Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Study of the Mean Platelet Volume in Children with Chronic Renal Diseases1342134611442110.21608/ejhm.2020.114421ENAli Mohamed Abu-ZeidSaed Mohamed MorsySherif Hassan MohamedJournal Article20200922Background: The mean platelet volume (MPV), which is a readily available indicator of platelet activation and function, is considered as a promising predictive and prognostic biomarker of cerebrovascular and cardiovascular diseases in several studies. The larger platelets tend to aggregate and produce larger amounts of adhesion molecules than small ones. Objective: To investigate the relationship between MPV levels and the glomerular filtration rate (GFR) in pediatric patients with Chronic Kidney Disease (CKD). Patients and Methods: A prospective case-control study was carried out at the Nephrology Unit in the pediatric department of Zagazig University Children Hospitals.40 children participated in study 20 of them having chronic kidney disease as a case group and a similar number of control children comparable with case group. We reviewed the medical records of patients between May 2018 and February 2019. Results: In this study, there was a positive significant correlation between MPV with Red cell Distribution Width (RDW) and creatinine and a negative correlation between MPV and eGFR in the CKD group. There was a statistically significant difference between case and control groups as regard serum creatinine, urea, and eGFR. There was a highly significant difference between the two groups regarding Hemoglobin, MPV, and RDW. There was a statistically significant difference between the two groups regarding systolic blood pressure (SBP) and diastolic blood pressure (DBP). There was a significant difference between the two studied groups as regard weight. MPV was significantly increased with the progression of CKD. Thus the lower the results of eGFR reflecting poor stage and prognosis of chronic kidney disease accompanied by higher values of MPV. Conclusion: The useful estimation of MPV provides a promising Cheap Biomarker in the monitoring of the course of progression in Chronic Kidney Diseased Children. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Hepatitis (C) Virus, Hepatitis (B) Virus and Human Immunodeficiency (HIV) Virus Coinfection and Their Impact Outcome on the Liver1347135111442410.21608/ejhm.2020.114424ENSaid Abdelbaky GadDepartment of Internal Medicine, Faculty of Medicine, Zagazig UniversityAhmed I. ElagrodyDepartment of Internal Medicine, Faculty of Medicine, Zagazig UniversityJournal Article20200922Background: Hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are the commonest chronic viral infections worldwide, they share most common routes of infections, they are hepatotropic viruses and their combined infections had bad outcome on the liver. Objective: To evaluate the risk of coinfection of the liver by both HCV, HBV and HIV on the liver outcome. Patients and Methods: This is a retrospective study of 241 patients attending different fever hospitals coinfected by HCV and or HBV with HIV but not HCV or HBV without HIV infections. Result: There was significant difference between male 59.8% and female 40.2%, age of patients, also there was significant difference as regard liver enzymes, cirrhosis, splenomegaly, international normalization ratio in triplet coinfections. Conclusion: There is high risk on liver outcome in the presence of coinfection between HCV or HBV and HIV.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Prognostic Value of Interleukin-17 A Gene Polymorphism and Serum IL-17 Levels in Adult Acute Myeloid Leukaemia Patients1352135811442510.21608/ejhm.2020.114425ENAhmed A AlnagarMohamed H MouradZainab A FarragLamiaa M KamelJournal Article20200922Background: T helper 17 (Th17) cells play a role in the pathogenesis and prognosis of acute myeloid leukemia (AML). Th17 cells produce interleukin (IL)-17A and IL-17F, that share strong surface expression and homology of the IL-23 receptor (IL-23R). Objective: To evaluate the expression of IL-17A gene polymorphism and IL-17 serum level in adult AML patients and to clarify its prognostic significance. Patients and methods: In this prospective study, 48 patients with de novo AML and 48 healthy matched controls were enrolled. Cases were diagnosed at clinical pathology and managed in Medical Oncology Departments. We evaluated both serum IL-17 levels, measured by ELISA, and IL-17A (rs2275913) gene polymorphism was assessed using realtime polymerase chain reaction (PCR) in all patients and control. All patients received “3+7” as induction, responders received 3-4 courses of high dose cytarabine as consolidation, while non-responders received salvage therapy. Results: Serum levels of IL-17 were higher in AML patients (median 27 pg/ml) vs 17 pg/ml in the control group (P < 0.001). Also, serum IL 17 level was higher in non-responders with median 37.5 (pg/ml) vs 23 (pg/ml) in responders (P < 0.001). while IL-17A mutant genotypes and alleles showed no significant relation between expression of IL-17 A gene polymorphism and response to treatment or outcome of studied AML cases. Conclusion: Serum IL-17 levels can be considered a useful diagnostic and prognostic factor in AML patients, unlike IL-17 A gene polymorphisms.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Less Invasive Surfactant Administration Comparing Intubation-surfactantextubation and Endotracheal Catheter in Dakahlia Hospitals1359136411442710.21608/ejhm.2020.114427ENNagwa Ahmed El-ShafiePediatrics Department, Faculty of Medicine, Zagazig University, EgyptEhab A. El-BannaPediatrics Department, Faculty of Medicine, Zagazig University, EgyptNada A MahmoudPediatrics Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20200922Background: Respiratory distress syndrome (RDS) is a primary cause of neonatal respiratory morbidity and mortality. For years, preterm infants with RDS have been managed with a combination of tracheal intubation and surfactant replacement therapy (SRT) followed by mechanical ventilation. SRT in preterm infants has been effective in decreasing infant morbidity and mortality and a major therapy in intubated preterm infants with respiratory distress after birth. Aim of the Work: To detect the efficiency of less invasive surfactant administration (LISA) and compare endotracheal catheter with intubation-surfactant-extubation (INSURE). Subjects and methods: Clinical trial. The current study was applied in the Neonatal Intensive Care Unit (NICU) in three hospitals in Dakahlia Governorate: Mit Ghamr General Hospital, Talkha General Hospital and Senbellawein General Hospital during the period from January to June 2019. Results: The results of this study suggest that thin tracheal catheter is the widely accepted route of surfactant replacement therapy and has slightly better outcome than the INSURE method. Future studies with a large number of patients are needed to show that this manner is as effective as thin tracheal catheter surfactant administration. Conclusion: The conclusion of the study is that thin tracheal catheter is the widely accepted route of surfactant replacement therapy, and has similar efficacy, feasibility and safety to its administration via endotracheal tube with higher success and less complications.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Transvaginal nUltrasound Measurement of Lower Uterine Segment Myometrial Thickness for the Prediction of Preterm Labor in Twins Gestations. Observational Study1365137211443010.21608/ejhm.2020.114430ENIbrahim Saif ElnasrObstetrics and Gynecology Departments, Faculty of Medicine, Menoufia University Menoufia, EgyptMohamed FahmyObstetrics and Gynecology Departments, Faculty of Medicine, Menoufia University Menoufia, EgyptHaitham HamzaObstetrics and Gynecology Departments, Faculty of Medicine, Menoufia University Menoufia, EgyptHesham AmmarObstetrics and Gynecology Departments, Faculty of Medicine, Menoufia University Menoufia, EgyptJournal Article20200922Background: Transvaginal ultrasound evaluation of cervical length considered a good predictor of PTL and recently lower uterine segment myometrial thickness had been used for this purpose. Objectives: Evaluating the efficacy and validity of transvaginal ultrasound measurement of lower uterine segment myometrial thickness (LUS-MT) in prediction of preterm delivery (PTL) in twins pregnancies. Patients and Methods: This is an observational prospective cohort study where ninety sex (96) twins pregnant women were enrolled. LUS-MT and CL were measured by transvaginal ultrasound between 16-24 gestational weeks. All patients were scheduled for routine antenatal care till delivery and divided in two groups: preterm group and full-term group. Results: 58 patients delivered at full term and 38 patients had preterm delivery. Among patients who had preterm delivery, 25 patients (56.8%) had LUS-MT <4.26 and 2 patients (3.8%) only had LUS-MT ≥4. among patients who delivered at full term, 50 patients (96.2%) had LUS-MT ≥4.26 and 19 patients (43.2%) had LUS-MT <4.26. The best cutoff value for LUS was 4.26 mm with area under the ROC curve (AUC) 0.917, sensitivity 92.1 %, specificity 86.2%, PPV 81.3%, NPV 94.3% and Accuracy 92.1 %. Conclusion: Transvaginal ultrasound measurement of LUS-MT is an effective, precise, applicable and safe procedure in predicting the preterm labor in twins gestation with high validity than cervical length. Use of lower uterine wall as a substitution of CL measurement in order to predict population at risk of preterm labor needs to be investigated.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Flibanserin Versus Vardenafil in the Treatment of Female Sexual Dysfunction, Randomized Controlled Clinical Trial1373137811443310.21608/ejhm.2020.114433ENAbdalla KandilDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine – Zagazig University.Amany NassarDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine – Zagazig University.Rasha Sayed Ahmed Mahmoud SeragDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine – Zagazig University.Journal Article20200922Background: Female sexual dysfunction (FSD) defined as the persistent/recurring decrease in sexual desire or arousal, the difficulty/inability to achieve an orgasm, and/or the feeling of pain during sexual intercourse. Therapeutic options available are few pharmacological options in the treatment of FSD. Objective: To study the efficacy of flibanserin and vardenafil on female sexual dysfunction and identify which is the best. Methods: The study was conducted in Gynecology and Obstetrics Department and Dermatology and Venereology Department, Faculty of Medicine, Zagazig University Hospitals during the period from February 2019 to December 2019. Thirty-two married female patients were included in this study. These patients were divided into two groups. Group I included sixteen patients who were treated by vardenafil and group II included the sixteen patients who were treated by flibanserin. Results: The present study showed that there were no statistical significant differences between the studied groups in any of demographic data. In addition, there were no statistical significant differences between the two studied groups in all scores pre-treatment. However, there was statistical significant increase in desire, orgasm and total score among Group II (flibanserin) compared to Group I (vardenafil) post-treatment. Conclusion: Treatment of FSD is multi-factorial. Medications alone do not resolve FSD. Flibanserin is a controversial drug approved for a controversial disorder amid huge controversy. While it may serve as the light in the long search for female sexual problems, which still has a long way to go. Women taking this drug must well be educated about the adverse events associated with this drug and the possible interactions. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Role of Metformin in Combination with Neoadjuvant Chemotherapy in Treatment of Breast Cancer1379138811443510.21608/ejhm.2020.114435ENAhmed Said Ahmed SaidHussein Ali Mustafa Abd Al-MuttelebMohammed Ali Morsy AbdeenMohammed Abd Al Rahman HassanSoha Abdelrazek Abbas AhmedJournal Article20200922Backgound: Globally, breast cancer is the most frequently diagnosed malignancy and the leading cause of cancer death in women. Improvements in chemotherapy, surgery, lymph node evaluation and hormone receptor blocking therapy have successfully doubled the survival of breast cancer patients. Objective: To determine whether metformin use was associated with improvement in pathologic complete response (PCR) rate in patients with breast cancer receiving neoadjuvant chemotherapy. Patients and Methods: This prospective study was conducted at the Clinical Oncology Department, Aswan University and Upper Egypt Hospitals in the period between 1/7/2016 and 1/9/2019. This study included 50 patients divided into 2 groups, test group (metformin group) and standard group (non-metformin group). Histopathology was confirmed by tissue core biopsy. Results: All patients in the two groups in our study achieved either pathological complete response or partial response. No patients developed disease progression or were still stable disease. Among the patients in test group (metformin group), 15 patients (60%) achieved pathological complete response (PCR) while 10 (40%) patients did not achieve PCR. However, among the patients in standerd group (non-metformin group) 9 patients (36%) achieved pathological complete response (PCR) while 16 (64%) patients did not achieve PCR. There was statistically significant difference between the two groups regarding the response with better PCR in metformin group (p value is 0.089). Conclusion: The addition of metformin to neoadjuvant chemotherapy has a significant impact on pathological complete response (PCR) in female patients with advanced breast cancer.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Study Serum Level of Interleukin-17 in Pediatric Systemic Lupus Erythematosus1389139511443610.21608/ejhm.2020.114436ENDoaa Mostafa TawfikMayy Abdel-Fattah MoahmedNaglaa Ali KhalifaAsmaa Ibrahim Mohamed GedJournal Article20200922Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease of unknown etiology. Objective: To assess serum levels of IL-17 in pediatric SLE (pSLE) and their association with clinical manifestations, laboratory findings, SLE disease activity index score (SLEDAI), and therapy. Patients and Methods: A case-control study was conducted at Pediatric Nephrology units, and Outpatient Nephrology Clinic of Children Hospital, Zagazig University. It was carried out over two years from September 2017 to August 2019. This study was performed on 60 patients classified into two groups: thirty of them were children with SLE and 30 apparently healthy children as a Control group of comparable age and gender. All patients were subjected to complete history taking and clinical examination. Laboratory investigations were done. Renal biopsy was done to 22 cases who were presented by renal symptoms. Results: Frequency of manifestation were malar rash 86.7%, photosensitivity 80.0%, renal manifestations, and anemia73.3% for each. SLEDAI score was 18 – 38. Class II lupus nephritis (LN) was the most common biopsies result (40%). The range of IL-17 for cases was (89.3 – 359 pg/ml), a highly significant increase in the Il-17 level in the case group than the control. A significant association between IL-17 level and renal manifestation, urea, creatinine, 24-hour urinary protein, and SLEDAI. Conclusions: Serum IL-17A is elevated more than 170 in pSLE patients with lupus nephritis, which correlates with disease activity and renal biopsy. IL-17 seems to have a possible role in the pathogenesis of lupus nephritis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Corneal Topographic Changes After Two Different Grafting Pterygium Surgery Techniques1396140011443810.21608/ejhm.2020.114438ENSabreen A OmarDepartment of Ophthalmology – Faculty of Medicine, Aswan University, Aswan, EgyptAbdalla M AbdallaDepartment of Ophthalmology – Faculty of Medicine, Aswan University, Aswan, EgyptAbdul Mongi E AliDepartment of Ophthalmology – Faculty of Medicine, Aswan University, Aswan, EgyptAhmed F GabrDepartment of Ophthalmology – Faculty of Medicine, Aswan University, Aswan, EgyptJournal Article20200922Background: Surgical treatment of pterygium can result in corneal topographic changes. It is not clear that those changes are universal or technique dependent. Objectives: Evaluation of corneal topographic changes following pterygium surgery using sutured conjunctival autografting versus sutured amniotic membrane grafting. Patients and methods: In this prospective randomized study, patients suffering from primary pterygia that extend between two and four millimeters over the cornea were included. Patients were separated into group I; underwent pterygium excision with sutured conjunctival autograft, and group II underwent pterygium excision with sutured amniotic membrane graft after a comprehensive ophthalmic examination. The following topographic parameters were noted: the axial curvature map, elevation posterior map, and corneal thickness map. Results: Significant improvement of the mean visual acuity measured using the logMAR test was found in both groups postoperatively. The improvement included UCVA and BCVA as well as anterior keratmetric and cylindrical power of the cornea without significant dissimilarity between study groups. No statistically considerable changes in the posterior corneal surface or the corneal thickness were found. Conclusions: Pterygium excision can cause changes in the keratmetric and cylindrical power of the cornea without the affection of the posterior corneal surface or the corneal thickness. The corneal topographic changes caused by the pterygium were not varied with the type of surgical technique used. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Ultrasonographic Evaluation of the Yolk Sac Diameter and Shape in the First Trimester of Pregnancy and Its Relation to Pregnancy Outcome1401140511444010.21608/ejhm.2020.114440ENHanan Atef Ahmed GhaliDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, EgyptAmr Abd Almohsen AlnemrDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, EgyptMohamed Abd Al Moniem IbrahemDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, EgyptAyat Ahmed Hassan Abou ElkhairDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, EgyptJournal Article20200922Background: Transvaginal sonography is used to assess the viability of first-trimester pregnancy. Significant data regarding normal and abnormal ultrasonographic measurements of the yolk sac (YS). The study aimed to know pregnancy outcome by assessing the role of ultrasonographic evaluation of yolk sac diameter and its shape in the first trimester. Patients and Methods: This study was conducted at the Obstetrics and Gynecology Department, Zagazig University Hospitals on 72 pregnant women in their first trimester of pregnancy. All pregnant women in their first trimester of pregnancy referred by the Department of Obstetrics for transvaginal sonography. All pregnancies with an abnormal appearing yolk sac were re-evaluated by sonography after two weeks. Results: The mean age was 26.9±3.9 years. It was found that there was no significant relationship between maternal age and pregnancy outcome. Regarding the absence of the yolk sac. It was not visualized in three cases, and all of them aborted later. Total mean YSD ± S.D was 3.7±1.8 mm, seen in GA from 6-9th weeks and there was no significant difference between the studied groups as regard YSD. Regarding normal YSD with the abnormal outcome, three cases with a normal YSD and regular morphology aborted after the 8 th week of gestation. Regarding large-sized YSD, it was found in three cases; two cases ended in a missed miscarriage at 8th week with YSD 8.4 mm and 8.2 mm respectively. In contrast, the third one with YSD 6.8 mm finally continued beyond 20 weeks with no demonstrable fetal anomalies. Regarding small-sized YSD; it was found in one case which ended in missed abortion at 7th week. Regarding the shape of the YS, an echogenic YS was detected in one case. Conclusion: The yolk sac diameter and shape as a sole parameter is a poor predictor for pregnancy outcome beyond 20 weeks and may be related to early pregnancy loss only. If any abnormality is observed, close follow up with ultrasonography is recommended for these pregnancies. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Comparative Study between Bupivacaine Alone and With Dexamethasone as An Adjuvant in Ultrasound-Guided Popliteal Nerve Block in below Knee Surgeries1406141111444310.21608/ejhm.2020.114443ENAhmed Alsaied Abd ElrahmanAyman Mohamady EldemrdashAmir Abouzkry ElsayedMohammed Hamdi Abolwafa EsmailJournal Article20200922Background: The popliteal nerve block is a form of regional anesthesia utilized for a variety of foot and ankle conditions. This form of anesthesia has become a popular technique to decrease postoperative pain, decrease narcotic use, and increase patient satisfaction. Objective: To compare the effect of adding dexamethasone to bupivacaine on duration of sensory and motor blockade of the popliteal sciatic nerve block in below knee surgeries. Patients and Methods: This prospective, randomized, double blinded, control clinical trial was carried out in Aswan University Hospitals for one year on 50 adult patients undergoing surgeries below knee from January 2019 to December 2019. Results: There was no statistically significant difference between the two study groups regarding onset of both sensory and motor blocks, but the durations of both sensory and motor blocks were statistically significantly longer in group A than group B (P=0.001, both). In group A , all the 25 patients (100%) requested their first analgesia through the first 12 hrs postoperatively, While in group B 11 patients (44%) requested their first analgesia through the first 12 hrs postoperatively and 14 patients (56%) requested their first analgesia through the second 12 hrs postoperatively, with statistically significant difference between the 2 study groups (P=0.001). As regard total rescue analgesic dose given (Nalbuphine IV) it was statistically significantly lower in group A than in group B (P=0.001). Conclusion: Addition of dexamethasone to bupivacaine in ultrasound–guided popliteal block significantly prolonged the duration of postoperative sensory and motor block.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Specified Influence of Painful Diabetic Neuropathy on Quality of Life in Egyptian Patients with Type 2 Diabetes Mellitus1412141811444410.21608/ejhm.2020.114444ENSally Sameh Ahmed MohammedOmnia Ibrahim Metwally StateAhmed Hassan ElsebaieMohammed Ali GameilJournal Article20200922Background: There is a lack of data in discrimination of different aspects of quality of life impairment in Egyptian patients with painful diabetic neuropathy (PDN). Objective: To assess the influence of PDN on different aspects of life quality in patients with type 2 diabetes mellitus (T2D). Patients and methods: A cross-sectional study that included 125 patients with T2D (100 with PDN and 25 without) during the period from December 2018 to May 2019. All patients were subjected to history, examination with modified Neuropathy Disability Score (NDS), neuropathy symptom score (NSS), visual analogue pain score (VAS), nerve conduction study for (peroneal, sural and ulnar nerves) bilaterally and Norfolk Quality of Life QuestionnaireDiabetic Neuropathy (Norfolk QOL-DN) and lab. Other neuropathy causes were excluded. Results: PDN patients have longer duration of T2D. Norfolk QOL-DN showed a significant deterioration of the activity of daily life (ADL) and general health status in PDN patients. We found a significant positive correlation between the NSS, VAS, NDS, superficial pain sensation, and the duration of T2D with the effects on ADL and health status in the case group. In addition, there was a significant positive correlation between insulin therapy, HbA1c, electrical sensation, NSS, VAS, NDS and the duration of T2D with axonal neuropathy. The NDS was the only independent predictor of ADL and health status impairment. Axonal neuropathy was independently determined by NDS, electrical sensation and insulin therapy. Conclusion: PDN impaired the activity of daily life and health status of patients with T2D. The NDS independently could predict axonal neuropathy, ADL and health status impairment.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Results of Percutaneous Fixation of Acute Scaphoid Fractures by Herbert Screw1419142511444610.21608/ejhm.2020.114446ENMohamed Ahmed Saleh GadDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Zagazig, EgyptEl-Sayed Abd Elmoaty AL-sherbinyDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Zagazig, EgyptHossam Fathi MahmoudDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Zagazig, EgyptMohamed Ismail Abd El-Rahman KotbDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Zagazig, EgyptJournal Article20200922Background: The Scaphoid bone is the tmost commonly fractured carpal bone. Proper clinical examination and radiological imaging is essential for early diagnosis and management. The management of scaphoid fractures varies from cast immobilization to open reduction and internal fixation. This paper explores the outcome of using headless cannulated screws in minimally displaced scaphoid fractures. Objective: Aim of this study is to assess the functional and clinical outcome of using cannulated headless screws in management of acute scaphoid fractures. Methods: A prospective study held between February 2019 and January 2020, where eighteen patients included with acute scaphoid fractures of Herbert B1, B2 and B3 classification. Fixation was done using both volar and dorsal percutaneous technique. Patients were evaluated postoperatively clinically using modified Mayo wrist score (MMWS). Results: Of mean age 34.5±8.37 years, the majority were with excellent final outcome (83.3%), good (5.6%), fair one case (5.6%) and only one poor (5.6%) and mean time of union was 9.66±1.9 months. Conclusion: All active young individuals with acute non-displaced or minimally displaced scaphoid fractures should be offered percutaneous internal fixation, for the sake of earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Umbilical and Middle Cerebral Artery Doppler Indices at Late Third Trimester in the Prediction of Perinatal Outcome in Growth Restricted Fetuses1426143111444710.21608/ejhm.2020.114447ENHossam Hassan Mahmoud El KtatnyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, EgyptKhaled Mohamed Ahmed MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, EgyptMostafa Amman Ahmed MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, EgyptJournal Article20200922Background: Intrauterine growth restriction (IUGR) is implied to those fetuses who do not achieve their genetically determined potential size. IUGR being a major complication of pregnancy may result in significant morbidity and mortality. Objective: To evaluate the potential value of (CPR) measured at 34-37 weeks’ gestation in predicting the perinatal outcome of pregnancies with FGR. Patients and Methods: A prospective observational study was conducted in Al-Helal Health Insurance Hospital from October 2018 to September 2019. The target population for this study were pregnant females with gestational age between 34- 37 weeks and with biometrically suspected intrauterine growth-restricted fetuses attending the hospital for antenatal care, and are fulfilling the inclusion and exclusion criteria. Doppler ultrasound evaluation of Umbilical and Middle cerebral arteries was performed and CPR was calculated. At 34-37 weeks’ gestation. Patients characteristics, intrapartum, and neonatal outcomes were recorded. The main outcomes required urgent Cesarean section (CS) due to intrapartum fetal compromise (IFC), 5-minute Apgar score below 7, neonatal death, and admission at neonatal intensive care unit (NICU). Results: A total of 40 women participated in this study with an unfavorable outcome in 20% of newborns. Abnormal CRP was present in 11 cases and was associated with a higher risk of adverse outcomes in terms of the need for urgent CS, lower fetal weight, 5-minute Apgar score under 7, and neonatal death and NICU admission > 10 days., and the diagnostic accuracy of CRP was superior to either umbilical artery pulsitivity index (UA-PI) or middle cerebral artery pulsitivity index (MCA-PI) alone. Conclusion: CPR was more effective, with higher specificity and diagnostic accuracy, in predicting perinatal outcomes compared with the individual Doppler parameters of MCA and UA.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Effect of Modified Ultrafiltration on Acute Kidney Injury Biomarkers and Clinical Outcome in Adult Patients Undergoing Valvular Heart Surgery1432143711444810.21608/ejhm.2020.114448ENHani Mohammed Ahmed RaslanAhmed Al-Saied Abdul RahmanHuda Fahmy MahmoudJournal Article20200922Background: Cardiac surgery associated with acute kidney injury (CSA-AKI) is a common and serious postoperative complication of cardiac surgery requiring cardiopulmonary bypass (CPB). CSA-AKI varies between 7% and 40% in large cohorts undergoing a variety of cardiac surgical procedures and is associated independently with increased morbidity and mortality. Objective: Our study aimed to investigate the effect of using modified ultrafiltration on acute kidney injury by using the levels of AKI biomarkers (serum creatinine and NGAL) in adult patients with no previous chronic renal disease undergoing valvular heart surgery using cardiopulmonary bypass. Patients and Methods: This prospective observational study was conducted at the cardiothoracic surgery unit, Kasr AL-Ainy hospital from February 2017 to July 2017 on 40 patients who underwent valve replacement surgery using cardiopulmonary bypass. The patients were randomly allocated into two groups: Group 1: Non-MUF group. Group 2: MUF group. Results: Regarding serum creatinine, the preoperative and 2h postoperative levels were not statistically different between the two studied groups (P>0.05), while in the non-MUF group, there was a significant increase (P<0.001) in the 2h. post-operative creatinine level compared with the pre-operative level. In the MUF group, there was no significant difference (P>0.05) between AKI and non-AKI patients in preoperative levels while the postoperative creatinine levels were significantly higher (P<0.04) in AKI than non-AKI patients. Conclusion: AKI after cardiac surgery is independently associated with a significant increase in morbidity, mortality, and health-care costs. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Subclinical Enthesitis in Rheumatoid Arthritis Patients and its Relation to Disease Parameters and Disease Activity1438144311445010.21608/ejhm.2020.114450ENMohamed Ismail Mohamed AbdelKareemDepartment of Rheumatology, Physical Medicine & Rehabilitation,
Faculty of Medicine - Al-Azhar University (Assiut)Tarek Mohamed AbdelAzizDepartment of Rheumatology, Physical Medicine & Rehabilitation,
Faculty of Medicine - Al-Azhar University (Assiut)Asmaa Abd ELraheem BoraiDepartment of Rheumatology, Physical Medicine & Rehabilitation,
Faculty of Medicine - Al-Azhar University (Assiut)Journal Article20200922Background: Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disorder of unknown etiology characterized by symmetrical joint synovitis and pain. RA has a wide clinical spectrum and may vary from mild nonerosive disease to severe inflammation and joint damage with extra articular manifestations. To detect enthesopathy, the European League Against Rheumatism (EULAR) recommends magnetic resonance imaging (MRI) or ultrasonography (US). Objective: To detect subclinical enthesitis in rheumatoid arthritis patients and its relation to disease parameters and disease activity. Patients and Methods: This prospective observational study included 50 adult patients diagnosed as rheumatoid arthritis according to the 2010 ACR-EULAR classification criteria for rheumatoid arthritis. The study was carried out in the Musculoskeletal Ultrasonography Unit of the Rheumatology, Physical Medicine and Rehabilitation Department, Al-Azhar University Hospitals Assiut. Results: We found that the mean age in case group was 46.3 ± 8.4 years. Females accounted for 62% (31 patients) of all patients. The disease duration ranged from one year to 15 years with a mean of 6.2 ± 1.9 years. The BMI was 19.5 ± 42 kg/m2 . Mean of disease activity evaluated by the disease activity score in 28 joints was 4.7 ± 1.5. Our findings demonstrated that prevalence of subclinical enthesitis in patients with rheumatoid arthritis was 32%. There was a statistically significant relation between 28-joint Disease Activity Score (DAS28) score and ultrasound detected enthesitis (p. value < 0.05). Conclusion: BMI, old age and long disease duration were suggested as the risk factors for subclinical enthesitis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Prevalence of Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites and Its Pattern in Aswan University Hospital1444144811445210.21608/ejhm.2020.114452ENMohammed Zain-Eldeen HafezDepartment of Internal Medicine, Faculty of Medicine, Assiut UniversityHala Abdallah Mahmoud AbdallahDepartment of Internal Medicine, Faculty of Medicine, Aswan UniversityKhalid Khairy Khalafalla AbdellatifDepartment of Internal Medicine, Faculty of Medicine, Aswan UniversityJournal Article20200922Background: Spontaneous bacterial peritonitis (SBP) is the most common infection and a lethal complication in patients with liver cirrhosis and ascites. It has high mortality and recurrence rates and poor long-term prognosis. Objective: This study was done to determine the prevalence of spontaneous bacterial peritonitis and its variants in patients of liver cirrhosis with ascites. Patients and Methods: This was a prospective, randomized, cross-sectional clinical study, included 100 adult patients of decompensated liver cirrhosis with ascites in Aswan University Hospital during the period from January 2019 to December 2019. Results: Diagnosis of SBP is based on ascitic fluid analysis as well as culture and sensitivity. The diagnostic criteria are PMNL > 250/mm³ and or positive culture. Mean of age of patients was 63.06 ± 9.67 years old. Majority of patients were males (63%) and 37 % were females. In Our study, 62% of patients were diagnosed SBP. Classic SBP in 30.6%, Culture Negative Neutrocytic Ascites (CNNA) in 59.7% and MNB in 9.7% of patients. Of 25 patients who have positive culture ascetic fluid, 60% were positive for gram-negative bacteria predominantly E. coli. Conclusion: Spontaneous Bacteria Peritonitis is the most common and life-threatening infection in patients who have liver cirrhosis and ascites. It is diagnosed by a) Ascitic fluid PMNL > 250/mm³. b) Positive ascetic fluid culture. c) Both a and b. It is found that SBP has recently increased in prevalence with predominantly causative organism gram negative E Coli.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Evaluation of Various Risk Factors in Neonatal Sepsis1449145611445310.21608/ejhm.2020.114453ENAmira Mohammed Mohammed HamedDepartment of Pediatrics, Faculty of Medicine-Al-Azhar University AssiutMohamed Fahmey IbrahimDepartment of Pediatrics, Faculty of Medicine-Al-Azhar University AssiutMaha Ali Abdel-AlimDepartment of Pediatrics, Faculty of Medicine-Al-Azhar University AssiutJournal Article20200922Background: Neonatal sepsis (NS) is a clinical syndrome characterized by signs and symptoms of infection in neonatal period of life. It covers various systemic infections of newborn such as septicemia, meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infections (UTIs). Objective: This study aims to evaluate the risk factors of neonatal sepsis and early detection of neonatal sepsis with easily accessible, inexpensive, and widely used laboratory tests. Patients and methods: This cross section study was conducted during a period of 6 months, on cases admitted to Atfal Misr Neonatal Intensive Care Unit (NICU) on 80 newborns who were divided into 3 groups: group A (n = 22): proven NS, group B (n = 18): clinical NS and Group C (n = 40): apparently healthy control. Results: In current study, there was significant positive correlation between MPV with age (r= 0.22 and p= 0.04), WBC (r= 0.66 and p= 0.0001) and CRP (r= 0.77 and p= 0.0001). On the other hand, there was significant negative correlation between MPV with HB (r= -0.74 and p=0.0001), platelet (r= -0.62 and p=0.0001) and uric acid (r= -0.37 and p= 0.001). In current study, there was significant positive correlation between uric acid with HB (r= 0.31 and p= 0.005), and platelet (r= 0.46 and p= 0.0001). On the other hand, there was significant negative correlation between uric acid with age (r=-0.11 and p=0.3), WBC (r= -0.42 and p=0.0001) and CRP (r= -0.42 and p= 0.0001). Conclusion: The presence of the particular set of risk factors can help in deciding the empirical antibiotic and thereby prevent delay in starting appropriate treatment. The combined use of CRP and MPV should be considered in the early diagnosis of NS; however uric acid levels may only be utilized as an additional tool to support diagnosis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Factors Affecting Glycemic Control in Type II Diabetic Patients1457146111445410.21608/ejhm.2020.114454ENMarwa Salah El-Dien Abd-ElraoufPublic Health Department, Faculty of Medicine, Benha University, Benha, EgyptJournal Article20200922Background: Diabetes is a major public health problem that affects morbidity, fatality and health care resources. Many factors can influence diabetic control. Diabetic control remains the main goal in management of diabetes mellitus and the major therapeutic target for prevention of complications due to diabetes Objective: Is to assess factors affecting glycemic control among type 2 diabetic patients. Patients and Method: a cross sectional study was conducted on 200 diabetics at the Internal Medicine Department, Benha University hospital. A case record form was used including sociodemographic features, anthropometric measurements and metabolic disease profile. Results: Participants were classified according to their glycosylated hemoglobin level into good (7%) and poor (93%) diabetic control. There was a statistically significant association between diabetic control and diabetes duration (p < 0.001), exercise (p = 0.001) (OR (95% CI): 5.59 (1.77-17.62)), body mass index (p < 0.001). There was a statistically significant difference between those with poor and good diabetic control as regard LDL level (OR (95%CI): 50 (6.41-333.3)) (p < 0.001), total cholesterol level (p < 0.001), (median (range): (237 (178-320) and 100 (100-300)) respectively and the mean value of fasting blood sugar ((mean ± SD): 298.52± 55.97 and 170±37.41 respectively, p < 0.001)). Conclusions: Majority of participants had poor diabetic control. Diabetes duration, regular exercise, BMI, LDL and total cholesterol levels significantly affected glycemic controlPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001A Clinico-Epidemiological Study of Pediatric Hair and Scalp Disorders1462146911445510.21608/ejhm.2020.114455ENMohammed M.S. YounisWaleed Ahmed MahmoudJournal Article20200922Background: Hair and scalp disorders are a common complaint in dermatology clinics and can be caused by several conditions, reflected in a specific diagnosis. Also, this problem is of prime concern in the pediatric population as it is associated with more significant psychological consequences in this growing age group. Objective: To evaluate the clinical and epidemiological profile of hair and scalp disorders in children attending to the Pediatrics and Dermatology Outpatient Clinics. Patients and methods: The current study included 1000 children attending the outpatient pediatric and Dermatology clinics in Alazher University Assiut within the period from June 2019 to April 2020, from them 200 children were diagnosed with hair disorder. All children were subjected to; thorough history taking, general and local examination, and dermoscopic examination. Results: In the present study we noticed that; male to female ratio was 0.8:1. The age groups with the largest and smallest numbers of children were those of children aged 10-12 and 1-3 years, respectively. Alopecia areata represented 15% of the studied patients. 10% of the included patients had seborrheic dermatitis. Pediculosis capitis was evident in 14% of the studied population. Tinea capitis was evident in 15% of the study population. Infectious causes were the most common causes of hair disorders in our study. Alopecia areata represented 15% of the studied patients.there is a significant difference value in tinea capitis and pediculosis capitis in urban than rural areas and there is a significant difference value in seborrheic dermatitis and alopecia areata in rural than urban areas. In the current study, malnutrition was evident in 30% of children with scalp diseases. Conclusion: Hair and scalp disorder in children is a common complaint in pediatrics clinics, and it is considered a challenge for pediatricians for reaching a proper diagnosis and therapy. Early management is needed, as it affects the normal physical and mental growth of children.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Epidemiological and Clinical Characteristics of Children Suffering from Inflammatory Bowel Diseases Attending Zagazig University Children Hospital1470147511445610.21608/ejhm.2020.114456ENHatem Mohammed HusseinDepartment of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, EgyptHossam Fathi ElsaadanyDepartment of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, EgyptEman Nabil Ebrahim Zein ElabedeenDepartment of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, EgyptJournal Article20200922Background: Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD). It is a chronic inflammatory disease that involves the gastrointestinal tract and results from a combination of genetic susceptibility, environmental exposure, and dysregulated responses to the intestinal microbiota. Objective: To study the natural history, patterns, and clinical characteristics of inflammatory bowel diseases (IBD) in Sharkia Governorate. Patients and Methods: The study was carried out in the Pediatric Hepatology and Gastroenterology Unit, at Zagazig University Hospital on a comprehensive sample of all children suffering from inflammatory bowel diseases that were included in the study (18 patients). We do retrospectively study all patients in whom the diagnosis of UC or CD was confirmed by clinical, laboratory, endoscopic, and histological examination in Zagazig university children hospital. Results: There is a predominance of UC among IBD cases. positive consanguinity was more evident in children with IBD (44.4%). According to sex the percentage of females (55.6%), male (44.4%). Percentage chance of gastrointestinal symptoms among the studied cases is diarrhea (83.3 %), mucus or blood in the stool (83.3%), Abdominal pain (66.7%), vomiting (44.4%), loss of appetite (38.9%), Nausea (38.9 %), Rectal bleeding (27.8%) and anoperineal lesion (22.2%). The Endoscopic finding of Crohn's disease showed a percentage of L1 (distal 1/3 ileum ± limited cecal disease) in (33.3 %) and L2 (Colonic) in (66.7%). Conclusion: UC was more common than the CD. IBD was more common in females. We believe that the present moment is critical in assessing the pattern of IBD spreading in Egypt, and the current status should be further studied by more exhaustive database and registry documentation of IBD patients and their characteristics.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Impact of modified ultrafiltration on Cardiac Surgery-Associated Acute Kidney Injury1476148211446510.21608/ejhm.2020.114465ENHani Mohammed Ahmed RaslanAhmed Al-saied Abdul RahmanHuda Fahmy MahmoudJournal Article20200922Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent happening affecting nearly 40% of the cases undergoing cardiac surgery. This is associated with increased hospital length of stay and mortality. Objective: The aim of our study was to investigate the relationship impact of modified ultrafiltration on cardiac surgery-associated acute kidney injury (CSA-AKI). Patients and Methods: This prospective observational study was conducted over a 6-month period (February to July 2017) at Cardiothoracic Surgery Unit, Kasr AL-Ainy Hospitals. The study included 40 patients undergoing routine valve replacement surgery using cardiopulmonary bypass. Results: There was no significant difference (P > 0.05) between AKI and non-AKI patients in pre-operative levels while the postoperative serum creatinine levels were significantly higher (P < 0.04) in AKI than non-AKI patients in the modified ultrafiltration (MUF) group. The pre-operative and 2h post-operative S. NGAL was significantly higher in AKI than non-AKI patients in the MUF group were. Duration of CPB was significantly (P < 0.001) prolonged in the AKI than the non-AKI patients. While, there was no significant difference regarding aortic crossclamp time. There was a significant longer ICU stay and duration of mechanical ventilation in AKI than non-AKI patients. Conclusion: Modified ultrafiltration after cardiac surgery is associated with a lower prevalence of morbidity and mortality. Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) can be used as an early plasma biomarker predictor for AKI in patients undergoing heart surgeryPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Relation of Uridine Diphosphate Glucuronosyltransferase 1A1 Promoter Gene Polymorphism (211G>A) With Risk of Hyperbilirubinemia in Neonates1483148811446710.21608/ejhm.2020.114467ENLotfy Mohamed ElsayedLaila Rasslan Abd El-AzizAmal Fawzy Abdel-MageedMohamed Mohamed YoussefJournal Article20200922Background: The gene 211G>A variants, that underlie complex disorders, are characteristically common in the neonatal hyperbilirubinemia. However, it is the contribution of multiple different co-expressed susceptibility genes that individually confer a small increase in risk coupled with environmental factors that generate complex disorder phenotypes. Objective: This study aimed to understand the relation of 211G>A promoter polymorphism in UGT1A1 gene and the risk of hyperbilirubinemia in newborns. Patients and Methods: The study included 50 newborns with hyperbilirubinemia with gestation age of ≥ 37weeks and postnatal age of ≤ 2 weeks with normal birth weight. 34 were males and 16 were females. They were divided into two groups; case group consisting of 30 neonates with the peak of total serum bilirubin (TSB) levels ≥ 16 mg /dl and control group consisting of 20 neonates with the peak total serum bilirubin (TSB) levels <12 mg/dl. Variation status of UGT1A1 genes in our study was determined by direct sequencing or genotype assays. Results: This study showed that UGT1A1 promoter gene polymorphism 211G>A genotype can be used as a novel method to detect susceptibility to indirect hyperbilirubinemia in neonates. Conclusion: Our findings added to the understanding of the significance of UGT1A1 in association with neonatal hyperbilirubinemia in East Delta of Egyptian population. Additionally we are in need for other studies to investigate the protective mechanisms. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Correlation Between Helicobacter Pylori Infection and Iron Deficiency Anemia in School-Aged Children1489149811531110.21608/ejhm.2020.115311ENMostafa Abd El-Azeem HassanDepartment of Pediatrics and Neonatology, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, EgyptIsmael Abd El-Razek KasemDepartment of Pediatrics and Neonatology, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, EgyptAhmed Salah Mohammed AliDepartment of Pediatrics and Neonatology, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, EgyptJournal Article20200926Background: Iron deficiency anemia (IDA) is recognized as a common nutritional problem in infants and young children in developing countries mainly due to poor nutrition in most cases. Objective: To evaluate the association between H. pylori infection and iron deficiency anemia in school-aged children. Patients and Methods: This study was conducted on 60 participants divided into two groups. Group I: formed of 30 patients suffering from iron deficiency anemia with hemoglobin (Hb) less than l1g/dL. Group II: formed of 30 healthy children (control Group) Results: In the current study we found that there was a significant decrease in weight and BMI among cases group p-value <0.001. In the current study, we found that there was a significant decrease in all CBC parameters among cases versus control. In the current study we found that there were significant differences between the two groups regarding nutritional status as in cases there was a higher percentage of low iron sources in the diet, there was a significant decrease in serum iron, ferritin, and TIBC in cases versus control. In the current study, we found that there was a significant increase in the number of positive samples for H pylori antigen in stool among cases versus control 63.3% versus 23.3% p-value 0.002. Conclusion: The results of this study demonstrate a significant association between children with iron deficiency anemia and positive H. pylori infection in school-age children. Moreover, H. pylori infection may be one of the significant causes of iron deficiency anemia.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Correlation between Uric Acid and Thyroid Hormones in Patients with Thyroid Disorders. A Case Control Study1499150511531210.21608/ejhm.2020.115312ENMona Youssry HelmyDepartment of Internal Medicine, Faculty of Medicine, Cairo University, Egypt0000-0002-0251-8466Journal Article20200926Background: Thyroid disease influences the purine metabolism, which may increase serum uric acid (UA) level. Previous studies showed a high incidence of hyperuricemia in patients with thyroid disorders but with low thyroid stimulating hormone (TSH)-to-serum uric acid association. Objective: Aim of this work was to investigate the serum uric acid relationship to thyroid hormones in patients with primary thyroid disorder. Subjects and Methods: This case-control study included a total of 105 patients, 35 healthy participants as a control group and 70 patients with primary thyroid disorders, attending at the Endocrinology Outpatient Clinic, Kasr El Ainy, Cairo University. The included subjects were divided into three groups; (Group I) consisted of 35 patients with primary hypothyroidism, (Group II) consisted of 35 patients with primary hyperthyroidism and (group III) consisted of 35 subjects representing the control group. Waist circumference and the BMI have been calculated. TSH, free T4 (FT4; thyroxine) and free T3 (FT3; triiodothyronine), fasting lipids, creatinine, urea, eGFR and uric acid were evaluated. Results: On comparing the three studied groups a statistical significant difference in UA level was found (p < 0.05), being highest in group I followed by group II then group III (6.59± 1.32mg/ dl, 6.38± 0.88mg/ dl and 5.48± 0.47mg/ dl respectively). Among hyperthyroid patients, there was a statistical negative significant correlation between UA and TSH (r -0.733-) and a positive significant correlation between Uric acid and FT3 (r 0.541) and FT4 (r 0.482). Conclusion: A significant negative correlation between uric acid and TSH and significant positive correlation between it and FT3 and FT4 among hyperthyroid patients were found. Focusing more on the possible correlation of uric acid and primary thyroid diseases. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Evaluation of Role of Ambroxol in Treatment of Bronchiolitis1506151111531710.21608/ejhm.2020.115317ENAhmed Tawfik Mohammed MohammedDepartment of Pediatrics and Neonatology, Faculty of Medicine (Assiut), Al-Azhar University, EgyptMostafa Abd Elazeem HassanDepartment of Pediatrics and Neonatology, Faculty of Medicine (Assiut), Al-Azhar University, EgyptMohammed M. S. YounisDepartment of Pediatrics and Neonatology, Faculty of Medicine (Assiut), Al-Azhar University, EgyptJournal Article20200926Background: Bronchiolitis is the most common reason for hospital admission in infants, accounting for 20% of hospitalization at < 1 year of age. The recently discovered human meta pneumo-virus and other viruses like adenovirus, parainfluenza virus type-3, influenza virus and rhinovirus also cause bronchiolitis that is indistinguishable from respiratory syncytial virus (RSV) disease. It is more common in males, those who are not breast fed and living in crowded conditions. Objective: The aim of the work was to assess role of Ambroxol inhalation in treatment of Bronchiolitis. Patients and Methods: This randomized controlled clinical trial included a total of included 40 children with bronchiolitis, attending at Department of Pediatrics, Sohag General Hospital. They were randomly divided into two groups, the control group consisted of 20 cases who were given bronchodilators, inhaled or systemic steroids, antibiotics if needed, or supportive measures and oxygen supplementation if needed. The intervention group consisted of 20 cases who were treated with Ambroxol inhalation in addition to supportive measures mentioned above. Results: There was insignificant differences between two groups regarding the need of oxygen and duration of oxygen therapy (p-value 0.337, 0.536 respectively). In the current study, we found that there was insignificant differences between two groups regarding degree of RD on admission but after treatment there was significant improvement in interventional group with p-value <0.001. In the current study, we found that there was significant difference between two groups regarding length of hospital stay as in interventional group was lower than control (p-value 0.002). Conclusion: It could be concluded that Ambroxol gives a good improvement in cases with bronchiolitis and decreases hospital stay. Furthermore, Ambroxol is safe, cheap and easy to administer.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Quality of Health Medical Services at Pediatric Cardiology Unit, Zagazig University Inpatient1512151911532110.21608/ejhm.2020.115321ENNorhan Ahmed Elsayed ElewaDepartments of Pediatrics - Faculty of Medicine, Zagazig UniversityAmr Megahed Abu ElNagaDepartments of Pediatrics - Faculty of Medicine, Zagazig UniversityAhmed AbdElSamad ElhewalaDepartments of Pediatrics - Faculty of Medicine, Zagazig UniversityMona Hamed Ibrahim MohamedDepartmentsof Community, Environmental and
Occupational Medicine - Faculty of Medicine, Zagazig UniversityJournal Article20200926Background: Patients’ satisfaction represents an important indicator for the quality of health care delivery, and it is a widely accepted factor, which needs to be studied repeatedly for better functioning of health care systems. Patient is the best judge for the quality of health care so the factors affecting patients’ satisfaction must be taken in consideration. Objective: The aim of this study was improvement of quality of the health care services provided to children in Pediatric Zagazig University Hospital. Patients and methods: This study was a cross sectional study that was held a sample of Cardiology Unit at Pediatric Department of Zagazig University Hospitals. It was carried out during the period from July 2018 to April 2019 on a total sample of 106 patients attending Zagazig University Hospital Cardiology Unit at Pediatric Department. Results: Among 106 participants 100% were females, 70.8% were secondary educated, 73.5% were non-workers, 55.7% were of low social class, 69.8% were from rural resident and 76.4% had not enough income with mean age of 24.48 ± 4.5 years. It was concluded that most of the studied patients (89.6%) were satisfied about the studied cardiology unit at pediatric department. It was found that patient satisfaction is affected by sociodemographic factors as age, sex, occupation, education, and social class. In addition, it was affected by satisfaction about environment, facilities, treatment, doctors, nurses, administrative personnel and information given for them. Conclusion: It was concluded that most of the studied patients are loyal to Zagazig University Hospital, as they will definitely intend to reuse and recommend Zagazig University Hospital Outpatient Clinics to others. Patient loyalty was found to be significantly affected by level of their satisfaction where satisfied patients tend to re-use and recommend the hospital Cardiology Unit at Pediatric Department more than dissatisfied ones.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Cumulative Radiation Exposure from Diagnostic Imaging in Zagazig University Pediatric Intensive Care and Chest Units1520152411556610.21608/ejhm.2020.115566ENTarek Abd El-Rahman AtiyyahMohammed Sanad Naguib NasrTalaat Salahdin AhmedMarwa Mohamed Sabri Abdelmonem MostafaJournal Article20200927<span>Background: </span><span>The medical use of ionizing radiation has expanded worldwide. The use of radiation in pediatric imaging (e.g. radiographs and computed tomography) saves lives and has a great clinical value for the diagnosis of pediatric illness and injury. However, inappropriate or unskilled use of such technologies may result in unnecessary exposure that may increase risk of malignancy occurrence.<br /> </span><span>Objective: </span><span>To detect the effect of multi exposure and its application on reaching to risk threshold of radiation through quantification of the cumulative effective dose (CED) of ionizing radiation attributable to diagnostic imaging in Pediatric Intensive Care Unit (PICU) and Chest Unit, Zagazig University Hospitals. Also, to examine the patterns of use of diagnostic X-ray imaging in these units.<br /> </span><span>Patients and Methods: </span><span>This study was conducted in Pediatric ICU and Chest Unit at Zagazig University Hospital from October 2018 to March 2019. 72 cases were included. Selected cases were observed and followed up in each time they were asked to perform x-ray radiography or CT film during their whole stay period in the hospital. </span><span>Results: </span><span>The median of x-ray + ct group was 3 7.9 msv in our study. Also, in our study, there was dose variation among units. The median of exposure of patients of Chest Unit was 6.51. While the median of patients of ICU was 1.9. Dose of CT in our study formed 53.8%. Our study revealed that CT chest equaled about 30 chest X-ray in our hospital. 74% of patients had very low and low risks.<br /> </span><span>Conclusion: </span><span>Cumulative exposure dose (CED) of ionizing radiation due to frequent X-ray films and CT scans in our </span><span>study aren’t likely to cause acute toxicity as they were relatively low but they may cause chronic toxicity and increases </span><span>the long-term risk for developing malignancy.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Clinical Evaluation of Hypothalamo-Pituitary-Thyroid Axis Hormones in Critically Ill Children. Cross Sectional Study at Zagazig University Children Hospital1525153011557410.21608/ejhm.2020.115574ENMohamed Nageeb Abo ElfottohHossam Mostafa KamalAhmed Mohamed Gab-allahEman El-Sayed AliJournal Article20200927<span>Background: </span><span>Critical illness is the medical condition in which a patient requires immediate intensive medical support of vital organ functions in order to survive. Independent of the underlying condition, critical illness is characterized by a uniform dysregulation of the hypothalamic</span><span>–</span><span>pituitary</span><span>–</span><span>peripheral axes. In the majority of these axes a clear biphasic pattern can be distinguished</span><span>.<br /> Objective: </span><span>To evaluate serum concentration of adrenocorticotrophin hormone, cortisol, TSH, free T4 in children who had severe illness in Pediatric Intensive Care Unit at Zagazig University Hospitals and El-Ahrar Hospital in Pediatric Intensive Care Unit.<br /> </span><span>Patients and Methods: </span><span>This study was cross sectional study which conducted at Zagazig University Hospitals and El-Ahrar Hospital in Pediatric Intensive Care Unit on 30 critically ill children. These investigations were measured for all participating patients (serum level of TSH, free T4, adrenocorticotrophin hormone and cortisol).<br /> </span><span>Results: </span><span>This study was conducted on 30 critically ill children. Mean±SD of age was 12.9±18.0 years. 53% were males. Serum cortisol level was high in about 43% of our critically ill children patients. Serum concentration of adrenocorticotrophin hormone was lower in about 90% in children who had severe illness in pediatric intensive care unit. Serum concentration of TSH was high in about 23% of our critically ill children patients. Serum concentration of free T4 in children was high in about 20% while was lower in 6.7% of our critically ill children patients. Secondary thyroid insufficiency represented 7% (2/30 cases).<br /> </span><span>Conclusion: </span><span>Secondary thyroid insufficiency represented in 7% of our critically ill children patients. No statistically significant differences in baseline characteristics of the studied critically ill children (stratified according to cortisol level). No statistically significant differences in ACTH, TSH and free T4 levels of the studied critically ill children (stratified according to cortisol level).<br /></span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281220201001Comparison between Levobupivacaine Alone and Levobupivacaine with Fentanyl in Extending the Duration and Postoperative Analgesia of Supraclavicular Brachial Plexus Block for Elective Upper Limb Orthopedic Surgeries1531153711557510.21608/ejhm.2020.115575ENHala MahmoudDepartment of Anesthesia and I.C.U and Pain Management, Faculty of Medicine, Sohag University, EgyptFawzy AbbasDepartment of Anesthesia and I.C.U and Pain Management, Faculty of Medicine, Sohag University, EgyptMahmoud Gamal El-Din YoussefDepartment of Anesthesia and I.C.U and Pain Management, Faculty of Medicine, Sohag University, EgyptGhada AbdelgaberDepartment of Anesthesia and I.C.U and Pain Management, Faculty of Medicine, Sohag University, EgyptJournal Article20200927<span>Background: </span><span>Brachial plexus Block is widely utilized nowadays in high risk patients with high safety margins providing hemodynamic stability and optimal muscle relaxation.<br /> </span><span>Objectives: </span><span>The aim of the work was to evaluate the efficacy of fentanyl as an adjuvant on hemodynamic stability, onset and duration of the block and postoperative analgesia.<br /> </span><span>Patients and methods: </span><span>This study included a total of subjected for upper limb </span><br /> <br /> <br /> <br /> <br /> <span>double blinded randomized </span><br /> <br /> <br /> <br /> <br /> <span>100 patients </span><br /> <br /> <br /> <br /> <br /> <span>orthopedic surgeries using<br /> </span><span>Hospital. </span><span>Patients were divided randomly into two groups, group L (control group) and group LF (study group). Regular hemodynamics monitoring were done.<br /> </span><span>Results: </span><span>there was no significant difference between both groups as regard hemodynamics, although there was significant faster onset of the block and prolongation of its duration in group LF. Also, the VRS pain score was significantly lower in the postoperative period in group LF and less analgesic requirement.<br /> </span><span>Conclusion: </span><span>It could be concluded that using fentanyl as an adjuvant to levobupivacaine is effective in enhancing the onset of the brachial plexus block and prolonging the duration of motor and sensory blocks with no hemodynamic changes. It effectively prolongs postoperative analgesia and lowers the analgesic requirements. </span>