The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1088-1093
Assessment of Knowledge, Perception and Impacts of Acne Vulgaris
among Saudi Community
Lama Mohammed Al Saud 1, Shaza Omar Alorabi2,Turki Mobark Alenzi 3,
Huda Ibrahim Alrwebah1 ,Wafa Ibrahim AlSaab4
1-King Saud Bin Abdulaziz University for Health Sciences,2-King Abdulaziz University
3-Northern Border University ,4-Princess Nourah bint Abdulrhman university
Background:Acne vulgaris is one of the most common dermatological diseases that affect young people. The
etiology of acne vulgaris is dependent on genetic factors and environmental and psychological stressthat
impact the quality of life.
Objectives:Evaluating the knowledge, perception and impact of Acne vulgaris Among Saudi Community and
its association with demographics of included subjects.
Methods: A questionnaire based on cross-sectional study was distributed among 452 adult populations from
KSAfor assessment of demographics of included subjects, knowledge and awareness of acne risk factors,
health belief and preventive behavior.
Results: Most subjects were aged 46-69 years old. Most of participants were females, married and highly
educated. The prevalence of acne was 12%. Genetics and psychological stressors were the most important risk
factors for acne. The level of knowledge was about acne and its risk factors were found to be good in 62% of
subjects. The level of knowledge was significantly associated with higher education and female gender. The
most common reported psychological effects of acne were embracement and depression.
Conclusion: A high level of awareness about acne was found among most of the participants and it was
significantly associated with female gender and higher education levels. The prevalence of acne was low
(12%) however it cannot be generalized allover KSA. Acne critically impacts the social behavior, increased
depression among patients.
Keywords: Acne, dermatology , KSA
usually cures spontaneously(14, 15).Patients with acne
Acne vulgaris is one of the most common
dermatological diseases that affect young people(1,
2). The etiology of acne vulgaris is dependent on
significant psychological dissatisfaction that
impacts the social, employment and educational
psychological stressors(3). Other factors could also
performance(16, 17). Deficient knowledge and wrong
contribute to enhancing the acne development as
beliefs despite high prevalence were found in
puberty, menstrual cycles, high carbohydrate diet,
KSA(18, 19). This study aimed to examine the
as well as infection(4-6).Four key elements are
prevalence, awareness of Saudi population toward
associated with the pathogenesis of acne like higher
acne vulgaris and studying the association between
production of sebum, agitated cornification of the
knowledge and demographic' of included subjects.
pilosebaceous unit, pathogenic microbial flora, and
Acne is a multi-factorial chronic and inflammatory
This is a cross-sectional community-based
disease that affect the pilosebaceous units of the
survey among the adult population in KSA aged
skin. The most common characteristics of acne
from 18 to above 70 years old of both genders. This
vulgaris are development of comedones, papules
study covered all governorates of KSA during the
and pustules. On the other hand, the prevalence of
period from January 2017 to May 2017.
pseudo cysts and nodules are scarce(13). Acne poses
a chief impact on psychological life of affected
The estimation of the sample size was calculated by
patients however it's being benign condition that
Raosoft sample size calculator as the response to all
questions was assumed to be 40%. Using a 5%
Received: 14 / 04 /2017 DOI : 10.12816/0039034
Accepted: 22 / 04 /2017
Paper 2 final copy
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1094-1100
Multi Drug Resistant Bacteria and Its Antibiotic Susceptibility at
Percutanous Endoscopic Gastrostomy (PEG) Tube Site of Long Term
Care Facility Elderly Residents
Reem Mohamed Sabry EL Bedewy
Geriatrics and Gerontology Department, Ain Shams University, Egypt
Corresponding author: Reem Mohammed Sabry EL Bedewy, Tel: 00201119955249; E mail:
Background: Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and
nutritional support in patients with a functional gastrointestinal system who require long-term enteral
nutrition. The objective of this descriptive study was to detect the commonest multidrug resistant bacteria
and its antibiotic sensitivity at PEG tube site of elderly residents at long term care facility (LTCF). Forty
two long term care facility elderly residents bedridden were having multi drug resistant organisms at
percutaneous endoscopic gastrostomy tube site. Informed consent taken from each patient or from his/her
guardian, also Ethical committee approval was obtained. Demographic data were collected and
comorbidities were established. Culture and sensitivity was done for pus samples from PEG tube site
(stoma) and documented multidrug resistant organisms with antibiotic susceptibility to a range of different
antibiotic groups. All samples were processed as per standard techniques and bacteria identified by standard
biochemical tests. IBM SPSS statistics (version 24, IBM corp., USA, 2016) was used for data analysis. The
age ranges from 60 to 79 years with mean 69.19 +/- 7.01 years. 47.6 % of residents in the age group 60-66 y
while 52.4% of residents are in the age group 67-80 y. Males were 57.1% while females were 42.9 %, The
predominant resistant detected organism in this sample was Klebsiella (57.1%) while E coli accounts for
28.6% and Proteus is 14.3%. The study revealed that klebsiella was highly statistically significant sensitive to
Cefepime (CPM), Imipenam (IMP), Ciprofloxacin (CP), and Colistin (CT) and statistically significant
resistant to Trimethoprim/Sulfamethoxazole (TS), and tobramycin (tobra.) Whereas Proteus was highly
statistically significant resistant to Cefepime (CPM), Colistin (CT), Imipenam (IMP) and highly statistically
significant sensitive to Ciprofloxacin (CP), Trimethoprim/Sulfamethoxazole (TS), tobramycin (tobra.). E
Coli was found to be highly statistically significant intermediately sensitive to Cefepime (CPM), Colistin
(CT), and Tobramycin and highly statistically significant resistant to Ciprofloxacin (CP),
Trimethoprim/Sulfamethoxazole (TS). Further studies are recommended on larger numbers of elderly
patients to confirm significant findings in this study, try to explain these findings, and make use of them in
Keywords: Antibiotic susceptibility, multi drug resistant bacteria, percutaneous endoscopic gastrostomy
(PEG) tube, long term care facility, elderly residents.
occurring in 5%-25% of cases in cohort studies8-10.
Percutaneous endoscopic gastrostomy (PEG) is
Resistant organisms causing PEG wound
the preferred route of feeding and nutritional
infections are a significant problem with a major
clinical impact and data from Lipp A and Lusardi
gastrointestinal system who require long-term
G review is that administration of systemic
enteral nutrition1. The reported rates of
prophylactic antibiotics for PEG placement
complications following percutaneous endoscopic
reduces peristomal infection11. Many patients
gastrostomy (PEG) tube placement vary from 16
requiring PEG are elderly with co-morbidities,
to 70 percent 2-6.
PEG wound infections caused by an increasing
A large meta-analysis reported a procedure -
incidence of resistant organisms5,12 . Residence at a
related morbidity of 9.4% and mortality of 0.53%
LTCF and older age are both recognized as
7. Peristomal wound infection is fairly common,
significant risk factors for harboring Multi drug
Received: 01 / 04 /2017 DOI 10.12816/0039035:
Accepted: 10 / 04 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1101-1106
Prevalence of Risk Factors for Coronary Heart Disease among
Patients Presented in Cardiology Clinic at King Abdul-Aziz
Hospital and Oncology Center Jeddah
Asma Saad Al Ahmari1, Wafaa Mohammed Alsbhani2, Mona Ahmed Al Hamad3, Sukayna Adil Al
Hamad4, Duoaa Mohammad Sakabomi5, Saja Mohammad Aljehani6, Molook Shebeeb Alotibi7
1 King Khalid University, 2 Ibn Sina National College For Medical Studies, 3 Safwa General Hospital,
4 Abqaiq Hospital, 5 October 6 University, 6 King Abdul Aziz University, 7 King Saud University
Background: Coronary heart disease is the leading cause of death in Saudi Arabia. We designed this
study with the objective to determine the prevalence of risk factors of this disease within patients
diagnosed with CHD.
Aim: our aim is to observe the current prevalence of risk factors of coronary heart disease (CHD), with
respect to the lifestyle. We will attempt to identify the possible causes of such habits.
Patients and Method: a cross-sectional study among 300 Saudi patients, with known coronary heart
disease, was conducted with help of a questionnaire. The study was conducted at the cardiology
department of King Abdul Aziz Hospital & Oncology Center in the city of Jeddah.
Results: the prevalence of CHD was higher in the male gender by a ratio of 2:1. Also, the prevalence
increases with age, the highest being found in age group over 75 years old which is 8 times higher than
was observed in age group 35-44 years. 72.5% females and 52.6% males of these atherosclerotic patients
was either overweight or obese. The same trend is seen in negative habits of 10 years duration, such as
lack of exercise as high as 75.6 % in males and 81.3% in females. Intake of fatty/fast food was found to
be 64.85% in both sexes. Intake of sweet/ sugary food was also high, and unfortunately consumption of
fruits and vegetables was low. The current smoking trend is 45.9% in men and 21.95% in women.
Conclusion: The risk factors assessed in the study were gender, age, obesity, smoking history, physical
inactivity, and eating habits. Unfortunately, physical inactivity, bad eating habits, and smoking were
found to be very common. The patients must be encouraged to practice healthy lifestyle modifications to
reduce morbidity and mortality.
Keywords: coronary heart disease; Saudi Arabia; risk factor prevalence; lifestyle habits in patients with
coronary heart disease.
According to the WHO  data published in May
Due to rapid economic growth in Saudi Arabia
2014, mortality due to coronary heart disease
with encouragement of free trade, it led to
(CHD) in Saudi Arabia reached 19,569 or
socioeconomic growth and sudden change in life
24.34% of total deaths, and ranks one in the
style from the past three decades with increased
leading causes of death in the Kingdom.
intake of poor quality food and adoption of a
Dyslipidemia, hypertension, diabetes, obesity,
very sedentary lifestyle . Obesity is a major
smoking, poor diet, lack of physical activity, and
drawback in the Saudi society. The prevalence
alcohol consumption are the most common risk
of BMI >30 among Saudi men was found to be
factors for myocardial infarction worldwide,
24.1% while among women it reaches 33.5% .
The overall prevalence rates of physical
INTERSTROKE studies . The national survey
inactivity among Saudi children, youth and
in Saudi Arabia reported 5.5% prevalence of
adults were roughly 60%, 70%, and 80%,
CHD, which is comparatively higher than China
respectively . In a study done by Noura A. et
(2%), India (3%) and Europe (5%), but lower
al.  95.4% of participants consumed
than the United States (6.7%) and Egypt (8.3%)
restaurants' fast food and 79.1% eat fast food at
[3, 4, 5].
least one time per week. Burgers and carbonated
soft drinks were the major kinds of fast food
Received: 10 / 04 /2017 DOI : 10.12816/0039036
Accepted: 18 / 04 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (1), Page 1107-1116
Management of Chronic Osteomyelitis Following Gunshot Injuries:
A Systematic Review of Literature
Esam E. Abuharba, Amr M. Abdelhady and Saleh G. Mansour
Orthopedic Department, Faculty of Medicine, Ain Shams University-Egypt.
Corresponding author: Esam E. Abuharba. Phone: 00201019480444. Email: firstname.lastname@example.org
Background: Chronic osteomyelitis of long bones are common in daily clinical practice, however, the
treatment of these diseases has still been a challenge and difficult for orthopedic surgeons. Gunshot injuries
lead to damage to bone and soft tissues that can complicate with bacterial invasion and cause bone
infection. Many ways can overcome of bone infection, surgical debridement, bone fixation and antibiotic
are used in management of chronic osteomyelitis. The objective of this systematic review was to review
available studies reporting in management of chronic osteomyelitis following gunshot injuries and compare
the methods used into the treatment.
Methods: A comprehensive literature search was performed from the electronic databases Medline,
PubMed, Google scholar, and Cochrane collaboration between 1995 and 2016. References were analyzed
from included studies, inclusion criteria included (1) English literatures, (2) Humans clinical trials, (3)
Orthopedic Journals only, (3) Definitive treatment strategy for management chronic osteomyelitis. In total,
5 articles were included in the systematic review.
Results: A total of 278 patients from 5 studies were included in this systematic review. The mean age of the
patients is all studies were 33.84 year, the ratio male to female is 6:1. The most of patients were classified
as Gaustilio type lllB and CiernyMader type lllB. The result of all different studies shows a good outcome
in 260 patients but 7 patients had poor outcome who were still had bone infection and one patient end by
amputation. Radiographic X-ray did postoperative follow up every two weeks. The mean follow up
duration was 40 months and all patients responsible for keep the fixator clean.
Conclusion: Our systematic review showed that the patients with chronic osteomyelitis were treated by
surgical debridement and bone fixation had a good result. But, this research lost the randomized trials
methods, risk factors of patients, compare control groups and good statistical analysis. Without any direct
comparison of treatment modalities, it is difficult to determine which individual treatment option is the most
Key words: Osteomyelitis, chronic infection, surgical treatment, gunshot injury, and radical debridement.
The term osteomyelitis defined as an inflammatory process accompanied by bone destruction and infected
by microorganism. The infection can be limited to a portion of the bone or can involve several regions, such
as periosteum, cortex, marrow, and the surrounding soft tissue. Historically, osteomyelitis has been
classified as acute, subacute, or chronic based on occurrence of infection or injury. The duration of
symptoms of infection is associated with peculiar anatomo-pathological findings and clinical and diagnosis
features (1). Management of chronic osteomyelitis is challenging to the patient and physician at the same
time. Treatment of chromic osteomyelitis consists of excision of the devitalized material, skeletal
stabilization, obliteration of dead space, obtaining good soft tissue cover and reconstruction of the bone
defects, all in conjunction with antibiotics (2).
Received: 01 / 04 /2017 DOI : 10.12816/0039037
Accepted: 10 / 04 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1117-1125
Glucocorticoids Induced End Organs Damage in Patients with
Systemic Lupus Erythematosus
Mohammed Afify Abd-El-Atty, Eman Ahmed Hafez, Noha Hussien Shedid and
Dalia Abdel Hamid El Sherbiny
Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Eman Ahmed Hafeez Mobile: 01005296023 , Email: Eman.email@example.com
Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that affects multiple
organs and requires long term treatment with GCs. GC-related end organ damage in SLE appears in the form of:
osteoporosis, Avascular Necrosis (AVN), cataracts, diabetes (DM) and cardiovascular disease.
Aim of the work: the present work was to assess the prevalence of the complications in SLE patients who were
treated with GCs for long periods and with moderate to severe cumulative steroid doses.
Patients and Methods: This study was done on 50 SLE patients who fulfilled the SLICC criteria for diagnosis
of SLE. All patients subjected to full history taking, clinical examination, slit-lamp examination to assess
cataract, laboratory investigations (ESR, CRP, FBS, 2-H PP, CBC, C3, C4 and anti-dsDNA), DEXA scan, MRI
scan (when needed), SLEDAI score and SLICC score assessments. All data were collected, tabulated and
statistically analyzed. Results: Regarding the frequency of steroid induced complications, 38% were
osteopenic, while 18% were osteoporotic patients. 10% had AVN. 18% had cataract. 14% had DM. There was
very strong relationship between steroid duration and the frequency of DM and cataract. But in osteopenia,
osteoporosis and AVN, there were weak relationship regarding steroid duration. There was very strong
relationship between cumulative steroid dose and the frequency of DM, cataract, osteoporosis and AVN. There
was no relationship between age and osteoporosis and AVN but in cataract and DM, there was strong
relationship. There was no relationship between sex and complications (DM, cataract, osteopenia, osteoporosis
and AVN). There was no relationship between disease activity (measured by SLEDAI score) and frequency of
steroid complications (DM, cataract, osteopenia, osteoporosis and AVN). There was strong relationship
between end organ damage (measured by SLICC damage index) and frequency of steroid complications (DM,
cataract, osteoporosis and AVN). Conclusion: Steroid intake (duration and dose) were major risk factors for
developing end organ damage in SLE patients.
Key words: SLE, steroid induced osteoporosis, AVN, cataract, DM, end organ damage.
Systemic lupus erythematosus (SLE) results
Their efficacy in treating SLE is beyond doubt.
from chronic and recurrent activation of the immune
However, GC-related side effects are many and
system, with production of antibodies and other
serious. Indeed, prednisone use has been consistently
protein products contributing to inflammation and
shown to increase irreversible damage in lupus
tissue damage . It is characterized by the
patients, a major predictor of morbidity and
production of a broad array of autoantibodies, with
. Glucocorticoid-related damage
antinuclear antibodies having the greatest sensitivity
calculated using the SLICC damage index is
for the diagnosis and antidouble-stranded DNA
defined as avascular osteonecrosis, osteoporosis,
antibodies having the greatest specificity . It is a
Glucocorticoid use is associated with significant
disproportionally affects women, especially in their
morbidity and mortality. Osteoporosis, with resultant
reproductive years . It may manifest as a mild
fractures, constitutes one of these morbid
disease with skin or joint involvement only or may
complications and is associated with significant pain
be severe, affecting vital organs such as the kidney,
and disability . Glucocorticoid administration is
central nervous system (CNS), and heart. This is
often overlooked as the most common cause of non-
why SLE has been addressed as a constellation of
traumatic osteonecrosis . Chronic glucocorticoid
different clinical variants, or better, as a galaxy .
therapy is associated with an increased risk of
Glucocorticoids (GCs) are among the most potent
immunosuppressive and anti-inflammatory drugs.
recommendations have been developed for
Received: 01 / 04 /2017 DOI : 10.12816/0039038
Accepted: 10 / 04 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1126-1134
Quality of life in Heamodialysis Patients with Residual Renal Function
Abdel-Basset El-Shaarawy Abdel-Azim, Abdel-Rhman Nabil Khedr and
Safaa Ahmed Abdel-Hamid
Internal Medicine and Nephrology Department, Ain Shams Faculty of Medicine
Corresponding author:Safaa Ahmed Abdel-Hamid(Email dr-safaaahmed 2005 @yahoo.com,01061743380).
Background: patients undergoing maintenance heamodialysis (HD) have a progressively loss of residual
renal function (RRF), Short-term morbidity and mortality are significantly higher in patients lost RRF,and
these patients frequently die before the development of long term complications of dialysis. HD patients
without preserved RRF have greater hospitalization rate, more significant malnutrition and health related
quality of life. Aim: the aim of the present study was to assess impact of RRF on QoL in chronic HD
patients and to study clinical and laboratory characteristics of these patients.
Patients and Methods: this cross sectional study was carried out on 40 adult clinical stable regular HD
Patients. They were divided into 2 groups according to the presence or absence of RRF.Group 1 included
20 HD patients with RRF (defined as urine volume >200 ml/24 h) and group 2 included 20 patients
without RRF (defined as urine volume <200 ml/24 h).
Results: patients with preserved RRF had a positive significant correlation between QoL scores, male
gender ,younger age, employment, higher BMI (p=0.006), higher hemoglobin (p=0.036), higher predialysis
serum creatinine (p=0.033), less complication during HD sessions hypotenstion (p=0.003),
hypertenstion(p=0.003), vomiting (p=0.017), cramps(p=0.010)and Less use of Phosphate binders and
Erythropoietin dose (p=0.020).
Conclusion: HD patients with preserved RRF had better QoL scores compared to patients without
RRF.Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged.
Keywords : residual renal function, heamodialysis, quality of life.
and vitamin D homeostasis, volume control, and
End-stage renal disease (ESRD) is a chronic
removal of "middle molecules" as 2-
restrictive illness that affects many aspects of
microglobulin or low molecular weight proteins (7
patient's life. Moreover, ESRD has become
worldwide public health problem(1)causing a high
RRF is associated with improved
level of disability in different domains of the
hemoglobin, reduced blood pressure,reduced left
patient lives,leading to impaired QoL (2).
ventricular hypertrophy (LVH),and improved
Health-related quality of life (HRQOL) is a
QoL (7 ,8 ). Furthermore, it has been shown that
multi- dimension concept that reflects a patient's
clinically important and statistically significant
perceived well-being and functioning in physical,
decreases in nutritional parameters occur with
psychological and social domains of health
RRF loss (6). Most of studies of RRF were
(3).Subjective HRQoL evaluation has particular
done in peritoneal dialysis(PD),very few
importance among patients groups suffering from
studies have analysed the relation between
chronic,degenerative or terminal conditions where
RRF and important outcomes in HD patients
the aims of health interventions are to improve
(7).The loss of RRF varies from one patient to
QoL rather than a curative effect(4).QoL is related
another,both on HD and on PD, but certain
with morbidity and mortality in HD patients,and
characteristics inherent to HD ,such as episodes
it is suggested that QoL should be considered in
of hypotension , volume depletion, and activation
the regular monitoring of dialysis patients(5).
of inflammatory mediators associated with the
biocompatibility of the dialyser and the
RRF on chronic HD is defined as a urine
dialysate , have been implicated as the primary
volume >200 ml/24 h (6).In recent years, there has
causes of loss of RRF in these patients (9).
been a greater focus on RRF of patients on
Strategies for preserving RRF start with the
chronic HD (6). RRF doesn't only reflects
recognition of its importance. It must be
remaining glomerular filtration rate (GFR) but it
measured regularly. The choice of dialysis
also reflect remaining endocrine functions such as
modality is important, but it would be a mistake
erythropoietin production, calcium, phosphorus
to think that the requirement to preserve RRF
should override other prerogatives .If ambulatory
Received: 01 / 04 /2017 DOI : 10.12816/0039039
Accepted: 10 / 04 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1135-1140
Role of High Resolution Computed Tomography in Diagnosis of
Interstitial Lung Diseases in Patients with Collagen Diseases
Marina Mikhail Fouad Hanna, Ahmad Mostafa Mohamed, Ahmed Mohamed Osman
Radiology Department, Faculty of Medicine, Ain shams University
Aim of the work: a descriptive study including analysis of HRCT chest done for patients known to have
collagen diseases for diagnosis and classification of interstitial lung diseases.
Patients and methods: forty five patients were included in our study (23 rheumatoid arthritis, 14 systemic
lupus erythematosis and 8 scleroderma). This was a retrospective study that included patients with collagen
diseases either outpatients or referred from the Rheumatology Departement at Ain Shams University
Hospitals to the Radiodiagnosis Department for HRCT chest examination.
HRCT chest images were interpreted for identification of lung interstitium architectural abnormalities
associated with collagen diseases and they were statistically analyzed. Results: The mean age of the selected
patients was about 42 years old. Parenchymal involvement was noted in 30 cases that represented 66.6% of
included cases in the study, 15 cases had normal HRCT of the chest representing 33.4% of the cases.
Conclusion: HRCT of the chest has a reasonable role in the diagnosis of interstitial lung diseases and has the
ability to be classify according to the pattern of involvement, distribution and extent of the disease as well as
to estimate the severity and help in prognosis of the disease process.
Keywords: High resolution computed tomography (HRCT); Interstitial lung diseases (ILD); Collagen
diseases (CD); Rheumatoid arthritis (RA); Systemic Lupus Erythematosis (SLE); Systemic Sclerosis (SS)
disorders with potentially substantial morbidity and
Collagen vascular diseases (CVDs), also
known as connective tissue disorders (CTDs),
ILD was defined as restrictive lung
include a diverse group of immunologically
function impairment (TLC and DLCO <80%
predicted) and/or radiologic signs consistent with
inflammatory response may affect many organs.
ILD on chest radiograph or HRCT .
Lung disease-especially interstitial lung disease
Interstitial lung disease (ILD) includes a
(ILD)-is frequent in the course of rheumatological
heterogeneous group of disorders that result in
diseases and causes mortality and morbidity rates to
diffuse parenchymal lung disease, with overlapping
increase. Since the overall incidence of ILD has
been estimated at 15%, physicians are urged to
make an early diagnosis and decide the best
HRCT is valuable in detecting ILD in
treatment for ILD in CVDs .
patients with a normal chest radiograph. In the
Interstitial lung disease (ILD) is frequent in
appropriate clinical setting, appearances on the
collagen vascular diseases (CVD) such as
HRCT scan may be sufficiently characteristic to
scleroderma, Sjogren's syndrome, systemic lupus
preclude the need for broncho-alveolar lavage
(BAL) or lung biopsy and histopathological
Although the clinical features of ILD associated
determining the protocol and interpretation of
with CVD are similar to those of idiopathic
HRCT scans should have expertise in the
interstitial pneumonia (IIP), the survival in CVD-
technique, be responsible for quality assurance and
ILD is much better, and most patients have a
ensure that an appropriate radiation dose protocol is
chronic indolent course .
used . ILD on HRCT was defined by the presence
Some of the most pressing challenges
of at least 1 of the 2 following radiologic features:
associated with interstitial lung disease (ILD) are
ground-glass opacification, and a reticular pattern
how best to define, diagnose and treat connective
including reticulation, bronchiectasis due to
tissue disease-associated ILD (CTD-ILD)--
macrocystic reticular pattern) .
Received: 5 / 06 /2017 DOI : 10.12816/0039040
Accepted: 14 / 06 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1141-1145
Stem Cell Therapy in Glaucoma
Hany M. El-ibiary , Lamia S. Elewa , Maha M. Ibrahim , Eman M. Wady
Department of ophthalmology. Faculty of medicine. Ain shams university
Glaucoma is a chronic, degenerative optic neuropathy, which cause progressive damage to the optic
nerve, retinal ganglion cell (RGC) death and characteristic damage to the visual field. Current glaucoma
therapeutics lower intraocular pressure (IOP) but they do not repair the damaged optic nerve or reverse vision
loss. So, new treatment strategies are in demand. Stem cell therapy presents a new intervention that holds
great promise for reversing vision loss. There are at least 3 potential targets for stem cell therapy in glaucoma:
the retinal ganglion cells , the optic nerve head, and the trabecular meshwork. Stem cells also have a
neuroprotective effect in glaucoma by improving retinal ganglion cell survival. There are many obstacles in
using stem cells in glaucoma as the regulation of differentiation, integration, host immune response,
tumorigenesis and ethical concerns.
Keywords: glaucoma, stem cell, transplantation, cell therapy , trabecular meshwork, neuroprotection.
Glaucoma is a chronic, degenerative optic
3. Angle closure glaucoma.
a. Primary angle closure glaucoma: Acute,
degeneration of retinal ganglion cells, optic nerve
Intermittent, Chronic, Status after acute angle
damage and results in irreversible loss in the visual
closure glaucoma attack and Primary angle
field. Current glaucoma therapeutics lower
closure glaucoma suspect, and
intraocular pressure by reducing aqueous humor
b. Secondary angle closure glaucoma: With
formation or increasing outflow of fluid (1).
pupillary block, With anterior pulling
Stem cell therapy presents a new
mechanism without pupillary block and With
intervention that holds great promise for reversing
posterior pushing mechanism without
vision loss. Particularly, as pluripotent stem cells
pupillary block (4).
can divide indefinitely and differentiate into
Aqueous Humor Dynamics
almost any types of cells in the body. In addition,
Aqueous humor is secreted by the ciliary
stem cells or progenitor cells can also work
body and fills the anterior chamber (the space
through a neuroprotective mechanism by secreting
between the cornea and the iris) and posterior
neurotrophic factors that prevent cell loss (2).
chamber (the space between the iris and lens).
There are two pathways for outflow of aqueous
Glaucoma is the leading cause of
humor , the trabecular or conventional outflow
irreversible blindness in the world. It can remain
pathway, through which most of the aqueous
asymptomatic until it is severe, resulting in
humor leaves the eye and uveoscleral pathway (5) .
presence of high number of undiagnosed
Management of Glaucoma
Treatment of glaucoma is long term; thus,
Glaucoma can be classified according to
it needs to be supplemented by a comprehensive
European Glaucoma Society Guidelines ( EGSc)
approach to the patient, including education about
the condition and the purpose of treatment. All
1. Congenital forms/ childhood glaucoma.
currently available drugs for treating glaucoma
2. Open angle glaucoma.
work by lowering the IOP via one or both of the
a. Primary open angle glaucoma ( POAG) :
following mechanisms: reduce the secretion of
POAG with high pressure , POAG with
aqueous humor; and/or increase the outflow of
normal pressure, Primary juvenile glaucoma,
aqueous humor through the trabecular meshwork
POAG suspect and Ocular hypertension.
and/or the uveoscleral pathway (6).
b. Secondary open angle glaucoma : Caused by
The treatment options currently available
ocular diseases, Iatrogenic secondary open
are medical therapy which is usually in the form of
angle glaucoma and Caused by extrabulbar
topical medications; laser therapy and surgery (6).
Received: 28 / 05 /2017 DOI : 10.12816/0039041
Accepted: 7 / 06 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1146-1154
Systematic Review: Osteochondral Allograft in Treatment of Knee
Articular Cartilage Injuries
Ahmad Mohamed Elsaeed, Ashraf Mohamed Elseddawy, and Mohammed Elmowafy Abdelwahed
Department of Orthopedics, Faculty of Medicine, Ain Shams University.
Purpose: The objectives of this study were designed to conduct a systematic review of clinical outcomes
after osteochondral allograft transplantation in the knee and to identify patients, defects, and graft-specific
Methods: We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled
Trials. Studies that evaluated clinical outcomes in patients after osteochondral allograft transplantation for
chondral defects in the knee were included.
Results: There were 11 eligible studies resulting in 550 knees with a mean follow-up of 150 months
(range, 30 to 261 months). The overall follow-up rate was 93%. The mean age was 31 years (range, 15 to
52 years), and 478 patients (63%) were men. With regard to etiology, the most common indications for
transplantation included post-traumatic (38%), osteochondritis dissecans (31%), osteonecrosis from all
causes (12%), AVN (1%) and idiopathic (9%). 63% of patients had concomitant procedures, and the
mean defect size across studies was 6.3 cm2. The overall satisfaction rate was 93%.
Conclusions: Osteochondral allograft transplantation for focal and diffuse chondral defects results in
predictably favorable outcomes and high satisfaction rates. Patients with osteochondritis dissecans,
traumatic and idiopathic etiologies have more favorable outcomes as younger patients with unipolar
lesions and short symptom duration. Future studies should include comparative control groups and use
established outcome instruments that will allow for pooling of data across studies.
The level of Evidence: Level IV, a systematic review of Level IV studies.
Keywords: Osteochondral allograft, Knee, treatment, osteochondral lesion
14 days, and allografts generally should be
Managing osteochondral defects of the knee in
implanted within 24 days3,4. Notably, frozen
young to middle-aged patients poses a difficult
problem for orthopedic surgeons. In the setting of
biomechanical properties compared with fresh
bony defects, as well as for larger chondral lesions,
treatments such as microfracture, autologous
Fresh osteochondral allograft transplantation
chondrocyte implantation (ACI), and osteochondral
was initially used to treat osteochondral defects
autograft transfer may be inadequate, leaving
after trauma or tumor; however, its indications have
osteochondral allograft transplantation as the main
expanded to include acute and degenerative
treatment option1. Osteochondral allografts are also
chondral defects of the knee (osteoarthritis,
indicated in patients after failure of other cartilage
spontaneous osteonecrosis of the knee [SONK],
repair technologies for chondral defects. The main
avascular necrosis, inflammatory conditions) 1.
advantage of using allograft is the presence of both
Most commonly, implanted in the femoral condyle,
viable hyaline cartilage and structural bone2.
allograft can also be implanted in the tibial plateau,
Historically, grafts were implanted within 24 hours
the femoral trochlea, and the patella; case series
of procurement, but concerns about disease
also report its use in more than one area of the knee
transmission have led to a minimum of 14 days
at a time7,8. Other variables in the allograft
required for aerobic, anaerobic, and spore forming
literature include the size of the lesion treated, the
bacteria, as well as, viral testing before release. In
use of concomitant procedures (high tibial
addition, aseptically processed prolonged fresh
osteotomy, distal femoral osteotomy, meniscal
grafts are most commonly used and maintained at
allograft), patient age, and the number of previous
4_C as opposed to frozen or cryopreserved grafts2.
procedures. As such, there is clearly a large number
Unfortunately, it is known that chondrocyte
of patient- and defect-specific variables that impact
viability decreases in allografts stored for more than
the outcomes after fresh osteochondral allograft
Received: 26 / 05 /2017 DOI : 10.12816/0039042
Accepted: 5/ 06 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1155-1161
Effect of Autologous Fibrin Gel and Platelet Rich Plasma Activated
by Ozone Versus Those Activated by Calcium Chloride on Wound
Healing and Prevention of Infection in High Risk Cesarean Sections:
Randomized Controlled Study
Marwa Wanas, Waleed Khalaf, Mohamed Elmandooh
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Marwa Wanas, e-mail address: firstname.lastname@example.org,tel.: 01229073329
Background: Cesarean delivery, one of the most common major surgical procedures performed
worldwide used for 15% of births around the world and it continues to increase in frequency. It is an
important contributor to surgical site complications such as infection, hematoma and dehiscence. Platelet
Rich Plasma (PRP) is a volume fraction of blood having a high concentration of platelets above the
baseline. This product is a rich source of growth factors. PRP can be activated by CaCl2 or medical Ozone.
The induction of growth factors found in PRP by ozone can support and potentiate their action.
Aim: The purpose of this study is to compare the effect of application of autologous Fibrin Gel and
Platelet Rich Plasma (PRP) activated by medical Ozone (Ozonated PRP) versus those activated by CaCl2
on wound healing and prevention of infection in high risk cesarean sections.
Design: 90 high risk pregnant females undergoing cesarean section were selected randomly according to
inclusion criteria and divided into 3 groups each contains 30 patients. Group Ca received Autologous PRP
and Fibrin gel activated by CaCl2 at the wound site. Group O received Autologous PRP and Fibrin gel
activated by Medical Ozone at the wound site while group P (control) did not receive any of them. All
patients were examined for wound complications and healing progress on day 1, day 7 and day 21
postoperative by visual analogue scale (VAS), REEDA scale and Vancouver Scar System (VSS).
Results: the results revealed statistically significance decrease in pain by VAS in group Ozone compared
to group P on day 7 and 21. For REEDA also group O showed significant decrease compared to group
Calcl on day 1 and 7 while compared to group P was also decreased on day 1, 7 and 21. Group Cacl was
significantly decreased compared to group P on day 7 and 21 only. Regarding VSS both group O and
group Cacl were significantly decreased compared to group P on all days.
Conclusion: this study gives evidence that applying autologous platelet rich plasma (PRP) promote
wound healing and when activated by Ozone gives better results and helps prevention of infection in
cesarean section of high risk patients.
Keywords: Cesarean section, PRP, Ozone.
and 15% and depends on factors such as
Cesarean section accounts for a substantial
antibiotic prophylaxis, length of labor, duration
proportion of total deliveries. In the United
of internal monitoring and duration of rupture of
States, the rate has risen steadily in the last half
century, peaking at 31% in 2006. At the same
Surgical wounds heal through a sequence of
time, the overall rate of post-CS complications is
several distinct physiological and biological
decreasing owing to use of antibiotic prophylaxis
events that include hemostasis, inflammation,
and regional anesthesia. Nevertheless, as
proliferation, epithelialization, fibroplasia, and
compared to vaginal deliveries, CS is still
maturation. This process is initiated immediately
associated with a higher risk of immediate and
upon injury. A platelet plaque develops which is
long-term maternal morbidity and mortality than
composed of platelets and fibrin, and the
vaginal delivery .
platelets release granules containing multiple
growth factors and thromboxane A2, the latter of
cesarean section is a commonly encountered
which acts as a potent vasoconstrictor .
complication. Its incidence ranges between 3%
Platelets are small discoid blood cells. The
Received: 22/ 05 /2017 DOI : 10.12816/0039043
Accepted: 01/ 06 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1162-1168
Calcium in the Management of Atonic Postpartum
Abd El-Samie M, Abd El- Hamid A, El-Ashmawy A, Ahmed B
Department of obstetrics and gynecology- Al-Azhar University-Assiut
Objective: was to compare the role of methergine, misoprostol and calcium in the management of atonic
postpartum hemorrhage. Design: Randomized Controlled Trial. Setting: This study was conducted in
obstetrics and gynecology department of Al-azhar University Hospital, Assiut.
Patients: 300 women with PPH were included in the study.
Intervention: 300 women, each received 5 IU of oxytocin as prophylaxis then divided into three groups:
Group A (N=100): women with atonic PPH took methergine, Group B (N=100): women with atonic PPH
took misoprostol and Group C (N=100): women with atonic PPH took calcium.
Outcome measures: The primary outcome was change in hemoglobin concentration before and after
Results: There was no significant difference between the three study groups as regard mean hemoglobin
level before and after treatment. However, a significant difference was present as regard mean change (drop)
in hemoglobin level after treatment, with misoprostol group showing the highest drop in Hb% (2.07 ±0.8)
compared to calcium group (1.7 ±0.8) and methergine group (1.3 ±0.5).
Conclusion: Methergine is more effective in controlling the amount of blood loss during delivery giving a
better chance in treatment of atonic postpartum hemorrhage followed with calcium then misoprostol.
Although of that calcium is good alternative to methergine with low side effects so can be used safely and
effectively when methergine is contriandicated.
Keywords: postpartum hemorrage, hemoglobin, calcium.
Postpartum hemorrhage (PPH) is a leading
nausea/ vomiting, bronchospasm, pyrexia, and
cause of maternal morbidity and mortality. In the
gastrointestinal disturbance .
developed world, the incidence of PPH overall,
AIM OF THE WORK
and that of severe cases resulting in transfusion
The aim of this study is to compare the role of
and/or hysterectomy, have increased significantly
methergine, misoprostol and calcium in the
over the first decade of the new millennium (2001-
management of atonic postpartum hemorrhage.
2010). These increases appear to be directly linked
to a concomitant increase in the incidence of
All participants were subjected to the
uterine atony . PPH can be prevented by using a
uterotonic immediately after birth of the baby, and
A) Detailed medical history including:
this intervention is recommended for all women. Personal history.
The preferred uterotonic is oxytocin, which is Menstrual history.
available in injectable form and requires Past and obstetric history (parity, methods of
refrigeration, making it impractical in settings
previous deliveries, gestational age of previous
where births still occur at home under the care of
unskilled birth attendants, or where refrigeration is
B) Physical examination:
not possible .
After history taking and fulfilling both
For prophylaxis against uterine atony,
oxytocin is routinely used during the third stage of
examination was done including: general
labor. If the uterus fails to adequately contract in
abdominal and pelvic examination.
response to oxytocin administration, second-line
C) Ultrasound examination:
uterotonics including methylergonovine maleate,
To ensure date of pregnancy, viability and
prostaglandin F2 (carboprost), calcium and
prostaglandin E1-analogue (misoprostol) are
D) Laboratory investigations:
recommended. While commonly used, these drugs
- Before intervention: Routine investigations
have important side effects and complications
including: kidney function, liver function, fasting and
including (depending on the drug) hypertension,
postprandial blood sugar and complete blood picture.
- After intervention: Hb% estimation.
Received: 22/ 05 /2017 DOI : 10.12816/0039044
Accepted: 01/ 06 /2017
Reassessment of Cases of Uncontrolled Bronchial Asthma in Port-Said Chest Hospital
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1169-1175
Reassessment of Cases of Uncontrolled Bronchial Asthma in
Port-Said Chest Hospital
Mohamed Ali Farrag, Eman Ramzy Al Adawy, Michael Moris Farid
Department of Chest Diseases, Faculty of Medicine - Ain-Shams University
Background: bronchial asthma is a heterogeneous disease characterized by chronic airway inflammation.
It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness
and cough that vary over time and in intensity, together with variable expiratory airflow limitation. This
definition was reached by consensus, based on consideration of the characteristics that are typical of
asthma and that distinguish it from other respiratory conditions. The causes of poorly controlled asthma
may lie in any of four major areas: diagnosis, medications, provoking agents, and presence of co-morbid
Aim of the work: this study aimed to assess causes of improper control of bronchial asthma among
patients in Port-Said Chest Hospital.
Patients and Methods: this retrospective study was done on 100 uncontrolled asthmatic patients selected
from outpatient clinic or inpatient wards in Port-Said Chest Hospital, over a period from January to May
Results: non-compliance and uncontrolled co-morbidities were the most common presented causes of
uncontrolled asthma (55% for each), however ttt improper represented 32% of cases. Other less common
causes were infection, offending drug, improper diagnosis, wrong technique and resistant asthma.
Keywords: asthma control test, uncontrolled asthma, bronchial asthma, asthma co-morbidities
control of bronchial asthma among patients in
The responsible causes of initiating asthma are
Port-Said chest hospital.
specific factors referred as allergens, which are
present in the patients' surroundings originating
PATIENTS AND METHODS
from outdoor and indoor environment. Hence,
allergens are divided into two categories; the
This retrospective study was done on 100
outdoor allergens such as pollen grains, fungal
uncontrolled asthmatic patients selected from
spores, dust particles and non-specific irritants,
outpatient clinic or inpatient wards in Port-Said
and the indoor allergens such as House Dust Mites
Chest Hospital, over a period from January to
(HDMs), animal allergens, fungal allergens,
insects and rodent allergens, etc... (1) .
Inadequate control of asthma continues to
present a serious problem, despite advances in our
1. Patients aged < 18 years.
understanding of the inflammatory basis of asthma
2. Gender: both sexes.
and a growing acceptance of disease management
3. According to GINA 2014 guidelines, patient
guidelines. Patients with inadequately controlled
considered uncontrolled if he has 3-4 of the
asthma often have limited therapeutic options and
remain at a high risk of serious morbidity and
Daytime asthma symptoms more than
Despite advances in the diagnosis and
Any night waking due to asthma.
management of asthma, surveys indicate that
Reliever needed for symptoms more than
many patients have poorly controlled symptoms
and experience frequent exacerbations. Three
Any activity limitation due to asthma.
quarters of hospital admissions and nine out of 10
deaths from asthma are likely to be preventable.
Patients with any other chronic disease (heart
The financial impact of asthma is considerable, in
diseases, liver diseases, kidney diseases and
large part due to the cost of asthma medications,
hospital admissions and time lost from work
Patients with upper or lower airway lung
(3).This study aimed to assess causes of improper
disease other than asthma.
Received: 29 /5 /2017 DOI : 10.12816/0039045
Accepted:8 /6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1176-1183
The Role of Diffusion Weighted MRI in The Differentiation
between Benign and Malignant Hepatic Focal Lesion
Amr Mahmoud Abdelsamed, Remon Zaher Elia, Mohammed Uday Hatim
Department of Radiodiagnosis, Faculty of Medicine - Ain Shams University
Corresponding author: Mohammed uday hatim, Email: email@example.com, Cell number: 01060560797
Background: early detection and diagnosis of hepatic focal lesions are an important step in clinical
work, which would allow effective surgical or mini-invasive therapy. With the advances in magnetic
resonance imaging (MR) technology, diffusion-weighted magnetic resonance imaging (DWI) is now
widely used as a standard imaging sequence in clinical work and shows its potential benefit in evaluation
of the focal hepatic lesions.
Aim of the work: the use of MR Diffusion imaging with both low and high B values to detect and
differentiate between benign and malignant hepatic focal lesion.
Methodology: the present study included 30 patients. They were El-Demerdash hospital patients with
hepatic focal lesions. Patients underwent US or CT before MR examination.
Results: thirty patients were included in this study, 20 males and 10 females. The patient's age was
ranging from 33 to 60 years. There were 24 primary hepatic focal lesions, (36.7% HCC, 3.3% focal
nodular hyperplasia, 3.3% cysts, 13.3% hemangiomas, 6.7% cholangiocarcinoma, 16.7% regeneration
nodule) and 6 metastatic lesions.
Conclusion: we hope to use DWI to be helpful in the characterization of focal liver lesions, especially if
the lesions show non classic appearance of contrast enhancement in Triphasic CT study and in patients
with renal insufficiency with inability to use contrast enhancement.
Recommendations: in our opinion, DWI is a useful adjunct to routine liver imaging (i.e. used as an
additional sequence to the standard protocol study and not as a unique imaging series); it is fast, requires
no intravenous contrast and is non-invasive. The radiologist has to be aware of the potential pitfalls and
limitations of the technique. In patients who cannot receive gadolinium-based contrast agents, DW MR
imaging has the potential to be a reasonable alternative technique to contrast-enhanced imaging. We
suggest the following strategy for evaluating DWI features of FLLs. We believe that most of the FLLs
can be practically classified as benign or malignant by using this scheme.
Keywords: MR Diffusion imaging, Low and high B values, DWI, Malignant hepatic focal lesion.
Early detection and diagnosis of
detection of FLLs. These studies generally
hepatic focal lesions are an important step in
showed better performance of DWI with low -
clinical work, which would allow effective
value in terms of lesion detection compared
surgical or mini-invasive therapy (1,2).
with T2WI (2).
With the advances in magnetic
DWI with higher b-value mainly
resonance imaging (MR) technology, diffusion-
reflects diffusion information of water
weighted magnetic resonance imaging (DWI) is
molecules motion within the lesions, which
now widely used as a standard imaging
help to improve the characterization of solid
sequence in clinical work and shows its
potential benefit in evaluation of the focal
Meanwhile, we found in practice that
hepatic lesions (3,4).
DWI with higher b -value also enables a better
DWI with low value can suppress the
detection of lesions in liver compared with
intra hepatic vascular signal, creating the so-
T2WI or other conventional sequences. For
called black blood effect, which improves the
example, solid focal liver lesions such as focal
detection of small focal liver lesions (FLLs)
nodular hyperplasia and hepato cellular
especially localized near small hepatic vessels.
carcinomas (HCCs) sometime can be difficult
Meanwhile, DWI with low-value has higher
to be detected on T2WI or even DWI with low
imaging quality compared with single shot fast
b -value due to either iso- or slightly hyper
spin-echo sequences (5,6).
signal intensity to liver parenchyma (7,8).
A substantial number of studies have
Diffusion is a physical process that
compared low B-value DWI with T2-weighted
results from the thermally driven, random
imaging (T2WI) for image quality and
motion of water molecules. In a container of
Received:1 / 6 /2017 DOI : 10.12816/0039046
Accepted:10 / 6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1184-1188
The Future of Glaucoma Treatment Ripasudil
Zafer F. Ismaiel , Mahmoud A. Abdel Hamed , Samah M. Fawzy , Nada E. Amer
Department of ophthalmology, Ain Shams University, college of medicine, Cairo, Egypt
Glaucoma is a leading cause for worldwide blindness and is characterized by progressive optic nerve
damage. The etiology of glaucoma is unknown, but elevated intraocular pressure (IOP) and advanced
age have been identified as risk factors. IOP reduction is the only known treatment for glaucoma.
Recently, drugs that inhibit Rho associated protein kinase (ROCK) have been studied in animals and
people for their ability to lower IOP and potentially treat POAG. ROCK inhibitors lower IOP through a
trabecular mechanism and may represent a new therapeutic approach for the treatment of glaucoma.
Ripasudil is the first Rho-kinase inhibitor ophthalmic solution developed for the treatment of
glaucoma and ocular hypertension in Japan 2014. ROCK inhibition not only reduces intraocular
pressure (IOP) but also increases ocular blood flow.
Keywords: Glaucoma, Optic nerve, K-115, Ripasudil, Rho kinase, ROCK inhibitor, Trabecular
meshwork, Ocular blood flow.
Glaucoma is an optic neuropathy in which at
Considerable evidence has shown that TM
least one eye has accelerated ganglion cell
cells are highly contractile and play an active
death characterized by excavated cupping
role in aqueous humor dynamics. It has been
appearance of the optic nerve with progressive
shown that TM tissues possess smooth muscle
thinning of retinal nerve fiber layer tissue and
cell-like properties. The contraction and
corresponding subsequent visual field loss .
relaxation properties of TM cells are regulated
Glaucoma is the second leading cause of
by several enzymes, which have become
preventable blindness worldwide. Despite
experimental therapeutic targets for lowering
availability of medical and surgical treatment
IOP. Cellular properties of the trabecular
many patients with glaucoma currently
meshwork are critical for conventional outflow
continue to lose vision . Clinically, it is well
accepted that the major risk factor for glaucoma
There are high levels of RhoA in TM cells that
is elevated intraocular pressure (IOP).
induce a contractile morphology, increased
Despite of use many drugs to modify the
actin fibers, increased focal cell to cell
course of the disease, none of the current
adhesions, increased levels of phosphorylated
medications for POAG is able to reduce the
myosin light chain (MLC) and increased
IOP by more than 25%30%. Also, some
extracellular matrix protein production. These
glaucoma patients show disease progression
changes will decrease aqueous humor drainage
despite of the therapeutics .
because of cellular and morphological changes
Ripasudil hydrochloride hydrate (K-115), a
in the TM cells. The ciliary muscle (CM) also
specific Rho-associated coiled-coil containing
plays an important role in the conventional
protein kinase (ROCK) inhibitor, is ophthalmic
route. As contraction of the CM leads to
solution developed for the treatment of
increased trabecular meshwork pore size and
glaucoma and ocular hypertension in Japan.
increased aqueous drainage .
Topical administration of K-115 decreased
Moreover, a significant number of patients
intraocular pressure (IOP) and increased
presenting with glaucoma continue to lose
outflow facility  .Rho kinase (ROCK)
vision despite responding well to therapies that
inhibitors are a novel potential class of
lower eye pressure non-IOP-dependent, so
enhancement of optic nerve blood supply and
compounds currently in Phase II and III US
Food and Drug Administration trials in the
strategies for glaucoma. Significantly elevated
United States. These selective agents work by
levels of RhoA have been detected by
relaxing the trabecular meshwork through
immunostaining in the optic nerve head of
inhibition of the actin cytoskeleton contractile
glaucomatous eyes compared with age-matched
tone of smooth muscle. This new mechanism
controls, reinforcing the association of Rho
aims to increase outflow facility in TM .
proteins and glaucoma pathophysiology .
Received:28 / 5/2017 DOI : 10.12816/0039047
Accepted:7 /6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1189-1195
Assessment of Decidual Natural Killer Cells CD56+ Population in
Placental Bed in Fetal Growth Restriction
Mohammad Alaa Mohi El-Din El-Ghannam1, Mohamed ElMandooh Mohamed1,
Mohammed Saeed El-Din El-Safty1, Nahla Mohamed Awad2, Noha Mahmoud Kasim1
1 Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University,
2 Early Cancer Detection Unite at Ain Shams University Hospitals, Cairo, Egypt
Corresponding author Tel.: +002 01009972366, E-mail address: firstname.lastname@example.org (Noha Mahmoud Kasim)
Aim: this study to compare the density of decidual natural killer cells (CD56) in deciduas of placental bed
in patients with Intrauterine Growth Retardation (IUGR) and women with normal pregnancy.
Patients and Methods: in the study 23 pregnant women were recruited and divided into 2 groups: The
study group (A): included 14 patient females which diagnosed as IUGR by ultrasound of the third
trimester and the control group (B): included 14 normal females at third trimester with no antenatal
complications recruited from the antenatal care clinics. All patients underwent elective cesarean delivery.
Decidual biopsies were taken during the operation. An immunohistochemical staining for decidual natural
killer cells (dNK, CD56+bright) and a semi quantitative scoring were done.
Results: In this study it was found that the Immunohistochemical scores and dNK cell population density
is statistically higher in controls compare with IUGR group (P<0.01)
Conclusions: findings reinforce the concept of pregnancy as a controlled systemic inflammatory state
that if altered can have adverse consequences for the mother and the fetus.
Keywords: Natural killer CD56, intrauterine growth retardation, decidua, immunohistochemical stain.
The most commonly adopted definition
Invasive trophoblasts are the key to the
to describe a fetus that has not reached its target
modulation of the state of the uterine vessels.
weight based on sonographic estimated fetal
These unique cells leave the placenta, penetrate
weight (EFW) for a certain gestation is an
the endometrium and upper layers of the
abdominal circumference (AC) or EFW
myometrium, selectively permeate the uterine
measurement <10th centile. The American
spiral arteries, and modify these vessels to yield
Congress of Obstetricians and Gynecologists
widened, low-resistance vascular channels that
(ACOG) and Royal College of Obstetricians and
carry the markedly increased maternal blood flow
Gynecologists (RCOG) agree that at this cutoff
to the placenta. Enacting this scenario takes a
the risk of perinatal morbidity and mortality
very delicate balancing of conflicting biological
needs between the mother and fetus. The fetus,
Altered NK cell numbers and activity
on the one hand, requires its invasive trophoblasts
have been associated with a variety of clinical
to penetrate the mother's uterus aggressively in
conditions such as endometriosis, recurrent
search of vessels to modify. The mother, on the
pregnancy loss, IUGR, and preeclampsia. Uterine
other hand, must protect herself from the invasive
NK cells have a unique phenotype compared to
trophoblasts, lest they completely penetrate her
blood NK cells and this is likely due to the
uterus, causing her to hemorrhage and bleed to
specific tissue environment in which they reside.
Specific chemokines produced by human
Aim: This study aims to compare the
endometrium and trophoblasts have been
density of decidual natural killer cells (CD56) in
identified that maybe responsible for recruitment
deciduas of placental bed in patients with
of NK cells. Uterine NK cells can produce
Intrauterine Growth Retardation (IUGR) and
cytokines and may be an important part of
women with normal pregnancy.
PATIENTS AND METHODS
The numbers and proportions of immune
This case control study was conducted at
cells also differ between blood and decidual
Ain-Shams University maternity hospital starting
tissue, as well as between different phases of
from April 2016 till January 2017.
In the study 30 pregnant women were
recruited a n d divided into 2 groups as following:
Received:26 /5 /2017 DOI : 10.12816/0039048
Accepted: 5/ 6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1196-1201
Role of Non-Contrast MRI in Diagnosis of Pulmonary Embolism
Iman Sherif Ahmad Mohamed a* Laila Ahmad Abdurrahman a Ahmed Mohamed Osman a
a Radiology Department, Faculty of medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mobile: +20 1067813007 E-mail address FEB1991283007@GMAIL.COM.
Background: Pulmonary embolism patients with contraindication to radiation exposure and contrast
injection. Objective: comparative study between the non -contrast Magnetic Resonance Pulmonary
Angiography (MR PA) and the Computed Tomography Angiography (CTA) in diagnosis of pulmonary
embolism (PE). Patients and methods: twenty-one patients were included in our study. All patients were
admitted and/or referred to Ain Shams University Hospital Departments, Kasr El Ainy Hospital and private
centers confirmed to have pulmonary embolism (PE) by CTA. All patients underwent CTA and non-contrast
MR-PA in the same day or within three consecutive days. The radiological examinations were interpreted by
two different radiologists. The results were compared and statistically analyzed. Results: The mean age of the
selected patients was about 49.43years old. 16 cases showed positive PE in both MR-PA and CTA. The 5
cases showed negative results in both. Conclusion: The non-contrast MR-PA has a reasonable sensitivity and
specificity in the diagnosis of PE especially in major branches. So, it can be used as an alternative to the CTA
especially when the CTA and the use of gadolinium are contraindicated.
Keywords: Magnetic Resonance Pulmonary Angiography (MRPA); Computed Tomography Angiography
(CTA); pulmonary embolism (PE).
Pulmonary embolism (PE) is a serious
carries a risk of allergic reactions and kidney
condition responsible for significant morbidity and
damage in some patients (6)
mortality. PE is currently the third leading cause of
Magnetic resonance-pulmonary angiography
cardiovascular death worldwide, so it requires
(MR-PA) is an attractive new method with the
prompt diagnosis and treatment to prevent
advantage of radiation avoidance and using of
potentially deadly consequences (1)
much less complicated gadolinium contrast agent
Pulmonary embolism occurs when a blood
which has less nephrogenic effect and less allergic
clot--usually from the leg--travels to the lung and
risk (7) .
blocks the pulmonary artery or one of its branches
Conventional MRA requires precise bolus
timing acquisition with respiration, which may be
The diagnosis of acute PE is considered a
hampered by a symptomatic PE patient. Another
clinical dilemma due to wide spectrum of multiple
MRA limitation is that it provides a lumen-only
nonspecific signs and symptoms (3). The D-dimer
imaging; mural PE filling defects will lack
results are of bad positive laboratory test being
conspicuity as these appear as dark signal against
positive in other situations rather than PE such as
the dark adjacent lung (8) .
cancer and inflammation (4)
So, alternatively non contrast MRA improves
CT pulmonary angiography (CTA) is highly
diagnostic accuracy and simplify the acquisition
sensitive and specific for the diagnosis of PE and
techniques remains an area of clinically important
has become the imaging method of choice in
development. The non-contrast MRA produces
patients suspected of having PE. The multislice CT
enhancing signal from the vessel wall, provides
offered high spatial and temporal resolution
high contrast with no need for bolus timing and
imaging in a short time scan. CTA has the ability
provides motion-insensitivity to respiration (9)
to assess the pulmonary tree down to the fifth and
to eighth order branches in less than 15 seconds
AIM OF THE WORK
due to high speed (5).
The aim of this work is to emphasize the role of
Limitations of CT include exposure to ionizing
non-contrast MR imaging in diagnosis of acute
radiation and iodinated contrast agent, which
pulmonary embolism in comparison to CTA and
Received: 1 / 6 /2017 DOI : 10.12816/0039049
Accepted:10 / 6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1202-1207
MRI Evaluation of Lumbar Disc Degenerative Disease
Noha Mohamed Osman, Fady Mamdouh Fawzy, Hanady Mohammed Lateef
Radiodiagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Aim of the work: lumbar disc degenerative disease is most leading cause of back pain, it is the most
common cause of disability at age above 45 years and 2nd most common reason for primary care physician
visit. Magnetic Resonance Imaging (MRI) is the standard imaging modality for detecting disc pathology
due to its advantage of lack of radiation, multi planar imaging capability, excellent spinal soft-tissue
contrast and precise localization of intervertebral discs' changes. this study aimed to evaluate the
characterization, extent and changes associated with the degenerative lumbar disc disease by Magnetic
Resonance Imaging. Study Design: cross-sectional and observational study.
Study Sample: forty consecutive and clinically examined patients with lower back pain suggestive of
lumbar disc disease. Material and Methods: 40 patients with age group between 17 and 80 years with low
back pain were diagnosed on 1.5 Tesla MRI machine. The following MRI findings were noted: lumbar
lordosis preserved or not, ligamentum flavum hypertrophy, facet joint arthrosis or osteophytes formation
and Endplate (modic) changes, decreased disc height as compared to the upper and lower vertebral levels
and loss of signals, disc bulge at different levels, Disc protrusion and disc extrusion was observed.
Result: most of patient showed loss of lumbar lordosis, facet joint arthrosis, ligamentum flavum
hypertrophy, Endplate (modic) changes, and osteophytes formation. Disc dehydration which is one of the
earliest features of aging and disc degeneration was present in (42%) patients with the most dehydrated disc
seen at L4/L5 and L5/S1. Patients with degenerative disc disease had the following disc contour
abnormalities. Disc bulges (26.5%) and herniations (10.5%). Herniations were further reported as broad
based herniations (9.5%), extrusions (19.0%) and the protrusions (71.4%). The most common site for
bulges and herniations was L4/L5 (33.6%) and (57.1%) respectively. The most common complication of
bulges and herniations was impingement of exiting nerve roots (40%) and compression of exiting nerve
roots and cauda equina (47.6%) respectively.
Conclusion: lumbar disc degeneration is the most common cause of low back pain. It is the most common
cause of disability at age above 45 years. Plain radiograph can be helpful, but MRI is the standard imaging
modality for detecting disc pathology due to its advantage of lack of radiation, multi planar imaging
capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes.
Keywords: Lumbar Disc,MRI, Degenerative Disease.
lumbar disc degenerative disease is most
leading cause of back pain, it is the most common
instability. The actual radiographic findings of
cause of disability at age above 45 years and 2nd
lumbar disc disease encompass a range of
most common reason for primary care physician
findings used to infer disc disease. The
visit(1). Risk factors for causing lumbar disc
radiographs are primarily used for assessing bony
degenerative disease include advancing age,
anatomy and alignment. They do not directly
socioeconomic status, torsional stress, smoking,
view the discs and soft tissues (4). CT scan is of
limited value in the correct diagnosis of
immobilization, psychosocial factors, gender,
degenerative disc disease. Often it can be normal
height, hereditary, genetic factors (2). Lumbar disc
in the face of this disease. A CT scan has little
degenerative disease describe a natural break down
direct value beyond the lumbar radiographs in the
of an intervertebral disc of spine, changes occur in
direct assessment of degenerative disc disease (5).
lumbar disc degenerative disease and lead to back
MRI like CT scanning can be used to evaluate the
pain can be osteoarthritis, herniated disc or spinal
spinal canal and space available for neural
stenosis. The diagnostic process includes, medical
structures, it has additional benefit of allowing
history, physical examination, imaging studies
the direct assessment of neural structures as well
including: X-ray, CT and MRI (3). Radiographs are
as the disc structure, this direct evaluation not
more often used to exclude other diagnoses rather
possible by CT scan, loss of water content,
than directly diagnose degenerative disc disease.
proteoglycans and collagens that occur in
Diagnoses that can be more directly excluded
degenerated intervertebral disc can be visualized
with appropriate X-rays include scoliosis,
on MR images (6). Radiologically, on MR images
Received: 2 / 6 /2017 DOI : 10.12816/0039050
Accepted:11 / 6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1208-1214
Urea and Creatinine Levels in Vaginal Fluid as A Predicator for
Length of Latency Period in Prelabour Membranes Rupture
Daniel Onsi Anis, Rasha Mahmoud Medhat Abd El-Hady,
Mohamed El-Mandooh Mohamed, Amr Mohamed El-Husseni
Obstetrics and Gynecology Department, Faculty of Medicine, Ain shams University
Corresponding Author: Rasha Mahmoud Medhat Abd El-Hady, Email: email@example.com
Background: The diagnosis of equivocal cases of prelabour rupture of membranes (PROM) with traditional
methods has been unreliable therefore various biochemical markers have been sought to confirm the same,
this study aims to determine the relation between the concentration of urea and creatinine in vaginal fluid
and length of latency period in women with PROM between 32 and 35 weeks gestation.
Methods: sixty patients were included in our study with PROM of their singleton pregnancies, their
gestational age ranged between 32- 35 gestational weeks by reliable menstrual history and confirmed by
pelvi-abdominal ultrasound. All samples were obtained within 6 hours after membranes rupture before
vaginal examination and the administration of any drugs All women will be put under observation for 48
hours and time of onset of delivery will be documented, the onset of labor will be diagnosed by either:
frequent uterine contractions more than 2 contractions in 10 minutes or CTG showing frequent contractions.
Results: The current study was conducted on a total number of 60 pregnant women, 20-35 year old; pregnant
between 32 and 35weeks. Our study demonstrated that patients with higher levels of vaginal fluid urea and
creatinine concentrations had earlier onset of labor. Patients with vaginal fluid urea and creatinine
concentrations above cut-off levels (urea 26.0 (mg/dL), creatinine 0.64 (mg/dL)) went into labor early
within a 48 hours latency period. This suggests vaginal urea and creatinine levels measurement in the
prediction of early delivery.
Conclusion: Measurement of urea and creatinine in vaginal fluid is a cheap and rapid method with high
sensitivity and specificity for the delivery interval after PROM. Therefore, these methods can be integrated
as non-invasive tests for the predication of delivery interval after PROM.
Keywords: Prelabour rupture of membranes (PROM); Amniotic fluid (AF); Amniotic fluid index (AFI);
Respiratory distress syndrome (RDS)
investigated induction of labor versus expectant
Prelabour rupture of the membranes (PROM)
management for women with prelabour rupture of
constitutes one of the most important dilemmas in
membranes and their primary outcome was the
current obstetric practice; it could be defined as
rate of neonatal sepsis (the proportion of babies
rupture of the fetal membranes preceding the
that develop neonatal sepsis) and secondary
onset of labor .
outcomes were the rates of neonatal respiratory
The optimal management of pregnancies
distress syndrome (RDS), cesarean section
complicated by PROM remains an area of great
(surgical delivery), and chorioamnionitis in
controversy in obstetrics .
women with PROM between 34 and 37 weeks'
One issue of paramount importance is the
gestation. All of which may support an active
decision to initiate expectant management versus
management approach to women with PROM.
immediate delivery. Expectant management
However, 70% of women with term PROM who
allows for prolongation of pregnancy with the
were managed expectantly were reported to
potential for improvement in neonatal outcome.
deliver within 24 hours, while only 15% were not
However, expectant management does pose
delivered up to 48 hours.
significant maternal and neonatal risks ; in
Among women with suspected prelabour
rupture of the membranes (PROM), an important
chorioamnionitis, cord prolapse and placental
question in clinical practice is whether or not the
abruption. In a randomized controlled trial in
woman will soon be in spontaneous labor,
2012, David van der Ham and colleagues,
therefore the ability to predict the latency period
Received: 21 / 6/2017 DOI : 10.12816/0039051
Accepted: 30/6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1215-1223
Asthma Control Assessment Using Asthma Control Test Among Pediatric
Patients Attending a Tertiary Care Hospital in Saudi Arabia
Bandar Alsahn1, Abdullah Alshamrani2, Abdulaziz Alzahrani1,
Othman Alsahmi1, Abdullah Alqudhybi1
King Saud Bin Abdulaziz for Health Science, 2Department of Pediatric, Prince Sultan Medical Military
Corresponding author: Bandar Alsahn, Phone no: +966555566659, Balsahan@gmail.com
Background: There are not enough data on the epidemiology of asthma in pediatric patients. The goal of the
study was toassess the level of asthma control using the childhood Asthma Control Test (c-ACT).
Methods: This cross-sectional descriptive study was conducted in the outpatient pulmonary clinic at King
Fahad Medical City in Riyadh.Pediatric patients who were diagnosed with bronchial asthma by their primary
treating physician were recruited over a one-year period. Patients completed the c-ACT and questionnaires,
which were associated with the quality of asthma control.
Results: Two hundred and ninety-two asthmatic patients (n = 292) were enrolled, and 35.3% of these
patients were female. The estimated prevalence of uncontrolled asthma at the time of the study was 45.2%.
Factors that were significant in asthma control were female gender (P-value = 0.041), winter months (P-
value = 0.01), allergic rhinitis (P-value = 0.036), and eczema (P-value = 0.039). However, the degree of
asthma control did not appear to be related to the place of residence, the type of clinic visited, pet ownership,
receipt of an influenza vaccine, or medication use.
Conclusion: This study identified evidence for the high prevalence of uncontrolled asthma in pediatric
patients in out-patient clinics and several factors that may contribute to poor asthma control. Physicians
should be aware of seasonality and of treating patients with comorbid eczema and allergic rhinitis.
Keywords: King Fahad Medical city (KFMC), asthma, pediatric, childhood Asthma Control Test (c-ACT).
Asthma is a disease characterized by chronic
in Saudi Arabia showed a cumulative prevalence
inflammation of the airways that causes recurrent
of 21.7%, with the highest score in the eastern
attacks of wheezing, shortness of breath and
province (33.7%) compared to the central region
coughing, especially during the night and/or early
(17.7%) and the western province (14.1%) .
morning. The hallmarks of asthma are intermittent
In literatures, studies have shown alarming
and reversible airway obstruction, chronic
levels of uncontrolled asthma in patients
worldwide and in Saudi Arabia. A study was
bronchial smooth muscle hypertrophy and
conducted in the United States to assess the level
hyperactivity, and abundant mucus secretion .
of asthma control and showed that 45% of cases
The primary goal in treating asthmatic patients is
were controlled, whereas 55% were uncontrolled
to achieve good asthma control. This result is
. Another study was conducted in Europe and
achieved by minimizing symptoms, activity,
showed that only 36% of cases asthma cases were
airway narrowing and bronchodilator use, while
controlled . Locally, a study was conducted in
preventing acute exacerbations [2,3].
seven major hospitals in Riyadh and revealed that
most of the asthma cases in Saudi Arabia are
Asthma is a significant health problem
uncontrolled, which accounts for 64% of all cases,
worldwide, and it is one of the most common
and only 5% of participants met the criteria for
chronic childhood diseases in many countries [4,5].
well-controlled asthma . Another study of
The prevalence in different countries ranges from
pediatric asthma patients with a smaller sample
1% to mid-30%. In the United States, for
size has shown that 59.3% of cases were
example, asthma affects more than seven million
children . In Saudi Arabia, the local reports
suggest that the prevalence of pediatric asthma is
Assessment of asthma control level can be
increasing and has been reported to be between
achieved using the Asthma Control Test, which
8% and 23% . A study that was conducted in
has been validated and recognized as an effective
Khobar and included 1,482 school boys revealed a
patient-friendly tool to assess the level of asthma
cumulative prevalence of asthma of 9.5% .
control . The childhood Asthma Control Test
Additionally, a 17-year study of pediatric asthma
(c-ACT) is a questionnaire composed of seven
Received: 9 /4 /2017 DOI : 10.12816/0039052
Accepted:16 / 4 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1224-1228
Role of Trans-catheter Ovarian Vein Embolization in The
Management of Symptomatic Chronic Pelvic Congestion in Females
Mai Shaaban Abd El-Galil, Ahmed Mohamed Bassiouny,
Karim Ahmed Abd El-Tawab, Hossam Abd El-Kader Moursy
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Mai Shaaban Abd El-Galil, Mobile: +201112010785, E-mail address
Background: Trans-catheter ovarian vein embolization has a role in the management of symptomatic
chronic pelvic congestion in females.
Objective: To assess the technical success and short term clinical efficacy of trans-catheter ovarian vein
embolization as a treatment for symptomatic pelvic congestion syndrome in women.
Methodology: Some of the cases are done at interventional radiology unit Ain Shams University and some
of them are taken from literatures.
Conclusion: Ovarian vein embolization has a great role in the management of symptomatic pelvic
congestion syndrome in women.
Keywords: Chronic pelvic pain (CPP), Pelvic congestion syndrome (PCS), Ovarian vein embolization
Chronic pelvic pain (CPP) is assumed to affect
posterior to the internal iliac artery, joining the
approximately 30% of all women in child bearing
external iliac to form the common iliac vein. Its
period and it accounts for almost 20% of
tributaries are divided into parietal and visceral.
outpatient gynecological appointments (1).
Parietal tributaries are the superior and inferior
Common causes of chronic pelvic pain are
gluteal, sciatic, sacral, ascending lumbar, and
obturator veins. Visceral tributaries are the uterine,
adhesions, atypical menstrual pain, urologic
gonadal, and vesicovaginal plexuses in women. In
disorders, irritable bowel syndrome, psychosocial
27% of cases, the internal iliac vein drains by
issues (2,3) and pelvic and vulval varicosities, as
means of two separated trunks. Rarely, it can drain
well as many other causes. Despite the extensive
directly into the inferior vena cava (IVC). Valves
diagnostic investigations and laparoscopic studies,
are found infrequently on the internal iliac veins
the exact cause of CPP remains rather elusive.
(10% of cases on the main trunk and 9% on its
Pelvic congestion syndrome (PCS) takes place
tributaries). Ovarian veins provide drainage of the
when varicosities develop around the ovaries in a
presence of CPP. Like lower limb varicose veins
pampiniform plexus, forming a rich anastomotic
pelvic varicosities are assumed to result from
venous plexus with the paraovarian, uterine,
dysfunctional valves of the veins, refluxing blood
vesical, rectal, and vulvar plexuses (Fig 1). Two
flow, with venous engorgement. Congested pelvic
or three trunks form a single ovarian vein at L4,
veins may be very painful and account for
with the left ovarian vein draining into the LRV
approximately 30% of cases of CPP (4).
and the right ovarian vein draining directly into
the IVC in the majority of women. In up to 10% of
AIM OF THE WORK
The aim of this work is to assess the
women, the right ovarian vein may also drain into
technical success and short term clinical efficacy
the right renal vein instead of the IVC (5).
of trans-catheter ovarian vein embolization as a
treatment for symptomatic pelvic congestion
Studies have shown that normal ovarian veins
syndrome in women.
have an average diameter of less than 5 mm.
The study was approved by the Ethics Board of
Valves are present in these veins, mainly in the
Ain Shams University.
distal third. Ahlberg et al found no ovarian vein
valves on the left side in 15% and none on the
Anatomy of the pelvic venous drainage in
right side in 6%. In those in whom valves are
present, they are incompetent in 40% on the left
The ovaries and uterus are drained by both
and in 35% on the right. Ovarian vein reflux has
the internal iliac and gonadal veins (Fig 1). The
been reported in 10% of female renal transplant
internal iliac vein passes slightly medial and
donors, up to 60% of whom develop PCS (6).
Received:20 /5 /2017 DOI : 10.12816/0039053
Accepted: 29/ 5 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1229-1235
MRI Features of Posterior Reversible Encephalopathy Syndrome
Abdul-Qader Isam Abdul-Hameed, Salwa Taha Ahmed Isma'il, Shaimaa Abdelsattar Mohammad
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Background and Purpose: Posterior Reversible Encephalopathy Syndrome (PRES) represents a clinico-
radiological constellation of neurological symptoms and radiological features. The syndrome tends
radiologically to be present with certain features and patterns. Our aim in this study is to investigate the
PRES radiological features by which it does present in our community and to correlate the findings
clinically. Methods: The MR images obtained for the 17 patients included in the study were analyzed for
the PRES features and patterns. Fluid Attenuation Inversion Recovery (FLAIR) sequence was the mainly
used sequence for assessment. Diffusion images with their apparent diffusion coefficient maps, T *
and Angiography were also utilized for further assessment and characterization. Results: Most of the cases
demonstrated a bilateral involvement (94%). The regional distribution supra-tentorially included parietal
and occipital affection in 94%, frontal lobe affection in 76%, and a temporal lobe affection in 71%. Infra-
tentorial involvement was noted in 41% of the cases. Pattern percentages were slightly different from those
available in the literature with the Holo-hemispheric Watershed pattern being the most common (35%).
Conclusion: The originally described PRES features are present in the majority of the studied cases. The
identified PRES patterns may reflect underlying clinical or pathological correlations, and hence can vary
Keywords: Keywords: Posterior Reversible Encephalopathy Syndrome, Reversible Posterior
Leukoencephalopathy Syndrome, Brain, Magnetic Resonance Imaging.
though atypical presentations have also been
syndrome (PRES) is a syndrome that was
According to the topographic distribution
originally described in the last decade of the
of the syndrome, four different radiological
twentieth century by Hinchey and colleagues1 and
patterns were recognized:
1. Dominant parieto-occipital pattern:
Leucoencephalopathy Syndrome (RPLS). The
This pattern represents what was thought
increasingly recognized syndrome is a clinico-
to be the typical presentation of PRES. The
neuro-radiological entity that describes a
hallmark of this pattern is the predominant
constellation of headache, vomiting, altered
parieto-occipital involvement (figure 1). Mild to
mentality state, blurring of vision, and seizure
severe forms of the pattern was recognized.
activities with imaging evidence of brain edema
Temporal involvement was variably noted.
involving gray and white matter with a posterior
Though it is described in the literature as the
region predominant fashion1.
The syndrome follows a sporadic pattern
and its incidence is unknown. The worldwide
reports haven't revealed any gender differences2,3.
Both children and adults involvement have been
observed4. The syndrome is frequently noticed to
be associated with acute hypertension5. Common
encephalopathy, however, it has been reported in
a wide spectrum of clinical conditions including
exposure to toxic agents, sepsis, autoimmune
diseases, malignancies and organ transplants6.
For the radiological evaluation, MR
imaging is considered the gold standard imaging
modality, and is recommended to be performed as
"typical" topography, it was found in 22.1% of
soon as PRES is suspected7. Typical radiological
features are usually present in the vast majority of
Figure 1: shows the typical features of the
cases especially the parieto-occipital dominance8
Parieto-occipital pattern of PRES seen by FLAIR;
there is a bilateral vasogenic edema affecting the
Received: 27 /5 /2017 DOI : 10.12816/0039054
Accepted:6 /6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1236-1245
Malignant Breast Tumors: Role of MRI in Predicting
Hossam Moussa Sakr, Allam Elsayed Allam, *Zinah Nashee Hasan
Department of Radiodiagnosis, Faculty of Medicine - Ain Shams University, *Thi-Qar University
Introduction: Magnetic Resonance Imaging (MRI) is an established supplemental technique to
mammography and ultrasonography for evaluation of breast lesions. Diffusion-weighted MR imaging (DWI)
has recently been integrated into the standard breast MRI in addition to images obtained from dynamic
contrast enhanced MRI. DWI is quantified using the Apparent Diffusion Coefficient (ADC) value which is
the measurement of the mean diffusivity of water in tissues along three orthogonal directions.
Aim of the Work: The aim of this study was to investigate the relationship between DWI findings
(represented by ADC values) and the dynamic contrast enhanced MRI findings (including functional
parameters and morphological criteria) with the histopathological grade of malignant breast tumors.
Methodology: 25 Patients (age >30 years) were enrolled in this study. All patients were referred either from
the screening clinic or the outpatient clinic of Eldemerdash Hospital with clinically suspicious findings and
the abnormality was detected by mammography and/or ultrasound. Included masses are those with BI-RADS
5 category on imaging, with no previous biopsy or treatment. There was no knowledge about the
histopathological diagnosis at the time of initial evaluation. Exclusion criteria were breast masses with
diagnosed or proved benign features. All patients were scheduled for dynamic MRI with diffusion weighted
imaging in addition to the conventional MR imaging.
Results: Histopathological analysis revealed all 25 lesions to be invasive ductal carcinomas not otherwise
specified. Grading of included carcinomas was as follows: 3 lesions (12.0%) were grade I, 14 lesions
(56.0%) were grade II and 8 lesions (32.0%) were grade III.
Conclusion: That makes DWI the best non-invasive tool available to predict grades of breast carcinoma.
However, further larger and more detailed studies are still needed to fully understand the role MR imaging in
distinguishing different histological grades of breast cancer.
Keywords: Malignant Breast Tumors, MRI, DWI, ADC, Histopathological
Magnetic Resonance Imaging (MRI) is an
detection of changes in the local biological
environment, without the need for intravenous
mammography and ultrasonography for evaluation
contrast material injection (2).
of breast lesions (1).
DWI is quantified using the Apparent
Dynamic contrast enhanced breast MR
Diffusion Coefficient (ADC) value which is the
imaging is currently accepted as the most sensitive
measurement of the mean diffusivity of water in
imaging technique for diagnosis of breast cancer. It
tissues along three orthogonal directions. ADC
provides important information not only on the
value can be affected by cellularity of the tissue,
morphology of the lesion but also on the functional
fluid viscosity, and membrane permeability.
aspect reflected by the pattern of uptake of the
Several potential applications for DWI and ADC
contrast medium. Integration of both kinetic and
value have been suggested and studied; including
morphological features is important for accurate
detection, characterization, and differentiation of
diagnosis (1). However, it provides no direct
breast lesions (3).
information about tumor cellularity, which is
Aim of the Work:
known to be an important index of tumor grade.
The aim of this study was to investigate the
Consequently, there has been an increasing interest
relationship between DWI findings (represented by
in the development and the use of diffusion-
ADC values) and the dynamic contrast enhanced
weighted breast imaging for its potential to
MRI findings (including functional parameters and
improve the diagnosis of breast lesions at the cost
morphological criteria) with the histopathological
of a small increase in the examination time (2).
grade of malignant breast tumors.
Diffusion-weighted MR imaging (DWI)
has recently been integrated into the standard
PATIENTS AND METHODS
breast MRI in addition to images obtained from
25 patients (age >30 years) were enrolled
dynamic contrast enhanced MRI. It is a non-
in this study. All patients were referred either from
invasive technique that has a high sensitivity for
the screening clinic or the outpatient clinic of
Received:15 /6 /2017 DOI : 10.12816/0039055
Accepted: 24/6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1246-1251
Surgical Wound Infection
Ebtesam Mohammed Alahmari, Roaa Fahad Alshabanah, Tahani Saeed Almohayya,
Norah Ibraheem Almanie, Reem Ali Almanie, Amal Nasser Alqahtani,
Sarah Saeed Alshahrani, Amjaad Saleh Aljelban
King Khalid Univerity, Abha, Saudi Arabia
Corresponding Author: Ebtesam Mohammed Alahmari, firstname.lastname@example.org
Surgical wound infections prompt antagonistic patient results, including delayed hospitalization and
demise. Wound infection happens with every entry point, however demonstrated procedures exist to
diminish the hazard of surgical injury diseases. Specifically, enhanced adherence to prove that based
deterrent measures identified with fitting antimicrobial prophylaxis can diminish the rate of surgical wound
infection. Various patient-related and technique related components impact the danger of surgical injury
disease, and henceforth counteractive action requires a package approach, with deliberate consideration
regarding numerous hazard factors, to diminish the hazard of bacterial pollution and enhance the patient's
defences. Forceful surgical debridement and successful antimicrobial treatment are expected to enhance the
treatment of surgical wound infections.
Keywords: Surgical wound infections, prophylaxis, Risk, antimicrobial.
Infection at or near surgical notches within 30
days of an operative process, named surgical site
of contaminants. A composite interaction between
infection, adds considerably to surgical morbidity
host, microbial, and surgical factors ultimately
and mortality every year. Surgical site infection
decides the counteractive action or foundation of a
(SSI) represents for 15% of every single
nosocomial disease and, amid surgical patients,
signifies the most widely recognized nosocomial
Microbial variables that impact the foundation
infection . Postsurgical infection prompts
of a wound infection are the bacterial inoculum,
expanded length of postoperative hospital stay,
radically raised cost, higher rates of hospital
microenvironment. At the point when these
readmission, and risked wellbeing results. In view
microbial elements are favorable, weakened host
of that, the initial phase in the treatment of SSIs is
protections set the phase for ordering the chain of
in their avoidance. This includes careful operative
occasions that create wound contamination. Most
procedure, timely administration of appropriate
surgical site infections (SSIs) are contaminated by
preoperative antibiotics, and an assortment of
the patient's own endogenous flora, which are
preventive measures directed at neutralizing the
existent on the skin, mucous membranes, or
danger of bacterial, viral, and fungal infection
hollow viscera. The customary microbial
posed by operative staff, the operating room
concentration mentioned as being highly allied
environment, and the patient's endogenous skin
with SSIs is that of bacterial counts greater than
flora. It is this last phase of contamination, and
10,000 organisms per gram of tissue (or on
particularly mechanical strategies for aversion.
account of burned sites, organisms per cm2 of
SSIs are allied not only with increased
wound) . The typical pathogens on skin and
morbidity but also with considerable mortality. In
mucosal surfaces are gram-positive cocci
a study, 77% of the deaths of surgical patients
(remarkably staphylococci); be that as it may,
were allied to surgical wound infection .
gram-negative aerobes and anaerobic bacteria
Kirkland et al  considered a comparative hazard
taint skin in the perineal ranges. The tainting
of death of 2.2 attributable to SSIs, in contrast
pathogens in gastrointestinal surgery are the huge
with corresponding surgical patients without
number of inherent entrail greenery, which
infection. Every single surgical wound are
incorporate gram-negative bacilli (eg, Escherichia
polluted by microorganisms, nevertheless in most
cases, infection does not improve because innate
including enterococci and anaerobic life forms 
host defenses are quite efficient in the elimination
Received: 17 / 4 /2017 DOI : 10.12816/0039056
Accepted:25 /4 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1252-1256
Assessment of The Prevalence of Pelvic Floor Disorders in Both Vaginal and
Cesarean Deliveries and Their Impact on The Quality of Life
Osama Saleh Hassan El Kady(1), Tarek Fathy Tamara(1), Haitham Abd El Mohsen Sabaa(1)
and Alaa Hafez Mohamed Shawky Hafez(2)
(1)Obstetrics and Gynecology department, Faculty of Medicine, Ain Shams University
(2)Obstetrics and Gynecology Department, El Mataria Teaching Hospital
Background: Pelvic floor disorders (PFDs) occurring in women comprises a broad range of clinical
scenarios such as pelvic organ prolapse (POP) and stress urinary incontinence (SUI).
Aim of the work: The objectives of the present study were to estimate differences in the prevalence of
pelvic floor disorders (POP & SUI) in Egyptian women by mode of delivery and their impact on patients'
quality of life using assessment questionnaire.
Materials and Methods: This observational (non-interventional) cohort study was conducted on 464 parous
women from the gynecologic out-patient clinic of Ain Shams Maternity University Hospital for measuring
the prevalence of POP and UI regards the mode of delivery in women delivered 5 years back or more and its
impact on the quality of their lives. Pelvic organ support was assessed using the Pelvic Organ Prolapse
Quantification method (POP-Q), and pelvic floor symptoms were evaluated using assessment questionnaire.
Results: Our study found that compared to Cesarean Section (CS; 32.8%), vaginal delivery (VD) was
associated with statistically significant increase in the occurrence (43.5%) and severity (Moderate-to-severe
UI [39.6% in VD vs. 10.5% in CS]) of UI especially SUI (VD vs. CS: 62.4% vs. 51.3%). Vaginal delivery
was associated with more than double the occurrence of POP (19.4% vs. 8.2% in CS), and more than triple
the concomitant occurrence of both POP and SUI (9.9% vs. 2.6% in CS).
Conclusion: There is a positive correlation between the mode of delivery - as an independent factor - and the
prevalence of pelvic floor disorders (both pelvic organs prolapse & urinary incontinence) in parous women.
Keywords: Pelvic organ Prolapse -Urinary incontinence - Pelvic Floor Disorders -Vaginal delivery -
or `levator ani', which allows the urethra, vagina
Pelvic floor disorder has been defined as the
and ano-rectum to transit the abdominal
presence of symptoms of UI or fecal incontinence
envelope)(4). In women, SUI is the involuntary loss
(FI), pelvic organ prolapse (POP), sensory or
or leakage of urine from the urethra during
emptying abnormalities of the lower urinary tract,
increases in intraabdominal pressure, which is not
defecation dysfunction, sexual dysfunction (SD)
accompanied by the sensation of urinary urgency.
and chronic pain syndromes, which can present
The relative frequency of occurrence of SUI is
separately or coexist(1). The most common
50% among women with urinary incontinence,
conditions subsumed under the term `female
and considering the age of patients, in 15-20% of
pelvic floor dysfunction' are urinary incontinence
women aged 40-60, on average(5).The etiology is
followed by female pelvic organ prolapse(2).
multi-factorial and is associated with pregnancy
Concomitant occurrence of POP and SUI is a
and childbirth, increasing infant birth weight,
common condition because both entities are
ageing, chronic cough, regular heavy lifting and
believed to result from pelvic floor damage due to
fascial defects, muscular weakness, or denervation
A normal vaginal delivery causes
injuries. However, women with coexisting POP
significant strain on the pelvic floor and can result
and deficit of the stress continence mechanism
in some women of fertile age developing urinary
may be subjectively continent because the descent
incontinence. Vaginal delivery is an even a greater
of the bladder base may mechanically kink or
risk factor for pelvic organ prolapse. Birth
compress the urethra. In these cases, SUI may be
weights, mode of delivery and length of the
revealed only after prolapse reduction and is
second stage of labor have been shown to be
defined as occult SUI(3).
additional risk factors(7). Caesarean section may
Pelvic organ prolapse can be considered
protect against urinary incontinence in women of
herniation of pelvic organs, that is, of bladder,
fertile age, but the effect does not persist when the
uterus, small bowel and/or rectal ampulla through
women become older (8). Many women with
the levator hiatus. The hernial portal is the `levator
objective prolapse are asymptomatic and do not
hiatus' (i.e. the opening in the pelvic floor muscle
need treatment. The most common symptoms
Received: 7 /5 /2017 DOI : 10.12816/0039057
Accepted:16 / 5 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1257-1259
Acute Coronary Syndrome in a 56-year-old Female with Sedentary
Lifestyle: A Case Report
Mohammed Adel Basyuni
Umm AlQurra University
Background: the average amount physical activity of women in Saudi Arabia predisposes them to ischemic
heart disease, in an otherwise completely healthy individual.
Aim: To emphasize the significance of lack of physical activity alone on cardiovascular health.
Case report: this case report describes an acute onset of severe coronary syndrome of a middle aged Saudi
woman with no other cardiac risk factors. Treadmill test was positive for inferolateral ischemia. CT
angiography revealed occluded arteries in five different locations. A PCI was performed after three months to
achieve complete vascularization.
Conclusion: normal lifestyle of women in Saudi Arabia should be considered very sedentary and a major risk
factor of ischemic heart diseases.
Keywords: Ischemic heart disease; coronary artery disease; sedentary lifestyle; women health, Saudi Arabia;
exercise ECG stress testing
Coronary artery diseases (CAD) have
The patient was completely fine until she
been estimated to be the leading cause of death in
developed chest pain two and a half months ago.
developing countries in 2010 . CAD happens
The chest pain was bilateral, radiating to
when the arteries that supply blood to heart muscle
shoulders, neck, and the jaw. It came on mild
become hardened and narrowed .
exertion, which is climbing one floor by stairs and
The most common risk factors include
lasted for 10-15 minutes. The pain was rapidly
family history, smoking , obesity, hypertension,
relieved by sitting. It was associated with burning
diabetes, lack of exercise, dyslipidemia, and stress
sensation in epigastric region, numbness in the left
. Smoking is associated with about 36% of cases
arm and hand, and breathlessness only during
. Lack of exercise has been linked to 712% of
pain. The severity of pain increased over time.
cases . Both rheumatoid arthritis and systemic
Patient denied dizziness, sweating, palpitation,
lupus erythematous are independent risk factors as
orthopnea, PND, edema, syncope attacks or
well [6, 7].
Unhealthy diet and physical inactivity are
On systemic review, she had no fever,
considered among the leading causes of major
weight loss, fatigue, or loss of appetite. She does
not have cough or runny nose, no headaches, no
cardiovascular disease, thus contributing to the
blurry vision, nor loss or change in any sensation,
global burden of disease, death, and disability in
no weakness, and no change in bowel or urinary
the Arab countries .
habits. She denied any bleeding or clotting
symptoms. She has acid reflux sometimes and
Aim: Our aim is to emphasize the impact of lack
therefore takes extra pillow during sleep, takes
of physical activity on cardiovascular health. In
Yansun (a concoction) and yoghurt for relief, but
this case a woman, with no risk factor of coronary
not any medication. She also occasionally gets
artery diseases except for lack of physical activity,
knee joint pain from two years after her
develops multiple coronary artery occlusions.
menopause for which she was prescribed calcium
tablets, but does not take them regularly.
A 56 year old Saudi woman was admitted
Risk factor assessment
to the cardiac care unit for elective PCI (Case from
She does not have hypertension, diabetes,
August 2016) as she complained of chest pain
or any other chronic disease, nor is she
from two and a half months.
dyslipidemic. She is not a smoker and has no
recreational habits. She was never obese. Her
Received:19 / 4 /2017 DOI : 10.12816/0039058
Accepted:27 / 4 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1260-1271
The Diagnostic Value of Combined Conventional MRI and Diffusion
Weighted MRI in Diagnosis of Non-Palpable Undescended Testes
Aisha Dabnon Abd Alnabie
Faculty of Medicine, Ain Shams University
Background: MRI is noninvasive imaging tool, does not involve ionizing radiation and yields multiplanar images
but it is sometimes less efficient in locating intra-abdominal functioning testicles and it fails to locate most of the
atrophied testicles. Additional MRI assessments, as fat-suppressed T2WI and DWI are useful methods to improve
the accuracy and sensitivity of diagnosis of non-palpable testes.
Objective of the Study: is to assess the value of adding diffusion-weighted sequences (DWI) to routine magnetic
resonance imaging (MRI) in identifying and locating nonpalpable undescended testes.
Results: a combination of DWI and conventional MRI including Fat-supp. T2WI sequence is the most accurate
means of detecting and localizing non-palpable undescended testes. The findings of DWI complement the
information on the location of undescended testes obtained with conventional MRI. In addition, DWI is helpful in
detection of testicular viability or atrophy properly before the operation.
Keywords: magnetic resonance imaging; undescended testes, diffusion, fat-suppression T2WI.
been shown to have low sensitivity in identifying
Undescended testis or cryptorchidism, a condition
in which one or both testicles are not appropriately
positioned in the scrotum at birth. It is the most
palpable testicles preoperatively in a recent meta-
common congenital genitourinary anomaly in boys
and has an incidence of 13% in term and 1530% in
Conventional MRI is moderately specific in
premature male infants. approximately 20% of
identifying absent testicles but poorly sensitive in
undescended testes are nonpalpable and either located
identifying the presence of non-palpable testicles.
in the abdomen or the canaliculi, or atrophic or are
Conventional MRI appears to be less efficient in
completely absent. Cryptorchidism is associated with
locating intra-abdominal functioning testicles and
impaired fertility, inguinal hernia, and increased risk
shows limited sensitivity in locating inguinoscrotal
of testis cancer (1).
testicles, but it fails to locate most of the atrophied
The Preoperative identification and location of
testicles, which makes conventional MRI a less
testicles can help to determine the optimal type of
reliable technique in providing guidance to
procedure and allow for appropriate advance
differentiate those children needing surgery from
planning. On the basis of the imaging findings, the
those who do not (5).
surgeon can appropriately counsel the patient and
Additional MRI assessments, fat-suppressed T2WI
alter the operative approaches needed. The imaging
and DWI are useful methods to improve the accuracy
findings could obviate the need for surgical
of diagnosis of non-palpable testes. It could prevent
exploration.in the case of absent or vanishing testicles
needless surgery and be worth the additional imaging
The Various imaging techniques have been
Diffusion weighted imaging (DWI) is an evolving
suggested for use in identifying and locating non-
technology with the potential to improve tissue
palpable testicles preoperatively with varying
characterization when findings are interpreted in
limitations including expense, invasiveness technical
conjunction with findings obtained with other
difficulty, radiation risk, need for contrast medium,
conventional MRI sequences. It provides functional
and need for sedation. Imaging approaches include
and structural information about biologic tissues; it is
ultrasonography, computed tomography (CT), routine
best used to solve specific problems (7). Use of DWI
MRI, magnetic resonance angiography (MRA), and
therefore facilitates characterization of tissue at the
magnetic resonance venography (MRV), some of
microscopic level in a mechanism different from T1
which require sedation or anesthesia and are without
and T2 relaxation. The degree of restriction of water
diffusion in biologic tissue is inversely related to
The least expensive and frequently used technique
tissue cellularity and the integrity of cell membranes
of all imaging tools is ultrasound. However, it had
(e.g. tumor tissue). Concordantly, intra-abdominal
Received:7 / 5 /2017 DOI : 10.12816/0039059
Accepted: 16/ 5/2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1272-1278
Procalcitonin as A Diagnostic and Prognostic Marker of Sepsis in
Critically Ill Patients in Intensive Care Unit
Fatema H. Ashour1,Hend M. Maghraby2,AsmaaS. Hassan3
1-Anaesthesia department, AL-Azhar University, Cairo, Egypt, 2- Internal medicine department, AL-Azhar
University, Cairo, Egypt, 3- Clinical pathology department, AL-Azhar University, Cairo, Egypt.
Background: Sepsis is a leading cause of mortality in critically ill patients. However, differentiating sepsis from
non-infectious triggers of the systemic inflammatory response syndrome (SIRS) is difficult. Procalcitonin is useful
biomarker of systemic inflammatory response to infection. Its level rises in response to a proinflammatory
stimulus, especially of bacterial origin and not rise significantly with viral or non infectious inflammation.
Objectives: The aim of this study was to determine the relation of procalcitonin (PCT) level with the development
of organ failure and mortality in critically ill septic ICU patients
Patients and Methods: The current study was conducted on 60critically ill adult septic patients aged between 18-
60 years old of both sex with anticipated stay of >48 hours. All patients were assessed clinically with
haemodynamic and full laboratory monitoring, CRP, a PCT level and SOFA score were calculated in the1st and the
4th day of admission.Results: There was significant increase in PCT level between three groups and no significant
difference between groups as regard CRP. According to SOFA score there was significant difference between three
groups. There was a positive correlation between PCT level and SOFA Score (r = 0.924, P = 0.001) while there
was no correlation between CRP and SOFA score (r = -0.233, P = 0.091).
Conclusion: PCT is a good diagnostic and prognostic marker of sepsis. PCT shows a closer correlation than that of
CRP with the severity of infection and organ dysfunction.
Keywords: Procalcitonin, SOFA, sepsis.
with viral or non-infectious inflammations. In serum,
Sepsis is a leading cause of mortality in
procalcitonin has a half-life of 25 to 30 hours4.
critically ill patients. Delay in diagnosis and initiation
C- Reactive protein (CRP) is a member of the class of
of antibiotics have been shown to increase mortality.
acute-phase reactants, as its levels rise dramatically
However, differentiating sepsis from non-infectious
during inflammatory processes occurring in the body.
triggers of the systemic inflammatory response
This increment is due to a rise in the plasma
syndrome (SIRS) is difficult, especially in critically ill
patients who may have SIRS for other reasons1.
predominantly by macrophages as well as adipocytes.
Multiorgan dysfunction syndrome represents a
It is thought to assist in complement binding to foreign
continuum of organ dysfunction from very mildly
and damaged cells and enhances phagocytosis by
altered function to total and, rarely, irreversible organ
macrophage It also play another important role in
failure and is the major cause of death in the intensive
innate immunity, as an early defense system against
care unit (ICU). Infections were initially thought to be
the main cause of multiorgan dysfunction2.
The SOFA is a six-organ dysfunction/failure score
Procalcitonin (PCT), a 13 kDa protein has
measuring multiple organ failure daily providing a
been studied as a useful biomarker of systemic
daily score of 0 to 24 points, each organ is graded
inflammatory response to infection. It is the
from 0 (normal) to 4 (the most abnormal). SOFA was
prohormone of calcitonin hormone and its production
to create a simple, reliable, and continuous score easily
during inflammation is linked to the bacterial
obtained in every institution6.
endotoxin and to inflammatory cytokines. The
physiological PCT serum level is below 0.5 ng/ml, but
PATIENTS AND METHODS
the rise to a value higher than 2 ng/ml is indicative of
The current study was carried out on 60 critically ill
sepsis3. The level of procalcitonin rises in response to
adult septic patients aged between 18-60 years old of
a proinflammatory stimulus, especially of bacterial
both sex admitted to I C U of ALZahraa hospital, AL-
origin. It is produced mainly by the cells of the lung
Azhar University with anticipated stay of >48 hours..
and the intestine. It does not rise significantly
After informed consent from patients or their relatives,
patients were subjected to: full medical history,
Received:1 /5 /2017 DOI : 10.12816/0039060
Accepted:10 / 5 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1279-1283
Comparison of Sensitivity and Specificity of DWIBS and Contrast Enhanced
T1Wi Sequences in Characterization of Suspicious Mammography Lesions
May Adel Abdel-Monem El-Samahy, Haytham Mohamed Nasser, Sherine Kadry Amin
Radiology Department, Faculty of Medicine, Ain-Shams University
Corresponding author: May Adel Abdel-Monem El-Samahy, Mobile: +201069767696,
E-mail address: Maisamahy@gmail.com
Background: Diffusion Weighted Imaging with Back-ground Suppression is a new technique which uses
the same concept of diffusion weighted imaging yet has the privilege of back-ground suppression and
acquisition at a wider range of b-values hence increasing sensitivity and specificity.
Objective: to determine the accuracy of DWIBS MR imaging in comparison to the DEC MR imaging in
characterizing suspicious mammography lesions.
Patients and Methods: twenty patients were included in the study, all with suspicious breast lesions from
Ain-Shams University mammography clinic. A cross-sectional study was held where all the patients
under-went MRI breast protocol which included DCE and DWIBS sequences. The MRI of all the patients
was read by two expert radiologists blinded to each other's opinion. Biopsy was then done for histo-
pathological correlation. The results were statistically analyzed.
Results: seventy percent of the patients included in our study had malignant lesions and 30% had benign
lesions. Both DWIBS and DCE showed comparable efficacy of 90% and 95% respectively.
Conclusion: DWIBS can be used as an adjunct to DCE breast MRI improving its sensitivity and
specificity. It can as well be used instead of DCE sequences in cases of renal impairment.
Keywords: Invasive ductal carcinoma (IDC), Invasive lobular carcinoma (ILC), Ductal carcinoma insitu
(DCIS), Lobular carcinoma insitu (LCIS), DWIBS (Diffusion weighted imaging with back-ground
suppression), DCE (Dynamic contrast enhanced)
DCE-MR imaging of the breast helps depict
Being the most common invasive cancer to
malignant lesions by showing their pathological
affect females worldwide, screening aiming at
vascularization. The kinetics of contrast
early detection and thereby improving outcomes
enhancement depends upon the capillary
of breast cancer has always been an issue of
permeability, micro vascular density and
diffusivity. These factors affect the rate of initial
For decades conventional X-ray mammograms
contrast uptake, wash-out as well as the
have been widely used for this purpose. This
heterogeneity of the lesion.
however resulted in many unnecessary biopsies,
since almost 50% of the biopsies following
enhancement with the morphologic features
suspicious mammograms were found to be
allows high sensitivity and specificity (7,8) .
negative. The anticipation associated with
The long examination times as well as the
waiting for unnecessary biopsies after query
need for intravenous contrast were found to be
mammography findings has created a real need
practical limitations of the DCE-MRI of the
for more informative imaging techniques (2,3,6) .
breast. This is especially appreciated in patients
To meet this growing need, MR imaging of
with contra-indications to MR contrast material
the breast has become a region of interest for
injection (2,4,5) .
researchers worldwide (3).
A newly introduced MRI sequence DWIBS,
Diffusion weighted MR imaging, which
which is the abbreviation of Diffusion Weighted
depends on the micro structural diffusivity of
Imaging with Background Suppression, allows
water between the cells, has been employed to
the acquisition of volumetric diffusion weighted
help characterize different breast lesions.
images with high lesion-to-background contrast,
Diffusion weighted imaging has proved high
hence making the use of contrast material
sensitivity and specificity in this insight, yet it
unnecessary. DWIBS is said to outweigh the
must be combined with administration of contrast
conventional DW imaging due to its short time of
enhanced imaging and the acquisition of dynamic
acquisition as well (2,4) .
contrast enhanced MR images for proper
The use of DWIBS approach is thought to
characterization (2,4,5) .
decrease the rate of unnecessary biopsies from
false mammography results without the need for
Received: 22 / 5/2017 DOI : 10.12816/0039061
Accepted:1 /6 /2017
Skin Adhesive Tape versus Non- Absorbable Sutures in
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1284-1288
Skin Adhesive Tape versus Non- Absorbable Sutures in
Repair of Laparoscopic Incision
Moustafa Ibrahim Ibrahim*; Amr Ahmed Mahmoud Riad; Safaa Ragab Ahmed*
Department of Obstetric and Gynecology ,Faculty of Medicine-Ain Shams University
Corresponding author: Safaa Ragab Ahmed: Safayasen438@yahoo.com. Tel: +2001061004222
Background: Every year several million women have to undergo gynecological surgery. As a result of that
they acquire an abdominal scar. Nowadays women of all ages place extreme importance on the appearance
of the scar in addition to the symptoms of pain, tenderness and itching. An aesthetically poor scar can have
a negative impact on the overall quality of life causing considerable distress, loss of self-esteem and
unhappiness. The appearance of the scar is of significant importance and is often the only reminder of
surgery. Aim of the Study: to compare between skin adhesive tape (steri-strips) and non-absorbable suture
in closure of abdominal laparoscopic port sites.
Patients and methods: The current prospective case control study was conducted at Ain Shams University
maternity hospital .the participating women were randomly allocated into two arms .Arm (A): women had
laparoscopic port sites closed with skin adhesive tape. Arm (B): women had laparoscopic port sites closed
with non- absorbable sutures.
Results: A total of 142 women were included. The overall incidence of pain was 0.1%and 0.2%, redness
was 8.5% and 23.9%,hotness was 2.8% and 12.7%, discharge was 1.4% and 4.2%, impaired healing was
1.4% and 5.6% and satisfaction was 94.4%and 63.4% in arm A and B respectively.
Conclusion: using skin adhesive tape (Steri Strep®) in closure of abdominal laparoscopic port sites is
associated with a decreased risk of wound complications and increased rate of patient satisfaction.
Keywords: Skin Adhesive tape, gynecological surgery, Laparoscopic Incision, non-absorbable sutures.
materials and adhering to good wound closure
Every year several million women have to
technique will ensure optimal wound healing. The
undergo gynecological surgery. As a result of that
ultimate goal of any skin closure technique is to
they acquire an abdominal scar. Nowadays
produce skin approximation and adequate healing
women of all ages place extreme importance on
with minimum wound complications like pain,
the appearance of the scar in addition to the
infection, scarring and keloid formation. Most
symptoms of pain, tenderness and itching. An
important to the patient is the pleasing aesthetic
aesthetically poor scar can have a negative impact
affect. Cost of the procedure should also be
on the overall quality of life causing considerable
distress, loss of self-esteem and unhappiness. The
Tissue adhesives offer the advantages of no risk
appearance of the scar is of significant importance
of needle stick injury and no requirement to
and is often the only reminder of surgery (1).
remove sutures later. Tissue adhesives have been
The outcome of the surgical skin closure is
used primarily in emergency rooms but this
influenced by the indication for the procedure, the
review looks at the use of tissue adhesives in the
location of the surgical site and the associated
operating room where surgeons are increasingly
intra-operative or post-operative complications.
using these for the closure of surgical skin
The general medical condition of the patient is
incisions (4, 5).
also of considerable importance. These factors are
Aim of the Study: to compare between skin
usually outside the control of the surgeon. The
adhesive tape (steri-strips) and non-absorbable
surgeon, however, can choose the technique of
suture in closure of abdominal laparoscopic port
closure and the suture material (2).
sites regarding: sound healing and patient
The technique of closure should be quick, easy,
cost effective and simple, while maximizing
wound cosmesis and patient satisfaction. The
PATIENTS AND METHODS
technique should be based on evidence and not
The current prospective case control study
only on the surgeon's preference and tradition.
was conducted at the operative wards of Ain
Any of the methods used should be able to restore
Shams University maternity hospital during the
the physical integrity and function of the injured
period from February 2017 to July 2017. The
tissue. Appropriate and careful selection of suture
material is important. Choosing the appropriate
laparoscopy and aging 20-40 y. women with
Received: 24/5 /2017 DOI : 10.12816/0039062
Accepted: 3/6 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1289-1290
Diabetic Foot Awareness among Diabetic Patients in Saudi Arabia
Mesale A Algshanen1, Mohammed F Almuhanna2, Ahmed M Almuhanna3, Faisal F Alghobaish4,
Omer S bari5, Naif A Alajji3, Hussain J Alabdullah2, Saad H Aldosari3, Salman I Alomran6,
Muayyad Abualjadayel7, Ahmed A Almeshari8, Meshal A Almustafa8, Fahad S Alqahtani3,
Mohammed D Alzamanan1, Khalid M Alotaibi3, Mahdi Y Alzamanan1
1 Najran University, College of Medicine, 2 Wroclaw Medical University, 3 King Saud University,
College of Medicine, 4 Ministry of Health, 5 Batterjee Medical College, 6 Prince Sattam University,
7 UQU University, College of Medicine, 8 King Fasial Universty
Aim of the work: diabetic foot disease(DFD) is diabetic patient's foot affection by ulcers which are
accompanied by peripheral vascular disease and/or diabetic neuropathy of the lower limb. Prevalence of
diabetic ulcer is ranging from 2%-10%. High rate of lower limb amputation in DFD (More than 15%) and
survival rate for undertaken amputation patient are short. Ninety diabetic amputations are performed monthly
in Saudi Arabia capital of Riyadh. Identification of DFD and diabetic patient's awareness of DFD and how to
take care of it will reduce the incidence of more complications like amputation.
This study aimed to evaluate knowledge, education, attitude and practice with diabetic foot among diabetic
patients all over Saudi Arabia. Patients and Method: cross-sectional study directed among the diabetic clinic
visitors in Primary Health Care Centers (PHCs s). Selection of 55 PHCs was done by random sampling. Ten
diabetic patients were randomly selected from each PHCs and collecting of data was done by interviews.
Research questionnaire contains three parts; first part is asking about demographic data; second part is about
data that are focusing on diabetes and its related questions and last part is the main part which asking about
diabetic foot. Results: 519 diabetic patients were participated in this study. Only 180 participants were
complaining of diabetic complications (34.7%). Most of participants (55.1%) get high score 7-8 out of 8
questions in Knowledge. Although, there were 166 persons (32%) who couldn't reach full score in attitude
evaluation. There was a large percentage of our participants (69%) had very low score 0-2 out of 6 in
assessment of previous education of diabetic foot. More than half of participants (56.5%) had score 6-10 out
of 15 in evaluation of practice with diabetic foot. Conclusion: diabetic foot in Saudi Arabia is existing, even
amputations and other diabetic foot complications were also present. Diabetic patients have good knowledge
and attitude toward diabetic foot. Education about diabetic foot and practice is still weak.
Keywords: diabetes mellitus, diabetic foot, diabetic patients, awareness, knowledge, education, attitude,
vascular disease and/or diabetic neuropathy of
Diabetes Mellitus(DM) is metabolic disorder
lower limb (6). Multiple factors can trigger DFD,
characterized by chronic hyperglycemia and
commonest are abnormal joint mobility or foot
trouble in metabolism of carbohydrates, protein and
pressure, trauma, foot deformity, peripheral
fat as a result of defect in insulin secretion, insulin
vascular disease or peripheral neuropathy (7).
action or both(1). DM is highly prevalent
Prevalence of diabetic ulcer was ranging from
worldwide, in 1980; 108 million adults (4.7%)were
2%-10% according to Moss et al. (8). High rate of
suffering from DM, this number increased to 422
lower limb amputation in DFD (More than 15%)
million (8.5%) in 2014(2). In 2015 a study was
and survival rate for undertaken amputation patient
published by International Diabetes Federation
is short (7). According to what published on 2009
(IDF); there is one adult suffering from diabetes in
In Saudi Arabia, ninety diabetic amputations are
every eleven and one undiagnosed diabetic patient
performed monthly in Saudi Arabia capital of
in every two patients(3). According to the World
Riyadh and this number is increasing quickly and
Health Organization (WHO): Saudi Arabia is 7th
becoming to appear at younger age (9). Early
for rate of diabetes in the world and 2nd highest in
Identification of DFD and diabetic patient's
middle east and pattern of diabetes is increasing in
awareness of DFD and how to take care of it will
the past years(5).
reduce the incidence of more complications like
Many complications affecting heart, kidneys,
eyes, vessels and nerves are result from DM,
In this study we aimed to evaluate knowledge,
leading to disabilities and premature death (5). One
education, attitude and practice with diabetic foot
of common and annoying complications is the
among diabetic patients all over Saudi Arabia.
Diabetic Foot(DFD). DFD is diabetic patient's foot
affection by ulcers accompanying with peripheral
In our research, we tried to reach most of the
Received: 17 /4/2017 DOI : 10.12816/0039063
Accepted:25 / 4 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1291-1296
Role of MRI CSF Flowmetry in Evaluation of
Hydrocephalus in Pediatric Patients
Abeer Maghawry Abdelhameed, Eman Ahmed Fouad Darweesh, Marwa Hosni Bedair
Radiology Department, Faculty of Medicine, Ain Shams University
Corresponding author: Marwa Hosni Bedair,Telephone number: 0106422840,E-mail: email@example.com
Background: phase contrast MR imaging is a rapid, simple and non-invasive technique which is
sensitive to even small CSF flows, and can be used to evaluate CSF flow both qualitatively and
quantitatively. Cine phase contrast MR images show CSF flow in a dynamic, more easily appreciable,
and in a more pleasing manner, allowing the delineation of obstruction, if present, along the portions of
CSF pathway where obstruction is common (foramen of Monro, acqueduct of Sylvius)
Patients and Methods: the study includes 20 patients from the pediatric population with
ventriculomegaly (diagnosed by a radiological report) referred from Ain Shams Pediatric Hospital,
Neurosurgery department at Ain Sahms University, clinic, and outpatients. Control group of 20 pediatric
patients of matched age group underwent CSF flow study to obtain normal reference values. These
patients had no hydrocephalus and came to our institute to undergo MRI for other neurological causes.
CSF flowmetry was added to their study after obtaining oral informed consent from their parents.
Results: our study included 20 patients, 8 males and 12 females, with age range 2 months - 12 years and
average age 3.5 years old. All patients included were diagnosed with hydrocephalus by a previous
radiological report. All patients underwent conventional MRI brain and CSF flowmetry. Patients were
given diagnosis based on findings of conventional MR images, and were categorized into groups
according to their underlying etiologies. 9 patients had aqueductal stenosis, 4 patients had atrophy, 2
patients had communicating hydrocephalus, 2 patients had Arnold Chiari malformation, 1 patient had
Dandy-Walker variant, 1 patient had obstruction at foramen of Monro, and 1 had obstruction at foramen
of Magendi. CSF flowmetry was added to evaluate the cause of hydrocephalus.
Conclusion: phase contrast MR imaging is a rapid, simple and non-invasive technique which is sensitive
to even small CSF flows, and can be used to evaluate CSF flow both qualitatively and quantitatively, and
could be used in conjunction with conventional MRI in assessment of cases of hydrocephalus.
Keywords: hydrocephalus, pediatrics, Phase contrast MRI.
Hydrocephalus could be defined as
and can be used to guide therapeutic decisions in
disturbance of formation, flow or absorption of
a more reliable manner, and follow up post
CSF. In infants, it leads to progressive
treatment outcome (3).
macrocephaly, while in childhood the patient
may present with signs of increased intracranial
AIM OF THE STUDY
tension. It's classified into communicating and
to demonstrate the role of CSF flowmetry using
phase contrast MRI in evaluation of
hydrocephalus in pediatric population.
Phase contrast MR imaging is a rapid,
simple and non-invasive technique which is
PATIENTS AND METHODS
sensitive to even small CSF flows, and can be
The study includes 20 patients from the pediatric
used to evaluate CSF flow both qualitatively and
population with ventriculomegaly (diagnosed by
quantitatively. Cine phase contrast MR images
a radiological report) referred from Ain Shams
show CSF flow in a dynamic, more easily
Pediatric Hospital and Neurosurgery department
appreciable, and in a more pleasing manner,
allowing the delineation of obstruction, if
present, along the portions of CSF pathway
where obstruction is common (foramen of
- Patients with range of age between 1-18 years
Monro, acqueduct of Sylvius) (2).
old diagnosed with hydrocephalus (clinically
CSF flow measurement at the suspected
level of obstruction gives reliable and
- No gender predilection.
reproducible results for more accurate diagnosis,
Received: 21 / 05 /2017 DOI: 10.12816/0039064
Accepted: 30/ 05 /2017
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1297-1300
Effective Phacoemulsification Time in Femto Cataract in Comparison to
Ahmed Hassan Assaf, Rania Gamal El Din Zaki, Yasmine Maher Mohammed, Marwa Mustafa Mahmoud
Department of Ophthalmology, Faculty of Medicine, Ain Shams University
*Corresponding author: Ahmed Hassan Assaf : firstname.lastname@example.org ,Tel no: 01001418338
Background: Cataract surgery is one of the most commonly performed surgery in the world and the number of
individuals with cataracts is predicted to reach 30 million by the year 20201. This number will continue to grow
as the population ages. more and more patients pursue surgery at the early stage of cataract in order not to endure
visual impairment. Phacoemulsification is the standard surgery procedure for cataract in the developed countries.
In recent years, femtosecond laser (FSL) has been introduced into phacoemulsification cataract surgery to
perform corneal incisions, capsulorhexis, and nuclear fragmentation. Numerous clinical studies have reported
that using FSL to perform nuclear fragmentation before phacoemulsification significantly reduces the amount of
ultrasound energy and effective phacoemulsification time (EPT) required in the surgery.
Purpose: The goal of the present study is to assess the effect of FSL on effective phaco time in comparison to
conventional phacoemusification procedure. Patients and Methods: a comparative study included 40 patients
with senile cataract (nuclear cataract grade III or more) based on lens opacification classification system III
(LOCSIII). The patients were subdivided into 2 groups; group (A) included 20 patients with senile cataract
underwent Femtosecond laser-assisted phacoemulsification (CATALYS FSL system (Abbott Medical Optics))
and group (B) included 20 patients with senile cataract underwent conventional phacoemulsification ( INFINTI
phacoemulsification platform (Alcon)). Effective phaco time had monitored and recorded in all patients.
Results: As regarding conventional phaco group, mean EPT was 19.80±24.33 and in femto group, mean EPT
was 1.05±1.28 with (p-value 0.001) which show highly significant difference between the two groups.
Conclusion: Femto-second laser assisted cataract surgery reduce effective phacoemulsification time for grade 3
or more of nuclear cataract in comparison to manual procedure.
Keywords: effective phacoemulsification time (EPT).
FSL. Another advantage of FLACS is its ability to
Cataract surgery is one of the most commonly
create a more circular and precise capsulorrhexis,
performed surgeries in the world and the number of
which can facilitate Phacoemulsification and
individuals with cataract is predicted to reach 30
intraocular lens (IOL) implantation, and offer more
million by the year of 2020¹.
accurate refractive outcomes after surgery .
Femtosecond laser is utilized to perform 4 steps
The goal of the present study is to assess the
in modern cataract surgery: primary and secondary
effect of FSL on effective phaco time in comparison
corneal incisions, capsulotomy, lens fragmentation,
to conventional phacoemusification procedure.
and astigmatic keratotomies(2,3).
The FSL guarantee the stability, precision,
PATIENTS AND METHODS
length, shape, and width of the corneal incisions.
A prospective study was conducted on 40
Another unique advantage is the possibility of
patients with senile cataract (Age above 50) seen at
imaging the cutting process, during and after
Ain Shams university hospital from October 2016 to
surgery. This is because the laser process is a three
march 2017. This study was carried out in
dimensional (3-D) scanning process and the essential
accordance to the tenets of the Declaration of
3-D beam delivery for acquiring a 3-D image is
Helsinki and ethical approval was obtained from Ain
already part of the system. Thus, the target tissue can
Shams University Research Ethics Committee.
be scanned easily without making room for
The study included 40 patients with mean age of
additional scanning mirror and lenses for imaging
group A 63.20±3.91, group B 62.15±1.50 with non
using Optical Coherence tomography (OCT) .
significant difference between the two groups. The
Reduction in estimated phaco time was found
percentage of male to female ratio was equal in
between standard cataract surgery and the optimized
group A with 50% each, Group B, females were
Received: 21 / 05 /2017 DOI: 10.12816/0039065
Accepted: 30/ 05 /2017