Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Study of Iron profile Level in Lupus Nephritis618261881352210.21608/ejhm.2018.13522ENMohamed Nabil RaafatInternal Medicine Department, Faculty of Medicine, Al-Azhar University (cairo), Egypt.Mamdouh Attia MohamedClinical Pathology Department, Faculty of Medicine, Al-Azhar University (cairo), Egypt.Ismail Mohamed ElmancyInternal Medicine Department, Faculty of Medicine, Al-Azhar University (cairo), Egypt.Eslam Abdelhaleem Abd Allah ElnemrInternal Medicine Department, Faculty of Medicine, Al-Azhar University (cairo), Egypt.Journal Article20180913<strong>Background:</strong>Systemic lupus erythematosus (SLE) is a multi-factorial, chronic autoimmune disorder, characterized by dysfunction of T and B lymphocytes. It affects various vital organ systems, and 70% to 90% of SLE patients are females. Lupus nephritis (LN) is one of the common complications in patients with SLE and influences overall outcome of these patients. About two-thirds of patients with SLE have renal disease at some stage which is a leading cause of mortality in these patient.Iron is critical in nearly all cell functions and the ability of a cell, tissue and organism to procure this metal is obligatory for survival. Iron is necessary for normal immune function, and relative iron deficiency is associated with mild immunosuppression. Concentrations of this metal in excess of those required for function can present both an oxidative stress and elevate risks for infection. As a result, the human has evolved to have a complex mechanism of regulating iron and limiting its availability.Ferritin levels correlate with disease activity in patients with SLE and developing of lupus nephritis<strong>. </strong><strong>Objective:</strong> To correlate between Iron profile and SLE activity and developing lupus nephritis. <strong>Materials and Methods:</strong> A prospective study was conducted on 75 adult persons: 25 Patients with SLE with proteinuria, patients with SLE without proteinuria, 25person have no SLE (control group).These person were Admitted at internal medicine department and outpatient clinic of Al-Hussein university hospital, Cairo, Egypt. SLE patients were diagnosed according to the American College of Rheumatology (ACR) criteria<sup>,</sup> Lupus Activity assessment by C3&C4, Lupus nephritis assessment using Albumin /creatinine ratio. Iron profile was measured and included: serum iron, serum TIBC, transferrin saturation and Serum ferritin levels were tested by ELISA. <strong>Results:</strong> There were no significant statistical difference between groups as regard age or sex however, There were significant difference between groups as regard S.iron, S. ferritin, TIBC and TSAT, Between group analysis results showed significantly lower s.iron and TSAT level of SLE patients with and without proteinuria in comparison with control group. While S. ferritin is significantly high in SLE patients with proteinuria in comparison with SLE patients without proteinuria and control group. And this data go with activity markers of SLE.<strong> Conclusions</strong>: 1) Hyperferritinemia is a useful marker in assessment of disease activity and severity of Albuminuria in SLE patients complicated by lupus nephritis, treatment of hyperferritinemia can result in decreased Albuminuria and delayed renal damage. 2) Iron homoeostasis is important in normal immune function and Iron disturbance can result in mild immunosuppression.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Comparison of the Duo of Insulin-Like Growth Factor Binding Protein-1/Alpha Fetoprotein (Amnioquick Duo+®) and Nitrazine Test for Diagnosing Query Rupture of Fetal Membranes618961971288510.21608/ejhm.2018.12885ENSherif Fekry Abd Allah HendawyDepartment of Obstetrics and Gynaecology, Faculty of Medicine - Ain Shams UniversitySherif Hanafi HussainDepartment of Obstetrics and Gynaecology, Faculty of Medicine - Ain Shams UniversityJamila Ahmed ElmabroukTripoli UniversityJournal Article20180908<strong>Background:</strong> premature rupture of membranes (PROM) constitutes one of the most important dilemmas in the obstetric practice. It could be defined as rupture of membranes before the onset of labour, irrespective of the gestational age. It is associated with infectious morbidity in mother and fetus, cord accidents, imminent term or preterm labour. For these reasons, its correct diagnosis is very important. A novel test used for diagnosing rupture of membranes (ROM) is Amnioquick duo+® (Biosynex, Strasbourg Cedex, France). Amnioquick duo+® is a rapid strip test with immunoassay that is simple, easy to perform, quick and noninvasive. It is an immunochromatographic test that identifies even trace amounts of both alpha fetoprotein (AFP) and insulin-like growth factor binding protein-1 (IGFBP-1). On other hand the traditional methods for diagnosis of PROM are through the patient’s history, leakage, ferning test and nitrazine test.<strong> Aim of the Work:</strong> the aim of this study is to compare the accuracy of the duo of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) and nitrazine test for diagnosing query rupture of fetal membranes in pregnant women with query PROM.<strong> Patients and Methods:</strong> this comparative cross sectional study was carried out at Ain Shams University Maternity Hospital between November 2017 to June 2018.<strong> Results:</strong> a total of one hundred and thirteen pregnant women > 24 weeks of gestation were included in the study with age ranging between 18 and 42 years (mean ± SD, 27 ± 6 years). Thirty eight (33.6%) women were primigravidae and 75 (66.4%) were multigravidae. Forty (35.4%) women were primiparas while 63 (64.6%) were multiparas. Twenty five (22.1%) women experienced one or more previous abortion. The Amnioquick duo+® test was more specific and accuracy in diagnosing rupture of membranes than Nitrazine test. The sensitivity and the specificity of Amnioquick duo+® test in diagnosing PROM was 100% and 97.3% respectively as compared to Nitrazine test which was 100% and 83%. The PPV and NPV of Amnioquick duo+® test were 98.7% and 100% as compared to Nitrazine test which were 92.7% and 100%.<strong> Conclusion:</strong> this study concluded that IGFBP-1/AFP (AmnioQuick® Duo+) test is rapid reliable non-invasive, easy and accurate bedside immunoassay test, better than nitrazine test and can used as complementary test to improve the management of women with women premature fetal membranes rupture.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Association between Vitamin D Deficiency and Preterm: A Case Control Study619862051288610.21608/ejhm.2018.12886ENShereif Mohammed Abd El HameedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams UniversityDina Yahia MansourDepartment of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams UniversityHeba Mohamed Adel Abou ZaghlaDepartment of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams UniversitySeham Hasan RishiDepartment of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams UniversityJournal Article20180908<strong><em>Background: </em></strong>Preterm labor refers to the delivery before 37th week of pregnancy. The World Health Organization (WHO) reported that about 15 million neonates are born preterm with about 1 million deaths occur during infancy. PTB infants who survive frequently suffer from chronic pulmonary diseases and learning deficits, causing heavy burdens for society and family. Preterm birth is one of the most serious medical complications of pregnancy.<br /> <strong><em>Purpose:</em></strong> to compare serum 25 hydroxy vitamin D levels among patients with preterm delivery and women who have full term birth.<br /> <strong><em>Patients and Methods</em></strong><strong><em>: </em></strong>a case-control study was conducted at Ain Shams University Maternity Hospital from December 2017 to May 2018. It was carried out on 138 women post delivery recruited, they were divided into group of patients with preterm babies and other group with full term babies, 69 women in each.<br /> <strong><em>Results:</em></strong> Mean level of 25 hydroxy vitamin D between preterm birth group was 4.4 ±2.5 ng/ml and between full term birth group was24.9±13.74ng/ml. Therefore, according to student T test and chi-square test, the current study found that there is significant difference in serum 25 hydroxy vitamin D levels between women with preterm birth and women with full term birth preterm birth.<br /> <strong><em>Conclusion: </em></strong>from this study it can be concluded that vitamin D assay can be used for prediction of preterm birth and vitamin D supplementation can be used routinely in prevention of preterm birth.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Nonopioid versus Opioid Based General Anesthesia Technique for Laparoscopic Cholecystectomy620662121361210.21608/ejhm.2018.13612ENMostafa ShalabyDepartment of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMofeed AbdallaDepartment of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAmr Samir MahmoudDepartment of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20180914<strong>Background: </strong>The choices of premedication and anesthetic techniques are able to influence the neurohormonal stress response by modulating the pathophysiological pathways. Various pharmacological agents like nitroglycerine, beta blocker, and opioids were used to decrease surgical stress of laparoscopic procedures to improve outcome, with their own limitations.
<strong>Objective:</strong> It was to compare the effect of opioid-free (using dexmedetomidine and propofol) and opioid-based (using fentanyl and propofol) TIVA techniques on hemodynamic stability, sedation postoperative pain intensity and the incidence of side effects in patients scheduled for LC.
<strong>Patients and Methods: </strong>Eighty patients who were scheduled for elective laparoscopic cholecystectomy were included in this study. Before induction of anesthesia, patients were randomly divided into two equal groups: (40 each). Dexmedetomidine group(Non-opioid group) received dexmedetomidine (1 µg/kg) over 10 minutes before induction of anesthesia followed by continuous infusion of 0.5 µg/kg/hr. till the end of surgery and Fentanyl group<strong> (</strong>Opioid group) received fentanyl (1.0 µg/kg) over 10 minutes before induction of anesthesia followed by continuous infusion of 0.4 µg/kg/hr. till the end of surgery.
<strong>Results: </strong>The results of the present study showed that there were no significant differences between the two groups regarding HR and MAP except after loading dose of the studied drugs, after intubation, after pneumoperitoneum, 15 min, 30 min, 45 min, and 60 min after induction where it was lower in dexmedetomidine group than fentanyl group. There were no significant differences between two groups regarding intraoperative SPO2, postoperative SPO2 and blood glucose level (mg/dl).
<strong>Conclusion: </strong>This study concluded that dexmedetomidine is better than fentanyl for patients who undergo elective laparoscopic cholecystectomy due to perioperative maintaining of hemodynamic stability, decrease dosages of postoperative analgesics, prolong the duration of postoperative analgesia and decrease postoperative nausea and vomiting.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group621362181309410.21608/ejhm.2018.13094ENMohamed Esmat Abo GareebUrology Department, Faculty of Medicine, Ain Shams UniversityAhmed Tawfick HassanUrology Department, Faculty of Medicine, Ain Shams UniversityWaleed Fawzy AbdelsamiUrology Department, Faculty of Medicine, Ain Shams UniversityJournal Article20180910<strong>Background: </strong>pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades.<strong> Aim of the Work:</strong> determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group.<strong> Patients and Methods</strong>: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy.<strong> Results:</strong> there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group.<strong> Conclusion:</strong> flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Evaluation of Carpal Tunnel Diagnosis, Management, and Outcome in Primary Health Care Center623062371371110.21608/ejhm.2018.13711ENSahar Salem A AlbalawiTabuk universityRuwaynah Waleed Aziz AlrahmanUmm Al-Qura UniversityAbdulrahman Mohsen AlthagafiUmm Al-Qura UniversityAbdulaziz Saud AlrahiliUmm Al-Qura UniversitySaad Saeed AlqahtaniPrince Sattam Bin Abdulaziz UniversitySalman Mohammed AlmutairiPrince Sattam Bin Abdulaziz UniversityDhafer Mubarak AlajmiPrince Sattam Bin Abdulaziz UniversityZeyad Saad AljohaniUniversity of JeddahFahad Abdullah AbualnassrTaibah UniversityAmmar Mohammed SabahTaibah UniversityJournal Article20180915<strong>Background: </strong>Carpal tunnel syndrome (CTS) is one of the commonest conditions encountered in primary care centers as mentioned earlier. CTS of mild to moderate severity can often be effectively treated in a primary care environment. However, many patients being referred immediately to hospital for consideration of surgical decompression.
<strong>Objective: </strong>In this study, we aim to evaluate the available primary care options and their efficacy in dealing with CTS.
<strong>Methods</strong>: PubMed database was used for articles selection, and the following keys used in the mesh (("Carpal tunnel syndrome"[Mesh]) AND ("Carpal tunnel syndrome/Management"[Mesh] OR "Carpal tunnel syndrome/Diagnosis"[Mesh] OR "Carpal tunnel syndrome/ Primary Health Care Center)). 5 studies were enrolled according to our inclusion, and exclusion criteria.
<strong>Results: </strong>Patients successfully treated with wrist splinting alone reported a higher level of satisfaction with their treatment compared to patients who failed wrist splint treatment or had surgical decompressionMechanical traction is associated with fewer surgical interventions compared to care as usual in CTS patients. Reductions in patient-reported symptoms at 6 months’ follow-up was similar in both groups.Steroid injection combined with splinting resulted in modestly greater reduction of symptoms, functional recovery, and improvement of nerve function at 12-week follow-up compared to steroid injection alone.
<strong>Conclusion</strong>: CTS is commonly encountered in primary care. So, a trial of conservative treatment can be done before referral for surgical decompression. Conservative treatment of CTS had shown a clear reduction in hand surgery waitlists, thus reduction in expenditures and costs. Wrist splinting is recommended as first line treatment for patients with symptoms of CTS. Other methods of non-surgical treatment include steroid injection, osteopathic manipulative therapy, mechanical wrist traction and combining wrist splinting with steroid injection or with NSAIDs use. Referral for surgical decompression may be a more appropriate option when the level of numbness and other symptoms are getting worse, or when conservative management has failed and is likely to lead to dissatisfaction.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Fetal Renal Volume and Renal Artery Doppler in Normal and Intrauterine Growth Restricted Fetuses623862421371210.21608/ejhm.2018.13712ENHani Maged Abd El-AalObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityKhaled Zakaria El-SheikhaObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityAhmed Mohammed Abd-Elrazek RagabObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20180915<strong>Objective</strong>: To evaluate the difference between fetal renal artery Doppler and fetal kidney volume in normal and intrauterine growth restricted fetuses
<strong>Design:</strong> A prospective cross sectional study.
<strong>Setting:</strong> Obstetrics and Gynecology department, Al-Azhar University.
<strong>Sample:</strong> One hundred pregnant women, 50 with normal fetal growth parameter, and 50 with restricted fetal growth.
<strong>Methods:</strong> Fetal renal volume was measured using 3-dimensional ultrasound. Umbilical artery and fetal renal artery Doppler indices were examined.
<strong>Main outcome measures:</strong> Correlation of Doppler parameter to fetal kidney volume, and association of fetal biometric indices to combined fetal kidney volume.
<strong>Results:</strong> Combined fetal renal volume was significantly reduced in growth restricted fetuses than in normally grown fetuses as the Mean of combined renal volume in IUGR was (21.0 ± 0.1) while in normal fetuses was (31.24±2.31). All fetal biometric indices were positively associated with combined kidney volume. Concerning the umbilical artery Doppler and fetal renal artery Doppler there was significantly difference between the two groups as the intrauterine growth restricted fetuses have a high Doppler.
<strong>Conclusion: </strong>Intrauterine growth restriction appears to be associated with a statistically significant decrease in the renal volume than the normally growth fetuses. The renal artery Doppler shows also significant difference between the two groups, which matches with other studies. This study supports the hypothesis that intrauterine growth restriction may be linked to renal disease and hypertension in late life and renal volume can be used as a parameter for diagnosis of IUGR.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Fasting Insulin Level Changes after Large Volume Liposuction624362511295110.21608/ejhm.2018.12951ENHanna HabibDepartment of General Surgery, Faculty of Medicine - Ain Shams UniversitySarah Abd AlazeemDepartment of General Surgery, Faculty of Medicine - Ain Shams UniversityNermin Abd AlazeemDepartment of General Surgery, Faculty of Medicine - Ain Shams UniversityJournal Article20180909<strong>Background: </strong>Obesity is a disabling disease which has gained greater attention worldwide. It significantly increases the risk for other diseases such as insulin independent diabetes mellitus also known as diabetes type 2. The most common surgical procedure for obesity is liposuction. It is traditionally performed either as small-volume liposuction or large-volume liposuction. <strong>Aim of the Work: </strong>to spot the light on the effect of large volume liposuction on fasting insulin level changes after 3 months postoperative and to find if LVL may obtain any improvement in metabolic variables. This study will provide the clinician with a more valid basis on which to advise patients undergoing body-contouring procedures, particularly to ensure realistic expectations regarding the effects of body-reshaping procedures on general health. <strong>Patients and Mehtods: </strong>This is prospective study was conducted on a total of 15 overweight and obese (BMI 26–35 kg/m<sup>2</sup>) premenopausal women (age 21–40years). All subjects were at their maximum body weight and weight stable for at least 3 months. The study took place at Ain Shams University Hospitals and other authorized hospitals under supervision of thesis supervisors studying fasting insulin changes after 3 months following large volume liposuction. <strong>Results: </strong>The present study demonstrates that large-volume abdominal liposuction should, by itself, be considered a clinical therapy for obesity and its metabolic sequelae. Aspiration of large amounts of subcutaneous abdominal fat in women with abdominal obesity, besides having cosmetic benefits, does significantly improve fasting insulin levels. Therefore, the procedure is safe and could successfully help obese subjects to reduce their potential metabolic risks.<strong>Conclusion: </strong>The analysis of the study suggests that plastic surgery could play a role in metabolism. The surgical removal of fat is not detrimental with regard to variation of metabolic indices.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001The Diagnostic accuracy of Ultrasound Guided Fine Needle Aspiration Biopsy for Dominant Nodules in Multinodular Goiter625262581295310.21608/ejhm.2018.12953ENAbd Elrahman Mohamed ElmaraghyDepartment of General and Endocrine Surgery, Faculty of Medicine, Ain Shams UniversityMahmoud Saad FarahatDepartment of General and Endocrine Surgery, Faculty of Medicine, Ain Shams UniversityMohamed Mahmoud ElsayedDepartment of General and Endocrine Surgery, Faculty of Medicine, Ain Shams UniversityAhmed Mohamed RushdiDepartment of General and Endocrine Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20180909<strong>Background: </strong>FNAC is useful tool to evaluate dominant thyroid nodule in patients with multi nodular goiter however, because the diagnostic performance of US-based FNAC criteria varies according to the individual international society guidelines, clinicians should be aware of the strengths and weaknesses of US-based FNAC criteria in the management of dominsnt nodules in patients with multinodular goiter. FNAC is an office procedure, done with or without local anesthesia with 23 to 27 gauge needle, to obtain cells samples for cytological examination. It is a safe, accurate and cost-effective way for evaluating dominant thyroid nodules. <strong>Objective: </strong>the aim of this study was to discuss the accuracy of Ultrasound guided FNAC technique in diagnosis of pathological types of dominant nodule in multinodular goiter.<strong> Patients and Methods: </strong>this was a prospective study to evaluate the accuracy of FNAC in diagnosis of pathological type of dominant nodule in 20 patients with multinodular goiters who referred to the endocrine surgery unit at El-Demerdash Hospital, Ain Shams University from March 2017 to December 2017.<strong> Results: </strong>in our study the FNAC results indicated malignancy in 1 patients (5%), benign in 13 patients (65%) and intermediate in 6 patients (35%). The final histopathological diagnosis was malignancy in 3 of the patients (15%); one case had follicular thyroid carcinoma while two of the patients had malignant papillary thyroid tumor. Among the rest, 17 patients (85%) had benign lesion or tumor. Out of the 13 cases identified to be benign lesion by thyroid FNAC 7.7% of the group subjects were found to be malignant follicular carcinoma by biopsy (N=1).<strong> Conclusion: </strong>the main problem among the clinical features is false negatives, as it implies the presence of undetected carcinomas. Although FNAC is useful test, our decision making should not be depend on the basis of its results and sometimes clinical and U/S criteria are preferred to cytological data.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Non-Invasive Markers for Liver Fibrosis in Chronic HCV Patients625962621295510.21608/ejhm.2018.12955ENMohamad Abd-ElrasheedDepartment of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMahmoud Abd-ElrasheedDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20180909<strong>Background:</strong> liver biopsy for years was the only trustable tool for liver cirrhosis evaluation, it is an invasive and painful procedure with considerable rate of complications. Looking for non-invasive markers was mandatory.<br /> <strong>Aim: </strong>we aimed to evaluate the use of non-invasive markers for fibrosis staging in HCV-infected patients.<br /> <strong>Patient and methods: </strong>from HCV patients subjected to antiviral therapy within 2015, 42 patients were evaluated with histopathological staging (metavir-staging) after liver biopsy. According to pathological stages, our patients were divided into two groups; group (I) of 18 patients with significant liver fibrosis and group (II) of 24 patients of non-significant liver fibrosis. For all patient age, ALT, AST, GGT, cholesterol, platelets count, bilirubin, prothrombin time and albumin were evaluated and statistically correlated with fibrosis stage.<br /> <strong>Results: </strong>patients with significant liver fibrosis had higher AST and GGT levels and lower S. Albumin and prothrombin time than patient without significant liver fibrosis. Patients with significant liver fibrosis had positive correlation between AST and GGT level and stage of fibrosis, also had negative correlation between S. Albumin, platelet count and prothrombin time and stage of fibrosis.<br /> Conclusion: non-invasive markers as AST, GGT, serum albumin, platelet count and prothrombin time could be used as markers for diseases severity in cirrhotic patients of HCV.<br /> <strong>Recommendation: </strong>recent studies must be done for evaluating these markers before and after HCV therapy is highly recommended.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Role of Medical Imaging in Cases of Stress Urinary Incontinence626362671295910.21608/ejhm.2018.12959ENAbdel Karim M. ElHemalyObstetrics and Gynecology Department, Faculty of Medicine for Boys, Al-Azhar UniversityIbrahim Mahrous KandilObstetrics and Gynecology Department, Faculty of Medicine for Boys, Al-Azhar UniversityMohammed Salah Elden HassanenObstetrics and Gynecology Department, Faculty of Medicine for Boys, Al-Azhar UniversityAmr Mahmoud Zaied MahmoudRadiology Department, Faculty of Medicine for Boys, Al-Azhar UniversityAttia Mohammad Attia IbrahimObstetrics and Gynecology Department, Faculty of Medicine for Boys, Al-Azhar UniversityJournal Article20180909<strong>Background:</strong> traditional methods for evaluation of women with urinary incontinence include urodynamic studies with measuring the pressure in the abdomen, the bladder, and the urethra and urine flow analysis. In addition, cysto-urethroscopy, cysto-urethrography are used for visualization of the bladder and the urethra.
<strong>Aim of the Study:</strong>urinary continence depends on a closed and empty urethra with high urethral pressure. High urethral pressure (Pura) depends on two factors; one is structural which is defined as damage and lacerations in the collagen chassis of the internal urethral sphincter (IUS), the second factor is acquired functional factor is having and maintaining high sympathetic tone at the IUS from toilet training.
<strong>Patients and Methods:</strong> 40 women who from SUI are examined clinically and investigated with sonar scanning 3DUS. 20 cases control by 3DUS. Patients with primary infertility those who had no vaginal deliveries, did not suffer cognitive behavioral therapy. This study is done at Bab El-Sharia Maternity University Hospital during the period from January 2017 to June 2018.
<strong>Result:</strong>the IUS, as it is a cylinder, the level and extent of the rupture along the cylinder will determine the type and the degree of urinary incontinence as well as the configurational shape seen on imaging (case with primary infertility two years ago).
<strong>Conclusion: </strong>we conclude that damage of the IUS leads low pura and stress urinary incontinence (SUI). Childbirth trauma causes damage to the collagen layer (the frame) of the vagina that leads to redundancy of the vagina and vaginal prolapse.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Serum Beta 2-Microglobulin as a Biomarker of Activity in Ulcerative Colitis626862711309710.21608/ejhm.2018.13097ENIhab Hassan NashaatInternal medicine and Gastroenterology, Ain Shams UniversityMaha Mohsen MohamedInternal medicine and Gastroenterology, Ain Shams UniversityTari Magdy AzizInternal medicine and Gastroenterology, Ain Shams UniversityMina Wagdy NakhlaInternal medicine and Gastroenterology, Ain Shams UniversityJournal Article20180910<strong>Background: </strong>ulcerative colitis (UC) is a chronic, idiopathic, inflammatory bowel disease that causes inflammation and ulcers in the innermost layers of the large intestine (colon) and rectum. Assessment of intestinal inflammation in UC is crucial and still remains a difficult challenge for the clinician. Although endoscopic modalities with biopsy sampling seem to be the most reliable method for estimating disease severity, they are invasive and costly. Apart from endoscopic interventions, disease severity can be assessed using both laboratory studies and non-invasive imaging tests. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cells (WBCs), acid glycoprotein, platelet count and albumin are in common use but have only modest accuracy in reflecting UC disease activity. Therefore, adjunctive use of additional serum markers that will be more sensitive and specific for determination of disease activity and achieving diagnostic accuracy is strongly needed in daily clinical practice.<strong> Aim of the Work:</strong> to investigate the diagnostic utility of beta 2 microglobulin (B2-M) levels and analyze this correlation with the activity of ulcerative colitis disease.<strong> Patients and Methods:</strong> a case control study that was conducted at the Gastroenterology Clinic, Internal Medicine Department, Ain Shams University during the period of January to July 2018. 60 patients were recruited for the study. They were divided as follows; Group “A”: 40 patients newly diagnosed as ulcerative colitis based on colonoscopy and biopsy, subdivided as follows; 20 patients with active ulcerative colitis and 20 patients with inactive ulcerative colitis. Group “B”: 20 healthy individuals free from any systemic diseases serving as a control group.<strong> Results:</strong> in this study, the serum levels of serum B2-microglobulins were highest in patients with active ulcerative colitis compared to those with inactive ulcerative colitis and the control groups. Also B2-microglobulins values become higher with higher number of presenting symptoms and endoscopic activity, which becomes higher in severe disease.<strong> Conclusion:</strong> our results revealed that serum B2-microglobulin was simple and non-invasive marker that could be helpful for differentiating active UC from inactive disease. Moreover, it was more helpful when used together with serum laboratory inflammatory indices (ESR and CRP).Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Retrospective and statistical study of pattern of acute poisoning among cases presented to emergency department of Kafr El - sheikh Governorate hospitals627262821309610.21608/ejhm.2018.13096ENMohamed A. El GendyForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Al -Azhar University, Cairo, EgyptNagy AlfadalyForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Al -Azhar University, Cairo, EgyptIbrahim N. MohamedForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Al -Azhar University, Cairo, EgyptJournal Article20180910<strong>Background</strong><strong>:</strong> Acute poisoning is a common situation in emergency departments all over the world. It may cause severe complications and death. Treatment of these cases requires great medical care and significant costs. There are many differences with respect to the pattern and cause of acute poisoning between geographical regions, even within the same country.<br /> <strong>Objective:</strong> This study was carried out to assess the pattern of acute poisoning with drugs, chemicals and natural toxins in both adults and children in Kafr El - Sheikh Governorate hospitals.<br /> <strong>Methods</strong><em>: </em>The study was conducted onacutely intoxicated cases admitted to some of Kafr El - Sheikh Governorate hospitals. The medical records of cases who were admitted due to acute poisoning from January 2015 to January 2017 were reviewed retrospectively.<br /> <strong>Results</strong>: This study included 1046 acute poisoned cases presented to ED. There were 85% less than 6 years old and 15 % more than 12 years old. .Number of males with toxic exposure was 421 while that of females was 625. Pharmacological agents, constituted the highest percentage of the poisoning (28.92%), followed by Insecticides (24.4 %), household products (20.45 %), food poisoning (12.5 %) and animal poisoning (8.03%).The majority of cases of acute poisoning were accidental (78.01%), followed by attempted suicide (21.98%).The majority of cases stayed at the hospital (51.9 %), while (40.8 %) Discharged from ED and about (7.2%) referred to nearest poison centers. 1027 patients (98.18%) recovered, only 1.3% developed complications.<br /> <strong>Conclusion</strong><em>: </em>Accidental poisoning is still a significant cause of morbidity. Regarding the high prevalenceofpharmaceuticaldrugandhouseholdproductspoisoninginchildren, implementation of legislations to ban over the counter selling of medications and to sell potentially dangerous chemicals in childproof containers is recommended. Improving proper and complete medical record-keeping is also suggested for a better information access.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Outcome of Endovascular Treatment of Cerebral Arteriovenous Malformations with Ethylene Vinyl Alcohol Coploymer628362901319510.21608/ejhm.2018.13195ENHusein El Sayed MohramDepartment of Neurosurgery, Faculty of Medicine – Ain Shams UniversityMohamed Alaa EL Dein HabibDepartment of Neurosurgery, Faculty of Medicine – Ain Shams UniversitySherif Hashem MouradDepartment of Neurosurgery, Faculty of Medicine – Ain Shams UniversityAhmed Hassan Abo ZeidDepartment of Neurosurgery, Faculty of Medicine – Ain Shams UniversityAbd Allah Mouhammed MaherSalemDepartment of Neurosurgery, Faculty of Medicine – Ain Shams UniversityJournal Article20180910<strong>Background: </strong>Cerebral AVMs are very rare lesions, and this rarity contributes to the difficulty of treating them. There is no consensus concerning the method of treatment to be chosen among neurosurgery, radiosurgery or embolization.
Onyx embolization could serve as a curative option with accepted morbidity and mortality. The introduction of Onyx and of catheters with detachable tips has no doubt increased the rate of endovascular occlusion, and decreased the risks associated with treatment in our experience.
<strong>Objective: </strong>The aim of the study was to assess the outcome of the use of Onyx in the treatment of intracranial AVMs as curative embolization or before neuro- or radiosurgery
<strong>Patients and Methods: </strong>This analytical prospective study was conducted on 25 patients who were diagnosed with cerebral arteriovenous malformations and underwent endovascular embolization with EVOH copolymer with curative intent during the study period. Interventional procedures were done in the neuro –endovascular unit, neurosurgery department Ain Shams University Hospitals and associate neuroendovascular unit in El Matarya Teaching Hospital in the period between September 2014 and April 2017.
<strong>Results: </strong>Actually comparing these results especially concerning the cure rate along with other studies was somewhat confusing and problematic owing to the diversity in results between studies across the last 15 years.
<strong>Conclusion: </strong>For the cases that are not fulfilling these criteria, embolization should be offered as preparing step for other modality of treatment. In our experience, for curative embolization, the AVM should be small sized (< 3 cm), supplied by one vascular territory, with feeders that can tolerate reflux up to 2–3 cm, with clear proximal parts of the draining veins, and not located in deep structures.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Pre-operative Prediction of Difficulties in Laparoscopic Cholecystectomy629162961371310.21608/ejhm.2018.13713ENMahmoud Mohamed IbrahimDepartment Of General Surgery, El Hussin Hospital, Al Azhar UniversityMohammed Hassan ElshafeyDepartment Of General Surgery, El Hussin Hospital, Al Azhar UniversityIbrahim Ismail ElshaikhDepartment Of General Surgery, El Hussin Hospital, Al Azhar UniversityJournal Article20180915<strong>Background: </strong>Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures being performed by general surgeons all over the world. Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. The purpose of our prospective study was to analyze various risk factors and to predict difficulty and degree of difficulty preoperatively by the use of a scoring system.
<strong>Objective: </strong>The objective of this study is to evaluate a Scoring system to predict difficult laparoscopic Cholecystectomy.
<strong>Patients and Methods: </strong>Laparoscopic cholecystectomy was done in the department of surgery, EL Hussin University Hospital. The parameters considered in the preoperative scoring method were old age, male sex, history of hospitalization, obesity, previous abdominal surgery scar, and palpable gall bladder, wall thickness of gall bladder, pericholecystic collection and impacted stone. A total of 50 patients were included in the study.
<strong>Results: </strong>We found that history of hospitalization; palpable gall bladder, impacted stone and gall bladder wall thickness were statistically significant factors for prediction of difficult laparoscopic cholecystectomy. Conversion rate from laparoscopic to open cholecystectomy was found to be 4%.
<strong>Conclusion: </strong>High risk patient may be informed beforehand regarding the probability of conversion and hence they may have a chance to make arrangements. Surgeons can also be aware about the possible complications that may arise in high risk patients.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Overview of Risk factors of diabetic macular edema treatment prognosis629763031371410.21608/ejhm.2018.13714ENAbdulrhman Ali Hassan HassanFaculty of medicine, King Khalid University, Abha, Saudi ArabiaAhmed Abdullah Yahya OjaemFaculty of medicine, King Khalid University, Abha, Saudi ArabiaMohammed Nasser Ahmed AsiriFaculty of medicine, King Khalid University, Abha, Saudi ArabiaSarah Hassan AsiriFaculty of medicine, King Khalid University, Abha, Saudi ArabiaJournal Article20180915<strong>Background:</strong> Diabetes mellitus (DM) is just one of the world's fastest growing chronic conditions as well as a leading cause of acquired vision loss, diabetic macular edema (DME) is a disease linked to diabetes. Some individuals with diabetes will certainly get a kind of retinopathy-a problem of the retina in the eye. Diabetic retinopathy could progress as well as result in DME (additionally referred to as retinal swelling) that might impact your vision, and is among the most usual reasons for blindness.
<strong>Objective:</strong> In this review we discuss about the most dangerous risk factors during treatment and in daily life, which can worsen the treatment prognosis.
<strong>Methods:</strong> PubMed and Embase database were searched up to July, 2018 for relevant studies that discussing the risk factors of glaucoma.
<strong>Result: </strong>It is clear that the variety of people affected by DM is expanding greatly, as is the variety of patients with problems from DM. Fortunately; the eye symptoms of DME can be identified and managed prior to considerable vision loss happens if patients with DM undergo routine eye tests and much better manage their systemic condition.
<strong>Conclusion: </strong>Close collaboration in between doctors and also ophthalmologists is important in the managing of patients with diabetic retinopathy and also DME. To make certain very early medical diagnosis as well as treatment all diabetic person patients should be screened for diabetic person retinopathy. Control of blood pressure, serum lipids, and also renal function are very important treatments focused on prevention of visual impairment associated with diabetic retinopathy and DME.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Cable Tie Seton in Surgical Treatment of High Perianal Fistula630463091371510.21608/ejhm.2018.13715ENEl-Sayed Ahmed Mohammed Awad AmmarGeneral Surgery department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAdel Mohammad Abdulhaleim LasheenGeneral Surgery department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed Shawki Abd-El-AzizGeneral Surgery department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20180915<strong><em>Background: </em></strong>Seton is any string-like material which when tied through the fistula tract causes an inflammatory reaction which stimulates fibrosis that fixes and prevents retraction of the sphincter continuity when it is divided. In this way, it maintains sphincter continuity during cutting process. <strong>Aim of work: was to evaluate the</strong> cable tie seton technique in surgical treatment of high perianal fistula, regarding the rate of fecal incontinences and recurrence<strong><em>. Patients and Methods</em></strong>: This prospective study included a total of 20 cases having single tract, high perianal fistula, primary or recurrent and who were managed by cable tie seton from October 2016 till September 2017. Patients were enrolled from General Surgery Department, Al-Hussein Hospital. Patients were instructed to follow up weekly for 10 weeks with continuous tightening of the seton.<strong><em> Results</em></strong>: All the patients were followed up for the state of incontinence for flatus, liquid and solid stool and follow up for recurrence, slippage of cable: Incontinence: There is 3 cases noticed in early 2 weeks incontinent for flatus. Incontinence for liquid stool noticed in 2 cases in early 1 week. Incontinence for solid stool not noticed in our study. In all cases, the cable tie seton was kept in its position and didn’t dislodged or slipped. <strong><em>Conclusion</em></strong>: It could be concluded that cable tie seton is safe, low cost, ubiquitous, pragmatic, precise, and accost effective option for the treatment of high perianal fistula. We there for recommended it for treating fistula in ano requiring the placement of aseton. It does not carry the disadvantages of repeated anesthesia and visits to the operating theater and reduce the morbidity, inconvenience, and cost to the patient.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Incidence of Placenta Accreta and its Complications in Cases of Previous Cesearean Sections with Placenta Previa Anterior at Al Hussein University Hospital631063151371610.21608/ejhm.2018.13716ENAbd Al Fattah Mohamed El SayedAl SenittyObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityAshraf Hamdy MohamedObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityIbrahim Mohammed MohammedAhmedObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20180915<strong>Objective: </strong>Incidence of placenta accreta and its complications in cases of previous cesarean sections with placenta previa anterior at Al Hussein University Hospital.
<strong>Materials and Methods</strong>:Ultrasound is the recommended first step in the diagnosis of placenta previa accreta. Color Dopplerultrasound has been suggested to aid in the diagnosis of placenta previa accreta. Magnetic Resonance Imaging also was used.
<strong>Results</strong>: Cesarean Hysterectomy performed in all cases of accretion, bladder injury in 19 (47.5%) cases, bowel injury in 1 (2.5%) case, all cases received intraoperative blood transfusion, postoperative blood transfusion in 38 (95%) cases and ICU admission in 25 (62.5%) cases.
<strong>Conclusion: </strong>The incidences of placenta accreta in cases of previous cesarean section with placenta previa anterior were 63%. Incidence, risk factors and Feto-maternal outcome of management of Patients with placenta accreta at Al Hussein University Maternity Hospital are comparable with those presented in several literatures.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Prevalence and Risk Factors of Diabetic Septic Foot among Attendees of Diabetes Center of Arar City, Northern Saudi Arabia631663231396510.21608/ejhm.2018.13965ENNajah Dhaher Y AlanziMedical Intern, Northern Border University, Arar, KSARehab Thayib R AlanaziMedical Intern, Northern Border University, Arar, KSAHadeel Saud D AlanaziMedical Intern, Northern Border University, Arar, KSAFadih Nada M AleneziMedical student, Northern Border University, Arar, KSARehab Mohammed A AlanaziMedical student, Northern Border University, Arar, KSAItizaz Hatim R AlanaziMedical student, Northern Border University, Arar, KSAMalak Sayah S AlkuwaykibiMedical student, Northern Border University, Arar, KSAMarwah Motlaq A AlanaziMedical student, Northern Border University, Arar, KSABanan Khalid M AlotaibiMedical student, Northern Border University, Arar, KSAHuda Owaid H AlanaziMedical student, Northern Border University, Arar, KSARehab Zaid M AlayyashiMedical student, Northern Border University, Arar, KSAReem Meshal T AlmjladMedical student, Northern Border University, Arar, KSARahmah Subhi H AlanaziMedical student, Northern Border University, Arar, KSAAmer Ahmed BallaAssistant Professor and Endocrine specialist, Faculty of medicine, Northern Border University, Arar, KSAJournal Article20180917<strong>Background:</strong> Diabetic septic foot contributes significantly to morbidity and mortality of patients with diabetes leading to substantial physical, physiological and financial burden for the patients and community at large. <strong>Objective:</strong> to determine the prevalence, patterns and risk factors of diabetic foot ulcers amongst patients with diabetes mellitus who were attending the diabetes center of Arar city in the period of the study.<strong> Methods:</strong> This was a retrospective study in the patients of the diabetes center of Arar city, Northern Saudi Arabia. The study was carried out during the period from 1 April to 31 May, 2018. All the patients attended the diabetes center in the period of the study were included in our data. The data were collected using a predesigned questionnaire. The questionnaire covered all the necessary items in the research. Data were collected through personal interviews with the participants and filling the questionnaires.<strong> Results:</strong> The prevalence of diabetic foot among the included diabetic patients was 52.8%. 77.8% had type II and 22.2% had type I, 83.3% had glucometer and 38.9% monitor their blood glucose level daily, 41.7% were obese, 77.8% had hypertension, 52.8% had hyperlipidemia. Only 11.1% examined the pulse and sensation the foot of the population. For diabetes control, 58.3% of them use oral tablets, 27.8% use insulin injection and 13.9% use both tablets and insulin but 52.8 of them have complication with treatment. <strong>Conclusion:</strong> The prevalence of diabetic foot among the included diabetic patients was high (52.8%). This emphasizes the importance of the more health education and better management of the diabetic patients in order to reduce the burden of health care costs of diabetic foot.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Lower Respiratory Tract Infection in Pediatrics, Treatment Approaches: Review Article632463301399010.21608/ejhm.2018.13990ENMohammed Hundur AlasmariMedical school, Najran University, Najran, KSAAbdulaziz Abdullah AlhazmiMedical school, Najran University, Najran, KSAAbdullah Salem Al HaiderMedical school, Najran University, Najran, KSAYaqoub Mubarak Ali AlhamamiMedical school, Najran University, Najran, KSANasser Naji Mohsen Al HarthiMedical school, Najran University, Najran, KSAMana Ali Mueidh Al HajlanMedical school, Najran University, Najran, KSAJournal Article20180917This article outlines the etiology and epidemiology of childhood acute lower respiratory tract infections (ALRI), preventative measures, and management of the most common and important cause of ALRI, pneumonia.
<strong>Method:</strong> We conducted a review to determine the proper treatment of Lower respiratory tract infection in pediatrics. In May 2018 we searched PubMed, Medline, and EMBASE databases <strong>Conclusion:</strong> Viral lower respiratory system infections in newborns and children are important clinical and socioeconomic problems worldwide. Viral lower respiratory system infections are mild and self-restricting in many cases. Specific patient groups are at risk of a severe program of illness, although formerly healthy infants with a viral lower respiratory tract infection may additionally develop extreme illness.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Risk factors associated with glaucoma disease progression633163361399610.21608/ejhm.2018.13996ENAli Yasen A AhmedMedical school Taif University, KSAIbrahim Hassan M AlthomaliMedical school Taif University, KSAOmar Mohammed A AlthobaitiMedical school Taif University, KSAMohannad Solaiman Faia AsseryMedical school Taif University, KSAAbdullah Abdulwahab N AlsiniMedical school Taif University, KSAJournal Article20180917<strong>Background:</strong> Glaucoma is a disease which damage the eye’s optic nerve. That so many instances of glaucoma can be undiscovered ways that research studies based in hospitals or specialist clinics, as an example, can be biased to specific classes of referred patients and so not representative of the Glaucoma associate. <strong>Objective:</strong> In this review we discuss risk factors that lead to onset of glaucoma and focus on risk factors affecting the progression of this disease, to give information to prevent and start early treatment. <strong>Method:</strong> PubMed and Embase database were searched up to July, 2018 for relevant studies that discussing the risk factors of glaucoma. <strong>Conclusion:</strong> The most consistent factors are older age and also higher baseline IOP. Currently, there is very little we can do about age, due to the fact that it is probably a surrogate threat factor for various other potentially more important elements, for example, mitochondrial performance. Because IOP can be lowered either medically or operatively, it is a flexible threat or prognostic element for open-angle glaucoma.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001The Use of CT and MRI in Evaluation of Primary Brain Tumors in Saudi Arabia633763411407510.21608/ejhm.2018.14075ENSaad Mohammed AlhaqbaniPrince Sattam Bin Abdulaziz University, Al-KharjDalal Aayed Al-HarbiBatterjee Medical College, JeddahAbdulaziz Musaad Mutiran AljohaniKing Khalid University, AbhaTalal Ahmad Ali AlomariAl-Baha University, Saudi ArabiaMohammed Mousa AlghamdiAlmaarefa Colleges, RiyadhFawaz Abdulrahman Alsaleh6Al Imam Mohammed Ibn Saud Islamic University, RiyadhEman Mohammad AlfarajImamAbdulrahman Bin Faisal University, DammamAbdulrahman Nasser AlakeelKing Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaJournal Article20180918<strong>Background: </strong>Imaging plays a crucial function in the management of patients with brain tumors. The technical improvement of computed tomography (CT) and magnetic resonance imaging (MRI) with the advancement of, brand-new imaging techniques highly enhanced the detection and characterization of brain tumors. This comprehensive review of literature is aimed to discuss the roles of MRI & CT in the diagnosis and evaluation of primary brain tumors, we attempted to discuss the advantage and disadvantage of each modality and which is more effective in this matter.<br /> <strong>Objective: </strong>to find a relevant article to our study, this is discussing the roles of MRI and CT in evaluation of Primary brain tumors. Several terms were used in the search through the databases; (MRI, CT, and Imaging), combined with (Brain cancer, primary brain tumors, glioblastomas).<br /> <strong>Method: </strong>We performed a comprehensive search of literatures among main medical databases; PubMed (MIDLINE), Embase, and science direct, up to November 2017, We limited our search to English language studies, and only to Human trails.<br /> <strong>Results: </strong>Computed tomography (CT) might be the very first modality employed in a patient presenting with a brain tumor but for one of the most part MRI is the primary imaging modality in brain tumor patients. The function of CT is mostly relegated to emerging imaging in the detection of hemorrhage, herniation, and hydrocephalus but mass effect from brain tumors and calcification within brain tumors such as oligodendrogliomas or meningiomas can potentially be discovered.<br /> <strong>Conclusion: </strong>The main use of MRI-based medical image analysis for brain tumor studies remains in medical diagnosis, patient tracking and treatment preparation, however it could also be useful in clinical trials.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Management of Abdominal Trauma with Liver Injuries among Patients in Riyadh, Saudi Arabia634263471407610.21608/ejhm.2018.14076ENKhaled Abdullah AlshareefAlmaarefa Colleges, RiyadhAmirah Mohammed AlosaimiAlmaarefa Colleges, RiyadhLuay Mohammed SahyunIbnSina National College for Medical Studies, JeddahHashem Mohammed JustaniahIbnSina National College for Medical Studies, JeddahMahmoud Talat KhodaryIbnSina National College for Medical Studies, JeddahFaisal Khalid AlhothaliUniversity of Jeddah, Saudi ArabiaYasir Mohammed AlsagoorUniversity of Groningen, NetherlandsYaser Abbas AlnajraniUniversity of Najran, Saudi ArabiaJournal Article20180919<strong>Background:</strong> recently, there was a shift in the management plan for liver blunt trauma from operative to non-operative treatment, as there were advances in critical care and sensitivity of diagnostic tools for detection of liver injury such as CT scan. <strong>Objectives:</strong> To estimate the prevalence and correlates of non-operative management of liver injury among abdominal trauma patients admitted under surgical team care. <strong>Patients and Methods:</strong> this is a retrospective cohort study carried out in Riyadh, Saudi Arabia from May 2017 to June 2018. All patients admitted to general surgery departments with abdominal trauma and liver injuries were included. Variables were obtained through file review. <strong>Results:</strong> the study included 54 patients with liver trauma. Their age ranged from 7 to 60 years with mean age of 29.2±11.3. Male was the dominant gender; with male to female ratio were 8 to 1. Regarding mechanism of injury, all cases of fall down and 88.9% of road traffic accidents compared to none of penetrating injury were treated non-operatively, p=0.011. Concerning CT grading, all cases of grade I compared to 75% of grade IV and 70% of grade III were treated non-operatively, p=0.016. Majority of patients treated non-operatively (45/48; 93.8%) compared to one third of those treated operatively (2/6; 33.3%) were improved on discharge, pConclusion: the prevalence of non-operative management of liver injury in Riyadh hospitals is currently very high, ever for high-grade injuries. Most of them were improved on discharge compared to those managed operatively. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Comparison between lateral partial turbinectomy and conchoplasty for concha bullosa634863531408710.21608/ejhm.2018.14087ENAtef Abd Allah Al MaraghyOtorhinolaryngology, Faculty of Medicine, Al- Azhar University, EgyptMohammed Abd Al Mon`em YonisOtorhinolaryngology, Faculty of Medicine, Al- Azhar University, EgyptMohammed Ahmed Al SharkawyOtorhinolaryngology, Faculty of Medicine, Al- Azhar University, EgyptAlaa Gamal Eldeen Ebrahim ZewailOtorhinolaryngology, Faculty of Medicine, Al- Azhar University, EgyptJournal Article20180919<strong>Background:</strong> pneumatization of the middle turbinate is common anatomic variations of lateral nasal wall, whereas rare in the superior and the inferior turbinate. <strong>Objective</strong>: to compare the efficacy of conchoplasty to lateral partial turbinectomy in the treatment of concha bullosa.<strong> Patients and Methods:</strong> this study included randomly selected 40 patients, who attended the ENT clinic at Al-Hussein University Hospital, Faculty of Medicine, Al-Azhar University during the period from June 2016 to November 2017.All patients have a symptomatic unilateral or bilateral concha bullosa. Patients were classified randomly into 2 groups; Group (1): 20 patients (50%) underwent lateral partial turbinectomy. Group (2): 20 patients (50%) underwent conchoplasty.
<strong>Results: </strong>there was complete cure or significant reduction in severity of complaints in 15 patients (75%) who underwent LPT. In the conchoplasty group 17 patients (85%) were significantly symptoms free at the end of the follow up period. 1 case which underwent LPT developed post-operative epistaxis requiring intervention. There were no cases of epistaxis requiring intervention in the conchoplasty group. Other complications noted in the LPT group included synechiae formation in three cases (15%).
<strong>Conclusion:</strong> as compared to lateral partial turbinectomy, conchoplasty is an equally effective surgery in the treatment of concha bullosa with lesser incidence of complications.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001A simple index to predict myocardial infarction size and adverse clinical outcome in patients with acute STEMI undergoing primary PCI635463581409010.21608/ejhm.2018.14090ENOsama AmineAbd El HamedCritical Care Department, Faculty of Medicine, Cairo UniversityWael SamyCritical Care Department, Faculty of Medicine, Cairo UniversityAkram AbdelbaryCritical Care Department, Faculty of Medicine, Cairo UniversityTarek ElgoharyCritical Care Department, Faculty of Medicine, Cairo UniversityAlia Abd-El-FattahCritical Care Department, Faculty of Medicine, Cairo UniversityJournal Article20180919<strong>Background:</strong> Early improvement of perfusion after acute MI will improve left ventricle function and decrease the infarction area, thus decreasing mortality.
<strong>Methodology:</strong> 52 patients presented with acute ST segment elevation MI Who underwent primary PCI within 24 hours of presentation. All patients were subjected to full history taking, physical examination, serial ECG, cardiac enzymes, calculation of relative importance index (RII) by dividing culprit segment diameter by left anterior descending , circumflex and right coronary arteries at their proximal segments and myocardial perfusion image to detect infarction size.
<strong>Results:</strong> There is significant correlation between RII and left ventricular dysfunction
<strong>(p: 0.028).</strong> Significant correlation between RII and mortality are present.
<strong>Conclusion:</strong> RII is significantly correlated with adverse clinical outcome in patients with acute STEMI.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001The Influence of Stress on Body Mass Index among Female University Students635963661435510.21608/ejhm.2018.14355ENNada Fahad M AlsultanStudent, King Faisal UniversityMalik Dham AlanaziStudent, King Faisal UniversityDaham Obaid AlshammariStudent, King Faisal UniversityZahrah Ali AlsayafiStudent, King Faisal UniversityYahya Mohammed AlzahraniStudent, King Faisal UniversityAyat Abdulnasser BoholigahStudent, Arabian Gulf UniversityKawthar Ali AlnahwiStudent, Arabian Gulf UniversityLama Zaki NasserullahStudent, Arabian Gulf UniversityLina Zaki NasserullahStudent, Arabian Gulf UniversityJournal Article20180921<strong>Background:</strong> The interrelatedness between obesity and psychological problems seems to be twofold, in that clinically meaningful psychological distress might foster weight gain and obesity may lead to psychosocial problems. Stress may contribute to changes in dietary behaviors that lead to weight change, with various effects related to sex baseline body mass index, or cortisol reactivity in response to stress. <strong>Objective:</strong> To describe the relationship between stress, weight-related health behaviors (e.g., eating behaviors, physical activity, sedentary behavior, sleep, cigarette smoking and binge drinking), and weight status using cross-sectional data from community college students. <strong>Methods:</strong> This was a community-based cross-sectional study. Data were collected from representative sample of undergraduate female students in Kingdom of Saudi Arabia. A total of 208 undergraduate female students were included in this study. The study period was from October 2017 to December 2017. Data were collected by means of personal interview with the participants using a predesigned questionnaire which was distributed among students and filled by personal interviewing after a brief introduction or explanation of the idea of the research to the participants . <strong>Results:</strong> There was a high significant correlation between stress and BW (P= 0.004). We found no relation between BW and academic year, fast food consumption, main meal content, muscular exercise and cause of stress. There was a high significant correlation between BW and number of meals per day (P= 0.000), stress level (P=0.000) and dealing with stress (P=0.017). <strong>Conclusion and Recommendations:</strong> Factors which were significantly associated with BMI and stress should be further studied to include number of meals per day, stress level and dealing with stress). Interventions among university students should relate actual measured BMI to stress perception of the students in order to target students at risk. Universities should offer individual counselling for at risk students in order to prevent eating disorders, and should offer psychological and stress related counselling, but should also counteract unrealistic body image concerns of students by broad health communication campaigns. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Assessment of knowledge and attitude and practice towards malignant hypertension among interns in Saudi Arabia, 2018636763711435610.21608/ejhm.2018.14356ENMajed Meshal H AlmutairiImam Mohammad Bin Saud UniversityMuhammad Abdullah M AlmalkiNorthen Border UniversityAbdulrahman Bader A AlaqlPrince Sattam Bin Abdulaziz UniversityJournal Article20180921<strong><em>Background: </em></strong>Malignant hypertension (MHT) is the most severe form of arterial hypertension.
<strong><em>Objectives: </em></strong>Assessing the knowledge, attitude and practice (KAP) regarding the malignant hypertension in Kingdom of Saudi Arabia (KSA). <strong><em>Methods: </em></strong>A cross-sectional questionnaire based study was conducted at 26 different hospitals in Saudi Arabia, Ministry of Health, from March to July 2018 among 260 interns. <strong><em>Results</em>: </strong>This study showed a high level of knowledge and awareness among the respondent’s regarding the malignant hypertension definition, cut off values, diagnosis, symptoms and treatment. The prompt knowledge was reflected by good attitude and practice among most of the interns. Most of the interns knew the definition of malignant hypertension, and the blood pressure values of hypertensive subjects without comorbidities, the difficulty in diagnosis of malignant hypertension and the importance of monitoring the blood pressure if suspecting malignant hypertension. Also, most of them showed good awareness of the targeted BP that would like to be achieved in hypertensive patients with diabetes mellitus and/or chronic kidney disease without proteinuria (87.5%). <strong><em>Conclusion</em>: </strong>The level of knowledge was sufficient among interns in KSA. Interns’ knowledge about malignant hypertension is reflected in their attitude and practice. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Gender Differences in Characteristics of Colorectal Cancer Patients: Eight Years’ Experience in Tertiary Care Center.637263761435710.21608/ejhm.2018.14357ENFutun AljoufiKing Saud bin AbdulAziz University for Health SciencesAdel YaskyKing Saud bin AbdulAziz University for Health SciencesSara QubaibanKing Saud bin AbdulAziz University for Health SciencesRoaa AmerKing Saud bin AbdulAziz University for Health SciencesAbdullah AlasaadKing Saud bin AbdulAziz University for Health SciencesHusam AltahanKing Saud bin AbdulAziz University for Health SciencesThekra AlGholaiqaKing Saud bin AbdulAziz University for Health SciencesHala AlMarzougKing Saud bin AbdulAziz University for Health SciencesEmad MasuadiKing Saud bin AbdulAziz University for Health SciencesAshwaq Al OlayanKing AbdulAziz Medical City Riyadh, KSAJournal Article20180921<strong>Introduction and Objectives: </strong>Colorectal cancer (CRC) has become a very common researched topic in Saudi Arabia. Significance of the disease lay as the third most common cancer in the Kingdom plus the various risk factors it may be connected to. Smoking, obesity, age, and gender should be further investigated in our community to focus our screening and minimize the burden of this disease. We tried to determine the differences between males and females in term of demographic<strong>, </strong>clinical and treatment characteristics.<strong>Methodology</strong>: A retrospective cohort study was performed in all cases of CRC from 2006-2014 in King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia (KSA). Categorical data were presented as frequencies and percentages to summarize patients’ demographic data. Chi-square was used to compare between sex and the site of metastasis. Moreover, Cox regression was used to assess the risk factors on mortality.<strong> Results: </strong>Out of 581 patients diagnosed with colorectal cancer, 326 (56.51%) were males.The mean age of colorectal patients at the time of diagnosis was 59.7.Majority of the BMI was overweight 183 (37.0%) smoking history was found in only 18 (3.5%) patients. Most of the patients were stage IV. The bio marker (K-RAS) was done for 189 colorectal cancer patients, of which male and female patients had mostly wild type. Tumor marker Carcinoembryonic Antigen (CEA) showed that most of the patients were in the high range for male patients 140(48.8%) and for females 115(53.2%). <strong>Conclusion: </strong>No difference was found in regards to K-RAS mutation distribution by gender. High CEA was not associated to any age or gender. There was no statistical significance in relation to gender and response to treatment.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200273320181001Assessment of Knowledge, Attitude and Practice of Parents about Immunization in Hail City, 2018637763811435810.21608/ejhm.2018.14358ENTamam Murdi AlshammariUniversity of Hail, Saudi ArabiaYazeed Saad R AlsubaieMajmma University, Saudi ArabiaSomeili, Suleman AliPrincess Basma Teaching Hospital, JordanNajla Mohammed AlajmiAlmaarefa University for Science and Technology, Riyadh, Saudi ArabiaKhalid Khalaf M AlanaziTabuk University, Saudi ArabiaMohammed Abdulkareem AbdrabAlamirImam Abdulrahman Bin Faisal University, Saudi ArabiaZayed Ahmad Eisa AlbenawiKing Khalid University, Abha, Saudi ArabiaAhmed Mohammed AlsahliGeneral practitioner, University Of Science &Technology in Sana’a, YemenNoor Sayed Saleh Darwish AlsharkhatJordan University of Science and Technology- Irbid, JordanAbdulaziz Jazza AlmejladKing Abdulaziz University, Jeddah, Saudi ArabiaMohammad Nasser AlmatrafiAlmotasem Bllah Ali AlhazmiJournal Article20180921<strong>ABSTRACT<br />Background:</strong>Immunization has shown major preventive aspects of infectious diseases, disability and death. <strong>Objectives: </strong>Assessing the knowledge, attitude and practice (KAP) of Saudi parents in Hail City regarding the immunization programs for children, Saudi Arabia (KSA), 2018. <strong>Methods:</strong> It is a cross sectional survey study that was carried out upon 420 parents that were randomly selected as the team focused on collection from public areas to get the appropriate knowledge level from the community for 3 months from May to the end of July, 2018. Parents and were asked to complete a questionnaire. The questionnaire contained 4 different parts about the demographics, knowledge, attitude and practice of parents toward immunization.<strong> Results: </strong>The included parents have shown a high level of awareness about vaccination regarding the preventive measures and importance of vaccination which resulted in positive attitudes and practice pattern among most of them. The overall KAP was good among most of parents. The higher KAP level wasn’t significantly associated with gender, educational degree and number of children. <strong>Conclusion: </strong>Most of Saudi parents in Hail City had good KAP toward immunization which wasn’t associated with gender and educational degrees. However, educational programs are still in need to increase the parents’ knowledge and practice especially among illiterate and less educated parents living in rural areas.