The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2429-2433
Partial Splenic Artery Embolization in Chronic Liver Disease
Mahmoud Agamy Mohamed Morsy, Amr Mahmoud Abdelsamad,
Ahmed amy Abdelrahman Abdelazeem, Wael Mohamed Fathy El Shawaf
Radiology Department, Faculty of Medicine, Ain shams University
Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices
including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to
effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable
amongst those cirrhotic patients who are not viable candidates for splenectomy.
Purpose: This study aims to discuss the role of partial splenic artery embolization in the treatment of the
decreased hematologic indices including thrombocytopenia and leukopenia in chronic liver disease and the
efficacy of this method in increasing of hematologic indices in cirrhotic patients with splenomegaly
Patients and methods: twenty-five patients with chronic liver disease were included.
All patients had chronic liver disease with hypersplenism and hyperactive bone marrow and all patients
underwent PSE in one session then follow-up after one month was done.
Results: The mean age of the selected patients was about 46years old.
All patients showed significant increase in the platelet count after one session and remained at appropriate levels
during the follow up period.
Postembolization syndrome was the most common complication and occurred in all patients (100%).Ascites
developed in 4 patients (16%). Portal vein thrombosis developed in 2 patient (8%) Splenic abscess developed in
1 patient (4%). No other complications has been reported. None of the patients developed septic shock. No post
procedure mortality occurred.
Conclusion: Partial splenic artery embolization is an effective method for the treatment of hypersplenism caused
by chronic liver disease and more safe than splenectomy as it results in improvement of the hematological status
with preservation of immunological role of the spleen.
Keywords: Splenic arterial embolization (SAE); Partial splenic arterial embolization (PSE); Hepatitis C Virus
(HCV); Complete Blood Count (CBC); Ultrasound (US), Computed Tomography (CT).
The spleen helps filter old and damaged cells from
low white blood cell counts, or thrombocytopenia, a
bloodstream. If the spleen is overactive, it removes
deficiency of circulating platelets in the blood .
the blood cells too early and too quickly. The spleen
Hypersplenism occurs in patients with chronic
plays a key role in helping your body fight infections.
liver disease, and splenectomy is the definitive
Problems with the spleen can make you more likely
treatment. However, the operation may be hazardous
to develop infections .
in patients with poor liver function. In recent years,
Many patients with advanced liver disease
partial splenic embolization (PSE) has been widely
(especially cirrhotic patients) develop portal
used in patients with hypersplenism and cirrhosis.
hypertension that results in an enlarged spleen and
This study was conducted to assess the safety and
subsequent platelet sequestration. The increase in
efficacy of PSAE in the management of
resistance to portal blood flow (i.e. increased portal
hypersplenism in cirrhotic patients.
pressure) causes redistribution of blood to the spleen,
Splenic embolization was first introduced in 1973,
subsequent pooling of platelets, and the increased
when autologous blood clot was used by Maddison to
clearance of platelets from the circulation .
Symptoms of hypersplenism include easy bruising,
hypersplenism treatment. Seven years later,
increased liability of bacterial infection, fever,
transcatheter partial splenic embolization (PSE) was
weakness, palpitations, ulcerations of the mouth, legs
developed by Spigos et al., which has been proved as
and feet, heavily bleeding from the nose or other
a safe and effective method of vascular occlusion.
mucous membrane. Most patients will develop an
Since then, PSE has ever been gaining its indications
enlarged spleen, anemia, leukopenia or abnormally
and is popularly used in the world, nowadays, and
increasingly performed to treat various clinical
Received:6 /1 /2018 DOI: 10.12816/0045637
Accepted: 16/ 1 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2434-2442
Prevalence of Diabetes among Patients with Chronic
Kidney Disease in Hail Region
Saleh Muflih Alghaythi, Meshari Sultan Turki Alsudayri, Fouad Taiwilaa Alshammari,
Ali Ghannam Alrashidi, Abdulaziz Muflih Alghaithi,
Meshal Fazaa Alrashidi, Abdulhafiz Ibrahim Bashir
College of Medicine, University of Hail, Kingdom of Saudi Arabia
Background: Diabetes is associated with increasing prevalence of chronic kidney disease (CKD) and
progression of the disease. Therefore, objective of this study was to estimate the prevalence of diabetes among
patients with CKD in Hail, Kingdom of Saudi Arabia (KSA).
Methodology: This is a cross-sectional study carried in the nephrology outpatient's clinic in King Khalid
Hospital. A total of 200 patients known to have CKD were included in the study.
Results: The study included 200 patients, of whom 98 (49%) were females and 102 (51%) were males, the
mean age of the population study is 55.6 years. The females were significantly lower age than the males. The
overall prevalence of diabetes in patients with CKD was 69% among them 73.9% with retinopathy. Diabetes
and female gender are associated with more advanced stage of CKD. The mean average of eGFR was
significantly lower in patients with diabetes and it inversely correlates with HbA1c. The mean time of onset of
CKD in diabetic patients after the diagnosis of diabetes is 11.7 ± 0.67 years, females are significantly lower
than males in the meantime of onset of CKD after the diagnosis of diabetes. Association of diabetes and
hypertension in patients with CKD 87.7% were hypertensive among them 72.6% were diabetics.
Conclusion: The role of diabetes as a risk factor for CKD and ESRD is higher than it has been estimated in
previous studies in other regions in Saudi Arabia. Females are at higher risk of CKD and eventually ESRD
Keywords: CKD, Risk factors, Hail, Saudi Arabia, GFR , ESRD,
of diabetic patients have diabetic nephropathy ,
Chronic Kidney Disease (CKD), defined as
clinical nephropathy occurs about 10-20 years
kidney damage that lead to progressive
after onset of diabetes , ESRD Almost 20-30 years
deterioration of renal function as measured by
after onset of diabetes, Both types of diabetes can
Glomerular filtration rate (GFR), and it is a
lead to chronic kidney disease and eventually
worldwide public health problem (1, 2). CKD is
ESRD , and type 1 diabetic patients after onset of
diagnosed when GFR becomes less than 60
clinical nephropathy is approximately 75 % are
ml/min per 1.73 m2 and/or kidney damage for
likely to reach ESRD while type 2 diabetic
three or more months, kidney damage is most
patients are approximately 20% likely to reach
ESRD (13). A greater incidence of end stage CKD
has been reported in Males (14), while Female
CKD is classified into five stages (stages 15)
gender has been associated with a slower
according to estimated GFR and urinary protein
progression of CKD and better kidney
excretion. End-stage renal disease (ESRD) which
conservation and patient health outcomes (15).
corresponds to an eGFR of <15 mL/min/1.73m (4).
Diabetic nephropathy is significantly associated
Prevalence of CKD is 8-16% worldwide (5) while
with diabetic Retinopathy and the greater severity
prevalence of CKD in Saudi population is around
of Retinopathy is associated with lower estimated
5.7% (6) and the prevalence of CKD in Hail region
glomerular filtration rate (eGFR) (16, 17). Therefore,
is (9.4%) (7).
objective of this study was to estimate the
Diabetes is a major health problem and it is
prevalence of diabetic nephropathy among patients
estimated to be the 7th leading cause of death in
with CKD in Hail, Kingdom of Saudi Arabia
2030 (8). The prevalence of diabetes is high among
Saudi population and is estimated to be 34.1% in
males and 27.6% in females (9). Saudi Arabia is
SUBJECTS AND METHODS
ranked among the top 10 countries in the world for
This is a cross-sectional study carried in the
the prevalence of diabetes (10).
nephrology outpatients clinic in King Khalid
Diabetes is the most common cause of CKD and
Hospital- Hail City which is located in the
ESRD in most parts of the world, 33% of the cases
northwestern of Saudi Arabia and has a population
with CKD (11, 12). therefore, increase of diabetic
of around 412,758 inhabitants. The study was
patients will lead to increase of CKD, 20 to 30%
Received:6 / 1 /2018 DOI: 10.12816/0045638
Accepted: 16/ 1 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2443-2446
Assessment of Knowledge about Liver Cirrhosis among Saudi Population
Jana Jamalaldeen Al-Johani, Saja Mohammad Aljehani, Ghaedaa Saad Alzahrani
King Abdelaziz University
Background: Liver cirrhosis is chronic disease associated with high mortality and morbidity rates all over the
Objectives: evaluating the knowledge of adult Saudi population toward liver cirrhosis.
Methods: A qualitative study was conducted in Kingdom of Saudi Arabia among 820 Saudi subjects during the
period from October to December 2017.
Results: A total of 820 subjects were enrolled in the study. All the subjects had good knowledge regarding the
definition of liver cirrhosis. The majority of subjects had moderate knowledge regarding the causes, prognosis
and treatment of liver cirrhosis. More than half of the subjects (54%) had good knowledge regarding liver
cirrhosis while 46% had poor knowledge. There was a positive significant association between younger age and
high level education with good awareness about cirrhosis of liver
Conclusion: The level of awareness among Saudi population toward LC was moderate which necessitates
encouraging the educational campaigns on T.V, internet and all over the whole parts of KSA.
Keywords: Liver cirrhosis, Knowledge, Saudi adults, KSA, Community.
SUBJECTS AND METHODS
Liver cirrhosis is defined as a progressive - Study design
and chronic liver disease that cause deterioration and
A qualitative study was conducted in Kingdom
destruction of liver cells. The connective tissue
of Saudi Arabia among community population
fibroids disturb the lymph and blood flow thus
during the period from October to December 2017.
interfere with the normal structure and physiology of - Sample size and population
The sample size was determined using Raosoft
The exact causes of liver cirrhosis can't be
sample size calculator(10)with 50% response rate and
defined till now but many disorders could result in
95% confidence interval and 5% margin error. The
increasing the liver cirrhosis morbidity and mortality
sample size for this study included 820 Saudi adults.
around the world (2). It is also related to alcoholic
The subjects were chosen using randomized
liver disease and chronic viral hepatitis as hepatitis C
technique from different parts of KSA and were
and B (3). The clinical symptoms differ among
interviewed in different randomized shopping malls.
subjects according to the first time for diagnosis,
The exclusion criteria were non-Saudi subjects,
severity and duration of the disease (4).
The incidence of liver cirrhosis is
significantly associated with older populations aged
from40 to 60 years old. In United States, it is the
All enrolled subjects undergone an interview and
fifth principalof mortality among old population (5).
asked to refill a questionnaire sheet to assess their
Also, it the most essential reason of mortality in
knowledge regarding liver cirrhosis.
Asia (6). In Kingdom of Saudi Arabia (KSA), liver - Ethical considerations
cirrhosis establishes a chief health disorder asabout
A written approval was given by the
10% suffer from HBsAg (7)and HCV represents
participants and the Faculty of Medicine. The
about 1.2-2.5% among Saudis (8, 9).
study was done after approval of ethical
To our knowledge, it is the first qualitative
board of King Abdulaziz university.
study conducted in KSA to assess the knowledge
community Saudi population toward liver cirrhosis.
- Statistical analysis
The data were possessed using the Statistical
AIM OF THE STUDY
Package for Social Science (SPSS) program version
The study aimed at evaluating the
22. The descriptive statistical data are shown as
knowledge of adult Saudi population toward liver
frequency and percentage. P values < 0.05is
Received:6 / 1/2018 DOI: 10.12816/0045639
Accepted:16 / 1/2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2447-2453
Catheter Directed Thrombolysis in Treatment of Acute Iliofemoral Deep
Venous Thrombosis: Determinants of Outcome
Mohamed Emam Fakhr, Emad El Din Ahmed Husein, Wagih Fawzy Abdel Malek,
Atef Abdel Hamid Desouky, Ramez Mounir Wahba, Mohamed Mahmoud Zaki
Vascular Surgery Department, Faculty of Medicine, Ain Shams University, Cairo
Corresponding Author: Mohamed Emam Fakhr, email:firstname.lastname@example.org
Background: Acute deep vein thrombosis (DVT) of the lower limbs occurs in about 1.0 person per 1000
population per year and is associated with substantial morbidity. Although anticoagulation effectively prevents
thrombus extension, pulmonary embolism, death, and recurrence may occur. Moreover, many patients develop
venous dysfunction resulting in post-thrombotic syndrome (PTS). PTS is associated with reduced individual
health-related quality of life and a substantially increased economic burden. Hence, additional and more
aggressive treatment, including systemic thrombolysis, thrombectomy, and catheter- directed thrombolysis (CDT),
has been introduced to accelerate thrombus removal. Numerous studies suggest that additional CDT may provide
highly effective clot lysis. There is little doubt that the overall benefit of thrombolysis depends on multiple factors,
including predisposing risks, symptom duration, thrombus extension, and technical approaches and interventional
success. Aim of the Work: This study aimed to define predictors of immediate and mid-long-term anatomic and
clinical failures to guide patient selection and to set a standard for patient and physician expectations. Patients
and Methods: This is a prospective observational cohort study that enrolled 20 patients (22 limbs) who presented
to the Ain Shams University hospitals in the period from 7/2015 to 7/2017 with acute iliofemoral deep venous
thrombosis (IFDVT) and fulfilled the inclusion criteria (mentioned below). Intrathrombus catheter directed
thrombolysis (CDT) was done. Assessments of predictors of immediate periprocedural success was based on
degree of clot lysis and resolution of symptoms and signs. Incidence of postthrombotic syndrome (PTS) was
calculated at 6 months postoperative using Villalta score (5 vs <5). Results: During the study duration, 20
patients (22 limbs) were recruited. The mean age was 40.95 ± 12.35 years old, 11 patients (12 limbs) were women.
The indication for CDT was severe progressive pain/swelling (18 limbs), and phlegmasia cerulea dolens (4 limbs).
5 patients (7 limbs) had IVC thrombosis at the initial venography. 5 limbs had balloon dilatation only while iliac
stenting was done in 12 limbs. 15 patients received CDT for 48 hours while 5 patients (7 limbs) received CDT for
24 hours (mean duration of CDT was 1.68 days). As regards bleeding, only 2 cases of those who had CDT for 24
hours had bleeding, while bleeding occurred in 12 cases of those who had CDT for 48 hours. There were no
recurrent DVT, intra or postoperative pulmonary embolism nor death within the study population till the end of
the follow up period (6months). 6 months post intervention, 7 limbs were free of PTS (Villalta score < 5), 15 limbs
had mild to moderate PTS, and no patients had severe PTS. The mean Villalta score was 5.14 ± 1.859.
Conclusion: In our study, determinants of outcome following CDT for acute IFDVT were: 1) access site, 2) dose
of thrombolytic agent used, 3) duration of thrombolysis, and 4) thrombus score at the end of the procedure. More
studies should be done comparing not only the effect of CDT on incidence of PTS but also its effect on its severity
(e.g. Villalta score) on short and long term.
Keywords: Catheter directed thrombolysis, Iliofemoral, Deep Venous Thrombosis, Determinants, Outcome.
Venous thromboembolism (VTE) is a
chronic venous insufficiency (3). Patients with IFDVT
major cause of morbidity and is the leading cause
stand to benefit from a treatment strategy that
of death in hospitalized patients (1).
removes the clot, such as catheter - directed
The complications of acute VTE, including
thrombolysis (CDT) or venous thrombectomy,
DVT, pulmonary embolism (PE), and the
followed by effective anticoagulation (1). Catheter-
postthrombotic syndrome (PTS), are the most
directed lysis seems to have a better outcome
common preventable cause of hospital death and a
compared to anticoagulant treatment or systemic lysis
source of substantial long-term morbidity. Severe
(4). There is little doubt that the overall benefit of
manifestations of the PTS are a consequence of
thrombolysis depends on multiple factors, including
ambulatory venous hypertension, which is
predisposing risks, symptom duration, thrombus
determined by a combination of factors, including
valvular reflux, persistent venous obstruction, and
interventional success. The identification of
the anatomic distribution of these abnormalities (2).
patients who will achieve favorable outcomes and
Early aggressive treatment of acute
derive long-term benefits from intervention is
iliofemoral DVT (IFDVT) is indicated to prevent
therefore paramount (5).
Received:7/ 1 /2018 DOI: 10.12816/0045640
Accepted:17 / 1 /2018
Cytokeratin-18 Fragment Level As a Biomarker of Non-Alcoholic Fatty Liver Disease In Egyptian Patients With Type 2 Diabetes Mellitus
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2454-2462
Effect of Deferred Cord Clamping on Respiratory Function in Neonates
Fekria Ahmed Mohamed Salama, Nermeen Ahmed Mostafa El-Ghareeb, Ahmed Adel Hassan
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University
Corresponding author: Ahmed Adel Hassan, email: email@example.com,01117219897
Background: the optimal timing of clamping of the umbilical cord after birth have been a subject of controversy
and debate, However, there is insufficient evidence to date to support a recommendation as regards the impact of
DCC on respiratory function in preterm neonates to delay cord clamping.
Aim of the work: this study aimed to evaluate the effect of deferred cord clamping on respiratory function in
preterm neonates born vaginal.
Methods: The study was randomized controlled trial, including 100 Pregnant women (age 20-35 years old) had
spontaneous preterm birth vaginal from 34-36+6 weeks, 50 subjected to ECC and 50 subjected to DCC.
Results: neonates in the two-randomization group differed significantly in requirement of O2 and ventilatory
support, and neonates in the ECC group had a mean that was higher than neonates in the DCC group in both
CPAP and nasal O2 (ECC 6 (12.0%) vs. DCC 1 (2.0%) ECC 27 (54.0%) vs. DCC 18 (36.0%) in CPAP and O2
requirement respectively. Apgar scores at 1 and 5 min were significantly different in the two groups, and in
general higher in DCC than ECC, reflecting better respiratory symptoms in group DCC.
Conclusion: the existing literature on delayed cord clamping has consistently demonstrated benefit especially for
preterm neonates in facilitating placental transfusion. Improved physiologic stability in transition (blood
pressure), better respiratory outcome, reduced need for transfusion is valuable improvements in outcome.
Keywords: DCC; ECC; preterm; respiratory.
· Charles White: 1773. "The common method
ECC has been described as CC performed
of tying and cutting the navel string in the instant
from 10 seconds and up to 60 seconds post delivery,
the child is born, is likewise one of those errors in
whereas DCC is defined as CC performed after 30 to
practice that has nothing to plead in its favour but
60 seconds or extending up to 2 to 3 minutes of birth,
and/or after cessation of pulsations in the cord.
· Darwin E: 1801 "Another thing very injurious
Accumulating evidence suggests that CC beyond 30
to the child, is the tying and cutting of the navel
to 60 seconds after birth is of benefit for most
string too soon; which should always be left till the
child has not only repeatedly breathed but till all
Multiple studies have demonstrated that
pulsation in the cord ceases. As otherwise the child
delayed clamping of the umbilical cord at delivery,
is much weaker than it ought to be, a portion of the
with consequent flow of autologous placental blood
blood being left in the placenta, which ought to have
into the neonate, will provide up to 30 percent more
been in the child" (1).
blood volume and 60 percent more red blood cells
Traditionally, the umbilical cord is clamped
(RBCs) to the neonate than after immediate cord
and cut immediately after birth, but in 2010, the
clamping. For preterm neonates, several clinical
Inter-national Liaison Committee on Resuscitation
trials of delayed versus immediate cord clamping
(ILCOR) recommended that the cord should not be
have reported mixed results sometimes favorable
cut for at least 1min after birth in infants not
with improved circulatory hemodynamics, better
requiring resuscitation. Recently the need of
cardiopulmonary adaptation to extrauterine life,
resuscitation is not acontraindication for DCC
diminished need for RBC transfusions, and less
intraventricular hemorrhage after delayed cord
recommended change in practice is to facilitate blood
clamping. For term infants, however, concerns have
transfer from placenta to baby to reduce iron
been raised that delayed clamping results in
deficiency and later anemia(2).
Umbilical cord clamping (CC) and sub-
erythrocytosis with plethora and hyperviscosity, and
sequent cutting are routine procedures performed at
hyperbilirubinemia. Thus, delayed cord clamping is
all facility-based deliveries, but the optimal time for
not widely practiced in the United States because
clamping remains unclear. After decades with focus
favorable clinical endpoints of delayed umbilical
on immediate or early cord clamping (ECC), the past
cord clamping trials have been inconsistent and
15 years have seen a shift toward delayed cord
because delayed cord clamping precludes prompt
clamping (DCC). This issue has provoked intense
resuscitation of preterm neonates and may cause
international debate and is further complicated from
problems of "overtransfusion" in term infants(4).
a lack of what defines both ECC and DCC(3).
Received:14 /1 /2018 DOI: 10.12816/0045641
Accepted:24 / 1 /2018
Ultrasonic Ovarian Drilling as a First choice in Infertile Women with Polycystic Ovary Syndrome
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2463-2469
Clinical Audit in the Management of Mild Pre-eclampsia in Upper Egypt
Mohamed Abd El-Samie Mohamed (1), Abd El-Naser Abd El-Gaber Ali (2)*, Amal Falih Gebreel (3)
Obstetrics & Gynecology Departments, AL-Azhar University (1),
South valley University (2), Sohag General Hospital (3)
*Corresponding Author: Abd El-Naser Abd El-Gaber Ali, Obstetrics & Gynecology Department - Faculty of
Medicine- South Valley University. Email: firstname.lastname@example.org
Background: Clinical audits based on standard criteria have been used in developed countries in order to
improve the management of certain diseases, but have been nowadays introduced in assessment of diseases in
developing countries as pre-eclampsia and eclampsia. Study Design: a retrospective study. Objective: to
assess the clinical audit in the management of mild Pre-eclampsia in Upper Egypt. Setting: Obstetrics &
Gynecology department, Sohag General Hospital. Duration: from 1st of January 2015 to the end of December
2015. Patients and methods: this clinical audit study was conducted on 108 pregnant women who had mild
pre-eclampsia from those admitted to Obstetrics & Gynecology department of Sohag General Hospital.
Patients were diagnosed as mild preeclampsia according to ACOG criteria, 2013 of mild preeclampsia.
Results: about 33% of studied cases developed featured of severe pre-eclampsia. Vaginal delivery was only in
31.4% of cases. The clinical audit was nearly adherence to standards of mild pre-eclampsia management but
was very poor in asking about symptoms of severe disease only obtained for 7.4% of cases, family history was
neglected completely, lower limb examination was fairly done in 60.2% of cases, pelvic examination was
done in 74.1% of cases and no case had chest or heart examination. 24 hours protein collection and protein
creatinine ratio were not done. Only 9.3% of cases were assessed and managed by consultants and 90.7% of
cases were assessed and managed by obstetric specialists. Conclusions& Recommendations: accesses to
prenatal care, early detection and diagnosis of pre-eclampsia, well monitoring and suitable management are
crucial elements in the pre-eclampsia prevention regarded to maternal death. Potential areas for further
improvement in quality of care for management of cases with mild pre-eclampsia related to standardizing
management guidelines, greater involvement of specialists in the management and continued medical
education on current management of disease for junior staff.
Keyword: Clinical Audit Mild Pre-eclampsia Upper Egypt.
the urine, some definitions included the formal
Pre-eclampsia (PE) is a pregnancy disorder
definition beside presence any organ dysfunction
characterized by increase in blood pressure and
. Preeclampsia incidence ranges from 2 to 8% of
presence of a significant amount of protein in
pregnancies all over the world. Hypertensive
urine . The disease usually occurs in last
disorders of pregnancy generally the 2nd cause of
trimester of gestation and becomes worse over
maternal death .Clinical audit is a process of
time. In severe cases there may be breakdown in
quality improvement which seeks to improve care
the erythrocytes, thrombocytopenia, elevated liver
of patient and his outcomes through systematic
enzymes, impaired kidney function, edema,
review of care against the explicit criteria and
dyspnea due to pulmonary edema, or visual
implementation of change. The structure,
defects. Pre-eclampsia has negative effects on
processes and outcomes aspects of care are
outcomes for both the baby and the mother. In
selected and systematically evaluated against
case of negligence in treatment, the disease may
explicit criteria. When indicated, changes are
lead to eclampsia which is characterized by
implemented at an individual, team, or service
presence of convulsions . An earlier survey of
level then further monitoring is used for
risk factors for maternal mortality at the study
improvement confirmation in delivery healthcare
centre implicated the quality of care in about 40%
of maternal deaths . The disease is more frequent
The aims of this audit were:
in primigravida and in cases of twins' pregnancies.
1. Auditing the current management of mild pre-
The underlying mechanism of the disease involves
eclampsia at Obstetrics & Gynecology department
abnormal placental blood vessels beside other
of Sohag General Hospital.
factors. Antenatal diagnosis mostly occurs. But
2. Identifying the gap between the current practice
rarely, the disease begins postnatal period .
on management of with mild pre-eclampsia cases
Diagnosis of pre-eclampsia historically required
at obstetrics & gynecology department of Sohag
high +blood pressure and presence of protein in
General Hospital and ideal practice (according to
Received:17 / 1/2018 DOI: 10.12816/0045642
Accepted:27 /1 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2470-2476
Q Value Based Ablation Profile versus Topography-Guided LASIK: A
Contralateral Comparative Study
Ismail Ibrahim Hamza*, Ahmed Hassan Assaf*, Mohamed Tarek El Naggar**,
Esraa Mohamed Abd El Monem**
* Ophthalmology Department, Faculty of Medicine, Ain Shams University
**M.B Ophthalmology Resident at Research Institute of Ophthalmology
Corresponding author: esraa elkholy , E-mail:email@example.com
Background: laser in situ keratomileusis (LASIK) has become the most widely used form of refractive
surgery. The objective of this surgical technique was to modify the anterior corneal shape by ablating tissue
from the stroma by means of the excimer laser after creating a hinged corneal flap. By this way, we were able
to change the refractive status of the patient and provided better unaided vision. Continuous improvements in
the original technique made the surgical procedure safer, more accurate and repeatable. These progressions
are due to the development of novel technologies that are responsible for new surgical instrumentation , which
makes the surgical procedure easier for the surgeon and better excimer laser ablation algorithms, which
increase the optical quality of the ablation and thus the safety of the vision correction procedure. Aim of
work: the aim of this study was to compare between Q value based ablation and topography-guided LASIK
as regards safety, visual acuity, contrast sensitivity and high order aberration HOAs (spherical, coma and
trefoil). Patients and methods: this study was conducted on 60 eyes of 30 patients, thirty eyes of them
underwent topography guided LASIK and the other 30 underwent Q value based ablation. Preoperative
CDVA (corrected distant visual acuity) was done. Postoperative UDVA and CDVA were measured.
Postoperative high order aberrations were measured 3 months postoperatively. Results: our results showed
that there was no statistically significant difference between both groups as regards UDVA, spherical
equivalent, high order aberrations and Strehl ratio point spread function. Conclusion: topographic guided
ablation and Q value based groups provided essentially equivalent outcomes after myopic LASIK, with
statistically insignificant difference between both profiles, although both laser profiles have been found to be
effective, safe and predictable.
Recommendations: we recommended doing more research regarding this study with larger number of cases
and doing further investigations.
Keywords: Q value, LASIK , UDVA, CDVA.
wavefront-guided algorithms. The wavefront-
Laser in situ keratomileusis (LASIK) has become
optimized approach considers an eye's refractive
the most widely used form of refractive surgery.
error and preoperative keratometry, in conjunction
The objective of this surgical technique is to
with the variable ablation depths of peripherally
modify the anterior corneal shape by ablating
delivered laser pulses, to apply a precalculated
tissue from the stroma by means of the excimer
aspheric ablation that aims to limit induced
laser after creating a hinged corneal flap. By this
spherical aberrations and maintaining the original
way, we are able to change the refractive status of
Q value of the cornea. The Wavefront-guided
the patient, providing better unaided vision.
approach renders a customized treatment plan
Continuous improvements in the original
based on an eye's unique preoperative
technique have made the surgical procedure safer,
aberrometry with the intent of not only
more accurate and repeatable. These progressions
minimizing induced postoperative aberrations but
are due to the development of novel technologies
also reducing or eliminating preoperative High
Order Aberrations (2). Topography-guided ablation
instrumentation, which makes the surgical
is a form of customized ablation that uses current
procedure easier for the surgeon and better
topography instead of a wavefront map as the
excimer laser ablation algorithms, which increase
basis for the treatment. It is found to be an
the optical quality of the ablation and thus the
effective way to treat irregular astigmatism, small
safety of the vision correction procedure (1).
optical zones, and decentered ablations in
Wavefront-based treatments can be classified into
symptomatic post-LASIK patients. It maintains
two broad categories: wavefront-optimized and
the prolate shape of the cornea, reduce corneal
Received:21 / 1 /2018 DOI: 10.12816/0045643
Accepted: 1/ 2 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2477-2483
Attitudes among Qassim University Medical Students, Saudi Arabia
Arwa Sulaiman A. Alkabas1, Aseel Ali Abdullah AlSaeed1, Khaled Suliman Alfozan2,
1 Medical Intern, Qassim University, 2Fifth year Medical Student, Qassim University, Saudi Arabia
3Family Medicine Consultant, Qassim University, Saudi Arabia
Background: health status and lifestyle pattern are examples of health-related practice and the determinant of
the individual's future health, performance and life expectancy. World health organization (WHO) indicated
that 60% of an individual's health-related quality of life depends on life style. The health status can be
controlled by adopting the important aspects for a healthy life style, dietary habit, stress management, physical
activity and smoking cessation. Methods: this cross-sectional study was conducted in College of Medicine,
Qassim University, Saudi Arabia to assess the health promoting lifestyle and associated factors of medical
students. Data was collected using the standardized HPLP II Questionnaires. The questionnaires were covered
in two parts. The first part includes demographic questions and second part included 52 questions related to
Health- Promoting Lifestyle Profile (HPLP-II).426 out of 652 students were participated with response rate of
65%. Results: this study showed that the average of total score regarding to health promotion for all
participants related to the different variable is too less 2.33 out of 4. In addition there is no statistical significant
relation between HPLP Total Scoreand the different study variables; P Value > 0.05. Our study indicated there
was strong positive correlation between HPLP total score and subscales level of significant
0.05 and 0.01.
Keywords: health-promoting lifestyles, medical students, Qassim University, Saudi Arabia.
Day by day chronic illnesses in developed
relations, and stress management. This type of
countries are on the rise. This situation underscores
lifestyle, in addition to improving one's health status
the importance of health services, which should be
and well-being, promotes a sense of satisfaction,
performed in a way to protect, endure, and improve
personal gratification, and self- improvement (4).
the health. The level of health in a society is
A study has been shown that the individual's
measured by the proportion of the healthy
life style choices and lifestyle-related behavior are
individuals within it. An individual who can
formed over years before joining the university.What
assimilate their healthy lifestyle behaviors in life can
is regrettable is that the university student is facing
protect him/ herself from diseases and live a more
many unfamiliar living conditions which are a
qualified and fulfilled life
challenge and sometimes find it difficult to cope
Health status and lifestyle pattern are
with them, as the changes in the study method,
examples of health-related practice and the
curriculum competing and social demands that may
determinant of the individual's future health,
result in a wide range of unhealthy behaviors as in
performance and life expectancy.World health
inadequate nutritional intake andphysical activity
organization (WHO) indicated that 60% of an
. In addition, they may have trouble in
individual's health-related quality of life depends on
organization of time which can have an effect on the
life style . The health status can be controlled by
rest and physical activity time.
adopting the important aspects for a healthy life
Today's medical students are tomorrow's
style;dietary habit, stress management, physical
doctors who are expected to have an important role
in protection and improvement of health in society.
activity and smoking cessation . WHO offers
In addition, they are responsible for the most up to
health-promoting principles and strategies for
date information for the health developing
different populations, and the strategies are not
constitution and for the changing of bad behaviors.
limited to a particular health issue. Development of
Physicians are expected to have an important role in
health-promoting behaviors is feasible through
protecting and improving health. They have an
education and community development policies,
invested interest as caregivers for the increased
rules, and regulations. In fact, these behaviors can
health of the society and as role models in lifestyle
help with the prevention of infectious diseases,
influences for individuals. In this regard, it is natural
injuries, violence, and mental illnesses . Health
to expect them to have the most up to date and
promotion is directly associated with disease
relevant information for the health-developing
prevention, and prevention is obviously preferred to
concept, and the ability to apply this knowledge
treatment. Health-promoting lifestyle (HPL) is a
inpractice. Medical faculties aim to educate students,
component of health promotion and includes six
so they can inform the society and also treat
dimensions: physical activity, nutrition, health
individual disease conditions as well as provide
Received:8 / 1 /2018 DOI: 10.12816/0045644
Accepted: 18/ 1 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2484-2489
Prevalence of Different Eye Diseases Excluding Refractive Errors
Presented at the Outpatient Clinic in Beheira Eye Hospital
Mervat Salah Mourad (1), Rafat Ali Rihan(1), Mouamen Moustafa(1), Ola Abdel Hamid Mansour(2)
1Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt, 2Ophthalmology
Department, Behira Eye Hospital, Damnhour, Behira, Egypt.
Purpose of this study was to determine the frequency and spectrum of eye disorders presenting to the eye clinic of
Damnhour, Behira Eye Hospital.
Introduction: Epidemiological studies provide information on the prevention, treatment, and minimization of the
impact of diseases on the society.
Subjects and Methods: During November 2016 to December 2016, all patients who presented to Damnhour,
Behira Eye Hospital suffering from ocular diseases other than refractive errors were included in this study.6252
patients were examined and evaluated for different eye diseases.
Results: Conjunctival diseases were the most common disorders seen (33.7 %), followed by eye lid and lacrimal
system diseases (27.4 %) and cataract (25.2 %).
Conclusion: The most common causes of ocular morbidity in patients seen at Damnhour, Behira Eye Hospital were
conjunctivitis, blepharitis, chalazia. These morbidities were preventable through community proper eye health
education and proper hygiene. Cataract was the leading cause of visual impairment in elders. Proper intervention
was needed to avoid visual impairment and blindness.
Keywords: Eyediseases, Excluding refractive errors, Damnhour, Beheira Eye Hospital.
Epidemiological studies provide information on
the prevention, treatment, and minimization of the
diabetic retinopathy accounts for 12% of all new
impact of diseases on the society (1).
cases of blindness (7).
The data published by the WHO showed that the
Conjunctivitis affects many people and imposes
total number of persons with visual impairment
economic and social burdens (8). The prevalence of
worldwide in 2010 was estimated to be 285 million,
conjunctivitis varies according to the underlying
including 39 million blind people, of whom around
cause, which may be influenced by the patient's age,
80 per cent were above the age of 50, with most of
as well as the season of the year. Viral conjunctivitis
the causes being preventable (2). Cataract is the
is the most common cause of infectious
leading cause of blindness worldwide. Cataract often
conjunctivitis. Allergic conjunctivitis is the most
develops slowly and can affect one or both eyes.
frequent cause, affecting 15% to 40% of the
Cataracts are the cause of half of blindness and 33%
population, and is observed more frequently in spring
of visual impairment worldwide(3). In the eastern
and summer (9).
Mediterranean region, cataracts are responsible for
Dry eye is a common disorder of the eye's
over 51% of blindness. Childhood-related cataracts
surface, characterized by the degradation of the fluid
are responsible for 520% of world childhood
layer covering the eye (tear film) and increased eye
inflammation (10). Dry eyes occur in 5% to 35% of the
Glaucoma is the second leading cause of
general population and are significantly more
blindness worldwide. It is a group of eye diseases
common in women(11).
which result in damage to the optic nerve and vision
AIM OF WORK
loss. The most common type is open-angle glaucoma
The aim of this study was to determine the
with less common types including closed-angle
frequency and spectrum of eye disorders presenting
glaucoma and normal-tension glaucoma(5). About 60
to the eye clinic of Damnhour, Behira Eye Hospital.
to 67 million people have glaucoma globally (6).
Diabetic retinopathy is a medical condition in
SUBJECTS AND METHODS
which damage occurs to the retina due to diabetes. It
During November 2016 to December 2016, all patients
affects up to 80 %of people who have had diabetes
who presented to Damnhour, Behira Eye Hospital
for 20 years or more. Each year in the United States,
suffering from ocular diseases other than refractive
Received:7 /1 /2018 DOI: 10.12816/0045645
Accepted:17 / 1 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2490-2497
Role of ADC Map MR Imaging in Prediction of Local
Aggressiveness of Prostate Cancer
Asaad Gamal Asaad Sorial, Omar Farouk Kamel, Mohsen Gomaa Hassan Ismail
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Asaad Gamal Asaad Sorial, Mobile: +201024134310,
Objective: of this study is to evaluate the relationship between ADC map values of MR imaging and
local aggressiveness of the prostate Cancer via comparing the ADC values and Gleason score in
Methodology: this study carried out in Radiology Department of Ain Shams University Hospitals. 21
patients with pathologically proven prostate cancer underwent pelvic MRI examination including
diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC).
Result: The mean ADC value is inversely related to Gleason Score.
Keywords: prostate cancer (PCA), Gleason score (GS), apparent diffusion coefficient (ADC),
transrectal ultrasound (TRUS).
tend to be more localized and at an earlier
Prostate cancer is the most commonly
diagnosed solid malignant tumor among men.
The Gleason scoring (GS) system has
The morbidity and mortality directly
been accepted internationally as a reference
attributable to this common malignancy are
grading system for prostate cancer with
significant. However, in a non-negligible
respect to tumor aggressiveness, tumors are
proportion of patients, the disease may be
classified as low risk (Gleason score, 6),
considered relatively indolent .
intermediate risk(Gleason score, 7) or high
The diagnosis of prostate cancer is
risk (Gleason score, 8) .
based on a digital rectal examination (DRE)
To establish the ADC as a strong
and assessment of serum prostate specific
biomarker for predicting prostate cancer
antigen (PSA) followed by transrectal
Gleason scores, standardization of quantitative
ultrasound (TRUS)-guided biopsy .
ADC metrics is of crucial importance .
T2-weighted MRI has been commonly
used to detect prostate cancer. Recently,
AIM OF WORK
diffusion-weighted MRI (DW-MRI) has been
The objective of this study is to
widely introduced in the clinical setting. It is
evaluate the relationship between ADC map
beneficial as it offers increased diagnostic
accuracy due to the clear delineation between
aggressiveness of the prostate cancer via
normal and prostate cancer, namely the high
comparing the ADC values and Gleason score
signal of cancerous lesions. DW-MRI is a non-
in prostate cancer.
invasive imaging technique that quantifies the
diffusion of water molecules in tissues without
PATIENTS AND METHODS
any contrast agents, tracers, or exposure to
radiation. DW-MRI may also provide
During a period of 6 months duration
from August 2017, twenty-one patients were
pathophysiological character of prostate
enrolled in the study. All patients with
elevated prostatic specific antigen (PSA)
values greater than 4 ng/ml underwent sextant
aggressiveness of prostate cancer (PCa) is of
TRUS guided biopsies. MRI examination was
key importance for appropriate management of
done either prior to the TRUS biopsy or at
this disease. The increase in life expectancy of
least 3 weeks after the TRUS biopsy.
the general population combined with efficient
The study was approved by the
screening methods will lead to an increase in
Ethics Board of Ain Shams University.
the number of new PCa cases. These cases will
Received: 22/ 1/2018 DOI: 10.12816/0045646
Accepted:2 / 2 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2498-2504
Role of Melatonin in Anesthesia and Intensive Care
Mina Munir William Khella*, Sherif Sayed Ali Sultan,
Abd EL Aziz Abdallah Abd EL Aziz
Anesthesiology, Intensive Care and Pain Medicine, Ain Shams University
*Corresponding author: Mohammed Elsheikh, E-mail: firstname.lastname@example.org,
Tel no: +2 01220440914
Background: delirium is an extremely common syndrome in the intensive care unit (ICU). It is characterized
by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk,
and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged
duration of ICU and hospital length of stay, and increased mortality. Melatonin and melatonin agonists
(MMA) have the potential to decrease the incidence and severity of delirium
Aim of the study: to review and assess the role of melatonin in several clinical applications in perioperative
management, critical care and pain medicine.
Conclusion: melatonin reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative
stress; emergence behavior; anesthetic requirements; steal induction; and safety. Evidence-based, multi
modal, surgical and anesthetic approaches have reduced morbidity and mortality following surgical
Keywords: Delirium, Melatonin, Anesthesia, Intensive Care.
Delirium, which is also known as an acute
physiological roles, many of which can have
confusional state, is a syndrome characterized by
important clinical applications. Some experimental
disturbance in consciousness (i.e., reduced clarity
studies and clinical trials are providing the basis for
of awareness of the environment), change in
future clinical applications of melatonin of use to
cognition including alteration in attention,
the anesthesiologist .
disorganized thinking, disturbed psychomotor
Exogenous melatonin has a number of
activity, and abnormal sleep-wake cycle .
beneficial actions, first and foremost is its use in
Intensive care delirium is a well-
the treatment of sleep disorders and jet leg. In
recognized complication in critically ill patients.
addition to sleep promotion, melatonin exerts
Delirium is an independent risk factor for death in
numerous other sedative and anti-excitatory
the intensive care unit (ICU), leading to over
effects that clearly go beyond sleep induction
sedation, increased duration of mechanical
since they are also observed in nocturnally-active
ventilation, and increased length of stay. Although
animals. This has been frequently studied in
there has not been a direct causal relationship
relation to its anticonvulsant actions, which have
shown between sleep deprivation and delirium,
been linked to a facilitating role of melatonin on
many studies have demonstrated that critically ill
-aminobutyric acid (GABA) transmission.
patients have an altered sleep pattern, abnormal
Experimental data support the analgesic and
levels of melatonin, and loss of circadian rhythms.
sedative role of melatonin. In adult human, its
Melatonin has a major role in control of circadian
analgesic role has been employed for treatment of
rhythm and sleep regulation and other effects on
diseases with chronic pain.
the immune system, neuroprotection, and
The hypnotic property of melatonin supports
oxidant/anti-oxidant activity. There has been
its possible use in different stages during
interest in the use of exogenous melatonin as a
anesthetic procedures, from premedication to
measure to improve sleep .
induction of general anesthesia for the modulating
Melatonin, once labelled as a master
effects of melatonin on anesthesia drugs . The
hormone, is a natural substance present in all major
present study aims at evaluating the role of
taxa of organisms. It is produced mainly in the
melatonin in several clinical applications in
pineal gland of all mammals and vertebrates and its
perioperative management, critical care and pain
secretion is high during night time and low during
day time. Melatonin is also synthesized in a
number of other organs and peripheral tissues from
Role of Melatonin in Anesthesia
tryptophan. Melatonin has a spectrum of important
Evidence-based, multi-modal, surgical and
properties and plays several important
anesthetic approaches have reduced morbidity and
Received:13 /1 /2018 DOI: 10.12816/0045647
Accepted: 23/ 1 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2505-2511
Assessment of Accuracy of Three Ultrasound Methods for Prediction of
Intrauterine Growth Restriction
Mohamed Taha Ismail, Ahmed Mahmoud Hussein*, Heba Abdel Basset Allam,
Reham Mostafa Mohammed
Department of obstetrics and gynecology, Ain Shams University, Cairo, Egypt
*Corresponding author: Ahmed Mahmoud Hussein, e-mail: email@example.com
Background: fetal growth restriction (FGR) is one of the most important complications encountered during pregnancy.
The growth-restricted fetus is a fetus that fails to reach its growth potential and is at risk for adverse perinatal morbidity
and mortality. The American College of Obstetricians and Gynecologists (ACOG) defines an IUGR fetus as a fetus with
an estimated weight below the 10th percentile
Objective: the study aimed to assess accuracy of transcerebellar diameter (TCD)/ abdominal circumference (AC) ratio,
head circumference (HC)/ abdominal circumference (AC) ratio and hepato-cephalic index (HCI) in predicting
intrauterine growth restriction (IUGR) after 20 weeks of gestation in pregnant women at risk of developing IUGR.
Materials and Methods: a prospective nested cohort study was conducted on 77 pregnant women at risk for IUGR at
Ain-Shams University Maternity hospital. all women were examined by abdominal two-dimensional ultrasound after
20 weeks of gestation to assess the sonographic gestational age (BPD, HC, FL, AC, AFI, degree of placental
maturation) in fetuses. The Fetal Liver Length (FLL) and Transcelebellar Diameter (TCD) were measured at the
time of the scan. Hepato-cephalic index (HCI) was calculated as Fetal Liver Length (FLL)/ Biparital diameter
(BPD). TCD/AC ratio was calculated by dividing Transcerebellar diameter (TCD) and abdominal circumference (AC).
HC/AC ratio was calculated by dividing Head circumference (HC) and abdominal circumference (AC). All women
were followed up and an abdominal ultrasound was done after 3 weeks to confirm diagnosis of IUGR and the same
fetal parameters were measured and documented
Results: in predicting IUGR; TCD/AC and HC/AC have significant excellent diagnostic performance with
95%CI 0.8291.000 and 0.8510.974 respectively. HCI has significant moderate diagnostic performance with 95%
CI 0.7870.956. As regards comparison between the three ratios in prediction of IUGR in our study, we found that:
TCD/AC with a cut-off value 13.77 has the highest diagnostic performance in prediction of IUGR. HC/AC with
a cut-off value 1.04 has moderate diagnostic characteristics in prediction of IUGR. HCI with a cut-off value
0.55 has the lowest diagnostic characteristics in prediction of IUGR
Conclusions: TCD/AC ratio had a better diagnostic validity and accuracy compared to HC/AC and HCI in
Keywords: Intrauterine growth restriction , transcerebellar diameter, head circumference, abdominal
Fetal growth restriction (FGR) is one of most
IUGR refers to the fetus who is SGA and
displays other signs of chronic hypoxia or
pregnancy (1). The terms small for gestational age
malnutrition. SGA is defined here as a fetus who
(SGA) and Intrauterine growth restriction (IUGR)
measures less than the 10th percentile for gestational
are often used interchangeably, although this is
age, whether it be because he is growth-restricted
misleading. The growth-restricted fetus is a fetus that
(IUGR) or just constitutionally small
fails to reach its growth potential and is at risk for
Approximately, 70% of fetuses is classified as being
adverse perinatal morbidity and mortality. The
below the tenth percentile due to constitutional
factors, such as female sex and ethnicity of the
Gynecologists (ACOG) defines an IUGR fetus as a
parents, and are not, therefore, involved in factors
fetus with an estimated weight below the 10th
that can determine increased perinatal morbidity and
percentile (2). But not all fetuses measuring less than
the 10th percentile are at risk for adverse perinatal
IUGR is estimated to affect approximately 3%
outcome; many are just constitutionally small.
5% of pregnancies, depending on the population
Received:25 /1 /2018 DOI: 10.12816/0045648
Accepted: 5/ 2/2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2512-2515
A Comparison between Vitamin D Level in Multiple Sclerosis and
Non-Multiple Sclerosis Patients
Lama A Rayyis1, Mahmoud H Almadani1, Sarah M Shaikhoon1, Hind A Alnajashi2
1-Faculty of Medicine at King Abdulaziz University, 2- Department of Medicine,
King Abdulaziz University, Jeddah, Saudi Arabia
Corresponding author: Lama A. Rayyis, E-mail: firstname.lastname@example.org, Mobile: 0126911955
Background: Multiple sclerosis (MS) is a demyelinating disease of the nervous system. Its etiology is still
not well understood. Lately, attention has been increased for the relation between MS and vitamin D
Objectives: This study aims to compare vitamin D level between MS and non-MS patients looking for any
Methods: This is a retrospective cohort study held at a tertiary hospital. It compares vitamin D level between
MS and non-MS patients in the period from 2010 to 2017. Vitamin D level <50 nmoI/L was considered as
low while level >50nmoI/L was labelled as normal. The means of the vitamin D level were compared using
the independent t-test with a p-value of 0.05 for significance level.
Results: Out of the 96 MS patients, only 72 patients had their vitamin D level measured. (51 females, mean
age 34.62). In comparison with 97 non-MS patients were included in the study (65 females, mean age 37.32).
Vitamin D level mean values in the MS and non-MS patients were calculated as 38.63 and 44.09
respectively. Comparing the means showed a p-value of 0.266.
Conclusion: Despite that vitamin D deficiency is known as one of the risk factors for MS, with the high
prevalence of vitamin D deficiency in this region, the development of MS can be attributed to more relevant
contributing factors and further studies regarding MS risk factors for our population are needed to be sought.
Keywords: Multiple sclerosis, Vitamin D deficiency, Vitamin D, Risk factors, Demyelination.
Multiple sclerosis (MS) is a demyelinating
less vitamin D rich foods. Vitamin D deficiency
disease of the nervous system. It is an autoimmune
may also affect the relapse rate in MS patient
disease that attacks the myelin sheath of the
according to some studies which showed a lower
nerves1. MS is one of the most common
MS relapse rate in patients with normal vitamin D
debilitating disorders in the world affecting
levels 9,10. One other aspect that shows the relation
patients usually between the age of 20 and 40 years
between vitamin D and MS is the effect of vitamin
with a female to male ratio of 3:1 1, 2. It is
D deficiency on the disability associated with MS
considered as the leading cause of non-traumatic
as studies showed that the active hormone 1,25
neurologic disability in young adults 3. The
(OH)2D3 can slow the progression of future
prevalence of MS is increasing worldwide, the
number increased from 2.1 million in 2008 to 2.3
Vitamin D deficiency affects almost one
million in 2013 4. Regarding the Arabian Gulf
billion people worldwide 12. In Saudi Arabia, the
region, recent studies showed moderate to high
prevalence of vitamin D deficiency was found to
prevalence of MS. In every 100,000 individuals,
be high (83.6%) according to a study done in a
31-55 has MS 5.
tertiary hospital on 10,709 patients 5,13. Other
MS etiology is still unknown. It is affected by
studies showed that 20 to 80 % of adults in Saudi
both genetic and environmental risk factors. Lately,
Arabia are vitamin D deficient14. Therefore, the
attention has been increased for a possible relation
high prevalence of vitamin D deficiency could be
between MS and vitamin D deficiency as one of
attributed to the fast rising incidence of MS in this
the environmental risk factors 5. One study found
that individuals with low blood levels of vitamin D
The relation between vitamin D and multiple
are 62% more likely to get MS compared to those
sclerosis have been suggested by many studies.
with normal levels 6.
One of the hypotheses included that the role of
Moreover, several studies showed that more
vitamin D in remyelination which is the process of
sun exposure which in turn leads to a decreased
new myelin sheath forming oligodendrocytes
risk of vitamin D deficiency leads to a lower MS
generation 16. Another hypothesis included the role
risk 7,8. MS patients are also reported to consume
of vitamin D in immunomodulation which has a
Received:20 / 12 /2018 DOI: 10.12816/0045649
Accepted:30 /12 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2516-2522
Awareness and Attitude among Saudi Females toward Breast
Cancer Screening in Al-Ahsa, KSA
Hawraa R. Al-Suroj1, Fatimah B. Al Ali1, Kawthar H. Al-Saleh1,
Lolowah E. Al-Hammar1, Sayed I. Ali1.
1- Department of Family Medicine, College of Medicine, King Faisal University, Al-Ahsa,
Kingdom of Saudi Arabia
Background: breast cancer is a progressive disease, there are three screening tests essential for early
detection; clinical breast examination (CBE), X-ray mammography and breast self-examination (BSE). Lack
of knowledge and wrong beliefs about cancer breast prevention among women affect adversely on their
perception of cure from early detection of the cancer and of screening tests effectiveness. Aim of the work:
this baseline study aimed to assess the awareness of females in Al-Ahsa about breast cancer and their practice
of BSE. Materials and Methods: this was a cross-sectional research, a self-administered survey was used a
questionnaire was distributed to 400 females aged between 20 and 70 years. The questionnaire was divided
into three domains: socio-demographic characteristics, the respondent's knowledge of breast cancer and BSE
and their experience of breast cancer screening and breast self-examination (BSE). Statistical analysis was
performed using SPSS version 23. Results: the overall response rate was 93.3%. Approximately half of the
respondents were highly educated (Bachelor degree) 109 (59.6 %). Of 319 female that responded only 98
(39.7%) had good awareness of breast cancer. 281 (88.1%) perceived the cause to be brought about by
smoking. This was followed, in descending order, by 272 (85.3%) who felt that the old age caused breast
cancer, 264 respondents (82.8%) attributed the cause to hereditary, 211 (66.1%) attributed the cause to oral
contraceptive use. Most of the participants were aware about the protective effect of the breast feeding and
multiparty against breast cancer, 306 (95.9%), 247 (77.4%) respectively Overall, 114 (35.7%) of the
participants aware of breast cancer knew of BSE as a method for the early detection of breast cancer and only
14 (4.4%) had ever performed.
Conclusion: the current status of awareness of breast cancer in Al-Ahsa and their use of BSE are insufficient.
Women need to be encouraged to self-monitor in order to detect abnormalities in their breasts. Appropriate
educational interventions are urgently required to encourage women to engage in regular BSE.
Keywords: awareness, attitude, breast cancer, knowledge, screening, selfexamination.
tests essential for early detection; clinical breast
Breast cancer in Kingdom of Saudi Arabia was
examination (CBE), X-ray mammography, and
the ninth leading cause of death for females in
breast self-examination (BSE) .
2010[1,2]. In 2009, It was reported that the new
Lack of knowledge and wrong beliefs about
cases of breast cancer were 1308 cases. Almost all
cancer breast prevention among women affect
the new cases around 25% were registered among
adversely on their perception of cure from early
Saudi women  and thus it is expected that the
detection of the cancer and of screening tests
occurrence of breast cancer in Kingdom of Saudi
effectiveness . Breast cancer presents most
Arabia will raise throughout the coming decades
commonly as a painless breast lump and a smaller
because of population's growth and aging . In
proportion with non-lump symptoms. For women
Saudi Arabia, even though it had once assumed
to present early to hospital they need to be "breast
that the incidence of breast cancer was low, further
aware"; they must be able to recognize symptoms
recent researches demonstrated that it is a serious
of breast cancer through routine practice of
disease in Saudi community, as in other areas on
practicable screening. At the present time, routine
the world [5,6]. Comparing with western countries,
mammography cannot be recommended in
the pattern of breast cancer in the Kingdom of
developing countries due to financial constraints
Saudi Arabia is very annoying. It typically appears
and the lack of accurate data on the burden of
at advanced stages and affects more the young pre-
breast cancer in these countries. In Saudi Arabia,
menopausal women [5,7,8]. Furthermore, Breast
there were few researches who demonstrated the
cancer is a progressive disease, small tumors are
awareness of detection breast cancer and the
probably to be at an early stage and therefore it will
practice of breast self-examination (BSE) among
have a better prognosis and more successful and
Saudi women [11- 14]. Several studies explored a
effective treatment . There are three screening
decline in cancer mortality as a result of early
Received:7 /1 /2018 DOI: 10.12816/0045650
Accepted:17 /1 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2523-2529
Prediction of Post Total Thyroidectomy Hypocalcemia Using
Perioperative Parathyroid Hormone
Abdel Rahman Mohamed El-Maraghy, Ahmed Mohammed Kamal, Mahmoud Saad Farahat, Haitham
Mostafa Elmaleh and Mohammed ElSaid Basyoni*
Department of General Surgery, Faculty of Medicine, Ain Shams University
*Corresponding author: Mohammed ElSaid Basyoni, E-Mail: email@example.com, Mobile: 00201140801790
Background: hypocalcaemia, which is a major contributing factor for delayed hospital discharge, occurs in
many patients following total thyroidectomy. Parathyroid hormone (PTH) measurement has been proposed as a
marker of this condition.
Aim: the aim of this study was to evaluate the reliability of perioperative parathyroid hormone measurement to
predict post-total thyroidectomy hypocalcaemia.
Patients and methods: a prospective randomized study was conducted in the period between July 2015 and
September 2017 in Ain Shams University, General Surgery Department, Endocrine Surgery Unit, Cairo, Egypt.
The study was conducted on sixty patients for whom total thyroidectomy was done. Parathyroid hormone was
measured pre-operative and 6 hours postoperative, and serum Ca was measured daily to predict hypocalcaemia.
Patients were evaluated for symptoms of hypocalcaemia and treated with calcium and vitamin D
supplementation as necessary.
Results: the study included 60 patients, 12 males and 48 females with mean age 39.1+ 16.52 (20-65). Co morbid
conditions included HTN, DM, ISHD and COPD. Most patients had nodular goiter (48 patients) whether
unilateral or bilateral. 63.3% of patients had follicular lesion by FNABC. All patients underwent total
thyroidectomy. Hypocalcemia developed in 16.7% (10 of 60) of the patients. Best cut off was 66% reduction
giving 77% Sensitivity and 91.4% Specificity. Positive predictive value was 85% and negative predictive value
Conclusion: the evaluation of PTH and corrected calcium levels 6 hours after thyroidectomy allows for an
accurate prediction of the trend of hypocalcemia. This study enables us to discharge most patients safely within
24 hours after total thyroidectomy.
Keywords: parathyroid hormone, total thyroidectomy, hypocalcaemia, parathyroid gland, serum CA.
hypocalcemia have been used. The traditional
Total thyroidectomy is now accepted
method of inpatient clinical assessment and
worldwide as the standard surgical procedure for the
monitoring of serum calcium levels is still used. The
management of benign bilateral nodular thyroid
routine use of oral calcium and/or vitamin D
disease. Hypocalcemia is a common complication of
supplements has been advocated by some endocrine
that procedure; the reported incidence varies from as
surgeons to minimize the incidence of hypocalcemia
low as 1% to as high as 50% for patients who
and shorten hospital stays (4, 5). More recently
underwent total thyroidectomy (1). Symptoms range
measurement of parathyroid hormone (PTH) after
from mild paresthesia and tingling to more severe
total thyroidectomy has been utilized to try to predict
cramps, tetany, and convulsions. Hypocalcemia
those patients at risk of developing post-
typically occurs at around 2448 h postoperatively
but may be as delayed as day 4, resulting in longer
The aim of this study is to evaluate the
patient stays than is otherwise necessary. With the
reliability of perioperative parathyroid hormone
increasing preference for shorter hospital stay (2, 3),
measurement to predict post-total thyroidectomy
post-thyroidectomy hypocalcemia became a problem.
The most commonly accepted reasons for
hypocalcemia are hypoparathyroidism secondary to
PATIENTS AND METHODS
devascularization of the parathyroid glands, resection
A prospective randomized study was
of the glands or both. Various strategies for
conducted in the period between July 2015 and
diagnosing and managing post thyroidectomy
September 2017 in Ain Shams University, General
Received:5 / 2/2018 DOI: 10.12816/0045651
Accepted:15 /2 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2530-2534
Impact of Parity on Early Cesarean Scar Healing
Hazem Mohamed Sammour1 , Abdellatif Galal Elkholy1, Radwa Rasheedy Ali1, Ebtesam Mamdouh Fadel2
1- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University
2-Department of Obstetrics and Gynecology , Mataria Teaching Hospital
Corresponding author: Ebtesam Fadel, E-mail: Ebtesam195@hotmail.com
Background: with increasing cesarean delivery rate the cesarean scar defects and related consequences should be
evaluated. Aim of the work: this study aimed to assess impact of parity on cesarean scar wound healing.
Methods: a prospective observational study was conducted on 51 females with singleton term pregnancy that
underwent uncomplicated prelabor primary cesarean section. 6 weeks later they underwent saline
hystrosalpingography. Females with medical diseases that can affect the healing process or received medications
can affect wound healing as corticosteroids or anticoagulant were excluded. Women used intrauterine device as a
contraceptive method inserted during CS, women with any structural uterine abnormality as cervical stenosis or
fibroid uterus or with pelvic infection at the time of saline hystrosalpingography were excluded from this study.
Results: 75% of the primiparous had CS niche, while, 82.9% of the multiparous group had CS defect (p=0.512).
The most prevalent shape of CS defect in the participants was the triangular shape (45.1%) followed by irregular
defect (31.4%). The anterior myometrial thickness and the residual myometrial thickness were significantly higher
among primiparous women with negative correlation between parity, anterior and residual myometrial thickness
(rho = - 0.917 and -0.753 respectively). Conclusion: parity was associated with significant reduction of both the
anterior and residual myometrial thickness.
Keywords: scar niche, parity, cesarean scar.
dilatation is 5 cm(8). According to Hayakawa et al. (9)
Cesarean delivery rate is increasing dramatically;
wedge defects 1 month after cesarean sections were
the percentage of cesarean births in the United States
found to be related to myometrium closure technique,
increased from 20.7% in 1996 to 32% in 2007.
gestational age, multiple pregnancies and premature
Cesarean deliveries increased in all ages, races, ethnic
rupture of membranes.
groups and gestational ages (1). With increasing CS
The current study aimed to assess the parity as a
rate, the long-term morbidity of CS scars was
factor that can impair CS uterine wound healing.
Uterine rupture, abnormal placental implantation,
uterine scar dehiscence in subsequent pregnancies and
scar ectopic pregnancy are common complications
A prospective observational study was conducted on
related to repeated cesarean sections(3). Moreover, the
51 females between 18 and 35 years with singleton
association between abnormal uterine bleeding
term pregnancy underwent uncomplicated prelabor
presented as post menstrual spotting and cesarean scar
primary CS through transverse lower uterine segment
defect was reported (4).
incision in Ain Shams University Maternity Hospital,
The incidence of cesarean scar defect ranged
while, females with medical diseases that can affect the
between 24 and 84 %. This wide range may be due to
healing process as diabetes mellitus, anemia, chronic
absence of unified detection method and diagnostic
renal disease, hepatic disease, coagulopathy or who
criteria for scar niche (5).Few studies assessed clinical
received medications can affect wound healing as
factors related to the present and past obstetric history
corticosteroids or anticoagulant, women used
that can influence the healing of a uterine cesarean
intrauterine device as a contraceptive method inserted
wound and scar niche size (6-9). Conflicting data exists
during CS, women with any structural uterine
regarding potential contributions of clinical variables
abnormality as cervical stenosis or fibroid uterus or
on the integrity of lower uterine segment and scar
with pelvic infection at the time of saline
defects. Two studies examined the importance of
hystrosalpingography were excluded from this study .
single-layer versus double-layer uterine closure with
All participants were subjected to a detailed clinical
contradictory results (6,7). The risk of large scar defect
assessment including: a detailed history, general,
increased if the duration of labor is 5 hours or cervical
abdominal, pelvic examinations, routine obstetric
Received:4 / 1 /2018 DOI: 10.12816/0045652
Accepted:14 / 1/2018
Role of Magnetic Resonance Imaging in Evaluation
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2535-2543
Role of Magnetic Resonance Imaging in Evaluation
of Anterior Knee Pain
Hanan M. Hanafi, Ali H. Ali, Hayder A. Sadeq*
Department of Radiodiagnosis
Faculty of Medicine, Ain shams University
*Corresponding author: Hayder A. Sadeq; Email: firstname.lastname@example.org; Mobile: 01026837016
Background: the term anterior knee pain is often used interchangeably with Patellofemoral pain
syndrome PFPS or runner`s knee. PFPS can be defined as anterior knee pain involving the patella and
retinaculum. Aim of the Work: to highlight the role of magnetic resonance imaging (MRI) in the diagnosis
and grading of the most common causes of anterior knee pain. Patients and Methods: this study included
fifty patients, their ages range between 10-60 years (average age 27 years). All presented with anterior knee
pain (AKP) and were referred to the Radiology Department of El-Demerdash Hospital for MRI examination
after orthopedic consultation. Results: the role of MRI in the diagnosis and grading of the most common
causes of anterior knee pain have been shown in this study. These causes have been classified in to five
disease categories; Patellar abnormalities represented most of them (64% of the sample size) and they
included chondromalacia patella, patellar instability, transient patellar dislocation and painful bipartite
patella. Hoffa`s diseases represented 12% of the sample size and they included Hoffa impingement syndrome
and Hoffa fibrotic bands. Patellar tendon disorders represented 6 % of the sample size and they included
Patellar Tendinopathy and Osgood Schlatter Disease. Quadriceps tendon disorders represented 4% of the
sample size and they included Quadriceps Tendinopathy. Other causes represented 14% of the sample size
and they included torn anterior horn of the lateral meniscus and cartilage injuries. Conclusion: many factors
may cause anterior knee pain. MRI is generally safe, non-ionizing, non-invasive and valuable imaging
technique which has been proven to be the modality of choice for establishing an accurate diagnosis of
different knee pathologies that cause anterior knee pain in different age groups. It also allows to know the
extent, severity, grades and types of the lesions, what will be necessary to decide appropriate treatment.
Recommendations: further studies on a larger scale of patients are needed to confirm the results obtained by
Keywords: MRI, anterior knee pain.
and has replaced diagnostic arthroscopy as the
Anterior knee pain (AKP) is the most
primary diagnostic modality for many knee
common knee complaint, usually occurring in
pathologies. Moreover, MR images can be used to
adolescents and young adults (1).
assess anatomic variants that may contribute to
Previous studies on prevalence estimates of
chronic patellar instability (4).
anterior knee pain in childhood and adolescence
vary widely from 3 to 40 % (2).
AIM OF THE WORK
Despite its high prevalence, the etiology
To highlight the role of magnetic
and differential diagnosis remains a challenge for
resonance imaging (MRI) in the diagnosis and
the treating physician, mainly due to the fact that
grading of the most common causes of anterior
there are no specific clinical signs, and the term
anterior knee pain`` encompasses a wide
spectrum of disorders (3).
PATIENTS AND METHODS
Magnetic resonance imaging (MRI) in the
This study included fifty patients, their
recent decades has become the gold standard
ages range between 10-60 years (average age 27
imaging modality for different knee pathologies as
years). All presented with anterior knee pain
it is safe, and RF pulses used in MRI do not cause
(AKP) and were referred to the radiology
ionization. With MRI, we can obtain direct
department of El-Demerdash hospital for MRI
coronal and oblique images which are impossible
examination after orthopedic consultation. The
with radiography and CT. Particularly useful for
study was approved by the Ethics Board of Ain
the scanning and detection of abnormalities in soft
tissue structures like the cartilage tissues, tendons,
and ligaments. MRI also can help determine
which patients with knee injuries require surgery.
Any patient complaining of anterior knee
MR imaging is recognized as a standard procedure
Received:7 / 1 /2018 DOI: 10.12816/0045653
Accepted:17 / 1/2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2544-2552
Assessment of Clinical Competences and Self-confidence of Radiologist and
Technologist at Asir Region Hospitals, Saudi Arabia
Mohammed Altolub (1), Munirah Batarfi (2), Mohammed Alshulayyil (1), Ahmed Mangahy(1)
1- Collage of medicine, King Saud bin Abdualaziz University for Health Science, Riyadh Saudi Arabia
2- Assistance Professor in Anatomy, Faculty of Medicine, King Fahad Medical City, Riyadh Saudi Arabia
Corresponding author: Mohammed Altolub,email: email@example.com
Background: Evaluating the clinical competencies of radiologist and technologist is the primary important
factor in all medical imaging areas, and it is a necessary prerequisite for assuring professional standard care in
Aim: to evaluate clinical competences from the views of radiologists and technologists by applying the
Radiographers Competence Scale (RCS).
Method: A cross-sectional survey conducted on 185 participants recruited from six hospitals of Asir region of
Saudi Arabia. All data were collected using the self-administrative questionnaire of 28 items scale of
radiographer competence scale consisting of the two components; initial care scale and technical radiographic
process. The level of competencies scale was rated through 10 point and frequency of use on 6 point scale.
Results: The survey completed by 82 (44.3%) radiologist and 103 (55.7%) technologist. Overall mean
significant (P < 0.001) differences scores of Initial Care scale observed between radiologist and technologist.
However, with reference to technical and radiographic process no mean significant differences were detected
between the two groups. The technologist attributed the highest evaluations to such competencies as
"Adequately informing the patient" and "Guiding the patient's relatives", while other attributes the lowest
evaluations expressed in the competencies. The radiologists attributed the highest evaluations to such
competences as "Collaborating with physicians "and "Independent carrying out of the doctors prescriptions",
while the lowest evaluations to the same competences as the technologists.
Conclusion: The significant findings underline the radiologist and high technologist competences in both
"Initial Care scale "and "Technical and Radiographic Process". However, the lower rated competences
emphasis on continuous professional development in the area of medical radiology.
Key words: Assessment, radiologists, technologists, radiographs.
7]. However recently, the rapid growth of the
The skill and art of radiography appeared a hundred
diagnostic and therapeutic imaging system, the
years ago, and from the earliest days, there have
continuous development of new measurement
been several arguments about the characteristics of
procedures, the increasing volume and maintenance
the radiographer in the field of diagnostic imaging
of the quality of services and growth in the field of
and radiation therapy. From the foundation the
radiology which directly affects the skills of the
level of radiography has been one of constant,
radiologist. Consequently, it also impacts on their
continuously changing and growing technology and
jobs and daily task that needs competent knowledge
radiographers have been on the main line of the
and skills which are reflect on patient care too [8 9].
developments that have taken place in healthcare
Consistently improvement and advancement in the
industry [1 3].
field of radiology and the changed radiographic
The field of radiography established differently in
procedures and nursing focus have persuaded
the United States and other European countries,
radiologists clinical competency [17. 21]. Because
which caused substantial differences in the
patients need quality care and support so that
educational curriculum and professional training of
patient's condition can be identified by the
these specialists [4 5]. Therefore, the institutions of
healthcare professionals . Furthermore, it is also
these countries organized their workstations, plan,
essential to understand the patient care and
carry out, and evaluated diagnostic and therapeutic
emergency management, especially quick diagnosis
radiological measures as per to the well-defined
and testing procedure. However, a rare clinical
competences to ensure the quality of the product [3, 6
condition, for example, mobile radiography
Received:20 /12 /2017 DOI: 10.12816/0045654
Accepted:30 / 12 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2553-2555
Is Partial Coherence Interferometry More Accurate than A Scan
Ultrasonography in The Estimation of Anterior Chamber Depth?
Doaa A Mahmoud
Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University,cairo,EGYPT.
Purpose: To assess the degree of agreement of anterior chamber depth (ACD) measurements by optical device
(NIDEK AL-scan biometer) and contact ultrasound A-scan (Mentor [R] - Advent [TM] A/B system US biometry).
Setting: Department of Ophthalmology at ALAZHAR University, Cairo, Egypt.
Methods: This prospective observational cross sectional comparative study of 50 normal healthy eyes were
included in this study, ACD estimation was done by 2 methods partial coherence interferometry(PCI), and contact
ultrasound A-scan. The measurements was performed by the same observer. The difference in measurements
between the two methods was assessed using the t-test.
Results: The mean ACD (±SD) by the two methods were (2.8 mm) and (3.5 mm), respectively. There was a
statistically significant difference between measurements recorded by the 2 methods (P<0.01).
Conclusion: there was a statistically different between the two methods the PCI values were significantly higher (by
0.7 mm) than the U/S values with no correlation between the two sets of values. So PCI is more accurate but we still
need U/S measurements in some situations (e.g., tear film abnormalities, corneal pathologies).
Keywords: AC depth, ultrasound, partial coherence interferometry, phakic IOL.
In this study, I evaluated the agreement between the
Accurate measurements of ocular dimensions
ultrasound biometry (mentor advent A/B System)
have gained considerable importance with the
(U/S) and the non-invasive partial coherence
development and increasing popularity of cataract and
keratorefractive surgeries . The anterior chamber
interferometry (PCI) (NIDEK AL-scan) biometer in
depth (ACD) measurement provides valuable
normal healthy eyes in determining the AC depth.
information in different fields in ophthalmology. It is
Our results provide strong backing to use the new
important for the new theoretical biometric formulas
imaging modalities partial coherence interferometry
used to calculate the power of intraocular lenses
for anterior chamber depth estimation.
(IOLs) . Phakic IOL implantation requires precise
ACD measurement for both surgical planning and IOL
MATERIALS AND METHODS
power calculation . The ACD is also implicated as a
A prospective observational cross sectional
screening risk factor for closed -angle glaucoma .
comparative study. The study was carried out at
Different methods for measuring the ACD are
Alzahraa University hospital between February - July
available, based on ultrasonic, optical and
2017. A total of 50 eyes of 25 healthy young nurses
photographic techniques. The most common method
school students were enrolled in the study.
for ACD measuring has been ultrasound (U/S)
The study protocol was in accordance with the
biometry. This method requires corneal contact, which
tenets of Declaration of Helsinki and was approved by
may lead to false results due to the indentation of the
the Local Ethics Committee of ALAZHAR University.
cornea, and the exact axial placement of the probe
Informed consent was obtained from each participant.
relative to the center of the cornea. Like all contact
Comprehensive anterior segment examinations of all
methods, it may be uncomfortable for the patient or
eyes were performed using slit lamp bio- microscopy.
even lead to damage of the corneal epithelium. Thus,
The exclusion criteria were: history of any intraocular
non-contact methods are preferred for the ACD
or corneal surgery, contact lens wear, glaucoma of any
measurement [5, 6].
type, systemic diseases such diabetes mellitus,
The uses of the optical low coherence reflectometry
intraocular pressure (IOP) of 20 mmHg or more,
(OLCR) and 820nm super luminescent diode
corneal anomalies, spherical refraction of 2.00 diopters
technology has emerged to provide a variety of data
(D) or more; or cylindrical refraction of 2.00 D or
including CCT and ACD readings .
Received:7 / 2/2018 DOI: 10.12816/0045655
Accepted: 17/ 2 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2556-2563
Kappa and Lambda Determination by Single Colored
Immunohistochemistry and Chromogenic in Situ Hybridization
Techniques in BCell Malignancies
Dahlia Ahmed Elsewefy, Amany Ahmed Osman, Abeer Attia Saad Eldeen,
Mohamed Tarif Hamza, Reham Mohamed Abo Elregal
Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Reham M, A, Abo Elregal, E-mail: firstname.lastname@example.org. Tel: +201005145217
Background: kappa and lambda light chains detection in bone marrow trephine sections help in the determination of
B-cell clonality through evaluation of light chain restriction.
Aim of the Work: was to compare the efficacy of single color detection-based immunohistochemistry (IHC) and
chromogenic in situ hybridization (CISH) in evaluating kappa/lambda expression in tissues harboring B-lymphoid
lesions. Patients and Methods: Forty patients were enrolled in this study. They were divided into three groups chronic
lymphocytic leukemia (CLL/SLL) group I (n=13), non-Hodgkin lymphoma (NHL) group II (n=24) and hairy cell
leukemia (HCL) group III (n=3). The 24 NHL cases comprised of (11 diffuse large B-cell lymphoma, 6 mantle cell
lymphomas, 3 marginal zone lymphoma, 2 lymphoplasmacytic lymphoma, 1 follicular lymphomas and 1 Burkitt's
lymphoma). Kappa and lambda light chains were detected in their bone marrow trephine sections using single colored
immunohistochemistry, chromogenic in situ hybridization and the results were compared to the flowcytometry as
Results: Light chain restriction (LCR) was detected by FCM in 100% of the cases followed by CISH (52.1%; 12/23)
of the cases and finally IHC (43%; 18/40).
Conclusion: Both conventional CISH and IHC are effective in determining monoclonality in cases of mature B- cell
neoplasm that has plasmacytic differentiation and with high amount of cytoplasmic Ig light chains such as MZL and
LP. However, they are not effective in determining monoclonality in cases with low amount of Ig light chain such as
cases of pregerminal and germinal center lymphoma. Yet, CISH is more informative than IHC due to the lack of
background staining which allowed for greater discrimination between absence and presence of monoclonality.
Keywords: kappa and lambda, chromogenic in situ hybridization, B-cell malignancies, light chain restriction.
The discrimination between benign and malignant
infiltrate of CD20 and CD3 suggests a reactive
lymphoid infiltrates in bone marrow trephine sections
lymphoproliferative process (5). Also, distribution of B
is one of the major dilemmas that confront
and T lymphocytes within lymphoid aggregates may
hematopathologist (1) .
serve as a useful criterion as aggregates which consist
Several morphological criteria have been
of a central core of T cells surrounded by a rim of B
suggested to resolve this issue such as: the size and
cells, are more likely to be benign. On the other hand,
number of the lymphoid aggregates, the presence of
an increased likelihood of malignancy occurs when
cellular atypia, the histotopography which is the
aggregates consist of a central core of B cells
localization of the lymphoid aggregates within the
surrounded by a rim of T cells (2, 3).
bone marrow space, relation to the surrounding tissue
Since there is no definitive numerical and
(margination or interstitial spillage of lymphoid cells),
and the presence of reticulin fibres, fat cells and
aggregates/nodular lymphoid hyperplasia (NLH), and
surrounding large sinuses. However, their application
malignant lymphoid aggregates in malignant
is often problematic and multiple exceptions to the
lymphoma the study of the usefulness of whether
general rules have been described (2-4). The phenotypic
monoclonality is definite proof of malignancy has
data using CD2 and CD3 might help to distinguish
between benign and malignant aggregates as
In hematopathology laboratory, the determination
homogeneous staining for CD20 favors bone marrow
of kappa or lambda light chain restriction can be done
involvement by B cell lymphoma, whereas a mixed
using flowcytometric immunophenotyping (FCI) but
Received:4 / 2 /2018 DOI: 10.12816/0045656
Accepted:14 / 2 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2564-2572
Pregnancy Outcome after Difficult Embryo
Transfer in IVF-ET Cycles
Salah T Fayed, Adel S Salah El-Din, Maged M Elshourbagy, Najlaa Sh Mahmod
Department of Obstetrics and Gynecology, Faculty of Medicine Ain Shams University
Corresponding author: Najlaa Sh Mahmod; Mobile: 01009076894; Email: email@example.com
Background: Embryo transfer (ET) is one of the most crucial steps in IVF/ICSI treatment. Although it,
apparently, seems simple, it is an integral part of IVF/ICSI and can affect the outcome of the whole treatment
cycle. The majority of couples (approximately 80%) who undergo IVF reach the ET stage, yet few pregnancies
occur. The pregnancy rate after ET is dependent on multiple factors including embryo quality, endometrial
receptivity, and the technique of the ET. Aim of the Work: The aim of the current study is to investigate the
clinical and ongoing clinical pregnancy rates in women who experience difficult embryo transfer (ET) after
IVF/ICSI cycle. Patients and Methods: This prospective cohort study was conducted at Dar Al-Teb Infertility
and IVF Center between January 2017 and January 2018. The study included 417 women planned to undergo ET.
Results: The biochemical, clinical and ongoing clinical pregnancy rates were significantly lower in women who
had difficult ET when compared to women who had easy ET [ORs 0.5, 95% CI (0.31 to 0.83); 0.48, 95% CI
(0.29 to 0.79); 0.36, 95% CI (0.21 to 0.62); respectively]. Conclusion: Difficult ET is associated with
significantly reduced biochemical, clinical and ongoing clinical pregnancy rates. Recommendations: ET should
be smooth with easy passage of the transfer catheter. Since any uterine manipulation during ET adversely affects
IVF results, therefore precaution should be taken to identify possibly difficult ET cases in advance.
Keywords: pregnancy outcome, embryo transfer, IVF-ET cycles.
outcome, an association between difficult ET and first
In vitro fertilization (IVF) has been used over
trimester miscarriage, among women who had initially a
decades as treatment for infertility with different
positive clinical pregnancy outcome, has been practically
etiologies. Despite the developing technology and
and clinically observed (unpublished observational
advances in the field, implantation failure remains a
major problem. Many factors have been proposed
AIM OF THE WORK
including endometrial receptivity, embryo quality
The aim of the current study is to investigate
and the procedure of embryo transfer (ET) (1).
the clinical and ongoing clinical pregnancy rates in
Embryo transfer (ET) is a short, yet the most crucial
women who experience difficult embryo transfer
and critical step that significantly affects the success
(ET) after IVF/ICSI cycle.
of the whole process of IVF (2). Most ETs are easy
and unforced. Difficulties are, however, encountered
PATIENTS AND METHODS
in up to 15-20% of cases. Reasons for difficult ET
include acute version of flexion angles between the
Dar Al-Teb Infertility and IVF Center.
vagina, cervix and the uterine corpus; stenosed
internal os; or previous false tract (3).
The period between January 2017 and
Several strategies have been proposed to
overcome difficulty during ET procedure, including
Prospective cohort study.
instructing the patient to have a full bladder at the
time of the procedure, and use of stylet with soft
The study included women planned to
catheter (4). Nevertheless, for a small group of
undergo ET according the following eligibility
women, ET procedure remains difficult and requires
further steps, which may induce uterine contractions
or provoke endocervical or endometrial bleeding; 1. Age: 20 35 years.
which both might have an adverse impact on 2. Women planned to go their first IVF/ICSI cycle after
successful implantation and the whole IVF outcome
controlled ovarian hyperstimulation (COH) using the
. More interestingly, several prospective and
long GnRH agonist protocol.
retrospective studies have observed that even women 3. Transfer of fresh good quality blastocyst-stage
who had successful implantation following difficult
ETs might have remote bad outcome, in terms of
miscarriage (1,4,7,8, 9). In addition to the evident
1. Women planned to undergo thawed-frozen
association between difficult ET and negative pregnancy
Received:11 / 2 /2018 DOI: 10.12816/0045657
Accepted:21 /2 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2573-2580
Role of MRI in Diagnosis of Rotator Cuff Tears
Hind Abdulelah Abdulsahib Altahhan1*, Maha Muhammed Abdelraoof2,
Marwa Elsayed Abdelrahman2
1 AlMustansiryah University- Iraq,2 Department of Radiology, Faculty of Medicine, Ain-Shams University, Cairo,
*Corresponding Author: Hind Abdulelah Abdulsahib Altahan, E-mail:firstname.lastname@example.org
Background: A rotator cuff tear is a tear of one or more of the tendons of the four rotator cuff muscles of the
shoulder. The rotator cuff is a group of muscles that play an important role in function of the glenohumeral joint.
Value of the clinical examination of a shoulder is often uncommonly exhibited; therefore, imaging modalities have
valuable implications in the management of rotator cuff pathologies.
Aim: the purpose of this study is to assess the diagnostic accuracy of MRI in diagnosis of rotator cuff tears.
Materials and Methods: we examined 20 consecutive cases of shoulder arthroscopy, who had undergone
preoperative investigation in the form of MRI. Comparing the accuracy of MRI for detection of full-thickness rotator
cuff tears, using the operative findings as the `gold standard' was used. All the patients presented to Radiology
Department referred from Orthopedic Outpatient Clinic, El-Demerdash University Hospital and Nassir Institution,
from January 2017 to October 2017.
Results: 16(80%) were males, 4(20%) were females, with age range from (27y) to (57y) (mean range 42y)
complaining of symptoms and signs of shoulder pain which go more with RCT The overall accuracy of MRI in
diagnosis of RCT, was 99%, while sensitivity and specificity was 99%,98.8) respectively, with P value less than
0.05. Conclusion: MRI is an accurate diagnostic imaging method for RCT specially for the FTT, and considered to
be best cost-effective, non-invasive imaging method for screening of rotator cuff tears .In patients who underwent
surgery, MRI yielded comparably high sensitivity for detecting full-thickness RCT.
Keywords: Magnetic resonance imaging, rotator cuff tear, Arthroscopy
sectional area, and fatty degeneration have
Rotator cuff tears are one of the leading causes
implications for the physiologic and mechanical
of shoulder pain with prevalence of 22.1% in general
status of the rotator cuff (9).
population, this prevalence increase with age (1,2), and is
Conventional MRI with T2-weighted
among the most common condition affecting the
images in the oblique coronal and oblique sagittal
shoulder (3).Rotator cuff tears may be either acute
planes is the preferred technique for imaging the
(caused by injury) or chronic (cumulative degeneration)
rotator cuff (1).
(4). In case of acute, major stress is needed to cause a
The purpose of the present study is to
tear in a healthy tendon, while in case of tendon with
assess the diagnostic accuracy of MRI in
preexisting degeneration the stress needed to cause a
diagnosis of rotator cuff tears.
tendon tear is considerably smaller (5).
Diagnosis for rotator cuff tears is based upon
PATIENTS AND METHODS
physical assessment and history, including description
This prospective study comprised of 20
of previous activities and acute or chronic symptoms,
consecutive patients with shoulder pain, who had
as well as systemic physical examination of the
undergone preoperative imaging in the form of US or
MRI and subsequently proceeded to arthroscopic or
Diagnostic modalities, depend on circumstances,
include X-ray, MRI, MR arthrography, double contrast
The study was approved by the Ethics Board
arthrography, and Ultrasound (7).
of Ain Shams University.
MR imaging can provide information about
rotator cuff tears such as tear dimensions, tear depth or
thickness, tendon retraction, and tear shape that can
influence treatment selection and help determine the
a) Patients with shoulder pain
b) Shoulder disability
In addition, tear extension to adjacent
c) No age predilection
structures, muscle atrophy, size of muscle cross
d) No sex predilection
Received: 4/ 2 /2018 DOI: 10.12816/0045658
Accepted: 14/ 2 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2581-2584
Prevalence of Irritable Bowel Syndrome among Medical
Students in Hail University, Saudi Arabia
Adnan Meteb Mohamed Almezani 1, Abdullah Ahmed Alkhalaf 2, Majid Naif Khalaf Alharbi 3,
Saud Abdulaziz Alhuwayfi 4, Hamoud Meshal Alshammari 5, Mohammad Salem Alshammari 6,
Omar Mohammad Alshammari 7, Abdullah Saleh Almuslam 8, Abdualelah Awad Alrashidi 9,
Khalid Faisal Omran Alharbi 10, Anas Abdulrahman Alqasem 11, Zied Abdullah Aljubour 12
College of Medicine University of Hail 1,2,3,4,5,6,7, College of Medicine Imam Abdulrahman Bin Faisal University
8, College of Medicine Jouf University 9, Ibn Sina College MBBS 10, College of Medicine AlMaarefa Colleges
Corresponding author: Adnan Meteb Mohamed Almezani, E-mail: email@example.com,
Phone no: +966554877775
Background: despite the modern society and medical knowledge, irritable bowel syndrome has been common
these days in medical students in Hail city.
Objectives: irritable bowel syndrome (IBS) is a common gastrointestinal disease presenting with abdominal
pain, bloating and change in bowel habit. This study aims to assess the prevalence of irritable bowel syndrome
in medical students in Hail's university, Saudi Arabia.
Methods: a cross-sectional study on the prevalence of irritable bowel syndrome was randomly distributed
among men and women in Hail University in Hail city, of Saudi Arabia from January to February 2018
involving 133 medical student participants. Results: in 18% of the participants have been diagnosed with IBS
and 28.5% fit Rome IV criteria for the diagnosis of IBS. Stress with a percentage of 69.2% and lack of exercise
75.9% being the highest risk factors of IBS.
Conclusion: our result showed that huge number of medical students are suffering from inflammatory bowel
Keywords: Irritable bowel syndrome, Medical students, Rome IV criteria.
A local study in eastern province of Saudi Arabia
Irritable bowel syndrome (IBS) is a chronic
showed that the prevalence of stress among medical
functional gastrointestinal disorder characterized by
students was 53% (7). As a result, medical students
recurrent episodes of abdominal pain, discomfort
are at higher risk of experiencing IBS comparing to
and altered bowel habits that are not explained by
other students in other specialties. A cross-sectional
structural or biochemical abnormalities (1). IBS is a
study was conducted on medical students in Beijing,
disorder that is a heterogeneous in nature and may
China showed that the prevalence of IBS is 33.3%
have a number of causes which may lie anywhere
(8). A similar study in King Abdulaziz University,
from the external environment to the contents of the
Jeddah showed a 31.8% prevalence of IBS among
gut lumen and from the enteric neuromuscular
medical students and interns (9).
apparatus and the gut immune system to the central
nervous system. IBS is the most common chronic
MATERIALS AND METHODS
A cross-sectional study involving 133 medical
approximately 10-20% of the worldwide population
students from Hail university of Saudi Arabia was
(2) and while in some people it represents a nuisance,
done between February-March 2018. The selected
for others it represents a significant negative impact
sample size for this study was randomly determined.
on daily life activities. Only 15 % of these patients
A self-administered questionnaire was developed
seek medical help and attention (2). Local studies in
after a careful review of literature on the subject and
Saudi Arabia revealed that 12% of primary health
it includes 14 questions. The questionnaire consisted
care visits and 28% of medical referrals to
of two parts. Part one; demographical data that
gastroenterologists are due to IBS (3,4). The
includes gender, age, marital status, educational
pathogenesis of this disease is not fully understood.
level. Part two; the students were asked whether
However, there are many factors that can affect
they have been currently diagnosed with IBS or not,
symptoms and severity of IBS such as anxiety,
whether they have been experiencing abdominal
depression, smoking and stress (5). Medical students
pain, discomfort and change in the bowel habit if
experience a high level of stress and pressure that
they have not been diagnosed with IBS. Students
may negatively impact their general health and life
were also asked if the current abdominal pain has
activities. A Korean study found that the prevalence
affected their educational level at university or not,
of IBS was 29.2% among 319 medical students (6).
if they are suffering from anxiety or not and if they
Received:9 /1/2018 DOI: 10.12816/0045659
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2585-2589
Assessment of Knowledge, Attitude and Practice of Parents Towards
Immunization of Children in Saudi Arabia, 2018
Rawan Fuad Habib1, Rawan Awad Alsubhi1, Deyala Wadie Saadawi 1, Ragdah Faisa L AL Hatim 1,
Ahmed Saleh1, Abdualelah Awad Alrashidi 2, Muhjah Abdulhakim Bukhari 3
1Ibn Sina National College, 2Jouf university, 3Umm Alqura university
Background: Immunization has shown a major preventive aspects of infectious diseases, disability and death.
Objectives: Assessing the Knowledge, attitude and practice (KAP) of Saudi parents in Saudi Arabia the
immunization programs for children, Saudi Arabia (KSA), 2018.
Methods: It is a cross sectional survey study that was carried among 600 different Saudi parents form different
Cities of Saudi Arabia for 3 months from Nov 2017 to Jan 2018. The parents completed a questionnaire that
contains 4 different parts about the demographics, knowledge, attitude and practice of parents toward
immunization. Results: The included parents have shown a high level of awareness about vaccination
regarding the preventive measures and importance of vaccination which resulted in positive attitudes and
practice pattern among most of them. The overall KAP was good among most of the parents (87.2%). The
higher KAP level was significantly associated with female gender, higher educational degree and having
higher number of children. Conclusion: Most of Saudi parents had good KAP toward immunization which
was associated with female gender and higher educational degrees. However, educational programs are still
needed to increase the parents' knowledge and practice especially among illiterate and less educated parents
living in rural areas.
Keywords: Knowledge, Attitude, Practice (KAP), Immunization, Vaccination, Parents, Children, KSA, 2018.
and practice pattern of parents toward vaccination
During the last few decades, the burden of the
from the first day of birth could provide early
infectious diseases has been reduced though
prevention from many communicable diseases,
immunization. Also, immunization has shown major
disabilities as well as other causes of death (10, 11).
aspects of disease, disability and death prevention.
The most common vaccine preventable diseases are
AIM OF THE STUDY
Rubella, measles, diphtheria, Tetanus, pertussis and
This study aimed at assessing the Knowledge ,
Polio (1, 2). Giving the child the appropriate vaccine
attitude and practice (KAP) of Saudi parents in
would significantly decrease the costs of disease
Saudi Arabia regarding the immunization programs
treatment and rates of disease thus enhance a good
for children as well as defining the correlation
quality of life for children (3). The WHO estimated a
between KAP and parent's demographics.
reduction in the death rate from infectious diseases
between 2 and 3 million each year (4). The main
vaccines for children in Saudi Arabia are scheduled
from birth to 6 years old by the Saudi Ministry of
It is a cross sectional survey study that was
Health to protect children from the diseases that
carried out in 600 houses that were randomly
could be prevented through immunization (5).
chosen using stratified sampling technique from the
Despite the major efforts of health authorities to
east, west, north and south parts of Saudi Arabia for
keep KSA free of Diphtheria, Pertussis, Tetanus,
3 months from Nov to the end of Jan 2018.
polio and measles, many physicians face major
obstacles from the parents about the safety,
The study included 600 different parents having
efficiency and the necessity of regular childhood
at least one child. The participants have been
vaccines (6). Most of parents in KSA believed that
interviewed in their own houses.
vaccines can cause autism and disabilities (7).
Also, in a global report issued by the CDC, it
This survey included an interview with the
was stated that the general attitude of parents was
parents and were asked to complete a questionnaire.
negative among most of them toward childhood
The questionnaire was collected and tested after
vaccination programs (8). Moreover, some parents
searching the available search engines including
thought that polio immunization will decrease the
Pubmed, Google scholar, science direct,..etc. using
fertility rate thus the parents attitude plays important
the key words including Knowledge , attitude,
role in vaccination process as they are the decision
makers for their children (9). The knowledge, attitude
vaccination. The data of the questionnaire were
collected and reviewed by 3 supervisors to test its
Received: 11/ 3 /2018 DOI: 10.12816/0045660
Accepted:21 / 3 /2018
Breast cancer is a heterogeneous disease, therefore, tumor with the same clinicopathological characteristics may be diverse in disease behavior, response to therapy and prognostic (Carey et al
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2590-2592
Predictive Role of Molecular Subtypes in Response to Neoadjuvant
Chemotherapy in Breast Cancer Patients
Soheir Helmy Mahmoud; Amr Shafik Tawfik; Doaa Atef Mohamed; Kamal Ahmed Shata
Clinical Oncology and Nuclear Medicine Department
Faculty of Medicine - Ain Shams University
Corresponding author : Kamal Ahmed Shata , email: firstname.lastname@example.org
Background: Breast cancer is increasingly regarded as a heterogeneous disease which can be classified into
distinct molecular subtypes with prognostic significance.
Objectives: Retrospective evaluation of the response to neoadjuvant chemotherapy for patients with the major
molecular subtypes of breast cancer as classified using immunohistochemical assay and to investigate the
patterns of benefit from the neoadjuvant chemotherapy in different molecular subtypes
Materials and methods: ER, PR, HER2 and ki-67 were used to divide102 breast cancer patients treated with
neoadjuvant chemotherapy (NCT) into 4 subtypes: luminal A (ER+,PR+,HER2-, and ki-67 14%), luminal B
(ER+, PR+,HER2- and ki-67>14% ; ER+ and/or PR+, HER2+), HER2-overexpression (ER-, PR- and HER2+)
and triple-negative (ER-, PR-,and HER2-). Results: Of the 102 patients analyzed, 9 patients (8.8% of all
patients) achieved pCR with 2.6% (2/76) for luminal subgroup, 0.0% (0/8) for HER2-overpression subgroup
and 38.9% (7/18) for triple-negative subgroup with a high statistical significant value (p=0.000). Conclusions:
Molecular subtypes are good predictors for response to NCT in breast cancer patients. Compared to luminal A
tumors, HER2-overexpression and triple-negative subtypes are more sensitive to NCT.
Keywords: Breast cancer - molecular subtype - predictive factor - chemotherapy - pathologic complete
surrogate marker of better survival (3). Luminal
Breast cancer is a heterogeneous disease,
tumors are considered to be less chemotherapy
therefore, tumor with the same clinicopathological
responsive, and someone even believe that luminal
characteristics may be diverse in disease behavior,
A tumors should receive endocrine therapy only
response to therapy and prognostic. Gene
and should avoid NCT. However, we implemented
expression profiling studies have identified at least
NCT in breast cancer patients not only to achieve
four categories of breast cancer: luminal A, luminal
pCR but also to change the choice of surgery.
B, HER2-overexpression, and basal-like subtype (1).
Treatment of luminal tumors with NCT can allow
Traditionally, neoadjuvant chemotherapy
breast-conserving surgery to take place and as such
(NACT) has been used in locally advanced breast
can be an effective treatment option for this group
cancers that are deemed inoperable. Also, it has
been increasingly used for tumors that are
AIM OF THE WORK
resectable, but the intent is to reduce the tumor size
The aim of this study is to report and
by NACT and subsequently remove a smaller
portion of breast tissue than would otherwise be
neoadjuvant chemotherapy for patients with the
removed at primary surgery. The aim of NCT is to
major molecular subtypes of breast cancer as
downstage the tumor load to increase the rate of
classified using immunohistochemical assay and to
breast-conserving surgery and to gain information
investigate the patterns of benefit from the
on drug response by breast assessment (2).
neoadjuvant chemotherapy in different molecular
Moreover, NCT provides the opportunity to
subtypes in Clinical Oncology Department, Ain
discover predictive markers of chemotherapy.
Shams University hospitals from 2011 to 2014.
Several researches had demonstrated that patients
achieved pathologic complete remission (pCR) had
PATIENTS AND METHODS
better prognosis than those that did not. The
prediction of the possibility of pCR before starting
Our study is retrospective study included
NCT can be used to maximize the treatment and
102 patients from 2011 till 2014. The patients who
minimize unnecessary toxicity (3). It is well
were initially diagnosed by core needle biopsy and
accepted that various subtypes of breast cancer
treated with NCT followed by definitive surgical
show different sensitivities to NCT. A large number
resection were retrieved from the Clinical
of clinical trials had revealed that pCR was related
Oncology Department, Ain Shams University
to good treatment outcomes and could be used as a
Received:19 / 2 /2018 DOI: 10.12816/0045661
Accepted: 1/ 3 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2593-2602
Effect of Honey Supplementation on Clostridium
Difficile Infection in Childhood Cancer
Mohsen Saleh El Alfy, Iman Ahmed Ragab, Sally Mohamed Saber,
Yasmin Gamal El Gendy, Zahia Shahat El Sayed
Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mohsen Saleh El ALFY, E-Mail:email@example.com, Mobile: 01000864343 and Iman Ahmed
Ragab , E- Mail : firstname.lastname@example.org,Mobile :01002550680
Background: the treatment of cancer is associated with nausea and vomiting, oral mucositis, constipation,
xerostomia and diarrhea and weight loss, additionally; chemotherapeutic agents promote inflammatory changes
in the gut, intestinal necrosis, and anaerobic conditions, allowing proliferation of Clostridium Difficile. Honey,
as a natural honeybee product, has antioxidant, antimicrobial, immunomodulatory and anticancer effects. Honey
can fight microbial infection by its immuno-activating, anti-inflammatory and prebiotic activity.
Objectives: the aim of this study was to evaluate the effect of honey supplementation on frequency of
Clostridium Difficile infection (CDI) and gastrointestinal complications in pediatric patients undergoing
Design: a cross sectional study conducted on 40 patients with malignancy recruited from Children's Hospital,
Ain Shams University, Oncology Unit and Clinic, Cairo, Egypt in the period from December 2015 to December
2016. Patients were divided into two groups; group I (25 patients) received honey in the dose of 2gm/kg 3 times
dailyfor 1month) while group II (15 patients) did not receive honey. All the studied patients were subjected to
medical history and clinical examination, with special emphasis on gastrointestinal complication including oral
mucositis, vomiting, diarrhea, constipation, and abdominal pain. Follow up was done for weight, height z score,
gastrointestinal complications and any adverse events. Stool analysis, culture, C difficle toxin A, B by ELISA
was done to all patients at baseline and repeated to patients receiving honey at week 4 of supplementation. Main
outcome measure frequency of CDI, gastrointestinal complication, febrile neutropenia .
Results: the frequency of C difficle was 8% (2), the first case was 9 years old patient with ALL (50%) and the
other 11 years old patient with Burkitts lymphoma both were diagnosed by positive stool culture and positive
stool ELISA for toxin A, B. gastrointestinal complications were significantly less and improved in the
supplemented group and mean of hemoglobin significant increase in group 1.
Conclusion: the frequency of CDI in children with cancer 8% diagnosed by stool culture and toxin A, B study in
stool. Honey improved the oral mucositis and different GIT complications associated with chemotherapy.
Keywords: Honey, Clostridium difficle, Childhood cancer, chemotherapy.
The treatment of cancer is associated with
of CDAD and simultaneously hinder its resolution
nausea and vomiting, oral mucositis, constipation,
xerostomia and food aversion and it thus play an
Honey is natural substance formed from nectar
important role in decreased food intake, nutrient
by honeybees. It is composed primarily of sugars
loss, energy expenditure alterations and weight
glucose, fructose and its greatest component is
loss, particularly lean body mass (1) .
water. Honey also contains numerous other types of
Clostridium difficile is a spore-forming, Gram-
sugar as well as acids, proteins, vitamins and
positive anaerobic bacillus that produces two
minerals (5). Honey can fight microbial infection by
toxins: toxin A and toxin B. It is a common cause
its immuno-activating, anti-inflammatory and
of antibiotic-associated diarrhea (AAD). It accounts
prebiotic activity. Honey inhibits the growth of
for 15-25% of all episodes of AAD (2)
microorganisms and fungi.
Cancer patients have a higher risk for C. difficile
The antibacterial effect of honey is mostly
infection as compared to noncancer patients (3).
against gram-positive bacteria (6). Important honey
Traditional chemotherapy agents have been shown
effects on human digestion have been linked to
honey oligosaccharides. These honey constituents
conditionsthat promote the incidence and severity
has a prebiotic effect, similar to that of
Received:27 /1 /2018 DOI: 10.12816/0045662
Accepted:7 / 2 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2603-2609
Correlation of Ultrasound & Mammography to Histopathology Results in Breast
Cancer. A One Year Study at King Khalid Hospital, Najran, Saudi Arabia
Qaed Salm Alhamami1, Mohammed Hussain Almetlag2, Malik Azhar Hussain3,
Ghadi Mohammed Al Hashan4, Atheer Raja Alyami5
1Radiology resident, King Khalid Hospital, Najran, KSA& Teaching Assistant, Najran University, Nagran,
2Radiology resident, Science and Technology University, King Khalid Hospital, Najran, KSA
3,Assistant Professor, Department of Surgery, College of Medicine, Northern Border University, Arar, 4Medical
Intern, Najran University, Nagran, KSA
Objective: To compare the ultrasound & mammography results to histopathology reports of breast cancer cases
presented in King Khalid hospital, Najran, Saudi Arabia, 2016. Methods: This retrospective cross-sectional
analytic study was performed on 105 patients with breast lumps, who were referred to breast clinic King Khalid
hospital Najran, during 2016. The patients' information was recorded using a checklist, which included name,
code, age, ultrasonography, and mammography results and pathology reports. The results of ultrasonography and
mammography were compared with histopathology. The results were analyzed on SPSS (version 16).
Results: The mean age of the patients was 42.3 (±5) years. Our results showed that in histopathology reports, in
(30/105) patients i.e. 28.6% were malignant, 26 patients (24.8% ) biopsy revealed benign disease. Examination
with mammogram revealed that, 33/105 i.e. (31.4%) were malignant and 40 cases (38.1%) had benign disease.
On ultrasound examination, 21/105 (20%) were malignant and 43(40.1%) had benign disease. The
mammography sensitivity was 76.6% and ultrasound sensitivity was 60%. Breast Imaging-Reporting and Data
System (BIRADS) by mammogram revealed the categories as follows; category 0 in 21.9%, 2in 11.4%, 3 in
31.4, 4 in 5.7%), 4a in 6.7%, 4b in 4.8%, 4c in1.9%, 5 in 8.6% in 6 in 4.8% and unclear in 2.9% of cases. Retro
areolar area was involved in 24.8%, Upper Outer Quadrant in 45.7%, Upper Inner Quadrant in 3.8%, Lower
Outer Quadrant in 4.8%, Lower Inner Quadrant in 8.6%, Diffuse involvement in 9.5% and unable to pick in
2.9%. By mammogram, the calcification found revealed 15.2% of examined patients had malignant lesions.
Findings of lymph nodes examination by mammogram revealed 5.7% of the examined patients had malignant
lesions. Significant difference (P<0.05) regarding the age group was found in pathology and mammogram
results. Conclusion: This study showed that mammography is the preferred diagnostic tool in screening early
breast cancer patients aged above than 40 years with a higher sensitivity; the results are near to open biopsy. For
the younger age group the use of ultrasonography in cases with high breast density is promising.
Keywords: Breast carcinoma, ultrasound, mammogram, comparison, histopathology.
Breast carcinoma is the top most malignancy and
reported at ages lower than 40 (5). Considering the
is the second cause of death in the adult female's
high incidence of advanced breast cancer at young
worldwide. Influencing factors for the incidence of
age group (between 4049), early diagnosis and
disease include estrogen/progesterone, the age of
staging the disease before surgery are important in
menarche/menopause, age at first pregnancy (1). Out
treatment plan (1).
of eight, one woman is affected with a lifetime risk
About all breast cancers are currently diagnosed
of about 12.5% (2).
by needle biopsy, there are some valid exceptions
Breast cancer comprised 25.8% of all newly
for which feasible or essential, and thus require
diagnosed female cancers in Saudi Arabia in 2012,
surgical excision (6). In addition, excisional biopsy
thus ranking as the most common malignancy
of breast lump is the first biopsy choice for obvious
among females with tremendous socioeconomic,
breast cancers in certain centers, also due to cultural
emotional, and public health implications (3). The
early diagnosis, by a meticulous clinical
The two non-invasive radiological investigations;
examination, staging of the disease by radiology and
Ultrasonography and mammography are the
histopathological analysis at the time of disease
important tools in early detection, prompt treatment
presentation play an important role in deciding type
and favorable outcome leading to increased survival
of surgery and fair outcome for these patients (4).
rate in younger females (8,9). Ultrasound Screening
The highest incidence rate in breast cancer
combined with mammography reduced the rate of
reported in 40- to 49-yearage group of adult women,
mortality in breast cancer by 22% in women above
and remaining 23% of cases of breast cancer
50years, and 15% in women aged between 4940
Received:10 / 1 /2018 DOI: 10.12816/0045663
Accepted:20 /1 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2610-2619
Outcome of Restrictive versus Liberal Blood Transfusion
Strategies in Intensive Care Unit Admitted Patients
Omar M ElSafty, Heba A Ahmed, Mohamed M Abdallah, Yahia M Yahia
Department of Anesthesia and Intensive Care
Faculty of Medicine, Ain Shams University
Corresponding author: Yahia M Mahia; Mobile: 01143008761 Email: email@example.com
Background: Anemia is a very common disease in critically ill patients. Approximately 29% of patients
have lower than normal hemoglobin levels when admitted to an ICU, and about 95% develop anemia within
3 days of admission. Aim of the Work: The purpose of this study was to evaluate the effects of restrictive
and liberal red blood cell transfusion strategies on mortality and morbidity in critically ill patients. And as a
result, recommend the more beneficial and the less deleterious strategy for critically ill patients.
Patients and Methods: This clinical interventional study was carried out at Intensive Care Unit, Benha
Teaching Hospital, Egypt, during a period from July 2017 to November 2017. This study was approved by
Ethical Committee of Faculty of Medicine, Ain Shams University, including the informed consents which
were obtained from either the patient or the closest family member. Results: Mortality rates in ICU were 16
% and 20% in group A and B respectively, 24% and 28% within 60 days respectively. There were lower
mortality rates with group A but with no statistically significant difference between groups according to
mortality during ICU Stay and mortality within 60 days. Conclusion: Comparison between the effect of
restrictive and liberal strategies of blood transfusion on mortality and morbidity in critically ill patients
showed no significant differences. Restrictive strategy is at least as effective to liberal strategy in critically ill
patients. Blood transfusion may be hazardous and cost-effective. Recommendations: Anemia is associated
with adverse clinical outcomes. However, randomized clinical trials are required to establish if transfusion is
beneficial or harmful in anemic patients. A restrictive transfusion strategy should be recommended within
the well-studied patient populations and clinical conditions, and the clinicians must continue to use their
experience and bedside clinical judgment to advocate the best management for their patients.
Keywords: blood transfusion, ICU, Restrictive, Liberal.
to specify an appropriate risk/benefit ratio for the
The World Health Organization (WHO)
transfusion. This is because it is also not
defines anemia as hemoglobin (Hb) less than 13
permissible to subject the patient to an
gm/dl in men and 12 gm/dl in women. It is known
intervention whose effectiveness has not been
that anemia is very common in critically ill
documented in terms of reduced mortality or
patients; 65% of critically ill patients have Hb
level < 12 gm/dl at time of admission to the ICU
and a mean admission Hb level of 11.3 gm/dl (1).
AIM OF THE WORK
As a result of this, 14.7 to 33% of patients
The purpose of this study is to evaluate
admitted to ICUs are transfused with RBCs during
the effects of restrictive and liberal red blood cell
their stay and 90% of transfusions are
transfusion strategies on mortality and morbidity
administered to non-bleeding patients with a mean
in critically ill patients. Then, as a result,
of 5 units of RBC per transfused patient. The
recommend the more beneficial and the less
mean pre-transfusion Hb level in ICU patients is
deleterious strategy for critically ill patients.
reported to be around 7.7-8.2 gm/dl (2).
Anemia may result in insufficient oxygen
PATIENTS AND METHODS
delivery (DO2) to vital organs and tissues if DO2
This clinical interventional study was
drops below a critical DO2. While clinical studies
carried out at Intensive Care Unit, Benha
suggest that increasing hemoglobin level via
Teaching Hospital, Egypt, during a period from
transfusion increases DO2, other studies show that
July 2017 to November 2017. This study was
measures of tissue oxygenation either decrease or
approved by Ethical Committee of Faculty of
do not change (3).Some studies have identified
Medicine, Ain Shams University, including the
RBC transfusion as a risk factor for mortality in
informed consents which were obtained from
critical care patients in general (4). However other
either the patient or the closest family member.
studies reported that RBC transfusion was
Patients Inclusion and Exclusion criteria:
associated with a decreased risk of in-hospital
We included patients who were expected to
death in ICU patients (5). This makes it is essential
stay in the intensive care unit more than 24 hours,
Received:19 /2 /2018 DOI: 10.12816/0045665
Accepted: 1/ 3 /2018
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2620-2625
Dynamic Contrast-Enhanced Magnetic Resonance Imaging; A Useful
Tool for Characterization and Assessment of Ovarian Masses
Rania A Maarof, Ahmed S Abdelrahman, Dhifaf A Habeeb
Department of Radiodiagnosis
Faculty of Medicine Ain shams University
Corresponding author: Dhifaf A Habeeb; Mobile: 01012411293; Email: Dc.firstname.lastname@example.org
Objectives: To evaluate the diagnostic performance of dynamic contrast enhanced magnetic resonance imaging
(DCE-MRI) for the characterization of complex ovarian tumors, by using histologic findings as the reference
standard. Patients and methods: 25 patients (age range from 24 to 60) with complex ovarian masses underwent
DCE-MRI before surgical excision. The study included 8 benign, 3 borderline & 14 malignant masses. The
following kinetic parameters were analyzed: enhancement amplitude (EA) in the form of MRE%, time to peak in
the form of T max & maximal slope (MS) & correlated with histopathological results.
Results: DCE-MRI achieved higher overall accuracy (85.7%) & specificity (86.5%) than conventional MRI.
MRE% was higher for malignant than for benign (p0.001) & borderline masses (p0.002). T max was of shorter
duration in malignant than in benign (p, < 0.001) and borderline (p, 0.018) masses. Type III curve was specific for
invasive malignant tumors. Conclusion: DCE-MRI can be a useful tool in characterization of complex ovarian
masses & in differentiating between borderline & invasive malignant neoplasms.
Keywords: Ovarian masses, DCE- MRI, enhancement amplitude, time to peak, maximal slope.
used in evaluating the extent of the disease, in
Ovarian cancer is the fifth leading cause of cancer
pretreatment planning including cytoreduction and
death after bronchial carcinoma, breast, colorectal
post treatment follow up(7). MRI can be a valuable
and pancreatic cancers. Ovarian cancer causes more
problem-solving tool, an adjunctive modality for
deaths than any other cancer of female reproductive
evaluating adnexal lesions, useful to give surgical
system; despite accounting for only 3% of all cancers
planning information without radiation exposure(6).
in women. When ovarian cancer is found in its early
More recently developed MRI sequences, like
stages, treatment is most effective (1). Adnexal
dynamic contrast enhancement sequences provided
masses are common and challenging diagnostic
additional capacities for adnexal lesion tissue
problem because overlapping imaging features of
benign and malignant tumors (2). It is of great
Contrast- enhanced MR imaging provides a
importance to characterize an adnexal mass as
depiction of the internal architecture of lesions,
accurately as possible to guide appropriate
particularly vegetation in a solidcystic lesion (9).
management, so treatment options become more
Dynamic contrast-enhanced MRI (DCE-MRI)
specific. This is particularly true for young women
depends on the leakage of contrast agent from
who should be offered conservative surgery for
capillaries into the extravascular extracellular space,
fertility preservation (3).
thus allowing quantitative analysis which reflects the
US is the first-line imaging investigation for
blood flow and the vascular permeability(10).
suspected adnexal masses, the disadvantage of
DCE-MRI can depict the distribution of contrast
ultrasonography (US) includes its limitation for
by measuring variations in vessel and tissue
characterization of the masses and staging of
enhancement over time. Variations in contrast
malignant masses (4). An adnexal mass is defined as
indeterminate on US when it cannot be confidently
histopathological features of the tumor (11) DCE-MRI
placed into either the benign or malignant has increasingly been used in oncology due to the
category (5). CT is commonly performed in evaluation
insights it offers into tumor microcirculation.
of a suspected ovarian malignancy, but it exposes
Angiogenesis is a key aspect of the growth and
patients to radiation(6).
metastasis of malignant tumors, and characterization
CT has a limited role in the primary evaluation and
of microcirculation can therefore be valuable in
characterization of ovarian lesions; however it can be
discriminating malignant from benign tumors(12).
Received:25 /2/2018 DOI: 10.12816/0045669
Study on Patients with Gunshot Wounds to the Ocular Region
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (2), Page 2626-2632
The Effectiveness of Fractional CO2 LASER in Treatment of
Striae Rubra and Striae Alba: A Comparative Study
Delbent I Mabrouk, Azza E Mostafa, Islam R Hamed
Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Ain Shams University
Corresponding author: Islam R Hamed, Mobile: 01142978441; Email: email@example.com
Background: Striae distensae are a well-recognized, common skin condition that rarely causes any
significant medical problems but are often a significant source of distress to those affected. The natural
evolution of striae is from red or purple, raised wavy lesions (striae rubra) to white atrophic lesions with
wrinkly surface (striae alba). Aim of the Work: was to compare the efficacy of the fractional CO2 laser in
the treatment of striae rubra versus striae alba. Patients and Methods: The present study included 20
patients above the age of 18 of both sexes; 10 patients had striae rubra and 10 patients had striae alba. They
were recruited from Dermatology outpatient clinic in Ain Shams University Hospital from June 2017 to
January 2018. 4 sessions of Fractional CO2 Laser for each patient were performed one month apart. The
treated striae were randomly selected from each patient (Striae rubra and alba) and were assessed before
starting treatment, at the beginning of every session and one month after the last session as regards length,
width, texture, color of striae and any complications encountered. Results: No significant difference was
found on comparing the clinical response (improvement of color P= 0.653), (improvement of atrophy P=
0.606), side effects (Hyperpigmentation P= 0.531), (Pain P=0.606), (Hypopigmentation P=0.305), (Erythema
P= 0.060), of both striae alba and rubra to the laser treatment. Conclusion: The present study showed
significant clinical improvement in both types of striae distensae treated by Fractional CO2 Laser with non-
significant difference between the 2 groups except the development of erythema in striae rubra group.
Furthermore, the histological improvement was significant for both groups with low incidence of the side
effects. Recommendations: Larger scale studies with longer follow up period are recommended to further
clarify the role of fractional CO2 laser in treatment of striae distensae.
Keywords: fractional CO2 Laser, treatment, striae rubra, striae alba.
lymphocytic infiltrate and sometimes eosinophils,
Striae distensae (SD) are frequent
as well as dilated venules and edema in the upper
undesirable skin lesions that result in considerable
part of the dermis. Whereas, fully developed
aesthetic concern (1). SD are usually of a cosmetic
mature lesions present a scanty lymphocytic
concern; however if extensive, they may rupture
infiltrate around the venules and reduced collagen
in an accident. Recent or immature stria defined as
bands in the upper third of the reticular dermis
linear bands of smooth skin which are
which are aligned parallel to the surface of the
erythematous or violaceous and may be itchy and
skin. Elastic fibers seem to be increased in number
slightly elevated. Such striae maintain their
and grouped in sets as a consequence of the loss
characteristics for a short period, usually
of collagen bands. In later stages, there is a
approximately 6 to 10 months. In their later stage,
thinning of the epidermis due to flattening of the
they become white, flat, or depressed, and are
rete ridges (4).
more difficult to treat (2).
In current practice, even with significant
The precise etiology and pathogenesis of
dermatologic advance in topical medications and
striae have not yet been clearly explained (3). They
light-based devices, total resolution of these
are commonly found during pregnancy, after a
lesions remains an unattainable goal. Al-Himadani
sudden gain or loss of weight, in Cushing's
et al. (6) identified that no high-quality treatments
disease, in association with prolonged use of
for SD exist. Among the main options are topical
strong systemic or topical corticosteroids and due
tretinoin alone (7), glycolic acid in conjunction
to rapid growth in adolescence with its consequent
with L-ascorbic acid or tretinoin (8), pulsed dye
skin distention (4). They are two and a half times
laser, CO2 laser, intense pulsed light (IPL) and the
more frequent in women and affecting up to 90%
excimer laser (1,4,9,10). It is also known that several
during pregnancy (5).
lasers (585 nm collagen remodeling pulsed dye
The histopathologic findings vary according
laser and 1,540 nm Er: Glass laser) have proven
to the duration of these lesions. Recent striae
efficacy in the induction of new collagen
show a deep and superficial perivascular
Received: 3/ 2 /2018 DOI: 10.12816/0045671
Accepted:13 / 2 /2018