c:\work\Jor\vol717_1 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3465-3472

Maximizing Resection of Diffused Low-Grade Glioma Functional Outcome
Ahmed Maamoun Ashour, Hassan Jalalod'din , Ayman El Shazly ,
Mohamed W. Samir, Hossam M. El Huseiny
Neurosurgery Department, Ain Shams University, Cairo, Egypt
*Corresponding author: Ahmed Maamoun Ashour, Mobile: +20111109466, email:dr.memoz@gmail.com


Background: most of adults with Diffuse Low Grade Gliomas (DLGGs) are diagnosed with an average age of 39
years and the diagnosis is often made around fully functioning individuals. Currently extent of resection (EOR) is a
generally known variable that impacts overall survival (OS), progression free survival and malignant
transformation in these gliomas.
Aim of the study: this study aimed to evaluate the risks and benefits of maximizing the extent of resection of
DLGGS, while preserving neurological function.
Methodology and Materials: this was a prospective observational study of group of consecutive 20 patients with
initial imaging diagnosis of supratentorial DLGGs. Preoperatively planned for maximal resection even if
presuming the proximity of these lesions to eloquent cortex and their relative diffuse nature on imaging. Results:
40 % were near eloquent area and 30 % at eloquent areas. GTR achieved in 10% and STR in 65%. Pre-operative
Karnofsky Performance Scale (KPS) was 100 in 10%, 90 in 65%, 72 hours post-operative 70 in 60%. During the
first 6 months of follow-up KPS was 100 in 60% of the study cohort while only one patient (5%) died. After 6
months KPS was 100 and represented 95% of the whole study. LOS was the longest (4-16 days) in near eloquent
and shortest in eloquent (5-8 days). 30% had pre-operative uncontrolled seizures, which cured post-operative, 50%
stopped AED within a year. Average back to work period was 2.5 for eloquent, near eloquent 2.8 and non-eloquent
2.6 months.
Conclusion: careful pre-surgical planning based on proper reviewed history, recent imaging techniques and
utilizing up-to-date intra-operative technology is helping to maximize safe surgical resection, while saving patient
function and quality of life.
Keywords: astrocytoma, oligiodendroglioma, extent of resection, KPS.


DLGG normally influence young people who
Conversely, maximal DLGG resection provided
have ordinary life. But, neurological deficits are
more amount of tissue, leading to increase in the
uncommon in patients with DLGG (Ordinarily diagnosed
reliability of
after seizures); regardless of the possibility that these
the histopathological diagnosis and grading. Also, biopsy
tumors are located within eloquent areas. This is because
has no therapeutic role (2). Depending on these
of mechanisms of cerebral plasticity, clarified by the way
oncological results, the strategy of management should be
that DLGG is a slowly growing tumor, giving numerous
moved toward operating the nervous system involved by
years to the cerebrum for functional remapping with
a chronic oncological disease and not a mass any more.
recruitment of perilesional or remote regions inside the
As the target is not to remove apart from the tumor
ipsilesional half of the cerebrum or of contra-hemispheric
visible on imaging studies, but to do the most possible
homologous regions. The integration these concepts into
extensive resection of the tissue invaded by DLGG,
therapeutic methods brought out dramatic updates in the
provided that this is not effecting functions. Thus,
management of DLGG, with an increase of surgical
neurosurgeon should aim the procedure to the individual
intervention in eloquent areas traditionally believed as
cerebral anatomical and functional organization, as
untouchable (1).
procedure within the cerebrum has to be different from
Currently, the role of biopsy is very narrow in
the any procedures outside the cerebrum. A corner stone
DLGG. As combining clinical and radiological data, the
in glioma surgery should be to tailor the resection on
diagnosis of glioma is typical in majority of cases. So, the
functional boundaries, with no margin, to maximize the
aim of neuropathological examination was to identify the
tumor removal while protecting eloquent areas (3).
actual grade of the glioma. But, there is a high risk of

sampling error. Muragaki el al. (2) showed that upgrading
of WHO grade I gliomas occurred in 11% of cases and
This study aimed to evaluate the risk and
downgrading of WHO grade III gliomas in 28%.
benefit of maximizing the extent of resection of
Received:20 / 3 /2018 DOI: 10.12816/0047662
Accepted:30 / 3 /2018

Full Paper (vol.717 paper# 1)

A The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3473-3478
Verapamil as An Adjunct to Local Anaesthetic for Brachial Plexus Blocks
Amir Ibrahim Mohamed Salah, Manal Mohamed Kamal, Ashraf Nabil Saleh Mostafa,
Ahmed Fakher Mohamed Abdou
Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams University, Cairo, Egypt

Upper extremity surgeries are recently performed under regional anesthesia. Regional
anesthesia of the upper extremity has several advantages over general anesthesia, such as improved
postoperative pain, decreased postoperative narcotic consumption, and reduced recovery time.
Supraclavicular approach of the brachial plexus block has gained importance for surgical and interventional
pain management purposes. Supraclavicular brachial plexus block provides an ideal condition for surgery of
the upper limb, maintains hemodynamic stability, decreases postoperative pain and allows for early
ambulation. However, the duration of the supraclavicular brachial plexus block is limited by the duration of
action of the local anesthetic used in the block.
Aim of the Work:
The aim of this study is to evaluate whether additional anesthetic effects could be
derived from addition of verapamil into local anesthetics injected into brachial plexus sheath.
Patients and Methods: This study was a prospective, randomized, controlled, double blind study had been
carried out in Matareya Teaching Hospital on 60 adult patients with a physical status ASA I & II
classification scheduled for upper limb surgeries for 6 months. Patients were randomly classified using
sealed envelopes into two equal groups (group I & group II) each of 30 patients.
Group I: 30 patients who
received 40 ml of 1% lignocaine (20ml) with 0.25% bupivacaine solution (20ml), Group II: 30 patients
who received 40 ml of 1% lignocaine(20ml) with 0.25% bupivacaine solution with 2.5mg verapamil
Results: Onset of sensory blockade time was marginally faster in Group II (12 ±1.8minutes) as compared
to Group I (12.6 ± 1.4 minutes). However this difference was statistically not significant. The increase in
duration of sensory blockade in Group II (209.90 ± 13.22 minutes) as compared to Group I (183.80 ± 11.68
minutes) was statistically significant (p < 0.001). Increase in duration of motor blockade in Group II
(172.00 ± 9.32minutes) as compared to Group I (168.20 ± 8.91 minutes) was statistically not significant (p
= 0.112).
Conclusion: we conclude that adding 2.5 mg verapamil with 0.25% bupivacaine solution (20ml) with 1%
lignocaine (20ml) to brachial plexus block can prolong sensory anesthesia without significant effect on
duration of motor block, onset of sensory and motor block.
Keywords: Verapamil, Brachial Plexus Blocks.

The interest in peripheral nerve blocks
Upper extremity surgeries are recently
has increased due to the availability of ultrasound
performed under regional anesthesia. Regional
machines. Ultrasound guided supraclavicular
anesthesia of the upper extremity has several
block has been shown to be a safe alternative to
advantages over general anesthesia, such as
the blind supraclavicular brachial plexus block as
it bypasses its complications, however there is a
postoperative narcotic consumption, and reduced
little evidence as yet to support the superiority of
recovery time (1).
ultrasound compared to any other method of
Supraclavicular approach of the brachial
nerve localization (3).
plexus block has gained importance for surgical
The advantage of the ultrasound guidance
and interventional pain management purposes.
in peripheral nerve block is the ability to confirm
Supraclavicular brachial plexus block provides an
local anesthetic spread around the target nerve.
ideal condition for surgery of the upper limb,
This is the difference from blind techniques,
maintains hemodynamic stability, decreases
which can easily fail because local anesthetic
postoperative pain and allows for early
does not surround the target nerve uniformly (4).
ambulation. However, the duration of the
The operator can manipulate the needle
supraclavicular brachial plexus block is limited
under direct vision to the appropriate depth and
by the duration of action of the local anesthetic
place the needle tip immediately adjacent to the
used in the block (2).
target nerve. With ultrasound imaging, the needle
Received:20 /3 /2018 DOI: 10.12816/0047663
Accepted:30 / 3 /2018

Full Paper (vol.717 paper# 2)

c:\work\Jor\vol717_3 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3465-3486
A Comparison between Magnesium Sulphate and Ritodrine on Delaying
The Active Phase of Labor in Women with Premature Rupture of
Membranes with Preterm Labor
Emad Maarouf Abd - Allatif 1, Abdallah Khalil Ahmed 1 and Alaa Ibrahim Abd- El Fatah Mohamed 2
1- Department of Obstetrics and Gynecology. Faculty of medicine, Al-Azhar University, Egypt.
2- Department of Obstetrics and Gynecology. General Authority for Health Insurance,
Damietta branch, Egypt
Preterm premature rupture of membranes (PPROM) refers to PROM before 37 weeks of gestation.
It is responsible for, or associated with, approximately one-third of preterm births and the single most common
identifiable factor associated with preterm labor (PTL). This is the leading cause of perinatal morbidity and
mortality. Management of preterm labor includes bed rest, adequate hydration, prophylactic cervical cerclage
and use of tocolytic drugs. Administrations of tocolytic drugs including magnesium sulphate (MgSO4) and
ritodrine have considerable influences on pregnancy outcomes.
Objective: The present study aimed at comparing between the effects of magnesium sulphate administration and
ritodrine on delaying the active phase of labor in women with premature rupture of membrane (PROM) and
preterm labor, and determining the best drug with best results and fewest side effects.
Patients and Methods: The present study was conducted on 80 patients, with established PROM, whose
gestational ages ranged between 28 and 34 weeks, admitted to the hospital with PROM with PTL. In the current
study, patients were allocated into two equal groups: group A (MgSO4), and group B (Ritodrine).
Results: Both drugs (MgSO4 and ritodrine) were effective on prolonging the gestational age of the studied
women in both groups, and there was no significant difference between both groups. MgSO4 had fewer side
effects than ritodrine, and there was significant difference between both groups.
Conclusion: Both magnesium sulphate and ritodrine increase delay in reaching the active phase of labor in
women with PROM with preterm labor.
Keywords: PROM, PTL, Tocolytics, Delay, Labor, Magnesium Sulphate and Ritodrine.

channel blockers (Nifedipine), nitrate (Nitroglycerine)
Premature rupture of membranes (PROM) is
and oxytocin receptor blockers (Atosiban) (3).
the rupture of the fetal membranes before the onset

of labor. In most cases, this occurs near term.
Tocolytics are used to ensure the administration of
However, when membrane rupture occurs before 37
corticosteroids and transportation to a center with
weeks' gestation, it is known as preterm PROM
neonatal intensive care unit facilities, tocolytic
(PPROM). PPROM is one of the clinical subtypes of
therapy can be administered for 48 hours.
preterm birth, and occurs in ~3% of pregnancies,
Throughout the years several types of tocolytic
resulting in one-third of preterm births. It remains
drugs have been used, all with different mechanisms
the leading cause of preterm deliveries and neonatal
of action (4).
mortality and morbidity (1).
The aim of this study was to compare between the
Preterm labor is a leading cause of perinatal
effects of magnesium sulphate administration and
morbidity and mortality. In spite of the improvement
ritodrine on delaying the active phase of labor in
in survival rates of preterm neonates, they are at
women with premature rupture of membrane
increased risk of long term neurodevelopmental
(PROM) and preterm labor, and determining the
best drug with best results and fewest side effects.
complications. More than three-quarters of

premature babies can be saved with feasible, cost
effective care, e.g. essential care during child birth
This study was a comparative study which was
and in the postnatal period for every mother and
conducted at the Department of Obstetrics and
baby, antenatal steroid injections given to pregnant
Gynecology, Al- Hussein University Hospital from
women at risk of preterm labor (2).
July, 2017 to Mars, 2018 on pregnant women with
Management of preterm labor includes bed rest,
gestational age from 28 to 34 weeks, who were
adequate hydration, prophylactic cervical cerclage
hospitalized for PPROM. The study was approved
and use of tocolytic drugs. Various tocolytic agents
by the Ethics Board of Al-Azhar University.

Patients were allocated into two equal groups: group
prostaglandin inhibitors (Indomethacin), calcium
A (Magnesium sulphate- treated) included 40

Received:20 / 3 /2018 DOI: 10.12816/0047664
Accepted:30 / 3 /2018

Full Paper (vol.717 paper# 3)

c:\work\Jor\vol717_4 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3487-3491

Knowledge and Attitude of Mothers on Risk Factors Influencing Pregnancy
Outcomes in Qassim, Saudi Arabia: A Cross-Sectional Study
Ibtehaj M. Alharbi, Alhanof F. Alharbi, Seetah M. AlHarbi, Hessa M. Alharbi, Thekra F. AlHarbi,
Nawal H. Alawaji, Albatoul A. Alluhaida
College of Medicine, Qassim University, Buraydah, Qassim, Saudi Arabia
Corresponding author: Ibtehaj Alharbi, Qassim University,Email: Ibtehajmh@gmail.com

One of the goals of the antenatal clinic is to prevent and recognize adverse pregnancy outcomes
(APO). APO include hypertensive diseases of pregnancy, pre-term birth, pregnancy loss and maternal death.
Our objective is to investigate the knowledge and attitude of mothers on risk factors of developing APO in
Saudi Arabia.
Methods: A cross-sectional study of female school teachers was conducted. 195 women were selected from
four different schools in the region. Inclusion criteria were women of reproductive age who had at least one
previous pregnancy. A self-administrated questionnaire on the knowledge and attitudes of risk factors that
influence pregnancy outcomes were used.
192 out of 195 mothers completed the questionnaire (98.4% response rate). The mean age of those
women was 33.6. Responses revealed that most women have good knowledge about the risks resulting from
malnutrition, diabetes, and drug abuse as the agreement on all of these statements were 80%. However, their
knowledge about the importance of maternal education and their attitude towards cesarean section was not
Although our sample was an educated group; low knowledge was detected in essential items.
This study revealed that the public had extremely low knowledge regarding cesarean section, the importance of
maternal age during pregnancy and how mother education can affect the delivery of her newborn. We
recommend that pregnant women should be educated in the importance of attending the antenatal clinic
Keywords: Pregnancy; outcomes; knowledge; attitude; Saudi Arabia.

need to be studied thoroughly to prevent such
One of the most essential goals of every
antenatal clinic (ANC) in every primary healthcare
With the increased in the incidence of low birth
center is to prevent and immediately recognize the
weight worldwide, assessing the contributory
occurrence of adverse pregnancy outcomes (APO).
factors on adverse pregnancy outcomes is of great
Although no specific definition was to be found,
value. Especially since these complications arise
this broad term can include hypertensive diseases of
from underprivileged uneducated females with high
pregnancy such as (gestational hypertension,
pregnancy rate, a scene commonly observed in
eclampsia and preeclampsia), pre-term birth,
rural areas where the only available healthcare
pregnancy loss, maternal death and having birth to
service is ANCs.
an infant with a low birth weight 1.

Results of epidemiological research in
developing countries prove the magnitude of this
This research was conducted as a cross-sectional
problem. Maternal mortality reaches a very high
study in Al -Qassim region from August 2015 to
level where every woman out of six will die during
May 2016. The target population was female school
labour or the postpartum period. In contrast, the
teachers from three cities in Qassim.
risk of dying during childbirth in more developed
The schools were selected based on random
countries is substantially lower (one in every
cluster sampling. Four schools from three cities in
30,000) 2. In Saudi Arabia, an Islamic middle
Qassim were selected; two from Buraydah, the
eastern country, the maternal mortality ratio has
other two were from Onizah and Ar Rass. Our
declined from 46 to 12 per 100,000 during the last
participants were all the school teachers present at
27 years 3.
the selected schools in the days of data collection
Our aim from this study is to add to the current
except for those who are not married and have not
literature in our understanding of these risk factors.
experience pregnancy. The instrument used to elicit
Knowledge and attitude of mothers in our society
responses from the participants was a 4-point Likert
scale questionnaire designed by the Eni-olorunda
Received:22 / 2 /2018 DOI: 10.12816/0047665
Accepted:3 / 3 /2018

Full Paper (vol.717 paper# 4)

c:\work\Jor\vol717_5 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3492-3499

Three-Dimensional Conformal versus Intensity Modulated Radiation Therapy in
Treatment of Nasopharyngeal Carcinoma
Sherif A AbdElWahab, Doaa A Mohammed, Ahmed M Gaballah, Mahmoud M Abdallah
Department of Clinical Oncology and Nuclear Medicine, Ain Shams University
Corresponding author: Mahmoud M Abdallah; Mobile: 01002025948; Email: mahmoud.abdallah293@gmail.com

Nasopharyngeal carcinoma is an endemic disease of Southeast Asia with incidence rates of
between 15 and 50 per 100 000. There is an intermediate incidence in North Africa and Far Northern
hemisphere while in the West the disease occurs sporadically. In Egypt the incidence rate is low and the peak at
age (50-54) is 3.4%, and other age varying between 0.3 and 0.4 per 100 000.
Aim of the Work:
The aim of this study was to evaluate and compare both techniques as regard their efficacy
on tumor response, local control, overall survival and progression free and treatment related toxicity between
both techniques.
Patients and Methods: This retrospective analysis included 54 patients diagnosed with primary
nasopharyngeal carcinoma recruited from the clinical oncology department, Ain Shams University and the
International Medical Center during 3 years (January 2014 -December 2016). They were divided into 2 groups,
group A was treated using 3D conformal radiotherapy (CRT) whereas group B was treated using intensity
modulated radiation therapy (IMRT).
Results: In general, acute toxicity was tolerable and complete healing was the rule. As a whole, group A
showed a higher toxicity profile as compared to group B. IMRT was able to decrease xerostomia and spare at
least part of the parotid gland excretory function which was shown in the salivary gland scintigraphy. Results
of the dosimetric comparison between both techniques showed that IMRT had a better tumor coverage and
conformity index. Homogeneity index was similar in the two groups. Also, doses received by the risk
structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT. Conclusion:
IMRT is considered as a more advantageous radiation treatment technique as it can deliver high-dose
irradiation to defined tumor targets while minimizing the dose delivered to the surrounding normal organs and
tissues, thereby improving the therapeutic ratio of radiation therapy. IMRT has been shown to offer superior
dose conformity to the tumor target and better sparing of critical organs in the treatment of NPC.
Keywords: three-dimensional ultrasound conformal, intensity modulated radiation therapy, nasopharyngeal


Nasopharyngeal carcinoma (NPC) is a rare
malignancy with an extraordinarily skewed
radiosensitive and chemo sensitive. Radiation
geographic distribution worldwide. It is more
therapy (RT) is the mainstay of treatment and is an
prevalent in Southern China, Southeast Asia and
essential component of curative-intent treatment of
Northern Africa. Nasopharyngeal carcinoma is
non-disseminated NPC. Stage I disease is treated
strongly associated with the Epstein-Barr virus (1).
by RT alone, while stage III, IVA, IVB disease are
There were an estimated 86,700 new cases of
treated by RT with concurrent chemotherapy.
NPC and 50,800 deaths. Although this disease may
Concurrent chemotherapy is recommended for
be considered one of the rarer forms of cancer
stage II disease (4,5).
globally, it is notable for its high incidence in select
Tumor control for carcinoma of the
geographic and ethnic populations, Nasopharyngeal
nasopharynx has been highly correlated with the
carcinoma is more common in male than female
dose delivered to the tumor. A total dose of 70 Gy
with a ratio of 2.3:1.
is needed for eradication of gross tumor and either
Three subtypes of NPC are classified into:
50­60 Gy or 46­60 Gy for elective treatment of
(type 1: squamous cell carcinoma, typically found
potential risk sites (4).
in the older adult population, type 2: non-
Conventional or so-called 2-dimensional RT
keratinizing carcinoma, type 3: undifferentiated
(2D-RT) has proven effective in the control of
carcinoma). Other malignant tumors of the
NPC. However, complications associated with
nasopharynx include nasopharyngeal papillary
irradiation of sensitive normal structures, such as
adenocarcinoma, plasmacytoma, minor salivary
the glands and inner ears in the path of the
gland tumors, melanoma, rhabdomyosarcoma, and
irradiation, are notable and often lifelong. Common
chordoma. The majority of lymphoma of the
toxicities with this technique, particularly with
nasopharynx is non-Hodgkin's lymphoma, diffuse
concurrent chemotherapy, included: xerostomia,
large B cell (3).
occurring in over 90 % of patients and 70 % have
Received:20 /3 /2018 DOI: 10.12816/0047691
Accepted:30 /3 /2018

Full Paper (vol.717 paper# 5)

c:\work\Jor\vol717_6 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3500-3503

Evaluation of the Various Risk Factors Associated with Placenta Previa
Development: A Simple Literature Review
Amina Abdo Salhi 1, Abdulaziz Abdullah Alhazmi 1, Rana Yahya Al-Qasem 2, Nouf Abdulrahman
Alqahtani 3, Maisa Khedir Ahmed 4, Marwah Sami Aljahli 5, Faten Talal Ashour 6, Rahaf Ali Alqahtani 7,
Elaf Mohammed Albasheri 8, Mohammed A. Syam 9
1- Najran University, 2- Al-Qasem University, 3- King Khalid University, 4- Al-Zaeim Al-Azhary
University, 5- Imam Abdulrahman University, 6- Dallah Hospital, 7- Taif University, 8- Ibn Sina Medical
College, 9- Suliman Al-Rajhi Colleges
Placenta previa is defined as ,the growth of placenta in the lower uterine segment over or near
the internal cervical osseous, it's an obstetric complication which usually occurs in the second trimester. A
lot of literatures have been done to study the risk factors associated with its development. Therefore, assessment
of the recent literatures must be done to provide a summarized paper analyzing the various risk factors that stands
behind placenta previa development, which will help in prevention and control the increasing in the incidence of
the condition. Objective: This study aimed to assess the various studies that investigate the risk factors that stand
behind the development of placenta previa, and provide a reference paper analyzing the last progression has been
reached. Methods: PubMed database was used for articles selection, and the following keys used in the mesh
("Placenta Previa/etiology"[Mesh] OR "Placenta Previa/genetics"[Mesh] OR "Placenta Previa/history"[Mesh]). A
total of 582 articles were found, with further restriction by PubMed filters, and reviewing the articles titles and
abstracts, the final results were 6 articles.
Further studies are still needed to be done to evaluate the modifiable risk factors, and to find a
solution for the increase in the number of cesarean because it have a significant impact on placenta previa
Evaluation, Risk Factors, Placenta Previa, Lower uterine segment.


Placenta previa is a relatively rare pregnancy
complication in which the placenta implants low in the
uterus, covering a small part or all of the cervix.
PubMed was chosen as the search database for the
Placenta previa complicates approximately 1 in 200
articles selection, because it is one of the major
deliveries (1, 2), and is one of the leading causes of
research databases within the suite of resources that
vaginal bleeding in the second and third trimesters (3, 4).
have been developed by the National Center for
It is associated with increased risks of maternal and
Biotechnology Information (NCBI). The following
infant morbidity and mortality.
As a results, it needs special treatment strategy
including restriction of physical activity, ability to get
immediate medical care, contraction controlling,
Previa/history"[Mesh] ) A total of 582 articles were
preventing infection and hemorrhage as well as
found, with further restriction by PubMed filters, and
timely caesarian section and postpartum
reviewing the articles titles and abstracts the final
management. However, alert bleeding during
results were 6 articles. Inclusion criteria, the articles
pregnancy and massive hemorrhage at cesarean
were selected based on the relevance to the project
section are not observed in all women with placenta
which should include one of the following topics,
previa. The ability to predict alert bleeding during
Placenta Previa (PP) Etiologies, Causes of PP,
pregnancy and massive hemorrhage at cesarean
Genetics, associated factors. Exclusion criteria, all
delivery is critical in the management of placenta
other articles which didn't have one of these topics as
previa prenatally, because prenatal diagnosis allows
their primary end point, or repeated studies.
for a planned approach and more controlled condition

with a possible treatment. Increasing incidence of
placenta praevia during recent years posed the
No software was used, the data extracted were
researchers to investigate more about the etiologies
based on specific form that contain title of the
behind it, we therefor will review the literatures done
study, name of the author, objective, summary, results,
in this field to assess the various risk factors, and
and outcomes, these data were reviewed by the group
provide a review paper that will summarize the recent
members to assess the various risk factors that stand
researches and investigations done to assess the
behind placenta previa development. Double revision
various risk factors of placenta previa.
Received:23 /2 /2018 DOI: 10.12816/0047666
Accepted:4 / 3 /2018

Full Paper (vol.717 paper# 6)

c:\work\Jor\vol717_7 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3504-3507
The Chronotype (Eveningness-Morningness) Effects on Academic
Achievement among Medical Students in Tabuk City, Saudi Arabia
Shelian Juweed Alnomsi1, Khalid Saleh Albalawi1, Omar Yarub Alali1 , Waled Mohammed Albalawi1,
Khalid Mohammed Albalawi1, Wedyan Saleh Albalawi1, Hyder Osman Mirghani2
1Medical students, Faculty of Medicine, University of Tabuk, 2Medical Department,
Faculty of Medicine, University of Tabuk, Saudi Arabia
Correspondence: Shelian Juweed Alnomsi, Phone: + 966598700027 e-mail: Shelian1414@gmail.com

Background: Thereis increasing awareness about theeffects of chronotype and sleep qualityand academic
performance among medical students.
The aim of the work:
This study assessed the relationship between chronotype, sleep quality, and academic
performance among Saudi medical students.
Materials and Methods: A cross-sectional study was conducted among169 clinical phase medical students
during the period from May 2017 to January 2018. Participants were invited to sign a written informed consent
then responded to a self-administered questionnaire, using the Pittsburgh Sleep Quality Index (PSQI) and the
weekdays and weekends bedtime and wake-up time, the chronotype was calculated from mid-sleep and wake
up time during weekends and sleep dept. Students also completed a diary detailing their sleep habits fortwo
weeks priorto filling out the questionnaire. The chi-square and Pearson's correlation were used for the
statistical analysis. Results:Participants (48.5% males), their meanage was22.90±1.27, 83.4% had poor sleep
quality. No correlation was found between cumulative grades (GPA), sleep quality, chronotype, body mass
index, and sleep duration during weekdays and weekends (p>0.005), the females medical students had good
sleep quality and lower body mass index, were more likely morning chronotype, and had higher GPA
compared to males.
Conclusion: No correlation was evident between the GPA, chronotype, and sleep quality. The women had
better sleep quality and GPA, they were more likely morning chronotype and had lower body mass index.
Keywords: sleep quality, chronotype, academic performance, medical students, Saudi Arabia.


There is considerable variation in human
evening are Night Owls. These preferences are
cognitive and physiologic function during the day
assumed to have unique, genetic, biological,
along the circadian rhythm, although the sleep-wake
contextual, and psychosocial components. Diurnal
cycle is regulated extensively by neural mechanisms
preferences had been linked to various habitual and
nonhabitual issues like eating habits, sleeping
environmental factors can substantially influence
behavior among University students, smoking, and
the timing and expression of sleep and wakefulness
drug use [5].
[1]. Sleep can be altered by various factors like the
Early chronotype or morningness have been
overuse of the internet and social media, sleep
linked to physical and mental health, self-esteem,
medications, and coffee intake. Furthermore, the
school functioning, and intimate relationship while
sleep can be profoundly altered by different medical
late or eveningness have been shown to be
conditions including depression, obstructive sleep
associated with mental illness, infections, smoking,
apnea, idiopathic hypersomnia, and chronic sleep
and poor sleep quality [6].
deprivation [2].
There is an increasing awareness about sleep
Previous literature reported the negative
effect on physical and mental health, sleep
association of bad sleep quality and physical and
disturbances could adversely affect medical students
mental health, academic achievement, andwell-
academic performance and is reflected on the whole
being of college students [3,4].
community in terms of medical errors. Evening
Morningness-eveningness is the difference
chronotypes work against their circadian clock and
between individuals regarding diurnal preference,
behave like shift workers in colleges that adopt
the sleep-wake pattern of activity, and alertness in
morning schedules. Thus it is important to estimate
the evening or morning. Persons with an extreme
the degree of the problem to help to implement
morning tendency ( a trend towards rising early in
preventive measures to improve the academic
the morning, perform mentally and physically best
in morning hours, and go to bed early in the
The quality of sleep and morningness-eveningness
evening) are called early Larks, while those who
have been studied individually; fewer researchers
rise later in the morning, stay awake later at night,
have examined the relationship between sleep
and perform at their best in the late afternoon or
quality and chronotype. The Kingdom of Saudi
Received:23 /2 /2018 DOI: 10.12816/0047667
Accepted:4 / 3 /2018

Full Paper (vol.717 paper# 7)

Summary The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3508-3517

Comparative Study between Anterior Chamber Iris Claw Phakic Iol and Posterior
Chamber Phakic Iol (Icl) for Correction of Myopia
Ahmed S. Abdel Rehim1, Nour Eldin A. Abdel Halim2, Fathy M. Elsalhy3
1,2,3 Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Fathy M. Elsalhy; Mobile: 01008825143; Email: fathyelsalhy2010@gmail.com

Compared to other refractive surgeries, implantation of phakic intraocular lenses (pIOLs) have more desirable
results and are potentially reversible procedures due to the possibility of explanting these lenses. These methods usually do not
require expensive or special surgical equipment and most ophthalmologists are able to perform these procedures; however
disabilities resulting from pIOLs are more severe compared to corneal refractive surgery. Due to the potential risk of damage
to anterior segment structures, especially corneal endothelial cell loss.
Aim of the Work: to compare between anterior chamber (AC) pIOL and posterior chamber (PC) pIOL in patients with
myopia as regard:
1- Uncorrected and best corrected visual acuity (UCVA & BCVA).
2- IOP(Intra ocular pressure).
3- Endothelial cell count (ECC).
4- Postoperative inflammation and complications.
Patients and Methods: This prospective comparative study included 30 eyes of patients suffering from high myopia at Al-Hussein
University Hospital from 2017 to 2018. The patients were divided into two groups:
Group (A): included (15) eyes where Polymethyl methacrylate (PMMA) iris-fixated AC pIOL were implanted (Artisan). Group (B):
included (15) eyes where the PC pIOL were implanted (Implantable CollamerLens (ICL V4).
In this study we did pre and postoperative specular microscopy, pentacam and IOP measurement by applanation tonometer to
evaluate endothelial cell count and IOP changes over 6 months. The main outcome measures were central corneal ECC, the
percentage of corneal endothelial cell loss and IOP changes. Secondary outcome measures were UCVA, BCVA, manifest refraction,
and complications.
Results: The mean pre-operative ECC in Group A was 3365±403 cell/mm² ranged from 2830 to 3846 cell/mm². In Group B, it
was 3329±356 cell/mm² ranged from 2901 to 3989. Post operative mean ECC in group A was 3183±344 cell/mm² ranged
from 2609 to 3686. In Group B, it was 3251±361cell/mm² ranged from 2432 to 3621 at 6 month after surgery.
The mean percentage endothelial cell loss in group A was 5.4% While in group B, it was 2.3% at the end of the follow up
period (6 months). The mean pre-operative IOP in group A was 15.63 ±1.74 mmHg ranged from 12 to 18.2 mmHg, while in
Group B, it was 15.53 ±1.98 mmHg ranged from 13 to 20 mmHg. Post operative mean IOP in group A was 14.95±1.01 mmHg
ranged from 12.5 to 16.2 mmHg, while in Group B, it was 14.69±1.20 mmHg ranged from 12.6 to 16.7 mmHg at 6 month
after surgery. The mean pre-operative UCVA in Group A was 0.03 ± 0.011 ranged from 0.01 to 0.04, while in Group B, it was
0.06 ± 0.023 ranged from 0.01 to 0.083. And by the end of the 6th month after surgery, the mean UCVA was 0.39 ± 0.10 in
Group A, while it was 0.5 ± 0.27 in Group B. The mean pre-operative BCVA in Group A was 0.3 ±0.12 ranged from 0.16 to
0.7, while in Group B, it was0.4 ± 0.22 ranged from 0.25 to 1.00 the mean BCVA at 6 month after surgery was 0.49± 0.12 in
Group A, while it was 0.62 ± 0.23 in Group B. The mean pre-operative spherical error (SE) in Group A was -15.3 ± 2.68 D
ranged from -11D to -20D, while in Group B, it was -13.72 ± 3.97D ranged from -7D to -20.25D. by the end of the 6th month
after surgery, the mean post operative SE was-1.02 ± 0.53 in Group A, while it was -1.18 ± 0.67 in Group B.
Conclusion: Our study revealed that pIOLs implantation (AC IOLs or PC IOLs) in high myopes had excellent results
including; stability of refraction for high myopes, reversibility, high optical quality, potential gain in visual acuity,
preservation of corneal architecture, asphericity and accommodation the comparison between the two types of pIOLs proved
that the ICL was superior over the Artisan as regards the effect on corneal endothelium and postoperative AC inflammation,
and they were equal as regards predictability, efficacy and the effect on IOP.
Keywords: Phakic intraocular lenses, endothelial cell count, high myopia.


High myopia represents a multiple management
errors and/or decreased corneal thickness is phakic
challenge. Surgical options such as refractive lens exchange
intraocular lenses (pIOLs) implantation. This is a preferred
are less desirable in younger patients as they result in the total
technique, since it preserves accommodation and corneal
loss of accommodation and a higher risk of retinal detachment.
architecture, is potentially reversible, and has outcomes that
Another option is excimer laser treatment (effective in the
are more predictable, with faster recovery than excimer
correction of low-to-moderate myopia). However, high
surgery (1).
refractive errors are beyond the boundaries of safety and
Refractive surgery is classified into two categories:
effectiveness of corneal surgery. Even with wavefront-
corneal based refractive surgery and lens based refractive
optimized and wavefront-guided treatment, common concerns
surgery (2). In corneal based refractive surgery, corneal
include lower predictability of the refractive outcome,
reshaping using excimer laser has proven to be very useful in
postoperative refractive instability, and the risk of
the correction of a wide spectrum of visual defects. However,
postoperative ectasia (1). Thus, in the absence of
common options like Laser assisted in situ keratomileusis
contraindications, the safest and most effective procedure
(LASIK), Photorefractive keratectomy (PRK), Laser assisted
for treating young patients with moderate-to-high refractive
Received:20 / 3 /2018 DOI: 10.12816/0047668
Accepted:30 /3 /2018

Full Paper (vol.717 paper# 8)

c:\work\Jor\vol717_9 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3518-3528

Monitoring of Free Living Amoeba in Some Drinking Water Treatment
Plant in Great Cairo Governorate, Egypt
Lamiaa A. Shawky 1 Faten El-Feky 2, Hanan Taher 2, Wael I. Ashour1.
1 Reference Laboratory for Drinking Water, Holding Company of Water And Waste Water,
2 Faculty of Science, Girls Branch Al-Azhar University, Cairo, Egypt
*Corresponding author: Wael Ibrahim Ashour, Tel +201002553987, +201285106668, Email: ashourwael@gmail.com

Background: Free-living amoebae (FLAs) in drinking water exerts an indirect public health hazards as they may
harbor pathogenic microorganisms that can escape drinking water treatment processes and reach to end user. The aim
of this study was to observe the existence of free-living amoebae through drinking water treatment plants in Great
Cairo governorate, Egypt. Water samples were collected from 3 drinking water treatment plants (DWTPs) and
filtered through nitrocellulose membranes, then placed on non-nutrient agar with Escherichia coli for cultivation of
free-living amoebae. Results:The obtained amoebae were morphologically identified and confirmed to genus level.
The results revealed that the occurrence of free-living amoebae in intakes and finished water of the examined
DWTPs reached 95% and 31%, respectively. The removal percentage of free-living amoebae through different
treatment processes reached its highest rate in Rod Elfarag DWTP (100%), followed by Embaba DWTP (63.64%),
and reached to (41.67%)in Shubra El-Kheima DWTPs. Almost all the morphologically identified (FLA) strains
proved to be related to genus Acanthamoeba, Naegleria. Conclusion: the presence of free-living amoebae in
drinking water exerts an indirect public health hazards as they may harbor pathogenic microorganisms that can
escape drinking water treatment processes and reach to end user.
Keywords: Free Living Amoeba, drinking water treatment plants, Greater Cairo.

disinfectant to maintain their lenses (5). Members of
Free-living amoebae are protozoa found in
only four genera of FLAs are opportunistic pathogens
soil and water. Among them, some are pathogenic
causing infections of the central nervous system,
and many have been described as potential reservoirs
of pathogenic bacteria (1). Free-living amoebae (FLA)
immunocompromised humans. Balamuthia is also
are a large diverse group of unicellular organisms in
associated with disease in immunocompetent
the kingdom protozoa. The presence of FLA in tap
children, and Acanthamoeba spp. cause a sight-
water may represent a health risk to both
threatening infection, Acanthamoeba keratitis, mostly
in contact-lens wearers. One heterolobosean amoeba
individuals (2). FLA has been described as reservoirs
flagellate, Naegleria fowleri is dangerously
for several pathogenic bacteria, such as Legionella,
pathogenic for humans )6 (. Genus Acanthamoeba
Mycobacterium and Chlamydia (2). They can be found
causes three clinical syndromes amebic keratitis,
in two morphological stages trophozoites and cysts.
granulomatous amebic encephalitis and disseminated
The trophozoite, or vegetative form, corresponds to
granulomatous amebic disease (eg, sinus, skin and
the period of metabolic activity of the amoeba with
pulmonary infections) (7). Acanthamoeba has impact
division, feeding, and motility whereas the cyst form
on the human health is associated with their own
corresponds to the dormant phase of amoeba that
pathogenicity. Acanthamoeba can also cause central
can resist hostile environmental conditions such as
nervous system infections, including gorillas,
nutrient depletion, osmotic stress, temperature
monkeys, dogs, ovines, bovines, horses, and
changes, pH variations, and disinfection of water
kangaroos, as well as birds, reptiles, amphibians, and
supplies (3) . Free-living amoebae (FLA) are non-
fishes)8). The manner of Acanthamoeba movement is
parasitic amoebae, completing their life cycle in
similar both at solid substrata and at water-air
the environment without requiring a host organism
interface. Adhesion forces developed between
(4). Free-living amoebae colonize different water
Acanthamoeba and the water-air interface are greater
systems including drinking water or domestic tap
than gravity, and thus amoebae are transported
water, which accounts for amoebic keratitis among
passively without detachment from the water surface.
contact lens wearers who use tap water instead of
Disinfection is the main practice for controlling the
Received:2/2 / /2018 DOI: 10.12816/0047669
Accepted:12 /2 /2018

Full Paper (vol.717 paper# 9)


Full Paper (vol.717 paper# 10)

c:\work\Jor\vol717_11 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3533-3536

Comparison of Ultrasonic (Harmonic Scalpel) Hemorrhoidectomy versus
Milligan-Morgan Hemorrhoidectomy for Hemorrhoidal Disease
Mohamed Ahmed Shawky Abdelaziz Deyab* , Mohamed Tag Eldin, Alsayed Hamdy.
AL-Azhar University, Faculty of medicine, General Surgery Department, Cairo, Egypt
*Corresponding Author. Email: M.shawkey.2006@gmail.com

Surgical excision using the Harmonic Scalpel is a modern technique for symptomatic third-
and fourth-degree hemorrhoids. The resulting mucosal defect is then left open.
Objectives: The purpose of this study was to compare techniques of hemorrhoid excision using the
Harmonic Scalpel versus the routine Milligan-Morgan technique.
Methods: From August 2017 to May 2018, 30 patients underwent surgical excision of complex grade III or
grade IV hemorrhoids via the Harmonic Scalpel another 30 patients operated with the traditional Miligian
Morgan technique. Data collected about patient clinical condition and perioperative details including
operative time and blood loss then post-operative acute pain and delayed pain and other complications then
the quality of life after returning to routine life including degree of satisfaction of the patients were recorded
in a master sheet and short form survey for documentation and statistical analysis.
Results: Both groups were comparable in terms of patient demographics and type of anesthesia. There were
no late complications. Mean follow-up was 4.9 (range, 4­6) months. Conclusion: hemorrhoidectomy with
Harmonic Scalpel significantly reduces perioperative time, blood loss and thus postoperative pain, without
diminishing quality of life.
Keywords : Harmonic Scalpel- Miligian Morgan- hemorrhoidectomy.

millimeters in depth. This difference causes less
Hemorrhoids (piles) arise from congestion of
postoperative pain and decreases the need for
internal and/or external vascular plexuses around
narcotic use (3,4 ).
the anal canal. Depending on the severity, they
In this study we presented our experience in
are classified into 4 degrees. In many cases
using Harmonic scalpel® in hemorrhoidectomy
hemorrhoidal disease can be treated by dietary
and evaluating the postoperative complications in
modifications, topical medications and soaking in
comparison to the use of electrocautery.
warm water, which temporarily reduce symptoms

of pain and swelling. Additionally, painless non-
surgical methods of treatment are available to
A prospective randomized trial comparing
most patients as a viable alternative to a
Harmonic Scalpel ® hemorrhoidectomy and
permanent hemorrhoid cure. In a certain
electrocautery sixty consecutive patients were
percentage of cases, however, surgical procedures
randomized into two groups: Harmonic Scalpel ®
are necessary to provide satisfactory long-term
and electrocautery hemorrhoidectomy. The
relief (1).
Surgical hemorrhoidectomy is a notoriously
hemorrhoids with external components or Grade
painful procedure. Considerable research over the
1V disease. Patients with additional anorectal
last two decades has concentrated on reducing
pathology as fissure or fistula were excluded, as
pain following these surgical procedures.
were patients with neurologic deficits, chronic
Investigators have concentrated in three areas;
pain syndrome, and those already on narcotic
analgesic delivery during the postoperative
analgesics. Pain was assessed using a visual
period, modification of the surgical technique and
analog scale preoperatively and on postoperative
the use of a variety of surgical instruments in the
Days 1, 2, 7, 14, and 28. Twenty-four-hour
hope of decreasing postoperative pain (2).
narcotic usage was recorded on postoperative
The rationale for the use of Harmonic
Days 1, 2, 7. Postoperative analgesia took three
scalpel® in hemorrhoidectomy is relatively low
forms: oral, intramuscular, and topical. All
temperature that divides the tissues through the
patients were prescribed oral naproxen sodium
high frequency ultrasonic energy that disrupts
550 mg twice a day. Patients were allowed to
protein hydrogen bonds. The relatively low
omit the oral analgesia if not required. All
temperature (80 °C) yielded results in minimal
patients were also offered intramuscular
lateral thermal injury (<1.5 mm). On the contrary,
injections of pethidine (according to body
both electrocautery and laser cause significant
weight) as necessary while they were still in the
lateral thermal injury and burn several
hospital. Patients were given 2 percent lidocaine
Received:20 /3 /2018 DOI: 10.12816/0047671
Accepted:30 / 3 /2018

Full Paper (vol.717 paper# 11)

c:\work\Jor\vol717_12 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3537-3540

The Use of Intra-Operative Nerve Monitoring (IONM) in Thyroid
Surgery to Reduce Recurrent Laryngeal Nerve Injury
1Ashwag Jamal Al Jehani, 2Feras Mohamed S.Alahmed,
3Abdulmalik Abdulfatah Al Atar, 4Saud Al Rashedi
1General Surgery Department, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh,
2 Security Forces Hospital Program, Riyadh, Saudia Arabia, 3Armed Forces Hospital, Oman,
4 General Surgery Training Center, Riyadh, Saudi Arabia
Corresponding author:Ashwag Jamal Al.Jehani, E.mail: dr.ashwag_ja@hotmail.com,mobile:00966566292990

Objectives: To assess the relation between use of Intraoperative nerve monitoring (IONM) in thyroid surgery and
the prevalence of RLN injury, and to assess its significance of IONM in reduction of RLN injury among patients
who underwent thyroid surgery.
Background: Recurrent laryngeal nerve (RLN) palsy is one of the big concerns for surgeons during thyroid
surgery. Surgeons tried to find ways to identify this nerve and preserve it. The most popularly used way is the use
of Intraoperative nerve monitoring (IONM).
In this retrospective study, we collected the data for all cases that underwent thyroid surgery in Security
Forces Hospital (SFH), Riyadh, Saudi Arabia during the period of 2010 to 2012. We divided participants to two
groups, those who used IONM and those who did not used IONM. The statistical Package for Social Sciences
(SPSS, version 22) was utilized for data entry and analysis. Categorical variables were described by frequencies
and percentages. Descriptive analysis involving Chi-square test was used to test significance of association
between categorical variables. The level of significance was set at P< 0.05.
Post-operation RLN injury was higher in those who underwent thyroid surgery without IONM, but the
difference was insignificant (p=0.460). Three of those patients who underwent the surgery without IONM has RLN
injury (3.1%), and no RLN injury reported of those who underwent surgery with IONM (0%).
IONM could help in identifying the RLN and preserving it from injury. Although, in this study there
were insignificant correlations between RLN injury and IONM. Further researches on a larger-scales is
recommended to get more informative results and allow better comparison.
Keywords: Recurrent laryngeal nerve; intraoperative nerve monitoring; thyroid; surgery; complications.


develop paralysis of RLN. (10, 11) Numerous studies
The advances that achieved in thyroid surgical
have failed to document that intraoperative monitoring
techniques during the last few decades only declined
of RLN significantly decreases the risk of paralysis. (12-
the risk for recurrent laryngeal nerve (RLN) injury but
15) On the other hand, other studies have reported a
did not lead to its disappearance (1). The incidence of
decrease in incidence of transient RLN paralysis when
RLN paralysis ranged between 1% and 20%,
RLN monitoring is utilized compared to simple
depending on the type of thyroid disease, surgical
identification of the nerve visually (2, 10). It has been
technique, the resection extension, and the surgeon's
documented that the use of RLN monitoring is
experience (2-5). RLN injury, if unilateral can diminish
associated with increased setup time cost of equipment
quality of life as it leads to some symptoms related to
(11). The aim of the current study was to assess the
voice impairment and subsequent limitations in
hypothesis that the use of intra-operative nerve
physical, social, psychological and communication
monitoring (IONM) in thyroid surgery can reduce the
functioning, whereas bilateral RLN injury can lead to
prevalence of RLN injury in comparison with thyroid
airway obstruction which is life-threatening (6). In
surgery with RLN visual identification alone.
recent years, intraoperative monitoring of recurrent

laryngeal nerve (RLN) has become a practice
commonly performed in thyroid surgery and has
The present study is a retrospective cohort study of
gained more acceptance as an addition to the gold
patients who underwent thyroid surgery at the Security
standard visual nerve identification (2, 4, 7-9). It is
Forces Hospital (SFH), Riyadh, Kingdom of Saudi
designed to visualize the RLN as well as to allow
Arabia throughout the period of January 1st 2010 to
assessment of its function intraoperatively. In addition,
December 31st 2012. Using the MR viewer system data
it can be used to explore the prognosis of patients who
was collected. All operated thyroid cases (n=137)
Received:25 /2 /2018 DOI: 10.12816/0047672
Accepted6: / 3 /2018

Full Paper (vol.717 paper# 12)

INTRODUCTION The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3541-3549

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided
Supraclavicular Brachial Plexus Block Versus Bupivacaine alone for
Upper Limb Orthopedic Surgery; A Comparative Study
Hesham Mohamed El Azzazi, Ashraf El Sayed El Agamy, Marwa Mostafa Mohamed,
Mostafa Mohamed Nageeb Abd Al-Salam
Department of Anesthesia, Intensive Care and Pain Management,
Faculty of Medicine, Ain Shams University, Cairo, Egypt

Brachial plexus blocks are among the most commonly performed peripheral nerve blocks for upper
extremity surgeries in clinical practice. Local anesthetics alone for supraclavicular brachial plexus block provide
good operative conditions but have shorter duration of postoperative analgesia. Several adjuvants added to local
anaesthetics in brachial plexus block are used to achieve quick, dense, and prolonged block. Dexamethasone has
been shown to prolong peripheral nerve blockade in animals and, when added to bupivacaine, to extend the
duration of analgesia in humans.
Objective: The aim of the current study was to evaluate the effects of adding dexamethasone (8 mg) to 28 ml of
bupivacaine 0.5% in ultrasound-guided supraclavicular brachial plexus block for upper limb orthopaedic surgery
versus bupivacaine 0.5% alone.
Patients and Methods
: The study included patients scheduled for elective upper limb orthopaedic surgery. A
randomized double-blinded controlled study is the design used in this study. It was carried on 40 patients who
were divided into two groups; 20 patients of each: group B (control group): patients received 28 ml of
bupivacaine 0.5% + 2 ml of normal saline and group D (study group): patients received 28 ml of bupivacaine
0.5% + 8 mg of dexamethasone (2 ml).
Results: There was significant difference between both groups as regards the onset of sensory and motor block,
group D has faster onset sensory block (10.30 ± 2.27 versus 12.85 ± 2.5 minutes, as well as motor block (15.15 ±
2.37 versus 18.25 ± 2.22 minutes). The duration of sensory block was significantly prolonged in group D than in
group B (18.45 ± 2.26 versus 10.33 ± 1.54 hours) as well as the duration of motor block (14.18 ± 2.24 versus 8.34
± 1.50 hours). There was significant prolongation of the duration of postoperative analgesia and less doses of
postoperative rescue analgesic in group D.
Conclusion: We concluded that addition of 8 mg of dexamethasone to bupivacaine 0.5% in ultrasound guided
supraclavicular brachial plexus block shortened the onset times of both sensory and motor blocks, significantly
prolonged their durations, and prolonged the analgesia of brachial plexus block with subsequent consumption of
less amount of postoperative analgesics in comparison to bupivacaine 0.5% alone.
Keywords: ultrasound, bupivacaine, brachial plexus, dexamethasone.

systemic side effects, prolong motor block and should
Brachial plexus blocks are among the most
also reduce the total dose of local anaesthetic.
commonly performed peripheral nerve blocks for
Various studies have investigated several adjuvants
upper extremity surgeries in clinical practice. It offers
many advantages over general anaesthesia for upper
bicarbonate added to local anaesthetics in brachial
limb surgeries such as sympathetic block, better
plexus block to achieve quick, dense, and prolonged
postoperative analgesia, high success rate and fewer
block, but the results are either inconclusive or
side effects (1). Various approaches to the brachial
associated with side effects (2).
plexus have been described but the supraclavicular
Dexamethasone, a high-potency, long-acting
approach is the easiest and most consistent method
glucocorticoid, has been shown to prolong peripheral
for anaesthesia and perioperative pain management in
nerve blockade in animals and, when added to
surgery below the shoulder joint. Local anaesthetics
bupivacaine, to extend the duration of analgesia in
alone for supraclavicular brachial plexus block
provide good operative conditions but have shorter
dexamethasone's mechanism of action may stem
duration of postoperative analgesia. This problem can
from decreased nociceptive C-fiber activity via a
be overcome by using long acting local anaesthetics
direct effect on glucocorticoid receptors and
like bupivacaine or by using adjuvant in regional
inhibitory potassium channels. Other suggested
anaesthesia. Adjuvant added to brachial plexus block
mechanisms include a local vasoconstrictive effect,
should prolong the analgesia, without having
resulting in reduced local anaesthetic absorption, or a
Received:20 / 3 /2018 DOI: 10.12816/0047673
Accepted:30 /3 /2018

Full Paper (vol.717 paper# 13)

A The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3550-3553

Color Doppler and Duplex Study in Assessment of Recipient
Patients in Post Liver Transplantation
Marwa Ibrahem Mohamed *, Ahmed Mohamed Bassiony *,
Yousef Ahmed Yousef **, Ahmed Hassan Ibrahem*
* Radio-Diagnosis Department, Faculty of Medicine, Ain Shams University, ** Radio-Diagnosis Department,
Faculty of Medicine, Misr University for Science and Technology
Liver transplantation is currently accepted as a first line treatment for patients with end-stage acute or
chronic liver diseases. Graft survival and overall patient survival have steadily improved since the first transplants
were performed in the early 1960s, but a significant percentage of transplants develop complications related to
vascular and biliary insufficiency. Graft ischemia after liver transplantation is associated with a high incidence of
morbidity and mortality. Aim of the Work: was to evaluate the sensitivity of Duplex ultrasound in detection most of
vascular complication after liver transplantation in correlation with CT angiography. Patients and Methods: The
study was done from July 2017 until January 2018, where 20 cases who underwent living donor liver transplantation
with post-operative complications. The cases were done at Dar Al Fouad Hospital and National Liver Institutes. The
cases were 16 males and 4 females. All cases where admitted to post-transplanting intensive care unit in the
postoperative period where a routine full laboratory and radiological assessment were done. The laboratory
assessment included full liver function tests, kidney function tests, complete blood picture, and C-Reactive
Protein. Immunosuppressant level and bilirubin level in drains had also done. Results: The patient age ranges
from 43 to 80 years with the mean age of 61.5 years. Eighteen cases had hepatitis C related cirrhosis (90%) One case
had veno-occlusive disease related cirrhosis (Budd Chiari syndrome). One case was Wilson disease. About 95% of
cases were suffering from end stage liver disease. The results we have reached are that Doppler U/S sensitivity in
diagnosis of these complications is about 75%. Conclusion: It could be concluded that gray-scale US and color
Doppler are the investigations of choice in postoperative liver transplantation. They can be used as routine steps in
the assessment of liver transplant graft postoperatively in recipient patient as early as possible within the first 3 days
after operation and used as a late follow up, as they are noninvasive, safe, cheap, and accurate. Routine use of gray-
scale US and color Doppler showed to minimize the impact of postoperative complications and maximize both graft
and recipient patient survival.
Keywords: Color Doppler, Duplex Study, Recipient Patient, Post Liver Transplantation.


Liver transplantation is currently accepted as a
arterial pseudo aneurysm. Biliary complications
first line treatment for patients with end-stage acute
include; biliary leakage, stricture and obstruction (4).
or chronic liver diseases (1).
Graft survival and overall patient survival have
ultrasonography and cross-sectional imaging
steadily improved since the first transplants were
studies often is most effective for diagnosis. Each
performed in the early 1960s, but a significant
imaging modality has specific strengths and
percentage of transplants develop complications
weaknesses, and the diagnostic usefulness of a
related to vascular and biliary insufficiency. Graft
modality depends mainly on the patient's
ischemia after liver transplantation is associated
characteristics, the clinical purpose of the imaging
with a high incidence of morbidity and mortality (2).
evaluation, and the expertise of imaging
Biliary and vascular complications and rejection
professionals (1).
of the transplanted liver are the main causes of
Ultrasound is the initial imaging modality of
malfunction and loss of the hepatic graft. Advances
choice for detection and follow-up of early and
in medical therapy over the last few years have led
delayed complications from all types of liver
to a more efficient diagnosis and treatment of
transplantation. Knowledge of the surgical
postoperative complications after orthotopic liver
technique of liver transplantation permits early
transplantation, thereby increasing the survival rate
after liver transplantation (3).
misdiagnosis (5).
Vascular complications include; hepatic artery
Doppler study in the postoperative period is a
stenosis and thrombosis, portal vein stenosis and
safe, accurate and non invasive method of
thrombosis, caval and hepatic veins obstruction,

complications in the hepatic parenchyma and bile
Received:20 / 3 /2018 DOI: 10.12816/0047674
Accepted:30 / 3 /2018

Full Paper (vol.717 paper# 14)

c:\work\Jor\vol717_15 Turky Alkhathlan et al.


Full Paper (vol.717 paper# 15)

c:\work\Jor\vol717_16 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3559-3571

The Possible Radio Protective Role of Aphanizomenon Flos-Aquae
(AFA) on Heart of The Adult Male Albino Rats
Fatma A. Eid, Asmaa A. M. Eldahshan and Safaa M. A. Hamid
Department of Zoology, Faculty of Science, Al- Azhar University, Cairo, Egypt
Corresponding author: Asmaa A. M. Eldahshan, email: asmaaeldahshan@yahoo.com

Aim of the work: this study demonstrated the drastic effects of ionizing radiation on the heart tissue of the
adult male albino rats and the possible radio protective role of AFA extract.
Material and Methods: a total of forty-eight mature male albino rats (Rattus rattus) weighing 180-200g were
fed on standard rodent pellets. Rats were equally categorized into four groups; each group contained 12 rats.
These groups were: 1-untreated normal control rats (C); 2- rats exposed to 4Gy of gamma-radiation (Irradiated
group R) and then they were sacrificed on days 5 and 21 (R1& R2 groups respectively) post-irradiation; 3- rats
were treated orally with 94.5mg/kg body weight/day of AFA extract for 3 weeks (AFA group) and then they
were sacrificed on 5 and 21 days (A1& A2 groups respectively) post- treatment; 4- rats were treated orally with
94.5mg/kg body weight/day of AFA extract for a period of one week before irradiation and three weeks after
irradiation (AFA-irradiated group), then the rats were sacrificed on 5 and 21 days (AR1& AR2 groups
respectively) post-irradiation and treatment, then the hearts were immediately excised.
Results: many drastic changes were observed in the cardiac muscle fibres of rats of R1 group. These changes
included: numerous hemorrhagic areas which contained hemolyzed blood cells and some nuclei of
myocardiocytes were pyknotic and others were hypertrophied with destruction in some fibres and widened
endomysium. Aggravated changes were also observed in the heart of rats of R2 group such as highly elongated
and congested cardiac blood vessels which contained hemolyzed blood cells and hemosiderin granules,
numerous hemorrhagic areas, necrotic areas and widened endomysium. On the other hand, highly increased
collagen fibres and amyloid- deposits were also noticed in the cardiac tissues of rats of R1 and R2 groups with
decreased PAS positive materials, total protein and DNA materials. Normal architecture of the cardiac muscle
fibres was detected in the rats of A1, A2 groups with slightly increased collagen fibres and slightly decreased
PAS positive materials, total protein, amyloid- protein and DNA materials. Also, AR1, AR2 groups showed
somewhat normal appearance and well developed cardiac muscle fibres, but some dilated endmysium spaces
were still detected in the cardiac muscle fibres of rats of group AR2. Furthermore, increased collagen fibres and
amyloid- deposits were realized in the cardiac muscle fibres of rats of AR1, AR2 groups with decreased PAS
positive materials, total protein and DNA materials.
Conclusions: AFA showed cardio- protective effect and powerful antioxidant action. So, it can be used under
medical supervision as a natural supplement.
Keywords: gamma-radiation, AFA, heart tissue.

induce alteration by interfering with the genetic
The effects of ionizing radiation on biological
materials of the cell. DNA double-strand breaks are
systems were mainly generated from experimental
generally accepted to be the most biologically
studies on animals and the radiation accidents.
significant lesions by which ionizing radiation
These effects depend on many factors such as
causes cancer and hereditary disease (4).
radiation type, radiation dose and radio sensitivity
Exposure to high radiation doses to the heart,
of the tissue receiving the radiation and also the
coronary, carotid and other large arteries received
volume of tissue exposed (1). Gamma rays are
radiation induced tissue damage, resulting in
ionizing radiation and thus are biologically
increased risk of circulatory diseases; the
hazardous (2).
underlying biological mechanism is the high level
Gamma rays are generally characterized as
of cell killing, leading to pro-inflammatory effects
electromagnetic radiation having the highest
and micro-vascular damage (5). Exposure to
frequency and energy and also the shortest
wavelength (below about 10 picometers ). Due to
histopathological changes. These changes differ in
their high energy content, gamma rays can cause
their severity according to the radio sensitivity and
serious damage when absorbed by the living cells
response of the individual organs and tissue (6).
(3). Gamma-rays are not stopped by skin; they can
Clear histopathological changes were observed
Received: / /2018 DOI: 10.12816/0047676
Accepted: / /2018

Full Paper (vol.717 paper# 16)

c:\work\Jor\vol717_17 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3572-3577

Knowledge, Awareness, and Attitude Regarding Infection Prevention and Control
among Medical Students in Al-Taif University
Nourah Ali Alshamrani, Rahaf Ghazi Altuwairqi, Hanouf Abdullah Alnofea
Al-Taif University
Infection prevention and control is required to prevent the transmission of communicable
diseases in all health care settings. The risk of acquiring a healthcare associated infection is related to the mode
of transmission of the infectious agent. As a result we wanted to assess the awareness level of infection control
among medical students. Objective: In this research we aim to identify the extent of knowledge, awareness, and
attitude regarding infection prevention and control among medical students in Taif University. Methods: The
researchers used the descriptive method for its relevance to the current research. The research population
included 250 medical students in Al Taif University. The researcher designed questionnaire as a data collection
method to serve the purpose of this research, and the descriptive approach was used for its relevance to the
current research. Conclusion: Most students were almost completely aware of the risk of infection transmission
through the hospital, and about all the precautions needed to prevent and control the infection within the
hospital. Also, the students were aware about the different kind of infectious disease.
Keywords: Knowledge, Awareness, Attitude, Infection Prevention and Control, Medical Students, Al-Taif
University, KSA

going to hospitals, and dealing with patients. As a
Health care-associated infections (HCAIs) are
result of these factors we have chosen to target the
important public health problems. They are
medical students in Al Taif University to assess
associated with significant increase in the risk of
their knowledge and attitude regarding infection
morbidity and mortality1. The International
prevention and control. A total of 250 out of 357
Nosocomial Infection Control Consortium found
medical students participated in our study.
that the rate of central line-associated blood stream
Profile of the Respondents of student:
infections in the intensive care units in Latin
The respondents of this study were asked to
America, Asia, Africa, and Europe were 4.9 per
provide information regarding their Gender,
1,000 central line days1-3. Almost, about 5%-10%
Academic Years, and Age.
of patients admitted to acute care hospitals acquire

an infection during their stay4. As a result, the
Table (1) represent the percentages, and number
awareness of medical students regarding infection
of Gender respondents to our study.
prevention and control the significant risk of
acquiring infections during their hospitals rotations
is essential. In this study we aimed to identify the
extent of knowledge, awareness, and attitude
regarding infection prevention and control among

medical students in Taif University.
It is evident from Table (1) that there were
signficant differince in sex of the participants in
Study Population and Sample Size
which Female gender total participants were
Testing the hypotheses developed to answer the
87.2%, on the other hand only 12.8% of the total
research question requires collection of data from
study sample were males. This might be because
individuals specific to the research undertaken. It
that males and females are studying in seperated
may be possible in certain occasions to collect data
classes and college loopy which is the situation
from every possible individual; however, in many
in all saudi arabia colleges. As a result, it was
cases, this is impossible due to restrictions of time,
difficult to contact with them and include them in
money, and access5. Therefore, it is proposed that
the study.
data should be collected from the people, events, or
Table (2) presents the demographic profile of the
objects that can provide the right answers to the
problem and from those who are considered
percentages, and a chart presenting the number of
representatives of the population5.
respondents of each group.
According to Sekaran and Bougie et al.5, a
population refers to "the entire group of people,
18 ­ 20 years
events, or things that the research desires to
20-23 years
investigate". Medical students face a lot of things
23 ­ 25 years
that might increase the risk of infection such as,
Received:27 /2 /2018 DOI: 10.12816/0047677
Accepted:8 /3 /2018

Full Paper (vol.717 paper# 17)

REVIEW OF LITERATURE The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3578-3584

Comparative Study between the Corneal Volume in Mild and Severe
Keratoconic Eyes Using Pentacam Tomography
Amr S. Mousa, Ahmed A. Abdul Latif, Weam M. Ebeid, Amal S. Abu Shusha
Department of Ophthalmology, Faculty of Medicine, Ain Shams University
Corresponding author: Amal S. Abu Shusha; Mobile: 01226939684; Email: amalsalah156@yahoo.com

Keratoconus is the most common corneal ectasia. It usually appears in the second decade of the
life and affects both genders and all ethnicities. Tomographic-based data have added significantly more
information to the screening of corneal ectasia. In addition to anterior corneal analysis, tomography also
provides information about the posterior cornea and the pachymetric distribution, which can increase our ability
to identify early and subtle corneal changes.
Aim of the Work:
The main aim is to determine how the corneal volume measurement changes in different
diameters of corneal tissue, in the central 3 mm and 5 mm in mild and severe cases of keratoconus; in an
attempt to quantify the loss of corneal tissue in keratoconus.
Patients and methods: This cross-sectional study included 20 eyes of keratoconic patients, from 15 to 36 years
old. They were divided into 2 groups, each group included 10 eyes: Group A: mild keratoconic cases with
steepest keratometry reading lower than 45 D. Group B: severe cases with steepest keratometry greater than 52
D, All cases were diagnosed as keratoconus using pentacam parameters.
Results: Corneal volume at 3 and 5 mm diameter was significantly lower in the severe keratoconic cases than
in mild cases (P<0.01).
Conclusion: based on the data in our study, we think the effect of keratoconus is not limited to corneal
thickness. Rather, it affects all anterior segment parameters of the eye and results in significant alternations with
the progression of the disease. There is a clear reduction of corneal volume in early keratoconus, and such
reduction increases significantly with the severity of the disease. Measurement of corneal volume could prove
to be a useful tool to monitor the progression of the disease and in other applications, such as assessing the
effect of treatments including corneal collagen crosslinking and implatation of Intacs.
Recommendations: Further studies on a larger scale of patients are needed to confirm the results obtained by
this work.
Keywords: corneal volume, keratoconus, pentacam tomography.

resulting in loss of their natural arrangement and
Keratoconus is a chronic, bilateral, usually
corneal thinning.
asymmetrical, non-inflammatory, ectatic disorder,
The basic diagnostic examinations for
being characterized by progressive steepening,
keratoconus include placido disk­based corneal
thinning and apical scarring of the cornea (1). As
topography, Orbscan I and II slit topography,
the cornea steepens, the amount of astigmatism
Pentacam Scheimpflug imaging (8).
increases, causing a distortion of the image which
reduces visual acuity of affected patients (2).
dimensional reconstruction of the cornea,
Keratoconus is a complex condition that
enabling evaluation of the anterior and posterior
involves both external factors, such as allergies
corneal surfaces and creation of a pachymetric
and eye rubbing, and genetics factors (3). Severity
map (9). Corneal thickness spatial profile, corneal
of the disease has been shown to be associated
volume (CV) distribution, percentage increase in
with family history and ethnic origin (4).
thickness, and percentage increase in volume were
Histological studies have described how, in
studied, and it was reported that these parameters
the advanced stages of keratoconus, the basal cells
could serve as indices to diagnose keratoconus
of the epithelial layer eventually disappear, leaving
and screen refractive candidates (10).
the epithelium with only one or two layers of
superficial flattened cells (5).
parameters that can be measured by modern
In the advanced stages of keratoconus,
examination techniques is the CV, it reflects
Bowman's layer may present prominent fracture
topographical and pachymetric changes and
lines (6) that are thought to occur in weak areas
characterizes corneal morphometric changes with
due to the inability to withstand normal
a single value (11).
intraocular pressure or physical stress, such as that
CV was recently identified as an additional
caused by eye rubbing, leading to breaks (7). The
screening factor for keratoconus (12). Significant
collagen lamellae in the keratoconic stroma slides
differences in CV have been reported between
normal and moderate keratoconic eyes, suggesting
Received:20 /3 /2018 DOI: 10.12816/0047678
Accepted:30 / 3 /2018

Full Paper (vol.717 paper# 18)

THE ROLE OF ADVANCED TECHNIQUES OF MRI IN EVALUATION OF PEDIATRIC BONE TUMORS The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3585-3590

The Role of Advanced Techniques of MRI in Evaluation of Pediatric Bone Tumors
Abeer Maghawry Abdelhameed *, Ayman Mohamed Ibrahim *, Noha Mohamed Osman *,
Sherif Ishak Azmy **, Eman Aly El-Din El-Sayed *
* Radiodiagnosis Department, Faculty of Medicine, Ain Shams University
** Orthopedic Surgery Department, Faculty of Medicine, Ain Shams University

Functional magnetic resonance imaging (MRI) improves tissue characterization and staging of bone
tumors compared to the information usually supplied by structural imaging. Dynamic MRI and diffusion MRI can be
performed in everyday practice. Tumour characterization can benefit from perfusion MRI with dynamic gadolinium
injection and enhancement time-intensity curve analysis combined with quantitative and qualitative diffusion MRI.
Aim of the Work:
is to elucidate the role of advanced MRI techniques in diagnosis of pediatric bone tumors and to
assess the diagnostic potential of Dynamic contrast enhancement (DCE) in conjunction with Diffusion weighted
imaging (DWI) in differentiating benign from malignant bone tumors.
Patients and Methods:
a prospective study conducted on thirty pediatric patients with clinically suspected and
radiologically proven bone tumor or tumor like lesion. The patients were referred from the Department of
Orthopedics, Ain Shams University. The patients were investigated using 1.5 Tesla magnetic resonance device. They
were subjected to conventional MRI and DCMI.
DWI with measurement of Apparent diffusion coefficient (ADC) values helped in the differentiation of
benign and malignant bone tumors, and that the best cut-off criterion is ADC of 0.9 and this means that 0.9
indicates malignant result while >0.9 is defined as benign results with overall sensitivity 100% and specificity 100%.
A type II curve was seen in 23 cases (one malignant and twenty two benign), type IV was seen in 5 cases (all are
malignant) and type V curve was seen in two malignant cases (after chemotherapeutic treatment). ROC analysis for
the Dynamic contrast enhancement (DCE) showed a sensitivity of 75 % and specificity of 100%.
DWI and DCE-MRI had been proven to be highly useful in the differentiation of benign and malignant
bone tumors. Measurement of ADC values improved the accuracy of the diagnosis of bone tumors. Moreover; they
could be used in the follow up of tumors and their response to therapy.
Keywords: Magnetic Resonance Imaging (MRI) - Pediatrics - Bone tumors - Diffusion weighted imaging (DWI) -
Apparent diffusion coefficient (ADC) ­ Dynamic study- Dynamic contrast enhancement (DCE).

evaluation of the extent of edema. Suppressing the fat
The bone tumors can be categorized as
signal in T1WI after injection of gadolinium-based
benign and malignant, and the latter may be sub-
contrast medium increases the conspicuousness when
categorized as primary and secondary 1.
assessing tumor vascularisation. Short T1 inversion
All imaging methods play a role in diagnosis
of bone tumors. Plain radiography is the primary
homogeneously suppress all fat signals 4.
imaging modality to suggest the diagnosis and judge
Improvement of treatment and outcome of
the nature of different bony lesions. When a lesion is
bone tumors require development of diagnostic tools
indeterminate or shows signs of aggressiveness,
that can help in differentiation between benign and
magnetic resonance imaging (MRI) is indicated for
malignant lesions in a non invasive and reliable
further characterisation. It is considered the gold
manner. Both diffusion-weighted imaging (DWI) and
standard for characterization of these lesions 2.
dynamic contrast enhancement magnetic resonance
Magnetic resonance imaging (MRI) plays a
imaging (DCE-MRI) have been major foci of
vital role in the evaluation of skeletal lesions,
ongoing research, and are verified as being helpful in
particularly in defining their composition, extent,
compartmental involvement, and relationship to the
musculoskeletal lesions 5.
adjacent structures 3.
DWI provides qualitative and quantitative
T1WI is very important in the evaluation of
functional information concerning the microscopic
bone marrow. Most bone tumors will be evident as
movements of water at the cellular level, using ADC
lesions with low signal against a background of
map as the quantitative measurement 5.
surrounding fatty marrow. T1WI also, provides
Dynamic imaging provides physiologic
excellent contrast among the cortical, marrow and
information that cannot be determined from
surrounding tissues 4.
conventional MR imaging, including information
The use of fat suppression (FS) in MRI can
regarding tissue vascularization and perfusion,
confirm or exclude the presence of fat in a lesion.
capillary permeability, and the volume of the
Water shows higher signal than fat on T2WI, but
interstitial space. MR imaging is performed with fast
suppressing the fat signal can allow an even better
Received:20 / 3 /2018 DOI: 10.12816/0047679
Accepted:30 /3 /2018

Full Paper (vol.717 paper# 19)

c:\work\Jor\vol717_20 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3591-3600

Comparative Study between Different Modalities of Treatment of HCV in
New Era of Direct Acting Antiviral Drugs (DAAs) in Aswan Governorate
Eman M El-Gindy, Ehab F Abdou Mostafa, Iman M Montasser, Fawzy M Ismail
Department of Tropical Medicine
Faculty of Medicine ­ Ain Shams University
Corresponding author: Fawzy M Ismail; Mobile: 01003140686,email: madkorfawzy@gmail.com

Hepatitis C virus (HCV) infection is considered a national progressing problem that threatens the
life of Egyptian people as Egypt has the highest prevalence of HCV infection in the world with prevalence rates
of 14.7 % of the adult population. HCV infection causes chronic hepatic inflammation and severe liver diseases,
such as liver cirrhosis and hepatocellular carcinoma. Currently, HCV is curable, unlike HIV and HBV. Goals of
therapy are to eradicate HCV infection to prevent hepatic cirrhosis, decompensation of cirrhosis, hepatocellular
carcinoma (HCC) and death. End point of therapy: undetectable HCV RNA in a sensitive assay (<15 Iu /ml) 12
weeks sustained virological response (SVR12) and 24 weeks (SVR24) after the end of treatment.
Aim of the Work: To assess the efficacy of DAAs in the treatment of HCV in Aswan Governorate; and to
compare between the different combinations of DAAs ± ribavirin ±interferon which were available during the
study period as regards efficacy and possible side effects in each treatment combination.
Patients and Methods: This retrospective study was conducted in Aswan Fever Hospital, Aswan Hospital
Health Insurance and Tropical Medicine Department Ain Shams University. Study population: Patients with
chronic hepatitis C who received treatment in the period from January 2015 to July 2016. Group I: Triple therapy
(Sofosbuvir + Ribavirin + Interferon) for 3 months. Group II: Sofosbuvir + Ribavirin for 6 months. Group III:
Sofosbuvir + Simeprevir for 3 months. Group IV: Sofosbuvir + daclatasvir ± Ribavirin for 3 months.
In Group I SVR was 74.3% ,Group II SVR was 60% ,Group III SVR was 85.7% and Group IV SVR
was 100% Conclusion: This is a large real-life report of the use of very low-cost generic medications for treating
HCV-G4 within the largest treatment programme worldwide. The use of entirely generic SOF DCV combination
with or without generic RBV was well tolerated and associated with high response rate in patients with different
stages of liver disease. This can be an example for other countries of similar limited resources for managing their
patients with HCV.
Keywords: HCV, direct acting antiviral drugs.

by a sensitive molecular method with a lower limit of
Hepatitis C is a disease with a significant global
detection 615 IU/ml (6).
impact. According to the World Health Organization,

there are about 150 million people chronically infected
with the hepatitis C virus (HCV) corresponding to 2-
To assess the efficacy of DAAs in the
2.5% of the world's total population (1).
treatment of HCV in Aswan Governorate; and to
Chronic hepatitis C is the most common cause of
compare between the different combinations of
chronic liver disease and cirrhosis and the most
DAAs ± ribavirin ±interferon which were available
common indication for liver transplantation in the
during the study period as regards efficacy and
United States (U.S), Australia, and most of Europe (2). It
possible side effects in each treatment combination.
is the most common chronic blood borne disease (3) and

it is a progressive disease, the rate of progression is
highly variable. HCV seroprevalence in Egypt 2008 was
Study design: Retrospective study.
estimated to be 14.7%. Accordingly, Egypt has the
Study setting: This study was conducted in Aswan
highest HCV prevalence in the world caused by
Fever Hospital, Aswan Hospital Health Insurance
extensive iatrogenic transmission during the era of
and Tropical Medicine Department Ain Shams
parenteral antischistosomal therapy mass campaigns (4).
Currently, HCV is curable, unlike HIV and HBV (5).
Study population: Patients with chronic hepatitis C
The goal of therapy is to cure HCV infection in order
who received treatment in the period from January
to prevent the complications of HCV-related liver and
2015 to July 2016. Total patients included in our
study were 140 patients subdivided into four groups
necroinflammation, fibrosis, cirrhosis, decompensation
,each group 35 patients.
of cirrhosis, HCC, severe extrahepatic manifestations and Group I (35 patients): Triple therapy (Sofosbuvir
death. The endpoint of therapy is an SVR, defined by
+ Ribavirin + Interferon) for 3 months.
undetectable HCV RNA in blood 12 weeks (SVR12) or Group II (35 patients): Sofosbuvir + Ribavirin for
24 weeks (SVR24) after the end of therapy, as assessed
6 months
Received:20 /3 /2018 DOI: 10.12816/0047680

Accepted:30 /3 /2018

Full Paper (vol.717 paper# 20)

c:\work\Jor\vol717_21 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3601-3613

Correlation between Haemoglobin A1c and Umbilical Artery Doppler as Predictors
for Perinatal Outcome in Pregestational Diabetic Pregnancy and Pregestational
Diabetic Pregnancy Complicated By Preeclampsia In Third Trimester
Yahia M Mizar 1, Ismael EL Garhy 2, Ashraf H Mohamed 2
1 Department of Obstetrics and Gynecology, Helwan General Hospital.
2 Department of Obstetrics and Gynecology, Faculty of Medicine ­ Al-Azhar University
Corresponding author: Yahia M Mizar, Telephone: 01006635077, E-mail: yahiamahmoud36@yahoo.com


Background: Diabetes mellitus is one of the most common metabolic disorders that occur during pregnancy.
It has two clinical patterns; either pregestational diabetes mellitus or gestational diabetes mellitus.
Pregestational diabetes mellitus is associated with worse maternal and fetal outcomes compared to gestational
diabetes mellitus. Objectives: To assess usefulness of using both heamoglobin A1C and umbilical artery
Doppler velocity waveform analysis in predicting adverse perinatal outcomes for both pregestational diabetic
pregnancies & pregestational diabetic pregnancies complicated by preeclampsia.
Methods: This comparative study was conducted on 150 pregnant women with gestational age 34 ­ 40 weeks
who were equally divided into 3 groups; 50 pregnant women with pregesational diabetes melleitus alone and
50 pregestional diabetes melleitus complicated with preeclampsia. These two groups were compared with 50
healthy pregnant women, free from medical disease, as control group. Results: In pregnant women with
pregestational DM, HbA1c should be kept below 7% and it is better to be less than 6.5% by proper glycemic
control, as higher levels of HbA1c were associated with bad perinatal outcomes in the forms of RDS, neonatal
hypoglycemia, macrosomia, IUGR, Apgar score 1 & 5min and NICU24. In addition to, bad maternal outcomes
in the forms of polyhyramnios, preterm labor, PROM, prolonged labor, mode of delivery, postpartum
hemorrage, puerperal sepsis, pulmonary embolism, preeclampsia and its complications as eclampsia, HELLP
syndrome, renal affection, hepatic affection and retinal affection. There was no significant relation between
long term maternal glycemic control (HbA1c) & the changes of blood flow velocity in the umbilical artery in
pregnancy complicated with diabetes mellitus unless the pregnancy is complicated with fetal growth restriction
or preeclampsia. Conclusion: An increased pulsatility index of umbilical Doppler was found in our study to be
the important predictor of perinatal outcome in diabetic pregnancies complicated by preeclampsia but not in
uncomplicated diabetic pregnancy.
Keywords: Diabetes Mellitus ­ Heamoglobin A1c ­ Umbilical Artery Doppler ­ Preeclampsia.

oved by establishment of the services of
Diabetes mellitus complicates approximately 3 to
preconception care (3).
5% of all pregnancies with 90% classified as
Preeclampsia is more frequent among women
with diabetes, occurring in approximately 12% as
Pregestational diabetes prevalence continues to rise
compared to 8% of the non-diabetic population.
largely due to increases in Type 2 diabetes
The risk of preeclampsia is also related to maternal
associated with obesity (1). Poor glycemic control
age and the duration of preexisting diabetes. In
during pregnancy is associated with adverse
patients who have chronic hypertension coexisting
maternal and fetal outcomes (shortened gestational
with diabetes, preeclampsia may be difficult to
period, greater risk of miscarriage, increased
distinguish from near-term blood pressure
likelihood of operative delivery, hypoglycemia,
elevations. The rate of preeclampsia had been
macrosomia, and increased NICU admission).
found to be related to the level of glycemic control,
Especially at risk are those with preexisting
with fasting plasma glucose (FPG) less than 105,
diabetes, who would benefit from earlier diabetes
the rate of preeclampsia was 7.8%, if FPG was
consultation and tighter glycemic control before
greater than 105; the rate of preeclampsia was
conception (2).
13.8%. In this same study, pregravid body mass
Pregestational diabetes mellitus is associated
index was also significantly related to the
with worse maternal and fetal outcomes compared
development of preeclampsia (4).
to gestational diabetes mellitus however the
The advances in the management of pregnancies
outcomes of pregestational diabetes mellitus are
complicated with pregestational diabetes resulted
comparable to those reported from other countries
in considerable improvement in maternal and
except in the stillbirth rate, which could be
perinatal outcomes. Preconceptional glycemic
control and advances in fetal surveillance have

Received:20 /3 /2018 DOI: 10.12816/0047681
Accepted:30 /3 /2018

Full Paper (vol.717 paper# 21)

c:\work\Jor\vol717_22 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3614-3615

A Case Report of Dengue Encephalitis: An Atypical Neurologic
Manifestation of Dengue Fever in Adults
Ibrahim Ahmed M Alnashri 1, Azzam Khalid A Laskar 1 , Nabeela Al-Abdullah 2,3.
1 Department of Internal Medicine, King Abdul-Aziz University Hospital, Jeddah, 2 Department of Infection
Control and Environmental Health, King Abdul-Aziz University Hospital, Jeddah, 3 Department of Public Health,
College of Nursing, King Abdul-Aziz University, Jeddah, Saudi Arabia.
Corresponding author: Ibrahim Ahmed M Alnashri, E-mail: ialnashri@hotmail.com
Dengue fever is a febrile disease caused by infection from one of the four dengue virus serotypes (DENV1,
DENV2, DENV3 and DENV4). The clinical manifestations of dengue fever are broad-spectrum, ranging from
asymptomatic to life threatening, shock syndrome. Usually, the dengue virus doesn't cause neurologic
manifestations, but recently this has been documented in some cases. We report a case of dengue encephalitis in a
42- year-old gentlemen from Bangladesh who was presented with a history of altered level of consciousness
associated with headache, subjective fever, fatigue, nausea and vomiting. Blood test results of Dengue
Immunoglobulin M (IgM) antibodies and polymerase chain reaction (PCR) were positive. In addition, other causes
of encephalitis were ruled out by appropriate laboratory investigations. Dengue Encephalitis should be considered
in the differential diagnosis of fever with altered level of consciousness, especially in areas where dengue fever is
Keywords: Dengue Encephalitis, Viral Encephalitis, Dengue Fever, Neurological manifestations.


Dengue fever is a febrile disease caused by
or alanine aminotransferase (ALT) 1000 units/L,
infection from one of the four dengue virus serotypes
impaired level of consciousness or organ failure) 3.
(DENV1, DENV2, DENV3 and DENV4). The
Usually, the dengue virus does not cause neurologic
dengue virus is a single-stranded RNA virus of the
manifestations, but recently this has been documented
flaviviridae family, transmitted by (Aedes aegypti) or
in some cases. The neurologic manifestations can be
(Aedes albopictus) mosquitoes during the feeding on
classified into three categories: the first is related to
human blood. The incidence of dengue cases has
the neurotropic effect of the virus like meningitis,
increased dramatically in the last decades but,
encephalitis, myelitis or myositis; the second is
unfortunately, the actual numbers of cases are
related to the systemic complications of the virus like
underreported or misclassified. One of the recent
encephalopathy, stroke or hypokalemic paralysis; the
studies gave an estimate of 390 million dengue
third involves post-infectious complications like
infections worldwide each year and over 2.5 billion
encephalomyelitis, optic neuritis or Guillain-Barre
persons at risk of infection 1,2. The clinical
Syndrome 4. The DENV2 and DENV3 serotypes of
manifestations of dengue fever are broad-spectrum,
the dengue virus are more frequently implicated in
ranging from asymptomatic to life threatening shock
causing neurologic manifestations 5. We report a case
syndrome. In 2009 the World Health Organization
of dengue encephalitis in a 42-year-old gentlemen
(WHO) classified dengue fever into three categories:
from Bangladesh.
(I) dengue without warning signs, which include the

residence or travel to an endemic area plus fever plus
two of the following (nausea/vomiting, rash,
A 42-year-old gentlemen, medically free,
headache/eye pain/muscle ache/joint pain, leukopenia
presented with a history of altered level of
and positive tourniquet test); (II) dengue with warning
consciousness for six days, associated with headache,
signs includes the first category in addition to one of
subjective fever, fatigue, nausea and vomiting. Other
the following: abdominal pain or tenderness,
systemic review was unremarkable. He discharged
persistent vomiting, clinical fluid accumulation
recently from another hospital against medical advice
(ascites or plural effusion), mucosal bleeding, lethargy
over financial issues. He is neither a smoker nor a
or restlessness, hepatomegaly more than two cm,
drug abuser. He has no history of contact with a sick
increase in hematocrit concurrent with rapid decrease
patient or recent travel. He also has no clear history of
in platelet count; (III) severe dengue includes the first
insect bite, but he lives in Ghulail district, which is
category with at least one of the following: severe
one of the slums in the south of Jeddah city. Clinical
plasma leakage leading to shock or fluid accumulation
examination on admission revealed pulse 55/min,
with respiratory distress, severe bleeding, severe
blood pressure 155/87 mm hg, temperature 36.8°C,
organ involvement (aspartate aminotransferase (AST)
respiratory rate 15/min, oxygen saturation 82.5%. He
Received:2 / 3 /2018 DOI: 10.12816/0047682
Accepted:11 /3 /2018

Full Paper (vol.717 paper# 22)

Microsoft Word - 925e5ad0a4edc7923c9e26a69434d2a9 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3616-3621
Immunohistochemical Expression of Napsin A, CD82 and
Cyclin D1 in Some Renal Tumors
Ibrahim Hassan Mohammed Yousef1, Sayed Abdel Raheem Sayed Ali1,
Murad Mahmoud Murad2, Yasien Mohammed Abdel Ghafour1
1.Department of Pathology, Faculty of Medicine. Al-Azhar University, 2.Department of Urology, Faculty of
Medicine. Al-Azhar University, Egypt.
Corresponding author: Yasien Mohammed Abdel Ghafour,Tel: 002-01060605353,Email: Dr.yasien2@gmail.com

Background: most of renal neoplasms are of epithelial origin and they are malignant. Renal cell carcinoma
(RCC) accounts for approximately 2% of all cancers. The disease resulted in more than 100,000 yearly deaths
worldwide. Histologic diagnosis of renal neoplasms is usually straight forward by routine light microscopy.
However, immunohistochemistry may be essential in several contexts, including differentiating renal from non-
renal neoplasms, differentiating subtypes of primary renal epithelial neoplasms and diagnosing rare types of renal
neoplasms or metastatic RCC in biopsy specimens. Aim of the work: multiple therapeutic options tailored to an
individual patient are now being offered. In view of these developments, availability of a robust and dependable
panel of immunohistochemical stains becomes even more important because pathologists are frequently asked to
render diagnosis on limited material. Material and methods: in this study a total number of 50 cases of some
types of renal cell tumors were immunohistochemically stained for Napsin A, CD 82 and Cyclin D1. Results:
these cases included 18 cases of ccRCC (36%), 16 cases of PRCC (32%), 8 cases of ChRCC (16%) and 8 cases of
oncocytoma (16%).Conclusion: we concluded that napsin A may be useful in differentiating between ccRCC and
PRCC (particularly type 1 which showed more vacuolated or clear cytoplasm). CD82 may be useful in
differentiating between ChRCC, which was CD82 positive and oncocytoma, which was CD82 negative. Cyclin
D1 had no significant value in the differentiation of different types of renal epithelial tumors.
Recommendation: we recommended the usage of Napsin A in differentiating between ccRCC and PRCC and
CD82 in differentiation between ChRCC and oncocytoma. More studies are needed to evaluate napsin A in
differentiating between ChRCC and oncocytoma.
RCC, napsin A, CD82, cyclin D1.

of primary renal epithelial neoplasms and diagnosing
Most of renal neoplasms are of epithelial
rare types of renal neoplasms or metastatic RCC in
origin and they are malignant. Renal cell carcinoma
biopsy specimens [2] . This is because renal cell
(RCC) accounts for approximately 2% of all cancers.
carcinoma is the most common `recipient' of the
The disease resulted in more than 100,000 yearly
curious phenomenon of metastasis of a cancer into
deaths worldwide. More than 90% of the renal cell
another cancer. Lung carcinoma is the most common
neoplasms arise from the renal tubules [1].
`donor', the resulting microscopic appearance
RCC is divided into 5 main histologic
leading to interesting problems of interpretation. The
subtypes: clear cell renal cell carcinoma (ccRCC),
opposite phenomenon also occurs, the most
spectacular example being renal cell carcinoma
chromophobe renal cell carcinoma (ChRCC),
metastasizing into a CNS hemangioblastoma in
collecting duct and unclassified RCC. ccRCC,
patients with von Hippel­Lindau (VHL) disease [3] .
PRCC and ChRCC are the 3 most common types,
Napsin-A expression was demonstrated in 86
comprising 70% to 80%, 14% to 17%, and 4% to
of 222 (39%) ccRCCs and 16 of 21 (76%) PRCCs
8% of all RCCs, respectively. Benign renal tumors
with a strong and diffuse staining pattern observed
comprise 10% and include several benign entities,
in PRCCs and a relatively weak and focal positivity
in ccRCCs. It was positive in 3% of ChRCC. The
angiomyolipoma and papillary adenoma [2] .
expression of napsin-A was also found to be
Histologic diagnosis of renal neoplasms is
inversely correlated to aggressive local tumor
usually straight forward by routine light microscopy.
However, immunohistochemistry may be essential
immunopositivity for CD82 in 78% (69/88) of
in several contexts, including differentiating renal
ChRCCs, but in only 3% (6/220) of ccRCCs. All 90
from non-renal neoplasms, differentiating subtypes
oncocytomas and 171 PRCCs were immunonegative
Received:20 / 3 /2018 DOI: 10.12816/0047683
Accepted30: /3 /2018

Full Paper (vol.717 paper# 23)

c:\work\Jor\vol717_24 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3622-3625

Neglected Perforated Gall Bladder with Generalized Peritonitis in
Old & Morbid Obese Patient
Hessa S. Alhabes, Samer Alkarak, Mohammed D. Alzamanan
King Khalid hospital ­NAJRAN city - KSA
The main cause of perforation of the gallbladder is cholecystitis with or without cholelithiasis. In old age,
spontaneous perforation of gallbladder can be due to decrease in its blood supply, which can be due to
atherosclerosis, focal vasospasm or localized vasculitis. Perforation of gallbladder is associated with high
morbidity and mortality, if left untreated. Here we report a case of a 60-year-old male with perforation of
Keywords: Spontaneous perforation, chronic cholecystitis, gallbladder, diabetes mellitus, elderly, gangrenous
cholecystitis, acute cholecystitis, cholelithiasis.


The main cause of gallbladder perforation is
tachycardia with relatively low blood pressure &
cholecystitis with or without gallstones [1].The
fever, with marked dehydration, chest was clear,
reported incidence of gallbladder perforation in
abdomen was distended with generalized tenderness
acute cholecystitis is 2-18% [2]. However, cases
& guarding more over right upper abdomen &B
reported as idiopathic or spontaneous gallbladder
scanty urine output.
perforation are not only rare but also have features
Laboratory studies:
that are different from those occurring as a
TLC: 12.3, Hb: 14.2 g/dL, blood sugar: 29.3 mmol/L
complication of cholecystitis. Their different
with positive ketone in urine & metabolic acidosis,
features can be described as peritonitis caused by
BUN: 9 mmol/L, S. creatinine: 182.22 umol/L,
gallbladder perforation lacking the typical clinical
serum Bilirubin: 56 umol/L (direct: 39.7), S. Na: 129
presentation, radiological and histopathological
mmol/L, S. K: 4.3
characteristics of cholecystitis or gallbladder
D-DIMER: positive. ECG showed sinus tachycardia.
perforation [3].As a result, the diagnosis is often
Imaging studies:
delayed or even missed.

Was done showed no air under diaphragm.
Ultrasound abdomen:
A 61 year old male known case of DM, HTN, and
The gallbladder fossa showed a large hyperechoic
old CVA came to ER complaining of generalized
structure with obvious acoustic shadowing & fluid
abdominal pain which started in the upper abdomen
collection at the area of gall bladder, but could not
before 1 week, and aggravated in the last 3 days
assess the wall of the gall bladder with perforated
associated with vomiting. On examination patient
gall bladder & advised to do CT abdomen with
was conscious, drowsy, vitals showed sinus
contrast study. It showed also free fluid in the pelvis

& perisplenic areas.

Received:3 /3 /2018 DOI: 10.12816/0047684
Accepted:12 /3 /2018

Full Paper (vol.717 paper# 24)

c:\work\Jor\vol717_25 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3626-3633

Incidence and Evaluation of Cases of Cannabis Use among Injured Patients
Admitted to Al-Azhar University Emergency Hospitals in Cairo
Sherif Fahmy, Ibrahim Nour, Mohammed Khedr, Abd El-Fattah Morsi and Abd El-Rahman Mohammed
Department of Forensic Medicine and Clinical Toxicology Faculty of Medicine, Al-Azhar University
*Corresponding Author: Abd El-Rahman Mohammed, Phone Number: 01007901576, Email: abdoyusuf39@gmail.com

Trauma remains the leading cause of death among young adults, excessive alcohol and drug
consumption are not only significant contributors to this epidemic, but are also independent predictors of injury
recidivism (repeated trauma). Patients and Methods: In the present study five hundred injured patients with
different types of injuries were randomly selected from Al-Azhar University Emergency Hospital. Trauma sheet
was done for every patient. Ten ml urine was obtained from each patient at the time of admission and before
receiving any kind of treatment whether medical or surgical. Then, toxicological screening was done for every
patient by using D-THC-123626(one step Drug of Abuse rapid test) is a uni drug panel Enzyme Immunoassay
(EIA) test. Results: Toxicological screening of urine samples of the studied injured patients for drug of abuse
revealed that the overall prevalence of positive screen was 84.2 % of the total injured patients.
Keywords: Trauma; substance of abuse; urine screening.


Marijuana, hashish, sinsemilla, and other
psychoactive products obtained from Cannabis
All subjects enrolled in this study were subjected to
sativa are the most widely used illicit drugs in the
the following after giving their informed written
world. Cannabis has been used for its euphoric
effects for over 4000 years (1). Cannabis is self-
1-History taking:
administered for its mood-altering properties, and
a- personal history.
has been described as an addictive, dependence-
b- Medical history.
producing drug due to the production of euphoria,
A-General examination.
impairment, an abstinence syndrome, and tolerance
B-Vital signs.
(2). In the past decade, researchers from all corners
C-Head and neck examination.
of the world have documented the problem of
d- Chest and heart examination.
cannabis use and driving linked to neurological
e- Abdominal examination.
deficits, including the impairment of motor
f- Upper and lower limbs examination.
coordination and reaction time (3). Cannabis use can

increase the risk of road traffic accidents in drivers
Laboratory studies
who are under its influence (4). Cannabis remains the
Ten ml of urine (a non-invasive technique with
second most cited drug after alcohol in motor car
concentrated metabolites in the urine sample for
crashes (5)
long duration) were obtained from each subject at

the time of admission and before receiving any
treatment. Any turbid sample or those samples
Place of the study:
containing blood were excluded. Catheterization
This study was carried out at Al-Azhar University
was done if the patient was unable to void urine or
Emergency Hospitals in Cairo (El-Hussein and Bab
comatose. Each sample was collected in a clean dry
Al-Sharya University Hospitals) on five hundred
and labeled test tube with code number and sample
subjects.The study was approved by the Ethics
date. Each sample was subjected to rapid qualitative
Board of Al-Azhar University.
screening by multi drug panel kits for detection of

Immunoassays were used to initially screen
D-THC-123626(one step Drug of Abuse rapid
specimens for cannabinoids (THC).
test) is a uni drug panel Enzyme Immunoassay
Confirmation of positives were done by gas
(EIA) Test.
chromatography/mass spectrometry (GC/MS).
Kits were used for qualitative screening analysis
Cutoff and Detection of Post Dose:
of cannabinoids.
The initial screening cutoff level is 50 ng/ml. The
Individually packed test devices.
GC/MS cutoff level is 15 ng/ml. The elimination
Package insert.
half-life of marijuana ranges from 14-38 hours. At
Disposable pipettes.
the initial cutoff of 50 ng/ml, the daily user will
Received:20 / 3 /2018 DOI: 10.12816/0047685
Accepted:30 /3 /2018

Full Paper (vol.717 paper# 25)

c:\work\Jor\vol717_26 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3634-3640

Awareness of Chronic Kidney Disease in Hail Region
Alanoud Mansour Ayed Albalawi1, Mohammed Ahmed2, Abdullah Abdulhadi Hammad Alharbi1,
Ali Dawood Mohammed Almansour1, AbdulRahman Ali AbdulRahman AlSogair1
1 College of Medicine, University of Hail, 2 Nephrologist, King Abdullah Center for Kidney Diseases,
Hail, KSA
Chronic kidney disease (CKD) is a common and growing problem worldwide; Earlier
recognition of chronic kidney disease (CKD) could slow progression, prevent complications, and reduce
cardiovascular-related outcomes. Study objective: to show the knowledge of the population Hail region on
CKD and its causes, risk factors, appropriate treatment, and consequences.
Methods: A cross sectional study carried out in Hail region during the period from 1 October to 31
December. Data was collected by personal interview using a predesigned questionnaire containing all the
relevant questions.
Results: Majority (60%) of participant have a good knowledge about CKD, 678 (71.4%) of participant think
that alcohol drinking are the most cause of CKD, 81.2% think smoking, 62.7% think DM and 60.7% think
that hypertension is the cause. Side pain are the most (84.4%) known symptom of CKD followed by difficulty
urination known in 74.4%, Oliguria in 67.8% and hypertension in 34.4%. About the risk factors of the
disease, 96.6% think that some food was the risk factors of CKD, 89.8% think about obesity, 81.5% think
about Analgesic, 56.0% think about DM and 30.5% think about positive family history of CKD. It's found
also that 85.6% of participant know that CKD 85.6% can't be treated without renal transplantation, 83.3%
with dialysis and 71.2% by drugs also large number of them know that it can be treated in high percentage.
Almost all of them say that CKD can be decreased by performing muscular exercises.
Conclusion: Current estimates of CKD awareness indicate that awareness remains unsatisfactory. Also, little
is known regarding whether increased awareness improves clinical outcomes for CKD patients. Further
research is necessary to continue to design and refine awareness campaigns aimed at dissemination of basic
CKD information, given both the high prevalence of CKD and its risk factors and the low estimated
awareness of CKD.
Keywords: chronic kidney disease, awareness, knowledge, population, Hail region.

presentation with most patients in an advanced
Chronic Kidney Disease (CKD) is becoming a
stage. This could have stemmed from a poor level
major health concern worldwide. For many
of awareness and knowledge of the disease as
patients, CKD is associated with substantial
reported by many authors [7,8]. Despite recent
morbidity and mortality [1,2]. Chronic kidney
attempts to increase individual and puplic
disease (CKD) is defined as abnormalities of
awareness about CKD through dissemination of
kidney structure or function, present for >3
clinical practice guidelines and recommendations
for patients with CKD or its risk factors to
with implications for health [3]. Since the initial
providers [9,10], community awareness events
stages of CKD can be asymptomatic, early disease
such as World Kidney Day [11,12], and free
detection is difficult. In undiagnosed and untreated
screening efforts for high-risk individuals like the
individuals CKD may gradually progress to End
Kidney Early Evaluation Program (KEEP) [13, 14], it
Stage Renal Disease (ESRD), the terminal stage of
remains low. Epidemiological studies in developed
CKD when costly Renal Replacement Therapy
countries have also shown a low level of
(RRT) via dialysis or renal transplantation
awareness, knowledge and risk factors of CKD.
becomes necessary to sustain the patient's life
Several studies have demonstrated that individuals
[4]. However, earlier-stage CKD can lead to several
who are provided with appropriate information
complications, such as anemia and bone mineral
and knowledge about CKD and its risk factors are
metabolism disorders, and poor outcomes,
more likely to engage in health-promoting
including cardiovascular events, morbidity, and
behaviors and life style modifications to decrease
mortality [5]. Identification of CKD requires high
the risk of CKD incidence. Therefore, improving
level of awareness about the disease, continuous
the public's knowledge about CKD and its risk
checkup, recognition of individual risk and
factors is an important strategy for CKD
appropriate laboratory testing (serum creatinine
prevention. The aim of this survey is to explore the
and/or urinary protein) [6]. The major challenge of
baseline knowledge of Hail region community
CKD patients in developing countries is the late
Received:8 /3 /2018 DOI: 10.12816/0047686
Accepted:17 /3 /2018

Full Paper (vol.717 paper# 26)

c:\work\Jor\vol717_27 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3641-3647
Underweight Adolescents in Northern Saudi Arabia - A Community-Based Study
Areej Muteb S. Alanazi1, Abdalla Mohamed Bakr Ali2, Zainab Muhammad Ibrahim Ory3,
Reem Mudhhi Essa Alanazi1, Nujud Muteb D. Alshammari1, Jawaher Mohammed Hassan Al Ruwaili1,
Jawaher Naif M. Althayidi1, Waad Salamah Alaleimi1, Rayyanah Mufadhi R. Alanazi1, Rawan Hamdan
Salem Alenazy1, Maha Ibrahim Alanazi1
1 Faculty of Medicine, Northern Border University, KSA.2 Faculty of Medicine, Sohag University, Egypt
3 Pediatrics Department, Faculty of Medicine, Northern Border University, KSA

Adolescence refers to the developmental period between childhood and adulthood, and the WHO
defines adolescents as individuals between the ages of 10­19 years. They make up about 20% of the world
population. Rapid development and urbanization of KSA has resulted in changes in nutritional and diet patterns that
have affected the BMI of children and adolescents and led to nutritional transition. The objective of this study was
to evaluate and estimate the weight status and prevalence of underweight in school-aged male and female
adolescents in Arar city, Northern Saudi Arabia using the BMI. Methods: This was a cross-sectional study that has
been conducted among school adolescents of both sexes, aged 12-18 years during the academic year 2015­2016
over a period of 9 months (October 1st, 2015 to June 30th, 2016). Information obtained through an interviewer
administered semi-structured questionnaire. Body mass index (BMI) was calculated as per the formula BMI =
weight (kg) / height(m2). Age and sex-specific BMI percentiles were computed based on the Centre for Disease
Control (CDC)/National Centre for Health Statistics growth curves. Results: In the studied participants (n = 849),
the male-female ratio was (48.1%:51.9%). About half (50.4%) of the studied adolescents had normal BMI, 25.7%
were underweight (below the 5th percentile), 18.1% were overweight and only 5.8% were obese (above 95th
percentile). In conclusion; nutritional status among adolescents is not so well. Yet more work is needed to identify
the more influential factors which can improve the nutritional status among adolescents in Arar beside nutritional
education programs to the mothers and/or care givers.
Keywords: Nutritional status; BMI; Adolescents; Underweight; Arar city; Northern Saudi Arabia

changes in nutritional and diet patterns that have
Adolescents growth assessment based on the Body
affected the BMI of children and adolescents and led
Math Index (BMI); -weight and height-, and age in
to nutritional transition [7, 8]. Overweight and obesity in
comparison to standards, references, and previous
children and adolescents are mostly associated with
studies is internationally recommended and recognized
economic development and affluence [9]. These
as an important public health indicator for the
conditions have significantly increased in low and
monitoring of the nutritional status and health in
middle income countries (LMICs) over time. [10, 11].
Now, overweight and obesity in children and
developmental period between childhood and
adolescents co-exist with underweight, stunting and
adulthood, and the World Health Organization (WHO)
wasting [12] that historically, were associated with the
defines adolescents as individuals between the ages of
developing world. The paradox of these two extremes,
10­19 years [2]. They make up about 20% of the world
known as the "double burden of malnutrition" [12, 13]
population [3, 4].
coexisting and largely attributable to nutrition
Stunting, defined as inadequate height for age, and
transition in LMICs [14], is a challenge to public health
wasting, defined as inadequate weight for height, are
[15]. Previous studies have shown different prevalence
anthropometric status indicators that are commonly
of underweight adolescents in countries with different
used for these assessments and studies. However,
nutritional habits, developmental conditions and
underweight, or inadequate weight for age, combines
geographic distribution [16]. A study conducted in
information about linear weight and growth
seven African countries has shown that the prevalence
retardation, and height [5]. Underweight people have a
of being underweight in Benin, Djibouti, Egypt,
BMI of less than 18.5 or a weight 15% to 20% below
Ghana, Malawi, Mauritania, and Morocco ranged from
that normal for their age and height group [6].
12.6% in Egypt to as high as 31.9% in Djibouti [17].
Rapid development and urbanization of the
However, Fryar et al [18]. study in the United States
Kingdom of Saudi Arabia (KSA) has resulted in
has shown that the prevalence of underweight children
Received:9 / 3 /2018 DOI: 10.12816/0047687
Accepted:18 /3 /2018

Full Paper (vol.717 paper# 27)

c:\work\Jor\vol717_28 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3648-3654

Association between Uric Acid Levels and Lipid Profiles in
Adult Population of Alkharj City
*Abdulrahman Bader Alaql1, Abdulrahman Ibrahim Almousa1, Fahad Saleh Alonazi1,
Mohammed Abdullah Aldossari1, Deepak Pathania1.
1 Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
Corresponding author: Abdulrahman Ibrahim Almousa, E-mail: dr.abdulrahmanim@gmail.com

High uric acid level used to predict many diseases including left atrial thrombus, it may
indicate aspirin-resistant patients. It could be also used as a biochemical index for diagnosing
adolescence depression. High uric acid level is a known risk factor for deterioration of renal function in
chronic kidney disease. It is also as a risk factor for cardiovascular disease and found to be associated
with increased arterial stiffness Aim: is to investigate the independent association between serum uric
acid and lipid profiles. Methods: Cross sectional study conducted over 200 patients who attended the various
out-patient department of Prince Sattam Bin Abdulaziz University Hospital Al Kharj in Saudi Arabia. The data
included individuals between 20 and 75 years old with lab test within the last year. Results: The data showed
that the highest level of uric acid was in patients older than 50 years old (394 SD ±77.77) and it decreased in
proportionate. The data showed significant association between the uric acid and the triglyceride (P = 0.003)
and no significant association with the total cholesterol (P= 0.511). It also revealed no significant differences
between the antihypertensive as well as antidiabetic groups and normal patients (P = 0.520 and 0.594
respectively). Conclusions: There is strong association between the uric acid and triglyceride, while high level
of uric acid is not associated with high level of total cholesterol. The antidiabetic as well as antihypertensive
drugs have significant effect over the triglyceride level while there is no significant effect on the TC level and
the UA.
Keywords: triglyceride, total cholesterol, antihypertensive drugs, antidiabetic drugs, hyperuricemia.

density lipoprotein, LDL, levels) are components of
High uric acid level used to predict many
MetS, and it is of interest to see how uric acid levels
diseases including left atrial thrombus2, it may
relate to these non-MetS lipid components, which are
indicate aspirin-resistant patients3. It could be also
typically measured routinely in lipid clinic patients.
used as a biochemical index for diagnosing
Indeed, some studies have suggested that serum uric
adolescence depression4. High uric acid level is a
acid fell by about 4­8% in dyslipidemic patients on
known risk factor for deterioration of renal function
specific lipid-lowering medications9, 10.
in chronic kidney disease5. It is also a risk factor for
Hyperuricemia is a condition with increased uric
cardiovascular disease and found to be associated
acid in the blood, uric acid (urate) is produced
with increased arterial stiffness6.
through the metabolism of purine compounds. The
The investigation of different factors or risk
normal adult male has a total body urate pool of
markers is an important clinical task to prevent
approximately 1200 mg, about twice that of the
several chronic diseases, particularly cardiovascular
normal adult female. This gender difference may be
ones. Many of these risks are well defined while
explained by an enhancement of renal urate excretion
others need to be identified. One relevant risk
in women of childbearing age due to the effects of
condition to health is the metabolic syndrome (MS),
estrogenic compounds11. Hyperuricemia may occur
which comprises a cluster of combined clinical and
because of decreased excretion (underexcretors),
laboratory abnormalities, including increased waist
production (overproducers),
or a
circumference, overweight or obesity, dyslipidemia,
combination of these two mechanisms12.Uric acid
systemic arterial hypertension, and glucose
has now been identified as a marker for a number of
intolerance or type II diabetes, all of which reflect
metabolic and hemodynamic abnormalities13.Along
with hyperuricemia, dyslipidemia has been described
atherogenic risk factors7.
as major risk factor of similar abnormalities.
Uric acid (UA) is not considered a criterion for
Dyslipidemia refers to lipoprotein disorders detected
the diagnosis of MS, but some studies have shown an
by laboratory tests, and usually occur without signs
association between high levels of UA and the
or symptoms during childhood and young adult age.
syndrome in different populations8. Furthermore, not
Proper recognition and management of lipoprotein
all dyslipidemic disorders (especially those
disorders can reduce cardiovascular morbidity and
associated with a predominant increase in low-
Received:10 /3 /2018 DOI: 10.12816/0047688
Accepted:19 /3 /2018

Full Paper (vol.717 paper# 28)

c:\work\Jor\vol717_29 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3655-3666

Impact of Ultrasound Elastography in The Diagnosis
of Solid Breast Lesions
Ahmed M. Monib, Amr M. AbdelSamad, Amany A. AbdElhakam
Department of Radiodiagnosis, Faculty of Medicine Ain Shams University
Corresponding author: Amany A. AbdElhakam; Mobile: 01069551758, Email:mony_elhenawy@yahoo.com

Ultrasound scanning is noninvasive, usually painless procedure that used as the main adjuvant
modality with mammography for depiction of the breast lesions nature. It is easy-to-use and less expensive
than other imaging modalities. Besides lacking the exposure risk to ionizing radiation as in mammography, it
also provides real-time imaging, and can easily detect lesions in women with dense breasts. Conventional
ultrasound however is not free from limitation. It cannot replace annual mammography and careful clinical
breast examination. Being an operator dependent, US needs experienced radiologists as well as good
equipment to avoid misinterpretation of the lesions, and to decrease the number of false positive and false
negative results. Aim of the Work: is to detect the impact of ultrasound elastography in diagnosis of solid
breast lesions, and to evaluate its capability in differentiating benign form malignant lesions, with special
focus on: A-Evaluation of sensitivity and specificity of sonoelastography, with cyto-histological diagnosis
taken as the reference. B-Detection of the ability of sonoelastography to provide additional information on
tissue elasticity in the event of equivocal mammographic and/or sonographic findings in order to guide the
diagnostic workup towards biopsy or follow-up. Patients and methods: The present study is a prospective
research work that included 39 patients with breast lesions where elastographic ultrasound was performed
following screening or diagnostic mammography and breast ultrasound to evaluate its possible impact on
accurate diagnosis and consequent guidance for management planning. This study was performed at a
private center in the period from September 2017 to March 2018. The patients' age ranged between (24 - 72
years) with a mean of 48 years. Results: The elastography scores for different breast lesions was:Lesions
that scored 1, 2, and 3 were considered benign(30/39 cases, 77 %), whereas lesions that scored 4 and 5 (9/39
cases, 23%) were considered malignant. After revising pathology results of the 30 cases diagnosed as benign
by elastography scoring 26/30(87%) were benign (true negative) by pathology and 4/30(13%) were
malignant by pathology (false negative).After revising pathology results of the 9 cases diagnosed as
malignant by elastography scoring 7/9(82.8%) lesions confirmed to be malignant by pathology (true
positive) and 2/9(17.2%) lesions were proved to be benign by pathology (false positive).The calculated
sensitivity of elastography score was 80%, specificity was 88.9%, PPV and NPV were 82.8% and 87%
respectively, and the total accuracy was 85.3%.Conclusion: Sonoelastography is a simple, non-invasive
diagnostic technique that provides information about the stiffness of a breast masses, thus completing the
morphological assessment of B-mode ultrasound. Recommendations: Other studies are recommended to be
performed on axillary lymph nodes, to evaluate the elastographic efficacy in differentiating between reactive
and malignant pathologically enlarged axillary lymphadenopathy.
Keywords: ultrasound elastography, solid breast lesion.

There have been marked advances in the
Breast cancer is the most common female
quality of ultrasound imaging over the past 2
neoplasm (31% of tumors in females), and the
decades (3). However the breast nodule is still a
second-leading cause of death among women.
daily challenge for the radiologist in the setting of
Breast lesions were first classified as malignant or
US diagnosis. This created the need for new
benign categories (1).
diagnostic approaches including ultrasound
The most prevalent malignant lesions
elastography (UE)(1).
were further subdivided into three subgroups
The principle of elastography is that
including: ductal carcinoma in situ (DCIS),
tissue compression produces strain (displacement)
invasive ductal carcinoma of nonscirrhous type,
within the tissue, and that the strain is smaller in
and invasive ductal carcinoma of scirrhous type
harder tissue than in softer tissue (2). Therefore, by
(2). Similarly, the most prevalent benign lesions
measuring the tissue strain induced by
were divided into three subgroups, including
compression, ultrasound elastography (UE) can
make the hardness of the tissue "visualize",
aberrations of normal development and involution
display its texture, and reflect the biological
(ANDI) (2).
characteristics of the mass. It shows promising
Received:20 / 3 /2018 DOI: 10.12816/0047689
Accepted30: /3 /2018

Full Paper (vol.717 paper# 29)

c:\work\Jor\vol717_30 The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 3667-3675
Evaluation of Central Auditory Processing in
Egyptian Multiple Sclerosis Patients
Gehan A. El-Zarea,1 Amany A. Shalaby2, Hussin M. Hussin3, Mohammad S. Ali1
1- Audiology Unit, Department of Otolaryngology, Faculty of Medicine ­ Al-Azhar University,
2- Audiology Unit, Department of Otolaryngology, Faculty of Medicine ­ Ain-Shams University,
3- Department of Neurology, Faculty of Medicine ­ Al-Azhar University, Cairo, Egypt
Many multiple sclerosis (MS) patients with normal peripheral hearing suffer from difficulties in
their hearing especially speech perception in background noise, which is possibly because of deficit of central
auditory processing in this group.
Objective: To elaborate the effect of MS on central auditory processing.
Subjects and methods: Seven audiologic tests including masking level difference (MLD), auditory memory
test (recognition, content and sequence), dichotic digit test (DDT), speech intelligibility in noise test (SPIN)
and gap in noise test (GIN) as well as electrophysiologic assessment (speech evoked ABR c-ABR and P300)
were used for comparing aspects of central auditory processing between MS patients and controls. Scores for
each test obtained through cross-sectional non-invasive study conducted on 30 Egyptian subjects with
relapsing-remitting MS who had mean age of 37.07 ± 11.43 years, and 30 controls with normal peripheral
hearing and mean age of 33.40 ± 9.38.
Results: This study demonstrated reduced MLD in MS at 500 & 1000 Hz in relation to controls. MS patients
were worse than controls in recognition memory (pv = 0.011), memory for contents (pv <0.001) and memory
for sequence (pv <0.001). in addition, low scores of DDT (version I & II) revealed in MS patients (pv =
<0.001& 0.011 for I & II respectively), reduced SPIN test score in MS subjects (pv<0.001), elevated threshold
and reduction of percent of correct answer obtained from GIN test in MS patients (Pv <0.001). Furthermore,
in MS patients, there were prolonged latencies and reduced amplitudes of c-ABR waves and P300. In
addition, significant differences were revealed between MS subjects and controls in all c-ABR measures
Conclusion: this study revealed apparent effect of MS on auditory processing.
Keywords: Multiple Sclerosis, Central Auditory Processing, Egyptian Multiple Sclerosis patients.


Valadbeigi et al. 3 concluded that the people
Multiple sclerosis (MS) is a Central Nervous
with MS suffer from some degree of disorder in
System (CNS) disorder characterized by
the temporal resolution which might be due to
involvement of CNS and, somehow, deficit in
neurodegeneration, which results in impairments
CAP. Therefore, for evaluating the temporal
in multiple domains. Also, central auditory nervous
resolution in people with multiple sclerosis, GIN
system (CANS) can be included. Because of the
test could be useful.
Aim of the work: To elaborate the impaction
destructions, MS results in a broad range of
of MS on central auditory processing.
symptoms, which include motor, cognitive, and

community-based survey in Al Quseir, Egypt, has
Subjects: This study was conducted on two
found an MS prevalence of 13.74/100,000 1.
groups; Patients group, 30 Egyptian patients with
The CAP constitutes a series of mental
definite MS (relapsing remitting type) according to
operations that the individual performs when
revised McDonald criteria 2010 (9 males, 21
dealing with information received via the sense of
females) aged from21 to 53 years with a mean age
hearing and can be described simply as "what the
of 37.07 11.43 were selected from the Neurology
brain does with what the ear hears". Efficient
out-patient clinic of Al-Hussin University Hospital
CAP involves a series of auditory skills that are
during the period from March 2016 to September
vital in the listening and communication process,
2017. Control group, 30 healthy subjects,
these include auditory discrimination, sound
Egyptians were selected from volunteers (16 males
localization, auditory attention, auditory figure-
and 14 females) with a mean age of 33.40 9.38.
ground, auditory closure, synthesis, auditory
They were demonstrated no auditory complaints in
analysis, auditory association and auditory
everyday listening situations. Normal peripheral
memory 2.
hearing sensitivity was required in both groups.
Written consents were taken from all subjects.
Received:20 / 3 /2018 DOI: 10.12816/0047690
Accepted30: / 3 /2018

Full Paper (vol.717 paper# 30)