c:\work\Jor\vol692_1 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1770-1777

Role of MDCT in Assessment of Inflammatory Renal Disease
Mohamed Abd Elaziz Ali, Yasser Ibrahim Abd Elkhalek, Amal Ghazy Ahmed Elkomy
Faculty of Medicine, Ain Shams University

ABSTRACT
Background:
Renal inflammatory diseases range from mild to severe, acute to chronic and may be associated
with predisposing risk factors like diabetes mellitus, human immunodeficiency virus (HIV), leukemia, vesico-
ureteric reflux and staghorn calculi. Ultrasound (US) is the initial screening modality and is used for guiding
interventions as well. The role of intravenous urography (IVU) has diminished lately, however it still remains
the best modality to diagnose calyceal irregularity of early tuberculosis, papillary necrosis and to evaluate
congenital anomalies. Aim of Work: The study aim to highlight the value of multidetecter C.T imaging in
assessment of renal inflammatory diseases.
Conclusion: C.T has the ability to diagnose and assess renal infection site and extension of infection to
pararenal fascia, renal infection unilateral or bilateral and infection focal or diffused. CT has important role in
assessment of complication and follow up of patients. CT guided FNAB can be done to diagnose renal
infection and differentiate between infection.
Keywords:
MDCT, HIV, Ultrasound, Intravenous Urography, Inflammatory Renal Disease.

INTRODUCTION

Renal inflammatory diseases range from mild to
MRI)
has
been
applied
to
differentiate
severe, acute to chronic and may be associated with
hydronephrosis from pyonephrosis as well as to
predisposing risk factors like diabetes mellitus,
detect infected cysts and tumors(3).
human immunodeficiency virus (HIV), leukemia,

vesico-ureteric reflux and staghorn calculi (1).
AIM OF WORK
Acute infections include acute pyelonephritis,
The study aim to highlight the value of
renal and perirenal abscesses, pyonephrosis,
multidetecter C.T imaging in assessment of renal
emphysematous pyelonephritis and emphysematous
inflammatory diseases.
cystitis. The chronic renal infections that we
The study was approved by the Ethics Board of
routinely
encounter
encompass
chronic
Ain Shams University.
pyelonephritis,
xanthogranulomatous

pyelonephritis, and eosinophilic cystitis. Acute
BACTRIAL INFECTION
pyelonephritis which may be focal or diffuse, may
ACUTE PYELONEPHRITIS
resolve with time or worsen to abscess formation
Acute pyelonephritis is usually diagnosed based
depending on the treatment rendered and immune
on clinical symptoms and laboratory data without
status of the patient(2).
imaging . The recommended phases of CT scan for
Imaging is not routinely indicated in urinary tract
evaluating renal infections are a non-contrast scan,
infections, however with severe symptoms, high
nephrographic phase at 50-90 s and excretory phase
risk immunocompromised state, diabetic patients
at 2 min if there is obstruction (4).
and antibiotic non-responders, it becomes

necessary. Plain radiography may provide evidence
Striated nephrogram which is an appearance
of gas in the renal area in emphysematous
described for acute pyelonephritis shows discrete
pyelonephritis or abscess and the typical mass like
rays of alternating hypo attenuation and hyper
calcification in end stage renal tuberculosis (Putty
attenuation radiating from the papilla to the cortex
kidney). Ultrasound (US) is the initial screening
along the direction of the excretory tubules (Figures
modality and is used for guiding interventions as
1 and 2). This appearance is ascribed to the
well. The role of intravenous urography (IVU) has
decreased flow of contrast due to stasis and eventual
diminished lately, however it still remains the best
hyper-concentration in the infected tubules (5).
modality to diagnose calyceal irregularity of early
Pyelonephritis may manifest as wedge shaped zones
tuberculosis, papillary necrosis and to evaluate
of decreased attenuation or a hypodense mass in its
congenital anomalies. Computed tomography (CT)
focal form. The diffuse form of acute pyelonephritis
is the gold standard for diagnosis and assessment of
may cause global enlargement,). Poor enhancement
severity
of
acute
pyelonephritis
and
its
of renal parenchyma, absent excretion of contrast
complications. Magnetic resonance imaging (MRI)
and streakiness of fat. Hemorrhagic bacterial
is indicated in pregnancy and patients with
nephritis which is relatively uncommon shows
contraindication to iodinated contrast such as
hyper attenuating areas representing parenchymal
transplant recipients. Diffusion weighted MRI (DW-
bleeding on non-contrast scan (5).
1770
Received:13 / 6 /2017 DOI: 10.12816/0040602
Accepted:22 /6 /2017

Full Paper (vol.692 paper# 1)


c:\work\Jor\vol692_2 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1778-1785

Role of Diffusion Weighted MRI in Characterization of Ovarian Tumors
Eman Soliman Metwally*, Susan Adil Ali Abdul Rahim**, Husham Aklo Mazzohi**
*Department of radiology, Faculty of Medicine - Ain Shams University, **Basra University


ABSTRACT
Background:
Ovarian masses present a special diagnostic challenge when imaging findings cannot be
categorized into benign or malignant pathology. Ultrasound (US), computed tomography (CT) and
magnetic resonance imaging (MRI) are currently used to evaluate ovarian tumors. Functional imaging by
means of diffusion weighted magnetic resonance imaging (DW-MRI) is now part of the standard imaging
protocols for evaluation of the female pelvis. DW-MRI is important MR imaging technique which enable
the radiologist to move from morphological to functional assessment of diseases of the female pelvis.
Aim of the Study:
The aim of the current study is to evaluate the diffusion-weighted MR imaging in
prediction of the nature of suspicious ovarian masses which are detected previously by conventional
ultrasound.
Patients and Methods: MRI Unit, radiodiagnosis department, Ain Shams University hospital. The study is
prospective, included thirty women who presented with suspicious adnexal masses on previous ultrasound
examination and referred for further assessment and characterization by DW-MRI. Patients with
contraindications to MRI (e.g. claustrophobia, cardiac prosthesis and metallic plates) are excluded.
Results: The study included 30 women ranging in age between 24 and 61 years with mean age
43.22±11.15. Out of 30 cases, 12 had of benign ovarian tumors while 18 had malignant tumors.
Conclusion: Thus, combination of DWI and conventional MRI implies using a completely noninvasive
technique with no radiation exposure. It is cost effective (no additional cost to MRI examination), and
easily added to the MR study protocols with no marked lengthening of examination time. It improves the
specificity of MRI and thus increasing radiologist's confidence in image interpretation which will finally
reflect on patient's outcome and prognosis.
Keywords: Diffusion weighted, MRI, CT, US, Ovarian tumors.

INTRODUCTION
Functional imaging by means of diffusion
Ovarian masses present a special
weighted magnetic resonance imaging (DW-MRI)
diagnostic challenge when imaging findings

cannot be categorized into benign or malignant
is now part of the standard imaging protocols for
pathology.
Ultrasound
(US),
computed
evaluation of the female pelvis. DW-MRI is
tomography (CT) and magnetic resonance imaging
important MR imaging technique which enable the
(MRI) are currently used to evaluate ovarian
radiologist to move from morphological to
tumors (1). Ultrasound is the first- line imaging
functional assessment of diseases of the female
investigation for suspected adnexal masses helping
pelvis (5).
in detection and characterization of ovarian tumors
In general, malignant tumors have a higher
(1). Computed tomography is commonly
cellularity than benign tumors; therefore, DWI can
performed for evaluation of a suspected ovarian
assist in differentiating malignant from benign
malignancy, but it exposes patients to radiation (2).
tumors (6).
Magnetic resonance image can be a
Diffusion-weighted MR imaging is used
valuable problem solving tool, an adjunctive
for tumor detection, tumor characterization, and
modality for evaluating adnexal lesions, useful to
the evaluation of treatment response in patients
give also surgical planning information without
with cancer (7).
radiation exposure (3).
When diffusion-weighted MR imaging is
MRI is able to identify different types of
used in gynecologic applications, cancers have
tissue contained in pelvic masses, distinguishing
shown lower ADC (apparent diffusion coefficient)
benign from malignant ovarian tumors, with an
values (8).
overall accuracy of 88% to 93% (2). However, the

only definitive diagnosis of an ovarian mass is
AIM OF THE STUDY
through histology (3).

The aim of the current study is to
Recent technical advances allow the use of
evaluate the diffusion-weighted MR imaging in
dynamic and diffusion MR imaging in abdominal
prediction of the nature of suspicious ovarian
and pelvic applications (4).
masses which are detected previously by
conventional ultrasound.
1178
Received: 3 /7 /2017 DOI : 10.12816/0040603
Accepted:12 /7 /2017

Full Paper (vol.692 paper# 2)


c:\work\Jor\vol692_3 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1786-1793

Relationship Between Hepcidin, Ferritin and C-Reactive Protein in
Hemodialysis Patients
Azza A. I. Elmenyawi*, Ahmed Hassan **, Seham A. Said ***and Sherif Sawar****
*Clinical pathology, **Nephrology, ***Microbiology and ****Urology Departments, National Institute of
Urology and Nephrology, Egypt

ABSTRACT

Objective: Uremia is a state of heightened inflammatory activation. This might have an impact on several
parameters including those used in the management of anemia as ferritin, serum iron, transferrin saturation,
C-reactive protein (CRP) and hepcidin levels. In spite of this complexity the existing data indicate that
hepcidin has an advantage over ferritin in guiding treatment of anemia in patients with chronic kidney
disease (CKD) as it directly reflects iron availability and the status of iron homeostasis.
Aim of the study:
was to determine serum hepcidin levels in maintenance haemodialysis (HD) patients and
to investigate its relation to ferritin and markers of inflammation as C-reactive protein.
Subjects and methods: This study was conducted on 40 maintenance haemodialysis patients and 20 age-
matched apparently healthy controls from October 2015 till February 2016 at the Haemodialysis
Departement, National Institute of Urology and Nephrology (NIUN). Creatinine, albumin, hemoglobin,
leucocytic count, CRP, hepcidin and ferritin were measured.
Results:
Serum ferritin and hepcidin levels were significantly higher in HD patients compared with
controls (825.67 ± 956.52 ng/ml and 9.2 ± 4.2 ng/ml vs 85.1± 63.35 ng/ml and 0.75 ± 0.39 ng/ml
respectively) (p< 0.001).There was significant difference in CRP in HD patients compared with controls
(4.28 ± 3.7mg/L vs 1.35±1.04mg/L respectively)(p<0.05).There were insignificant positive weak
correlations between serum levels of hepcidin and ferritin (r = 0.05, P = 0.74).
Conclusion:
Serum hepcidin levels are increased in HD patients and, hence, could be used in the evaluation
of anemia in such patients. Serum hepcidin provides useful information about the level and availability of
iron during inflammation as compared with traditional markers of iron status. Availability of the ELISA
assay for serum hepcidin will facilitate the routine measurement of hepcidin in clinical practice.
Keywords: Hepcidin, Ferritin, Hemodialysis, C-Reactive Protein.

INTRODUCTION

Anemia is commonly seen in all stages of renal
marrow can be corrected effectively by intravenous
disease but is much more pronounced in patients
iron therapy, which improves hemoglobin (Hb)
with end-stage renal disease (ESRD)[1].Patients
response[5].On the other hand, the inflammation
with anemia due to chronic kidney disease (CKD)
frequently seen in dialysis patients may also
are at increased risk of hospitalization, increased
contribute to iron-restricted erythropoiesis by
length of hospital stay, reduced quality of life and
reducing the release of stored iron from the
higher mortality[2].The main causes of anemia in
reticuloendothelial system to circulating trans-
those patients are decreased erythropoietin (EPO)
ferrin, a condition that, unlike iron depletion,
production, chronic inflammation, shortened half
reduces the likelihood and extent of response to
life of erythrocytes and iron deficiency[3].
intravenous
iron
administration[6].
Anemia can be corrected effectively using
The observation that polymorph nuclear
erythropoiesis-stimulating agents (ESA). However,
leucocytes from patients on maintenance
a considerable proportion of patients exhibit a
hemodialysis (MHD) had two- to three-times the
suboptimal response to ESA, and iron deficiency
iron content as leucocytes of healthy subjects may
has been identified as the major cause of this hypo
reflect the defective regulation of iron transport
responsiveness
[4].
proteins. The accurate identification of patients
Because of accelerated erythropoiesis driven by
who would benefit from iron therapy has relevant
the ESA treatment (coupled with the ongoing
clinical and economic implications, as it enables a
uremia and dialysis-related iron losses), ESRD
better response to ESA, while avoiding the risks
patients on ESA are at high risk of developing
associated
with
overzealous
iron
iron-restricted erythropoiesis because the rate at
therapy[7].Unfortunately, the laboratory tests used
which iron is released from stores and delivered to
to evaluate iron status have revealed a suboptimal
the bone marrow fails to match the increased iron
accuracy in identifying cases that will respond to
demand. This limited availability of iron to bone
intravenous iron,[8] as their relationships with iron

status tend to be confounded by other factors, such
1786
Received: 2 / 8 /2017 DOI : 10.12816/0040604
Accepted:12 /8 /2017

Full Paper (vol.692 paper# 3)


c:\work\Jor\vol692_4 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1794-1802
Using of Magnesium Sulphate for Fetal Neuroprotection in Patients Presenting
by Intrapartum Fetal Distress at Term: A Randomized Controlled Trial
Amr Abdel-Aziz Mahmoud Nadim1, Ahmad ElSayed Hassan ElBohoty1,
Reda Mokhtar Kamal Ghanem1, Fatma Mohamed Mahmoud2
1Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University

ABSTRACT
Background:
labour is a stressful event for the fetus but is well tolerated by most fetuses. However, in some
infants stress of labour in terms of metabolic acidosis can lead to Hypoxic Ischemic Encephalopathy (HIE).
HIE around term remains a major cause of neonatal mortality and morbidity with lifelong chronic
disabilities. Such insults are not limited to high risk pregnancies but can also occur in about 50% of low risk
pregnancies. On current evidence, it is estimated that in about 10 of brain damaged infants, the cause is
hypoxia during labour.There has been considerable interest in magnesium sulfate (MgSO4) because
magnesium alleviates excitotoxic damage by binding to the magnesium site on the NMDA (N-methyl-D-
aspartate) glutamate channel.
Aim of the Work: magnesium sulphate (MgSo4) for fetal neuroprotection in patients presenting by
intrapartum fetal distress at term.
Patient and Methods: this is a randomized controlled trial (RCT). The current study was conducted to
single term pregnant women who developed intrapartum fetal distress (as defined later) and need emergency
CS (ceaseran section) according to Ain Shams protocol. This study was carried on 200 pregnant females,
recruited from observation and labour wards of Ain Shams University Maternity Hospital. The current study
was conducted to single term 200pregnant women who developed intrapartum fetal distress and needs
emergency CS (cesarean section) according to Ain Shams protocol to examine the effects of administered
magnesium sulphate .patient were invited to participate in the study after providing clear explanation of the
study and its expected values.
Result: patients were invited to participate in this study after providing clear explanation of the study and its
expected values. The demographic data of included women showed no significant difference between groups
in the age and gestational age There was a significant difference in Apgar score at 5 min between MgSo4
and placebo.MgSo4 had significantly lower the risk of decrease Apgar score < 7 at 5min(p:0.029) .Mgso4
also had significantly lower seizure attacks (p:0.002) and had highly significantly reduce NICU admission
rate (MgSo4 group 20(20%) and placebo group 43(43%)(p: 0.001)).In MgSo4 group, 23 women reported
adverse reactions associated with procedure. Among them, 16 (16%) reported only flushing and 7 (7%)
reported only nausea. In placebo group, were 8 (8%) reported flushing and 2 (2%) reported nausea.
Conclusion and Recommendation: magnesium sulfate is effective in reducing risk of Apgar score <7 at
5min. Magnesium sulfate appear to be effective in reducing seizure and NICU admission. Magnesium
sulphate is associated with maternal morbidity rather than non exposure in the form of nausea and flushing.
The improvement in short-term outcomes without significant increase in side effects indicate the need for
further trials to determine if there are long-term benefits of magnesium and to confirm its safety.
Keywords. Magnesium Sulphate, Fetal Neuroprotection, Intrapartum Fetal Distress, cesarean section.

INTRODUCTION


Labour is a stressful event for the fetus but is
estimated that in about 10 of brain damaged
well tolerated by most fetuses. However, in some
infants, the cause is hypoxia during labour (5).
infants stress of labour in terms of metabolic
Neonatal HIE is an acute, non-static
acidosis can lead to Hypoxic Ischemic
encephalopathy caused by intrapartum or late
Encephalopathy (HIE) (1,2,3).HIE around term
antepartum brain hypoxia and ischemia. Persistent
remains a major cause of neonatal mortality and
hypoxia implies ,,asphyxia, usually associated
morbidity with lifelong chronic disabilities(4).
with hypercarbia and causing metabolic acidosis
Such insults are not limited to high risk
(6). The latter ­ in effect, a cumulative oxygen debt
pregnancies but can also occur in about 50% of
­ is quantified in blood by the base deficit value
low risk pregnancies. On current evidence, it is
and the risk of damage. Ischemia (insufficient

blood to supply needs) of the ,,nonessential organs
1794
Received:16 / 7 /2017 DOI : 10.12816/0040605
Accepted: 25/7 /2017


Full Paper (vol.692 paper# 4)


c:\work\Jor\vol692_5 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1803-1813

Role of Vitamin D supplementation in Immunomodulation and improvement
of symptoms of patients with Chronic Spontaneous Urticaria
Mahmoud Mohamed El- Sayed, Fawzia Hassan Abo-Ali, Dina Sayed Sheha,
Abeer Abdelhamid Eissa
Department of Internal Medicine, Faculty of Medicine, Ain Shams University

ABSTRACT
Background:
Chronic Spontaneous Urticaria (CSU) is an allergic auto-immune disease with more than 6
weeks of continuous symptoms, it is known to trigger allergic wheal formations and angioedema. Vitamin D
at optimal levels plays an important role in adjusting innate immunity thus People who has deficient or
insufficient levels of serum vitamin D suffer from disturbance in immune system. Accordingly, studies have
been established to explore the effect of vitamin D on CSU. Aim of the Study: To determine the effect of 12
weeks daily oral vitamin D supplementation [ high (4,000 IU/d) versus low (600 IU/d) dose of orally
administered vitamin D3] on Urticaria activity score (UAS-7), quality of life (QOL) and medication burden in
patients with chronic spontaneous urticaria, and to assess the relationship between vitamin D levels and CRP
in these patients. Patients and methods: This single blind randomized prospective study conducted to 50
patients with CSU, admitted to Ain shams hospital, 50 patients were divided into 2 groups according to the
dose of vitamin D orally administrated to these subjects, the first was group A , patients have received vitamin
D orally in High dose 4000 IU/Day compared to group B , which included 25 cases received oral vitamin D in
a low dose concentration 600 IU/d , Patients has been followed up in 3 times at baseline (0 week) , 6 weeks
and 12 weeks intervals. Results: Serum vitamin D levels in Group were higher than Group B (44.48 12.86
vs 34.45 5.43). Medication consumption was higher in group A compared to group B, thus favors orally low
dose administration of vitamin D at first 6 weeks in the beginning of treatment course. UAS7 score in group
A was better than Group B from baseline) to 6 weeks (P=0.009 vs 0.239) and from 6 weeks to 12 weeks. (P= 0.011 vs
<0.0011). There was no significant difference in serum CRP between group A and group B as regards to CRP,
furthermore there was no statistically correlation between 3 times intervals in group A and group B separately
(12.71 1.47 vs 13.11 1.45). Conclusion: Improvement of both quality of life, and UAS7 score after
receiving of High dose 4000 IU/d vitamin D orally in Group A, could benefit patients with CSU and decrease
the complication of this disease. It was also found Serum Vitamin D level has no significant relation with C Reactive
protein level, thus we couldn't relay on evaluation the chronicity of urticarial by measuring its value in serum
blood with patients suffering from chronic spontaneous idiopathic urticaria.
Keywords: Vitamin D, Urticaria, auto-immune diseases, Immunomodulation.

INTRODUCTION

Chronic urticaria with or without angioedema
effects of inflammatory mediators associated with
(CU) is a common allergic skin condition
the disease, including IL-6 (3).
associated with considerable morbidity and burden
Treatment options are limited, and the mainstay
on health care expenditure. CU is defined as
of therapy is symptomatic control with
urticarial wheals occurring daily or almost daily
antihistamines. Systemic corticosteroids, anti-
and lasting longer than 6 weeks. It has been
leukotrienes, hydroxychloroquine, cyclosporine,
estimated that 10% to 20% of the population
dapsone, anti-IgE monoclonal antibody therapy,
develop an acute episode of urticaria in their
and other anti-inflammatory agents may be used,
lifetime and 1% to 3% develop CU (1). Through a
which themselves can pose substantial adverse
comprehensive approach, cutaneous symptoms
events and cost. A potential alternative and safe
sometimes can be ascribed to drug, food,
immune-modulator is vitamin D (4).
aeroallergen, contact allergen, or autoantibodies to
Vitamin D has immunomodulatory properties and
the high-affinity IgE receptor or to free IgE.
is able to suppress the inflammatory milieu,
However, in most cases, the diagnosis remains
including IL-6 and CRP. In the clinical practice,
idiopathic (2).
vitamin D status is assessed by measurement of the

circulating level of 25-hydroxyvitamin D
Chronic spontaneous urticaria (CSU) is an
[25(OH)D], considered as the best indicator of
inflammatory disease, characterized by acute phase
vitamin D status, including its (5).
response (APR) and in many cases by the immune-
Vitamin D plays key roles in innate and
activation. C-reactive protein (CRP) is a marker of
adaptive immunity through the stimulation of Toll-
systemic CSU activity, reflecting the systemic
like
receptors,
increasing
pro-inflammatory
1803
Received:21 / 7/2017 DOI : 10.12816/0040606
Accepted:30 / 7 /2017

Full Paper (vol.692 paper# 5)


c:\work\Jor\vol692_6 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1814-1822

TSH and AMH in Infertile Women
Hazem Mohamed Sammour, Wessam Magdi Abuelghar,
Nermine Essam El-Din Abd El-Salam, Haitham Hassan Ahmed
Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University

ABSTRACT
Introduction:
Infertility is defined as the inability of a couple to achieve pregnancy over an average period
of one year (in women under 35 years of age) or 6 months (in women above 35 years of age) of unprotected
sexual intercourse. Infertility can be due to female, male reasons or both. It can be either primary or
secondary. Aim of the work: The aim of this study is to evaluate the association between thyroid function
and serum AMH levels. Methodology: Type of the study: this study was conducted a case control study.
Study site: This study was carried out at Ain-Shams maternity hospital (outpatient infertility clinic).
Duration of study: In the period between December 2015 and December 2016. Patients and study design:
According to the sample size calculation by using the IBM© Sample Power© Software (IBM© Corp.,
Armonk, NY, USA), the study performed on 128 women divided into 2 equal groups as follows:
Group "1" (study group): 64 infertile women at reproductive age (20-35) years.
Group "2" (Control group): 64 normal fertile women aged (20­ 35) years.
Result: TSH and patient age that were strongly correlated with AMH levels in 26 post-matched infertile
patients using multivariate logistic regression. Both TSH levels and patient age significantly impacted
AMH levels in infertile patients. Conclusion: AMH levels were inversely correlated with TSH levels in
infertile women of reproductive age. Recommendations: The study should be done using larger sample
sizes in a multicenter trial including both urban and rural areas to validate results. Autoimmune thyroid
antibodies (thyroglobulin antibody and thyroid peroxidase antibody) could be assessed with TSH, FT4, FT3
and AMH as there is a strong association between infertility and autoimmune thyroid antibodies.
Keywords: TSH and AMH, Thyroid function, Infertile Women.

INTRODUCTION

Infertility is defined as the inability of a couple
Moreover, although levothyroxine replacement
to achieve pregnancy over an average period of
therapy for subclinical hypothyroidism in infertile
one year (in women under 35 years of age) or 6
patients
remains
debatable,
thyroxin
months (in women above 35 years of age) of
supplementation may improve fertility to
unprotected sexual intercourse. Infertility can be
successful pregnancy (5).
due to female, male reasons or both. It can be
This data suggests that hypothyroidism is
either primary or secondary (1).
strongly correlated with infertility (5).
Thyroid
dysfunction
and
autoimmune
On the other hand, female fecundity decreases
thyroiditis are known adverse risk factors for
with increasing age, primarily because of
pregnancy as well as fertility, regardless of the
decreased ovarian function. Anti-mullerian
presence of disease in women of reproductive age
hormone (AMH) is a dimeric glycoprotein
(2). In particular, hypothyroid women are at an
belonging to the transforming growth factor-beta
increased risk of menstrual disorders and infertility
(TGF-B) super family, which act on tissue growth
because of altered peripheral estrogen metabolism,
and differentiation. It is produced by the granulosa
hyperprolactinaemia and abnormal release of
cells from pre-antral and small antral follicles.
gonadotropin-releasing hormone (2).
Ovarian research after oophorectomy showed that
The prevalence of subclinical hypothyroidism
serum AMH levels were closely correlated with
characterized by aberrant high serum thyroid-
the number of primordial follicles; therefore,
stimulating hormone (TSH) levels with normal
AMH is a suitable biomarker of ovarian age in
free thyroxin (FT4) levels in infertile women are
women of reproductive age (6).Expectedly, ovarian
reported to be approximately 20% and it is a
function may be affected by impaired thyroid
primary cause of subfertility (3). Indeed, average
function; however this association has not been
TSH levels in infertile women were reportedly
studied enough.
higher than those in normal fertile women. And
AIM OF THE WORK
elevated serum TSH levels were associated with
The aim of this study is to evaluate the
diminished ovarian reserve in infertile patients (4).
association between thyroid function and serum

AMH levels.
1814
Received: 11 /7 /2017 DOI : 10.12816/0040607
Accepted:20 /7 /2017

Full Paper (vol.692 paper# 6)


c:\work\Jor\vol692_7 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1823-1827

Role of Diffusion Weighted MRI Imaging in Detection of Liver Metakstases
Khalid E. Allam, Mennatallah H. Shalaby, Israa A. Moulood
Department of Diagnostic Radiology, Faculty of Medicine, Ain Shams University

ABSTRACT
Background:
diagnosis of liver metastases is of essential importance in the staging of patients with a
known primary tumor. Aim of the work: The study aimed to evaluate role of DWI in diagnosis of liver
metastasis. Patients and methods: twenty patients were included in this study. The cases were evaluated
over 6 months at Ain Shams University Hospital with a 1.5 Tesla Phillips (MR System Achieva) whole
body imager. Results: in the sample of the study which was composed of 20 patients there were two
patients who presented with negative lesion in DW MRI with sensitivity 100%, specificity 90% and
accuracy 95%.
Conclusion: DWI alone performs equally well as Gd-MRI in the diagnosis of liver metastases. In cases
where gadolinium injection is not allowed, dynamic contrast-enhanced imaging can be replaced by a
protocol based on unenhanced T1- and T2-weighted imaging combined with DWI. Recommendations:
Further studies on larger scale of patients are needed to confirm the results of the study.
Keywords: diffusion, weighted MRI imaging, liver metastasis.

INTRODUCTION
frequently more cellular than the tissue from
Liver cancer is one of the leading causes
which they originate and thus appear to be of
of all cancer related deaths. In fact, the
relatively high signal intensity (restricted
secondary
hepatic
malignancies
(liver
diffusion) at DWI (6). DWI is being applied for
metastases) are more common than the primary
the detection of liver metastases. In the liver, low
ones. Almost all solid malignancies can
b-value images (e.g., b = 50­150 s/mm2) that
metastasize to liver (1). Accurate diagnosis of
suppress the high-signal flow from the hepatic
liver metastases is essential for appropriate
vessels, resulting in black blood images, have
management of these patients. Multiple imaging
been found to be useful for lesion detection.
modalities, including ultrasound, computed
Metastases appeared as high-signal-intensity foci
tomography (CT), positron emission tomography
at DWI. Some of the challenges encountered in
and MRI are available for the evaluation of
DWI of the liver are cardiac motion and
patients with suspected or known liver
susceptibility artifacts that can obscure or
metastases (2).
diminish visualization of the left lobe.
There is growing interest in the
The susceptibility effects may result from
applications
of
diffusion-weighted-imaging
air in the adjacent stomach or colon. Artifacts
(DWI) in oncologic area. DWI has important
resulting from cardiac motion can be reduced by
advantages because it does not require contrast
triggered acquisition by ECG or a peripheral
medium, a very quick technique and it provides
pulse unit, thus improving image quality and
qualitative and quantitative information that can
signal-to-noise ratio in the left lobe of the liver.
be helpful for tumor assessment (3). DWI is an
Images may also be acquired with the aid of
imaging technique which provides tissue contrast
respiratory triggering to minimize inadvertent
by the measurement of diffusion properties of
breathing motion. However, these techniques
water molecules within tissues. Diffusion is
increase the image acquisition time, which can
expressed in an apparent diffusion coefficient
render the examination more susceptible to bulk
(ADC), which reflects the diffusion properties
motion (6). This study aimed to evaluate the role
unique to each type of tissue (4).
of DWI in diagnosis of liver metastasis.
Both low and high b-value DWI are

effective in suppressing vascular structures that
PATIENTS AND METHODS
may mimic or obscure liver lesions, but low b-
Twenty patients were included in this
value DWI provides a higher signal-to-noise
study. The cases were evaluated over 6 months
ratio, is less prone to cardiac motion-induced
duration at Ain Shams University Hospital with
signal loss and suffers less from eddy current-
a 1.5 Tesla Phillips (MR System Achieva) whole
induced distortions. Previous studies have
body imager.
already shown that low b-value DWI is more

sensitive than high b-value DWI in detecting
Inclusion Criteria
malignant liver lesions (5). Tumors are
1823
Received: 24 / 7 /2017 DOI : 10.12816/0040608
Accepted:3 /8 /2017

Full Paper (vol.692 paper# 7)


c:\work\Jor\vol692_8 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1828-1831

Effect of Serum Potassium Level on Hemodynamic Stability during the
Hemodialysis Session
Heba Mahmoud Lotfy Elsayed, Mohammed Mahmoud Abd Elghany,
Cherry Reda Kamel
Department of Nephrology, Faculty of Medicine, Ain Shams University
Corresponding Author: Heba Mahmoud Lotfy Elsayed, email: hebalotfyg@gmail.com, Tel,00201065754823

ABSTRACT
Potassium is the major intracellular cation with concentrations reaching 120-150 mEq/L. On the contrary, the
extracellular fluid potassium concentration is much lower and kept within very narrow levels between 3.5-
5.0mEq/L (1). Aim of the work: this work aimed to assess serum potassium level in patients on regular
hemodialysis and to determine its clinical impact on hemodynamic stability during the hemodialysis session.
Patient and method: serum (K) level of 30 patients on regular hemodialysis was measured before and after
dialysis and the results were correlated with electrocardiographic (ECG) changes. Results: there was no change
in P wave, PR interval or QT interval in all the patients, while QRS was found to be shortened in 3 patients (10
%) in the post-dialysis ECG and elongated in one patient (3.3%) in the post dialysis ECG, T wave showed
dynamic changes in the form of reduction in the amplitude of T wave in 11 patients (36.7%). Conclusion: the
absence of electrocardiographic changes in hyperkalaemic haemodialysis patients should be interpreted with
caution.
Keywords: hemodialysis, potassium, hyperkalemia, chronic kidney disease.

INTRODUCTION

Potassium is the major intracellular cation with
potassium concentration, which occurs in the early
concentrations reaching 120-150 mEq/L. On the
stages of a dialysis treatment, is arrhythmogenic (3).A
contrary,
the
extracellular
fluid
potassium
study showed a rapid decrease in the concentration
concentration is much lower and kept within very
of serum potassium during the initial stage of the
narrow levels between 3.5-5.0 mEq/L (1). A
dialysis following reduction of dialysate potassium
predialysis serum potassium of 4.6 to 5.3 mEq/L was
translates into a decrease in systolic and mean blood
associated with the greatest survival in maintenance
pressure mediated by a decrease in peripheral
hemodialysis patients. Whereas, potassium <4.0 or
resistance (4).
>5.6 mEq/L was associated with increased
Hyperkalemia is defined as a serum K
mortality.Intermittent hemodialysis may result in
concentration-greater
than
5.0mEq/L.
The
fluctuating serum K levels, which at the extremes
prevalence of hyperkalemia in hemodialysis (HD)
can reach pathologically high or low concentrations
patients was reported to be about 8.7-10%. Mortality
(2). It is not clear which range of predialysis serum K
related to hyperkalemia has been shown to be about
is most beneficial in maintenance hemodialysis
2-5% of deaths among patients with end stage renal
patients. A high-normal serum K level could offer a
disease ( ESRD) and about 24% of patients with
survival advantage by being less arrhythmogenic.It
hemodialysis
(
HD)
required
emergency
is also unclear what the ideal dialysate K
hemodialysis due to severe hyperkalemia (5). It was
concentration should be. Indeed, dialysate baths with
found that haemodialysis patients with a high
higher K concentration could be assumed beneficial
predialysis serum potassium concentration (<5.5
by virtue of inducing less fluctuation in serum K
mEq/L) did not manifest typical electrocardiographic
levels. However, a high dialysate K concentration
( ECG) changes associated with hyperkalaemia and
might be associated with more frequent episodes of
that total serum calcium concentration had an
hyperkalemia and its deleterious cardiovascular
inverse relation with T wave amplitude .Also, there
effects (2).The usual dialysate potassium level was 2
was no difference in T wave amplitude or T wave to
mmol/L.The lowest mortality has been associated
R wave ratio between those with low or high pre-
with the use of 3 mmol/l potassium. Low dialysate
dialysis serum potassium concentration.Thus, the
concentrations, particularly those of 0 or 1 mmol/L
absence of electrocardiographic (ECG) changes in
should be avoided. If used, extreme caution should
hyperkalaemic haemodialysis patients should be
be exercised because the rapid decline in plasma
interpreted with caution (6).
1828
Received:9 /7 /2017 DOI : 10.12816/0040609
Accepted: 18/ 7 /2017

Full Paper (vol.692 paper# 8)


c:\work\Jor\vol692_9 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1832-1837

The Role of Radiology in Anterior Shoulder Dislocation
Mohammed Alammari1, Abdulmalek Rshood Al-Qwizani2, Abdullah Fahad Alzayed2, Aminah
Abdulghany Sabbagh1, Omar Abdulmohsen Alshadokhi2, Al Qahtany. Faisal Hani M3, Faisal Hammad
Aldossary2, Eyaad Talat Ghallab4, Tariq Hamid Alfalag5, Faisal Abdullah Alrwithey6, Alzahrani Rashad
Mohammed7, Hamed Ali Hamed8
1 Battarjee Medical College, 2 Imam Mohammed Bin Saud Islamic University, 3 Imam Abdulrahman Bin
Faisal University, 4 King Abdullah Medical Complex Jeddah, 5 Dow University of Health Sciences,
6 Taibah University, 7 Taif University, 8 King Khaled University
Corresponding Author: Mohammed Alammari -
Dr.malammari7@gmail.com
ABSTRACT
Glenohumeral bone defects are a typical finding in shoulder dislocation and they are intensely connected
with the reappearance of dislocation and failure following arthroscopic Bankart repair. Advanced imaging
assessment should subsequently be performed in order to recognize, quantify and portray the bone defects.
Despite the fact that magnetic resonance has significant value in the appraisal of the glenoid labrum and rotator
cuff, computed tomography scan is the examination of choice for studying bone defects. The imaging
methodology selected for shoulder dislocation relies upon its accessibility and the treatment plan for a specific
patient. Radiography is economical and is promptly accessible. It ought to be executed as the underlying
imaging examination in patients giving a clinical issue identified with the shoulder. It complements the other
advanced methods and gives an outline of the bony components of the shoulder joint. In few patients,
radiography obviates additional imaging.
Keywords: Bone Defect, Glenohumeral instability, Imaging, Shoulder dislocation, Radiography, Bankart
lesion.

INTRODUCTION
[11, 12]. Magnetic resonance arthrography is the
The glenohumeral joint is fundamentally
imaging modality of excellent to assess the labrum.
unstable as the large humeral head articulates with
It has the highest sensitivity and specificity of all
the small shadow glenoid fossa, and it is the most
obtainable modalities. Nevertheless, it is invasive
commonly dislocated joint [1]. Static stabilizers
and might not be needed in patients in whom
(glenoid labrum, capsule and glenohumeral
surgery is not being deliberated as a treatment
ligaments) and dynamic stabilizers (rotator cuff and
possibility [13, 14, 15].
long head of the biceps) cooperate to guarantee the
Conventional magnetic resonance imaging
preservation of the stability of this joint [2, 3].
(MRI) delivers a good overview of shoulder lesions
Disturbance of this complex balance triggers the
and anatomy, mainly the soft-tissue structures. On
beginning of intermittent shoulder dislocation.
the other hand, it is less precise than magnetic
Glenohumeral bone instability are viewed as one of
resonance arthrography for delineation of
the primary driver of repeat of dislocation [4].
insignificant labroligamentous lesions allied with
Various clinical and biomechanical studies have
shoulder dislocation [16]. Computed Tomography
featured the part of these deformities in repetitive
(CT) arthrography mainly has been superseded by
scenes of dislocation and dislocation after surgical
MR arthrography. CT arthrography is typically
treatment, demonstrating how they cause changes
utilized when MRI is not accessible. It is beneficial
in the contact powers on the joints and lessen their
in presenting bony lesions and anterior and
resistance to dislocation [5, 6]. Avulsion of the
posterior labral and capsular lesions [17].
glenoid labrum and inferior glenohumeral ligament
Glenohumeral instability can be categorized more
complex (Bankart lesion) is the lesion frequently
by underlying causes: atraumatic, macrotraumatic,
comes across after a first scene of anterior
and microtraumatic. They can similarly be
glenohumeral instability [7, 8]. Generally, the
characterized by the several degrees of subluxation
imaging methodology selected for shoulder
or dislocation. Further subdivisions contain
dislocation relies upon its accessibility and the
direction and voluntary/involuntary mechanisms. A
treatment plan for a specific patient [9, 10].
first time acute shoulder dislocation can moreover
Radiography is economical and is promptly
represent the first presentation of recurrent
accessible. It ought to be executed as the underlying
dislocation. Patients may be categorized into the
image examination in patients giving a clinical
following 2 clinical categories, which denote the 2
issue identified with the shoulder. It complements
ends of a broad spectrum:
the other advanced methods and gives an outline of
the bony components of the shoulder joint. In few
patients, radiography obviates additional imaging
1832
Received:11 / 7 /2017 DOI : 10.12816/0040610
Accepted: 20/7 /2017

Full Paper (vol.692 paper# 9)


c:\work\Jor\vol692_10 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1838-1848

The Relation Between Red Cell Distribution Width (RDW) And Coronary Artery
Calcium Score(CACS) in The Diabetic Patients Undergoing Coronary CT Angiography
Ahmed Mohamed Onsy, Mohamed Abd El-Samie Shehata ,
Adham Ahmed Abd El Tawab ,* Abd El Rahman Ali Khalil
Department of Cardiology, Faculty of Medicine, Ain Shams University
*Corresponding author: Abd El Rahman Ali Khalil, email: mido90011@gmail.com, Phone:002 01003002369

ABSTRACT
Background:
red cell distribution width is a marker associated with increased mortality and morbidity in
cardiac patients, however it's relation with coronary artery calcium score (CACS) is not well studied yet.
Aim of the work: this study aimed to assess the relation between red cell distribution width (RDW) and
coronary artery calcium score (CACS) in the diabetic patients undergoing coronary CT angiography.
Patients and methods: this study was conducted on 60 patients presented for assessment of coronary artery
disease (CAD) by coronary CT angiography and they were categorized into 2 groups, group (A) diabetics(30
patients),group(B)non-diabetics (30 patients), All patients included in this study were subjected to: History
Taking, complete physical examination, multi-slice CT coronary angiography (MSCT) including calcium
score(CACS), laboratory investigations including complete blood count (CBC) including RDW(SD&CV),
serum calcium level(total and ionized), erythrocyte sedimentation rate (ESR), lipid profile. Results: higher
RDW(SD) was associated with the presence of greater coronary complexity of CAD and higher calcium score.
In our study total serum calcium and RDW (SD) were found to be independent predictors of high Ca score
more than 100, while ionized calcium and systolic blood pressure(SBP) were independent predictors of high
Calcium score more than 400. Cut off value of RDW to predict high calcium score (more than 100) was
RDW(CV) more than 13.45 & RDW(SD) more than44.45, while Cut off value of RDW to predict high
calcium score (more than 400) was RDW(SD) more than 45.1.
Conclusions: a greater baseline RDW(SD) value was independently associated with the presence of a greater
coronary complexity of CAD and higher calcium score.
Keywords: MSCT, CACS, RDW (SD and CV), CA, OR,CI.

INTRODUCTION
artery disease (5) heart failure(6) and peripheral
Over the last decade, cardiovascular disease
arterial disease(7) and also with poor TIMI flow
(CVD) has become the largest cause of death
following
primary
percutaneous
coronary
worldwide. Chronic coronary artery disease
intervention(8) and poor outcome of trans catheter
(CAD) was estimated to affect 16.8 million people
aortic valve implantation. The RDW is also
in the United States; of these, 9.8 million had
elevated
in
some
subclinical
states
of
angina pectoris and nearly 8 million had a
atherosclerosis. Coronary artery calcification
myocardial
infarction
(MI).
In
2002,
(CAC) is a well-established marker of the total
cardiovascular deaths were about 57 millions
burden of coronary atherosclerosis (9).
worldwide, and 80% of these cardiovascular deaths
Some studies demonstrated that higher CAC
were in the developing world (1). Many tools can
scores are associated with increased risk for
help in
diagnosis like
electrocardiogram,
coronary artery disease (CAD) related events(10),
echocardiography,
stress
testing,
nuclear
and that addition of CAC score to traditional risk
cardiology and cardiovascular magnetic resonance
factors improves risk stratification(11).Diabetes
imaging. However, multi-slice CT coronary
mellitus (DM) represents a strong risk factor for
angiography is becoming one of the most important
CAD, albeit its association with CAC is
tools which can help greatly in detection of cardiac
controversial. While a number of studies have
diseases and evaluating coronary artery disease
found significant relationship between high CAC
(CAD) noninvasively (2,3). In the 1950s, heart
and DM (12).
disease became more recognized as a significant
AIM OF THE STUDY
cause of mortality in the United States.
this study aimed to assess the relation between
Red cell distribution width(RDW) is a measure
red cell distribution width (RDW) and coronary
of the variability in circulating erythrocyte size that
artery calcium score (CACS) in diabetic patients
is often used in the differential diagnosis of anemia
undergoing coronary CT angiography.
(4). the increased red cell distribution width (RDW)
PATIENTS AND METHODS
was found to be associated with a poor prognosis
Patients: this study included sixty consecutive
and increased mortality rate in several
patients whom were undergoing multi-slice CT
cardiovascular diseases such as stable coronary
1838
Received: 20 / 7 /2017 DOI : 10.12816/0040611
Accepted: 29/7 /2017

Full Paper (vol.692 paper# 10)


c:\work\Jor\vol692_11 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1849-1855
Cerebrospinal Fluid Level of Glutamic Acid Decarboxylase (GAD)
Antibody in Patients with Encephalitis
Omnia F El Rashedy, Zainab N Ahemad; Ahemad R Ahemad,Hameda E Ebraheem
Department of Pediatrics & Clinical Pathology,Faculty of Medicine, Ain Shams University
Corresponding author: Hameda E Ebraheem, email:dr.hamedaeid@gmail.com.

ABSTRACT
Background
: Assaying the Glutamic Acid Decarboxylas( GAD) antibody in patients with encephalitis in
cerebrospinal fluid and blood serum and its role in autoimmune encephalitis in children.
Objective: This study Aimed at screening for GAD antibody in CSF of children presenting with acute
encephalitis with non bacterial cause mostly autoimmune.Participants and methods: study is a pilot
prospective study, conducted in the Pediatric department, Children's Hospital, Ain Shams University.Fifty
patients diagnosed with encephalitis exhibited at least one sign of parenchymatous brain dysfunction such as
altered consciousness personality or behavior change, seizure, paresis, or ataxia. Encephalitis was defined as the
presence of encephalopathy plus at least two of four findings: (1) fever (body temperature>38C); (2) abnormal
cerebrospinal fluid examination (pleocytosis>5 white blood cells/mL and/or increased protein content>40
mg/dL) with negative cerebrospinal fluid culture; (3) abnormal electroencephalography findings compatible
with encephalitis such as diffuse or focal slow activity, or periodic lateralized epileptiform discharges; and
(4)abnormal results of neuroimaging, including computed tomography and magnetic resonance imaging (10),
,with age ranged from 6-144 Months; followed up In the period from September 2014 till March
2016.Basic clinical evaluation and laboratory investigations were done, GAD antibody level was measured
in CSF and blood serum. Results: GAD receptor antibody titer was done in CSF which range from (36 -
368 ng/l) with median of 64.83 (57.93-74.48), while in serum it range from (42.76-900) ng/l) with median
89.5(58.62-154.5).It was found that 6/50 (12%) patients had high GAD receptor antibody titer were high in
CSF. The other 44/50 (88%) patients had low GAD antibody titer. In serum samples of twinty patients we
had 8/20 (40%) patients had high GAD antibody titer and the rest were low GAD antibody titer 12/20
(60%).Significant occurrence of DCL, hospitalization plus mechanical ventilation and long term sequel
were detected in patients with high GAD antibody titer. EEG findings; Two patients showed generalized
epileptogenic activity, one patient had diffuse cortical dysfunction and two patient had multifocal
epileptiform discharge and the rest of patients had normal finding. Eighty six precent had normal MRI
findings,While 7 patients (14%) had non specific findings;3 patients had transient cortical meningeal
enhancment,2 patients had high intensity in medial temporal lobe,one had abnormal signal intensity in
medial temporal lobe and one patient had global brain atrophy. Conclusion: GAD Abs are directed against
an intracellular antigen. The proposed pathogenic mechanisms of neurological disease in patients with
antibodies directed against intracellular proteins is not clear. The present study emphasizes the importance
of studying the CSF of patients with encephalitis suspected to be mediated by GAD autoimmunity.Both
serum and CSF level must be assessed simultaneously as CSF level may change rapidly with fluctuation of
disease. There are great efforts to be done to define the role of these GAD antibodies and to determine how
they affect central nervous system function. These studies must be carried out so that appropriate
treatments can be provided for the growing number of patients with possible antibody-mediated
conditions.
Keywords:
GAD, CSF, EEG,MRI, autoimmunity.

INTRODUCTION
Encephalitis refers to an inflammatory
Encephalitis is an acute infection or
disorder of the brain resulting in altered mental
inflammation of the brain parenchyma that most
status, seizures, or focal neurologic deficits,
commonly
affects
children
and
young
usually accompanied by signs of inflammation in
adults.Many aspects of the pathogenesis of acute
the cerebrospinal fluid and magnetic resonance
encephalitis and acute encephalopathy have been
imaging (MRI) findings ranging from normal to
clarified in the past decade, although many
extensive abnormalities. The causes of
unknown mechanisms remain to be elucidated.
encephalitis are numerous, and most patients
The pathogenesis of encephalitis is divided into
undergo extensive testing for infectious
infectious or immune mediated mechanisms (1).
etiologies without discovery of a causative agent
(2).
9481
Received: 14 / 7 /2017 DOI : 10.12816/0040612
Accepted:23 / 7 /2017

Full Paper (vol.692 paper# 11)


c:\work\Jor\vol692_12 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1856-1859

Frailty and Cognitive Impairment
Walaa Hasan Mancy, Moatassem Salah Amer,
Nermien Naim Adly, Shaimaa Nabil Mohammed Rohaiem
Geriatric and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Walaa Hasan Mancy, Mobile: +201011307776, E-mail address:walaamancy@hotmail.com


ABSTRACT

Background: frailty is defined as a multifactorial syndrome leading to difficulties in maintaining
homeostasis, and vulnerability to stressors. Depression shares many manifestations, risk factors and
consequences with frailty. Some studies included cognitive assessment as a component to evaluate frailty.
Aim of the work: this study aimed to assess depression and cognition in frail elderly and to assess if
depression could be underlying link between cognitive function and frailty. Patients and methods: this case
control study included 102 males and females elderly living in geriatric homes in Cairo and excluded those
who were bedridden or had sensory impairment interfering with communication, stroke, Parkinsonism, severe
osteoarthritis, or dyspnea on ordinary exertion. All patients were subjected to comprehensive geriatric
assessment. Frailty was diagnosed using a modified version of Fried criteria. We used the physical activity
metric that was constructed by Avila-Funes.
Conclusion: this study showed that cognitive impairment and depression did not differ between frail and
non-frail subjects.
Keywords: frailty, cognitive impairement, depression, elderly, geriatric homes.

INTRODUCTION

older living in geriatric homes in Cairo.
Frailty in the elderly is defined as a
Exclusion criteria
multifactorial syndrome which occurs due to a
bedridden subjects or those with sensory
decrease in metabolic activities and reserves,
impairment interfering with communication, stroke,
difficulties in maintaining homeostasis and
Parkinsonism, severe osteoarthritis, or dyspnea on
vulnerability to stressors, progressing to increased
ordinary
exertion.
risk for disabilities(1). The prevalence of frailty in
The study was approved by local ethical
community-dwelling
elderly
populations
is
committee of Faculty of Medicine, Ain Shams
approximately 11%; however; this estimate differs
University. All patients were subjected to
considerably depending on how frailty is identified
comprehensive geriatric assessment. Cognitive
with estimates ranging from 4% up to 59% (2).
function was assessed by mini-mental status
Depression shares many manifestations, risk factors
examination (MMSE)(8), adjusted MMSE for age
and consequences with frailty.For example,
and education (9) and Clock Drawing Test (CDT)
physical inactivity and fatigue are criteria used to
was performed in those educated(10). Depression
define both frailty and depression (3) (4). In addition,
was assessed by geriatric depression scale-15
the inclusion of cognitive performance in frailty
(GDS-15)(11).Cases with frailty were diagnosed
diagnosis has been discussed in some investigations
with a modified version of the construct described
and in this sense, there were studies that included
by Fried et al.(12) . The original frailty index used
cognitive assessment as a component to evaluate
the short version of the Minnesota Leisure time
frailty (5-7). This study aimed to assess depression
activity questionnaire (13) to assess physical activity,
and cognition in frail elderly and to assess if
while we used the physical activity metric that was
depression could be an underlying link between
constructed by Ávila-Funes(14). Nutritional status
cognitive function and frailty.
among elderly was assessed through Mini

Nutritional Assessment (MNA) (15) using the Arabic
PATIENTS AND METHODS
Version (16), functional assessment was done using
This case control study, was conducted at
activities of daily living (ADL)(17), Arabic
elderly homes, among non-frail versus frail elderly.
version(18) and instrumental activities of daily living
Inclusion criteria: males and females, 60 years and
(IADL)(19).The study was approved by the Ethics
Board of Ain Shams University.
6581
Received: 24 / 7/2017 DOI : 10.12816/0040613
Accepted:3 / 8 /2017

Full Paper (vol.692 paper# 12)


c:\work\Jor\vol692_13 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1860-1863
Accuracy of The SRK/T Formula Using Partial Coherence Interferometer,
AL-Scan after Phacoemulsification
Mona N. Mansour
Ophthalmology Department, Faculty of Medicine (for Girls), Al-Azhar University
Correspondence to Mona N. Mansour, MD, Department of Ophthalmology, Faculty of Medicine (for Girls), Al-Azhar
University, Nasr city 11754, Cairo, Egypt, Tel: +20 101698 3770; fax: +20 2 22638357; e-mail:
mansour04@hotmail.com

ABSTRACT
Purpose:
To evaluate the accuracy of SRK/T formula used for IOL power calculation by partial coherence
interferometer in patients undergoing phacoemulsification surgery.
Patients and methods: A prospective interventional clinical study included 40 eyes of 34 patients who
underwent uncomplicated phacoemulsification with IOL implantation from March 2015 to March 2017.
Biometries were measured using ultrasound or AL-scan and intraocular lens power was calculated using the
SRK-T formula. Patients were divided into 2 groups based on device used for IOL power calculation: AL-
scan or ultrasound ; Axial length: >=25 mm or < 25mm; or lens opacity: Cataractous or clear lens. The mean
error (ME) was calculated from the difference between the formula predicted refractive error and the actual
post operative refractive error by the end of the followup (3 months postoperative).
Results: Mean axial length measured preoperatively was 27.47 ± 316mm (21.55-34.05) mm. 60 percent of
the patients were within 0.5 D of the predicted refractive error and 90 percent were within 1.0 D. There was
no statistically significant difference in the overall performance of the SRK/T formula between the mean error
when dividing the patients into 2 groups according to: device used for IOL power calculation (P= 0.274);
Axial length (P= 0.46); or lens opacity (P= 0.18) in precision of predicting postoperative refraction.
Conclusions : SRK/T formula helps in improvement of the accuracy of IOL power calculation and
decreasing the postoperative refractive error. By using SRK/T formula, there was no statistically significant
difference between the AL-scan or applanation ultrasound used in biometry.
Keywords: Partial Coherence Interferometer, biometry, AL-scan, Ultrasound, IOL power, SRK/T formula.

INTRODUCTION
Meditec AG, Jena, Germany) was introduced in
Over the years, development of biometry,
1999 followed by other instruments with continuous
phacoemulsification, and intraocular lens (IOL)
modifications in biometry (4). Little is known about
calculation
enabled
precise
prediction
of
the accuracy of the devices for IOL power
postoperative refraction (1).
calculation, with the exception of the IOLMaster ,
The parameters needed for accurate IOL
which was the first to be marketed, and the Lenstar
calculation including: Axial length (AL), corneal
LS900 (5).
refractive power (K1 and K2), and anterior chamber
The PCI AL-scan (Nidek, Gamagori, Japan) using
depth (ACD), must be precisely measured to
PCI and Scheimpflug imaging techniques made it
determine the correct IOL power to achieve the
possible to measure axial length, corneal refractive
target refraction (2).
power, anterior chamber depth, central corneal
Intraocular lens (IOL) power calculation formulas
thickness, white-to-white distance, and pupil size in
have been evolving since 1949 when the first IOL
a single sitting based on those values and
into a human eye was implanted (2). Various
automatically calculates the appropriate IOL power
theoretical and regression formulas are available for
to be used in cataract surgery by onboard software
calculation of IOL power. Third- and fourth-
(1). The purpose of this study is to evaluate the
generation formulas are now the most preferred
accuracy of SRK/T formula used for IOL power
formulas. The SRK/T is one of the third-generation
calculation by the PCI AL-scan in patients
formulas that was representing a combination of
undergoing phacoemulsification surgery .
linear regression method with a theoretical eye

model (3). Ultrasound (US) biometry (A-Scan) had
PATIENTS AND METHODS
been considered the gold standard for axial length
A prospective, comparative study was carried out
and ACD measurement. The partial coherence
at Al-Zahraa university hospital from March 2015 to
interferometer (PCI)-based IOLMaster (Carl Zeiss
1860
Received:12 /3 /2017 DOI : 10.12816/0040614
Accepted: 21/ 3 /2017

Full Paper (vol.692 paper# 13)


c:\work\Jor\vol692_14 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1864-1873
Anesthetic considerations for Endo-Vascular Management of
Intracranial Aneurysms
Mohamed Metwally El Barbary1, Gamal Fouad Saleh Zaki,
Mahmoud Hassan Mohamed, Noura Mohamed Mahmoud
1Department of Anesthesia, Faculty of Medicine, El Zagazig University
2Department of Anesthesia, Intensive Care and Pain Management,
Faculty of Medicine, Ain Shams University

ABSTRACT
Intra cranial aneurysms are acquired lesions responsible for about 80% of non-traumatic sub arachnoid
hemorrhage. Treatment of the condition in the past has relied on craniotomy and clipping of the aneurysm to
prevent a recurrent hemorrhage. Nowadays endovascular coiling is the best primary treatment. The
anesthesia in interventional radiology room has special arrangement and precautions. Intra operative
management of endovascular cerebral aneurysm from the start including: arrangement of the room,
monitoring, induction, maintenance and emergence of the patients. Post-operative care is very important and
good management of potential perioperative complications like: aneurysm rupture, cerebral infarction,
cerebral vasospasm, contrast reaction and nephropathy is mandatory.
Aim of the Study: reviewing the current medical literature as regards the anesthetic considerations and
problems of endo-vascular management of intracranial aneurysm.
Conclusion: anesthesia in interventional radiology room should have special arrangements and precautions.
Intra operative management of endovascular cerebral aneurysm from the start including: arrangement of the
room, monitoring, induction, maintenance and emergence of the patients. Post-operative care plays a key
role in mitigating potential perioperative complications like: aneurysm rupture, cerebral infarction, cerebral
vasospasm, contrast reaction and nephropathy are mandatory.
Keywords: anesthesia , Post-operative care, Intracranial Aneurysms.

INTRODUCTION

Stroke and cerebrovascular diseases are the

second leading cause of death worldwide and
with an untreated acute ruptured aneurysm [3].
account for significant healthcare costs and
Treatment of aneurysm involves obliterating the
morbidity among survivors [1].
aneurysm by surgical clipping via the intracranial
Hemorrhagic strokes result from the rupture of
route or coiling via the endovascular route. If both
weakened blood vessel walls, usually aneurysms
treatment options are possible for a particular
or arteriovenous malformations. Often a
patient, endovascular coiling is the preferred
subarachnoid hemorrhage (SAH) results from the
method [4].
rupture of these vessels [2]. The incidence of
Endovascular coil embolisation of unruptured
cerebral aneurysms in the general population is
intracranial aneurysm (UIA) is associated with a
1.5­8.0%. Multiple aneurysms exist in 20% of
5­10% risk of morbidity and nearly zero mortality
patients diagnosed with aneurysm. There is an
from the procedure [5].Complete or near complete
increased incidence in first degree relatives, and
occlusion is usually achieved in >90% of cases,
an estimated lifetime risk of 2­5%.
and endovascular therapy seems to reduce the risk
The significant increase in the number of
of future rupture significantly. Endovascular
asymptomatic aneurysms diagnosed is most likely
therapy appears to be a safe and effective
a consequence of screening policies. Patients can
treatment for selected unruptured intracranial
present with symptoms of subarachnoid
aneurysm [6].
haemorrhage (SAH), cranial nerve palsies,
The SAH is often complicated by re-bleeding,
seizures,
cerebral
compression,
and
hypertension, cerebral edema, delayed cerebral
hydrocephalus. Cerebral aneurysm is responsible
ischemia
(DCI),
electrolyte
abnormalities,
for 77% of acute spontaneous SAH. Patients who
hydrocephalus,
seizure
activity,
and
survive a SAH have a 4% risk of a further bleed in
cardiopulmonary dysfunction. Monitoring for and
the first 24 h and a 1% risk per day thereafter. The
consideration of each of these complications
morbidity and mortality (3%) rates related to
should guide anesthetic management from
embolization of an acute aneurysm are lower than
preoperative through postoperative treatment [1].
those associated
1864
Received: 24 / 7 /2017 DOI : 10.12816/0040615
Accepted:3 / 8/2017

Full Paper (vol.692 paper# 14)


c:\work\Jor\vol692_15 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1874-1879

Comparative Study of Male and Female Sebum Production
Mohammed AR. Abdallah, Nehal Mohamed Zuelfakkar, Radwa Hasan Elbana
Department of Dermatology, Venerology and Andrology,
Faculty of Medicine, Ain Shams University
ABSTRACT
Background:
Evidence is given that gender-related differences in skin physiological properties exist. The
aim of this study was to evaluate the difference between male and female sebum production by measuring
sebum production over ½ hour, 1 hour and 11/2 hours in both males and females. Subjects and Methods:
The study included 200 healthy volunteers and was carried out in the Dermatology outpatient clinic- Ain-
Shams University ­ during the period from January and February 2017 (as the sebum secretion is lower
during this time of year). A total of 200 healthy male and female subjects (Fitzpatrick's skin types I­IV) with
their age ranged from 15-25years old participated in this clinical study after giving avocal informed consent.
Participants were divided to 100 males and 100 females. Results: Among male participants, it was found
that sebum production significantly increase with time; sebum production at 1 hour was significantly higher
than that at 0.5 hour; furthermore, sebum production at 1.5 hour was significantly higher than that at 0.5
hour. Conclusion: Sex difference is a significant factor affecting the amount of sebum production; which is
significantly higher among males in comparison to age matched females. Rate of casual sebum production
significantly increase among both males and females over time. Recommendations More studies are
recommended to determine the factors and mechanism; molecular and endocrinal, behind the strong relation
between male gender and the increased amount of sebum production.
Keywords: sebum, males, females, dermatology.

INTRODUCTION


Sebum is a naturally occurring substance

that is produced by the sebaceous glands, which
Research has also shown that people
are found in the skin of mammals. The primary
with high sebum levels tend to produce sebum
function of sebum is to moisturize, lubricate and
that has a different composition than that of
protect skin and hair, maintaining effective,
people with normal sebum levels. Apparently,
hydrophobic barrier, preventing water loss and the
people with acne tend to have decreased levels
invasion of microorganisms (1).
of free fatty acids, but increased levels of
The composition and rate of sebum
glycerides and squalene. Some scientists have
production varies between individuals, and it can
proposed that these compositional changes play
even vary depending where on the body the
a role in the development of acne (4).
sebum is produced. Sebum is a complex mixture
The proliferation of sebaceous glands and
of naturally produced fats, oils, waxes,
the subsequent production of sebum is directly
cholesterols and other molecules. It is important
regulated by a complex system of hormones and
to remember that the fats and oils present in
other cellular signals. Going deeper, these
sebum do not originate directly from the fats and
hormonal signals are controlled by an even more
oils consumed in the diet. Rather, sebum is
complex balance that includes genetics,
manufactured and stored by the sebaceous glands
environmental conditions, metabolic conditions,
under the direction of a highly specialized
stress, diet, injury and many other factors (1).
biological process (2).
Research has shown that sebum secretion
In human, sebum is composed primarily
levels change in response to seasonal and
of glycerides, free fatty acids, wax esters and
environmental changes. Sebum production
squalene. Glycerides are more commonly known
increases in summer. These changes may be due
as "fats" and are molecules of two or three free
to the increased fluidity of sebum in warmer
fatty acids connected together by a glycerol
conditions (5).
backbone. Free fatty acids are the building blocks
Androgens in male stimulate the
of glycerides and other molecules. They are
proliferation of sebaceous glands, particularly
composed of a polar head group and a non-polar
those located on the face, chest and upper back.
(aliphatic tail). Wax esters are molecules
Individuals with excessively high levels of
composed of fatty acids linked to fatty alcohols by
androgen hormones tend to have higher levels of
an ester bond. Squalene are hydrophobic chains of
sebaceous gland proliferation, sebum production
carbon atoms that serve as the basic building
and acne vulgaris. Female with elevated androgen
block for naturally occurring steroids and other
levels tend to have higher levels of acne and
types of signal molecules (3).
hirsuitism (excess body hair growth). The effect
1874
Received: 9 /6 /2017 DOI : 10.12816/0040616
Accepted:18 /6 /2017

Full Paper (vol.692 paper# 15)


c:\work\Jor\vol692_16 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1880-1888

Value of Glycosylated Hemoglobin at 34 Weeks Gestation in
the Prediction of Adverse Neonatal Outcome
Hassan T. Khairy, Mohamed E. Mohamed, Sherif H. Hussain, Mohamed S. Al-Refaie
Department of Gynecology, Faculty of Medicine, Ain Shams University

ABSTRACT
Background:
Gestational diabetes is diabetes, or high blood sugar levels, that develops during pregnancy.
It occurs in about 4% of all pregnancies. It is usually diagnosed in the later stages of pregnancy and often occurs
in women who have no prior history of diabetes. Aim of the Work: To assess the predictive value of elevated
glycosylated hemoglobin at 34 weeks' gestation with adverse fetal outcome as regard fetal macrosomia and
neonatal hypoglycemia. Patients and Methods: This prospective longitudinal cohort study included 98 pregnant
women who were recruited from the obstetric outpatient clinic and department at Al-Galaa Teaching Hospital.
Results: HbA1c 7.9 has sensitivity of 88.1% and specificity of 66.1%, in prediction of macrosomia and a
sensitivity of 91.9% and specificity of 63.9% in prediction of Hypoglycemia. Conclusion: HbA1c 7.9 has
moderate diagnostic characteristics in prediction of macrosomia, and hypoglycemia, low diagnostic characteristics
in prediction of RDS and NICU. Recommendations: Use of HbA1C is recommended for patients with GDM for
screening, follow up and prediction of adverse neonatal outcomes.
Keywords: Glycosylated Hemoglobin, gestation, adverse neonatal outcome, fetal macrosomia.

INTRODUCTION

Women with gestational diabetes who receive
needed because of the increased risk of severe
proper care typically go on to deliver
hypoglycemia during pregnancy, Perform SMBG,
healthy babies. However, if you have persistently
both pre- and postprandial, to achieve glycemic
elevated blood glucose levels throughout
targets and improve pregnancy outcomes. Women
pregnancy, the fetus will also have elevated blood
with presentational diabetes may use aspart or
glucose levels. High blood glucose can cause the
lispro in pregnancy instead of regular insulin to
fetus to be larger than normal, possibly making
improve
glycemic
control
and
reduce
delivery more complicated. The baby is also at risk
hypoglycemia, Women should be closely
for having low blood glucose (hypoglycemia)
monitored during labor and delivery, and maternal
immediately
after
birth.
Other
serious
blood glucose levels should be kept between 4.0
complications of poorly controlled gestational
and 7.0 mmol/L in order to minimize the risk of
diabetes in the newborn can include a greater risk
neonatal hypoglycemia Metformin and glyburide
of jaundice, an increased risk for respiratory
may be used during breast feeding., women with
distress syndrome, and a higher chance of dying
type 1 diabetes in pregnancy should be screened
before or following birth. The baby is also at a
for postpartum thyroiditis with a TSH test at 6­8
greater risk of becoming overweight and
weeks postpartum All women should be
developing type 2 diabetes later in life. If diabetes
encouraged to breastfeed since this may reduce
is present at any stage of pregnancy, there is an
offspring obesity, especially in the setting of
increased
risk
of birth
defects and
maternal obesity (2). There is a statistically
miscarriage compared to that of mothers without
significant correlation between HbA1c and BMI,
diabetes. Women with gestational diabetes have a
amniotic fluid index, and neonatal outcomes.
greater chance of needing a Cesarean birth (C-
HbA1c of 7 or higher was found to be a cutoff
section), in part due to large infant size.
value for the prediction of prematurity, with area
Gestational diabetes may increase the risk of pre-
under curve of 91.7%. HbA1c may be a useful
eclampsia, a maternal condition characterized by
marker for prematurity in pregnant diabetic women
high blood pressure and protein in the urine.
and may correlate with fetal outcome. For the
Women with gestational diabetes are also at
antenatal care of diabetic mothers, it is
increased risk of having type 2 diabetes after the
recommended is to maintain HbA1c less than 7%
pregnancy (1). Pregnant women with type 1 or type
decrease fetal adverse outcome (3).
2 diabetes should receive an individualized insulin
Advise pregnant women with type 1
regimen and glycemic targets typically using
diabetes to test their fasting pre-meal, one hour
intensive insulin therapy Strive for target glucose
post-meal and bed time blood glucose levels daily
values:
Fasting
PG
<5.3
mmol/L1-hour
during pregnancy. Advise pregnant women with
postprandial <7.8 mmol/L2-hour postprandial <6.7
type 2 diabetes who are on a multiple daily insulin
mmol/L, Be prepared to raise these targets if
injection regimen to test their fasting pre-meal, one
1880
Received: 18 / 7 /2017 DOI : 10.12816/0040617
Accepted:27 /7 /2017

Full Paper (vol.692 paper# 16)


Role of MRI in the Diagnosis of Different Bone Marrow Lesions The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1889-1894
Role of MRI in the Diagnosis of Different Bone Marrow Lesions
in Pediatric Patients with Hematological Malignancies
Hanan Mohammed Eisa, Mostafa Mahmoud Gamal El Deen, Yosra Abdelzaher Abdullah,
Ayda Aly Youssef, Tamer Farouk El Naggar
Radio-diagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Tamer Farouk El Naggar, Email:tamerthedoctor@gmail.com, Tel:01012623467

ABSTRACT
Background:
hematological malignancies are one of the major causes of childhood morbidity; leukemia is the
most common of pediatric cancers whereas lymphoma is the third most common childhood malignancy, NHL
accounts for approximately 7% of cancers in children younger than 20 years. In patients with hematological
malignancies the diagnosis of bone marrow involvement is important to determine prognosis and treatment
protocols. MR imaging is the most sensitive imaging modality in the diagnosis of bone marrow infiltration and
provides excellent details and additional accurate information about the extent of bone marrow involvement. Aim
of the Work:
this study aimed to evaluate the role of MRI in the diagnosis of different bone marrow lesions in
pediatric patients with hematological malignancies with a trial to highlight the role of different recent modalities in
the diagnosis, staging, monitoring management and in post treatment follow up of these patients. Patients and
Methods:
this study involved 63 patients (37 males and 26 females) with mean age of 9 years (range from 1.5
years: 16 years). They are cases of bone marrow biopsy proven hematological malignancy. They were categorized
into two groups, group I: new cases who had bone marrow infiltration, they received no previous chemotherapy,
group II: cases under follow up who have bone infarction, with history of chemotherapy or bone marrow
transplantation (BMT). The MRI examinations were performed on a superconducting 1.5 T unit. Chi-square test
was used to study the association between each 2 variables or comparison between 2 independent groups as
regards the categorized data. The probability error at 0.05 was considered significant, while at 0.01and 0.001 were
highly significant. Results: the different bone marrow lesions included in this study group of patients showed
different MRI diagnostic criteria. A highly significant probability of errors was found in the relation between ADC
values of bone infarction, bone marrow infiltration and red marrow. Conclusion: MRI provides an excellent
imaging modality for the diagnosis of different bone marrow lesions is pediatric patients with hematological
malignancies and can reliably differentiate between them based on the characteristic findings of each.
Keywords
: bone marrow, leukemia, lymphoma, magnetic resonance imaging.

INTRODUCTION

Leukemia is the most common cancers of
lesions in pediatric patients with hematological
pediatric accounting for about 30% of diagnoses
malignancies with a trial to highlight the role of
(1).Lymphomas, Hodgkin's and non-Hodgkin's
different recent modalities in the diagnosis, staging,
lymphoma, represent 3%­5% of all malignancies
monitoring management and in post treatment
worldwide. By statistics, bone marrow involvement
follow up of these patients.
found in 5%­15% of patients with Hodgkin's

lymphoma and in 20%­40% of non-Hodgkin's
PATIENTS and METHODS
lymphoma patients (2).
This study involved 63 patients (37 males and 26
Bone is a substantial tissue, yet its pattern on
females) with mean age of 9 years (range from 1.5
plain X-rays may be misleading indicating
years: 16 years).
inactivity. It is composed of an irregular mesh of
They are cases of bone marrow biopsy proven
collagen, called woven-fibered bone, which is a
hematological malignancy i.e leukemia and
transient substance that either forms a marrow cavity
lymphoma based on bone marrow biopsy, they were
or replaced by an osseous tissue arranged in cords,
all referred to the MRI to investigate their complaint
called lamellar bone (3). In patients with
of pain either back pain or limb pain and the MRI
hematological malignancies the diagnosis of bone
examinations were tailored according to the patient
marrow infiltration is crucial to determine prognosis
complaint, contrast was added if patient condition
and to identify suitable treatment protocols (2). MR
permitted, sedation was used in non cooper able
imaging is undoubtedly an extremely sensitive
young patients below 7 years old, They were divided
technique in the demonstration of bone marrow
into two groups, group I: new cases who have bone
infiltration (4).
marrow infiltration, they received no previous
AIM OF THE WORK The purpose of this study is
chemotherapy, group II: cases under follow up who
to evaluate the role of MRI in the diagnosis of
have bone infarction, with history of chemotherapy
different bone marrow
or bone marrow transplantation (BMT) Chi-square
1889
Received:26 / 7 /2017 DOI : 10.12816/0040618
Accepted: 5/8 /2017

Full Paper (vol.692 paper# 17)


c:\work\Jor\vol692_18 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1895-1900

The Role of Diffusion-Weighted MRI in the Characterization of
Musculoskeletal Soft Tissue Tumors
Mohamed A. Nassif, Susan A. Abdul Rahim, Rana Z. Hussien
Department of Radio-diagnosis, Faculty of Medicine, Ain Shams University
Corresponding author: Rana Zahim Hussein, Mobile: 01006639731, Email: ranazahim2010@gmail.com

ABSTRACT
Background:
magnetic resonance imaging (MRI) has an important role in characterization of soft tissue tumors,
yet, it lacks specificity for differentiation between the benign and malignant lesions. Aim of the Work: this study
aimed to evaluate the ability of DW MRI in detection and characterization of the musculoskeletal soft tissue
tumors. Patients and methods: this prospective study included 30 patients (20 females and 10 males) referred to
MRI unit Ain shams University Hospital for MRI evaluation of musculoskeletal soft tissue tumors. Results: from
30 cases, 12 cases were benign (40%), 18 cases malignant (60%). From 12 cases of the benign, 8 cases were 40
years and 4 cases were > 40. From 18 cases of the malignant, 7 cases were 40 and 11 cases > 40. Ranging of
ADC value of benign tumors (1.72-2.58); mean ADC (2.21 10-3 mm2/sec). Ranging of ADC value of malignant
tumors was 0.52-1.82. Mean ADC value was 0.90 10-3 mm2/sec. Cut-off ADC value 1.14 less than 1.14 was
benign and more than 1.14 was malignant; sensitivity 94.4% and specificity 91.7%. Conclusion: DWI with ADC
mapping and measurement of ADC value proved to be a valuable non ­invasive tool in differentiating between
benign and malignant musculoskeletal soft tissue tumors. Recommendations: a larger population for future
studies is needed. Thus, histopathologic work up is required for reliable characterization of soft tissue tumors (4).
Keywords: diffusion-weighted MRI, musculoskeletal, soft issue, tumor.

INTRODUCTION

Musculoskeletal soft-tissue tumors are arising

from ectodermal and mesodermal layers (1). They can
DWI has the potential to differentiate
generally be classified into two main categories, that
benign from malignant soft tissue tumors because
is, soft-tissue sarcomas and benign tumors, and these
malignant tumors have greater cellularity with
tumors can occur at any age and present at any site (1,2).
more restricted diffusion than benign tumors (7).
MRI is indispensable in the evaluation of
This study aimed to evaluate the ability of
soft tissue tumors and become modality of choice.
DW MRI in detection and characterization of the
It offers improved soft tissue contrast when
musculoskeletal soft tissue tumors.
compared to other modalities (3).

There are some findings on MRI which are
PATIENTS AND METHODS
indicative for malignancy, such as infiltration of
This was a prospective study which included
adjacent tissue destruction of bones and tendons and
30 patients (20 females and 10 males) referred to
the size of mass. There are no criteria available to
MRI Unit, Ain shams University Hospital for MRI
clearly distinguish benign mass from malignant,
evaluation of musculoskeletal soft tissue tumors.
some very aggressive tumors present as encapsulated
This study included clinically suspected or
mass without surrounding edema and only minimal
previously diagnosed musculoskeletal soft tissue
enhancement which are in general indicative for
tumors by other modalities with no age or sex
benign process. Thus, histopathological work up is
predilection. Patients with contraindication to MRI
required for reliable characterization of soft tissue
(e.g.: patients who have heart pacemaker, metallic
tumors (4). The DWI now is used in association with
foreign body and metallic device) and patients with
conventional MRI with the objective of improving
severe claustrophobia were excluded.
diagnostic accuracy and treatment evaluation. DWI

An informed consent from all patients was
allows quantitative and qualitative analysis of tissue
taken before the MRI examination.
cellularity and cell membrane integrity and has been
MRI technique
widely used for tumor detection and characterization
Patients were examined using 1.5 T closed
to monitor treatment response (5). The tissue contrast
MRI machine (MR system Intra, PHILIPS) using
using diffusion weighted image (DWI) is different
the most optimal surface coil accommodates each
from that attained using conventional MR technique.
lesion. The predetermined examination protocol
The DWI involves the diffusion motion of water
was applied to all patients that included the
protons in tissue, which produces different contrast in
following:
different kinds of tissues, because of this procedure
1) T1-WI (TR/TE=400-700l14-30,fov,20-35)and
provides different information about the diseased
T2-WI
(TR/TE=2800-4500/80-120,FOV20-
tissue (6).
35)in axial, coronal and /or sagittal.
1895
Received: 28 / 7 /2017 DOI : 10.12816/0040619
Accepted: 7/8 /2017

Full Paper (vol.692 paper# 18)


c:\work\Jor\vol692_19 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1901-1907

Incidence and Risk Factors That Predict Chronic Hypertension after
Delivery in Women with Hypertensive Disorders of Pregnancy
Hesham M. Fathy, Ahmed K. Makled, Haitham A. Sabaa, Mohamed A. Yonis
Department of Obstetrics and Gynecology, Faculty of Medicine ­ Ain Shams University

ABSTRACT
Background:
hypertensive disorders of pregnancy (HDP) are important disorders complicating 5% to 10%
of all pregnancies and they are a leading cause of maternal and fetal morbidity and mortality and associated
with subsequent development of chronic hypertension. Aim of the work: this study aimed to determine the
incidence and risk factors that predict chronic hypertension after delivery in women with hypertensive
disorders of pregnancy. Patients and Methods: this cohort prospective study was conducted at Ain Shams
University, Maternity Hospital. This study included a sample of 207 pregnant women with hypertensive
disorders of pregnancy, followed up for persistence of hypertension after 3 months postpartum. Results: the
subjects were categorized into case group (n=25, 12.1%) included patients diagnosed as chronic hypertension
at the postpartum period and the control group (n =182, 87.9%) included the rest of the study subjects.
Clinical and demographic factors were evaluated. By multivariate regression analysis, age, gestational age at
diagnosis, parity, preeclampsia and early onset hypertension with end-organ dysfunction were predictors of
progression to chronic hypertension. Conclusion: 12.1% of women diagnosed with HDP continued with
persistent hypertension after delivery and some clinical and demographic risk factors such as old maternal
age at HDP, lower gestational age at diagnosis, multiparous women, preeclampsia and hypertension with
end-organ dysfunction were predictors of progression to chronic hypertension. Recommendations: further
studies on a larger scale of patients are needed to confirm the current results.
Keywords: risk factor, chronic hypertension, delivery, hypertensive disorders of pregnancy.

INTRODUCTION

Hypertensive disorders of pregnancy (HDP)
Several metabolic and obstetric risk factors
are important disorders with lethal effects on
(eg. obesity) related to hypertension postpartum in
mothers and children (1). They complicate 6­8%
the short term and predisposed to the subsequent
of pregnancies and usually resolve postpartum (2)
development of chronic hypertension after
and associated with pulmonary edema, stroke,
preeclampsia in initially normotensive women (8).
acute kidney injury, disseminated intravascular
Preeclampsia may be the better predictor of
coagulopathy, and death in the antepartum period
future cardiovascular diseases since it was
(3). Clinical monitoring, risk factor evaluation,
associated with a wider range of cardiovascular
and early intervention could benefit women with
risk factors (9). Proteinuria in hypertensive
hypertension in pregnancy (4). HDP is strongly
pregnancy diseases is associated with a longer
and associated with future hypertension and
persistence of hypertension postpartum (10).
women who experience this condition should be
A recent study showed that some clinical and
counseled regarding lifestyle modification and
demographic risk factors such as early onset
careful ongoing blood pressure monitoring, this
hypertension with end-organ dysfunction, higher
might be provided to all pregnant and postpartum
pre-pregnancy BMI and smoking were reliable
women with identifiable risk factors for future
predictors of progression to chronic hypertension
hypertension (5). Greater awareness of this
in the postpartum period (11).
association may lead to earlier diagnosis and
Postpartum hypertension can threaten well-being
improved management, thus reducing a proportion
and longevity in life. Controlling the high BP
of the morbidity and mortality from such diseases
during antepartum and postpartum periods is
(6). Postpartum hypertension can be related to
related to reduce maternal morbidity and mortality
persistence
of
gestational
hypertension,
(12).
preeclampsia, or preexisting chronic hypertension,
Stepwise approach toward the diagnosis and
or it could develop de novo postpartum secondary
management
of
women
with
persistent
to other causes. The differential diagnosis is
hypertension postpartum should be provided (7).
extensive, and varies from benign (mild
Currently, there is very little information on the
gestational or essential hypertension) to life-
clinical risk factors of chronic hypertension at the
threatening such as severe preeclampsia,
postpartum period. This study aimed to determine
eclampsia and cerebrovascular accidents (7).
the incidence and risk factors that predict chronic

1901
Received: 19 / 7 /2017 DOI : 10.12816/0040620
Accepted:28 / 7 /2017

Full Paper (vol.692 paper# 19)


c:\work\Jor\vol692_20 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1908-1910

The Role of Diffusion Weighted MR Imaging in Assessment of
Hepatocellular Carcinoma after Radiofrequency Ablation
Hana Hamdy Nassef, Aliaa Sayed Sheha and Ali Abbass Radhi
Department of Radio-diagnosis, Faculty of Medicine, Ain Shams University

ABSTRACT
Background:
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: this study aimed to evaluate the feasibility of DWI and
the corresponding ADC values to detect tumor response after radiofrequency ablation for hepatocellular
carcinoma. Patients and methods: MR examinations were done for 20 HCC patients post-RFA. Pre and post
gadolinium 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 can be concluded that DWI is a feasible follow-up tool for post ablation liver contributing in
detection of residual lesion.
Keywords: MRI, carcinoma, Radiofrequency Ablation, liver tumor.

INTRODUCTION

Hepatocellular carcinoma (HCC) is the
1. MR protocol
most common primary liver malignancy and is a
Magnetic resonance imaging examinations were
leading cause of cancer-related death worldwide (1).
performed on a Philips Intera Achieva 1.5 T
Surgical resection and local ablative therapies
super conducting MR unit , with a 16- channel
represent the most frequent first lines therapies
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
Recovery).
such as RFA, the usual morphological criteria
d) In phase and out phase gradient echo sequences.
primarily based on the maximal lesion size cannot
e) Heavy T2 weighted images.
be used with confidence, as the induced ablation
3. Dynamic study
zones comprise the tumor and its margin (4).
Dynamic study was performed after bolus
Diffusion-weighted
imaging
represents
a
injection
of
0.1mmol/kg
bodyweight
of
promising non-invasive diagnostic tool for the
Gadolinium - DTPA at a rate of 2ml/s, flushed
evaluation of HCC treatment responses to loco
with 20ml of sterile 0.9% saline solution from the
regional therapies (5). ADC value changes have
antecubital vein. The injection of contrast media
been shown to occur early after treatment and
and saline solution was performed by automatic
correlate well with tumor necrosis (5).This study
injector.
aimed to assess role of diffusion weighted MRI in 4. Diffusion study
evaluation
of
treatment
response
after
Respiratory-triggered fat-suppressed single-shot
radiofrequency
ablation
for
hepatocellular
echo planar DW imaging was performed in the
carcinoma.
transverse plane with tri-directional diffusion
PATIENTS AND METHODS
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 till 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
radiofrequency ablation for hepatocellular carcinoma.
characteristics and pattern of enhancement in the
Exclusion criteria included patients with MRI
dynamic imaging as well as number and site of the
incompatible devices such as cardiac pacemaker,
detected focal lesions. Then provisional diagnosis
metallic valves, hearing aids or aneurismal clips.
was reported. We reviewed the diffusion images
Documented consent must be obtained from
with ADC values for final radiological
each patient involved in the study.
characterization and detection of focal lesion.
1908
Received:23 /7 /2017 DOI : 10.12816/0040621
Accepted: 2 / 8/2017

Full Paper (vol.692 paper# 20)


c:\work\Jor\vol692_21 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1911-1917
Closure Versus Non Closure of Subcutaneous Tissue in Cesarean Section in
Diabetic Women: A Randomized Controlled Trial
Mustafa G F, Abd El Rahman R M, Rozeik K M
Department of Obstetrics and Gynecology-Faculty of Medicine - Ain Shams University
Corresponding author: Khaled Mostafa, email: khaledrozeik2014@gmail.com

ABSTRACT
Background:
caesarean section is one of the most commonly performed abdominal operations on women
in most countries of the world. Its rate has increased markedly in recent years and is about 20­25% of all
child-births in most developed countries. Aim of the work: this study aimed to assess the surgical site
infection rate and patient satisfaction following closure of the subcutaneous tissue compared to non-closure
of subcutaneous tissue in the diabetic women undergoing cesarean section. Patients and methods: this
randomized prospective controlled study was conducted in Ain Shams University, Maternity Hospital.
Elective cesarean section was done during the period from June 2016 to May 2017 to a sample of 88
pregnant women with diabetes mellitus. Results: there was no significant difference between closure and
non ­closure of the subcutaneous tissue in cesarean section in the diabetic women regarding SSI and wound
complications. However, there was a significant difference between closure and non- closure of the
subcutaneous tissue as regard the time needed for cesarean section closure which was in favor of non -
closure of the subcutaneous tissue. Conclusion: closure of the subcutaneous tissue was superior to non-
closure as regard patient satisfaction and cosmetic outcome. Recommendations: subcutaneous tissue
closure can be used in diabetic patients undergoing cesarean section as long as it was not associated with
significant increase in SSI, it had better cosmosis and patients' satisfaction.
Keywords: closure, non-closure subcutaneous tissue, cesarean section, diabetic women.

INTRODUCTION
PATIENTS AND METHODS
Cesarean section is one of the most
This was a randomized prospective
common operative procedures performed in
controlled study conducted in Ain Shams
modern obstetrics [1]. Cesarean section rates
University, Maternity Hospital during the period
showed wide variation among countries in the
from June 2016 to May 2017.In this study elective
world, ranging from 0.4 to 40 percent and a
cesarean section was done to a sample of 88
continuous rise in the trend has been observed in
pregnant women with diabetes mellitus.
the past 30 years [2]. Closure of the subcutaneous
Sample size calculation
fat theoretically decreases tension on the above
The required sample size had been calculated
skin layer. Suture closure of the subcutaneous fat
using the G*Power Software (Universität
could therefore result in superior cosmetic
Düsseldorf, Germany), setting the type 1 error
outcome by decreasing tension on the skin layer.
()at 0.05and the power (1- )at 0.8. Data from a
Evidence suggested that suture closure of the
previous study showed that the incidence of
subcutaneous fat at the time of CS reduced the risk
surgical site infection associated with closure of
of wound disruption in women with a
subcutaneous tissue was 2% compared to 7% in
subcutaneous tissue larger than two centimeters [3].
association with non-closure of subcutaneous
Gestational diabetes mellitus (GDM) is a
tissue [6]. So, it is estimated that a total sample size
condition characterized by glucose intolerance
of 88 patients equally randomized into either study
during pregnancy and is associated with a variety
group (n=44 patients per group).
of adverse birth outcomes, including excessive
Inclusion criteria
fetal weight gain and related increases in the rate
1. Pregnant women in childbearing period (25-35
of cesarean delivery and perinatal injury [4]. The
years).
most common complications of CS are superficial
2. Women planned for elective cesarean section.
surgical site complications including sepsis,
3. Pregnant women with gestational diabetes or
seroma formation and breakdown [5]. This study
women with type 2 diabetes according to
aimed to assess the surgical site infection rate and
medical
records
according
to
ACOG
patient satisfaction following closure of the
classification [7]
subcutaneous tissue compared to non- closure of
Exclusion criteria
subcutaneous tissue in diabetic women undergoing
1. Hemoglobin less than 10g/dl.
cesarean section.

1911
Received:18 / 7/2017 DOI : 10.12816/0040622
Accepted:27 / 7 /2017


Full Paper (vol.692 paper# 21)


c:\work\Jor\vol692_22 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1918-1922

Hypofractionated Radiotherapy Versus Conventional Radiotherapy in
Management of Patients with High Grade Gliomas Older Patients and Poor
Performance State
Hesham A. Elghazaly, Dina A. Salem, Nagi S. Gobran, Mariam M. Hussien
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University
Corresponding author: mariam abuzaid ,email:dr.romiaa@gmail.com

ABSTRACT
Background:
as guidelines for glioblastoma treatment was based on trial included patients less 70 years old and
good performance only. We did a randomised trial to assess the optimum palliative treatment in patients aged 60
years and older and poor performance patients.
Patients and Methods: this study included 50 (elderly and/or frail patients) with high grade glioma who
presented to the Clinical Oncology Department, Ain Shams University during the period of November 2013 to
march 2016.Theywere categorized in two groups (25 in each group). Group A received standard conventional
fractionation of 60 Gy in 30 fractions over 6 weeks. Group B received 45 Gy in 15 fractions over 3 weeks.
Results: progression free survival in conventional RTH group was 4.1 months, while in hypo fractionated group
it was 4.2 with no statistically significant difference between the two groups. The median overall survival was
7.2 in the conventional group and 7.4 months in the hypo fractionated group with no statistically significant
difference between the two groups. After age analysis patients 70 years old median overall survival was 5.4
month and 6.8 month in patients 70 years received hypofractionation.it was statistically significant difference
(P value = 0.047).
Conclusion: this study showed that short course of radiotherapy has the same efficacy as slandered conventional
radiotherapy in older patients and frail patients. And in patients over 70 years short course should be the
slandered of care.
Keywords: Hypofractionation, Glioblastoma, Multiform,Elderly patients.

INTRODUCTION

Glioblastoma is the most common primary brain
2013 to March 2016 were randomized 1:1 (25 in
tumor and most aggressive with survival less than
each arm).
one
year
(1,2).
Chemoradiotherapy
with
1-Group A: received standard conventional
temozolomide became the standard of care in 2004,
fractionation of 60 Gy in 30 fractions over 6 weeks.
after a large phase III study, in which patients were
2- Group B: received 45 Gy in 15 fractions over 3
aged 70 years or younger; increased age was found
weeks.
to be a negative prognostic factor(3,4). Elderly and
ELIGIBILITY CRITERIA
frail patients usually not withstand combined
Inclusion Criteria
therapy and extensive treatment might not be seen as
Patients who diagnosed as high grade glioma by
justify able owing to the short survival (5).
postoperative (debulking surgery) or biopsy or MRI
cAlternatives to the standard 6 weeks of
spectroscopy.
radiotherapy that are associated with similar or
Ages eligible for study: 18-60yrs with karnofsky
improved survival and quality of life would be
performance state 50 - <70, or patients more than
beneficial treatment short treatment times could also
60 years old karnofsky performance state 50.
lessen demands on medical resources and reduce the
Patients reliable for follow up.
risk of treatment being withheld(6).
Exclusion Criteria

Prior chemotherapy or radiation for high grade
METHODS
glioma. Or radiotherapy to brain.
Study design
Serious concomitant diseases preventing the safe
This phase III prospective study included 50 (elderly
administration of radiotherapy or likely to interfere
and/or frail patients) with high grade glioma who
with the study assessments.
presented to the clinical oncology department, AIN
Concomitant
administration
of
any
other
SHAMS University during the period of November
experimental drug under investigation
1918
Received:21 / 7 /2017 DOI : 10.12816/0040623
Accepted:30 /7 /2017


Full Paper (vol.692 paper# 22)


c:\work\Jor\vol692_23 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1923-1930

Comparison of Broth Micro Dilution and Disk Diffusion Methods for
Susceptibility Testing of Dermatophytes
Manal Abd El Alim, Rania M Abdel Halim, Sara A Habib
Clinical Pathology Department, Ain Shams University, Cairo, Egypt

ABSTRACT
Background:
Dermatophytes are responsible for the majority of the fungal infections involving skin, hair
and nails. There has been a remarkable increase in the number of fungal infections especially in those people
whose immune system is compromised by aging, HIV infection, organ transplantation or cancer therapy.
Objective:
The aim of this study was to compare both broth microdilution method & disk diffusion method
for in-vitro activity of some antifungal drugs (Terbinafine, Fluconazole, Itraconazole) against different
species of dermatophytes.
Patients and Method:
This study was performed on 50 dermatophyte isolates recovered from various
clinical specimens (skin, hair and nail) collected from dermatology outpatient clinic of Ain Shams University
Hospital. All samples were cultured on sabarouds. Isolates recovered from SDA were subcultured on Potato
Dextrose Agar (PDA) & incubated at 28°C for 7 days to enhance sporulation. The growth was harvested in
sterile saline & the conidial and hyphal suspension was adjusted to 0.5 macfarland. Then antifungal
susceptibility was done using: Disk diffusion (DD) method and Broth micro dilution (BMD) method.
Results:
There was a highly significant agreement between the antifungal susceptibility testing of
fluconazole, itraconazole and terbinafine by disk diffusion method and Broth micro-dilution method. In our
study agreement between both methods for itraconazole was 1.00 (kappa), for terbinafine was 0.947, and for
fluconazole was 0.878. The factors that may affect the results of BMD or DD are type and size of inoculum,
composition of the media, temperature and duration of incubation and disc strength.
Conclusion:
There was a highly significant agreement between the antifungal susceptibility testing of
fluconazole, itraconazole and terbinafine by disk diffusion method and Broth micro-dilution method.
Keywords:
Dermatophytes, Disk diffusion, Broth micro-dilution.

INTRODUCTION

Dermatophytes are responsible for the
hairy skin of the body), Tinea cruris (groin), Tinea
majority of the fungal infections involving skin,
pedis (foot) or athlete's foot and Tinea barbae or
hair and nails1.
barber's itch (bearded areas of the face and neck).
There has been a remarkable increase in the
Favus is a chronic type of ringworm involving the
number of fungal infections especially in those
hair follicles4.
people whose immune system is compromised by
According to the genera, dermatophytes can
aging, HIV infection, organ transplantation or
be classified into Trichophyton which affect
cancer therapy2.
mainly the skin and nails, Microsporum which
The organisms are transmitted either by
affect mainly the hair and Epidermophyton which
direct contact with infected host (human or
affect mainly the skin5. Trichophyton rubrum,
animal) or by direct or indirect contact with
Trichophyton
tonsurans
and
Trichophyton
infected exfoliated skin or hair in combs, hair
mentagrophytes
are
the
most
common
brushes, clothing, furniture, theatre seats, caps,
dermatophytes. Trichophyton rubrum affect face,
bed linens, towels, hotel rugs, and locker room
trunk, beard area, nails, feet and groin area
floors. Depending on the species the organism
infection. Trichophyton mentagrophytes affect the
may be viable in the environment for up to 15
surface of the hair (large spore ectothrix) which
months. There is an increased susceptibility to
manifest clinically as kerion. Trichophyton
infection when there is a pre-existing injury to the
tonsurans invade the hair shaft (endothrix) which
skin such as scars, burns, marching, excessive
manifest clinically as black dot infection. Another
temperature and humidity3.
common dermatophyte is Microsporum canis,
Clinically, dermatophytes (ringworm) can be
which is transmitted from animals such as cats and
classified depending on the site involved. These
dogs to humans causing small spore ectothrix
include Tinea capitis (scalp), Tinea corporis (non-
which manifest clinically as scally ringworm6.
1923
Received: 12 / 6 /2017 DOI : 10.12816/0040624
Accepted:21 /6 /2017


Full Paper (vol.692 paper# 23)


RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1931-1940

Evaluation of the Response of Fractional Carbon Dioxide (CO2) Laser and
Punch Elevation Technique in Treatment of Acne Scars: A Split-face
Comparative Clinical, Histopathological, and Immune Histochemical Study
Seif­Allah Mohamed Refaat El-Fiky, Sahar El-Sayed Ahmed, Elhussainy,
Manal Hassan Moussa, Rania Mahmoud Elhusseiny
Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Ain Shams University

ABSTRACT
Background:
Acne is the most common skin disease affecting adolescents and young adults, with associated
scarring and its sequelae. Treatment options are either lifting procedures raising scar base closer to normal skin
surface, or resurfacing ones injuring epidermis and superficial dermis with neocollagenesis and epidermal repair.
Punch elevation (PE) method is better for improving deep atrophic acne scars, that can be combined with depth
resurfacing. CO2 laser stimulates new collagen formation, tightens skin and raises scar to surface. Aim of the
Work:
to assess efficacy and safety of combination of PE technique and fractional co2 laser (Fr co2 L) compared
to fr co2 L alone. Subjects and Methods: 20 atrophic post acne scars patients were subjected to history taking,
general and dermatological examinations, identifying scars types and grades. Treatment response at start, before
each fr. co2 L session and 4 weeks after last laser session was clinically evaluated by Goodman and Baron scale,
and recording patients' photographs, satisfaction, and complications. Histopathological examination of scar skin
biopsies before and 4 weeks after the last fr. co2 L session was done using H&E, Mallory trichome, sliver stain
and immunohistochemical VEGF. Results: combined treatment with fr co2 L and PE was more effective in
improving post acne scars than fr. co2 L resurfacing alone. Histopathological examination before combined fr.
co2 L and PE treatment and 1 month after the last fr. co2 L session showed high significant increase in epidermal
thickness (H&E), increase in collagen fiber type III (Mallory trichrome stain), decrease in collagen fiber type I
(sliver stain) and increase in fibroblasts' activity (VEGF). Conclusion: both PE technique and fr. co2 L
resurfacing show promising efficacy and safety in treating atrophic post acne scars, complementing each other to
improve skin texture and appearance, with excellent cosmetic outcomes.
Keywords: Acne scar, Punch elevation, Fractional CO2 Laser, Efficacy, Safety.

INTRODUCTION

Acne is an inflammatory disease of the
Subcision (25). Procedural management includes
pilosebaceous units in the skin of the face, neck, chest
microdermabrasion, chemical peels, and percutaneous
and upper back (25). While the reported prevalence
collagen induction by microneedling (3). Various
rates of acne vulgaris vary from 35 % to 90 % in
ablative and non--ablative lasers and light energies are
adolescents, and it persists into adulthood in
also available for treatment of atrophic acne scars (26).
approximately 12% of cases with psychological and
Fractional carbon dioxide lasers have now been
social implications (8). In some patients with acne, the
considered the gold standard treatment for atrophic
inflammatory response results in permanent,
acne scars and skin rejuvenation (28, 27, 18, 16). They
disfiguring scars from either increased tissue
ablate the skin surface and help in tightening the
formation or due to loss or damage of tissue.
collagen fibers underneath. Furthermore, they treat
Hypertrophic scars and keloids are examples of scars
only fractions or columns of the affected skin, leaving
that result from increased tissue formation. Atrophic
skin intervening areas untreated which stimulate rapid
scars are caused by loss or damage of skin tissue,
skin re-epithelialization, with minimal chance of
occur in 80-90%, and can be classified into icepick,
prolonged and serious adverse effects (13, 11).
rolling and boxcar scars (6).
Another common treatment approach for atrophic
Many treatment modalities are available that reduce
acne scars is Punch elevation, utilizing a circular blade
the appearance of acne scars, however acne scars are
applied only to the base, not the walls of the scar
often difficult to be treated and require the use of
yielding a more even skin after healing with reduction
many various approaches over multiple sessions.
of pitted or pockmarked look (7).
Medical management of atrophic scars can be done
AIM OF THE WORK
using topical retinoids. Surgical management includes
The current work aimed at comparing the efficacy of
punch excision or elevation, skin grafting and
combined use punch elevation and fractional carbon
1931
Received:19 /7 /2017 DOI : 10.12816/0040625
Accepted: 28 / 7/2017

Full Paper (vol.692 paper# 24)


c:\work\Jor\vol692_25 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1941-1949

Study of Vitamin D3 Supplementation on Chronic Kidney Disease (Mineral Bone
Disease (CKD ­ MBD) Parameters in Patients with Chronic Kidney Disease Stage 3)
Mona Hosny Abdel Salam*, Mohamed Mostafa Mohamed *, Cherry Reda Kamel*,
Abdelkhalek Fouad Mahmoud**
* Internal Medicine Department, Faculty of Medicine, Ain Shams University** Internal Medicine,
Ministry of Health, Cairo , Egypt
Corresponding Author: Mona Hosny Ashmawy, Mobile: 01093387764, email:salamhosnymona2015@gmail.com

ABSTRACT
Background:
Bone profile parameters are affected by decreased estimated GFR within chronic kidney disease
stage 3. We aimed to investigate if bone profile parameters response to vitamin D3 supplementation , within
this stage , became affected by the presence or absence of diabetic state. Materials and methods: 30
patients having chronic kidney disease (stage 3) were enrolled in the study. 19 patients constituted non ­
diabetic group I and 11 patients constituted diabetic group II . All of them have received vitamin D3 1000 IU
daily for 3 months . For all patients the following measurements were performed before and after vitamin
D3 use :CBC , ESR1 & ESR2 , blood urea , serum creatinine , estimated GFR , complete urine analysis ,
serum Na , protein / creatinine ratio , serum calcium , serum phosphorus , calcium ­ phosphorus product ,
serum albumin , serum alkaline phosphatase , and intact serum parathyroid hormone. Results: Serum
calcium levels have increased, while intact parathyroid hormone has decreased within both groups , with a
more obvious response within the diabetic group . Serum alkaline phosphatase , serum phosphorus , and
calcium ­ phosphorus product did not show any significant change, they were within their level after
vitamin d3 use .ESR 1 and ESR 2 levels were higher from the start of the study within the diabetic group.
Their mean level values have significantly decreased in a highly significant way within this group .
Kidney function parameters and proteinuria have been deteriorated within the two groups , being worse
within the diabetic group . Conclusion: Vitamin D3 use within stage 3 chronic renal disease patients is
effective for patients support against bone mineral disturbances occurring within this disease .
Keywords: Vitamin D3 - CKD-MBD ­ Bone profile ­ Diabetes Mellitus ­ CKD stage 3.

INTRODUCTION


Vitamin D is a steroid hormone which is
hyperparathyroidism and its associated disorders
required to regulate serum levels of calcium and
in chronic kidney disease (5) .
phosphorus , as well as bone metabolism .
Most patients on dialysis are treated with
Vitamin D can be obtained from dietary sources
vitamin D receptor agonists ( VDRAs ) , such as
( D2 and D3 ) , together with exposure of the
calcitriol , doxercalciferol , or paricalcitol , for
skin to ultraviolet ( UV ) light ( D3 )(1).
management of secondary hyperparathyroidism .
Chronic kidney disease leads to progressive
Supplementation with VDRAs without its nutritional
derangement of vitamin D metabolism . Renal
vitamin D precursor may not optimize clinical
synthesis of 1,25 ­ dihydroxyvitamin D ( 1, 25 [
benefits (6). Kovesdy et al.(7) ,have reported
OH ]2D ) is reduced , due to decreased activity
increasing confusion as regards which type of
of 1 alpha ­ hydroxylase (2). The decrease in
vitamin D preparations ( nutritional versus active
vitamin D synthesis in chronic renal disease
formulas ) , should be used within chronic
results in hypocalcemia , secondary
kidney disease patients.
hyperparathyroidism , and subsequent renal
PATIENTS AND METHODS
osteodystrophy(3). The etiologies of hypo-vitaminosis
This is a clinical trial which was carried out
D occurring in end- stage renal disease ( ESRD )
on 30 chronic kidney disease stage 3 patients ,
population are not only due to decreased renal
who attended the Benha Hospital for Health
ability to transform 1-alpha ­ hydroxyvitamin D
Insurance and the Benha University Hospital
to its active form , but also they include
outpatient clinics , from April to August 2016
limited sunlight exposure , reduced ultraviolet ­
.All patients were above 18 years old .
induced vitamin D synthesis in the skin , and
Patients were divided into two groups : Group I:
disturbed vitamin D metabolism (4) . Replacement
consisted of 19 patients who always had normal
of active vitamin D has been considered an
blood glucose levels ( Non ­ diabetic group I).
essential step in the management of secondary

1941
Received:21 / 5 /2017 DOI : 10.12816/0040627
Accepted:30 /5 /2017

Full Paper (vol.692 paper# 25)


c:\work\Jor\vol692_26 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1950-1958

Study the Effect of Apocynin on Some Renal Functions in
Ischemia/Reperfusion Injury in Male Albino Rats
Basma Abd Elfattah Helal, Romysaa Ali Elshrbiny,
Mohamed Mohamed Shebl, Nermen Mohamed Mady
Department of Physiology, Faculty of Medicine, Tanta University

ABSTRACT
Background:
Apocynin (4-hydroxy-3-methoxyacetophenone) which isolated from the traditional medicinal
plant Picrorhiza kurroa, is a naturally occurring methoxy-substituted catechol, experimentally used as an
inhibitor of NADPH oxidase and of the concomitant ROS production. Apocynin also proved to be a potent anti-
inflammatory agent, based on the selective inhibition of the production of ROS by activated human PMNs.
Aim of the Study:
to explore the protective effect of Apocynin and the NADPH oxidase inhibitor on kidney
damage induced by ischemia/reperfusion (I/R) in a rat model. Subjects and Methods: Fourty male albino rats
were categorized into four equal groups of 10. Group 1: Sham operated control group, Group 2: Ischemia /
reperfusion (I/R) group; which underwent bilateral renal ischemia for 1 hour followed by a 23 hour reperfusion,
Group 3: 4-week Apocynin treated group in which rats received Apocynin with a dose o16 mg/kg /day for 4
weeks followed by bilateral renal ischemia for 1 hour then 23 hour reperfusion afterwards , and Group 4: 8-
week Apocynin treated group in which rats received Apocynin with a dose of 16 mg/kg /day for 8 weeks then
bilateral renal ischemia for 1 hour followed by 23 hour reperfusion.
After reperfusion, the animals were sacrificed, the blood samples were collected for determination of blood urea
nitrogen, serum creatinine, 24 hour urine were collected for determination of creatinine clearance. Kidneys of all
animals were harvested and evaluated biochemically through determination of tissue MDA, MPO, GPX and
catalase level. Results: Kidney tissue MDA, MPO, serum BUN and Creatinine levels were found to be
significantly higher in the I/R group. GPx level showed a significant decrease, while there was a slight decrease
in Catalase level when compared with Sham operated group. Creatinine clearance was impaired in renal I/R
group. Renal I/R injury has also induced an extensive tubular necrosis, glomerular damage, and apoptosis.
Apocynin significantly reduced MDA and MPO and increased GPX and catalase in both treatment groups when
compared to the I/R group (p< 0.001). The elevated BUN and creatinine levels were significantly reduced in
treatment groups, also creatinine clearance was restored to around normal value.
Conclusion: with accordance to the findings and outcome of the present study, Apocynin has exerted protective
effects against ischemia/reperfusion injury by ameliorating the kidney damage induced by I/R injury to a
significant extent. However, there was no significant difference in the outcome if the treatment was extended
from 4 to 8 weeks.
Keywords: Apocynin, NADPH-oxidase, Ischemia, Reperfusion injury, Reperfusion injury.

INTRODUCTION

Ischemia/ reperfusion (I/R) injury, which is a major
inflammatory cells, endothelial cells, platelets, injured
reason for acute renal failure, occurs in many
cells, and cell debris, via many enzymatic mechanisms
conditions, such as hypotension, sepsis, shock, open
is one of the most important reasons for reperfusion
renal stone surgery, partial nephrectomy, and renal
injury [5]. NADPH-oxidase (NOX) is a major enzyme
transplantation [1]. Renal I/R injury continue to be
that uses NADPH to generate superoxide, initial ROS
associated with significant morbidity and mortality
molecule, from oxygen[6]. In the kidney, NADPH
despite advances in preventive strategies and
oxidase components are expressed abundantly in the
supportive measures [2]. Although reperfusion is
renal vessels and in the glomerular mesangial and
essential for the survival of ischemic tissue, there is
podocyte cells, the macula densa, and the thick
good evidence for reperfusion itself causes additional
ascending limb, distal tubule, and collecting ducts [7].
cellular injury [3]. Renal I/R induces some injury in the
Apocynin (4-hydroxy-3methoxy-acetophenone),
cortical proximal tubules and a more severe generally
naturally occurring methoxy-substituted catechol, is an
lethal injury in the outer medullary proximal tubules ,
inhibitor of NOX and extracted from the roots of
Infiltration of neutrophils and macrophages in the
Apocynum cannabinum (Canadian hemp) and
kidney occurs after reperfusion [4]. Production and
Picrorhiza kurroa (Scrophulariaceae) [8]. It was used to
releasing of reactive oxygen species (ROS) by
treat dropsy and heart troubles in India and currently
1950
Received:29 /7 /2017 DOI : 10.12816/0040628
Accepted:8 / 8/2017

Full Paper (vol.692 paper# 26)


c:\work\Jor\vol692_27 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1959-1963

Knowledge, Attitude and Practice of Mothers on Acute Respiratory
Infection in Children under Five Years in Saudi Arabia, 2017
Maha Fahad Alluqmani1, Abdulrahman Abdullah Aloufi2, Amnah Makki Al Abdulwahab3,
Abdullah Ismail Khalil alsharif4, Abdullah Abdulaziz A AlShathri5, Mosab Shaher AlShehri6, Samah
Ali aharbi1, Samaher Ibrahim Hawsawi7, Nawal Ahmed Alshmmary8, Bati Jassim I Alshammari8
1Ibn Sina National College,2King Salman Military Hospital,3King Khalid University,4Tabuk University,
5King Faisal University, 6Imam University,7Umm Al-Qura University,8Northen Border University

ABSTRACT
Background:
management and prevention of acute respiratory infections (ARI) is a worldwide problem
especially in developing countries. Mothers are the caregivers of their children and thus their knowledge
could be used as preventive measure for the disease.
Objectives: assessing the knowledge, attitude and practice (KAP) of Saudi mothers toward ARI in children
less than five years old in the Kingdom of Saudi Arabia.
Methods: the study included 733 mothers admitted to a random sample of PHC from different districts of
KSA. The mothers were interviewed and asked to fill up a predesigned questionnaire during the period from
February 2017 to June 2017. The questionnaire comprised of 4 parts including the mothers' demographics
and KAP. Results: the mean age of mothers was 41.3 years old and the duration of marriage was from 10-20
years in most of mothers (41.9%). The majority of participants had college degree (53.9%) and 44% of
subjects were working mothers. Most of subjects had good knowledge about that ARI is a disease of both
upper and lower respiratory infection, pneumonia as a complication of ARI, the overuse of antibiotic and
bacterial resistance and cough being the most common symptom of ARI. Poor knowledge was related to the
use of antibiotics and consulting a physician if children had ARI. The knowledge score of mothers was good
in 46% of subjects and 54% have insufficient knowledge. The attitude and practice of mothers was poor
among more than half of the participants.Conclusion: most of Saudi mothers had inadequate, knowledge,
attitude and practice toward ARI. The better understanding and sufficient knowledge was significantly
correlated with young ages, short duration of marriage and higher education.
Keywords: KSA, KAP, Acute Respiratory Infections (ARI), Primary Health Care.

INTRODUCTION
parents use a potentially harmful herbals and
The most common cause leading to
remedies with wrong conceptions, also the lack of
morbidity and mortality among children under five
adequate knowledge about the correct method of
years old is acute respiratory infection (ARI) that
applying antibiotics in the medical care of young
results in high burden of economic costs and the
children highlighted the importance of intensive
most important cause for children admission to
research studies in the field of intensifying the use
health services among children(1). It includes upper
of proper preventive measures in dealing with ARI
respiratory infection (common cold, ear infection,
infected young children(10).The objective of the
tonsillitis) and lower respiratory tract infection
study was to evaluate the KAP of Saudi mothers
which presented as pneumonia with increased
toward acute respiratory tract infection in children
respiratory rate(2). ARI etiological agents are
less than five years.
Staphylococcus aureus, Haemophilus influenzae

type b (Hib), Streptococcus pneumoniae, and other
METHODS
bacterial species. Also, there are some viral agents
The cross sectional study was approved
including measles virus, respiratory syncytial virus
from the ethical committee of the faculty of
(RSV), influenza virus, human parainfluenza
medicine then was conducted at a random sample
viruses and varicella virus(3, 4). The estimated rate
of Primary Health Care Centers (PHCCs) in KSA
of ARI morbidity among children less than 5 years
during the period from February 2017 to June
in KSA was 50% as reported in health care centers.
2017. Twenty four health care centers were
Also, a high rate of using antibiotic and other
randomly included in the study using the stratified
drugs were found to induce ARI. The excessive
random sampling technique in which a
use of X-rays and laboratory investigations (5, 6) are
representative sample of 733 Saudi mothers
promoting factors in the spread of ARI. The
admitted to PHCC for seeking health care for their
assessment of parent's KAP Received great
children. The mothers were interviewed separately
attention by many research workers(7-9). Many
and asked to fill-up a self-administrated
1959
Received:7 / 7 /2017 DOI : 10.12816/0040629
Accepted: 16 / 7 /2017

Full Paper (vol.692 paper# 27)


c:\work\Jor\vol692_28 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1964-1967

Study of Knowledge, Attitude and Practice of Saudi Women towards
Physical Activity, 2017
Akram Adel Alandijani1 , Samar Yousif Alali2, Abdullah Saud Alotaibi3, Aisha Abdulrahman
Alsulami4,Rehab Abdulmohsen Alali2, Rabab Abdulrazaq Makkawi5 , Waleed Ali Alshehri6,
Eman Mushabab Ibrahim6, Riyadh Awadhallah Alahmadi1, Hassan Mohammed Alshehri6
1Taibah University,2 Primary Health Care Center Alahsaa,3King Faisal University,
4King Abdulaziz University,5 Umm AL-Qura University, 6King Khalid University

ABSTRACT
Background:
Physical activity is an effective component of health and prevention of disease. Increasing the
general health knowledge about physical activity could prevent obesity and chronic diseases.
Objectives: Study the knowledge, attitude and practice (KAP) of Saudi women regarding physical activity in
Kingdom of Saudi Arabia (KSA). Methods: This was a community based survey study conducted among 800
Saudi adult females chosen randomly using a multistage random technique during the period from January to
April 2017. The study included subjects were asked to fill up a predesigned questionnaire including questions
about socio-demographics and assessing the KAP about physical activity.
Results: Most of females (64%) had poor knowledge while 36% had good awareness about the physical
activity. About 72.2% had poor practice pattern but 22.8% had good practice pattern of physical activity. The
attitude toward physical activity was good in the majority of subjects (75.1%) and poor in (24.9%) of them. The
overall general KAP of included females regarding physical activity was poor in 62% and good in 38%.
Conclusion: The overall general KAP was low among the studied groups thus, there is a dispensable need for
providing a good and safe environment for women for practicing routine physical activity. Also, more efforts
should be carried out to increase the KAP of females toward physical activity through educational campaigns in
internet, TV and health care facilities.
Keywords: KAP, Physical Activity, Women, KSA.

INTRODUCTION

Physical activity is essential for maintenance
Many studies showed that the Saudi
of health and prevention of diseases as about 5 of
population don't practice physical activity either in a
noninfectious diseases were strictly related to
sufficient duration or adequate frequency and this
physical activity (1, 2). Also, it is important for
could be attributed to ignorance, not having time,
enhancing the metabolic process and a key factor of
lack of facilities and lack of motivation (10-14). Also,
contributing in energy expenditure in youth thus
there is a lack in the studies considering physical
improving the fitness, bone and cardiovascular health
inactivity in KSA and its complications (14). This
(3-5).However, physical inactivity significantly has
study aimed to study the KAP of Saudi women
negative impact on the health and well-being of
regarding physical activity in KSA.
subjects thus increasing the prevalence of chronic

diseases (6, 7).
METHODS
During the last 30 years, there was a turnover
Study design and population
in the lifestyle in the Kingdom of Saudi Arabia as the
A community bases survey study conducted
standard of living has raised and there were
in Saudi Arabia during the period from January to
modernization and mechanization in all aspects of
April 2017. The study population was a randomized
life. Also, the hot and dry climate in KSA made
800 Saudi adult females selected by multi-stage
people tend to use cars rather than walking or using
randomization system from the thirteen governorates
bicycles. The way of food consumption has shown
of Saudi Arabia. Inclusion criteria were Adult Saudi
major transformations as there is a rise in adoption to
females aged from 18-50 years old. Non-Saudi
consuming carbonated water, sugar-sweetened
females, age less than 18 and incomplete data were
beverages and high calorie foods (8, 9).
excluded from the study.


1964
Received: 10 /7 /2017 DOI : 10.12816/0040630
Accepted: 19 /7 /2017

Full Paper (vol.692 paper# 28)


c:\work\Jor\vol692_29 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1968-1972

Evaluation of Parents Knowledge about the Dangerous Effect of Excessive
Use of Antibiotics on Children with URTIs in Saudi Arabia, 2017
Maram Mohammed Aljohani1, Mai Khalid Alakhmimi1, Abdulaziz Zaher Alalmaei2,
Musab Shakir Alshareef 3, Saad Saleh Aldughaythir 3, Ahmed Abdullah Saleh Alenazi4,
Seba Ghaithan Alamri3, Rawan Ahmad Alsahafi1,Furat Mohammed Alrajhi1,
hamood sulaiman alturaigi2
1King Abdulaziz University,2Imam Muhammad Ibn Saud Islamic University,3King Saud Bin Abdulaziz
University For Health Sciences,4Ibn Sina National College,5Al Batterjee Medical College

ABSTRACT
Background:
upper respiratory tract infections (URTIs) are highly encountered by children all over the
world with repeating episodes from 6-8 times during the year. However being of viral origin and a self-
limited disease, many parents' attitudes forces physician to use antibiotics thus resulting in antibiotic
resistance.
Objectives: to study the parental knowledge, attitude and practice (KAP) toward antibiotic use among
children with URTIs in Kingdom of Saudi Arabia.
Methods: a self-administered questionnaire was distributed among parents presented at a random sample
of primary schools in KSA from February 2017 to June 2017.
Results: a total of 547 parents were included from different parts of KSA, most of them were females,
graduated from a college and received a moderate income. Overall, KAP toward using antibiotics in
URTI for children was very low among 72% of subjects and was good in only 28% of subjects showing
that there was inappropriate level of KAP among the studied population.
Conclusion: Saudi parents have inadequate knowledge about antibiotic use in children for treating URTIs
that showed incorrect answers for attitudes and practices.
Keywords: KSA, KAP, Upper Respiratory Tract Infections (URTIs), Antibiotic Resistance

INTRODUCTION

One of the most prevalent diseases among
authors confirmed the relationship between the
pediatrics is upper respiratory tract infections
development of resistance with unnecessary use of
(URTIs) with high incidence and repeated from 6-8
antibiotics (14, 15).
per year(1). Most of the outpatient clinics and
The major causes for development of
emergency departments visits were attributed to
antibiotic resistance are excessive and inappropriate
URTI infection in children (2, 3). The URTI is the
use of antibiotics by both parents and physician (16,
cause of children absence from schools and poses a
17). Most of parents had low knowledge toward
high economic costs on the healthcare facilities and
antibiotic use and had the perception that antibiotics
authorities due to unnecessary medical care visits (4,
could treat most of infections. Also, many
5).
physicians describe antibiotics for avoiding
Antibiotics are mainly used for treatment of
secondary bacterial infection (18). Therefore, this
bacterial infections however it is widely used in
study was planned to study the KAP of Saudi
case of treating URTI in pediatric health care
parents toward the use of antibiotics for treatment of
facilities even though its viral origin would result in
URTI in children.
ineffective practice and resistance(6, 7). As for

general practitioners about 33% of them would
METHODS
prescribe antibiotics at the end for URTI in
It is a descriptive community based study
children(8, 9). Also, it has been found that about
that was conducted in a random sample of primary
23.4% of antibiotic prescriptions in ambulatory care
schools in KSA from the period of February 2017 to
of children in United States were of no clinical
June 2017. The study was done after approval of
indications (10).
ethical board of King Abdulaziz university.
The misuse of antibiotics has been a global
Using the stratified random sampling technique, 47
concern of and a public health issue as it would
boys schools and 42 girls schools were included in
result in antibiotic resistance that is an increasing
the study where the parents of children were
threat on children's health (11, 12).
interviewed during the parent's day. The study
The WHO considered antibiotic resistance
participants were 547 parents of children aged from
as a public threat and a global problem (13) and many
6-10 years old who were attending the parent's day
1968
Received: 8 / 7 /2017 DOI : 10.12816/0040631
Accepted: 17 / 7 /2017

Full Paper (vol.692 paper# 29)


c:\work\Jor\vol692_30 The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1973-1977

Assessment of Knowledge, Attitude and Practice towards Hepatitis B
among Healthy Population in Saudi Arabia, 2017
Mohammad Abdulrhman Wedhaya1, Mohammed Ahmad Kurban2, Dina Abdulkareem Abyadh1 ,
Ali Saleh R Alshamrani3, Ghaedaa Saad Alzahrani2, Hatim Ali Alhabi1, Sami Samran Alrehaily1 ,
Amal Mohammed Alqahtani3, Mohammed Hamzah Mansi4, Abdullah Saeed Mofareh5

1Ibn Sina National College, 2King Abdulaziz University ,3King Khalid University,
4Taibah University, 5Qassim University

ABSTRACT
Background: hepatitis Virus B is a major health problem in Kingdom of Saudi Arabia (KSA) as it is one of
the most endemicity countries for being hepatitis B seropositive.
Objectives: evaluation of the knowledge, attitude and practice (KAP) of Saudi population toward hepatitis B
infection in KSA.
Methods: a descriptive cross sectional study was conducted among 890 Saudi subjects aged between 20-50
years old. All participants were interviewed during the period from February 2017 till June 2017 and filled-
up a predesigned validated questionnaire that consisted of 4 parts including the demographics and KAP.
Results: out of the 890 Saudi subjects, 69.3% were females, 48.3% were working, 77% had college degree
and 50.9% of them aged from 20-30 years old. The prevalence of hepatitis B among the studied population
sample showed that only 8% of subjects declared that they had hepatitis B infection. Most of the participants
had good knowledge regarding the means of HB transmission, the definition, symptoms and effects of the
disease. The attitude of subjects was good in 60% but the level of practice was poor among 66% of subjects
as most of subjects hadn't been screened or vaccinated for hepatitis B infection.
Conclusion: the level of KAP toward hepatitis B was good in 56% of subjects with high scores of good
knowledge and attitude but with poor practice levels among most of the subjects.
Keywords:
KAP, Hepatitis B, Cross-Sectional, Adult, KSA.

INTRODUCTION

METHODS
Hepatitis B virus (HBV) is considered a global
- Study design
disease of humanity with estimated prevalence of
After receiving an approval from the ethical
30% around the world but about 350 million of
committee of the faculty of medicine, a cross
population were found to be serological carries of
sectional descriptive study was assessed among the
hepatitis B (1). It is an infectious disease and the tenth
Saudi population sample during the period from
leading cause of death all over the world, also it
February 2017 to May 2017.
could occur with no seasonal spreading(2, 3).
HBV could be transmitted through contaminated
- Sample size and population
blood, secretions and unsafe sex. The disease is
This study included 890 Saudi subjects without
divided into two phases; acute or chronic infection.
physical or mental disturbs who were randomly
The acute phase could result in fulminant hepatitis
chosen from all governorates of KSA and their age
with urgent need for liver transplantation(4). On the
ranged from 20-50 years old. A written informed
other hand, chronic type is significantly associated
consent was received from all subjects. Privacy and
with death due to cirrhosis and failure of liver that
confidentiality of the data were confirmed during the
results in hepatocellular carcinoma (HCC)(5, 6).
study. We have no conflict of interest.
The incidence of HBV infection is very high
- Study tools
among hospital workers as most of them were never
The KAP of all the participants was evaluated
vaccinated (7). The surveys that concern assessing
by using a self-administrated questionnaire that
the knowledge, attitude, and practice (KAP) toward
contains four sections for data collection and was
hepatitis B could be advantageous for improving the
revised by the supervisors of the research then
health and preventing the spread of infection (8-10).
translated onto Arabic. The first part included
This study aimed at studying the KAP of Saudi
questions about the demographics of the
population toward hepatitis B infection for the
included subjects, part two involved questions about
achievement of valuable preventive measures.
1973
Received: 9 /7 /2017 DOI : 10.12816/0040632
Accepted: 18 /7 /2017

Full Paper (vol.692 paper# 30)