Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Assessment of Retinal Nerve Fiber Layer Thickness Using Optical Coherence Tomography in Patients with Type 2 Diabetes Mellitus445244584482610.21608/ejhm.2019.44826ENHesham Fawzy KhalilDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbd El-Mongy El-Saied AliDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed Mohamed Aly IbrahimDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed Fathi Mohammed HatataDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190815Background: Diabetic retinopathy (DR) is the most common ocular complication of diabetes mellitus (DM) and considered one of the leading causes of blindness in developed countries. Diabetic retinopathy is predominantly a microangiopathy in which high glucose levels can make small blood vessels particularly, vulnerable to damage. Objective: The aim of this work was to assess the thickness of peripapillary retinal nerve fiber layer (RNFL) measured by Swept Source optical coherence tomography (SS-OCT) in patients with Type 2 Diabetes Mellitus (DM). Patients and Methods: The study was an observational cross-sectional study. The study was conducted on 40 eyes of diabetic patients from the outpatient clinic in ophthalmology department of Al-Azhar University Hospitals. All patients were subjected to a complete ophthalmic examination including OCT. Results: The current study showed a negative correlation between parameters related to DM (duration of DM, and state of glycemic control measured by HbA1C) and all the parameters related to RNFL, and RGCL thickness but this correlation was statistically insignificant, and there was statistically significant decrease in superior RNFL thickness in patients with mild DR than patients with no DR, however, this difference was statistically insignificant in all parameters related to RGCL thickness in the two groups. Conclusion: Optical coherence tomography (OCT) provides non-invasive, quantitative and objective measurement of RNFL thickness, optic nerve head, and RGCL thickness with high resolution and accuracy. This could be the method of choice for monitoring the neurodegenerative changes in DR.https://ejhm.journals.ekb.eg/article_44826_ca7b232c3ead157adf5b3af0db84dd6b.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701The Prognostic Value of Left Ventricular Function on Sepsis Outcomes in Critical Care Unit Patients445944684482710.21608/ejhm.2019.44827ENHossam Eldeen Salah ShabanhDepartments of
Internal Medicine, Faculty of Medicine, Al-Azhar UniversityAbdellah Hussein Al-sadekDepartments of
Internal Medicine, Faculty of Medicine, Al-Azhar UniversityIbrahim Farag-Allah SaidDepartments of Cardiology, Faculty of Medicine, Al-Azhar UniversityAhmed Mohammed Said SallamDepartments of
Internal Medicine, Faculty of Medicine, Al-Azhar UniversityJournal Article20190815Background: Sepsis is the most prevalent life menacing condition presupposed patients’ admission to intensive care units. The underlying cardiovascular consequences of sepsis comprehended marvelous increase of the cardiac output, reduction of the peripheral vascular resistance along with impaired capillary permeability. Aim of the study: The present investigation was implemented to retrieve the prognostic value of LVF assessment using speckle tracking echocardiography (STE) among Egyptian adults, who admitted to the intensive care unit as a resultant impact of sepsis or septic shock. Methods: Patients admitted at the Critical Care Unit, who initially diagnosed with sepsis or septic shock within 8 hours. After fulfilling their criteria and being aged more than 18 years, they were eligible for inclusion in the study. All participants were submitted to rigorous history taking, clinical evaluation, laboratory assessment, and STE. The study embraced an overall 50 patients.. Results: Left ventricular longitudinal strain (LVGLS) was the only parameter which attained statistically significant highly positive correlation with SOFA score among septic shock patients (r = 0.794, p = 0.021). The results of this model revealed that LVGLS (p<0.001) attained high ability in the prediction of Sepsis-related Organ Failure Assessment (SOFA) score and Acute Physiologic and Chronic Health Evaluation (APACHE) score. Conclusions: The capability of STE investigation for the detection of left ventricular dysfunction among septic or septic shocked critically ill patients is a promising and feasible approach, which have a crucial impact on the prognosis of such patients.https://ejhm.journals.ekb.eg/article_44827_49d78ad7d45779f2aaf46dc2c2a19c5d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Vestibular Assessment in Chronic Noise Exposure Subjects446944734482910.21608/ejhm.2019.44829ENAli A. AliAudiovestibular Unit, Department of Otolaryngology, Faculty of Medicine – Al-Azhar UniversityAtef A. El-MaraghyDepartment of Otolaryngology, Faculty of Medicine – Al-Azhar University, Cairo, Egypt.Ahmed M. AhmedAudiovestibular Unit, Department of Otolaryngology, Faculty of Medicine – Al-Azhar UniversityHany A. MohanyAudiovestibular Unit, Department of Otolaryngology, Faculty of Medicine – Al-Azhar UniversityJournal Article20190815Background: The damaging effect of noise on vestibular disturbance is well known, first described in 1890 by Haberman in tinkers with occupational hearing loss. Others have reported vestibular disturbances and abnormalities, such as balance disorders, dizziness, vertigo, and even spontaneous nystagmus in workers exposed to various kinds of occupational noise. Objective: To evaluate vestibular function in subjects with chronic noise exposure. Subjects and methods: Eighty subjects were included in the study, divided into 2 groups: 60 subjects exposed to noise in laundry with mean age 41.53±11.15 (study group) and 20 subjects not exposed to noise with mean age 38.60±6.48 (Control group). All subjects underwent audiovestibular evaluations (puretone audiometry, tympanometry, vedionystagmography, and posturography). Results: This study demonstrated elevated hearing threshold at audiometric frequencies 2-8 KHz (pv <0.001) and speech discrimination (pv <0.001). in addition, marked caloric weakness and reduced SOT composite scores (pv = <0.001), reduced SOT equilibrium scores in noise exposure subjects (pv<0.001), reduced SOT sensory scores in VEST and PREF (Pv <0.001). Furthermore, there was a positive correlation between duration of exposure and auditory and vestibular implications. Conclusion: this study revealed apparent effect of noise on auditory and vestibular system.https://ejhm.journals.ekb.eg/article_44829_327217a09e0eed97eb90bbd001f5a584.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Corneal Endothelial Changes by Specular Microscopy after Uncomplicated Phaco-Emulsification of Hard Senile Cataract Graded by Pentacam447444824489510.21608/ejhm.2019.44895ENAdel Abdelrahman OsmanDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptSayed Mostafa El-SayedDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAmr Ehab FahmyDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190816Background: Cataract is the most prevalent ophthalmic cause of reversible blindness and it is one of the primary concerns of the public health perspective surgery which is the primary and only treatment method known. Objective: Assessment of corneal endothelial changes by using specular microscopy, after uncomplicated phacoemulsification in moderately hard nuclear 3 senile cataract. Patients and Methods: The present study was performed on 30 eyes of 30 individuals preoperative assessed by pentacam to detect grade 3 nuclear cataract to be selected in our study, then corneal endothelium assessed by specular microscopy to evaluate the corneal endothelium to be reference and to be compared to 1st and 3 rd month. Results: A highly significant decrease in ECD 1st month post-operative and a significant decrease in ECD 3rd month in relation to pre-operative state. Highly significant increase in the coefficient of variation 1st month postoperative and non-significant increase in the 3rd month in relation to preoperative state. Highly significant decrease in the percentage of hexagonality 1st month and 3rd month post operatively. There is a highly significant reciprocal correlation between age and pre-operative endothelial cell density. 3rd month post-operative decrease in ECD is significant correlated to male sex. Conclusion: A major finding of our manuscript is that the harder the senile cataract the more time and surgical manipulation was done in spite of the same surgeon and the same operative condition lead to more endothelium lost and the more variation between the cells and decrease in the percentage of hexagonal post-operative.https://ejhm.journals.ekb.eg/article_44895_38c4dbec984ea37c13e415ebe91c750d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Evaluation of the Effectiveness of Rotational Conjunctival Flap Compared to Free Autografting for Ocular Surface Reconstruction after Surgical Removal of Primary Pterygium448344924483010.21608/ejhm.2019.44830ENAbu Bakr Mohammad Farid Abul NagaDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed Gomaa EL MahdiDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptSultan Hussien Ali HasanDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190815Background: pterygium is a fibrovasular lesion of the ocular surface that can display an aggressive clinical behavior and occasionally, threatens the vision. Although there is no consensus on its pathogenesis, recent evidence suggests that is a prolifrative rather than degenerative condition, strongly correlated with exposure to ultraviolet radiation of solar light. Objictive: the purpose of this study was to compare the surgical outcomes when using the technique of conjunctival autograft versus conjunctival rotational flap for reconstruction of ocular surface following primary pterygium excision. Patients and Methds: this study included 20 eyes of 20 patients with primary pterygia attending at the National Eye Center, Rod El Afarag Hospital. Operated eyes were divided into 2 groups, 10 eyes each Group A: included 10 eyes managed by pterygium excision followed by ocular surface reconstruction using rotational conjunctival flap technique. Group B: included 10 eyes managed by pterygium excision followed by ocular surface reconstruction using free conjunctival autograft technique. Results: The better result wase in cases treated by conjunctival autograft group with 10 % recuurence while the higher recurrence rate 20% was seen in cases by rotational conjunctival flap group. Other minor complications were found such as flap retraction in 2 cases of group, buttonhole of the graft in one case in group B, flap edema was in lower incidence than graft edema and no suture granuloma happened in both groups. Conclusion: free conjunctival autograft and rotational conjuctiavl flap showed comparable results, in reducing recuurence rate; they are safe and effective methods of pterygium surgery that produces only few complications.https://ejhm.journals.ekb.eg/article_44830_95357980dea91c3c934fb11886fccab7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Study of The Effect of Repetitive Transcranial Magnetic Stimulation on A Sample of Children with Autism Spectrum Disorder449344984483210.21608/ejhm.2019.44832ENAli Ismail Abd AlrahmanDepartment of Psychiatry, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAmgad Ahmed Moshref GabrDepartment of Psychiatry, Faculty of Medicine, Al-Azhar University, Cairo, EgyptTarek Ibrahim Mohamed ElfekeyDepartment of Psychiatry, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190815Background: Autism Spectrum Disorder (ASD) is a behaviorally defined complex neurodevelopmental syndrome. ASD is one of the most common child psychiatric disorders. Despite the long history of research on ASD, no much is known yet about the exact biological causes and how the disorder can be effectively treated. Objective: To study clinical effect of repetitive Transcranial Magnetic Stimulation (rTMS) on a sample of children with autism spectrum disorder. Patients and Methods: the sample consisted of 30 children. Their ages ranged from 4 to 10 years old. After being diagnosed clinically according to DSM-5 through a designed semi-structured interview and through application of childhood autistic rating scale CARS and assessment of the degree of clinical severity of autism spectrum disorders according to DSM-5. Results: The results of the study after the completion of 12 sessions of rTMS, there was a significant difference and improvement in the severity of the clinical symptoms for ASD except for the level of activity and listening response and use of the body by comparing the severity of symptoms before and after rTMS. Comparing results before and after rTMS by the level of clinical severity of autism according to DSM-5; at the level of severity in social communication, the improvement was statistically significant (p-value 0.001). At the level of severity in restricted and repetitive behaviors the improvement was statistically highly significant (p-value <0.001). Conclusion: this study concluded that rTMS over left dorso-lateral prefrontal cortex may be safe and effective way of providing a relief of ASD symptoms.https://ejhm.journals.ekb.eg/article_44832_8993e9eecbdfa1b6e353fa0cf3252969.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Correlation between Autoimmune Thyroid Diseases and Helicobacter Pylori Infection449945054483310.21608/ejhm.2019.44833ENMohammed Nabil RaafatDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMagdy Abd Al-Kareem El DahshanDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMohammed Salah HusseinDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityTarek Abd Al-Kareem El DahshanDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityMohammed Ahmed Abd-ElghanyDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityJournal Article20190815Background: Helicobacter Pylori (H. Pylori) usually acquired in childhood, it colonizes the gastric mucosa of about 50% of the world’s population at some time in their life. In eastern countries, H. pylori infection has a prevalence of approximately 70%. Objective: To correlate between H. pylori infection and autoimmune thyroid diseases (AITD). Patients and Methods: This is a cross-sectional study done on 200 patients selected as a convenient sample with upper GI upset. They were selected from gastroenterology outpatient clinics at Al-Hussein and Alexandria Police Hospitals, during the summer months of 2018. They were classified according to the results of stool H. pylori Ag testing into two groups; positive and negative (each group 100 patient). This is cross-sectional study done on 200 patients selected as a convenient sample Results: Our results indicated that patients with H. pylori infection were more susceptible to AITD. There was significant association between H. pylori infection and both Hashimoto's and Graves' disease. H. pylori infection had shown to be associated with elevated liver enzymes, anemia, and IL 17. Conclusion: There is a significant positive relationship between H. pylori infection and Hashimoto's disease (HT). There is a significant positive relationship between H. pylori infection and Graves' disease (GD).https://ejhm.journals.ekb.eg/article_44833_415cf114f5d41f5b5330ee4ae5062b80.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Effect of Neodymium-YAG Laser Posterior Capsulotomy on Intraocular Pressure450645134503210.21608/ejhm.2019.45032ENAdel Mohamed Abdul Wahab KhalilDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptSanaa Ahmed MohamedDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAmel Mahmoud HanafyDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190818Background: Posterior capsule opacification (PCO) also known as Secondary cataract is the most common complication following cataract surgery. It can occur between few months and many years after implantation of intraocular lenses (IOLs), with incidence figures ranging from <5% to as high as 50%. Objective: The aim of this study was to determine the frequency of intraocular pressure elevation after Nd: YAG laser posterior capsulotomy for treatment of PCO. Patients and Methods: A prospective non-randomized study that was conducted at Al Zahraa University Hospital. The study included a total of 40 eyes of 31 patients. All patients underwent Nd: YAG laser posterior capsulotomy. Patients were followed up at 4 hours, 1 day, 1 week and 1 month after laser capsulotomy. Nine cases were bilateral, 15 were males (48%) and 16 were females (52%). Results: The majority of patients (90%) showed significant improvement in visual acuity after capsulotomy and about 87.5% of patients had final BCVA of 6/6-6/12, visual acuity after 24 hours was 6/9 in 20 eyes (50%) and 20 eyes (30%) had VA of 6/12. All the 40 patients had visual acuity improvement of 1 or more lines after capsulotomy. No one had further decline in visual acuity after capsulotomy. Conclusion: The present study depicts the Nd: YAG laser capsulotomy as a good, successful treatment of PCO, because it was found to be modern, non-invasive, effective mode of treatment of PCO with lesser complications and it does not require hospitalization.https://ejhm.journals.ekb.eg/article_45032_7dc79279dd43b8df9fe30b04db80238e.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Assessment of Musculoskeletal Ultrasound Guided Injection of The New Regenerative Medicine Techniques (Neural Prolotherapy and Platelet Rich Plasma) Impact versus Well Established Techniques (Steroid Injection) in Cases of Carpal Tunnel Syndrome Secondary to Rheumatoid Arthritis451445234503410.21608/ejhm.2019.45034ENAhmed A. Abdel-AzizDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHegazy M. Al-TamimyDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed M. FahmyDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMahmoud S. Abd AllahDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190818Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming poly-arthritis with extra-articular manifestations in 10–20% of patients, especially those with high titers of rheumatoid factor. Extra articular pathology includes bursitis, tendonitis and neuritis, which results from entrapment, nerve ischemia due to vasculitis or drugs used to treat this condition.Carpal tunnel syndrome is the most common compression neuropathy associated with rheumatoid arthritis. Aim of the Work: To evaluate the efficacy of Neural Prolotherapy and Platelet Rich Plasma in treatment of carpal tunnel syndrome secondary to rheumatoid arthritis. Patients and Methods: Ninety patients with Rheumatoid Arthritis (RA) that were all fulfilling the 2016 ACR/EULAR classification criteria for RA. All were over the age of sixteen years at time of diagnosis, complaining of burning pain or paresthesia in the median nerve distribution of the hand. They were recruited from Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from December 2018 to July 2019. Results: Neural Prolotherapy and Platelet Rich Plasma (PRP) have improved all measured parameters like visual analogue scale (VAS), nerve conduction studies and neuromuscular ultrasonography parameters in carpal tunnel syndrome secondary to rheumatoid arthritis. Conclusion: Neural Prolotherapy and Platelet Rich Plasma proved to be effective treatments of carpal tunnel syndrome secondary to rheumatoid arthritis.https://ejhm.journals.ekb.eg/article_45034_29a54a86267b663bdcaccafba781dcd8.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Ultrasonographic Assessment of Diaphragmatic Function and Its Correlation with Chronic Obstructive Pulmonary Disease Severity452445324503510.21608/ejhm.2019.45035ENAbd El-hay Ibrahim Abd El-hayDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHoussam Eldin Hassanin Abd ElnabyDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed Mohy Mohamed Erfan El-gamalDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190818Background: chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world, and it is projected to be the third leading cause of death by 2020. More than 3 million people died because of COPD in 2012, accounting for 6% of all deaths globally. Objective: the aim of this study is to assess the diaphragmatic function in COPD patients using the ultrasonographic technique, and to study its correlation with severity of the disease. Patients and Methods: this study was carried out during the period from November 2018 to June 2019, on sixty patients with clinically stable chronic obstructive pulmonary disease (COPD), during their follow up in the outpatient clinic of Chest Department, Bab-Al-Sha'reia University Hospital. Results: thickness of the diaphragm (TD) at different lung volumes and capacities (RV, FRC and TLC) estimated by U/S, was found to be progressively decreased with increasing COPD severity. TD was found to be decreased significantly in COPD patients when compared with controls. The only exception was the presence of a non-significant relationship between TDRV in control and mild COPD groups, which may denote that diaphragmatic thickness is not markedly affected in early COPD at low lung volumes. Conclusion: U/S is a simple, easily learned, non-invasive and reliable method that can be used in assessment of the diaphragmatic function and kinetics. There is a significant negative correlation between diaphragmatic function (assessed by measuring diaphragmatic thickness and excursion through U/S) and COPD severity.https://ejhm.journals.ekb.eg/article_45035_aa5e34eed0d1846edc1ec5d82a705a8a.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Outcome of Adjustable Suspensory Fixation for Femoral Graft in ACL Reconstruction453345374503710.21608/ejhm.2019.45037ENAdnan A. Alim Al SebaieDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed Ibrahim AbulsoudDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed Mohamed Mahmoud SalemDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190818Background: The incidence of torn anterior cruciate ligament (ACL) has greatly increased, with today’s increasing enthusiasm for sports activities. As a result, reconstruction of the torn anterior cruciate ligament became a common surgical procedure in orthopaedic surgery. Objective: To evaluate short term clinical outcome of adjustable suspensory fixation for femoral graft in ACL reconstruction. Methods: All patients treated for ACL reconstruction with an ipsilateral hamstring between March 2017 and March 2018 were evaluated. Subjects were assigned to TightRope™ (TR) femoral fixation. All patients were evaluated with the Lachman test, pivot-shift test, 2000 International Knee Documentation Committee (IKDC) knee examination. The subjective evaluation was performed using the Lysholm knee score. CT examination was performed to evaluate femoral and tibial tunnels enlargement at four different levels. All patients were assessed at a 12 month follow-up visit. Power analysis was performed a priori in accordance with the femoral and tibial tunnels enlargement values from the CT scans. Results: The group was homogenous at baseline with regard to age, gender, BMI, dominance and disease duration. At the final follow-up, no statistically significant differences were found according to subjective and objective clinical outcome measures. According to the femoral tunnel enlargement, no statistically significant difference was found between tunnel at operation and 12 months later. Conclusion: In transtibial ACL reconstruction, the use of adjustable-loop length device products, on the femoral side, led to better clinical and radiological resultshttps://ejhm.journals.ekb.eg/article_45037_a65912380dfc7f44f5d672851fb477b9.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Effect of Steroid Loaded Middle Meatal Gelfoam Sheet on Endoscopic Sinus Surgery Outcome453845444503810.21608/ejhm.2019.45038ENGamal Abd-Elhameed Abd-ElmaksoudDepartment of Otorhinolaryngology, Faculty of Medicine, Zagazig UniversityMagdy Ibrahem GoudaDepartment of Otorhinolaryngology, Faculty of Medicine, Zagazig UniversityKhalid Ahmed KhaterDepartment of Otorhinolaryngology, Faculty of Medicine, Zagazig UniversityJournal Article20190818Background: Endoscopic sinus surgery (ESS) represents the overall accepted type of surgical treatment for chronic rhinosinusitis with nasal polyposis (CRSwNP) refractory to medical treatment. Presence of postoperative Middle meatal adhesions are a potential cause of surgical failure. Triamcinolone is recently proposed as a solution for these adhesions. Objective: This study was designed to evaluate the effect of steroid loaded middle meatal gelfoam sheet on endoscopic sinus surgery outcome regarding middle meatal adhesions and synechiae formation in patients with CRSwNP refractory to medical treatment. Patients and Methods: This prospective, randomized, single-blinded, placebo-controlled study was conducted on 62 nasal cavities of 31 patients with bilateral CRSwNP. At the end of ESS, randomly gelfoam sheet loaded with triamcinolone was placed in one middle meatus and another gelfoam sheet loaded with saline in the contralateral middle meatus for 1 week. Results: Our results as regards topical application of steroids to the middle meatus showed a statistically significant difference between the steroid side and the saline (control) side in reduction of synechia formation after ESS. Therefore, topical application of steroids is effective in minimizing synechiae formation after ESS. It is also safe and no local or systemic complications were noted during the study. Conclusion: Results of our study demonstrated that the steroid loaded middle meatal gelfoam sheet has a role in minimizing middle meatal adhesions and synechiae formation after endoscopic sinus surgery for patients with CRSwNPhttps://ejhm.journals.ekb.eg/article_45038_4acc8ff0fb28ddc3c92058cf25f62650.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Evaluation of the Repeated Exposure of Hexaflumuron on Liver and Spleen Tissues and Its Mutagenicity Ability in Male Albino Rat454545524503910.21608/ejhm.2019.45039ENMohamed A. NoaishiMammalian and Aquatic Toxicology Department, Central Agricultural Pesticides Lab. (CAPL), Agricultural
Research Center, Ministry of Agriculture, Egypt.H. H. Abd AlhafezMammalian and Aquatic Toxicology Department, Central Agricultural Pesticides Lab. (CAPL), Agricultural
Research Center, Ministry of Agriculture, Egypt.Sanaa A. AbdulrahmanMammalian and Aquatic Toxicology Department, Central Agricultural Pesticides Lab. (CAPL), Agricultural
Research Center, Ministry of Agriculture, Egypt.Journal Article20190818Background: Hexaflumuron (HFM) is an insect growth regulator (IGR); it is highly effective against a wide range of pests. Aim of the work: Due to the lack of toxicological assessments of this insecticide especially the formulation type, the objective of the present study was aimed to investigate the toxicological effects of repeated exposure of HFM formulation on adult albino rats. Materials and methods: Three groups were administered daily by gavage for (28 days) at dose of 11, 4, and 2.5 mg/kg b.wt respectively. In addition to control group. Results: The results of acute toxicity indicated HFM exhibited moderate to some extent high toxicity toward the treated rats. Slight tremors and bleeding from nose were observed. The repeated exposure results revealed the high and middle doses exhibited methemoglobinemia. Also, the HFM treatment led to increase in AST and ALT levels. The urea and creatinine levels were not significantly increased except the level of creatinine in high dose. According to the histopathological findings the middle and low doses of HFM revealed greater injurious in liver and spleen tissues than induced by high dose. HFM induced a statistically significant increase in the micronucleus (MN) frequency in a dose-dependent manner compared with a negative control group. Conclusion: So, it is obvious the middle and low doses induced damage in the liver and spleen organs while the high dose induced damage in blood, bone marrow, and kidney organs.https://ejhm.journals.ekb.eg/article_45039_ab61cd111932d05bce610ce82528c4e3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Predictors of Success of Shock Wave Lithotripsy for Ureteral Stones Based on Computed Tomography Scan parameters455345564504010.21608/ejhm.2019.45040ENAbdelrahman A HassanUrology Department, Al-Azhar Faculty of Medicine, Cairo, EgyptHussein H MahmoudUrology Department, Al-Azhar Faculty of Medicine, Cairo, EgyptHassan A MohammedUrology Department, Al-Azhar Faculty of Medicine, Cairo, EgyptMohammed S AbdelbakyUrology Department, Al-Azhar Faculty of Medicine, Cairo, EgyptJournal Article20190818Background: For shock wave lithotripsy has proven to be an effective, safe and truly minimally invasive option for the treatment of nephrolithiasis. Various technical factors as well as patient selection can impact the success of the procedure. Objective: The aim of this study was to identify the parameters on NCCT that may predict the success of shock wave lithotripsy (SWL) in ureteral stones. Patients and Methods: 102 patients who underwent SWL for ureteral stones at sayed Galal University Hospital from January 2015 to August 2018 diagnosed by non-contrasted computed tomography were studied. The failure was defined as remnant stones >4 mm. We assessed age, sex, body mass index, stone size, location, skin-to-stone distance (SSD), presence of JJ and the presence of secondary signs (hydronephrosis, renal enlargement, perinephric fat stranding, and tissue rim sign). Results: 102 patients with success rate 61.8%, stone size, stone density were significantly associated with outcome of SWL. While SSD, JJ and secondary signs (hydronephrosis, perinephric fat stranding and tissue rim sign) were insignificant. On multivariate analysis, stone size and stone density were the independent factors affecting the outcome of SWL. Conclusions: The study demonstrated that stone size and density are significant and independent predictors of outcome in patients with upper ureteral stones. However SSD and signs of impaction still have to be evaluated.https://ejhm.journals.ekb.eg/article_45040_f53037b00dedb32a87552bd4a03037d5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Traumatic Brain Injury Associated with Hyponatremia455745634504110.21608/ejhm.2019.45041ENSamy M SelimNeurosurgery Department, Faculty of Medicine for Girls, Al-Azhar UniversityJournal Article20190818Background: Traumatic brain injury (TBI) is a one of the commonest injuries treated at the Neurosurgery Department. The incidence rate is approximately 3% in the general population and the mortality rate is about 30% of all injury deaths. Hyponatremia leads to high morbidity and/or mortality in TBI patients. Our study discusses the epidemiology of TBI associated with hyponatremia. Methods: Retrospective analysis of 80 patients with TBI between February 2017 and November 2018 was performed. The relationship between the incidence of hyponatremia in TBI patients and age, sex, GCS, type, severity of injury and whether the patient was submitted to surgery or not. Results: Out of 80 TBI patients recruited for the study, 25 of them suffered from hyponatremia. Hyponatremia following TBI wasn’t related to age, sex but it was related to the type of injury, the Glasgow Coma Scale (GCS) score ≤ 8, surgical history. TBI with hyponatremia usually had longer stay in the hospital and bad outcome. Conclusions: Sever TBI patients (GCS score ≤ 8), intracranial hemorrhage and/or skull base fracture are susceptible to developing hyponatremia and require additional treatment aiming to normalization of serum sodium levels to prevent deterioration of their condition. Abbreviations: ANP, Atrial natriuretic peptide; CSWS, Cerebral salt wasting syndrome; SIADH, Syndrome of inappropriate secretion of antidiuretic hormone; TBI, Traumatic brain injuryhttps://ejhm.journals.ekb.eg/article_45041_22d96356187285784f3123fbc2f615e3.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Estimation of the Prophylactic Effect of the Egyptian Propolis Extract against Aluminum Silicate Toxicity on Some Organs of Albino Rats: Growth Performance and Histochemical Studies456445694504210.21608/ejhm.2019.45042ENAli H. Abu-AlmaatyZoology Department, Faculty of Science, Port Said University, Port SaidYasmin M. Abd El-AzizZoology Department, Faculty of Science, Port Said University, Port SaidNahed A. OmarZoology Department, Faculty of
Science, Damietta University, EgyptAhmed M. AbdeenZoology Department, Faculty of Science, Mansoura University, EgyptJournal Article20190818Background: the liver is a critical organ because it contains most of the accumulated metals where toxic effects can expected. Also, the lung is directly affected by receiving aluminum as aluminum silicate. Exposure of aluminum leads to production of free radicals that damage living organs and tissues. Aim of the work: this study aimed to evaluate the nucleic acid content in liver, lung and cerebellum tissues intoxicated by aluminum silicate (AlS) and the possible ameliorative effect of propolis extract (PP). Material and methods: Forty male albino rats (weighting 100-120 grams) were categorized randomly into four groups, ten rats on each group (n=10). The 1st group considered as the healthy control group. The 2nd group received 200 ml PP/kg b.wt., day after day by stomach gavage. The 3 rd group was injected intraperitoneally by 20 mg AlS/kg b.wt., twice weekly. The 4th group was treated with AlS in addition to PP as the same doses as in the 2nd and 3rd groups. After two months for each group. Liver, lung and cerebellum organs were harvested. Results: decreased body weight gain of rats was realized with weakly stained nucleic acids contents in liver, lung and cerebellum tissues that intoxicated by AlS. While, using the supplemented treatment (PP) at the same time with the induction of AlS compound showed an ameliorative effect on the nucleic acid contents. Conclusion: propolis has anti-oxidant by inhibiting AlS toxicity on nucleic acids in the different experimental organs of rats.https://ejhm.journals.ekb.eg/article_45042_97e138da30960ba6025c5d4893e2c5f7.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Study of The Relationship between Severity of Liver Cirrhosis and Pulmonary Function Tests457045764504310.21608/ejhm.2019.45043ENNabil Farouk AwadDepartments of Chest Diseases, Faculty of Medicine, Al-Azhar UniversityAbd-Allah Mohammad ElbalshaDepartments of Chest Diseases, Faculty of Medicine, Al-Azhar UniversityMohamed Zakria Abo AmerDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar UniversityMohamed Helmy Elsayed IbrahimDepartments of Chest Diseases, Faculty of Medicine, Al-Azhar UniversityJournal Article20190818Background: Cirrhosis is a condition in which the liver does not function properly due to long-term damage. This damage is characterized by the replacement of normal liver tissue by scar tissue. Objective: The aim of this work is to study the relationship between severity of liver cirrhosis according to the ChildPugh score and pulmonary function tests (namely spirometry and arterial blood gas). Patients and Methods: The study is a cross sectional one, which was carried out on 50 patients admitted in the inpatient wards, or in regular follow-up in the out-patient’s clinics of the Gastroenterology Departments, in Al-Azhar University Hospitals between November 2018 and May 2019.They were divided into 3 groups according to Child Pugh Classification (A, B and C). Result: The prevalence of hypoxia was(30%) in all studied groups (50 patients), the hypoxia was present in patients with Child C and Child B (62%) and (29.4%) respectively but none of Child A had hypoxia. It was noted that all pulmonary functions were worst in patients Child class C when compared to other groups. However, patients Child B had also significantly worse pulmonary functions when compared to patients class A. We also showed that pulmonary functions are significantly correlated with synthetic liver function, Child and MELD score. The deterioration of liver functions and rise of patients score is accompanied by worsening of all pulmonary functions. Conclusion: Patients suffering from severe liver cirrhosis and ascites, have significant reduction in (PaO2) and (SaO2) in association with restrictive pulmonary function pattern (up to 100% of patients with massive ascites).https://ejhm.journals.ekb.eg/article_45043_c131a9ceb316e6e3fb8edeb4bb506069.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Bone Mineral Density and Trabecular Bone Score in Patients with Non-Radiographic Axial Spondyloarthropathy457745874504410.21608/ejhm.2019.45044ENHesham Salah HamoudDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar UniversityMohamed Magdy GhitDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar UniversityMohammad Abd Elmoez AliDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar UniversityIslam Mohamed Elsayed KhaledDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar UniversityJournal Article20190818Background: spondyloarthropathies (SpA) are a group of chronic inflammatory rheumatic conditions that share multiple clinical features including axial and/or peripheral arthritis, enthesitis, absence of serum rheumatoid factor and presence of common extra articular manifestations. Objective: the aim of this work is to study bone mineral density and trabecular bone score at patients with nonradiographic axial spondyloarthropathy. Patients and Methods: this study is a cross sectional study in which 200 patients having chronic back pain selected from those attending the outpatient clinic and inpatient of Al-Azhar University Hospitals, Damietta and were divided into two groups: 1- (Group A, study group): (160) patients had inflammatory low back pain fulfilling Calin criteria for inflammatory low back pain. 2- (Group B, control group): (40) patients had mechanical low back pain not fulfilling criteria of inflammatory back pain. Results: regarding results of clinical examination, there was significant increase of arthritis, dactylitis, enthesitis and psoriasis in Group A when compared to Group B (43.3%, 16.7%, 30.0%, 20.0% vs 3.3%, 0.0%, 3.3% and 3.3% respectively). In addition, there was significant increase of arthritis plus dactylitis and arthritis plus enthesitis in Group A when compared to Group B (16.7%, 30.0% vs 3.3% and 0.0% respectively). Conclusion: results of the present study proved that, both bone mineral density and trabecular bone scores showed early changes in patients with non-radiographic axial spondylo-arthropathy. In addition, both correlated with each other and with results of axial magnetic resonance imaging. Thus, they are advocated in diagnosis of nr. SPA.https://ejhm.journals.ekb.eg/article_45044_075ee5ed6297be4383a7f780b61c6091.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Early Results of Fibular Osteotomy for Treatment of Medial Compartment Osteoarthritis458845904504510.21608/ejhm.2019.45045ENAdnan ElsebaiyDepartment of Orthopaedic Surgery, Al-Azhar Faculty of Medicine, CairoHesham SafwatDepartment of Orthopaedic Surgery, Al-Azhar Faculty of Medicine, CairoAhmed Abdel Rahman AshiryDepartment of Orthopaedic Surgery, El-Fayoum General HospitalJournal Article20190818Background: knee O.A was treated by total knee arthroplasty but it is new procedure still under trial for treatment of medial compartment knee O.A. Objective: To assess the early results of proximal fibular osteotomy as a new surgery for pain relief and improvement of functions of the knee in patients with medial compartment OA. Patients and methods: From July 2016 to September 2018, 10 patients who underwent proximal fibular osteotomy for medial compartment osteoarthritis. Preoperative and postoperative knee society score (KSS) and visual analogue scale (VAS) were obtained to assess knee functions and pain Results: median knee society score (KSS) show improvement postoperatively from 83 to 105 and visual analogue scale (VAS) decreased postoperatively from 8.5 to 4. Conclusions: This study shows that proximal fibular osteotomy (PFO), a new surgery, can effectively relieves pain and improves knee function in patients with medial compartment osteoarthritis.https://ejhm.journals.ekb.eg/article_45045_42930827a9c7c4f340fc2c9bfdf81712.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Uterine Artery Doppler study and Serum B-Human Chorionic Gonadotropin as Predictors of Preeclampsia459145995918210.21608/ejhm.2019.59182ENAfaf A. IsmailDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAziza NassefDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMona El DesoukyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20191114Background: preeclampsia (PE) is defined as the presence of high blood pressure (BP > 140/90 mmHg) after 20 weeks gestation, in a previously normotensive non-proteinuric patient with one or more of the following: significant protienuria (> 0.3 g/24 h), maternal organ dysfunction or utero- placental dysfunction. Aim of the Work: screening of preeclampsia using serum β-HCG titre at 11-14 weeks of gestation and uterine artery Doppler study at 11-14 weeks and 22-24 weeks of gestation. Patients and Methods: the study was a prospective. It was conducted at the outpatient clinics of Obstetrics and Gynecology of Al-Zahraa University Hospital, Al-Azhar University during the period from February 2017 to April 2018. Results: the uterine artery pulsatility index (PI) and resistance index (RI) of both uterine artery were significantly high in those patients who developed PE. In the uterine artery Doppler study at 11-14 weeks of gestation, the mean PI and RI of both right and left uterine arteries were significantly different between the two groups, PI and RI were higher in PE group, the mean of right uterine artery PI in PE group was 2.39 ± 0.38 VS 1.69 ± 0.34 in non PE group. It was statistically highly significant (P value was 0.004). The maternal serum β-HCG titre was insignificantly different in those who developed preeclampsia and others. Conclusion: the maternal uterine artery PI and RI in early pregnancy (11-14 weeks of gestation) and in mid pregnancy (22-24 weeks of gestation) were increased and associated with occurrence of preeclampsiahttps://ejhm.journals.ekb.eg/article_59182_08f89ee4b67305f77c7b5c4dba2361a2.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701The Effects of Dexmedetomidine on Airway-Related Complications During Emergence from General Anesthesia in Nasal and Paranasal Surgeries460046074516910.21608/ejhm.2019.45169ENNabeel Ibrahim Fathy ElmasryAnesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar UniversityMaamoun Mohamed IsmaelAnesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar UniversityAmr Soliman HamroushAnesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar UniversityAhmed Gamal Moustafa HegazyAnesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20190819Background: Stimulation of various sites, from the nasal mucosa to the diaphragm, can evoke laryngospasm. To reduce airway reflexes, tracheal extubation should be performed by special technique or with drugs that do not depress ventilation. However, tracheal extubation during rhinoplasty may be difficult because of the aspiration of blood and the possibility of laryngospasm. Dexmedetomidine has sedative and analgesic effects, without affecting respiratory status. Objectives: To evaluate the effects of dexmedetomidine on airway-related complications during emergence from general anesthesia (GA) in nasal and paranasal surgeries. Patients and Methods: This prospective randomized clinical study was included 90 patients of both sexes, admitted for elective nasal and paranasal sinus surgery. They were randomly allocated into three groups 30 patients each, Group A: Standard awake extubation technique. Group B: fully awake “no stimulation extubation” technique. Group C: Dexmedetomidine–group, who received intravenous (I.V) dexmedetomidine 0.5-1 μg/kg bolus in 100 ml of normal saline over 10 minutes before the end of surgery by 10 minutes, The dexmedetomidine bolus was followed by 0.2 μg/kg/hr which was stopped immediately when extubation was done. Results: The following parameters were assessed between the three groups: hemodynamics, airway-related complications, extubation time. Group C: was associated with a significant increase in extubation quality compared with group A and group B regarding hemodynamics, airway-related complications, extubation time. Conclusion: This study showed that the dexmedetomidine group associated with minimal circulatory reflexes and airway-related complications further to the advantage of short extubation time compared with the “no stimulation” extubation technique.https://ejhm.journals.ekb.eg/article_45169_6307d39a7293cda0ccb4c056f76321bd.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Ultrasonographic Enthesis Evaluation in Patients with Recurrent Acute Anterior Uveitis with and without Spondyloarthropathy460846154564810.21608/ejhm.2019.45648ENAsaad NooreldinDepartments of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assiut, EgyptMohamed Ismail AbdelkareemDepartments of Rheumatology, Faculty of Medicine, Al-Azhar University, Assiut, EgyptAhmed Moslam IbrahimDepartments of Rheumatology, Faculty of Medicine, Al-Azhar University, Assiut, EgyptAmr Mohamed MahmoudDepartments of Rheumatology, Faculty of Medicine, Al-Azhar University, Assiut, EgyptJournal Article20190823Background: spondyloarthritis (SpA) is a group of chronic diseases recognized by arthritis and extraarticular lesions e.g. uveitis, enthesitis, dermatological affection. About 35% of SpA patients may present with recurrent attacks of acute anterior uveitis (AAU). Purpose: it was to detect whether patients with idiopathic recurrent AAU who were positive or negative for Human Leukocyte Antigen B27 (HLA–B27) had a frequency of enthesis lesions compared to that seen in patients with SpA. Patients and Methods: a prospective study of enthesis evident on musculoskeletal ultrasound examination was done on sixty patients and twenty controls, the eighty were categorized into 4 groups; group 1 included 20 patients with known SpA group 2 included 20 with recurrent AAU HLA–B27 positive and didn’t have SpA aspects group 3 included 20 with recurrent AAU HLA–B27 negative and didn’t have SpA and group 4 included 20 healthy controls. Using Madrid Sonography Enthesitis Index (MASEI) twelve enthesis locations were assessed in each participant. Results: a total of 960 entheses sites were examined by ultrasonography in all 80 participants. The MASEI cut-off limit of ≥18 points was 75%, 60%, 45%, and 10% of the participants in the 4 groups; respectively. The MASEI score was significantly higher in groups 1&2 than in groups 3&4. The differences between the two groups were statistically significant. Conclusion: a high percent of HLA–B27 positive patients with idiopathic recurrent AAU without characteristics of SpA have enthesis lesions with about percent to those seen in patients with known SpA.https://ejhm.journals.ekb.eg/article_45648_3d39051df649cbf266a6447f434eae92.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Helicobacter Pylori Seropositivity in Hyperemesis Gravidarum During Pregnancy461646214544910.21608/ejhm.2019.45449ENEsmail El-GarhyDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityYehia A. WafaDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityAhmed OkashaDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20190821Background: Prevalence of hyperemesis gravidarum varies from 0.3 to 1.5% of all live births. The exact cause is not well known and is probably multifactorial. It is the most common cause of hospitalization in the first half of pregnancy and second only to preterm labor for pregnancy overall. The etiology of emesis gravidarum remains unknown. But a number of possible causes have been studied as endocrinal, immunological, psychological, metabolic, genetic and even infectious such as helicobacter pylori infection. Aim of the Work: To assess the value of screening for helicobacter pylori seropositivity in hyperemesis gravidarum for better evaluating and improving the cure rate especially in resistant cases. Patients and methods: A prospective controlled comparative study was conducted on 100 pregnant women in the first trimester, where 50 of them were suffering from hyperemesis gravidarum (group A) and another 50 healthy women were chosen as a control group (group B). They were recruited from the outpatient clinic of Al-Galaa Maternity Teaching Hospital, Cairo, Egypt from January 2019 till June 2019. After approval of the local ethics committee, a written consent was obtained from each woman before inclusion in the study. Fasting and post prandial sugar, Liver and kidney function tests, thyroid function tests, CBC, urine and electrolyte examination as well as serum examination for IgG of helicobacter pylori were done for each one. Results: Serum helicobacter pylori IgG antibodies seropositivity and acetonuria was significantly higher in group A than in group B while serum sodium and potassium levels were significantly lower in patients with hyperemesis gravidarum than control group. Conclusion: The treatment of H. Pylori infection may reduce the risk of hyperemesis gravidarum and its complications.https://ejhm.journals.ekb.eg/article_45449_388d41eaac78634fc4220b2cf79d1d54.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Significance of Neuropilin-1 Expression, Ceruloplasmin oxidase and Copper in Egyptian Children with B-Lineage Acute Lymphoblastic Leukemia462246274564910.21608/ejhm.2019.45649ENNawal M. Abdel QawyDepartment of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar UniversityAlshaymaa M. AlhabibiDepartment of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar UniversitySahar A. KhalilDepartment of Pediatric Oncology, National Cancer InstituteMarwa M. AbdelfattahCentral Public Health Laboratories, Ministry of Health, Cairo, EgyptJournal Article20190823Background: Neuropilins are transmembrane glycoproteins that act as receptors for vascular endothelial growth factors (VEGF) and are involved in the process of tumor angiogenesis. Ceruloplasmin is a member of the multi copper oxidase family. It has antioxidant properties that play a central role in protection of the body against advanced oxidation protein products. Objective: This study was aimed to assess the expression of Neuropilin-1(NRP-1) on blasts of B-lineage precursor lymphoblastic leukemia (ALL) to be used in the diagnostic panel of this disease. We also aimed to assess the alteration of the levels of ceruloplasmin oxidase and copper as a compensatory mechanism to minimize the effects of reactive oxygen species resulting from leukemias. Subjects and Methods: This study was conducted on 40 children with newly diagnosed B-lineage precursor lymphoblastic leukemia. 40 age-matched controls were enrolled to serve as control. The expression of NRP-1 on peripheral blood samples was evaluated by flow cytometry as the proportion of positive cells expressing the marker. Ceruloplasmin oxidase and copper levels were assessed by immunoturbidimetric assay. Results: There was highly significant increase in the proportion of positivity of NRP -1 in patients compared with control group (P<0.001) Ceruloplasmin oxidase and copper levels were also higher in patients compared with control group (P<0.001). Conclusions: It could be concluded that NRP-1 is a valuable marker for diagnosis of B-lineage ALL. There is an increase in the levels of ceruloplasmin oxidase and copper which at the time of diagnosis of B-ALL.https://ejhm.journals.ekb.eg/article_45649_8c262b48dbfe0d7dc7e56859ba90974f.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Comparison of the Effect of Nitroglycerin, Magnesium Sulphate and Dexmedetomidine as Hypotensive Agents in Lumbar Spine Surgery462846384565110.21608/ejhm.2019.45651ENOsama Helal AhmedDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University, Assuit, EgyptTawfik Mohamed Nour-EldinDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University, Assuit, EgyptWaheed Mohamed AliDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University, Assuit, EgyptMarwa Ali Abd El ZaherDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University, Assuit, EgyptJournal Article20190823Background: in orthopedic procedures more blood is lost from raw bone and muscle surface than from identifiable blood vessels. Moderate hypotensive anesthesia was found to significantly decrease the average blood loss by nearly 40%, reduce the need for transfusion by 45% and shorten the average operating time by nearly 10%. Objective: The aim of the current study was to compare magnesium sulphate and dexmedetomidine with nitroglycerin as regard hypotensive effect as primary outcome, volume of blood loss, blood substitution and pattern of recovery as secondary outcome during lumbar spine surgery. Patients and Methods: This prospective, controlled, comperative, randomized, double blind study included a total of ninty patients aged 21-50 years of both sex, ASA I-II scheduled for elective lumber spine surgery, attending at Department of Orthopedic, AL-Azher university Hospital in Assuit as single center study. Patients have received either dexmedetomidine, magnesium sulfate or nitroglycerine. Results: There were highly significant difference (P <0.000) with duration of surgery between different study groups with duration of surgery shortest in dexmedetomidine group followed by magnesium sulfate group and then nitroglycerine group. There were highly significant differences between different study groups with fluid maintenance with higher volume in nitroglycerine group then magnesium sulfate group and then dexmedetomidine group. There were highly significant differences (P <0.000) with systolic blood pressure between study groups at A1 and hypotensive agent discontinuation with lowest systolic blood pressure in dexmedetomidine group followed by magnesium sulfate group and then nitroglycerine group. Conclusion: nitroglycerine, magnesium sulfate and dexmedetomidine could induce hypotension, but dexmedetomidine showed more favorable hemodynamic profile as regard blood pressure and heart rate.https://ejhm.journals.ekb.eg/article_45651_54099ea73f377b1c4eeaaa293871eab4.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Randomized Comparative Study between Direct and Indirect Tibial Revascularization in Management of Critical Limb Ischemia463946424565210.21608/ejhm.2019.45652ENAbdelaziz Ahmed AbdelhafezDepartment of Vascular surgery, Faculty of Medicine, Al-Azhar UniversityOmar Mokhtar ElhayegDepartment of Vascular surgery, Faculty of Medicine, Al-Azhar UniversityHany Abd Elmomen Abdel FatahDepartment of Vascular surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20190823Background: The importance of the angiosome concept in critical limb ischemia remains controversial. Aim of the study: to assess the outcomes of direct re-vascularization (angiosome-targeted tibial angioplasty alone) (DR) versus indirect re-vascularization (IR) non angiosome target, in isolated tibial lesions. Patients and Methods: thirty patients were included and presented to vascular surgery department of Al-Azhar University Hospitals with infra-popliteal arterial lesions, randomly distributed into two equal groups;15 patients was treated with (DR) while 15 patients treated with (IR). Results: fifteen patients reached the end point of adequate healing: (9 patients with ‘DR’ technique and 6 patients with ‘ID’ technique) and 9 patients underwent major amputations. The limb salvage after one year was 70%. Conclusion: direct re-vascularization (DR) of the tibial vessels appears to improve wound healing and limb salvage rates compared with IR, with no effect on patency, morbidity, mortality or re-intervention rates.https://ejhm.journals.ekb.eg/article_45652_0ec8edc063a3f891be22100514fcb4ea.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701The Effect of Ketamine as Adjuvant in Ultrasonic Guided Supraclavicular Brachial Plexus Block464346484565610.21608/ejhm.2019.45656ENEzzat Mahmoud EL-SoudyDepartment of Anesthesia and I.C.U, Faculty of Medicine, Al-Azhar University, Assiut, EgyptAlaa Mahamed Ahmed AtiaDepartment of Anesthesia and I.C.U, Faculty of Medicine, Al-Azhar University, Assiut, EgyptWahed Mahamed AliDepartment of Anesthesia and I.C.U, Faculty of Medicine, Al-Azhar University, Assiut, EgyptAhmed Ismail Abdel SabourDepartment of Anesthesia and I.C.U, Faculty of Medicine, Al-Azhar University, Assiut, EgyptJournal Article20190823Background: many of the surgical procedures are done daily all over the world. Patients get benefit from the amazing advances in both surgical and anesthesia techniques. However, despite the progress in understanding the physiology of pain and the pharmaceutical properties of painkillers, many patients are still suffering from severe postoperative pain after surgery. Objective: The aim of the current study was to determine the effect of the addition of 25 µg/kg body weight ketamine to 0.5% bupivacaine supra-clavicular brachial plexus block on quality of block, the time of onset and postoperative analgesia time. Patients and Methods: it is a prospective double blinded controlled study that was carried out on 150 patients ASA I – II, aged 18-50 years with different upper limb surgeries of the forearm and the hand in Assiut and Al-Azhar University Hospitals. Results: ketamine was more effective with a mean complete sensory block onset of 11.93±2.95 minute in the ketamine group compared to12.60±3.00 minutes in the control groups. The study also showed that ketamine hastened the onset of complete motor block, with a mean complete motor block onset of 17.33±3.79 minute in the ketamine group compared to 19.67±4.45 minutes in the control group. As regard analgesia duration, the present study showed that ketamine group prolonged the analgesia duration. Conclusion: It could be concluded that addition of (25 µg/kg) ketamine to bupivacaine improves onset of the block, postoperative pain-free time (VAS) and reduces the consumption of postoperative analgesics in patients undergoing different upper limb surgeries of the forearm and the hand.https://ejhm.journals.ekb.eg/article_45656_25b50075d121291799c671507db0cfca.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Role of External Fixator Combined with T-Plate Internal Fixation in The Treatment of Comminuted Distal Radial Fractures464946614565810.21608/ejhm.2019.45658ENMostafa Hussien HegazyDepartment of Orthopedics, Faculty of Medicine, Tanta UniversityWaleed Mohammed EweesDepartment of Orthopedics, Faculty of Medicine, Tanta UniversityAshraf Atef MahmoudDepartment of Orthopedics, Faculty of Medicine, Tanta UniversityMostafa Abdel Fadil AlakbawyDepartment of Orthopedics, Faculty of Medicine, Tanta UniversityJournal Article20190823A technique of external fixator combined with T-plate internal fixation for intra-articular fractures of the distal radius is based on the finding that the separate t-plate fixation do not give complete stability to the fracture. However, if it is combined externally by external fixator, you get a solid synthesis of the fractured radius. This enables early mobilization of the wrist without the use of plaster cast. Objective: The aim of the study was to evaluate the results of external fixator combined with palmar T-plate internal fixation for the treatment of comminuted distal radial fractures. Patients and methods: This was a prospective study that was conducted on 20 patients. Patients were treated by the external fixator combined with T-plate internal fixation. All patients were attending to the Emergency Department and Outpatient Clinic of Orthopedic Surgery Department in Tanta University Hospitals. Results: Patients had excellent range of motion, normal ROM of the arm, shoulder and hand. No significant differences in the radiographic parameters were detected between fracture fixation and fracture healing. Complications were few. At final follow-up evaluations, patients had well to excellent results with respect to range of motion scores. Stable fixation allowed starting active and passive motion of the wrist without compromising postoperative alignment. The poor results in this case were due to late intervention, osteoporosis due to old age and poor general condition of the patient, which resulted in incomplete union. Conclusion: External fixator combined with T-plate internal fixation is an efficacious treatment option for intraarticular distal radius fractures with excellent long-term results.https://ejhm.journals.ekb.eg/article_45658_c8b8042bac312e5968f6091973da175d.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Serum Cholinesterase Level as a Biomarker in Detecting Liver Injury in Patients with Chronic Hepatitis C466246684565910.21608/ejhm.2019.45659ENSalem Soliman Ahmed SalamaDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityBahy El-Deen El-Sayed El-BahnasawyDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMahmoud Abd Ellatif HashishDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityMustafa Mohammed Mustafa Al EbiaryDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityJournal Article20190823Background: hepatitis C virus can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, HCC and the need for liver transplantation. Objective: the aim of this study is to evaluate serum cholinesterase (CHE) level as a biomarker for detecting liver damage in patients with chronic hepatitis C. Patients and Methods: the current study was carried out on 50 subjects selected from the outpatient's clinic of Internal Medicine Department of Sayed Galal Hospital, Al-Azhar University and admitted to the internal department. The study was performed in the period between July-2014 to July -2019. Results: Sensitivity of cholinesterase is 100%, its specificity is 100% and its accuracy is 100%, in predicting liver injury in patients with chronic hepatitis C. Cholinesterase is positively correlated with Hb, platelets and albumin. Cholinesterase is negatively correlated with ALT, AST and ALP, total & direct bilirubin, PT, INR, urea, creatinine and AFP. There is significant increase of cholinesterase among compensated compared with decompensated cirrhotic patients. There is significant decrease of cholinesterase among compensated cirrhotic patients compared with controls. There is significant decrease of cholinesterase among decompensated cirrhotic patients compared with controls. Conclusion: cholinesterase is an excellent biomarker of cirrhosis with good sensitivity and specificity. Cholinesterase shows good correlation with albumin, PT, INR and Child-Puch score. Cholinesterase distinguishes decompensated cirrhosis from compensated cirrhosis well.https://ejhm.journals.ekb.eg/article_45659_9ba3c8944c7a0ceb63c1b3663a849df5.pdfPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200276720190701Characterization of The Type of Response to Different HCV Antigens and Quantification of Viral Load in Newly Diagnosed Hepatocellular Carcinoma Patients466946744566010.21608/ejhm.2019.45660ENDina Usama Sharaf El DinDepartment of Pharmacy, National Cancer InstituteMagdy AminDepartment of Microbiology, Faculty of Pharmacy, Cairo
UniversityHadir El MahlawyDepartment of Clinical Pathology, National Cancer Institute, Cairo, EgyptSamah RadwanDepartment of Clinical Pathology, National Cancer Institute, Cairo, EgyptJournal Article20190823Background: Hepatitis C virus (HCV) is a blood born virus that is considered a major cause of chronic liver disease and hepatocellular carcinoma (HCC) worldwide. HCV is thought to induce HCC either indirectly or directly by the effect of its viral proteins on different host cell proteins and signaling pathways. Objective: The aim of the study was to characterize the type of response to different HCV antigens, quantify HCV viral load, transforming growth factor- beta and miRNA 122 in patients with newly diagnosed Hepatocellular Carcinoma. Patients and methods: This study was done on three groups: the first group consisted of 40 newly discovered hepatocellular carcinoma patients with HCV infection. The second group consisted of twenty HCV infected patients with other types of cancer (other than HCC). The third group consisted of 20 healthy individuals served as a control group. Serum was separated for detection of the four parameters. Results: TGF-β showed a very weak negative correlation with the miRNA 122 serum levels that is statistically non-significant. Results also showed that miRNA 122 may not be useful in differentiating between liver cirrhosis from HCC patients and it is associated with the severity of the disease rather than the viremia count. Conclusion: Study showed no correlation between the four investigated parameters (HCV antigens, HCV viral load, TGFβ- serum levels of miRNA 122) in an attempt for early diagnosis of HCV induced HCC.https://ejhm.journals.ekb.eg/article_45660_de2ee106937cbdd1bfbf04dd1de19169.pdf