c:\work\Jor\vol715_1 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3079-3085

The Role of Olive Leaves and Pomegranate Peel Extracts on
Diabetes Mellitus Induced in Male Rats
Fahmy G. Elsaid1,2,*, Khalid M. Alsyaad1, Fatimah A. Alqahtani1
1Biology department, Science College, King Khalid University, KSA
2Zoology department, Faculty of science, Mansoura University, Egypt
*Corresponding author:Fahmy G. Elsaid,email; elsaidfg@gmail.com
Metabolic diseases such as diabetes mellitus (DM) were progressively widespread all over the
world and the alteration of oxidative stress and antioxidants associated with DM was established.
Aim of the work: The natural products were used in many ancient cultures to overcome the DM, so
pomegranate peel and olive leaves will be investigated in this work.
Materials and Methods: Adult male albino rats (Sprague Dawley), weighing 220-250 g, were used in this
study. Animals were classified into five groups, five rats in each group. Control group: rats were served as
normal healthy control and were received no treatment but only normal chow diet and water ad libitum for 4
weeks. Diabetic group: rats were intraperitoneal injected with STZ at dose of 40 mg / kg b. wt. for a single dose.
Diabetic and olive leaves extract group: diabetic rats were orally administered with watery extract of olive
leaves at dose of 250 mg / kg b. wt. for 4 weeks. Diabetic and pomegranate peel extract group: diabetic rats
were orally administered with pomegranate peel at 250 mg / kg b. wt. for 4 weeks. Diabetic and mix of olive
leaves & pomegranate peel group: diabetic rats were orally administered with pomegranate peel and olive
leaves at 250 mg / kg b. wt. for 4 weeks.
Results: The oxidative stress markers such as lipid peroxidation and hydrogen peroxide were increased but
there was a decrease in the antioxidants makers such as glutathione peroxidase, superoxide dismutase, glucose-
6-phosphate dehydrogenase, reduced glutathione and total antioxidants capacity in the liver of diabetic rats. The
expression of insulin receptor and glucose transporter 2 genes was inhibited in liver of diabetic rats. Watery
extracts of olive leaves and pomegranate improved the biochemical and molecular changes associated with DM.
Conclusion: The results showed a hypoglycaemic, hypocholesterolemic and hypolipidemic action of olive
leaves and pomegranate peel.
Keywords: Diabetes mellitus, antioxidants, oxidative stress, glucose transporters, insulin receptor,
pomegranate, olive leaves.

such as glutathione peroxidase (GPx), catalase
There are many metabolic disorders and
(CAT) and superoxide dismutase (SOD) activities
autoimmune diseases involved in the destruction of
enhance the elimination of superoxide anion,
the -cells of the pancreas which leads to subsequent
hydrogen peroxide (H2O2) and hydroxyl radicals3.
insulin deficiency and aberrations that bring about
The decreased glutathione-S-transferase (GST)
resistance to insulin action. Streptozotocin (STZ),
activity in the liver of STZ-induced diabetic rats was
glucosamine-nitrosourea compound, is an antibiotic
detected4. So, diabetes produces deviation of lipid
mediator that has been broadly used for inducing
profiles and increases the oxidative stress markers
type-1 diabetes in many animals by affecting
like lipid peroxidation (LPO), H2O2 and decreases
disintegration and necrosis of pancreatic -cells1.
the antioxidants profile in the liver. Damasceno5
Insulin shortage can be produced in different
reported that STZ produced oxidative stress and
depletion of antioxidant systems in both blood and
Hyperglycemia leads to dyslipidaemia as an increase
tissues particularly, liver. Free radicals are quenched
of triglyceride, total cholesterol and LDL-C levels in
by efficient systems of antioxidant enzymes such as
sera and affect lipid metabolism. Hence, high plasma
SOD, CAT, GST and GPx as well as the nutrient-
triglyceride levels and lowered HDL-cholesterol are
derived antioxidants flavonoids, carotenoids,
corporate with diabetes.
terpenoids and GSH.
Hyperglycaemia possibly increases the
The movement of glucose through the
oxidative stress by elevating glucose auto-oxidation,
plasma membrane is occurred by a carrier-mediated
protein glycation, free fatty acids and initiation of
diffusion transport system. Glucose transporter 2
the polyol pathway. The role of antioxidants is
(GLUT2), the primary hepatic liver transporter, is a
essential in diabetes and the decrease of plasma
low affinity, high capacity transporter expressed in
antioxidants develops the impacts of diabetes2.
high levels on the sinusoidal membranes of
Hence, the levels of free radical scavengers reduced
hepatocytes, the basolateral membrane of intestinal
throughout the progression of diabetes. Reduced
epithelial cells, renal proximal tubule cells, and
glutathione (GSH) and other relative antioxidants
pancreatic beta-cells6. Hepatocytes and pancreatic -
Received:20 /12 /2017 DOI: 10.12816/0046605
Accepted: 30/12 /2017

Full Paper (vol.715 paper# 1)

c:\work\Jor\vol715_2 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3086-3092

Adenovirus Association with Graft versus Host Disease in
Paediatric Bone Marrow Transplantation Recipients
Arwa Kamhawy 1, Kouka Saad Eldin Abd Elwahab 1, Jaylan Ayoub 1,
Abd Elrahman Zekri 2, Alaa Elhaddad 3
1-Microbiology and Immunology Department, Faculty of Medicine for Girls, Al Azhar University, Cairo, 2-
Molecular Biology and Virology Department, National Cancer Institute, Cairo University, Cairo, 3- Paediatric
Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
Adenovirus (Ad) infections have delayed clearance in paediatric patients. The immune suppression
that occurs after hematopoietic stem cell transplantation (HSCT) can reactivate adenovirus, resulting in life-
threatening disseminated disease. Aim of the work: to assess adenovirus infection in recipients of bone marrow
transplantation and to find out if there is an association between adenovirus infection and the occurrence of graft
versus host disease (GVHD) in these patients. Patients and methods: The study was conducted on 30 pediatric
patients admitted to Nasser institute, for bone marrow transplantation. Serum and stool samples were collected one
day prior to bone marrow transplantation, and every one or two weeks afterwards till the patient completed 100
days after HSCT. The adenoviral DNA was monitored in the patients serum and stool samples by quantitative real
time polymerase chain reaction (qPCR). The stool samples that tested positive for the presence of adenovirus were
processed by cell culture technique for isolation of the virus. Results: Adenoviral DNA was detected in the fecal
samples of 11 out of 30 patients (36.6% of cases); the viral load ranged from 1.2 X 10³ copies/gram, to 8.4 X 107
copies per gram, two patients had 2 positive stool samples with rising titer indicating the reactivation of the
adenovirus. The adenoviral DNA was detected in the serum samples of only two patients (6.6% of cases), with a
low titer, one of them was only 500 copies/ml and the other one was 1.6 X 104 copies /ml. The remaining serum
samples of the patients who shed the adenovirus in their stool were all negative for adenoviral DNA. These two
patients, who had Ad DNA in their serum, had no adenoviral shedding in their stool. The adenovirus reactivation
was not associated with increased risk of developing GVHD, diarrhea or CMV reactivation.
Conclusion: although the adenovirus was shed in the stool of 9 patients, the viral shedding was not associated with
increased risk of developing GVHD, diarrhea or CMV reactivation.
Keywords: Adenovirus, hematopoietic stem cell transplantation (HSCT), graft versus host disease (GVHD), bone
marrow transplantation.

Viral reactivations, of AdV defined as viraemia
Hematopoietic stem cell transplantation (HSCT) is
with >1000 copies/mL while serum or plasma Ad DNA
the last treatment option for a variety of diseases,
loads greater than 106 copies per mL have an increased
including certain hematologic malignancies, inborn
risk for fatal complications. According to different
errors of metabolism, immune deficiencies, and bone
studies 6, 7, 8 the estimated rate of Ad infection after
marrow failure syndromes 1. Besides the risk of
HSCT ranges from 3­47%, with a mortality rate from
developing bacterial and fungal infections, there is a
10% to 80%. In post-HSCT patients, adenoviruses are
substantial risk of viral infection or reactivation during
the cause of severe respiratory disease, hepatitis, and
the immunosuppressed period after HSCT. Among all
colitis or hemorrhagic cystitis 9,10. Screening for AdV
viruses; cytomegalovirus (CMV) and adenoviruses
in the stool and molecular monitoring of viral load in
(Ad) are important 2. Adenovirus (Ad) and
serial stool specimens may facilitate early detection of
cytomegalovirus infections have delayed clearance in
impending viremia11. The frequency of Ad viremia in
paediatric patients. There is an immune suppression
individuals with peak virus levels in stool specimens
after hematopoietic stem cell transplantation (HSCT),
above 1 × 106 copies per gram was 73% vs 0% in
which can reactivate these viruses, resulting in life-
patients with Ad levels in stool specimens below this
threatening disseminated disease 3.
threshold 12.
Adenoviruses are nonenveloped, double-stranded
The aim of this study was to assess Adenovirus
deoxyribonucleic acid (dsDNA) viruses, at present, 51
infection in recipients of bone marrow transplantation
serotypes and over 70 genotypes have been defined
by real time polymerase chain reaction (qPCR) and to
within seven species (A­G) 4. Adenovirus species C is
find out if there is an association between adenovirus
most frequently isolated in the general population and
infection and the occurrence of GVHD in these
HCT recipients 5.
Received:23 / 2 /2018 DOI: 10.12816/0046606
Accepted:3 / 3 /2018

Full Paper (vol.715 paper# 2)

Postatrophic hyperplasia (PAH) of the prostate gland often demonstrates overlapping histological features with prostatic adenocarcinoma (PCA) The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3093-3100

Role of Immunohistochemistry in the Differentiation between Low Grade Prostatic
Adenocarcinoma (Small Acinar Pattern) and Some Benign Mimickers
Salah El-din Sayed Omar Semary1, Al-Sayed A. Abd-Elrahman 2, Wagih M. Abdelhay 3,
Esam O. Kamel4 ,Wail M. Gad-Elrab5
1-Department of Pathology, Faculty of Medicine Al-Azhar University, Damietta 2- Department of Human
Anatomy, Faculty of Medicine Port Said University 3- Department of Histology and Cytology, Faculty of
Medicine Al-Azhar University, Cairo 4- Department of Histology and Cell Biology, Faculty of Medicine Al-
Azhar University, Assuit Branch 5- Department of Human Anatomy, Faculty of Medicine Al-Azhar University.

Background: prostatic adenocarcinoma is characterized by diverse architectural growth patterns and can be
confused with some benign prostatic lesions. The most common pseudoneoplastic lesions in the prostate that can
mimic low-grade prostatic adenocarcinoma are post-atrophic hyperplasia (PAH), atypical adenomatous hyperplasia
(AAH) and sclerosing adenosis of the prostate (SAP). Objective: this study aimed to evaluate the histopathological
and immunohistochemical features of some pseudoneoplastic lesions of the prostate that could potentially be
confused with low-grade prostatic adenocarcinoma (small gland pattern). Material and Methods: 100 specimens
of prostatic lesions were enrolled in this study and analyzed retrospectively (50 needle biopsy specimens and 50
transurethral resection of prostate (TURP) specimens). All cases had atypical foci that required further workup.
Four slides per specimen were cut, one slide for hematoxylin and eosin stain (H&E) and the other 3 slides for
immunohistochemical (IHC) staining by antibodies against 34E12 cytokeratin, p63 and alpha methyl acyl
coenzyme A racemase (AMACR). Results: histological examination (prior to IHC staining) revealed provisional
histological diagnosis of 35 cases of PAH, 12 cases of AAH, 13 cases of SAP and 40 cases of low grade prostatic
adenocarcinoma. Immunohistochemical results revealed immunopositivity to 34E12 in a discontinuous pattern in
13 out of the 35 cases of PAH (13/35), immunopositivity to 34E12 and p63 in a continuous basal pattern in 17
cases (17/35) and negativity for all markers in 5 cases (5/35). 29 cases out of the 40 prostatic carcinomas showed
immunopositivity for AMACR and negativity for 34E12 and p63 (29/40), 5 cases were negative for all markers
(5/40) and 6 cases were positive to p63 and negative for AMACR and 34E12 (6/40). 8 out of the 12 cases
diagnosed as AAH showed immunopositivity to 34E12 and p63 in a discontinuous pattern and negative to
AMACR (8/12), 2 cases were positive to AMACR and negative to basal cell markers (2/12) and 2 cases were
negative to all markers. All the 13 cases diagnosed histologically as SAP showed immunopositivity to 34E12 and
p63 and immunonegativity to AMACR. Conclusion: immunohistochemistry (IHC) can be contributive in the
diagnosis of prostatic adenocarcinoma if used with care and experience. No single marker can establish a diagnosis
on its own, but interpretation must always be in conjunction with H&E morphology.
Keywords: prostatic carcinoma, benign mimickers, immunohistochemistry


needle biopsy because of the therapeutic implications[2].
Before making a diagnosis of prostatic carcinoma
Atypical Adenomatous Hyperplasia (AAH) is another
(PCA), it is prudent for the pathologist to consider the
various benign patterns and processes that can simulate
adenocarcinoma. AAH should be considered as
prostatic adenocarcinoma. Most mimickers fit within
a benign lesion and patients followed conservatively.
the small gland category and the most common ones
The term should not be used as a `wastebasket' for
giving rise to false-positive cancer diagnosis are
small glandular lesions that are difficult to classify, or
for suspicious atypical small gland proliferations just
adenomatous hyperplasia, sclerosing adenosis and
below the threshold of adenocarcinoma [3]. Up to 2% of
seminal vesicle-type tissue. Knowledge of these
over diagnosis of prostatic adenocarcinoma in
patterns on routine microscopy coupled with the
transurethral resection specimens might be due to
prudent use of immunohistochemistry will lead to a
sclerosing adenosis of the prostate (SAP). SAP is a
correct diagnosis and avert a false-positive cancer
transition zone lesion of the prostate that can simulate
interpretation [1]. Post-atrophic hyperplasia (PAH) is
small acinar carcinoma [4].
best known to the surgical pathologist as a mimic of
prostatic adenocarcinoma because of its overlapping
Selection of the Studied Cases
architectural and nuclear features. PAH is a
100 specimens (50 needle biopsy specimens and 50
proliferative, non-involuting lesion and distinguishing
transurethral resection of prostate (TURP) specimens
PAH from PCA is particularly important on prostate
Received:20 / 3 /2018 DOI: 10.12816/0046607
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 3)

c:\work\Jor\vol715_4 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3101-3108

Renal Stones among Adult Population in Arar City, Northern Saudi Arabia
Alfuhigi, Zuhur Dhaher M1, Amer Ogla Faleh Alfuhigi2, Ahmed Hamad Ahmed Sulaiman3,
Alruwaili, Anwar Eid M1, Alshalan, Maha Hazzaa F1, Alanazi, Alaa Ali S1, Alshammari, Mashail Rasheed
M1, Alshammari, Nujud Muteb D1, Alanazi, Abrar Asaad M1, Alshubayni, Bashaer Mahmoud A1,
Maha Thiab Abdalaziz Alshbiny1, Alruwily, Zain Amer l1, Albanaqi, Ihtifal Slamah S1,
Alanazi, Waad Kareem A1, Alshareef, Zainab Abdullah N1
1 Northern Border University, Arar, 2 Security Forces Hospital,3 Internal Medicine,
Northern Border University, Arar, KSA

Renal stone is a major health problem with adverse medico-economic consequences. It cost the
healthcare services a great deal of money without reaching any desired destiny. Objective: To describe the
current prevalence, risk factors, manifestations, methods of diagnosis and treatment of renal stones in Arar city,
Northern Saudi Arabia Method: Cross-sectional community based on survey applied to the adult of the general
population of Arar city during the period fromJune to October 2017. The statistical significance level is made at
less than 0.05. Results: Among 470 participants, 57.7% male and 42.3% females, 23% had renal gravel, 13%
had renal stones. Only 15% complained from recurrent renal colic and 28% had family history of renal stones or
gravels. Among the found cases of renal stones, 39.7% had family history of renal stones (P<0.05), 30% had
other chronic diseases, 67% have renal gravels (P<0.05) and more than half (55.2%) of them had recurrent renal
colic (P<0.05) and 39.9% were obese (P<0.05). The most common symptom is renal colic as it appear in 55% of
cases and 82% of affected people are diagnosed by complete urine analysis and ultrasound examination. The
most common type is oxalate stone 55.2%, uric acid stones 27.6% and mixed stones 17.2%. More than half
(55.2%) of renal stones are small in size and 46% found in the kidney. Most (84%) of the cases get herbal
treatment, 89% medical treatment and only 8.6% got surgical treatment but 46% had recurrent stones.
The prevalence of renal calculi and associated renal colic in Arar city, Northern is considerable.
Suggestions for health education about risk factors in addition to future researches are mandatory.
Keywords: Renal Stones; Oxalate stone; Uric acid stones; Adult Population; Arar City; Northern Saudi Arabia


in the most part and there still is thirst for more
The nephrolithiasis, or as such publically known
epidemiological reports extending to several regions.
the renal stone is an ongoing major health problem
Renal stone is usually associated with several
worldwide with an every-changing incidence and
lethal complications ranging from acute obstruction
prevalence over time. According to the available
of urinary tract to chronic kidney diseases [8]
data, the prevalence and incidence of renal stone
Furthermore, it is leading cause of the consumption
kept on changing from time to time and varying
of strong addictive pain medication. To cap it all,
from place to another [1]. This variability was
those pain medication which is not addictive are to
apparent among different sociodemographic and
the detrimental to the patients' renal function. To
geographic features, such as gender [2], nationality [3],
illustrate, a previous study stated that NSAIDs are
age[2], and seasons [4,5] or could be attributed to
associated with a decline of the kidney function [9].
availability of highly sensitive modality, like
As consequence, it would be better to focus attention
Computed Tomography scan (CT scan) [6] After all,
on how to prevent and completely resolute the renal
there has been a uniformed result which could
stones rather than employing the conservative
epidemiological trends at any time anywhere in the
The knowledge of epidemiology, etiology, risk
world. The most striking example of this conceded
factors and pathogenesis can assist in putting a limit
conclusive trends is that the renal stone is more
to the increasing incidence of the renal stones [10] .
predominant among men [7].
To clarify, a previous study had confirmed the cost-
In the Kingdom of Saudi Arabia, a number of
efficacy of the prevention of renal stone [11] .
studies were conducted on the epidemiology of renal
In Saudi Arabia Khan et al. studied the
stone [5] However, those studies were retrospective
epidemiological risk factors and composition of
urinary stones in the middle region of Saudi Arabia.
Received:25 / 1 /2018 DOI: 10.12816/0046609
Accepted:5 / 2 /2018

Full Paper (vol.715 paper# 4)

Factors Affecting Difference Between EGW and AGW in Liver Transplantation The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3109-3115

Factors Affecting Difference between EGW and AGW in
Liver Transplantation
Mohamed Kamel Sobhi, Ahmed Gamal El-Din Othman, Hany Saeid Abdel-Baset,
Mohamed Mohamed Bahaa El-Din
Department of General Surgery, Faculty of Medicine, Ain Shams University

*Corresponding author: Mohamed Kamel Sobhi, Email: mohmmdkamel@gmail.com, Mobile: 01062207023

An accurate preoperative estimate of the graft weight and remnant liver volume is vital to avoid
small-for-size syndrome(SFSS) in the recipient and ensure donor safety after Living donor liver transplantation
(LDLT). CT has been widely used as a method for the preoperative volumetric assessment of the liver
transplantation. The graft size as measured from preoperative imaging which is often different from the actual
weight of the liver graft as obtained by the donor hepatectomy.
The difference between preoperative volumetry and Actual graft weight (AGW) was graded into minimal
difference (15%) and big difference (>15%).
Aim of The Work:
This study was conducted to assess different preoperative factors that might affect the
difference between estimated graft weight and actual graft weight in liver transplantation.
Patients And Methods: This single center retrospective study was conducted on 86 cases who have been
subjected to donation for liver transplantation in Ain Shams Center of organ transplantation.Donors were divided
into two groups:
Group (A):
formed of 33 donors who showed minimal difference (15 %) between EGV and AGW.
Group (B): formed of 53 donors who showed big difference (>15 %) between EGV and AGW.
Each donor data was examined for: Age, Sex:
male or female, Body mass index (BMI), Lipid profile (positive /
negative) Type of hepatectomy (Rt lobe / Lt lobe), AGW.Estimated graft weight (EGW), Total liver volume, Liver
biopsy: Fibrosis (positive/ negative), Steatosis: Negative: (0%) and Positive: (5% or 10%).
EGW of 903 gm was identified as cutoff point of the best specificity with the best sensitivity showing
60.4 % and 60.6% for sensitivity and specificity, respectively. At this cutoff point, 47.7% of cases (n=41) showed
EGW < 903 gm, while 52.3% of cases (n=45) showed EGW 903 gm. Thus, it can be said that cases showed
EGW 903 gm have a probability of 71.1% to have big difference between EGW and AGW (15%).
EGW of 1069 gm was identified as another cutoff point of a better specificity on ROC curve showing 32.1% and
93.9% for sensitivity and specificity, respectively, on ROC curve. At this cutoff point, 77.9% of cases (n=67)
showed EGW < 1069 gm, while 22.1% of cases (n=19) showed EGW 1069 gm. Thus, it can be said that cases
showed EGW 1069 gm have a probability of 89.5% to have big difference between EGW and AGW (15%).
TLW of 1587 gm was identified as cutoff point of the best specificity with the best sensitivity and specificity on
ROC curve showing 56.6% and 60.6% for sensitivity and specificity, respectively, on ROC curve. At this cutoff
point, 50% of cases (n=43) showed TLW < 1587 gm, while 50% of cases (n=43) showed TLW 1587 gm.
Thus, it can be said that cases showed TLW 1587 gm have a probability of 69.8% to have big difference between
EGW and AGW (15%).
TLW of 1807 gm was identified as another cutoff point of better specificity on ROC curve showing 18.9% and
93.9% for sensitivity and specificity, respectively, on ROC curve. At this cutoff point, 86% of cases (n=74)
showed TLW < 1807 gm, while 14% of cases (n=12) showed TLW 1807 gm. Thus, it can be said that cases
showed TLW 1807 gm have a probability of 83.3% to have big difference between EGW and AGW (15%).
Conclusion: TLV and EGV in CT volumetry are most reliable preoperative factors that can predict big difference
between EGW and AGW. Re-evaluation of CT volumetry protocol is recommended for better prediction.
AGW: EGW. EGW: EGW. LDLT: Living donor liver transplantation. SLV: standard liver volume.
TLV: total liver volume.

Received:20 / 3 /2018 DOI: 10.12816/0046610
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 5)

c:\work\Jor\vol715_6 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3116-3120

Conventional Hemorrhoidectomy versus Ligasure
Hemorrhoidectomy: A Comparative Study
Al Sayed A Hamdy, Yaser H Hasan, Muhammad M Allam
Department of General Surgery, Faculty of Medicine ­ Al-Azhar University
Corresponding author: Muhammad M Allam; Mobile: 01286690084; Email: muhammad.allam1@outlook.com

Hemorrhoidal disease is one of the most common anorectal diseases and surgical
hemorrhoidectomy remains one of the most common operations in general surgery. Milligan-Morgan Described
the conventional hemorrhoidectomy since about 70 years ago, then surgical hemorrhoidectomy had changed
little over years until the introduction of LigaSure hemorrhoidectomy. Aim of the Work: Is to compare
between conventional (Milligan-Morgan) hemorrhoidectomy and LigaSure hemorrhoidectomy in treating
patients with 3rd and 4th degree internal piles. Patients and Methods: This randomized control clinical trial was
done at Mounira General Hospital over a period from April 2017 to March 2018 on the basis of: It included 40
adult patients with 3rd and 4th degree hemorrhoids divided randomly into 2 equal groups: Group A (n: 20
patients) underwent LigaSure hemorrhoidectomy. Group B (n: 20 patients) underwent Conventional
hemorrhoidectomy. Results: There was a highly significant difference between the two study groups as regard
the operative time, in the LigaSure hemorrhoidectomy group the mean operative time was 11.15 ± 2.68
minutes, while in the conventional technique group the mean time was 28.75 ± 4.20 minutes. As regards the
post-operative pain, in the 1st day, there was a highly significant difference between the two study groups; in the
LigaSure hemorrhoidectomy group the mean post-operative pain was 3.80 ± 1.54; while in the conventional
technique it was 5.95 ± 0.99. Regarding the post-operative pain, in the 1st week, the LigaSure
hemorrhoidectomy group mean was 2.60 ± 1.27; while in the conventional method was 4.80±0.89. As regard
the intra-operative estimated blood loss, a significant difference between the two study groups was present. In
ligaSure hemorrhoidectomy group 40% had almost no bleeding, 20% had minimal blood loss, 20% had mild
loss and 20% had moderate blood loss in comparison with conventional method group patients; 0% with no
blood loss, 15% with minimal loss, 55% with mild loss and 30% with moderate blood loss. As regards duration
of wound healing, in the LigaSure group, the mean time was 2.65 ± 0.74 weeks while in the in the conventional
technique group, it was 4.60 ± 0.82 weeks which was statistically highly significant. With LigaSure
hemorrhoidectomy only 6 patients out of 20 needed anal packing, in contrast with conventional method group
that needed an anal pack for the whole 20 patients. Conclusion: We conclude that LigaSure hemorrhoidectomy
is better than conventional (Milligan-Morgan) hemorrhoidectomy in terms of less operative time, less intra-
operative blood loss, less post-operative pain, less post-operative analgesics and earlier wound healing and
return to daily work hence higher patient satisfaction. Recommendations: Further studies on a larger scale of
patients are needed to confirm the results obtained by this work.
Keywords: LigaSure Hemorrhoidectomy, Conventional Hemorrhoidectomy, Milligan-Morgan.


Hemorrhoids is a very common anorectal
On another front, Wang et al. have
disease. Defined as symptomatic enlargement
and/or distal displacement of anal cushions. Apart
hemorrhoidectomy with sub mucosal dissection is
from abnormally dilated vascular channel and
a fast, safe, and excellent modality for achieving
destructive changes in supporting tissue within
bloodless dissection of the hemorrhoidal cushions
anal cushions, there is emerging evidence that
with a limited complication rate. Compared with
hemorrhoids is associated with hyper perfusion
state of anorectal region and some degree of tissue
method of dissection prominently reduces post-
inflammation (1).
operative pain and numbers of parenteral
analgesic injections. LigaSure also provides
intervention; Milligan-Morgan described the
minimal collateral thermal spread, limited tissue
classic operation for surgical hemorrhoidectomy
charring and absence of sutures might lead to less
more than 70 years ago. Thereafter colorectal
post-operative pain, consequently the LigaSure
surgeons are in non-stop search for the most
system would facilitate earlier hospital discharge
effective least painful technique for surgical
and return to normal work or activities (3).
treatment. This traditional approach is effective;
Aim of the Study
however it often is accompanied by a high
Is to compare between conventional
incidence of complications, such as urinary
retention, hemorrhage, and significant pain (2).
LigaSure Hemorrhoidectomy.
Received:20 / 3 /2018 DOI: 10.12816/0046611
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 6)

c:\work\Jor\vol715_7 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3121-3124
Interbody Fusion. Is It Has a Rule in Broken Screws in Surgical
Management of Lumbar Spondylolisthesis?
Micheal Zohney1, Ahmed Sawy1, Nazek Ahmed1, Hamdi Nabawi Mostafa2*

1Department of Neurosurgery, Nasser Institute for Research and Treatment, Cairo,
2Department of Neurosurgery, Faculty of Medicine, Misr University for Science and technology, Giza,
*Corresponding Author: Hamdi Nabawi Mostafa, Email: hamdi.nabawy@gmail.com, Tel: +201223932347

for many years, posterolateral fixation for lumbar spondylolisthesis by using pedicle screw has been the
standard procedure for lumbar spondylolisthesis. For increasing fusion and anterior support, the interbody fusion, either
with cage or bone, were used by many surgeons, one of the most disappointing complications of pedicle screw fixation
is broken screw.
Aim: it was to compare the number of cases with a broken screw in case of interbody fusion and control group.
Patients and Methods:
this is retrospective cohort study in six years comparing between two groups: Group I
posterolateral fixation (PLF), Group II posterolateral interbody fusion (PLIF). it analyzed 26 cases of broken screw
occurred in six years from 2010 to 2016 which were done in Nasser Institute by the same surgeon and same system.
Results: twenty-six cases were reviewed, the mean age was 44.6 years, female : 6/26 (23%), male : 20/26 (77%),mean
weight: 74.8 kg, site for broken screw: (L1: 4 patients ­ L2: 2 patients ­ L3: 2 patients ­ L4: 4 patients ­ L5: 6 patients
­ S1: 8 patients), 6 patients had broken screws following trauma, while 20 patients were found spontaneous, all patients
were found intraoperatively to have posterolateral fixation, they underwent redo screw fixation,18 patients underwent
redo screw fixation with posterolateral interbody fusion (PLIF) while the other 8 patients underwent redo screws
fixation with posterolateral fixation. All patients with PLIF didn't come back with broken screws, while 2 patients with
posterolateral fixation came back with broken screws again
Conclusion: posterolateral interbody fusion (PLIF) may have a rule in preventing broken screw in the management of
lumbar spondylolisthesis.
Keywords: Spondylolisthesis, Posterolateral fixation (PLF), posterior lumbar interbody fusion (PLIF), broken screw.

Pedicle screw breakage is reported to occur in
Spondylolisthesis is a condition characterized
1-11.2% of inserted screws and in 0.4-24.5% of
by a failure of the three column support with severe
patients (5,6). This implant failure can be a result of
complex instability requiring reconstruction of the
pseudarthrosis and can lead to pedicle screw or rod
altered supporting structures (1,2).
breakage. Appropriate radiographs can demonstrate the
In the past 40 years, a wide variety of spinal
screw breakage and revised spinal surgery is the
mainstay of treatment when there is a broken pedicle
spondylolisthesis. The fusion rate was found to
improve with the use of internal fixation using

transpedicular screw fixation that allowed segmental
fixation of the spine for treating spondylolisthesis (2).
This study was retrospective cohort study in
The use of posterior lumbar pedicle screw
six years to analysis single factor in implant failure,
instrumentation is now the standard for reconstruction
which is comparing the number of cases with broken
of the affected segment; its widespread application
screw between two surgical techniques Group I:
introduced the era of segmental spinal fixation (3).
posterolateral fixation (PLF), Group II: posterolateral
Posterior lumbar interbody fusion (PLIF) has
interbody fusion (PLIF) and the results of revisions of
been used in management of spondylolisthesis
cases by both techniques.
especially of isthmic type (2,3). The goal of lumbar
Between January 2010 and January 2016, at
fusion is to obtain solid fusion so as to alleviate pain.
Nasser Institute for Research and Treatment, Ministry
Unlike the posterolateral gutter fusion, the PLIF
Of Health, a total of 432 patients have done posterior

lumbar fixations of which 322 patient did posterolateral
achieves spinal fusion in the low back by inserting a
fixation (PLF) and 110 did posterior lumbar interbody
cage made of either allograft bone or synthetic material
fusion by synthetic material (peek), reported cases of
(peek or titanium) directly into the disc space(4).
implant failure were 26.
Received:20 / 3 /2018 DOI: 10.12816/0046612
Accepted:30 /3 /2018

Full Paper (vol.715 paper# 7)

c:\work\Jor\vol715_8 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3125-3130

Epistaxis: The Commonest Otolaryngological Emergency in Arar,
Northern Saudi Arabia
Raed Khalid Raja Alanazi1, Turki Suliman Saleh Alkhuliwi2, Alhanouf Hussein Saad Alahmari3,
Mana Abdullah Saud Al Yami4, Awwatf Sattam Alshammari1, Haifa Lafi Alenzi1,
Nawaf Fahad Alshuraym5, Munirah Abdullah Almakhayitah6, Narjis Bakkar7
1 Northern Border University, Arar, 2 Ministry of Health, 3 King Khalid University, Aseer " Abha ",
4 Najran University, Najran, 5 Imam Muhammad Ibn Saud Islamic University, Riyadh,
6 King Faisal University, Alhassa, 7Almareefa College, Riyadh, KSA

Epistaxis is a common clinical condition that ranges from a minor nuisance to a life threatening
emergency. It may be a chronic problem or symptom of generalized disorder . Objective: to determine the
etiology, risk factors and the outcome of the conservative and surgical management of epistaxis in the studied
population. Methods: This is a cross-sectional, community-based survey being directed to the Saudi adult
population living in Arar city during the period of October and November 2017. The study instrument is a self-
administered, pre-designed questionnaire. Results: The study included 175 epistaxis cases, 39.4 % females and
60.6 % males, 45.1 % were 20-29 years . Hypertension was found in 4.0%, 20% were smokers and 7.4% were
ex-smokers. Epistaxis was idiopathic in 56.6 % of cases, local injury in 16%, nasal allergy in 8.6%, nasal
infection in 7.4%, mucosal irritation in 2.9%, high blood pressure in 2.9%, foreign bodies in 2.2%, nasal tumors
in 1.7% and blood dyscrasias in 1.1%. Most (85.1%) of the cases were treated at home and 14.9% in the
emergency department of hospitals. Cauterization of bleeding point, employed for only 1.7% of the cases and
surgical treatment in only 1.1%. Conclusion: epistaxis was more common in males than females, most cases
are idiopathic, local injury and nasal allergy are also considered causes. The majority of epistaxis were not life
threatening and can be treated conservatively. Most of the cases were treated at home mainly by pressure on the
nose and considerable percentage treated in the emergency department of the hospitals mainly by nasal backing.
Keywords: Epistaxis, Otolaryngological , Arar, Northern Saudi Arabia.


than 50 years, they are affected in the same rang
Epistaxis is considered one of the most
Epistaxis are divided into 2 types, anterior and
problem in the world (1). It is usually present as an
posterior epistaxis, according to the origin of
emergency, a chronic problem or as symptoms of
bleeding (7), anterior epistaxis arise from damage of
generalized disorder as it consider the manifestation
Kiesselbach'splexus on the lower portion of the
of multiple local and other systemic disorders of the
anterior nasal septum, known as the Little's area,
body (2,3). Epistaxis occur in 60% of person all
while posterior epistaxis arise from damage to the
over the world at a point of their life time but only
posterior nasal septal artery (4,8). Anterior epistaxis
6% of these patients seek for medical treatment (1, 4).
are more common than posterior as it represent
The prevalence of epistaxis increase in children less
80% of the cases, bleeding is profuse in posterior
than 10 years and adolescents in a minor form
epistaxis because of larger vessels in that location
while it occur in sever form in patients older than
(usually sphenopalatine artery). While the etiology
50 years which may need otolaryngological
of epistaxis is unknown in 80-90% of the cases
intervention (5), and it increase in children because
(idopathepistaxis) the etiology can be divided into
of sports injuries and road traffic accidents due to
systemic or traumatic causes and it vary according
their aggressive life style while it occur in patient
to age and anatomical location (4,9).
more than 50 years due to vascular pathologies,
Traumatic epistaxis is more common in
hypertension and malignancy (6). It's found that
younger individual due to facial injury or a foreign
males are more affected than female in younger age
body in the nasal cavity (8,9), most of patients with
because of their frequent involvement in high risk
epistaxis from trauma were actually victims of road
taking behavior. Young males are the most active in
traffic injury. Trauma being the most common
the population and so are more vulnerable to trauma
cause of epistaxis can partly explain the frequency
from nose picking especially among children,
of this problem in males. Non traumatic injury is
fights, road traffic accident with maxillofacial
common in old people as it may occur due to organ
injuries causing epistaxis, while in older age ,more
failure, neoplastic conditions, inflammation, or
environmental factors (Temperature, humidity,
Received:25 / 1 /2018 DOI: 10.12816/0046613
Accepted:5 / 2 /2018

Full Paper (vol.715 paper# 8)

c:\work\Jor\vol715_9 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3131-3135

Variations of Corneal Hysteresis in Myopic Patients with
Normal Pentacam Findings
Amr Esam Ali, Ahmed Youssef, Abdel Megid Tag El Din
Al Hussein University Hospital, Al Azhar University, Cairo governorate, Egypt
Corresponding author: Amr Esam Ali ,E-Mail: amr_esam_masoud@yahoo.com, Mob: 002-01221499345

Background: hysteresis refers to the energy lost during the stress/strain cycle which is the result of viscous
damping in the corneal tissue, is an indicator of corneal biomechanical properties. Refractive surgery currently
uses corneal thickness as a basic qualification and planning parameter. However, corneal hysteresis may be
more useful as a qualification factor for LASIK, a significant decrease in the IOP and biomechanical properties
is found in eyes following LASIK surgery
Objective: this study aimed to reveal the variations of corneal hysteresis in patients with normal pentacam
findings and to see if a correlation exists between corneal hysteresis, corneal resistance factor, mean
keratometric reading, central corneal thickness and anterior chamber depth during the pre-operative assessment
of myopic patients going for LASIK.
Patients and methods: in this study we did an analysis of corneal hysteresis in a group of myopic patients with
normal pentacam findings undergoing evaluation for refractive surgery. In our study we included 50 eyes of 26
patients aged between 18 and 44.Results: this study included a mean keratometric reading of 44.108 D±
1.3243D, the mean central corneal thickness was 522.1um±38.416um, the mean anterior chamber depth was
3.2098mm±0.249mm the mean corneal hysteresis was 9.582 mmHg±1.4702 and the mean corneal resistance
factor was 9.64 mmHg ±1.9838.Conclusion: our data suggested that patients should get their corneal hysteresis
tested as a part of their routine investigation portfolio before undergoing refractive surgery as it may play a role
in determining patients that are at higher risk of developing ectasia after surgery.
Keywords: corneal hysteresis, myopic patients , normal pentacam .


1- A static resistance component (characterized by
Hysteresis refers to the energy lost during the
the corneal resistance factor), for which
stress/strain cycle. Viscous materials flow when an
deformation is proportional to applied force.
external shear stress is applied, but, unlike
2- A dynamic resistance component (characterized
materials with elastic properties, they do not regain
by corneal hysteresis), for which the relationship
their original shape when the stress is removed.
between deformation and applied force depends on
Collagen is viscoelastic and therefore exhibits
time. In short, the tissue response in the presence of
hysteresis (1).Corneal Hysteresis (CH), which is the
a force depends not only on the force magnitude
result of viscous damping in the corneal tissue, is
but also on the velocity of the force application.
an indicator of corneal biomechanical properties
Factors affecting corneal biomechanics (4)
.The Ocular Response Analyzer (ORA; Reichert
These can be classified into extra-corneal and intra-
Inc., Depew, NY) is a novel instrument for
corneal factors.
measuring the adjusted intraocular pressure (IOP)
Extra-corneal factors:
of the eye. It is also one of the instruments capable
The atmospheric pressure which exerts a
of measuring the biomechanical properties of the
force on the external surface of the cornea.
cornea (2).
Pressure exerted by the eyelids
Corneal biomechanical properties influence
Pressure exerted by the extra-ocular
muscles (indirectly through their sclera insertions).
alterations in corneal pathology and following
The IOP which exerts a force on the internal
corneal refractive surgery (2).
surface of the cornea.
The pentacam is a rotating Scheimpflug
Intra-corneal factors:
imaging technology used to measure the anterior
These are inherent factors to the own corneal
and posterior corneal surfaces, as well as other
structure, which has the elasticity, plasticity,
anterior segment structures (3).
deformability and viscosity necessary to support
The human cornea can be described by having
the pressures exerted by the extra-corneal factors.
2 principal properties (4):
These included:
1. Corneal thickness.
2. Collagen fibres.
Received:16 / 10 /2017 DOI: 10.12816/0046614
Accepted:26 / 10 /2017

Full Paper (vol.715 paper# 9)

c:\work\Jor\vol715_10 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3136-3141

Clinical Features Clusters in Systemic Lupus Erythematosus
Mansour M, and Helaly M
Rheumatology Department, El-Galaa Military Family Hospital, Cairo, Egypt.
Corresponding author: Helaly M, e-mail: dr.marwahelaly@gmail.com

Systemic lupus erythematosus (SLE) is a multi-systemic heterogeneous autoimmune disease.
Attempts have been made trying to classify lupus into more homogenous subsets with pathogenic, therapeutic, or
prognostic significance. Objective: was to evaluate the possibility of existence of the main clinical features of
Systemic Lupus Erythematosus (SLE) in clusters. Patients and Methods: The demographic data, cumulative
clinical and laboratory features of 150 Egyptian SLE patients were studied. Some of the main clinical manifestations
were then selected for cluster analysis using the K-means cluster analysis procedure. Results: Three distinct groups
of patients were identified. Cluster 1 (n: 27) showed higher age at diagnosis and was characterized by high
prevalence of mucocutaneous manifestations (malar rash, discoid rash, photosensitivity, oral ulcer) and arthritis but
having low prevalence of serositis and hematologic manifestations (hemolytic anemia, leukopenia, and
thrombocytopenia). Patients in cluster 2 (n: 81) showed mainly renal and hematological manifestations but had the
lowest prevalence of mucocutaneous manifestations and arthritis. Cluster 3 patients (n: 42) had the most
heterogeneous features; they had a high prevalence of mucocutaneous manifestations, serositis, hematologic
manifestations and renal involvement. Conclusion: patients with systemic lupus erythematosus could be divided into
clusters of distinct patterns of clinical manifestations.
Keywords: SLE, clusters, clinical features.


consents). We attempted to identify clinical patterns of
Systemic lupus erythematosus (SLE) is a multi-
organ manifestations in these patients by using the
systemic heterogeneous autoimmune disease with
cluster analysis and compared prevalence of various
innumerable clinical and laboratory manifestations.
The course of the disease is characterized by
immunosuppressive drugs among these clusters of
exacerbations and remissions, with the development of
new organ manifestations or progression of existing
In this study, all cumulative data used had drawn
manifestations. The prognosis of SLE is largely
from the database. Recorded data from this database
unpredictable and highly variable. Previous studies in
included demographic characteristics (gender and
different ethnic groups (Caucasians, Africans,
age), duration of disease, cumulative clinical features
Americans, and Chinese) have reported the frequency
recorded since the diagnosis of SLE, autoantibody
of occurrence of various clinical and laboratory
features of SLE1­4. Attempts have been made trying to
hydroxychloroquine, cyclophosphamide, azathioprine,
classify lupus into more homogenous subsets with
methotrexate, cyclosporine A, mycophenolate mofetil
pathogenic, therapeutic, or prognostic significance 2-6.
and tracrolimus) ever or currently being received.
The aim of the current study was to evaluate the
Clinical features [malar rash, discoid rash,
possibility of existence of the main clinical features of
photosensitivity, oral ulcers, arthralgia/arthritis,
Systemic Lupus Erythematosus (SLE) in clusters.
serositis (pleuritis, pericarditis, and serositis of

abdominal cavity), renal disorder (persistent
proteinuria >0.5 g per day; >3+ by dipstick or presence
This was a cross-sectional study included a total
of active cellular casts; or biopsy evidence of lupus
of 150 Egyptian adult SLE patients attending at
Rheumatology Department, El-Galaa Military Family
(seizure and psychosis), haematological involvement
Hospital, Cairo, Egypt. Approval of the ethical
[anemia, leucopenia (<4000/mm3), thrombocytopenia
committee and a written informed consent from all the
(<100,000/mm3)] and autoantibodies [anti-dsDNA,
subjects were obtained. This study was conducted
anti-Smith (anti-Sm), and anti-phospholipid (aPL)]
between (March 2017 and February 2018). All patients
were defined according to the revised ACR
have fulfilled at least four of the 1997 revised
American College of Rheumatology (ACR) criteria for
autoantibodies associated were also studied; including
the classification of SLE9 (all of them gave informed
Received:20 /3 /2018 DOI: 10.12816/0046615
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 10)

c:\work\Jor\vol715_11 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3142-3147

Dose Response Effect of Nitroglycerin on Cardiac Hemodynamic Functions and
Myocardial Infarction in a Rat Model of Ischemia Reperfusion
Nada Kotb Abd Elfatah Kotba, Amany H Hasanina, Nevien Fekry Abdalla Hendawya,
Naglaa Samir Ahmedb and Ahmed Nour Eldin Hassana.
Departments of aClinical Pharmacology, and bPathology, Faculty of Medicine,
Ain Shams University, Cairo, Egypt
Corresponding author: Nada kotb, email: nada_kotb@yahoo.com, Tele: 01006382017

Millions of people suffer from acute coronary syndrome, angina, acute myocardial infarction
(MI), or related illnesses. These patients are prescribed nitroglycerin (NG) for the management of these
diseases. Accordingly, any risk associated with the use of nitroglycerin can potentially affect those people
despite of the undeniable benefit in relieving acute angina. Aim of the present work: was to study the
potential of treatment with 3 different doses of NG (25, 50, 100 mg/kg) to develop nitrate tolerance.
Materials and Methods: 50 Male Albino rats were randomly divided into 2 main groups: sham group and
ischemia/reperfusion (I/R) groups, which was further subdivided into 4 groups, Untreated group; NG 25, 50
and 100 mg groups; rats received nitroglycerin three times daily for 3 days before induction of ischemia
reperfusion. the effect of NG on cardiac functions and infarction size and severity score were assessed.
Results: Rats exposed to I/R exhibited a significant decrease in their cardiac hemodynamic functions ( left
ventricular end diastolic pressure; LVEDP and dp/dtmax) and development of a measurable cardiac infarction
area. Regarding pretreatment with NG; NG 25 mg/kg improved cardiac functions and myocardial infarction
size & severity score. NG 50 mg/kg significantly decreased myocardial contractility and increased myocardial
infarction size. Meanwhile NG 100 mg/kg produced significant decrease in cardiac functions and significant
increase in myocardial infarction size & severity score.
Conclusion: NG pretreatment dose dependently decreased cardiac hemodynamic functions and increased
myocardial infarction size & severity score in a rat model of ischemia reperfusion.
Key words: Nitroglycerin, cardiovascular system, LVEDP, LV dP/dtmax, ischemia/reperfusion.

mostly failed to demonstrate an improvement in
Cardiovascular diseases (CVDs) is the leading
prognosis5. An old retrospective meta-analysis
cause of morbidity and mortality, accounting for
study performed in post-infarct patients revealed
17.3 million deaths globally each year and it is
that the nitrate use was associated with an
expected to grow to 23.6 million by the year
unfavorable prognosis6. Moreover, it was
20301. 80 percent of these deaths occur in lower
demonstrated that sustained treatment with NG
and middle-income countries1.
resulted in an increase in infarct size and cardiac
dysfunction after myocardial infarction in rats7.
including coronary heart disease (CHD), heart
Acute high-dose of organic nitrates also is likely to
failure, rheumatic fever/rheumatic heart disease,
cause a similar loss of potency in the form of
stroke, and congenital heart disease. Ischemic
heart disease, consisting principally of CHD, is the
The aim of the present work was to study
predominant manifestation of CVDs2.
the effect of treatment with 3 different doses of
NG (25, 50, 100 mg/kg, three times daily for three
nitroglycerin (NG), has long been one of the key
successive days on cardiac hemodynamics and
therapies for CVDs including coronary artery
myocardial infarction size in a rat model of
disease, acute myocardial infarction and
congestive heart failure3. The ability of

mammalian cells to convert NG to vaso-relaxant
nitric oxide (NO) played a significant part in the
Experimental animals: All animal procedures
discovery of the unique role of both NO and NG in
were approved by the Institutional Animal Ethics
acute angina and congestive heart disease4.
Committee for Ain Shams University, Faculty of
It is worthy to mention that most of the
Medicine. Male albino rats (weighing 250 to 300
studies that used organic nitrates for the treatment
g) were purchased from National Research
of heart failure and coronary artery disease (CAD)
Institute (Cairo, Egypt) and housed in an animal
demonstrated improvement in symptoms, but
room with temperature (22-24°C) and lighting (12
Received:20 /3 /2018 DOI: 10.12816/0046616
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 11)

c:\work\Jor\vol715_12 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3148-3152

Confidence Levels of Intern Doctors during Root Canal Treatment
Procedures in Saudi Arabia
Ahmad Y AlQisi, Ibrahim Yahya A Alsalhi, Waleed Hussain Ali Alwadei, Zahra A. Alsafi,
Eman A. Alshahrani
College of Dentistry, King Khalid University, Saudi Arabia
Corresponding author's email: king.a2020@hotmail.com

Endodontic is one of the difficult branches in dentistry as it requires special skills to deals with
treatment of the root canals. These difficulties comes from anatomical complexities of the roots, working area
is very limited, and clear and clean area before final obturation is required which is difficult to achieve. In
addition, complications and subsequent retreatment are difficult and are time- and materials-wasting.
Methods: A self-administrated questionnaire was distributed to intern dentists at all dental school all around
the Kingdom of Saudia Arabia. It consisted of 10 questions related to all possible procedures in endodontic
treatment. The confidence level was scored in 5-points Liker scale ranging from 1 "very little confidence" to 5
"very confident". Data were analyzed using SPSS V22 software program. A p-value < 0.05 was considered
Results: Thirteen different dental schools from 13 different universities including 230 intern dentists were
included in the analysis. Number of the included interns varied considerably between universities. The largest
number of participants were from King Khalid University with 47 interns (18.7%) and the least number of
participants were from Alfarabi College and Majmaah University with 9 interns, equally. Most participants
were confident or very confident of most of the endodontic procedures. More than two thirds (71.74%) of
participants had no experience in removing broken instruments from root canals. About 19.57% of participants
also had no experience in performing retreatment of failed RCT. Twenty eight (12.17%) participants had very
little confidence regarding using rotary instruments. Less than one third (29.13%) of participants were
confident regarding irrigation of root canals. Only three questions had significant differences in means between
universities. With regard to gender, no significant differences were found in relation to all confidence
Conclusion: Level of confidence regarding endodontic treatment among intern dentists in Saudia Arabia is
acceptable. More practical training, however, for the most difficult procedures are highly recommended.
Keywords: Education, endodontics, self-confidence, dental students, Saudi Arabia

provide the patient with a correct and qualified
Dentistry is an art and science; it requires
treatment (4, 5).
good skills besides practical and theoretical bases.
It is well-known that with the presence of different
Most of its branches are difficult and one of them
institutional dental schools the dental curriculum
is endodontic branch which deals with treatment of
and thus the practical requirements including
the root canals. These difficulties comes from
endodontics will be greatly different.
anatomical complexities of the roots, working area
On the other hand, some basics of the
is very limited, and clear and clean area before
knowledge and science should exist and should be
final obturation is required which is difficult to
the same all around the dental schools to meet the
minimum prerequisites to offer a good treatment
In addition, complications and subsequent
for patients. Low self-confidence among dental
retreatment are difficult and are time- and
students or freshly graduated dentists will
materials-wasting (1-3). All these procedures require
negatively reflect on their treatment (6-8).
the dental students and dental practitioners to have
Feedback from dental students or intern
good skills and self-confidence.
dentists regarding their perception of the dental
It is essential, therefore, to include the
subjects and receiving their suggestions and
required basics in the dental curriculum to provide
preferences are helpful for improving the learning
those students and future dentists with the required
curriculum and process (9-11).
knowledge and to improve their skills to be able to
The aim of the present study was to evaluate
perform a correct diagnosis for the endodontic
the confidence level among freshly graduated
cases and to make a correct treatment plan to
dentists in different schools in Saudia Arabia.

Received:29 / 1 /2018 DOI: 10.12816/0046617
Accepted:9 / 2/2018

Full Paper (vol.715 paper# 12)

c:\work\Jor\vol715_13 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3153-3157

Role of Ketamine as an Adjuvant to Bupivacaine in C-Arm Guided
Thoracic Paravertebral Block Analgesia for Modified Radical Mastectomy
Sanaa Mohamed Elnoamany 1, Nabil Ali El Sheikh 1,
Asmaa Fawzy Amer 1, Areeg Kotb Ghalwash 2
1 Anethesiology & Surgical I.C.U, Faculty of Medicine, Tanta University, 2 M.B.B.CH

Breast cancer is the most common type of cancer found in women and today represents a significant
challenge to public health. Postoperative pain is the most distressing symptom experienced by the patient. Pain
induces metabolic, hormonal and cardio-respiratory responses that affect the outcome of surgery.
Aim of the Work: The aim of this study was to evaluate the role of ketamine as an adjuvant to bupivacaine in c- arm
guided thoracic paravertebral block analgesia for modified radical mastectomy. Patients and Methods: This study
was carried out in Tanta University Hospitals in Surgery Department from April 2016 to October 2016 on sixty-two
patients scheduled for elective modified radical mastectomy divided into two equal groups each contain 31 patients,
group 1 received PVB with bupivacaine only under c arm and group 2 received PVB with bupivacaine and ketamine
as pre emptive analgesia and watch what is the outcome. Written informed consent was taken from each patient.
Results: This prospective randomized double blind study was carried out on 62 patients divided into two equal
groups where group two showed statistically significant decrease in VAS , total amount of analgesic and delay in
time of first analgesic requirement in comparison with group one and significant difference as regard hemodynamics
and postoperative complication between two groups. Conclusion: We concluded that addition of ketamine to
bupivacaine as an adjuvant in C-arm guided PVB appears to be more beneficial than the use of bupivacaine alone for
postoperative analgesia in modified radical mastectomy surgery.
Keywords: Ketamine, Bupivacaine, Radical Mastectomy, C-Arm Guided Thoracic Paravertebral, Block

Thoracic paravertebral nerve block (TPVB)
Breast cancer is the most common type of
cancer found in women and today represents a
multimodal analgesia in breast surgery as it
significant challenge to public health (1).
Several treatment decisions may be offered
postoperative analgesia.
to women with breast cancer including surgery,
This technique is associated with a superior
radiotherapy, and endocrine and chemotherapy.
control of the pain, a reduction in opioids
mastectomy (MRM)
consumption after surgery, a decrease in
represents a primary therapeutic strategy. It is an
postoperative nausea and vomiting, and an overall
exceedingly common procedure with an increased
decrease in length of hospital stay. So, it has been
incidence of acute and chronic pain (2).
suggested as an ideal adjunct to general anesthesia
Postoperative pain is the most distressing
for modified radical mastectomy (7). While most
symptom experienced by the patient. Pain induces
trials of TPVB for breast surgery show benefit,
their effect on postoperative pain intensity, opioid
responses that affect the outcome of surgery (3).
The provision of intra and post-operative
postsurgical pain varies due to use of different
analgesia is an integral part of the anesthetic
drugs (8).
practice. It was found that pre-emptive analgesia
Bupivacaine is the most often used local
has the potential to be more effective than a similar
anesthetic for many blocks in adult. It provides
analgesic treatment initiated after surgery (4).
analgesia which lasts for only 4-12 hours. Rescue
Metabolic stress response can be avoided if
analgesia is thus required when effect of block
analgesia is provided thirty minutes prior to
wears off (9).
incision which stays well into postoperative period
Prolongation of local analgesia has been
and saves the patients from the hazards of stress
achieved by the addition of various additives like
response. There is evidence that pain services affect
morphine, tramadol, fentanyl, ketamine, clonidine,
morbidity and duration of hospital stay (4, 5).
dexmedetomidine and midazolam to prolong the
Many pain services use co-analgesia based
postoperative analgesia. They were used in varying
on four classes of analgesics, namely local
concentrations in different studies to achieve
maximum benefit (9).
inflammatory drugs (NSAIDs), and acetaminophen
Ketamine is an N-methyl-D-aspartate
(paracetamol) (6).
receptor antagonist, with analgesia mediated by
increased spinal inhibition of nociceptive
Received:20 / 3/2018 DOI: 10.12816/0046618
Accepted: 30/ 3 /2018

Full Paper (vol.715 paper# 13)

c:\work\Jor\vol715_14 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3158-3165
Levonorgestrel Releasing IUS (Metraplant E) in the Management of
Copper IUD Related Heavy Painful Menstrual Loss
Mohamed Ezz El-Din Aly Azzam*, Amal El-Shabrawy EL-Sayed, Samah Mohamed Ali Abd El- Azym
* Obstetrics and Gynecology Department, Ain Shams University.
Corresponding author: Mohamed Ezz El-Din Aly Azzam; Mobile: 01003465651; Email: prof.ezzeldinazzam@gmail.com

the LNG-IUD was first introduced in Finland in 1990 and is currently marketed in most European
countries and in the US since 2000. The Levonorgestrel IUD is approved for 5 years, but lasts up to 10 years and
reduces the menstrual blood loss and pelvic infection rates.
Aim of the Work: this study aimed to evaluate safety and efficacy of levonorgestrel releasing IUS (Metraplant-E)
in the management of copper IUD related heavy painful menstrual loss. Among women of low socioeconomic
status attended to family planning clinic at Abo-Elnomros Hospital (Abo-Elnomros is small village ­Giza
Government, Egypt. Patients and Methods: this was a prospective cohort study and it was performed in Abo-
Elnomros hospital. Women who attended to the hospital (Family planning clinic) for IUD follow up and had
complications (bleeding and dysmenohrea) for which copper IUD is removed. Results: all women in the present
study reported a marked reduction in MBL, which started from the first menstrual period following insertion of
Metraplant ­E. Bleeding was reduced further over the next months until the 6th month except two cases .
Amenorrhea occurred in 38 cases. The difference in menstrual bleeding was highly significant (P <0.0001).
Hemoglobin level increased from a mean baseline value of 10.0 ± 1.3 at baseline controls to a mean level of 10.5
± 1.2 after 6 months of Metraplant-E use. Differences in hemoglobin levels were highly significant P <0.0001.
Conclusion and Recommendations: the copper IUD is the most commonly used method of reversible
contraception worldwide and is used by an average of 23 percent of female contraceptive users. The copper IUD
is associated with increased menstrual flow both in length of menses and in amount of blood loss. The most
common reasons for the discontinuation of this method are menstrual bleeding and dysmenorrhea. Metraplant- E
is effective in significantly reducing the amount of menstrual blood loss in women with heavy painful menstrual
loss related to copper IUD. Strong endometrial suppression is the principal mechanism, explaining both the effect
on menstrual blood loss and the contraceptive performance of the IUS. Proper treatment of the chronic
endometritis prior to Metraplant-E insertion is recommended. Actively informing women about benefits, risks and
common side effects of IUS appears to improve consideration and acceptance of the method.
Keywords: levonorgestrel releasing IUS, metraplant E, IUD, LARC.

consideration and acceptance of the method (5). The
Intrauterine methods of contraception (IUC)
most common reasons for the discontinuation of this
include the copper intrauterine device Cu-IUD and the
method were menstrual bleeding and dysmenorrhea.
Levonorgestrel releasing intrauterine systems LNG-
In the first year of use between 4% and 15% of
IUS. IUC is considered to be a long acting reversible
women using a copper IUD it was removed for these
method of contraception (LARC) (1,2). The IUD is the
reasons (6). One of the most versatile forms of a long-
most commonly used method of reversible
acting reversible method of contraception (LARC) is
contraception worldwide and it is used by an average
the levonorgestrel-releasing intrauterine system
of 23 percent of female contraceptive users, with a
(LNG-IUS). This system is an extremely effective
range of <2 to >40 percent depending on the country
contraceptive and has many non-contraceptive health
(3) .
benefits, including suppression of menstruation,
In 2014, IUDs were used by 27 percent of female
maintenance of iron stores, improvement in
contraceptive users in Asia and 17 percent of female
dysmenorrhea and endometrial protection for women
contraceptive users in Europe. Use of IUDs has
on estrogen replacement therapy (7).
increased in the United States (US). In the decade
The LNG-IUS offers, in addition to its
from 2002 to 2012, IUD use rose from 2 to nearly 12
excellent contraceptive efficacy, further added health
percent among US women using contraception (4).
benefits. The immediate and intense suppression of
Actively informing women about benefits, risks and
the endometrium leads to over 90% reduction of
common side effects of IUDs appeared to improve
menstrual blood loss over a period of 12 months.
Received:6 /1 /2018 DOI: 10.12816/0046620
Accepted:16 /1 /2018

Full Paper (vol.715 paper# 14)

c:\work\Jor\vol715_15 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3166-3170

Screening of Oral Cancer Using Plasma Biomarkers
Hamdi Abdulwahab Alhakimi
Department of Dental Health, Albaha University, Saudi Arabia
Corresponding author: Hamdi Alhakimi, Email: dr.hamdi.hakimi@gmail.com
Aim of the work: there are many types of biomarkers (DNA biomarkers, RNA biomarkers and protein
biomarkers). They have a pivotal role in early detecting of oral cancer. In this review, we aimed to summarize the
potent plasma biomarkers which have been reported to have pivotal role in the detection and diagnostic different
types of oral cancer. Methods: an electronic search in MEDLINE was conducted through PubMed using this search
strategy (Plasma biomarker or plasma indictors) and (Oral cancer or oral tumor or oral squamous cell carcinoma).
The search resulted in 158 eligible study and finally 10 potential articles were included in this systematic review.
Results: in general, 9 articles used oral squamous cell carcinoma (OSCC) while, only one study used gingival
squamous cell carcinoma as a type of oral cancer in order to evaluate the potential of biomarker to detect oral
cancer. In eight articles microRNAs were predominantly used as potent biomarkers, different types of microRNAs
were used. Plasma hsa-miR-542-3p recorded potential performance as biomarker in diagnosis of OSCC with AUC
0.82. Down regulation of hsa-miR-542-3p were correlated with increasing of surviving expression in OSCC.
Conclusion: we can conclude that plasma microRNAs biomarkers occupied wide scope of the included studies in
this review and could be serve as potent and sensitive biomarkers (especially plasma miR-125b expression and
combination of miR-196a and miR-196b) for prognostic and diagnostic different types of oral cancer.
Keywords: oral cancer, biomarkers, plasma, screening, DNA, RNA, protein.

suppressor inhibited cell proliferation and induced
Oral cancer is classified as one of the most
apoptosis. Gu et al.(9) reported that plasma miR-125b
prevalent cancer around world (1,2). The wide spread
was as promising plasma biomarker for detecting oral
for this malignant disease is associated with some of
squamous cell carcinoma(OSCC). It had strong ability
unhealthy habits as smoking and alcohol addicting, in
to differentiate OSCC from healthy controls.
addition to molecular mutations which are considered
Significantly increasing of plasma miR-125b
as carcinogenesis agent (3). Early detection for oral
expression was detected in patients with OSCC
cancer may help to reduce patient morbidity and
compared to healthy controls. Other studies revealed
mortality. This mainly depends on the early and
that the combined determination of plasma miRNAs
accurate diagnosis (4). There are some substances
could be considered as potential diagnostic
defined as biomarkers produced by tumor or by
biomarkers for OSCC. Lu et al.(10) showed that, the
normal tissue which can be used as specific markers
combined determination of miR-196a and miR-196b
for detecting cancer or monitoring the progression of
levels recorded excellent accuracy, sensitivity and
therapeutic response. Biomarkers may be a single
specificity in the prediction of oral cancer.
molecular or a series of molecules which could be
Furthermore, Su, et al.(11) suggested that plasma
detected in a variety of body fluids as plasma and
TIMP3 was a potential biomarker for predicting the
salivary (5, 6). There are many types of biomarkers
tumor stage and T status in patients with OSCC.
(DNA biomarkers, RNA biomarkers and protein
In this review we aimed to summarize the potent
biomarkers) which have a pivotal role in early
plasma biomarkers which have been reported to have
detecting of oral cancer (7). Cytokines (Pro-
pivotal role in the detection and diagnostic different
inflammatory, anti-inflammatory and chemokines)
types of oral cancer.
may release from the tumor and surrounding

lymphocytes and could be used as biomarkers in early
detecting of oral cancer.Tachibana et al.(8) revealed
An electronic search in MEDLINE was conducted
that in their study on plasma miRNAs biomarkers in
through PubMed using this search strategy "plasma
patients with gingival squamous cell carcinoma
biomarker" or plasma indictors and "oral cancer" or
(GSCC) plasma miR-223 level in gingival squamous
"oral tumor" or "oral squamous cell carcinoma". The
cell carcinoma differed significantly from that in the
search resulted in 158 eligible study, 135 articles were
controls, therefore they reported that miR-223 could
irrelevant when their title and abstract were screened,
serve as diagnostic biomarker and act as a tumor
127 irrelevant articles, five reviews and three
Received:30 /1 /2018 DOI: 10.12816/0046619
Accepted:10 /2 /2018

Full Paper (vol.715 paper# 15)

c:\work\Jor\vol715_16 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3171-3178

Types of Surgical Repair and Outcome in Patients with Tetralogy of
Fallot: Experience from A Single Center in Saudi Arabia

Kafaf S Jalali 1, Mohamed Mofeed F Morsy2,4, Sherif S Salim3,4, Abdulhameed A Alnajjar4 ,
Saad Q Khosh-Hal4, Aitizaz U Sayed4, Ali E Jelly4, Ibrahim H Alharbi4,Mohamed H Abdelwahab4,5,
Khalid M Alharbi4, Mustafa A Almuhaya4 , Ashraf R. Abutaleb2,Benouadah D Jamal6, Mansour M
1Taibah University, Medina, Saudi Arabia, 2Sohag University, Egypt, 3Menoufiya University, Egypt,
4Pediatric Cardiology, Medina Cardiac Center, Saudi Arabia, 5Department of Cardiac Surgery, Alazhar
University, Egypt, 6 Anesthesia Department, Algeirs Univesity, Algeria
Corresponding author: Kafaf Jalali, Email: jalalikafaf@gmail.com
Congenital heart disease is the most prevalent form of primary congenital disability in newborns
and is the leading cause of death in children with congenital malformations. It occurs in approximately 0.8% of
live births. With advances in both palliative and corrective surgery, the number of children with congenital heart
disease surviving to adulthood has increased dramatically . Tetralogy of Fallot (TOF) is one of the conotruncal
family of heart lesions in which the primary defect is an anterior deviation of the infundibular septum (the
muscular septum that separates the aortic and pulmonary outflows). Objective: To revise patients with tetralogy
of Fallot (TOF) underwent palliative or total corrective surgical repair in Madinah, Saudi Arabia. Methods:
retrospective study was approved from the institutional review board of Madinah cardiac center and abandoned
the need for patient consent. Patient Demographic data and procedure details were retrieved from the hospital
information system (HIS). From 2014 till end of 2017, 72 patients had the diagnosis of TOF (ICD 10 code,
Q21.3). Twelve patients were excluded from them. Thus, 60 patients were left as the study cohort. Fifty four
patients had total repair from the start (Group I), 3 patients had initial palliative procedure (group II) and 3
patients had both initial palliative procedure then later total repair. All patients from 1 day to less than 14 years
are included. All data were analyzed using GraphPad prism version 5.00 for windows. Results: 61.67% of our
patients were males, and 38.33% were females with the ratio of 1.6 (Male: Female). Six (10%) cases were
subjected to a palliative correction surgery (group I) and 57 (95%) cases were subjected to total repair surgery
(group II). 11 (18.3%) cases had post-operative complications, 2 (18.2%) cases from group I and 9 (81.8%) cases
from group II. Regarding to the type of surgery there was no statistically significant difference between gender
and pre and post-operation stay. Also no significance with length of stay, re-intervention, mortality and
complications. While there was a significant correlation between age, weight, RPA and LPA. Conclusion: We
described our experience in Madina Cardiac Center regarding management of tetralogy of Fallot
patients. Our results are comparable to international results. A study includes results from allover Saudi
Arabia is recommended
trisomies 21, 18, and 13, but up-to-date experience
Tetralogy of Fallot (TOF) is a cyanotic
points to the much more frequent association of
congenital cardiac defect that was first described by
microdeletions of chromosome 22. The risk of
Stenson in 1672 and later named for Fallot, who in
recurrence in families is 3% [5]. Tetralogy of Fallot
1888 described it as a single pathological process
results in low oxygenation of blood due to the mixing
responsible for pulmonary outflow tract obstruction,
of oxygenated and deoxygenated blood in the left
ventricular septal defect (VSD), revoking aortic
ventricle, through the ventricular septal defect (VSD),
root, and right ventricular hypertrophy [1-3].
and preferential flow of the mixed blood from both
Tetralogy of Fallot occurs in 3 of every 10,000
ventricles through the aorta because of the barrier to
live births. It is the most frequent cause of cyanotic
flow through the pulmonary valve. This is known as a
cardiac disease in patients beyond the neonatal age
right-to-left shunt. The primary symptom is known to
and accounts for up to one-tenth of all congenital
be low blood oxygen saturation with or without
cardiac lesions [4]. The etiology is multifactorial, but
cyanosis from birth or developing in the first year of
reported associations include untreated maternal
life. If the baby is not cyanotic, then it is sometimes
diabetes, phenylketonuria, and intake of retinoic acid.
pointed to as a "pink tet" [6].
Associated chromosomal anomalies can consist of
Received: / /2018 DOI
Accepted: / /2018

Full Paper (vol.715 paper# 16)

Introduction The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3179-3183

Value of Midkine as a Diagnostic Serum Marker in Hepatocellular Carcinoma
Desouky E. Abou Ammo 1 , Ashraf F. Barakat 2, Amira Y. Ahmad 1 , Rehab R. Farag 1
1- Department of Clinical Pathology, 2- Department of oncology, Faculty of Medicine, Tanta University
Corresponding author: Rehab R. Farag, email: Rehab.ramadan1988@gmail.com

hepatocellular carcinoma (HCC) represents a global health problem. It is the fifth most
common cancer but the second leading cause of cancer-related death in men worldwide. In Middle Eastern
countries, liver cancer is a major concern among men, especially in Egypt and Saudi Arabia. The incidence
of HCC has increased sharply in the last 5­10 years, with an especially high incidence in Egypt. So, early
detection and diagnosis of these cases are required for successful treatments and improved outcomes. Aim of
the Work:
this study aimed to detect the efficacy of serum level of Midkine as an early marker for HCC
diagnosis compared to AFP serum level. Patients and Methods: this prospective study was conducted on a
total of 50 subjects, 30 of them with HCC and 20 apparently healthy subjects matched for age and sex with
patients. It was carried out at the Clinical Pathology Department, Tanta University Hospital. Results: a
significant increase (p < 0.001) in serum midkine level was detected in HCC group compared with control
group from a mean of 391.45 ± 96.09, in control group to a mean of 1074.53 ± 106.27, in HCC. Conclusion:
serum midkine may serve as a novel diagnostic tumor marker for the detection of hepatocellular carcinomas.
it was recommended to do further studies on early cases with larger population
including AFP-negative patients, to justify its implementation in clinical practice.
Keywords: hepatocellular carcinoma, midkine, alpha-fetoprotein.


Hepatocellular carcinoma (HCC) represents
was originally discovered in embryonal carcinoma
a global health problem. It is the fifth most
cells and involved in the early stage of retinoic
common form of cancer worldwide and the third
acid­induced differentiation (8). Midkine was
most common cause of cancer-related deaths (1).
identified as 1 of the 5 important potential novel
In Egypt, HCC represents 75% of malignant liver
biomarkers for early detection of hepatocellular
tumors. Liver cancer is the 5th most common
carcinomas (9). In addition, mounting evidence has
cancer in both genders, the 6th in female
indicated that midkine plays a significant role in
representing 3.4% of cancers and 2nd in order in
carcinogenesis- related activities, such as
males after cancer urinary bladder representing
11.5% of all cancers. In 2010, liver cancer came
mitogenesis, transformation, and angiogenesis, in
in the 3rd order in both sexes (8.1%), 1st in males
many types of solid tumors, including
(12.1%) and 5th in females (4%) (2). Owing to the
hepatocellular carcinomas (10).
diagnostic and therapeutic progress during the

past decades, the hepatocellular carcinoma
outcome has been improved in a proportion of
This study aimed to detect the efficacy of
patients who were diagnosed at an early stage and
serum level of Midkine as an early marker for
received curative treatments (3). However, only
HCC diagnosis compared to AFP serum level.
about 10% to 20% of patients are currently

eligible for potentially curative therapies at the
time of diagnosis (4). Most of the patients with
This prospective study was carried out at
hepatocellular carcinomas are diagnosed at an
Clinical Pathology Department, Tanta University
advanced stage and their prognosis remain very
Hospital and included 50 subjects categorized into
poor (5). Thus, early detection and diagnosis of
two groups:
hepatocellular carcinomas still present the best
Group I: 30 HCC patients, selected from
chance for successful treatments and improved
Clinical Oncology Department Tanta
outcomes (6).Alpha-fetoprotein (AFP) has been
University Hospital.
widely used as a serologic diagnostic tumor
Group II: 20 apparently healthy subjects
marker for hepatocellular carcinomas. However,
matched for age and sex with patients and
serum AFP is elevated in only about 33% to 65%
had included as a control group.
Studied groups were subjected to the
nonspecific elevation of serum AFP has been
found in 15% to 58% of patients with chronic
1. Full history taking and thorough clinical
hepatitis and 11% to 47% of liver cirrhosis (7).
Midkine, a small heparin-binding growth factor,
Received:20 / 3/2018 DOI: 10.12816/0046622
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 17)

c:\work\Jor\vol715_18 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3184-3190
Role of Magnetic Resonance Imaging in Diagnosis and Staging of
Uterine Cervical Carcinoma
Ahmed F Abdel Ghany, Mona A Abdel Wahed, Waleed K AL-Habash
Radiodiagnosis, Faculty of Medicine ­ Ain Shams University
Corresponding author: Waleed K Al-Habash; Mobile: 01140213300; Email: waleedhabash63@gmail.com
MRI examination is a useful modality for staging and evaluation of gynecologic malignancy. The
diffusion-weighted MR imaging (DW-MRI or DWI) method has been introduced to cancer diagnostics, and has
widened the diagnostic capabilities of MRI. Functional information from DWI and DCE-MRI can supplement
morphologic information obtained with conventional cross-sectional imaging methods.
Aim of the Work: The aim of the present study is to evaluate the role of MRI in the diagnosis & staging of
uterine cervical cancer & to assess the value of apparent diffusion coefficient (ADC) in the studied individuals.
Patients and Methods: This prospective study included twenty two patients with clinically suspected cervical cancer
and twenty two apparently healthy women with normal MRI appearance of the cervix. It was conducted in El-
Demerdash Hospital. The patients were referred from the Gynecology Department to the Radiology Department
(Women's Imaging Unit) for further MRI assessment with DWIs. Ten patients were followed up after receiving
chemo-radiotherapy. Results: There was a high statistical difference between cervical cancer patients (Before-
treatment) and control group according to ADC Value. There was a high statistical difference between cervical cancer
patients (post-treatment) and control group according to ADC Value. In addition, there was a high statistical difference
between cervical cancer patients (pre-treatment) and (post-treatment) according to ADC Value. The comparative study
between ADC values versus tumor size and between ADC values versus histopathological result (types and grading)
of the tumor was statistically non-significant. Conclusion: DWI serves as a functional technique, which provides
information about water mobility, tissue cellularity, and stability of membrane integrity that can discriminate cervical
carcinoma from healthy tissue, and increasing the radiologist's confidence in image interpretation. Therefore, it
implies a non-invasive technique, which can be used especially if contrast intake is avoided as in pregnancy. ADC
values are reliable for differentiating cervical cancer from normal cervix with higher diagnostic accuracy when added
to DWI interpretation. Recommendations: Further studies on a larger scale of patients are needed to confirm the
results obtained by this work.
Keywords: MRI, uterine cervical carcinoma.

noninvasive characterization of biological tissues based
Cervical cancer is the third most commonly
on the properties of water diffusion, and thus can provide
diagnosed cancer worldwide and the fourth leading
micro-structural information on the cellular level (7). This
cause of cancer death in women (1).
modality is helpful in initial staging of known
Most women with cervical cancer are diagnosed
malignancies, differentiating benign from malignant
before the age of 50 years old. However, older women
lesions, assessing treatment response, and determining
remain at risk. Cervical cancer is both preventable and,
the presence of disease recurrence. Thus, DWI becomes
treatable if identified early (2). The staging system of the
increasingly important in the evaluation of cervical
International Federation of Gynecology and Obstetrics
cancer patients (8). Lucas and Cunha (9) suggested
(FIGO) which is most commonly used, accept the use
DWI as an excellent tool for identification of small
of Magnetic Resonance Imaging (MRI) as an adjunct to
even a few mm sized lymph nodes. Also the
clinical staging. Also, the guidelines from European
combination of DWI & T2-weighted image in
Society of Urogenital Radiologist (ESUR) recommend
identification of parametrial extension & recurrent
using MRI for staging of cervical cancer and follow up
disease found to be more accurate than using T2-
(3). The role of MRI in gynecological oncology has
weighted image alone. New advanced MRI
evolved over the past several years (4). MRI with a
techniques may be helpful for developing optimal
good soft tissue contrast and multi-planar imaging
diagnosis & therefore optimal therapy for patient
capability is an optimal method for evaluation of
with cervical cancer.
gynecologic malignancies including cervical cancer.
Aim of the work
MRI is obviously better than computed tomography for
The aim of the present study is to evaluate the role of
loco-regional disease assessment, especially for primary
MRI in the diagnosis & staging of uterine cervical
tumor and adjacent soft tissue extension (5). Moreover,
cancer & to assess the value of ADC in the studied
MRI allows accurate identification of stromal and
parametrial invasion, the exact volume, shape,
direction of the primary lesion and nodal status,
which helps the clinician in treatment planning (6).
This prospective study included twenty two patients
MRI Diffusion-Weighted Image (DWI) enables
with clinically suspected cervical cancer and twenty
Received:20 / 3/2018 DOI: 10.12816/0046623
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 18)

c:\work\Jor\vol715_19 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3191-3199
Towards Precise Identification of The Medically Important Flesh Fly, Sarcophaga
(Liopygia) argyrostoma (Robineau-Desvoidy, 1830) (Diptera: Sarcophagidae)
Ahmad M. M. Galhoum
Department of Zoology, Faculty of Science, Al-Azhar University, Cairo, Egypt.
Corresponding author: Ahmad Galhoum , Email: ahmadgalhoum@hotmail.com
Although of its medical importance and its role in the forensic investigation field, flesh fly, Sarcophaga
(Liopygia) argyrostoma is not well taxonomically studied. This work aimed to use different tools
(morphological and biochemical) toward precise identification of this species. By using SEM, different types
of antennal sensilla (used for host location among other functions) had been classified to be applied as potential
accurate taxonomic character. Trichoid sensilla are the most common and numerous types on S. argyrostoma
antennae, in addition chaetica, basiconica and campaniform types are found to be represented by a few
numbers. Gas chromatography-mass spectrometry (GC/MS) analysis characterized thirty-eight cuticular
hydrocarbons components (CHCs) found in the flesh fly integument. The hydrocarbons identified were
belonged to seven categories (i.e. Alkane, Alkene, Cycloalkane, monocyclic hydrocarbons, Alkyne, Polycyclic
and Cycloalkane hydrocarbons), with chain length ranged from C5 to C35. Cuticular hydrocarbon profile now
used precisely in insect taxonomy. Most studies on Sarcophaga were carried out on larvae, it's very important to
study adult flies to suggest precaution and control measures against adults to reduce their harmful role in
diseases transmission.
Keywords: Sarcophaga argyrostoma, Taxonomy, Medical importance, Myiasis, SEM, CHCs.

characters. During recent years, several SEM based
Sarcophagidae Hagen, 1881 is a medium-sized
papers appeared, dealing with larval morphology of
family of Diptera which include about 2600 species.
calyptrate flies of veterinary and medical
importance[10]. In addition to the physiological
especially in tropical and warm temperate climate
function performed by sensilla, they have a useful
regions[1]. Practically, species of Sarcophaginae are
tool in taxonomic and phylogenetic studies.
difficult to identified based on external feature and
Different species in the order Ephemeroptera were
can only be precisely identified using characters of
taxonomically compared using scanning electron
male genitalia[2]. Sarcophagid spp. applied in
microscopy (SEM)[11].
forensic investigations as they have been found on
As regards the importance of the insect
carcasses throughout the decomposition process,
antennal sensilla as they play an important role in
being slightly less abundant only during the
host location, food selection, oviposition site
advanced stages of decomposition[3].
Several sarcophagid spp. recorded as
mechanoreceptor and in various behaviors during
facultative myiasis agents[4]. Sarcophaga (L.)
adult life, numerous studies have characterized the
argyrostoma is classified as included in the category
antennal sensilla of different insect species[12].
of nosocomial myiasis agents because they have
On the other hand, few studies were carried on
been found in wound myiasis affecting hospital
other regions of the body and their taxonomic value
patients who are immobilized[5].
e.g. the sensilla of tarsi and ovipositors of six fruit
Most studies on myiasis were carried out on
flies[13]; labial sensilla and their distribution in
larval stage of flies (maggots) as the larvae is the
Reduviidae (Triatominae and Peiratinae) and
direct causative agent of myiasis[5].
The members of Sarcophagidae received little
intraspecific similarity in the shape and numbers of
attention in Egypt. Complete descriptions of the
labial sensilla could be used as taxonomic
immature stages of S. (L.) argyrostoma (R.-D.)[6], [7].
They applied classical description with SEM figures
Cuticular hydrocarbons (CHCs) are essential to
in some cases, but no modern documentation
the survival of the insects, because their primary
techniques were applied.
function is to prevent dehydration[15] and they
New approach has been introduced for species

identification (e.g. DNA barcoding[8], Cuticular
microorganisms[16]. The CHCs are synthesized by
hydrocarbon profile[9]).
secreting cells derived from epidermal cells and are
Scanning electron microscopy (SEM) is
transported to the cuticle via hemolymph by
lipophorin proteins[17]. Cuticular hydrocarbons are
Received:1 / 1 /2018 DOI: 10.12816/0046624
Accepted:11 / 1 /2018

Full Paper (vol.715 paper# 19)

c:\work\Jor\vol715_20 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3200-3205

The Prevalence of Stress among Medical Students and Its Effects on
Academic Performance in The Kingdom of Saudi Arabia
Bashaer Mahboub Alalwani (1) , Abdulkader Al Juhani(1) , Saja Mohmmmed Fallatah(2) , Sefana Abdulhaleem
Abdulmajeid(2),Douaa Alawi Alsaidi(2) , Raghad Abdulmueid Mahyuddin(2),Zuhour Mohammed Haneef(2)
Royal Commission Medical Center (1), Batterjee Medical College (2)
Corresponding author: Bashaer Mahboub Alalwani, Mobile: 00966507000396, Email: Alalwaniba@rcymc.med.sa

A definition of stress is anything that can disturbs the normal individual's mental or physical
wellbeing. Medical school is known to be stressful branch in higher education and requires a lot of effort.
In fact there is an increase in the incidence of stress between medical students. Young students are more liable to
develop stress due to the high competitive field of medicine.
Aim of Study: the study is to explore the prevalence of stress among medical students and its effects on their
academic performance in the Kingdom of Saudi Arabia.
Methods: A cross sectional study was conducted in under graduate medical students and interns at Faculty of
Medicine in the kingdom of Saudi Arabia, a quota sampling was used. The questionnaire was validated, self -
administrated with a Kessler Psychological Distress Scale (K10) used to conduct the data . Results: In total, of
1900 students and interns , 29.5% were males , 70.1% females .The prevalence of stress among undergraduates
82.1% and interns 17.1%, the prevalence of severe stress was in the undergraduate female 84.6%. According to
the results the proportion of female who had stress was higher 70.1%than their counterpart males 29.5%. The
prevalence of stress was highest among fourth year students 21.1%, and first year 4.8% showed the lowest .There
was a high association between a study year and level of stress p >(0.00) There is high association between
studying medicine and developing symptoms of stress( p value 0.001). Most of the 60.6% of the participants
developed symptoms related to exposure to stress, most common symptoms were gastrointestinal
(67.19%).There is significant association between marriage and stress (p vale 0.19).There is no association
between work and stress (p <0.132).There is no association between martial statues and stress (p value<0.386).
Conclusion: The main result in this study shows high prevalence of stress among medical students in Kingdom
of Saudi Arabia compared to others studies .The Level of stress is more among the female students compared to
the male students. The main causes of stress are related to hours of sleep, hours of studying and marriage.
Keywords: stress , medical students , study medicine

was 31.2% (5), while in a Malaysian medical school
Medical school is known to be stressful branch
it was 41.9%(6) , in a Thai medical school
in higher education and requires a lot of effort.
61.4%(7)and in Jizan university was (71,9%) (8).
Therefore there is an increase in the incidence of
According to a study conducted at College of
stress between medical students (1). The large
Medicine, in Jizan University, Jizan, Saudi Arabia,
amount of information leaves a little time for the
it's found that there is a difference in prevalence of
medical students to relax and refresh, because of that
stress between male and female medical students,
stress and depression have been always linked to
the prevalence of stress among the females was 77%
mental and physical issues (2).
while that among the males it was 64%. There is a
A definition of stress is anything that can disturbs
statistically significant association between gender
the normal individual's mental or physical wellbeing
and stress (p<0.05). and the age of the students
(3). So stress could be beneficial or harmful. The
ranged from 18 to 26 years, with a mean age of 20.8
beneficial stress will improve the individual
performance, increase achievement and imagination.
Even though the difference in mean age of the
While the harmful stress will affect your general
two groups, stressed and not stressed, was very
health (4).
small; the analysis shows that the difference is
Many studies have shown that the level of
statistically significant.
stress is higher in medical student comparing to
There is a strong belief that stress levels can
other faculties a study was conducted In three British
influence the eating habits and may affect weight
universities revealed that the prevalence of stress
and Body Mass Index. The Mean weight and Mean
Received:21 / 1 /2018 DOI: 10.12816/0046625
Accepted1: / 2 /2018

Full Paper (vol.715 paper# 20)

c:\work\Jor\vol715_21 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3206-3210

Vaginal Progesterone versus Cervical Cerclage or Both for
Prevention of Preterm Delivery
Mohammed Abdel Samie*, Hossam Hassan Elkatatny*, Rehab Mouhamed Magdy Naim**.
*Faculty of Medicine Al-Azhar University, Assuit,** Obstetrics and Gynecology in Akhamim Hospital
Corresponding author: Rehab Naim, Tel: 01061765449, Email: magdyrehab86@yahoo.com

Preterm labor (PTL) occurs in 5-13% of pregnancies before 37 weeks' gestation. Multiple
pregnancy and iatrogenic preterm birth remain important causes of prematurity. Three interventions have been
proposed to treat patients with a sonographic short cervix: (1) vaginal progesterone administration, (2) cervical
cerclage for patients with a history of preterm birth and (3) vaginal pessary. Aim of the work: evaluate the
efficacy of vaginal progesterone supplementation, cervical cerclage, or a combination of both in the prevention
of PTL and their impact on the perinatal outcome. Patients and methods: Randomized controlled trial done on
asymptomatic women with a sonographic short cervix (cervical length <25 mm) in the midtrimester, singleton
gestation, and previous spontaneous preterm birth at less than 37 weeks of gestation. The study conducted in the
Obstetrics and Gynecology Department at Sohag General Hospital. Results: this study showed that there was
no significant difference between the 4 studied groups regarding each of age, cervical length and gestational
age. It also showed that either vaginal progesterone only or cerclage only reduced the risk for preterm labor
significantly compared to control. Moreover, combination of cerclage and vaginal progesterone resulted in
higher reduction of preterm labor.
Keywords: Cervical Cerclage, Cervical Incompetence, Preterm Delivery, Vaginal Progesterone.


Preterm labor (PTL) occurs in 5-13% of
pessary (13). Recently, a combination of vaginal
pregnancies before 37 weeks' gestation. The
progesterone and a pessary has been reported to be
incidence of early PTL (<34 gestational weeks) is 1-
a successful method to reduce the rate of preterm
3.6%. Preterm birth remains the leading cause of
delivery in twin gestations with a cervix of <25
perinatal morbidity and mortality worldwide (1).
Multiple pregnancy and iatrogenic preterm birth
The availability of vaginal progesterone and
remain important causes of prematurity, however, the
cerclage for the prevention of preterm birth in
prevention of recurrent spontaneous preterm birth in
women with a short cervix, singleton gestation,
singletons has been highlighted recently by the USA
and previous spontaneous preterm birth could
Food and Drug Administration approving, and the
create a dilemma for physicians and patients about
American College of Obstetricians and Gynecologists
the optimal choice of treatment. Thus far, there are
endorsing(2). Most of the efforts to prevent preterm
no randomized controlled trials comparing vaginal
birth have been focused on the treatment of
progesterone and cerclage directly. In the absence
symptoms or signs of activation of the common
of this evidence, indirect meta-analysis has
pathway of parturition(3,4)i.e., increased uterine
emerged as an accepted and valid method for the
contractility(5,6)preterm cervical ripening (7) and/or
comparison of competing interventions with the
membrane decidual activation(8,9).
use of a common comparator(18).
Although the detection of increased uterine

contractility(10) has been the focus of clinicians and
reproductive biologists for decades, emerging
To evaluate the efficacy of vaginal
clinical(11)and laboratory-based evidence(12) suggests
progesterone supplementation, cervical cerclage,
that focusing on the uterine cervix may yield
or a combination of both in the prevention of PTL
approaches to identify the patient who is at risk for
and their impact on the perinatal outcome.
preterm delivery as well as interventions to prevent

it(13,14).Three interventions have been proposed to
treat patients with a sonographic short cervix: (1)
Study Design:
Randomized controlled trial
cervicalcerclage for patients with a history of preterm
birth(16) and (3) vaginal
Asymptomatic women with a sonographic

short cervix (cervical length <25 mm) in the

midtrimester, singleton gestation, and previous
Received:18 /12 /2017 DOI: 10.12816/0046626
Accepted:28 /12 /2017

Full Paper (vol.715 paper# 21)

Advanced techniques of magnetic resonance imaging in the diagnosis of articular cartilage lesions The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3211-3220

Imaging of Postoperative Cosmetic Breast Surgery
Sherif H. Abogamra, Khaled A. Ali, Asmaa M. Esmail
Department of Radiodiagnosis, Faculty of Medicine, Ain shams University
Corresponding author: Asmaa M Esmail; Mobile: 01114114649: Email: drasmaamabrouk@gmail.com

cosmetic breast procedures, as well as implants, are increasingly being performed and many women
who had undergone cosmetic operation present for mammographic screening. There are three general categories of
cosmetic surgery performed on the breast including breast augmentaion,breast reduction and breast reconstruction.
A wide variety of breast implants which being used in most of augmentation surgeries are available on the market
and are broadly categorized by lumen number, filler type, and surface contour. Aim of the work: this study aimed
to illustrate the role of different imaging modalities in postoperative cosmetic breast surgery. Results: MRI is the
modality of choice for evaluation of silicone breast implant integrity. MRI is not recommended as a screening
modality for implant rupture in asymptomatic women with breast implants. Conclusion: Since the number of
cosmetic breast surgeries is increased with increased number of patients present for assessing the operation as
example; implant integrity; a radiologist should be familiar with the spectrum of appearances of the complications.
The imaging appearances of the cosmetic breast as common breast implants and their complications using different
radiological modalities as mammogram, ultrasound and MRI are varied. Recommendations: In symptomatic
patients, after an initial evaluation with mammography and USG, noncontrast MRI is recommended to rule out the
diagnosis of rupture. Dynamic contrastenhanced MRI could be indicated in patients with breast reconstruction
surgeries after mastectomy for breast cancer or in breast implant patients with suspicious masses.
Keywords: imaging modalities, postoperative cosmetic breast surgery.

radiologists are often asked to evaluate for
Many women regard their breasts as important
complications or evidence of failure (3).The number of
to their sexual attractiveness, as a sign of femininity
women undergoing breast implant procedures is
that is important to their sense of self. Due to this,
increasing exponentially. It is, therefore, imperative
when a woman considers her breasts deficient in
for a radiologist to be familiar with the normal and
some respect, she might choose to undergo a plastic
abnormal imaging appearances of common breast
surgery procedure to enhance them, either to have
implants. Diagnostic imaging studies such as
them augmented or to have them reduced, or to have
mammography, ultrasonography and magnetic
them reconstructed if she suffered a deformative
resonance imaging are used to evaluate implant
disease, such as breast cancer. After mastectomy, the
integrity, detect abnormalities of the implant and its
reconstruction of the breast or breasts is done with
surrounding capsule, and detect breast conditions
breast implants or autologous tissue transfer, using fat
unrelated to implants. Magnetic resonance imaging of
and tissues from the abdomen, which is performed
silicone breast implants, with its high sensitivity and
with a TRAM (transverse rectus abdominis) flap or
specificity for detecting implant rupture, is the most
with a back (latissiumus muscle flap). Breast
reliable modality to asses implant integrity. Whatever
reduction surgery is a procedure that involves
imaging modality is used, the overall aim of imaging
removing excess breast tissue, fat, skin and the
breast implants is to provide the pertinent information
repositioning of the nipple-areola complex (1).
about implant integrity, detect implant failures, and to
Cosmetic improvement procedures include breast lift
detect breast conditions unrelated to the implants,
(mastopexy), breast augmentation with implants, and
such as cancer (4).
combination procedures; the two types of available
breast implants are models filled with silicone gel,
The Aim of this study was to illustrate the
and models filled with saline solution. These types of
role of different imaging modalities in postoperative
breast surgery can also repair inverted nipples by
cosmetic breast surgery.
releasing milk duct tissues that have become tethered.
Surface anatomy of the breast:
Furthermore, in the case of the obese woman, a breast
Breasts are modified skin glands, located on
lift (mastopexy) procedure, with or without a breast
the anterior and also partly the lateral aspects of the
volume reduction, can be part of an upper-body lift
thorax. Each breast extends superiorly from the
and contouring for the woman who has undergone
second rib to the sixth costal cartilage inferiorly,
massive body weight loss (2).Cosmetic plastic surgery
medially to the sternum, and laterally to the mid-
procedures, as well as implants, are increasingly
axillary line (fig.1).The nipple­areola complex is
being performed. These implants are often
located between the fourth and fifth ribs (5).
encountered on routine imaging examinations, and
Received:20 / 3 /2018 DOI: 10.12816/0046627
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 22)

c:\work\Jor\vol715_23 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3221-3228

Role of 320 Detector Row CT Perfusion in Assessment of
Myocardial Perfusion
Fatma Salah Eldin, Omar Farouk Kamel, Ahmed Hassan Soliman, Nadin Fawzy Abd Elaziz
Radiodiagnosis Department, Ain Shams University, Cairo ,Egypt
Corresponding Author Nadin Fawzy Abd Elaziz, Email: sallyhatim2005@gmail.com.Tel.01225161312


Aim of the work: this study aimed to evaluate the coronary artery morphology and myocardial perfusion by single
reproducible non-invasive contrast enhanced CT acquisition by using DECT scanners with high sensitivity and
specificity as well as high diagnostic accuracy without the need to increase the contrast material or radiation dose.
Patients and Methods: this study was done during the period from October 2016 to December ,2017; age was
ranged between 42 to 73 years old, were 35 patients with CAD diagnosed by cCTA underwent DECT for
assessment of myocardial perfusion. The study included 35 patients referred for DECT myocardial perfusion
examination in the Police Authority Hospitals, Radiodiagnosis Department in Cairo after diagnosing by cCTA. Each
patient included in the study was subjected to full history taking, reviewing medical sheet, cCTA and CT myocardial
perfusion examination. Technique was performed by using Aquilion one dynamic volume 320 detector rows CT,
Toshiba Medical System, Tochigi-ken, Japan. Results: our study showed a significant correlation and good
agreement between the findings of DECT myocardial perfusion defects and the findings of stenosis and its degree
on cCTA on a segmental basis with 83% sensitivity, 87% specificity, 86% accuracy, 74% positive predictive value
and 92% negative predictive value. Conclusion: DECT myocardial perfusion has high diagnostic as compared to
cCTA as the gold reference standard.
coronary CT angiography, dual energy CT (DECT) myocardial perfusion.


Coronary artery disease (CAD) causes sudden
stenosis by using multidetector CT as compared to
death, nonfatal myocardial infarction, unstable angina
invasive coronary angiography. While, promising
(1). And it is believed to be the underlying cause in
reports on ventricular function and infarct imaging by
approximately two-thirds of patients with chronic
using multidetector CT have been published, data on
heart failure (HF) and low ejection fraction (EF) (2)
global LV function, regional wall motion (RWM), and
where regional myocardial dysfunction leads to
PD assessment with multidetector CT in the acute MI
global ventricular dysfunction and heart failure over
setting are somewhat limited. If these assessments can
time (3). Appropriate risk stratification and
be reliably obtained by using multidetector CT
management of patients with acute MI requireed a
combined with CT coronary angiography, it may
comprehensive assessment of the coronary arteries,
provide an excellent tool for the rapid noninvasive
global and regional left ventricular (LV) function, and
diagnostic and prognostic evaluation of patients with
infarct size (4). Currently, these data are acquired over
acute MI (7).
several days of hospital admission, with the use of a

variety of resources including echo-cardiography,
cardiac magnetic resonance (MR) imaging (5),
The study was conducted from October 2016 to
invasive coronary angiography and single photon
December ,2017 ; 35 patients known to have CAD
emission computed tomography (SPECT) imaging
with and without ischemia. Their age ranged from
that have shown a sensitivity of 88% and specificity
42 to 73 years. All patients were subjected to
of 76% for the detection of CAD when compared
clinical examination and conventional imaging.
with invasive coronary angiography (6). With
Comprehensive explanations of the procedures were
advances in multidetector computed tomography
done for all patients, including the associated risks
(CT) technology, multidetector CT scanners with
and contraindications.
sub-millimeter collimation and fast gantry rotation

(330 msec), potentially permit a noninvasive
assessment of coronary anatomy, global and regional
Each patient included in the study subjected to:
LV function and perfusion defects (PDs) and delayed
enhancement (6) showed high sensitivity and
Full history taking.
specificity for detection of substantial coronary artery
- Reviewing medical sheet whenever available.
Received:20 / 3 /2018 DOI: 10.12816/0046628
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 23)

c:\work\Jor\vol715_24 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3229-3231

Role of Diffusion Weighted MR Imaging in Assessment of
Hepatocellular Carcinoma after Radiofrequency Ablation
Hossam Fahmy Abdel Hamid, Ahmed Hassan Soliman, Jalal Khaleel Abduljaleel
Department of Radio-diagnosis, Faculty of Medicine, Ain Shams University
hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Surgical
resection and local ablative therapies represent the most frequent first lines therapies adopted when liver
transplantation cannot be offered. Aim of the work: this study aimed to evaluate the feasibility of DWI and the
corresponding ADC values to detect tumor response after radiofrequency ablation for hepatocellular carcinoma.
Patients and methods: MR examinations were done for 20 HCC patients post-RFA. Pre and post gadolinium
enhanced images as well as DW sequences were performed. ADC values of ablation zones and liver
parenchyma were assessed. ADC values of ablation zones and adjacent signal alterations identified in DWI
were analyzed. Results: residual or recurrent lesions were detected in 4 patients (20%). The mean ADC value
of ablated zones differed significantly from that of normal liver parenchyma. The corresponding ADC values
were significantly lower in patients with residual lesion than in patients without residual lesion. Conclusion: it
can be concluded that DWI is a feasible follow-up tool for post ablation liver contributing in detection of
residual lesion.
Keywords: MRI, carcinoma, radiofrequency ablation, liver tumor.

Documented consent must be obtained from each
Hepatocellular carcinoma (HCC) is the
patient involved in the study.
most common primary liver malignancy and is a

leading cause of cancer-related death worldwide (1). 1. MR protocol
Surgical resection and local ablative therapies
Magnetic resonance imaging examinations were
represent the most frequent first lines therapies
performed on a Philips Intera Achieva 1.5 T super
adopted when liver transplantation cannot be
conducting MR unit, with a 16- channel body coil.
offered(2). Radiofrequency ablation has become the 2. Pre-contrast imaging included
most widely used local thermal ablation method in a) T1 weighted (T1W) images.
recent years because of its minimally invasive nature b) T2 weighted (T2W) images.
(3). After certain loco-regional treatments such as c) T2 SPAIR (Spectral Attenuated Inversion Recovery).
RFA, the usual morphological criteria primarily d) In phase and out phase gradient echo sequences.
based on the maximal lesion size cannot be used with e) Heavy T2 weighted images.
confidence, as the induced ablation zones comprise f)
the tumor and its margin (4). Diffusion-weighted 3. Dynamic study
imaging represents a promising non-invasive
Dynamic study was performed after bolus
diagnostic tool for the evaluation of HCC treatment
injection of 0.1mmol/kg bodyweight of Gadolinium -
responses to loco regional therapies (5). ADC value
DTPA at a rate of 2ml/s, flushed with 20ml of sterile
changes have been shown to occur early after
0.9% saline solution from the antecubital vein. The
treatment and correlate well with tumor necrosis
injection of contrast media and saline solution was
(5).This study aimed to assess role of diffusion
performed by automatic injector.
weighted MRI in evaluation of treatment response

after radiofrequency ablation for hepatocellular 4. Diffusion study
Respiratory-triggered fat-suppressed single-shot

echo planar DW imaging was performed in the
transverse plane with tri-directional diffusion
This study was conducted during the period between
gradients by using different b values 0,300,600
November 2017 till April 2018 at MRI Unit at Ain
sec/mm2 to increase sensitivity to cellular packing.
Shams University Hospital on 20 patients (14 male

and 6 female) treated by radiofrequency ablation for 5. MR analysis
hepatocellular carcinoma. The study was approved
The morphological features of each lesion were
by the Ethics Board of Ain Shams University.
recorded included size, shape, margin, signal
Exclusion criteria: included patients with MRI
characteristics and pattern of enhancement in the
incompatible devices such as cardiac pacemaker,
dynamic imaging as well as number and site of the
metallic valves, hearing aids or aneurismal clips.
detected focal lesions. Then provisional diagnosis
was reported. We reviewed the diffusion images with
Received:20 / 3 /2018 DOI: 10.12816/0046629
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 24)

c:\work\Jor\vol715_25 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3232-3235
The Prevalence of Hernia Repair and its Associated Risk Factors in Saudi Arabia
Yazid Abraheem Ayed Alzapni 1, Yousef Ateeg Awad Alsadi 1, Manal Abdullah Flaywi Alhamazani 1,
Abdulmohsen Saad Mohsen Alghassab 1, Abdullah Ahmed Alkhalaf 1, Yahya Dokhi Rashid Altamimi 1,
Zaid Awad Hamoud Alshammari 1, Anfal Hazza Abdullah Alhobera 1, Yossef Fahad Khaled Alshammari 1,
Alzamil Abdullah Fahad A 1, Adnan Meteb Mohamed Almezani 1, Faisal Hameed Al-Anazi 2,
Nawaf Faisal Al-Harthi 3, Nwaf Shabram Alsabi Alenezi 4
College of Medicine University of Hail 1 , College of Medicine Prince Sattam Bin Abdulaziz University 2, College
of Medicine Tabuk University 3, College of Medicine Northern Border University 4
Corresponding author: Yazid Abraheem Ayed Alzapni, E-mail: Yazid_alzapni@yahoo.com, Phone no: +966502624348

despite the modern life and people knowledge about certain diseases, the prevalence of hernia repair
procedures and its associated conditions have been increased in the recent years in Saudi Arabia.
prevalence of hernia repair procedures is almost known in the modern countries. This study was done
to know the prevalence of hernia repair procedures in Saudi Arabia.
Methods: a cross-sectional study on knowing the prevalence of hernia repair procedures in Saudi Arabia was
distributed among men and women from February to January to February 2018 to 523 participants on many
different social media platforms.
Results: 3.8% of the participants had done hernia repair procedure. Regarding risk factors that may lead to hernia
repair procedure, 29.1% of the participants had a positive family history of hernia repair procedure, 44.5% of the
participants were obese, 27.6% were smoker, 25.8% ate high fat diet, 17.5% suffered from chronic constipation,
12.6% suffered from chronic cough, 8.3% had major surgeries, 7.7% were diabetic, 5.2% had been admitted to ICU,
4.6% suffered from urinary retention, 2.1% had major trauma, 1.25% had been diagnosed with atherosclerosis
disease and 37.7% were having no risk factors.
Conclusion: at the end of this study, we found out that hernia repair procedure is increased among people in Saudi
Arabia and multiple people are suffering from many risk factors that may lead to hernia and then hernia repair
procedure eventually.
Keywords: hernia, obesity , chronic constipation.


look for medical care if there is a painful or swelling
Hernia is bulging of a viscus or part of a viscus
on the abdomen, in the groin or pubic bone, or if the
through an orifice in the walls of its internal cavity. It
patient is complaining from other symptoms of
is one of the most common surgical procedures being
hernia(6,7). About 3% to 10% of hernia repair were
performed around the world. Hernia is classified as
complicated with severe or moderately severe pain for
primary or recurrent; also may be reducible or
more than a year of all hernia repair procedures, this
irreducible. Incarcerated and strangulated are subtypes
result is in a significant impact on social life, sexual
of irreducible hernia. The most common form is the
life and life parameters(8).
external abdominal hernia(1). Almost about 20 million

hernia repairs are performed yearly, hernioplasty is a
common surgical procedure around the world(2).
A cross sectional study involving 523 men and
Multiple repair procedures have been described to
women participants from all over Saudi Arabia was
date, anyhow tension-free mesh repairs are commonly
distributed from January to February 2018. The study
used procedures today due to their low recurrence
was a self-administered questionnaire that was
rates post-surgical procedures(3). Outcomes of
distributed on a web site link through a different
incisional hernia procedures are discouraging.
social media platforms to all participants. The
Relapses rates of suture repair of incisional hernia are
questionnaire involved 6 questions that included two
present with 12% to 54%(4). On the other hand, relapse
parts ; part one was about asking the participants
rates of mesh repair is 2% to 36%(5). The important
questions about their age, gender and marital status.
risk factors of hernia include pregnancy, strenuous
Part two was about general questions regarding hernia
exercise , chronic constipation, weight gain and
repair procedure and its associated risk factors like
increase intra-abdominal pressure. The patient should
wether the participants had done hernia repair or not.
Received:1 /2 /2018 DOI: 10.12816/0046630
Accepted:11 /2 /2018

Full Paper (vol.715 paper# 25)

c:\work\Jor\vol715_26 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3236-3240

Medication Safety Practice in Pediatric Ward
Alotaibi Rashed H , Alhalabi Mohammed W,Essa Marwan A,
Alzahrani Fahad A,Alqarni Mohammed A,Maimsh Omar M,Aljefri Hasan M
Department of Pediatrics, College of Medicine, King Abdulaziz University Hospital , Jeddah, Saudi Arabia
Corresponding Author: Omar Moussa Maimsh. Mobile: +966540992424. Email: Maimsh24@gmail.com

Background: As the medicine advanced, drug therapy became one of the most important and effective therapies
in health care system. Which also raises the possibility of its mortality and morbidity. Drug-drug interaction
(DDI) is defined as the occurrence of a harmful combination of prescribed drugs in a given patient. DDIs is a
known cause of hospital visits, admissions and increases in health care use that could be prevented. In this
study, we aimed to detect the DDIs prevalence in pediatric patients in King Abdulaziz university
hospital(KAUH), Saudi Arabia.
Methodology: Retrospective cross-sectional study on a sample taken from all pediatric patients at KAUH in
Jeddah, Saudi Arabia between January ­ December 2106, with no exclusion criteria. We extracted the data from
KAUH medical files. DDIs, severity and documentation of the DDIs were identified using micromedex. Data
entry using microsoft office 2016. Data analysis using SPSS 21 and multivariate regression was done to assess
the association of DDI with other factors.
Results: Three hundred and fifty-nine patients were selected with the mean age (SD) 7.06 (5.9), 202 (56.2%)
were male. A total of 233 DDIs were identified in 64 (17.8%) of the patients with the mean (SD) 3.64 (3.52). Of
all identified DDIs, the severity classification was: major [123 (52.79%)], moderate [67 (28.76%)], minor [37
(15.88%)] and contraindicated [6 (2.58%)]. The documentation of DDIs was excellent [9 (3.8%)], good [89
(38.2%)] and fair [135 (58%)]. Significant association with medications number 5 or more had been suggested.
Conclusion: The prevalence of DDIs although much less than other studies but the higher proportion of major
severity. Patients 1-3 years of age and those on 5 or more medications need more strict monitoring as they have
more risk to have DDIs.
Keywords: medications, drugs, pediatrics, safety, interactions.


An earlier study has suggested that up to 3 % of
As the medicine advanced, drug therapy became
hospital admissions were due to DDIs 10-12. DDIs
one of the most important and effective therapies in
are associated with increased health care use 13.
health care system. It also raises the possibility of
DDI rates of 32% for pediatric patients and 22% for
its mortality and morbidity1.
psychiatric ones 14. Zurita and Rojop in recent
In the United States, the economic burden of
research found that 68 % of a schizophrenic patient
medication-related morbidity and mortality is as
at risk of DDI 15. A meta-analysis conducted by
high as $177 billion 2. Johnson JA estimated the
Dechanont demonstrated that the hospital
cost of drug-related problems in 2013 about 300
admission rate of DDI was 22.2 % and the hospital
billion in the US 3. Some studies showed that 85 %
visits rate was 8.9% 16. A recent study done in
of the patients had at least one drug therapy
Saudi Arabia showed that 104 DDI in 57
problem and 29 % had five or more drug therapy
prescriptions 17. 49% of hospitalized pediatric were
problems 4. A research in Saudi Arabia indicated
associated with at least one potential DDI 18.
that 4.5 % of hospital admissions was due to drug-
Finally, due to the limited data on DDI
related problems 5.
prevalence in our region, we aimed to detect the
"Administration of an enormous number of
DDIs prevalence in pediatric patients in King
Abdulaziz university hospital(KAUH), Saudi
medications at the same time " is the polypharmacy
definition stated by WHO 6. polypharmacy is a

common tool in modern medicine especially in
patients with chronic diseases, syndromes and
Retrospective cross-sectional that was conducted at
elderly 7.
King Abdul-Aziz university hospital, Jeddah, Saudi
DDI defined as the occurrence of a harmful
Arabia that started from January 2016 ­ December
combination of prescribed drugs in a given patient
8. DDI in patients with multiple medications is a big
All the admitted pediatric patients were included,
concern 9.
sample selection was a systematic random sampling
of pediatric patients.
Received:2 /2 /2018 DOI: 10.12816/0046631
Accepted:12 /2 /2018

Full Paper (vol.715 paper# 26)

c:\work\Jor\vol715_27 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3241-3248
Fungemia in Immunocompromised Patients (Hematological Malignant and
Hematopoietic Stem Cell Transplant Patients during Febrile Neutropenia)
Mohammed Mohammed Sherif¹, Mohammed Mostafa Elsaadawy¹, Mohamed Hamed Khalaf ²,
Mostafa Mahmoud Elnakib³ And Hatem Mohamed Newishy¹
1 Microbiology and immunology Department, Faculty of Medicine, Al- Azhar University, Cairo, Egypt,
2 Oncology and Hematology Hospital, Maadi Armed Forces Medical Compound, Cairo, Egypt,
3 Microbiology and Immunology Department, Military medical academy, Cairo, Egypt
Corresponding author: Hatem Mohamed Newishy, email: hattem87@yahoo.com

Fungal infections are a major cause of morbidity and mortality among febrile neutropenic patients.
The choice of empiric antifungal regimen is based on susceptibility pattern of locally prevalent pathogens.
Objectives: to determine fungemia, identify fungal spectrum and their antifungal susceptibility pattern.
Methods: From 150 hematological malignant and hematopoietic stem cell transplant patients during febrile
neutropenia, blood cultures (B.C) were processed. Results: Eight fungal isolates (5.3%) were recovered which found
to be represented by candida spp. Five of them were non albicans Candida (62.5%) and three of them were Candida
(37.5%). C. parapsilosis resulted in the most frequent Candida non albicans (CnA) species (37.5%). All C.
strains were isolated from patients with vascular catheters. C. krusei fungemia generally occur in patients
with previous exposure to fluconazoles. All species of Candida were sensitive to amphoterecin B, echinocandins and
voriconazole. Persistent fever for prolonged duration and prolonged broad spectrum antibiotic use were statistically
significant risk factors for developing fungemia. Also extent of neutropenia, duration of chemotherapy,
immunosuppressive therapy, altered mucosal barriers and presence of central venous lines were considered major risk
factors for development of fungemia. Conclusion: The current study was limited by method of diagnosis and low
sample size in a single center experience. Furthermore review of the epidemiology of fungemia which was represented
by candidemia at our institution revealed the percentage of candidemia was 5.3% and non albicans Candida species
were the predominant isolates. Recommendations: The choice of therapy in neutropenic patients should be formulated
based on local antimicrobial susceptibility of these organisms. Close monitoring of fungal infection in patients
receiving broad-spectrum antibiotics is mandatory.
Febrile neutropenia, Fungemia, Aetiology, Risk factors.

[4]. BSI in this population should be closely monitored
The general term fungemia describes the
and optimal management of established infection is
presence of a fungal species in the blood. A positive
mandatory to improve outcome in neutropenic patients
culture may indicate a widespread infection or
and prevent complications [5]. Yeasts have been
commonly, the infection of an intravenous catheter.
increasingly present as aethiological agents of
Often the term fungemia is used synonymously with
fungemia, including Candida albicans and other
candidemia because Candida species are more
species such as Candida non-albicans [6]. The
prevalent [1]. Neutropenia is defined as an absolute
prevalence of candidemia among patients with
neutrophil count (ANC) of less than or equal to 500
hematological malignancy has been found to vary
cells per mm3 or a count which is expected to fall to
widely between 1.6% and 22.9% depending on the
that level within the next 1-2 days [2]. It is a common
patient profile studied, geographical location involved,
complication in patients receiving immunosuppressive
and diagnostic criteria used [7]. Blood cultures (BCs)
therapy for any cause such as those with acute
remain the gold standard for fungemia diagnosis and
leukemia, other hematological malignancies and after
are recommended in current guidelines. As they are
bone marrow transplantation [3]. Infection is an
culture-based techniques, the isolation of yeasts from a
important complication of neutropenia and is
blood sample is delayed until the microorganism
associated with a high morbidity and mortality.
growth becomes detectable (median time to positivity
Common amongst these infections are those involving
is 2­3 days, ranging from one to more than 7 days). In
the blood stream and lower respiratory tract. In febrile
addition, their sensitivity is low: only 50­75% [8]. The
neutropenic patients, the attack rate of blood stream
present study was conducted to determine incidence of
infection (BSI) is reported to be between 11 and 38%
fungemia in immunocompromised patients (with
Received:20 /3 /2018 DOI: 10.12816/0046632
Accepted:30 /3 /2018

Full Paper (vol.715 paper# 27)

c:\work\Jor\vol715_28 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3249-3253
The Prevalence of Cholecystectomy and its Associated
Risk Factors and Complications in Saudi Arabia
Sultan Mahja Marzouq Alanazi 1, Taif Farhan Mansi Alruwaili 1, Abdulsalam Abdulmohsen
Eid Almofadhli 1, Abdullah Ali Alghabban 1, Ahmed Abdullah Alomaim 1,
Hamad Turky Hamad Alrasheedi 1, Haifa Saud Albrahim 1, Hamad Halail Thani Alanazi 1,
Eman Mohamed Alshammary 1, Abdullah Fahad Algharbi 1, Shadiah Nasser Muhya Alrashidi 1,
Abrar Hamad Saleh Alageel 1, Faisal Fahad Aljuaid 2, Marwan Ahmed Jaafari 2,
Nojoud Mohammed Abdullah Al_Farhan 3, Hussain Saad Bin Hussain Alahmari 3
College of Medicine University of Hail 1, College of Medicine Prince Sattam Bin Abdulaziz University2,
College of Medicine King Khalid University3
Corresponding author: Sultan Mahja Marzouq Alanazi, E-mail: sulti7@yahoo.com, Phone no: +966554066046,
E-mail: dr.adnan7777@hotmail.com

despite the modern life and people knowledge about certain diseases, the prevalence of
cholecystectomy procedures have been increased in the recent years in Saudi Arabia.
prevalence of cholecystectomy is almost known in the modern countries. This study was done to know
the prevalence cholecystectomy procedures in Saudi Arabia.
Methods: a cross-sectional study on knowing the prevalence of cholecystectomy procedures in Saudi Arabia was
distributed among men and women from January to February 2018 on 523 participants on many different social
media platforms.
Results: 6.5% of the participants had done cholecystectomy procedure. 32.4% of the participants who had the
procedure suffered from post procedure complications. Regarding risk factors that may lead to cholecystectomy
procedure, 45.5% of the participants had a positive family history of cholecystectomy, 44.5% of the participants were
obese, 27.6% were smoker, 25.8% ate high fat diet, 17.5% suffered from chronic constipation, 12.6% suffered from
chronic cough, 8.3% had major surgeries, 7.7% were diabetic, 5.2% had been admitted to ICU, 4.6% suffered from
urinary retention, 2.1% had major trauma, 1.25% had been diagnosed with atherosclerosis disease and 37.7% were
having no risk factors. 61.4% of the participants thought that cholecystectomy is the definite treatment of
Conclusion: at the end of this study, we found out that cholecystectomy procedure is increased among people in
Saudi Arabia and multiple people are suffering from many risk factors that may lead to cholecystitis and then
cholecystectomy procedure eventually
Keywords: cholecystectomy , obesity , smoking.


body weight and avoiding spicy and fast fried foods
Gallstone disease is the most common of abdominal
would result in prevention of gallstones related diseases
diseases in which patients are admitted to hospital for
rates(10,11,12,13) . Cholecystectomy is the world gold
immediate intervention in the developing countries (1).
standard for symptom relief in uncomplicated
Gall stones are the most common risk factor for
admission to emergency room and surgical intervention
cholecystectomy is not always required because in up to
that cause a significant worldwide health impact and
31 % of patients, conservative management results in
economic issue(2) . Gall stones are known as
optimal outcomes regarding symptom control(15). Some
accumulation of solid material as cholesterol, bile acids
patients do not give a history of a biliary colic but
and pigmented components in the biliary tract
report nonspecific abdominal symptoms(16). Never the
system(3,4,5) . The common risk factors that contribute to
less, up to 41 % of patients still report post-
gallstones are elderly age, female gender, obesity, lack
cholecystectomy pain, suggesting inefficient benefit of
of exercise, major surgeries, pregnancy and critically ill
cholecystectomy(17). The mismatching of symptoms and
patients(6,7,8) . Furthermore, increase levels of serum
procedure leads to a variation practice. This happens
lipids and glucose above normal are associated with
when there is uncertainty about the best option for
gallstone diseases(9) . Multiple studies showed that
effective intervention or when different criteria are
active physical activity, modifying life style, normal
applied in the decision to perform surgery(18).
Received:3 /2 /2018 DOI: 10.12816/0046633
Accepted:13 /2 /2018

Full Paper (vol.715 paper# 28)

c:\work\Jor\vol715_29 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3254-3260

Effect of Aminophylline on Atracurium Induced
Neuromuscular Block
Mostafa ME El-Hamamsy, Josef M Botros, Hani M Yassen, Moaz I Mohammed*
Department of Anesthesiology, Faculty of Medicine, Fayoum University
*Corresponding author: Moaz I Mohammed, Mobile: 01096007637 Email: abumalik5@yahoo.com

theophylline is a naturally occurring methylxanthine that plays a role in various body functions
through different mechanisms which include: phosphodiesterase enzyme inhibition, adenosine receptor
antagonism etc. Its action on skeletal muscles to counteract fatigue and /or paralysis is through increasing
acetylcholine release from motor nerve ending and increasing calcium concentrations within the muscle fiber
itself. These combined effects therefore can antagonize nondepolarizing neuromuscular blockers through
competitive antagonism in generally anesthetized patients. By the use of neuromuscular monitors, this effect
could be evaluated and also to assess doses for reversal of residual drug-induced neuromuscular paralysis.
Aim of the Study:
the aim of this study was to evaluate the effect of theophylline on facilitating the recovery
from atracurium induced neuromuscular blockade. Patients and Methods: this study was performed on sixty
(60) patients undergone elective surgeries had been expected to be about one-hour duration, with balanced
general anesthesia after obtaining approval of the Ethical and Scientific Committee of Al Fayoum University,
and written informed consents from patients. In this study, we used theophylline to antagonize atracurium
induced muscle paralysis. Results: the results showed effective antagonism of atracurium paralyzing effect and
rapid recovery from this paralysis. Conclusion: theophylline antagonizes atracurium induced neuromuscular
blockade by several mechanisms either at the prejunctional or postjunctional level by AR antagonism or PDI or
by RyR channel activation. Recommendations: we recommend further studies to be done on different
categories of patients as diabetics, cardiac patients, elderly and etc. to assess its safety among those patients. We
recommend further studies to be done on different categories of patients as diabetics, cardiac patients, elderly
and etc. to assess its safety among those patients.
Keywords: Phosphodiesterase enzyme inhibition, theophylline, Neuromuscular blockade, atracurium,
Neuromuscular monitoring, Train of four (TOF).


subsequently enhancing twitch tension upon
electrical stimulation in animals (7). Also, it had
pharmacological adjuncts to general anesthesia used
to facilitate endotracheal intubation and ease of
contractility and enhance neurotransmitter release at
instrumentation in certain types of surgeries. An
the motor nerve terminals in animals (8,9). So, it has
undesirable sequale is residual neuromuscular
been used recently in anesthesia to antagonize the
blockade that is linked with aspiration, decreased
neuromuscular blocking effect of non-depolarizing
response to hypoxia and obstruction of the upper
neuromuscular blockers. It had been reported that
airway soon after extubation (1). Thus, many drugs
theophylline antagonizes the effect of pancuronium
are used to facilitate recovery from this blockade
(10,11). Other studies have reported that milrinone
and prevent residual neuromuscular blockade as
and olprinone ­ a selective PDI III inhibitors
neostigmine, sugammadex, protease inhibitors, K-
commonly used in heart failure due to their
channel agonist nicorandil and phosphodiesterase
inotropic and vasodilatory effect ­ facilitate the
inhibitors (PDI) (2).
recovery from the neuromuscular blockade induced
In our study, we will test theophylline
by vecuronium (12,13).
which is a non-selective PDI and non-selective
However, no published study has been made to
Adenosine receptor (AR) blocker. It is commonly
assess the effect of theophylline on recovery from
used in the treatment of upper airway obstruction
atracurium- which is an intermediate acting non-
disorders as Asthma and chronic obstructive
depolarizing neuromuscular blocker ­ in humans.
pulmonary disease (COPD) (3,4). Recently, it has been
used to antagonize sedative and hypnotic effects ­
The aim of this study is to evaluate the effect of
monitored by bispectral index (BIS) - of inhalational
theophylline on facilitating the recovery from
agents, barbiturates, benzodiazepines, opioids and
atracurium induced neuromuscular blockade.
propofol (5,6).
Also, theophylline has been reported to
enhance resting calcium concentrations in skeletal
This study was performed on sixty (60) patients
muscles by antagonizing adenosine receptors and
undergone elective surgeries had been expected to
Received:20 / 3 /2018 DOI: 10.12816/0046634
Accepted:30 / 3 /2018

Full Paper (vol.715 paper# 29)

c:\work\Jor\vol715_30 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (5), Page 3261-3272
Comparative Study between 2D and 3D Ultrasound Cervicometry and
Digital Assessment of the Cervix before Induction of Labour
Yahia A. Wafa1, Nabil F. Mohamed2, Mohamed S. Abouzeid1*
1Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
2Department of Obstetrics and Gynecology, Al-Agoza Police Hospital
*Corresponding author: Mohamed S. Abouzeid; Mobile: 01003324095; Email: tahasaber49@gmail.com

labor is the physiological process by which the fetus is expelled from the uterus to the
outside world. It is defined as increase in myometrial activity or more precisely, a switch in the myometrial
contractility pattern from contractures (long-lasting, low-frequency activity) to contractions (frequent, high
intensity, high frequency activity), resulting in effacement and dilatation of the uterine cervix.
Aim of the Work:
this study aimed to compare between 2D and 3D ultrasound cervicometry and digital
assessment of the cervix before induction of labor.
Patients and Methods
: this study was carried out at Obstetrics and Gynecology Departments of Al-
Hussien University Hospital and Al-Agoza Police Hospital from July 2016 to January 2018 on one hundred
(100) women; their ages ranged from 18 to 35 years and the gestational ages ranged from 37-42 weeks. All
patients had medical indications for labor induction.
there were highly statistically significant relations (HS) between mode of delivery and cervical
length, bishop score and posterior cervical angle as p value (0.001).It was found that the more obtuse the
angle, the higher the probability of vaginal delivery and the reverse for the cervical length. This means that
Bishop Score and cervical length and posterior cervical angle had the same dependency in predicting successful
labor induction.
Conclusion: in this study we found that the successful induction correlated significantly with transvaginal
ultrasonographic measurments of the posterior cervical angle and cervical length and Bishop Score. But,
Bishop Score appeared to be specific and accurate than the ultrasonographic measurements in prediction of
successful vaginal delivery.
Recommendations: further studies on large number of participant with the same indication of induction
and the same gestational age are recommended to assess Bishop Score and transvaginal ultrasonographic
measurements and to evaluate each of them as predictors of successful labor induction.
Keywords: 2D and 3D ultrasound, cervicometry, digital assessment, cervix, induction of labour.

The management of post term
Prolonged pregnancy is a real problem in
pregnancy constitutes a challenge to clinicians.
modern obstetrics. It causes an anxiety among
Knowing who to induce, who will respond to
pregnant women (1). In a United Kingdom study,
induction and who will require a caesarean
undelivered women at 41 weeks gestation had a
section (CS) (5).Post term pregnancy is associated
significantly higher anxiety score than women
with higher rates of stillbirth, macrosomia (birth
who had delivered (2).
weight > 4000g), birth injury and meconium
According to the World Health
aspiration syndrome (4).
Organization (WHO), the definition of post-term
pregnancy is the pregnancy that had extended to
pregnancy remains controversial. Despite many
or beyond 42 weeks (294 days) of gestation
trials, there is still no consensus regarding the
(3).Prolonged gestation complicates 5% to 10% of
most appropriate management of this difficult
all pregnancies and confers increased risk to both
situation, thus in many instances the decision as
the fetus and mother (4).
whether to intervene in prolonged pregnancy is
Post term pregnancy is a pregnancy that
based on tradition and emotion rather than
extends to 42 weeks of gestation or beyond.
scientific data (6).
Fetal, neonatal and maternal complications
Ultrasonographic measurements as the
associated with this condition have always been
cervical length, the fetal occiput position, the
underestimated. it is not well understood why
estimated fetal weight and whether the head is
some women become post term although in
well flexed or not are good predictors for
obesity, hormonal and genetic factors have been
successful labor induction in prolonged in
primigravidas (7).

Induction of labor is indicated when
benefits to the mother or the fetus outweigh those
Received:20 /3 /2018 DOI: 10.12816/0046635
Accepted:30 /3 /2018

Full Paper (vol.715 paper# 30)