Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Early Outcome of Minimally Invasive Versus Median Sternotomy Mitral Valve Replacement In Patients With Severe Chronic Obstructive Pulmonary Disease18618914042510.21608/ejhm.2021.140425ENAhmed S. MahmoudRafik F B. SolimaAmira I. AlamaldeenPassant M. HassanFouad M. RasekhJournal Article20210117<span>Background: </span><span>Minimally invasive valve surgery is considered much more beneficial than routine median sternotomy in patients undergoing open heart surgery with sever chronic obstructive pulmonary disease (COPD).<br /> </span><span>Objective: </span><span>To compare between early outcomes of minimally invasive versus routine median sternotomy in patients with severe COPD undergoing isolated mitral valve replacement (MVR).<br /> </span><span>Patients and Methods: </span><span>100 patients with severe COPD between October 2016 and September 2019 underwent isolated MVR. Patients were divided into 2 groups: Group (A): 50 patients underwent surgery via minimally invasive approach and group (B): 50 patients underwent surgery via median sternotomy. Early postoperative complications, Intensive Care Unit stay and total hospital stay were compared in both groups.<br /> </span><span>Results: </span><span>The mean age was 60 ± 9 years for Group (A) and 61 ± 10 years for Group (B), (</span><span>P </span><span>= 0.29). Combined postoperative complications were significantly lower in Group (A) [8 (16%) versus 12 (24%), P < 0.05]. The median postoperative mechanical ventilation time was 10 hours in group (A) versus 22 hours in group (B) (P < 0.05). The median ICU stay in group (A) was 1.5 days versus 3 days in group (B) (P < 0.05). The median length of total hospital stay was 7 days in group (A) versus 13 days in group (B) (P < 0.05). The overall hospital mortality was 2 patients (4%) in group (A) versus 1 patient (2%) in group (B) P < 0.05.<br /> </span><span>Conclusion: </span><span>Minimally invasive had better early outcome than routine median sternotomy in patients with severe COPD undergoing MVR and should be considered as a good option in these patients.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Early Outcomes of Using Radial Artery in Coronary Artery Bypass Surgery in Cairo University Hospitals19019214042810.21608/ejhm.2021.140428ENFouad M. RasekhDepartment of Cardiothoracic Surgery, Faculty Medicine - Cairo UniversityAhmed S. MahmoudDepartment of Cardiothoracic Surgery, Faculty Medicine - Cairo UniversityJournal Article20210117<span>Background: </span><span>Using arterial grafts is commonly associated with good outcome. Using left internal mammary artery and radial artery can achieve complete arterial revascularization of left coronary system by using sequential grafting or multiple Y Technique.<br /> </span><span>Objective: </span><span>We present our experience in using internal mammary artery and radial artery (RA) Y-graft in 100 patients. </span><span>Patients and Methods</span><span>: Between February 2016 and January 2019, 100 patients (aged 45-60 years) with the diagnosis of multi-vessel disease underwent complete arterial revascularization using left internal mammary artery (LIMA) and RA. </span><br /><span>We used the technique of RA (Y) or (T) graft on LIMA to revascularize left coronary system; we did multiple (Y) or (T) graft or sequential grafts.<br /> </span><span>Results </span><span>The operating time was 220±20 minutes in average, the bypass time was (92.5 ± 16.7) minutes, and cross-clamp time was (70.6 ± 20.6 minutes). LIMA was anastomosed to the left anterior descending coronary artery (LAD) system in all patients. RA Y-graft was anastomosed to LIMA in all patients. Sequential grating using RA was done in 20 patients. The mean ICU stay of the patients was (2.2 ± 0.5 days). Mean hours of mechanical ventilation was (14.3 ± 2.9). Four patients required re-exploration for bleeding. 66 patients needed blood transfusion. 45 patients required inotropes. </span><br /> <span>Conclusions</span><span>: RA can be used safely with LIMA to revascularize left coronary territory using sequential grafts or multiple (Y) grafts. This method allows for complete arterial grafting in multi-vessel disease using only single IMA and RA grafts with good early results.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101The Role of Helicobacter Pylori Infection in Idiopathic Thrombocytopenic Purpura in Children19319814043110.21608/ejhm.2021.140431ENAl Zahraa Elsayed AhmedDepartment of Pediatrics, Faculty of Medicine, Sohag UniversityAshraf Mahmoud RadwanDepartment of Pediatrics, Faculty of Medicine, Sohag UniversityHeba Latif RizkDepartment of Pediatrics, Faculty of Medicine, Sohag UniversityJournal Article20210117<span>Background: </span><span>Many studies had found obvious relation between helicobacter pylori infection and chronic idiopathic thrombocytopenic purpura; several studies have reported remission of immune thrombocytopenic purpura (ITP) after eradication of a coexistent Helicobacter pylori infection in adults, data in children are limited.<br /> </span><span>Objective: </span><span>To detect the association of H. pylori infection and idiopathic thrombocytopenic purpura in children and the effect of eradication of the infection on platelet count in these patients.<br /> </span><span>Patients and methods: </span><span>This study was conducted on 83 chronic idiopathic thrombocytopenic purpura children with age range from 3 to 13 years. They were 46 males 37 females. Also the study included 104 healthy individual with </span><span>the same range of age. They were 58 males and 46 females as a control group. This was between October 2018 and September 2019 in the Pediatric Hematology and GIT Clinics or inpatients wards of Pediatric Department.<br /> </span><span>Results: </span><span>Clinical benefit occurred in 31 cases of the 83 chronic ITP (cITP) patients screened; nevertheless, we have a simple, inexpensive, non</span><span>‐</span><span>invasive screening method; the adverse events of eradication therapy are negligible, together with an affordable cost, all uncommon attributes among the specific treatments currently available for cITP; therefore it is worthwhile to test for and treat H. pylori infection. </span><br /> <span>Conclusion: </span><span>Our data showed a prevalence of H. pylori infection in cITP pediatrics that was similar to other studies. We found that successful H. pylori eradication induced platelet response in 37.3% of 83 cases included in our study</span><span>. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Governance: Governance Indicators in Nursing Faculty, Benha University19920414043510.21608/ejhm.2021.140435ENAbdel-Rahim S. ShoulahDepartment of Community Medicine, Faculty of Medicine, Benha University, Benha, EgyptSabry A. SalemDepartment of Community Medicine, Faculty of Medicine, Benha University, Benha, EgyptHala A. Abed HassenDepartment of Community Medicine, Faculty of Medicine, Benha University, Benha, EgyptHoda S. Abd El-HamidDepartment of Community Medicine, Faculty of Medicine, Benha University, Benha, EgyptOmyma M. HassenDepartment of Community Medicine, Faculty of Medicine, Benha University, Benha, EgyptJournal Article20210117<span>Introduction: </span><span>Governance is the system through which the organization's work is directed and monitored at the highest level in order to achieve its objectives and to meet the standards of responsibility, integrity and openness. </span><span>Objectives: </span><span>To determine the degree of practice of the principles of governance in the of nursing faculty from viewpoint of its faculty members, administrative staff and students. </span><span>Subjects and Methods: </span><span>This descriptive cross sectional study was conducted to assess the degree of practicing the principles of governance at University College of Nursing in Benha from the viewpoint of its faculty members, administrative staff and students. Data were collected using a questionnaire formed of 83 questions to staff member, administrators and students.<br /> </span><span>Results: </span><span>This study finding illustrated that 60.0% of staff members, 62.6% of administrators and 59.2% of students had their knowledge about governance in Benha Faculty of Nursing regarding total items.<br /> </span><span>Conclusion: </span><span>There is no statistically significant difference between staff member, administrators and students regarding their score of knowledge about total transparency, total participation and total rule of law. However difference between staff member, administrators and students regarding their score of knowledge about total accountability, total strategic vision and total efficiency and excellence are of statistically significant importance. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Genotyping and Severity of Rotavirus Infection among Infants and Children with Acute Diarrhea20521114044010.21608/ejhm.2021.140440ENManar FathyDepartment of Pediatrics, Faculty of Medicine, Zagazig UniversityRania M AmerDepartment of Microbiology and Immunology, Faculty of Medicine, Zagazig UniversityMohamed A AlmalkyDepartment of Pediatrics, Faculty of Medicine, Zagazig UniversitySherif El GebalyDepartment of Pediatrics, Faculty of Medicine, Zagazig UniversityJournal Article20210117<span>Introduction: </span><span>Rotavirus (RV) belongs to the Reoviridae virus family and the virion comprises of three concentric protein layers. Worldwide, rotavirus (RV) is the most common cause of severe gastroenteritis (G.E.) among infants and young children especially in those countries which has not launched a RV vaccination program and approximately 40% of hospitalized patients suffering from gastroenteritis were infected with RV. </span><span>Objective: </span><span>To determine the prevalence of rotavirus infections, genotypes and degree of severity of its acute diarrhea in infants and children attending the children hospital, at Zagazig University Hospitals. </span><span>Patients and methods: </span><span>this study was done on 140 patients admitted to Children Hospital, Zagazig University suffering of gastroenteritis, Vesikari clinical severity score was done and stool sample was taken from patients, which was tested for RV by dipstick method and positive patients underwent genotyping by immunochromatography using PCR technique.<br /> </span><span>Results: </span><span>Among the studied group 128 patients (91.4%) showed positive results for rotavirus detection by dipstick analysis of stool, while only 12 patients (8.6%) were negative. The Vesikari score of severity ranged from 9 to 15 with median of 12 and its mean ± SD was 11.9</span><span>±</span><span>1.3. G3 and P8 were the most types in the examined patients.<br /> </span><span>Conclusion: </span><span>rotavirus is still the main cause of severe gastroenteritis that requires hospital admission. G3 and P8 are the most detectable genotypes.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Myocardial Protection with Glucose-Insulin-Potassium Infusion during Cardiopulmonary Bypass for Coronary Revascularization21221614044610.21608/ejhm.2021.140446ENEssam Ezzat Abd El-HakeemDepartment of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Assiut UniversityAhmed Elsaied Abd Elrahman AlyDepartment of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Sohag University, EgyptOsama Salah El Din MahmoudDepartment of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Sohag University, EgyptAhmad Hamody HassanDepartment of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Sohag University, EgyptJournal Article20210117<span>Background: </span><span>Sodi-Pallares and colleagues first time introduced use of glucose-insulin and potassium (GIK) solution for myocardial protection. They used this solution in patients with acute myocardial infarction and concluded that GIK solution limited electrocardiographic changes in these patients.<br /> </span><span>Objective: </span><span>To investigate the effectiveness of the GIK solution regarding myocardial protection evaluated by postoperative creatine kinase MB (CKMB) and cardiac troponin I levels.<br /> </span><span>Method: </span><span>In this prospective, randomized clinical trial, sixty-four patients were assigned into two groups: GIK group, in which glucose-insulin and potassium infusion were given during surgery, and non-GIK group in which only saline infusion was given during the procedure.<br /> </span><span>Results: </span><span>All CK-MB values were lower in the GIK group than the Non-GIK group in the postoperative period (6, 12 an</span><span>d 24 hours’ samples) with statistically significant results. Troponin values were lower in the GIK group versus </span><span>the Non-GIK group after 6 and 12 hours with statistical significance (P < 0.001 and 0.022 respectively). </span><span>Conclusion: </span><span>The addition of GIK infusion throughout the operation to standard myocardial protective techniques in patients undergoing on-pump coronary artery bypass graft (CABG) surgery attenuates myocardial ischemic injury. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101COVID-19 Quarantine Measures and Its Impact on Pattern of Life of School Children21722414045010.21608/ejhm.2021.140450ENEman M. ArabyDepartment of Public Health and Community Medicine, Faculty of Medicine, Benha University– EgyptEhab M. EmadeldinDepartment of Physical Health Sciences, Faculty of Physical Education, Benha University– EgyptHany M. ZakariaDepartment of Educational Sciences and Psychological - Faculty of Physical Education - University of Benha – EgyptJournal Article20210117<span>Background: </span><span>Although the physical effects of lockdown due to COVID-19 pandemic have become largely known, the psychological effects are still unknown. </span><span>Objective: </span><span>to investigate physical and psychological impact of quarantine measures among school children in Egypt. </span><span>Methodology: </span><span>This study investigated the impact of lockdown measures on eating, sleeping, mood and behavior of school children using online survey. </span><span>Results: </span><span>Total participants were 1507, aged </span><span>between 6 to 14 years, private schools’ students represented 60% of responders. 96.4% ha</span><span>d changes in sleeping pattern, 77.8% had changes in eating pattern, 21.7% showed worries about general health condition, 70.5% had mood and behavioral changes especially aggressive behavior and finally, 37.3% had problems in concentration and focusing. Sociodemographic factors significantly affected sleeping of children during quarantine. Males were more affected considering bed time, 77.8 % of those returned to bed wetting were girls, the most affected age group was 8 -10 years old , urban residents and the first ordered child were the most affected. Changes of eating pattern were more common among females, within the age group 8-10 years, first ordered child of families with sufficient monthly income. Those having one or both of his/her parents is a health care worker were significantly affected and had more worries about health. Finally, sex was the only factor affecting behavioral changes (male more than females). </span><span>Conclusion</span><span>: COVID-19 has a notable impact on eating, sleeping patterns as well as mood and behavior of the children.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Epidemiology of Central Venous Catheters Infection in Hemodialysis Patients22523014281510.21608/ejhm.2021.142815ENSaid M. Al-BarshomyNeveen G. El-AntonyMohammed SakrRehab H. El SokaryJournal Article20210124<span>Background: </span><span>Vascular access infections in hemodialysis patients increase by 2-3 folds in central venous catheters compared to arteriovenous fistula or graft. Among these infections exit site infections, tunnel infections and catheter- related bloodstream infections (CRBSI), are the most common complications. CRBSIs are major risk of hospitalization as well as mortality in hemodialysis patients.<br /> </span><span>Objective: </span><span>To study the epidemiology of central venous catheter related infections (CVC-RI), patterns of microbial infections and antibiotic sensitivity among our hemodialysis patients.<br /> </span><span>Patients and methods: </span><span>94 ESRD patients on hemodialysis with temporary central venous catheter (CVC) inserted for more than 48 hours, monitored for the development of CVC related infections (CVC-RI) and divided into two main groups according to presence of catheter infection; (A) non-infected catheter patients and group (B) infected catheter patients<br /> </span><span>Results: </span><span>The rate of CVC-RI is high in our hemodialysis patients (42.5 %). There was a significant difference between the two studied groups as regard duration of HD and catheterization duration. Patients with evident catheter infections had significantly higher total leucocytic count (TLC) and C-reactive protein (CRP) values. There was a significant positive correlation between CRP with catheter duration and TLC. Staphylococcus aureus was the most prevalent isolated bacteria. Vancomycin was the most common used antibiotic among infected patients.<br /> </span><span>Conclusion: </span><span>CVC-RI rate is high in our hemodialysis patients (42.5 %). Prolonged duration of CVC usage and diabetes are major risk factors related to infections. Both S. aureus and Gram-negative micro-organisms were the most common organisms found in our study. Vancomycin and imipenem were the most common effective antibiotics according to our blood cultures.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Study of Urinary N-Acetyl-Beta-D-Glucosaminidase as a biomarker of Diabetic Nephropathy23123614287910.21608/ejhm.2021.142879ENAmira A. MahmoudNoha M MostafaOsama MesbahOmar M SabrySaid M. Al-BarshomyJournal Article20210124<span>Background: </span><span>Diabetic nephropathy (DN) is a major cause of morbidity and mortality in diabetic patients worldwide. Plenty of tubular damage biomarkers have been discovered. Urinary N-acetyl-</span><span>β</span><span>-D-glucosaminidase (NAG) is a hydrolytic enzyme that acts on glycosyl compounds. NAG is excreted in abnormally high amounts in many renal diseases.<br /> </span><span>Objective: </span><span>The aim of this work was to study the importance of Urinary N acetyl-</span><span>β</span><span>-D-glucosaminidase level as an early biomarker for detection of DN and to assess the degree of kidney affection in various stages of DN.<br /> </span><span>Patients and methods: </span><span>100 subjects divided into five groups: Group 1: 20 healthy volunteers (control group), group 2: 20 pre diabetic persons, group 3: 20 normo-albuminuria diabetic patients, group 4: 20 micro-albuminuria diabetic patients (ACR 3 -300 mg/mmol) and group 5: 20 macro-albuminuria diabetic patients (ACR </span><span>≥ </span><span>300 mg/mmol).<br /> All individuals were subjected to full history taking, ECG & echocardiography, abdominal ultrasound, laboratory investigations (HbA1c, fasting and post prandial blood glucose, lipid profile, oral glucose tolerance test (OGTT), blood urea, serum creatinine, serum uric acid, e-GFR and urinary NAG.<br /> </span><span>Results: </span><span>There was high significant difference between the five groups regarding duration of the disease, fasting blood sugar, postprandial blood glucose, HbA1c, Serum cholesterol, albumin/creatinine ratio, serum urea and creatinine, e-GFR and urinary NAG. In addition, there was significant positive correlation between urinary NAG and albumin/creatinine ratio, blood urea, creatinine, and e-GFR.<br /> </span><span>Conclusion: </span><span>The urinary NAG can be used as an early urinary biomarker for early detection and progression of diabetic nephropathy in type 2 diabetic patients.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Study of MICS in Hemodialysis Patients and Its Relation with Serum Thyroid Hormones23724014288110.21608/ejhm.2021.142881ENMohamed Omar Al Sayed AliDepartment of Internal Medicine, Faculty of Medicine – Zagazig UniversityMohammed Ali Fahmy El ZanatyDepartment of Internal Medicine, Faculty of Medicine – Zagazig UniversityTamer Mohamed GodaDepartment of Internal Medicine, Faculty of Medicine – Zagazig UniversityJournal Article20210124<span>Background: </span><span>Malnutrition-inflammation complex syndrome (MICS) is a frequent and serious problem in patients undergoing dialysis with estimated prevalence about 18</span><span>–</span><span>75%. The etiology is multifactorial. MICS is believed to be main cause of erythropoietin hyporesponsiveness, low free triiodothyronine (FT3) and increased mortality and hospitalization among the dialysis patients.<br /> </span><span>Objective: </span><span>To determine the prevalence of MICS and identify association between MICS and thyroid hormones. </span><span>Patients and Methods: </span><span>This was cross sectional study, which was conducted on 91 patients admitted at Hemodialysis Units of Zagazig University Hospitals and Fakous General Hospital. Blood samples had been obtained before the initiation of the HD session and after an 8 hours fasting, blood measurements included: Serum urea, creatinine, TSH, T3, FT3 and FT4.<br /> </span><span>Results: </span><span>This study showed that, prevalence of MICS was about 56%. There was statistically significant difference between patients had MICS and patients without MICS regarding age, and duration of hemodialysis. There was no statistically significant difference between patients had MICS and patients without MICS regarding T3, T4, TSH. There was statistically significant difference between patients had MICS and patients without MICS regarding serum creatinine.<br /> </span><span>Conclusion: </span><span>This study concluded high prevalence of malnutrition-inflammation complex syndrome on patients on dialysis. There was no association between MICS and thyroid hormones.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Accuracy of Thyroid Imaging Reporting and Data System in Evaluation of Thyroid Neoplasm24124814288210.21608/ejhm.2021.142882ENTamer Youssef MohamedEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptAtef Mohamed Abdel LatifEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptAhmed Mahmoud Mohamed ZakiEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptMahmoud Abd El ShahidEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptMohammed Mohammed Abd Elfatah AliEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptAhmed Elsayed LotfyEndocrine Surgery Unit, Faculty of Medicine, Mansoura University, EgyptJournal Article20210124<span>Background: </span><span>Several US Thyroid Imaging Reporting and Data Systems (TIRADS) have been proposed for risk assessment of thyroid nodules. The nodules are usually divided into variant categories based on TIRADS and are then guided to Fine Needle Aspiration (FNA) Biopsy or follow-up, according to the risk of malignancy</span><span>. Objective: </span><span>To assess the specificity, sensitivity and accuracy of TIRADS in diagnosis of thyroid neoplasm </span><span>Patients and Methods: </span><span>This study included 60 patients presented to the General Surgery and Endocrine Surgery Unite Outpatient Clinic at Mansoura University Hospitals with thyroid disorders. The study was conducted during the period between 1 November 2018 and the end of March 2020.<br /> All patients were radiologically evaluated using neck ultrasound with TIRADS classification. Fine needle aspiration was performed and the results of both were compared to the postoperative pathology reports. </span><span>Results: </span><span>the current study evaluated the accuracy of TIRADS (TIRADS 3,4a and 4b) compared to (TIRADS 4c and 5) with sensitivity 83.3%, specificity 92.9%, PPV 83.3%, NPV 92.9% and accuracy 90.0%.<br /> </span><span>Conclusion: </span><span>TIRADS scoring system is of great value in the diagnosis of simple nodular goiter as it gives a degree of accuracy more than 90% compared to FNAC were the degree of accuracy was 78.3%.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Prevalence of Pseudoexfoliation Syndrome in Patients with Sensorineural Hearing Loss24925514288510.21608/ejhm.2021.142885ENBasma Ebrahim MohamedAbdalla Mohamed Al Amin AbdallaEssam Ali Abo El MagdAhmed Fathy GabrJournal Article20210124<span>Background: </span><span>Pseudoexfoliation syndrome (PEX) is a complex systemic disorder of the extracellular matrix primarily affecting the eye and visceral organs. In this age-related disease fibrillar extracellular material is produced and accumulates in many ocular and extraocular tissues.<br /> </span><span>Objective: </span><span>To study the prevalence of pseudoexfoliation syndrome among patients with sensorineural hearing loss. </span><span>Patients and Methods: A </span><span>cross-sectional study, conducted on 50 patients with sensorineural hearing loss at the departments of Ophthalmology and Otolaryngology of Aswan University Hospital, was performed among patients aged 50 years and older and both sexes were included while patients with a history of acute ear disease, head trauma, long term exposure to heavy noise, intake of ototoxic drugs and chronic suppurative otitis media (cholesteatoma) were excluded.<br /> </span><span>Results: </span><span>The prevalence of PEX among SNHL patients was estimated in the current study as 36%. The mean age was 61 (±7.1) years and ranged from 50 to 77 years old. The majority of participants (35 patients, 70%) were female. Thirty-three patients (66%) of participants had chronic co-morbidities. Unilateral PEX was represented by 10 patients (55.6%), while bilateral PEX was represented by 8 patients (44.4%).<br /> </span><span>Conclusion: </span><span>This study establishes the reciprocal association between pseudoexfoliation and sensorineural hearing loss. The main reason for this association remains unclear although the infiltrative nature of PEX can still explain this concurrence.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101The Possible Radio Protective Role of Gum Arabic on The Kidney Cortex of Adult Male Albino Rats25626914388610.21608/ejhm.2021.143886ENHeba Ahmed Mohamed KandealZoology Department, Faculty of Science, Al-Azhar University, EgyptFatma Ahmed EidZoology Department, Faculty of Science, Al-Azhar University, EgyptHemmat Mansour AbdelhafezZoology Department, Faculty of Science, Al-Azhar University, EgyptAmr Mahmoud Abd El-HadyFaculty of Applied Medical Sciences, Misr University for Science and Technology (MUST), EgyptJournal Article20210127<span>Aim of the work: </span><span>the use of ionizing radiation exposure increases, </span><span>oxidative stress </span><span>especially for cancer patients. Therefore, there is a critical need to develop antioxidants that prevent oxidative stress damage. Gum Arabic is an antioxidant and anti-inflammatory mediator. This study aimed to assess the possible radio protective effect of gum Arabic (</span><span>Acacia senegal</span><span>) against gamma irradiation-induced injury on the rat kidney. </span><span>Materials and Methods: </span><span>four groups of male Albino rats (each of 12 rats) received normal saline (G1), dose 5Gy of gamma irradiation (G2), orally administered with 25 mg/kg gum Arabic for 3 weeks (G3) and gamma irradiation plus oral gum Arabic administration for 7 days before and 21 days after irradiation (G4). </span><span>Results: </span><span>in the gamma irradiated group, histopathological and ultrastructural examinations of the rat kidney cortical tissue revealed signs of degeneration to the cortical renal tubules and glomeruli. In contrast, gum Arabic treatment alleviated most of the damaging effects of gamma radiation. </span><span>Conclusion: </span><span>oral administration of gum Arabic could ameliorate adverse gamma radiation-induced effects that might be attributed to its antioxidative and free radical scavenging effects.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101A Comparative Study of External Dacryocystorhinostomy with Stent Versus No Stent in Acquired Nasolacrimal Duct Obstruction27027514388810.21608/ejhm.2021.143888ENAlaa Abdulmongy Abdulfattah SadakaDepartment of Ophthalmology, Faculty of Medicine, Aswan UniversityAbdallah Mohammed AlAminDepartment of Ophthalmology - Faculty of Medicine, Al-Azhar University, EgyptNashwa Nasser Mohammed GadDepartment of Ophthalmology, Faculty of Medicine, Aswan UniversityJournal Article20210127<span>Background: </span><span>Epiphora is defiened as decreased tear transfusion or defective tear discharge flow. Blockage of the NLD (NLDO) prevents the flow of tears from the eye to the nose, leading to symptoms of obstruction. Dacryocystorhinostomy (DCR) was established as the predominant measure.<br /> </span><span>Objective: </span><span>To evaluate the effect of intubation on the outcome of external dacryocystorhinostomy.<br /> </span><span>Patients and methods: </span><span>It was a prospective interventional randomized study. The study was carried on 40 eyes of patients were going to do DCR under general anaethesia. They were divided into 2 groups as follows: Group A (20 participants) were undergoing external dacryocystorhinostomy with silicone intubation and group B (20 participants) were undergoing external dacryocystorhinostomy without intubation.<br /> </span><span>Results: </span><span>At the final follow up of the patients of the two groups for 6 months, there were 4 cases had persistent epiphora post-operative two cases in group (A) and two cases in group (B). This indicated that there was no significant difference between the use of intubation or not in cases of acquired NLDO and chronic dacryocystitis. </span><span>Conclusion: </span><span>External dacryocystorhinostomy is still gold standard surgical treatment in primary nasolacrimal duct obstruction. This study showed that the silicone tube implantation is not necessary in the surgery.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101The Pattern of Electrolyte Imbalance in Critically Ill Children admitted in Pediatric Emergency Unit at Sohag University Hospital27628114388910.21608/ejhm.2021.143889ENSafaa Hussein AliDepartment of Pediatrics, Faculty of Medicine, Sohag University, Sohag, EgyptMontasar Mohammed MohammedDepartment of Pediatrics, Faculty of Medicine, Sohag University, Sohag, EgyptRaafat Shawky YoussefDepartment of Pediatrics, Faculty of Medicine, Sohag University, Sohag, EgyptJournal Article20210127<span>Background: </span><span>Electrolyte abnormalities are one of the common medical problems that should be addressed well in hospitalized children. Electrolyte abnormalities could occur due to underlying illness or incorrect management with fluid input. Electrolyte disorders have a significant impact on patient outcomes; treating physicians usually pay attention to the underlying medical illness but preventable and manageable electrolyte disorders are often overlooked.<br /> </span><span>Objective</span><span>: To identify the pattern of electrolyte imbalance in critically ill children in the pediatric emergency unit at Sohag University Hospital.<br /> </span><span>Patients and methods: </span><span>We included 150 children aging from one year to 12 years age, presenting with manifestations suggesting electrolyte imbalance coming to the pediatric emergency unit at Sohag university hospital, the period from May 2018 to May 2019.<br /> </span><span>Results: </span><span>Hypocalcaemia was the most common electrolyte imbalance accounted for (83.33 %) of studied cases, followed by hypokalemia accounted for 96 (64.00%) of studied cases, then hyponatremia accounted for 54 (36.00%) of studied children, then hypernatremia accounted for 31 (20.67%) of studied children, followed by hyperkalemia accounted for 23 (15.33%) of studied cases. According to our study, it was found that children with hypernatremia had an 8.9 times higher risk of dying, AOR 8.92, 95% CI, 2.26:35.24 than children with normal sodium levels. As regard to our study, we found that children with hyperkalemia had 8 times higher risk of death than children with normal potassium level (AOR=8.07, 95% CI, 1, 39-47, 00).<br /> </span><span>Conclusion: </span><span>Electrolyte abnormalities are common in children admitted to the emergency with an underlying medical illness and contribute to significant morbidity and mortality. Preventive measures in high-risk patients and early treatment would decrease morbidity and mortality.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Glutathione S- Transferase as a Marker of Acute Kidney Injury in Pediatric Intensive Care, Zagazig University Children Hospital28228814389610.21608/ejhm.2021.143896ENSamir M. ZamzamNehad AK Abd ElfatahNoha AM RezkMagdi MH SolimanJournal Article20210127<span>Background: </span><span>Glutathione S-transferases (GST) are </span><span>major phase II detoxification enzymes </span><span>having central roles in the cellular detoxication of a diverse group of exogenous and endogenous harmful compounds.<br /> </span><span>Objective: </span><span>The aim of the work was to investigate the role of GST in development of acute kidney injury in PICU, Zagazig University Children Hospital.<br /> </span><span>Patients and Methods</span><span>: A prospective cohort study was conducted on 50 pediatric patients admitted to PICU who were divided into two groups according to incidence of Acute Kidney Injury (AKI). Patients were subjected to clinical, laboratory, and plasma & urinary GST evaluation.<br /> </span><span>Results</span><span>: AKI developed in 24% of patients. There was no significant relation between presence of AKI and patient age, gender, weight, height, </span><span>or </span><span>clinical outcome</span><span>. </span><span>There were significant relations between plasma and urine GST and presence of AKI. There is statistically non-significant relation between Pediatric Risk, Injury, Failure, Loss, End-Stage renal disease (pRIFLE) staging and plasma and urine GST. There were statistically significant negative correlations between each of plasma and urine GST on one side and both heart rate and estimated creatinine clearance on the other side. Plasma GST can predict presence of AKI at cutoff </span><span>≥30.5, with </span><span>AUC 0.964, sensitivity 100%, specificity 84.%, PPV 66.7%, NPV 100% , accuracy 88%. Urinary GST in prediction of AKI was </span><span>≥12.5, with AUC 0.95, sensitivity 91.7%, specificity 84.2%, with accuracy 86%. </span><span>Conclusion</span><span>: It could be concluded that AKI had significant incidence in PICU admission. High levels of plasma and urine GST Pi after admission in PICU are associated with an increased development of AKI and GST Pi is a valuable tool for early diagnosis of AKI.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Association of Apolipoprotein A1 Gene Polymorphism and Coronary Heart Diseases in Patients with Type 2 Diabetes Mellitus28929514389710.21608/ejhm.2021.143897ENNearmeen M. RashadGehan A. EbrahemAmal S. El-ShalMohamed R. H. Abo- ZenarIslam G. AhmedMohamed G. HamedJournal Article20210127<span>Background: </span><span>Type 2 diabetes mellitus (T2DM) is one of the world's most common diseases with a high prevalence and incidence.<br /> </span><span>Objective: </span><span>To investigate the association of APOA1 polymorphism (-75 G/A) with dyslipidemia and susceptibility to CAD among Egyptian patients with T2DM.<br /> </span><span>Patients and Methods</span><span>: A total number of 72 subjects with T2DM and 72 age and sex matched healthy controls were enrolled for the study. T2DM patients were subdivided to T2DM without CAD (n=36) and T2DM with CAD (n=36). Genotyping of the APOA1 was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) combined with gel electrophoresis, and then confirmed by direct sequencing.<br /> </span><span>Results: </span><span>Our findings revealed that GA and AA genotypes and A allele of APOA1 G-75A were significantly higher in controls than T2DM without CAD cases. Also, GA and AA genotypes and A allele of APOA1 G- 75A were significantly higher in controls than T2DM with CAD cases. The risk of CAD were significantly lower among patients carrying GA and AA genotypes than those carrying GG genotype (OR (95%CI): 0.16 (0.06-0.48), </span><span>P</span><span><0.001; OR (95%CI): 0.08 (0.01-0.78), </span><span>P</span><span><0.01, respectively). Our findings revealed significantly higher values of HDL in AA genotype of APOA1 G-75A compared to GA and GG. On the other hand, there were significantly lower values of TC and TG in AA genotype of APOA1 G-75A compared to GA and GG. </span><span>Conclusions</span><span>: The individuals with the APOA1 -75 GA and AA genotypes and A allele were likely to have a lower risk of T2DM and CAD as a result of its effect on HDL-C serum levels.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Effect of Use of Single Dose of Misoprostol on Blood Loss during Myomectomy29630114457710.21608/ejhm.2021.144577ENAlaa Elden Fath Alah AlhalabyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, EgyptHend Ali ShehlDepartment of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, EgyptHeba Maged Abo ShadyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, EgyptNabih Ibrahim El KhoulyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, EgyptJournal Article20210129<span>Background: </span><span>Uterine leiomyomas are the commonest benign tumours in women, which are estrogen-dependent and grow during the reproductive life. Standard treatment for leiomyoma is hysterectomy or myomectomy according to women's age and fertility. Prostaglandins and particularly PGE1 as misoprostol have an impact on uterine contractions and decrease blood loss.<br /> </span><span>Objective: </span><span>To evaluate the effect of using a single dose of vaginal misoprostol (400 Microgram) one hour before abdominal myomectomy on intraoperative blood loss.<br /> </span><span>Materials and methods: </span><span>This prospective randomized study was carried out postmenstrual upon 50 women with symptomatic uterine myoma who attended to Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University during the period from October 2019 until October 2020. All subjects were divided into two equal groups: Misoprostol group included 25 women administered 400 mg misoprostol vaginally one hour before operation, and control group included 25 women underwent operation without misoprostol. Outcome variables included: intraoperative blood loss (ml), postoperative hemoglobin values, postoperative hematocrit values and operative time.<br /> </span><span>Results: </span><span>there was statistically significant difference between the two studied groups according to amount of intraoperative blood loss (ml) as Misoprostol group showed less blood loss than control group [(308.0 </span><span>± </span><span>32.66 vs. 404.4 </span><span>± </span><span>87), with p = 0.001]. In addition, there was statistically significant difference between the two studied groups regarding operative time as Misoprostol group showed shorter duration than control group [(56.8 ± 3.12 vs. 78.6 ± 10.6), with p=0.001].<br /> </span><span>Conclusion: </span><span>A single dose of preoperative vaginal misoprostol is an effective method for reducing blood loss and operative time during abdominal myomectomy operations.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Discrepancy of Glycosylated Haemoglobin and Fructosamine in Egyptian Patients with Prediabetes and Iron deficiency30230714457910.21608/ejhm.2021.144579ENMohammed Ali GameilMaha Mahmoud ElshafieMohammed Ayed Mohammed RashwanShaimaa Saber ElashwahTarek Elsayed AbouzidJournal Article20210129<strong>Background: </strong>the controversies concerning the influence of iron deficiency on glycaemic control parameters in patients with prediabetes prompted us to conduct this research.
<strong>Objective: </strong>Our aim was to get a delicate estimation of these changes that may alter the management plan in this clinical situation.
<strong>Patients and methods:</strong> a case control study included 197 Egyptian patients with prediabetes; 113 patients with iron deficiency versus 84 patients without iron deficiency (control group) during the period (May 2019 - October 2019). History, physical examination and laboratory tests of fasting and postprandial plasma glucose (FPG and PPPG), glycosylated haemoglobin (HBA1c), fructosamine, serum creatinine, ALT, AST, CBC, ferritin, serum iron and total iron binding capacity (TIBC) were done.
<strong>Results:</strong> HBA1c was significantly higher in the iron deficiency group than the control group with non-significant difference between the studied groups regarding FPG and PPPG. HBA1c level was positively correlated with fructosamine, exclusively in the healthy group indicating the lack of credibility of HBA1c in iron deficient subjects with prediabetes. HBA1C level was inversely correlated with serum iron level in both study groups.<strong> Conclusion:</strong> there is discordance in glycaemic control parameters in patients with prediabetes and iron deficiency. Diagnosis of deranged glucose homeostasis in patients with co-existent iron deficiency and prediabetes should not be with HBA1c solely.
<span><br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Outcomes and Indications of Mini Percutaneous Nephrolithotomy in Zagazig University Hospitals Patients30831514458010.21608/ejhm.2021.144580ENSafwat Elsayed Abou HashemDepartment of Urology, Faculty of Medicine, Zagazig University.Hazim Mohammed El GalalyDepartment of Urology, Faculty of Medicine, Zagazig University.Ahmed Mohammed EliwaDepartment of Urology, Faculty of Medicine, Zagazig University.Ahmed Ismail Abdel Rahman KotbDepartment of Urology, Faculty of Medicine, Zagazig University.Journal Article20210129<span>Background: </span><span>PCNL is a well-established treatment option for patients with large and complex renal calculi. In order to decrease morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage. A modification of the technique of standard PCNL has been developed. This is performed with a miniature endoscope via a small percutaneous tract (11</span><span>–</span><span>20 F) and was named as minimally invasive or mini- PCNL.<br /> </span><span>Objectives: </span><span>To improve medical service for patients attending for Zagazig University Hospital by determining indications and outcomes of M-PCNL when used as treatment modality for patients with renal stones.<br /> </span><span>Methods: </span><span>This prospective cohort study was conducted at Urology Department Zagazig University Hospitals during the period from March to November 2019. 48 patients from those attending to Urology Outpatient Clinic. Percentage of improvement of patients M-PCNL was 94%, so sample was calculated to be 32 patients using open EPI with CI 95%.<br /> </span><span>Results: </span><span>48 patients and percentage of improvement of patients M-PCNL was 94%. Male represented 53.8% of the studied patients. Mean age was 35.10 years, ranged from 18 to 60 years. Mean body mass index was 39.56 kg/m</span><span>2</span><span>, ranged from 18.60 to 63.20 kg/m</span><span>2</span><span>. Mean preoperative hemoglobin was 12.56 g/dl, ranged from 11 to 14 g/dl. The most common site of stone was renal pelvis in 44.6% of the studied patients. Mean stone density was 1024.76, ranged from 220 to 1500. Mean stone size was 1.86 mm, ranged from 1.20 to 3-mm. Mean tract diameter was 16.92 mm, ranged from 14 to 18 mm.<br /> </span><span>Conclusion: </span><span>Mini-PCNL was safe and efficacious in treatment of patients with renal stone disease. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Ultrasonographic Evaluation of Placental Sites and Thickness at Second Trimester and Its Correlation with Pregnancy Outcome31632214458210.21608/ejhm.2021.144582ENIbrahim Mohiy El-MaghrabyFellow, Obstetrics & Gynecology Department, Shibin El Kom Teaching Hospital, Menoufia, EgyptJournal Article20210129<span>Background: </span><span>Adverse fetal outcome has a wide spectrum of perinatal mortality and morbidity as low fetal Apgar score, admission to NICU, low birth weight, stillbirth & maternal morbidity, and mortality. The use of ultrasonography of placental sites and thickness is the most effective method to estimate the adverse pregnancy outcome. </span><span>Objective</span><span>: To investigate the relationship between placental sites, diameter, and thickness at the second trimester with pregnancy outcome. </span><span>Patients and Methods: </span><span>the current study was conducted at the Obstetrics & Gynecology Department in Shibin El Kom Teaching Hospital, on 200 pregnant women with a single fetus presenting for routine antenatal care in the second trimester, from September 2016 to August 2017. Detailed history, laboratory investigations, obstetric and ultrasound follow up study was done. </span><span>Results: </span><span>The mean age of all patients was 27.54±5.03 years old. Placental sites were associated with placenta previa, placenta abruption, bleeding, FGR, and preterm delivery. Also, the placental diameter was highly related to placenta previa, placental abruption, bleeding and positively correlated with age and body mass index. Regarding, the placental thickness, it was highly associated with macrosomia and negatively correlated with age, and positively correlated with GA.<br /> </span><span>Conclusion: </span><span>Placental implantation at the 18</span><span>th </span><span>to 24</span><span>th </span><span>weeks can be used as being at risk for adverse outcomes. Low placental implantation sites are associated with higher frequent preterm (labor & deliveries) and lower postpartum hemorrhage. High lateral placental implantations are associated with lower Apgar scores.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Comparative Study between Analgesic Effects of Intrathecal Administration of Midazolam Versus Tramadol with Bupivacaine for Infra-Umbilical Surgeries32332814489610.21608/ejhm.2021.144896ENMohamed Abdel Raheem MohamedDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Sohag University, Sohag, Egypt.Hitham Mohamed AliDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Sohag University, Sohag, Egypt.Fawzy Abbas BadawyDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Sohag University, Sohag, Egypt.Journal Article20210130<strong>Background: </strong>The administration of bupivacaine intrathecally as a regional anesthesia is commonly used to provide anesthesia for lower abdominal surgeries. The motor blockage of bupivacaine provides adequate blockage, which allows the surgeons to do their work comfortably and also provides effective postoperative analgesia in early postoperative period. However, adding adjuvants to the local anesthetics to prolong the period of postoperative analgesia after fading of the spinal anesthesia was tried in many studies. These supplements as regard to postoperative pain relief are beneficial as they decrease or abolish the need for the administration of analgesics and their associated complications.
<strong>Objective: </strong>To compare the analgesic effect of intrathecal midazolam versus intrathecal tramadol when added to bupivacaine during spinal anesthesia after infra-umbilical surgeries.
<strong>Patients and methods</strong>: In our study we included 80 patients scheduled for elective surgeries in the lower abdomen and lower limbs (infra-umbilical surgeries) under spinal anesthesia. They were randomly divided to one of two groups. Group M received 10 mg of hyperbaric bupivacaine + 2 mg midazolam, and group T received 10 mg of bupivacaine + 20 mg of tramadol (total is 3cc in both groups). The comparison was done by using the visual analogue scale (VAS) for assessing postoperative pain score and recording the duration of postoperative analgesia.
<strong>Results: </strong>The postoperative analgesia duration was significantly higher in the tramadol group than midazolam group (P<0.05).
<strong>Conclusion: </strong>Addition of 20 mg tramadol to bupivacaine during spinal anesthesia provides longer duration of analgesia when compared to intrathecal midazolam 2.0 mg.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Role of Renal Parenchymal Thickness and Renal Isotope Scan in Predicting Outcome After Pyeloplasty in Children with Ureteropelvic Junction Obstruction (UPJO)32933414489710.21608/ejhm.2021.144897ENMohamed Shawkey El-DesoukeyDepartment of Urology, Faculty of Medicine, Zagazig University, Sharkia, EgyptSalem Ahmed KhalilDepartment of Urology, Faculty of Medicine, Zagazig University, Sharkia, EgyptEmad Abdelhamid SalemDepartment of Urology, Faculty of Medicine, Zagazig University, Sharkia, EgyptMohamed Mahmoud SeleemDepartment of Urology, Faculty of Medicine, Zagazig University, Sharkia, EgyptJournal Article20210130<strong>Background:</strong> Pelviureteric junction obstruction (PUJO) is the most common cause of pediatric hydronephrosis.
<strong>Objective:</strong> To find the relation of renal parenchymal thickness & isotope scan preoperatively & postoperatively in predicting outcome after pyeloplasty.
<strong>Patients and Methods:</strong> This prospective study included, 30 children ≤ 18 years, with 1ry unilateral UPJO from September 2018 to September 2019 were included in the study. Ultrasound abdomen was done on all patients to look at the size of the kidney, parenchymal thickness & renal echogenicity. DTPA scan was done to measure the GFR, t½ and split function of each kidney & all patients underwent open pyeloplasty. Patients were followed up after the operation at 1, 3, and 6 months respectively. At each follow-up visit, U/S was performed & renal isotope was done at the 6<sup>th</sup> month. The preoperative parameters were compared with the same parameters after surgical repair of the UPJO at 3rd & 6th months.
<strong>Results</strong>: In our study, there was an improvement in (83.3%) with a significant change in all parameters at 6<sup>th</sup> months postoperatively (<em>P</em> < 0.01) as T ½ significantly decreased while parenchymal thickness, GFR of the affected kidney & split renal function were significantly increased postoperatively.
<strong>Conclusions:</strong> This study showed that parenchymal thickness and renal isotope are good predictors for pyeloplasty outcome.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Effect of Progesterone Replacement Therapy on Uteroplacental Circulation in Treatment of Threatened Abortion33534214489810.21608/ejhm.2021.144898ENYousef Abo Elwan ElsayedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptWalid Abdallah MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptAmira Ahmed Said ZolfakarDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptBasem Mohamed HamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, EgyptJournal Article20210130<strong>Background</strong>: Miscarriage is interruption or termination of pregnancy before 20 weeks based upon the day of the last normal menses or it is the expulsion of the product of conception before the age of medicolegal viability which is 26<sup>th</sup> weeks of gestation in Egypt or fetal weight < 500gm or fetal length ≤ 25 according to WHO definition.
<strong>Objective:</strong> This study was performed to compare the effect of vaginal micronized progesterone and oral dydrogesterone on utero-placental circulation in threatened miscarriage.
<strong>Patients and Methods</strong>: A prospective clinical study in Zagazig University Hospital during the period from December 2018 to August 2019. Included fifty pregnant cases complaint of first trimester vaginal bleeding and diagnosed as threatened miscarriage. They were classified into two groups on a randomized basis, the first group received micronized vaginal progesterone (400 microgram daily) while the second one received dydrogesterone orally (40 mg at once then 10 mg every 8 hours). Both groups were followed up every two weeks for three visits by serial transvaginal Doppler ultrasound measurement of pulsatility index, resistance index, and systolic/diastolic (S/D) ratio of the spiral arteries, uterine arteries & intrachorionic area.
<strong>Results</strong>: The study demonstrated that vaginal progesterone administration, contrary to oral dydrogesterone treatment, decreased spiral artery pulsatility and resistive indices. No major changes in the uterine artery blood flow impedance were observed, only S/D ratio significantly decreased in the dydrogesterone group.
<strong>Conclusion</strong>: It could be concluded that vaginally administrated progesterone was nearly as equally effective as oral dydrogesterone in prevention of miscarriage in pregnant women with threatened abortion with different effects on the uteroplacental circulation.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Using Gelfoam Technique to Reduce the Incidence of Seroma Formation after Modified Radical Mastectomy34334614489910.21608/ejhm.2021.144899ENTamer Mohamed ElshahidyDepartment of General Surgery, Faculty of Medicine, Zagazig University, Egypt.Mohamed Mahmoud MokhtarDepartment of General Surgery, Faculty of Medicine, Zagazig University, Egypt.Mahmoud Abdou YassinDepartment of General Surgery, Faculty of Medicine, Zagazig University, Egypt.Journal Article20210130<strong>Background: </strong>Breast cancer is the most prevalent cancer in our surgical practice in Egypt. Seroma is one of the most annoying complications after modified radical mastectomy and axillary clearance. Different modalities have been used to decrease the incidence of seroma.
<strong>Objective:</strong> To assess the impact of using gelfoam in decreasing seroma formation following modified radical mastectomy.
<strong>Patients and methods: </strong>This randomized controlled trial was done on eighty patients operated upon for modified radical mastectomy between January 2019 and November 2020 in Zagazig University Hospitals. Patients were randomly allocated into two groups; in each one forty patients. In the first group (group A) we used the gelfoam under the mastectomy and axillary flaps; in the second group (group B) we did the same surgical technique without using the gelfoam.
<strong>Results: </strong>We noticed that the incidence of seroma formation among group (A) was 2.5% versus 17.5% in group (B), with statistically significant difference between both of them (P<0.05).
<strong>Conclusion: </strong>The use of gelfoam is an effective procedure which reduces the incidence of seroma formation under mastectomy flaps.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Comparative Study between Efficacy of Serratus Anterior Muscle Block as A Regional Analgesia Technique and I.V Morphine Infusion in Patient with Fracture Ribs34825214490010.21608/ejhm.2021.144900ENWesam Abd El-Galil Abu-ElwafaDepartment of Anaesthesia, ICU & Pain Management, Sohag Faculty of Medicine, Sohag UniversityIslam Ahmed RagabDepartment of Anaesthesia, ICU & Pain Management, Sohag Faculty of Medicine, Sohag UniversityAbdelrahman Hassan AbdelrahmanDepartment of Anaesthesia, ICU & Pain Management, Sohag Faculty of Medicine, Sohag UniversityWael Alham MahmoudDepartment of Anaesthesia, ICU & Pain Management, Sohag Faculty of Medicine, Sohag UniversityJournal Article20210130<strong>Background:</strong> Rib fractures are very common and are detected in at least 10% of all injured patients, the majority of which are because of blunt thoracic trauma with road traffic collisions being the main cause. Pain management of the acutely injured patient with rib fractures can be difficult for even the most experienced emergency physician.
<strong>Objective: </strong>To evaluate the safety and efficacy of serratus anterior muscle plane block as a regional analgesic technique performed in patient with fracture ribs.
<strong>Patients and Methods: </strong>Randomized, controlled study was carried out in Department of Anesthesia and Intensive Care Unit, Sohag University Hospital. Forty patients with lateral multiple rib fractures were included in this study. All patients were suffering from excruciating pain and were not responding to conventional analgesics. The patients were randomly assigned into two groups, 20 patients each. Group A, for whom serratus anterior plane block (SAP) was done and Group B, for IV morphine infusion.
<strong>Results: </strong>In Group A, the mean pain score decreased from 9.1 ± 0.7 to 0.6 ± 0.7 after intervention. In group B, the mean pain score improved from 9.3 ± 0.8 to 1.15 ± 0.8 after IV morphine infusion. Pain scores gradually decreased. There were no significant difference between the two groups when the other trauma surveys were compared.
<strong>Conclusion:</strong> Ultrasound guided Serratus Anterior Plane block is an effective technique for providing analgesia in patients with anterior and lateral rib fractures with fewer risks of complications.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Study of Perinatal Outcome of Severe Late onset Intrauterine Growth Restriction using Biophysical and Doppler Fetal Parameters35436114490110.21608/ejhm.2021.144901ENMedhat Essam Eldeen HelmyMohamed Ehab Ali SalitShaimaa Abdel-hamid HassaneinAhmed Sabry Fouad El-hamoulyMohamed ELsibai AnterObstetrics and Gynecology Departments, Faculty of Medicine, Menoufia University Menoufia governorate, Egypt.Journal Article20210130<strong>Background:</strong> Intrauterine growth restriction is one of the most common causes of perinatal morbidity and mortality worldwide. Strong evidence about the optimum method of surveillance is needed.
<strong>Objective:</strong> to determine the relationship between biophysical fetal parameters and arterial and venous Doppler parameters in fetuses with severe intrauterine growth restriction (IUGR).
<strong>Patients and Methods:</strong> This is a Prospective cohort study was conducted at Menoufia University Hospital during the period from March 2019 to September 2020. Fourty two IUGR fetuses with elevated Umbilical Artery (UA) Doppler had follow up with Doppler (UA, middle cerebral artery and ductus venosus) and Biophysical profile (BPP). Patients were stratified into three groups: G1: abnormal UA alone. G2: brain sparing effect. G3: abnormal DV Doppler. Our main primary outcome was neonatal intensive care unit (NICU) admission while secondary outcomes were APGAR score, Birth weight, EFW and stillbirth rate.
<strong>Results </strong>UAEDV was present in 29 fetuses (69%), Absent/Reversed (AREDV) in 13 (31%). Brain sparing was observed in 18 fetuses (42.85%). Abnormal DV Doppler was noticed in 5 fetuses (11.9%). The BPP was > 6 in 28 fetuses (66.6%). Abnormal doppler (UA, MCA, DV) and abnormal BPP were significantly associated with increased NICU admissions, Still birth rates, lower APGAR scores, EFW and Birth weight. Multivariate regression analysis was performed, and it was found that abnormal MCA was the most associated parameter with NICU admission. <strong>Conclusion:</strong> Fetal Doppler (UA, MCA, DV) and BPP are complementary antenatal modalities. Therefore, pursuit of a combined testing approach has merit.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Epidural Analgesia in Breast Surgery36226814490210.21608/ejhm.2021.144902ENAhmed Elsaied Abd-Elrahman AliDepartment of Anesthesia and Intensive Care and Pain Medicine, Faculty of Medicine – Sohag UniversitySherif Kamal Hafez ArafaDepartment of Anesthesia and Intensive Care, Faculty of Medicine - Kafr Elsheikh UniversityAmir Abou Zkry ElsayedDepartment of Anesthesia and Intensive Care, Faculty of Medicine - Kafr Elsheikh UniversityMahmoud Fawzy Shehata El SharkawyDepartment of Anesthesia and Intensive Care, Faculty of Medicine - Aswan UniversityJournal Article20210130<strong>Background: </strong>Breast Surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery.
<strong>Objective: </strong>To assess the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) compared with thoracic epidural analgesia (TEA) for breast surgery. <strong>Patients and methods:</strong> This is a prospective randomized clinical study done at Aswan University Hospitals. The present study was conducted on sixty female patients ASA I-II, their ages ranged from 20-50 years and scheduled for unilateral breast surgery. The patients were allocated randomly into three groups (n=20 each) according to type of regional anesthesia administrated. <strong>Results:</strong> There was no significant difference between the studied groups in age, body weight, height and BMI. VAS pain scores throughout the first 24 hrs postoperative showed that there was highly statistically significant decrease in VAS in immediate till 6 hrs postoperative in SAPB group (VAS in group C was less than in groups A and B, P-value < 0.001). As regard to side effects, no complications in the studied groups were recorded such as pneumothorax, vascular puncture, or local anesthetic toxicity. <strong>Conclusion:</strong> Serratusanterior plane blockmaintained hemodynamic stability as compared to TE and it produced low pain scores and less total morphine consumption in the early postoperative period after unilateral breast cancer surgery. These advantages, suggest the usefulness of SAPB especially in outpatient surgery.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Association of Receptor Activator of Nuclear Factor-κB Ligand (RANKL) and Osteoprotegerin with Secondary Hypogonadism in Egyptian Females with Beta-Thalassemia Major36937814490310.21608/ejhm.2021.144903ENNearmeen M. RashadAmira M. El-HelalyAhmed M. RadwanNeveen F. IbrahimJournal Article20210130<strong>Background:</strong> Thalassemia is the most common cause of chronic hemolytic anemia and is correlated with significant morbidity and mortality. Osteoprotegerin (OPG) is an α tumor necrosis factor receptor superfamily glycoprotein that acts as a decoy receptor for the receptor activator of nuclear factor kappa B ligand (RANKL), exerting an antiresorptive bone effect and also play critical roles in hypogonadism associated osteoporosis.
<strong>Objective: </strong>Toexplore the serum levels of RANKL and OPG in adult Egyptian females with Beta-Thalassemia Major (BTM) and to detect their relations with female hypogonadism
<strong>Patients and Methods</strong>: a prospective cross-sectional controlled study enrolled 50 control females and 45 women with BTM. We measured OPG and RANKL by ELISA, Bone mineral density (BMD) of the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry
<strong>Results: </strong>Among 45 patients with BTM, 27 patients had hypogonadotropic hypogonadism, and they had significantly higher values of serum RANKL (8.3±1.8pmol/l) compared to BTM without hypogonadism (5.9±1.01) and controls (5.5±1.11). Regarding serum OPG, there were no non-significant differences between the studied groups. Linear regression analysis test revealed that serum RANKL levels were independently correlated with BMD femur and spine, while serum OPG levels were independently correlated with BMD spine and LH. The sensitivities and the specificities of serum RANKL levels by ROC tests to discriminate against BTM patients with hypogonadism were 91.1% and 96%.
<strong>Conclusions:</strong> Serum RANK levels elevated in BTM patients particularly hypogonadism groups. The diagnostic power of serum RANKL was highly significant thus, it could be used as a biological marker of hypogonadism in BTM.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200282220210101Novel Biomarker Serum Calprotectin for Early Diagnosis of Diabetic Peripheral Neuropathy in Type 2 Diabetes Patients37938514490410.21608/ejhm.2021.144904ENFarid Fawzy Abd El-hafezAyman Abd-Elrahman Mohamed Nsr-AllahAhmed Kamal Abd Eljalil MohamedAzza Moustafa AhmedAmira Ahmed MahmoudJournal Article20210130<strong>Background: </strong>Calprotectin was identified as an endogenous activator of Toll-like receptor 4 (TLR4) and as receptor for advanced glycation end product (RAGE). Elevated plasma levels of calprotectin have been reported in a variety of chronic inflammatory conditions. Elevated calprotectin levels have been reported to predict microvascular alterations in type 2 diabetes (T2DM) patients.
<strong>Objective: </strong>To make an up to date review of serum level of calprotectin as a predictor for early diagnosis of peripheral neuropathy in type 2 diabetes patients.
<strong>Patients and methods: </strong>A total number of 90 subjects were included in the study after fulfillment of the inclusion and exclusion criteria. Calprotectin was measured for all the 90 subjects.
<strong>Results: </strong>Serum calprotectin levels were significantly higher in group III “diabetics with neuropathy” compared to group II “diabetics without neuropathy “and group I “healthy controls”.
<strong>Conclusion: </strong>High levels of calprotectin were detected in type 2 diabetic patients with peripheral neuropathy.