Clinical Short-Term Outcome of Severe Untreated Aortic Stenosis The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 , Page 806- 814

Clinical Short-Term Outcome of Severe Untreated Aortic Stenosis
Mohsen Fahmy Metwally, Ahmed Ahmed Khashaba, Mostafa Ahmed Elnozahi,
Salaheldin Hefny Alahwany*
Department of Cardiology, Ain Shams - Faculty of Medicine*
*Corresponding author: Salaheldin H. Alahwany, Tel: 01019406524, Email:

Background: sclerocalcific aortic valve is a common condition. Risk stratification and decision making
are particularly complex in adults with aortic stenosis (AS), because the disease mainly affects elderly
patients who represent a heterogeneous population and require balanced and individualized analysis using
a multidisciplinary collaboration. Further research is needed to provide better evidence in particular on
spontaneous risk, earlier detection of LV dysfunction, and the results of transcatheter treatment and
medical therapy.
Objectives: to study the clinical short term outcome of the severe untreated severe sclerocalcific aortic
valve stenosis and also to evaluate the correlation between echocardiography assessment of aortic stenosis
and clinical history and examination.
Methods: in our study of 50 patients with severe sclerocalcific aortic stenosis, were subjected to full
history taking along with full clinical examination and transthoracic echocardiography at baseline and
follow up. The TTE criteria for diagnosis of severe Sclerocalcific aortic stenosis are increased
echogenicity and thickening of the aortic valve leaflets with mean gradient greater than 40 mm Hg, and
maximum jet velocity greater than 4 m per second, valve area less than 1.0 cm2.
Results: at short term follow up of our patients (2 years), there were significant increase in the number of
patients who developed symptoms of angina and heart failure (p<0.01) but there was no statistically
significant increase in those who develop syncope (P=0.106). There were very evident echocardiographic
findings in the form of highly significant (p<0.01) decrease in the EF & valve area and increase in the
MPG, PPG, Max. Jet velocity.
Conclusion: 41.2% of previously asymptomatic patient developed symptoms at follow up. There were
very evident and significant changes in the echocardiographic findings related to significant decrease in the
EF & vave area and increase in the MPG, PPG, Max. jet velocity and intracardiac dimensions that is
reflected in the clinical symptoms progression throughout the follow up period.
Keywords: Sclerocalcific - Severe aortic stenosis - Aortic valve replacement - Ejection fraction ­ aortic
valve area- Max. Jet velocity-mean pressure gradient.


Aortic stenosis (AS) is the most common
Patients may or may not have symptoms, but
valvular disease in older adults. Aortic stenosis
once symptoms manifest, AS has poor outcomes
can be congenital or degenerative, with the latter
when left untreated (2,3,4).
resulting from calcification of the aortic valve
In addition, patients may develop chest pain on
over time. Although congenitally bicuspid valve
exertion, effort dizziness or lightheadedness,
with calcification is the most common form of
easy fatigability, and progressive inability to
AS overall, degenerative calcific (sclerocalcific)
exercise. Ultimately, the patient develops the
AS of the trileaflet valve is the most common
classic triad of chest pain, heart failure,
form observed in persons aged 60 years and
and syncope (1,5) .
older. Sclerocalcific AS is the most common
Sudden cardiac death is a frequent cause of
form of AS among older adults in the United
death in symptomatic patients but appears to be
States (1).
rare in the asymptomatic (1% per year) (3,5) .
Calcific AS is a chronic progressive disease.
As the severity of aortic stenosis worsens, the
During a long latent period, patients remain
force the LV must generate to overcome the
obstruction increases progressively. Although
emphasized that duration of the asymptomatic
inotropic reserve and development of LV
phase varies widely among individuals (2,3).
hypertrophy serve initially to compensate for this
Received: 5 / 06 /2017 DOI : 10.12816/0038178
Accepted: 12 / 06/2017

Full Paper (vol.681 paper# 1)

c:\work\Jor\vol681_2 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 815- 823

Comparative Studies on the Histology of Eye Retina in Some Nile
Fishes with Different Dial Activities
Ahmad M Azab1, Hoda M Shoman2, Ragaa M El-Deeb3,
Hemmat M Abdelhafez2 and Sanaa E Abdel Samei2
1. Zoology Department, Faculty of Science (Boys), Al-Azhar University, Cairo
2. Zoology Department, Faculty of Science (Girls), Al-Azhar University, Cairo
3. Zoology Department, Faculty of Science, Ain Shams University, Cairo
Corresponding author: Ahmad Azab,


Aim of the work: the present work aimed to study the comparative histology of some fresh water
fishes inhabiting the Nile River in Egypt. These fishes have different dial activities; Oreochromis niloticus is
diurnal,while Clarias gariepinus, Bagrus bajad and Chrysichthys auratus are nocturnal. Results: the retinae of
all studied fishes (O. niloticus,C. gariepinus, B. bajad and Ch. auratus) are composed of ten layers. These layers
are the inner limiting membrane (ILM), nerve fiber layer (NFL), ganglion cell layer (GCL), inner plexiform
layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), outer limiting
membrane (OLM), photoreceptor layer (PL) and pigmented epithelial layer (PE).
The histological structure showed three types of the photoreceptors (single and double cones as well
as single rods) in Oreochromis niloticus. The pigment epithelium layer in C. gariepinus, B.bajad and
Ch. auratus completely hides the photoreceptors.
A considerable variation was recorded between the different studied fishes in the whole retinal
thickness as well as their retinal layers.
Conclusion: Whole retinal thickness in O. niloticus (diurnal activity) is large in comparison with that of the
other three siluriform fishes (nocturnal activity).
Keywords: Nile, Fish, Oreochromis niloticus, Clarias gariepinus, Bagrus bajad, Chrysichthys auratus, Eye,
Retina, Histology, Diurnal, Nocturnal.

enable the fish to find their prey under light and
Fish possess various kinds of sense organs
dark conditions or even when weather changes,
and use them to detect many kinds of information
resulting in sudden changes in light conditions. The
in the ambient environment [1]. The same authors
high density of cones suggests that it has a
classified the sense organs in fishes into three
relatively good photopic visual activity and may
groups: 1-organs of chemical sense which comprise
indicate diurnal activity [11].
the olfactory organs, taste buds and Jacobson's
Predaceous fish may be divided into two
organ; 2- organs detect pressure change and the
groups on the basis of their method of finding and
movement of the medium which comprise the inner
procuring food; being diurnal and nocturnal
ear, lateral line organ and pit organs; 3-organs of
predators [12]. In diurnal fishes, vision plays the
vision which include the eyes.
main role in capturing prey, whereas nocturnal
Vision has profound effects on the
fishes apply the senses of smell, touch and lateral
evolution of organisms by affecting survivorship
line organ. Nocturnal species show photoreceptor
through such behaviors as mating, foraging and
adaptations to generally increase their sensitivity to
predator avoidance[2-6].Vision in fish depends on
light, while diurnal species show adaptations to
size and position of the eye, morphology and
increase color discrimination [13,14].However, that a
structure of retinal photoreceptors and structure of
switch from a diurnal to a nocturnal life style is
the pigment epithelium[7,8].
indeed possible, it has been reported for several
The interspecific variations in retinal
species. [15-17].
structure reflect the feeding habits and photic
The most important morphological
habitat conditions of the respective species. Rod
adaptation of the visual system of mesopelagic
cells provide high visual sensitivity, being used in
fishes is the enlargement of their eyes compared to
low light conditions, while cone cells provide
body size[18]; a larger eye will increase the chance
higher spatial and temporal resolution than rods
of photon capture (greater pupillary aperture),
and allow for the possibility of color vision by
thereby allowing improved detection of body
comparing absorbance across different types of
silhouettes [19,20].
cones which are more sensitive to different
The present study was carried out to
compare between the histological structure of the
The retinal pigment epithelium is
eye retina of diurnal fishes (Oreochromis niloticus)
optimally exposed to incoming light in the dark in
and that of nocturnal fishes (Clarias gariepinus,
the case of rods and under light conditions in the
Bagrus bajad and Chrysichthys auratus).
case of cones. This capacity might be important to

Received: 01 / 04 /2017 DOI : 10.12816/0038179
Accepted: 10 / 04 /2017

Full Paper (vol.681 paper# 2)

c:\work\Jor\vol681_3 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 824- 828

The Introduction and Validation of Arabic Sino-Nasal Outcome
Test (A-Snot-22)
Fahad Al-Safran1, Mohammad Al-Bar 2, Abdulaziz Almazrua1, Bander Alzahrani1
1College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia,
2Department of Otolaryngology, King Fahd Hospital of the University, Dammam, Saudi Arabia

the Sino Nasal Outcome Test questionnaire 22 (SNOT-22) is recommended among the validated
and published instruments to assess the impact of CRS on the quality of life in adults.
Aim of the work: is to perform translation, cross-cultural adaptation and validation for the Sino Nasal
Outcome Test (SNOT)-22 in the Arabic language and. Methods: SNOT-22 questionnaire were translated from
English to Arabic by two independent native Arabic translators. This was followed by retranslation back from
Arabic to English by two independent native English translators, questionnaires were then distributed to
patients diagnosed with CRS at the Otolaryngology clinic in King Fahd Hospital of The University and
grouped healthy volunteers. Results: the study included individuals divided into 104 cases and 110 controls,
who reported no Sino nasal disease. Cronbach's alpha was 0.939, while controls scored 0.943 suggesting good
internal consistency within the SNOT-22 questionnaire. The SNOT scores for the cases and controls (median
(IQR)) were 42.0(25, 58, 25) and 12.5(4, 31, 25) respectively and were compared using a Mann-Whitney test
showing a statistically significant difference in the scores between two groups (p=0.000). Conclusion: the
results indicate that the Arabic version of the SNOT-22 is a valid and a reliable instrument.
Keyword: Chronic Rhino sinusitis, Sino-nasal Outcome Test-22, Arabic language, Quality of life.


though SNOT-22 questionnaire is recommended for
Chronic Rhinosinusitis (CRS) is defined as
its use in CRS, it is not yet available in Arabic (1).
inflammation of the nose and the paranasal sinuses
By taking account that, an effective translation of
characterized by two or more symptoms, one of
SNOT-22 into other languages should consider
cultural and linguistic differences; in this study, we
blockage/obstruction/congestion or nasal discharge,
aimed to translate, culturally adapt and validate the
±facial pain/pressure, ±reduction or loss of smell
SNOT-22 questionnaire from English into Arabic
more than 12 weeks (1). CRS causes a significant
reduction in the quality of life through physical pain
and social performance compared to congestive
We performed questionnaire survey SNOT-22
heart failure, back pain and chronic obstructive
contains 22 questions on CRS related symptoms.
pulmonary disease (2, 3, 4).
Symptom severity is graded zero to five ­ with zero
The Sino-nasal Outcome Test (SNOT 22)
indicating no problem at all and five indicating the
questionnaire is the advanced prototype of previous
worst possible symptom. We distributed on 104
version, the SNOT 20, which lacks the two items of
patients diagnosed with CRS at the Otolaryngology
nasal blockage and changes of taste and smell (5).
clinic in our hospital and 110 of healthy volunteers.
The Sino-nasal outcome test questionnaire 22
Both groups answered the final draft of the Arabic
(SNOT-22) is recommended among the validated
version of SNOT 22. The study was previously
and published instruments to assess the impact of
approved by the Hospital's Research Ethics
CRS on the quality of life in adults. The
Committee (No:201601133, Date: October 2 ,
questionnaire contains 22 items graded in 6 levels (0
2016). Translation Validation of the Arabic
for no problem, 5 for worst possible symptom) and
questionnaire included translation of original
the final score is obtained by adding scores for
SNOT-22 items from English to Arabic by bilingual
items (range: 0 to 110) the greater the score, the
translators. The translators were instructed to
worse quality of life (6). SNOT-22 questionnaire is
prepare a context for general population, avoiding
in English and has been translated and validated in
medical terms .
several languages including Brazilian, Portuguese

(1,4), Danish (2), Czech (3), Persian (5) , French (6),
Inclusion criteria
Greek (7,8), Lithuanian (9), and Spanish (10). Even
1- Age range:19-69 years old
Received: 04 / 04 /2017 DOI : 10.12816/0038180
Accepted: 22 / 04 /2017

Full Paper (vol.681 paper# 3)

c:\work\Jor\vol681_4 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 829- 836

Surgical Intervention versus Endoscopy in the
Treatment of Bile Duct Stones
Ahmed Marwan Alshaalan1, Forsan Hani Arafsha2, Mohammed Abdulaziz Othman3, Eisa Adil
Sanai2, Mohammed Hamdan Alwabisi3, Basam Zuhaer Sindi4, Mohammed Saleh Dumyati4, Mahir
Mazin Alsinnari4, Abdulghaffar Talal Halawani4, Hussain Mahfood Alkhadrawi5, Rayan
Abdulshakur Niyazi4, Ali Malik Alahmed5, Dalal Aayed Alharbi2, Abrar Mubarak Algharbi6,
Louai Ahmad Zakwan Al-Jabri2, Faisal Adnan Alshabrawi2
1- Ibn Sina National College, 2- Battarjee Medical College , 3- King Abdulaziz University ,
4- Umm alqura university ,5- University of Dammam,6- Almaarefa colleges
Corresponding Author: Ahmed Marwan Alshaalan,

Bile duct stones (BDSs) may happen in up to 4%­15% of all patients for whom cholecystectomy is
performed. Patients giving CBDS have manifestations including: biliary colic, jaundice, cholangitis,
pancreatitis or might be asymptomatic. It is critical to recognize essential and auxiliary stones, in light of
the fact that the treatment approach shifts. Stones found some time recently, amid, and after
cholecystectomy had likewise contrasting medicines. Distinctive strategies have been utilized for the
treatment of CBDS yet the appropriate treatment relies on upon conditions, for example, quiet'
fulfilment, number and size of stones, and the specialists involvement in laparoscopy. Endoscopic
retrograde cholangiopancreatography with or without endoscopic biliary sphincterotomy, laparoscopic
CBD investigation (transcystic or transcholedochal), or laparotomy with CBD investigation (by T-tube,
C-tube inclusion, or essential conclusion) are the most regularly utilized strategies overseeing CBDS
(Common bile duct stones). We will survey the pathophysiology of bile duct stones, finding, and
distinctive procedures of treatment with particular concentrate on the different surgical modalities.


Bile duct stones are one of the medicinal
focuses. Factors, for example, infection status,
conditions prompting surgical mediation. They
may happen in 4%­15% of all patients for
endoscopic, radiological and surgical aptitude,
whom cholecystectomies are performed. At the
and human services financial matters will all
point when patients give CBD [1], the one
have huge impact on rehearse [2].
critical question that ought to be replied: what is
Surgical intervention in bile duct stones:
the best methodology of treatment under the
Surgical extraction of bile duct stones in the
giving conditions? There are contending
meantime as (laparoscopic) cholecystectomy
offers the chance to absolutely treat gallstone-
diagnosing CBDS as to symptomatic execution
related infection in a solitary stage method.
attributes, specialized achievement, wellbeing,
Administrator, patient and technique related
and cost adequacy. Administration of CBDS
elements all impact result.
typically requires two separate groups: the
In spite of the fact that in a minority of
gastroenterologist and the surgical group.
patients there remains a vital prerequisite for
One of the key elements in the
administration is at first the recognition of
CBDS, before, amid, or after cholecystectomy.
cholecystectomy as the operation of decision for
The principle alternatives for treatment are pre-
symptomatic gallstones. More than 95% of
or postoperative ERCP with endoscopic biliary
irritate bladders are presently evacuated
sphincterotomy (EST), laparoscopic or open
laparoscopically, and all the more as of late the
surgical bile conduit leeway. There are different
system of LBDE has turned out to be all the
alternatives for the treatment of CBDS, for
more broadly accessible [3]. LBDE requires
example, electrohydraulic lithotripsy (EHL),
extracorporeal shockwave lithotripsy (ESWL),
choledochoscope together with light source and
dissolving arrangements, and laser lithotripsy.
camera, and dispensable instrumentation like
It is improbable that one choice will be
that required for ERCP (e.g. crate, inflatables,
suitable for every clinical situation in all
and stents). Albeit open bile conduit

Received: 04 / 04 /2017 DOI : 10.12816/0038181
Accepted: 12 / 04 /2017

Full Paper (vol.681 paper# 4)

c:\work\Jor\vol681_5 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 837- 844
The Role of Serum Adiponectin Levels in Women with
Polycystic Ovarian Syndrome
Hanaa A. Amer, Rania A. Abo-Shady, Doaa M. Abd Elaziz, Yara M. Khattab*
Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: Yara Mahmoud Khattab, E-mail :,
Phone number: 00201111486669

Adiponectin is a recently identified adipocyte-derived collagen-like protein. In humans,
adiponectin levels were found to be decreased in obese, compared to normal individuals, whereas high
adiponectin levels are independently associated with increased insulin sensitivity. The specific role of
adiponectin in these metabolic conditions is not clear: it may have a causative role, or it could be
regulated by insulin and serve as a marker for insulin resistance. Adiponectin levels hold great promise
for use in clinical applications as a potent indicator of underlying metabolic complications.
Aim of the work: The present study was aimed to evaluate the link between adiponectin and
polycystic ovarian syndrome (PCOS) and the potential use of adiponectin as a biomarker for PCOS.
Patients and methods: The study included 84 female patients presenting to the Reproductive and
Infertility Clinics at Ain Shams University Maternity Hospital, starting from June 2016 till January
2017. They were divided into four groups based on the diagnosis of polycystic ovarian syndrome
(PCOS); Cases were selected as: Group I non-obese PCOS group (n = 21), Group II obese PCOS group
(n = 21). Controls were selected as: Group III non-obese control group (n = 21) and Group IV obese
control group (n = 21). All the Control subjects had normal, regular menstruation, normal ovarian
findings on ultrasound, and normal luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
levels. None displayed hirsutism. PCOS subjects were enrolled when they had satisfied two of the three
following inclusion criteria: 1. Oligomenorrhea or amenorrhea. 2. Clinical or biochemical
hyperandrogenism. 3. Ultrasonographic polycystic ovarian morphology. Serum adiponectin, metabolic
and hormonal parameters were compared in PCOS patients with BMI matched controls. Measurement
of plasma adiponectin levels done by Enzyme Immunoassay kit in Ain Shams University Maternity
Hospital lab.
Results: Serum adiponectin level was significantly lower among cases than controls (p value < 0.001).
No significant difference was found between cases and controls regarding their hormonal profile except
for testosterone and insulin levels which were significantly higher among cases (p value <0.001). As
regard insulin resistance, there was a significant difference where cases were higher than control (p
value <0.001).
Conclusion: It could be concluded that PCOS was found to correlate with low adiponectin levels,
independently of BMI. The relationships between adiponectin and insulin resistance and sensitivity,
metabolic syndrome, and BMI in women with PCOS suggest that adiponectin potentially could serve as
a marker for disease risk and provide opportunity for earlier intervention if knowledge is successfully
translated from laboratory to clinical practice.
Keywords: Adiponectin, PCOS, Enzyme-Linked Immuno-Sorbent Assay


Polycystic ovarian syndrome (PCOS) is the most
syndrome, insulin resistance and cardiovascular
prevalent worldwide female endocrine disorder [1].
risks [4]. Besides hyperandrogenism and chronic
PCOS is the most common cause of anovulatory
anovulation, insulin resistance (IR) is another
infertility. PCOS has different etiologic factors and
important characteristic of PCOS. Both obese and
it has a clinical presentation which may include
lean PCOS patients have reduced insulin
insulin resistance,
obesity and
sensitivity. IR, which is exacerbated by obesity and
hyperandrogenism plays a major role in the
development of metabolic disorders, including type
polycystic ovaries on ultrasound [2,3].
2 diabetes and cardiovascular diseases [5]. Insulin
PCOS is also common among infertile arabian
resistance has the critical role in the development of
female population and it is associated with
PCOS. There are several reports that emphasize the
significant elevations in markers of metabolic

Received: 04 / 04 /2017 DOI : 10.12816/0038182
Accepted: 13 / 04 /2017

Full Paper (vol.681 paper# 5)

c:\work\Jor\vol681_6 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 845- 852

Impact of Scissors Type Used for Episiotomy on the Prevalence of
Obstetric Anal Sphincter Injury: Randomised Controlled Trial
Salama H.A.,Sakna.A.N,Salama H.M.,Abdelhafeez S.A.
Department of Obstetrics and Gynecology,Faculty of Medicine, Ain Shams University, Cairo, Egypt


Aim: to compare between the prevalence of obstetric anal sphincter injury (OASIS) after cutting
mediolareral episiotomy by angled, curved or straight scissors in women in labour.
Methods: The current randomized controlled trial was conducted at Ain Shams University Maternity
Hospital. The participating women were randomly allocated into three arms. Arm (A): women had
mediolateral episiotomy cut by angled scissors. Arm (c): women had mediolateral episiotomy cut by
curved scissors .Arm (s): women had mediolateral episiotomy cut by straight scissors. Primary outcome
was the occurrence of Obstetric Anal Sphincter Injuries (OASIS).
Results A total of 300 primiparous women were included. The overall incidence of OASIS was 5%,17%
and 15 % in arm A,C and S respectively.
Conclusion: using angled scissors in cutting mediolateral episiotomy results in less cases of obstetric anal
sphincter injury compared to cutting episiotomy by straight or curved scissors.
Keywords: episiotomy, obstetric anal sphincter injury, scissors, mediolateral, angled, straight.

Episiotomy is an incision of the perineum to
enlarge the vaginal opening and facilitate
mediolateral , lateral, J-shaped and anterior
delivery 1.It shouldn't be done routinely in
episiotomy. Mediolateral episiotomy is the most
normal vaginal delivery but restrictive
frequent type used which extends from midline
episiotomy is done in some situations as fetal
laterally and downwards away from the rectum
distress and instrumental vaginal delivery 2. It
should be done at time of fetal head crowning 3.
advantage of less scarring, better
Episiotomy can be complicated by
cosmetic healing and less blood loss, while
bleeding, pain, infection, dyspareunia, perineal
mediolateral episiotomy has less incidence of
tears and obstetric anal sphincter injuries 9.
rectal injury 4.
Perineal tears occuring during vaginal
Mediolateral episiotomy angle should be
delivery affect women's wellbeing 10. Severe
between 45 and 60 degree to avoid perineal tears
perineal tears may involve anal sphincter which
5. The angle of mediolateral incision is different
may have co-morbidities as perineal pain,
at the time of incision from that after repair. The
rectovaginal fistula and anal incontinence 11.
post incision angle of 60 and 40 degree is 40 and
22.5 degree respectively 6.
(OASIS) is known to be a major risk factor for
anal incontinence in women, leading to nine
approximately one half the length of the
times increase in anal incontinence compared
perineum. Perineum is the distance from
with men. Anal incontinence (ie, incontinence of
posterior forchette to middle of anal opening 7.
liquid feces and flatus) can have a devastating
Different types of scissors have been
impact on a person's quality of life 12.
used in cutting episiotomies such as straight,
OASIS should be excluded by routine
curved and angled scissors. It is thought that
per-rectal examination after every vaginal
curved or angled scissors produce incision away
delivery and if suspected endoanal ultrasound is
from anal sphincter. However, Obstetric
to be done. Anal incontinence is under-reported
guidelines don't provide sufficient data on
by women so obstetricians and midwives should
comparison of use of different scissors on
ask about it during history taking 13.
episiotomy 8.

Received: 01 / 04 /2017 DOI : 10.12816/0038183
Accepted: 10 / 04 /2017

Full Paper (vol.681 paper# 6)

c:\work\Jor\vol681_7 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 845- 864

A Systematic Review of ACL Reconstruction Rehabilitation
Obada Bashir Awad1, Sami Amer M Alqarni2, Hani Mousa Alkhalaf3, Faris Ali Alnemer4,
Khalid Ayed Abdullah Alahmari 2, Saeed Mubarak Saeed Alshahrani2, Sami Aoudah Tami
Alahmari2, Mohammad Abdul Majeed Abdul Ahad1, Haitham Sulaiman A Habtar2,
Mohammed Ali S Almousa4, Abrar Abdulrahman M Alarabi1, Salem Baty D Alshahrani2,
Fawaz Nawaf Alshaalan5, Mohammed Thamer Shaker Alghalibi6,
Mohammad Abdullah M Alshahrani2, Abdullghany Mohammed Dowaikh7
1 Almaarefa University, 2 King Khalid University, 3 Intern King Faisal University, 4 King Abdulaziz
University, 5 Prince Sattam Bin Abdulaziz University, 6 Taif University, 7


Background: Anterior Cruciate Ligament (ACL) reconstruction is a well-known surgical knee procedure
performed by orthopaedic surgeons. There is a general consensus for the effectiveness of a postoperative
ACL reconstruction rehabilitation program, however there is little consensus regarding the optimal
components of a program
Objective of the Study: to assess the merits and demerits of current ACL reconstruction rehabilitation
programs and interventions based on the evidence supported by previously conducted systematic reviews.
Methods: a Systematic search in the scientific database (Medline, Scopus, EMBASE , and Google
Scholer) between 1970 and 2017 was conducted for all relevant Systematic reviews discussing the
primary endpoint ( ACL reconstruction rehabilitation ) studies were analyzed and included based on the
preset inclusion and exclusion criteria. Study screening and quality was assessed against PRISMA
guidelines and a best evidence synthesis was performed.
Results: the search results yielded five studies which evaluated eight rehabilitation components (bracing,
Continuous passive motion (CPM), neuromuscular electrical stimulation (NMES), open kinetic chain
(OKC) versus closed kinetic chain (CKC) exercise, progressive eccentric exercise, home versus
supervised rehabilitation, accelerated rehabilitation and water based rehabilitation). A strong evidence
suggested no added benefit of short term bracing (0-6 weeks post-surgery) compared to standard
treatment. Whilst a moderate evidence reinforced no added advantage of continuous passive motion to
standard treatment for boosting motion range. Furthermore, a moderate evidence of equal effectiveness of
closed versus open kinetic chain exercise and home versus clinic based rehabilitation, on a range of short
term outcomes. There was inconsistent or limited evidence for some interventions including: the use of
NMES and exercise, accelerated and non-accelerated rehabilitation, early and delayed rehabilitation, and
eccentric resistance programs after ACL reconstruction.
Conclusion: short term post-operative bracing and continuous passive motion (CPM) introduce no
benefit over standard treatment and thus not recommended. A moderate evidence suggested equal
efficiency for 1) CKC and OKC are equally effective for knee laxity, pain and function, at least in the
short term (6-14 weeks) after ACL reconstruction and 2) home based and clinic based rehabilitation.
Nevertheless, the degree of physiotherapy input remains unclear.
Keywords: ACL rehabilitation, pre-operative rehabilitation, post-operative rehabilitation.


Dynamic knee stability is affected by both
Prevalence of ACL injuries
passive (ligamentous) and active (neuromuscular)
Injuries occur frequently among young athletes,
joint restraints. Among the contributors to knee
with knee injuries accounting for 10­25% of all
joint stability, the anterior cruciate ligament
sports-related injuries3. Athletes involved in
(ACL) has long been considered the primary
jumping, pivoting, or cutting, such as skiers or
passive restraint to anterior translation of the tibia
soccer players, are at increased risk for serious
with respect to the femur1. Moreover, the ACL
knee injuries including anterior cruciate ligament
contributes to knee rotational stability in both
(ACL) tears. An estimated 250,000 ACL-related
frontal and transverse planes due to its specific
injuries occur annually in the United States 4,
orientation2. The ACL has been the focus of
leading to 80,000 to 100,000 surgical ACL
many biomechanical/anatomical studies and is
reconstruction surgeries per year 5.Additionally,
among the most frequently studied structures of
female athletes are 2 to 8 times more likely to
the human musculoskeletal system over the past
injure their ACL compared to their male
counterparts6. Serious knee injury may result in
Received: 01 / 04 /2017 DOI : 10.12816/0038184
Accepted: 10 / 04 /2017

Full Paper (vol.681 paper# 7)

c:\work\Jor\vol681_8 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 865- 877

Incidence of Pulmonary Embolism in CCU at King Faisal Hospital,
Taif, Saudi Arabia
Nesriene M. El Margoushy1, Rawan W. Al-Suwat2, Wejdan A. Al-Otaibi2 ,
Mohammed M. Mougrabi3 .
1Medicine Department, College of Medicine, Taif University, 2College Of Medicine, Taif University,
3Cardiology Department, King Faisal Hospital, Taif, Saudi Arabia.

Pulmonary embolism (PE) is a frequent cause of death and serious disability with a risk
extending far beyond the acute phase of the disease. Despite advances in diagnosis and treatment, high
mortality rates are still a common problem. Aim of the work: was to assess the incidence rate of
pulmonary embolism among patients attending CCU of King Faisal hospital in Taif, Saudi Arabia and the
most common risk factors of pulmonary embolism in these patients. Patients and methods: a cross
sectional study for 6 month duration, in the period from June 2016 to December 2016. Patients were chosen
from CCU of King Faisal hospital, Taif, Saudi Arabia. The study includes 20 patients diagnosed as
pulmonary embolism from both sexes (male/female =10/10) with mean age 58.9±19.9 years old and 20
healthy control volunteers (male/female =14/6) with mean age 52.1±19.5 years old were chosen for
comparison; incidence rate of pulmonary embolism was calculated and the related risk factors in these
patients were evaluated via a questionnaire done to each patient and control. Results: 80% and 70% of
patients and control lived in Taif, respectively. Incidence rate of pulmonary embolism was 5.5%. 25% of
patients were smoker and 15% of control group were smoker. Conclusion: the presented study assessed the
incidence of pulmonary embolism and its risk factors in King Faial hospital in Taif, Saudi Arabia. All risk
factors of pulmonary embolism mentioned in international researches were emphasized in this research
particularly travelling history, oral contraceptive therapy and cancer with respect to other risk factors.
Key words: Pulmonary embolism, risk factors, Saudi Arabia and Taif city.


Pulmonary embolism (PE) is a frequent cause of
effective and right ventricular failure is
death and serious disability with a risk extending
potentially reversible.
far beyond the acute phase of the disease (1).
Patient risk factors include age, personal history
Despite advances in diagnosis and treatment, high
of venous thromboembolism and active
mortality rates are still a common problem (2). PE
malignancy, disabling conditions as heart or
occurs due to pulmonary bed obstruction which is
respiratory failure, congenital or acquired
most probably due to blood clot, wedged into one
coagulation disorders, hormone replacement
of the arteries of the lungs. Blood clots most
therapy and oral contraception. Residence of
commonly come from the deep veins of the legs,
intensive care units is considered at risk for
a condition termed deep vein thrombosis (DVT).
developing venous thromboembolism. The most
When multiple clots are involved, the portions of
common symptoms of a pulmonary embolus are
lung served by each blocked artery may die due
chest pain which is pleuritic in nature, cough with
cutting off of blood supply leading to pulmonary
bloody sputum and shortness of breath worsen
infarction, this infarction will decrease oxygen
with effort and may occur at rest (4).
supply to the lung. The incidence of the disease is
In order to diagnose a pulmonary embolism, a
around 0.5­1 case per 1000. Acute pulmonary
review of clinical criteria to determine the need
embolism may prove fatal if not suspected and
subsequently treated; most patients usually die
concentration is an important test performed in
during the first few hours of presentation hence
patients with suspected thrombotic disorders,
early diagnosis is of importance (3) .
used to diagnose thrombosis. A negative result
Acute right ventricular failure is the most
practically rules out thrombosis, a positive result
can indicate thrombosis but does not rule out
Emergency management is usually highly
other potential causes (5).
Received: 01 / 04 /2017 DOI : 10.12816/0038185
Accepted: 10 / 04 /2017

Full Paper (vol.681 paper# 8)

c:\work\Jor\vol681_9 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 878- 884

Misoprostol before Elective Caesarean Section for Decreasing the
Neonatal Respiratory Morbidity: A Randomized Control Trial
Hassan Tawfik Khairy, Sherif Fathi El-Mekkawi,
Ahmed Mohamed El-Kotb, Soad Ismail El-Sorady
Faculty of Medicine, Ain Shams University, Department of Obstetrics and Gynecology
Corresponding author: Soad Ismail El-Sorady, mobile number: +201012985579, e-mail:

neonatal respiratory morbidities are common neonatal outcome the worrisome the mothers the
most when approaching labour. They vary in clinical presentations with various long term effects, the most
importantly related to caesarean section are Transient Tachypnea of the Newborn (TTN), Respiratory Distress
Syndrome (RDS), Persistent Pulmonary Hypertension (PPHN). Aim of the Work: the aim of this study is to
assess the efficacy of Misoprostol or the Prostaglandin E1( PGE1) on the reduction of the neonatal respiratory
morbidity in women scheduled for term caesarean section (38-38+6 weeks Gestational Age (GA).
Patients and Methods: this is a Randomized Controlled Trial (RCT) which was conducted over six months
from November 2016, to April 2017 on 120 pregnant women who were approached before elective caesarean
section (ECS), managed in Ain Shams University Maternity Hospital (ASUMH), and their neonates followed
up in the Neonatal Intensive Care Unit (NICU) of Ain Shams University Maternity Hospital to assess the effect
of Misoprostol when given for women one hour before their scheduled caesarean section upon reducing the
neonatal respiratory morbidity.
Results: the current study revealed a highly statistically significant difference between groups according to
respiratory morbidity, and especially the TTN using Chi-square test, with p-value <0.001 Highly Significant.
Conclusion: the study concluded that when a vaginal tab containing Misoprostol 200 microgram given to
women one hour before term elective caesarean section between 38-38+6 weeks compared to placebo, it
simulates the normal labour to enable the neonate through catecholamines surge, and thus surfactant secretion
for better adaptation to the extrauterine life.
Recommendations: Misoprostol can be administered vaginally to candidate pregnant women with term
pregnancies with certain inclusion criteria before an elective caesarean section (after exclusion of any
contraindication and thorough good history taking and clinical examination) in order to reduce the neonatal
respiratory morbidity and especially the transient tachypnea of newborn. Thus, decrease the duration of neonatal
NICU admission and mortality.
Keywords: neonatal respiratory morbidities, TTN, RDS, PPHN, PG, Misoprostol, cesarean section, GA,
resorption of pulmonary fluid, as a result of
Neonatal respiratory morbidities may
defective catecholamine surge (5), its incidence is
occur in either term or preterm newborns with a
5.7/1000 deliveries (95% CI;1.7-2.7) in a review
higher relative risk in preterm, and whether born
of 33,289 term deliveries (37 to 42 weeks) in
vaginally or through caesarean section, but in a
London, UK, with a higher incidence in the
higher percentage after elective caesarean section
elective caesarean section group (35.5/1000)
whose rate is rising either due to maternal
compared to
request, obesity, and older maternal age than
(12.2/1000) after C.S during labour and
after normal vaginal delivery (1) or emergency
(5.3/1000) born vaginally (6). And also includes
caesarean section (2). It is responsible for 30% of
persistent pulmonary hypertension (PPHN) in
neonatal deaths (3).
which the fetal pulmonary vascular resistance
It has several subdivisions: one is the
remains high and the pulmonary blood flow still
respiratory distress syndrome (RDS) which is
low after delivery (3).
called hyaline membrane disease, it can occur in
Physiologically, Catecholamines can
about 1% of pregnancies as a result of a
stimulate pulmonary fluid absorption through
pathology in lung surfactant either qualitative or
acting upon beta-adrenergic receptors in fetal
quantitative (3), and usually in preterm neonates
lung which present more late in gestation (5), and
. Another is transient tachypnea of the newborn
thus enable the secretion of surfactant (3). This
(TTN) in which there is respiratory distress and
surge of catecholamines can be provoked
increased respiratory rate due to delayed
through prostaglandins given before caesarean
Received: 01 / 04 /2017 DOI : 10.12816/0038186
Accepted: 10 / 04 /2017

Full Paper (vol.681 paper# 9)

c:\work\Jor\vol681_10 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 885- 893

Microrna 192 Gene Expression in Type II Diabetic Nephropathy
Atef A. El-Monem1, Mohamed H. Mahfouz1, Mona A. Mohamed2,
Heba Gamal Abd El-Aziz3and Nora Hussien3*
National institute of diabetes and endocrinology (NIDE)1,Biochemistry Department, Faculty of science (Girls),
Al-Azhar University2, Biochemistry Departments, Faculty of Pharmacy (Girls), Al-Azhar University3
*Corresponding author: E-mail address:

Diabetic nephropathy (DN) is the common cause of kidney failure in patients with diabetes
mellitus. MicroRNAs (miRNAs) are short non-coding RNAs of about 22 nucleotides which recently have been
shown to play vital roles in mammalian gene expression. Aim of the study: was to investigate the role of
miRNA-192 in the pathogenesis of diabetic nephropathy and disease progression. Patients and Method: Sixty
five patients with uncontrolled diabetes mellitus, they were subdivided into; thirty nine patients with
normoalbuminuria (<20mg/L); their ages ranged between 48-67 years and the onset of disease between 1-5
years; twenty six patients with microalbuminuria (20-200 mg/L), their ages ranged between 47-66 years and the
onset of disease between 5-15 years, in addition to twelve apparently healthy individuals as control; their ages
ranged between 51-67 years. Serum Transforming growth factor beta (TGF-), Interleukin 18 (IL-18) were
determined using ELISA technique, the expression level of miRNA-192 in whole blood using (RT-PCR) was
determined, other biochemical parameters as fasting plasma glucose (FPG), glycated haemoglobin (HbA1c),
lipid profile and creatinine were estimated using commercial available kits. Patients were given written contest.
Results: The level of miRNA-192 expressions was significantly lower in microalbuminuria group when
compared to normoalbuminuria group. Serum level of IL-18 and TGF- were significantly higher in both patient
groups when compared to control group and their levels were significantly higher in microalbuminuria group
than normoalbuminuria group. Conclusion: Together with TGF-1 and IL-18, miRNA- 192 may not only be
used as molecular biomarker in diabetic microvascular complications but also as early marker of alterations in
specific biological processes in the kidney.
Keywords: Diabetic nephropathy, miRNA-192, IL-18, TGF-.


The incidence of type 2 diabetes mellitus (T2DM)
pathogenesis of diabetes play a significant role in
has increased significantly, especially in developed
several renal disorders development and progression
countries (1). Many studies have speculated that
(11), including diabetic nephropathy (12). Effects of
diabetes mellitus causing microvascular and
inflammatory cytokines on renal disease are involved
macrovascular pathological conditions could result in
various complications leading to a sever morbidity in
T2DM subjects (2). Approximately, 40% of T2DM
extracellular matrix, apoptosis and necrosis,
patients develop diabetic nephropathy (3). Diabetic
endothelial permeability, oxidative stress (13), which
nephropathy (DN) is a progressive kidney disease
cause the development of microvascular diabetic
caused capillaries damage of the kidneys' glomeruli
complications as neuropathy, retinopathy, and
(4). Its prevalence is rising in developed countries,
nephropathy (14). IL-18 is a member of the IL-1
and it was considered one of the primary causes for
family and was primarily described as an interferon
end-stage renal disease in diabetic patients (5).
gamma inducing factor (15). It has been associated
Microalbuminuria is a widely-used as an early
with obesity (16), insulin resistance (17), and
marker for nephropathy in diabetic patients (6). TGF-
Dyslipidaemia (18).Circulating levels of IL-18 have
families are essential for regulation of cellular
consistently been reported to be elevated in patients
growth, differentiation and apoptosis, as well as
with T2DM in different studies(19), and have also
immune suppression (7). TGF-1 has been known as a
been suggested to participate in microangiopathy
key mediator in extracellular matrix formation (8). In
such as nephropathy in T2DM (20). MicroRNAs
fibrosis and in tissue remodelling during disease
(miRNAs) are endogenous ubiquitous non-coding
progression indifferent organs, Up-regulation of
single-stranded (ss) RNA transcripts, frequently of
TGF-1 is informed to be necessary (9), in which
19­25 nucleotides in length that alter the
glomerular fibrosis in the kidney is included (10).
differentiation, growth, apoptosis and proliferation of
Received:21/3/2017 accepted:30/3/2017 DOI: 10.12816/0038187

Full Paper (vol.681 paper# 10)

c:\work\Jor\vol681_11 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 894- 898

The Role of Diffusion-Weighted Magnetic Resonance Imaging in the
Evaluation of Patient with Non Traumatic Orbital Lesions
Hala Abou Senna, Tojan Taha, Zahraa Udyi Hatm*
Department of Radiodiagnosis,Faculty of Medicine - Ain Shams University
*Corresponding author: Zahraa Udyi Hatm, e-mail:

orbital lesions represent a spectrum of benign and malignant lesions in adults and children
that can be challenging to diagnose and treat. Imaging plays an important role in diagnosis, due to a
potentially limited clinical examination and risks associated with biopsy. Magnetic resonance imaging
(MRI) is a powerful tool for imaging the orbit, due to the excellent tissue contrast it provides.
this study aims at assessing the ability of diffusion weighted magnetic resonance imaging to
differentiate the benign from malignant orbital lesions.
Patients and Methodology: this study population included 25 patients; they were attended El-
Demerdash University Hospital with non-traumatic orbital lesions. All patients had fulfilled specific
inclusion and exclusion criteria. The patients were evaluated by MRI orbit and diffusion study in attempt
to differentiate the benign orbital lesions from malignant one.
Results: the pool of our study is 25 patients (16 female and 9 males) with orbital lesions, the patients age
ranged from 1 year to 70 years. There are 48% of the cases diagnosed as having benign lesions and 52%
have malignant lesions. Retinoblastoma is the commonest (12%) pathological diagnosis. The calculated
apparent diffusion coefficient (ADC) values of the lesions ranged from 0.6 ­ 2.1 x 10-3 mm2/sec. The
ADC value of 0.89 x10-3 mm2/sec is a cut off between benign and malignant orbital masses.
Conclusion: we concluded that the combination of conventional MRI finding and ADC calculation
together with clinical finding could improve the diagnostic efficacy of MRI in the differentiation between
benign and malignant orbital masses with considering the cut off ADC value between benign and
malignant orbital masses.
Keywords: Diffusion-Weighted Magnetic, Resonance Imaging in, Non Traumatic Orbital Lesions


Orbital lesions represent a spectrum of
predictor of histological nature and tool for
benign and malignant lesions in adults and
guiding intervention (1).
children that can be challenging to diagnose and
Diffusion weighted MRI is based on the
treat. Imaging plays an important role in diagnosis,
assessment of the random water proton movement
due to a potentially limited clinical examination
within tissues and reflects cellular density and
and risks associated with biopsy. Magnetic
tissue architecture, providing imaging techniques
resonance imaging (MRI) is a powerful tool for
that does not require the use of ionizing radiation
imaging the orbit; due to the excellent tissue
or MR contrast agents and can easily be
contrast it provides (1).
implemented into a standard MRI protocol.
Proptosis is one of the most common
Changes in water molecular diffusion can be
indications for an ophthalmologist to order
measured in vivo with DWI. This measurement of
imaging. The two imaging techniques for the brain
the self-diffusion coefficient of water indicates the
and orbit are computed tomography (CT) and
mobility of water within tissue and is called the
MRI. Imaging techniques for visualizing
apparent diffusion coefficient (ADC) (3).
pathology of the brain and orbit continue to evolve
and improve. The clinicians now have a wide
variety of diagnostic tests from which to choose.
This study aims at assessing the ability of
Additional noninvasive magnetic resonance (MR)
diffusion weighted magnetic resonance imaging to
characterization of tumors has become available
differentiate the benign from malignant orbital
through diffusion-weighted imaging (DWI) (2).
DWI can help characterize indeterminate

orbital lesions and greatly aid in tissue
characterization with high accuracy when used in
Study Population

conjunction with clinical and conventional MRI
This study included 25 patients, who were
findings, providing an additional noninvasive
attended El-Demerdash University Hospital with
non-traumatic orbital lesions.
Received: 04 / 04 /2017 DOI : 10.12816/0038188
Accepted: 18 / 04 /2017

Full Paper (vol.681 paper# 11)

c:\work\Jor\vol681_12 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 899- 903

Evaluation of Serum Angiopoietin-2 in Children and
Adolescents with Sickle Cell Disease
Nevine G. Andrawes1, Eman A. Ismail2, Maged Maher Salib Roshdy3, Amna Mohamed Ibrahim1
Pediatrics1, Clinical Pathology2 and Opthalmology Departments, Faculty of Medicine,
Ain Shams University

Background: A pro-angiogenic state has been found in adults with sickle cell disease (SCD), mainly
because of elevated angiopoietin-2 levels. Aim of the work was to determine the level of Angiopoietin-2
in children and adolecents with SCD and assess its relation to markers of hemolysis and iron overload.
Methods: Forty SCD patients in steady state were studied focusing on hydroxyurea therapy, hematological
profile and serum ferritin. Patients were compared to 40 healthy controls.
Results: Angiopoietin-2 levels were significantly higher in SCD patients compared with healthy controls
(8506.3 ± 3789.5 pg/mL versus 2791.7 ± 1263.6 pg/mL; p<0.001). Angiopoietin-2 levels were
significantly higher in SCD patients with cardiopulmonary complications. Significant positive correlations
were found between serum angiopoietin-2 levels and age as well as HbS. Conclusions: Elevated
angiopietin-2 levels in SCD highlights the role of angiogenesis in the pathophysiology of SCD.
Angiopoietin-2 may be considered a promising risk marker for screening of SCD patients at risk of
cardiopulmonary complications.
Keywords: Serum Angiopoietin-2, Children, Adolescents, Sickle Cell.

with SCD and assess its relation to markers of
Sickle cell disease (SCD) is caused by a
hemolysis and iron overload.
mutation in the hemoglobin chain, resulting in

the production of an abnormal hemoglobin (HbS)
in the erythrocyte. Under conditions of low
This cross sectional study was conducted on
oxygenation, HbS polymerizes leading the
40 patients with sickle cell disease. They were
erythrocyte to adopt sickle-shaped morphology.
recruited from the regular attendants of the
Pediatric Hematology Clinic, Pediatric Hospital,
pathophysiological mechanisms that involve
Ain Shams University during the period from
intravascular hemolysis and recurrent vaso-
June 2015 to August 2016. Another 40 age- and
occlusion, in association with chronic vascular
sex- matched healthy children were enrolled as
inflammation and endothelial activation, leading
controls. An informed consent was obtained from
to painful vaso-occlusive episodes, auto-
each patient or control or their legal guardians
infarction of the spleen, acute chest syndrome,
before enrollment in the study.
stroke, pulmonary hypertension, renal damage
The study was approved by the Ethics Board of
and a shortened lifespan (1,2).
Ain -Shams University.
Angiopoietins are growth factors that promote
Inclusion criteria
angiogenesis together with vascular endothelial
Patients with SCD diagnosed by history,
growth factor (VEGF) (3; 4). Angiopoietin-2 (Ang-2)
is expressed primarily in the vascular endothelium
complete blood picture (CBC), reticulocyte
at sites of vascular remodeling (2). It acts by binding
count, markers of hemolysis as well as
to the endothelium-specific receptor tyrosine
hemoglobin analysis using high performance
kinase 2 (Tie-2). The Ang/Tie system tightly
liquid chromatography (HPLC) (7).
controls the endothelial phenotype during
Patients were in a steady state at time of sample
angiogenesis and vascular inflammation by a
collection (not in sickling crisis).
competitive inhibitor of Ang-1 for Tie-2 binding,
thereby inhibiting Ang-1/Tie-2 signaling (4). Ang-
All included patients were studied focusing on:
Disease onset and duration.
neovascularization (5).
Transfusion history:
The aim of this study was to determine the level
Hydroxyurea therapy.
of Angiopoietin-2 in children and adolescents
History of splenectomy.

Assessment of anthropometric measurements.

Received: 16 / 04 /2017 DOI : 10.12816/0038189
Accepted: 25 / 04 /2017

Full Paper (vol.681 paper# 12)

c:\work\Jor\vol681_13 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 904- 909

Maternal Serum Amyloid A level in Pregnancies Complicated
with Preterm Premature Rupture of Membranes
Mahmoud Aly Ahmad ElShourbagy, Hossam Mohamed Mohamed Hemeda,
Bassem Aly Islam, Amal Saeed Bakr Abd Ellatif
Department of Obstetrics and Gynecology, Faculty of Medicine- Ain Shams University, Egypt
Corresponding Author: Amal Saeed Bakr Abd Ellatif, Department of Obstetrics and Gynecology, Faculty
of Medicine, Ain Shams University, Egypt. Phone: +201028228411, E-mail:

serum amyloid A (SAA) is a cytokine-inducible acute-phase reactant whose plasma
concentrations can exceed 1 mg/mL during an acute-phase response (500 to 1000 fold of plasma levels
greater than in the non inflammatory state) thus representing an ideal marker for clinical use. Preterm
premature rupture of membranes (PPROM) complicates only 2% of pregnancies but is associated with
40% of preterm deliveries and can result in significant neonatal morbidity (Prematurity, sepsis and
pulmonary hypoplasia) and mortality. Aim of the work: this study aimed to find out association between
maternal serum amyloid A level and preterm premature rupture of membranes. Also to compare SAA,
CRP levels, N/L ratio in the study group. Patients and methods: this study is a cross sectional study
conducted in Ain Shams University Maternity Hospital from December 2015 ­ December 2016 on 58
pregnant women. Women have been allocated in this study, represented in two groups:
1- Study group: including 29 women complaining of preterm premature rupture of membranes. 2- Control
group: including 29 women as control group with no complain. Venous blood sample was taken from
each participant (study group within 1hour from onset of PPROM, control group during their follow up
visit to the clinics). Serum amyloid A, Micro C reactive pretein, total WBCs and neutrophil/lymphocyte
ratio (NLR) were calculated. Results: the results point out that PPROM cases had significantly lower GA
and APGAR scores at 1 min and more prone to neonatal sepsis which may lead to death. PPROM women
have significantly higher total WBC, N/L ratio CRP and serum amyloid A. There were significant
positive correlations between amyloid-A, N/L ratio& CRP in both groups. Serum amyloid A level above
2 ng/ml is a risk factor for PPROM and low Apgar score at 1 min. but has low predictive value. CRP with
cut off value 5.0 mg/dl has better predictive value in discrimination between PPROM group and control
group.Conclusion: Results assessed possible association between maternal SAA, maternal and fetal
parameters in pregnancies complicated with PPROM.
Keywords: preterm premature rupture of membranes, serum amyloid A, C reactive protein,
Neutrophil/Lymphocyte ratio.

examination. The traditional minimally invasive
Preterm premature rupture of membranes
gold standard for the diagnosis of ROM relies on
(PPROM) is defined as spontaneous membranes
clinician ability to document 3 clinical signs on
rupture that occurs before the onset of labor and
sterile speculum examination: (1) visual pooling
37 weeks gestation (1) .
of clear fluid in the posterior fornix of the vagina
PPROM complicates only 2% of pregnancies
or leakage of fluid from the cervical os; (2) an
but is associated with 40% of preterm deliveries
alkaline pH of the cervicovaginal discharge,
and can result in significant neonatal morbidity
which is typically demonstrated by seeing
and mortality. The three causes of neonatal death
whether the discharge turns yellow nitrazine paper
associated with PPROM are prematurity, sepsis
to blue (nitrazine test); and/or (3) microscopic
and pulmonary hypoplasia. Women with
ferning of the cervicovaginal discharge on drying.
intrauterine infection deliver earlier than non-
Evidence of diminished amniotic fluid volume (by
infected women and infants born with sepsis have
Leopold's examination or ultrasound) alone
mortality four times higher than those without
cannot confirmthe diagnosis, but may help to
sepsis. In addition, there are maternal risks
suggest it in the appropriate clinical setting
associated with chorioamnionitis (2).
(3).PPROM is multifactorial in nature. Infection
PPROM is largely a clinical diagnosis. It is
and inflammation appears to play an important
typically suggested by a history of watery vaginal
role in its aetiology (4).Serum amyloid A (SAA),
discharge and confirmed on sterile speculum
the most prominent representative amongst acute-
phase proteins can reach plasma levels 500 to
Received: 16 / 04 /2017 DOI : 10.12816/0038190
Accepted: 25 / 04 /2017

Full Paper (vol.681 paper# 13)

Summary The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 910- 922

Comparative Study between Myoring and Ferrara Ring
Intracorneal Implantation Using Femtosecond Laser for
Treatment of Keratoconus
Hany M. Sammour, Mahmoud M. Ismail, Abdelghany I. Abdelghany, Mahmoud A. Shafeek
Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt*

Keratoconus is a bilateral progressive, non-inflammatory ectatic corneal disease
characterized by changes in corneal collagen structure and organization. Though the etiology remains
unknown, novel techniques are continuously emerging for the diagnosis and management of the disease.
Intracorneal rings are an effective way for treating keratoconus; the surgery is safe and has an adequate
biocompatibility. The procedure is adjustable and reversible and, most importantly, effective in
improving unaided visual acuity (UAVA), best corrected visual acuity (BCVA).
Aim of the Work:
To compare the efficacy of MyoRing versus Ferrara ring using femtosecond laser for
treatment of keratoconus as regards the visual outcome, refractive changes, keratometery reading (K-
max), proper depth tilt and haze by anterior segment OCT and complications.
Patients and Methods: This study included forty eyes of patients with keratoconus. They were divided
into two groups. Group (A) included twenty eyes of patients with keratoconus subjected to femtosecond
laser assisted MyoRing implantation, while Group (B) included twenty eyes of patients with keratoconus
subjected to femtosecond laser assisted Ferrara ring implantation.
In group (A) MyoRing all patients showed improvement in UAVA, BCVA, refraction and K-
max except 4 patients (20%) who showed no visual improvement despite the refractive and topographic
improvement. Using the anterior segment OCT in interpretation of visual, refractive and topographic
findings showed that those 4 patients had their MyoRings implanted at shallower depth with presence of
intracorneal ring tilt. In group (B) Ferrara ring all patients showed improvement in UAVA, BCVA,
refraction and K-max except 2 patients (10%) who showed no visual improvement despite the refractive
and topographic improvement. Using the anterior segment OCT in interpretation of visual, refractive and
topographic findings showed that those 2 patients had their Ferrara rings implanted at shallower depth
with presence of intracorneal ring tilt.
Conclusion: In comparison between two rings, there were no differences in different parameters except
that the Ferrara ring showed more improvement in BCVA and spherical component. Using the anterior
segment OCT in assessment of implanted rings, helped us to explain the non-improvement in visual
outcomes despite the refractive and topographic improvements.
Keywords: keratoconus, Anterior segment OCT, MyoRing, Ferrara ring, femtosecond laser.

INTRODUCTION Keratoconus is a bilateral
penetrating keratoplasty will be the treatment of
progressive, non-inflammatory ectatic corneal
choice 1.
disease characterized by changes in corneal
Intracorneal rings are an effective way for
collagen structure and organization. Though the
treating keratoconus; the surgery is safe and has
etiology remains unknown, novel techniques are
an adequate biocompatibility. The procedure is
continuously emerging for the diagnosis and
adjustable and reversible and, most importantly,
management of the disease 1.
effective in improving unaided visual acuity
Common methods of vision correction for
(UAVA), best corrected visual acuity (BCVA).
keratoconus range from spectacles and rigid gas
It reduces the manifest refractive spherical
permeable contact lenses to other specialized
equivalent (MRSE) and keratometry readings,
lenses. Corneal collagen cross linking is
improves contact lens tolerance, and reduces
effective in stabilizing theprogression of the
the anisometropia between the two eyes.
disease. Intracorneal ring segments can
Intracorneal rings have a positive impact on the
improve vision by flattening the cornea in
quality of life in keratoconic patients 2.
patients with mild to moderate keratoconus.
The Myoring (DIOPTEX) is a complete,
Topography guided customized ablation
flexible, continuous, PMMA ring designed to
treatment betters the quality of vision by
correct moderate and high myopia. The
correcting the refractive error and improving
diameter ranges from 5.0 to 8.0 mm, the
the contact lens fit. In advanced keratoconus
thicknesses ranges from 150 to 350 m and the
with corneal scarring, lamellar or full thickness
width of the ring is 0.5mm. The anterior surface
Received: 19 / 04 /2017 DOI : 10.12816/0038191
Accepted: 27 / 04 /2017

Full Paper (vol.681 paper# 14)

c:\work\Jor\vol681_15 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 923-928

Fat Embolism Syndrome Due to Fracture Right Femur: A
Case Report
Khalid Al Shareef, Muhammad Asadullah, Muhammad Helal
General surgery Department, King Faisal Medical Complex, Taif, Saudi Arabia


Fat embolism syndrome (FES) is usually associated with fractures of long bones and pelvis.
Symptoms usually occurs hours to days after injury. We present a case with fat embolism
syndrome due to fracture femur. Prompt supportive treatment of patient's respiratory system and
additional pharmaceutical treatment provides the positive outcome. There is no specific therapy
for fat embolism syndrome. Prevention, early diagnosis, and adequate symptomatic treatment are
very important. The incidence of fat embolism syndrome is reduced markedly in last decades due
to early stabilization and surgical correction of fractures of long bones.
Key words: Fat embolism syndrome, Trauma, Femur fracture.

Fat embolism is fat particles that enters the
of FES patients develop severe hypoxemia
and respiratory insufficiency requiring
occlusion. Fat emboli (macroglobules) can
mechanical ventilation6.
cause a more serious condition called Fat
Neurological features in the form of
embolism syndrome, in which there is
agitation, delirium, seizures, or coma are
multisystem dysfunction 1. The majority
seen in 86% of patients with FES7.
(95%) of cases of fat embolism syndrome
Dermatological dysfunction is developed as
occur after major trauma. The incidence of
non-palpable petechial rash in conjunctiva,
FES with single long bone fracture is 1-3%
axilla chest and neck in up to 60% of cases.8
and with bilateral femoral fracture it has
Some other minor symptoms that may also
been reported in up to 33% of patients. An
be present are, anemia, low platelets,
overall mortality of 5-15% has been
tachycardia, pyrexia, myocardial depression,
described 2.
and renal changes (e.g., oliguria, or
Clinical symptoms and signs of fat
embolism syndrome(FES) are evident hours
Clinical findings are important in diagnosis
to days after injury and are characterized by
of FES, while biochemical changes may also
respiratory distress, altered mental status
be of value. The most common classification
skin petechiae3. Pulmonary dysfunction in
scheme for diagnosis is that of Gurd and
the form of dyspnea, tachypnea and
Wilson, providing major and minor
hypoxemia are the primary manifestations
diagnosis criteria (Table 1), according to
occurring in 75% of cases 4. 10% of cases
which the diagnosis of FES requires the
may develop respiratory failure and 5-8% of
presence of at least one major and four
patients may progress to severe acute
minor criteria 4.
respiratory distress syndrome(ARDS) 5. Half

Received:1/4/2017 DOI : 10.12816/0038192

Full Paper (vol.681 paper# 15)

c:\work\Jor\vol681_16 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 929-935

Recent Trends in Retinal and Choroidal Imaging
Tarek A. El-M'amon*, Abdel-rahman G. Salman*, Safaa S. Mahmoud *, Alyaa B. Mohammed
*Department of ophthalmology, Ain Shams University, college of medicine, Cairo, Egypt
The last decade have witnessed a tremendous advancement in retinal and choroidal imaging
technologies thanks to improved light sources, detectors and high speed computers which are
continuously improving. There are many examples as Fundus autofluorescnce is a relatively novel
imaging method that allows topographic mapping of lipofuscin distribution in the retinal pigment
epithelium cell monolayer as well as of other fluorophores that may occur with disease in the outer
retina and the subneurosensory space. Optical coherence tomography is a method of using low-
coherence interferometry to determine the echo time delay and magnitude of backscattered light
reflected off an object of interest. This method can be used to scan the retina with very high axial
resolution. Optical coherence tomography angiography (OCTA) is a new non-invasive imaging
technique that employs motion contrast imaging to get high-resolution volumetric blood flow
information generating angiographic images in just a few seconds. OCT is undergoing another
transformation with Multicolor technology by combining with confocal scanning laser
ophthalmoscope t to acquire images using data from three simultaneous lasers red, green and blue
taking advantage of the different wavelengths of each of these colors to image 3 different zones of
the retina .
Keywords: Fundus autofluorescence (FAF) ­ Age related macular degeneration (AMD) ­ Optical
coherence tomography (OCT) - Optical coherence tomography angiography (OCTA) ­Multicolor
imaging (MCI)
Retinal pigment epithelium (RPE) is a single
lipofuscin, FAF may use other excitation
layer of polygonal shaped cells, which
wavelengths to detect additional fluorophores,
separates the choroid from the neurosensory
retina. It is responsible for phagocytosis and
autofluorescence (5). Commercially available
lysosomal breakdown of pigmented outer
FAF systems include fundus cameras (FC),
segments of photoreceptors. Over the course
confocal scanning laser ophthalmoscopes
of a lifetime, each RPE cell will phagocytose 3
(cSLO), and ultra-wide field technologies. .
billion outer segments. With aging, incomplete
Fundus camera systems often utilize longer
or partial breakdown of these segments in the
wavelength (530 to 580nm) excitation
compared to cSLO (488nm) (6).Near infra-red
fundus autofluorescence can be recorded
Accumulation of lipofuscin above a certain
using excitation wavelengths of 790 nm
threshold can cause functional loss of cells and
with emissions above 800 nm using a
lead to apoptosis (2). Fundus autofluorescence
cSLO, Its emission corresponds to areas of
(FAF) is a non-invasive imaging technique
higher density melanin in the retinal pigment
that detects ocular fluorophores, which is
epithelium and choroidal pigment (7).
naturally occurring molecules that absorb and
emit light of specified wavelengths (3).
Lipofuscin is a dominant ocular fluorophore
that absorbs blue light with a peak excitation
FAF is highly valuable in age-related macular
wavelength of 470nm and emits yellow-green
degeneration (AMD) as RPE damage is a
light at a peak wavelength of 600-610nm (4).
hallmark of the disease, patients with early
FAF utilizes blue-light excitation, then collects
AMD, characterized by sub RPE deposits
emissions within a preset spectra to form a
called drusen. Drusen have a variable
brightness map reflecting the distribution of
appearance on FAF depending on size,
composition, and health of the overlying RPE
Received:17/4/2017 DOI: 10.12816/0038193

Full Paper (vol.681 paper# 16)

c:\work\Jor\vol681_17 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 936-953
Percutaneous Coblation nucleoplasty in patients with
Contained lumbar disc prolapse: One year follow-up in a
Prospective case series
Hany Abd Allah, Hesham Mohamed Elsaady farhoud, Hany gamil yousef
Wael Shaaban Mahmud, HanyZaky Mohamed
Department of Orthopedic Surgery,Faculty of Medicine for Girls, AL-Azhar University
Corresponding, mob no;01225898516

clinical outcome data was analyzed for 100 patients withcontained disc herniation
who underwent percutaneous discdecompression procedure using Coblation® technology,after
failing to respond toconservative management.

Patients and Methods: Patients presented with clinicalsymptoms of discogenic low back
pain and/or leg painFollow-up data was collected up to 12 months.Patient gender distribution was
68% female, 32% male, witha mean age of 39 years.With mean duration of back pain of 8.57
,ranging from 3 to 17 month and mean duration of leg pain of 4.36 .ranging from 2 to 10
monthaccording to visual analogue scale for pain assessment.The mean pre-procedure pain level
for all patients wasReported as 7.56 for back and 7.72 for leg while average pain level was 4.86
for back and 3.42 for leg at the 12-month follow-up post procedure period. And according to
Oswestry disability index for functional assessment. The mean pre procedure index was 31.48
range from 23-40. It decreased after 12 month to 13.82 range from 5-32.
Results:The results of this analysis indicated that PDD usingCoblation technology, isan
effective procedure for patients presenting withdiscogenic back and/or leg pain who have failed

Keywords:Percutaneous disc decompression, nucleotomy,contained disc herniation, Coblation,

of patients withchronic low back pain, the
Chronic low back pain is the most
lumbar disc is the principlepain generator (3,
common ailment inmodern industrial
4). While the uncertainty continues asto
whether discogenic pain is mediated via a
amongmusculoskeletal disorders, resulting
chemical,mechanical, neural, or combination
in serious financialand social consequences .
Because of its highlyspecialized role and
discogenic pain has been reportedin 39% of
chronic low back pain patients by Schwarzer
theintervertebral disc is the focal point of
etal.(3) and 26% of the patients by
pathology for mostlow back pain, including
Manchikanti et al. (4)Pain arising from the
sciatica, though the mechanismand pathway
posterior annulus of the intervertebraldisc
of pain generation and conduction has
can present as buttock, hip, groin, and lower
notbeen elucidated (1).
limbpain without direct involvement of the

nerve root.

identifiedintervertebral discs as capable of
It is a commonly held belief that
generating pain in thelow back, along with
facet joints, nerve root dura,ligaments,
intervertebral disc play a role in causingdisc
fascia, and muscles. Many investigators
degeneration resulting in discogenic pain.
haveestimated that, in a substantial percent
The natureof the association between
DOI: 10.12816/0038194

Full Paper (vol.681 paper# 17)

c:\work\Jor\vol681_18 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 954-966
Role of Magnetic Resonance Cholangio-Pancreaticography in Differentiating
between Benign and Malignant Causes of Biliary Obstruction
Sahar Mohamed El gaafary, Ahmed Samy Abdelrahman,
Zeinab Mahmood Muhammed
Depaetment of radiology,Faculty of Medicine ­ Ain Shams University
*Corresponding author:,, Dr.zeinab-
Background: the initial evaluation of obstructive jaundice involves distinguishing between intra and extra
hepatic biliary obstruction. The goal of any radiologic procedure is to confirm the presence of biliary
obstructive by detecting biliary dilatation, its exact location, extent and probable cause. Aim of the Study: to
evaluate the role of Magnetic Resonance Cholangio-Pancreatography in differentiating benign from malignant
causes of biliary obstruction using surgical, ERCP or histopathological findings as a gold standard. Patients and
a prospective study done on 20 patients with clinical and laboratory finding suggestive of biliary
obstruction. All patients underwent non enhanced MRCP on 1.5 Tesla machine (Philips). The final diagnosis
of MRCP was correlated with results of ERCP in addition to biopsy and histological diagnosis to those
patients had neoplasms. Results: Out of 20 cases, there were 11 benign and 9 malignant cases. Mean age of
patients with malignant obstruction was more than benign with slight female preponderance. The diagnostic
accuracy of MRCP in differentiating benign from malignant biliary obstructive diseases in correlation with
surgical, ERCP and histopathological outcome was85.7%, 96.3%, and 93.3% respectively. It was found that
irregular, asymmetric and long segment narrowing was more common in malignant stricture. Conclusion:
MRCP is a rapid and non-invasive, procedure in assessing cases with suspicions biliary obstructions. It
offered a diagnostic accuracy nearly equivocal to ERCP. MRCP can also replace the diagnostic part of ERCP
procedure, so that time is spent only on its th erapeutic part, and hence decreasing complications of a lengthy
ERCP. Recommendations: benign or malignant nature of biliary obstruction can be assured by MRCP by
observation of stricture margin, dilatation, and length and accordingly proceed to next step in management.
MRCP is an efficient diagnostic procedure for detection of presence, level, cause of obstruction and routinely
advocated before any intervention is planned.
Key words: Magnetic resonance cholangio-pancreaticography, benign, malignant, biliary obstruction
Malignant obstruction is most commonly caused
by cholangiocarcinoma. Other causes are cancer
obstructive jaundice is a type of jaundice in which
head of pancreas, gall bladder carcinoma, lymph
there is blockage of flow of bile from the liver to
nodes and metastasis (2).
the intestine resulting in redirection of excess bile
and its products, like bilirubin into the blood. It can
Ultrasonography (USG) is usually used as initial
lead to complications like ascending cholangitis,
imaging modality to diagnose the biliary
hepatorenal syndrome, and mal-absorption and
obstruction, but artifacts due to bowel gas, gall
hence requires urgent intervention. The role of
bladder and bile duct calculi, breathing artifacts
radiologist therefore is important in early diagnosis
and obesity brings it down in the list of imaging
and in accurately delineating the level and the cause
modality of choice in obstructive jaundice (3).
of obstruction, thus helping in staging as well as
preoperative assessment of tumor respectability (1).
CT scan has limited value in helping diagnose
CBD stones because many of them are radiolucent
Benign and malignant biliary obstructions are
and CT scan can only image calcified stones. It is
difficult to differentiate with imaging alone.
also less useful in the diagnosis of cholangitis
Benign obstruction is most commonly caused by
because the findings that specifically suggest bile
choledocholithiasis. Other causes are post
duct infection (increased attenuation due to pus,
cholecystectomy stricture, inflammatory stricture
bile duct wall thickening, and gas) are seen
formation secondary to pancreatitis and idiopathic
infrequently. Lastly, CT scan is expensive and
cause, choledochal cyst, primary sclerosing
involves exposure to radiation, both of which
cholangitis, and Mirrizi syndrome (2).
Received: 7/3/2017
Accepted:14/3/2017 DOI: 10.12816/0038195

Full Paper (vol.681 paper# 18)

c:\work\Jor\vol681_19 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 967-973

Specific IgE Immunoassay for House Dust Mites by Using Multiple Allergen
Simultaneous Test (MAST) in Asthmatic Children
Mohammed Youssef Saad1 and Hany Abd El-Hady El-Khaleegy 2
1Department of Parasitology, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt.
2Department of Pediatrics, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt.
Background: house dust mites are considered as a major cause of bronchial asthma in young children.
Inhalation of dust mite allergens by hypersensitive individuals can result in acute attacks of bronchial
asthma. Multiple allergen simultaneous test (MAST) for the detection of specific IgE of different
allergens is one of the important diagnostic tools for bronchial asthma. Patients and Methods: the study
group consisted of forty children suffering from bronchial asthma selected from the outpatient clinic of
Pediatrics, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt as well as another normal
forty healthy volunteer children were selected as controls. Total IgE immunoassay and quantitative
measurement of allergen specific IgE (Biocheck GmbH, Germany) were estimated for all of them.
Results: it was found that, out of 27 positive IgE subjects, 20 were positive by poly-check test providing
sensitivity of 74.1%; and out of 53 negative IgE subjects, 50 were negative, providing specificity of
94.3%. Conclusion: Poly-check (MAST), in vitro tests can be used in screening for allergens in asthmatic
children with high specificity.
Keywords:house dust mites, bronchial asthma, allergy, specific IgE, multiple allergen simultaneous test
Immunoglobulin E (IgE) has an essential role
in type I hypersensitivity reaction in many
1. Study population
bronchial asthma, sinusitis,
The study group consisted of forty children
allergies, urticaria and atopic dermatitis as well
suffering from bronchial asthma. They were
as allergic rhinitis 1. During the allergic
selected from the outpatient clinic of Pediatrics,
response, the plasma cells produce IgE
Faculty of Medicine, Al-Azhar University, New
antibodies, which are capable of binding a
Damietta, Egypt during follow up. A detailed
specific allergen via its Fab portion. Different
history including name, age, sex and factors
aggravating symptoms e.g. dust, cold, smoking,
corresponding allergen-specific IgE antibodies 2.
exercise and insecticides was taken. They were
examined for symptoms of bronchial asthma and
The determination of specific allergens is one of
other allergic conditions e.g. allergic rhinitis,
the most important tests for the diagnosis and
dermatitis, sinusitis, conjunctivitis and urticaria
treatment of allergy 3 where Multiple Antigen
as well as clinical presentation and frequency of
Simultaneous Test (MAST) is a common tool
attacks per year. Another normal forty healthy
for identifying and measuring of specific IgE for
volunteer children of the same age and sex were
indoor allergens e.g. house dust mite's species
selected as a control group. Exclusion criteria
included smoking, parasitic infections, TB, and
pteronyssinus and Dermatophagoides farinae) 4.
other lung diseases.
2. Specific IgE immunoassay using MAST
The present study was designed to detect
specific IgE for house dust mites by using
The Polycheck® (Biocheck GmbH, Germany)
Multiple Allergen Simultaneous Test in
is an enzyme immune assay for the quantitative
asthmatic children.
measurement of allergen specific IgE in serum
Received:24/4/2017 accepted:3/5/2017 DOI: 10.12816/0038196

Full Paper (vol.681 paper# 19)

c:\work\Jor\vol681_20 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 974-981

Depression among Medical Students in Saudi Arabia
Najeeb saleh alsalameh1, Adnan khalifah alkhalifah1, Najat kreem alkhaldi2, Alsafa abdulaziz
Qassim university college of medicine1
Corresponding author : Najeeb saleh alsalameh ( ,mobile:
stress may be experienced by college students especially medical students because they
have several psychological and academic stressors. Due to the increase in stress the depression
prevalence increases. There are several factors for depression including gender. Assessing depression
between medical students is very important for early treatment as a lack in treatment leads to poor
Aim: To investigate the prevalence rate of depression in medical students in KSA.
Methods: this study was performed on 1171 medical students from different years of college; the
PHQ-9 questionnaire was used.
Results: low rates were found for the depressive syndrome and depressive disorder with equal rates
for moderate and severe symptoms, females expressed more depression severity than males.
Conclusion: depression prevalence rate was low between medical students and females expressed
more depression and depressive symptoms than males.

Keywords: Depression prevalence, Depression in KSA, Medical student`s depression

College students may experience stress
of students in mainland China were depressed
due to the nature of college life [1].Medical
[17], while in Taiwanese study [18] the level of
education is considered to be stressful [2]. The
suicidal ideation was high and exceeded
medical students have psychological and
10%.Also, it was found that in Chinese
academic stressors [3]. Prevalence of depression
physicians, the frequency of depressive
in high school students has been observed to
symptoms was over 65% [19].
range from14% to 33% and stress reaches 35%
Depression was suggested to be more
[4,5]. Medical students experience higher levels
prevalent in females than in males' medical
of depressive symptoms than the others [6].
students [20-26], younger students [27-29].
The risk factors for depression and
Depression of medical students may lead them
stress were reported to be birth older, gender,
to commit suicide [21,30,31]. Some studies [32,33]
familial history of chronic diseases, history of
reported that 11.2% to 17.4% of medical
relative loss and history of psychiatric illness
students experience suicidal ideation annually.
[4]. It was suggested that several factors may
In a recent study, also it was reported that
affect determinants of depression between
medical students experience high rates of
students such as the difference in culture [7].
depression and suicidal ideation [34].
Risk factors for medical students including
Suicidal behavior is a complex
student abuse and hazing [8,9], sleep deprivation
phenomenon; there are several predictors of
[10] academic stress and workload [11,12].
suicidal behavior [35]. Suicide is the second
Assessing of stress and depression between
cause of death for youths, whose age ranges
university students is an area of research [1].
from 15 to 24 years in the USA [36]. Suicide
There were high rates of psychological
involves a fundamental element which is
morbidity between students, such as anxiety
suicidal thoughts which gradually increase in
and depressive symptoms have been reported
severity [35]. These thoughts tend to be more
from several parts of the world [2].
prevalent in university students [35]. Suicidal
Depression prevalence and depression
ideation vary from4.9% to 35.6% [12,37]. It was
symptoms between students differ between
found that suicidal ideation prevalence was
different studies from 1.4% to 73.5% [13,14],
more frequent as revealed by percentages of
other studies [15,16] found that rates of
26%, 35% [38] and reached up to 43% [39]. In
depression in medical students ranged
another study, it was found that 12% of
from2.9% to 38.2%. It was found that 16.8%
students had suicidal thoughts and 2.6% of
Accepted:16/4/2017 DOI: 10.12816/0038197

Full Paper (vol.681 paper# 20)

c:\work\Jor\vol681_21 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 982-990

Jihan A. Mohamed (1), Salah M. Abdallah (2), Almahdy M. Alatrouny(3), Hatem M. Newishy (4).
(1)Ophthalmology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt. (2,3,4)Medical
microbiology & Immunology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
PURPOSE: To evaluate the bacterial contamination associated with contact lenses and lens care solutions used by a
group of soft contact lens (CL) users (daily & extended wear CL) and the susceptibility pattern of the isolated organisms
to antibiotics for 12 months duration. METHODS: This prospective case controlled, non randomized study included 50
participants of contact lens (CL) wearers from Outpatient Clinics at Al-Azhar University Hospitals, International Eye
Hospital New Damietta and available special clinics, (between 2013 and 2014). The sample population was divided into
two groups: a Case group: 30 contact lens users (60 eyes) were suffering from symptoms and signs of conjunctivitis in
one or both eyes; a Control group: 20 CL users were not suffering from conjunctivitis. Samples were taken from
solution in contact lens storage cases; daily wear CL, extended wear CL, and conjunctiva were cultured on different
media. Microbiological identification of the organisms and their antimicrobial susceptibility were done in accordance to
standard protocols. RESULTS: In the case group, positive growth was found in 85% of the lens care solution, 65% of
the contact lenses, and 56.7% of the conjunctiva of participants. While in the control group, it was found in 10% , 20%
and 15% respectively, with a statistically significant difference between both groups (P<0.001). There was no
statistically significant differences between the two usage schedules (daily wear and extended wear) regarding results of
solution and contact lens cultures (p =0.599) and (p=0.694) respectively, but there was a significant higher growth in the
conjunctival cultures of extended wear contact lenses (p =0.014). The isolated organisms in case group were;
Staphylococcus epidermidis (36.3%), followed by Pseudomonas aeruginosa (34.7%), Staphylococcus aureus (15.3%),
Anthracoid (5.6%), Escherichia coli (4.1%), Diphtheroid (1.6%), Non haemolytic streptreptococci (1.6 %) and least was
found to be Mycoplasma (0.8%). Antibiotic susceptibility tests revealed that all isolates are sensitive to gatifloxacin,
Impenem and ciprofloxacin which are commercially ophthalmological antibiotics. CONCLUSION: Prevention of
bacterial contamination of contact lens can reduce the risk of developing ocular infections. Lens care practices amongst
the participants were not optimum which resulted into high contamination level. Hence, creating awareness among the
users about the lens care practices and regular cleaning and replacements of lens cases are required.
Keywords: Contact lens infections, lens care accessories, microbial contamination, Antibacterial susceptibility.


CLs are a safe and effective vision correction and
The corneal surface may breakdown forming a small
the wearers have many choices as continuous wear,
corneal abrasion, due to routine lens use. Presence of
frequent replacement or daily disposable lenses (1)
CL as a foreign body in the eye leads to dry eyes. So
Bacterial keratitis is a sight-threatening contact lens
the microbial keratitis has become an increasingly
complication. Wearing contact lens is the main risk
important problem in recent years (4). The microbial
factor, and sleeping with contact lenses is the major risk
contamination of CL care product is a major problem
factor among contact lens wearers (2).
for contact lens wearers. Other factors related with CL

uses, such as duration of use, frequency of cleaning and
CL can act as a vector for microorganisms to adhere
change of contact lens lead to microbial contamination
to and transfer to the ocular surface. Commensal
(5). CL related keratitis is a serious impediment of
microorganisms that uneventfully cohabitate on lid
contact lens wears, with nearly one out of five
margins and conjunctiva and potential pathogens that
hospitalized cases needing corneal transplantation(6).
are found transiently on the ocular surface can inoculate
The incidence of contact lens related microbial keratitis
CL in vivo. In the presence of reduced tissue resistance,
has been enhanced in developing countries (7).Infectious
these resident microorganisms or transient pathogens
conjunctivitis is mainly bacterial (approximately 78%
can invade and colonize the cornea or conjunctiva to
to 80% of cases being bacterial in origin) (8).
produce infection (3).
Received:9/5/2017 accepted:18/5/2017 DOI: 10.12816/0038200

Full Paper (vol.681 paper# 21)

c:\work\Jor\vol681_22 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 991-1002
Anti-inflammatory effect of Hostacortin (steroidal) or Vioxx (non-
steroidal) on mice infected with Schistosoma mansoni and treated with
Salah M. E. Soliman, Ismail M. Al-Sharkawi*, Kamal A. El-Shaikh** and Fatma E.Salem**.
Zoology Dep., Faculty of Science, Al-Azhar Ueeniv., Assiut, Egypt.
*Zoology Dep., Faculty of Science, Tanta Univ., Egypt.
** Zoology Dep., Faculty of Science, Helwan Univ., Egypt.

Background: Schistosoma mansoni, a helminthic parasite induces granulomatous inflammation
following deposition of the eggs in the liver. The present study was conducted to evaluate the efficacy
of two anti-inflammatory drugs; Hostacortin (steroidal) and Vioxx (non-steroidal) in ameliorating the
damaging effects of S. mansoni infection in mice. The effects of the two anti-inflammatory drugs after
treatment of schistosomiasis mansoni with praziquantel (PZQ) in mice were assessed for management
of S. mansoni infection. Materials and Methods: The PZQ drug was administered to 6-weeks S.
infected mice at one oral dose of 685 mg/kg body weight. The anti-inflammatory activity of
the two drugs was evaluated at dose levels of 10, 50,100 and 200 mg/kg body weight in mice infected
with 80 S.mansoni cercariae / mouse and treated for 10 consecutive days after 6-weeks of infection.
Some biochemical parameters indicating the hepatic function as enzymatic activity of transaminases;
alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT) and alkaline phosphatase
(ALP) in liver as well as serum albumin and liver total protein were performed to evaluate the
possible anti-inflammatory effect of any of the two used anti-inflammatory drugs in ameliorating the
severity of the disease. In addition, some parasitological parameters as worm burden, liver egg count,
hepatic granuloma size and hepato-somatic index were performed to evaluate the possible anti-
inflammatory effect of any of the two used anti-inflammatory drugs in ameliorating the severity of the
disease. Results: The results indicated that Hostacortin had no marked effect on the parasite burden
and liver egg count. However, it caused a percentage decrease by 14.9 in the elevated ALP activity
and pronounced increases by 33.2% and 11.3% in ALAT and ASAT activities, respectively, in liver
tissue homogenate. Also, a significant reduction in granuloma size by 22.5% and 31.6% for doses 100
and 200 mg/kg, respectively, was recorded. Hostacortin treatment with PZQ improved the liver status
as indicated by a significant reduction in number of worms, eggs count and size of the liver
granuloma. However, Vioxx did not affect the parasite burden and liver egg count, it caused high
reduction in the enzymatic activities of ALAT, ASAT, and ALP in liver tissue homogenate. In
contrast with Hostacortin, Vioxx significantly increased the granuloma size by 27.6% at a dose level
of 200 mg/kg. Conclusion: the treatment with Hostacortin, after PZQ treatment, ameliorates to some
extent the severity of the disease, but Vioxx treatment causes additional hepatotoxicity in the S.
infected mice after treatment with PZQ.
Keywords: Anti-inflammatory drugs, Granuloma, Hostacortin, Praziquantel ,S. mansoni.Vioxx

Human schistosomiasis (bilharziasis) is one
risk for developed schistosomiasis. The
of the most important parasitic diseases. It is
regions of the Middle East and North Africa
reported to be endemic in 77 countries in
tropical and subtropical regions, leading to
schistosomiasis, especially Egypt, which has
infection of about 250 million individuals
about 7.2 million infected individuals. In
worldwide. About twenty million of them
Egypt, schistosomiasis is the major public
suffered severe consequences from the disease
health problems in rural regions, with almost
and the others are symptomatic. Symptoms
7.2 million Egyptians are infected [4-6]. In
range from fever, headache and lethargy, to
humans, the blood schistosomal flukes reside
in the mesenteric and vesical venules ; have a
hepatosplenomegaly and even death [1-3]. More
life span of many years and daily produce a
than 600 million people in the tropics are at
large number of eggs . Mature eggs of S.
received:1/4/2017 accepted:17/4/2017 DOI: 10.12816/0038201

Full Paper (vol.681 paper# 22)

c:\work\Jor\vol681_23 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 1003-1009

Flexural Strength of Provisional Crown and Fixed Partial Denture Resins
Sawsan Badr Sehaqi1, Anfal Abdullah Almohammed Saleh2, Dhay Abdullah Tawi1,
Maha Salem Baaboud1, Abrar Almarzouq2, Maryam Alhaddad2, Danh Abdullah
Almalki1, Marwah Radi Alnasser2, Naif Abdullah Abu Rass3, Mohsen Shinpir
1 Batterjee Medical college for science & technology,2 Riyadh Colleges of Dentistry and Pharmacy
(RCsDP),3 Ibn Sina National College
Corresponding author: Sawsan Badr Sehaqi,, 0550445568.
Purpose: The purpose of this study was `to appraise the fracture strength of provisional crown and
fixed partial denture resins with an in vitro test system. Materials and Methods: Bar-type specimens
were fabricated according to American National Standards Institute/American Dental Association
specification number 27. Reinforcement materials; polyethylene fiber and glass fiber are compared.
Provisional crown-bridge materials are autopolymerising Poly Ethyl Metacrylate (PEMA),
autopolymerising Poly Methyl Metacrylate (PMMA), bis-acryl composite resin and light cured
composite resin). A total of 150 specimens are arranged for the flexural strength test. The specimens
are divided into 5 groups according to the type of resin used (Dentalon Plus, Tetric Ceram, Charisma,
Protemp 3, TAB 2000) and then every group was distributed into 3 subgroups rendering to the type
of fiber reinforcement (Construct, Fiber-splint ML). Unreinforcement specimens functioned as the
control. Specimens were fractured in a universal testing instrument until the point of rupture. Mean
flexural strengths were calculated in MPa. Comparisons were completed with analysis of variance
and then Duncan's multiple range tests. Results: Mean flexural strengths ranged from 63.45 to 397.8
MPa. There are statistical difference between the groups (Fiber-splint ML, Construct and control).
Conclusion: Flexural strengths were material- rather than classification precise. Several, but not all,
bis-acryl resins validated expressively superior flexural strength over traditional methacrylate resins.
There was significant difference between Fiber-splint ML, Construct and control group.

Keywords: Flexural strength, Bis-acryl composite resin, Provisional crown.

Provisionalization of settled reclamations is a
have been effectively utilized for this reason.
basic piece of the treatment before
These are Poly Methyl Methacrylate Resins
arrangement of the last rebuilding efforts. The
(PMMA), Poly Ethyl Methacrylate Resins
quick defensive, utilitarian, and balancing out
(PEMA), vinyl ethyl methacrylate pitches,
estimation of break rebuilding efforts are
butyl methacrylate, epimine, preformed
helpful for symptomatic purposes where the
networks of plastic and cellulose shells,
useful, occlusal, and stylish parameters are
metals, polycarbonate materials, bis-acryl
produced to distinguish an ideal treatment
composites, bis-GMA composites, Urethane
result before the culmination of conclusive
Di Methacrylate Resins (UDMA) [3].
techniques [1]. While choosing a material for a
brief restoration, physical and machine-driven
Temporary materials for the most part show
properties of the materials ought to be
low break qualities, especially when the
considered. Clinically critical properties
patient must utilize the temporary rebuilding
incorporate quality of the material, its
for an amplified period, when the patient have
unbending nature and reparability, exothermic
parafunctional propensities, or when long-
response following polymerization and
traverse prosthesis is arranged [4].
ensuing polymerization shrinkage, peripheral
uprightness and shading soundness. By and by
Imperviousness to useful load and expulsion
there is no single material that meets the ideal
powers which are mechanical variables must
necessities for every one of the circumstances
be considered while picking a temporary
[2]. Be that as it may, there are materials that
remedial material for clinical utilize.
Temporary rebuilding efforts are manufactured
Accepted: 19/4/2017 DOI: 10.12816/0038217

Full Paper (vol.681 paper# 23)

c:\work\Jor\vol681_24 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68, Page 1010-1021

A Study of lung Ultrasonography in Infants with Acute Lower
Respiratory Tract Infection as a Quick and Safe Alternative
Tool in a Group of Egyptian Infants
Laila Mahmoud Abd El Ghafar Hegazy (1), Asmaa Al Husseiny Ahmed
Al Sharkway (1), Hossam Moussa Sakr (2), Ahmed Essam El-Said Ahmed (1)
Departments of Pediatrics (1) and Radiodiagnosis (2)
Faculty of Medicine -Ain Shams University
*Corresponding author: Ahmed Essam El-Said Ahmed ( 01016854590 )


Background: Acute lower respiratory infections (ALRI), such as pneumonia and bronchiolitis, are the
leading cause of morbidity and mortality in children under five years of age. Aim of the Work: To
study ultrasonography findings in infants with acute lower respiratory tract infection and to test its
sensitivity and specificity in comparison to clinical and conventional x- ray for diagnosis of childhood
acute lower respiratory tract infection. Patients and Methods: The present cross sectional study was
conducted on sixty patients were chosen according to inclusion criteria (fever with signs of respiratory
distress) to compare chest ultrasonography to chest x-ray in diagnosis of children with acute lower
respiratory tract infection. Results: In our study, diagnostic Accuracy of ultrasound was 93.45%,
while diagnostic Accuracy of chest X- ray was 81% in patients' group. Sensitivity of ultrasound in
cases of Bronchiolitis was 87.5% in comparison to chest X-ray was 78.1%, sensitivity of ultrasound in
cases of pneumonia was 84.2% in comparison to chest X- ray was 52.6%. According to specificity,
there is no difference in specificity between all patients' group Conclusion: In view of our study it can
be concluded that, chest US offers an important contribution to the diagnostic procedures of acute
lower respiratory tract infection in children, as Bronchiolitis, pneumonia and pleural effusion with
higher sensitivity, specificity and positive predictive index comparable to chest X-ray.
Key words: lung ultrasonography, infants, acute lower respiratory tract infection, pneumonia,
Standard definition of childhood Acute
deaths in 2013 (3). In Egypt, it was estimated
Lower Respiratory Infection (ALRI) is
that 10% of children deaths below the age of 5
inflammation of the airways/ pulmonary tissue,
years is likely caused by pneumonia and other
due to viral or bacterial infection, below the
acute respiratory infections (4). Community-
level of the larynx. ALRI, such as pneumonia
acquired pneumonia (CAP) is one of the most
and bronchiolitis, are the leading cause of
common serious infections in children. Its
morbidity and mortality in children under five
incidence among children aged less than 5
years of age (1). According to recent estimates,
years in developing countries reached 0.29
every year about 120­156 million cases of
child per year, with a mortality rate of 1.3­
ALRI occur globally with approximately 1.4
2.6% (5). For many years, Transthoracic
million resulting in death. More than 95% of
Ultrasound (TUS) was limited exclusively to the
these deaths occur in low and middle income
examination of pleural effusions. However, over
countries (LMIC) (2). In 2015 there were about
the past few years ultrasonography of the pleural
291 million cases around the world. These
space and lung parenchyma is gaining a wide
resulted in 2.74 million deaths down from 3.4
consensus in different conditions in clinical
million deaths in 1990. This was 4.8% of all
practice, particularly in emergency (6). Chest
DOI: 10.12816/0038202

Full Paper (vol.681 paper# 24)

c:\work\Jor\vol681_25 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68(1), Page 1022-1034

Effect of the anti-inflammatory drugs Hostacortin (steroidal) or Vioxx
(non-steroidal) on the liver of mice infected with Schistosoma mansoni.

Salah M. E. Soliman, Ismail M. Al-Sharkawi*, Kamal A. El-Shaikh** and Fatma E.Salem**.
Zoology Dep., Faculty of Science, Al-Azhar Ueeniv., Assiut, Egypt.
*Zoology Dep., Faculty of Science, Tanta Univ., Egypt.
** Zoology Dep., Faculty of Science, Helwan Univ., Egypt.

Background: The schistosome parasite induced granulomatous inflammation in the host following
oviposition in the liver.Aim:The present study aimed to evaluate the efficacy of two anti-
inflammatory drugs; Hostacortin (steroidal) and Vioxx (non-steroidal) in ameliorating the damaging
effects of S. mansoni infection in mice. Materials and methods: The anti-inflammatory activity of
the two drugs was evaluated at dose levels of 10, 50,100 and 200 mg/kg body weight. Each drug was
orally administered to mice infected with 80 S.mansoni cercariae / mouse for 10 consecutive days
after 6-weeks of infection. Some biochemical parameters including the hepatic function as enzymatic
activity of aminotransaminases; alanine aminotransferase (ALAT), aspartate aminotransferase
(ASAT) and alkaline phosphatase (ALP) in liver as well as serum albumin and liver total protein were
determined. In addition, some parasitological parameters as worm burden, liver egg count hepatic
granuloma size and relative liver weight were performed to evaluate the possible anti-inflammatory
effect of the two anti-inflammatory drugs in ameliorating the severity of the schistosomiasis disease.
Results: The results showed that Hosstacortin treatment had no marked effect on the parasite burden
and liver egg count. However, it caused a pronounced improvement with a high tendency for
normalization in transaminases (ALAT and ASAT) and alkaline phosphatase (ALP) activities in liver
tissue homogenate. In addition, serum albumin and liver total protein was observed to attain, to some
extent, their normal levels by increasing dose regimens of Hostacortin. Also, a significant reduction in
granuloma size by 22.2% and 31.6% was detected for doses of 100 and 200 mg/kg Hostacortin,
respectively. On the other hand, Vioxx did not affect the parasite burden and liver egg count while it
caused high reduction in the enzymatic activities of ASAT, ALAT and ALP in liver tissue
homogenate. Also, a moderate increase in serum albumin and a significant reduction in liver total
protein levels were observed in mice treated with Vioxx. In contrast to Hostacortin, Vioxx treatment
induced a significant increase in the granuloma size by 29.3% at a dose level of 200 mg/kg.
Conclusion: The treatment with Hostacortin was found to ameliorate to some extent the severity of
the disease, but Vioxx treatment caused additional hepatotoxicity in the S. mansoni infected mice.
Keywords: Anti-inflammatory drugs, Granuloma, Hostacortin, Mice, S. mansoni, Vioxx.


regions, with almost 7.2 million Egyptians
Schistosomiasis is a parasitic disease caused
infected [5-7].
by platyhelminth worms of the genus
Eggs laid by Schistosoma mansoni adult
Schistosoma. The disease affects 207 million
females in the mesenteric veins pass through
people in the developing world, with
the intestinal wall and then exit the host
approximately 800 million, mostly children, at
through the feces, or they are swept into the
risk of the infection. Twenty million of the
liver and trapped in the sinusoids, where they
induce granulomatous lesions. However,
consequences from the disease and the others
accumulation of fibrotic tissue also obstructs
are symptomatic. Symptoms range from fever,
blood flow through the liver, resulting in portal
headache and lethargy to severe sequelate
hypertension, extended periportal fibrosis and
including ascites, hepatosplenomegaly and
portal shunting [8]. In human, the blood
even death [1-4]. More than 600 million people
schistosomal flukes have a life span of many
in the tropics are at risk for developing
years and daily produce large number of eggs.
schistosomiasis. In Egypt, schistosomiasis is
Mature eggs of S. mansoni have harmful to the
the major public health problems in rural
host. These eggs are inducing granuloma
Received: 1/5/2017
DOI: 10.12816/0038204
Accepted: 15/5/2017

Full Paper (vol.681 paper# 25)

c:\work\Jor\vol681_26 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68(1), Page 1035-1041

Adjusted Serum leptin and leptin Adiponectin ratio in correlation with
Hyperemesis gravidarum
El zeneny A.H , Sayed A.M , Abdel hafez A.M and Hafez S.A.
Department of obstetrics and Gynecology, Faculty of Medicine, Ain Shams University ,Cairo
Aim t
: o determine the level of serum leptin, adiponectin and leptin /adiponectin ratio in women
with hy
esis gravidraum and compare them w
ith those with normal pregnancy in order to
speculat t
e heir role in prediction and a

ssessement of severity of the disease. P
atients and
method T
: his case control study was conducted at the department of Obstetrics and Gynecology,
Ain-shams university maternity hospital. A total of 90 women are included in the study and are
divided into two groups G
. r
oup A Fourty f
- ive pregnant women with y
h peremesis gravidarum..
Group B : Fourty f
- ive pregnant women with no y
h peremesis gravidarum..the groups were
compared for age, gestational age, body mass index,Leptin ,adiponectin, adjusted leptin
level, l,eptin to adiponectin ratio w
ere calculated in each group. Primary outcome was the increase
in adjusted leptin level in hyperemesis gravidarum group.
Results: leptin was found to be significantly high in the HG group (37.91± 6.42 ) , also Adjusted
leptin level were found to be significantly higher in the hyperemesis gravidarum group(4.36±
1.26) than in the control group (P = 0.001 ) and adiponectin level were found to be lower in the
HG (9.34±1.49) than in the control group. There was increase in leptin to adiponectin ratio as
compared with severity of the disease. The maternal leptin level was positively correlated with
gestational age in the HG group ( r = 0.011, p= 0.944 ). Also the maternal adiponectin level was
positively correlated with BMI in the HG group ( r = 0.290 , p = 0.054). Etiology of the
hyperemesis gravidarum is multifactorial. However we can postulate the adjusted leptin level as a
good predictor for hyperemesis gravidarum.,alsoLeptin to adiponectin ratio can be used to
determine severity of the disease.
Keywords: Hyperemsis gravidarum ;Adjusted leptin; Leptin; adiponectin ; leptin to adiponectin
pathophysiology for hyperemesis
gravidraum is not clear, it has been proposed
Nausea and vomiting is a common
that hormonal allergen as well as genetic
symptom of early pregnancy. Affecting up
factors, immunolgical,
to 80 % of women. While the reported
neuropsychosomotic,and metabolic factors
incidence of hyperemesis gravidraum is 0.
may play a role in the etiology of
5-2. 0% [ 1] . Hyperemesis gravidarum [HG]
hyperemsis gravidraum [3]. HG, like nausea
is a significant but underappreciated illness
and vomiting (NVP), typically occurs
of pregnancy. It is the most commen
between the 4th and the 10th week of
indication for admission to the hospital in
gestation, with resolution by 20 weeks of
the first half of pregnancy and second only
gestation. In approximately 10% of HG
to preterm labour as a cause of
patients, symptoms will persist throughout
hospitalization overall. Hyperemesis
pregnancy [4].
gravidarum is a state characterized by
intractable vomiting during pregnancy,
Leptin and adiponectin are the
leading to dehydration, ketonemia,
hormones that are secreated mainly by the
electrolyte imbalance and weight loss[ 2].
adipose tissue to signal the status of body
Although recent researches say that the
energy stores to the central nervous system.
DOI: 10.12816/0038205

Full Paper (vol.681 paper# 26)

c:\work\Jor\vol681_27 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68(1), Page 1042-1048

Placental Cord Drainage versus no Placental Drainage in the Management
of Third Stage of Labour: Randomized controlled trial
Ahmed Mohamed , Hassan Awwad Bayoumy, Amgad Al-Said Abou-Gamrah, Ahmed Abdel Shafy

Obstetrics and Gynecology department, Faculty of Medicine-Ain Shams University

Back ground:the third stage of labour begins immediately after the birth of the baby and ends with
the expulsion of the placenta and fetal membranes.It is preceded by contraction and retraction of the
uterus to reduce uterine size and expel the placenta with minimal haemorrhage. Placental cord
drainage involves clamping and cutting of the umbilical cord after the birth of a baby and then,
immediately unclamping the maternal side of the cord so the blood can drain freely into a container.
Aim of the work:the aim of this study is to assess the effect of placental cord drainage during active
management of the third stage of labour on reducing both blood loss and the length of the third stage.
Materials and Methods:a randomized controlled trial was carried out on180 patients who underwent
vaginal delivery at Ain Shams University Maternity Hospital labour ward.Population of this study
were randomly assigned to either:Group A: 90 patients was the study group(cord drainage).Group
90 patients was the control group(no cord drainage). Moreover,the duration of third stage was
compared as the primary outcome. The incidence of postpartum hemorrhage, retained placenta,
manual removal of placenta, and the need for blood transfusion were compared.
Results:the duration and amount of blood loss of third stage of labour was significantly lower
in study group than control group.Furthermore,the Postoperative pulse rate,Systolic Blood
Pressure, Diastolic Blood Pressure,Hemoglobin and hematocrit value were significantly higher in
study group than control group. The retained placenta (manual removal),Postpartum hemorrhageand
Blood transfusion were non-significantly less frequent among study group than among control group.
Conclusion:active management of the third stage of labour with the cord drainage method
significantly reduced postpartum hemorrhage and the duration of the third stage.
Key Words:Placental cord, Third stage, Postpartum hemorrhage,Labour, Drainage.

The 3rd stage of labour refers to the
stage of labour mainly involves maternal effort
interval from delivery of the fetus to the
assisted by gravity or putting the baby to the
separation and expulsion of the
breast without using artificial oxytocin or early
placenta(1).Prolongation of the third stage of
clamping or controlled cord traction(5).
labor increases the complication rate,
In the management of third stage of
especially the incidence of postpartum
labour nowadays, it is a common practice to
haemorrhage (PPH) (1).
clamp both sides of the cord and cutting it then
In addition,Postpartum hemorrhage
wait until there are signs of placental
(PPH) accounts for between one quarter and
separation then deliver the placenta by
one-third of allmaternaldeathsworldwide and
controlled cord traction (brandet Andrews
is the major cause of maternal
maneuver) (6). Unclamping the cord at
mortality(2).Furthermore,the third stage of
maternal side and releasing of placental blood
labour is generally managed using two
has been suggested for facilitating delivery of
different approaches: active and physiological
the placenta it is physiologically plausible that
or expectant management (3).
draining bloodfrom the placenta would reduce
Active management generally includes
its bulkiness allowing the uterus to contract
administration of uterotonic agents, controlled
and retract effectively leading to delivery of
cord traction, and uterine massage after
placenta and may reduce the duration of 3rd
expulsion of the placenta, helps to prevent
stage of labour(6).
PPH and reduce maternal mortality in all
Cord drainage in 3rd stage of labour
deliveries(4). Expectant management of third
involves unclamping the previously clamped
DOI: 10.12816/0038206

Full Paper (vol.681 paper# 27)

c:\work\Jor\vol681_28 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68(2), Page 1049-1058

Effect of Topical Application of Nano Retinol on Mild
to Moderate Acne Vulgaris
May El-Samahy, Manal Ahmed Sharara and Sally Sobhy Abd Elaziz
Department of Dermatology and Venereology Faculty of Medicine ­ Ain Shams University


Background: Acne vulgaris is a common skin condition with substantial cutaneous and psychologic
disease burden. Estimates of acne prevalence vary substantially given the absence of a universally accepted
or grading schema. Aim of the Work: The aim of work is to assess the efficacy and tolerability of topical
application of Nano retinol in the treatment of mild to moderate facial acne vulgaris in comparison to
classic retinoids. Patients and Methods: This study was conducted as a prospective, split face comparative
clinical study on 30 female patients participated for treatment of facial acne vulgaris. All patients recruited
from outpatient clinic of dermatology department, Ain Shams University in the period from November
2015 to December 2016.History and clinical examinations were done for each patient. Results: reduction
in the total and inflammatory acne lesion count were reported to be significantly greater in the nano
formulation as compared to the conventional formulation .local adverse events were significantly less in the
nano formulation as compared to the conventional formulation. Conclusion: nanosomal retinol with
iontophoresis is more effective and better toletated than its convential formulation with nearly no side
effects and no precautions for use. Recommendations: More studies are needed on a wider scale, greater
number of patients with different grades of acne vulgaris to support our findings.
Keywords: topical application, nano retinol, acne vulgaris.

Acne vulgaris is a common inflammatory
skin condition, although often perceived as a
self-limited disease of adolescence, its
comedones this results from the interaction
prevalence remains high into adulthood.
between numbers of factors: the abnormal
Nearly ninety percent of teenagers have acne
development and differentiation of follicular
vulgaris, and half of them continue to
cells of the pilosebeceous unit. The increased
experience symptoms as adults (1). By the age
cornification keratinization of follicular cells
of forty years, one percent of men and five
due to deposition of keratin within them
percent of women still have lesions (2).

While several different acne-grading
hyperseborrhea (oily skin), hypercolonization
scales have been used in clinical trials, no
and growth of bacterium propionibacterium
standard method for acne grading has been
acne within the follicles and inflammation and
adopted into practice. The basic acne severity
immunological reaction. Hyper cornification of
index is proposed method for assessing acne
the pilosebaceous duct results from the
severity based upon lesion type, number and
presence of androgens, local cytokines, and
location (3).
abnormalities of the sebaceous lipids (6).
Acne vulgaris is categorized broadly into
Guidelines in treatment of acne vulgaris
mild, moderate, severe forms. Lesions may
focuses on acne severity and degree of
persist on the face, chest or back areas with the
inflammation. Treatment options include proper
greatest density of pilosebaceous unit (4). Mild
skin care, topical and oral antimicrobials, topical
acne is typical limited to the face and is
and systemic retinoid, benzoyl peroxide and oral
characterized by non-inflammatory closed and
contraceptives for female patients. These
open comedones with few inflammatory
treatments may use in combination to achieve
lesions. An increasing number of inflammatory
disease resolution (7).
papule and pustule on face and often-mild
Retinoids influence proliferation and
trunkal disease characterizes moderate acne.
differentiation of cells and reverse the
Finally, acne is considered severe when
abnormal desquamation by increasing the
nodules and cysts are present. In these cases,
follicular epithelial turn over and accelerating
facial lesions are often accompanied by
the shedding of corneocytes, which leads to an
widespread trunkal disease (5) .
suppression of micro comedone formation.
DOI: 10.12816/0038208

Full Paper (vol.681 paper# 28)

c:\work\Jor\vol681_29 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (1), Page 1059-1068
The Relationship between Abdominal Aortic Calcification and Cardiac
Abnormalities in Hemodialysis Patients
Tamer Mohamed Ragb1, Ahmad AlaaEldin Ahmad Saad1,Moneir Osman Amin Abd Elaal2,
ALSayed Mohamed Rashed1, Abdellah Nazeer Yassin3
Departments of Internal medicine1, Cardiology2, and Radiology3,
Faculty of Medicine, Al Azhar university, Cairo, Egypt

Abdominal aortic calcification (AAC) is a marker of subclinical atherosclerotic disease and
an independent predictor of subsequent vascular morbidity and mortality.
Aim of the work:
This study was conducted to investigate the association of abdominal aortic calcification
with cardiac abnormalitiesin hemodialysispatient (HD).
Methods: This cross-sectionalobservational study wasperformed on 90 patients (50 males and 40
females)with chronic kidney disease, stage 5 (CKD)of varying etiologies from hemodialysis unit at Al-
Hussein UniversityHospital. They wereundergoing regularhemodialysis for more than 6 monthes.Laboratory
investigations were done including liver function tests, kidney function tests,complete blood count
(CBC),C-reactive protein (CRP), fasting and random blood glucose,lipid profile, calcium,
phosphorus,calcium phosphate productandparathormone(PTH).In addition, Echocardiography and X-
ray plain radiography were determined.
Results: Out of 90 HD patients, 37 patients (41.1 %) had valvular calcification, all of them (41.1 %) had
aortic valve calcifications and AAC score exceeded 6. Only 7 patients (7.8%)had mitral valve
calcifications. Moreover, cases with mitral valve calcifications had aortic valve calcification and AAC score
above 12. Seven patients (7.8 %) had mildaortic regurgitation (AR)and 4 patients (4.44%) had aortic
Conclusion: AAC precedes the occurrence of cardiac abnormalities in HD patients and has been shown to
have significant prognostic significance for cardiovascular events and mortality.
Abdominal, Calcification, Cardiac, kidney disease, Chronic, Radiography.


Vascular calcification (VC) is a common
(6,7). Dialysed patients showed increased calcium
complication associatedwith chronic kidney
deposition within the cardiac valve apparatus,
disease (CKD) and the major cause of
namely aortic and mitral valves . As a matter of
cardiovascular disease (CVD) in the patients with
fact, haemodynamically significant aortic valve
end stage renal disease (ESRD)(1).Furthermore,
stenosis is more prevalent and accelerated in
ESRD patients when compared with subjects with
exhibitaccelerated calcification of the intima,
normal kidney function (8).
media, heart valves and likely the myocardium as
Calcification of the aortic and mitral valve on
well as the rare condition of calcificuraemic
echocardiography has been linked to coronary
arteriolopathy (calciphylaxis)(2).
atherosclerosis in the general population and
The prevalence of VC increases as CKD
carotid intima-media thickness (an indirect marker
progresses, from 40 % at stage 3 CKD to 80­99 %
of atherosclerosis) among patients undergoing
at stage 5 CKD on dialysis (3). Mineral and bone
haemodialysis , suggesting that vascular
disorder (MBD) is also a frequent complication of
andvalvular calcification might share common
CKD associated with increased risk of VC,
pathogenetic mechanisms(9).
arterial dysfunction, morbidity and mortality (4). A
Structural and functional cardiac abnormalities
studies were revealed that every 1.0 mg/dL of
are common in patients with CKD. 70­80% of
serum phosphorus was associated with 18%
CKD5D patients have abnormal left ventricular
increase of the risk of death in patients with CKD,
(LV) structure and/or function and 74% of CKD
indicating that hyperphosphatemia is an
stage 5 patients show evidence of LV hypertrophy
independant risk factor for mortality among those
(LVH) at the initiation of renal replacement
patients (5). In addition, hyperphosphatemia is a
key regulator involved in multiple mechanisms
Therefore, this study wasperformed to assess the
that induce and promote the progression of VC.
abdominal aortic calcification and to find out its
Therefore, prevention of MBD and lowering the
relation to cardiac abnormalities in HD patients.
circulating levels of phosphate and calcium have

become major targets in the treatment of VC
Received: 01 / 04 /2017 DOI : 10.12816/0038209
Accepted: 10 / 04 /2017

Full Paper (vol.681 paper# 29)

c:\work\Jor\vol681_30 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (1), Page 1069-1074

Impact of Second Hand Smoke Exposure on Birth Weight: A Pilot
Cohort Study
Labib K., Hamedy A., Ali W.
Department of Obstetrics and Gynecology, Ain shams university

: to examine the associations of passive smoking during 3rd trimester of pregnancy and birth
Design: prospective (cohort) study. Setting: this study was conducted at Ain Shams University
maternity hospital between period June 2015 and May 2016.
Study subjects: A total of 200 women during their 3rd trimester of pregnancy were included in the study
with verbal consent from each woman
Measures: through written (self-administered questionnaire) and exhaled carbon monoxide (CO) test
Results: Current SHS was significantly associated with lower gestational age at delivery, lower birth
weight, lower 1-min Apgar score and higher rates of SGA neonates.
Conclusion: the current study showed a significant association between SHS in pregnant women and
increased rates of preterm delivery, low birth weight and SGA neonates.
Key words: second hand smoke exposure, pregnant women in 3rd trimester of pregnancy, birth


Cigarette smoking during pregnancy is one of
association between second hand smoke
the important modifiable causes of poor
exposure and adverse perinatal outcomes.

ountries1.Although the prevalence of cigarette
smoking is routinely monitored in high income
Study subjects
countries, a paucity of data exists in middle and
The study was carried out at Ain Shams
low-income countries2.


participants were recruited during their antenatal
A recent report of middle and low income
care visits at obstetric clinics during their 3rd
countries shows that a population -based
trimester of pregnancy. After obtaining the
prevalence of tobacco use was approximately
hospitals' permission for data collection, we
2.6% in middle and low income countries .In
asked pregnant women who visited the prenatal
Egypt which was surveyed in 2005, the rates
care clinic whether they would participate in
were 0.4% for cigarette smoking, 0.1% for
this study and those who voluntarily agreed to
smokeless tobacco, and 0.4% for any form of
do were enrolled. They were reassured that their
tobacco. Data was obtained from demographic
smoking status is confidential, no personal
and Health surveys, which are routinely,
identifiers were disclosed and all the data was
conducted in middle and low income countries 3.
gathered only for research purposes and not for
Second-hand tobacco smoke (SHS) is referred
public use. A total of two hundred women were
to as "environmental" tobacco smoke (ETS) 4,
enrolled in this prospective cohort study
(SHS) consists of exhaled smoke as well as side-
stream smoke that is released from the burning
cigarette between inhalations and it has a very
Assessment of exposure to passive smoking is
similar composition5.
achieved through written (self-administered
questionnaire).At the time of enrollment, a
questionnaire was administered to the
The aim of the current study was to assess the
participant and they were followed up till
prevalence of SHS among pregnant Egyptian
delivery and we obtained the birth outcomes
women, to evaluate the demographic data of
through chart review. The questionnaire
these women, and to assess the
captured the sociodemographic characteristics:

age, marital status, education, employment,

attitude toward smoking during pregnancy,
Received: 01 / 04 /2017 DOI : 10.12816/0038210
Accepted: 10 / 04 /2017

Full Paper (vol.681 paper# 30)

c:\work\Jor\vol681_31 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (1), Page 1075-1081

Helicobacter Pylori in Pediatrics
Wafaa M. Alsbhani1, Basam Z. Sindi2, Mohammed S. Dumyati2, Anwar A. F Alammari3,
Shorooq A. Alenzi4, Sulafa T. Sindi3, Abrar H. hakami5, Njood W. Nazer3, Omar M. Maimsh3,
Anas H. Alzahrani3, Mashael B. Alrubaian6, Kawkab A. hammam7, Ahad A. Alsharief8,
Ali M. Alshubaily9, Hailah H. AlQarni 9, Weaam S. Magram3
1 Ibn Sina national college for medical studies,2 Umm Al-Qura University,3 King Abdul-Aziz University,
4 Taibah University, Medina, 5 Jazan University ,6 Almaarefa Colleges for Science & Technology (MCST),
7 Assuit University, Egypt,8 Maternity & Children's Hospital in Makkah (MCH in Makkah),9 King Abdul-Aziz Hospital
Corresponding Author: Wafaa M. alsbhani - ­ 00966562856248

This review includes the main pediatric studies published from April 2011 to march 2016. The important
studies involving H. pylori genomes, especially those pertaining to genomic diversity, disease outcome, H.
pylori population structure and evolution are reviewed. Genotypic variability in H. pylori strains influences the
clinical manifestation of the infection. The antigen stool test is becoming the "gold standard" in prevalence
studies, and according to the epidemiologic studies, the prevalence of H. pylori in childhood is not decreasing
any more in the developed world. Studies showed conflicting results regarding the association between H.
pylori infection and iron deficiency anemia. One study suggests that H. pylori eradication plays a role in the
management of chronic immune thrombocytopenic purpura. The prevalence of H. pylori was higher in chronic
urticaria patients and following H. pylori eradication, urticarial symptoms disappeared. An inverse relationship
between H. pylori infection and allergic disease was reported. The resistance rate of H. pylori strains is high in
children. Therefore, among other important issues concerning H. pylori in pediatrics, guidelines published by
ESPGHAN and NASPGHAN last year also recommended culture and susceptibility testing before first-line
treatment in areas with high or unknown antibiotic resistance rates.
Keywords: Helicobacter pylori, H pylori, infection, pediatrics


statistically significant differences in clinical or
Helicobacter pylori infection is the leading
demographic characteristics or in the endoscopic
cause of gastric cancer worldwide. However, in
and histologic features of the patients infected with
children, H. pylori related malignancy is extremely
cagA-positive strains as compared with those
rare and it is generally acquired in this period [1].
infected with cagA-negative strains.
Various factors influence malignant potential
Several studies were performed to identify
including age of infection, bacterial genotype, host
Helicobacter pylori virulence factors that could be
immune response, and host genetics. H. pylori
related to the evolution of disease. High positivity
of virulence genes was found in dyspeptic or
inflammation of gastric mucosa in pediatric patients
asymptomatic children [1­4]. Acute exposure to
are cagA, vacAs1, and babA, and their detection
VacA initially triggers host autophagy to mitigate
could be of importance in areas with high risk of
the effects of the toxin in epithelial cells. Raju et
carcinoma. Sicinschi et al.[1] used stool samples
al. [5] identified a host autophagy gene (ATG16L1),
instead of gastric biopsy samples to genotype H.
susceptible for H. pylori infection and defined the
pylori virulence markers and found a high
mechanism by which the autophagy pathway is
incidence of cagA and vacAs1 allele (in 66.1 and
affected after H. pylori infection.
91.7%, respectively) in asymptomatic children with
The virulence role of iceA allele was not clearly
H. pylori infection in a gastric cancer high risk area
demonstrated until recently when a meta-analysis
in Columbia. This could be concluded to be a
involving 50 relevant studies confirmed the
contributing factor for the high incidence of gastric
importance of iceA1 allele in the development of
cancer in adults in this area. Meanwhile Oliveira et
peptic ulcer disease (PUD), especially duodenal
al. [2] described the prevalence of infection with
ulcer [5]. On the other hand, connection between
cagA-positive strains in a group of children and
iceA allele and gastric cancer was not confirmed [6].
adolescents in southern Brazil. The prevalence of
Lewis (Le) blood-group epitopes on the surface of
cagA-positive H. pylori was 29.6%. There were no
H. pylori mimic structures present on human gastric
Received: 01 / 04 /2017 DOI : 10.12816/0038212
Accepted: 10 / 04 /2017

Full Paper (vol.681 paper# 31)

c:\work\Jor\vol681_32 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (1), Page 1082-1087

Prevalence and Risk Factors for Abuse among Saudi Females, KSA
Halawi Azhar Ahmed A1 , Almalki Zahrah Abid A2 , Ahmed Alsadah3 ,
Aseeri Arwa Abdullah S4 , Jabri Shagra Abdullah H1 , Alasmri Boshra Saeed4,
Altuwajiri Abdulrahman Abdulaziz S , Al-Hussan Taef Hassan,
Alhawaj Fatimah Abdulwahab6 , Alhawaj hanan Abdulwahab7
1-Jazan University, 2-Umm Alqura University, 3-Maastricht University, 4-King Khalid University
5-Majmaah University, 6-Dammam University, 7-Arabian Gulf Universit


Background: Domestic violence against Saudi women is arising recently. Also, statistics indicate that
married women are the largest segment of abuse victims in Saudi society.
Objectives: Estimating the prevalence of female abuse allover Saudi Arabia as well as assessing the most
important factors associated with abuse.
Methods: The survey was conducted during the period from January to April 2017. The study population
consisted of 758Saudi Arabian females from thirteen governorates of Saudi Arabia. A self-administrated
questionnaire that consists of 3 scales including demographics of females and husband's and the perception
of women toward causes of abuse, frequency and types was distributed among participants. Results: The
prevalence of abuse among the studied population was 32%%. The most common risk factors for being
abused were addiction to drugs and alcohol. The majority of women reported minor physical abuse.About
40.5% of women asked for divorce after abuse. Being divorced, low educated, jobless, polygamy family
were considerably associated with being abused. Illiterate husbands, jobless and low income were shown to
be the most important male variables that were associated with abuse.
Conclusion: The abuse showed a high prevalence rate (36%) indicating high ignorance of female rights as
well as increasing the range of abuse allover KSA. The most significant factors associated with abuse were
being working, low education of female and husband. Also, non-working husbands and poor income were
related to high abuse levels.
Keywords: Wife, Abuse, Physical, KSA.


The worldwide prevalence of abuse was a focus
several causes of domestic violence in Saudi
of many researchers as well as national surveys for
Arabia such as ignorance regarding women's
studding its causes and impacts on the mental as
rights, and social approval of violence(1, 7, 8).Also,
well as physical health status of women (1-3).The
abused women reported many obstacles after
overall prevalent rates of abuse varied from 10-
being abused to express their feeling, can't report
50% with different rates from developed and
being abused, social habits and traditions in
developing countries and the studies were
addition to privacy of family; thus women escape
conducted in emergency departments, community
through pursuing divorce as the only solution (1, 9).
based or international surveys as well as police
This study aimed to evaluate the prevalence of
records (4-6).
physical wife abuse among teachers of
In KSA, its prevalence is increasing
intermediate schools in KSA.
dramatically ranging from 39 % to 58% with

several types as physical and emotional abuse(5, 6).
However being a serious problem, violence is a
Study design and population
hidden problem in Arabic and Islamic countries
A quantitative, cross-sectional study
and most of abused females didn't tell health care
was conducted in Saudi Arabia, a Middle-Eastern
providers that they were abused (1).
country with an estimated population of
The factors related with abuse in KSA may be
31,742,308 people according to the General
unfamiliarity with the rights of women, there are
Authority for Statistics, Kingdom of Saudi Arabia
Received: 12 / 04 /2017 DOI : 10.12816/0038213
Accepted: 20 / 04 /2017

Full Paper (vol.681 paper# 32)