Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Occupational Pesticides Intoxication among Agricultural Workers1916192312271210.21608/ejhm.2020.122712ENMahmoud Ali SalehDepartment of Community, Environmental and Occupational Medicine, Faculty of Medicine, Benha UniversityHassan El Sayed El FarDepartment of Community, Environmental and Occupational Medicine, Faculty of Medicine, Benha UniversityOmyma Mahmoud HassanDepartment of Community, Environmental and Occupational Medicine, Faculty of Medicine, Benha UniversityMarwa Salah El-Dien AbdElRaoufDepartment of Community, Environmental and Occupational Medicine, Faculty of Medicine, Benha UniversityShaima Adel Elsayed AliDepartment of Community, Environmental and Occupational Medicine, Faculty of Medicine, Benha UniversityJournal Article20201111Background: Pesticide intoxication is a public health problem in many developing countries. Approximately 18.2 per 100 000 agricultural workers worldwide have occupational-related pesticide acute and chronic toxicity symptoms. Objective: This study aimed to investigate the toxic symptoms in pesticide-exposed agricultural workers. Patients and Method: A cross sectional study was conducted on 390 agricultural workers using an interview questionnaire that consists of socio-demographic and exposure data, safety practices and self-reported toxicity symptoms. Physical examination and investigations were done. Results: Among the self-reported toxicity symptoms, cough was the most common acute symptom (59%) while skin problems were the most reported chronic symptoms (11.5%). There was a statistically significant difference regarding age between those with & without blurring of vision [(median, 50 and 39 years respectively) P < .001], muscle spasm [(median, 49 and 40 years respectively) P < .001] and skin problems [(median, 48 & 41 years respectively) P < 0.007]. Regarding duration of exposure, there was a statistical significant difference between those with & without blurring of vision [(median, 10 and 50 years respectively) P < .001], muscle spasm [(median, 10 and 6 years respectively) P < .001] and skin problems [(median, 12 and 6 years respectively) P < .001]. There was statistical significant negative correlation between serum cholinesterase level and age, duration of pesticides exposure and body mass index. Conclusions: The most self-reported pesticides toxicity symptom was cough (59%) while walking problems were the least reported one (5.9%). Age and duration of pesticides exposure are significant risk factors for pesticides toxicity.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Urinary Netrin-1 as an Early Marker for Diabetic Nephropathy1924193012271310.21608/ejhm.2020.122713ENEzzat M. MohammedFawzy A. El-MessallamyAhmed M. MazroueIslam A. ElsayedAmal A. ZidanJournal Article20201111Background: Netrin-1, a laminin-related secreted protein, is a proximal tubular injury urinary marker. It is released in the urine of both humans and mice and highly stimulated after acute and chronic renal diseases. Objective: The current study aimed to assess the value of urinary netrin-1 level as an early marker for diabetic nephropathy. Patients and Methods: A total of 60 diabetic patients and 20 healthy controls were enrolled in this case-control study. Diabetic patients were subdivided into normoalbuminuria, microalbuminuria, and macroalbuminuria. Urinary netrin-1 levels were analyzed by enzyme-linked immunosorbent assay (ELISA). Results: Urinary netrin-1 excretion was significantly higher in the diabetic group (1418.3±733.6 pg/mg creatinine) compared to the control group (477.4±283.6 pg/mg creatinine) with the highest value in the macroalbuminuria group (1919.4±573.4 pg/mg creatinine) and the lowest value in normoalbuminuria group (833.7±595.3 pg/mg creatinine). ROC curve analysis showed that urinary netrin 1/creatinine at a cutoff point of >630.75 pg/mg with AUC of 0.899 had 83.3% sensitivity and 85% specificity for prediction of diabetic nephropathy (P<0.001). Conclusion: Our study is suggesting that urinary netrin-1 may be a useful biomarker for early detection of diabetic nephropathyPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Role of Hysterolaparoscopy in The Evaluation and Management of Female Infertility1931193612271410.21608/ejhm.2020.122714ENWael Hussein Al-BrombolyDepartment, Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.Hussein Mohammed Abdel-DayemDepartment, Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.Amr Ahmed Abdel-RahmanDepartment, Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.Bashaer Rashad Ali Gamal El-DinDepartment, Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.Journal Article20201111Background: The definition of infertility is one year of unprotected intercourse with no pregnancy among married couples. Objective: The aim of the study is to assess the efficacy and safeness of combined hysterolaproscopy on evaluation and management of female infertility. Patients and Methods: A prospective clinical triad study was carried on 416 patients infertile women aged between 18 and 42 years with either primary or secondary infertility with normal hormone profile and without male factor infertility at the Cytogenetics and Endoscopy Unit, at Zagazig University. Those females underwent both hysteroscopy and laparoscopy through the period from August 2017 to July 2018. Results: This study showed that 42.7% of primary infertility and 59.5% of secondary infertility cases did not have any abnormality detected on laparoscopy. Endometriosis was the most common abnormality found in primary infertility followed by peritoneal adhesions, which was(12.2%) the most common abnormality found in second infertility followed by endometriosis. Abnormality in cases of primary infertility was intrauterine septum, and in secondary infertility was intrauterine synechia. Conclusions: Diagnostic hysterolaparoscopy is a very safe and effective tool for the evaluation of infertility particularly for detection of conditions like endometriosis, tubal adhesions, and intrauterine septumPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Role of Ultrasonography in Diagnosis of Pleuropulmonary Diseases in Adults1937194712271510.21608/ejhm.2020.122715ENTarek MA ElziatDepartment of Diagnostic Radiology,
Faculty of Medicine, Aswan UniversitySalah MA MakladDepartment of Diagnostic Radiology,
Faculty of Medicine, Aswan UniversityShaimaa RM AliDepartment of Diagnostic Radiology,
Faculty of Medicine, Aswan UniversitySayed AE MohammedDepartment of Chest Diseases
Faculty of Medicine, Aswan UniversityJournal Article20201111Introduction: The advantage of transthoracic ultrasound (TUS) includes the absence of ionizing radiation, easy performance, rapid, accurate, safe, short time of examination, lower cost, bedside availability and high sensitivity in detecting pleural and pulmonary diseases. Aim of this study: Aim of the current study was to assess of the role of transthoracic ultrasound in pleuropulmonary diseases in adults. Patients and methods: The present study included 50 patients who fulfilled the selection criteria and formed the study population. The present study was conducted in Radiology Department, Aswan University Hospital in the period from December 2016 to November 2017. All patients were subjected basically to full history taking, full clinical examination, chest x-ray, chest ultrasonography, CT chest and histopathological correlation for some cases. Results: In this study, patients were classified into 2 groups based on the final diagnosis. The first group included 28 cases with pleural diseases that the US reported sensitivity of 96.43%, specificity of 81.8%. The second group included 22 patients with pulmonary diseases that the US reported sensitivity of 95.45%, specificity of 78.57%. Recommendations: TUS has a valuable role at diagnosis of pleuropulmonary diseasesPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Frequency of Inborn Errors of Metabolism among Infants with Non-Apparent Causes of Failure to Thrive in Zagazig University Hospitals1948195212271610.21608/ejhm.2020.122716ENAzza Ibrahim El-DesoukyDepartment of Pediatrics, Faculty of Medicine – Zagazig UniversitySherif Mohamed El-GeballyDepartment of Pediatrics, Faculty of Medicine – Zagazig UniversityTarek Mahmoud BeyoumiDepartment of Pediatrics, Faculty of Medicine – Zagazig UniversityJournal Article20201111Background: Inborn errors of metabolism (IEM) are disorders in which there is a block at some point in the normal metabolic pathway caused by a genetic defect of a specific enzyme. Diagnosis is important not only for treatment and prognostication but also for genetic counseling and antenatal diagnosis in subsequent pregnancies. Objective: The present study aimed to find out the relative frequency of inborn errors of metabolism among infants with unapparent cause of failure to thrive (FTT). Patients and Methods: This study was cross-sectional prospective study, which was conducted during the period from 2017 to August 2019. It included 58 cases with non-apparent cause of failure to thrive admitted at Pediatric Department, Faculty of Medicine, Zagazig University. All studied cases were subjected to: EMS (extended metabolic screen) using filter paper by Tandem Mass Spectrometry. Urinary organic acids analysis was performed. Results: In this study, frequency of inborn errors of metabolism (IEM) among the studied unapparent causes of FTT cases was 8.6%. Types of IEM diseases among the studied cases were one case for each of biotinidase enzyme deficiency (1.7%), methyl malonic acidemia (1.7%), mitochondrial disease (1.7%), organic acidemia (1.7%) and phenylketonuria (1.7%). There was statistically significant increase in complains of vomiting and diarrhea among cases with inborn errors of metabolism than those without inborn errors of metabolism. Conclusion: There was high frequency of inborn errors of metabolism (IEM) among FTT without apparent cause. Frequency of hypoglycemia, positive ketone in urine, high anion gap and high serum ammonia were significantly more frequent among cases with inborn errors of metabolism than those without inborn errors of metabolism.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Different Treatment Modalities of Colo-Rectal Cancer (Retrospective Study)1953195712347810.21608/ejhm.2020.123478ENAbbas Mahmoud SarhanDepartment of Clinical Oncology, Faculty of Medicine, Zagazig University, Sharkia, Egypt.Mohammed Abdelgawad SolimanDepartment of Clinical Oncology, Faculty of Medicine, Zagazig University, Sharkia, Egypt.Eman Ali El-SebaiDepartment of Clinical Oncology, Faculty of Medicine, Zagazig University, Sharkia, Egypt.Mahmoud Mohammed Ahmed El-DemeryDepartment of Clinical Oncology & Nuclear Medicine, Ahmed Maher Teaching Hospital, Cairo, EgyptJournal Article20201116Background: Colorectal Cancer (CRC) is the most common type affecting the gastrointestinal tract accounting for about 13% of all malignancy diagnosed each year. Although Surgery stays the most effective treatment in managing colorectal carcinoma, there is a rapid increase in the use of preoperative radiotherapy and chemotherapy. Objective: So, the present study was conducted to identify the different therapeutic modalities used in the treatment. Patients and Methods: This study was a retrospective study that included CRC patients treated at the Clinical Oncology Department, Zagazig University Hospital during the period from 2012 to 2017. Medical records of 385 patients, who were referred to the Clinical Oncology Department after being diagnosed with CRC were obtained and used to collect data about different treatments and then analyzed. Results: Chemotherapy regimen FOLFOX was received in (45.5%) of cases and partial response in 41 % of cases was observed. Patients received at least one line of chemotherapy with either adjuvant or palliative intent. Rectal cancer patients who received neoadjuvant concurrent chemo& radiotherapy showed a partial response in 45.5 % of cases. Xeloda was the most common chemotherapy received in most cases who received either adjuvant or neoadjuvant CCRT. Recurrence occurred in (81%) of cases. Conclusion: Chemotherapy regimen FOLFOX was received in most cases. Patients received at least one line of chemotherapy with either adjuvant or palliative intent, FOLFOX was the most chosen protocol. Xeloda was the most common chemotherapy received in most casesPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Studies on the Effect of Aqueous Green Tea Extract on Lipid Profile and Vascular Reactivity in Hypercholesterolemic Albino Rats1958196612347710.21608/ejhm.2020.123477ENMohammed Hassan El-BakryDepartment of Pharmacology, Faculty of Medicine, Al-Azhar University, Assiut, EgyptRamadan Hassan IbrahimDepartment of Pharmacology, Faculty of Medicine, Al-Azhar University, Assiut, EgyptEl-Shazly Abdelaal MohasebDepartment of Pharmacology, Faculty of Medicine, Al-Azhar University, Assiut, EgyptJournal Article20201116Background: Hypercholesterolemia is one of the most important risk factors for atherosclerosis and subsequent cardiovascular disease (CVD). CVD is the leading cause of cardiovascular morbidity and mortality worldwide, currently, there is a major trend to use herbal remedies for the treatment and prevention of hypercholesterolemia. Objective: In the present work, we investigated the effect of aqueous green tea extract on lipid profile and vascular reactivity & changes in body weight in hypercholesterolemic albino rats Materials and methods: Adult male albino rats were chosen as an animal model for this study. Rats were brought from animal house, Faculty of Medicine, Assiut University, Assiut, Egypt, and were maintained on a balanced diet with water supply freely in clean containers. They were kept for two weeks to adapt to the laboratory conditions before the start of the experiment. Forty age-matched male albino rats with initial body weights ranging from 200 to 220g were used. Results: In group (III & IV), total cholesterol, LDL, and triglyceride levels were significantly decreased respectively& HDL were significantly increased compared with the group II (p < 0.05). also in group (III & IV) the aortic contractility is decreased and aortic relaxation were significantly increased compared with the group II (p < 0.05) & body weight was decreased significantly (p < 0.05) in group IV compared with the group II. Conclusion: The results obtained by the present study showed that administration of aqueous green tea extract to the hypercholsterolemic rats has a role in improvement of plasma lipids, vascular reactivity& body weight.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Purine Nucleoside Phosphorylase (PNP) Deficiency: A Case Report1967196912348010.21608/ejhm.2020.123480ENRawia AlbarAlaa AlesaDina SaqaJamanah AbdulazizMohammad BatoukAbdullah AlesaJournal Article20201116Background: Purine nucleoside phosphorylase (PNP) deficiency is a rare genetic disease that results in combined immunodeficiency. Its inheritance is autosomal recessive and affects the purine metabolic pathway. There is a profound effect on T-cells and variable B-cell dysfunction. There is a strong association with neurological dysfunction in as many as two thirds of cases and autoimmunity in one third. When PNP activity is absent or greatly diminished, deoxyguanosine triphosphate (dGTP) is believed to accumulate in the mitochondria, which inhibits ribonucleotide reductase and mitochondrial DNA repair. This is very harmful to T lymphocytes and leads to DNA damage and apoptosis during thymus selection. Case: A toddler girl diagnosed with PNP) deficiency that is currently being managed using different type of modalities with good response. Results: The patient was admitted in an outside hospital when she developed fever for 4 days along with a perianal abscess. Septic shock was suspected, and she was initially started on gentamycin and tazocin then switched to vancomycin, mereponem and metrodinazole. After resolution of fever, the patient was transferred to our tertiary care center to undergo immunology work up. Upon finally receiving the patient she was stable and afebrile, however there was severe neutropenia and leukopenia. A multidisciplinary team, which included general pediatrics, hematology, Infectious diseases and immunology, handled her case. Furthermore, the patient was switched back to tazocin and gentamycin and completed 14 days with good response and full resolution of fever. Following the multidisciplinary team plan, an immunology/hematology work up was initiated. Conclusion: After 14 days of treatment, there was a good response and resolution of fever. Then, a multidisciplinary team plan, an immunology/hematology work up was initiated. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Anandamide Level in Men with Oligoasthenoteratozoospermia1970197612348210.21608/ejhm.2020.123482ENMoustafa A El TaiebAbdallah Mahmoud A AliMona H SedeekAya AA HusseinJournal Article20201116Background: Male infertility is a relatively common medical condition. Male partners are found to be solely responsible for 20–30% of infertility cases. Oligoasthenoteratozoospermia (OAT) is the most common laboratory finding in infertile men. Endocannabinoids are endogenously produced substances, that primarily act at cannabinoid receptors (CBRs), thus reproducing some of the biological actions of the natural cannabis sativa components (the “cannabinoids”). The endocannabinoid system is involved in several physiological processes, including fertility and body weight control. Objective: The aim of this study was to detect the level of anandamide (AEA) in patients with OAT and its relation to BMI. Patients and methods: This study was a case control study. It was hold between June 2018 to April 2019 in the Dermatology, Venereology and Andrology Department at Aswan University Hospital. The study included 20 patients with OAT and 9 as controls. Semen analysis using CASA was done. AEA level in seminal plasma was measured using ELISA kits. BMI was calculated. Results: AEA level in seminal plasma significantly decreased in men with ligoasthenoterat- ozoospermia than control (P < 0.009). AEA concentration on seminal fluid was significantly increased with an increase in BMI (P= 0.023). On the other hand, a significant negative relationship was present between BMI and semen volume (P= 0.03). Conclusion: AEA concentration in seminal plasma was significantly decreased in patients with OAT. AEA concentration in seminal fluid was significantly increased with an increase in BMI. On the other hand, a significant negative relationship was present between BMI and semen volume.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Femoral Cartilage Thickness and Vitamin D Level in Systemic Sclerosis Patients and Relation to Disease Severity1977198412348310.21608/ejhm.2020.123483ENMohammed Abd El Monem TeamaInternal Medicine Department, Division of Rheumatology and Immunology, Faculty of Medicine,
Ain Shams University, Cairo, EgyptHanan Mohamed FaroukInternal Medicine Department, Division of Rheumatology and Immunology, Faculty of Medicine,
Ain Shams University, Cairo, EgyptSafaa A. HusseinInternal Medicine Department, Division of Rheumatology and Immunology, Faculty of Medicine,
Ain Shams University, Cairo, EgyptFatma Mohammed BadrInternal Medicine Department, Division of Rheumatology and Immunology, Faculty of Medicine,
Ain Shams University, Cairo, EgyptJournal Article20201116Background: Systemic sclerosis (SSc) is a heterogeneous autoimmune disorder associated with vascular dysfunction and fibrotic changes. Low vitamin D levels and decreased femoral cartilage thickness (FCT) have been observed in SSc. Objectives: This study aimed to evaluate the relation between serum level of vitamin D and FCT among SSc patients and to correlate both with clinical features and disease severity score. Patients and Methods: This study included 40 SSc patients, divided into 2 groups; group 1: sufficient vitamin D (level > 30 ng/ml), group 2: insufficient vitamin D (level < 30 ng/ml). All patients were subjected to history taking, clinical examination, and assessment of disease severity by Medsger Disease Severity Index (MDSI), laboratory investigations, 25 (OH) vitamin D level and musculoskeletal ultrasound of both knees to assess FCT. Three midpoint measurements of FCT were taken from each knee: lateral femoral condyle (LFC), femoral intercondylar area (ICA) and medial femoral condyle (MFC). Results: Thin FCT was found in 60% of patients. There was insufficient vitamin D level in 65% of patients. Age was negatively correlated with FCT at right MFC area and female parity was also negatively correlated with right ICA and MFC areas. FCT was significantly lower in group 1 at areas of left MFC and LFC areas, but no relation between femoral cartilage thickness and vitamin D level with disease severity. Conclusion: There is significant relation between femoral cartilage thickness and vitamin D level in scleroderma patients, both decline in SSc patients but not related to disease severity score.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Factors Affecting Employment in Maintenance Hemodialysis Patients in Egypt1985199212348410.21608/ejhm.2020.123484ENMagdy El-SharkawyDepartment of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, EgyptYahya MakkeyahDepartment of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, EgyptDoaa ElwaslyDepartment of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20201116Background: Most of hemodialysis patients are unemployed and the few who are working are at risk of losing their jobs. Therefore, factors affecting employment need to be studied. Objective: Our aim was to access factors affecting employment among working-age patients on hemodialysis all over Egypt as it was not assessed before. Patients and Methods: This study was conducted between October 2012 and April 2015 in multiple hemodialysis centers by direct interview of the patients and collecting the data from the medical record in a special data collection sheet. Results: The study was conducted on 16280 hemodialysis patients in 19 Egyptian governorates. 21.2% of the patients were employed, 81.6% of the employed patients were men, and their mean age was 47.25+11.31. Hypertension was the most common etiology of end-stage renal disease (ESRD) and was the commonest comorbidity in employed patients. Employment was affected by age, gender, ESRD etiology and most comorbid conditions apart from comorbid chronic liver disease and chronic obstructive pulmonary disease. Factors affecting employment was dialysis frequency, duration, complications, dialyzer type, material, and surface area, dialysate type, dialysate Na, K and vascular access, haemoglobin (Hb) level, Ca/PO4 ratio, parathormone (PTH), iron injection, blood transfusion, erythropoietin intake, vitamin B complex intake, L carnitine intake, phosphate binders, cinacalcet and folic acid intake while Kt/v and urea reduction ratio and vitamin D supplements did not affect employment. Conclusion: Similar to the other studies we found that employment was not common among hemodialysis patients, which was affected by age, gender, ESRD etiology and comorbidities apart from chronic obstructive pulmonary disease (COPD) and chronic liver disease (CLD) which differed from other studies. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Serum Golgi Protein 73 as a Biomarker for Liver Fibrosis in Chronic Hepatitis C Patients1993200012477210.21608/ejhm.2020.124772ENHala A Abdel-AzeezDepartment of Clinical Pathology, Faculty of Medicine, Zagazig UniversitySamar M SharafDepartment of Clinical Pathology, Faculty of Medicine, Zagazig UniversityEman A ElshamyDepartment of Tropical Medicine, Faculty of Medicine, Zagazig UniversityAbeer A FikryDepartment of Clinical Pathology, Faculty of Medicine, Zagazig UniversityJournal Article20201122Background: Serum Golgi protein 73 (GP73) is a promising biomarker of liver fibrosis, but most data are from hepatitis B virus-related liver diseases rather than hepatitis C virus (HCV). Objective: To evaluate the use of GP73 as a marker for liver fibrosis in chronic HCV patients and to correlate it with fibrosis staging of liver biopsy and other laboratory findings. Subjects and Methods: The study included 37 chronic HCV patients who were subdivided according to liver biopsy results into chronic HCV patients without fibrosis (10) and chronic HCV patients with fibrosis (27). 37 healthy individuals were taken as control. All participants were subjected to determination of liver function tests with calculation of AST-to-Platelet Ratio Index (APRI) and serum GP73 by ELISA. Results: GP73 was significantly increased in chronic HCV patients with fibrosis when compared to patients without fibrosis and healthy control. A significant positive correlation was observed between GP73 and advanced liver function tests, increased fibrosis stage and APRI in chronic HCV patients with fibrosis. Based on receiver operating characteristic (ROC) curve analysis, GP73 had an area under curve (AUC) of 0.909 with 81.8% sensitivity and 93.3% specificity for prediction of significant fibrosis. On combination with APRI, the sensitivity was increased to 90.9%. Conclusion: GP73 can be used as serum marker for prediction of significant liver fibrosis in chronic HCV patients either alone or in combination with APRI. It can be also useful in monitoring fibrosis progression.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Clinical Outcomes of Upper Gastrointestinal Bleeding in Egyptian Patients with Decompensated Liver Cirrhosis, Does the Bleeding Source Matter?2001200512477410.21608/ejhm.2020.124774ENMohamed S MohamedInternal Medicine Department, Faculty of Medicine, Zagazig UniversityMohamed G HamedInternal Medicine Department, Faculty of Medicine, Zagazig UniversityAmr S HanafyInternal Medicine Department, Faculty of Medicine, Zagazig UniversityMohamed AA BassionyInternal Medicine Department, Faculty of Medicine, Zagazig UniversityJournal Article20201122Background: Upper gastrointestinal bleeding (UGIB) is a prevalent emergency and mortality cause in cirrhotic patients. It prolongs the hospital length of stay (LOS) and increases hospital readmission. Objectives: We investigated the clinical outcomes of acute variceal bleeding (AVB) and non-variceal bleeding (NVB) in patients with decompensated cirrhosis and the possible risk factors for prolonged hospital LOS. Patients and Methods: All patients with decompensated liver cirrhosis and UGIB (AVB & NVB) hospitalized from August 2018 to March 2019 were enrolled in this study. We assessed mortality rate, the hospital LOS and hospital readmission rate along with the probable risk factors associated with prolonged hospital LOS. Results: Our study included 582 patients with decompensated liver cirrhosis, 367 patients had AVB and 215 patients had NVB. There was no significant difference in mortality rate between both groups (11.4% vs. 9.3%, P= 0.43). The hospital LOS in AVB patients was longer than that in NVB group (5.8 ± 2.2 vs. 4.3 ± 1.8, p=0.001). Rate of hospital re-admission within 30 days was significantly higher in the AVB group (27%) compared to NVB group (18%). Inhospital re-bleeding and the need for repeated endoscopy were also higher in AVB patients (20%) than in NVB patients (12%). Risk factors for prolonged hospital LOS were development of hepatic encephalopathy, spontaneous bacterial peritonitis (SBP), in-hospital re-bleeding, Child C score and higher Model for end-stage liver disease (MELD) score. Conclusion: Patients with decompensated cirrhosis and AVB have longer hospital LOS and re-hospitalization rate than those with NVB with no significant difference in mortality rate between both groups.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Immunohistochemical Nucleocytoplasmic Localization of Light Chain3 in the Keratinocytes of Psoriatic Skin2006201112478010.21608/ejhm.2020.124780ENRehab Monir SamakaDepartment of Pathology, Faculty of Medicine, Menoufia University, Menoufia, EgyptAlaa Hasan MaraeDepartment of Dermatology, Andrology & STDs, Faculty of Medicine,
Menoufia University, Menoufia, EgyptManar Ali FariedDermatologists, Menoufia Governorate, EgyptJournal Article20201122Background: Light chain3 is a sensitive autophagy-related protein distributed within the mammalian tissues. The role of LC3 localization in psoriasis pathogenesis is still poorly understood. Objective: This study aimed to investigate, for the first time up to our knowledge, the localization of Light chain3 (LC3) in the keratinocytes of psoriatic skin by immunohistochemical study. Materials and methods: This prospective case case-control study was carried out on 30 patients presented with chronic plaque psoriasis versus 30 age and gender-matched apparently healthy volunteers. Clinical data were collected and Psoriasis Area and Severity Index (PASI) was assessed. From all controls and cases (lesional and perilesional), skin biopsies were taken and the epidermis was assessed for histopathological changes and LC3 immunoreaction. Results: There was a highly significant difference (P<0.001) between the control skin and psoriatic skin (lesional and perilesional) regarding the epidermal LC3 localization. Nucleocytoplasmic LC3 localization was dominant in lesional skin specimens. Conclusion: Nucleocytoplasmic localization of LC3 in the keratinocytes of the psoriatic skin might play a pivotal role in psoriasis pathogenesis. This can open a new gate for target therapy in psoriasis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Outcome of Direct Acting Antiviral Drugs (DAADs) for Hepatitis C Virus (HCV) in the Setting of Chronic Kidney Disease (CKD) in Upper Egypt2012201512478310.21608/ejhm.2020.124783ENIman Ibrahim SarhanDepartment of Nephrology, Faculty of Medicine-Ain Shams UniversityMohamed Mostafa AliDepartment of Nephrology, Faculty of Medicine-Ain Shams UniversityAhmed Abd Elmonem HassanDepartment of Nephrology, Faculty of Medicine-Ain Shams UniversityMostafa Abd Elnasier Abd ElgawadDepartment of Nephrology, Faculty of Medicine-Ain Shams UniversityJournal Article20201122Background: The frequency of hepatitis C virus (HCV) infection remains high in patients with CKD and plays a detrimental role in mortality in this population, and patients undergoing maintenance dialysis are still at risk of developing HCV infection and HCV disease prevalence of anti-hepatitis C virus (HCV) patients who undergo longterm dialysis are significantly greater than those with normal kidney function. Objectives: The aim of the study was to assess outcomes (efficacy, side effects, and possible complications) of DAADs for HCV in presence of CKD. Subjects and methods: this was retrospective cohort study that was conducted at Aswan Fever Hospital and Luxor Fever Hospital for anti HCV therapy between Jan 2018 and July 2018 including 60 patients recruited from both hospitals with all stages of CKD and were receiving DAADs. Results: the results revealed that PC (%) in patients from Aswan ranged between 61-100 with mean ±S.D. 83.09±9.258 while in patients from Luxor it ranged between 66-100 with mean ±S.D. 84.95±6.764. There was no statistically significant difference between groups (P=0.458). HCV PCR in all patients from Aswan at baseline were positive while after 3 months 27 (90%) were negative and 3 (10%) were positive and after 6 months all patients were negative while in patients from Luxor they all were positive while after 3 months 28 (93.3%) were negative and 2 (6.7%) were positive and after 6 months all patients were negative. There was no statistically significant difference between groups. Conclusion: Treatment with newer DAAs is effective and safe for the treatment of HCV-infected chronic kidney disease patients.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Assessment of Right Liver Lobe Size / Serum Albumin Ratio as a New Non-Invasive Predictor for the Presence of Oesophageal Varices in Egyptian Patients with HCV Related Liver Cirrhosis2016202512479310.21608/ejhm.2020.124793ENEmad Ahmad AwadDepartment of Internal Medicine, Gastroenterology and Hepatology, Faculty of Medicine,
Ain Shams University, Cairo, EgyptWael Ahmed YousryDepartment of Internal Medicine, Gastroenterology and Hepatology, Faculty of Medicine,
Ain Shams University, Cairo, EgyptHasan Mokhtar HasanDepartment of Internal Medicine, Gastroenterology and Hepatology, Faculty of Medicine,
Ain Shams University, Cairo, EgyptAhmed Mohamed ElGhandourDepartment of Internal Medicine, Gastroenterology and Hepatology, Faculty of Medicine,
Ain Shams University, Cairo, EgyptJournal Article20201122<span>Background: </span><span>Oesophageal varices are the most critical porto-systemic shunts that develop secondary to portal hypertension, which is considered the main complication of liver cirrhosis. Many studies recommend the screening of all cirrhotic patients by endoscopy, but repeated endoscopic examinations are unpleasant for patients and have a high- cost impact and burden on endoscopic units. </span><span>Objective: </span><span>This study aimed to evaluate the accuracy of using the right liver lobe size/serum albumin ratio as a non-invasive predictor of esophageal varices in patients with HCV-related liver cirrhosis. </span><span>Patients Methods: </span><span>This prospective study included 30 patients with liver cirrhosis and 30 patients who underwent upper gastrointestinal endoscopy for any causes other than liver cirrhosis. All studied subjects underwent a detailed history and clinical examination, biochemical workup, upper gastrointestinal endoscopy, and abdominal ultrasound. The right liver lobe/serum albumin ratio was calculated for all patients.<br /> </span><span>Results: </span><span>There was a statistically significant difference between the control and the study subgroups as regards the Right lobe of the Liver/Albumin ratio (p-value 0.007). The diagnostic accuracy of the Right lobe of the Liver/Albumin ratio was assessed using the ROC curve which revealed a sensitivity of 86.67% and specificity of 73.33% at cut-off value >3.88, with an acceptable discriminative accuracy of 79.9%.<br /> </span><span>Conclusion: </span><span>The use of Right liver lobe/serum albumin ratio can help physicians by restricting the use of endoscopic screening only to patients presenting a high probability of esophageal varices. This is especially useful in clinical settings where resources are limited, and endoscopic facilities are not present in all areas.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001The Stress Hormone Copeptin as a Prognostic Biomarker in Acute Illness2026202912479810.21608/ejhm.2020.124798ENRaef Malak BotrosDepartment of Internal Medicine & Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, EgyptMaram Mohamed MaherDepartment of Internal Medicine & Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, EgyptRahma Khaled El ShaerDepartment of Internal Medicine & Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, EgyptHanan Mahmoud AliDepartment of Internal Medicine & Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20201122<span>Background: </span>
<span>Copeptin has been evaluated as biomarker for several illnesses such as cerebrovascular stroke, heart </span>failure, showing a promising role mainly as a prognostic biomarker. Copeptin levels seem to be strongly related to short, mid, and long-term mortality in patients admitted to hospital showing that copeptin could be a valuable prognostic tool in the most frequent disease entities.
<span>Objective: </span><span>The aim of the current study was </span><span>t</span><span>o study the level of copeptin as a prognostic biomarker in acute illness. </span>
<span>Patients and Methods: </span>This study included a total of 64 patients with acute deterioration of their chronic illness as chronic liver diseases (most of them were child C on Child-Pugh score), COPD (admitted with infective exacerbation), cerebrovascular stroke and Decompensate heart failure and 20 controls, attending at emergency room, Ain Shames University Hospital.
<span>Results: </span><span>Serum copeptin levels have positive correlation with longer duration of hospitalization, the higher the copeptin level the more length of hospital stay (r= 0.264</span><span>* </span><span>p= 0.035). There was highly statistically significant difference between copeptin level and survival rate, </span><span>copeptin concentrations were significantly higher in non- survivors than in survivors </span><span>(p=0.000).The mean of copeptin level among patient who died was 500 ) pmol/L with range of 70 to 750 pmol/L, while the mean of copeptin level among survivors was 60 pmol/L with range of 20-600 pmol/L.<br /> </span><span>Conclusion: </span><span>It could be concluded that copeptin has a role in prognosis of mortality and morbidity of hospitalized patients and high copeptin level significantly associated with a longer hospital stay and a poor outcome of hospital admission.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Vitamin D Levels in Full-Term Neonates with Indirect Hyperbilirubinemia2030203512480010.21608/ejhm.2020.124800ENNeveen T. AbedDepartment of Pediatrics, Faculty of Medicine, Benha University, EgyptFarida F. NegmDepartment of Pediatrics, Faculty of Medicine, Benha University, EgyptEnas S. AhmadDepartment of Clinical and Chemical Pathology, Faculty of Medicine, Benha University, EgyptHeba A. MohammedDepartment of Pediatrics, Faculty of Medicine, Benha University, EgyptJournal Article20201122<span>Background: </span><span>Jaundice is a common clinical sign in neonatal medicine. Considering the different roles of vitamin D, its lower level may be correlated with neonatal jaundice. </span><span>Objectives: </span><span>This study aimed to demonstrate the relationship between serum vitamin D level and neonatal hyperbilirubinemia and to measure its level in their mothers. </span><span>Subjects and methods: </span><span>This case-control study was conducted on 90 neonates and their mothers, 60 neonates with hyperbilirubinemia in patients group and 30 healthy neonates age and sex matched in control group < /span><span>. </span><span>Blood samples from neonates and their mothers were obtained and sent for laboratory estimation of 25-hydroxy vitamin D, calcium, magnesium, phosphorus, alkaline phosphatase and parathyroid hormone. </span><span>Results: </span><span>There is highly significant decrease of vitamin D levels among patients than controls, significant negative correlation between vitamin D levels and serum bilirubin in neonates and no significant difference regarding different laboratory parameters among their mothers. </span><span>Conclusion: </span><span>Decreased levels of vitamin D were significantly correlated with neonatal indirect hyperbilirubinemia so, low vitamin D can be included among risk factors for neonatal jaundice.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Short-Term Results of Patient Specific Instruments (PSI) – Total Knee Replacement (TKR)2036204512480310.21608/ejhm.2020.124803ENMohamed Mosa Mohamed MahmoudDepartment of Orthopaedic and Trauma Surgery, Faculty of Medicine, Al Azhar University, Assiut BranchAmr Abdelhalem AmrDepartment of Orthopaedic and Trauma Surgery, Faculty of Medicine, Al Azhar University, Assiut BranchMA HafezDepartment of Orthopaedic and Trauma Surgery, Faculty of Medicine, 6 October UniversityJournal Article20201122<span>Background: </span><span>TKR is an effective treatment for severely arthritic knees. PSI TKR is a recent technique, which relies on preoperative formulation of specific instruments for every patient preoperatively, aiming at decreasing surgical time and instruments and increasing accuracy and functional outcome. </span><span>Objective: </span><span>Assessment of functional and radiological outcome of PSI TKR after a period of 3 years duration. </span><span>Patients and Methods: </span><span>40 TKRs in 24 patients were done using CT-based PSI technique. Pre-and postoperative knee society score (KSS) were measured and digital long-leg X-rays were obtained for all patients. Hip-knee-ankle, proximal tibia land lateral distal femoral angles together with mechanical axis deviation were measured for all patients to assess the mechanical axis alignment after TKR. </span><span>Results: </span><span>HKA (hip knee ankle) has decreased from 4.70 varus preoperatively to 1.27 varus. The mean knee society score had markedly increased from 31.2 preoperatively to 85.3 with fair to excellent KSS was 95% after 3 years duration. </span><span>Conclusion: </span><span>PSI TKR is an effective technique in knee replacement as conventional method. With the advantages of reduction of the operative steps and concurrent potential complications.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Changes in Fetal and Uteroplacental Doppler Waveforms After Antenatal Dexamethasone Administration in Women at Risk of Spontaneous Preterm Birth2046205312487210.21608/ejhm.2020.124872ENMohamed Elsibai AnterObstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, EgyptAyman Abd Elkader ShabanaObstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, EgyptSally Mohamed Ali BadrObstetrics and gynecology department, El-Bagour general Hospital, Menoufia, EgyptNehad Mahmoud HosenyObstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, EgyptJournal Article20201122<span>Background: </span><span>Early detection of fetal risk is one of the main issues in today's obstetrics. Ultrasound diagnosis plays a significant role, as the introduction of the Doppler imaging method in the evaluation of blood flow has enabled non- invasive assessment of uteroplacental circulation.<br /> </span><span>Objective: </span><span>To assess the impact of maternal dexamethasone on doppler waveforms velocity flow of the fetal umbilical and middle cerebral arteries and maternal uterine arteries in pregnant women at risk of preterm labor with normal fetal vascular resistance. </span>
<span>Patients and methods: </span><span>This cross-sectional study was conducted at the Department of Obstetrics and Gynecology at Menoufia University hospital on 36 patients who were diagnosed as having threatened preterm birth. All the patients were enrolled in the study with routine follow up according to local protocols in the period between January 2019 and November 2019. Full history taking, full general, obstetric examination, and Ultrasound examination was performed. </span>
<span>Results: </span><span>After dexamethasone administration, Umbilical A resistive and Pulsatility indexes were significantly decreased to (1.084 ± 0.118 and 0.66 ± 0.054) in comparison to before dexamethasone (1.121±0.124 and 0.70±0.058). Regarding the Uterine Doppler values, mean Pulsatility index before dexamethasone was 0.79±0.049 (right) and 0.78 ±0.038 (left) decreased significantly to 0.78±0.044 (right) and 0.77±0.036 (left) after dexamethasone. Similarly, the mean Resistive index before dexamethasone was 0.55±0.027 (right) and 0.54±0.026 (left) decreased significantly to 0.53±0.023 (for right and left) after dexamethasone. </span>
<span>Conclusions: </span><span>dexamethasone administration for the pregnant mothers at risk of preterm labor enhance the flow of blood to the fetal umbilical, middle cerebral arteries and maternal uterine arteries 24 hrs. after its administration.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Physiotherapy is A New Line in Management of Chronic Pelvic Inflammatory Diseases2054205612487310.21608/ejhm.2020.124873ENDalia Ibrahim MorsiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, EgyptAhmed Mohammed NofalDepartment of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, EgyptJournal Article20201122<span>Background: </span><span>Pelvic inflammatory disease (PID) is an inflammatory condition of the upper female genital tract. Chronic PID include both residue of acute and subacute attack of infection. Generally shortwave diathermy (SWD) is used to decrease pain and edema, thus improves the inflammatory reaction and accelerates the healing of the chronically inflamed tissues. </span><span>Objective: </span><span>To evaluate the therapeutic efficacy of shortwave diathermy in the management of chronic PID. </span><span>Materials and methods: </span><span>80 patients with chronic PID for more than 6 months diagnosed by thorough history, clinical examination and cervical swabs. Patients were divided into two groups: First group (group 1): patients received both medical treatment and shortwave diathermy. Second group (group 2): patients received only medical treatment. </span><span>Results </span><span>There was a statistically highly significant improvement of clinical and laboratory manifestations in the first group of patients compared to the baseline and compared to the second group.<br /> </span><span>Conclusion </span><span>shortwave diathermy has a fair therapeutic efficacy in the treatment of chronic PID.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Incidence of Atrial Fibrillation in Hemodialysis Patients2057206212639910.21608/ejhm.2020.126399ENMohamed El-Tayeb NasserDepartment of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, EgyptAdham Ahmed Abdel TawabDepartment of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptRaafat Boshra MehanyDepartment of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, EgyptMostafa Abd El-Nassier Abd El-GawadDepartment of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20201129Background: Chronic kidney disease patients usually experience several comorbid conditions including cardiovascular disorders and at final end-stage renal disease (ESRD) stage, cardiovascular mortality accounts for about 50% of total mortality. End-stage renal disease (ESRD) patients commonly have a higher risk of developing cardiovascular diseases than general population. Objective: The aim of the work was to detect the incidence of atrial fibrillation (AF) in hemodialysis patients for six months. Patients and Methods: The study was a prospective cohort study for six months included 250 adult patients with end stage renal diseases on regular hemodialysis sessions in National Institute of Urology and Nephrology in Cairo, Egypt for at least six months with no past history suggestive of any arrhythmias and normal holter ECG at the start of the study. Results: The study included 250 patients, of them 37 patients refuse follow up after 6 months and 18 patients were died before our follow up holter ECG so mortality rate 14.4%. For the current study population, there were 102 male patients (52.3%) and 93 female patients (47.7%) with mean age 54.39 ± 9.98 (19:73) and BMI 29.01±1.28 (24.5:34). In study population 96 patients were diabetic (49.2%), 84 patients were hypertensive (43.1%), 100 patients were with ischemic heart diseases (51.3%) with median renal replacement duration 4 (3 – 6) with range (1 – 13). The main etiological causes of dialysis were diabetes mellitus, hypertension and analgesic nephropathy and other different causes of dialysis 35 patients (45%).The study showed association between incidence of AF in hemodialysis patients and different factors as increased BMI (0.006), prolonged duration of renal replacement therapy (0.017), diabetes mellitus (0.005), hypertension (0.000), ischemic heart diseases (0.02) and left atrium dilation (0.000). Conclusion: It could be concluded that the incidence of AF in patients with ESRD is 16.4% .The risk factors for increased incidence of AF in hemodialysis are; increased BMI, increased duration of renal replacement therapy, hypertension, diabetes mellitus, ischemic heart diseases and left atrium dilation by echocardiography.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001The Effect of Adding Kinesio Tape to Mulligan's Mobilization in Patients with A Cervicogenic Headache2063206812640010.21608/ejhm.2020.126400ENLamyaa Ahmed NeyaziDepartment of Physical Therapy, International Institute of Cancer, Cairo UniversityNadia Abdelzim FayazDepartment of
Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo
UniversitySamah Saad Almoogy ZahranDepartment of
Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo
UniversityAhmed Hamdi AzzamDepartment of Orthopedic Surgeries, Faculty of Medicine, Cairo University, EgyptJournal Article20201129Background: Cervicogenic headache is a major problem in many people suffering from upper cervical dysfunction with a great conflict in its physical therapy management. Objective: The aim of the work was to determine the effect of Adding Kinesio Tape To Mulligan's Mobilization in patients with a cervicogenic headache. Patients and methods: Fifty four patients with cervicogenic headache included in the study; from outpatient clinic, Faculty of physical therapy, Cairo University Hospital (Kasr El Ainy), were randomly assigned into two equal groups ; group A (Kinesiotaping and mulligan techniques), Group B (mulligan techniques). Their mean ± SD age, weight, height and BMI were 37.74±5.55 years, 80.62±6.27 kg, 170.11±5.5 cm and 27.48±2.73 kg/m² respectively. The visual analogue scale (VAS) is used for measuring intensity of cervicogenic headache. Frequency and duration of cervicogenic headache are collected from subjective data of patients. Correlations between the examined parameters were also measured. Kinesiotaping application with mulligan SNAGs were companied in group A and mulligan SNAGs done only in group B. Results: There was significant improvement of VAS outcome scores and frequency and duration of cervicogenic headache in Group (A) more than Group (B). Conclusion: It could be concluded that adding kinesio tape to mulligan's mobilization in patients with a cervicogenic headache is found to be an effective in treatment of cervicogenic headache.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001A Case Report of Cesarean Scar Site Endometriosis: Diagnosis and Management2069207012640310.21608/ejhm.2020.126403ENMedhat Monir K FadelDepartment of Reproductive Health and Family Planning, National Research InstituteMariam Sherif S ZakiDepartment of
Occupational and Environmental health, Benha University, Qalyubia, EgyptJournal Article20201129Endometriosis is a frequent clinical problem in women of reproductive age, which means the presence and proliferation of endometrial glands and stroma outside the uterus, the most common site of endometriosis is in the pelvic cavity, extra pelvic endometriosis as on the surgical scar (as caesarean section, laparoscopic incision, episiotomy, and hysterectomy scars) which is relatively rare, it is clinically presented by chronic pelvic pain, dysmenorrhea, dyspareunia, subfertility, infertility, and poor both maternal & fetal outcomes and even stillbirth. Caesarean section endometriosis is presented with cyclic pain and bleeding from the scar site. Our 33- year case presented with a scar site endometriosis after the third Cesarean section. MRI was done to exclude uterine fistula and a definite diagnosis has been made by histopathology. Management involved different modalities of treatment including medical management, Mirena coil insertion. However, the definite treatment was surgical excision of the endometriotic lesion and reclosure of the skin incision.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Assessment of Serum (YKL-40) As an Early Diagnostic Marker of Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus2071207712640410.21608/ejhm.2020.126404ENMohamad Ahmed ShaabanMohamad Abd El-raoof KoranyRania Mohamad Azmy El-ShazlyMohammad Ali Nasr IbrahemKfr Elshiekh Liver Centre, Kfr Elshiekh-Egypt.Journal Article20201129Background: YKL-40 is an inflammatory marker, a positive association between elevated circulating YKL-40 levels and increasing levels of albuminuria, which have been described in patients with type 1 and type 2 diabetes indicating a role of YKL-40 in the progressing vascular damage resulting in microvascular disease. Objectives: To assess serum YKL-40 as an early diagnostic marker of diabetic nephropathy in type 2 diabetes mellitus. Patients and Methods: 70 patients with type 2 diabetes mellitus (46 males and 24 females) were included in this study, another 19 healthy volunteers (12 males and 7 females) were chosen as a control group (group I). Patients were further classified according to their Albumin/creatinine ratio into three groups: group II; Diabetic normoalbuminuric, group III; Diabetic microalbuminuric and group IV; Diabetic macroalbuminuric. All subjects (patients and controls) participating in the study were subjected to full history and clinical examination and routine laboratory investigations and also specific laboratory investigations include glycated hemoglobin (HbA1c), urine creatinine, microalbumin, albumin creatinine ratio, and serum YKL 40. Results: The present study showed that serum YKL-40 significantly increased in diabetic patients than in the control group. In addition, there was a significant increase of YKL-40 in the macroalbuminuric group compared to the normoalbuminuric group and microalbuminuric group and a significant increase of YKL-40 in a microalbuminuric group compared to the normoalbuminuric group. Conclusion: The serum levels of YKL-40 in type 2 DM were significantly higher than in normal patients, and its level increased with increasing urinary albumin excretion rate.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Mirabegrone versus Solifenacine in Treatment of Overactive Bladder in Female Patients in Zagazig University Hospitals2078208312640610.21608/ejhm.2020.126406ENAbd Allah Mohammed SalemDepartment of Urology, Faculty of Medicine - Sert University, LibyaOsama Mostafa KamhawyDepartment of Urology, Faculty of Medicine – Zagazig University, EgyptEmad Abd Elhamid SalemDepartment of Urology, Faculty of Medicine – Zagazig University, EgyptIbrahim Ismail ElsayedDepartment of Urology, Faculty of Medicine – Zagazig University, EgyptJournal Article20201129Background: Overactive bladder (OAB) syndrome, consisting of urgency, with or without urgency incontinence, often with frequency (voiding more than eight times in a 24- h period) and nocturia (need to wake up one or more times per night for urination), is a highly prevalent disorder with a significant impact on quality of life (QoL). Objective: To evaluate the safety and efficacy of mirabegron 50 mg in comparison to solifenacin 5 mg in the treatment of female patients suffering from overactive bladder symptoms. Patients and Methods: This prospective randomized study was conducted in Zagazig University Hospitals during the period From November 2018 to April 2019. Thirty consecutive female patients aged from 18 to 65 years old were included in this study. Results: Mirabegrone significantly was associated with hypertension only in one case, and Solifenacine significantly was associated with blurred vision, constipation and dry mouth. Comparison between mirabegron and solifenacin group according to day and night frequency, urge and urge incontinence pretreatment showed that there was no significant difference between both groups. Comparison between mirabegron and solifenacin groups according to day and night frequency, urge and urge incontinence after taking mirabegrone or solifenacin showed that mirabegron group was significantly lower as regards day and night frequency also in urgency and urgency incontinence post treatment. Conclusions: Solifenacin and mirabegron were effective in improving over active bladder symptoms. Mirabegron showed greater tolerability with fewer patients discontinuing therapy because of side effects. mirabegron can be considered as the drug with the better balance between efficacy and tolerability in the treatment of OAB.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Study of The Effect of Nutrition and Glycemic Control and on IGF-1 and Growth in Pre-pubertal Egyptian Children with T1DM2084208712640710.21608/ejhm.2020.126407ENRaef Malak BotrosAliaa Ahmed Abdo El-SherbeenyNancy Samir El BarbaryAla Muhammed MuhammedHanan Mahmoud AliJournal Article20201129Background: Pre-Pubertal children who have T1DM are shorter than their non-diabetic peers. Objective: In the current study we aimed to evaluate the role of HbA1c and IGF-1 in these cases. Patients and Methods: The present study was a cross-sectional study conducted on 80 pre-pubertal Egyptian children: 30 males, 30 females with T1DM and 20 age-matched controls (10 males and 10 females), the participants were recruited from the Outpatient Clinic of the Pediatric Department of Ain Shams University Hospitals and the National Institute of Diabetes and Endocrinology in Cairo, Egypt during the period from July 2018 to January 2019. Results: The height and weight percentiles were found to be lower in type 1 diabetic children when compared to the controls with median values of 14.50 (IQR 27.98) in male patients, 17.95 (IQR 29.18) in female patients, and 87 (IQR 20.58) in the controls. A negative correlation between serum IGF-1 and HbA1c as well as the height and weight percentiles were found with (P = 0.014, 0.009, and 0.05 respectively). Serum IGF-1 levels were also found to be significantly lower in patients (P <0.001) with a mean value of (77.60 ± 69.377) in male patients and (64.0 ± 29.402) in female patients and (201.0 ± 102.798) in the controls. HbA1c was also found to be negatively correlated with height percentile (P = 0.012). Conclusion: The glycemic control tested by HbA1c is an important indicator of linear growth in pre-pubertal children, Height, and weight percentiles were found to be lower in type 1 diabetic patients when compared to the healthy controls (P < 0.001) in both cases.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Optical Biometry Versus Ultrasound Biometry2088209212640810.21608/ejhm.2020.126408ENAbd Elkhalek I. ElsaadaniDepartment of Ophthalmology, Faculty of Medicine Menoufia University, Menoufia, EgyptNermeen M. BadawiDepartment of Ophthalmology, Faculty of Medicine Menoufia University, Menoufia, EgyptAsmaa Z.A. ElterawyDepartment of Ophthalmology, Faculty of Medicine Menoufia University, Menoufia, EgyptJournal Article20201129Background: Implantation of an intraocular lens (IOL) is the gold standard in modern-day cataract surgery. Over the last decade, IOL power calculations have become a focal point of cataract surgery. Objective: To compare the sensitivity and specification of optical biometry and applanation ultrasound biometry in the measurement of intraocular lens. Patient and methods: This prospective cohort study was done on 100 eyes from one hundred patients undergoing phacoemulsification with primary intraocular lens implantation. and scheduled for cataract surgery in the Ophthalmology Department of Menoufia University Hospitals and El-Mahalla Ophthalmology Hospital. Fifty eyes of patients were measured by ultrasound measurement (by A-Scan, Group 1) and the other 50 eyes by optical biometry (by IOL Master, Group 2). Result: in Group 1There were 22 eyes of 22males (44%), and 28 eyes of 28 females (56%) with a mean age was 58.4 ±10.13years. While, in Group 2, there were 16 eyes of 16 males (32%), and 34 eyes of thirty-fourth females (68%) and the mean age of the patients in this group was 61.2±9.25 years. The mean IOL of the patient in Group I was (18.86±2.57) with minimum IOL power (16.29) and maximum IOL power (21.43). Whereas, the mean IOL potent ion of the patient in group II was (20.5±1.98) with minimum IOL power (18.52) and maximum IOL power (+22.48). Conclusion: We can conclude that IOL measurements performed by using the Zeiss IOL Master, using partial coherence interferometry, resulted that a significantly better IOL power forecast and therefore the refractive result in cataract surgery than Applanation US biometry. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Relationship between Hepatic Artery Resistive Index and Liver Fibrosis Score in Non-Alcoholic Fatty Liver Disease Patient2093209812641010.21608/ejhm.2020.126410ENAshraf Mohammed Mohammed AlkabeerTarek Mohamed Mohamed MansourMohammed Atef Mohammed Abd El KaderMohammed Mahmoud Abd El NaserJournal Article20201129Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most important precursors of chronic liver disease all over the world. Doppler ultrasonography is an essential part of evaluating the vascular haemodynamic variation seen within NAFLD. Objective: Assessment of the role of Hepatic Artery Resistive Index (HARI) in NAFLD patient and the relation between HARI and grading of fatty liver by ultrasound. Patients and methods: One hundred Egyptian patients diagnosed to have NAFLD based on ultrasound abdomen 35, 35, and 30 patients in grade1, grade 2, and grade3 NAFLD, respectively and 20 healthy subjects as control group were subjected to hepatic artery Doppler study. The study was carried out in the Outpatient Clinic of Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt. Results: Our study results showed high statistical significant difference (p-value < 0.001) between studied groups as regards hepatic artery resistance index. There was an inverse relationship between HARI and different grades of fatty liver in patients (p < 0.001). Hepatic artery resistance index (RI) decreased as the severity of diffuse fatty infiltration increases. Conclusion: Hepatic artery resistance index (RI) decreases as the severity of diffuse fatty infiltration increases.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200281520201001Study of The Podocalyxin as An Early Marker for Diabetic Nephropathy and Its Correlation with Stages of Diabetic Nephropathy in A Sample of Egyptian Patients with T2DM2099210212700010.21608/ejhm.2020.127000ENSalah El-Din Ahmed ShelbayaDepartment of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, EgyptRana Hashem IbrahimDepartment of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, EgyptNourhan Safwat SawirsDepartment of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, EgyptHanan Mahmoud AliDepartment of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20201202<span>Background: </span><span>Nephropathy is a major complication of diabetes, and is the main cause of end-stage kidney disease. Early recognition of nephropathy in diabetic patients is critical because it creates an opportunity to prevent the occurrence of diabetic nephropathy and/or even slow down the process of end-stage kidney disease attributable to diabetes. Human cells; podocytes (pods) have been shown to be functionally and structurally affected in the natural history of diabetic nephropathy.<br /> </span><span>Objective: </span><span>Study of the podocalyxin as an early marker for diabetic nephropathy and its correlation with stages of diabetic nephropathy in a sample of Egyptian patients with type 2 diabetes mellitus (T2DM).<br /> </span><span>Patients and Methods</span><span>:This study was a cross sectional study conducted on 80 subjects divided into four groups: Group 1: 20 diabetic patients with normalbuminuria. Group 2: 20 diabetic patients with nephropathy and microalbuminuria stages. Group 3: 20 diabetic patients with nephropathy and macroalbuminuria stages, Group 4:20 apparently healthy volunteers were included as a control group.<br /> </span><span>Results: </span><span>Urinary podocalyxin (PCX) was significantly higher in patients group compared to control group. Urinary PCX was significantly higher in macroalbuminuric group followed by microalbuminuric group then normoalbuminuric group. There was a positive significant correlation between urinary PCX and glycemic profile [Fasting blood sugar (FBS), 2hrPP, Glycosylated Hemoglobin (HbA1C)], serum creatinine and albumin creatinine ratio (ACR).<br /> </span><span>Conclusion: </span><span>Urinary podocalyxin is a beneficial as an early marker for early stages of diabetic nephropathy in type 2 DM patients.<br /> </span>