Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Left Ventricular Torsion before and after Percutaneous Mitral Balloon Valvuloplasty168016862851910.21608/ejhm.2019.28519ENShady Mohamed Akl El-Sayed AklMinistry of Health, Sherbeen General HospitalMohammad Ismail Al-DeftarCardiology Department, Faculty of Medicine, Al-Azhar UniversityAbdelMohsen Mostafa AboualiaCardiology Department, Faculty of Medicine, Al-Azhar UniversityMohamed Salem ElbazCardiology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20190309Background: The valve disease is frequently caused by the rheumatic mitral stenosis in developing and developed countries alike and it is still a key issue. Although there is a significant decrease in rheumatic fever diffusion, its percentage is still about 12% of the native valvular heart disease. Aim of Work: The key objective of this work was to assess the impact of percutaneous mitral balloon valvuloplasty (PMBV) on the LV torsion and this objective was achieved by using the two-dimensional speckle-tracking echocardiography. Patients and Methods: The study used the prospective observational method and had been carried out in the Department of Cardiology, Al-Azhar University Hospitals. The treatment group consisted of 35 patients who were candidates for PMBV and the control group consisted of 20 matching patients in terms of gender and age but they were healthy. All the participants of study had been assessed using the conventional echocardiography and speckletracking echocardiography on the previous day and 3 months after the procedure. Results: Using the parameters of the conventional echocardiography, we found that there were no significant differences between the treatment group and the control group in the LV ejection fraction (EF) and RV systolic function (TAPSE) before the PMBV. After applying the Speckle-tracking echocardiography, the results indicated that LV torsion decreased in the treatment group compared to the control group before the PMBV. After 24 hours and 3 months after the PMBV, the patients of treatment group had shown a statistically significant improvement in LV torsion. Conclusion: The LV torsion in MS patients significantly improved immediately and in the short-run follow-up after the PMBVPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101The Effect of Dual Trigger of Oocyte Maturation with Gonadotropin-Releasing Hormone Agonist and Low-Dose Human Chorionic Gonadotropin on Pregnancy Rate in Women at Risk of Ovarian Hyperstimulation Syndrome168716972852010.21608/ejhm.2019.28520ENMarwa Salah Elsayed Abdel-AalObstetrics and Gynecology Departments, Faculty of MedicineYehia Abdel Salam WafaObstetrics and Gynecology Departments, Faculty of MedicineShokry Abdel Azeim El ShershabyInternational Islamic Center for Population Studies and Research (Assisted Reproduction Unit)
Al-Azhar UniversityJournal Article20190309Background: the purpose of this study was to compare rates of ovarian hyperstimulation syndrome (OHSS) and the pregnancy outcome after using gonadotropin-releasing hormone agonists (GnRHa) alone and GnRHa in combination with low-dose human chorionic gonadotropin (hCG, dual trigger) for final oocyte maturation in women undergoing controlled ovarian hyperstimulation (COH). Patients and Methods: the study included 150 female patients with high risk of OHSS occurrence who were allocated by the Computer-based randomization method into two groups with 75 patients in each arm, Group I received GnRHa trigger and Group II received dual trigger (GnRHa + low-dose (1500 IU) hCG trigger). Results: Our study showed that the incidence of OHSS was higher after dual trigger than GnRHa trigger but with no statistically significant difference (8.0 vs 1.33 %, p >0.05). There were 6 cases of OHSS developed with dual trigger group (Group II) (3 were mild early OHSS, 2 were moderate early and one case was severe late OHSS). In contrast, there was only one case of severe late OHSS seen in Group I. Conclusion: Dual trigger for final oocyte maturation using GnRHa and low-dose hCG is associated with increased the incidence of early OHSS compared to GnRH alone. However, dual trigger appears to be a safe approach with a satisfactory pregnancy outcome. Also, the dual trigger improves the oocyte maturation, the number of yield embryos and the quality of embryos.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Histopathological Study of the Chronic Toxic Effects of Dapoxetine Administration on Testes of Male Albino Rats169817012852110.21608/ejhm.2019.28521ENMohammed Fathy AssasaDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine,
Al-Azhar University, Cairo, EgyptEsam Said MohammedDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine,
Al-Azhar University, Cairo, EgyptOsama Moustafa MoustafaDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine,
Al-Azhar University, Cairo, EgyptAhmed Mohammed Albuomy Abo AlfotohDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine,
Al-Azhar University, Cairo, EgyptJournal Article20190309Background: Dapoxetine is a short acting oral SSRI, purely created for the on-demand treatment of premature ejaculation. The present study was carried out to see the histopathological effects of Dapoxetine on the testis of adult albino rats. Materials and methods: Dapoxetine was administered orally by gavage to rats for consecutive 70 days, Eighty apparently healthy male albino rats weighing 125–150 g were used throughout the experiments .The rats were divided randomly into four groups (n=6). Each group 20 rats: Group (1) Control group, Group (2) receiving 1 mg of dapoxetine /70 days, Group (3) receiving 5 mg of dapoxetine /70 days and Group (4) receiving 10 mg of dapoxetine /70 days. Histological slides were prepared and stained with H and E stain. On examination, distortion of seminiferous tubules, decreased thickness of germinal epithelium, decreased diameter of seminiferous tubules and decreased counts of germinal cell lineage were found in treated groups.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Effect of Maternal Obesity on Labor Induction in Postdate Pregnancies170217092852210.21608/ejhm.2019.28522ENFarid I. HassanObstetrics and Gynecology Department,Faculty of Medicine,Al -Azhar UniversityMofeed F. MohamedObstetrics and Gynecology Department,Faculty of Medicine,Al -Azhar UniversitySalah Eldin M. AliObstetrics and Gynecology Department,Faculty of Medicine,Al -Azhar UniversityJournal Article20190309Background: Obesity has been recognized by WHO as "a pandemic nutritional disorder which represents a rapidly growing threat to the health of populations of countries world wide". As obesity increases, so does the number of women of reproductive age who are overweight and obese. The problems related to the management of obesity in pregnancy are many. There are both short-and long-term complications and implications for both mother and fetus. Aim of the Work: Evaluation of the effect of maternal obesity on labor induction in post-date pregnancies. Patients and Methods: This prospective case-control study was conducted on two hundred (200) pregnant women who were divided into 2 groups: 100 non-obese pregnant women with BMI < 30 kg/m2 and 100 obese pregnant women with BMI ≥ 30 kg/m2 . These women were investigated for success of induction of labor. All women participants were recruited from Al Hussein and Military Hospitals Departments in the period from 12 – 2017 till 11 – 2018. Results: As regards success of induction, our study revealed that a greater number of obese women had failed induction ending in CS delivery ( no dilatation of cervix after 24 hours of vaginal prostaglandin ) compared to their normal weight counterparts. Conclusion: Obesity is associated with increased incidence of failure of induction of labor ending in CS delivery, increased duration of induction of labor till vaginal deliveries, low Apgar score and increased fetal birth weight.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Anterior Segment Optical Coherence Tomography Changes after Phacoemulsification171017182852310.21608/ejhm.2019.28523ENHeba Allah A SaidDepartment of Ophthalmology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo-EgyptHeba M. AbdelrahmanDepartment of Ophthalmology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo-EgyptAhmed Sh. AbdullahDepartment of Ophthalmology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo-EgyptJournal Article20190309Background: phacoemulsification can cause changes in the anterior segment parameters that could be detected by anterior segment optical coherence tomography. Purpose: To determine the changes in the anterior segment parameters and intraocular pressure after phacoemulsification (IOP). Subjects and methods: A prospective, non-randomized study included twenty eyes with visually significant cataract that underwent phacoemulsification with foldable intraocular lens implantation (IOL). Complete ophthalmological examination and anterior segment optical coherence tomography (ASOCT) were performed before surgery and one month postoperatively. Results: There were statistically significant differences in the anterior segment parameters after cataract surgery. The anterior chamber angle (ACA) at the temporal side before and one month after surgery were 22.58º ± 6.4º , 33.14 º ± 6.48º respectively (p < 0.001). The ACA at the nasal side before and one month after surgery were 23.33º ± 6.93º, 34.16º ± 6.99º respectively (P< 0.001). Conclusion: Phacoemulsification with IOL implantation results in significant widening of the ACA proved by quantitative assessment of ASOCT imaging. At the same time it caused small but significant reduction in IOP.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Management of Keratoconus Using Myoring171917242852410.21608/ejhm.2019.28524ENAhmed Rabie MohammedDepartment of Ophthalmology, Faculty of Medicine, Al Azhar UniversityMahmoud Mohamed IsmailDepartment of Ophthalmology, Faculty of Medicine, Al Azhar UniversityMohammed Ahmed WahdanDepartment of Ophthalmology, Faculty of Medicine, Al Azhar UniversityAhmed Hassan BaradaDepartment of Ophthalmology, Faculty of Medicine, Al Azhar UniversityJournal Article20190309Background: keratoconus (KC) is an ectatic condition of the cornea which is usually progressive and noninflammatory, affecting both eyes asymmetrically. It is characterized by stromal thinning that leads to corneal surface irregularity. Vision affection is due to irregular astigmatism and corneal scarring. Aim of the Work: assessment of the effectiveness of Myoring intreating patients with keratoconus. Patients and Methods: prospective non-randomized non-comparative clinically controlled study, Myoring was implanted for (20) eyes of 20 patients with progressive keratoconus. Results: visual acuity and corneal parameters improved significantly in all patients after one year postoperatively. Conclusion: Myoring when used in suitable patients has the potential to produce excellent long-term vision results in mild, moderate and advanced keratoconus cases, regardless of cone position and disease progression.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Measurement of Helicobacter Pylori in Patients with Bronchial Asthma172517312857810.21608/ejhm.2019.28578ENAbaas Saeed Al-maragyDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammed Abdallah RakhaDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmed Abdel-Hameed Abou-ZeedDepartment of Clinical pathology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohanad Mohammed AhmedDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190310Background: Current evidence indicates an inverse association between Helicobacter pylori and asthma and allergy. H. pylori is a Gram-negative bacterium which represents the major cause of peptic ulcer and gastric cancer, and preferentially elicits a T helper (Th)-1 response. Many H. pylori factors, such as the neutrophil-activating factor of H. pylori (HP-NAP), are able to drive Th-1 polarization and to display a powerful inhibition of allergic Th-2 response. Special attention has been drawn to HP-NAP as a potential novel strategy for the prevention and treatment of asthma and atopy. Aim of the Work: This study was aimed to measure helicobacter pylori in patient with bronchial asthma. Subjects and Methods: This study included a total of 50 patients with bronchial asthma and 20 age-matched control individuals attending at AL-Hussein, Al-Azhar University Hospitals in the period between April 2018 and December 2018. All patients underwent full history taking, complete clinical examination, plain chest X-ray, routine lab investigations, spirometry before and after bronchodilators and H. pylori antigen in stool by ELISA. Results: The results of this study revealed that there is a relation between bronchial asthma and helicobacter pylori. Conclusion: There were improvement in pulmonary function tests in asthmatic patients with H. pylori positive more than asthmatic patients with H. pylori negative.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Role of Platelet Indices and Antiplatelet Antibody in Differentiating Immune Thrombocytopenic Purpura from Other Causes of Thrombocytopenia173217362857910.21608/ejhm.2019.28579ENNagwa Mohammed MowafyDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhr UniversityMohsen Taha ElkeiyDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhr UniversityMohammed Abdel-Hameed KhedrDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhr UniversityMohamed Haseeb Gouda MasselihyDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhr UniversityJournal Article20190310Background: thrombocytopenia may be defined as a decrease in number of platelets in the circulating blood. Bone marrow examination may be required to discriminate causes of thrombocytopenia as hypoproductive or hyperdestructive. However, this procedure is invasive and time consuming. Objective: this study aims to assess the diagnostic value of mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell-ratio (P-LCR) and anti-platelet antibody in discriminating causes of thrombocytopenia as hypoproductive or hyperdestructive immune thrombocytopenia purpura (ITP). Patients and Methods: the study was conducted on 45 subjects15 patients suffering from ITP, 15 patients suffering from other causes of thrombocytopenia, and 15 healthy controls. All of them were subjected to full clinical history, examination and routine investigation including CBC, routine chemical analysis (liver function, renal function, etc.), BM aspirate and detection of antiplatelet antibody. Results: the results of this study revealed that in ITP patient group, we found that the MPV, PDW and P-LCR were significantly higher in comparison to non-ITP group. As regard anti-platelet antibody detection by ELISA method was positive (60%) in ITP group, positive (26.7) in nonITP group and negative in all patients in control group. It revealed no significant difference between ITP group and non-ITP group to diagnose ITP. Conclusion: from this study, we could conclude that, measuring of platelet indices (MPV, PDW and LCR) provides useful diagnostic test in differentiating ITP from hypoproductive thrombocytopenia, thus may avoid the need for bone marrow examination. Measurement of anti-platelet antibody is not a reliable test in diagnosis of ITP.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Teratogenicity of Monosodium Glutamate on The Pregnant Rats and Their Fetuses173717472858010.21608/ejhm.2019.28580ENN.A Abu ElnagaZoology Department, Faculty of Science, Al-Azhar University, Cairo (Girls Branch),M. SarhanZoology Department, Faculty of Science, Al-Azhar University, AssuitH. MansourZoology Department, Faculty of Science, Al-Azhar University, Cairo (Girls Branch),Journal Article20190310Background: 2% to 3% of all living newborns showed at least one recognizable congenital malformation. Monosodium glutamate (MSG) is widely used as flavor enhancer. But, it induces embryonic and fetal toxicity in rats during the gestational periods. Aim of the work: this study aimed to detect the effects of MSG on placenta and fetal developmental stages at 15th and 19th days of gestation. Material and Methods: fifty mature pregnant Albino rats (Weight 200 ± 20 g) were categorized into two groups according to the time of dissection at 15thor 19th days of gestation. From each group, half of the pregnant mothers (G15 and G19)were daily administrated MSG ( 7 g/10mL/kg b. w. by oral)from the 9th to 14th days of gestation). The control groups (C15 and C 19) were received water only. Results: in G15 and G19 groups, the uterine and fetal shape, number of implantation sites, number of living fetuses, body length, fetal and placental weights and the placental co-efficient were negatively changed when compared to the control groups(C15 and C 19). Also, the placental tissue showed congested blood sinuses and large hemorrhagic areas which contained hemolysed blood cells. Some atrophied decidual cells and pyknotic nuclei were observed with highly distorted maternal and fetal placental layers. Conclusions: this study showed that shortterm MSG exposure caused several maternal and fetal changes. Therefore, MSG is considered as embryotoxic agent and the mothers must avoid administration of this substance during the gestation periodPan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Immunohistochemical Study of Cancer Stem Cells and Angiogenic Markers in Renal Cell Carcinoma, Clinicopathologic Correlation174817582858110.21608/ejhm.2019.28581ENWalaa Ibrahim Mohamed GhonaimDepartment of Pathology, Faculty of Medicine, Al- Azhar University, Cairo, EgyptBahaa Bedeir GhannamDepartment of Pathology, Faculty of Medicine, Al- Azhar University, Cairo, EgyptAbeer Said FargDepartment of Pathology, Faculty of Medicine, Al- Azhar University, Cairo, EgyptEman Mohamed AhmedDepartment of Pathology, Faculty of Medicine, Al- Azhar University, Cairo, EgyptJournal Article20190310Background: Despite advanced therapy of renal cell carcinoma (RCC), up to 40% RCC develop recurrence with high metastatic rate and continues to be one of the fatal forms of cancer. Therefore, detecting new biomolecular markers for prognosis of RCC is important and a major need. Relevant markers of CSCs and angiogenic may serve as prognostic biomarkers of RCC. However, their actual prognostic significance remains inconclusive. Aim of the work: we planned this study to evaluate CD133 and VEGF immunohistochemical expression in renal cell carcinoma cases and its correlation with clinicopathologic data to evaluate their clinical significance and prognostic value. Methods: this study was carried out on 50 cases of radical nephrectomy specimens. Hematoxylin and eosin-stained sections from all cases were re-evaluated and further stained immunohistochemically stained sections were done by using antibodies against CD133 and VEGF. Results: expression of CD133 was down -regulated with the level of malignancy of the RCC and was tightly correlated with tumor grade (p=<0.001), capsular invasion (p=<0.001) and grade of lymphocytic infiltrate (p=<0.001), while, there were no significant associations between CD133 expression and tumor stage, the type, size, TNM stage grouping and tumor laterality. Expression of VEGF was associated with high grade (p<0.001) and clinical stage (p=0.026), large size (p=0.008), capsular invasion (p=<0.001), nodal invasion (p=0.011) and grade of lymphocytic infiltrate (p=0.002) of RCC. There was a statistically significant correlation between CD133 and VEGF with adverse relation between the two markers. Conclusions: our study demonstrated that the expression of CD133 was down -regulated with the level of malignancy of the RCC and was tightly correlated with tumor grade, capsular invasion and grade of lymphocytic infiltrate. These facts demonstrated that CD133 play an important role in the development and progression of RCC. Elevated expression of VEGF is a characteristic feature of high grade and stage, large size and capsular invasion of RCC. There was a statistically significant correlation between CD133 and VEGF with adverse relation between the two markers.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Comparative study between three Different Doses of Magnesium Sulfate as a Technique of Hypotensive Anesthesia during Functional Endoscopic Sinus Surgery175917682867610.21608/ejhm.2019.28676ENHamed A. SanadDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAmgad Z. MohamedDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAhmed A. Abd-elraoufDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityJournal Article20190313<span>Background: </span><span>Hypotensive anesthesia represents a great challenge for the anesthetists. Although, there is great benefit from inducing hypotensive anesthesia, there is a great risk of major morbidity and mortality.<br /> </span><span>Aim of this work: </span><span>Evaluation of the optimal dose of MgSo4 to create hypotension during functional endoscopic sinus surgery.<br /> </span><span>Materials and methods: </span><span>This prospective, control, randomized, clinical study was conducted on 60 patient divided into three groups. Patients were recruited from the Department of Anesthesia and Intensive Care, AL- Azhar University Hospitals. Each group received different dose of MgSo4 5-10-15 mg/kg/h. Then, we took measures of Bp, Spo2, HR and cortisol. Our observations then were statically analyzed.<br /> </span><span>Results: </span><span>There was more stability in hemodynamic parameter in group II and III. There was significant decrease in blood pressure in group III. In addition, there was a decrease in heart rate in group II and III but this decrease wasn't significant. Magnesium sulphate decreased release of stress hormone especially in group III.<br /> </span><span>Conclusion: </span><span>Deliberated hypotension is very useful during surgery to decrease time and blood loss. Magnesium sulphate is one of the most useful techniques to induce hypotension during surgical operation. We suggest that using magnesium sulphate in 40 mg\kg as loading dose then continuous infusion at 15 mg\kg\h is the most effective and safest technique. Magnesium sulphate is very useful agent to abolish stress response. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101The Influence of Fetal Head Circumference and Fetal Weight Assessed by Intrapartum Ultrasound on Labor Outcome178517902867810.21608/ejhm.2019.28678ENIsameel Talaat ElgarhyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityNoha Mohamed SabryDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityHossam Mohamed Mohamed AbdelkaderDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20190313<span>Background: </span><span>birth represents one of the most important of all the experiences of the human race. Despite the complexity and sophistication of modern obstetrics, it is important to remember the simple objective of every pregnancy, namely the delivery of healthy baby to healthy mother. During the last decade, assessment of prolonged second stage has been incorporated into the standard routine antepartum and intrapartum evaluation of labor.</span><span>Objective: </span><span>Theaimofthepresentstudywastodetermineiffetalheadcircumferenceandfetalweightcould predict the rate of caesarian section and vaginal deliveries in primigravidas women in labor.<br /> </span><span>Patients and methods: </span><span>The study is a prospective cohort study that was conducted at Alexandria Police Hospital maternity labor ward from April 2018 to December 2018. One hundred pregnant parturient admitted to the labor ward of Alexandria Police Hospital for delivery were participated in this study according to specific inclusion criteria. </span><span>Results: </span><span>The present study assessed ultrasonographically the head circumference and fetal weight as predictive values on labor outcome. The receiver operator curve (ROC) showed that these were good predictors of mode of delivery (sensitivity of 85 % and specificity of 92.6 %).<br /> </span><span>Conclusion: </span><span>The numerical data have a significant relation between intra partum head circumference and fetal weight relative to maternal pelvic diameter and the incidence of primary caesarian section, maternal and fetal complications. So measurement of intrapartum head circumference and fetal weight are good predictors of labor outcome.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Comparative Study between Metformin and Insulin in Controlling Gestational Diabetes Mellitus179117982867910.21608/ejhm.2019.28679ENEhab Hassanin MohamadDepartments of Obstetrics & Gynecology,
Faculty of Medicine, Al-Azhar UniversityAbdel Monsef Abdel Hamed SedekDepartments of Obstetrics & Gynecology,
Faculty of Medicine, Al-Azhar UniversityAhmed Fathy Abdel AzizDepartments of Clinical Pathology,
Faculty of Medicine, Al-Azhar UniversityHisham Adel Abo ElezDepartments of Obstetrics & Gynecology,
Faculty of Medicine, Al-Azhar UniversityJournal Article20190313<span>Background: </span><span>the use of antidiabetic drugs to control gestational diabetes was controversial. Some studies suggest a possible link between the use of oral antidiadetics and fetal anomalies, fetal macrosomia and neonatal hypoglycemia whereas others have demonstrated no such relationship.<br /> </span><span>Objective: </span><span>This study aims to assess the efficacy of metformin in controlling maternal blood glucose level compared to insulin in women with GDM.<br /> </span><span>Patients and Methods: </span><span>The present study included 116 pregnant women who have been diagnosed as gestational diabetics before 34 weeks gestation with singleton pregnancy. They had FBG level ranging from 90- 169 mg/ dl or 2-hour postprandial blood glucose level ranging from 110-176 mg/dl. The exclusion criteria include pregnant women with preexisting DM and underlying diseases known to affect fetal growth, preeclampsia, unbalanced chronic disease, twin pregnancy, or refused to participate.<br /> </span><span>Results: </span><span>Comparison of the baseline characteristics was performed between 2 groups and there were no significant differences between the two groups regarding maternal age, gravidity, parity, GA at time of diagnosis, GA at beginning of treatment, and BMI at time of diagnosis. Analysis of the results revealed that </span>
<span>metformin was an effective medication for control of euglycemic with diet only.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Effect of Upper Versus Lower Limbs Resisted Exercise on Nitric Oxide Levels in Diabetic Patients; Type 2179918032868010.21608/ejhm.2019.28680ENSamir ElgazzarDepartment of Physical Therapy for Cardiovascular, Respiratory Disorders and Geriatrics,
Faculty of Physical Therapy, Cairo UniversityOmar ElsaadanyDepartment of Physical Therapy for Cardiovascular, Respiratory Disorders and Geriatrics,
Faculty of Physical Therapy, Cairo UniversityHany ObayaDepartment of Physical Therapy for Cardiovascular, Respiratory Disorders and Geriatrics,
Faculty of Physical Therapy, Cairo UniversityMohamed HelmyDepartment of Physical Therapy for Cardiovascular, Respiratory Disorders and Geriatrics,
Faculty of Physical Therapy, Cairo UniversityJournal Article20190313<span>Background: </span><span>There were 8.2 million cases of diabetes in Egypt in 2017 with prevalence in adults about 15.1%. </span><span>As the number of people diagnosed with type 2 diabetes continues to increase it has become imperative that health care providers understand the importance that exercise plays in the treatment of this disease and preventing its complications including nephropathy, retinopathy and cardiovascular disease.<br /> </span><span>Objective: </span><span>this study aimed to investigate the effect of upper resisted exercise versus lower resisted exercise on glycosylated hemoglobin and nitric oxide (NO) in diabetic patients type 2.<br /> </span><span>Methods: </span><span>this study included 60 diabetic patients who were selected from the outpatient clinic of Internal Medicine Department in Agouza Police Hospital from July 2018 to December 2018. They were assigned into two groups equal in number. Group (A) received a program of upper limbs resisted exercise and Group (B) received a program of lower limbs resisted exercise for 3 months.<br /> </span><span>Results: </span><span>The results of this study revealed a significant increase in six-minute walk test and nitric oxide and a significant decrease in glycated hemoglobin in both groups. Group (A) is superior to Group (B) in modulating glycated hemoglobin and nitric oxide levels. Group (B) is superior than Group (A) in increasing six-minute walk test.<br /> </span><span>Conclusion: </span><span>upper limbs resisted exercise is beneficial than lower limbs resisted exercise in modulating glycated hemoglobin and nitric oxide in type 2 diabetic patients. Lower limbs resisted exercise is beneficial than upper limbs resisted exercise in improving six-minute walk test.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Effects of Laparoscopic Sleeve Gastrectomy on Hypertensive Morbidly Obese Patients180418082868110.21608/ejhm.2019.28681ENHazem AliDepartments of General Surgery,
Faculty of Medicine for Boys, Al-Azhar University, Damietta, EgyptMasoud Kh. El-SyedDepartments of General Surgery,
Faculty of Medicine for Boys, Al-Azhar University, Damietta, EgyptReihan M. SaadDepartment of Cardiology,
Faculty of Medicine for Boys, Al-Azhar University, Damietta, EgyptJournal Article20190313<span>Background</span><span>: bariatric surgery is the standard way for obtaining a sustainable weight reduction in morbidly obese patients and it is a beneficial in lowering hypertension (both on the short and long terms)and improving other metabolic parameters. LSG is a relatively safe, simple and effective procedure which gained more popularity and became the most commonly performed bariatric operation.<br /> </span><span>Aim</span><span>: this prospective, randomized study designed to evaluate the outcomes of laparoscopic sleeve gastrectomy (LSG) on hypertensive morbidly obese patients.<br /> </span><span>Patients and Methods: </span><span>this prospective, randomized study was performed between January 2015 and December 2018 on 50 morbidly obese patients for whom a laparoscopic sleeve gastrectomy for treating morbid obesity was done in the department of general surgery, Al-Azhar University Hospital, Damietta.<br /> </span><span>Results: </span><span>the comorbidities among the 50 patients included hypertension (40), dyslipidemia (20), sleep apnea (18) and diabetes mellitus (15). These preoperative comorbidities significantly improved within 6 months after LSG and at the end of follow-up period which was one year after operation, nearly all comorbidities were resolved or improved.There was also a significant short-term effect on obesity and hypertension following surgical treatment and the decrease of blood pressure occured prior to significant reduction of weight.<br /> </span><span>Conclusions: </span><span>laparoscopic sleeve gastrectomy can improve and resolve elevated blood pressure in morbidly obese patients not only on the long term but also on the short term. It is a relatively safe and effective method not only for reduction of excessive body weight but also for improving and resolving many other comorbidities of morbid obesity. </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Study of Serum Betatrophin Level in The Patients of Type 2 Diabetes Mellitus180918162868210.21608/ejhm.2019.28682ENAliaa H. El-GhandourDepartment of Clinical Pathology, Faculty of Medicine, Tanta UniversityAml S. El-BendaryDepartment of Clinical Pathology, Faculty of Medicine, Tanta UniversityAbeer A. ShahbaDepartment of Internal Medicine
Faculty of Medicine, Tanta UniversityGhada A. SolimanDepartment of Clinical Pathology, Faculty of Medicine, Tanta UniversityJournal Article20190313<span>Background: </span><span>Type 2 DM is due primarily to lifestyle and genetic factors. A number of lifestyle factors are known to be important to the development of type 2 DM. Betatrophin, also known as angiopoietin-like protein (ANGPTL8), is a circulating protein predominantly produced in the liver and adipose tissue. Betatrophin is </span><span>induced as a result of insulin resistance. It is reported to modulate pancreatic β</span><span>-cell mass and glucose homeostasis reflectable on lipid metabolism.<br /> </span><span>Aim of the Study: </span><span>Evaluation of the role of betatrophin in patients with type 2 diabetes mellitus.<br /> </span><span>Patients and Methods: </span><span>This clinical study was carried out at Clinical Pathology Department, Tanta University Hospital and included 80 subjects who were divided into two groups: Group 1:40 Patients diagnosed with type 2 diabetes mellitus. Group 2: 40 normal subjects with matched age and sex as a control group.<br /> </span><span>Results: </span><span>In type 2 diabetes mellitus patients group, serum betatrophin ranged from 25.83 to 860.65 ng/l with a median value of 54.815 ng/l while in control group, betatrophin ranged from 7.5-53.2 ng/l with a madian value of 11.250 ng/l. There was significant statistical difference in betatrophin between the two groups. (P < 0.001). Betatrophin was significantly higher in type 2 diabtes mellitus patients as compared to control group. </span><span>Conclusion: </span><span>Circulating betatrophine concentrations were significantly increased in patients with T2 DM and associated with glucose homeostasis and insulin sensitivity. Thus, the level of serum betatrophin has a potential role in detection and pathogenesis of T2DM.<br /> </span>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Estimation of Serum Hepcidin and Ferritin in Patients with Chronic Liver Disease181718252885610.21608/ejhm.2019.28856ENSafia Mahmoud MohamedDepartments of Tropical Medicine, Faculty of Medicine for Girls, Al-Azhar UniversityAmal Abd El-Aleem MorsyDepartments of Clinical Pathology,
Faculty of Medicine for Girls, Al-Azhar UniversityNessren Mohamed Bahaa El-Deen MohamedDepartments of Tropical Medicine, Faculty of Medicine for Girls, Al-Azhar UniversityAya Ragab MohamedDepartments of Tropical Medicine, Faculty of Medicine for Girls, Al-Azhar UniversityJournal Article20190318Background: Hepatitis C virus affect iron metabolism leading to iron overload which associated with liver damage. Aim: estimation of the level of serum hepcidin and ferritin in chronic hepatitis C, cirrhosis and hepatocellular carcinoma on top of hepatitis C. Methods: this study was conducted on 60 Egyptian patients (study group); Group I comprise 20 patients with chronic HCV infection, Group II comprise 20 patients with HCV cirrhosis, Group III comprise 20 patients with HCC due to HCV infection, and also, control group comprise 20 apparently healthy individuals. All patients and control were subjected to history taking, clinical examination, abdominal ultrasound, computed tomography on abdomen. Laboratory investigations include complete blood picture, renal function tests, liver function tests, and viral hepatitis marker. Antinuclear antibody, Alpha-fetoprotein, serum iron, serum ferritin and serum hepcidin. Results: There was highly significant decreased in S. iron level in group I, II and III in comparison to control group (p=0.000). There was highly significant increase in S. Ferritin level in group II and group III in comparison to control group and in group III in comparison to group I. Also, there was significant increase in S. Ferritin level in group II in comparison to group I. There was highly significant decrease in S. hepcidin level in group II and group III in comparison to control group, in group II and group III in comparison to group I and in group III in comparison to group II. S. Hepcidin has highly significant negative correlation with S. ferritin in group I, II and III. Conclusion: Low levels of serum iron, ferritin and hepcidine were observed in HCV cirrhotic and HCC compared to control group.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Vitrectomy with Inverted Internal Limiting Membrane Flap Technique for Treatment of a Traumatic Macular Hole182618312885710.21608/ejhm.2019.28857ENEmad Abdel Aal SaliemOphthalmology Department, Al-Azhar Faculty of Medicine, Assiut, EgyptJournal Article20190318Background: Macular hole is a round full-thickness opening in foveal center which is an important cause of central vision loss. In most cases it is idiopathic, i.e., due to abnormal vitreo-foveal traction without any apparent predisposing conditions. Other causes include 1) High myopia. 2) Blunt ocular trauma. Aim: to evaluate the anatomical closure rates and visual outcomes in patients with traumatic macular holes treated by vitrectomy with inverted internal limiting membrane (ILM) flap technique. Patients and Methods: a prospective interventional study was conducted on 10 eyes of 10 patients with traumatic macular holes not spontaneously closed for more than 3 months after trauma and treated by vitrectomy with inverted internal limiting membrane flap technique at I-vision private center, Cairo and Alforsan eye private center, Assiut between September 2015 and December 2018. After surgery, both closure rate and visual outcome were re-evaluated monthly during the follow up period up to 6 months. Results: the main best-corrected visual acuity improved after PPV with inverted ILM flap technique from 0.87 ± 0.09 logMAR at baseline to 0.73 ± 0.11 logMAR at 1st month, to 0.49 ± 0.13 logMAR at 3rd month and reached to the maximum improvement 0.29 ± 0.10 logMAR by the end of 6th month (P < 0.001). The macular holes were successfully closed in all cases (100%). Conclusion: vitrectomy with inverted internal limiting membrane flap technique is associated with complete closure of the macular hole with restoration of the normal architecture and also a significant improvement of vision.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101New Concepts for Surgical Management of Spontaneous Intra-Cerebral Hematomas183218352885910.21608/ejhm.2019.28859ENAbd El-Halim Abd-Elrazek MousaDepartment of neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamed Ahmed El-labbadDepartment of neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMustafa Mahmoud Mohamed TolbaDepartment of neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190318Background: Spontaneousintracerebral hemorrhage (ICH) represents cerebral parenchymal bleeding that may also extend into ventricular, and rarely, subarachnoid space. ICH, as a stroke subtype, is associated with poor neurological outcome as well as high mortality (about 40% per month). ICH can be classified as either primary or secondary, depending on the underlying cause of bleeding. Objective: This study was aimed to represent criteria for surgical management for spontaneous intracerebral hematomas. Patients and Methods: This study included a total of 30 subjects, both sexes, aged 19-80 years with variable sizes and sites of spontaneous intracerebral hematomas. Conscious level and functional disabilities were measured by the neurological examination, Radiological evaluation was done pre, early post-operative and a month later to evaluate: the evacuation of the hematoma, monitoring the hemostatic measures done intraoperative to prevent re-collection of the hematoma in presence of different co- morbidities like HTN, coagulopathy, … etc. Results: Statistics revealed significant improvement in subjects operated with GCS ≥ 8, with motor power deficit G 0 , clear chest , age below 60 years old (P>0.001). Conclusion: Patients with spontaneous intracerebral hematomas showing good prognosis in patients below 60 years old, with clear chest complaining of motor power deficit G 0, with GCS≥ 8.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Assessment of Liver Fibrosis Using Real Time Elastography and FIB 4 Score in Comparison to Liver Biopsy in Chronic HCV Egyptian Patients183618432886010.21608/ejhm.2019.28860ENHassan Abd El Hafiez RashedDepartment of tropical medicine, Faculty of Medicine - Al-Azhar UniversityDiaa Mohamed EltebiDepartment of tropical medicine, Faculty of Medicine - Al-Azhar UniversityAhmed Hany EissaDepartment of tropical medicine, Faculty of Medicine - Al-Azhar UniversityMohamed Mahmoud El KassasNational Hepatology and Tropical Medicine Research Institute, Cairo, EgyptJournal Article20190318Background: HCV is one of the etiologies causing liver fibrosis through direct deposition of extracellular matrix in the liver as a response to wound healing to compensate for the injury Aim of this study: Assessment of liver fibrosis using sonography-based real time elastography (RTE) and FIB 4 score in comparison to liver biopsy for assessment of the stage of liver fibrosis in chronic Egyptian HCV patients. Patients and methods:116 patients with HCV were enrolled in the study from 2014-2015 in the National Hepatology and Tropical Medicine Research Institute Outpatient Clinics, Cairo, Egypt. Results: The mean RTELFI of the studied group was 2.68 ± 0.74. The correlation between different fibrosis stages, FIB-4 and RTELFI showed significant relations between the degree of hepatic fibrosis and FIB-4 with p = 0.001 & RTELFI with p < 0.001. Positive correlation was detected between fibrosis stage, FIB-4 and RTELFI. At a cutoff value of 3.26 for RTELFI, the test had a sensitivity of 72% and a specificity of 90% in detecting advanced fibrosis with AUC = 0.791 (95% confidence interval 0.649-0.933). At a cutoff value of 2.26 for FIB-4 index, the test had a sensitivity of 50% and a specificity of 87% in detecting advanced fibrosis with AUC = 0.797 (95% confidence interval 0.683-0.911). Conclusion: RTE has excellent accuracy for F4 and F ≥ 3 and is superior to FIB-4.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Assessment of Serum Level of Chitinase-3-Like-Protein 1 among Psoriatic Patients184418482886210.21608/ejhm.2019.28862ENEmad Eldin Abdelmoneim El-GamalDepartment of Dermatology, Venerology and Andrology, Faculty of Medicine, Al-Azhar UniversityHany Othman Abo Al-WafaDepartment of Dermatology, Venerology and Andrology, Faculty of Medicine, Al-Azhar UniversityHesham Samir Abd-AlsameeDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityMarwa Eslam BaziedDepartment of Dermatology, Venerology and Andrology, Faculty of Medicine, Al-Azhar UniversityJournal Article20190318Background: psoriasis is a chronic inflammatory autoimmune skin disorder, with a high relapse rate. The etiology and pathogenesis of psoriasis are still unclear. Many cytokines produced by inflammatory cells give rise to the induction and maintenance of psoriatic plaques. YKL-40 or chitinase 3-like protein1(CHI3L1) may be involved in angiogenesis in psoriasis which has an important role in the pathogenesis of the disease. Objectives: The aim of this study was to study the serum level of YKL-40 in patient with psoriasis in order to assess its possible role in pathogenesis and severity of the disease. Patients and method: this study included 60 psoriatic patients and 30 healthy subjects of matched age and sex, served as a control group. Blood samples were taken from all patients and controls for estimation of serum level of YKL-40 by ELISA. Results: A statistically significant increase in median serum YKL-40 level in psoriatic patients compared with control group. A positive correlation between serum YKL-40 and severity of psoriasis according to PASI score. Conclusion: serum YKL-40 can be used as a new marker for evaluation of disease severity, progression and therapeutic decision in psoriasis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Management of Women with Severe Preeclampsia by Different Regimens of Magnesium Sulfate184918562886410.21608/ejhm.2019.28864ENAbd EL Samea Hassan KhalifaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMohamed Mohamed FarahatDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityKhaled Mustafa AlsaudiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20190318Background: Preeclampsia is serious syndrome that can affect human pregnancy causing serious complications. Preeclampsia is pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation. Objective: The aim of our study was to assess the comparative effects of three regimens for the administration of the magnesium sulfate when used for the care of women with severe preeclampsia to determine the effective dose of magnesium sulfate in controlling cases with severe preeclampsia and prevention of eclampsia and to determine whether only loading dose of magnesium sulfate is effective in prevention of eclampsia or not. Patients and methods: The study included 240 pregnant women presenting to the casualty unit diagnosed as cases of severe preeclampsia in the Obstetrics and Gynecology Department, Al-Azhar University Hospital and EL Mahalla General Hospital. A randomized controlled study that compared three regimens for administration of MgSO4 used for these cases. Results: There was no significant difference between occurrence of eclampsia in the three groups after either administration of loading dose of MgSO4 only or administration of loading dose with maintenance dose for 12 hours or maintenance dose for 24 hours in the studied patients. Conclusion: Magnesium sulfate proved to cause many hemodynamic changes as it has vasodilator effect on maternal and fetal blood vessels. Magnesium sulfate should be given to all patients with severe preeclampsia.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Adverse Effects of Mono Sodium Glutamate, Sodium Benzoate and Chlorophyllins on some Physiological Parameters in Male Albino Rats185718642886510.21608/ejhm.2019.28865ENEman G.E. HelalDepartment of Zoology, Faculty of Science (Girls), Al-Azhar University, Egypthttps://orcid.org/0Abrar W. BarayanMinistry of Health, Maternity and Children Hospital, Saudi Arabia, MakkahMohamed A. AbdelazizPhysiology Department, Faculty of Medicine, (Boys), Al –Azhar University, EgyptNahla S.A. EL-ShenaweDepartment of Zoology, Faculty of Science (Girls), Al-Azhar University, EgyptJournal Article20190318Background: Chlorophyllin is known as natural green. Chlorophyll derivative is used as a food additive (food–coloring agent). Mono sodium glutamate (MSG), the sodium salt of amino acid glutamate, is a food additive that popularly used all over the world as “Flavor enhancer”. Aim of the work: This study aimed to determine the hazardous effects of sodium benzoate, chlorophyllin and mono sodium glutamate on some physiological parameters in male albino rats. Materials and Methods: This study had been done on forty male albino rats. The Animals were divided into four groups; Group I (Control untreated group), Group II (Sodium benzoate-treated group), Group III (Chlorophyllin-treated group) and Group IV (Mono sodium glutamate-treated group). Blood samples were collected, sera were separated and used for estimation of some biochemical parameters (liver enzymes, kidney function, glucose, protein profile and lipid profile) and hormonal levels [testosterone, T3 (triiodothyronine) and T4 (thyroxine)]. Results: There was an increase in the activities of liver enzymes ASAT and ALAT as well as the levels of glucose, kidney function (urea and creatinine), lipid profile (TC, TG, VLDL and LDL), Insulin and HOMA-IR (insulin resistance) in the sodium benzoate- and mono sodium glutamate-treated groups. While chlorophyllin-treated group showed the same results except for glucose level, kidney function, insulin and HOMA-IR. In addition, there was an increase in the level of (T4) and (T3) in MSG group but these levels decreased in benzoate group. A drop in protein profile (total proteins, albumin), high-density lipoprotein (HDL) and testosterone hormone in benzoate and glutamate groups as compared to the control rats. Conclusion: It could be concluded that some food additive like sodium benzoate and mono sodium glutamate have extreme effects on liver and kidney function, protein and lipid profiles as well as on thyroid and testosterone hormones. So, it is recommended to minimize the use of these additives to protect young children and mature people from these destructive effects.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Mitomycin in Choanal Atresia Repair186518682886810.21608/ejhm.2019.28868ENAhmed AbdelfattahDepartment of Otorhinolaryngology, Faculty of Medicine Cairo, Al-Azhar UniversityAhmed Ibrahim ZaghloulDepartment of Otorhinolaryngology, Faculty of Medicine Damietta, Al-Azhar UniversityJournal Article20190318Background: choanal atresia is one of congenital anomalies that needs surgical repair. Nasal re-stenosis and obstruction are side effects of endoscopic repair. Mitomycin was proposed to decrease postoperative stenosis and/or obstruction. Aim of the Work: it was to address the efficacy of adjuvant mitomycin therapy application in providing the postoperative patency in choanal atresia. Patients and Methods: this study is a record analysis of surgical outcomes of transnasal endoscopic surgical choanal atresia repair in Al-Azhar University Hospitals (Cairo and Damietta). The study included records of 30 children with either uni- or bi-lateral choanal atresia. Eighteen (18) children of themwereoperated upon with adjuvant mitomycin therapy. Meanwhile, records of 12 children were operated uponwithout adjuvant mitomycin andconsidered as a comparison group. Postoperative stenting was carried out in all participants. The collected information included demographic information, associated co-morbidities, operative details, and endoscopic findings. The outcome measures were: granulation tissue formation, need for postoperative dilation and need for revision surgical intervention. Results: re-stenosis was reported in 11 (28.9%) patients. The need for revision surgery was reported in 10.3%. The postoperative dilatation was required in 10 (25.6%) patients, and there was no significant difference between mitomycin and comparison groups. Conclusion and Recommendation: the use of adjunctive mitomycin therapy with endoscopic repair of choanal atresia seems to be effective and safe approach. Multicenter follow up trials should be done to fully evaluate the value (benefits) of adjuvant mitomycin therapy in choanal atresia repair.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Role of Multislice CT in Diagnosis, Staging and Evaluation of Malignant Pleural Mesothelioma186918772887010.21608/ejhm.2019.28870ENDina Ahmed Hassan TorkyDepartment of Radiodiagnosis, Faculty of Medicine (girls), Al-Azhar University, Cairo, EgyptHoda Mahmoud AbdelwahabDepartment of Radiodiagnosis, Faculty of Medicine (girls), Al-Azhar University, Cairo, EgyptFadila Mamdouh ElsayedDepartment of Radiodiagnosis, Faculty of Medicine (girls), Al-Azhar University, Cairo, EgyptJournal Article20190318Background: Malignant mesothelioma is a rare but fatal disease that arises from the epithelial lining of the pleura, peritoneum, pericardium and tunica vaginalis. Malignant pleural mesothelioma (MPM) is the most common form, accounting for 80-90% of malignant mesotheliomas Aim of the work: was to identify the value of CT in diagnosing malignant pleural mesothelioma and applying the AJCC and the IMIG staging system for MPM. At the time to identify the limitations of CT if any. Patient and methods: This prospective study included a total of 20 patients with CT findings suggestive of malignant pleural mesothelioma, diagnosed at Radiology Department, Damanhur Oncology Center. All patients had undergone multislice CT chest with intravenous contrast for detection and staging of the tumor. This study was conducted between March 2018 and December 2018. The data collected were tabulated and analyzed statistically. Results: CT study of the chest for cases of MPM was able to evaluate and diagnose the disease, with most of the important staging items being easily seen on CT yet this study also showed the limitations of CT in the staging MPM since CT alone was not able to prove the involvement of the chest wall, diaphragmatic muscle and trans diaphragmatic extension. Conclusions: Chest CT alone is often sufficient for disease staging and treatment planning. Typical CT findings that suggest MPM include unilateral pleural effusion with nodular irregular pleural thickening which can be discrete or diffuse with or without inter lobar fissure thickening and nodal metastasis.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Cisplatin Plus Gemcitabine Versus Paclitaxel Plus Gemcitabine as First-Line Therapy for Metastatic Triple Negative Breast Cancer187818832887110.21608/ejhm.2019.28871ENSharehan Hassan Soliman MustafaClinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Suez Canal UniversityMaha Lotfy ZamzamClinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Suez Canal UniversitySoheir El-sayed Abdel MohsenClinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Suez Canal UniversityEhab Mohammed HassanenClinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Suez Canal UniversityJournal Article20190318Background: Although breast cancer management has generally improved, there is still a standing challenge represented by the triple-negative breast cancer whose recurrence is highly frequent, disease-free survival shortened, and the overall survival is extremely poor. The Aim of Work: Compare between the total response rate of using gemcitabine/cisplatin versus paclitaxel/gemcitabine regimens to treat the metastatic triple-negative breast cancer cases. Materials and Methods: A random clinical trial method carried out on patients with metastatic triple-negative breast cancer who attended to the Department of Oncology and Nuclear Medicine, Suez Canal University, in 2016/2017. A random assignment used to allocate patients who are qualified to: Group (A) to receive cisplatin /gemcitabine (cisplatin 75 mg/m² on day 1; gemcitabine 1000 mg/m² on days 1 and 8) or Group (B) to receive paclitaxel/gemcitabine (paclitaxel 175 mg/m² on day1; gemcitabine 1000 mg/m² on days 1 and 8) every 3 weeks for eight cycles at maximum or until the development of disease progression or the intolerable toxic effect. Results: Cases of triple-negative breast cancer were 144 (20.9%) and those of metastatic triple-negative breast cancer were 110 (15.98%). Within a-12-month follow-up period, the total response rate of Group (A) was significantly higher than Group (B) (69.1% versus 47.3%, respectively). In addition, the median disease-free survival of Group (A) was significantly higher than that of the Group (B) (mean 7.18 versus 5.49 respectively). Conclusion: Cisplatin/gemcitabine can be used alternatively, even a superior regimen to paclitaxel/gemcitabine, for patients with metastatic triple-negative breast cancer.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Short Letrozole Therapy Vs Extended (Long) Letrozole Therapy for Induction of Ovulation in Women with Polycystic Ovary Syndrome188418902887210.21608/ejhm.2019.28872ENMahmoud M. A. El-AzizDepartment of Obs. & Gyn., Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Mohamed S. FouadDepartment of Obs. & Gyn., Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Tamer F. OufDepartment of Obs. & Gyn., Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Journal Article20190318Background: polycystic ovary syndrome (PCOS) is the major cause of anovulatory infertility. Letrozole and other aromatase inhibitors (AIs) have been introduced as a new treatment option could challenge clomiphene citrate (CC) for ovulation induction in this group. Objective: to compare the efficacy of short vs extended courses of letrozole therapy for ovulation induction in PCOS women. Patients and Methods: this is prospective randomized comparative study done on 60 patients attended El-Hussein Hospital and previously diagnosed as having PCOS, based on the revised Rotterdam criteria (2003). Patients were divided randomly into 2 treatment groups, group I, short letrozole therapy (30 patients, received 5mg of letrozole from 1st to 5th day of menstrual bleeding) and group II, long letrozole therapy (30 patients, received 2.5mg of letrozole from 1st to 10th day of menstrual bleeding). All patients of both groups monitored by trans-vaginal ultrasound on day 10 of the cycles. HCG injection (5,000 IU IM) was given when at least one follicle measured ≥ 18mm. Intercourse were advised for 24-36h after HCG injection. Serum HCG and trans-vaginal ultrasound were done 2 weeks after HCG injection in the absence of menstruation for diagnosis of pregnancy. Results: in long letrozole therapy, total number of follicles, mean number of mature follicles, endometrial thickness, percentage of patients ovulated after treatment, occurrence of pregnancy were greater when compared to results of short letrozole therapy. Conclusion: long letrozole therapy can produce more mature follicles and subsequently more pregnancies than short letrozole therapy.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Role of Topical Mytomycin C Application in Improving Outcome of Functional Endoscopic Sinus Surgery189119012887310.21608/ejhm.2019.28873ENMohammed A. El DabaaOtorhinolaryngology Department, Faculty of Medicine, Al- AZHAR UniversityAtef A. El MaraghyOtorhinolaryngology Department, Faculty of Medicine, Al- AZHAR UniversityMohammed A. YonesOtorhinolaryngology Department, Faculty of Medicine, Al- AZHAR UniversityYahya M. DawoodOtorhinolaryngology Department, Faculty of Medicine, Al- AZHAR UniversityMahmoud A. MegahedOtorhinolaryngology Department, Faculty of Medicine, Al- AZHAR UniversityJournal Article20190318Background: functional endoscopic sinus surgery, (FESS), is a minimally invasive surgical procedure that opens up the paranasal sinus ostia with an endoscope. Endoscopic sinus surgery is seen as the standard treatment in chronic rhinosinusitis and Sinonasal polyposis. Objective: it was to assess the efficacy of intra and postoperative topical application of Mitomycin C after endoscopic sinus surgery in reducing adhesions and scar formation and improving outcome of FESS. Patients and Methods: this study included 60 cases (24 female (40%) and 36 male (60%) ranging in age from 18 to 50 years) with mean 34 bilateral chronic rhinosinusitis with or without sinonasal polyposis undergoing functional endoscopic sinus surgery. Every patient in this study had been submitted for full history taking, general examination, full ENT examination routine preoperative laboratory investigations and computerized tomography study on the nose and paranasal sinuses. Functional endoscopic sinus surgery had been done for all patients. Results: In our study, bilateral nasal obstruction was presented in 46 patients (76.6%), anterior nasal discharge was presented in 22 patients (36.6%), posterior nasal discharge was presented in 18 patients (30%), headache was presented in 40 patients (66.6%) and facial pain was presented in 12 patients (20%). Endoscopic assessment of the patients 2 months after F.E.S.S revealed that the adhesions presented in 32 sides (26.7%) mainly occurred on the control side 25 (41.7%) while the Mitomycin C side showed minimal adhesions 7 (11.7%) with significant P value (0.04). Conclusion: Topical application of MMC at end of FESS has beneficial role in prevention of adhesion formation and synechiae without any side effects/complications.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200274820190101Correlation of End-Tidal Carbon Dioxide Tension with Arterial Carbon Dioxide Tension in Patients with Respiratory Failure on Mechanical Ventilation190219062887410.21608/ejhm.2019.28874ENHamdy ZoairDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Ahmed EwisDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Islam EzzatDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Journal Article20190318Background: Patients undergo mechanical ventilation need continuous evaluation of their respiratory condition. Monitoring of end-tidal carbon dioxide (ETCO2) as noninvasive measurement of arterial carbon dioxide (PaCO2) is a good tool for assessment and management of mechanically ventilated patients. Aim of the work: The aim of this work is to correlate expiratory end-tidal carbon dioxide tension with arterial carbon dioxide tension in patients with respiratory failure on mechanical ventilation and its significance. Patients and methods: This study was carried out on 50 patients on invasive mechanical ventilation with acute or acute on top of chronic respiratory failure admitted to respiratory I.C.U. at Bab El- Shaeria University Hospital, Studied patients had obtained two ABG samples one at the onset of mechanical ventilation(M.V.) and the second when the patient was on weaning mode of mechanical ventilation with continuous capnographic monitoring and reading record at the onset of ABG sampling. Results: The study include 31 males (62%),and 19 female (38%),24 patients (48%) had C.O.P.D, 9 patients (18%) had pneumonia, 8 patients (16%) had O.H.S, 7 patients (14%) had I.L.D and2 patients (4%) had acute severe asthma. The study shows no statistical significant difference between PaCO2 and ETCO2 at the onset of mechanical ventilation (74.78 ± 20.19 and67.5 ± 19.23) mmHg and on weaning mode (43.98 ± 8.07 and 42.2±7.2) mmHg. that PaCO2 measurements vary approximately 2-7 mmHg above ETCO2 values which mean good correlation between PaCO2 and ETCO2. Conclusion: - ETCO2 measurement provides an accurate estimation of PaCO2 in ventilation and weaning which may reduce the need for invasive, high coast monitoring and repeated arterial blood gas analyses.