c:\work\Jor\vol683_1 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1301-1307

The Role of Dynamic Contrast Enhanced and Diffusion Weighted MRI in
Characterization of Suspicious Breast Masses
Randa Hussein Abdullah, Amal Ibrahim Othman, Hussein Abdullah Hussein
Department of Diagnostic Radiology, Faculty of Medicine, Ain Shams University
Corresponding author: Hussein Abdullah Hussein

Early detection and diagnosis of breast cancer are mandatory for accurate management.
Traditionally, mammography and ultrasound are the basic imaging techniques for the detection and
localization of breast masses. The low sensitivity and specificity of these imaging tools resulted in a
demand for new imaging modalities.
Aim of study:
to evaluate the role of either diffusion weighted images-MRI or dynamic contrast enhanced
MRI in differentiating malignant from benign breast lesions comparing with histopathology results.
Patients and Methods: from November 2016 to July 2017, a total of 20 patients presented with suspicious
breast lesions BIRADS (4&5) were included in the study. All participants underwent breast DWI and DCE-
MRI. Results were compared with histopathological results as a standard final diagnostic method. Results:
the study included 20 female patients with suspicious breast lesions, there was 15 (75%) malignant lesions
while benign lesions, while benign lesions were 5 (25%) cases. DCE-MRI was found to have a sensitivity
of 86.7% and specificity of 80%. ADC cutoff value was found to have a value of 1.143*10-3, which was the
best to differentiate between benign and malignant breast masses. DWI MRI was found to have sensitivity
of 93.3% and a specificity of 80%.
Conclusion: DW-MRI alone gave the same performance as in combination with DCE-MRI. The
comparison of DWI and DCE-MRI provides a dramatic superiority in the sensitivity, specificity and
accuracy of breast DWI-MRI over other modality.
Keywords: Breast, DWI, DCE, BIRAD


Breast cancer is the second leading cause of
DCE-MRI to differentiate lesion nature is now
death after lung cancer1. It is commonest cancer in
widely established5.
females2. Improving diagnostic methods will

subsequently improve outcome in survival rate in
patients with breast cancer3. New techniques in
MR imaging of breast (i.e. DWI and DCE) are
This was a prospective trial carried out in the
under the scope in recent literatures to study their
period from November 2016 to July 2017 in
sensitivity and specificity to differentiate between
diagnostic radiology department of Ain-Shams
benign and malignant lesions4. The reported
University Hospital. The study consisted of 20
diagnostic indices for DCE are highly variable5.
female patients (age range 25-73 years old with
This variability can be allocated to lesion criteria
mean± SD 9.05± 12.75years). Suspicious lesions
used to differentiate from the start6,7.
were examined by triple maneuvers (history
Lesion morphology and enhancement kinetics
taking, clinical examination, sono-mammography
are commonly used biomarkers in DCE8. BIRAD
and biopsy).
MRI lexicon involves morphological evaluation of
Ethical Approval
breast lesion. This can be achieved by evaluating
All study procedures were performed in
margin, shape, enhancement pattern, shape and
accordance with the ethical standards laid down in
internal enhancement pattern9. Kinetic assessment
the 1964 Declaration of Helsinki and its later
is achieved by detecting initial and post-initial
enhancement of breast lesion.
Diffusion-weighted imaging was added in many
Inclusion criteria
centers world-wide to increase sensitivity and
1- Adult female gender only
specificity of conventional MRI10,11. Usefulness of
2- Newly diagnosed lesions
breast DWI-MRI was reported by many literatures
3- BIRAD 4 & 5
from 2002. The sensitivity was in range of 80%-
Exclusion criteria
96% and its specificity was in range of 46%-
1- Recent breast trauma or surgery in the last 6
91%12. However, combination of DWI-MRI and
Received: 24 / 5 /2017 DOI: 10.12816/0039666
Accepted: 3/ 06/2017

Full Paper (vol.683 paper# 1)

c:\work\Jor\vol683_2 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1308-1315
Male Breast Cancer: A Retrospective Study
Hatem Mohamed Abdallah, Ramy Refaat Youssef Ghali,
Mai Mohamed Ali Ezz El Din, Hesham Mahmoud Elshimy
Clinical oncology department, Ain Shams University
Corresponding author : Hesham Mahmoud Elshimy, Tel:01007431882, email: drelshimyhesham@gmail.com

The male breast cancer (MBC) is a rare disease and represents less than 1% of all malignancies
in men and less than 1% of all breast cancers incident.
Aim of study: In this descriptive retrospective study we aimed to provide clinico-epidemiological
characteristics of MBC. To present the treatment given with respect to DFS , TTP & OS, to identify possible
prognostic factors of the disease and the toxicities encountered by the treatment given.
Patients and Method: Out of 11313 cancer patients 3046 were breast cancer; 28 of them were MBC. All
patients presented to clinical oncology department in Ain Shams University in the period from January 2008 to
December 2014 and follow up till December 2016
Results: The median age of patients was 59 years. Around 90% had hormone receptor positive (estrogen and/or
progesterone receptors).Two third of the patients had advanced T-stage (T3 and T4). Infiltrating ductal
carcinoma the most common type of histology was encountered. Modified radical mastectomy was the most
common (75%) type of surgery done followed by chemotherapy for 21 patients and loco-regional radiotherapy
for 20 patients. Tamoxifen was administered in 19 patients. Relapse occurred in 14 patients (50%). The 5-year
disease-free survival (DFS) was 21.4%, the 5-year time to progression (TTP) rate was 21.4% and the 5-year old
overall survival (OS) rate was 35.7%.
Conclusion: There is always a delay in the male patients since the first complaint until they seek medical
advice, which results in an advanced disease at presentation.
Keywords: Male breast cancer, Female breast cancer, BRCA gene, Tamoxifen, Aromatase inhibitor


Male breast cancer (MBC) is a rare disease,
associated with increased risk of MBC;
accounting for less than 1% of all malignancies in
approximately 15% to 20% of men with breast
men and for less than 1% of all incidents of breast
cancer report a family history of breast or ovarian
carcinoma (BC) .
cancer .
Establishing the precise risk factors for MBC has
A personal history of a second primary tumor is
proved challenging due to the rarity of the disease.
reported in more than 11% of MBC patients. Men
However the etiology of MBC is unclear, but
diagnosed with a first primary breast cancer have a
hormonal levels may play a role in the development
16% increased risk of developing a second primary
of this disease .
cancer in comparison with the general male
Factors which have been associated with an
population. The risk of a second site-specific cancer
increased risk are: testicular abnormalities, obesity,
is elevated for gastrointestinal cancer, cancer
physical inactivity, bone fractures after the age of
pancreas, cancer prostate, melanoma and non-
45, liver cirrhosis, radiation exposure and alcoholic
melanoma skin tumors .
beverages intake. Many of these risk factors are
BRCA2 mutations have been identified in 4-40%
of MBC patients, whereas BRCA1 mutations are
estrogen/androgen, resulting in a relative excess of
infrequent. The estimated risk for male carriers of
estrogen .
BRCA 2 of developing breast cancer is 5-10%,
The most well-known single condition
whereas the risk for BRCA1 carriers is 1-5% .
predisposing for MBC is Klinefelter´s syndrome
About 90% of all male breast tumors prove to
(carrier type XXY) with a 30-50 relative risk of
be invasive ductal carcinomas, followed by ductal
developing breast cancer
carcinoma in situ .Since the male breast lacks
Similar to female breast cancer (FBC), a
terminal lobules, unless it is exposed to high doses
positive family history (FH) of breast cancer is
of endogenous and/or exogenous estrogens, the
Received: 17/ 06 /2017 DOI: 10.12816/0039667
Accepted: 26/ 06 /2017

Full Paper (vol.683 paper# 2)

c:\work\Jor\vol683_3 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1316-1324

Conservative Management versus Ventilation Tube Insertion in
Children with Otitis Media with Effusion Accompanying Cleft Palate
Mohamed Abd El Raouf Masoud, Ayman Mohamed ElKahky,
Mohamed Amir Hassan, Nadia Hassan Shahba
Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University
*Corresponding author: Nadia Hassan Shahba tel +201065333627 email: nadia.shahba89@gmail.com

Background: O
titis media with effusion (OME) is a collection of non-purulent fluid in the middle ear space;
it is almost universal in children with cleft palate. Cleft palate (CP) is among the most common congenital
malformations, with an overall incidence of around 1 in 700 individuals. Surgical closure of the cleft palate
may lead to improvement in the audiological status of the patients, but whether early surgical correction can
improve the middle ear status in CP children remains open for debate.
Aim: A meta-analytical study to evaluate and compare the outcome of ventilation tube insertion versus
conservative management in management of otitis media with effusion accompanying cleft palate.
Methods: A review process was used to assess eligible studies drawn from included published medical
articles about conservative management versus ventilation tube insertion in children with otitis media with
effusion accompanying cleft palate through searching the Medline data base (www.pubmed.com) and
Cochrane library. Then Data were extracted and analyzed from the included studies.
Results: 30 relevant articles were found, by application of inclusion criteria 8 articles were found meeting the
inclusion criteria and could undergo Meta-analysis. Our results have shown that OME in children with
repaired cleft palate can be managed satisfactorily without routine use of ventilation tube (VT). The presence
of OME does not lead to long term complications in all patients. Hearing impairment due to OME can be
satisfactorily treated with hearing aid (HA) in a majority of children. VT need to be inserted only if the child
is not compliant with using a HA or develops recurrent suppurative otitis media. Patients should be followed-
up closely for OME to prevent complications. Conclusion: Routine use of ventilation tube in CP patients
should be discouraged; instead Treatment should be based on the need and willingness of the children and
their parents. Also with respect to individual bases such when the child is proved to have OME and hearing
loss that affect child language and speech development. Insertion of ventilation tubes should be offered as an
alternative to hearing aids or conservative management by close otological and audiological follow up.
Keywords: - Otitis media with effusion, Cleft palate, ventilation tube, conservative management


Otitis media with effusion (OME) is a
age of onset, prolonged course, higher rate of
collection of non-purulent fluid in the middle ear
recurrence, higher incidence of surgery and later
space; it is almost universal in children with cleft
complications, and potential diagnostic difficulties
palate. Cleft palate (CP) is among the most
(4). OME can impair hearing at stages thought to be
common congenital malformations, with an overall
important in the development of language,
incidence of around 1 in 700 individuals (1).
behavioral and social relationships. As a
Children with cleft palate are highly
consequence it can influence the quality of life in
susceptible to OME because of abnormal insertion
these individuals (5).
of the levator veli palatini and tensor veli palatini
The aim of this study is to evaluate
muscles on the Eustachian tube, resulting in poor
different protocols for management of OME
active opening of the tube and developing OME(2).
accompanying CP children. Outcomes measured in
Surgical closure of the cleft palate may lead
this study are effectiveness of ventilation tube
to improvement in the audiological status of the
insertion (VTI) versus conservative management
patients, but whether early surgical correction can
for hearing, speech and language development.
improve the middle ear status in CP children
Complications and sequelae of the treatment
remains open for debate (3). In fact, CP patient will
modality in the form of tympanic membrane
develop particular problems because of the earlier
Received: 12/ 06 /2017 DOI: 10.12816/0039668
Accepted: 21/ 06 /2017

Full Paper (vol.683 paper# 3)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1325-1331

Study of Serum Irisin in Patients with Thyroid Dysfunction
Mohamed H. El-Gayar, Khaled M. Makboul, Ahmed M. Bahaa El Din, Mohamed S. Mohamed
Internal Medicine and Endocrinology department, Faculty of Medicine, Ain Shams University

irisin, identified as a proteolytic cleavage product of the fibronectin type III domain-
containing protein 5 (FNDC5), It is a novel myokine secreted by contracting skeletal muscle, possibly
mediating some exercise health benefits via ,,browning of white adipose tissue. Irisin causes a significant
increase in total body energy expenditure and resistance to obesity-associated insulin resistance in mice,
while controversy still exists concerning irisin origin, regulation and function in humans.
Aim of the work
: our study aimed to detect relation of thyroid status (hypo, hyperthyroid) with serum
irisin, ck and peripheral neuropathy. Patient and methods: this study was conducted on 60 candidates
consisted of 40 patients with thyroid dysfunction selected from Endocrine outpatient Clinic and Inpatient
Department of Ain Shams University Hospitals and 20 healthy volunteers from April 2016 to October 2016.
Informed consent was obtained from all participants. Patients of both genders, age more than 18 years old,
20 patients with hypothyroidism, 20 patients with hyperthyroidism and 20 healthy volunteers. We excluded
significant renal, hepatic and cardiac disease, severe associated acute illness or depression, pregnant
females, diabetes, hypercortisolism, hypocortisolism, muscular or neurological disorders, routinely taking
drugs as statins, intensively involved in a sport or any strenuous physical activity. All participants were
subjected to full medical history taking, general clinical examination and laboratory investigations as
thyroid and thyroid-related hormone concentrations as well as a thyroid ultrasound examination and thyroid
scan for patients with hyperthyroidism. Serum irisin level, CK and nerve conduction velocity were
measured. Results: irisin level was higher in hyperthyroid group than euthyroid group with a significant
difference. In comparison with normal NCV candidates and reduced NCV candidates with other variables
there was only border line significant difference with irisin p-value. Non significant value of irisin and CK
level were detected for diagnosis of hypothyroidism. Irisin has highly significant value for diagnosis of
hyperthyroidism with (sen 95%, sp 42.5). Increased BMI is the only independent predictor for
hypothyroidism by using multivariable binary logistic regression analysis. Decreased BMI and irisin are
independent predictors for hyperthyroidism. Conclusion: serum irisin level is one of predictors for
hyperthyroidism, on the other hand irisin does not have a significant value to predict hypothyroidism.
Serum irisin was found to be higher in patients with hyperthyroidism in comparison with euthyroid
participant with non statistically significant difference between hypo and hyperthyroidism. Serum CK level
does not have a significant value in diagnosis of thyroid dysfunction (hypothyroidism or hyperthyroidism).
Serum irisin level was low in thyroid dysfunction cases with delayed NCV compared to thyroid dysfunction
cases and normal NCV with border line significant difference.
Keywords: irisin, thyroid dysfunction and nerve conduction.


Irisin is a newly discovered adipo-
local control of T3 activity is crucial during the
myokin, which is reported to have a significant
various phases of myogenesis (2).
influence on the body metabolism and
Hypothyroidism is the most common
thermogenesis. Other influencing factors on
endocrinal disorder. The variety of end-organ effects
metabolic state are thyroid hormones, which
and wide range of disease severity from entirely
increase heat production and control the energy
asymptomatic individuals to patients in coma with
balance. Due to numerous similarities in action it
multisystem failure can make hypothyroidism an
seems imperative to explore these substances
elusive clinical entity. Peripheral neuropathy occurs
potential mutual influence on the body (1).
early in hypothyroidism even before other
Thyroid hormone signalling regulates
symptoms occur. Hence early detection of
crucial biological functions, including energy
peripheral neuropathy in hypothyroidism is
expenditure, thermogenesis, development and
necessary for early diagnosis and treatment (3).
growth. The skeletal muscle is a major target of
Both hypothyroidism and hyperthyroidism
thyroid hormone signalling. Regulation of the
may cause signs and symptoms of neuromuscular
expression and activity of deiodinases constitutes a
dysfunction. Hypothyroidism has been associated
cell-autonomous, pre-receptor mechanism for
with the clinical features of myopathy (for example,
controlling the intracellular concentration of T3. This
proximal muscle weakness) mononeuropathy and
Received: 12/ 06 /2017 DOI: 10.12816/0039669
Accepted: 21/ 06 /2017

Full Paper (vol.683 paper# 4)

c:\work\Jor\vol683_5 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1332-1338
Effect of General Anesthesia versus Spinal Anesthesia in Cesarean
Section on Regain of Gastrointestinal Motility
Bayoumi M.
Ain shams University, Faculty of Medicine, Department of Obstetrics and Gynecology

cesarean section is a common major hospital surgical procedure performed nowadays. One of
the most common postoperative complications is postoperative gastrointestinal paralysis (Ileus) that must be
minimized due to its possible serious consequences.
this study aims to compare the time to regain intestinal motility after general anesthesia versus
spinal anesthesia for cesarean section.
this prospective controlled study was carried out at Ain Shams University Maternity Hospital
during the period from April 2016 to June 2017 after approval of the hospital health ethical committee. It
included 150 patients who had C.S and they were subdivided into 2 groups according to a randomization scale
(spinal versus general). Results: spinal anesthesia results in a quicker return of bowel activity after cesarean
section, decreased hospital stay and less use of post-operative opioids than general anesthesia.
Recommendations: we recommend the use of spinal anesthesia for cesarean section especially if there's no
contraindication for that.
Keywords: post-caesarean section ileus, GI hypomotility, spinal and general anesthesia.

Postoperative hypomotility may affect all
Contraindication to regional anesthesia i.e.
parts of the gastrointestinal tract, but with different
parturient refusal, coagulopathy, significant
times or recovery to normal function, small
hypovolemia, systemic or local sepsis, increased
intestine function generally normalizes first, often
intracranial pressure, severe stenotic valvular heart
within several hours of surgery(1). All anesthetics
disease, preexisting neurologic conditions and local
used for induction or maintenance of general
anesthetic or fentanyl allergy. High risk
anesthesia may depress gastrointestinal motility,
pregnancies as pre-eclampsia, eclampsia, any
also incising the peritoneum and manipulation of
medical disorder (DM, cardiac and thyroid
the bowel will completely inhibit the motility.
diseases), previous intestinal surgery or previous
Effect of anesthesia and antispasmodics on the
gynecological operations or previous CS, History of
colon may also cause postoperative ileus. The large
chronic constipation and increased operative time
intestine is devoid of intercellular gap junctions
more than 50 minutes.
which make the colon more susceptible to the
Elimination criteria
inhibitory actions of anesthetics, in particular,
Any intraoperative complication, presence
halothane, enflurane and atropine delay gastric
of intestinal or omental adhesions, increased
intraoperative blood loss (more than 1000cc),

insertion of intra-peritoneal drain and excessive
small bowel manipulation.
This prospective controlled study was
Patients were asked for informed consent,
carried out at Ain Shams University Maternity
full history taking, examination of vital signs and
Hospital from April 2016 to June 2017 after
approval of the hospital health ethical committee. It
included 150 patients who had C.S and were
General anesthesia
subdivided into 2 groups according to a
Parturients in this group received standard
randomization scale. On the day of the operation
rapid sequence induction with pre-oxygenation by
each randomly received a closed opaque envelope
100%oxygen for 3 minutes followed by 4-5 mg/kg
for the selection of the procedure (Spinal versus
anesthesia was maintained with up to 1.5 %
isoflurane and oxygen, neuromuscular blockade
Inclusion criteria
was maintained with 0.4mg/kg atracurium.
Patients set for planned C.S under either
general or spinal anesthesia: age from 18 to 35
Spinal anesthesia
years, full term singleton pregnancy (37-41 weeks).
Spinal anesthesia was performed at L2-3 or
Exclusion criteria
L 3-4 inter vertebral space using a fine spinal
Received:12/06/2017 DOI: 10.12816/0039670
Accepted: 21/ 06 /2017

Full Paper (vol.683 paper# 5)

c:\work\Jor\vol683_6 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1339-1341

The Role of Diffusion Weighted MR Imaging in Assessment of
Hepatocellular Carcinoma After Radiofrequency Ablation
Ahmed Mostafa Mohamed, Amir Louis Louka, Akeel Faisal Ghazee
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Surgical resection and
local ablative therapies represent the most frequent first lines therapies adopted when liver transplantation
cannot be offered. Aim of the work: was to evaluate the feasibility of DWI and the corresponding ADC
values to detect tumor response after radiofrequency ablation for hepatocellular carcinoma.
Materials and methods: MR examinations were done for 20 HCC patients post-RFA. Pre and
postgadolinium enhanced images as well as DW sequences were performed. ADC values of ablation zones
and liver parenchyma were assessed. ADC values of ablation zones and adjacent signal alterations identified
in DWI were analyzed. Results: Residual or recurrent lesions were detected in 4 patients (20%). The mean
ADC value of ablated zones differed significantly from that of normal liver parenchyma. The corresponding
ADC values were significantly lower in patients with residual lesion than in patients without residual lesion.
Conclusion: It could be concluded that DWI is a feasible follow-up tool for postablation liver contributing in
detection of residual lesion.
Keywords:MR, Hepatocellular Carcinoma, Radiofrequency Ablation


Documented consent must be obtained from each
Hepatocellular carcinoma (HCC) is the most
patient involved in the study.
common primary liver malignancy and is a leading
1. MR protocol
cause of cancer-related death worldwide (1).
Magnetic resonance imaging examinations were
Surgical resection and local ablative therapies
performed on a Philips InteraAchieva 1.5 T super
represent the most frequent first lines therapies
conducting MR unit , with a 16- channel body coil
adopted when liver transplantation cannot be
2. Pre-contrast imaging included
offered(2). Radiofrequency ablation has become the
a) T1 weighted (T1W) images.
most widely used local thermal ablation method in
b) T2 weighted (T2W) images.
recent years because of its minimally invasive
c) T2 SPAIR (Spectral Attenuated Inversion
nature(3). After certain loco-regional treatments
such as RFA, the usual morphological criteria
d) In phase and out phase gradient echo
primarily based on the maximal lesion size cannot
be used with confidence, as the induced ablation
e) Heavy T2 weighted images.
zones comprise the tumor and its margin(4).
3. Dynamic study
Dynamic study was performed after bolus
promising non-invasive diagnostic tool for the
injection of 0.1mmol/kg bodyweight of Gadolinium
evaluation of HCC treatment responses to loco
- DTPA at a rate of 2ml/s, flushed with 20ml of
regional therapies (5). ADC value changes have
sterile 0.9% saline solution from the antecubital
been shown to occur early after treatment and
vein. The injection of contrast media and saline
correlate well with tumor necrosis (5).
solution was performed by automatic injector.
The aim of the current study was to assess role of
4. Diffusion study
diffusion weighted MRI in evaluation of treatment
Respiratory-triggered fat-suppressed single-shot
response after radiofrequency ablation for
echo planar DW imaging was performed in the
hepatocellular carcinoma.
transverse plane with tri-directional diffusion
gradients by using different b values 0,300,600
The study was conducted during the period
sec/mm2 to increase sensitivity to cellular packing.
between November 2016 and May 2017 at MRI
5. MR analysis
unit at Ain Shams University Hospital on 20
The morphological features of each lesion were
patients (14 male and 6 female) treated by
recorded included size, shape, margin, signal
characteristics and pattern of enhancement in the
carcinoma. Exclusion criteria included patients with
dynamic imaging as well as number and site of the
MRI incompatible devices such as cardiac pacemaker,
detected focal lesions. Then provisional diagnosis
metallicvalves, hearing aids or aneurismal clips.
was reported. Second, we reviewed the diffusion

images with ADC values for final radiological

characterization and detection of focal lesion.
Received: 12/ 06 /2017 DOI: 10.12816/0039671
Accepted: 21/ 06 /2017

Full Paper (vol.683 paper# 6)

c:\work\Jor\vol683_7 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1342-1349

Association between Chlamydia Trachomatis Cervicitis and Preterm Labor
Sabry Sayed Mohamed*, Noha Hamed Rabei*, Malames Mahmoud Faisal*, Amira Sayed Amin**

* Obstetrics and Gynecology Department Faculty of Medicine, Ain Shams University
** Obstetrics and Gynecology Department (Alkhzendara Hospital)

Preterm labor (PTL) is a major determinant of neonatal morbimortality with adverse
consequences for health. The causes are multifactorial, with intrauterine infection probably explaining most
of these outcomes. It is believed that infection with Chlamydia trachomatis (CT) is also involved in PTL.
Objective: To compare the prevalence of chlamydia trachomatis cervicitis in women with preterm labor and
control at term. Methods: This was a case-control study conducted at Ain Shams University Maternity
Hospital. This study included 70 pregnant women with singleton fetus who attended the causality and were
selected to participate in the study. They were divided into two groups, cases and control group each 35
patients. Swab was taken from endocervix and chlamydia trachomatis DNA was examined by real time
polymerase chain reaction (PCR). Data were analyzed by Chi-square test.
The prevalence of chlamydia trachomatis cervicitis in women with preterm labor is higher than in
women at term; 8 cases out of 35 (22.9%) as compared to the women in the control group which was 2 cases
out of 35 (5.7%) and this difference was statistically significant using (p =0.04).
This study proved that there is an association between chlamydia trachomatis cervicitis and
preterm labor. Screening and treatment of Chlamydia trachomatis infection are recommended to decrease
cases of preterm labor.
Chlamydia Trachomatis, Preterm labor, polymerase chain reaction.

A history of a preterm delivery is one of the
The etiology of preterm labor remains unknown,
most significant risk factors. The recurrence risk
prediction lacks specificity, prophylaxis is
factor of preterm birth in women with a history of
helpless, diagnosis is difficult and the benefits and
preterm delivery ranges from 17% to 40% and
risks of tocolytic therapy are still debatable. The
appears to depend on the number of prior preterm
above quote testifies to the complexity of preterm
deliveries (3). Multiple gestations carry one of the
labor, a process that ultimately results in
highest risks of preterm delivery. Approximately
considerable neonatal morbidity and mortality. It
50% of twins and nearly all higher multiple
is difficult to quantify the incidence of
gestations end before 37 completed weeks. The
spontaneous preterm labor, as many studies related
average length of gestation is significantly shorter
to preterm birth do not discriminate between
for twins (36 weeks), triple (33 weeks), and
spontaneous preterm labor and iatrogenic/
quadruplets (31 weeks) than it is for singletons (39
therapeutic preterm delivery(1). However, it has
weeks) (6).
been estimated that the incidence of preterm labor
Vaginal infections, such as bacterial vaginosis (7)
varies from 5% to 10% of all births in developed
and those due to Neisseria gonorrhea, Chlamydia
countries (2).
trachomatis, group B streptococcus, Ureaplasma
The pathogenesis of preterm labor is not well
urealyticum and Trichomonas vaginalis have been
understood, and it is often not clear whether
associated with preterm delivery (8).
preterm labor represents early idiopathic activation
Infections play a major role in the genesis of
of the normal labor process or results from a
preterm birth and may account for 25-40% of
pathogenic mechanism (3). So, preterm labor
events. The frequency of infection in preterm birth
probably represents a syndrome rather than a
is inversely related to the gestational age.
specific diagnosis, since the causes are varied (4).
Endotoxins released by microorganisms and
Recent studies of the epidemiology and
cytokines stimulate uterine contractions. Further
pathophysiology of preterm birth have identified
the decidual response may include release of
four pathways leading to preterm labor and
matrix-degrading enzymes that weaken fetal
membranes leading to premature rupture (9).
Trials of prevention of spontaneous preterm
Decidual hemorrhage.
labor received greater interest to prevent
Uterine over-distension.
associated complications and allow trials to
Premature activation of the normal
enhance fetal lung maturity (10).
physiologic initiation of labor(5).
Received: 5/ 06 /2017 DOI: 10.12816/0039672
Accepted: 14/ 06 /2017

Full Paper (vol.683 paper# 7)

c:\work\Jor\vol683_8 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1350-1357

Role of Magnetic Resonance Imaging in Diagnosis of
Chronic Hip Joint Pain in Adults
Hanan Mohamed Issa, Ahmed Hassan Soliman, Alyaa Lateef Hasan
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University

Chronic hip pain is a common problem in adults. In the absence of a known acute trauma, it
can be a diagnostic problem as it can be attributed to many causes. The most common causes are avascular
necrosis, inflammatory causes, transient osteoporosis or neoplastic lesions. Aim of the Work: The aim of
this study is to evaluate the role of magnetic resonance imaging (MRI) in the evaluation and diagnosis of
different causes of chronic hip pain in adults. Patients and Methods: The study was conducted on thirty
patients who had chronic hip pain and they were referred to undergo MR imaging of hip joints in MRI Unit
in Al-Hussain Teaching Hospital in Thi-Qar / Iraq and Ain Shams University Hospital in Cairo / Egypt.
Conclusion: MRI is an essential imaging modality in musculoskeletal system in general and in hip region
specifically. Recommendations: MRI should be done preferably with a limited number of sequences. If the
diagnosis is still query or whenever inflammation or a neoplastic process is suspected, we should do other
sequences in different imaging planes and go for contrast injection and post contrast studies (T1WI).
Key words: MRI , chronic hip joint , adults.

Clinical data is essential for selecting the
The hip joint is designed to withstand
most appropriate imaging techniques in patients
repeated motion and a fair amount of wear and tear.
with chronic hip pain. Range of motion, gait
This ball and socket joint (the body's largest) fits
abnormalities, locking or snapping, duration of
together in a way that allows for fluid movement.
symptoms, and pain patterns (e.g. worse at night
Whenever you use the hip (for example, by going
increased with exercise, relieved by aspirin) can
for a run), a cushion of cartilage helps prevent
be very useful for reducing the potentially long
friction as the hip bone moves in its socket Despite
list of differential diagnoses. Radiographs may
its durability, the hip joint isn't indestructible ,With
provide specific information for common
age and use, can wear down or become damaged.
disorders such as osteoarthritis (OA) or less
Muscles and tendons in the hip can get overused.
common disorders such as primary bone tumors.
The hip bone itself can be fractured during a fall or
Whether the radiographs are normal or not, they
other injury. Any of these conditions can lead to hip
are often of considerable value for the selection of
pain (1) .
additional techniques and for comparison with
Chronic hip pain is a perplexing clinical
studies such as magnetic resonance imaging
problems. Symptoms may be related to numerous
(MRI) examinations (2) .
etiologies, including trauma, neoplasms, and
MRI detects osseous, articular, or soft-
arthropathies. Pain may be due to osseous, intra-
tissue abnormalities. It is both highly sensitive and
articular, periarticular, or soft tissue pathology.
specific for detecting many abnormalities
Referred pain from the lumbar spine, sacroiliac
involving the hip or surrounding soft tissues and
joints, or knee may add to the potentially
should in general be the first imaging technique
confusing clinical picture (2) .
used following radiographs (2) .
The hip is a primary weight-bearing joint.
MRI has become the imaging study of
Disorders of the hip are a potential source of
choice in diagnosing most hip disorders. Also, it is
debility to patients of all ages. In the absence of
amethod of choice in characterizing the various
known acute trauma, hip pain is a common
disorders and assessing the full extent of osseous,
diagnostic problem (3) .
chondral and soft tissue involvement. MRI can
In patients who have hip complaints, the
exquisitely demonstrate joint effusions, synovial
source of pain often involve surrounding
proliferations, articular cartilage abnormalities,
structures (the lower back and pelvis) rather than
subchondral bone, ligaments, muscles, and juxta
the hip joint. Therefore, it is important to maintain
articular soft tissues (6) .
an awareness of these neighboring structures as
It has been successfully used in imaging
well as of the articular hip (4) .
disease processes of the hip because of its optimal
Causes of chronic hip pain include
capability, increased soft tissue contrast, and lack
inflammation, osteoarthritis, traumatic and
of ionizing radiation (7) .
neoplastic causes (5) .
Received: 12/ 06 /2017 DOI: 10.12816/0039673
Accepted: 21/ 06 /2017

Full Paper (vol.683 paper# 8)

c:\work\Jor\vol683_9 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1358-1363

Study of Automated Red Blood Cells Parameters in Correlation with Routine
RBCs Morphology by Smear Review
Tahany Ali El Kerdany , Soha Abo El Ela , Janette Botros Shoukry Aziz
Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain shams University.
Corresponding author:dr_janet5889@hotmail.com

: sysmex XT 1800i coulter is a hematology analyzer incorporating new electronic and
mechanical design with advanced algorithm technology to perform CBC. The principles of sysmex XT1800
are electrical impedance technology, optical scatter technology, flow cytometry. The sysmex XT-1800i
haematology analyser is used in unique fluorescence flow cytometry (FFC) technology. FFC looks at
deoxyribonucleic acid (DNA) content, cell size and inner cell complexity rather than cell size alone. This
generates remarkably accurate results. Review rates and turnaround time are reduced due to specific
fluorochrome labelling. The XT-1800i offers true quantitative immunoglobulin ( IG) counting instead of the
flagging delivered by other technologies.
Patiant and Method: Evaluation of this instrument was performed on 200 samples of inpatient and
outpatient people in Ain Shams University Hospitals. We collected samples from all departments of the
hospital randomly of any age and sex except those of age less than 18 years old.
Results : this study was centered upon RBCs indices which were mean corpuscular volume (MCV),mean
corpuscular hemoglobin(MCH),red cell distribution width (RDW) after comparing sysmex XT 1800 coulter
results for RBCs parameters with morphology by smear review under the microscope. We found that the
device sensitivity was 74.7% , 75 % ,83 % and specificity was 74.3% , 79.5 % ,78.7% according to RBCs
size ,chromasia and anaesocytosis respectively.
Conclusion: at the end of our study we reached to specific criteria at which we must do a blood film smear
review to evaluate RBCs abnormalities which cannot be evaluated by the device.
: hematology analyzer, abnormal RBCs morphology.

four parameters are widely available now and can
Peripheral blood smear (PBS) examination is a
be useful to physicians in diagnosis of iron
very important tool which is used in diagnosis and
deficiency anemia because the parameters are
follows up of abnormal results on a complete blood
direct measures that reflect the iron available for
count (CBC) to evaluate different types of blood
hemoglobin (Hb) synthesis [4]. Owing to the fact
cells. It helps to diagnose and monitor numerous
that manual microscopic examination of the blood
conditions that affect blood cell populations [1]. The
smear is subjective, time consuming and quite
routine microscopic examination of a well spread,
misleading impressions can be drawn from
Leishman-stained PBS for RBCs morphology
inadequately prepared smears, a number of
presents a wealth of information regarding red cell
automated hematology analyzers have been
size, shape, inclusions and hemoglobin content that
developed to manage heavy workload. But, due to
are basic and fundamental in hematology testing [2].
the incompleteness of accurate morphological
During the past three decades, a number of
information on individual RBCs from these
automated hematology analyzers have been
instruments , 5-10 % of samples in hematology
developed; most of which directly measure two
laboratories undergo smear review for abnormal
RBCs parameters, RBCs count and mean
RBCs morphology, from where comes the
corpuscular volume (MCV). The rest of the RBCs
importance of studying the relationship between
indices are calculated from RBC, MCV and
RBCs morphology reporting and the results of
hemoglobin (Hb) [3]. Nowadays, hematology
automated RBCs parameters from hematology
automation offers more than CBC testing. There
analyzers [5]. With the help of different statistical
are four immature RBC parameters that can be
tests and algorithms, the relationship between the
automatically reported with every CBC to provide
complex data obtained from hematology analyzers
the information needed for the physician to assess
regarding RBCs parameters and blood smear
the state of erythropoiesis. These parameters are
examination results can be analyzed in order to
number of circulating reticulocytes (RET),
create a practical guideline that may help
immature reticulocyte fraction (IRF), reticulocytes
predicting RBCs morphology from hematological
Hb content and nucleated RBCs (nRBC). All these
Received: 12/ 06 /2017 DOI: 10.12816/0039674
Accepted: 21/ 06 /2017

Full Paper (vol.683 paper# 9)

c:\work\Jor\vol683_10 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1364-1367

Role of PET/CT in Monitoring Response in Treatment of
Non-Hodgkin Lymphoma Patients
Annie Mohamed Nasr Eldin, Hossam Moussa Sakr, Aml Ibrahim Ahmed,
Wesam Kamel El Afify
Radiodiagnosis Department, Faculty of Medicine, Ain Shams University
Corresponding author email: wesam _km@yahoo.com, Phone no: 01067893907

Aim of the work
: positron emission tomography (PET) response assessment of residual nodal masses
in patients with lymphoma after completion of therapy is performed visually using Douveille as the
reference. The primary objective of this study was to define the role of PET in response assessment of
Non Hodgkin Lymphoma patients and define various response criteria.
Patients and methods: our prospective study included 40 patients with Non Hodgkin's lymphoma
diffuse large B cell type assessed for response assessment after completion of therapy, two readers
independently assessed response by IHP and Deauville criteria. The addition of morphological
parameters on CT was assessed in relation to therapy response.
Results: Non Hodgkin lymphoma is one of chemosensitive tumors with high ability of nodal and
extranodal spread and PET /CT is more sensitive than CT in monitoring response to treatment in non
Hodgkin lymphoma diffuse large B cell type patients.
Conclusions: PET/CT is the best tool for evaluation of the response to treatment in patients with Non
Hodgkin lymphoma diffuse large B cell type, as well as Douveille criteria represent the accurate
indicator of response categories determination.PET/CT has an obvious impact on clinical practice
according to the response results and activity of residual lesion.
Keywords: Fluorodeoxyglucose 18F, Positron emission tomography, Computed tomography,
Lymphoma and Therapy.


Non-Hodgkin lymphoma (NHL) is one of
viability of this residual tissue cannot be assessed
the most common hematologic malignancies
by CT alone. In such cases, PET/CT is used to
worldwide. The incidence of NHL has been
determine whether treated tissue is active disease
rising for several decades; NHL incidence among
or inactive fibrosis/scar [5].
males is significantly higher than in females [1].

One of the most evident advantages of
FDG-PET was its ability to detect significant
This study was conducted on 40
changes in glucose metabolism or even complete
patients complaining of NHL referred by their
remission. This enables clinicians to detect much
clinicians to radiology Department at Tanta
earlier the effectiveness of a given antineoplastic
Cancer Center. All patients were performed CT
treatment, as compared to the traditional CT
for initial staging, then the patient underwent full
imaging alone [2].
chemotherapy protocol ranging from 6 to 8
Evaluating response to treatment; PET is
cycles with 3 to 4 weeks in between cycles.
a significant predictor of progression free
Then, after finishing chemotherapy by 4 to 8
survival (PFS) and overall survival (OS). Early
weeks they underwent PET/CT.
(18) F- PET imaging also has a potential to
Patients included in our study will be
identify patients with delayed response and no
selected with the following inclusion criteria:
favorable prognosis despite achieving a clinical Age group: no age predilection.
complete response [3].
Both sexes.
PET/CT scanning after completion of Diagnosed cases with diffuse large B-cell type
therapy should be performed within two months
and preferably at six to eight weeks after Histological confirmed.
chemotherapy [4].
Presenting to Tanta Cancer Center since Jan 2011.
PET/CT provides information on Receiving treatment.
tumor characteristics both morphologic and
The acquisition of co registered CT and
functional. As mentioned above, patients who
PET images were performed in one session.
have undergone therapy often have residual
Images were reconstructed and viewed on work
tissue at sites of previously active disease. The

Received: 12/ 06 /2017 DOI: 10.12816/0039675
Accepted: 21/ 06 /2017

Full Paper (vol.683 paper# 10)

c:\work\Jor\vol683_11 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1368-1373

Role of Electrocardiogram-Gated Multidetector Computed
Tomography in Diagnosis of Congenital Heart Disease
Marwa Ali, Yasser Ali Mohammed, Marwa El-Sayed Abdel Rahman
Radiology department, Ain Shams hospitals
Corresponding author: Marwa Ali, email: marwaaliibrahim2014@yahoo.com
Aim of the work: this study aimed to assess the role of ECG gated multidetector computed tomography in
detection and characterization of congenital heart diseases. Patients and method: this study was carried out in
the Radiology Department of Ain Shams University Hospitals. A total of 30 patients presented with
clinically/echocardiographically known to have congenital heart disease. They were 17(56.7%) females and 13
(43.3%) males. Their age was ranged from 3 days -18 year old. Results: Regarding the cardiac abnormalities,
we found good agreement between Echo and ECG gated MDCT as regard cardiac abnormalities with kappa
value measuring 0.771. Regarding great vessels anomalies, we found overall good agreement between Echo
and MDCT where k measuring 0.790. As regard extracardiac findings, lung changes that were seen in MDCT
only in form of lung consolidation in three cases (10%) and one case of unilateral lung hypoplasia (3.3 %).
Conclusion: ECG gated MDCT is considered as an essential non-invasive diagnostic tool for the evaluation of
congenital cardiac and extra cardiac great vessels. MDCT is complementary to the cardiac echocardiography
especially in complex heart abnormalities.
Keywords: MDCT, ECG, congenital.
Patient preparation
Congenital heart disease (CHD) is one of the most Explanation of the study to patients or his/ her
commonly occurring congenital anomaly, affecting 4-
care giver and obtaining consent. Measuring
10/1000 live births (1).It is a major cause of serious
patient body weight for calculation of amount of
morbidity and mortality. It is usually defined as
contrast media and sedative material if indicated.
clinically significant structural heart disease present at Fasting for 3 hours and checking serum
birth (2).The survival of CHD patients has also increased
creatinine before contrast administration.
because of improvements in early diagnosis and Placement of Peripheral venous line in a right
treatment (3).Catheter angiography was used for many
upper limb vein
years as the investigation of choice for diagnosing Children who were below 5 years old and
CHD, the risk of complications associated with its
uncooperative were orally administered 10%
invasive nature and use of contrast medium led to it
chloral hydrate, at a dose of 50 mg/kg, 30 min
being superseded by newer, non-invasive modalities.
before MDCT scanning.
Echocardiography (ECHO), cardiac magnetic resonance Children aged 5 years or older underwent the
(CMR), and cardiac computed tomography (CCT) are
study without sedation and were trained on
the primary modalities used for noninvasive cardiac
breathing exercise if cooperative.
imaging in patients with CHD (1).

The patient will be supine and middle in CT
gantry. ECG leads will be put on the chest of
This study was included 30 patients with suspicious or
Procedure duration: 10 -15 minutes.
congenital heart disease referred for MDCT
Patients were scanned with MDCT
machines (80 and 128 -slice spiral CT).The
Inclusion criteria

radiation dose was kept to minimum by

Both sexes were included
reducing the kilo voltage and the recent

Pediatric patients (up to age 18 years old).
machines adjust tube current according to the
Exclusion criteria
patient's weight .ECG leads were put on the

Patients are known to have absolute
patient's chest.
contraindication of contrast e.g. renal failure.
A preliminary scout was taken.
Dual injector was used: syringe A: non-
Patients were subjected to:
ionic contrast (1-2 ml /kg) and Syringe B: 20
1- Full history taking from the parents and elder children.
ml saline. Nonionic contrast agent was injected
2-All patients underwent ECG gated cardiac CT
through a peripheral venous line by using a
examination of the heart and great vessels. The
power injection followed by 20 ml saline. The
study was done in the CT unit at Ain shams university
total contrast volume used for pediatric CT is

Received: 12/ 06 /2017 DOI: 10.12816/0039676
Accepted: 21/ 06 /2017

Full Paper (vol.683 paper# 11)

c:\work\Jor\vol683_12 Fixation of Unstable Neck Femur Fractures...


Full Paper (vol.683 paper# 12)

c:\work\Jor\vol683_13 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1381-1389

Telemedicine: Between Reality and Challenges in Jeddah Hospitals
Abeer Abdulrahman J Althbiti , Farah Mamoun Al Khatib and Nuha Ayman AL-Ghalayini
Pharmacy Department, Ibn Sina National Collage For Medical Studies, Jeddah, KSA
Corresponding Author: Abeer Abdulrahman J Althbiti - Abeera-1221@hotmail.com ­ 00966534888056

Telehealth system is defined as the use of electronic information and telecommunication
technologies to support and promote long-distance clinical health care, patient and professional health-
related education, public health and health administration. The main aim of this study is to assess
difficulties and limitations in hospitals that have healthcare system in Jeddah ,Saudi Arabia from applied
new techniques such as Telehealth and if they have tendency to use this technique or not . This study also
aims to determine the association between increase in quality of healthcare system and new techniques
applied such as Telehealth system by literatures reviews. Methods: A cross-sectional study was conducted
in 114 medical providers who worked at hospitals in Jeddah, Saudi Arabia. The medical providers were
interviewed using paper-based questionnaire as well as electric-based questionnaire, data collected and
analyzed by using SPSS. Results: Interested participants in technology were high by 59%, participants
actually interested to implement advanced Telehealth Technologies by percent of 84%, and respectively
that factor of lack of awareness were a major factor by 90%, factor of this technique may take a new health
care system and it may being a time consuming and take a lot of money and training 71%, this previous
percentage and frequency also present factor of resistance in both medical social and community. 63% saw
that it is hard to get someone qualified as well as 62% saw that there is a lack of human resources in
hospitals and misusing factor took a percent of 50%, some of participants saw that There is no strong need
for this technique and he is think it is not important or it is not differ from face to face visit by percent of
40%. Conclusion: There are a high acceptance of new technique in hospitals and regardless of
demographic information there is a high interest in technology, we determine most factors that may limit
implementation of this technique and these factors may give us a general look about challenges of
implementing the other techniques too, if we can determine the problems then we can resolve them to
achieve high quality healthcare systems in our hospitals.
Keywords: Telehealth, Telemedicine, Quality of healthcare system, Limitations, New technologies.
responds and adapts to the changing health needs
When thinking about healthcare, most of us
and contexts of societies. Some distinguish
conjure up images of office visits or trips to the
telemedicine from telehealth with the former
ER. Whether it's for a routine check-up, lab tests,
restricted to service delivery by physicians only,
an outpatient procedure or major surgery, the norm
and the latter signifying services provided by
is for patients and caregivers to leave their homes
health professionals in general, including nurses,
(often sitting in traffic or rushing from work) to
pharmacists, and others. However, telemedicine
meet their doctor at a healthcare facility of some
and telehealth are synonymous and used
kind. But things are changing (1). Telemedicine is
interchangeably (4).
the use of medical information exchanged from
Historically, telemedicine can be traced back to
one site to another via electronic communications
the mid to late 19th century (5).With one of the first
to improve patients health status (2).
published accounts occurring in the early 20th
The World Health Organization (WHO) defines
century when electrocardiograph data were
telemedicine as "the delivery of health care
transmitted over telephone wires (6). Telemedicine,
services, where distance is a critical factor, by all
in its modern form, started in the 1960s in large
health care professionals using information and
part driven by the military and space technology
communication technologies for the exchange of
sectors, as well as a few individuals using readily
valid information for diagnosis, treatment and
available commercial equipment (5, 7). Examples of
prevention of disease and injuries, research and
early technological milestones in telemedicine
evaluation, and for the continuing education of
include the use of television to facilitate
health care providers, all in the interests of
consultations between specialists at a psychiatric
advancing health of individuals and their
institute and general practitioners at a state mental
communities" (3).
hospital (8), and the provision of expert medical
The many definitions highlight that telemedicine is
advice from a major teaching hospital to an airport
an open and constantly evolving science, as it
medical centre (9). Recent advancements in, and
incorporates new advancements in technology and
increasing availability and utilization of,
Received: 7 / 4/2017 DOI: 10.12816/0039678
Accepted:15 / 4/2017

Full Paper (vol.683 paper# 13)

c:\work\Jor\vol683_14 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1390-1394
Anatomical Variations of Nasal Structures in Chronic Rhinosinusitis as Detected
by Computed Tomography Scan
Omar Adnan Hasan, Mohamed Amir Hassan, Ehab Kamal Fawzy, Ahmed Mahmoud Maarouf
Department of Otorhinolaryngology, Faculty of Medicine-Ain Shams University

There is a wide range of anatomical variations affecting the nose, paranasal sinuses (PNS) best
diagnosed by Computed Tomography (CT). These variations may cause impairment of mucociliary drainage of
the PNS resulting in sinusitis. Objectives: In this paper, the aim is to study the relationship of the anatomical
variations of the lateral nasal wall, nasal septum and paranasal sinuses with the occurrence of chronic
rhinosinusitis. Methods: The study included two groups of patients, the first has chronic rhinosinusitis while the
second was without chronic rhinosinusitis. Anatomical variations of nose and paranasal sinuses which are nasal
septal variations, concha bullosa, agger nasi cells, haller cells, paradoxical middle turbinatesand uncinate
process variations were detected in both groups to investigate the relation between the anatomical variations and
chronic rhinosinusitis. Results: A case control study was done which showed that there a significant statistical
relation between nasal septal deviation and chronic rhinosinusitis.
Conclusion: There was a significant relation between nasal septal deviation and chronic rhinosinusitis.
Key words: Anatomical variations, Chronic rhinosinusitis, CT scan.


There is a wide range of anatomical variations
chronic sinusitis on CT scan is scored according to
affecting the nose, paranasal sinuses (PNS) best
Lund-Mackay scoring system (Radiologic grading of
diagnosed by Computed Tomography (CT), which is
sinus systems proposed by Lund and Mackay) as: 0=
a non-invasive imaging modality with high image
no abnormality, 1= partial opacification and 2= total
resolution and reconstruction capability. These
opacification. The sinus groups include the
variations may cause impairment of mucociliary
maxillary, frontal, sphenoidal, anterior ethmoidal
drainage of the PNS resulting in sinusitis (1) (2). Many
and posterior ethmoidal sinuses. Osteomeatal
anatomical variations have been studied and the
complex is scored as: 0 (not obstructed) and 2
relation between them and sinusitis is not clear till
(obstructed). Thus a total score is from 0 to 24 (9).
now (3). Some studies showed statistically significant
Despite the fact that concha bullosa of the middle
association between common anatomical variations
turbinate is usually asymptomatic, it has been
and the presence of sinusitis (4). While in other
involved in cases of inflammatory sinus disease and
studies, no statistically significant relationship was
nasal obstruction (10). Few studies have examined the
found (5). With the increased use of endoscopy for
role of anatomical variations of osteomeatal complex
the treatment of paranasal sinus diseases surgically,
such as concha bullosa, septal deviation, uncinate
attention is now focused on the analysis of the lateral
process variations, Agger nasi cells, Haller cells and
nasal wall and paranasal sinus anatomy (6). Chronic
paradoxically curved middle turbinate in the
adult rhinosinusitis is rhinosinusitis lasting more
development of traditional chronic rhinosinusitis (11).
than 12 weeks and the diagnosis is confirmed by the
Theoretically these variants can shift and compress
presence of major and minor clinical factors (7).
osteomeatal complex components, causing an
CT imaging has become a widely accepted tool for
obstruction to the mucus drainage of the paranasal
assessment of the PNS. It gives detailed anatomy of
sinuses and further predispose to sinusitis (3).
the lateral nasal wall; and considered necessary to

endoscopic sinus surgery (ESS). A pneumatized
middle turbinate, also called concha bullosa is the
This case control study included 88 cases as
most commonly detected anatomical variation of the
recommended by statistician which were collected
lateral nasal wall. CT of the paranasal sinuses offers
from January 2017 to June 2017 from Al Demerdash
the gold standard in terms of imaging that shows the
hospital and divided into two groups:
extension of inflammatory disease and the fine
The first group was the study group
detailed anatomy and its variants (8).The severity of
including patients who had chronic rhinosinusitis as
Received:7 / 6/2017 DOI: 10.12816/0039679
Accepted: 16 / 6 /2017

Full Paper (vol.683 paper# 14)

c:\work\Jor\vol683_15 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1395-1399

Prevalence of Metabolic Syndrome and Its Related Factors among Adults
Sultan Mohammed Badri1, Lujain Hamza Arafsha2, Khaled Abdullah Bin Hassan3, Mishary Ali Shawani3,
Ahmed Ali Alasmari3, Khalid Ali Rofidi3, Lojein Faisal Alnomari1, Aseel Sameer Tammar1, Abdullah
Waheed Calacattawi4, Waleed Abdulaziz Almosfer5, Abdulrahman Mohammedsaeed Baqasi2
1 Ibn Sina National College, 2 Umm Alqura University, 3 Al Imam Mohammad Ibn Saud Islamic University, 4
King Abdulaziz University, 5 Majma'ah University
Corresponding Author: Sultan Mohammed Badri, Sultanbadri@Gmail.Com

This study was designed to estimate the prevalence of metabolic syndrome and its determinants,
as well as baseline information about the related factors among the adult population.
A cross sectional study of 252 participants has been conducted in February 2017 at King Abdulaziz
Hospital and Oncology Center. A structured questionnaire was administered, collecting information on personal
medical history as well as socio-demographic and behavioral characteristics. Anthropometrics, blood pressure,
and venous blood samples were obtained. Metabolic syndrome was defined according to the International
Diabetes Federation (IDF) criteria.
Results: The prevalence of metabolic syndrome was 32% according to the IDF. In addition to WC is the best
predictor for metabolic syndrome in the Saudi population.
Conclusion: This study showed that Metabolic Syndrome is highly prevalent in Jeddah, Saudi Arabia. Also
there is a high prevalence of hypertension, obesity and diabetes. Therefore, to reduce the risk of cardiovascular
events, screening for and early detection of risk factors for Metabolic Syndrome are suggested.
Metabolic Syndrome, Adults


but both insulin resistance and central obesity are
Metabolic syndrome (MetS) is a cluster of
considered the main causes [14]. Genetic and
interrelated risk factors for cardiovascular disease
environmental factors such as a sedentary lifestyle,
(CVD) [1]: diabetes, high fasting plasma glucose,
unhealthy dietary habits and high rates of cigarette
abdominal obesity, low high-density lipoprotein
smoking contribute to MetS development [15]. In the
cholesterol (HDL-C), elevated triglycerides and high
general population, genetic and environmental
blood pressure [2,3]. The concept of MetS has existed
differences may partially be responsible for the
for at least 80 years [4]. MetS was first described as
difference in prevalence rates of MetS in different
X syndrome [5]. Different organizations have
countries [15-18]. MetS enhances the risk for various
proposed several diagnostic criteria for MetS and the
diseases such as diabetes, cardiovascular disease,
most commonly used is the Adult Treatment Panel
fatty liver, asthma, ovarian cysts [19] and some
III (ATP-III) and adapted ATP-III criteria (NCEP
cancers [20]. To reduce the risk of these mentioned
/ATP-III-A) [6, 7] by the National Cholesterol
diseases, studying the prevalence of this syndrome
Education Program (NCEP), the International
seems to be essential in different populations. The
Diabetes Federation (IDF) [8] and the World Health
findings of this study will provide a baseline
Organization (WHO) criteria [9].
information about the prevalence of MetS and its
The prevalence of MetS is increasing
related factors among the adult population.
globally [10]. Based on reports, around 20-25% of the

world's adult population has MetS, and mortality rate
amongst these people is twice as likely from heart
Samples were collected at King Abdulaziz
attack and three times as likely from stroke compared
Hospital and Oncology Center in Jeddah, Saudi
with people without MetS [11]. A survey among
Arabia. As part of the admission process, these
adolescents in the United States reported a
individuals underwent clinical and laboratory
prevalence of MetS in more than a quarter of the
screening with an inclusion criterion of being aged
obese population and in nearly seven percent of the
20 years or older. A total of 430 individuals
overweight population [12]. More importantly, the
identified to be overweight or having abdominal or
prevalence of this disorder is increasing in children
generalized obesity presented for pre-admission
and young adults worldwide [13]. The underlying
screening during the four-week study period in
cause of the MetS continues to challenge the experts
February 2017.
Received: 20 / 4 /2017 DOI: 10.12816/0039680
Accepted:28 /4 /2017

Full Paper (vol.683 paper# 15)

c:\work\Jor\vol683_16 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1400-1404

New Agents in Treatment of Psoriatic Arthritis
Abdellatif M.M; El Gogary A.K; El Shishtawy H.F; Farrag D.A.
Rheumatology and Rehabilitation department, Faculty of Medicine, Ain Shams University

Background: psoriatic arthritis is a long term inflammatory arthritis. Psoriatic arthritis is leading to bone erosion,
joint destruction and associated with nail diseases, dactylitis, enthesitis, sponnylitis and uveitis.
Aim of this study was to review the new lines of treatment for psoriatic arthritis with or without skin affection.
Treatment, the underlying process in psoriatic arthritis is inflammation; so, treatments are directed to reduce and
control inflammation. Although no clear correlation exists between joint inflammation and the skin in every
patient, the skin and joint aspects of the disease often must be treated simultaneously. However, only certain
therapies are effective for psoriasis and psoriatic arthritis. Systemic agents, can be used for both skin and joint
manifestations, it includes methotrexate and ciclosporin. For the biologic agents, the tumour necrosis factor
inhibitors such as adalimumab, etanercept, infliximab, golimumab and certolizumab are effective. Ustekinumab is
a recently agent belonging to the group of anti-IL-12p40 antibodies and has been shown to be efficacious. Newer
drugs in the treatment which have shown efficacy for both psoriasis and psoriatic arthritis consist of the anti-IL-17
agent, secukinumab, and a phosphodiesterase-4 inhibitor, apremilast. As well as the oral JaK inhibitor,
tofacitinib, have very limited but promising data.
Keywords: psoriasis, psoriatic arthritis, anti- TNF, anti-IL-17, small molecules inhibitors.


oral retinoids (e.g. acitretin). In treating psoriatic
arthritis alone, non-steroidal anti-inflammatory drugs
inflammatory disorder characterized by uncontrolled
(NSAIDs), intra articular corticosteroid injections and
proliferation of keratinocytes, activated dendritic cells,
disease-modifying anti-rheumatic drugs (DMARDs),
release of pro-inflammatory cytokines, and recruitment
such as sulfasalazine, are the agents commonly
of T-cells to the skin [1]. Psoriasis usually presents 8­
prescribed. It should be noted that the DMARDs and
10 years before psoriatic arthritis, although some
NSAIDs, although able to control symptoms, do not
patients present with psoriatic arthritis with psoriasis.
retard progression of radiographic joint damage [5].
Both of them are immune-mediated chronic
Conventional systemic therapies effective for both
inflammatory diseases with a similar pathogenesis,
psoriasis and PsA include methotrexate, ciclosporin and
synchronous treatment should be undertaken to
leflunomide. The advantage of biologic agents for the
minimize side effects and financial burden of
treatment of psoriasis and PsA has not precluded the use
medications [2].
of these drugs because of their oral route of
The peak of psoriatic arthritis incidence occurs
administration and lower cost [6]. Biologics have now
between 30 and 50 years of age. It is characterized
been increasingly used for patients with both psoriasis
clinically by edema, pain, tenderness, and stiffness of
and PsA when first-line therapy has failed [7].
the joints, ligaments and tendons (dactylitis and
The aim of the present study is to review the new
enthesitis) [3].
lines of treatment for psoriatic arthritis with or
Both the innate and adaptive immune systems are
without skin affection.
involved in the pathogenesis of psoriasis and PsA. T

cell activation is a key component specifically, TH1
TH17 and TH22 cells are up regulated in psoriasis
A PubMed search (without methodological search
lesions [4].
filters or limits)on the words "psoriasis", "psoriatic
Several factors must be considered in selecting
arthritis", "pathogenesis of psoriatic arthritis" and
therapy, including type of psoriasis, severity and extent.
"pharmacological & non-pharmacological treatment
Not all therapies that target psoriasis can treat PsA and
of psoriatic arthritis" in the title and abstract was last
vice versa. In treating psoriasis alone, commonly used
performed on 1 May 2017. Relevant results from the
agents include topical corticosteroids, coal tar, vitamin
articles which were selected for review are
D analogs (e.g., calcipotriol), topical tazarotene, narrow
summarized and presented in this narrative review.
band ultraviolet B (NBUVB) phototherapy, sporalen
The study was approved by the Ethics Board of Ain
plus ultraviolet A (PUVA) photo-chemotherapy and
Shams University.
Received: 8 /6 /2017 DOI: 10.12816/0039681
Accepted:17 / 6 /2017

Full Paper (vol.683 paper# 16)

c:\work\Jor\vol683_17 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1405-1410

The Relationship of Complexity of Coronary Artery Disease and
Complexity of Peripheral Arterial Disease
Sameh Saleh Sabet , Hany Mohammed Fakhry,
Khaled Aly Abdelkader , Alaa Ahmed Reyad Elkiey
Cardiology Department, Faculty of Medicine, Ain Shams University

Atherosclerosis is a disease of the large and medium-sized arteries causing luminal narrowing
(focal or diffuse). Aim of the Work: Measure the relationship between coronary artery disease complexity
using SYNTAX score and peripheral arterial disease complexity using TASC II score. Patients and
The study was designed as a prospective single center cross-sectional study conducted at Ain
shams university hospitals. The study included 50 patients referred for elective coronary angiography in the
time period from August 2016 till July 2017.
Results and conclusion: Patients with complex PAD had complex CAD. This finding suggested that PAD
and CHD are different clinical manifestations of atherosclerosis and systemic pan vascular involvement is
present in patients with complex lesions. (P-value 0.046).
Keywords: Peripheral Vascular Disease, Complexity, Coronary, Artery Disease, Complexity.


Atherosclerosis is a disease of the large and
complexity using SYNTAX score and peripheral
medium-sized arteries causing luminal narrowing
arterial disease complexity using TASC II score.
(focal or diffuse). This occurs as a result of the

accumulation of lipid and fibrous material between
the intimal and medial layers of the vessel1.
The study was designed as a prospective single
Because atherosclerosis is a systemic
center cross-sectional study conducted at Ain
disease, presence of PAD is considered a strong
shams university hospitals. The study included 50
predictor of cardiovascular events which is 5-7%
annually. In the AGATHA study, patients with
angiography in the time period from August 2016
PAD in one vascular bed had a 35% chance of
till July 2017.
having disease in at least one other territory, and
50% had cerebrovascular or coronary heart disease.
Inclusion criteria
There was a 2-3% nonfatal myocardial infarction
rate, and a twofold to threefold increase in the
undergoing diagnostic coronary angiography for
occurrence of angina compared with age-matched
coronary artery disease according to ESC 2014
controls. Risk of cardiovascular mortality increases
revascularization guidelines.
with asymptomatic PAD and surprisingly the risk
Exclusion criteria
may not differ from symptomatic PAD 2.
1) Patient's refusal.
Trans Atlantic Inter-Society Consensus II
2) Vasculitis.
(TASC II) classification is an internationally
3) Contraindication for CA e.g. (active
derived definition that is dedicated for the
bleeding, coagulopathy, active infection, etc.).
assessment of peripheral artery disease according to
4) Non atherosclerotic stenosis.
anatomical distribution, number and nature of
5) Acute limp threatening ischemia.
lesions (stenosis and occlusion) 3.
6) Patients with known or suspected infectious
or inflammatory conditions.
comprehensive scoring system dedicated for the
7) Patients with serum creatinine more than
assessment of complexity and severity of coronary
1.3 mg/dL.
artery anatomy and lesion characteristics.

SYNTAX score is a valuable marker of major
adverse cardiovascular events and cardiovascular
A) History:
B) Complete physical examination:
C) Laboratory investigations:
The aim of this work is to measure the
D) Coronary angiography:
relationship between coronary artery disease
Received: 5 / 6 /2017 DOI: 10.12816/0039682
Accepted: 14 /6 /2017

Full Paper (vol.683 paper# 17)

c:\work\Jor\vol683_18 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1411-1417

Relationship between Ceramic Restorations
Rami Amin Gashgary2, Tariq Mohammed Alshehri 1, Ibraheem Abdulrahman Aljomai1, Hani Hussain Alghamdi
1, Mohammed Ali A Alasmri 1, Roya Aali Alshamrani 1, Amal kamal jumaymi 1, Alaa jafar alsharif 1, Roaa Saeed
AlHakami 1,
Sara talal Musallam 1, Waad ahmed Almazrouie 1, Reema Abdulkader Azzeem1, Maha Salem
Baaboud 2,
Sawsan Badr Sehaqi 2
Ibn sina national college for medical studies1, Batterjy Medical college for science & technology2


Sintered ceramics and glass-ceramics are broadly utilized as biomaterials for dental restoration, particularly
as dental onlays, inlays, veneers, crowns or bridges. Biomaterials were advanced whichever to veneer metal
frameworks or to create metal-free dental restorations. Diverse sorts of glass-ceramics and ceramics are
obtainable and important today to satisfy customers' needs (patients, dentists and dental technicians) with
respect to the properties of the biomaterials and the processing of the products. All of these different types of
biomaterials already cover the entire range of indications of dental restorations. Today, patients are
increasingly interested in metal-free restoration. Glass-ceramics are particularly suitable for fabricating inlays,
crowns and small bridges, as these materials attain extremely solid, aesthetic outcomes. High-strength
ceramics are favoured in conditions where the material is exposed to high masticatory forces.
Keywords: Dental Restoration, Ceramics, Computer-Aided Design, Computer-Aided Manufacturing,

Some metals which are utilized as restorative
The history of restorative dentistry can be followed
materials in dentistry can constitute an issue for a
back similar to ancient Egyptian periods. Cases of
few patients. These issues may uncover themselves
tooth replacement prostheses made from gold wire,
as allergies [5], gum staining [6] and release of
ox bone or wood have been established. Later
metallic ions into the gingival tissue and the
restoratives had a revitalisation about two hundred
gingival fluid [7]. These downsides, and also the look
years ago when air fired porcelains and cast gold
for more esthetic materials by patients and dentists,
restorations were made to restore and replace teeth.
have motivated innovative and improvement of
It appears that in ancient times the key requirement
metal-free ceramic systems.
was to supplant teeth lost as a because of gum
There has been a fast diversification of equipment
ailment, though lately it is to restore teeth damaged
and materials accessible for computer-aided
by decay. Dental ceramics are materials that are a
design/computer-aided manufacturing (CAD-CAM)
piece of frameworks planned for delivering dental
of ceramic prostheses. The accessibility of CAD-
prostheses that thusly are utilized to supplant lost or
CAM processing allowed the use of polycrystalline
damaged dental structures. The literature on this
zirconia coping and framework materials. The
subject characterizes ceramics as inorganic, non-
comparatively high stiffness and good mechanical
metallic materials made by man by warming raw
dependability of partially stabilized zirconia permits
minerals at high temperatures [1]. Ceramics and
thinner core layers, longer bridge spans, and the use
glasses are brittle, which implies that they show a
of all-ceramic fixed partial dentures (FPDs) in
high compressive strength however low elasticity
posterior locations [8]. Ceramics can be categorized
and might be broken under low strain (0.1%, 0.2%).
by their microstructure (amount and type of
By way of restorative materials, dental ceramics
crystalline phase and glass composition). They can
have impediments generally because of their
also be classified by the processing technique
powerlessness to withstand useful forces that are
(power-liquid, pressed or machined) [9].
present in the oral cavity. Consequently, at first,
Methods of Ceramic Fabrication
they discovered constrained application in the
A review of the literature involved taxonomy of
premolar and molar areas, even though additional
dental ceramics, wherein materials were categorized
improvement in these materials has allowed their
according to their composition and indications [10].
use as a posterior long-span fixed partial prosthetic
The following section is categorized by method of
restorations and structures over dental implants [2].
fabrication. This complements the previous review
All dental ceramics show low fracture durability
and reflects the recent diversification of CAD-CAM
when contrasted with other dental materials, for
systems (Table 1). Ceramics, having similar
example, metals [3]. Metal ceramic systems combine
composition might be fabricated by different
both the exceptional esthetic properties of ceramics
laboratory methods, and every method of forming
and the amazing mechanical properties of metals [4].
outcomes in a different distribution of flaws,
Received: 21 / 4 /2017 DOI: 10.12816/0039683
Accepted: 29 / 4/2017

Full Paper (vol.683 paper# 18)

c:\work\Jor\vol683_19 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1418-1424
The Role of Brimonidine Eye Drops as an Adjunctive Therapy for Optic Nerve
Protection in Patients with Controlled Open Angle Glaucoma
(1)Jihan A. Mohamed, 2) Omaima I. Abo-Elkhei
(1) Ophthalmology Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt.
(2) Community and Occupational Medicine Department, Faculty of Medicine (Girls), Al-Azhar University,
Cairo, Egypt.

Objective: This study aims to evaluate the neuroprotective role of brimonidine eye drops in patients with
controlled open angle glaucoma.
Methods: This study is prospective and non-randomized. It was done between January,2014 and April, 2016.
It included 33 eyes with controlled open angle glaucoma who were referred to Al Zahraa University Hospital.
Brimonidine eye drops (BMD) were administrated. Follow up was done every 6 months for 12 months and
three visual field (VFs) examinations were done to all patients using Humphrey Visual Field Analyzer II
745.Results: There is a gradual decline of IOP mean values from 15.3 ± 3.6 mmHg baseline to 13.5 ± 3.0
mmHg after 6 months and to 11.7±2.1 mmHg after one year of the use of BMD eye drops. The mean values
of MD measurements showed improvement after BMD eye drops use as it becomes lower than baseline
values after 6 months (-7.2 ± 5.2 vs -5.1 ± 3.7 respectively), with further improvement after one year of BMD
eye drops use as it becomes lower than that after 6 months (-5.1 ± 3.7 vs -3.3 ± 3.6 respectively). Similarly,
PSD measurements after 6 months (4.6 ± 3.1 vs 4.0 ± 3.1). Furthermore, measurement after one year of BMD
eye drops use show more improvement as it becomes lower than measurements after 6 months (4.0 ± 3.1 vs
3.4 ± 4.4).
Conclusion: Neuroprotection can be used to reduce the risk of glaucomatous progression independent of its
effects on IOP as the future treatment modality.
Keywords: Glaucoma, IOP, Visual field, Brimonidine eye drops.


Glaucoma is second only to cataract among
TM (4). BMD has been found to prevent progressive
visual disorders, but it is a major cause of
RGC loss and thinning of the inner retinal layer and
worldwide irreversible blindness. Bilateral
visual impairment in a normal tension glaucoma.
blindness will be present in 5.9 million people with
This was achieved through stimulation of
open angle glaucoma and 5.3 million people with
production of nerve growth factor (NGF), brain-
angle closure glaucoma in 2020 (1).
derived neurotrophic factor (BDNF), and basic
Glaucoma is the ocular disorders with
fibroblast growth factor in multiple pathways (5).
multiple-factorial induce via a clinical optic
BMD significantly lowers the rate of visual field
neuropathy with or without enhance the intraocular
progression, attributed to an IOP-independent
pressure. Few research claims that the IOP is the
protective effect of BMD (6).
best approach to treat the glaucoma (2).

Visual field loss and RGCs death continue
to occur in patients with well controlled intraocular
This intervention prospective study was
pressures and thus, a consensus has recently been
carried out between January,2014 and April, 2016
reached that additional treatment strategies are
in Al Zahraa University Hospital. Thirty three eyes
needed (3).
with controlled open angle glaucoma (16 patients
Recently, there has been a growing interest
with bilateral eye affection and one patient with a
in using neuroprotective drugs for the treatment of
unilateral eye affection) were included in this study.
glaucoma. Brimonidine (BMD) is a selective 2-
Mean age of patients + SD was 43.0 ± 9.4 years
adrenergic receptor agonist that is used clinically to
(Range: 29 - 64 years). All patients had a diagnosis
lower the IOP by decreasing the production of
of open angle glaucoma based on the appearance of
aqueous humor and facilitating its outflow via the
the optic disc and reproducible perimetric defects
Received: 1 /5 /2017 DOI: 10.12816/0039684
Accepted: 10 /5 /2017

Full Paper (vol.683 paper# 19)

c:\work\Jor\vol683_20 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1425-1435

The Role of local Anesthesia Instillation in Pain Alleviation Post Laparoscopy
Christien Magdy Fouad Zaki, Mohammad Abd El Hameed Nasr Al Deen,
Ahmed Mohamed Mamdouh
Department of Obstetrics and Gynecology, Faculty of Medicine,
Ain Shams University


Background: Gynecological laparoscopy is now becoming a more popular technique for diagnosis and
treatment of infertility cases; however gynecological laparoscopy is usually followed by Post-operative pain
which may be attributed to small incision in abdominal wall or as a result of diaphragmatic irritation by
inflating gases.
Aim of the Study: was to assess the role of local anesthesia instillation in pain relief after laparoscopy.
Patients and methods: the present study was a randomized trial study performed on 146 women aged 20-35
years, admitted to Ain Shams University hospitals. Patients were split into 2 equal groups, Group(A): further
subdivided into A1 and A2 whom undergone diagnostic and operative laparoscopy respectively- patients
administrated 20ml of 0.25% of Bupivacaine instilled intraperitoneal-and Group (B): further subdivided into B1
and B2 -whom undergone diagnostic and operative laparoscopy respectively-Patients administrated 20ml of
0.75% of Ropivacaine instilled intra-peritoneal. Vital signs and Pain scores were measured preoperatively,
immediate postoperative, 1 hours, 2 hours, 4 hours, 8 hours, 12 hours postoperatively. Data was collected,
tabulated, then analyzed using IBM© SPSS© Statistics version 22 (IBM© Corp., Armonk, NY).
Results: administration of 20mL of Ropivacaine 0.75% at the end of technique gave pain relief for four hours
in group B1 and pain relief for three hours in group B2, associated with an increase in heart rate and blood
pressure for two hours in group B1 and B2 for three hours.
Conclusion: instillation of local anesthetic after laparoscopy promotes pain relief post operatively and further
minimizes the postoperative hospital stay.
Keywords: laparoscopy, ropivacaine, bupivacaine, local Anesthesia, postoperative pain, intraperitoneal


Effective postoperative analgesia is important
respiratory depression, and sedation. Newer
from the patient's perspective and can also improve
clinical outcomes. Recent surveys report only
analgesia/patient controlled analgesia, have adverse
modest success in providing suitable analgesia, as
effects, are expensive, and require trained personnel
30% to 86% of surgical patients report moderate to
and special equipment (3).
severe pain after a surgical procedure. Although
Preoperative analgesia is an analgesic regimen
"advanced" analgesic techniques such as epidural
initiated before the onset of tissue trauma and could
analgesia or perineural catheters, can provide
have effects that outlast the pharmacokinetic. It is
superior analgesia, many of these analgesia
based on the theory of prevention of prevention of
modalities are labour-intensive and expensive(1).
central pain sensitization. Different techniques of
The management of postoperative pain has
preoperative analgesia have been reported,
received much interest in recent years. The degree
including intramuscular, intramuscular, intravenous,
of postoperative pain, as ultimately perceived by the
epidural and local anesthetics used in peripheral
patient, is mulfactorial and depends on variables
never block, intraperiotenal instillation, or wound
such as type and duration of the operation, type of
infiltration (4).
anesthesia and analgesia used, and the patient's
Laparoscopy in infertility is one of the infertility
mental and emotional status (2).
procedure for diagnosis and treatment of infertility.
There are many methods of postoperative pain
Pain after laparoscopic gynecology may occur in
treatment. The traditional and most widely used is
lower abdomen, back and shoulder. It may be
parenteral opioid. Parenteral narcotics in general are
transient or persistent for at least 3 days (5).
associated with nausea, vomiting, constipation,
Received: 7 / 6/2017 DOI: 10.12816/0039685
Accepted:16 /6 /2017

Full Paper (vol.683 paper# 20)

c:\work\Jor\vol683_21 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1436-1441

Causes and Management of Wound Infection
Ahmad Mohammad Kashha1, Ayat Hassan Zailai2, Waad Suliman Alsaadi3, Rahaf Yaseen
Almutawa3, Moath Hassan Albarakati3, Amir Hamoud Almhmadi3, Wafa Saleh Alkhuzaie4,
Abdullah Hussain alZahrani5, Shahad Khalid Ali balbaid1
Battarjee Medical College1, Cairo University2, Umm Alqura University3,
Ibn Sina National College4, King Abdulaziz University5
Corresponding author: Ahmad Mohammad Kashha , email: A-1k1@hotmail.com


Aim of the work: the care of patients with a wound infection may seem conflicting, various diverse
antibiotic preparations may be utilized after some time with an end goal to control the causative organism
and a kwide range of treatment procedures might be utilized by various healthcare experts. With the
approach of Independent (Supplementary) Nurse Prescribing Courses and the future potential for medical
caretakers with reasonable capabilities to recommend antibiotics for patients with wound infections, there is
a requirement for attendants and different specialists to review and update their insight into this vital subject.
Keywords: Wound Infection, Treatment, Antibiotic, Antiseptics.

All surgical wounds are infected by microbes,
The advancement of a wound infection relies
nonetheless in most cases; infection does not
upon the intricate interaction of many components.
improve as innate host defenses are quite efficient
In the event that the honesty and defensive
in the removal of contaminants.
capacity of the skin is broken, expansive amounts
A complex interplay between host, microbial and
of various cell sorts will enter the injury and start a
surgical features eventually determines the
fiery reaction. This might be described by the
avoidance or creation of a wound infection. The
exemplary indications of redness, torment,
postponement in recuperation and ensuing
swelling, raised temperature and fever. This
expanded length of doctor's facility stay
procedure eventually plans to reestablish
additionally has financial outcomes. It has been
homeostasis [1]. The potential for infection relies
assessed that every patient with a surgical site
upon various patient factors, for example, the
infection will require an extra 6.5 days in the
condition of hydration, diet and existing medical
hospital, which brings about the multiplying of
conditions and in addition extraneous variables,
healing center expenses related with that patient
for instance identified with pre-operative, intra-
[4]. Surgical site infections are allied not only with
operative and post-operative care if the patient has
increased morbidity, but also with substantial
experienced surgery. This frequently makes it hard
mortality. In a study, 77% of the deaths of surgical
to foresee which wounds will become infected.
patients were related to surgical wound infection
Subsequently the avoidance of wound infection
[5]. Kirkland et al. [6] calculated a relative risk of
ought to be an essential administration objective
death of 2.2 attributable to surgical site infections,
for all medicinal services specialists [2]. The 2002
in comparison with matched surgical patients
overview report by the Nosocomial Infection
without infection.
National Surveillance Service (NINSS), which
The study was approved by the Ethics Board of
covers the period between October 1997 and
Umm Alqura University.
September 2001, showed that the frequency of

hospital acquired infection identified with surgical
Symptoms of Wound infection
injuries was as high as 10%. These infections
The clinical presentation of wound infection
muddle ailment, cause tension, increment tolerant
contains fever, induration, erythema, edema, pain
distress and can prompt passing. The cost to the
and a change in drainage to an infected nature. On
NHS is nearly £1 billion pounds for every annum
the other hand, symptoms of infection in chronic
[3]. Gathered data on the frequency of wound
wounds or drained patients might be more difficult
infections possibly underestimate the true
to extricate. In these cases, diagnosis might
incidence as most wound infections arise when the
depend on non-specific symptoms, for example,
patient is discharged and these infections can be
anxiety, disorder, or decrease in glycemic control
treated in the community without hospital notice.
in the diabetics. Most wound infections are caused
Infections of the surgical wound are a standout
by bacterial colonization, initiating either from the
amongst the most widely recognized HAIs and
normal flora on the skin, or bacteria from other
are a vital reason for horribleness and mortality.
parts of the body or the outside environment. The
Received: 17 /4 /2017 DOI: 10.12816/0039686
Accepted: 25 / 4 /2017

Full Paper (vol.683 paper# 21)

c:\work\Jor\vol683_22 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1442-1451
Role of The First Trimester Maternal Serum High Sensitivity C­Reactive
Protein and Second Trimester Placental Volume Measurement by 3d Doppler
Ultrasound in Early Detection of Pre-Eclampsia
Osama Saleh Elkady, Osama Ismail Kamel, Wesam Abd Elmohsen Mohammed Badawy
Department of Obstetrics and Gynecology, Faculty of Medicine,
Ain Shams University


Background: Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure and
a significant amount of protein in the urine. It affects 2­8% of pregnancies worldwide. Complications include
impaired liver function, kidney dysfunction, visual disturbances and red blood cell Breakdown. PE continues to be
a major cause of maternal and fetal mortality. Thus, efforts at discovering reliable prediction models to identify
those at risk at an early stage are critical. And since Placental maldevelopment plays a pivotal role in the
pathogenesis of PE, therefore, evaluation of the placental volume and vascular flow indices using different
techniques can contribute in the prediction of adverse pregnancy outcomes.
Aim of the Work: to assess the ability of high sensitivity c reactive protein (Hs CRP) and 3D power Doppler of
placental volume and vascular flow indices to predict Preeclampsia.
Patients and methods: This is a prospective cohort study by multi operators conducted on 200 women with
singleton pregnancy who underwent screening for eligibility and eventually included with respect to the inclusion
criteria. The study has been done during the period from October 2015 till December 2016. 1st trimesteric serum
level of HsCRP detection tests, 1st trimesteric abdominal ultrasonographic examination and 2nd trimesteric color-
Doppler techniques were done and placental volume was measured and Follow up at delivery to confirm Pre-
eclampsia has followed. Study Outcomes included the development of hypertention, limb edema or other of pre-
eclampsia complication. Data were statistically analyzed using IBM© SPSS© Statistics version 23.
Results: HsCRP was significantly (P 0.05 and 0.01) high in Pre-eclampsia group compared to the normal
pregnancy group. Moreover, Placental volume (PV), Vascularization index (VI), Flow index (FI) and
Vascularization flow index (VFI) were significantly (P 0.05 and 0.01) lower in Pre-eclampsia group than the
normal pregnancy group.Conclusion: there was a statistically significant correlation between first-trimester
HsCRP and the 2nd trimester placental volume and its vascular indices in the prediction of complications of
uteroplacental insufficiency. Further studies with large number of patients have to be carried out to reach
conclusive evidence of the significance Doppler in prediction of pre-eclampsi, .and HsCRP.
Keywords: Preeclampsia, C ­Reactive Protein, 3d Doppler Ultrasound, Placental Volume Measurement.

(more than1.2mg/dL), thrombocytopenia (platelet
Pre-eclampsia is defined as new onset of
count <100000/L), elevated serum transaminases
hypertension and either proteinuria or end organ
twice upper limit of normal level, heamolytic
dysfunction after 20 weeks of gestation in previously
anaemia, and dypnea, retrosternal chest pain(1).
normotensive woman , Severe hypertension and
Despite many studies on its pathogenesis, there are
signs/symptoms of end organ injury are considered
still many unanswered questions. Abnormal
the severe spectrum of the disease (1).
trophoblastic invasion, immunologic mal-adaptation
Pre-eclampsia is one of the most serious
between fetal, maternal paternal tissue, and also
complications during pregnancy and is a major cause
genetic factors, all have been reported as causative
of maternal mortality and morbidity.
factors (3).
It is also one of the complications during pregnancy.
Human placenta produces Hs-CRP and releases it
It is seen in about 5-10% of all pregnancies (2).
predominantly into the maternal blood. Hs-CRP is a
Associated symptoms with severe pre-eclampsia are
systemic inflammatory marker and it has been shown
systolic blood pressure 160mmHg or diastolic
that it can be found in amniotic fluid and fetal urine.
pressure 110mmHg on two occasions at least 4
Its increased amount directly relates to poor
hours apart, persistent headache, visual disturbances,
pregnancy outcome(4). Previous studies have reported
persistent epigastric or upper abdominal pain, nausea,
that maternal Hs-CRP level increases during pre-
vomiting ,mental changes, elevated serum creatinine
eclampsia. At the same time it has been shown that
Received: 6 / 6 /2017 DOI: 10.12816/0039687
Accepted:15 /6 /2017

Full Paper (vol.683 paper# 22)

c:\work\Jor\vol683_23 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1452-1461

Effect of Normal Saline Infusion versus Dextrose 5% Infusion on The
Duration of Labor in Nulliparous Women: Randomized Controlled Trial
Khaled H. Swidan, Amgad A. Abou-gamrah, A. AbdelShafy, Marwa O. Abughanima
Obstetrics and Gynecology Department, Faculty of Medicine
Ain Shams University, Cairo, Egypt.

During labor, it is common for women to have no or little nutrient intake, inspite of the fact
that the demand of energy increases as a result of skeletal and smooth muscle contraction.
Aim of the Work: This study aims to evaluate the effect of intravenous dextrose-saline infusion compared
with intravenous normal saline infusion in acceleration of active phase of labor in nulliparous women.
Patients and Methods: This prospective randomized controlled trial was conducted on nulligravida
patients recruited from those attending labor ward of Ain Shams University, Maternity hospital who are,
singleton gestation, 36 weeks or more. Results: Total duration of first and second stages of labor was
significantly shorter among Dextrose 5% group than among Normal saline group. Conclusion: Dextrose 5%
solution administration is associated with shortened duration of labor because it provides the required
energy for pregnant mothers during the labor procedure through the detraction of harmful metabolites
produced together with ATP production and results in acceleration of the labor process.
Recommendations: Dextrose 5% administration during labor is associated with shortened duration of
labor. Further studies with larger sample sizes, more outcomes and different dextrose concentration is
required to determine the exact effect of dextrose.
Key words: dextrose, labor, nulliparous women, saline infusion.


During labor, it is common for women to
Shrivastava et al. who demonstrated that parenteral
have no or little nutrient intake, in spite of the
administration of dextrose solution was associated
fact that the demand of energy increases as a
with shortened labor course in term vaginally
result of skeletal and smooth muscle contraction
delivered nulliparous women in spontaneous labor
(1). Myometrial contractility is one of the
(6). Dappuzzo-Argiriou et al. demonstrated that
multiple factors affecting the progress of labor.
the use of intravenous fluid containing 5%
As adequate hydration improves the muscle
dextrose did not lower the chance of cesarean
performance in prolonged exercise and labor can
delivery for women admitted in active labor (7).
be considered as a prolonged exercise, adequate
Fong et al. demonstrated that neither
fluid administration may improve the labor
rate of delivery nor dextrose administration in
intravenous fluid altered the labor length or
Glucose is the main substrate for
delivery outcomes in nulliparous women who
pregnant uterus. Adequate resource of glucose is
were presented in active labor (8).
needed to maintain exercise tolerance and muscle
Administration of a dextrose solution,
efficiency, because these are important factors in
regardless of concentration, was associated with
the progress of human labor and parturition.
a shortened labor course in term vaginally
Therefore, it can be postulated that dysfunctional
delivered nulliparous subjects in active labor (9).
or prolonged labor procedure, a leading

indication for primary cesarean delivery, could at
least in part be raised from inadequate uterine
This study aims to evaluate the effect of
forces or inappropriate coordinated contractions
intravenous dextrose-saline infusion compared
because of inadequate availability of the
with intravenous normal saline infusion in
substrate (3).
acceleration of active phase of labor in
Garite et al. demonstrated that by
nulliparous women.
increasing the rate of maternal hydration, a

reduction in frequency of prolonged labor could
be achieved, and possibly there will be a lesser
Study design
need for oxytocin and cesarean delivery (4).
Randomized controlled trial.
Eslamian et al. confirmed the effect of
Study setting
increased parenteral hydration on decreasing the
This study was conducted in Ain Shams
duration of labor (5). This work was followed by
University Maternity hospital.
Received:7 / 6 /2017 DOI: 10.12816/0039688
Accepted:16 /6 /2017

Full Paper (vol.683 paper# 23)

c:\work\Jor\vol683_24 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1462-1468
Awareness of Tuberculosis Among General Populations in
Riyadh Region and Its Surroundings
Faisal K Alkulaib1, Ibrahim M AlFuraih2, Zainab M Alabbad3, Mohammed N Almusaad4,
Ahmed A ALmeshari3, Ahmed S ALwesaibie3, Faisal N Alshuwair2, Zaid A Alhamdan3,
Kawthar H Alsaleh3, Hanadi H AL-Thobiati5, Nouf Alqahtani6, Nawaf M Alamri7,
Mohammed A Shaikh5, Mohammed S Alharthi8, Ali H Alhawaj9, Ali M AlJazzar3
1AL Maarefa Colleges for science and technology, 2 King Saud University, 3King Faisal University, 4Al
Imam Mohammad Ibn Saud Islamic University, 5Umm Al-Qura University, 6Princess Nourah Bint
Abdulrahman University, 7Taif University, 8Najran University, 9Ibn Sina National College for Medical


Background: In the past, and until the end of the twentieth century, TB was one of the major causes of
death. Nowadays, the world is still challenging with TB control, even though the percentage of TB has been
decreased. In Saudi Arabia, annual TB incidence rate is 12/100,000 population. Even though incidence rate
of TB has been decreased in Saudi Arabia, still TB not fully control. Getting the world free from TB will
not happen if general populations don't aware about TB.
Aim: To evaluate knowledge, attitude and practice towards TB among general populations in Riyadh
region of Saudi Arabia. Method: This is a cross-sectional study done by selection of general populations in
Riyadh region by random sample. The study was done by a self-administrated questionnaire that contains
demographic data part and other parts that evaluate the awareness of TB. Comparison of results between
many variables by Chi-Square Test and P-value < 0.05 was considered as a significant level.
Result: Around 519 participants in this study (Response rate 94.36%) by mean age 33. Only 3.3% have a
history of TB and 21.1% have relative with a history of TB. Only 19.4% of participants have good
knowledge, only 18.0% have favorable attitude and most of the participants have a good practice (67.6%).
People with high degree educational level have better knowledge than others. Non-Saudi people are better
than Saudis in practice and people who have relative with a history of TB are better in attitude than others.
In practice, Female are better than male, married people also better than single, people with a history of TB
or relative with a history of TB are better than others.
Conclusion: Papulations in Riyadh and its surroundings have a very low level of knowledge toward TB.
Most people have unfavorable attitude level. Even though there is a high level of good practice but still it
needs to be increased. Education has an important role to increase the level of knowledge about TB.
Keywords: tuberculosis, TB, Saudi Arabia, General papulation, Riyadh region.

Authority for Statistics [5,6]. According to the
Tuberculosis (TB) is an infectious disease
World Health Organization (WHO), in 2016,
caused by bacteria called Mycobacterium
Saudi Arabia reported an annual TB incidence
tuberculosis, is affecting lungs mostly [1]. In the
rate of 12/100,000 population [7]. Even though the
past, and until the end of the twentieth century,
incidence rate of TB has been decreased in Saudi
TB was one of the major causes of death. And
Arabia from 2000 till now, still TB in Saudi
that was because of many factors like the high
Arabia not fully control regardless our
prevalence of Human Immune Deficiency Virus
government effort to do. Treatment success rate is
(HIV/AIDs); changing of socioeconomic status,
still 62% registered in 2014 which is under WHO
migration, the growth of populations and many
target (85%) [5, 7, 8].
other causes [2]. Nowadays, the world is still in
The World is going on to eradicate TB in the
challenges with TB control, even though the
future, and this is the WHO's Plan to get the
percentage of TB has been decreased [3, 4]. We
world free from TB. And this plan contains
have more than 10 million cases have been
reducing death cases from TB by percentage 95%
recorded in 2015, most of them in Asia (61%) [4].
and preventing new cases by percentage 90% in
Saudi Arabia is the third largest country in the
the period between 2015 to 2035 [9].
Middle East, with total population number more
This will not happen if general populations
than 31 million according to last demographic
don't know what is TB, and what the cause of it,
scan done at 2016 which done by General
what is the mode of transmission of it, and how to
Received:22 / 6 /2017 DOI: 10.12816/0039689
Accepted:30 / 6 /2017

Full Paper (vol.683 paper# 24)

c:\work\Jor\vol683_25 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1469-1474

Estimation of Serum Ferritin Level in Preterm Labour
Hazem F. El-Shahawy1, Sherif F. Hendawy1, Alaa S. Hassanin1, Mona M. Abd El-Azeem2
1 Obstetrics and Gynecologydepartment, Faculty of Medicine,Ain Shams University, Egypt.
2 Department of Obstetrics and Gynecology Alex. Governorate Obstetric Hospital,
(Dar Ismail Hospital), Egypt.

Background: Preterm birth is the leading cause of newborn deaths and also the leading cause of death in
children under 5 years of age. There is wide spread suspicion that subclinical infection is a common
accompaniment and cause of preterm labour. Ferritin is an acute phase reactant and it increases during
Aim: The objective of this study is to measure serum ferritin level in cases of established preterm labour
(PTL) as a possible marker of infection.
Study Setting: This study conducted at Ain Shams University Maternity Hospital from March 2015 to
November 2015.
Study design: A case-control study.
Patients and Methods: The study involved 2 groups.
Study population: 60 cases divided into two groups:
Group (I): included 30 patients with established (PTL) between 30 to 34 weeks gestational age (GA).
Group (II): (Control group) 30 patients with uncomplicated pregnancies between 30 to 34 weeks GA.
Serum ferritin was analyzed in the 2 groups.
Results: The results pointed out that there was statistically significant difference between two groups as
regarding serum ferritin level as p value was <0.0001 . The median serum ferritin level in preterm labour
group and control group was 150 (100 ­ 150) ng/ml and 20 (15 ­ 25) ng/ml respectively. The best cut off
value of serum ferritin as predictor of preterm labour was >55 ng/ml with a sensitivity of 96.7% and
specificity of 96.7 %.
Conclusion: Serum ferittin can be used as a marker of preterm labour.
Keywords: Infection, Preterm labour, Serum Ferritin


Preterm labour is defined as regular uterine
in the number of preterm deliveries in the last 25
contractions before 37 completed weeks of
gestation with intact membranes with 4cm or more
The causes of preterm labour (PTL) include
of cervical dilatation observable during a 2hour
multiple pregnancies, infections, and chronic
conditions such as diabetes and high blood
The World Health Organization (WHO)
pressure. The reports also suggest that PTL may be
factsheet revealed that 15 million babies are born
due to one or more of the pathophysiologic
too early every year and almost 1 million children
processes such as amnio-chorionicdecidual or
die each year due to complications of preterm
systemic inflammation, activation of the maternal
birth(2) .
or fetal hypothalamic-pituitary-adrenal axis,
Preterm birth, i.e., birth before 37 weeks of
decidual hemorrhage, or pathologic distension of
gestation period, an important obstetric problem, is
the uterus. But a clear understanding of the
the major cause of neonatal mortality and morbidity
molecular mechanism has not developed yet(5).
across the globe. Nearly 70%of the neonatal deaths
Many maternal and biochemical data as well as
are due to preterm delivery (PTD)(3).
other demographic and behavioral factors have
Preterm pregnancy accounts for about 10%
been used and tried for the prediction of PTD but
of the total pregnancies. There has been an increase
none of them have succeeded(6). Thus, there is an

urgent necessity to develop such a marker which

can render information regarding PTD.
Received: 13 /6 /2017 DOI: 10.12816/0039690
Accepted: 22 /6 /2017

Full Paper (vol.683 paper# 25)

c:\work\Jor\vol683_26 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1475-1480

The Effect of Partial plenic Artery Emblizatin in The
Cntrl of Hyperplenim
Mhamed Harun Haan Ibrahim, hrief Hamed MtafaAbgamra,
Ahmed amy Abdelrahman Abdelazeem
Radiology Department, Faculty of Medicine, Ain shams University

Aim of the work
: A descriptive study to investigate the effect of partial splenic artery embolization in the
control f hyperplenim.
Patients and methods: Fifteen patient with hyperplenim due to chronic liver disease were included.
This was a prospective study that included patients with thrombocytopenia (platelet count <70.000) which
referred from the Tropical Department at Ain Shams University Hospitals to the Interventional Radiology Unit
for partial splenic embolization.
Partial splenic arterial embolization was performed to reduce the hyperfunction of the spleen in patient with
hypersplenism. Results: The mean age of the selected patients was about 48years old.
The most common cause of hypersp1enism is chronic 1iver disease due to HCV infection in 12 patients (80%),
bi1harzial disease in 2 patients (13%) and mixed HCV and bi1harzial infection in 1 patient (7%).
The mot frequent rik factor were pat history of b1ood transfusion in 7 patient (47%), pat history of
urgery in 5 patient (33%), and pathitory of parentral antibilharzia1 treatment in 3 patient (20%).
Bleeding tendency wa found in 15 patient (100%), while abdominal pain wa found in 12 patient (80%). A
regard other ymptom, lower limb swelling and abdominal enlargement were noticed in 30% and 20% of
patient repectively, anemic manifetation and recurrent infection were noticed in 53% and 47% of patient
Potembolization syndrome wa the mot common complication and occurred in all patient (100%). Newly
developed acite occurred in 2 patient (13%). plenic abce wa developed in 2 patient (13%). No other
complications had been reported.
Conclusion: Partial splenic arterial embolization is an effective method for the treatment of thrombocytopenia
resulting from hypersplenism in patients with liver cirrhosis; however, the procedure is associated with
complications, and hence must be performed only if clearly indicated and by an expert person.
Keywords: Splenic arterial embolization (SAE); Partial splenic arterial embolization (PSE); Hepatitis C Virus
(HCV); Complete Blood Count (CBC); Ultrasound (US), Computed Tomography (CT).


Hyperplenim i a pathlgical cnditin
the bdy t prduce antibdie againt encapulated
characterized by increaed pling rdetructin f
micrrganim and predipe patient t epi.
the bld crpucularelement by the pleen, which
After plenectmy, a ecnd urgical peratin r
iften managed by urgical remval rtran-
additinal tranfuin may be required a the
catheter ablatin f the pleen[1].
cnditin that i treated with thiurgery may recur
Many dirder may lead t hyperplenim,
including cirrhi with prtal hypertenin,
The uefplenic artery emblizatin i ued fr
the intentinal infarctin f plenictiuet reduce
ytpenicpurpura, thalaemiamajr, and hereditary
their cnumptive activity. In 1973, Maddin
phercyti ; and diffueplenicinfiltratinfrm
reprted the initial clinical trial with plenic arterial
emblizatin, but evere cmplicatin f cmplete
plenic infarctin including plenic abcee
ymptm f hyperplenim may include
frmatin and ther grave cmplicatin, uch
abdminal dicmfrt, pain and repiratry ditre,
aplenic rupture, epticemia and pneumnia, have
prevented it acceptance a a viable treatment
thrmbcytpenia, leukpenia and anemia [3].
ptin. ince then, many authr advcated
An effective treatment fr hyperplenim may be
incmplete r partial plenic arterial emblizatin,
ttal plenectmy, however; it impair the ability f
Received:7 / 6 /2017 DOI:
Accepted:16 /6 /2017 10.12816/0039691

Full Paper (vol.683 paper# 26)

c:\work\Jor\vol683_27 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1481-1485
Fetal Head Circumference as a Predictor of Successful Spontaneous
Vaginal Delivery
Sadek M.M., Amer M.I., Abd El Aleem M.M.
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Intrapartum head circumference is an integral part of sonographic models and important for
the purpose of fetal weight estimation as well as in cases which abnormal fetal head growth is suspected, it is
considered the interface between maternal pelvis and fetus. Aim: This study aims to assess the accuracy of
fetal head circumference compared to expected fetal weight as a predictor of spontaneous vaginal delivery
Methods: A prospective observational study was conducted on 996 women in active stage of labor admitted
to Labor ward of Ain Shams University Maternity Hospital and Labor ward in Manshiet El Bakry general
hospital. Results large head circumference (odds ratio, 2.8; 95% CI, 1.37­5.73; p-value; .005 was
independent predictors for cesarean delivery, and no significant difference on mode of delivery between
different expected fetal weight,
Conclusion: A large head circumference is more strongly associated with unplanned caesarian section than
high expected fetal weight.
Keywords: intrapartum head circumference, Spontaneous Vaginal Delivery, spontaneous vaginal delivery.


The world health organization (WHO) defines

There are a lot of factors that can affect
normal birth as "spontaneous in onset, low risk at
the success of normal vaginal delivery especially
the start of labor and remaining so throughout
fetal biometry
labor and delivery. The infant is born
The fetal head, from an obstetrical viewpoint, and
spontaneously in the vertex position between 37
in particular its size, is important because an
and 42 weeks of pregnancy. After birth, mother
essential feature of labor is the adaptation between
and infant are in good condition1.
the fetal head and the maternal bony pelvis5. And
This is considered the preferred way of natural
it is represent the point of interface between
labor and delivery. It occurs when a pregnant
passenger and passageway6.
woman goes into natural labor without drugs or

other methods of inducing labor, and gives
birth/delivers her baby normally, without a C-
A prospective observational study was conducted
section, vacuum extraction, or forceps2.
on 997 women in active stage of labor admitted to
Obstetricians have divided labor into 3 stages that
Labor ward of Ain Shams University Maternity
delineate milestones in a continuous process.
Hospital and Labor ward in Manshiet El Bakry
First stage: from the onset of labor to full
general hospital, in the period from January 2016
dilatation (commonly lasts for 8-12 hours in a first
to June 2016.
labor, 3-8 hours in subsequent labors).
Inclusion Criteria:
Second stage: from full dilatation of the cervix to
Singleton pregnancy, term pregnancy,vertex
delivery of the baby (commonly lasts 1-2 hours in
presentation and signed the informed consent to
a first labor, 0.5-1 hour in subsequent labors)
participate in the study
Third stage: from delivery of the baby to the
Exclusion criteria:
delivery of the placenta (commonly lasts up to 5-
Multiple pregnancy, Labor before 37
15 minutes if actively managed3.
weeks + 0 days or after 42 week gestation,
Active management often involves prophylactic
Previous caesarian section (vaginal birth after
administration of oxytocin or other uterotonics
caesarian section) and Other presentations than
(prostaglandins or ergot alkaloids), cord clamping
/ cutting4.
All included women in this study were subjected

Received:13 / 6 /2017 DOI: 10.12816/0039692
Accepted:22 /6 /2017

Full Paper (vol.683 paper# 27)

c:\work\Jor\vol683_28 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1486-1490

Assessment of Knowledge and Attitude and Practice of Safety, Effectiveness and
Consequences of Bariatric Surgery Among Community In Saudi Arabia
Amani Jamil Alqurashi1, Abdullah Saleh Alshafi2, Saud Mohammed Saud Aleisa1,
Zainab Yaseen Albahrani3, Abdullah Saad Alalyani1, Abdulrahman Mubarak M Almutairi4,
Alzaidi Ahmed Abdulghani1, Faisal Abdullah Almoumen5, Osama Sulaiman Alkhudhairi6
1Taif University,2King Khalid University, 3King Faisal University,4 Majmaah University, 5Imam Abdulrahman
Bin Faisal University,6Imam Muhammad Ibn Saud Islamic University, Saudi Arabia


Background: Obesity was reported to be highly prevalent in KSA. Bariatric surgery is considered as the most
effective, beneficial, and permanent method for treatment of obesity and decreasing the long-term mortality
Objectives: Evaluating the knowledge and beliefs about the safety and effectiveness of bariatric surgery among
adult Saudi population.
Methods: A questionnaire based on cross-sectional study was distributed among 790 adult Saudi population
form January 2017- June 2017. The questionnaire was based on 4 aspects including subject's demographics,
anthropometric measures, knowledge about obesity and its causes and beliefs about Bariatric surgery.
Results: Overweight and obesity were found to be high among the studied population. The most common causes
for obesity were bad life style habits and genetic factors. There was a good knowledge about obesity but low
favorable beliefs about bariatric surgery as 55.7% of subjects have non-favorable beliefs about the Bariatric
surgery and 44.3% have favorable beliefs about the surgery. The favorable beliefs about bariatric surgery were
significantly associated with female gender and subjects having high BMI scores.
Conclusion: The knowledge of subjects about obesity and its preventive measures were high but the favorable
perceptions about Bariatric surgeries were low. These results indicated that efficient educational programs about
obesity and Bariatric surgeries are needed for control of obesity and its complications as well as increasing the
availability of weight loss surgeries.
KAP, Safety, Effectiveness, Consequences, Bariatric Surgery, KSA


KSA was reported to have a rapid increase in the
mortality(12, 13). The aim of this study was to assess
prevalence of obesity as about 33% of Saudi adults
the knowledge and beliefs about the safety and
are obese and 70% are overweight(1). Many factors
effectiveness of bariatric surgeries among adult
contribute to high incidence of obesity including
Saudi population.

hypertension, sleep apnea as well as osteoarthritis.
Also, life style as diet, exercise and demographics
After approval of the ethical committee of
play a significant role in obesity(2-4).
faculty of medicine, this cross-sectional study was
Obesity has many comorbid pathogenic role in
conducted among adult Saudi population form
many metabolic and cardiovascular diseases as well
January 2017- June 2017 in thirteen governorates
as poses a risk factor for ovarian, uterine, breast,
allover KSA with a population size of 31,742,308
prostate and colon cancer(5-7).Obesity is a
people as reviewed by the General Authority for
preventable disease that could be managed by
Statistics (GAS), KSA in 2016(14). The sample size
modifying life style, exercise, eating habit and using
was taken to be 790 Saudi adult participants
pharmacological therapy(8, 9). During the past two
assuming the response rate of 50% and 95%
decades, surgical treatment of obesity has shown a
confidence interval(15). Non-Saudi population, age
growing importance for reduction of weight and
less than 18 years old and incomplete data were
decreasing the rates of disease morbidity and
excluded. An informed consent was obtained from
mortality(10, 11).
all participants included in the study and they were
Bariatric surgery is considered as the most
informed that the study has no expenses on their
effective, beneficial and permanent method for
treatment of obesity and decreasing the long-term
Received: 15 / 4 /2017 DOI: 10.12816/0039693
Accepted: 23 / 4 /2017

Full Paper (vol.683 paper# 28)

c:\work\Jor\vol683_29 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1491-1496
Assessment and Evaluation of the Level of Satisfaction After
Lasik Among Myopic Patients in Aljouf City
Ahmed Naif Alolaywi1, Mohammed Ahmedhani Kilani2, Abdullah Zamil Almani1
Hatim Hassan Najmi3, Abdulaziz Dhaifallah Alanazi1, Fahad Saleh Alruwaili1,
Abdulaziz Faisal alrubayyi1, Khaled abd Alsalam Zaky4
1College of Medicine, Aljouf University, 2Maastricht University, Netherlands,
3Medical College, Jazan University, 4Ophthalmology Department, Aljouf University

Background: Laser in situ keratomileusis (LASIK) has being used as the most effective and common
refractive surgical procedure of choice for correction and elimination of myopic errors. The use of refractive
surgeries has aided subjects to get rid of contact lenses either soft or rigid as well as eye glasses.
Objective: Evaluate the level of satisfaction and the impact on the quality of life in myopic patients after a
LASIK operation.
Methods: This is a cross-sectional and community based survey study in which 111 participants were
enrolled. All patients underwent a data collection and Satisfaction assessment including a 29 Likert model
Results: High levels of satisfaction (81.9%) and quality of life (76.5%) were found among myopic patients.
Most of patients did LASIK to get rid of their glasses and to have good visual results regarding to reading,
driving, swimming at day light or at night. The majority of subjects revealed that the surgery achieved their
goal, and 83.8% would praise LASIK for friends. Females showed a significant higher motive for performing
LASIK to improve their general look. The medical professions showed lower levels of satisfaction toward
quality of vision than educational professions.
Conclusion: A high level of satisfaction, quality of life and vision satisfaction was found in the present study
after LASIK among myopic patients in Aljouf city.
Keywords: Lasik, Level of Satisfaction, Myopic Patients, Aljouf City, KSA


Laser in situ keratomileusis (LASIK) has being
is considered as the measurable unit for assessing
used as the most effective and common refractive
the quality of procedure and medical services(15). In
surgical procedure of choice for correction and
addition, the worldwide satisfaction from LASIK
elimination of myopic errors(1-4). The use of
ranged from 82-98% (4, 16). Therefore, this study
refractive surgeries has aided subjects to get rid of
was conducted to evaluate the satisfaction of
contact lenses either soft or rigid as well as eye
myopic patients after LASIK surgery.
glasses (5, 6).

During LASIK, the most critical and important
Literature review
step is the formation of a corneal that could be
In Seoul and Pusan, a study was conducted to
accompanied by intraoperative technical obstacles
identify the factors influencing the post-operative
resulting in postoperative complications which
satisfaction in myopia patients receiving laser in
affects the visual perception of patients(7, 8). The
situ keratomileusis (LASIK). The study included
knowledge about the complications of each step,
288 patients who received LASIK. The patients
etiology, implications and the management of
with very severe myopia tended to be more
intraoperative as well as postoperative surgery
satisfied with the treatment than those with mild
outcomes is a must for avoiding complications and
myopia concluding that LASIK can be more
obtaining good results(9-11).
effective to those suffering from a severe visual
The satisfaction of myopic and astigmatism
patients after LASIK was reported to be high and of
Another research aimed to study the effect of
great success in many studies that were conducted
LASIK on the quality of life (QOL)and to identify
in Gulf region (12-14). As the satisfaction of patients
the factors that may affect the level of satisfaction

after LASIK in 104 patients treated with LASIK for
Received: 16 / 4 /2017 DOI: 10.12816/0039694
Accepted: 24 / 4 /2017

Full Paper (vol.683 paper# 29)

c:\work\Jor\vol683_30 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1497-1504

Magnesium in Intensive Care Unit: A Review
Galal A. Elkady*, Raoof R. GabAllah* and Amr Z. Mansour**
* Anesthesia and Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams
** Critical care Department, Faculty of Medicine, Cairo University
Corresponding author: Ahmed Ibrahim Bedir, ahmed bedir ahmedbedircardiology@gmail.com

Aim of the work:
there is an increased interest in the role of magnesium ions in clinical medicine, nutrition
and physiology. Magnesium affects many cellular functions, including transport of potassium and calcium
ions and modulates signal transduction, energy metabolism and cell proliferation. Magnesium deficiency is
not uncommon among the general population: its intake has decreased over the years. Magnesium
derangement results in various symptoms and signs; magnesium supplementation or intravenous infusion
may be beneficial in various diseased states; so this review aimed to highlight the physiology of magnesium
in humans, the derangement of magnesium in the form of hyper and hypomagnesemia , their clinical picture
and the clinical and therapeutic uses of magnesium in the critical ill patients .
Methods: references were obtained from Medline, Google Scholar and Ovid from 1960 to 2017. All
categories of articles (clinical trials, reviews, or metaanalyses) on this topic were selected.
Conclusion: magnesium is a critical physiological ion; it has many known indications in anesthesiology and
intensive care because of its interactions with drugs used in intensive care. Intensive care specialists need to
have a clear understanding of the role of this important cation. Magnesium is gaining recognition as a
clinically important electrolyte in intensive care and emergency medicine .Recent clinical trials and case
reports increase interest of magnesium as an effective therapeutic agent for potentially life-threatening
problems such as torsade de pointes, digitalis toxicity, bronchospasm and alcohol withdrawal, subarachnoid
hemorrhage, acute myocardial infarction, preecalmsia , eclamsia ,hypertension , diabetes , metabolic
syndrome and cardiac arrhthymias .
Keywords: physiology of magnesium, hyper and hypomagnesemia , magnesium in ICU


There is an increased interest in the role of
phosphate trans-associated enzymes; magnesium
magnesium ions in clinical medicine, nutrition and
may also bind the enzymes directly ( i.e RNA and
physiology. Magnesium affects many cellular
DNA polymerases ) and alter their structure
functions including: transport of potassium and
therefore , the availability of an adequate quantity
calcium ions and modulates signal transduction,
Mg may be considered as a critical factor for
energy metabolism and cell proliferation.
normal body and cellular homeostasis and function
Magnesium deficiency is not uncommon among
(2) .Magnesium is a critical physiological ion and its
the general population; its intake has decreased
deficiency might contribute to the development of
over the years especially. The magnesium
pre-eclampsia to impair neonatal development and
supplementation or intravenous infusion may be
to metabolic problems extending into adult life.
beneficial in various diseased states (1). The Mg
Pharmacologically, magnesium is a calcium
ion, the second most abundant intracellular cation
antagonist with substantial vasodilator properties
after potassium, plays essential roles in the
but without myocardial depression. Cardiac output
structure and function of the human body; it is an
essential cofactor in a wide variety in the
administration, compensating for the vasodilatation
physiological processes , including protein
and minimizing hypotension.
synthesis and stability, neuromuscular excitability
Neurologically, the inhibition of calcium
and the conduction of neural impulses, stimulus-
channels and antagonism of the N-methyl-D-
contraction coupling and muscular contraction,
aspartic acid (NMDA) receptor raises the
magnesium is an indispensable part of the activated
possibility of neuronal protection. It is the first-line
Mg ATP complex and it is required for adenosine
triphosphate ( ATP ) synthesis in the mitochondria
preeclampsia and eclampsia and it should be
.Also, magnesium is an important cofactor in over
administered to all patients with severe
300 enzymatic reactions and it is required for the
preeclampsia or eclampsia (3).
activity of all rate limiting glycolytic enzymes,
The study was approved by the Ethics Board
protein kinases and more generally , all ATP and
of Ain Shams University.

Received:8 / 6 /2017 DOI: 10.12816/0039695
Accepted:17 / 6 /2017

Full Paper (vol.683 paper# 30)

c:\work\Jor\vol683_31 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1505-1512

Assessment of Serum Desnutrin Levels in Patients with Acne Vulgaris
Hanan M Saleha, Manal A Shararab, Mohamed A Habibc
Department of Dermatology, Andrology and Venereology, Ain Shams University, Cairo, Egypt

Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of
pilosebaceous units (hair follicles and their accompanying sebaceous gland). Desnutrin is the major
triglyceride lipase in the adipose tissue of mice and excessive secretion from adipocytes results in decreased
triacylglycerol storage and increased lipolysis, fatty acid oxidation and thermogenesis.
The aim of this study is to evaluate serum level of Desnutrin in acne vulgaris patients and
correlate it with disease severity.
Patients and Methods:
This study was performed on 40 patients with active acne lesions and 40 healthy
subjects with no previous history of acne and no active acne lesions as controls. The control group was
composed of age, gender, and Body mass index (BMI) matched individuals. All the patients were recruited
from the outpatient clinic of Dermatology & Venereology Department, Ain Shams University hospitals, from
March 2016 till August 2016.Serum desnutrin assessment was done by ELISA kit using Sandwich-ELISA as
a method. The Micro elisa stripplate has been pre-coated with a Horse Radish Peroxidase antibody specific to
desnutrin. The optical density was measured spectrophotometrically.
There was a significantly lower level of serum desnutrin among cases compared to that of control
group, while the fasting blood glucose level was significantly higher among cases compared to that of control
group. The collective data from both study groups showed a significant negative correlation between the
mean serum fasting blood glucose level and desnutrin level. There was no significant correlation between the
severity of acne and serum desnutrin level.
The level of serum desnutrin can affect the occurrence and the progression but not the severity
of acne among susceptible individuals. The level of fasting blood glucose is also of value regarding the
occurrence of acne and has a negative effect on the level of desnutrin.
: Acne, Serum desnutrin, severity, fasting blood glucose, lipid profile.


Acne vulgaris is a common chronic skin
promoting the development of acne. There was
disease involving blockage and/or inflammation of
significant improvement of acne severity in patients
pilosebaceous units (hair follicles and their
who adhered to a low glycemic load diet resulted in
accompanying sebaceous gland). Acne can present
significant reductions in weight, body mass index,
as noninflammatory lesions, inflammatory lesions,
free androgen index, increased IGF-bindingprotein
or a mixture of both, affecting mostly the face but
also the back and chest (1). Acne vulgaris has a
bioavailability of free IGF-1 and improved insulin
multifactorial pathogenesis, of which the key factor
sensitivity. Serum IGFBP-1 and IGFBP-3 increased
is genetics. Acne develops as a result of an
from baseline in the low glycemic load group (4).
interplay of the following four factors: (1) follicular
Desnutrin is a patatin-like domain-containing
epidermal hyperproliferation with subsequent
protein, desnutrin (PNPLA2), is also known as
plugging of the follicle, (2) excess sebum
human adipose triglyceride lipase (ATGL), TTS2.2
production, (3) the presence and activity of the
and ipla2. Desnutrin is highly expressed in adipose
commensal bacteria Propionibacterium acnes, and
tissue and produced at low levels in other tissues.
(4) inflammation (2).
Desnutrin secretion is stimulated by fasting and
Androgens and insulin contribute to an increase
glucocorticoids (5).
in sebum production in the pathogenesis of acne
Desnutrin is the major triglyceride lipase in the
vulgaris. In addition, a correlation between insulin-
adipose tissue of mice and excessive secretion from
like growth factor-1 (IGF-1) and facial sebum
adipocytes results in decreased triacylglycerol
levels has been shown (3).
storage and increased lipolysis, fatty acid oxidation
High glycemic load diets may result in
and thermogenesis. It has been reported that these
increased androgen activity and IGF-1, thereby
Received: 22 / 6 /2017 DOI: 10.12816/0039696
Accepted:30 / 6 /2017

Full Paper (vol.683 paper# 31)

c:\work\Jor\vol683_32 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1513-1519

Acute and Chronic Sinusitis Causes and Management
Abdulrahman Faleh N Almutairi1, Rahaf Wajih Shafi2, Shahad Ahmed Albalawi3,
Mohammed Adel Basyuni4, Abdulaziz A. Alzahrnai4, Abdulaziz Abdulilah Alhaifi4,
Adel Ahmed Alshehri4, Muath Ahmad Al-Gadouri4, Ayman Saeed Alghamdi4
1 Medical University of Warsaw, 2 King Abulaziz University Hospital, 3 Tabuk University,
4 Umm Alqura University.
Corresponding author: Dr. Abdulrahman Faleh N Almutairi, Abdulrahmanalmutairi90@gmail.com

Sinusitis is categorized by inflammation of the lining of the paranasal sinuses. As the nasal mucosa is
instantaneously involved and as sinusitis infrequently occurs without concurrent rhinitis, rhinosinusitis is
currently the preferred term for this condition. Acute sinusitis is a clinical diagnosis; thus, an understanding
of its presentation is of paramount importance in differentiating this entity from allergic or vasomotor rhinitis
and common upper respiratory infections. No precise clinical sign or symptom is sensitive or specific for
acute sinusitis, so the overall clinical impression should be used to guide management. Chronic sinusitis is an
inflammatory procedure that includes the paranasal sinuses and persists for 12 weeks or longer. The
literature has reinforced that chronic sinusitis is nearly always accompanied by concurrent nasal airway
inflammation and is frequently preceded by rhinitis symptoms; hence, the term chronic rhinosinusitis (CRS)
has evolved to more accurately define this condition. Treatment of sinusitis, whether medical or surgical, is
intended at decreasing inflammation and obstruction in the sinonasal passages. Antibiotics, even though
frequently used in sinusitis, ought to not be managed unless there is suspicion of an acute bacterial infection.
Keywords: Chronic, Rhinosinusitis, Antimicrobial Treatment, Sinus.

Chronic sinusitis is one of the more pervasive
Sinusitis is categorized by inflammation of the
chronic ailments in the United States, influencing
lining of the paranasal sinuses. Since the nasal
people of all age groups. It is an inflammatory
mucosa is instantaneously included and as sinusitis
procedure that includes the paranasal sinuses and
infrequently occurs without concurrent rhinitis,
perseveres for 12 weeks or more. The literature has
rhinosinusitis is currently the preferred term for this
reinforced that chronic sinusitis is quite often joined
condition [1, 2]. Numerous classifications, both
by simultaneous nasal airway inflammation and is
clinical and radiological, have been proposed in the
frequently preceded by rhinitis symptoms; as a
literature to define acute sinusitis. Even though no
result, the term chronic rhinosinusitis (CRS) has
consensus on the precise definition presently exists
developed to all the more precisely depict this
subacute sinusitis represents a temporal progression
condition. CRS may manifest as one of the three
of symptoms for 4-12 weeks. Frequent acute
major clinical syndromes: CRS without nasal
sinusitis is diagnosed when 2-4 episodes of
polyps, CRS with nasal polyps, or allergic fungal
infection happen per year with no less than 8 weeks
rhinosinusitis. These orders have a lot of remedial
between episodes and, as in acute sinusitis, the
importance. Most cases of chronic sinusitis are
sinus mucosa completely normalizes between
attacks. Chronic sinusitis is the perseverance of
deceptive symptomatology beyond 12 weeks, with
demonstrates inversely from acute sinusitis.
or without acute intensifications [3]. Acute sinusitis
Symptoms of chronic sinusitis include nasal
is a clinical finding; along these lines, a
stuffiness, postnasal drip, facial fullness, and
comprehension of its presentation is of vital
malaise. Chronic sinusitis can be non-infectious and
significance in separating this substance from
allergic or vasomotor rhinitis and common upper
respiratory contaminations. No particular clinical
environmental pollutants [4, 5]. Allergic rhinitis,
indication or sign is sensitive or particular for acute
nonallergic rhinitis, anatomic obstruction in the
sinusitis, so the general clinical impression ought to
ostiomeatal complex, and immunologic ailments
be utilized to guide management. To accurately
are identified hazard factors for chronic sinusitis.
diagnose and treat contagious disorders of the
Medical treatment is focused toward controlling
paranasal sinuses, the clinician must have
awareness of the developmental milestones. The
infections, decreasing edema of sinus tissues, and
improvement of the paranasal sinuses arises in the
easing the drainage of sinus secretions. The
third week of gestation and remains until early
objective in surgical treatment is to re-establish
sinus ventilation and to redress mucosal restriction
Received:2 / 6 /2017 DOI: 10.12816/0039697
Accepted: 11 / 6 /2017

Full Paper (vol.683 paper# 32)

c:\work\Jor\vol683_33 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1520-1526

Lidocaine and Dexamethasone for Paracervical Block Anesthesia in
Women with Missed Abortion (Randomized Controlled Trial)
Abdelmegeed I. Abdelmegeed, Amr A. M.Riad, Amin M. Al Ansary, Mohamed A. A. Darwish
Obstetrics and Gynecology Department, Faculty of Medicine , Ain Shams University .
Corresponding author: Abdelalim56@gmail.com, Tel: +20201020232235

Aim of the work:
nerve block is a technique whereby local anesthetic solutions are infiltrated around a
nerve (or perineurally) to provide anesthesia and analgesia. Nerve block for intraoperative and postoperative
pain management is associated with improved analgesia, fewer opioid-related adverse events, earlier
ambulation and shorter hospital stay when compared to intravenous opioid analgesia alone. This study aimed
to assess the efficacy of adding dexamethasone to lidocaine for cervical block anesthesia for prolonging the
duration and anesthetic effect in women with missed abortion undergoing vacuum evacuation.
Patients and methods: this study is a randomized controlled trial and it was conducted in accordance with
the ethical committee protocols and informed consent procedures of Ain Shams University Maternity
Hospital during the period between Augusts to December 2016. Sample size was calculated using PASS®
version 11 programs, setting the type-1 error () at 0.05 and the power (1-) at 0.8.
Conclusion: para cervical block can be used as a safe and effective anesthetic technique in patients who need
surgical uterine evacuation of missed abortion. Adding dexamethasone can increase effectiveness and duration of
para cervical block. Intraoperative pain level was accepted in 80% of patients, these patients had no or mild to
moderate accepted pain. We did not detect any postoperative complications in our patients including
(excessive vaginal bleeding, hematoma or general manifestations of lidocaine toxicity) and It is
recommended to apply PCB for cases of first trimester missed abortion who require uterine suction
evacuation. Lidocaine is preferably mixed with dexamethasone to have better results as regards pain score. It
is the anesthetic method of choice especially when general anesthesia is a high risk procedure.
Keywords: anti cardiolipin antibody (ACL), Anti-phospholipid syndrome (APS), Beta-human chorionic
gonadotropins (B-HCG), BPD, parietal diameter (Bi), Crown rump length (CRL).


Nerve block is a technique whereby local
general anesthesia or a combination of those(3). One
anesthetic solutions are infiltrated around a nerve
of the most important aspects in treating missed
(or perineurally) to provide anesthesia and
abortion is the sufficient management of pain
analgesia. Nerve block for intraoperative and
during the process of evacuating the uterus,
postoperative pain management is associated with
regardless of whether patients undergo dilatation
improved analgesia, fewer opioid-related adverse
and curettage with sharp curette or manual vacuum
events, earlier ambulation and shorter hospital stay
aspiration (4).
when compared to intravenous opioid analgesia

alone (1).
First-trimester abortions are usually performed,
One hundred women who were diagnosed to
while the woman is awake or minimally sedated.
have missed abortion and who fulfilled all
There is a general expectation that women will
selection criteria (Inclusion-Exclusion criteria
experience some pain or discomfort during the
shown below) were invited to participate in the
abortion. Despite various techniques, many patients
study voluntarily and , when accepted , they signed
still find surgical abortion uncomfortable, 78-97%
the study's informed consent form . These women
of patients showed at least moderate procedural
were selected either from the outpatient clinic or
pain (2).
from the emergency department.
First-trimester surgical abortions are associated
women were randomizely divided into two equal
with pain especially during injection of the cervical
block, cervical dilation, suction aspiration and
Group A received paracervical block
postoperatively with uterine cramping despite
anesthesia in the form of lidocaine and
various methods of pain control. Multiple methods
dexamethasone .
of pain control in surgical abortion are available
Group B received paracervical block
and appear safe and effective. Pain control can be
anesthesia in the form of lidocaine and placebo.
in the form of local anesthesia, conscious sedation,

Received: 3 / 6/2017 DOI: 10.12816/0039698
Accepted: 12 /6 /2017

Full Paper (vol.683 paper# 33)

c:\work\Jor\vol683_34 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1527-1532

1,5 Anhydroglucitol Evaluation as Glycemic Control Parameter
of Diabetes Mellitus in Pregnancy
Helmy M. Elsayed, Mohammed EM. Ibrahim, Mohammed SL El Safty, Samar MM Salim
Department of Obstetrics and Gynecology,Faculty of Medicine, Ain Shams University

1,5-Anhydroglucitol (1,5-AG) provides a reliable opportunity to assess the frequency and
extent of intermittent hyperglycemic episodes. Aim of the Work: this study aimed to evaluate an alternative
parameter to monitor blood glucose in pregnancies complicated with diabetes mellitus by studying the
relationship between 1,5 Anhydroglucitol and self-monitoring of blood glucose level in pregnant women
complicated with diabetes mellitus. Patients and Methods: this cross-sectional study with retrospective data
was conducted on seventy pregnant women known to have pre-gestational or gestational diabetes mellitus
attending Ain Shams University Maternity Hospital fulfilling the inclusion criteria of pre-gestational or gestational
diabetes mellitus according to the criteria of the American Diabetes Association. Results: this study revealed a
highly significant negative correlation between MMG (mean maximum glycemia) and 1,5 AG (r: -0.817, p-
value: <0.001), also pre prandial blood glucose level (r: -0.500, p-value: <0.001) and a negative correlation
and highly significant was found between post prandial blood glucose level and 1,5 AG (r: -0.640, p-value:
<0.001). Conclusion: 1,5-AG is better than HbA1c as a tool for monitoring the glucose profile in pregnancies
complicated by diabetes mellitus especially for the hyperglycemic episodes. Recommendations: as majority
of interpretations for utility of 1,5-AG in pregnancy are based on scanty few clinical data so there is a scope
of potential possibilities for its use in pregnancy and continuous research may allow its new applications and
usefulness in pregnancy in the future.
Keywords: 1, 5 Anhydroglucitol, Glycemic Control Parameter, Diabetes Mellitus, Pregnancy.


clear. It has been demonstrated that pregnant
Diabetes mellitus (DM) during pregnancy
women may have lower hemoglobin A1c levels
can lead to serious risks for both mother and fetus.
than non pregnant women (5). Hemodilution and
DM type1 and DM type 2 affect 1% of
increased cell turnover have been postulated to
account for the decrease. Iron deficiency has been
underestimation. Due to the increasing prevalence
presumed to cause the increase of hemoglobin
of DM type 2 caused by obesity in a younger age
A1c in the last trimester (6). In current clinical
group, it is assumed that the prevalence of
practices, the common indexes to evaluate the
pregnancies complicated by DM type 2 will
blood glucose states are glycated hemoglobin
increase as well (1).The possible complications due
(HbA1c) and fructosamine (FA). However, these
to diabetes during pregnancy are severe. The
can only reflect the integrated average blood glucose
mother has an increased risk of preeclampsia,
concentration of the preceding 8­12 weeks or 2­3
infections, ketoacidosis, hypoglycemia and
weeks, respectively, and potentially overlook the
microvascular diseases such as retinopathy,
important hyperglycemic excursions that may be
nephropathy and neuropathy. In addition, there is
balanced out by hypo- glycaemia. Thus, neither
an increased risk for miscarriage, still birth,
HbA1c nor FA can reflect recent glycemic
congenital defects and neonatal morbidity and
excursions sensitively. So, in addition to HbA1c and
death (2). For congenital defects, a dose-response
FA, there is an imperative need for more intensive
relation is found: the poorer the peri-conceptional
and sensitive blood glucose monitoring markers to
blood glucose control, the greater is the risk on
reveal not only blood glucose levels but also recent
congenital defects. Another major complication is
hyperglycemic excursions (7).1,5-Anhydroglucitol
macrosomia, which is a risk factor for
(1,5-AG), the 1-deoxy form of glucose, has been
instrumental delivery, caesarean section, shoulder
measured and used clinically in Japan for over a
decade to monitor short-term glycemic control
hypoglycemia after birth (3). There is strong
(8).1, 5-AG level in plasma reflects short-term
evidence that proper management of gestational
(postprandial especially) changes in serum glucose
diabetes mellitus (GDM) and pre-existing DM
and could be an excellent tool to achieve optimal
during pregnancy leads to better health outcomes
glycemic control as an adjunct to HbA1c. 1,5-AG

level monitoring is the useful method to identify
for both mother and child (4). The mechanisms of
otherwise well controlled patients with transient
hemoglobin A1c discrepancy in pregnancy are not
hyperglycemia ­ patients at high risk of
Received: 10 / 6 /2017 DOI: 10.12816/0039699
Accepted: 19 / 6 /2017

Full Paper (vol.683 paper# 34)

c:\work\Jor\vol683_35 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1533-1540

The Impact of Comorbidities on the Outcome of Tuberculous Patient
in Respiratory Intensive Care Unit
Mona Mansour Ahmad1, Hossam EL Dien M Abdel-Hamid1, Marwa Hassan AL Makawy2
1 Chest Department, Ain Shams University Hospital, 2 Abbassia Chest Hospital, Cairo, Egypt

Aim of the work:
there are limited data regarding active pulmonary tuberculosis (APTB) patients requiring
ICU admission. This study aimed to determine the mortality rate and risk factors associated with TB
patients with comorbidities requiring respiratory intensive care unit (RICU) admission. Patients and
a combined retrospective-prospective study was conducted from November 2014 to October
2016 and from November 2016 to April 2017 on adult patients with APTB admit to the RICU of Abbassia
Chest Hospital for a period of more than 24 h. Demographic, clinical and therapeutics characteristics as
well as outcome (RICU morality) were obtained from the medical records. Results: in this study a total of
43 patients were considered (median age 45 years for non survived patients and 36 years for survived
patients). The RICU morality rate was 81.4%. Respiratory failure was the most common cause of admission
to RICU 37,2% (16 patient). Mechanical ventilation (MV) was needed in 69.8% of patients (30 patients).
Death rate in the diabetic patients was14.29%, in patients with renal disease it was 20% , in case of HIVit
was 17.14% and in case of malignancy it was 8.57%.There was highly significant mortality rate
accompanying LCF and the ratio was 31.43%,in case of respiratory failure type II it was 94.28% and in
mechanical ventilation it was 80%. Non survived patients had high significant APACHE SCORE 21.4±6.2
and the main cause of death was mainly ventilatory 80%(28 patients).
Conclusion: the present study showed a very high mortality rate among TB patients with comorbidities
requiring respiratory intensive care unit (RICU) admission and identified associated co morbidities, risk
factors and a predictor of RICU mortality.
Keywords: active pulmonary tuberculosis, mortality, respiratory intensive care unit, co morbidities.


According to the World Health Organization, more
by the inhalation of crystalline silica particles,
than 2 billion people (one third of the world's
almost always due to occupational environments,
population) are currently infected with the
including mining, sandblasting, quarrying, ceramic
tuberculosis (TB)bacillus , it continues to be a leading
working and iron smelting(8), but silicosis and
cause of burden and death among infectious diseases
silica dust exposure are not deemed risk factors for
worldwide (1).
relapse or re-infection(9).
Several non-communicable diseases (NCDs), such as
Low BMI at the time of diagnosis has also been
DM, alcohol use disorders and smoking-related
linked to risk of treatment failure, death during TB
conditions, are responsible for a significant proportion
treatment and relapse (10). Other chronic
of TB cases (2). NCDs may complicate treatment
conditions, such as autoimmune and systematic
and management of TB, due to clinical challenges
disorders, chronic renal failure, liver failure,
(e.g. among people with DM) as well as behavioral
certain malignancies and wide range of immune-
challenges (e.g. among people with alcohol use
suppressant treatments, are also associated with
disorders) (1). Smoking also affects the chance of cure
TB (11).
from TB. Severity of TB at the time of diagnosis and

risk of relapse has been linked to smoking. In addition,
few studies have been found that smokers have a
This is a retrospective-prospective study design
higher risk of death from TB and other poor treatment
started in October 2016 in which adult patients (>
outcomes than nonsmokers (3).
16 years) with active pulmonary TB previously or
Nicotine is hypothesized to act directly on nicotinic
subsequently admitted to the respiratory ICU
acetylcholine receptors on macrophages to decrease
(RICU) of Abbassia Chest Hospital between
intracellular tumor necrosis factor- production and,
november 2014 to October 2016 (retrospective
thus, impair intracellular killing of M. tuberculosis
part) and between November 2016 to April 2017
(4).There is an evidence that DM leads to delay culture
(prospective part). Patients who stayed at RICU
conversion (5)and that the risk of death during TB
less than 24 hours or presenting with inactive
treatment is increased (6) as the risk of relapse (7).
pulmonary TB or extra pulmonary TB were
The association between silicosis and pulmonary
excluded. The Abbassia Chest Hospital is
TB has been well documented. Silicosis is caused
a special, tertiary care hospital with 600-bed
Received: 11 / 6 /2017 DOI: 10.12816/0039700
Accepted: 20 / 6 /2017

Full Paper (vol.683 paper# 35)

Computerized tomographic study of the normal dimensions of the anterior horn of lateral ventricle in adults The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1541-1548

Impact of Chronic HCV Infection on Coronary Calcification in
Prevalent Haemodialysis Patients
Magdy M.S. Elsharkway; Walid A. Bichari; Mohamed M. Mohamed and Mohamed I.A. Ahmed
Internal Medicine and Nephrology Department, Faculty of Medicine,
Ain Shams University
Hepatitis C virus (HCV) chronically infects an estimated 170 million people worldwide.
Approximately 30% of patients who develop acute hepatitis C recover spontaneously, signaled by improved
symptoms, normalized liver-related chemistries, loss of HCV RNA from serum, and the development of
HCV antibody. Cirrhosis rates become significant after 20years of HCV infection. Haemodialysis is a
process that uses a man-made membrane (dialyzer) to clear wastes such as urea from the blood, restore the
proper balance of electrolytes in the blood and eliminate extra fluid from the body. Vascular calcification is
common in patients with advanced haemodialysis and is associated with poorer outcomes.
Objectives: The aim was to evaluate the possible impact of chronic HCV infection on coronary calcification
in prevalent haemodialysis patients in Naval Forces hospital, Alexandria, Egypt and its relation to
demographic data, haemodialysis data and other laboratory findings.
Patietns and methods: This cross-sectional study was carried out on 60 patients with at least one year
duration on regular haemodialysis; 30 HCV negative prevalent haemodialysis patients and 30 HCV positive
prevalent haemodialysis patients.
Our study revealed that HCV negative patients included 25 (83.3%) males and 5 (16.7%) females,
their mean age was 51.67 ± 6.91 years. The mean haemodialysis duration was 7.5 ± 1.89 years. There were
statistically a high significant difference between HCV negative prevalent haemodialysis patients and HCV
positive prevalent haemodialysis patients regarding AST, significant differences regarding ALT and albumin
and non-significant differences regarding bilirubin, prothrombin time, international normalized ratio,
cholesterol and total glycerides. But, there were no significant differences between HCV negative prevalent
haemodialysis patients and HCV positive prevalent haemodialysis patients regarding CKD-MBD parameters
(including PO4 and iPTH), except for calcium which exhibited statistically a significant difference. Also,
there were no significant differences between HCV negative prevalent haemodialysis patients and HCV
positive prevalent haemodialysis patients regarding creatinine, sodium and potassium, significant differences
regarding URR, C-reactive protein and a high significant difference regarding Ca score. In HCV negative
prevalent haemodialysis patients, there were statistically significant correlations regarding dialysis duration
and international normalized ratio and high significant correlations between Ca score and creatinine, AST
and prothrombin time. In HCV positive prevalent haemodialysis patients, there were statistically significant
correlations between Ca score and dialysis duration and creatinine. Other correlations were insignificant.
There were non-significant relations between Ca score and gender and dialysis vascular access.
Conclusion: A very high incidence of vascular calcification was found in chronic haemodialysis patients in
our study as compared to other studies. Vascular calcification is correlated with many risk factors and
control of the modifiable risk factors can help to decrease prevalence of vascular calcification.
Keywords: chronic hepatitis C virus, coronary calcification, vascular calcification, haemodialysis.


Hepatitis C virus (HCV) infection remains
chronic kidney disease (CKD). It occurs in the
frequent in patient receiving long-term dialysis
intimal and medial layers of the arterial wall, the
both in developed and less-developed countries.
most important type in CKD being calcification in
The natural history of HCV infection in dialysis
the media. It is related to decrease vascular
elasticity and increased mortality) 3). The
Defining the natural history of HCV remains
mechanisms of arterial calcification are complex
difficult for several reasons: the disease has a very
and are regulated by plasma components, which
long duration, it is mostly asymptomatic, and
keep minerals dissolved and repress their
determining its onset may be difficult. Additional
deposition in tissues (4).
factors can modify the course including
Patients on haemodialysis (HD) suffer from
coinfection with HBV, HIV, and alcohol use (1, 2).
extensive cardiovascular calcifications (VCs).
Vascular calcification is a very common
Vascular calcification is an independent risk factor
form of extra skeletal calcification in patients with
and might explain the excessively increased

cardiovascular mortality in this population(5,6).
Received: 22 / 6 /2017 DOI: 10.12816/0039701
Accepted:30 / 6 /2017

Full Paper (vol.683 paper# 36)

c:\work\Jor\vol683_37 The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (3), Page 1549-1553

Management of Placenta Previa During Pregnancy
Abdulrahman Abdulelah Almnabri1, Emtenan Abed Al Ansari2, Murooj Mohammed Abdulmane2,
Deyala Wadie Saadawi 2, Taghreed Abdualaziz Almarshad 2, Ahmad Abdullatif Banoun2, Nora Samir
Mufti3, Bashayer Sadagah Bati2, Miznah Saud Almarwanie 2, Leena Abdulrahman Alahdal2, Afaf
Mohammed Mas Ebrahim2, Safaa Mahmood Al-Hasani3, Mohannad Ali Alghamdi4.
1 Umm Alqura University, 2 Ibn Sina National College, 3 Batterjee Medical College, 4 KING ABDULAZIZ
Corresponding Author: Dr. Abdulrahman Abdulelah Almnabri, A.Almnabri93@Gmail.Com .
Placenta previa is an obstetric complication (OS) that traditionally shows painless vaginal bleeding in the
third trimester secondary to a strange placentation close or covering the interior cervical OS. Due to the
inherent risk of hemorrhage, placenta previa may cause serious morbidity and mortality to both the fetus and
the mother. Recently there have been two defined types of placenta previa: complete, and marginal. We here
review the complications, incidence, risk factors, and management options of placenta previa.
Keywords: Placenta Previa, Fetus, Cesarean Hysterectomy, Vaginal bleeding.


Placenta previa is an obstetric complication that
cesarean segments over the most recent 50 years is
traditionally shows painless vaginal bleeding in the
incompletely a causative factor to the expanding
third trimester secondary to a strange placentation
number of instances of placenta previa [4]. The
close or covering the interior cervical os.
Nevertheless, with the technologic developments in
announced in the literature is around 4 for each
ultrasonography, the determination of placenta
1000 births. Hazard factors related with an
previa is ordinarily made previously in pregnancy.
expanded danger of placenta previa were
Generally, there have been three characterized sorts
progressed maternal age, past abortion, grand
of placenta previa: complete, partial, and marginal
multiparity, history of past C/S, and smoking amid
[1]. These definitions have been combined into two
pregnancy [5]. Patients with placenta previa must
definitions: complete and marginal previa. Placenta
reduce activity to avoid rebleeding. Furthermore,
Previa is characterized as a condition that happens
pelvic examinations and intercourse must be
in pregnancy when the placenta anomalous was
embedded in the lower uterine segment, partially or
In recent years, publications have described the
completely covering the inner cervical os [2].
diagnosis and result of placenta previa on the basis
Complete placenta previa is the point at which it
of localization, using transvaginal sonography
covers the internal os, partial is the point at which
(TVS) when the exact relationship of the placental
the placenta in part covers the os, and marginal is
edge to the internal cervical os may be precisely
the point at which the placenta approaches the
measured. The expanded prognostic value of TVS
border of the os [3]. The rising frequency of
diagnosis has rendered the imprecise terminology

of the traditional classification obsolete [6].

Figure 1. Normal Placenta vs Placenta Previa.
Received: 1 / 6 /2017 DOI: 10.12816/0039702
Accepted: 10 / 6 /2017

Full Paper (vol.683 paper# 37)