Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001The Effectiveness of Tracheal Decannulation Criteria: A Prospective Study1722172511999910.21608/ejhm.2020.119999ENYasmin AljedaaniMajed AlMourgiFahad AlshehriMohamed HatemJournal Article20201021Background: Long-term insertion of the tracheostomy tube may lead patients to have complications such as tracheal stenosis, leakage, sepsis or aspiration. Aim of the work: Our study aimed at applying standards for decannulation of the tracheostomy tube depending on the expertise from prior studies. Methods: The study included 102 patients who underwent tracheostomy during the study period. Results: Surgical tracheostomy was done in operating room in 67% of patients and in intensive care unit by percutaneous dilatational technique in 33% of patients. Decannulation was successful in 97.7% of patients and discharged from the hospital within 24-48 hours. Decannulation failed in 2.3% of patients. Conclusion: The decision to perform elective decannulation of the tracheostomy tube can be challenging. However, we have demonstrated that decannulation based on objective criteria is effective in improving clinical judgment and weaning safety, with a low failure rate. We did not encounter any mortality or significant adverse events.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Growth Disorders in Children with Type 1 Diabetes in Aswan, Egypt1726173112000010.21608/ejhm.2020.120000ENMagda Farghali GabriTreza Saad AbdshaheedEdrees Hasan ZakiIslam Fathy ElNakeebHanan Mohammed AlyJournal Article20201021Background: Type 1 diabetes mellitus is the most common chronic metabolic disorder in children. Diabetic children who take proper nutrition and good care attain normal growth status. One sign of poorly controlled diabetes is poor growth. Objective: This study was conducted to assess the growth parameters (weight, height, and body mass index) in diabetic children and to study the impact of age at diagnosis, duration of the disease, and disease control on the growth parameters. Patients and Methods: This is a cross-sectional study that carried out on diabetic children aged from 6 to 18 years old in 8 months period. History, examination with stress on anthropometric measurement (weight, height, and body mass index) together with HbA1c level was done. Results: Mean HbA1c was (10.85 ± 2.299) %. Patients with HbA1c of more than 9% were 75.5%. There was an insignificant negative correlation between HbA1c and age and disease duration and a significant negative correlation between HbA1c and tanner staging, but there was no relation between HbA1c and sex or family history. There was a significant negative correlation between HbA1c and weight, HbA1c, and body mass index, while there was an insignificant negative correlation between HbA1c and height. There was an insignificant correlation of weight to disease duration, while there was a significant positive correlation of height to disease duration. Conclusion: in this study, most of our patients were uncontrolled diabetic patients. Weight, height, and BMI were less in uncontrolled patients than controlled patients.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Parathyroid Hormone Profile In Sickle Cell Disease In School Aged Children1732173512000210.21608/ejhm.2020.120002ENHosny Mohamed Ahmed El-MasryMostafa Abd-Elazeem HassanAlaa Mohamed HashemAbdullah Arafa ShabanJournal Article20201021Background: Sickle cell disease (SCD) is group of hemoglobinopathies associated with hemolytic anemia and vasoocclusive complications. All forms of SCD are inherited in an autosomal recessive fashion. Parathyroid hormone plays an essential role in calcium and phosphorus homeostasis, which is achieved by its action on target organs (intestine, bone and kidney), leading to normal bone formation and mineralization and normal physiological concentration of calcium and phosphorus. Objectives: This study aimed to detect the effect of sickle cell disease on parathyroid hormone and consequently on serum calcium (S.Ca), phosphorus (ph), alkaline phosphatase (alk.Ph) and magnesium (Mg) on patients with sickle cell anemia. Subjects and Methods: Forty children known as sickle cell disease patients, twenty of them were SCD (HbSS) (11 males and 9 females). The other twenty were known SC trait (10 males and 10 females). The ages of the children ranged from 5 to 15 years old. All were in non-crises state in routine Outpatient Clinic visits, compared to twenty apparently healthy, age matched and with normal hemoglobin from Atfal Masr Hospital as control. Neither patients nor control received calcium supplementation before the study. Results: The results indicated that sickle cell patients and sickle cell trait patients had hypocalcaemic tendency associated with supernormal parathyroid hormone level and implied impaired calcium absorption from intestine leading to disturbed calcium metabolism, which might contribute in skeletal changes seen in sickle cell patients. Conclusion: We found that there was statistically significant decrease in serum Ca levels accompanied with increase in serum PTH, ph, alk Ph and Mg levels in SCD and Sickle cell trait patients compared to control group.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Current Situation of Rhinogenic Headache in-between Sohag University Students1736174112000310.21608/ejhm.2020.120003ENYousry Othman Abdel-RahmanEslam M. AliTasneem Mohammed BakheetMahmoud M. ElbahrawyJournal Article20201021Background: Headache is a symptom of pain anywhere in the region of the head or neck, and it can occur as a result of many conditions whether serious or not. Objective: To detect the rhinogenic headache cases among Sohag University students and to determine their characteristics. Patients and methods: Over a period from Oct 2017 to May 2019, 104 patients were complaining of rhinogenic headache and diagnosed by CT scanning. Data obtained using a structured questionnaire. Results: Most of the population enrolled in the study (59.6 %) were females, mostly in the first grade (46.2 %), inhabiting rural and/or slum areas of Sohag (69.2 %). Smoking habit associated with all pneumatization cases and 16.7 % of DNS were male cases. Frontal site of headache predominated, then the nasal\glabellar site. These followed by periorbital, tempro-parietal, temporal and scalp regions respectively in 32.7, 25, 17.3, 11.5, 7.7 and 5.8 % of the rhinogenic cases. Compressing and dullness types are predominated in cases of rhinogenic headache without abnormalities in about 55 %. The associated symptoms with rhinogenic headache cases included malaise, allergic nasal symptoms like running nose and red eyes, sneezing, nasal itching and bleeding. Congestion and occlusion affected larger percent (55.8 %), followed by running nose (40.4 %) and postnasal discharge (46.2 %). Diminished sense of smell to a lesser extent of rhinogenic headache cases. In addition, sore throat, bad mouth odor and chronic cough had been reported in some cases. Conclusion: Understanding the preoperative CT scan is substantially important because it is the road map for the sinus surgeon.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Evaluation of Vitamin D in Preterm Neonates and Effects of its Supplementation in Preterm Neonates with Respiratory Distress Syndrome1742174912000410.21608/ejhm.2020.120004ENAmira Mohammed Mohammed HamedMona Mohamed AbdelmeguidAhmed Haggag IsmailAya Eissa Ahmed OthmanJournal Article20201021Background: Prematurity and related problems, especially respiratory distress syndrome, are one of the main challenges for neonatal medicine. Many studies have shown the relationship between lung development and vitamin D. Objective: To investigate Vitamin D status and to evaluate the effect of vitamin D supplement as adjuvant therapy in the management of respiratory distress syndrome (RDS) in preterm infants. Patients and Methods: This study included 90 preterm neonates chosen from those at NICU of Minya General Hospital and Al-Azhar University, Assiut, Egypt. The cases were divided into two main groups; a group with RDS (case group 66 cases) and a group without RDS (control group =24 cases). The group with RDS was further subdivided into three subgroups (subgroup I received just traditional therapy and the subgroup II received traditional therapy plus vitamin D 400 IU/day, while subgroup III received traditional therapy plus vitamin D 800 IU/day). Results: The RDS group had lower neonatal and maternal vitamin D concentrations than the group without RDS. We found a strong positive correlation between neonatal and maternal vitamin D levels on the day of delivery. The subgroups supplemented with vitamin D had a significant improvement in all ABG parameters, lower Downs score, less hospital stay, less morbidity than the subgroup without vitamin D supplementation. Conclusion: Administration of vitamin D as adjuvant therapy in cases of RDS was associated with a significant decrease in severity, rate of complications, and duration of hospital stay in the subgroup received 800 IU/Day compared to the subgroup received 400 IU/Day.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Safety and Efficacy of Direct Acting Antivirals (Sofosbuvir & Daclatasvir) in treatment of Chronic HCV in HIV-HCV Co-Infected Egyptian Patients1750175312000510.21608/ejhm.2020.120005ENMahmoud Ezat HegazyInternal Medicine Department, Faculty of Medicine –Zagazig University, EgyptIhab Barsoum FahimInternal Medicine Department, Faculty of Medicine –Zagazig University, EgyptMahmoud Ahmed Sharaf EldinInternal Medicine Department, Faculty of Medicine –Zagazig University, EgyptSaeed Abd Elbaky GadInternal Medicine Department, Faculty of Medicine –Zagazig University, EgyptJournal Article20201021Background: Liver-related mortality is considered the most common cause of death in HIV/HCV-co infected individuals. Accordingly, treatment of HCV infection in HIV/HCV-co infected individuals is a priority to manage such major health burden. Objectives: To evaluate the safety and efficacy of treatment of chronic HCV by DDAs in HCV-HIV co-infected Egyptian patients. Patients and methods: It is an observational study that included 22 patients; only 18 HCV\HIV co-infected patients completed the study [14 males (77.8 %) and 4 females (22.8 %)]. Their ages ranged from 21 to 46 years with a mean age of 32.89 years. Half of them married and 72% of them working. 61% of them are smokers and IV addicts. Patients were divided into two groups according to HIV PCR. Group I included 12 Patients with HIV PCR > 50 copies/mm and group II that included 6 patients with HIV PCR < 50 copies \mm. Results: The rates of a sustained virologic response (SVR) at post-treatment week 12 (SVR 12) were high [17/18 (94.4%)]. The most common adverse events were fatigue (66.7%), headache (50%) and there was a high safety profile on using direct-acting antivirals (DAAs) and no patient discontinued treatment because of adverse events. No serious adverse events or mortality was reported. In addition, AST & ALT were significantly decreased at end of treatment and 12 weeks after treatment. Otherwise there were no significant changes in both hematological and chemistry labs. Conclusions: Daclatasvir plus sofosbuvir for 12 weeks resulted in a high rate of sustained virologic response in patients co infected with HIV and HCV with high safety profile after treatment completion.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Effect of Nicotine on the Rat’s Tongue and the Possible Protective Role of Royal Jelly Light and Scanning Electron Microscopic Study1754176612000710.21608/ejhm.2020.120007ENSalwa M. OuiesHuman Anatomy and Embryology Department, Faculty of Medicine, Sohag UniversityJournal Article20201021Background: nicotine (NIC) is an active substance in tobacco, the excessive use of tobacco products has been associated with various lesions in the oral cavity. Royal jelly (RJ) believed by many authors to be an anti-oxidant that protects different organs. Aim of the work: this study aimed to detect the effect of nicotine on the structure of the tongue and the possible protective effect of royal jelly. Materials and methods: 30 adult male rats were equally categorized into 3 groups. Group I: 10 rats used as the control group; Group II: 10 rats received nicotine sulphate 2 mg/kg subcutaneously daily for 4 weeks; Group III: 10 rats received nicotine as the previous group and royal jelly (100 mg/kg by intra-gastric tube daily) for 4 weeks. After 24 hrs of the last dose, the animals were dissected. Tongues were processed for the histological and scanning electron microscopic study.Results: group II revealed that the lingual dorsal surface was formedof irregularly and destructed papillae. Most of these papillae were thin with blunted or absent tips. Fungiform papillae showed destruction of their epithelium and ill-defined pores. Lamina propria showed depletion of the collagen fibers, skeletal muscle fibers revealed separations and destruction. Group III revealed restoration of the normal appearance at some regions and presence of nicotine effects at the others within light microscope and apparent restoration of the normal shape as seen within the electron microscope. Conclusion nicotine has harmful effects on the tongue and the addition of RJ can decrease these harmful effects, but not prevent it.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Study of Serum Magnesium level and Atherosclerotic Changes in Patient on Maintenance Hemodialysis1767177412000810.21608/ejhm.2020.120008ENAhmed Rabie AlarbagyInternal Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.Yassein Salah Yassein MohamedInternal Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.Mai Magdy Saad ZeidInternal Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.Heba EL Sayed Kasem MohamedInternal Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.Journal Article20201021Background: Cardiovascular complications in dialysis patients focused on atherosclerosis. Serum magnesium has a role in cardiovascular complications in dialysis patients. Objectives: This study aimed to study the correlation between serum magnesium level and atherosclerotic changes in patients on maintenance hemodialysis. Patients and methods: This prospective study included 60 patients with end-stage renal disease patients on maintenance HD, divided into Group I: (20 patients) with normal serum magnesium level (1.7 -2.8 mg/dl), Group II (20 patients) with low serum magnesium level (< 1.7mg/dl) and Group III (20 patients) with high serum magnesium level (> 2.8mg/dl.). Serum magnesium and lipid profile and intima-media thickness (IMT) of both common carotid arteries were measured. Results: Our results showed a significant negative association between level of serum Mg and IMT complex of both common carotid (P = 0.045) and ischemic heart disease in the studied patients (P = 0.012). The binary logistic regression for the predictors for IHD and CCA-IMT, we found that serum magnesium not an independent factor for atherosclerosis but we found that age and DM (P ˂ 0.001) followed by cholesterol and triglycerides (P ˂ 0.05) are the most independent factors for CCA-IMT. Also, age (with OR: 95% confidence Interval) (0.145:1.26-1.06) (P ˂ 0.001) and triglycerides (1.02:1.05-1.002), (P ˂ 0.05) are the independent factors for IHD. Conclusion: Our study revealed a significant inverse correlation between level of serum Mg and CCA-IMT and IHD in the studied HD patients. Thus, we suggest that regular screening of HD patients for serum Mg and CIMT with special consideration to diabetic and old patients is recommended to stratify their CV risk. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Coronavirus Anxiety Scale: Content Validity and Reliability of Arabic Version1775177912000910.21608/ejhm.2020.120009ENSamir El SayedDoaa ShokrySarah GomaaJournal Article20201021Background: Psychiatric manifestations of individuals impacted by the coronavirus pandemic have not been sufficiently investigated. It is very important to find a short valid and reliable scale for particularly assessing the anxiety manifestations during coronavirus disease -2019 (COVID-19) pandemic which is suitable in our culture leading to early intervention and management. Objectives: The current study aimed to validate the Arabic version of corona virus anxiety scale (CAS) and assess its reliability and translation into Arabic. Patients and Methods: CAS has been translated into Arabic. Methodological design was used to investigate content validity index (CVI) reported by eleven expert jurors. The Arabic version was distributed among 700 participants who completed the scale. Intra class correlation coefficient (inter-rater and intra-rater agreement) and Cronbach’s α reliability coefficients were addressed to investigate reliability. Results: The CVI Item for relevance ranged from 0.90 to 1.0 and for clarity from 0.71 to 1.0. All inter-rater and intra-rater correlation coefficients are positive and significant and ranges from 0.78 to 0.92 for inter-rater and from 0.88 to 0.96 for intra-rater. The inter-rater and intra-rater correlation coefficients of the total score were 0.83 and 0.92, respectively. The total Cronbach’s α of the total scale was 0.92. Conclusion: Corona virus anxiety scale (CAS) Arabic version based on the results is valid, reliable, stable, and its translation is convenient to the culture. It can be used for screening of anxiety manifestations concomitant with Covid 19 pandemic. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001The Relationship Between Serum Lead Level and Uremic Pruritus in End-Stage Renal Disease Patients on Regular Hemodialysis1780178412044110.21608/ejhm.2020.120441ENEssam Eldin Mahmoud LotfyLamiaa Abd Elwahab MohammedNafesa Mohammed KamalHatem Elmaghawry Mohammed ElsheikhJournal Article20201026<span>Background: </span><span>Uremic pruritus (UP) is commonly described as a daily or near-daily occurrence of itch that spans large bilaterally symmetrical surface areas. Blood lead level (BLL) has been noted to be associated with inflammation and nutritional status in long-term HD patients.<br /> </span><span>Objective: </span><span>To evaluate the possible relationship between BLL and UP in chronic HD patients.<br /> </span><span>Patients and Methods: </span><span>This Cross-Sectional Study was carried out in the Hemodialysis Unit in EL Agouza Hospital from November 2018 to the end of April 2019 and included 100 randomly selected patients with end- stage who received hemodialysis sessions thrice weekly, four hours /session, for more than 6 months. Dialysate with standard ionic composition and a bicarbonate-based buffer is used for all patients.<br /> </span><span>Results: </span><span>The mean age of the chosen patients were ±SD 48.6 ± 7.1 years and the difference among the groups was non-significant (p-value 0.116). The study included 42 females (42%) and 58 males (58%). There was no significant difference among the studied groups (p=0.292) regarding sex. According to Pruritus Onset in our study, there was a non-statistically significant difference among the studied groups. In our study, there was a statistically highly significant difference among different groups regarding Serum Lead (μg/dL) (p-value <0.001). In our study, </span><span>Serum Lead ≥ 14μg/dL is a cut</span><span>-off value predictor for pruritus in HD patients with a sensitivity of 89.5%, specificity of 64.2%, and an accuracy of 69%.<br /> </span><span>Conclusion: </span><span>Serum Lead is a predictor for the incidence of pruritus in patients with end-stage renal disease maintained on hemodialysis.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Mini External Fixator for Management of Fracture Metacarpals and Phalanges of the Hand1785178812044310.21608/ejhm.2020.120443ENAhmed Al Saeed Abd AllahDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, EgyptKhaled Idrees Abd Al RahmanDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, EgyptMohammed El Sadek AttiaDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, EgyptAhmed Mohammed Abdel WahabDepartment of Orthopedic Surgery, Faculty of Medicine, Zagazig University, EgyptJournal Article20201026<span>Background</span><span>: Fractures of metacarpals and phalanges are the most common fractures of the upper extremity. </span><span>Objective: </span><span>The aim of this study was to assess the functional outcomes of management of metacarpal and phalangeal fractures by mini external fixator.<br /> </span><span>Patients and Methods</span><span>: This prospective study included a total of 12 patients with fractures of metacarpals and phalanges, attending at Orthopedics and Traumatology Departments, Zagazig and Helwan University Hospitals. This study was conducted between August 2018 and July 2019 and was done to assess the functional outcomes of metacarpal and phalangeal fractures fixed by mini external fixator.<br /> </span><span>Results</span><span>: In this study there was good union time among studied group with average 8.33±2.1 weeks. One case (8.3%) had pin tract infection and one case (8.3%) had delayed union >12 weeks, malunion founded in 2 cases (16.7%) and stiffness founded in 3 cases (25%). At the end of the follow up period, two patients (16.7 %) sustained malunion deformities, one patient (8.35%) had rotational deformity and in another patient (8.35%) had angular malunion. Regarding active movement score 75% were acceptable results (Excellent and Good) and 25% were not acceptable results (Fair and Poor). There was significant association between acceptability of outcome and deformity, as 66.7% of not accepted result had deformity while no one from accepted outcome had deformity</span><span>. </span><span>Conclusion</span><span>: Use of mini external fixator is an adequate procedure for unstable phalangeal and metacarpal fractures. In cases of open fractures, the mini external fixator allows wound inspection and care and avoidance of hardware application at fracture site.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Dexamethazone Prophylaxis before Near Total Thyroidectomy to Reduce Vocal Dysfunction: A Randomized Clinical Trial1789179512044410.21608/ejhm.2020.120444ENAtef Mohamed Abdel LatifEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptTamer Youssef MohamedEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptAhmed Elsayed LotfyEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptAhmed Helmy Mohamed AhmedEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptJournal Article20201026<span>Background: </span><span>Thyroidectomy operation is one of the most common operations around the world. There are different complications of thyroidectomy including vocal cords dysfunction, hypocalcaemia, pain, bleeding, hematoma, nausea and vomiting.<br /> </span><span>Objective: </span><span>This study aimed to study the prophylactic effect of dexamethasone 8 mg/2ml amp, intravenous before near total thyroidectomy to reduce vocal dysfunction. Also, to study the effect in relation to pain, nausea, vomiting and hypocalcaemia.<br /> </span><span>Patients and Methods: </span><span>This study was conducted in Mansoura University Hospitals, Endocrine Surgery Unit during the period between July 2018 and June 2019. All patients were admitted from the Outpatient Clinic. All patients were informed about the surgical procedure in the clinic and a written consent was taken from all patients participating in the study. Sample size was calculated using G- Power with effect size 0.8 and power of 0.8 where it was 100 patients (50 patients in each group).<br /> </span><span>Results: </span><span>comparing the 2 groups postoperatively, the dexamethasone group had fewer complications as regards postoperative nausea, vomiting, pain, hypocalcaemia and vocal dysfunction.<br /> </span><span>Conclusion: </span><span>From this study, it was shown that dexamethasone 8 mg/2ml IV before near total thyroidectomy has significant effect regarding reduction of postoperative nausea, pain, vomiting, hypocalcaemia and vocal cords mobility, which was less affected. In addition, there was no side effects of dexamethasone administration. Therefore, we advise to give dexamethasone to all patients before thyroid surgery.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Role of Metformin in Combination with Trastuzumab and Neoadjuvant Chemotherapy in Treatment of HER-2 Positive Breast Cancer1796180312044610.21608/ejhm.2020.120446ENAhmed Said Ahmed SaidHussein Ali Mustafa Abd Al-MuttelebMohammed Ali Morsy AbdeenMohammed Abd Al Rahman HassanSoha Abdelrazek Abbas AhmedJournal Article20201026<span>Backgound: </span><span>HER2 overexpression is a good predictive marker of HER2 targeted therapy, which means that HER2 therapy will be very effective in reducing the size of HER2 positive breast cancers. Therefore, the size of HER2 positive breast cancer can easily be reduced in patients who wish to have a breast-conserving operation, and potentially improves the outcome of patients if pathologic complete response (PCR) can be achieved. </span>
<span>Objective: </span><span>To determine whether metformin use with trastuzumab was associated with improvement in PCR rate in patients with breast cancer receiving neoadjuvant chemotherapy.<br /> </span><span>Patients and Methods: </span><span>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 30 patients divided into 2 groups, test group (metformin group) and standard group (non-metformin group). Histopathology was confirmed by tissue core biopsy. </span>
<span>Results: </span><span>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), 12 patients (80%) achieved pathological complete response (PCR) while 3 (20%) patients did not achieve PCR. However, among the patients in standerd group (non-metformin group) 9 patients (60%) achieved pathological complete response (PCR) while 6 (40%) 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). </span>
<span>Conclusion: </span><span>The addition of metformin to tratuzumab in neoadjuvant chemotherapy has a significant impact on pathological complete response (PCR) in female patients with HER-2 positive breast cancer.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Posterior Approach to Neurotize Suprascapular Nerve by Spinal Accessory Nerve1804180912044810.21608/ejhm.2020.120448ENMuhammad Hassan Muhammad Abdel-AalMohammad Reda AhmadHassan Rabea Galal AshourAhmed Mohamed Desoky HemidJournal Article20201026<span>Background: </span><span>Surgical reconstruction of the shoulder is a high priority in patients with total brachial plexus injuries. This is not only because functional control of the shoulder is of paramount importance, but also because of the overall reduced success of reinnervation of muscles below the elbow</span><span>.<br /> Objective: </span><span>This study aimed to neurotize suprascapular nerve by spinal accessory nerve through posterior approach. </span><span>Patients and methods: </span><span>This prospective cohort study was conducted in the Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Zagazig University within the period from November 2018 to July 2019. Twelve patients were included in the present study. All patients were exposed to traumatic brachial plexus injuries.<br /> </span><span>Results: </span><span>our study showed progressive improvement of shoulder flexion, abduction and external rotation. By the comparison between pre- and postoperative range of movement. It was recorded that the mean value of shoulder flexion has significantly elevated from 4.167 ± 4.68 preoperative to be 59.58 ± 8.11 (P < 0.001). The mean value of shoulder abduction was increased significantly from 4.58 ± 4.50 preoperative to 65.41 ± 8.91 postoperative (P < 0.001). Moreover, the mean value of external rotation was improved significantly from 5.83 ± 5.15 preoperative to 65.42 ± 9.64 postoperative.<br /> </span><span>Conclusion: </span><span>That transferring spinal accessory nerve to the suprascapular nerve via the posterior approach for restoring shoulder abduction and external rotation is an effective and reliable treatment with high success rate in patients with brachial plexus palsy.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Comparative Study between Treatment by Vacuum-Assisted Closure (VAC), Treatment by Hyperbaric Oxygen Therapy and Traditional Treatment of Diabetic Foot Infection1810181412044910.21608/ejhm.2020.120449ENAhmed El-Said MousaDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Mahmoud Salah ShehataDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Mohamed Mohsen SalemDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Journal Article20201026<span>Aim</span><span>: To compare the therapeutic effects of vacuum-assisted closure therapy, hyperbaric oxygen therapy, and traditional moist dressings in improving the healing process of chronic diabetic foot infection.<br /> </span><span>Study design</span><span>: A prospective randomized study.<br /> </span><span>Patients and Methods: </span><span>A total of 75 patients, with a chronic diabetic foot infection, were included in this study. After surgical debridement, all patients were randomly classified into 3 groups, with 25 patients in each group. Group A were treated by VAC therapy, Group B were treated by HBOT and Group C were treated by traditional moist dressings respectively. Wounds were evaluated every week for six weeks as regards the size, timing of healthy granulation tissue formation, local wound complications, and number of debridement sessions.<br /> </span><span>Results: </span><span>There was a significant reduction in the wound size in group A with a mean of 70.25 %, B with 62.65 % compared to group C with 32.46 %. As regards healthy granulation tissue formation onset, it was more rapid in group A with a mean of 6.5, B with 7 compared to group C with 14 days. As regards the number of debridement sessions and local wound complications they were significantly less in group A than the other two groups.<br /> </span><span>Conclusion: </span><span>Vacuum-assisted closure (VAC) therapy appears to be safe, more effective with less complications than the other two methods in the treatment of diabetic foot infection, and can be used with HBOT simultaneously if indicated.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Impact of Phototherapy on Oxidative Stress Indices in Preterm Neonates with Unconjugated Hyperbilirubinemia1815182112045010.21608/ejhm.2020.120450ENKhaled HassaanAwadDepartment of Pediatric, Al-Azhar University, Assiut, EgyptWalid A. ElmorsyDepartment of Clinical Pathology, Al-Azhar University, Assiut, EgyptJournal Article20201026<span>Background</span><span>: Neonatal jaundice is one of the most common neonatal problems especially in preterm ones. Preterm babies are treated with different types of phototherapy. Preterm neonates have a weak antioxidant defense mechanism. Both the hyperbilirubinemia and phototherapy have an impact on this antioxidant defense system.<br /> </span><span>Objective: </span><span>In the current study we aimed to assess the effect of hyperbilirubinemia and phototherapy in the oxidant/antioxidant status of preterm newborns. </span>
<span>Subjects and Methods: </span><span>Thirty late preterm </span><span>(≥</span><span>35 weeks) neonates with non-hemolytic neonatal jaundice in the 3-9 days of life were involved in the preset study, and received phototherapy. 15 healthy neonates of the same gestational and postnatal age without jaundice were included as a control. We assessed the total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI). </span>
<span>Results: </span><span>TOS and OSI were significantly higher (P<0.01); TAC level was significantly lower (P<0. 01); in jaundiced preterm neonates than in control group. Following phototherapy there were significant increase in TOS and OSI (P<0. 01) and decrease in TAC (P<0.001).<br /> </span><span>Conclusions</span><span>: Both hyperbilirubinemia and phototherapy induce oxidative stress in preterm neonates. </span><span>Recommendations</span><span>: preterm neonates with significant hyperbilirubinemia benefits of phototherapy overwhelm the risks. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Efficacy of Oxytocin Infusion Versus Tranexamic Acid Infusion in Controlling Blood Loss During Elective Lower Segment Caesarean Section1822182712045310.21608/ejhm.2020.120453ENNashwa Elsaid HassanDepartment of Obstetrics and Gynecology, Faculty of Medicine-
Ain Shams UniversityNermeen Ahmed Mostafa ElghareebDepartment of Obstetrics and Gynecology, Faculty of Medicine-
Ain Shams UniversityFady Makram ZakiDepartment of Obstetrics and Gynecology, Faculty of Medicine-
Ain Shams UniversityJournal Article20201026<span>Background: </span><span>Caesarean section represents a risk factor for intrapartum and postpartum hemorrhages and a burden of ongoing anemia. Therefore, methods of controlling blood loss during caesarean section decrease maternal morbidity and mortality and enhance the quality of mother's life during puerperium.<br /> </span><span>Objective: </span><span>to compare efficacy of oxytocin infusion after oxytocin bolus and efficacy of tranexamic acid infusion after oxytocin bolus in controlling blood loss during elective lower segment caesarean section.<br /> </span><span>Patients and methods: </span><span>The study included 138 legally adult pregnant women (18 </span><span>– </span><span>38 years old) with singleton pregnancies at term (37 </span><span>– </span><span>42 weeks) who were recruited from Ain Shams University Maternity Hospital where and booked for primary elective caesarean section. They were randomly divided into three groups. Group (A) was given an intravenous slow bolus of oxytocin 10 IU over 1 minute and 40 IU oxytocin in 500 l of 0.9% saline solution over 4 hours after delivery of baby. Group (B) was given an intravenous slow bolus of oxytocin 10 IU over 1 minute and 1 gm tranexamic acid in 200 ml of 0.9% saline solution over 5 minutes after delivery of baby. Group (C) was given only an intravenous slow bolus of oxytocin 10 IU over 1 minute after delivery of baby. The three groups would be compared </span><span>regarding to gravimetric assessment of “measured” blood loss and mathematical estimation of “calculated” blood loss. </span><span>Results: </span><span>The estimated and calculated blood loses in group (A) were statistically insignificant less than those in group (B). But those loses in group (C) were statistically significant more than the loses in other groups.<br /> </span><span>Conclusion: </span><span>The tranexamic acid infusion after oxytocin bolus is effective as oxytocin infusion after oxytocin bolus in controlling blood loss during elective lower segment caesarean section. It can help against postpartum hemorrhage with no considerable side effects.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Histological Structure of Dentate Gyrus in Global Cerebral Ischemia/Reperfusion Injury and Role of Nitraetes in Protection1828183412045910.21608/ejhm.2020.120459ENSamah Sayed Hassan Elsayed SolimanDepartment of Anatomy and Embryology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.Mostafa Mahmoud El-HabibyDepartment of Anatomy and Embryology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.Neveen Mohamed El-SherifDepartment of Anatomy and Embryology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.Marwa Abdel-Samad Al-GholamDepartment of Anatomy and Embryology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.Journal Article20201026<span>Background: </span><span>Ischemia-reperfusion injury is a hell mark of stroke that happens if blood supply is returned back after a period of ischemia. However, the benefit from restored blood supply by reperfusion can cause bad effect compared to permanent occlusion.<br /> </span><span>Objectives: </span><span>This study aimed to analyze morphological alterations in dentate gyrus tissue during ischemia and its effects on histology of cells and to understand mechanisms of brain ischemia-reperfusion injury to develop effective therapy. </span><span>Results: </span><span>Many experiments proved that the mechanisms of ischemia-reperfusion injury include complement activation, leukocyte infiltration, oxidative stress, platelet adhesion and aggregation and mitochondrial-mediated mechanisms leading to blood-brain-barrier (BBB) disruption, which leads to brain edema.<br /> </span><span>Conclusion: </span><span>In summary, over the past few years there have been significant advancement in our understanding of molecular and cellular mechanisms of ischemia-reperfusion injury in the brain. The major mechanisms of reperfusion injury are clear but are still far from being clinically successful. Thus, further investigations on brain reperfusion </span>injury mechanisms are wanted. Also, role of nitrates in protection for ischemia-reperfusion brain injury.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Histological Structure of Pancreas in Chronic Pancreatitis and The Role of Pancreatic Stellate Cells1835183912100810.21608/ejhm.2020.121008ENGhada Hamed Hasan RomehDepartment of Anatomy and Embryology, Faculty of Medicine, Menoufia University, Menoufia, EgyptFatma El-Nabawia Abdel-Hady El-SaftyDepartment of Anatomy and Embryology, Faculty of Medicine, Menoufia University, Menoufia, EgyptAbeer El-Said El-Mehi, Manar Ali FariedDepartment of Anatomy and Embryology, Faculty of Medicine, Menoufia University, Menoufia, EgyptJournal Article20201101<span>Background: </span><span>Chronic pancreatitis is a progressive inflammatory disease that causes damage and fibrosis of the parenchyma of pancreas, thus leads to endocrine and exocrine dysfunction.<br /> </span><span>Objective: </span><span>The goals of this review were to analyze morphological alterations in pancreatic tissue during chronic pancreatitis and this analysis addresses the effect of pancreatic stellate cells (PSCs), on chronic pancreatitis, and collagen fiber deposition.<br /> </span><span>Results: </span><span>This review also discussed the different immunohistochemical markers for PSCs. Alpha smooth muscle </span><span>actin (α</span><span>-SMA) is an excellent marker for activated PSCs. </span><span>Transforming growth factor beta (TGFβ) is an important </span><span>profibrogenic cytokine that appears to act by stimulating collagen production by PSCs.<br /> </span><span>Conclusion: </span><span>It was concluded that chronic pancreatitis caused a significant and progressive serious effects on the acinar cells, duct system, and islets of Langerhans in the form of intracellular vacuolations, decreased zymogen granules, pyknotic nuclei and thickening of the duct wall, and extensive fibrosis. It is hypothesised that during </span><span>pancreatic injury, PSCs are activated and proliferated exhibiting positive staining for the cytoskeletal protein α</span><span>- SMA, and synthesising amounts of extracellular matrix proteins, particularly collagen.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Serum Levels of Tumor Necrosis Factor- Like Weak Inducer of Apoptosis (TWEAK) in Patients With Psoriasis Vulgaris1840184412100910.21608/ejhm.2020.121009ENAmin Mohamed AmerSara Mohammed SaadSally Mahmoud ShalabyMai Ahmed SamirJournal Article20201101<span>Background: </span><span>Psoriasis is a chronic, immune-mediated, systemic inflammatory disease that is defined by a characteristic skin reaction produced when elevated levels of inflammatory cytokines that alter the growth and differentiation of skin cells. Tumour necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) has been implicated in the pathogenesis of variety of inflammatory disorders and autoimmune diseases. However, studies conducted on the relationship of TWEAK and psoriasis patients are limited.<br /> </span><span>Objective: </span><span>We aimed to assess the serum level of TWEAK in psoriatic patients and determine whether levels are related with clinical variables, such as disease severity and duration.<br /> </span><span>Patients and Methods: </span><span>The study was conducted on 30 patients with psoriasis attending Dermatology, Venerology & Andrology Outpatient Clinic, Faculty of Medicine, Zagazig University Hospitals spanning the period from January 2019 to March 2019. They were divided into mild, moderate and severe according to Psoriasis Area and Severity Index (PASI) score, 10 patients in each group. The patients' age ranged from 10 to 60 years old. 10 healthy subjects with matched age and sex served as control group.<br /> </span><span>Results: </span><span>There was non-significant difference between the studied groups regarding age, BMI, sex, family history, DM and smoking. However, the difference between them was highly significant regarding itching and presence of stressors. The mean TWEAK levels were significantly higher in psoriasis patients than in control subjects, which was significantly associated with severity and duration of the disease. There was positive correlation (P < 0.001) between serum TWEAK levels and severity of psoriasis with highly significant level in severe cases.<br /> </span><span>Conclusion: </span><span>The serum TWEAK levels significantly correlated with the clinical state, as represented by the PASI score. Also, it was found that TWEAK measurement in serum of patients with psoriasis provides a tool for monitoring disease activity and its use as a marker of disease severity. Thus, they have prognostic significance. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Evaluation of Serum Endothelin-1 (ET-1) and Nitric Oxide (NO) Levels in Unconjugated Hyperbilirubinemic Neonates1858186512101210.21608/ejhm.2020.121012ENHosny M. A. El-MasryAlaaeldin A. HassanAlaa M. HashimMohammed Abo-Alwafa AladawyAsmaa Ahmed Alameldin AbdelwahabJournal Article20201101<span>Background: </span><span>Neonatal hyperbilirubinemia is the most common cause of admission in NICU. Phototherapy is the golden standerd therapy long time ago, which shows efficacy and safety but its side effects should be studied in depth. Both endotheline 1 (ET-1) and nitric Oxide (NO) are potent vasoconstrictor and vasodilator respectively and they are affected by phototherapy.<br /> </span><span>Objectives: </span><span>This study aimed to investigate the impact of phototherapy on the level of ET-1 and NO in fullterm and preterm as well as studying their effect on hemodynamic stability in treated newborns.<br /> </span><span>Subjects and Methods: </span><span>This study included 120 newborn infants who were classified into two groups. 60 patients (30 term infants and 30 preterm infants < 37 weeks and > 30 weeks) with unconjugated hyperbilirubinemia indicated for phototherapy and not indicated for exchange transfusion and the onset of jaundice from 2</span><span>nd </span><span>to 4</span><span>th </span><span>day. In addition, to 60 apparently healthy newborns as control group with matched age, sex, weight and gestational age. </span><span>Results: </span><span>There was significant increase in both endothelin-1 and nitric oxide in both fullterm and preterm groups after phototherapy. For fullterm and preterm groups, ET-1 levels significantly increased after 12 hour and 24 hour phototherapy (p-value = 0.048 and 0.013 respectively) for fullterm (p-value = 0.046 and 0.028 respectively) for preterm. Nitric oxide levels among fullterm and preterm groups significantly increased after 12 hour and 24 hour phototherapy (p-value = 0.042 and 0.012 respectively) for fullterm (p value =0.048 and 0.012 respectively) for preterm. The means heart rate changes among fullterm and preterm groups were significantly increased. However, mean arterial blood pressure among full term and preterm groups was significantly decrease after 24 hours of phototherapy. There was a positive correlation between serum levels of ET-1 and NO and heart rate after phototherapy among term and preterm neonats. A negative correlation was found between mean BP and serum levels of NO and a positive correlation between serum levels of ET-1 and mean BP after phototherapy among term and preterm neonates.<br /> </span><span>Conclusion: </span><span>There was a significant increase in both endothelin-1 and nitric oxide in both full term and preterm groups after treatment with photo-therapy. In addition, a significant increase in mean heart rate and a significant decrease in mean blood pressure among preterm and fullterm groups before and after phototherapy and before phototherapy versus controls.<br /> </span>
<span><br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Comparative Study between Simple Percutaneous Transluminal Angioplasty and Drug-Coated Balloons in Chronic Total Occlusion of The Femoro-popliteal Artery1866187112101310.21608/ejhm.2020.121013ENEmad El-dien Ahmed HusseinMohammed Ahmed Mohammed IsmailAli Mahmoud Mohammed GalalAhmed Khalf FathyJournal Article20201101<span>Background: </span><span>Atherosclerotic peripheral artery disease (PAD) affects a growing number of patients in aging populations. Peripheral artery disease (PAD) accounts for a large proportion of cardiovascular disease (CVD) prevalence in most world regions.<br /> </span><span>Objective: </span><span>This study aims to evaluate and compare the patency, clinical outcome, and limb salvage rates between the simple percutaneous Transluminal angioplasty and the drug-coated balloons in chronic total occlusion of the femoropopliteal arterial segment on the short-term course.<br /> </span><span>Patients and Method: </span><span>A prospective randomized controlled comparative study was conducted in the vascular surgery department; Aswan University Hospital during the period from March 2018 to March 2020. In total, 30 patients with a well-established diagnosis of superficial femoral artery (SFA) and/or proximal popliteal lesions with symptoms of PAD.<br /> </span><span>Results: </span><span>The primary patency at 12-month following treatment with DCB was significantly better 100. %, 80.0%, 60.0% at 1, 6, 12 months compared with POBA 86.7 %, 66.7%, 46.7% at 1, 6, 12 months. The rate of clinically- driven TLR was the same in both groups (26.6%). The use of DCB was safe and did not increase the major adverse clinical events (death, myocardial infarction, and minor or major amputation) when compared with those seen with the use of the uncoated balloons).<br /> </span><span>Conclusion: </span><span>Use of DCBs is associated with improved vessel patency when compared to POBA in patients with FPD. There was no difference in clinically driven TLR between DCB and POBA in our study.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Factors Affecting Length of Stay in Pediatric Emergency Department in Zagazig University Hospital1872187712101410.21608/ejhm.2020.121014ENMohamed Mosaad Abohashem Ahmed NassarDepartment of Pediatrics, Faculty of Medicine - Zagazig UniversityBeshir Adhallah HassanDepartment of Pediatrics, Faculty of Medicine - Zagazig UniversityHossam Fathi El-SaadanyDepartment of Pediatrics, Faculty of Medicine - Zagazig UniversityJournal Article20201101<span>Background: </span><span>Emergency medicine now is recognized as an essential part of public health service. As the services provided by emergency departments (EDs) increase and the management process becomes more complicated, patients stay in EDs for longer periods and EDs become more crowded. A number of studies have discussed the adverse impacts of ED crowding, which include prolonged waiting times, increased complications, and increased mortality.<br /> </span><span>Objective: </span><span>The aim of this work was to analyze factors affecting length of stay (LOS) in the pediatric ED. </span><span>Patients and methods: </span><span>This Cross-sectional study was conducted in the Pediatric Emergency Unit of Zagazig University Hospitals, from July 2019 until December 2019. Assuming that rate of admission of children in Emergency Department is 200 cases/month, so a comprehensive sample of 1200 children was included in the study.<br /> </span><span>Results: </span><span>The age of the studied cases ranged from 1 month to 12 years with mean 3.62 years. Regarding sex, 53.4% were female. In our study, the 43.8% of patients were discharged from the ED in the current study. This study showed that 71.8% of the studied cases came to hospital from 9 am to 9 pm. There was no statistically significant difference between length of stay and sex. In the present study, mean value of length of stay (hours) was low among discharged patients (0.20 ± 0.59) than admitted patients (0.51± 0.58).<br /> </span><span>Conclusion: </span><span>We concluded that several factors are associated with high average emergency department LOS. High LOS may lead to increases in expenditures and may have implications for patient safety, whereas certain organizational changes, communication improvement, and time management may have a positive effect on it. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Neutrophils-to-Lymphocytes Ratio in Children with Acute Heart Failure1878188312101510.21608/ejhm.2020.121015ENMohamed Salah Mousa IbrahimDepartment of Pediatrics, Faculty of Medicine - Zagazig UniversityAzza Ali KhalilDepartment of Pediatrics, Faculty of Medicine - Zagazig UniversityAl-Shaymaa Ahmed Ahmed AliDepartment of Pediatrics, Faculty of Medicine - Zagazig UniversityJournal Article20201101<span>Background: </span><span>Heart failure is a common cause of morbidity and mortality in pediatric patients in the third world. Heart failure in children occurs due to heart lesions that cause volume overload as in large ventricular septal defect or due to lesions that causes obstruction to flow as in aortic stenosis.<br /> </span><span>Objective: </span><span>This study aimed to evaluate the neutrophils to lymphocytes ratio in children with heart failure & to investigate if this ratio is helpful in predicting mortality and adverse outcome in those patients. </span>
<span>Patients and methods: </span><span>Our study was performed over a number of 80 children 40 of them were having CHD with acute heart failure, 20 of them were congenital heart disease (CHD) without failure and 20 of them were normal. The was conducted in Pediatric Cardiology Unit and Pediatric ICU, Zagazig University Children Hospitals during the period from February 2017 till May 2018. </span>
<span>Results: </span><span>Our present work showed that neutrophils, CRP and NLR were statistically higher in the Heart failure group compared to cardiac group and control group. While lymphocytes and </span><span>oxygen saturation </span><span>(SO</span><span>2</span><span>) were statistically lower in the heart failure group. The echocardiographic findings showed that compared to cardiac group, the heart failure group was significantly higher regarding PAP and LVEDD but significantly lower regarding EF and FS. </span>
<span>Conclusion: </span><span>Elevated NLR seems to be a predictor of short-term mortality in patients with acute heart failure. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Excision of Posterior Mediastinal Neurogenic Tumor: Video Assisted Thoracoscopic versus Thoracotomy1884188912101610.21608/ejhm.2020.121016ENRezk Zenhom AbogamelaDepartment of Cardiothoracic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.Elkahely MohamedDepartment of Cardiothoracic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.Journal Article20201101<span>Background: </span><span>The posterior mediastinal tumors represent different diseases. Most of them are detected incidentally. Regarding difficult anatomic access for mass in the mediastinum, surgical excision remains the best method for diagnosis and therapeutic result. Video-assisted thoracic surgery (VATS) is increasingly used for the management of posterior mediastinal mass. This study aimed at evaluation of the outcomes of VATS compared to conventional thoracotomy in treatment of posterior mediastinal tumors.<br /> </span><span>Patients and Methods: </span><span>A retrospective analysis was performed of 22 patients who underwent surgery for posterior mediastinal neurogenic tumors at our Department in </span><span>Security Force Hospital </span><span>(SFH), Riyadh, KSA </span><span>from September 2013 to January 2018</span><span>. Nine tumors were excised via video</span><span>‐ </span><span>assisted thoracic surgery (VATS) and 13 tumors via surgical thoracotomy.<br /> </span><span>Results: </span><span>When compared with the thoracotomy group, patients in the VATS group had a shorter operation time (</span><span>95±3</span><span>3 min vs. </span><span>130±3</span><span>5 min, P=0.023), less blood loss ( mL vs. </span><span>180±9</span><span>5 mL, P=0.</span><span>0005</span><span>), and shorter time of hospital stay and discharge </span><span>(2.5±0.</span><span>7 days vs. </span><span>3.6±0.7 </span><span>days, P = 0. ).<br /> </span><span>Conclusion: </span><span>VATS is safer and more effective surgical procedure for excision posterior mediastinal neurogenic tumors with good outcomes than conventional thoracotomy.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Intravenous Dexamethasone Prolongs the Analgesic Effect of Caudal Bupivacaine after Hypospadias Repair Surgery1890189512101710.21608/ejhm.2020.121017ENWesam A. Abo ElwafaDepartment of Anaesthesia and Intensive Care, Faculty of Medicine, Sohag UniversityAmr A. ZakariaDepartment of Anaesthesia and Intensive Care, Faculty of Medicine, Sohag UniversityAbdelrahman H. AbdelrahmanDepartment of Anaesthesia and Intensive Care, Faculty of Medicine, Sohag UniversityWael A. MahmoudDepartment of Anaesthesia and Intensive Care, Faculty of Medicine, Sohag UniversityJournal Article20201101<span>Background: </span><span>Dexamethasone has a powerful anti-inflammatory action and has been demonstrated to reduce morbidity after surgery.<br /> </span><span>Objective: </span><span>The aim of this study was to examine the effects of a single i.v. dose of dexamethasone in combination with caudal block on postoperative analgesia in children.<br /> </span><span>Patients and methods: </span><span>Sixty pediatric patients (aged 2-10 years) undergoing hypospadias repair surgery were included in this prospective, randomized, double-blinded study at Sohag University Hospital. After induction of general anaesthesia, children received either dexamethasone 0.5 mg </span><span>∕ </span><span>kg (maximum 10 mg) (n=30) or the same volume of saline (n=30) i.v. A caudal anaesthetic block was then performed using 1 </span><span>ml ∕</span><span>kg of bupivacaine 0.25% in all patients.<br /> </span><span>Results: </span><span>After surgery, rescue analgesic consumption, pain scores, and adverse effects were evaluated for 24 h. The time to first administration of acetaminophen (rescue analgesia) was significantly longer in the dexamethasone group (11.35 ± 2.36 hr vs 8.75 ± 1.33 hr) with a significant value of 0.01. Total amount of the analgesia required (paracetamol) was significantly lower in dexamethasone plus caudal block group than the caudal block alone (430 mg vs 680 mg) respectively.<br /> </span><span>Conclusion: </span><span>Postoperative pain scores were lower in the dexamethasone group and the incidence of adverse effects was similar in both groups. Intravenous dexamethasone 0.5 mg </span><span>∕ </span><span>kg in combination with a caudal block augmented the intensity and duration of postoperative analgesia without adverse effects in children undergoing hypospadias repair surgery.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Comparison between Mycophenolate and Cyclophosphamide in Treatment of Lupus Nephritis1896190212191810.21608/ejhm.2020.121918ENAyman Abd El Aziz Abd El RahmanDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.Aldosoky Abd El Aziz AlsaidDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.Wael Mohamed Abdelkader AbdelazizDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.Journal Article20201106Background: Systemic lupus erythematosus is a chronic inflammatory disease that can affect any organ, but very often injures the kidney. It is more prevalent in women than men across all age groups and populations; the femaleto-male ratio is higher at reproductive age, ranging between 8:1 and 15:1, and is lowest in prepubertal children at about 4:3. Aim of the Work: To study the effect of intravenous cyclophosphamide versus oral mycophenolate (MMF) in the treatment of lupus nephritis (LN). Subjects and Methods: This was a prospective, randomized, comparative study on the efficacy of I.V cyclophosphamide compared to oral MMF in the induction therapy of LN. In this study 40 patients of systemic lupus erythematosus with lupus nephritis, were included. All patients were divided randomly into two groups. The first group included 20 female patients who given Oral Corticosteroid 1mg /kg and intravenous cyclophosphamide 500mg once every two weeks for 6 months. The second group included 20 patients receiving oral corticosteroid 1mg /kg and oral mycophenolate 2-3g/day (1200 mg/m2) for 6 months. Results: - As regard serum creatinine, alb/cr ratio, serum albumin, ESR, Anti DNA, c3, and eGFR there was a highly significant difference between before/after the treatment in each group, with no significant difference comparing the two group to each other. Conclusion: In our study, both MMF and IVC show significant improvement in patients with lupus nephritis with no superiority of one of them to the other.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Assist Control Ventilation Versus Synchronized Mode Intermittent Mandatory Ventilation in Pediatric Intensive Care Unit1903190912192010.21608/ejhm.2020.121920ENNehad Ahmed Karam Abd El FatahDepartment of Pediatrics, Faculty of Medicine, Zagazig University, EgyptDalia Abdul Latif Abdul RahmanDepartment of Pediatrics, Faculty of Medicine, Zagazig University, EgyptIbrahim Saleh Farag AgaaribDepartment of Pediatrics, Faculty of Medicine, Sirte University, LibyaJournal Article20201106Background: Ventilator weaning consists of the gradual reduction of ventilatory support and the transfer of respiratory control and the work of breathing back to the patient, resulting in discontinuation of mechanical ventilation. Objective: The aim of this study was to compare between assisted controlled (AC) ventilation mode and synchronized intermittent mandatory ventilation (SIMV) mode for easy weaning in pediatric intensive care unit (PICU). Subjects and methods: This was non-randomized control trial; 50 patients were selected and divided alternatively into two equal groups: an AC group (ACG) and an SIMV group (SIMVG). The patients were connected on SIMV or AC mode according to inclusion and exclusion criteria and follow up of the cases was done regarding ventilator settings, compliance of the patients, need of sedation, and progress of weaning process. Results: the results revealed that there wass statistically non-significant difference between the studied groups regarding progress or weaning interruption. Larger percentage within both groups had progressive uninterrupted weaning. Conclusion: We found no evidence to support any clear-cut advantage of SIMV or AC in the acute management of respiratory failure, and we concluded that AC and SIMV could improve and fasten the weaning process and increase the success rate of weaning.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281420201001Comparative Study between Backdoor and Conventional Thyroidectomy in Non-Recurrent Goiter1910191512192110.21608/ejhm.2020.121921ENYasser Aly El – SayedDepartment of General and Endocrine Surgery, Faculty of Medicine – Mansoura UniversityTamer Yousef MohamedDepartment of General and Endocrine Surgery, Faculty of Medicine – Mansoura UniversityAmr Samir ElsaiedDepartment of General and Endocrine Surgery, Faculty of Medicine – Mansoura UniversityOsama Mohammed Mohammed MostafaDepartment of General and Endocrine Surgery, Faculty of Medicine – Mansoura UniversityJournal Article20201106Background: Thyroidectomy is the most common endocrine surgery. The traditional procedure of thyroidectomy is through midline splitting of strap musculatures. The Backdoor approach of thyroidectomy is an established method to explore thyroid and parathyroid lesions. Objective: To evaluate how safe and feasible is the backdoor approach for thyroidectomy and to compare its results with the conventional thyroidectomy technique. Patients and methods: This prospective study was conducted at Mansoura University Hospitals. We included 40 cases with benign non-recurrent goiter who were divided into 2 equal groups; group “A” included 20 cases who underwent the conventional procedure, and group “B” which included the remaining 20 cases who underwent the backdoor procedure. Results: Regarding the early post-operative period, the backdoor group (group B) experienced less post-operative pain scores and thus, less need for analgesic requirement (1.67 vs. 3.76 for the other group – p = 0.017). One case (5%) in group A was complicated by hematoma and was managed via surgical exploration. Both groups had the same range of hospital stay after the operation (2 days). Superficial surgical site infection was diagnosed in one case (5%) in each group. Transient post-operative hypocalcemia was encountered in 5 cases (25%) in group A and 2 cases (10%) in group B (p = 0.179). Conclusion: Based on our study findings, it was evident that back door thyroidectomy has more advantages compared to the conventional approach including: Less post-operative pain as peritracheal fascia is not closed, easy identification of parathyroid glands and recurrent laryngeal nerve and avoidance of recurrent laryngeal nerve injuries.