Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001The Evaluation of Routine Central Nodal Dissection in Radiologically Node Negative Differentiated Thyroid Carcinoma570957141176610.21608/ejhm.2018.11766ENAyman AbdAllah AbdRaboDepartment of General Surgery, Faculty of Medicine-Ain Shams UniversityMohamed Fayek MahfouzDepartment of General Surgery, Faculty of Medicine-Ain Shams UniversityAhmed Adel DarwishDepartment of General Surgery, Faculty of Medicine-Ain Shams UniversityAhmed Yosry AbdulAleem AmmarDepartment of General Surgery, Faculty of Medicine-Ain Shams UniversityJournal Article20180828<strong>Background:</strong> thyroid cancer is the most common malignant disease in endocrine system and is rapidly increasing in incidence. The use of routine prophylactic central neck dissection for the treatment of differentiated thyroid cancer has been an area of debate over the past few decades.<strong> Aim of the Work: </strong>the primary aim of surgery was to resect disease, minimize the chance of recurrence and achieve this with minimal morbidity. Selecting the appropriate procedure is critical as not only does surgery provide initial therapy, but also optimizes the patient for adjuvant radioactive iodine (RAI) therapy when required.<strong> Patients and Methods:</strong> this study was conducted to evaluate the efficacy of prophylactic central lymph nodal dissection in patients diagnosed with differentiated thyroid carcinoma from several points of view including operative time, hospital stay, postoperative complications and most importantly the recurrence. Our patients were operated upon between August 2016 and August 2017 with minimal follow up of 6 months and follow up extended to 2 years after surgery.<strong> Results</strong>: Operative time was significantly higher in group B with a mean time of 141.68 ± 12.72 as compared to group A. The most outstanding difference in terms of complications was detected in transient hypoparathyroidism that occurred in 16% of group B patients. A single case of recurrence was detected at 12 month in group A that was confirmed by fine needle aspiration cytology which required reoperation.<strong> Conclusion:</strong> there was no convincing evidence that pCND leads to an improvement in recurrence rate, overall survival, or any clinically significant variable when applied indiscriminately to DTC patients.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Clinicopathologic Study of Endometrial and Hormonal Changes after Metformin Therapy in Patients with Polycystic Ovary Syndrome571557241176710.21608/ejhm.2018.11767ENSalah-el-din Sayed SemaryDepartment of Pathology, Faculty of Medicine, Al-Azhar University, DamiettaAl-Sayed A. Abd-ElrahmanDepartment of Anatomy and Embryology, Faculty of Medicine, Port Said University, EgyptAhmad TahaDepartment of Physiology, Faculty of Medicine, Port Said University, EgyptMahmoud F. MidanDepartment of Obstetrics and Gynecology, Al-Azhar Faculty of Medicine, DamiettaRashed M. RashedDepartment of Obstetrics and Gynecology, Al-Azhar Faculty of Medicine, DamiettaTarek M. EmranDepartment of Clinical Pathology, Al-Azhar Faculty of Medicine, DamiettaN TahraDepartment of Obstetrics and Gynecology, Al-Azhar Faculty of Medicine, DamiettaJournal Article20180828<strong>Background:</strong> polycystic ovary syndrome (PCOS) is a common disorder of women in reproductive age. PCOS, a complex genetic condition, is a heterogeneous syndrome of clinical and/or biochemical androgen excess, ovulatory dysfunction and polycystic ovaries. Metformin has been shown to improve fertility in the ovulatory patients with PCOS, inducing not only a high ovulation and pregnancy rate, but also reducing the incidence of miscarriages.<strong> Aim of the Work:</strong> this study aimed to evaluate the effects of metformin on hormonal profile and endometrial tissue, including pattern of immunohistochemical expression of androgen receptors (AR), in patients with PCOS.<strong> Patients and Methods:</strong> 50 women with polycystic ovary syndrome (PCOS) were enrolled in this study. Each patient was submitted to detailed history taking, clinical examination including hair all over the body, body weight, body height and body mass index (BMI), transvaginal sonography, laboratory investigations ( LH, FSH, fasting insulin, free testosterone). Endometrial samples were taken for histopathological evaluation and assessment of androgen receptors. These investigations were done before and after three months of metformin treatment. <strong>Results:</strong> there was a significant decrease of BMI of the studied cases after metformin administration (P value <0.001). Also, there was a significant decrease of LH level after metformin administration from 8.07 ± 2.48 mIU/ml to 6.85 ± 3.5 mIU/ml and a significant decrease of fasting insulin level from 13.5 ± 5.3 before metformin administration to 10.2 ± 6.9 after administration. As regard to pathological results before metformin treatment, histopathological examination of the endometrial specimens revealed features of early proliferative endometrium in 32 cases, late proliferative in 10 cases, while the remaining 8 cases showed features of simple endometrial hyperplasia. Among the 32 cases with early proliferative endometrium, 30 cases progressed to late proliferative endometrium after treatment with metformin, while the remaining 2 cases showed no morphologic changes. Among the 10 cases with late proliferative endometrium, 3 cases progressed to early secretory phase, 3 cases to mid-secretory and 4 cases progressed to late secretory endometrium indicative of ovulation. Regression of hyperplasia was noted in 3 out of the 8 cases diagnosed as simple endometrial hyperplasia. As regard to immunohistochemistry (IHC), we found that women with PCOS exhibited marked increase in endometrial androgen receptors (AR) expression compared to the normal fertile controls (p<0.001). Significant decrease in AR expression in endometrial tissue after metformin therapy was observed (p<0.003).<strong> Conclusion:</strong> metformin therapy in patients with PCOS restores menstrual cyclicity, induces ovulation and showing decrease in LH level, fasting insulin, and AR expression in endometrial tissue.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001The Utility of P53, P63, P57 and Ki67 Immunohistochemistry in the Differentiation between Hydropic Abortion and Molar Pregnancy (Immunohistochemical Study)572557351176810.21608/ejhm.2018.11768ENSalah-el-din Sayed SemaryDepartment of Pathology, Faculty of Medicine, Al-Azhar University, DamiettaAl-Sayed A. Abd-ElrahmanDepartment of Anatomy and Embryology, Faculty of Medicine, Port Said University, EgyptMhammed Hafez MohammedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Port Said University, EgyptJournal Article20180828<strong>Background:</strong> the classification of molar gestations into complete and partial hydatidiform moles and their differentiation from hydropic abortion are traditionally accomplished by histomorphology alone, but sometimes, the process may be inaccurate or inconclusive. Recently, immunohistochemical staining techniques have been reported as a good diagnostic adjunct complementary to histologic diagnosis. One of the advantages of this method is the ability to apply it retrospectively to sections of routinely formalin fixed/paraffin embedded tissue and therefore, there is no need for expensive or sophisticated techniques.<strong> Aim of the Work:</strong> this study aimed to determine if immunohistochemical expression of p53, p63, p57 and Ki67 could aid in differentiating molar from non molar pregnancies on one hand and complete mole from partial mole on the other.<strong> Materials and Methods:</strong> a total of 180 placental specimens were enrolled in this study including 60 non molar placental specimens with hydropic changes and 120 molar specimens (60 complete hydatidiform moles (CHM) and 60 partial hydatidiform moles (PHM). These cases were examined histologically and immunohistochemically for expression of p53, p63, p57 and Ki67.<strong> Results:</strong> there was a significant difference in p57 expression between HA and PHM (P value < 0.05) and also between PHM and CHM (P value < 0.003). There was a significant difference in Ki67 expression between HA and PHM (P value < 0.03), PHM and CHM (P value < 0.01) and between HA and CHM (P value < 0.009). There was no significant difference in P63 expression between HA and PHM (P value ˃0.8), PHM and CHM (P value ˃0.5), and also between HA and CHM (P value ˃0.2). A significant difference in p53 expression between HA and CHM (P value < 0.007) was noted, also between PHM and CHM (P value = 0.005), while no significant difference between HA and PHM in expression of p53 (P value ˃0.8).Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Supraclavicular Brachial Plexus Nerve Block versus Patient Controlled Analgesia for Post-Operative Pain Management in Forearm Surgery573657421177010.21608/ejhm.2018.11770ENMohamed Mohamed Nabil El ShafeiAnesthesiology and Intensive Care Department, Faculty of Medicine, Ain Shams UniversityMahmoud Hasan Mohamed HasanAnesthesiology and Intensive Care Department, Faculty of Medicine, Ain Shams UniversityAhmed Abd Eldayem Abd ElhakAnesthesiology and Intensive Care Department, Faculty of Medicine, Ain Shams UniversityMai Mohamed Zakaria AbdelhamidAnesthesiology and Intensive Care Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180828<strong>Background:</strong> supraclavicular Brachial plexus block is an excellent method for attaining optimal operating conditions for upper limb surgeries by producing complete muscular relaxation, maintaining haemodynamic stability and the associated sympathetic block.<strong> Aim of the Work:</strong> the purpose of this study was to compare Supraclavicular Brachial plexus nerve block to patient controlled analgesia for postoperative pain management in forearm surgeries. Therefore, we performed a randomized study to compare the efficacy of Supraclavicular Brachial plexus nerve block with that of patient controlled analgesia.<strong> Patients and Methods:</strong> sixty-four patients presenting to Ain Shams University hospitals for forearm surgeries were enrolled in this prospective randomized study after providing written consents. Participants were instructed about the study protocol and visual analogue scale (VAS). Approval was obtained from the research ethics committee of anesthesia and intensive care department, at Ain Shams University.<strong> Results:</strong> the results of the study revealed that there is significant difference between supraclvicular brachial plexus block and patient controlled analgesia regarding the postoperative analgesia after forearm surgery.<strong> Conclusion:</strong> there is significant difference between supraclvicular brachial plexus block and patient controlled analgesia regarding the postoperative analgesia after forearm surgery. Significantly better pain control was observed in the supraclvicular brachial plexus block group. Patient satisfaction was greater in the supraclvicular brachial plexus block group. Nausea and vomiting were observed more frequently in patient controlled analgesia group.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Impact of Direct Acting Antiviral Drugs (DAADs) on Cognitive function among Hepatitis C Virus Infected Patients574357471297210.21608/ejhm.2018.12972ENHassan Salah Eldin HamdyDepartment of Tropical Medicine, Faculty of Medicine, Ain Shams UniversityMohamed Salah ELdin Abd El HamidDepartment of Tropical Medicine, Faculty of Medicine, Ain Shams UniversityMohamed Ahmed ShafikDepartment of Neurology Medicine, Faculty of Medicine, Ain Shams UniversityEnass Mohamed Ahmed Mohamed SolimanDepartment of Tropical Medicine, Faculty of Medicine, Ain Shams UniversityJournal Article20180909<strong>Background:</strong> chronic hepatitis C virus (HCV) is a major cause of liver-related morbidity and mortality. Successful antiviral therapy with sustained viral clearance is associated with improved quality of life, and reduced risk of liver complications such as cirrhosis and hepatocellular carcinoma.<strong> Aim of the Work:</strong> to evaluate the impact of HCV eradication using direct acting antiviral drugs (DAADs) on cognitive function among hepatitis c virus infected patients.<strong> Patients and Methods:</strong> this study was conducted at Viral Hepatitis Unit of Dar El Shefaa Hospital (one of the centers of national committee for control of viral hepatitis) and MASRI (Faculty of Medicine Ain-Shams Research institute) unit at El-Demerdash Hospital. Data were prospectively collected using MoCA, PHQ-9 and PSQI scales to assess the cognitive function of the treated patients with the newly used DAADs before the start of treatment, during treatment and at 12 weeks after the end of treatment, and the laboratory data were collected from the files of the patients in the previously mentioned centers.<strong> Results:</strong> results of the current study as regarding the analytical part of the study showed that: Pre treatment: slightly cognitive impairment was found with mild level of depression and sleep disturbance with MoCA test Mean ± SD 23.02 ± 4.96. At the end of treatment: there was no direct effect of the newly used drugs on the cognitive function. After 3 months of treatment (SVR): there was significant improvement of the cognitive function.<strong> Conclusion:</strong> HCV eradication had beneficial effect on cognitive function. Sofosbuvir based treatment had no effect on cognitive function.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001A Comparative Study between the Performing Spinal Anesthesia in Sitting versus Lateral Position on Patient Hemodynamics574857521187510.21608/ejhm.2018.11875ENGalal Adel El KadiAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams UniversityRanda Ali Shokry MohamedAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams UniversityAndrew Mehany FaresAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams UniversityJournal Article20180829<strong>Background:</strong> spinal anesthesia is frequently accompanied by hypotension, which may be defined in absolute terms as a systolic blood pressure of 90 or 100 mmHg or in relative terms as a percentage (20% fall from baseline). The severity of hypotension depends on the height of the block, the position of the patient and the volume status. <strong>Aim of the Work:</strong> to compare the effect of performing spinal anesthesia in sitting versus lateral position on patient hemodynamics (blood pressure and heart rate).
<strong>Patients and Methods:</strong> after approval from departmental ethics committee and written informed consent from the patient, a randomized study was conducted on eighty patients with American society of anesthesiologists physical status I and II aged from 21 to 50 years of both genders. The study conducted from January 2018 to May 2018. Preoperative investigations were done according to the local protocol designed to evaluate the patients.
<strong>Results: </strong>The onset of sensory block of spinal anesthesia (the time needed to reach the sensory level between T8 & T10) was relatively faster in lateral group (3.93 ± 1.05) than in sitting group (4.40 ± 1.26) but, these differences were statistically not significant.
<strong>Conclusion:</strong> because we have used hyperbaric bupivacaine, it is more likely that the drug settled down more quickly in the sitting position than in the lateral position. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Comparison between Cabergoline and Coasting in Prevention of Ovarian Hyperstimulation Syndrome and their effect on Intracytoplasmic Sperm Injection Outcome575357691187710.21608/ejhm.2018.11877ENIsmaeil M. El-GarhyDepartment of Obstetrics and Gynecology,
Faculty of Medicine, Al Azhar UniversityAhmed O. Abdel MotaalDepartment of Obstetrics and Gynecology,
Faculty of Medicine, Al Azhar UniversityMohamed G. OmrDepartment of Obstetrics and Gynecology,
Faculty of Medicine, Al Azhar UniversityJournal Article20180829<strong><span lang="EN-US">Aim of the work: </span></strong><span lang="EN-US">ovarian hyperstimulation syndrome (OHSS) is an iatrogenic, serious and potentially fatal complication of ovarian stimulation, affecting1–14% of all IVF/ICSI cycles. This study aimed to compare cabergoline after hCG administration with delayed hCG administration (coasting) in high risk patients to prevent OHSS in ART cycles. <strong>Patients and methods:</strong> this prospective comparative randomized study included 100 patients at risk of OHSS performed in the Assisted Reproductive Technologies Center, Al-Azhar University and in Private IVF Centers during the period from November, 2015 to October, 2016. <strong>Results:</strong> comparison between the two groups showed no significant difference regarding age, BMI, presence of risk factors of OHSS, but there was a significant difference regarding FSH, LH and the mean diameter of follicles on day of hCG administration.<strong> Conclusion: </strong>PCOS affects 5 to 10% of women of childbearing age and is the most common cause of anovulatory infertility in developed countries. <strong>Recommendations: </strong>further studies including large number of cases and for longer duration will further confirm the efficacy of cabergoline and coasting on prevention of OHSS.</span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Comparative Study between Flexible Ureteroscopy and Semirigid Ureteroscopy in Management of Upper Ureteric Stones using Laser Lithotripsy577057761187810.21608/ejhm.2018.11878ENYoussef Mahmoud KotbDepartment of Urology, Faculty of Medicine – Ain Shams UniversityAhmed Farouk MahmoudDepartment of Urology, Faculty of Medicine – Ain Shams UniversityKerollous Nashaat Harras SolimanDepartment of Urology, Faculty of Medicine – Ain Shams UniversityJournal Article20180829Background: There are various options in the management of proximal ureteral stones, which includes medical expulsive therapy, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS; retrograde), percutaneous nephrolithotomy (PCNL), laparoscopy (LAP), and open surgery.
<strong>Objective:</strong> The aim of this study was to evaluate the efficacy and safety of both semirigid and flexible ureteroscopy in management of upper ureteric stones using laser lithotripsy.
<strong>Patients and Methods:</strong> To achieve this goal, this prospective study was done at the urology department, Ain Shams University Hospitals on 60 patients with upper ureteric stones less than 2 cm in size. They were divided into groups of 30 patients in each group. Patients in group A were treated by semirigid ureteroscopy. While patients in group B were treated by flexible ureteroscopy using laser lithotripsy in both procedures.
<strong>Results:</strong> Stone free rate was 90.0% in group A while it was 93.3% in group B. Mean operative time was 55.07 ± 13.24 min in Group A while it was 64.63 ± 17.33 min in Group B. Success rate was 76.7% in group A, while it was 90.0% in group B. 20% of patients in group A had intra or postoperative complications in the form of: 6.7% of cases had failure to access to the stone, in 3.3% of cases there was upward migration of stone toward kidneys, 3.3% of cases had ureteral submucosal injury, 3.3% of patients had postoperative fever and 3.3% of patients developed haematuria.
<strong>Conclusion:</strong> Flexible ureteroscopy is a favorable option for patients having proximal ureteral stones with higher stone free rate and success rate. On the other hand, semirigid ureteroscopy is an acceptable alternative for treatment of proximal ureteral stones. Flexible ureteroscopy costs is much higher compared to semirigid ureteroscopyPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001The Prevalence of Musculoskeletal Disorders among EMS Personnel in Saudi Arabia, Riyadh577757821187910.21608/ejhm.2018.11879ENNawfal AljerianKing Abdullazez Medical City- RiyadhSaud AlshehriKing Saud Bin Abdullazez UniversityEmad MasudiKing Saud Bin Abdulaziz UniversityAbdulaziz Mohammad AlbawardiKing Saud Bin Abdullazez UniversityFiasal AlzahraniKing Abdullazez Medical City- RiyadhRadhi AlanaziKing Saud Bin Abdullazez UniversityJournal Article20180829<strong>Background:</strong> Musculoskeletal disorders (MSDs) are common among EMS personnel throughout the world.<br /> Objective: The aim of the study was to determine how common the (MSD) among the EMS personnel and its associated factors such as smoking, BMI and place of work (field-workers and hospital-workers) in Saudi Arabia, Riyadh.<br /> <strong>Methods:</strong> Cross-sectional study to measure the prevalence of (MSD) among the EMS personnel. The Nordic Musculoskeletal Disorders Questionnaires were distributed to collect the data from SRCA and tertiary hospitals. The required sample size was 180 from each group. Chi-square test was used to assess the association between the MSDs and categorical date.<br /> <strong>Results:</strong> Questionnaires of 360 participants were completed and analyzed. The most prevalent site affected was the lower back (60.3%) followed by knees (41.4%), neck (40.3%) and upper back (40%); the least frequent disorder was that of hip/thigh (10.3%). Hence, (37.2%) of the paramedics suffer low back pain during their duty. Also, BMI results have shown a prevalence of obesity (19.2%), overweight (41.4%) and only (36.1%) fall within the normal range of BMI and increased BMI is highly associated to lower back (p=0.009). Furthermore, smokers number were very high (65%) and it was associated with MSD with (P<0.05) in the lower back and knees. The result showed that there was no significant difference between work places.<br /> <strong>Conclusion:</strong> The very high prevalence of MSDs was found among paramedics. It is suggested that paramedics have to be engaged in programs at their work place. Such as, exercise, improve the manual handling techniques and encourage smoke cessation. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Syntactic Profile in Children with Autism Spectrum Disorders (ASD)578357871188010.21608/ejhm.2018.11880ENOmnya M. LotfyENT Department, Phoniatric Unit, Faculty of Medicine, Ain Shams University, Cairo, EgyptAzza A. AzzamENT Department, Phoniatric Unit, Faculty of Medicine, Ain Shams University, Cairo, EgyptAhmed N. KhattabENT Department, Phoniatric Unit, Faculty of Medicine, Ain Shams University, Cairo, EgyptSafaa R. El-SadyENT Department, Phoniatric Unit, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180829<strong>Background: </strong>in autism spectrum disorder the range of language abilities varies between total muteness to an apparent grammatically complex language. There is a debate on the effect of autism on syntax development if it is normal, delayed or deviant<strong>.</strong>
<strong>Aim of the Work: </strong>it was to assess the syntactic profile of ASD children.
<strong>Patients and Methods:</strong> a cross sectional descriptive research design. The subjects of this study comprised a convenient sample of 20 children diagnosed as ASD and other 20 normal children as control group with age range between 3 years 8 months and 11 years 8 months. Modified Arabic preschool language scale (PLS-4) Test and Stanford Binet intelligence scales, fifth edition were done for all children and Child autism rating scale (CARS) was done for children with ASD.
<strong>Results</strong>: syntax in ASD is significantly delayed compared to the syntax of normal subjects. Significant impairments in certain items of syntax as (Making grammatical judgments or repairing grammatical errors, understanding pronouns or expressing them, retelling sentences or stories, answering logically using negation, expressing jobs in speech, using irregular plurals, using dualization, question formulation, using past tense forms and using words that describe physical state) was found.
<strong>Conclusion:</strong> syntax in ASD was found to be affected and is found to be below the total language level of the study subjects and this was confirmed by sustained repeated impairments in certain items of syntax. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Role of MRI in Diagnosis of Medulloblastoma578857941188110.21608/ejhm.2018.11881ENSameh M. AbdelwahabDepartment of Radiology, Faculty of Medicine - Ain Shams UniversityAmgad S. Abdel-RahmanDepartment of Radiology, Faculty of Medicine - Ain Shams UniversityBasma Gamal AbdelrhmanDepartment of Radiology, Faculty of Medicine - Ain Shams UniversityJournal Article20180829<strong>Background:</strong> Brain tumors represent the most common solid neoplasm in children and second most common pediatric malignancy overall. The majority of primary childhood brain tumors occurs in the infratentorial compartment and includes: medulloblastoma, juvenile pilocytic astrocytoma (JPA), ependymoma, brainstem/pontine glioma, and atypical teratoid rhabdoid tumor (ATRT) which is an additional rare but important primary brain tumor of early childhood.
<strong>Objective: </strong>This study aims to provide an overview of the imaging features and appearances of the most common primary posterior fossa brain tumors in children and the diagnosis of medulloblastoma. <strong> </strong>
<strong>Patients and Methods: </strong>The pool of our study was 25 patients (12 males and 13 females) who presented to diagnostic radiology departments at EL Demerdash Teaching Hospital and National Cancer Institute. They had been diagnosed to have posterior fossa lesions. Patients’ age ranged from 1 to 17 year with mean age of 4.73 years.<strong>Results: </strong>statistically significant difference between medulloblastoma and other posterior fossa tumors according to location and diffusion. Medulloblastoma is 4<sup>th</sup> ventricular in location and shows restriction in diffusion weighted images. <strong>Conclusion: </strong>Medulloblastoma is predominately 4<sup>th</sup> ventricular in location, Medulloblastoma is restricted in diffusion weighted images.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Comparison between Cyanoacrylate, Sutureless and Polypropylene Sutures in Mesh Fixation on Lichtenstein Tension free in repair of Open Inguinal Hernia579558061188310.21608/ejhm.2018.11883ENAhmed Abd El Aal SultanDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityMahmoud Saad Kamal IsmailDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityMohamed Ibrahem ELAnanyDepartment of General Surgery, Faculty of Medicine, Al Azhar UniversityJournal Article20180829<strong>Background:</strong> inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become gold standard in open inguinal hernia repair. Despite the low recurrence rates; postoperative pain and discomfort remain a problem for a large number of patients.<br /> <strong>Aim of the work: </strong>the aim of this study is to compare between cyanoacrylate, sutureless and polypropylene sutures in mesh fixation on lichtenstein tension free in repair of open inguinal hernia regard as postoperative pain, infection, recurrence,& cost benefit.<br /> <strong>Methods:</strong> a total of thirty patients with primary unilateral uncomplicated inguinal hernia were randomized to undergo lichtenstein tension free hernioplasty, and were randomized using close envelope into three groups: Group A: Inguinal hernioplasty with mesh fixation using polypropylene sutures (10 patients), Group B: Inguinal hernioplasty with mesh fixation using cyanoacrylate glue (10 patients) and Group C: Inguinal hernioplasty with mesh placement without sutures (10 patients). Primary outcome was early and late postoperative pain. Secondary endpoints were use of painkillers after 24 hours, morbidity rate and recurrence rate. Follow-up time was 6 months.<br /> <strong>Results:</strong> significantly, less postoperative pain was reported in group <strong>B</strong> compared to the other two groups <strong>(A&C)</strong>. Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay and earlier return to daily activities were seen in patients within group<strong>(B)</strong>.Clinical recurrence was reported in only one patient in Group <strong>C</strong> after a period of four months follow up postoperatively.<br /> <strong>Conclusion: </strong>cyanoacrylate glue seemed to be a simple, original, reasonable, feasible, reproducible technique and competitive alternative to the standard tissue-penetrating meshfixation devices in open inguinal hernioplasty. It is accompanied by a reduction in chronic inguinal pain, with no increase in the early recurrence rate.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Role of Percutaneous Transcatheter Embolization of Gonadal Vein Using N-Butyl Cyanoacrylate in Treatment of Varicocele580758121188510.21608/ejhm.2018.11885ENLobna Abdelmonem HabibRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptNermeen Nasry KeriakosRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptKhaled Essam BasiounyRadiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180829<strong>Background:</strong> Percutaneous embolization of the internal spermatic vein to treat varicoceles is a minimally invasive outpatient procedure that, when performed by experienced interventional radiologists, has high technical success rates, low recurrence rates, very low morbidity and minimal radiation. It has been demonstrated to be equal to surgical ligation in clinical results and as or more cost effective. Its minimally invasive nature allows it be well tolerated with shorter recovery times and less discomfort relative to surgery. When skilled and experienced vascular and interventional radiology services are available, embolization is an effective alternative to surgery and should be offered as such or as primary therapy for varicocele treatment.
<strong>Objective:</strong> The aim of this study is to discuss the role of N-buty cyanoacrylate for gonadal vein embolization in treatment varicocele causing testicular pain or infertility.
<strong>Methodology:</strong> this study was carried out in Radiology Department of Ain Shams University Hospitals.
This сross seсtionaƖ desсriptive study inсƖuded 20 patients with variсoсeƖe presented ƅy pain, infertility or recurrence after surgery and diaɡnosis was confirmed ƅy uƖtrasound.
<strong>Result: </strong>varicocele embolization has significant role in improving scrotal pain and infertility.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Comparative Study between The Addition of Pethidine Vs Fentanyl to Hyperbaric Bupivacaine for Spinal Anesthesia in Caesarean Section581358171204410.21608/ejhm.2018.12044ENGihan Seif Elnasr MohamedAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams UniversityNoha Sayed Hussien AhmedAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams UniversityGamal Eldin Adel Abdel HameedAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams UniversityAisha Abd Rahman El SabaaAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams UniversityJournal Article20180831<strong>Background:</strong> cesarean section is the most common obstetric surgery in the world. Spinal anesthesia is a preferred technique for cesarean delivery for its distinct advantages over general anesthesia as the simplicity of the technique, reliability, minimal fetal exposure to drugs, patients’ awareness and minimization of the hazards of aspiration.
<strong>Aim of the Work:</strong> to define first time require analgesia in postoperative among two groups.
<strong>Patients and Methods:</strong> this prospective comparative study was carried on fifty patients, ASA physical status II, aged from 18 to 45 years. These patients were scheduled for elective caesarean delivery under spinal anesthesia and divided to two groups. This protocol was approved by Research Ethical Committee of Ain Shams University. Written informed and verbal consent was obtained from each patient before being included in this procedure.
<strong>Results:</strong> the addition intrathecal 25mg pethidine make the total duration of analgesia 169.20 ± 7.59 minute but adding 25μg fentanyl intrathecal extended the period of effective analgesia up to 178.40 ± 6.25 min with high significant P-value (0.000). The rapid onset of sensory and motor blocks in (F) group than (P) group with P value=0.000, also increased duration of sensory and motor blocks in (F) group than (P) group with P value 0.000.
<strong>Conclusion:</strong> intrathecal opioid is a good technique of labor analgesia, although pethidine was the most widely used opioid for obstetric analgesia, it has character of local anesthetics so adding pethidine intrathecal in dose 25mg enhanced effect of local anesthetics but associated with more complications as nausea, vomiting and hypotension.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001The Predictors of Obstructive Sleep Apnea at A High Altitude: Results of a Population-based Study in the Western region of Saudi Arabia581858271204510.21608/ejhm.2018.12045ENFahad Rajallah AlharthiDept of Internal Medicine College of Medicine, Taif UniversityIbrahim MasoodiDept of Internal Medicine College of Medicine, Taif UniversityNaif AlomairiDept of Internal Medicine College of Medicine, Taif UniversityAbdullah Hassan AlmuntashiriDept of Internal Medicine College of Medicine, Taif UniversityAbdulaziz AlfaifiDept of Internal Medicine King Abdul Aziz Specialist hospital, Taif ,KSAJournal Article20180831<strong>Background: </strong>The sleep disturbances are common at high altitudes. This study aimed to determine the prevalence and predictors of obstructive sleep apnea at high altitudes.<br /> <strong>Methods:</strong> This cross-sectional observational study was conducted from March 2018 to June 2018 to assess the predictors of obstructive sleep apnea based on Berlin, Stop-Bang and Epworth sleepiness scale questionnaire from adult population of Taif City at an altitude of 1879 m from sea level in Saudi Arabia.<br /> <strong>Results: </strong>Of 1002 participants, the majority (614 participants, 61.3%) was males and the mean± SD age of participants was 30.6± 10.3 years (Range 11 - 67 years). In this study 24.9% participants were found to be at a high risk of having sleep apnea. Male gender, older age and smoking were found to be significantly associated with higher risk of sleep apnea according to Berlin, Stop-Bang and Epworth sleepiness scale questionnaire. Diseases found to be associated with a high risk of developing sleep apnea included hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes (p<0.001), psychological disorders (p<0.001) and asthma (p<0.001) .On the other hand, cardiac disorders were found to have an insignificant effect on sleep apnea (p=0.076) in this study. Almost one-third of the participants (34.9%; 95% CI= 32.0% to 37.9%) were found to have an abnormal level of daytime sleepiness according to Epworth Sleepiness Scale (ESS). These results were comparable to the previous studies at low altitude.<br /> <strong>Conclusions: </strong>Our study demonstrated that the predictors of OSA at high altitudes are comparable to those at low altitudes.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001The predictors of Gastroesophageal Reflux Disease among University students: A cross sectional study in the western region of Saudi Arabia582858381204610.21608/ejhm.2018.12046ENGamal Mohamed HasanElnemrDepartment of Internal Medicine, Faculty of Medicine, Taif University, KSA Department of Medical and Radiological Researches, Nuclear Materials Authority, Egypt.Abdullah Hassan AlmuntashiriDepartment of Internal Medicine, Faculty of Medicine, Taif University, KSASaud Abdulaziz AlghamdiDepartment of Internal Medicine, Faculty of Medicine, Taif University, KSAFahad Rajallah AlharthiDepartment of Internal Medicine, Faculty of Medicine, Taif University, KSAIbrahim MasoodiDepartment of Internal Medicine, Faculty of Medicine, Taif University, KSAJournal Article20180831<strong>Background: </strong>Gastroesophageal reflux disease (GERD) is one of the most common health problems that cause a financial burden on healthcare systems worldwide. The prevalence of GERD in Saudi Arabia is steadily increasing. There is a paucity of data regarding GERD among University students.<br /> <strong>Material and Methods: </strong>This cross-sectional observational study was conducted to assess the prevalence of GERD among male students of Taif University in the western region of Saudi Arabia in addition to determining the risk factors associated with the occurrence of GERD. Data were collected through a self-administration questionnaire. In addition, weight and height were measured to calculate the body mass index (BMI) of participating students.<br /> <strong>Results: </strong>Of 464 students who participated from different colleges of the University; More than half of the male students in Taif University (53.2%, 95% CI= 48.7% to 57.8%) suffer from GERD. There was higher prevalence among smokers, overweight and obese students, those who drink plenty of soft drinks. Students with hypertension, psychiatric diseases, diabetes mellitus, asthma or irritable bowel syndrome had higher prevalence of reflux. GERD was significantly present among students with history of psychological stress. <strong>Conclusion: </strong>Special consideration should be given to raising the awareness of about gastro esophageal reflux disease among the public and its controllable risk factors. The psychological stress among University students needs to be tackled to decrease reflux among them.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Incidence and Prognosis of Acute Renal Failure in Patients with Severe Sepsis and Septic Shock583958481204710.21608/ejhm.2018.12047ENMadiha M ZidanDepartment of Anesthesia, Intensive Care and Pain Management
Faculty of Medicine, Ain Shams UniversityAhmed A El-ShebinyDepartment of Anesthesia, Intensive Care and Pain Management
Faculty of Medicine, Ain Shams UniversityRafeek Y AtallaDepartment of Anesthesia, Intensive Care and Pain Management
Faculty of Medicine, Ain Shams UniversityMohamed A MohamedDepartment of Anesthesia, Intensive Care and Pain Management
Faculty of Medicine, Ain Shams UniversityJournal Article20180831<strong>Background: </strong>Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. Acute kidney injury (AKI), previously called acute renal failure (ARF) is an abrupt loss of kidney function, Generally it occurs because of damage to the kidney tissue caused by decreased kidney blood flow (Kidney ischemia) from any cause. AKI may lead to a number of complications, including metabolic acidosis, high potassium levels, uremia, changes in body fluid balance, and effects on other organ systems, including death. <strong>Aim:</strong> The aim of the study is to show the incidence and prognosis of acute renal failure in patients with sepsis and septic shock. <strong>Patients and methods: </strong>This prospective randomized study was conducted on patients who were admitted to ICU in Ain Shams University Hospitals. Forty patients were included in this study and an informed written consent was obtained from patients and/or relatives. All patients were adult, more than 18 years old, admitted to ICU suffering from severe sepsis or had septic shock for monitoring, management and follow up to their condition in period of six months. All patients were more than 18 years old that were critically ill either in severe sepsis or had septic shock. We excluded patients less than 18 years old, patient or relatives who refused to be included in this study, and if he/she has a history of previous kidney troubles or dysfunction. All patients were subjected to assessment of the demographic data of the patient, causes and site of infection, pathogenic bacteria as declared by different cultures, APACHE 2 score on admission, all patients were managed as declared by ICU, protocol for septic patients, hemodynamic monitoring was done daily, routine lab investigation daily, coagulation profile had to be done on days 0, 3, 7 of admission, SOFA score on days 0, 3, 7 of admission, renal functions include blood urea and creatinine clearance test had to be done daily, any deterioration of renal function was reported, and if the patient was in need for renal replacement therapy or dialysis, this would be reported. <strong>Re</strong><strong>sults: </strong>Forty patients were included in this study, their ages with a mean of 58.37 ± 15.66 years. 23 patients (57.5%) were males and 17 patients (42.5%) were females. The most frequent risk factors were hypertension (62.5%) followed by diabetes (52.5%). The incidence of AKI was 60% of patients and the need for renal replacement therapy (RRT) was 9 (22.5%). Outcome of admitted patients in ICU was 23 (57.5%) survived patients and 17 (42.5%) non-survived patients. The study showed that there were no statistical significant differences between AKI and Non-AKI patients except for; gender (male), BMI, gram –ve bacterial infection, creatinine, BUN, creatinine clearance, history of ACE administration, use of vasopressors, APACHE II score at admission and mortality were statistically significant (p < 0.05). <strong>Conclusion:</strong> The incidence of AKI was 60% of patients in our study. The development of septic AKI adversely affected clinical outcomes. Moreover, the severity of AKI was associated with increased short-term mortality as observed in ICU patients. The study showed that there were no statistical significant differences between AKI and Non-AKI patients except for; gender (male), BMI, gram –ve bacterial infection, creatinine, BUN, creatinine clearance, history of ACE administration, use of vasopressors, APACHE II score at admission and mortality were statistically significant (p < 0.05).Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Manual Placental Removal versus Cord Traction for Placental Delivery at Caesarean Section in Correlation to Blood Loss584958551204810.21608/ejhm.2018.12048ENEsmael Mohamed Talaat El GarhyDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityAshraf Hamdy MohamedDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityHazem Sayed ShaabanDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityAhmed Mohamed Mostafa SalemDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20180831<strong>Background: </strong>Delivery by cesarean section is one of the most commonly performed obstetrical operations all over the world, but it exposes women to the inherent risks of major abdominal surgery, e.g., injury to the pelvic structures, infection, and the need for blood transfusion etc. Antepartum physiological adaptation in preparation for blood loss at delivery includes a 42% increase in plasma volume and a 24% increase in red blood cell volume by the third trimester<strong><em>.</em></strong><strong> Objective: </strong>The aim of this work was to compare the manual removal of placenta and spontaneous placental delivery combined with cord traction at caesarean section. <strong>Patients and Methods: </strong>We compare between both groups using computer programs to evaluate the safety and efficacy of each method. <strong>Results: </strong>There was a significantly higher estimated intraoperative blood loss in women who had their placentae manually separated when compared to women who had spontaneous placental separation.<strong> Conclusion: </strong>There was a statistically significant drop of hematocrit level in both groups with no statistically significant drop of hemoglobin. In addition, there was increased incidence of endometritis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Assessment of the Relation between Fetal Hemodynamic Indices in Late Pregnancy and Birth Weight in Gestational Diabetic Mellitus Mothers: A correlational study585658641204910.21608/ejhm.2018.12049ENMagdy Mohamed MahmoudAbd El GawadObstetrics and Gynaecology Faculty of Medicine – Ain Shams University.Mohamed HussainMoustafaObstetrics and Gynaecology Faculty of Medicine – Ain Shams University.Laila AlyFaridObstetrics and Gynaecology Faculty of Medicine – Ain Shams University.Noha Emad El DinAbd El AzizObstetrics and Gynecology at Manshyet El Bakry General Hospital.Journal Article20180831<strong>Background: </strong>The offspring of women with gestational diabetes mellitus (GDM) are prone to macrosomia. However, birth weight is difficult to be correctly estimated by ultrasound because of fetal asymmetric growth characteristics. This study aimed at investigating the correlations between fetal hemodynamics, fetal growth indices in late pregnancy and birth weight in GDM. <strong>Methods: </strong>A total of 180 women with GDM and 180 normal controls (NC) with singleton gestation and presented between 38-40 weeks gestation were enrolled in this study. Fetal hemodynamic indices, including the systolic/diastolic ratio (S/D), resistance index (RI), pulsatility index (PI) of umbilical artery (UA), middle cerebral artery (MCA), and renal artery (RA), were collected. Fetal growth indices, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL), were also measured by ultrasound. Birth weight, mode of delivery and need for Neonatal ICU admission data were collected. <strong>Results</strong>: The independent samples <em>t</em>-test showed that BPD, HC, AC and FL were larger in GDM than in NC (<em>P </em>< 0.05). Birth weight was higher in GDM than in NC (<em>P </em>< 0.001). Among all included women, there was a highly statistically insignificant difference between GDM and NC groups as regard all ultrasound indices including UA_S/D, UA_RI, UA_PI, MCA_S/D, MCA_RI, MCA_PI, RA_S/D, RA_RI and RA_PI (P>0.05). Pearson’s correlation analysis showed in GDM group that there was a highly statistically significant negative correlation between birth weight and the following ultrasound indices: (UA_RI, UA_S/D, UA_PI, MCA_RI and MCA_PI) and that there was a statistically significant positive correlation between birth weight & RA_RI (P<0.01) (<em>r </em>= −0.273, −0.453, −0.537, −0.237, −0.265 and 0.169 respectively, <em>P </em>< 0.05), but As regard NC group there was a highly statistically significant negative correlation between birth weight and the following ultrasound indices: (UA_S/D, UA_RI, UA_PI and MCA_PI) (<em>r </em>= 0.148, -0.360, -0.252 and -0.184 respectively, <em>P </em>< 0.05) but no correlation was found with any of renal artery indices (<em>P </em>> 0.05). <strong>Conclusions</strong>: Fetal hemodynamic indices in late pregnancy might be helpful for estimating newborn birth weight in women with GDM.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Comparison between the role of contrast enhanced mammography and dynamic contrast enhanced MRI in assessment of breast cancer recurrence587558851205710.21608/ejhm.2018.12057ENSaher Mohamed ElfikyRadiology department, Faculty of medicine, Ain Shams UniversityNoha Abdelshafy ElsaidRadiology department, Faculty of medicine, Ain Shams UniversityEnas Ahmed AzebRadiology department, Faculty of medicine, Ain Shams UniversityMarwa Elsayed ElmorRadiology department, Faculty of medicine, Ain Shams UniversityNehal AbdelshafyAbdelaleemRadiology department, Faculty of medicine, Ain Shams UniversityTarek Hamed Gomaa HassanDepartment of Radiodiagnosis, Ain Shams University, Cairo, EgyptJournal Article20180831<strong>Purpose</strong>: To elucidate the diagnostic value of contrast enhanced mammography in comparison with dynamic MRI in cases of breast cancer recurrence and to correlate with available clinical data, histopathology findings and/or follow up. <strong>Methods</strong>: 30 patients were enrolled in this study. The age ranged between31-68 years old. Patients were referred from the General Surgery or Oncology Departments in the period from August-2015 until April-2018. The patients underwent full history taking and clinical examination and CESM and breast magnetic resonance image (BMRI) examination. Finally US guided biopsy was performed. <strong>Results</strong>: Contrast enhanced spectral mammography (CESM) showed slightly lower sensitivity (88.89%) and overall accuracy (86.67%) than BMRI (96.30% and 90% respectively). However specificity was higher in CESM (66.67%) than that of BMRI (33.33%). <strong>Conclusion</strong>: In spite of the lower sensitivity of the CESM compared to MRI, the CESM appeared to be a suitable, easy, more comfortable, low cost and fast alternative to MRI in early detection of breast cancer recurrence specially for patients with contraindications to MRI.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Laparoscopic repair of inguinal hernia transabdominal preperitoneal (TAPP) versus total extraperitoneal (TEP) Techniques588658951205810.21608/ejhm.2018.12058ENHazem Abd El-Salam MohammadDepartment of general surgery, Faculty of Medicine, Ain Shams UniversityAhmed Adel AbbasDepartment of general surgery, Faculty of Medicine, Ain Shams UniversitySameh Khaled AhmedAliDepartment of general surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20180831<strong>Background: </strong>The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculotendinous layer. The exact cause of inguinal hernia is still unknown but the factors contributing in its occurrence include; preformed congenital sac, chronic passive rise in the intra-abdominal pressure and weak abdominal wall. <strong> Objective: </strong>The aim of this study is to compare the results of laparoscopic hernioplasty with Transabdominal pre-peritoneal (TAPP) versus Totally Extraperitoneal (TEP) as techniques for repair of inguinal hernia. <strong>Patients and Methods: </strong>In our study, 30 patients were included divided on two groups, 15 for each. Group A; underwent laparoscopic Transabdominal pre-peritoneal (TAPP) repair with mesh, Group B; underwent laparoscopic Totally Extraperitoneal (TEP) repair with mesh. Follow up of patients was done in the out-patient clinic at ain shams hospitals, 7 days after discharge then at 3, and 6 months postoperatively at the period between March 2018 and August 2018. <strong>Results: </strong>Both groups were compared in terms of operative technique, operative time, intra & post operative complications, early post operative pain within one week, hospital stay, restriction of physical activity and incidence of recurrence and chronic pain. <strong>Conclusion:</strong> Interpretation of results revealed that the TEP repair appeared technically more difficult as evidenced by increased operative time and more post operative pain in first hours. It needs a long learning curve and a dedicated team for technique excellence. However, it is preferred because it is associated with less wound-related complications, shorter hospital stay and rapid return to normal activity. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Internal Limiting Membrane Peeling for Diffuse Tractional Diabetic Macular Oedema589659061205910.21608/ejhm.2018.12059ENMohamed I. EL-KasabyDepartment of Ophthalmology, Faculty of Medicine for girls, Al-Azhar University, Cairo- EgyptJournal Article20180831<strong>Aim: To</strong> determine the efficacy of internal limiting membrane (ILM) peeling vitrectomy for diffuse tractional diabetic macular oedema. <strong>Patients and methods: </strong> A prospective non –randomized interventional study was carried out at Nour- EL–Hayaha Eye Center (Cairo) between March, 2015 and March, 2017. 40 eyes of 31 patients with symptomatic marked diminution of vision and tractional diabetic macular oedema were enrolled in this study. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. 23-gauge vitrectomy with internal limiting membrane peeling assisted by staining by brilliant blue G stain(BBG) were performed for all patients with a follow –up period at least 6 months. Spectral domain optical coherent tomography (SD OCT) images were obtained at the follow –up visits to determine the presence of an epiretinal membrane (ERM). <strong>Results: </strong>At 6 months there was a median 200µ decrease from baseline in the central subfield thickness (P<0.005).Mean change in the central subfield macular thickness was -150µ (SD± 130.56).There was 7 (17.5%) cases developed iatrogenic retinal break during removal of posterior vitreous and treated by endodiathermy, of greatest importance, 3(7.5%) eyes developed a vitreous hemorrhage treated by conservative treatment after B scan evaluation, and 1(2.5%) eye developed a retinal detachment. All complications were successfully managed. 23 out of 40 eyes (57.5%) underwent cataract surgery with IOL implantation within 6 months of pars plana vitrectomy. Transient elevation of IOP was developed in 7(17.5%) eyes and managed carefully with antiglucomatous drugs. One eye developed persistent elevation of IOP that required maintenance anti glaucomatous drug. Also macular hole developed in one eye and epiretinal membrane developed in one eye. <strong>Conclusion: </strong>ILM peeling achieved higher anatomic success with a reduced need for additional surgical interventions and or event postoperative ERM formation that might result in subsequent visual loss.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Myoring Femtosecond-Assisted Intracorneal in Management of Keratoconus590759171206010.21608/ejhm.2018.12060ENMohamed I. EL-KasabyDepartment of Ophthalmology, Faculty of Medicine for girls, Al-Azhar University, Cairo- EgyptJournal Article20180831<strong>Purpose</strong>: To evaluate long term follow‑up data on implantation of a full‑ring intra‑corneal implant (Myoring) for management of keratoconus with no cross linking postoperatively done. <strong>Patients and methods:</strong> A prospective non –randomized interventional clinical study was carried out at Nour- EL–Hayaha Eye Center (Cairo) between July, 2015 and July, 2017.40 eyes of 20 patients with symptomatic marked diminution of vision and keratoconus grade 2 to 4 were enrolled in this study. For all patients, a MyoRing (Dioptex, GmbH, Austria) was implanted using a femtosecond laser (Victus Femto Second Laser SW version 3.2 Technolas Perfect Vision GmbH .Munich, Germany). Inclusion criteria; age was between 18 and 35 years, maximum K reading less than 60D (based on pentacam examination), and a central corneal thickness (CCT) was at least 380 μm. Patients who had corneal scarring, any concomitant ocular disease or any history of ocular surgery were excluded from the study. Patients who failed to complete follow-up examinations one month after the surgery were also excluded. <strong>Results</strong>: 40 eyes of 20 patients 5 males (25%) and 15 females (75%) with keratoconus grade 2 to 4 enrolled in this study with a mean age of 24.6 ± 7.92 years. Preoperatively, mean central corneal thickness (CCT) was 440.25±44.49 μm in the right eye and mean CCT 441.35±43.02 in the left eye, while mean keratometry (K) readings, 52.57±5.24diopters (D) in the right eyes and 50.16±3.59 D in the left eyes. Postoperatively, there was a statistically significant improvement in the uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), K readings, manifest spherical and cylindrical refractive errors, and spherical equivalent (P<0.05). Mean K reading decreased by 6.8 D, from52.57±5.24D to 45.77±2.16D. No serious intraoperative complications were occurred. <strong>Conclusion</strong>: Myoring had the capability in halting the progression of the disease, Insert it whatever the site of lesion and it was noticed that no need for cross linking done postoperatively.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Pain Assessment after Short Course versus Long Course Palliative Radiation of Painful Bony Metastasis591859261206110.21608/ejhm.2018.12061ENKhaled Abdelkarim MohamedDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams UniversityDalia Abd El-Ghany El-KhodaryDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams UniversityAhmed Mostafa MohamedDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams UniversityAbdelfattah Rashad AbdelfattahElmasryDepartment of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams UniversityJournal Article20180831<strong>Background:</strong> the most common cause of pain in cancer patients is bone metastases. <strong>Objective: </strong>to evaluate the different fractionation schedules. <strong>Patients and Methods:</strong> this is a prospective cross sectional study conducted at Ain-Shams University Hospitals and Nasser Institute Cancer Centre, to assess the equivalence of two fractionation regimens (20 Gy over 5 fractions versus 30 Gy over 10 fractions) as regard pain relief in painful bony metastases. Over 6 months fifty patients were assigned to either fraction arms using consecutive sampling. <strong>Results:</strong> both fractionation regimens were effective at palliating pain from bone metastases. Pain score was consistently going down from week 0 to week 12, although maximum benefit was reached earlier in the shorter arm (at week 8), both comparison groups leveled a favourable response at week 12. At 3 months, the observed overall response rate was 88% versus 84% and complete response rate was achieved in 44% versus 36% in both short- and long fractionation course respectively, with no statistical difference was found in terms of pain relief. With the median time to pain progression was 79.0 days for the short arm versus 77.0 days for the protracted arm. <strong>Conclusion:</strong> lower dose of radiotherapy may provide equivalent outcomes to higher ones in palliating bone pain. So, the the surrounding normal tissue role in pain process caused by bone metastases as well as the effect of radiation in this environment has to be furtherly investigated, which may lead to pain control augmentation. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Prophylactic use of Parenteral Ketamine versus Ondansetron for Prevention of Shivering during Spinal Anesthesia in Hernia Surgeries592759341206210.21608/ejhm.2018.12062ENNabila Abdel AzizFahmyDepartment of Anesthesiology, Intensive Care Medicine & Pain Management, Faculty of Medicine, Ain Shams UniversityAyman Ibraheem TharwatSayedDepartment of Anesthesiology, Intensive Care Medicine & Pain Management, Faculty of Medicine, Ain Shams UniversityAmr Hosny HamzaAliDepartment of Anesthesiology, Intensive Care Medicine & Pain Management, Faculty of Medicine, Ain Shams UniversityAya-tullah Hosny Kamal El-DeenAbd El-AleemDepartment of Anesthesiology, Intensive Care Medicine & Pain Management, Faculty of Medicine, Ain Shams UniversityJournal Article20180831<strong>Background: </strong>Perioperative shivering is a common complication in modern anesthesia. It’s usually defined as readily detectable fasciculation or tremors of the face, jaw, head, trunk or extremities lasting longer than 15 seconds.
<strong>Aim of the work:</strong> Compare the anti-shivering effect of parentral low dose ketamine and ondansetron after spinal anesthesia during hernia surgery, as well as the anticipated side effects and complications.
<strong>Patients and Methods</strong><strong>: </strong>This study presents a prospective randomized single blinded study. After obtaining approval from the medical ethical committee of Ain Shams University, this study was conducted in Ain Shams University hospitals operating rooms. Study period was from January 2018 to May 2018.
<strong>Results:</strong> Our results indicated that low dose ketamine and ondansetron were effective, with more extent to ketamine, in prevention of post spinal shivering in patients undergoing hernia surgery and these results agreed with other results of studies done before.
<strong>Conclusion: </strong>Our results indicated that Prophylactic low dose ketamine (0.25mg/kg) and Ondansetron (4mg) significantly decreased shivering in patients undergoing spinal anesthesia without significant side effects. Ketamine found to be more effective in controlling post spinal shivering.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Attitudes and Perceptions of Medical Students toward Neurosurgery as a Career, Riyadh, Saudi Arabia593559391206310.21608/ejhm.2018.12063ENNayef Ghasham AlQahtaniKing Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia.Turki AlhumaidKing Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia.Khalid AlmazyadKing Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia.Ibrahim AlmesnedKing Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia.Abdulaziz AlmusalamKing Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia.Sajida AghaKing Saud Bin Abdulaziz University for Health Sciences, Medical Education, Riyadh, Saudi ArabiaJournal Article20180831<strong>Introduction: </strong>Medical students usually show a preference toward a specific specialty. They could have the preference before entering the medical school but their preference could change. There has been a decline in surgical specialty as a career choice by medical students more recently. <strong>The objective</strong> of the study is to evaluate the attitude and perception of medical students toward neurosurgery. <strong>Methods and Materials: </strong>This is a cross-sectional study that was conducted in King Saud Bin Abdulaziz University for health sciences in RIYADH, SAUDI ARABIA on 218 medical students from the fifth and sixth year, using a validated questionnaire comprising of 15 questions with a scoring based on Linkert ranking scale (1, disagree; 2, agree somewhat; 3, agree moderately; 4, agree Strongly). <strong>Results:</strong> The distribution response was 85%, only 186 (102 males vs. 84 females) medical students completed the questionnaire. The data shows that the majority of students think that their neurosurgery teaching is inadequate, neurosurgical history is difficult to obtain, neurosurgical signs are difficult to elicit and that most of them 86% aren’t considering neurosurgery as a future career because it can impede family life. <strong>Conclusion: </strong>This study point out some areas that can be targeted and improved to enhance the student’s perception of neurosurgery as a specialty and to facilitate learning of neurosurgery knowledge during medical school. Also, a study on a larger sample might be required to generalize the results. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Assessment of Oral Metronidazole in Pain Management Post Haemorrhoidectomy594059431206410.21608/ejhm.2018.12064ENEssam Fakhry EbiedGeneral Surgery - Faculty of Medicine- Ain Shams UniversityAhmed Adel DarweeshGeneral Surgery - Faculty of Medicine- Ain Shams UniversityAhmed Aly KhalilGeneral Surgery - Faculty of Medicine- Ain Shams UniversitySahar Mahmoud ShahbanNmrGeneral Surgery - Faculty of Medicine- Ain Shams UniversityJournal Article20180831<strong>Background: </strong>Haemorrhoids are a very popular disease. Approximately 50% to 66% of people have problems with haemorrhoids at some point in their lives. The pathophysiology of haemorrhoids is not exactly well known. Theories were developed trying to understand the pathophysiology of haemorrhoids e.g., varicose vein theory, anal lining sliding theory, hyperactivity of internal sphincter theory and vascular hyperplasia theory. Diagnosis is made by integration of available clinical data (symptoms), clinical examination and investigations. Although, we are using the term to refer to the disease resulting from their congestion and swelling, it is hard to evaluate the exact prevalence of haemorrhoids in a certain community as a lot of people suffering from the condition don’t seek for medical advice
<strong>Objectives: </strong>This thesis study was done to assess the efficacy of oral metronidazole administration in management of post haemorrhoidectomy pain.
<strong>Patients and Method: </strong>This study was conducted at El Demerdash Hospital and Damanhour National Institute in 1/1/2018 to 30/6/2018. 80 patients presented to the General Surgery Clinic and met the inclusion criteria in six month duration. The participants were divided into two groups 40 in each group.
<strong>Results: </strong>When the results of both groups were put in a comparison, it showed that group A had a significant lower pain values in day 1 and 3 than group B but both groups(p=0.043*,p= 0.004)results were equivocal in day seven with no significant difference(p=0.268). Also results showed that group B needed more analgesics than group A and that confirms that metronidazole do decrease pain experienced by the patients after the operation and decreased their need for analgesics(p=0.043). Otherwise, both groups show no significant differences according to the time of first bowel movement(p=0.967).
<strong>Conclusion: </strong>Oral Metronidazole administration post haemorrhoidectomy significantly decrease the post-operative pain and decrease the need for more analgesics with no significant effect on the time of the first bowel movement.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Assessment of the Use of Ultrasound in Local Anesthesia for Ophthalmic Surgery594459531206510.21608/ejhm.2018.12065ENIbrahim Hassan El-BannaAnesthesiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptIbrahim Abdel-GhanyAnesthesiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptAmr Mohmoud MontaserAnesthesiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptHadeel Magdy Abdel-HameedAnesthesiology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20180831Eye surgery is the most common surgery in the elderly. Many ophthalmic procedures, such as cataract extraction can be performed safely in an outpatient setting, using regional anesthesia and mild sedation. The number of outpatient ophthalmic procedures will increase as the population continues to age. Advantages of regional anesthesia over general anesthesia are numerous; it is generally safer with less incidence of complications and less bleeding.
<strong>Aim</strong>: The purpose of this thesis is to evaluate the use of ultrasonography in the performance of local anesthesia for ophthalmic surgery. This assessment includes whether ultrasound will add to the safety of the technique and its success rate.
<strong>Patients and methods</strong>: After approval of our institutional ethics committee and obtaining a written informed consent, 100 adult patients having routine cataract extraction were divided randomly into: Group A (peribulbar anesthesia) and Group B (retrobulbar anesthesia), with 50 patients in each group. Each group was subdivided into two subgroups: In one the anesthesia was administered blindly, in the second using B-scan ultasonography, with 25 patients in each one. Patients randomly allocated to one of these four subgroups until the required number is reached in each group.
<strong>Results</strong>: Results of the current study demonstrated comparable degree of globe akinesia after 10 minutes (p = 0.342). The majority of cases showed no globe movement after 10 minutes. Similarly, lid akinesia showed no significant difference between 4 groups (p = 0.082). This was accompanied by partial satisfaction of the majority of surgeons with the procedure; comparable in the 4 subgroups (p = 0.270).
<strong>Conclusion</strong>: Peribulbar and retrobulbar regional anesthesia of the orbit during cataract surgery are safe procedures if blindly applied. Ultrasonography-guided needle injection doesn’t add to the safety and/or efficacy of the procedure. Therefore, ultrasound guidance is not an advantage in orbital regional anesthesia; whether administered by the peribulbar or retrobulbar technique.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273120181001Role of MDCT in diagnosis of lower limb peripheral arteries diseases Ali Basyoni Amin, Haytham Mohamed Nasser, Mohamed Shaker Ghazy Radiology departments, Ain Shams Hospitals.595459601206610.21608/ejhm.2018.12066ENAli Basyoni AminRadiology departments, Ain Shams Hospitals.Haytham Mohamed NasserRadiology departments, Ain Shams Hospitals.Mohamed Shaker GhazyRadiology departments, Ain Shams Hospitals.Journal Article20180831<strong>Background:</strong> Lower limb peripheral arterial disease (PAD) is a common disease that affects about two hundred million peoples per year. It is the third leading cause of cardiovascular morbidity. We plan to evaluate the diagnostic performance of 64-section computed tomographic (CT) angiography in the assessment of steno-occlusive disease in patients with PAD, with conventional digital subtraction angiography (DSA) as the reference standard.
<strong>Aim of study:</strong> is to compare the diagnostic accuracy of multidetector computed tomographic (MDCT) angiography in diagnosis of PAD compared to the DSA as pre-operative evaluation of lower limb peripheral arterial diseases.
<strong>Patients and methods</strong>: The study included 20 patients clinically presented with symptomatic PAD from February 2018 to July 2018. The study protocol was approved, and written informed consent was obtained from all patients. The patients underwent CT angiography and subsequent DSA. For stenosis analysis (≥70% stenosis), the arterial bed was divided into 35 segments and evaluated by three readers. Inter observer agreement was determined with generalized κ statistics. Accuracy, sensitivity, specificity, was calculated. Mc Nemar test was used to prove significant differences between CT angiographic and DSA findings.
<strong>Results:</strong> A total of 700 arterial segments were evaluated, with excellent agreement between readers (κ ≥ 0.928). On a segmental basis, both sensitivity and specificity for stenosis of 70% or more were at least 96% (386 of 400 segments and 290 of 300 segments, respectively), with an accuracy of 98% (686 of 7oo segments).There was no significant difference between CT angiographic and DSA findings (P = .62–.87). <strong>Conclusion:</strong> The diagnostic performance of 64-section CT angiography is excellent in patients with clinical symptoms of PAD.