University on 40 patients suffering from ruptured AVMs and underwent procedural intervention during the period from 2018 to 2020 for evaluation of the efficacy of endovascular embolization of AVM using detachable-tip microcatheters and Onyx 18®. The interventional procedures for treatment of cerebral AVMs included the following procedures either in solitary or combined fashions; endovascular embolization and stereotactic radiosurgery.<br /> <strong>Results:</strong> AVM patients were 28 males (70.0%) and 12 females (30.0%), the mean age of all patients was 27± 0.4 years; all of them presented with spontaneous intracranial hemorrhage, 40.0% had associated neurological problem. About 65.0% of patients presented with bad grade by modified Rankin Scale (mRS). MVA were graded according to Buffalo score ranged from 1 to 4 with median 2 and about 47.5 % of patients had Buffalo 2. While Spetzler-Martin's grading ranged from 2 to 5 with median 3 and about 47.5% of patients had SMG 3. Obliteration percent was 90 ranged from 70% to 100% with median 90%.<br /> <strong>Conclusion:</strong> The application of Onyx in ruptured intracranial arteriovenous malformations is flexible, effective and safe. Onyx provides the opportunity to adjust the treatment to each individual patient.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248831_d620ec26adb5b578afc77e1cebf5afc3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Preoperative Continuous Positive Airway Pressure Versus Incentive Spirometer in Morbidly Obese Patients Undergoing Bariatric Surgeries: Randomized Comparative Study3523353024883210.21608/ejhm.2022.248832ENDema Alaa SalamaWaleed Mohammed El SarrafMona Abdelgalil HashishMohammed AdelHegazyDepartment of anesthesia and intensive care, faculty of medicine, Mansoura universityJournal Article20220710<strong>Background:</strong> Morbidly obese patients have high risk to develop postoperative pulmonary complications, 80% of them have obstructive sleep apnea and obesity hypoventilation syndrome. Patients with sleep breathing issues often use continuous positive airway pressure (CPAP) machines, which employ mild air pressure to keep the airways open. Incentive spirometry encourages cases to take slow, deep breaths, triggering natural sighs.<br /> <strong>Aim:</strong> to compare preoperative CPAP and incentive spirometer on postoperative pulmonary complications incidence in morbidly obese cases post laparoscopic bariatric surgeries.<br /> <strong>Patients and method:</strong> 52 morbidly obese patients underwent general anesthesia for laparoscopic bariatric surgery were randomly allocated either received CPAP or incentive spirometry before the day of surgery, patients were assessed for postoperative pulmonary complications, changes in pulmonary function, lung mechanics and postoperative hypoxia incidence.<br /> <strong>Results:</strong> there was no significant change among both groups in the context of postoperative respiratory complications: atelectasis was the most common complications (61.5% and 46.2% in CPAP and spirometry respectively). Better postoperative pulmonary function profile and lung mechanics was noted in spirometry group.<br /> <strong>Conclusion:</strong> Preoperative application of CPAP and incentive spirometer have comparable result as regard incidence of postoperative pulmonary complications. However, incentive spirometer improves intraoperative lung mechanics and postoperative pulmonary functions.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248832_ce7b3f657b22362d4c090305853b9f3a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Study of Serum Ferritin Levels in Patients with NAFLD and Its Relation to Male Gender and Smoking3531353624883310.21608/ejhm.2022.248833ENEhab M. AbdelraheemDepartments of 1 Tropical MedicineNorhan AliDepartments of 1 Tropical MedicineLamia Hamdy Ali2 Clinical Pathology, Faculty of Medicine, Minia University, EgyptYasser A AbdelghaniDepartments of 1 Tropical MedicineJournal Article20220710<strong>Background:</strong> The second-leading cause of cirrhosis and liver transplantation in the world is non-alcoholic fatty liver disease (NAFLD). NAFLD encompasses a wide spectrum of diseases, including simple steatosis, non-alcoholic steatohepatitis (NASH), cirrhosis, and its effects, including hepatocellular cancer and mortality. In individuals with NAFLD, serum ferritin levels have been proposed as a potential predictor of the frequency and severity of liver fibrosis. The aim of the current study is to evaluate serum levels of ferritin in NAFILD as predictor to disease severity and its relation to male gender and smoking.<br /> <strong>Patients and methods</strong>: Ninety-nine adults enrolled in the study between January 2019 and May 2019. Patients had to have NAFLD, based on the NAFLD Liver Fat Score (NLFS Score) and the Hepatic Steatosis Index (HIS Score). Advanced fibrosis was defined as stages 3-4. Analyses were performed. Serum ferritin levels were assessed for each through venous sampling.<br /> <strong>Results:</strong> On assessment of liver fibrosis by the FIB-4 index, there was 67 had F0 (67.7%), 27 had F1-2 (27.3%) and 5 had F3-4 (5.1%). there was a significant correlation between serum ferritin and disease severity. Male patients had higher significant values than females (p=0.003). Smoker patients showed highly significant values in comparison to non-smokers (p=0.014) serum ferritin where it was higher in males. No significant correlation was found between liver fibrosis and serum ferritin.<br /> <strong>Conclusions:</strong> In NAFLD patients, higher serum ferritin was linked to male gender and smoking history. The findings suggest that NAFLD in a male smoker adult is more susceptible to liver disease development and should be treated aggressively.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248833_e45ea080f0d9d9efa28164e37357f996.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Genetic Detection of Folate Pathway Inhibitors Genes among Acinetobacter spp. Isolates3537354224883410.21608/ejhm.2022.248834ENNaseer Flaih Zghair Al-GhazalyNabil Salim Saaid TuwaijJournal Article20220710<strong>Background: </strong>Exist of folate pathway inhibitor genes among <em>Acinetobacter </em>spp. isolates are regarded as a significant mechanism of resistance for sulfa drugs in this pathogen. <strong>Objective: </strong>This study aimed to investigate genes associated with sulfa drugs resistance among <em>Acinetobacter </em>spp. using Polymerase Chain Reaction (PCR). <strong>Patients and Methods: </strong>This study included 928 specimens from patients who visited the main hospitals and private clinic laboratories of Al-Najaf City-Iraq. All specimens were cultivated and bacterial diagnosis was done according to standard methods. Antibiotics susceptibility and molecular investigation for sul-1, sul-2, sul-3, dfr-A, dfr-B, dfr-G and dfr-K for all Acinetobacter spp. isolates were done. <strong>Results:</strong>The rate of <em>Acinetobacter</em> spp. isolates were 28 (5.4%). Results showed a high resistance towards antibiotics classes, 28 (100%) of isolates were resistance to piperacillin, cefotaxime, ceftriaxone, ceftazidime and cefepime, while the lowest resistance rate was against minocycline reached 42.85. PCR showed 28 (100%) of <em>Acinetobacter</em> spp isolates were harbored sul-1 and drf-G genes. 25 (89.29%) and 21 (75%) of isolates were positive for sul-2 and drf-A genes respectively, while sul-3, drf-B and drf-K genes were not detected.<br /> <strong>Conclusion: </strong>There is a great deal of concern about antimicrobial agent resistance and also about the number of drug-associated resistance genes contained in <em>Acinetobacter</em> spp. isolates especially sul-1, sul-2, dfr-A, and dfr-G, which have a significant role in sulfa drug resistance.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_248834_3582411f8c0cc27125217b17195db626.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prevalence of Heart Failure Among Type 2 Diabetic Patients in Benha City, Egypt: A Hospital-Based Cross-Sectional Study3543354924921910.21608/ejhm.2022.249219ENRasha O. AbdelmoniemDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptAmira M. ElsayedDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptReham M. AhmedDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptWalaa M. IbrahimDepartment of Internal Medicine, Faculty of Medicine, Benha University, EgyptJournal Article20220317<strong>Background:</strong> Diabetes mellitus is highly prevalent amongst patients with heart failure, especially those with heart failure and preserved ejection fraction (HFpEF), and patients with the two conditions have a higher risk of mortality compared with patients without diabetes or heart failure. The aim of the study is todetermine the prevalence of heart failure among type 2 diabetic patients in Benha city, Egypt and to assess the different causes and risk factors of heart failure (HF) and the impact of glycemic control on the prevalence of HF as well as the effect of different anti-diabetic drugs on control of HF.
<strong>Patients and methods:</strong> This cross-sectional study was conducted on 200 patients with type 2 diabetes attending the outpatient and inpatient clinics of Benha teaching hospital. All included patients were subjected to full history taking, complete clinical examination and laboratory investigations.
<strong>Results: </strong>The prevalence of HF in diabetic patients was 35.5% [28 (39.4%) females and 43 (60.6%) males], while patients without heart failure represented 64.5% [85 (65.9%) females and 44 (34.1%) males]. The mean age was 60 (SD 11) for patients with HF, and 58 (SD 11) years for those without HF. Glycemic control was significantly lower in those with HF (9.9%) than those without HF (68.2%), with p < 0.001.Fasting blood glucose and HBA1c were significantly higher in those with HF failure than those without HF (p < 0.001). The number of patients with HF who were on sulfonylurea and thiazolidinediones (TZD) was significantly higher than those without HF who were using them. <strong>Conclusion:</strong> There is a strong association between type 2 diabetes and both prevalent and incident HF. TZDs are not recommended in patients with symptomatic heart failure, and initiation of therapy is contraindicated in patients with established HF.https://ejhm.journals.ekb.eg/article_249219_8e70aa84834798b0d80e43937680f9eb.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Ultrasonography For Fluid Assessment in Parturients with Preeclampsia Undergoing Elective Cesarean Section Under Spinal Anesthesia3550356024922010.21608/ejhm.2022.249220ENDina A. ElebedyDepartment of Anesthesiology, Faculty of Medicine, Mansoura University, EgyptSherine A. BakreyDepartment of Anesthesiology, Faculty of Medicine, Mansoura University, EgyptAboelnour BadranDepartment of Anesthesiology, Faculty of Medicine, Mansoura University, EgyptHanaa M. ElBendaryDepartment of Anesthesiology, Faculty of Medicine, Mansoura University, EgyptJournal Article20220316<strong>Background</strong>: Preeclampsia is a syndrome characterized by hypertension and organ system involvement. Fluid assessment is essential to avoid complications. Point of care ultrasonography (POCUS) is noninvasive tool used in assessment of parturients with preeclampsia. <strong>Objective: </strong>This study evaluated perioperative ultrasonography for assessment of lung congestion, optic nerve sheath diameter (ONSD), and IVC diameters in parturients with preeclampsia. We hypothesized a difference in pulmonary congestion over time during cesarean delivery.
<strong>Patients and methods:</strong> This was a prospective observational study of one hundred ASA II-III parturients with preeclampsia, singleton pregnancy undergoing elective cesarean delivery under spinal anesthesia. Lung ultrasonography, IVC diameters and ONSD ultrasound performed at baseline, at 1 h and 2 h after spinal anesthesia, Lung ultrasound for quantification of the Echo Comet Score (ECS). The maximum and minimum IVC diameters assessed using the subcostal long-axis view. ONSD measured 3 mm behind the globe.
<strong>Results:</strong> No significant difference in the ECS and ONSD at 1 hour and 2 hours compared with baseline (<em>P</em>=0.46), (<em>P</em>=0.16) respectively. The maximum and minimum IVC diameters were larger at 1 h and 2 h compared with baseline (<em>P</em><0.0001).There was a positive correlation between the ECS and ONSD at 2 h. (r<sup>2 </sup>= 0.689, <em>P</em><0.001).
<strong>Conclusion: </strong>No significant difference in the ECS and ONSD at 1 hour and 2 hours after spinal anesthesia compared with baseline. Non-invasive POCUS used for fluid assessment in parturients with preeclampsia.https://ejhm.journals.ekb.eg/article_249220_2253d0879c39f91440e6d0b02fd6c751.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Interventional Radiology in the Management of Liver Diseases: Review Article3561356324922110.21608/ejhm.2022.249221ENMostafa Saleem HassafDepartment of Interventional Radiology, Ibn Sina Specialty Centre, IraqJournal Article20220714<strong>Background: </strong>Infections of the liver are common and can continue a long time. Furthermore, the fatality rate associated with chronic liver illnesses remains high, despite continuing development of novel diagnostic and treatment processes. As a result, significant attempts to improve imaging techniques have been made, notably in this decade. The morphology, circulation, metabolism, parenchymal texture, fibrosis, and/or tumour viability of the liver can all be investigated using contemporary imaging methods. Some of the novel imaging techniques and procedures that have made it possible to monitor liver function include magnetic resonance perfusion, magnetic resonance elastography, and dual-energy computed tomography (CT).
<strong>Objective: </strong>The study aimed to highlight on improved imaging techniques and advanced interventional radiology (IR) technologies, new multimodality treatments for liver illnesses have been developed.
<strong>Methods: </strong>PubMed and Google scholar were searched using the following keywords: Liver diseases, CT, MRI and liver treatments. The authors also screened references from the relevant literature, including all the identified studies and reviews, only the most recent or complete study was included, and in peer-reviewed articles between February 2010 and July 2021.<strong>Conclusion:</strong> Finally, this special review reviewed recent breakthroughs in both diagnostic and interventional radiology, providing us with useful perspectives in this rapidly evolving discipline.https://ejhm.journals.ekb.eg/article_249221_c6ec33ff4436cce7e01bb8966f3a7304.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Radiology and the Treatment of Brain Injury and Disease: Review Article3564356624922410.21608/ejhm.2022.249224ENMostafa Saleem HassafDepartment of Interventional Radiology, Ibn Sina Specialty Centre, IraqJournal Article20220714<strong>Background: </strong>Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Radiology, MRI, CT, and PET scans play an important role in the evaluation, diagnosis, and triage of patients with TBI. Recent studies suggest that it will also help predict patients’ outcomes.
<strong>Objective: </strong>This study aimed to investigate the benefits from using MRI, CT, and PET scans to diagnose brain injuries or diseases, radiologically. <strong>Methods:</strong> PubMed, Google scholar and Science direct were searched using the following keywords: Brain injury, brain disease, MRI, CT and PET scans. The authors also screened references from the relevant literature, including all the identified studies and reviews, only the most recent or complete study was included between December 2007 and January 2022. Documents in a language apart from English have been excluded as sources for interpretation. Papers apart from main scientific studies had been excluded (documents unavailable as total written text, conversation, conference abstract papers and dissertations).
<strong>Conclusion:</strong> Primary and metastatic brain tumours are frequently observed in neuroimaging practice. Because of the wide number of treatment options currently available to treat these tumours, post-treatment imaging interpretation has proven to be challenging. Understanding post-treatment imaging methods, treatment response criteria, and common treatment-related issues will help you tackle this tough topic more easily.https://ejhm.journals.ekb.eg/article_249224_bc9504f95ccac8c0e54d8d4277be6922.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701CT Characterization of COVID-19 Infection: Analysis of 1000 PCR Positive Cases in First and Second Waves3567357424922710.21608/ejhm.2022.249227ENMohamed M. El-BarodyDepartments of 1Radio Diagnosis, South Egypt Cancer InstituteMarwa MakboulRadiodiagnosisHelal F. Hetta3Medical Microbiology & ImmunologyLamees M. Bakkar4Chest, Faculty of Medicine, Assiut University, Assiut, EgypShimaa Farghaly2Radiodiagnosis,Journal Article20220714<strong>Background: </strong>There is a wide variety of CT radiological findings of COVID-19 infection, this study aimed to analyze retrospectively the similarities and differences of CT radiological findings between first and second waves in the confirmed coronavirus patients.
<strong>Materials and methods: </strong>comparative retrospective study between two COVID-19 pandemic waves was conducted on 1000 patients who were diagnosed as COVID-19 patients, at Assiut University hospital, 500 patients in the period from May 2020 to August 2020, while the other 500 patients were in the period from October 2020 to January 2021, all underwent MSCT chest and a comparison between similarities and differences of CT radiological findings was done.
<strong>Results</strong>: Both waves showed nearly the same mean and percentage of total CT severity score with no significant difference between them as p-value > 0.05. There is also a positive moderate correlation between age and total MSCT severity score of the lung in the first wave (r=0.51, p-value<0.001), while a significant positive mild correlation in the second wave (r=0.31 and p-value <0.001), atypical findings were encountered in the second wave more than in the first wave with the most common one was pulmonary fibrosis by (7.2%).
<strong>Conclusion:</strong> Great similarity in CT radiological findings between the two COVID-19 pandemic waves was detected. However, the main difference between them was in the severity of lung involvement in different age groups and demonstration of atypical findings which was more common in the second wave.https://ejhm.journals.ekb.eg/article_249227_43e7fc25cf0eab76481442fdb51af9dc.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Immunohistopathological Study for Patients with Appendicitis due to Enterobius vermicularis worm3576358124931710.21608/ejhm.2022.249317ENAli A. Mohy1Department of Biology, Faculty of Science, University of Kufa, IraqSaleem Khteer Al-Hadraawy1Department of Biology, Faculty of Science, University of Kufa, IraqKais Khudhair ALhadrawi2Radiology Techniques Department, Collage of Medical Technology, Islamic University, Najaf, IraqJournal Article20220316<strong>Background: </strong>Intestinal <em>E. vermicularis</em> worm infection is asymptomatic and endemic in Iraq, but it can cause appendicitis; symptoms vary depending on the stage of the gastrointestinal disease. The <em>E. vermicularis</em> worm has caused several cases of appendicitis. <strong>Objective:</strong> This study aimed to find out how common <em>E. vermicularis</em> was in appendectomy samples and whether it played a role in appendicitis development. <strong>Patients and Methods:</strong> Just 30 (3.15 %) of the 950 surgical specimens removed from patients with clinical appendicitis tested positive for <em>E. vermicularis</em> worms. Two ml blood was drawn from positive samples to measure cytokines (prostaglandin two and Transforming growth factor-beta 1), with 30 healthy people serving as a control group. From January to August 2019, all samples were taken from patients who visited AL-Zahra maternity and paediatrics and AL-Hakeem hospital in AL-Najaf province. Patients' appendixes were biopsies, stained with eosin hematoxylin, and microscopically diagnosed. <strong>Results:</strong> The findings of this study showed a substantial increase (P0.05) in serum levels of PGE2 and TGF-1β as compared to the control group, as well as a histological spectrum of appendicitis associated with a large number of <em>E. vermicularis</em> eggs, the lymphoid follicle reactive germinal center, prominent eosinophilic infiltration. <strong>Conclusion:</strong> Based on this research's findings, we believe that E. vermicularis worm infection can cause appendicitis and an immune response manifested by elevated PGE2 and TGF-1β levels in the blood.https://ejhm.journals.ekb.eg/article_249317_237b90de814b6eec3e729b298e015911.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Study of Geriatric Nutritional Risk Index and Creatinine Index in Elderly Hemodialysis Patients for Nutritional Assessment3582358924931810.21608/ejhm.2022.249318ENNany Hasan El GayarDepartment of 1Internal MedicineAli Mahmoud RamadanDepartment of 1Internal MedicineMona Tahon2Clinical and Chemical Pathology, Faculty of Medicine,
Alexandria University, Alexandria, EgyptJournal Article20220316<strong>Background: </strong>Patients undergoing hemodialysis (HD) frequently experience malnutrition, and this condition has strong causal relationship with mortality risk. Patients on hemodialysis typically use both the Geriatric Nutritional Risk Index (GNRI) and the Creatinine Index (CI) for evaluation of their nutritional status.
<strong>Objective:</strong> To compare CI and GNRI for evaluation of malnutrition in elderly hemodialysis patients.
<strong>Methods</strong>: This study included 60 patients aged ≥65 years on maintained hemodialysis who attended Hemodialysis Unit of Alexandria Main University Hospital. Full clinical assessment and routine laboratory investigations were done. Anthropometric measurements were estimated. Nutritional assessment using CI, GNRI, and Short Form Mini Nutritional Assessment. Cognitive function was evaluated using MMSE (mini mental status examination), Get up and Go Test (GUGT), (ADL), and (IADL) were assessed.
<strong>Results</strong>: 43.3% had normal nutrition, 33.3% at risk of malnutrition and 23.3% had malnutrition. BMI, hemoglobin and serum albumin were significantly lower in at risk and malnutrition groups but cholesterol, triglycerides and ESR were significantly higher in at risk and malnutrition groups. GNRI, CI and were significantly lower in at risk and malnutrition groups. All severe cognitive impairment cases (57.1%) were malnourished. 35.7% of mild cognitive impairment were malnourished and 7.1% of normal cognitive functions cases were malnourished. 38.3% had impaired instrumental activities of daily living (IADL), 26.7% had impaired activities of daily living (ADL) and 65% were at risk of falls.
<strong>Conclusion: </strong>GNRI is easy screening scoring tool for identifying the risk of malnutrition and has higher sensitivity and specificity compared to CI in hemodialysis elderly patients.https://ejhm.journals.ekb.eg/article_249318_44fb587b147359cd7e3b9fa75383e595.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Competency Levels of Physical Therapists at the Health Institutions: A Cross Sectional Survey3590359724931910.21608/ejhm.2022.249319ENHoda A. Eltalawy1Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, EgyptIbrahim Abdelhakim2National Institute for Neuro-motor System, Cairo, EgyptMaya G. Aly1Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, EgyptDoaa Tammam Atia2National Institute for Neuro-motor System, Cairo, Egypt
3Department of Physical Therapy of Women’s Health & Pediatrics, Faculty of Physical Therapy,
Heliopolis University for Sustainable Development, Cairo, EgyptFaten Hassan Abdelziem1Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, EgyptJournal Article20220317<strong>Background: </strong>Competency level assessment is essential for physical therapists (PTs) to monitor the acquisition of competency and improve the standards of clinical practice.
<strong>Objective</strong><strong>:</strong> To assess and compare competency levels among Egyptian PTs of the governmental health institutions in urban areas. <strong>Subjects </strong><strong>and Methods:</strong> This survey included 574 PTs of Bachelor (BSc); Diploma; Doctor of physical therapy (DPT); Master (MSc); and Doctorate of Philosophy (PhD) holders of both genders. Self-assessment of competency levels was carried out by using Egyptian physical therapists’ Competencies Questionnaire (EPTCQ), which consisted of 10 standards represented 51 indicators. The questionnaires were analyzed and computed based upon individual- and profession-related variables. <strong>Results: </strong>Comparison between different academic categories indicated highly significant differences (p≤0.0001). The lowest percentage of competency level (57.91%) was demonstrated by BSc holders while the highest percentage (86.01%) was reported by PhD holders. There was an incremental increase in the percentage of Diploma (60.80%), DPT (69.65%) and MSc holders (76.95%).
<strong>Conclusion:</strong> Percentage of overall competency levels among Egyptian PTs was 70.27%. Increased mean values in proportion to the levels of academic qualifications were mainly attributed to the nature and depth of academic programs, their co-activities and cumulative experience. These findings are of importance to enhance self-assessment culture and procedures, and to provide a basis for academic programs reform and upgrade in order to improve practice standards and enhance competency of PTs.https://ejhm.journals.ekb.eg/article_249319_a9186132e67ea05efd4cb122e2c7b572.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Mechanical Versus Unipolar Hysteroscopic Removal of Endometrial Polyp before Intracytoplasmic Sperm Injection: Review Article3598360124932010.21608/ejhm.2022.249320ENSayed Ahmed Mohammed TahaObstetrics & Gynaecology Department, Faculty of Medicine, South Valley University, Egypt,Mahmoud Ibrahim Almolakab ElAlrashidy2Obstetrics & Gynaecology Department, Faculty of Medicine, AL-Azhar University, Egypt,Sayed Abo Elabaas MohamedObstetrics & Gynaecology Department, Faculty of Medicine, South Valley University, Egypt,Journal Article20220310<strong>Background:</strong> Endometrial polyps (EPs) are stromal and endometrial gland hyperplastic growths. Both premenopausal and postmenopausal women have a lack of apoptotic regulation and an increase of oestrogen and progesterone receptors. An embryonic age-synchronized receptive endometrium is necessary for successful implantation. By specific mechanisms, EPs impair endometrial receptivity and implantation. Because a polyp delays the hormonal response that an endometrium in good health ordinarily elicits, implantation is put at risk. Additionally, when EPs are present, a different set of endometrial markers participate in the decasualization, implantation, and trophoblast invasion processes.
<strong>Objective: </strong>The study's goal was to evaluate the results of endometrial hysteroscopic polyps’ removal surgery via the unipolar electrodes versus mechanical (scissor) under hysteroscopy.
<strong>Conclusion:</strong> Both compared mechanical and unipolar were safe and effective in hysteroscopic removal of endometrial polyp. The mechanical hysteroscopic removal was preferable in terms of operative time, polypectomy time and pain tolerance. Mechanical hysteroscopic removal non-significantly improve the clinical pregnancy.https://ejhm.journals.ekb.eg/article_249320_72e059a0ea992d674f03bee5509c084e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Are Doppler Ultrasound Parameters Correlated with Thyroid Antibody Levels in Hypothyroid Patients with Hashimoto’s Thyroiditis?3602360824932110.21608/ejhm.2022.249321ENOmar M MahmoudRadiology Department, South Egypt Cancer Institute, Assiut University, Assiut, EgyptHaisam AttaRadiology Department, South Egypt Cancer Institute, Assiut University, Assiut, EgyptDoaa M FouadRadiology Department, South Egypt Cancer Institute, Assiut University, Assiut, EgyptJournal Article20220715<strong>Background: </strong>Hashimoto’s thyroiditis is the most frequent etiology of hypothyroidism. The most popular imaging technique for assessing thyroid nodules and the thyroid gland's echogenicity and vascularity is thyroid ultrasonography.
<strong>Objective:</strong> To compare Doppler ultrasound parameters and thyroid-stimulating antibodies in Hashimoto’s thyroiditis.
<strong>Patients and methods:</strong> Seventy-eight patients diagnosed with Hashimoto’s thyroiditis were prospectively evaluated by grayscale and Doppler ultrasound examination. This study was done between October 2019 and October 2021 at South Egypt Cancer Institute. We evaluated the overall vascularity of the thyroid gland. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the inferior thyroid arteries (ITAs) were measured. The serum levels of T3, T4, T3, T4, TSH, anti-thyroid peroxidase antibody (anti-TPO), and anti-thyroglobulin antibody (anti-TG) were assessed for all patients. We tested the correlations between the following variables: serum levels of TSH, T3, T4, anti-TPO, anti-Tg, and ITA-PSV, EDV, and RI of the ITAs.
<strong>Results:</strong> We found a strong correlation between thyroid antibodies and the Doppler ultrasound parameters. Anti-Tg and Anti-TPO are strongly correlated with PSV, EDV, and RI of the ITAs.
<strong>Conclusion:</strong> In Hashimoto’s thyroiditis patients, PSV, EDV, and RI of both ITAs are significantly correlated with the thyroid antibodies. These findings may help in the assessment of the efficacy of treatment and follow-up of these patients.https://ejhm.journals.ekb.eg/article_249321_38510d8a2368516c07983778c78ab358.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of The Role of Seminal Plasma Clusterin in Infertility Associated with Leukocytospermia3609361624934810.21608/ejhm.2022.249348ENAshraf Hassan Ahmed HassanDepartment of Dermatology, Andrology and STDS, Faculty of Medicine, Mansoura University, EgyptAdel Abd El-Kader ZalataDepartment of Dermatology, Andrology and STDS, Faculty of Medicine, Mansoura University, EgyptSherif Refaat EsmaielDepartment of Dermatology, Andrology and STDS, Faculty of Medicine, Mansoura University, EgyptIslam Mohamed Mohamed EldisokyDepartment of Dermatology, Andrology and STDS, Faculty of Medicine, Mansoura University, EgyptJournal Article20220317<strong>Background: </strong>Many factors can contribute to male infertility and one of them is presence of high concentration of WBCs in semen which is known as leukocytospermia. Clusterin is a seminal plasma protein with proposed cytoprotective role against oxidative stress and other harmful effect of leukocytospermia.
<strong>Objective</strong>: This study aims to investigate the role of seminal plasma clusterin in infertility associated with leukocytospermia.
<strong>Patients and methods</strong>: A prospective case-control study was conducted on 96 men recruited from Mansoura University Hospitals Andrology outpatient clinic. We divide them into four groups: fertile without leukocytospermia (control group), fertile with leukocytospermia group, infertile without leukocytospermia group and infertile with leukocytospermia group.
<strong>Results</strong>: The seminal plasma levels of clusterin concentration were found to be significantly reduced in all groups in comparison to the control group (P<0.0001). Also comparing both infertile groups showed significant reduction in clusterin in the group associated with leukocytospermia (P=0.0034). Moreover, clusterin showed high significant positive relationship with semen parameters, alpha-glucosidase, acrosin activity index and total antioxidant capacity. However, it showed significant negative relationship with MDA (p < 0.0001). These results support the protective role of clusterin against the oxidative stress in semen, which represents one of the most important mechanisms by which leukocytospermia could affect semen quality and interfere with fertility function.
<strong>Conclusions</strong>: Clusterin has an important sperm protective role against oxidative stress and seminal plasma clusterin level is significantly reduced in infertile patients with leukocytospermia, which may explain one of the mechanisms of how leukocytospermia interferes with the fertility function.https://ejhm.journals.ekb.eg/article_249348_97d35703475ed15a00388925608cbd90.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prevalence and Associated Co-morbid Conditions of Urinary Incontinence in Frail Elderly Males3622362924935110.21608/ejhm.2022.249351ENNahla M. ZakiGeriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, EgyptRania M. Abou-HashemGeriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, EgyptHala S. SweedGeriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, EgyptSuzan Mounir AliGeriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, EgyptJournal Article20220320<strong>Background</strong>: Urinary incontinence (UI) is considered one of the main geriatric giants and it is prevalent in elderly frail males as well as females.
<strong>Objective</strong>: To determine the prevalence and associated co morbid conditions of UI in frail older males.
<strong>Subjects and methods</strong>: A cross-sectional study was conducted in Ain-Shams Geriatrics Hospital. About 350 elderly males were screened for being frail using the clinical frailty scale. Among them, 120 frail older males were included in our study, they were screened for the presence of UI, its type, duration and severity using the Arabic version of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). All participants were subjected to comprehensive geriatric assessment with assessment of cognition, depression, functional status, past medical history, associated co morbidities and laboratory investigations.
<strong>Results</strong>: The study participants had a mean age of 72.6 years, prevalence of UI was 50% and mixed UI was the most prevalent type. UI was significantly associated with older age, higher number of comorbidities, depression, functional impairment, pyuria, congestive heart failure, diabetes, osteoarthritis, chronic kidney disease, benign prostatic hyperplasia and chronic constipation, and only congestive heart failure, pyuria and depression were the independent predictors of UI. There was no significant relationship between type of UI and its severity while a significant relationship was between its duration and severity.
<strong>Conclusion</strong>: UI is one of the geriatric syndromes that commonly exists among frail older males affecting mood, function and quality of life.https://ejhm.journals.ekb.eg/article_249351_7a59e9a7bacbd56f73b2095c6384cc71.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701A Randomized, Controlled Research Comparing between Lidocaine and Magnesium Sulfate for Induced Hypotension during Middle Ear Surgery3630363624935410.21608/ejhm.2022.249354ENAbeer El Sayed FarhatDepartments of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine for Girls,
Al-Azhar University, Cairo, EgyptRasha Lotfy El SaiedDepartments of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine for Girls,
Al-Azhar University, Cairo, EgyptJournal Article20220321<strong>Background: </strong>Controlled hypotension is a strategy to minimize blood loss and improving operative field visibility.
The aim of the study is to see the effectiveness and safety of lidocaine and magnesium as hypotensive drugs during middle ear surgery.
<strong>Patients and methods</strong>: This study was conducted on 75 participants, ASA I or II planned for middle ear operation, participants were divided randomly into 3 groups. Lidocaine group (group L) received bolus of 1 mg/kg IV lidocaine then 2 mg/kg/h infusion of lidocaine. Magnesium group (group M) received a 15 mg/kg/h infusion after receiving an IV 35 mg/kg bolus in 150ml saline within 15 minutes. Control (group C) was infused with normal saline 10 mg/kg/h.
<strong>Results:</strong> Lidocaine group offers better surgical field exposure with better surgeon's satisfaction than magnesium and control groups. There was insignificant variation among investigated groups regarding mean arterial pressure (MAP) immediately post induction. Intraoperative MAP revealed insignificant variations among lidocaine and magnesium groups but substantial differences between both and control group. Regarding heart rate (HR) there was insignificant variation among investigated groups at baseline and after induction however there was significant decrease in HR from baseline post intubation and all the study time. Lidocaine group's intraoperative blood loss was less than other two groups, patients in magnesium and control groups needed more fentanyl doses. The operating time, emergent and recovery time was substantially shorter in the lidocaine group than magnesium and control groups.
<strong>Conclusion:</strong> During middle ear procedures, lidocaine has superior results due to significant reduction in operative field bleeding, optimal field exposure, and shorter procedure times than magnesium and control groups.https://ejhm.journals.ekb.eg/article_249354_e3d2176d9ba0d0c371b772182957e20b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Modern Diagnostic and Therapeutic Options for Retroperitoneal Fibrosis; Review article3637364524935710.21608/ejhm.2022.249357ENMohammed Raafat Hassan MohammedUrology department, Ahmed Maher Teaching Hospital, Cairo, EgyptMostafa Mohmmad Mohammad Ebraheem RashedUrology department, Ahmed Maher Teaching Hospital, Cairo, EgyptMahmoud Saeed Mahmoud IbrahemUrology department, Ahmed Maher Teaching Hospital, Cairo, EgyptJournal Article20220316<strong>Background:</strong> Retroperitoneal fibrosis (RPF) is a rare condition characterized by inflammation and fibrous tissue deposition in the abdomen surrounding the aorta. This process has the potential to spread to nearby tissues, resulting in several complications, the most common and serious of which is a ureteral blockage.<br /> The most common cause is idiopathic retroperitoneal fibrosis (IRF), on the other hand, it can also be due to a variety of other elements. However, the illness’s main cause is still unknown. In retroperitoneal fibrosis, it surrounds the aorta and common iliac artery causing ureteral obstruction. Secondary spread of retroperitoneal fibrosis has been linked to malignant illness, medications, radiation exposure, and surgery.<br /> The predominance of retroperitoneal fibrosis is categorized as idiopathic, which is caused by an immune response. Idiopathic retroperitoneal fibrosis is nowadays thought to be a component of the illness group linked to immunoglobulin G4, a systemic inflammatory disease whose concept was only recently proposed.<br /> <strong>Conclusion:</strong> According to current research, over half of all instances of IRF might be due to newly found, illnesses linked to immunoglobulin G4 that are medically varied (IgG4-RD). Corticosteroid medications will be the first therapy for IRF, however, immunosuppressant drugs are also active therapy. This research adds a new understanding of concepts about etiopathogenesis, clinical manifestations, diagnosis, and therapy options for various forms of RPF.https://ejhm.journals.ekb.eg/article_249357_155aa68f0c36ce991c240e4cb9d8611c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Fetal Thigh Circumference for the Prediction of Fetal Birth Weight using Ultrasound3645364924950910.21608/ejhm.2022.249509ENAli El-Shabrawi AliDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, EgyptMohamed Sabry MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, EgyptMenna Allah MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, EgyptMohamed Mahmoud Abd El-RahmanDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, EgyptJournal Article20220320<strong>Background: </strong>Accurate foetal birth weight estimate is crucial for detecting growth limitation, preterm, and situations where clinical decisions affecting labour induction or delivery mode need to be made.This research study was conducted to determine the accuracy of predicting prenatal weight using foetal thigh circumference (TC).
<strong>Patients and methods: </strong>Between November 2018 and September 2019, we performed a cross-sectional study of pregnant women. We included single intrauterine pregnant women with no complications, and who delivered within 48 hours after examination, with gestational ages ranging from 38 to 41 weeks. Within 48 hours following birth, the true foetal weight was estimated.
<strong>Results: </strong>We included 123 pregnant women, with a mean gestational age of 38.78 (SD 0.85) weeks and a mean age of 26.68 (SD 5.24) years. Of them, 21.1% were nulliparous. We found an ultrasound parameter-to-actual-weight association that was statistically significant in favour. The greatest association between actual foetal weight and TC (r =0.685; p < 0.001). Simple linear regression showed that TC is a predictor of estimated fetal weight (<em>B</em> =153.5, p < 0.001). Between estimated foetal weight and actual weight, as well as between estimated and real TC, we found no discernible difference (p values 0.398 and 0.06, respectively).
<strong>Conclusion: </strong>When used in conjunction with other fetal measures, the foetal thigh circumference may aid in the precise computation of fetal birth weight. To increase the accuracy of birth estimations, regular ultrasound examinations should include fetal thigh circumference measurement.https://ejhm.journals.ekb.eg/article_249509_3824bc53ae510d1332a55d702f7445e2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of The Effect of Mastectomy Flap Fixation and Axillary Space Obliteration with Separation of Both Spaces in Reduction of Seroma Formation in Modified Radical Mastectomy Cases. Ismailia Teaching Oncology Hospital Experience3651365524951010.21608/ejhm.2022.249510ENAdel Mohamed IsmailDepartment of Surgical Oncology, Ismailia Teaching Oncology Hospital, EgyptJournal Article20220321<strong>Background:</strong> The most prevalent complication following a modified radical mastectomy (MRM) is seroma located under mastectomy flap and/or axilla, with excessive drainage of serous fluid in the drain, long period of the drain inside the wound with risk of infection. Formation of seroma was diagnosed clinically as collection of fluid under the mastectomy flaps and axilla seen as fluctuant, non-tender swelling.
<strong>Objective:</strong> To study the effect of mastectomy flap fixation and axillary space obliteration with separation of both spaces in comparison with classic modified radical mastectomy in diminishing of seroma formation.
<strong>Patients and methods:</strong> This study included 60 female patients over the age of 20 who were undergoing modified radical mastectomy and were randomly divided into two groups of 30 each, Group A (flap fixation, axillary space obliteration, and two space separation) and Group B (non-flap fixation). Mastectomy flaps were sutured to the underlying pectoralis fascia to obliterate the dead space, with axillary space obliteration by suturing flap into serratus anterior muscle and separation of both spaces along the lateral border of the pectoralis major muscle.
<strong>Results: </strong>There was a statistical significant decrease in day of removing the drain, total seroma volume and frequency of postoperative seroma among Group A (with Flap fixation) compared to Group B (without Flap fixation). There was high statistically significant changes in mean total seroma volume between two group, which ranged (250-1100 cc) in group (A) compared with (1500-3500 cc) in group (B).
<strong>Conclusion:</strong> Dead space obliteration following MRM is a simple technique that lowers the incidence of seroma formation, total seroma volume and days of drain removal.https://ejhm.journals.ekb.eg/article_249510_c4b42a3536cbf5d7e2d63dc87e08b3a0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Early Results of Latissimus Dorsi Tendon Transfer to Improve Shoulder Functions in Late Obstetrical Brachial Plexus Palsy3656366024951110.21608/ejhm.2022.249511ENSara Abdallah Ibrahim DohinaDepartment of Plastic, Reconstructive and Microsurgery, Faculty of Medicine, Zagazig UniversityMohamed Hassan AbdulaalDepartment of Plastic, Reconstructive and Microsurgery, Faculty of Medicine, Zagazig UniversityAhmed Mohamed AliDepartment of Plastic, Reconstructive and Microsurgery, Faculty of Medicine, Zagazig UniversityMohammad-Reda AhmadDepartment of Plastic, Reconstructive and Microsurgery, Faculty of Medicine, Zagazig UniversityJournal Article20220323<strong>Background</strong>: Latissimus dorsi (LD) tendon transfer showed good results and outcomes in management of late obstetrical brachial plexus palsy. <strong>Objective</strong>: To assess the early results of LD transfer on external rotation and abduction of the shoulder in late obstetric brachial plexus palsy patients. <strong>Subjects and Methods: </strong>At Plastic Surgery Department, Zagazig University Hospitals, we conducted this observational case series study on a group of late obstetrical brachial plexus cases (as one group of 14 patients). <strong>Results:</strong> 57.1% of the affected limbs were right side and 42.9% were left side. 2 cases representing 14.3% of the total cases had history of primary surgery. 21.4% of the cases were affected at the level of C5-6 and 78.6% of the cases were affected at the level of C5-6-7. All cases showed significant improvement in all scores. The average operational time was 1.2 hours (from 1.1 hours as a minimum time and 1.5 hours as a maximum time). <strong>Conclusion</strong>: The results of our study support the advantage of LD tendon transfer in late obstetrical brachial plexus cases in improving the abduction and external rotation functions of the affected limb.https://ejhm.journals.ekb.eg/article_249511_0a9a2ed9bb4f65378c7e4f134e94ed0a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Priapism: Current Updates in Clinical Management; Review article Mohammed Raafat Hassan Mohammed3661366724951210.21608/ejhm.2022.249512ENMohammed Raafat Hassan MohammedUrology department, Ahmed Maher Teaching Hospital, EgyptJournal Article20220316persistent erection. There are three recognised types of priapism at this time: ischemic or low-flow priapism, non-ischemic or high-flow priapism, and stuttering priapism. These are all based on the history and pathophysiology of the individual episodes.
It is characterised by a long-lasting, painful, and rigid erection produced by an abnormality in venous blood outflow from the corpora cavernosa, which is similar to penile compartment syndrome. Patients of ischemic priapism with sickle cell syndrome are more susceptible to stuttering priapism, which is characterised by self-limiting, recurring, and intermittent erections. When arterial blood drains excessively into the corporus cavernosus, a condition known as non-ischemic priapism results in an erection that is neither painful nor rigid. Because the emergency status and treatment choices for ischemia and non-ischemic priapism differ, it is necessary to make an accurate distinction between the two in order to begin appropriate therapeutic therapy. An important part of treating and managing priapism is ensuring that patients retain their ability to perform sexual functions even after the symptoms of priapism have disappeared. Medical and surgical advances in treating and preventing priapism are reviewed in this article, as well as scientific studies in this rapidly evolving subject.https://ejhm.journals.ekb.eg/article_249512_3e368bb85ffd637160812e77521a33b0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220723Integrated Use of Transthoracic Ultrasound and Echocardiography in Evaluating Patients with Chronic Obstructive Pulmonary Disease3668367525064910.21608/ejhm.2022.250649ENAhmed Gouda El GazzarDepartments of 1ChestTarek Samy EssawyDepartments of 1ChestHany Hassan Ebaid2Cardiology, Faculty of Medicine, Benha University, Benha, EgyptAsmaa El Desoukey MohammadDepartments of 1ChestShaimaa Magdy AboYoussofDepartments of 1ChestJournal Article20220322<strong>Background: </strong>Multiorgan clinical ultrasonography (pulmonary, cardiac, and vascular) has emerged as a tool of considerable usefulness in managing patients with chronic obstructive pulmonary disease (COPD) in numerous situations, including detecting concomitant heart failure or associated pulmonary hypertension.
<strong>Objective:</strong> To study the role of integrated use of transthoracic ultrasound and echocardiography in evaluating patients with COPD and their relation to the severity of the disease.
<strong>Patients and Methods: </strong>This study included 100 patients with clinically stable COPD during their follow up in the Chest Department and Chest Outpatient Clinic, Benha University Hospital. Patients were divided and classified according to GOLD 2019 (based on post bronchodilator FEV1) into 4 groups, each consisted of 25 patients.
<strong>Results: </strong>All COPD patients in this study, were males, with a mean age of 60.77 ± 6.05 years (49–73). Prominent A lines were detected in 69% of patients, irregular pleural line was present in 12% of patients and A profile was detected in 43% of patients. The diaphragmatic ultrasound (US) findings were significantly decreased with the increase of severity. 86% of the study patients showed abnormal echo findings. Severe TR was recorded in 23% and severe PH was recorded in 5%. LVDD grade I was recorded in 33% of patients and LVDD grade II was reported in 7%.
LVSD was reported in 4% of patients and cor pulmonale was reported in 12% of them.
<strong>Conclusion: </strong>Integrated use of transthoracic US and echocardiography is of great usefulness in evaluating COPD patients, screening for PH, estimating the prognosis, and in careful monitoring of these patients.https://ejhm.journals.ekb.eg/article_250649_add6be26c1a875e53ad0abc608aad9e2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220723Role of Sonoelastography versus Magnetic Resonance Imaging in Patellar Tendon Lesions3676368025065110.21608/ejhm.2022.250651ENNadia Talaat Abdelhai MahmoudDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, EgyptManal Farouk AltohamyDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, EgyptFarida Mohamed ElfawalDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, EgyptAhmed Mohamed AlsoweyDepartment of Radiodiagnosis, Faculty of Medicine, Zagazig University, EgyptJournal Article20220322<strong>Background: </strong>Sonoelastography is a growing tool in evaluation of tendon pathologies. Due to its superficial position, patellar tendon pathology can be well evaluated by superficial ultrasound (US) and sonoelastography. Evaluation of tendon pathology is best done with magnetic resonance imaging.
<strong>Objective: </strong>Toevaluation of the accuracy of sonoelastography compared to MRI in patellar tendon lesions.
<strong>Patients and methods: </strong>Forty eight patients (25 males, 23 females) with patellar tendon lesion were referred from the Department of Orthopedic Surgery and Rheumatology Outpatient Clinics. The patient’s mean age was 42.85 (ranged from 12 to 68) years. All patients were evaluated by US, sonoelastography and MRI.
<strong>Results: </strong>The mean modulus of elasticity of the patellar tendon in this study was 114.4 kPa ranging from 70-186 kPa. There were three cases that were wrongly diagnosed as patellar tendon lesion by US and sonoelastography but they showed no abnormality in MRI [no tendon thickening or signal intensity changes]. The percentage of true positive cases was 93.8% compared to 6.2% false positive cases.
<strong>Conclusion: </strong>When compared to magnetic resonance imaging (MRI), shear-wave elastography provides adequate accuracy (93.8%) when measuring patellar tendon stiffness.https://ejhm.journals.ekb.eg/article_250651_7344e5f9186927081c7943e9bd1b5b5f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Surgery versus Conservative Care for Persistent Sciatica Lasting 3 to 6 Months3681368325065510.21608/ejhm.2022.250655ENAmr Adel Abd-ElaalDepartment of Spine Surgery, Helmeya Military Hospital, Military Academy, Cairo, EgyptMohammed Abd-EL-Baset HegazyDepartment of Spine Surgery, Helmeya Military Hospital, Military Academy, Cairo, EgyptMahmoud Elsayed MassoudDepartment of Spine Surgery, Helmeya Military Hospital, Military Academy, Cairo, EgyptJournal Article20220723<strong>Background:</strong> Low back pain due to lumbar disc prolapse is a common disorder. The treatment of chronic sciatica caused by herniation of a lumbar disk has not been well studied in comparison with acute disk herniation.
<strong>Patients and Method:</strong> In a single-center trial, we randomly assigned 150 patients ?? how many with sciatica that had lasted for 3 to 6 months and lumbar disk Mention the time of the study and groups of patients
herniation at the L4–L5 or L5–S1 level in a 1:1 ratio (75 patients in each group) to undergo discectomy or to receive 6 months of standardized non-operative care followed by surgery if needed. The study was conducted for 1 year from 2020 to 2021.
<strong>Results:</strong> The mean score for leg-pain intensity was 7.7 in the surgical
group and 8.0 in the nonsurgical group. The primary outcome of the leg-pain intensity score at 6 months was 2.8 in the surgical group and 5.2 in the nonsurgical group < /p>
<strong>Conclusion:</strong> Discectomy was superior to nonsurgical care concerning pain intensity at 6 months of follow-up.https://ejhm.journals.ekb.eg/article_250655_d08a62c3e2ac511ff218e1f9eb95413d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Role of Echocardiography in Evaluation of the Effects of Sacubitril–Valsartan on Vascular Stiffness in Patients with Heart Failure: Review Article3684368725066010.21608/ejhm.2022.250660ENElshaimaa Ali Elsadek SeaoudDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptTarek Ahmad NaguibDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptIsmail Talha ElbarkyDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptMoataz Abdelmonem ElkotDepartment of Cardiology, Faculty of Medicine, Zagazig University, EgyptJournal Article20220321<strong>Background:</strong> Heart failure with reduced ejection fraction (HFrEF) people are exposed to increased risk of death that can be predicted by several factors, one of which is increased vascular stiffness. Sacubitril-valsartan has not been thoroughly investigated in this population to determine its effects on vascular function and structure. Based on the vasodilatory features of sacubitril–valsartan, we expected that fractional area change (AFAC) as well as aortic distensibility (AD), when measured through 2D transthoracic echocardiography (TTE), should enhance with treatment course in HFrEF patients.
<strong>Objective:</strong> This review article aimed to determine whether aortic stiffness can be measured by echocardiography in heart failure patients receiving sacubitril-valsartan medication or not.
<strong>Methods:</strong> Search terms for the study included echocardiography, HFrEF, sacubitril-valsartan, aorta, and entresto in PubMed and Google Scholar. After the writers carefully analysed references from the relevant literature, including all the acknowledged research and reviews, only the most recent or complete studies between February 1995 and July 2021 were included. Since no sources for interpretation could be found, non-English language documents have been ignored. Dissertations, discussions, abstract papers from conferences, and everything else that wasn't a fundamental scientific research had been excluded.
<strong>Conclusion:</strong> The positive benefits of sacubitril–valsartan on AD and AFAC as evaluated by TTE are increasing gradually from baseline to six months.https://ejhm.journals.ekb.eg/article_250660_9bc1bbe9e8b54fed0e80c58bec7a9f37.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Missed Glaucoma: A Study on Accidentally Discovered Cases with Juvenile Glaucoma3688369125066210.21608/ejhm.2022.250662ENAhmad K. KhalilGlaucoma Unit, Department of Glaucoma and Optic Nerve, Research Institute of Ophthalmology, Giza, EgyptJournal Article20220723<strong>Background: </strong>The diagnosis of juvenile glaucoma can be missed, as this age group seldom seeks ophthalmological consultation in the lack of ocular symptoms
<strong>Objective:</strong> This study aimed to evaluate incidence of missed/late diagnosed glaucoma in the juvenile age group.
<strong>Methods:</strong> A retrospective case series on 38 cases in the juvenile age group (age 8-45 yeas) who were diagnosed with glaucoma. The incidence of missed/delayed diagnosis of glaucoma in these cases were reported and evaluated.
<strong>Results:</strong> 22 (57.9%) patients presented with advanced glaucoma with a cup/disc (C/D) ratio of 0.8 or more and significant visual field (VF) changes in one or both eyes. 4 (10.5%) of these patients had total glaucomatous optic atrophy in 1 eye at the time of diagnosis. The remaining 14 patients (36.8%) were diagnosed as mild/moderate juvenile glaucoma with C/D ratio less than 0.8 at time of diagnosis. Clinical findings of 7 of these cases are described here.
<strong>Conclusion</strong>: Juvenile glaucoma is an often missed potentially blinding glaucoma.https://ejhm.journals.ekb.eg/article_250662_5ca1ab1d8f867e13943859221099d5f3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Effect of Lesion Age on Short Term Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention3692369825120910.21608/ejhm.2022.251209ENKhaled Mohamed M. MandourDepartment of Cardiology, Faculty of Medicine- Zagazig University, Zagazig, EgyptMahmoud Diaa El MenshawyDepartment of Cardiology, Faculty of Medicine- Zagazig University, Zagazig, EgyptAhmed Mohamed El ZaiatDepartment of Cardiology, Faculty of Medicine- Zagazig University, Zagazig, EgyptAlaa Elsayed Mohamed SalamaDepartment of Cardiology, Faculty of Medicine- Zagazig University, Zagazig, EgyptJournal Article20220324<strong>Background: </strong>Chronic total occlusions (CTO) represent a continuously increasing lesion subset in contemporary angioplasty practice, which is observed in about 15% of patients undergoing coronary angiography with a higher prevalence in those with previous coronary artery bypass grafting (CABG).
<strong>Objective:</strong> To determine the impact of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
<strong>Patients</strong> <strong>and methods</strong>: Sixty six patients with CTO having significant angina or recent acceleration of previously chronic stable angina, admitted to National Heart Institute and Zagazig University Hospitals were included in this cohort study to determine the impact of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). According to the CTO age, our study population was subdivided into 3 groups: group 1 (CTO age of > than 3 to 12 months), group 2 (CTO age of 12 to 24 months) and group 3 (CTO age of >24 months). All patients were subjected to PCI for coronary chronic total occlusion.
<strong>Results:</strong> There was statistically significant relation between the studied groups regarding gender. Within the group with CTO from 3 to 12 months, 54.5% were females versus 22.7% and 18.2% within the groups of 12 to 24 and >24 months respectively. There was statistically significant relation between time for PCI and time of CTO. On doing Turkey HSD test, the difference was significant between 3 to 12 months and each other group (as in this group, time of PCI was significantly the lowest time). <strong>Conclusion: </strong>Success of CTO - PCI in the current era of new dedicated CTO equipment is unlikely to be affected by CTO lesion age.https://ejhm.journals.ekb.eg/article_251209_77337ed7e3bd0f37c476340a0abb8bba.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Estimation of Calprotectin, IL-17, and IL-23 levels in the Blood of Iraqi Patients with Crohn’s Disease3699370225121210.21608/ejhm.2022.251212ENAl-Hassan Talib Waly1 Department of Biology, Collage of Science, University of BaghdadAbed Hassan Barraj1 Department of Biology, Collage of Science, University of BaghdadJournal Article20220327<strong>Background: </strong>Crohn’s disease (CD) is a common disease of the gastrointestinal tract. It is cause heavy inflammation of the digestive system, and it can hit any area of the digestive tract. Cytokines are very important in the progression and reduction of disease severity so it is important to know about them.<br /> <strong>Objective:</strong> The aim of this study is to measure levels of IL-23, IL-17, and calprotectin in serum of Iraqi patients with Crohn’s disease, and also measure the levels of inflammation markers CRP, ESR, and WBCs and the reasons for their elevation in blood or serum of patients.<br /> <strong>Materials and Methods: </strong>Inthe current study, 30 Iraqi patients with Crohn’s disease and 30 Iraqi control were included. From November 2021 to April 2022 blood samples were collected, samples were collected in the Gastro-Enterology and Hepatology Hospital in Baghdad, Iraq. The biomarkers used to assess disease activity were C-reactive protein (CRP), complete blood count (CBC), and erythrocyte sedimentation rate (ESR). Calprotectin, IL-23, and IL-17 were measured by the sandwich enzyme-linked immune-sorbent assay technology.<br /> <strong>Results:</strong> Higher incidence of Crohn’s disease was noticed in males compared to females, and a higher incidence was found in patients with medium economic situation. The mean age for Crohn’s disease diagnosis was 22.96 ±1.89. Abnormal levels of CRP, ESR, WBCs were noticed and also high levels of IL-23, IL-17, and calprotectin were found in serum of Crohn’s disease patients.<br /> <strong>Conclusion: </strong>Elevation of cytokines and inflammatory markers in the blood depends on the severity of the inflammation.https://ejhm.journals.ekb.eg/article_251212_3330916467cd44c0b6a432dadaa675c2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessing Maternal Satisfaction with Cesarean Delivery at Zagazig University Hospital in Egypt3703370925121310.21608/ejhm.2022.251213ENAbdulmagid Mahmoud SarhanDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptMohamed Mostafa ZaitounDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptSafy Lotfy AtiaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptJournal Article20220324<strong>Background:</strong> Cesarean Delivery is the most common method of delivery in Egypt. It is applied in more than 60% of all deliveries. Women for whom it is indicated must accept the procedure and be satisfied with it. Satisfied mothers are found to be more positive about their condition and more likely to actively participate in their treatment regimens and hence, better maternal and neonatal outcomes. <strong>Objective: </strong>The study aimed to improve the quality of perinatal care by assessing the level of satisfaction after cesarean delivery and determining the reasons for maternal satisfaction and dissatisfaction. <strong>Methods:</strong> This was a cross-sectional study conducted from June to December 2021 at Zagazig University Hospital, Egypt. A total of 221 women who delivered by Cesarean were enrolled and interviewed using a simple structured researcher-administered questionnaire for data collection.
<strong>Results:</strong> The mean age was 27.83 ± 5.24 years, and the median parity was 1. The overall satisfaction with hospital delivery services was high (93.7%). Women’s satisfaction was associated with birth outcomes, nurses’ concern and attitude, time spent with the doctor during the examination, care providers’ measures taken to assure privacy during examination and availability of medicines. Facility cleanliness gained the least satisfaction.<br /> <strong>Conclusion:</strong> The study found that most women were satisfied with the care received during Cesarean delivery. In-depth studies are needed to assess satisfaction with many aspects of the Cesarean birth experience.https://ejhm.journals.ekb.eg/article_251213_60b9323de9c79244a2d65616b5691bfc.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Role of Serum Magnesium in Patients with Chronic Obstructive Pulmonary Disease3710371625121410.21608/ejhm.2022.251214ENShaimaa Magdy Abou YoussefDepartments of 1Chest DiseasesMedhat Fahmy NegmDepartments of 1Chest DiseasesAsmaa Adel Alfalah2Clinical Pathology, Faculty of Medicine, Benha University, Benha, EgyptHanaa Mohamed Ahmed MohamedDepartments of 1Chest DiseasesMarwa Elsayed ElnaggarDepartments of 1Chest DiseasesJournal Article20220322<strong>B</strong><strong>a</strong><strong>c</strong><strong>kground:</strong> Whether serum magnesium has a role in the treatment of chronic obstructive pulmonary disease (COPD) patients is still up for debate. Magnesium levels in COPD patients and the frequency of exacerbations were examined in this study, which also attempted to identify a possible cut-off point for diagnosing an exacerbation.
<strong>Patients and M</strong><strong>et</strong><strong>h</strong><strong>o</strong><strong>ds:</strong> This prospective observational study included 150 subjects, 30 of whom appeared healthy, and 120 of whom had COPD patients who visited the Benha University Hospital Chest Department between May 2021 and February 2022 for follow-up. Demographics data, clinical manifestations, and the number of admissions in previous year of all participants were collected together with measuring of serum magnesium levels.
<strong>Results: </strong>There were 60 stable COPD patients (55 males and 5 females) and 60 acute exacerbated COPD (AECOPD) patients (58 males and 2 females). Stable COPD patients had a mean serum magnesium level of 2.04 (SD 0.05) mEq/L, while patients with AECOPD had levels that were 1.61 (SD 0.07) mEq/L, with statistically significant difference. Receiver operating characteristic curve showed a cut off value of 1.91 mg/dL of serum magnesium to diagnose exacerbation.
<strong>Conclusion: </strong>Hypomagnesemia is common in COPD patients who are experiencing flare-ups, which increases their risk of relapse, their frequency of flare-ups, and their need for hospitalization. Magnesium, therefore, is a risk factor for COPD exacerbation that is both independent and adjustable.https://ejhm.journals.ekb.eg/article_251214_6c2b43ed04dadb466c6a18ce1d8e87b7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Relation between Magnesium Level and Cardiovascular Calcification in Chronic Hemodialysis Patients3717372125122010.21608/ejhm.2022.251220ENAshraf Hassan AbdelmobdyDepartment of Internal Medicine and Nephrology; Nephrology Department,
Faculty of Medicine Ain Shams University, Cairo, EgyptMahmoud Mohammed ZakiDepartment of Internal Medicine and Nephrology; Nephrology Department,
Faculty of Medicine Ain Shams University, Cairo, EgyptNouran Abdel Fattah SayedDepartment of Internal Medicine and Nephrology; Nephrology Department,
Faculty of Medicine Ain Shams University, Cairo, EgyptAbdelrahman KhedrDepartment of Internal Medicine and Nephrology; Nephrology Department,
Faculty of Medicine Ain Shams University, Cairo, EgyptJournal Article20220323<strong>Background:</strong> Patients with chronic kidney disease (CKD) are susceptible to cardiovascular calcification because of a variety of factors. It is possible that magnesium (Mg) may play a role in the calcification of the arteries in several ways.
<strong>Objectives:</strong> The goal of this research was to examine the relationship between serum magnesium level and vascular stiffness & valvular calcification in hemodialysis patients.
<strong>Patients and methods:</strong> This prospective cross sectional case control study included a total of 100 prevalent hemodialysis patients who were maintained on thrice weekly hemodialysis sessions, attending at hemodialysis unit, Ain Shams university Hospitals. The included subjects were divided into two groups; Group I: consisted of 68 individuals with normal Mg levels, while group II: contained 32 patients with low Mg levels.
<strong>Results:</strong> No statistically significant differences were found as regards the laboratory and radiological investigations between both groups apart from hemoglobin (Hb) result. Mg level was positively correlated with Hb level.
<strong>Conclusion:</strong> It could be concluded that there is high prevalence of cardiovascular calcification among hemodialysis patients that may be related to age but without a statistically significant correlation to Mg level. Cardiac functions decrease with the progression of atherosclerosis and arterial stiffness.https://ejhm.journals.ekb.eg/article_251220_49aac3667fd62288d8793d9177597674.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Intranasal Dexmedetomidine Versus Midazolam as Sedative Premedication for Children in Day Case Surgery3722372625165410.21608/ejhm.2022.251654ENAshraf Saed Sayed AhmedDepartment of Anesthesia, Intensive Care and pain management, Faculty of Medicine Zagazig University, EgyptFarahat Ibrahim AhmedDepartment of Anesthesia, Intensive Care and pain management, Faculty of Medicine Zagazig University, EgyptAyoub Alhady Ramdan AldrhopyDepartment of Anesthesia, Intensive Care and pain management, Faculty of Medicine Zagazig University, EgyptAmany Fouad AhmedDepartment of Anesthesia, Intensive Care and pain management, Faculty of Medicine Zagazig University, EgyptJournal Article20220323<strong>Background:</strong> Anxiety in children undergoing surgery was considered challenging situation for anesthesia. The intranasal dexmedetomidine and intranasal midazolam as preoperative sedation drugs are used.
<strong>Objective: </strong>The aim of the current work was to evaluate and compare intranasal dexmedetomidine versus midazolam as premedication in pediatric anesthesia according to sedation scale, anxiety scale, child - parent separation scale, and mask accepting scale, heart rate, blood pressure, oxygen saturation and respiratory rate.
<strong>Patients and methods:</strong> The study was carried out on 90 children, 2 to 6 years old, who underwnt day surgical procedures at Zagazig Univerisity Hospital. They were randomly assigned into three equal groups, all were given the study drug intranasally diluted in 1 ml NS. C-Group given 1 ml NS, D-group given 2ug/kg dexmedetomidine, and M-group given 0.3mg/kg midazolam. The groups were compared rgarding onset and degree of sedation, child parent separation scale, mask acceptance scale, hemodynamic parameters, and postoperative analgesic requirements.
<strong>Results: </strong>The three groups were comparable with respect to basic demographic data. D - group showed higher alert sedation scale compared to M - group and C - group from 10 min intraoperative. Anxiety scale was significantly higher in C - group in comparison to other groups from 20 min intraoperative. Child parent separation scale was significantly lower in M - group in comparison to M - group and C - group. The median mask acceptance scale was significantly lower in D - group in comparison to M - group and C group.
<strong>Conclusions</strong>: Intranasal dexmedetomidine 2 μg/kg could be used effectively and safely as a pre-anesthetic medication in children undergoing day case surgery compared to Intranasal midazolam 0.3 mg/kg.https://ejhm.journals.ekb.eg/article_251654_d1a667f9fe3790ae6567021992f85545.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Contrast-Enhanced Digital Mammography Versus Digital Mammography in The Discrimination between Benign and Malignant Breast Lesions3727373225165510.21608/ejhm.2022.251655ENOmar M MahmoudRadiology Department, South Egypt Cancer Institute1Roaa M A ShehataRadiology Department, South Egypt Cancer Institute1Mostafa A M El-SharkawyRadiology Department,
Faculty of Medicine2, Assiut University, Assiut, EgyptHosam M KamelRadiology Department, South Egypt Cancer Institute1Journal Article20220327<strong>Background: </strong>The diagnosis of breast cancer is based on a clinical examination, sono-mammography, and magnetic resonance imaging. Mammography is considered a key tool in the diagnosis and early identification of breast cancer. However, a quarter of malignant cases are missed by using mammographic screening alone. Contrast-enhanced digital mammography (CEDM) has increased the opportunity for early detection and better Breast Imaging-Reporting and Data System (BI-RADS). assessment of breast cancer patients. <strong>Results: </strong>This prospective study included 115 patients, 75% were malignant and 25% were benign. Full-field digital mammography (FFDM) and CEDM were performed using the FUJIFILM Innovality mammography machine unit. The receiver operating characteristic (ROC) curve and Youden index analysis showed increased overall diagnostic performance of CEDM over FFDM alone, with the area under the curve (AUC) of 0.900 versus 0.755 (P = 0.0020). CEDM showed increased specificity 80% versus 65%, sensitivity 94.7% versus 86%, and accuracy 88.3% versus 80.5% (P <0.001) compared to FFDM alone. The calculated accuracy of CEDM in the detection of the multiplicity of malignant lesions was increased by 44.4% versus 27% compared to FFDM alone. CEDM improved the BI-RADS categorization of breast lesions and increased the accuracy in the detection of bilateral malignant breast lesions by 8.3% versus 5.5% compared to FFDM.
<strong>Conclusion: </strong>CEDM is a more potent imaging modality than FFDM alone in the discrimination between benign and malignant breast lesions, it improves the accuracy of BI-RADS categorization of breast lesions and is better in the evaluation of the multiplicity of breast cancer.https://ejhm.journals.ekb.eg/article_251655_b1da051db1b8156978b34d0bc2b4ba5a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Interleukin-17 Serum Level and Its Prognostic Significance in Children with Immune Thrombocytopenia3733373625165710.21608/ejhm.2022.251657ENTamer Hasan Moustafa HassanDepartments of 1PediatricsMohamed Mohamed Abdel Salam2Medical Biochemistry, Faculty of Medicine, Zagazig University, Zagazig, Egypt.Asmaa Diaa Eldin Ali AbdeenDepartments of 1PediatricsNermin Raafat Abdel FattahDepartments of 1PediatricsJournal Article20220328<strong>Background:</strong> Immune thrombocytopenia (ITP) is an acquired hematological disorder that is developed secondary to the production of auto-antibodies against platelets leading to isolated thrombocytopenia, in the absence of other causes of thrombocytopenia such as drugs, infections, malignancy, or other autoimmune diseases.
<strong>Objective: </strong>This study aimed to determine serum levels of IL-17 and evaluate its prognostic significance in children with immune thrombocytopenia.
<strong>Subjects and methods:</strong> A case control study carried out in Pediatric Hematology Outpatient Clinic, Zagazig University Hospitals during the period from September 2019 to August 2020. It included 100 subjects who were divided into 2 group; 50 children with ITP and 50 age and sex matched healthy children as a control group.
<strong>Results:</strong> In this study, newly diagnosed patients with ITP had significantly higher levels of IL-17 compared to persistent and chronic patients with ITP (554.3, 259.9 and 158.6 pg/ml in in newly diagnosed ITP, persistent ITP and chronic ITP respectively, p < 0.001).
<strong>Conclusion:</strong> We concluded that serum IL-17 predicts susceptibility to ITP in Egyptian children with ITP.https://ejhm.journals.ekb.eg/article_251657_69d344ecf16f16b0819065a82a7cbcf1.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Eradication of H. Pylori in HCV-Related Liver Cirrhosis Does Not Improve Thrombocytopenia3737374025165910.21608/ejhm.2022.251659ENYasser A. Abdelghani1Department of Tropical Medicine and Gastroenterology, Minya University, Minya, EgyptMostafa Mohamed Zanaty2Department of Critical care and Emergency Nursing, Faculty of Nursing, Mansoura University, EgyptEhab M. Abdelraheem1Department of Tropical Medicine and Gastroenterology, Minya University, Minya, EgyptJournal Article20220328<strong>Background: </strong>In patients with chronic liver disease, thrombocytopenia is the most prevalent hematological abnormality. Immunological thrombocytopenic purpura (ITP) has been attributed to infection with Helicobacter pylori (H. pylori). In individuals with persistent ITP, eradication of H. pylori causes an increase in platelet counts and is therefore recommended. However, it is uncertain if eradication will influence platelet counts in HCV-related liver cirrhosis in the same way.
<strong>Objective: </strong>The purpose of this study was to determine the prevalence of active Helicobacter pylori in patients with HCV-related liver cirrhosis and to evaluate the effectiveness of H. pylori eradication on platelet count in HCV-related liver cirrhosis patients.
<strong>Patients and Methods:</strong> A total of 100 individuals were included in the study, and those who were tested positive for H. pylori were treated. H. pylori eradication was determined by detecting H. pylori antigen in the stool four weeks after the end of the therapy. Complete blood count, prothrombin time (PT), and liver function tests were all tested (ALT, total bilirubin, Alfa fetoprotein, serum creatinine and albumin). Platelet counts were assessed following the final eradication medication at 1, 3, and 6 months.
<strong>Results:</strong> H. pylori positivity was identified in 66 of the 100 individuals with HCV-related liver cirrhosis. In all of the patients, the oral treatment regimen was successful in eradicating H. pylori. All of the patients had a Child-Pugh classification of A. The platelet counts of patients with H. pylori eradication did not significantly increase following treatment.
<strong>Conclusion:</strong> In HCV-related liver cirrhosis, eradication of H. pylori does not ameliorate thrombocytopenia.https://ejhm.journals.ekb.eg/article_251659_72c6f4ed62664f08566a960480f7dd09.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Methylene Blue Spray versus Conventional Surgical Techniques for Identification of Recurrent Laryngeal Nerve and Parathyroid Glands during Thyroidectomy3741374525166010.21608/ejhm.2022.251660ENYasser A. Orban1Department of Surgery, Faculty of Medicine, Zagazig University, EgyptAdel M. Ismail2Department of Surgical Oncology, Ismailia Teaching Oncology Hospital, Ismailia, EgyptYasser Baz3Department of Surgery, Faculty of Medicine, Helwan University, EgyptOsama Abdelazez1Department of Surgery, Faculty of Medicine, Zagazig University, EgyptMohamed M. Alkilany1Department of Surgery, Faculty of Medicine, Zagazig University, EgyptJournal Article20220329<strong>Background:</strong> Thyroid surgeries are commonly operated head and neck surgeries. Significant morbidity is caused by thyroidectomy complications such as recurrent laryngeal nerve (RLN) and parathyroids injuries.
<strong>Objective:</strong> To reduce the risk of complications after thyroidectomy, we employed methylene blue spray to locate the RLNs and parathyroid glands.
<strong>Patients and method: </strong>This was a prospective, randomized, controlled trial of 80 patients with thyroid disease who were eligible for total thyroidectomy. Group 1: patients were managed by traditional thyroidectomy where the RNL and parathyroid glands were identified anatomically. Group 2: Diluted methylene blue spray was used to aid in the identification of the RLN and the parathyroid glands.
<strong>Results: </strong>Both groups had the RLN identified. In group 2 the neve did not take the dye and remained white. At least one of the parathyroid glands could be identified in 35 patients in group 1, while it was identified in 37 patients in group 2. The parathyroid was stained with methylene blue then the dye was washed out in 3 minutes. Neither group had a statistically significant advantage over the other in identifying the parathyroid gland, p-value=0.356. The RLN was identified in all patients of both groups.
<strong>Conclusion: </strong>Methylene blue dye spraying is technically feasible, safe, and effective method for identifying and protecting the RLN and parathyroid glands during thyroidectomy. It can be used as adjunct for the identification of these structures in difficult cases. Minimizing postoperative hypocalcemia requires accurate identification of at least one of the parathyroid glands.https://ejhm.journals.ekb.eg/article_251660_e607be630aed281af470174240464c3d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Bilateral Simultaneous Femoral Neck Fractures Secondary to Epileptic Seizure: Case Report3746374825203110.21608/ejhm.2022.252031ENFalih Ali DhahriDepartment of Orthopedic Surgery, King Abdulaziz Hospital, Jeddah, Saudi ArabiaYassir AlsahafyDepartment of Orthopedic Surgery, King Abdulaziz Hospital, Jeddah, Saudi ArabiaJournal Article20220329<strong>Background: </strong>Musculoskeletal injury secondary to epileptic seizure can occur among patients during episode of seizure. It might be complicated with fractures or dislocations. Femoral neck fracture secondary to epileptic seizure has a rare incidence.
<strong>Objective: </strong>This was a case report which had bilateral femoral neck fractures secondary to epilepsy with delay presentation. Patient was treated with bilateral hemiarthroplasty.
<strong>Case report: </strong>31 years old male smoker unemployed known to have epilepsy for 15 years using Valproic acid 500 mg BID with no complaint to his medication. He was complaining of bilateral hip pain with inability to bear weight that was missed by physicians at that time and the patient neglected his symptom. After more than 2 months, he came to Emergency Department with same symptoms where imaging showed bilateral femoral neck fractures.
<strong>Conclusion:</strong> Bilateral femoral neck fracture secondary to epileptic seizure has a rare incidence. Physicians whether emergency physicians or orthopedic surgeons should consider it if the patient has any symptoms or signs of femoral neck fracture to avoid any complications and delay of management.https://ejhm.journals.ekb.eg/article_252031_d17e534078080e2876e9528b5278a812.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Comparison between Short and Long Protocols of Head Up Tilt Table Test3749375625203310.21608/ejhm.2022.252033ENEmad Effat FakhryCardiology Department, Faculty of Medicine, Ain Shams University, EgyptIslam Mahmoud BastawyCardiology Department, Faculty of Medicine, Ain Shams University, EgyptMaha Mohamed Mohamed KhalifaCardiology Department, Faculty of Medicine, Ain Shams University, EgyptJournal Article20220328<strong>Background: </strong>There are several potential causes of syncope, however vasovagal syncope is quite prevalent. Knowing the root cause of syncope requires a thorough history and a variety of investigative methods. Time and energy could be conserved with a streamlined approach for the head-up tilt table (HUT) test.
<strong>Objective: </strong>The present study aim was to compare the efficacy of a shorter HUT technique to the longer standard methodology.
<strong>Patients and Methods</strong>: The study was conducted on 276 patients with history of syncope. In the interest of patient care, all patients were directed to HUT. Complete clinical evaluations were performed on all patients, both generally and locally, in addition to a 12-lead electrocardiogram (ECG) as a baseline. They were classified randomly in 2 groups, the first group (group A) included 150 patients who underwent HUT test by the conventional long protocol which included 15 minutes duration in stage I, and the other group included 126 patients (group B) underwent the same procedure with the modified short-timed protocol which included only 10 minutes duration in stage I.
<strong>Results</strong>: Our results showed no statistically significant differences between the two groups in terms of test outcomes; nevertheless, there was a statistically significant difference in patient recovery time between the two groups for the shorter-timed procedure (mean 2.64 ± 1.35 minutes) versus the long-timed protocol (4.05 ± 1.19l minutes), with p value <0.001.
<strong>Conclusions</strong>: When attempting to identify neuro-cardiogenic syncope, using the shorter timed protocol for HUT testing is just as valid as using the longer timed technique. Reduced time and effort spent on the procedure contributed to better patient recovery time and convenience.https://ejhm.journals.ekb.eg/article_252033_c18a7e7a10a15ca971b2beb51e53dfe0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Flexible Ureterorenoscopy versus Shockwave Lithotripsy in Management of Residual Stone Fragments after Percutaneous Nephrolithotomy3757376425203510.21608/ejhm.2022.252035ENMansour Ali Aboubakr OmarDepartment of Urology, Faculty of Medicine - Zagazig University, EgyptKhaled Mohammed AbdalsamadDepartment of Urology, Faculty of Medicine - Zagazig University, EgyptEsam Abdelmohsen MahmoudDepartment of Urology, Faculty of Medicine - Zagazig University, EgyptMahmoud Mohamed MalekDepartment of Urology, Faculty of Medicine - Zagazig University, EgyptJournal Article20220403<strong>Background:</strong> Shock wave lithotripsy (SWL) and flexible ureterorenoscopy (FURS) have been used to treat renal stones.
<strong>Objective:</strong> This study aimed to compare the results of FURS and SWL in managing post- percutaneous nephrolithotomy residual stone particles.
<strong>Subjects and Methods: </strong>This prospective randomized controlled study included 48 patients with renal residual stones. It was conducted at Urological Department, Zagazig University Hospitals to compare the outcomes of SWL and FURS for the treatment of residual stone fragments from ≥ 4 mm to ≤ 20 mm following percutaneous nephrolithotomy (PNL).
<strong>Results:</strong> The success rate, operating time, residual stones, and complications in the two groups were all significantly different. One month following surgery, the SFR was higher in the FURS group (91.7%) than in the SWL group (66.7%) (p < 0.02). Less time was spent operating on patients in the SWL group (37.6 ± 7.63) than FURS group (57.50 ± 8.84). Complication rate was 16.6% in the SWL group and 12.5% in the FURS group.
<strong>Conclusion: </strong>Treatment of 0.4–20 mm residual stone fragments following PNL using FURS, SWL, and other techniques was found to be safe and successful in all cases. Compared to SWL, the SFR of FURS was greater, and the retreatment rate was lower. The operating duration in the FURS group was the longest.https://ejhm.journals.ekb.eg/article_252035_1bf028f3bfbfbb45d7b2d53a37df67d7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Effect of Antegrade direct hotshot Graft Perfusion in On-pump Coronary Artery Bypass Grafting3765377025203810.21608/ejhm.2022.252038ENMohamed ElkhoulyDepartment of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, EgyptAhmed FouadDepartment of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, EgyptJournal Article20220405<strong>Background:</strong> Cardiac ischemic time reduction and myocardium protection can be achieved by warm blood perfusion into arterial or venous grafts during proximal anastomosis construction in coronary artery bypass graft (CABG) as off-pump surgeries. However, there is few previous on-pump CABG surgery studies of the impact of warm arterial blood primary graft perfusion.
<strong>Objective:</strong> Our study aimed to investigate the positive benefits of warm arterial blood perfusion of grafted ischemic myocardial segments (through venous or arterial grafts during proximal graft anastomosis creation) on myocardium preservation.
<strong>Patients and Methods:</strong> One hundred and twenty patients were submitted to coronary artery bypass graft (CABG) as on-pump surgeries involving proximal graft anastomosis. They were allocated randomly into two equal groups. Group A undergone aortic root antegrade hotshot infusion. While in group B, the additional warm arterial blood bypass graft perfusion was performed before cross- clamp removal, followed by proximal anastomosis, which had been accomplished using partial aortic clamp.
<strong>Results: </strong>The requirement for the inotropic support and defibrillation throughout cardiopulmonary bypass (CPB) separation, total CPB duration inotropic support, IABP use, postoperative AF and MI as well as ICU and hospital stay were considerably lesser in group B when compared to group A.
<strong>Conclusion: </strong>As summarizing, there was a significant myocardium recovery impact from the addition of antegrade direct bypass graft perfusion to aortic root warm blood hotshot throughout proximal graft anastomosis during on pump CABG.https://ejhm.journals.ekb.eg/article_252038_9019af8d9a6534bbed41519ea4351089.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Modified Minimally Invasive Reduction and Osteosynthesis System Technique for Fixation of Proximal Humeral Fractures versus Multiple K-Wires Fixation3771377925204110.21608/ejhm.2022.252041ENAbdulmenem Hassan Altaher SalemDepartment of Orthopedic Surgery Faculty of Medicine, Zagazig University, EgyptMohamed Abdullah ElsoufyDepartment of Orthopedic Surgery Faculty of Medicine, Zagazig University, EgyptAmr Mohamed EladawyDepartment of Orthopedic Surgery Faculty of Medicine, Zagazig University, EgyptOsama Mohamed MetwallyDepartment of Orthopedic Surgery Faculty of Medicine, Zagazig University, EgyptJournal Article20220404<strong>Background</strong>: Fractures of the upper extremity, most commonly the proximal humerus, are commonly treated with the Minimally Invasive Reduction and Osteosynthesis System (MIROS) as well as a modified version of it.
<strong>Objective</strong>: To compare the radiological and functional outcome of modified MIROS technique and traditional multiple K-wires fixation for the treatment of proximal humeral fractures.
<strong>Patients and Methods: </strong>At Orthopedic Department of Zagazig University Hospital, we operated upon 18 patients, with a mean age of 53.1 ±9.79, 6 patients had two-part, 7 patients had three-part and 5 patients had four-part fractures, half of them were treated by K-wires and the other by Modified MIROS technique.
<strong>Results:</strong> The mean Constant score (CS) for the entire series, at the end of the follow-up period, was 74.5±17.40 in the K-wires group, 2 patients had excellent results, 3 patients had good results, 2 patients had fair results and 2 patients had poor results. In the Modified MIROS group, the mean CS was 81.5± 17.62, 3 patients had excellent results, 3 patients had good results, 2 patients had fair results and 1 patient had poor results. 7 patients had complication, 4 patients in the K-wires group as pin tract infection, delayed union, stiffness and nonunion, 3 patients in the modified MIROS group as pin tract infection, shoulder stiffness and inferior subluxation of glenohumeral joint.
<strong>Conclusion</strong>: Modified MIROS technique can be a very demanding procedure that may fail to provide a satisfactory reduction, particularly in dislocation with four-part injuries.https://ejhm.journals.ekb.eg/article_252041_bdb609176c350f22ef6f62dacc0d1078.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prevalence of Otorhinolaryngology Manifestations in COVID-19 Patients3780378525205210.21608/ejhm.2022.252052ENRasha FaiselAbu El DahabOtoRhinolaryngoglogyNashwa RefaatAudiology, Shebin El Kom Teaching Hospital, EgyptJournal Article20220330<strong>Background</strong>: As COVID19 is a pandemic disease with a variety of symptoms. It was a must to study these symptoms focusing on ENT symptoms both during the illness and post recovery.
<strong>Objective:</strong> This study aimed to evaluate the prevalence of otolaryngological manifestations in COVID-19 patients.
<strong>Methods: </strong>A non-random cross sectional observational study included 18 patients had COVID-19. They underwent otorhinolaryngology examination. Subjective methods were used for smell and taste and audiovestibular evaluation. PTA was performed in all frequencies to determine the type and level of hearing impairment.VNG was done to detect vestibular insults if present.
<strong>Results:</strong> The sample collected showed that 14 (77.7%) patients felt dizzy. Regarding smell affection, 11(61.1%) patients had smell affection of varying degrees. Sore throat and dysphagia were reported in 55.5% of patients. Dysphonia was in 6 (33.3%). Also, generalized symptoms were present in 13 (72.3%). Tinnitus only was present in 7 patients (38.9%) with 57.2% of them had normal hearing level, while the rest (42.8%) had hearing loss. As regards PTA findings, hearing impairment was bilateral in 16.66%, unilateral in 22.2% and normal hearing was noted in 61% of cases. VNG revealed central affection in 2 patients (11.1%) only.
<strong>Conclusion: </strong>Audiovestibular system can be affected by SARS-COV-2 resulting in sudden sensorineural hearing loss (SSNHL) and dizziness. No systematic research was done, so the real prevalence of COVID-19 related SSNHL and dizziness around the world is unknown. Further research needs to be done.https://ejhm.journals.ekb.eg/article_252052_3e781b684dbbb9b61f1d2169ace65a30.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Scapulothoracic Dissociation Without a Neurological Compromise: A Case Report3786378925220110.21608/ejhm.2022.252201ENAbdullah Abdulkarim AlharbiAnas Mohammad Nabil AbbasWalid Fathi MousaJournal Article20220731<strong>Background: </strong>Scapulothoracic dissociation is a high-energy traumatic disruption of the scapulothoracic articulation often associated with severe neurovascular injuries, scapula fractures, and clavicular fractures. It is a rare injury that can be recognized on chest X-ray.
<strong>Objective: </strong>This case report presents our patient with left femur and tibia shafts fracture, and left clavicle fracture with scapular separation indicating scapulothoracic dissociation.
<strong>Case report: </strong>26 years old male patient medically free, presented to our hospital on 25/4/2019 after a history of road traffic accident, the driver lost control as he was driving around 100km/hr and the car rolled over multiple times, patient was the passenger and not seatbetled and due to that he was ejected from the car, he suffered from loss of consciousness and does not remember the events of the accident and his presentation to the hospital.
<strong>Conclusion: </strong>Scapulothoracic dissociation, although a rare injury, may be life threatening. Priority should be placed on resuscitative measures, as these patients have sustained significant trauma. As threatening ischemia is rare, careful observation is recommended for the nonthreatened limb. For the ischemic limb, inspection of the neurological injury is recommended as complete plexus injuries bear a poor functional prognosis and sequelae can include early amputation and death.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252201_c878eb129295d11528e9a493cfc3610e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Effect of Radiofrequency Current Application during Catheter Ablation on Heart Rate Variability in Patients with Supraventricular Tachycardia3790379725220510.21608/ejhm.2022.252205ENNashaat Lotfy RamzyRania Samir AhmedHayam Mohammed EldamnhouryEmad EffatFakhryFaculty of Medicine, Ain Shams University0000-0002-8993-4250Journal Article20220731<strong>Background: </strong>To a large extent, the heart's functions are influenced by the autonomic nervous system involving hemodynamics, properties of cardiac conduction, heart rate (HR), as well as cardiac myocytes cell functions, and cardiac arrhythmogenesis. In the present study, heart rate variability (HRV) was evaluated in patients receiving radiofrequency catheter ablation for supraventricular tachycardias to determine if there was a correlation between the amount of radiofrequency current used and the HRV change.
<strong>Patient and Methods</strong>: For this one-arm clinical trial, 60 patients with drug-resistant supraventricular tachycardias were recruited; they underwent radiofrequency ablation and were followed up for 6 months after the procedure.
<strong>Results: </strong>Compared with pre-ablation data, at the follow-up evaluation after radiofrequency ablation, HRV were found to be shorter. Results from a 24-hour Holter monitor showed an increase in mean HR, whereas HRV parameters such as time domain indices (SDNN, rMSSD) and frequency domain index, which reflect the attenuation of parasympathetic tone, were reduced in the follow-up at 1 month and 6 months post-ablation. 30 patients, or 50%, had a high sinus rate 6 months after ablation. Compared to patients without AV nodal modification or postero-septal accessory pathway ablation, HRV changes were more pronounced in those with these procedures.
<strong>Conclusion: </strong>Six months following radiofrequency ablation, cardiac autonomic dysfunction was still evident when measured by alterations in time domain and frequency domain HR variability measures. Perhaps one cause of parasympathetic denervation is its role in post-ablation sinus rate.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252205_7f8189c2f3b8c7aa99094672de0e74d4.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701A Study on The Effectiveness of Accelerated Crosslinking in Managing Cases with Progressive Keratoconus in Children and Adolescents3798380125220910.21608/ejhm.2022.252209ENAhmad K. KhalilJournal Article20220731<strong>Background: </strong>Keratoconus (KC) normally appears around adolescence, while advanced instances have been documented in youngsters as young as four years old. KC occurs at a greater rate and progresses quicker in juvenile patients than in adults. The advancement of KC may result in visual impairment in young patients, as well as ramifications for the child's social and scholastic development.
<strong>Objective:</strong> To study the effectiveness of accelerated collagen crosslinking (CXL) in halting the progression of keratoconus in children and adolescents for up to 3 years after treatment.
<strong>Patients and Methods:</strong> This was a retrospective interventional study. 15 eyes from 9 children and adolescents, who had a confirmed progressive keratoconus, underwent accelerated collagen crosslinking (CXL), and followed up for 3 years for mean keratometric reading (Km), corneal front astigmatism (Astig), pachymetry at pupillary center, <strong>Index of surface variance</strong> (ISV), and <strong>Index of vertical asymmetry</strong> (IVA)
<strong>Results: </strong>Mean logMAR VA significantly improved. No statistically significant change occurred in K mean values from preoperative to postoperative values at years 1-3. Main K-apex decreased significantly from preoperative 54.34 ± 5.31D to 52.34 ± 5.37 at year-1 postoperatively (P = 0.004), 51.24 ±4.51 at year-2 (P = 0.012), 51.13 ± 4.87 at year-3 (P = 0.007). The mean topographic cylinder (Astig) values did not change significantly from preoperative to year-1 (P =0.90) at year-2 (P =0.13) at year-3 (P =0.75). Mean pachymetry value at the center of the cornea significantly changed from preoperative 507.25 to 475.167 at year-1 (P =0.22) and 463.9 at year-2 (P =0.004), but not year-3 (483.67, P=0.18).
<strong>Conclusions:</strong> The accelerated technique of collagen cross-linking could stop the progression of keratoconus with no serious adverse effects in adolescent cases over a period of 3-years.
<strong> </strong>
<strong> </strong>https://ejhm.journals.ekb.eg/article_252209_71ef8ba30059470440cd77cdde4f2645.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Impact of Low Sodium Dialysate on Different Echocardiographic Parameters in Prevalent Hemodialysis Patients3802380725221310.21608/ejhm.2022.252213ENAshraf Hassan AbdelmobdyOsama Mohamed MahmoudWalid Mohamed SallamReham Saeed TawfikNahed Moawad RakhaJournal Article20220731<strong>Background: </strong>About one-fifth of the adult population has end-stage renal disease <strong>(</strong>ESRD), which is associated with an elevated risk of illness and death. To remove excess sodium from the body, hemodialysis treatments using dialysate sodium (D-NA) with a concentration of 120 mEq/L have been utilized for decades. Higher D-Na (around140 mEq/L) has been employed for dialysis hemodynamic stability over time.
<strong>Objective:</strong> To determine the impact of decreased dialysate Na (equal to or less than 135 mEq/L) on cardiac functions and different echocardiographic parameters in prevalent hemodialysis patients.
<strong>Patients and Methods</strong><strong>: </strong>At Rod Elfarag Hospital's Dialysis Unit, 45 patients on regular hemodialysis underwent a 6-month prospective study.
<strong>Results:</strong> This study found a significant difference between baseline and six-month lab results in terms of hemoglobin, WBCs, platelets and Ht/URR as well as serum albumin and Ca/Na/phosphorus and BNP (p < 0.001). We discovered a highly statistically significant variation in PR interval, QRS duration, and QT interval between the baseline and follow-up ECGs after six months (p < 0.001). There was high statistically significant difference between baseline echocardiography and after 6 months echocardiography as regard left atrium diameter, ejection fraction (EF%), diastolic blood pressure (DBP) and systolic BP (p < 0.001).
<strong>Conclusion: </strong>Our results showed that the PR interval, QRS duration, and QT interval at baseline were all statistically significantly different from those after six months of treatment. DBP couldn't be lowered in this short time frame at all. This strategy's impact should be investigated in depth over an extended period of time.
https://ejhm.journals.ekb.eg/article_252213_87186b871bb2305756eb0258902f221b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Comparison Between the Knotless Suture Technique and The Conventional Technique in Rectus Sheath Closure of Cesarean Section3808381125221710.21608/ejhm.2022.252217ENMohamed Abd El-KarimObstetrics and Gynecology department, Damietta Faculty of medicine - Al-Azhar UniversityAhmed Mohamad Abd EltawabSamia Mohamad EidJournal Article20220731<strong>Background:</strong> The rectus sheath is closed during a cesarean section using a variety of methods and suture materials. To ensure optimal healing and minimize problems, a few general guidelines should be followed while sealing the anterior abdominal wall. All sutures used to seal the musculofascial wall must be tightened to roughly resemble the incision's margins. The tissue will become ischemic and necrosis will form if a further strain is applied.
<strong>Objective:</strong> The purpose of this study was to compare the Knotless suture technique to traditional techniques in rectus sheath closure after a cesarean section.
<strong>Patients and Methods: </strong>In this randomized control study 90 patients undergoing cesarean section were divided into two equal groups in the Obstetrics and Gynecology Department at Al-Azhar University hospitals of Damietta for elective cesarean section.
<strong>Results: </strong>In the present study, there was no statistically significant difference between study groups as regards infection of wound dehiscence at 1<sup>st</sup> week. Also, there was a statistical increase in the number of granulomas and discomfort in group B than in group A.
<strong>Conclusion:</strong> In conclusion, we can say knotless suture for rectus sheath closure post-CS could save time and provide an effective method for closure of rectus sheath with a lower risk of complications, postoperative pain, and discomfort.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252217_f3a5abb9d233f4092f37004dd5f44165.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Mosca's Technique in Surgical Treatment of Symptomatic Flexible Flat Foot in Children and Adolescents3812381825222210.21608/ejhm.2022.252222ENMohsen Mohamed Abdo Mar'éiRiad Mansour MegahedMohammed Said Mohammed AbdelhafezReda Hussien El-kadyJournal Article20220731<strong>Background:</strong> Flexible flatfoot refers to downfall of the medial longitudinal arch on the weight bearing state, while it looks relatively normal in the non-weight-bearing position. The deformity has three components heel valgus, forefoot abduction and downfall of the medial longitudinal arch. <strong>Objective: </strong>This study aimed to evaluate Mosca technique in correction of all the components of the deformity of flexible flatfoot in one sitting.
<strong>Patients and Methods:</strong> A prospective study on 16 feet of 16 patients (8 males and 8 females) who underwent Mosca technique for symptomatic flatfoot in the period between July 2018 and July 2020. All patients were operated upon in Zagazig University Hospitals. The mean age of the studied group was 10.4 years old, and their mean follow up period was12 months. Clinical assessment using American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was performed. Radiological assessment of talonavicular coverage and talo-first metatarsal angle was done.
<strong>Results:</strong> Radiological results showed median decrease in the lateral talo-metatarsal angle from 27° preoperative to 3° postoperative at last follow-up. Meanwhile the median decrease in the talonavicular angle was 33° preoperative to 6° postoperative (P < 0.05). Postoperative complications were minimal and controllable. Superficial wound infection on the lateral aspect of the foot which improved with antibiotics.
<strong>Conclusions:</strong> Correction of all components of the deformity in one sitting, the technique does not use arthrodesis, so the distribution of stresses in the different foot joints is not disturbed.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252222_cfc6f8d2160f91e07c5387ee7c122863.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701An Updated Overview of Bipolar Depression: Review Article3819382125222710.21608/ejhm.2022.252227ENMohammad Gamal SehloHayam Mohamed El-GoharySamar Mohamed AbdElgayedMerhan Ezzat Abdel Azeem MohamedJournal Article20220731<strong>Background: </strong>People with major depressive disorder (MDD) experience many different symptoms, including feeling guilty, low self-esteem with unhappiness as well as decreased capacity to enjoy life's simple pleasures. They may also experience changes in their sleep and appetite patterns, as well as feelings of hopelessness and suicidal thoughts. Depression and bipolar disorder (BD) are two of the most frequent mental diseases that lead to disability globally.
<strong>Objective: </strong>To give an updated overview about bipolar depression.
<strong>Methods:</strong> Bipolar depression and people with major depressive disorder were all looked for in PubMed, Google scholar, and Science direct. References from relevant literature were also evaluated by the authors, but only the most recent or complete study from January 2000 to May 2021 was included. Due to the lack of sources for translation, documents in languages other than English have been ruled out. Papers that did not fall under the purview of major scientific investigations, such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations, were omitted.
<strong>Conclusion</strong>: Researchers are performing numerous neuroanatomical and neuroimaging investigations to learn more about bipolar disorder. Bipolar disease is associated with impairments in neurocognitive processing abilities, which can be seen in a variety of neuropsychological domains such as psychomotor speed, attention, memory, executive function, as well as learning.
https://ejhm.journals.ekb.eg/article_252227_2a5953780baf9ee6132bba2a5c98bfd0.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Value of Rectus Sheath Suspension of Vaginal Vault in Total Abdominal Hysterectomy3830383325223710.21608/ejhm.2022.252237ENAbdelrahman FathyObstetrics and Gynecology Department, Damietta Faculty of medicine - Al-Azhar UniversityAbdelrahman Ali EmamSamia Mohamad EidJournal Article20220731<strong>Background:</strong> Surgical management of vaginal vault prolapse post hysterectomy has improved with the use of the recto suspension technique. The technique is also used for prolapsing of the posterior vaginal wall rectus sheath suspension was described as a quick procedure with low morbidity and a short hospital stay.
<strong>Objective:</strong> This study was aimed to evaluate rectus sheath suspension used as a treatment for vaginal vault prolapse after total abdominal hysterectomy.
<strong>Patients and Methods: </strong>This interrupted time series clinical trial estimated the value of rectus sheath suspension of vaginal vault which was done on 50 patients undergoing total abdominal hysterectomy, at the Department of Obstetrics and Gynecology, Al-Azhar University Hospitals, Damietta.
<strong>Results:</strong> Follow-up in the first week showed that the number of cystorectocele decreased to 5 (10%). Also, in the 1<sup>st</sup> month of follow-up; after three months post-operative it increases to 7 (14%) cases. We found a significant decrease in cystorectocele number from pre and postoperative and a slight increase from 1<sup>st</sup> to 3<sup>rd</sup> months
<strong>Conclusion:</strong> Using autogenous rectus fascia strips for suspention of vaginal vault in total abdominal hysterectomy is effective method for prophylaxis against vault prolapse after total abdominal hysterectomy and decrease number of postoperative cystorectocele in patients with preoperative mild cystorectocele, it also devoid of any serious complications such as described with other techniques.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252237_86b930d7ece5b6911ca339435fadd07b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of Serum Interferon Gamma in Patients with Vitiligo versus Control Group3839384325224410.21608/ejhm.2022.252244ENMahmoud Yousry M. Abdel MawlaNaglaa Ali KhalifaFathia Mohamed KhattabHala Kamal Hussien MohamedJournal Article20220731<strong>Background:</strong> Vitiligo is an autoimmune illness that causes uneven depigmentation by gradually destroying melanocytes in the skin. This disfiguring condition commonly affects the face and other visible regions of the body, causing psychological distress. Vitiligo usually appears in young people and progresses throughout their lives, resulting in a high disease burden and a poor quality of life.
<strong>Objective:</strong> The aim of this study was better clarification the possible participation of interferon gamma (IFN-γ) in the pathogenesis of vitiligo.
<strong>Patients and Methods:</strong> This case control study included 28 Patients with Vitiligo, and 28 healthy controls. Serum level of IFN-γ was measured by ELISA.
<strong>Results:</strong> Age showed a non-significant correlation with serum IFN-γ in vitiligo and control group. Serum IFN-γ showed a significant strong positive correlation with the degree of severity in vitiligo group. In vitiligo patients’ number of areas affected showed a significant positive correlation with serum IFN-γ. Serum IFN-γ also showed a significant positive very strong correlation with Psoriasis Area Severity Index (PASI) and Vitiligo Area Severity Index (VASI) score. Duration of the disease showed a significant correlation with serum IFN-γ only in vitiligo patients.
<strong>Conclusion:</strong> It could be concluded that the augmented IFN-γ serum level is found in patients with vitiligo, marking the systemic inflammatory nature of these diseases. The study proved that IFN-γ serum level significantly increases with Vitiligo diseases activity.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252244_e67103b614ea2195ac7ff55398af8242.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Use of Thoracic Fluid Content As A Guide For 6% HES Infusion during Hypervolemic Hemodilution Among Placenta Accreta Patients Undergoing Cesarean Section. A Randomized Controlled Trial3834383825224110.21608/ejhm.2022.252241ENSherif Abdullahdepartment of anesthesia, Faculty of Medicine, Cairo University, Egypt0000-0001-6226-3656Mahmoud AbdeltawabMona Youssry0000-0002-0251-8466Ahmed Ibrahim ElsonbatyJournal Article20220731<strong>Background:</strong> Hypervolemic hemodilution used in major surgeries is an effective method for reducing blood transfusion requirements. However, it may cause fluid overload and even pulmonary edema. Patients with placenta accreta are the focus of this study, which examines if TFC may be used as a guide for 6 percent HES infusion to minimize fluid overload.
<strong>Patients and Methods: </strong>This randomized controlled study was done on 108 patients with placenta accreta scheduled for cesarean section. They were split into two equal groups: the control group received an IV infusion of 6 percent HES at 15 ml/kg for 30 minutes before surgery for hypervolemic hemodilution and the TFC group received the same regimen but stopped if TFC =40 k ohm−1. The occurrence of pulmonary edema detected by lung ultrasound was reported. Hypoxia, total volume infused, heart rate, and mean arterial pressure were documented.
<strong>Results: </strong>A significant proportion of the control group had pulmonary edema, compared to just 1.8 percent of the TFC group. In the TFC group, hypoxia was less common, and the total volume infused was lower. U/S score was positively correlated with delta TFC and other parameters, while was negatively correlated with total fluid infused.
<strong>Conclusion: </strong>TFC was able to reduce the incidence of pulmonary edema, hypoxia, ultrasound scores, and the total infused volume. In patients undergoing significant procedures such as placenta accreta surgery, our data show that TFC is an effective guide for hypervolemic hemodilution.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252241_4a81009d7dc32e2327bbf0786e3d19f7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Management of Discogenic Back Pain Using Intradiscal Radiofrequency3844384825224510.21608/ejhm.2022.252245ENSalah Sabry MohamedSamy Hassanin MohamedAhmad Mohamad El-SharkawyAmr Mohamad Al-BakryJournal Article20220731<strong>Background</strong>: Degenerated discs producing discogenic back pain had nerves reportedly to be present in the inner third of the annulus fibrosis and nucleus pulposus. The electromagnetic field of the intradiscal radiofrequency (PRF) method was focused at the center of the target disc.
<strong>Objective: </strong>This study aimed to evaluate the better management and reducing chronic discogenic low back pain (LBP) and disability.
<strong>Patients and methods:</strong> This study included 26 patients who were diagnosed with chronic LBP without radiculopathy or neural compromise in MRI and carried out at Neurosurgery Department, Faculty of Medicine, Zagazig University. Complete history taking, clinical examination radiological examination were done preoperatively and postoperatively.
<strong>Results:</strong> The present study included 26 patients with age ranged from 16 to 58 years. The majority of our patients were classified to be overweight by 38.4%<strong>.</strong> Level of physical activity was reported by patients; 38.5%, 30.8%, 19.2% and 11.5% had moderate, vigorous, light and sedentary physical activity respectively. MRI imaging was done for all patients pre and postoperatively with no change reported as larger percentage had disc bulge (65.4%), followed by black disc (34.6%)<strong>.</strong> Among the studied patients, 73.1% had decrease in mean CPK postoperatively. Regarding final outcome (improvement in both OSI and VAS), 17 patients had successful outcome. There was statistically non-significant association between outcome and either age, sex, BMI, occupation, exercise level, preoperative MRI findings, CPK, OSI, VAS or sitting intolerance. Age, BMI, CPK, OSI and sitting intolerance were non-significantly higher among those with failed outcome.
<strong>Conclusion:</strong> Intradiscal radiofrequency appears to be an effective method for selected patients with chronic discogenic low back pain.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252245_f364193ad486ef31fbf05ed887e84c8a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Efficacy of Complete Mesocolic Excision with Central Vessel Ligation Technique on Lymph Nodes and Safety Margins Compared with Conventional Surgery for Colon Cancer Treatment: Prospective Observational Study3849385425224810.21608/ejhm.2022.252248ENMahmoud Thabet AyoubMohamed BakrMostafa AbdelghafoorAmr Essam Hassan FarghalyJournal Article20220731<strong>Background: </strong>The prevalence of colon carcinoma is fairly limited in Egypt, but it has a high fatality incidence. Colon carcinoma is a significant public health issue globally.
<strong>Objectives: </strong>This study aimed to determine if complete mesocolic excision (CME) with main vessel ligation approach yields an oncologically better outcome in terms of lymph nodes and safety margins compared to traditional operation for colon carcinoma.
<strong>Patients and methods: </strong>A prospective observational research that was conducted in the General Surgery Department of the Assiut University Hospitals between 2019 and 2021.
<strong>Results:</strong> Twenty-nine patients performed conventional surgery (non-CME group) and other twenty-nine patients performed CME with sharp separation of the supplying vasculature's (central vessel ligation, CVL) and the embryological planes (CME group). Substantially improved outcomes were noted regarding safety margin clearance and lymph node output (CME group: 22.5 vs. non-CME group:12, P<0.0001) and lymph node ratios (CME group: 0.03 vs. non-CME group: 0.22; P<0.0001).
<strong>Conclusion:</strong> When carried out in accordance with the right embryological plans and by trained practitioners, CME seems to be a safe therapy. The lymph node ratios are also affected since it offers superior specimens with a larger lymph node output. Therefore, it should be researched and implemented more often to use CM with CVL.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252248_d4cbe69a05e0de79ac7055e22ac6eb82.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Pulmonary Ultrasound Scoring System for Intubated Critically Ill Patients and Its Association with Clinical Metrics and Mortality3855386125225010.21608/ejhm.2022.252250ENMarwa El Sayed El NaggarAhmed Goda El GazzarSara Ayman SaeedNashwa Ahmed AminJournal Article20220731<strong>Background: </strong>Preliminary research has shown that pulmonary ultrasonography (PU) has become a vital tool for quickly diagnosing the cause of acute respiratory failure (ARF), as well as monitoring therapy progress in critically sick patients. The aim of the present study is to examine the relationship between the PU grading system and clinical metrics to identify the etiology of ARF with assessment of treatment response.<strong> Patients and methods:</strong> A prospective cohort study of 50 ARF patients was recruited from Benha University Hospital's respiratory, general, and coronary critical care units. PU examinations were performed at 3 time points during a patient’s ICU stay at intubation, 48 hours after intubation and after extubation.<strong> Results:</strong> The research comprised 28 men and 22 women. The average age of participants was 58 years old. COVID-19 was the most common diagnosis (46%). Average intubation was 6.42 days, with a P/F ratio of 172.14 and average length of stay in the ICU 10.06 days. The average length of stay in the hospital was 12.6 days, with death rate 68%. Mean first US score was 18.1 and second US score 17.54. The first total US score had a substantial positive association with mortality rate. The initial total US score had also a substantial positive link with the length of ICU stay and ventilation days (p < 0.001), whereas the P/F ratio had a negative correlation with the total lung score (p < 0.001). <strong>Conclusion:</strong> First-to-total US score had positive connection with mortality, length of hospital stay, length of ICU stays, ventilation days, and negative connection with P/F ratio.
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<strong> </strong>https://ejhm.journals.ekb.eg/article_252250_256f6328bf363ff1d611615ee3b56a47.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Role of MRCP and Diffusion Weighted Imaging in Diagnosis of Extrahepatic Biliary Stricture3862386725225110.21608/ejhm.2022.252251ENSaeda Mohamed Abd ElwhabAhmed Okasha MohamedMohamed Abd Elshafy ElsheimyAhmed Al Sabaqy AbdulwarethEsraa Khalifa HassanJournal Article20220731<strong>Background:</strong> A non-invasive and secure alternative to existing unreliable diagnostic techniques is magnetic resonance cholangiopancreatography (MRCP) and diffusion weighted imaging(DWI), which may be used to examine biliary strictures and image the biliary tree.
<strong>Objectives:</strong> This study's primary goal was to assess how well DWI to MRCP in detection of level and differentiation of causes of extra-hepatic biliary stricture<strong> (</strong>benign or malignant)<strong>.</strong>
<strong>Patients and methods</strong>: South Valley University's Qena University Hospital served as the site of this cross-sectional investigation. This research comprised 30 individuals who were healthy enough for an MRI test between January 2021 and January 2022 and who had obstructive jaundice that was either known to exist or was clinically believed to exist.
<strong>Results</strong>: In the studied patients, MRCP correctly diagnosed 16 cases out of 19 cases as benign stricture according to histopathology with three false negative malignant strictures. DWI correctly diagnosed 18 cases out of 19 cases as benign stricture according to histopathology with one false negative malignant stricture. Sensitivity, specificity, PPV, NPV and accuracy of MRCP in comparison with histopathology was 100%, 84.21%, 78.57%, 100% and 90% respectively. Sensitivity, specificity, PPV, NPV and accuracy of DWI in comparison with histopathology was100% ,94.74% , 91.67% , 100% and 96.6% respectively.
<strong>Conclusion</strong>: DWI greatly enhances the diagnosis accuracy for identifying benign and malignant biliary strictures and is superior to MRCP in the identification and characterization of biliary obstructing disorders.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252251_61c9ff08a2c1c3337eb29ad6f52d1c37.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Adverse Effects of COVID-19 Infection on Pregnant Females Admitted to Zagazig Isolation Hospitals3868387325225210.21608/ejhm.2022.252252ENAmr Abd Al-Mohsen AlnemrKhaled Baiomy ElsayedNotaila Mohammed ShehataJournal Article20220731<strong>Background:</strong> COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly across the world. As pregnant women are at greater risk of complications, they were advised to take additional precautions as the COVID-19 pandemic unfolded.
<strong>Objective:</strong> The aim of the present study was to provide an efficient and robust local database regarding the maternal and neonatal outcomes for the pregnant cases.
<strong>Patients and methods:</strong> An observational retrospective cohort study included 50 pregnant women, infected with COVID-19. They were admitted to Zagazig Isolation Hospitals during the study period, either aborted or in labor. All women were also subjected to detailed history taking, thorough investigations and medical examination. The patients were monitored during delivery and prior to it, with evaluating the respiratory symptoms. The maternal and neonatal outcomes were assessed.
<strong>Results:</strong> There was statistically significant relation between maternal outcome and duration of ICU stay. There was statistically significant relation between maternal outcome and result of CT chest.There was statistically non-significant relation between maternal outcome and neonatal gender or mode of delivery.There was statistically significant relation between maternal outcome and fetal weight, gestational age (higher with good outcome).There was statistically significant relation between need for NICU admission and fetal weight (lower in babies needed NICU admission).
<strong>Conclusion:</strong> Pregnant women, who are infected with COVID-19 doubly, require extra care. There was currently insufficient evidence on COVID-19 and pregnancy, with the majority of cases occurring late in pregnancy, which poses a really potential danger for the mother and her baby.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252252_68654bcdba324835213a631dc352421f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701CT-Guided Interventional Radiology Procedures: Review Article3874387725232410.21608/ejhm.2022.252324ENMostafa Saleem HassafDepartment of Interventional Radiology, Ibn Sina Specialty Centre, IraqJournal Article20220406<strong>Background: </strong>Interventional radiology guided by computed tomography (CT) uses minimally invasive techniques to perform medical diagnostics and treatments. Because it is widely available and can be conducted using a wide range of equipment, CT is frequently utilized for interventional image guiding.
<strong>Objective:</strong> This article highlighted for CT-guided interventional radiology procedures, areas and technique.
<strong>Methods:</strong> Google scholar and PubMed were searched using the following keywords: CT-guided interventional radiology and CT scan. The authors also screened references from the relevant literature including all the identified studies and reviews, only the most recent or complete study was included, between June 2002 and December 2020.
<strong>Conclusion: </strong>The use of CT-guided interventions radiology may offer a number of advantages. A high accuracy of instrument placement avoids the damage of vulnerable structures adjacent to the target and high accuracy to perform diagnostic and therapeutic medical procedures. In addition, could reduce the need for verification scans or CT fluoroscopy resulting in less radiation exposure.https://ejhm.journals.ekb.eg/article_252324_0a6a93556e3a40d8b553afc23b3ccf5f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Association of Plasma and mRNA Expression Levels of Ghrelin with Nutritional Status in Egyptian Patients with End-Stage Renal Disease on Regular Hemodialysis3878388425223210.21608/ejhm.2022.252232ENNearmeen M. RashadMay M. SamiNafesa M. KamalJournal Article20220731<strong>Background:</strong> Malnutrition is commonly detected in end-stage renal disease (ESRD) and is a key predictor of their survival. In ESRD patients on hemodialysis protein-energy, malnutrition is significantly observed. The plasma and mRNA expression levels of ghrelin are dysregulated in ESRD.
<strong>Objective:</strong> The current study aimed to investigate the plasma and mRNA expression levels of ghrelin among Egyptian patients with ESRD on regular hemodialysis and to assess their relations with anthropometric measures and laboratory tests as well as nutritional status.
<strong>Patients and methods:</strong> A case-control study enrolled 45 healthy control and 50 patients with ESRD on regular hemodialysis. Nutritional assessment was done by subjective global assessment scores (SGA). Patients with ESRD were classified according to their nutritional status into mild, moderate, and severe malnutrition groups. Plasma ghrelin levels were measured using an ELISA and mRNA expression of ghrelin was measured using real-time PCR.
<strong>Results:</strong> The plasma and mRNA expression levels of ghrelin were significantly higher in ESRD patients with mild and moderate malnutrition compared to the control group. However, the levels of plasma ghrelin were meaningfully lower in ESRD patients with severe malnutrition compared to the control group. plasma and ghrelin mRNA expression levels significantly positively correlated with serum creatinine and BUN and significantly negatively correlated with MAMC, Hb, albumin, transferrin and total iron-binding capacity (TIBC) (P<0.001). Serum creatinine transferrin, as well as triceps skin fold, were independently correlated with plasma ghrelin. While serum creatinine transferrin and triceps skin fold, as well as TIBC, were independently correlated with ghrelin mRNA expression levels. <strong>Conclusion:</strong> Ghrelin plasma and relative expression levels were significantly higher in ESRD patients with mild and moderate malnutrition compared to control subjects. While the levels were significantly lower in the severe malnutrition group.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252232_212003c7bb3162bd494f77830ebc6bfc.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Usefulness of Anti-Müllerian Hormone to Predict Outcomes of Threatened Miscarriage in Naturally Conceived Pregnancies3885389125282610.21608/ejhm.2022.252826ENAyman Mohamed AlashhbAzza Abd Elmageid Abd ElhameidNabila Elsayed MousaKhaled Fathy HelalJournal Article20220803<strong>Background</strong>: Anti-Müllerian hormone (AMH) levels fluctuate in a complicated and not always one-way fashion in the early stages of pregnancy. An abundance of research has looked at how AMH levels correlate with various pregnancy problems.
<strong>Objective</strong>: To determine the association between AMH and miscarriage among women naturally conceived pregnancy.
<strong>Methods</strong>: Total of 40 pregnant women at gestational age ranged between 6-8 weeks who had first trimester threatened miscarriage while they were trying for naturally conceive were included in our prospective cohort study at Obstetrics and Gynecology Department at Fetomaternal Unit in Zagazig University Hospital. All patients were subjected to assay serum AMH.
<strong>Results:</strong> Anti-Mϋllerian hormone (AMH) among the studied cases ranged from 0.8 to 4 ng/ml with mean 2.41 ng/ml and median 2.55 ng/ml. Statistical analysis revealed a negative connection between AMH and age and statistical +ve significant correlation between AMH and gestational sac size, crown lump length, yolk sac size and fetal heart rate among the studied cases. There was a statistically significant decrease in AMH among cases had aborted before 20 weeks compared to cases completed pregnancy. AMH at cut off <1.9 ng/ml had sensitivity 85.7%, specificity 87.9% and accuracy 87.5% in prediction of early pregnancy loss among the studied cases.
<strong>Conclusion:</strong> Ovarian reserve may be accurately measured by measuring anti-Müllerian hormone levels in the blood. However, findings on the significance of AMH level in making pregnancy predictions are inconsistent. The likelihood of having a miscarriage is inversely related to AMH levels. Miscarriages are more common among women who have substantially decreased ovarian reserve.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252826_af03052a77a35b8ba74cac05433be19f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Movement and Play Behaviors of Egyptian Children After Covid-19 Pandemic Restrictions: Cross-Sectional Study3892388125282710.21608/ejhm.2022.252827ENRehab R. RiadMaya G. AlyNanees E. MohamedJournal Article20220803<strong>Background: </strong>Children’s everyday lives had undergone substantial alterations due to the COVID-19 epidemic. Children's insufficient physical exercise and excessive sedentary behavior are serious issues.
<strong>Objective: </strong>To investigate the effects of COVID-19 limits on children's play and movement habits in Egypt.
<strong>Methods: </strong>A cross-sectional sample of 400 Egyptian children aged 5-14years. The Arabic version of the online outbreak survey was used to evaluate children's movement and play behavior before and during the COVID-19 epidemic. Data analysis included descriptive statistics and test-retest reliability.
<strong>Results: </strong>By comparing the collected data with WHO guidelines, it was found that 2.3% of screened children fulfilled the 24-hour combined movement behavior criteria; 57% met sleep recommendations; 36.9% met moderate-to-vigorous physical activity guidelines, and 12.3% met screen-time guidelines. During the epidemic, children in Egypt had decreased physical activity levels, more sluggish habits, and less sleep. The Arabic version of the survey showed excellent reliability.
<strong>Conclusion: </strong>The COVID-19 epidemic restrictions had a bad impact on Egyptian children's play and movement patterns. Future initiatives to safeguard and advance child health should be considered.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252827_ec3c9a4562a9fc3e32fceaccc84792f7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Adherence to Sulfonylureas in Comparison to Metformin among T2DM Patients: A Systematic Review and Meta-Analysis3900390525282910.21608/ejhm.2022.252829ENFahad Saud AlanaziHind Fahad AlqubaliOmar Atallalh AlatawiAhmed Yassin AlrefaeiAhmed Hussain AlshaikhiMaha Salim AlbalawiAbdulrhman Nasser AlwadaiJournal Article20220803<strong>Background:</strong> Improved adherence to oral anti-hyperglycemic drugs (OAHs) may improve glucose control while also lowering diabetes morbidity, mortality, and long-term health resource consumption. <strong>Aim:</strong> This study aims to compare the adherence of type 2 diabetes mellitus (T2DM) patients to sulfonylureas with metformin.
<strong>Methods:</strong> This systematic review and meta-analysis followed the PRISMA 2020 guidelines. A systematic search was done in PubMed, MEDLINE through Clarivate, Web of Science through Clarivate, and EBSCO. Studies retrieved were managed in Rayyan–Intelligent systematic reviews website for duplicate removal and screening. Review Manager 5.4 was used to generate forest plots to estimate pooled odds ratios using a random-effect model. We used the Higgin’s I2 test for assessing between-study heterogeneity. We used funnel plots for assessment of publication bias.
<strong>Results:</strong> This review included data from 11 studies on 274,202 T2DM patients. Random effect meta-analysis revealed that the odds for higher proportion of adherence favoured sulfonylurea group (OR = 1.34, 95% CI [1.08-1.65]). The comparison between sulfonylurea and metformin adherence using OR was significant (p=0.007).
<strong>Conclusion:</strong> The study concludes that T2DM patients were significantly more adherent to sulfonylurea than metformin, however, the analysis showed significant heterogeneity. We recommend adherence measures to be devised when prescribing OHAs.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252829_f24e14f04e8030ac2eebaf60ecdd0910.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Evaluation of Adipokines Among Children Infected with Some Protozoan Intestinal Parasites3906391025283010.21608/ejhm.2022.252830ENLina Jamal Al-AniHarith Saeed Al-WaridJournal Article20220803<strong><span lang="EN-AU">Background</span></strong><span lang="EN-AU">: Adipokines are molecules produced by adipose tissue that have involvement in the body's energy/metabolic status and inflammation. It has recently been shown that there is a relationship between these molecules and infection with some intestinal parasites. <strong>Objectives</strong>: The current research aimed </span><span lang="EN-AU">to ass</span><span lang="EN-AU">ess the effect of <em>Cryptosporidium</em> and <em>Giardia lamblia</em> on adipokines. <strong>Patients and methods</strong>: This research was conducted in Baghdad from October 2021 to March 2022. The study included 56 children of both sexes, ranging in age from 2 to 15 years.</span><span lang="EN-AU"> The enrolled children were divided, according their stool examination, into infected by <em>Giardia lamblia</em> (n=21), infected by <em>Cryptosporidium</em> (n=23) and apparently healthy children (n=12). All participating children were subjected to some biometric measurements (body mass index (BMI), </span><span lang="EN-AU">weight for age percentile and height for age percentile</span><span lang="EN-AU">) and adipokines assessment (adiponectin, leptin and IL-6). <strong>Results:</strong> </span><span lang="EN-AU">A significant increase</span><span lang="EN-AU">(</span><span lang="EN-AU">P˂0.05</span><span lang="EN-AU">)</span><span lang="EN-AU"> in adiponectin and leptin were observed for <em>Cryptosporidium</em> and <em>G. lamblia</em> infections versus the control group. While significant decrease </span><span lang="EN-AU">(</span><span lang="EN-AU">P˂0.05</span><span lang="EN-AU">)</span><span lang="EN-AU">in IL- 6 were noticed for <em>Cryptosporidium</em> and <em>G. lamblia</em> infections compared to the control group. BMI, weight for age percentile and height for age percentile were not significantly related with each of adiponectin, leptin and IL-6 for infected patients and control groups. <strong>Conclusions: </strong>Leptin and adiponectin secretion, as well as nutrient absorption, can be interfered with by intestinal <em>Cryptosporidium</em> and <em>G. lamblia</em>. Their precise function in intestinal parasitosis requires further study.</span>
<strong><span lang="EN-AU"> </span></strong>https://ejhm.journals.ekb.eg/article_252830_875ee204b1b92f3539c28d2803eb26fb.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Detection of Adverse Cardiac Events in Patients with Acute Myocardial Infarction3911391525283210.21608/ejhm.2022.252832ENMahmoud Abdelaziz AbdelrashidMohamed Yehya AbdelrazekMosbah Taha HassanienMagdy Mohamed Abd ElsameaJournal Article20220803<strong>Background:</strong> Myocardial infarction (MI) has an annual incidence rate of 600 occurrences per 100,000 people and affects over 1.5 million people. This study aimed to assess the major adverse cardiac events (MACE) in patients presenting with acute myocardial infarction (AMI). <strong>Patients and methods:</strong> A cohort study involved 180 patients with acute myocardial infarction attended to the coronary care unit at Department of Cardiology Zagazig University Hospitals and National Heart Institute. Patients were divided into: Group I: 155 patients with no MACE and Group II: 25 patients with MACE. All patients were subjected to full history taking, clinical examination and laboratory investigation. CHADS-VASc and GRACE scores were performed. <strong>Results:</strong> The mean age of the current study population was 56.2 (SD 9.9) years, 76.7% of them were males. The mean BMI was 27.9 (SD 3.1) kg/m<sup>2</sup>. About 56.1% of patients were smokers and 45% were hypertensives. CHADs-VASc score of the current study patients was ranging from 0 to 4. The mean GRACE score was 135 (SD 23) ranging from 64 to 187. GRACE score was 0-108 in 12.8%, 109-140 in 50.6% and > 140 in 36.7% of the studied patients. Death occurred in 3.3% of patients. Among the current study patients 2.2%, 2.2%, 3.3% and 3.9% had stroke, stent thrombosis, MI and heart failure, respectively.
<strong>Conclusion:</strong> CHA2DS2-VASc and GRACE scores are simple and easily calculated scores that provides an additional consideration in predicting of MACE in patients with AMI.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252832_3b0081142c05c8154221e24768dd2787.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Dermatological Manifestations Associated with Covid-19 Patients in Elbagour General Hospital, El-Menoufia Governorate3916392425283310.21608/ejhm.2022.252833ENAzza GaberFaragFaculty of medicine menofia university0000-0002-0333-5506Azza Zagloul LabeebMarwa Abo El-Nour Gamal AminMustafa Elsayed ElshaibNada Farag ElnaidanyJournal Article20220803<strong>Background:</strong> Corona virus-19 disease (COVID-19) marked the beginning of a new pandemic COVID-19 after massive numbers of acute pneumonia with unknown origin. Some COVID-19 confirmed patients experienced some skin lesions that might be a clinical sign of COVID-19.
<strong>Objective:</strong> This study aimed to determine the diversity of skin lesions caused by COVID-19 in Elbagour Hospital admitted COVID-19 positive cases.
<strong>Methods:</strong> A prospective cohort study included patients from both sex who were COVID-19 confirmed and experienced skin lesions. 1020 patients having COVID-19 were examined. Out of them, 600 cases showed skin lesions. They were evaluated in El-Bagour General Hospital during the isolation period from March 2020 to March 2021. Dermatological examinations were done to assess skin lesions. The ABCD score was used to determine the severity of COVID-19 patients.
<strong>Results:</strong>We reported eight types of skin lesions in the form of pityriasis rosea like lesions (387; 63%), vesicular like exanthema (320; 53.3%), erythema multiform (298; 49.7%), petechiae (232; 38.7%), urticarial lesions (231; 38.5%), maculo-papules (220; 36.7%), livedo reticularis (84; 14%) and pseudo-chilblain (74; 12.3%). Presence of skin lesions were significantly associated with moderate and severe cases (p < 0.05). Livedo reticularis was significantly linked to a high mortality rate (p < 0.001).
<strong>Conclusion:</strong>Presence of skin lesions, as well as their number, onset and type were associated with COVID-19 prognosis. Presence of early (within the first 4 days) and more than 2 skin lesion types denoted disease severity. Moreover, livedo reticularis and maculo-papules warn against more disease severity, while presence of pseudo-chilblain points to moderate disease.
<strong> </strong>https://ejhm.journals.ekb.eg/article_252833_973851d3d241085405bb563fe2bec24d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Effect of Ondansetron on Spinal-Induced Hypotension by Using Bupivacaine -Dexmedetomidine Mixture Intrathecally for Percutaneous Nephrolithotomy3925393025307210.21608/ejhm.2022.253072ENMohamed F. ElnagarEnas A. Abd Al- MotelebMahmoud M. OthmanAlrefaey K.AlrefaeyDepartment of anesthesia and surgical Intensive care, Faculty of medicine, Mansoura university0000-0001-6580-4008Journal Article20220804<strong>Background:</strong> Percutaneous nephrolithotomy surgery<strong> (</strong>PCNL)is preferably performed under spinal anesthesia (SA). Bezold -Jarisch reflex (BJR), is mediated by serotonin receptors (5-HT<sub>3</sub>) located on the vagus nerve and within the wall of the cardiac ventricles, contributes to the occurrence of hypotension and bradycardia after SA. Ondansetron; an antiemetic drug was investigated as a 5-HT<sub>3</sub> antagonist for inhibition of BJR.
<strong>Aim of the work:</strong> This study aims to assess the effect of Ondansetron on spinal-induced hypotension during PCNL surgery under SA.<strong> Patients and Methods:</strong> This prospective randomized double-blinded study included eighty-four patients scheduled for PCNL under SA in Urology and Nephrology center, Mansoura University. Patients were randomized into two equal groups: Group C (n=42 cases) and Group O(n=42 cases) which received IV ondansetron 4mg 5 minutes before SA.
<strong>Results: </strong>No statistical difference regarding basal characteristics, perioperative SBP, DBP, the incidence of intraoperative hypotension, the required dose of ephedrine, frequencies of hypotension, and duration of each hypotensive episode was detected in our study. <strong>Conclusions:</strong> in our study, ondansetron 4mg IV 5 minutes before spinal anesthesia in cases of PCNL under SA using a bupivacaine-dexmedetomidine mixture didn't reduce the incidence of hypotension and didn't reduce the required dose of ephedrine
<strong> </strong>https://ejhm.journals.ekb.eg/article_253072_61541600f3b5c0f6e08de2f80855a646.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Efficacy of Single Screw Fixation for Slipped Capital Femoral Epiphysis3931393725307510.21608/ejhm.2022.253075ENDalal Ahmed Hasan SalhKhalid Edris AbdelrahmanAhmed Mohammed AbdelwahabIbrahim Abdelallatif Ibrahim AlgohinyJournal Article20220804<strong>Background</strong>: Several studies have failed to demonstrate a clinical or biomechanical advantage to multiple pins and advocate the using larger-diameter one screw inserted into the center-center position of epiphysis in managing of Slipped Capital Femoral Epiphysis (SCFE).
<strong>Objective</strong>: evaluation of functional outcome of using single screw in fixation of SCFE. <strong>Methods: </strong>The present study included 18 patients with slipped capital femoral epiphysis who enrolled for single screw fixation at Orthopedic Department, Zagazig University Hospitals.
<strong>Results:</strong> Southwick angle was significantly decreased from 32.38±12.33 to 23.0±10.74. Harris hip score was non-significantly increased from 51.05 ± 17.63 to 75.05 ± 12.57. About 5.6% of the studied patients had complication and 94.4% had no complication. There was significant relation between complication and renal failure co-morbidity<strong>. Conclusion</strong>: single screw fixation has good results with low complication rate and considered as an effective method in managing slipped capital femoral epiphysis. Single-screw in situ fixation is the optimal treatment for a stable SCFE, while immediate mild reduction, decompression, and internal fixation are preferred for an unstable SCFE.
<strong> </strong>https://ejhm.journals.ekb.eg/article_253075_a9e8b88e18464dfb27ac04977fb3d60e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Trans-abdominal Color Doppler US versus Direct Multi-detector Computed Tomography Venography in the Diagnosis of May-Thurner Syndrome3938394625307610.21608/ejhm.2022.253076ENMarwa SamyMohammad Koriem Mahmoud OmarOmar Gamal MokhtarOsman Mahmoud AhmedAbeer Houssein AliJournal Article20220804<strong>Background:</strong> Early recognition and treatment of May-Thurner Syndrome (MTS) is critical in order to avoid the potential complications and irreversible sequelae that may result in lifestyle limitations. The diagnosis of MTS depends on both clinical and imaging findings. The study aimed to compare the efficacy of transabdominal Color Doppler US (CDUS) with that of direct multi-detector computed tomography venography (MDCTV) in the diagnosis of MTS using conventional venography and intravascular ultrasound (IVUS) as gold standard.
<strong>Patients and Methods: </strong>One-hundred patients with clinically suspected MTS were graded by Clinical Etiological Anatomical Pathological (CEAP) classification. All patients underwent transabdominal CDUS of the deep pelvic and lower limbs veins followed by direct MDCTV. Based on venography and IVUS results, the diagnostic performances of both imaging modalities in diagnosing MTS and detecting associated iliofemoral DVT, synechiae, and venous collaterals were quantified. Finally, the degree of agreement between each imaging method and the gold standard and between both modalities was calculated.
<strong>Results:</strong> Conventional venography and IVUS confirmed the MTS diagnosis in 77 out of 100 patients. There was a predominance of females (62%), young and middle-aged (83%), and overweighed patients (60%). MDCTV showed significantly higher accuracy (100%) in diagnosing MTS than that of CDUS (91%) (p=0.008). There was no significant difference between MDCTV and CDUS regarding the detection of iliofemoral thrombus, synechiae, and venous collaterals (all p>0.05). MDCTV and CDUS showed substantial agreement in the detection of venous stenosis, iliofemoral thrombus, and synechiae (k=0.78, 0.77, and 0.72) and almost perfect agreement regarding venous collaterals (k=0.91).
<strong>Conclusions: </strong>Direct MDCTV is a valuable reference in the diagnosis and preoperative workup of MTS with comparable accuracy to that of the more invasive venography and IVUS. Due to its low accuracy in iliac veins evaluation, trans-abdominal CDUS should not be used as the sole investigative tool to confirm or ruled out MTS and combined MDCTV is mandatory.
<strong> </strong>https://ejhm.journals.ekb.eg/article_253076_ab2b9603dacef6b98002b856744f4d0e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Relation between MBL2 Gene Polymorphism and Pediatric Bronchial Asthma at Zagazig University Hospitals3947395125307710.21608/ejhm.2022.253077ENHanan Mustafa Elsayed MohammedMohamed Sanad NaguibYousif Mohamed Yousif HasanReham Hassan Anis MohammedSabry Abdel Rahman TolbaJournal Article20220804<strong>Background:</strong> Among children, asthma is the most frequent chronic inflammatory illness with an airway hyper reactivity that leads to blockage and restriction of the airflow.
<strong>Objective:</strong> To detect relation between mannose binding lectin (MBL) genetic polymorphisms and childhood asthma among pediatric population at Zagazig University Hospitals.
<strong>Patients and methods:</strong> 116 individuals were studied in this case-control research, 1<sup>st</sup> control healthy group were 29 healthy non-asthmatic of matched age with patients in 2<sup>nd</sup> group who were 87 asthmatic children agedbetween 5 and 15 years old in Zagazig University Pediatric Hospital, Pediatrics Outpatient Clinic.
<strong>Results:</strong> There were statistically significant variations in IgE levels amongst the four groups investigated, with all the asthmatic groups significantly greater than the control group. There was significant difference found between cases and control group according to distribution of MBL2 gene polymorphism, and distribution of MBL2 gene alleles.
<strong>Conclusion:</strong> Our research on elevated levels of MBL and IgE in asthmatics suggests that these antibodies are part of the body's innate immunity, MBL may play a role in asthma pathogenesis by promoting airway inflammation or raising the likelihood of asthma development.
<strong> </strong>https://ejhm.journals.ekb.eg/article_253077_370e6b264488750b6f4119fdcffa0641.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Impact of Initiation of Insulin Therapy on Serum Prolactin and Cortisol Levels in Type 2 Diabetic Male Patients3952395825307810.21608/ejhm.2022.253078ENHany Khairy MansourMohamed Saad HamedAlyaa Ahmed El SherbenyYasmine Hamdy MostafaNesma Ali IbrahimJournal Article20220804
<span lang="EN-US"> </span>
Background: Starting insulin therapy significantly improves overall glycemic control in type 2 diabetes mellitus (T2DM) patients who had not been able to meet their target glycemic control objectives with oral anti-diabetic medication therapy. Objective: To assess impact of initiation of insulin therapy on serum prolactin and cortisol levels in T2DM male patients.<br />Patients and methods: The study was conducted on 30 male T2DM patients attending diabetes clinic at Ain Shams University Hospitals. All patients were subjected to the following investigations at the time of initiation of insulin therapy: Fasting plasma glucose (FBG). 2 hours post prandial plasma glucose (2HPPBG), Hemoglobin A1c (HbA1c), serum cortisol (9 a.m.) and serum prolactin.<br />Results: On studying the correlation between cortisol and prolactin with other laboratory findings showed that there were no significant correlations between cortisol and prolactin, and FBS, 2HPPBG and HbA1C in the first and third visits in group I. No significant correlations between cortisol and prolactin with FBS and 2HPPBG in the second visit in group I. However, there was a significant positive correlation between cortisol with FBS (P=0.028) and HbA1C (P=0.033) in group II. Also, a significant positive correlation between cortisol with FBS (P=0.034) and 2HPPBG (P=0.041) in group III. There was a highly significant positive correlation between cortisol and FBS (P=0.001) in group III. Also, there was a highly significant positive correlation between prolactin and 2HPPBG (P=0.008) in group II.<br />Conclusion: The present study suggests that initiation of insulin therapy in poorly controlled T2DM patients achieves a highly significant reduction in blood glucose level. Also, insulin therapy in T2DM patients has impact on other hormones regulating blood glucose level as it reduces serum prolactin and cortisol levels.<br /><br />https://ejhm.journals.ekb.eg/article_253078_31315fc4c9e2086f727d069bbcf19819.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Right Ventricular Diastolic Dysfunction in Young Adults after Mild COVID-193959396825307910.21608/ejhm.2022.253079ENMohamed Saber HafezIslam BastawyHeba KamelJournal Article20220804<strong>Background: </strong>Myocardial injury is neither limited to the acute Coronavirus disease 2019 nor moderate-to-severe cases.
<strong>Objectives: </strong>This study aimed to evaluate the relationship between right ventricular diastolic dysfunction and post- Coronavirus disease 2019 cardiovascular sequelae in young adults with mild disease.
<strong>Patients and Methods: </strong>This study recruited 150 young adults (between 18 and 30 years) who were classified into three equal groups: Group A included 50 patients who sustained cardiac symptoms 12 to 14 weeks following mild Coronavirus disease 2019. Group B included 50 patients who did not show cardiac symptoms 12 to 14 weeks following mild Coronavirus disease 2019. Group C included 50 gender-matched healthy subjects of similar ages without previous Coronavirus disease 2019. Each subject underwent a detailed transthoracic echocardiographic study to detect right ventricular diastolic dysfunction by measuring the tricuspid valve E/A ratio, tricuspid deceleration time, tricuspid E/e' ratio and tricuspid e'/a' ratio.
<strong>Results:</strong> Right ventricular diastolic dysfunction was higher in group A (80% versus 30% versus 0%, p < 0.001). Tricuspid valve e’/a’ was lower in group A (0.86 ± 0.2 versus 1.08 ± 0.2 versus 1.44 ± 0.28, p < 0.001) while tricuspid valve E/ e’ was higher (6.7 ± 1.1 versus 3.25 ± 3 versus 3.04 ± 0.36, p < 0.001). Post- Coronavirus disease 2019 patients with right ventricular diastolic dysfunction had a higher right ventricular basal diameter, higher right ventricular systolic pressure, lower right ventricular tricuspid annular plane systolic excursion, and lower fractional area change.
<strong>Conclusions:</strong> After recovery from mild Coronavirus disease 2019, some of young adults had right ventricular diastolic dysfunction, which was more prevalent in those with post- Coronavirus disease 2019 cardiac symptoms.
<strong> </strong>https://ejhm.journals.ekb.eg/article_253079_6c68a80cf0f36b8f0dc4a511834f0773.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Proximal Hypospadias Repair by Using Longitudinal Preputial Double-Layerd Island Flap Technique3969397525308010.21608/ejhm.2022.253080ENIbrahim Emhemed Salem AltomiAbdElhafez Mohamed ElshewailAmin Mohamed SalehIsmail Mohamed Ali TantawyJournal Article20220804<strong>Background</strong>: Longitudinal Dorsal Island Flap (LDIF) can be employed to overcome the drawbacks of onlay and tubularized urethroplasty in management of hypospadias.
<strong>Objective</strong>: To improve outcome and reduce complications of cases with proximal hypospadias associated with severe chordee and deficient urethral plate by using longitudinal preputial double-layered island flap two stage technique. <strong>Patients and Methods: </strong>weincluded twenty patients, who had proximal hypospadias associated with deficient urethral plate, and were admitted to Pediatric Surgery Department at Zagazig University Hospital during study period. <strong>Results:</strong> The results of our study showed early complication after 1<sup>st</sup> stage: wound infection only in one case (5%), which was complicated by fistula formation, which was closed spontaneously. After 2<sup>nd</sup> stage the results showed 3 cases suffering from meatal stenosis managed by repeated dilatation but unfortunately one of them suffering from urethral diverticulum later on. Also, one of cases complicated with urethral fistula, which needed surgical repair. The cosmetic appearance was not good after the 1<sup>st</sup> stage, but it became better after the 2<sup>nd</sup> stage as the excessive tissue was removed and the meatus reached the position on glans penis.
<strong>Conclusion</strong>: For proximal hypospadias repairs, the longitudinal preputial island flap approach has an excellent success rate and is suitable for a wide range of cases. It is considered as good option especially in patients with underdeveloped urethral plate among proximal hypospadias patients.
<strong> </strong>https://ejhm.journals.ekb.eg/article_253080_2a5b84210527820ce3455d3f9b1260a9.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Intelligence Quotient in Children with Mucopolysaccharidoses3976397925308110.21608/ejhm.2022.253081ENTarek Hamed AttiaDepartment of Pediatrics, Faculty of Medicine, Zagazig University, EgyptMohamed Refaat BeshirDepartment of Pediatrics, Faculty of Medicine, Zagazig University, EgyptAhmed Hosni Mohamed Abdel FattahDepartment of Pediatrics, Faculty of Medicine, Zagazig University, EgyptRania Emad Abd-elsamad MohamedJournal Article20220804<strong>Background:</strong> The category of lysosomal storage diseases known as mucopolysaccharidoses (MPS) is characterized by the buildup of glycosaminoglycans (GAGs) in tissues and organs as a result of the lack of certain enzymes needed for the breakdown of cellular GAGs. For all individuals, the Wechsler and Primary Scale of Intelligence (WPPSI) was used to calculate their intelligence quotient (IQ) and evaluate their cognitive abilities. <strong>Objective:</strong> The aim of the present study was to assess intelligence quotient in MPS children.<strong> Patients and Methods:</strong> This study was conducted in 72 children in Pediatrics Department in Zagazig University Hospital, over 6 months. They were divided into 2 groups; A case group included 24 children diagnosed with MPS in Pediatrics Department in Zagazig University Hospital, and a control group included 48 children matched for age and sex. <strong>Results:</strong> This study showed that age of onset of disease ranged between 1 and 6 with mean 1.96 (SD 1.30) years. This study showed that the mean age of diagnosis was 5.25 (SD 2.83) years and ranged between 1 and 13. The present study showed that all cases with MPS had positive coarse facies. The mean value of full IQ was statistically lower among the case group than the control group. <strong>Conclusion:</strong> Among children with MPS, there was a measurable decrease in IQ associated with positive family history. IQ was low among children with MPS compared with controls. <br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_253081_bd9c59db4b4786d222cf8e5f6210a5f5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Interleukin 15 Gene Polymorphism in patients with Alopecia Areata3980398525308210.21608/ejhm.2022.253082ENAml Mohamed MontaserMohmed Helmy ELnabalawySoheir Abdelgaber EltoukhyAhmed Fawzi IsmaelJournal Article20220804<span lang="EN-US">Background: </span><span lang="EN-US">According to a research done on mice using an IL-15 receptor blocker, there is evidence that IL-15 may be involved in the pathophysiology of Alopecia Areata (AA).</span><span lang="EN-US"> It's possible that cytokine gene polymorphisms in the regulatory regions could play a role in immune system illness etiology by altering cytokine concentrations in the body. The aim of the present study was to evaluate the possible association of IL-15 genetic polymorphism (rs17015014) with the risk of development of AA and correlate it with severity of the disease. </span><span lang="EN-US">Patients and methods: </span><span lang="EN-US">This case control </span><span lang="EN-ZA">study was conducted on 50 patients suffering from AA and 50 control subjects. After clinical and dermoscopic examination, severity of AA was measured by SALT score. Detection of interleukin 15 gene polymorphism in DNA extracted from blood sample by polymerase chain reaction and Restriction Fragment Length Polymorphism detection were performed. </span><span lang="EN-US">Resu</span><span lang="EN-US">lts:</span><span lang="EN-US">Distribution of IL-15 (rs17015014) gene polymorphism among cases was 22% GG, 60% GC, 18% CC genotypes, while controls had 30% GG, 50% GC and 20% CC genotypes. </span><span lang="EN-ZA">Cases had 52% G and 48% C alleles, while controls had 55% G and 45% C alleles. No significant association was found regarding genotypes, alleles and AA cases (p > 0.05). No significant associations were found regarding IL-15 single nucleotide Polymorphism (SNP) (rs17015014) with SALT scores.</span><span lang="EN-US">Conclusion</span><span lang="EN-US">: </span><span lang="EN-ZA">No associations were found regarding IL-15 genetic polymorphism (rs17015014) with risk of development of AA or disease severity. No associations were found regarding IL-15 genotypes with disease course, recurrence, site of affection or findings of dermoscopy in patients</span><span lang="EN-ZA">.</span>
<span lang="EN-US"> </span>https://ejhm.journals.ekb.eg/article_253082_ec62744a740037eadb092b7d31766d1c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Intra- Versus Extra-Corporeal Anastomosis After Laparoscopic Right Hemicolectomy For Colon Cancer: A Comparative Study3986398925308310.21608/ejhm.2022.253083ENOsama Abdel Aziz Mohamed EltihNawel El Sayed HusseinMahammed Rajab Mostafa AboudaAhmed Kamal El-taherJournal Article20220804<strong>Background:</strong> An anastomosis between the small and large intestines must be created after bowel resection. The best method for re-establishing continuity is extracorporeal anastomosis, although intracorporeal (IC) anastomosis is also an option that has been proven to be as secure and effective in a number of observational studies.
<strong>Objective: </strong>This study aimed to standardize the most ideal technique of anastomosis after laparoscopic right hemicolectomy with the least chance for leakage and better quality of life for patient of cancer colon.
<strong>Patients and Method:</strong> A prospective clinical trial study was conducted in the Onco-Surgery Unit, General Surgery Department, Faculty of Medicine, Zagazig University through the period from October 2021 to July 2022. The study included 18 patients with right side colon cancer for Laparoscopic right hemicolectomy. The patients were divided into two equal groups 9 cases for intracorporeal ileocolic anastomosis (Group A) and 9 cases for extracorporeal ileocolic anastomosis (Group B).
<strong>Results:</strong> Our findings were mainly that EC anastomosis group had a significantly shorter operative time compared to group A (p value 0.004), and significantly longer postoperative hospital stay (p value 0.0001). In the current study, IC anastomosis had markedly lower complication rate 11.1% versus 88.9% in EC group (p value 0.0001).
<strong>Conclusion:</strong> Intracorporeal (IC) anastomosis after laparoscopic hemicolectomy is time saving and less morbid technique compared to extracorporeal anastomosis.
<strong> </strong>https://ejhm.journals.ekb.eg/article_253083_96b3cf5d3598e9e83b3fe3cf975021d3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701New Lines in the Treatment of multiple Warts: Review Article3990399325407310.21608/ejhm.2022.254073ENMohamed NasrSara MohamedBasma M. ElkholyJournal Article20220811<strong>Background: </strong>Warts are a widespread, benign, and typically self-limiting cutaneous ailment that is exceedingly prevalent. They might be as small as a few millimeters or as large as several centimeters. Papillomaviruses, which cause warts, are transmitted via contact with infected skin. Epithelial lesions ranging from benign to malignant may be caused by human papilloma virus (HPV), which are two-stranded DNA viruses. Due to the absence of an envelope, HPV is extremely persistent and resistant to a wide range of treatment drugs. HPV genotypes that cause both skin and genital warts have been completely classified to date. Trauma sites like the hands and feet are the most prevalent locations for them to occur. Treatment options for warts include various forms of destructive methods such as cryotherapy, electrocoagulation, topical salicylic acid, topical 5-fluorouracil, laser surgery, and others. A viable treatment option in these situations appears to be immunotherapy. As evidence of the importance of immunity, immunosuppressed persons are more likely to develop and maintain warts.
<strong>Objective: </strong>To review different lines in management of different types of warts.
<strong>Methods:</strong> Multiple warts, new lines, and treatment were all looked for in PubMed, Google scholar, and Science direct. References from relevant literature were also evaluated by the authors, but only the most recent or complete study from January 2008 to May 2021 was included. Due to the lack of sources for translation, documents in languages other than English have been ruled out. Papers that did not fall under the purview of major scientific investigations, such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations, were omitted.
<strong>Conclusion: </strong>Immunotherapeutic modalities are effective in wart therapy with the advantage of avoiding scarring of destructive therapies and acting on injected and non-injected warts.
<strong> </strong>
https://ejhm.journals.ekb.eg/article_254073_1d9a0b935b838026f0b3763fed5db68a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Coronary Angiographic Findings in Acute Coronary Syndrome with and without ST-Segment Elevation in Lead aVR Patients3994399825407410.21608/ejhm.2022.254074ENAhmed Alallah Elsayed ElbeheryMahmoud Diaa El-MenshawyMahmoud Abdelaziz Abde LrashidMohammed Maher AllamJournal Article20220811<strong>Background:</strong> Acute coronary syndrome (ACS) is usually associated with dynamic electrocardiographic (ECG) changes and serial ECGs can present important information, especially if the ECG at first medical contact was not informative.
<strong>Objective: </strong>To achieve better management of association between ST-segment shifts in lead augmented vector right (aVR).
<strong>Patients</strong> <strong>and methods</strong>: This is an observational cross-sectional study multi-center study that was conducted on patients with acute coronary syndrome in Cardiology Departments at Zagazig University Hospitals, Mansoura University Specialized Medical Hospital, and 15 May Hospital to assess the correlation between ST-elevation in lead AVR in patient with acute coronary syndrome and coronary angiographic findings. 120 patients were recruited and were as follows: 52 patients with ACS whose ECG showed ST segment elevation (STE) in lead aVR and 68 patients with ACS but without STE in lead aVR.
<strong>Results:</strong> left main coronary artery (LMCA), left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA) stenosis were significantly higher in ACS patients with STE in aVR compared to ACS patients without STE in aVR (p <0.001, 0.006, <0.001, and <0.001 respectively). 2 and 3 vessels affection were significantly higher in ACS patients with STE in aVR compared to ACS patients without STE in aVR (p =0.002 and <0.001). STE in aVR was a significant predictor for LMCA stenosis (OR: 14.67 and p value <0.001), 3 vessels disease (OR: 3.97, p value =0.004).
<strong>Conclusion:</strong> STE in aVR could be used as a significant predictor for LMCA stenosis and 3 vessels disease. In addition, GABG is considered the best management to improve ASC with STE in aVR.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254074_0e4c6c081bd8eb670675dd5b29b4f2cf.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Randomized Trial of Stone Fragment Active Retrieval Versus Spontaneous Passage after Pneumatic Lithotripsy of Ureteral Stones3999400425407510.21608/ejhm.2022.254075ENGamal Abdelmalek MorsiAlaa Refaat MahmoudHazem Abdelsabour DeifMostafa Mohammed Osman MohammedJournal Article20220811<strong>Background:</strong> The third-highest rate of all urinary issues is urinary stone illness. Patients with stones less than 5 mm have a 68% spontaneous passage rate, while patients with stones larger than 6 mm have a very low spontaneous passage rate of 5%. The aim of the present study was to assess the difference between complete retrieval of small stone gravels versus spontaneous passage of these gravels after uretroscopic lithotripsy as regard intraoperative and postoperative complications and stone clearance.
<strong>Patients and methods: </strong>A randomized controlled clinical trial was carried out at Urology department, Al-Azhar University Hospital between February 2021 and August 2021. It included 60 patients with lower ureteric stones admitted to the Urology Department for endoscopic management.
<strong>Results: </strong>Patients who underwent intraoperative fragment retrieval had significantly longer operative time in comparison to those underwent spontaneous fragment expulsion (57.53 ± 15.13 vs. 34.90 ± 8.14 minute; <em>p < /em><0.001). Operative time ranged between 36 and 88 minute in case of fragment retrieval and between 25 and 54 minute in case of spontaneous fragment expulsion. Only 2 (6.7%) patients from those underwent spontaneous fragment expulsion and 5 (16.7%) patients from those underwent intraoperative fragment retrieval developed intraoperative complications with no significant differences (<em>p < /em>=0.21).
<strong>Conclusion: </strong>Ureteroscope has been safe and efficient in managing ureteroscopy, leaving gravels 3 mm or less after uretroscopic lithotripsy is associated with mild post-operative symptoms as abdominal pain, burning micturition but less operative time, less complication of anaesthesia, less operative cost less effort from surgeon and less intraoperative complication, so that this method is advisable.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254075_ac38c6acb1cdeff5b117c5a12cec6ab1.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Role of Postoperative Continuous Positive Airway Pressure: Review Article4005400825407610.21608/ejhm.2022.254076ENAhmed El-Saied Abd- El RahmanHala Mahmmoud HashimFawzy Abbas BadawyGada Abd El Gaber RezkEman Kamal El-Dien HusseinJournal Article20220811<strong>Background:</strong> For those with Obstructive Sleep Apnea (OSA), the most effective therapy is continuous positive airway pressure (CPAP). CPAP uses positive airway pressure to keep the patients’ respiratory passages open while they sleep (or are awake and breathing normally). End-expiratory alveolar pressure that exceeds ambient pressure is known as a "positive end-expiratory pressure" (PEEP). PEEP is created by CPAP, which maintains a predetermined pressure during the whole breathing cycle, including inhalation and exhalation. It has been shown to lower daytime exhaustion, cardiac risk factors, as well as blood pressure.
<strong>Objective: </strong>The primary therapy for OSA is CPAP. CPAP was evaluated in this study to see if it reduced blood pressure in OSA patients. Research on CPAP and blood pressure in various subgroups of people was analyzed specifically for this study.
<strong>Methods:</strong> Research was carried out through PubMed, Google scholar and Science direct using the terms [Continuous positive airway pressure And Positive end-expiratory pressure OR Obstructive Sleep Apnea]. References from relevant literature, including all identified research and reviews, were also evaluated by the authors, although only studies published between December 2007 and June 2021 were included.
<strong>Conclusion: </strong>Although the overall impact of CPAP on blood pressure is minimal, even modest reductions in blood pressure may benefit in the prevention of cardiovascular events. This impact on those with uncontrolled hypertension merits further investigation. Variability in blood pressure response to CPAP therapy gives an opportunity for more study on this topic. Constant CPAP use has long been associated with an increased risk of hypertension.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254076_ec09a35a661775aa038c5ee7def20656.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Vitamin D Level and Nutritional Status in Children with Cholestatic Disorders4009401325407710.21608/ejhm.2022.254077ENSarah Abdelrashidpediatric department, faculty of medicine, October 6 university, Cairo, EgyptNehal El KoofyMona FathyEngy A. MogahedRokaya Mohamed ElsayedJournal Article20220811<strong>Background: </strong>Malnutrition and vitamin D deficiency is a frequent complication in children with chronic cholestatic disorders. <strong>Objective:</strong> This study aimed to assess nutritional status and serum level of vitamin D in children with chronic cholestasis.<strong> Methods:</strong> Forty infants and children (1–6 years) with cholestatic liver diseases were enrolled from the Pediatric Hepatology Department, Cairo University Children’s Hospital. Nutritional history, anthropometric measurements [including weight, height, mid-upper arm circumference (MUAC) and triceps skin fold (TSF)] and serum vitamin D were assessed. Vitamin D was correlated with liver functions. Assessment of nutritional status was performed using subjective nutritional global assessment (SGA) and nutritional risk screening tool STRONGkids.
<strong>Results:</strong> The mean age of the patients was 2.7 ± 1.67 and 67.5% were males. The most frequent diagnosis was biliary atresia (42.5%) followed by cholestasis with normal GGT (32.5%) then cholestasis with high GGT (25%). Although, all patients were on regular doses of oral vitamin D, the number of vitamin D deficient patients was 13 (32.5%). Vitamin D is not correlated with liver functions. Anthropometric measurements showed that TSF was the most accurate parameter to detect malnutrition (77.5% of patients were below fifth percentile). About 47 and 72 % of the patients had malnutrition according to SGA and STRONGKids respectively.
<strong>Conclusion:</strong> Malnutrition and vitamin D deficiency are common among cholestatic children despite regular oral supplementations. MUAC and TSF are effective applied anthropometric measures for nutritional assessment. Vitamin D is not correlated to the liver functions.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254077_a73371dcd6262f78600aaabbb36d0df7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Impact of Lung Ultrasound Use on Postoperative Outcome in Fast Track Adult Cardiac Surgery: A Randomized Controlled Study4014402325407810.21608/ejhm.2022.254078ENMohamed E. Elshehawi0000-0001-9421-7750KA AwadHazem E. MoawadNabil A. MageedJournal Article20220811<strong>Background:</strong> Although lung ultrasound (LUS) has been widely used in the critical care setting, its applications in perioperative management of different lung pathologies are still limited.<br /> <strong>Objective:</strong> This randomized controlled study aimed to evaluate the benefits of perioperative LUS followed by LUS-guided recruitment maneuver in adults undergoing open heart surgery.<br /> <strong>Methods: </strong>One hundred patients admitted for elective cardiac surgery were enrolled in this trial. They were divided into two groups; the control group (Group C) included 50 patients who underwent LUS without LUS guided interventions, and LUS group (Group L) included the remaining patients who underwent LUS followed by LUS-guided recruitment maneuver and other interventions according to the finding. <br /> <strong>Results: </strong>Baseline characteristics of the study population and perioperative variables showed no significant difference between the study groups. Postoperative pulmonary complications tended to be significantly higher in Group C (22% versus 6% in Group L – p = 0.021). the incidence of postoperative desaturation was significantly higher in the control group than in the intervention group. However, the incidence of intraoperative desaturation was similar between the control and intervention groups. Better aeration, B-line, and compliance scores were detected when LUS-guided recruitment was applied. Additionally, Group L expressed higher O<sub>2</sub> saturation in most of the recorded readings. There was a significant decline in the duration of postoperative mechanical ventilation and the need for respiratory support LUS-guided recruitment was applied.<br /> <strong>Conclusions: </strong>Postoperative pulmonary outcomes showed a significant improvement in association with LUS-guided recruitment maneuvers and other interventions after adult cardiac surgery.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_254078_f148b548969da768189f9c9748eac42c.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Effect of Shockwave Therapy on Postmenopausal Sacroiliac Joint Pain: A Randomized Controlled Trial4024403025407910.21608/ejhm.2022.254079ENKholoud N. MohamedKhadiga S. AbdulazizMohamed F. Abo ElaininDoaa A. OsmanJournal Article20220811<strong>Background: </strong>Sacroiliac joint pain is a common complaint among women and old-aged people, affecting their life quality. <strong>Objective:</strong> To examine the effect of shockwave therapy on postmenopausal sacroiliac joint pain.
<strong>Subjects </strong><strong>and Methods:</strong> Thirty postmenopausal women with sacroiliac joint pain were randomly chosen and divided into 2 groups of equal number. Group (A) received muscle energy technique for 8 weeks, whereas group (B) received the same muscle energy technique in addition to shockwave therapy for 8 weeks. The outcome measures were the mean values of pressure pain thresholds (PPT) at five chosen points in the sacroiliac joint region to assess pain sensitivity, visual analog scale (VAS) to evaluate pain intensity, and Oswestry disability index (ODI) to evaluate the functional disability. All of them were evaluated before and after treatment.
<strong>Results:</strong> A comparison of the two groups after treatment showed statistically significant increases in the mean values of PPT at the five chosen points (p < 0.05), as well as significant reductions in the scores of VAS and ODI (p < 0.05) in favor of group (B).
<strong>Conclusion:</strong> Shockwave is effective in treating postmenopausal sacroiliac joint pain through decreasing pain sensitivity and intensity, as well as improving functional ability.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254079_89b240eb621c20c3bddad1a5bf89d53f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Obstructive Sleep Apnea: Respiratory Complications – A Review Article4031403725408010.21608/ejhm.2022.254080ENAhmed El-Saied Abd- El RahmanHala Mahmmoud HashimFawzy Abbas BadawyGada Abd El Gaber RezkEman Kamal El-Dien HusseinJournal Article20220811<strong>Background:</strong> It's not uncommon for people to suffer obstructive sleep apnea syndrome (OSAS); 2%-25% of the general population are affected. However, OSAS is common in those who have undergone elective surgery. Patients with collapsing upper airway have an increased risk of surgical complications when under sedation and/or anesthesia. To effectively treat individuals with OSAS, it’s critical to rapidly identify them.
<strong>Objective:</strong> In this review, the epidemiology of OSAS in postoperative patients was examined. We emphasized the significance of anaesthesia, sedation, opioids, while describing why these patients have a higher postoperative complications’ risk. Further, we addressed the preoperative identification and perioperative management of these individuals.
<strong>Methods:</strong> Research was carried out through PubMed, Google scholar and Science direct using the terms OSAS, Perioperative complications, Respiratory problems, and continuous positive airway pressure (CPAP). References from relevant literature, including all identified research and reviews, were evaluated (only studies published between July 2003 and January 2022 were included). There were no reliable sources of interpretation for documents written in any language other than English. All but the most important scientific papers had been omitted: not available as a complete written text such as a transcript of a conversation or a formal paper such as a conference abstract or thesis.
<strong>Conclusion: </strong>Opioids, sedation, and anesthesia have been proven to aggravate sleep apnea during the perioperative phase, which may raise the risk of perioperative problems. It is essential to identify these individuals before surgery in order to take the necessary precautions during their perioperative care.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254080_72ac36fee6ed5cb0edb9e4c53a566023.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Use of Platelet Count Combined with Magnetic Resonance Imaging to Measure Spleen Volume and Right Liver Volume to identify Cirrhosis and Esophageal Varices4038404425408110.21608/ejhm.2022.254081ENMostafa Mohamad AssyAyman Fathy ZeidHamed Abdel Hakim GobranSarah Al Sayed Mahmoud MetwallyJournal Article20220811<strong>Background:</strong> Low platelets count (PLT), high spleen volume on ultrasonography, and a high Child-Pugh score are among the most reported recent cirrhosis assessment characteristics.<strong> Objective:</strong> This study aimed to evaluate the utilization of platelet count combined with magnetic resonance imaging to measure spleen volume (SV) and right liver volume to identify cirrhosis and esophageal varices (EV).
<strong>Patients and methods: </strong>A total of 50 cirrhotic patients diagnosed by abdominal ultrasound and/or MRI. They were referred from the General Medicine and Tropical Departments of Zagazig University Hospitals. We studied platelet count combined with magnetic resonance imaging to measure spleen volume and right liver volume for detection of severity of cirrhosis and esophageal varices.
<strong>Results:</strong> The best cutoff value of SI/platelet count in prediction of cirrhosis and child C were ≥ 3.24 and ≥ 6.625 respectively. SV/platelet count and SI/platelet count differed significantly among groups. RVPS differed significantly between groups and was significantly lower in OV. The best cutoff value of SI/platelet count and SV/platelet count in prediction of OV were ≥ 5.05 and ≥ 3.24 respectively. RVPS differed significantly between studied groups as it was significantly lower in OV.
<strong>Conclusion:</strong> With the advancement of the Child-Pugh class, the ratio of SV/PLT and SI/PLT increased, as the Child-Pugh class progressed PLT and RVPS diminished. RVPS can be used as a new combination parameter to determine the occurrence of cirrhosis and discriminate between the CPS classes.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254081_53568eded436da5373f510ba64eafa57.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Relation of Serum Lipoprotein (a) and Severity of Coronary Artery Disease in Type 2 Diabetic Patients4045405025408210.21608/ejhm.2022.254082ENAhmed Fathy Mohamed AbdallahCardiology, Faculty of Medicine - Menoufia University, EgyptRehab Ibrahim YaseenFatma El-Zahraa Abdel-Monem ZeinJournal Article20220811<strong>Background:</strong> For coronary artery disease, lipoprotein (a), or Lp (a), is a well-established risk marker.
<strong>Objectives:</strong> The aim of the current work was to determine the correlation between the severity of coronary artery disease and the serum lipoprotein (a) level in diabetic patients.
<strong>Subjects and methods:</strong> At the National Heart Institute, Cairo, we conducted this cross-sectional observational study. From July 2021 to January 2022. 114 Type 2 diabetic individuals qualified for coronary angiography were enrolled in the study. All the participants in the trial were subjected to full history taking, clinical examination, ECG, Echocardiography, complete blood count, liver enzymes and serum creatinine, Lipoprotein (a) measurement and coronary angiography.
<strong>Results:</strong> According to the results of our research, patients with high levels of lipoprotein (a) also had higher Syntax scores (p-value < 0.001). On the contrary, patients' lipoprotein (a) levels did not correlate statistically with any of the other measurements taken (p-value > 0.05).
<strong>Conclusion:</strong> It could be concluded that patients with diabetes may have an increased risk of cardiovascular disease if their Lp (a) level is elevated, and the Lp (a) level is an essential clinical marker in both the general population and those with diabetes. A higher Lp (a) level in type 2 diabetics, according to our findings, is of great clinical significance.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254082_76bb207d13ae63143f2cdc693d8efcde.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Dexamethasone versus Dexmedetomidine as Adjuvant to Bupivacaine in Ultrasound Guided Erector Spinae Plane Block for Analgesia in Total Abdominal Hysterectomy4051405625408310.21608/ejhm.2022.254083ENDoaa Shaaban Mohammed AliAhmed Mohammed SalamaKamelia Ahmed AbazaFatma Mahmoud AhmedJournal Article20220811<strong>Background: </strong>Local anesthetic adjuvants prolong analgesia duration with single shot interfascial plane blocks.They potentiate the analgesic effect of the local anesthetics. These adjuvants include several groups and different mechanisms of action such as dexamethasone and dexmedetomidine.
<strong>Objectives: </strong>This study was aimed at achievement of better analgesia for total abdominal hysterectomy patients via prolongation of sensory block duration and reducing opioid consumption.
<strong>Patients</strong><strong>and</strong><strong>Methods:</strong>This study was carried out at Zagazig University Hospitals where 84 female patients scheduled for total abdominal hysterectomy aged from 40 to 60 years, ASA physical status grade I, II and body mass index (BMI) 18.5-30 kg/m<sup>2</sup>. Patients were classified into three groups (28 each), group C (received bilateral ESPB with 20 ml bupivacaine 0.25% plus 1ml saline), group O (received bilateral ESPB with 20 ml bupivacaine 0.25% plus 1ml dexamethasone (4mg)), group D (received bilateral ESPB with 20 ml bupivacaine 0.25% plus 1 ml dexmedetomidine (0.5ug/kg) in saline). They underwent history taking, general examination, laboratory investigations, preoperative erector spinae plane block (ESPB) and GA.
<strong>Results</strong>: There was statistically significant difference between three groups regarding visual analog scale (VAS) and nalbuphine consumption where D group had better pain control than other groups.
<strong>Conclusions: </strong>It could be concluded that dexmedetomidine as an adjuvant to 0.25% bupivacaine in ultrasound guided erector spinae plane block is more efficacious than dexamethasone in hastening the onset, prolonging sensory blockade, delaying the time for request of rescue analgesia, and decreasing total nalbuphine consumption.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254083_efc361f1e9fdd1806e977110e7de7070.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Artificial Versus Modified Natural Cycles for Endometrial Preparation for Frozen-Thawed Embryo Transfer4057406125408410.21608/ejhm.2022.254084ENMagdi Ragab ElsayedWalid Mohamed Sayed Ahmed ElnagarHanan Abraheem Almahtot ImbayyahShahenda Ahmed Elsayed IbrahimJournal Article20220811<strong>Background</strong>: Improvements in IVF have led to an increased number of embryos not available for immediate transfer due to concern about multiple pregnancies. Cryopreservation of supernumerary embryos with subsequent frozen–thawed embryo transfer (FET) is an excellent solution to surplus embryos and has become a common practice in infertility centers.
<strong>Objectives:</strong>The aim of the current work was to evaluate the success rate of hormonal replacement therapy (HRT) and modified natural cycle protocol in frozen–thawed embryo transfer (FET).
<strong>Patients and methods</strong>: Randomized controlled trial study was done at department of Obstetrics and Gynecology, Zagazig University and in a private Center in the period from January 2021 to March 2022. Included 84 women who underwent Frozen-thawed embryo transfer (FET). The women were divided into 2 groups; Natural cycle group included 42 women, 3 of them escaped from the study. Artificial cycle group included 42 women, 2 of them escaped from the study.
<strong>Result</strong>: This study showed that there were no statistically significant differences in the number of embryo thawing, the number of embryo transfers, the degree of embryos, as well as the rate of biochemical and clinical and continuous pregnancy among the studied groups.
<strong>Conclusion:</strong> It could be concluded that both modified natural and artificial cycle for endometrial preparation in frozen-thawed embryo transfer cycles appears to be equally successful about pregnancy rates.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254084_5a1f4896eea5e99d4538c5845466fbe8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Study of Lipoprotein-Associated Phospholipase A2 as a Potential Biomarker for Diabetic Kidney Disease in Type 2 Diabetes4062406725408610.21608/ejhm.2022.254086ENIbrahim M. SalemMabrouk I. IsmailAdel A.M. GhorabRabab FouadOsama MosbahGhada KhalifaAlaa Ahmed Abdelateef IbraheemMedhat Ibrahim MahmoudNafesa M. KamalJournal Article20220811<strong>Background:</strong> A common consequence of diabetes is diabetic kidney disease (DKD). Increased Lp-PLA2 plasma levels have been related to higher risk of development of DKD in type 2 diabetes patients.
<strong>Objective:</strong> To illustrate the significance of using lipoprotein phospholipase A2 as potential early biomarker for detecting diabetic nephropathy among type 2 diabetic patients.
<strong>Patients and methods: </strong>A case-control study were conducted at the nephrology unit in partnership with Theodor Bilharz Research Institute and the Internal Medicine Department of Zagazig University Hospitals. This study was performed on (33) type 2 diabetic patients and were compared with 11 healthy subjects who were matched age, sex as a control group. Plasma LP-PLA2 was assessed among all subjects.
<strong>Results: </strong>It is more common in diabetic patients to have elevated plasma LP-PLA2 levels than in healthy people. LP-PLA2 levels were much higher in diabetic patients with microalbuminuria than in those with normoalbuminuria, and higher with macroalbuminuria than with microalbuminuria. Plasma LP-PLA2 levels were correlated to creatinine, urea and UACR reflecting that it is a marker of early nephropathy. The ROC curve for the validity of plasma LP-PLA2 in detecting kidney disease in type2 diabetic patients with micro and macroalbuminuria showed high specificity and sensitivity.
<strong>Conclusion:</strong> LP-PLA2 could be considered an early indicator of diabetic nephropathy in patients with type 2 diabetes.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254086_381ada793609766a747f560292b641c2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701MRI Diagnostic Performance and Inter-Observer Agreement of Kaiser Score in The Assessment of Different Breast Lesions4068407525408710.21608/ejhm.2022.254087ENMarwa MakboulRadiodiagnosis department, Assiut University, Faculty of MedicineShimaa FarghalyJournal Article20220811<strong>Introduction: </strong>to evaluate Kaiser Score's diagnostic efficacy and inter-reader reliability and contrast it with the typical BI-RADS Lexicon.<strong>Materials and methods: </strong>This retrospective study included 100 participants with a total of 109 breast lesions, at Assiut University hospital in the period from January 2021 to June 2021. The fifth edition of the MRI BI-RADS Lexicon was used to determine the BI-RADS category for each lesion after two radiologists reviewed all MRI scans. Following the flowchart for the Kaiser Score, they were then categorized according to BI-RADS category assignments. Finally, a comparison of the Kaiser BI-RADS and score results with the MRI BI-RADS and histological data was made to assess the diagnostic accuracy and inter-observer agreement.
<strong>Results</strong>: There was no noticeable difference between the Kaiser score and the BI-RADS, MRI BI-RADS, or the BI-RADS as the p-values for the diagnosis of all breast lesions, whether mass or NMEL, were 0.597, 0.84, and 0.495 respectively.
The inter-observer agreement between Readers 1 and 2 in the diagnosis of all breast lesions, regardless of whether they were mass lesions or NMELs, using both Kaiser BI-RADS and MRI BI-RADS, was also significantly higher since the p-value was less than 0.001. <strong>Conclusion:</strong> Kaiser score and MRI BI-RADS can be combined to enhance reader agreement and reduce experience-related variability. For readers with less experience, it can also be very helpful in making the diagnosis of doubtful and suspicious breast lesions.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254087_6dd839f2bdd7eedfb90a8799ef9a9b61.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prognostic Value of NT-proBNP and 3 Months Readmission or Mortality after Congenital Heart Surgery4076408025408810.21608/ejhm.2022.254088ENAlhussein Mostafa ZahranAlhassan Mostafa ZahranMedhat Ali Salah Abd ElghaffarJournal Article20220811<strong>Background:</strong> The use of NT-proBNP in predicting outcomes after juvenile congenital heart surgery is uncertain. <strong>Objective: </strong>We wanted to determine whether the novel biomarker NT-proBNP might be used to identify babies at increased risk of readmission or death after congenital heart surgery.<strong> Patients and Methods:</strong> This was a cross-sectional study done from April 2021 to January 2022, at Pediatric Intensive Care Units at Alhusien and Bab Alsharia University Hospitals. Our study included 100 patients in the pediatric and adolescent age group. Biomarkers were assessed using an enzyme-linked immunosorbent assay with patterned arrays and electrochemiluminescence detection. The manufacturer's specifications were respected while repurposing pre-owned kits and equipment.<strong> Results: </strong>Soluble suppression of tumorigenicity 2 pre and postoperative values were significantly associated with readmission. Postoperative NT-ProBNP values were significantly associated with readmission. Only preoperative soluble suppression of tumorigenicity 2 with cut-off value of 1.46 showed significant association with readmission with sensitivity and specificity of 84.6 and 79.3% respectively. Postoperative NT-ProBNP and soluble suppression of tumorigenicity 2 with cut-off values of 904.12 and 1.46 respectively showed significant association with readmission with sensitivity and specificity of 95.5% and 97.7% respectively for NT-ProBNP and sensitivity and specificity 84.6% and 74.7% respectively for soluble suppression of tumorigenicity 2. No laboratory parameter change showed significant association with readmission.<strong> Conclusion:</strong> Postoperative NT-proBNP levels were strongly related with readmission after juvenile congenital heart surgery, with good sensitivity and specificity.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254088_8b58bfbe38c009fc3fbae710b523a775.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Use of Postoperative Antibiotics in Tonsillectomy: A Comparative Study4081408425482710.21608/ejhm.2022.254827ENNehad Hassan AbdElrahmanAhmed Fathy Mohamed AwadUsama TayaJournal Article20220815<strong>Background</strong>: After a tonsillectomy, the bared tonsillar fossa becomes colonised by the oral bacterial flora, which can cause a strong localised inflammatory reaction, pain aggravation, and a delay in healing. The present study aimed to evaluate and compare the effect of antibiotics given orally or intravenously with no antibiotic protocol on post-bipolar diathermy tonsillectomy morbidity.
<strong>Patients and methods</strong>: From January 2021 to January 2022, a total of 300 patients indicated for tonsillectomy. Those patients were divided into three equal groups. Group I received injectable antibiotic in the first two days’ post-operative followed by oral amoxicillin clavulanic acid for another 5 days. Group II received oral antibiotic (amoxicillin clavulanic acid 7 days postoperative. Group III didn’t receive antibiotic postoperative period.
<strong>Results</strong>: Vomiting and secondary diarrhoea were observed in high frequency in patients who received oral antibiotic (group II). Other data included fever, pain score and return to normal diet and normal activity showed no significant differences between the different groups.
<strong>Conclusion</strong>: Based on the current study, there is no effect of antibiotics use on speed of recovery and pain score. New multi-center clinical trials are warranted to confirm such findings.
https://ejhm.journals.ekb.eg/article_254827_4e9b9bb2578d189518e67b591fe7cd2b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Assessment of Uterine Artery Blood Flow in Threatened Miscarriage by 2D Doppler Ultrasound4085408925482910.21608/ejhm.2022.254829ENAhmed Mohammed El HussineyShahenda Ahmed El-SayedMohammed Fathi Abo HashimBasma Sobhy Abd-ElhameedJournal Article20220815<strong>Background</strong>: Transvaginal Doppler ultrasound is a non-invasive and commonly available screening approach for disorders of placental function early in pregnancy that can be used to predict a range of obstetric issues that can be associated to improper placentation and implantation. The present study aimed to assess uterine artery blood flow in threatened miscarriage using Doppler indices of uterine arteries to predict the fate of threatened miscarriage in 1st trimester.<strong> Patients and methods</strong>: A comparative study was conducted in Departments of Obstetrics and Gynecology in Zagazig University Hospitals and Kafr Saqr Central Hospital during the period from December 2019 to September 2021. The study included 64 pregnant women divided two groups; Group A (study group), included 32 pregnant women with threatened miscarriage, and Group B (control group) included 32 pregnant women with normal pregnancy. Transvaginal ultrasound Doppler studies of both uterine arteries flow indices including pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV) were carried out.<strong> Result</strong>: Peak systolic velocity (PSV) of uterine arteries was significantly higher in group (A) (44.46±16.56) compared to group (B) (26.96±5.97). On the other hand other flow indices did not significantly differ between by Mean the groups. <strong>Conclusion:</strong> Information regarding the uteroplacental circulation obtained with the use of color Doppler ultrasound could provide relevant and important prognostic information in cases of threatened miscarriage.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254829_149776a561f63d4c296917ce9bd11510.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Comparative Study between Mesenchymal Stem Cells and Flax Seeds Oil against Toxicity of Lead Acetate on the Spinal Cord Tissue of Male Albino Rats4090410025483110.21608/ejhm.2022.254831ENAbdEl-Raheim A. El-shaterRana A. AliZainab M. MaherMariam A. FawyJournal Article20220815<strong>Background: </strong>Lead is a common heavy metal that persists in the environment and has many toxic effects on the central nervous system, especially the spinal cord. <strong>Objective:</strong> The current study investigates the effect of mesenchymal stem cells (MSCs) and flax seeds oil (FSO) on the spinal cord tissue against lead acetate toxicity in male albino rats.
<strong>Materials and Methods</strong>: Forty adult male albino rats were divided equally into four groups. The first group served as control rats. The second group received lead acetate (100 mg/kg) intraperitoneally daily for seven days. Group 3 after lead acetate intoxication then treated with a single dose of MSCs (1 × 10<sup>6</sup> cells/rat intravenously injection). In the 4<sup>th</sup> group 3 after lead acetate intoxication then rats were treated orally with FSO (1 ml/kg) for thirty days. At the end of the experiment, spinal cord tissues were collected to determine the lead level in the spinal cord, histopathology, immunohistochemistry for cleavage caspase3, and estimate DNA damage by comet assay.
<strong>Results: </strong>Our results revealed significantly increased lead concentration in spinal cord tissue in group 2. In addition to, upregulation of cleavage caspase 3 and elevation of DNA damage in the spinal cord tissue and histopathological alterations in spinal cord tissues. Nevertheless, the treatment of MSCs and FSO groups recorded a decline in lead levels in the spinal cord tissue and downregulation of cleaved caspase 3 and DNA damage and histopathological improvement. <strong>Conclusion:</strong> Our investigation showed that MSCs are more effective than FSO against lead acetate induced toxicity.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254831_3f660cbd3e71e3774b9b732b0762c0a2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Predictors of Short-Term Mortality in Patients with Acute Pulmonary Embolism4101410525483310.21608/ejhm.2022.254833ENRasha A. AbdelfattahAhmed H. MohamedYosra M. AliMohammad O. Abdel AzizNoha M. AbdullahHany T. AsklanySaleh A. MohammedMahmoud M. HigaziAli O. AbdelazizJournal Article20220815<strong>Background:</strong> Pulmonary embolism (PE) is associated with short- and long-term adverse events including mortality. Prompt diagnosis, risk stratification and treatment can improve the outcome. The objective of the present study is to determine the predictors of early death within 30 days in the course of acute pulmonary embolism (APE). <strong>Patients and methods:</strong> One hundred patients with APE were recruited from both inpatients department and ICUs at Cardiothoracic Minia University Hospital .All patients subjected to detailed history, general and local chest examination. Laboratory investigation included CBC, Hs-CRP, troponin and D-dimer. CT pulmonary angiogram (CTPA) with calculation of pulmonary artery obstructive index (PAOI) using Qandali Score and measurement of right ventricle to left ventricle (RV/LV) ratio, Echo with measurement of pulmonary artery systolic pressure (PASP) were done for all patients. Patients were monitored for 30 days from the onset of symptoms to assess the mortality. <strong>Results:</strong> Patients classified according to outcome into survivors, 80 (80%) patients and 20 (20%) non-survivors patients. Po2 and Sao2 were significantly higher in survivors (P values 0.0001 and 0.05, respectively). Pulmonary Embolism Severity Index (PESI) was significantly higher in the non-survivor group(P value 0.001). PAOI and RV/LV ratio were higher in non survivors with (P value 0.001 and 0.001, respectively). Also central location of emboli was higher in non survivors representing. PASP was higher in non survivors (P value 0.001). <strong>Conclusion:</strong> The non-survivor group showed decrease Po2 and Sao2, higher PESI, PAOI, RV/LV ratio, and dilated RV compared with the survivor group. Thus these parameters could be predictors for poor patient outcome.
<strong> </strong>https://ejhm.journals.ekb.eg/article_254833_fe738a308c239bb1bc4510dbd2f7ad5b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prognostic value of Elevated Serum Inflammatory Markers in Adult Patients receiving Induction Chemotherapy for Acute Leukemia4106411225515710.21608/ejhm.2022.255157ENShimaa AbdelmoneemInternal medicine department, faculty of medicine, Zagazig university, Zagazig, EgyptMohammad Al-AkkadAyman FathyMohamed Gamal YousefAlaa A. OmranElsayed Anany MetwallyJournal Article20220815<strong>Background:</strong> Leukemias are a diverse collection of neoplastic illnesses with distinct morphological, immunophenotypic, cytogenetic, and molecular characteristics of malignant cells. C-reactive protein (CRP) testing is traditionally used to assess the degree of infection, diagnosis of sepsis as well as the response to antimicrobial treatment. In the absence of iron overload, cancer patients have a higher level of serum ferritin. CRP and serum ferritin (SF) are inflammatory indicators that can predict the presence of systemic illness<strong>.</strong><br /> <strong>Objective: </strong>Our study aimed to estimate the role of serum ferritin and CRP in the early detection of systemic infection and the prognostic value of these markers in denovo adult patients receiving chemotherapy for acute leukemia.<br /> <strong>Methods</strong>: This cross-sectional study was performed in the period from February 2016 to February 2017 in the Clinical Hematology Unit, Internal Medicine Department, and included 30 denovo adult patients who were diagnosed with acute leukemia; 14 of them were females and 16 were males.<br /> <strong>Results:</strong> After a median follow-up period of 1 year with a range (1.1- 11.2) months; there was a statistically significant cumulative overall survival in younger, non-hyperferritinemia, non-septic patients, and in whom responded to therapy (p=0.02, 0.02 and 0.03 respectively). Furthermore, there was no statistically significant correlation of OS with CRP or erythrocyte sedimentation rate (ESR). Hyperferritinemia (>150) and elevated CRP (>33) were independable risk factors predicting sepsis (P=0.007 and 0.016 respectively) by using a Multivariate logistic regression model.<br /> <strong>Conclusion:</strong> Modest elevation of the blood level of CRP and ferritin above the normal range showed an association with the probability of systemic infection in patients who underwent dose-intensive induction chemotherapy even in absence of clinical evidence of sepsis.<br /> <strong> </strong>https://ejhm.journals.ekb.eg/article_255157_13400b20febbb3f6538a240ed3afc49d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Iron Deficiency Anemia in Children with Febrile Convulsions: A Case–control Study at Sohag University Hospital4113411625520210.21608/ejhm.2022.255202ENPotros Wasfy GaballahMostafa Mohamed AbosderaAshraf M. R Abou-TalebJournal Article20220817<strong>Background: </strong>Iron is necessary for healthy growth and development, and iron deficiency has been linked to behavioural problems, mental impairment, and reduced immunological function in children. Iron deficiency anemia (IDA) affects 48.5 percent of Egyptian preschoolers (aged 6 to 59 months).
<strong>Objective: </strong>The aim of this study was to evaluate the iron status in children with first febrile seizure (FFS).
<strong>Patients and Methods</strong>: This was a case-control hospital-based study that included children with febrile convulsion as case group and children with febrile illness without convulsion as controls, aged from 6 months to 6 years at Sohag University Hospital. Our study included 110 children, 55 as case group and 55 as controls from June 2019 to December 2020. <strong>Results: </strong>Pallor observed in 28% only of case group against only 17% of control group. The mean temperature at which children start to convulse was 39.36±51. The mean Hb level of case group was statistically significantly lower than normal and was 10.73±1.44 versus 11.77±1.24 for control group. The mean of serum ferritin was statistically significantly lower than normal and was 13.41±11.71 versus 30.18±8.9 for control group. The mean of total iron binding capacity (TIBC) was statistically significantly higher than normal and was 430.91±87.8 versus 362.73±63.81 for control group.
<strong>Conclusion:</strong> The result suggests that iron deficiency anemia may be a risk factor for febrile seizures. Thus screening for IDA should be considered in children with febrile seizures. Fever can worsen the negative effect of anemia or iron deficiency on the brain and a seizure can occur as a consequence. This suggests that iron deficient children are more prone to febrile seizures.
<strong> </strong>https://ejhm.journals.ekb.eg/article_255202_3fc05987d81b541446d2ecaadc7ae397.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Prognostic Factors of Short-Term Mortality in Spontaneous Bacterial Peritonitis Patients4117412025520410.21608/ejhm.2022.255204ENAmr AhmedFaculty of Medicine, Sohag UniversityKhairy Hammam MorsyAsmaa Naser MohammadJournal Article20220817<strong>Introduction:</strong> In cirrhotic individuals, spontaneous bacterial peritonitis (SBP) is one of the most frequent side effects. 1-year mortality is up to 50% even with strong prevention, early diagnosis, and effective care.
<strong>Aim:</strong> To analyze prognostic factors of short-term mortality in SBP individuals.
<strong>Patients and Methods: </strong>In our study, 92 SBP patients were involved. Prothrombin time, international normalized ratio (INR), liver enzymes, serum albumin, total bilirubin, complete blood count, and serum creatinine were all evaluated. A sample of ascitic fluid was collected for chemical analysis. Follow up of the patients was done during hospital admission for complications and mortality.
<strong>Results: </strong>Significantly correlated with mortality were Child score (P=0.02), MELD score (P=0.003), hepatic encephalopathy (P=0.009), and hepatorenal syndrome (P<0.001) in SBP patients. Patients who died had considerably higher WBCs (P=0.003), serum creatinine levels: basal creatinine (P<0.001), maximum creatinine (P<0.001) and last creatinine (P<0.001), ascitic fluid WBCs (P<0.001) and PMNL count (P<0.001) while platelets (P<0.001), ALT (P<0.001), Serum total bilirubin (P<0.001), ascitic fluid protein(P<0.001) and ascitic fluid albumin (P=0.007) were higher in survivors.
<strong>Conclusion:</strong> In SBP patients, WBCs, serum creatinine, ascitic fluid WBCs and PMNL count, MELD score, Child-Pugh score, hepatic encephalopathy and hepatorenal syndrome were all strongly linked to mortality.
<strong> </strong>https://ejhm.journals.ekb.eg/article_255204_6f78d5708f144e8ef0c5758700f57e71.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Oral versus Vaginal Misoprostol in Management of Blighted Ovum4121412625520610.21608/ejhm.2022.255206ENMostafa Gamal Abdelhaleem MohammedJournal Article20220817<strong>Background:</strong> Vaginal misoprostol is preferable than oral misoprostol in the first trimester of pregnancy, according to clinical research.
<strong>Objective</strong>: Comparing the success rate, tolerability and side effects between oral and vaginal 600µg misoprostol in the management of blighted ovum.
<strong>Subjects and Methods: </strong>Our study was carried out on 100 pregnant women diagnosed as blighted ovum, admitted to the Obstetric Unite in Al-Galaa Teaching Hospital and after careful. U/S examination and after second opinion examination all of the participants were informed about the procedures and the possible failure of our study. Two groups were created (50 in each group), (A) took misoprostol orally and (B) group took misoprostol virginally.
<strong>Results:</strong> The gestational ages did not differ significantly between the two groups of participants (P>0.05). Patients who successfully completed medicinal abortions and those who needed surgical evacuation were not statistically different. Also, according to side effects, there was no statistically significant difference in the two groups (P>0.05) except for diarrhea and vomiting, which were significantly increased in oral group.
<strong>Conclusion:</strong> Using oral and vaginal misoprostol 600µg as medical managing for a blighted ovum, their effectiveness is practically identical.
<strong> </strong>https://ejhm.journals.ekb.eg/article_255206_da1d8d529e6680baac9d8435af7f2468.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701Clinical Profile and Comorbidity of Epilepsy in El Minia, Egypt: A Hospital-Based Study4127413925520910.21608/ejhm.2022.255209ENSafaa Ali ZydanEman Saif EldeenOmaima I. Abo-ElkheirMarwa Abdellah OsmanJournal Article20220817<strong>Background:</strong> Classifying epileptic cases based on in-depth study and analyzing groups of different ages and gender can enhance the accuracy of diagnosing epileptic patients.
<strong>Objective: </strong>This research aimed to identify the different clinical profiles of epilepsy and its comorbid disorders.
<strong>Methods:</strong> A one-year hospital-based cross-sectional study conducted on hundreds of epileptic patients including a detailed history, clinical examination, electroencephalography (EEG), neuroimaging (MRI), and psychometric assessment.
<strong>Results:</strong> There were two groups including 56.0% males and 44 % females. 83.5% of patients were rural residents. Generalized onset seizures were 73.5%, focal-onset seizures reported 20.5% and 6.0% unknown type. Abnormal EEG occurred in 77.5% and 22.5% of patients showed abnormal neuroimaging findings. Structural causes of epilepsy were recorded in only 20.5%. Monotherapy was applied to 80.5% and 19.0% received polytherapy. The treatment gap was reported at 17% with a significant statistical difference between age groups. Attention-deficit hyperactivity disorder (ADHD) was recorded in 15.0%, migraine was reported in 12.0%, cerebral palsy (CP) was recorded in 7.5%, and intellectual disability was reported in 3.0%. A significant negative correlation between the IQ level and both duration of epilepsy and seizure frequency/month was reported. Furthermore, a significant positive correlation was reported between the duration of epilepsy and seizure frequency/month.
<strong>Conclusion: </strong>Epilepsy is characteristic in our patients and shows age and sex differences in terms of many features. Most of the patients were receiving monotherapy. There were patients with a positive treatment gap, ADHD, and intellectual disability (ID). Structural causes of epilepsy were recorded among more than a fifth of patients.
<strong> </strong>https://ejhm.journals.ekb.eg/article_255209_035538a8fc60ad54f76956e892939d53.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200288120220701The Expression of CD47 and its Association with Other Biochemical Storage4140414525521210.21608/ejhm.2022.255212ENNoha BassiounyIbrahim Y Abdel-MessihDalia KhaledHebat Allah NaderJournal Article20220817<strong>Background: </strong>CD47 is an integrin associated protein which decreases with PRBCs (packed red blood cells) prolonged storage that possibly leads to less effective blood transfusion. Electrolyte imbalance occurs due to inactivation of Na+/K+ ATPase pump in low temperature which in turn leads to continuous increase of extracellular potassium, which is considered life threatening for patients with renal failure or those with massive transfusions. The objective of the present study is to evaluate the expression of CD47 by flow cytometry with other biochemical storage changes (pH, sodium and potassium ions) in CPD/SAGM packed non-leucoreduced Group (A) versus CPD/SAGM leucoreduced Group (B) red blood cell units at different storage times (on day 7, 14, 28 from date of red blood cells collection).
<strong>Subjects and</strong> <strong>Methods: </strong>Nearly 450 ml of whole blood is obtained into quadruple blood bags and further subdivided into 20 non-leucoreduced units and 20 leucoreduced units. Non-leucoreduced and leucoreduced units are stored at 4 ± 2◦C. Samples are taken from each packed red blood cell unit at days 7, 14 and 28 and tested for Na+ and K+ ions, pH and CD47 marker by flow cytometry.
<strong>Results: </strong>Both leucoreduced and non-leucoreduced units show a highly significant decrease in Na+, pH and CD47 expression and a highly significant increase in K+ level. However, there was no statistically significant difference found between the 2 studied groups regarding Na+ and K+ levels, pH and CD47 expression on packed red cells except for Na+ on 28<sup>th </sup>day which was slightly higher in leucoredced than non-leucoreduced units.
<strong>Conclusion:</strong> Red cell storage lesion is an inevitable process. Our study showed a highly statistically significant decrease in CD47 by flow cytometry in both leucoreduced and non-leucoreduced PRBCs along the storage period from day 7 to day 28.
<strong> </strong>https://ejhm.journals.ekb.eg/article_255212_aaabc468b3aeb69b08498fa41a1ede33.pdf