ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5517-5526

Evaluation of the Protective Roles of Synthetic Zeolite on Some Physiological and
Biochemical Parameters after Cadmium Toxicity of Crayfish (Procambarus Clarkii)
Mohamed M.A. Shahat 1&3, Maged M.A. Fouda 1&4, Hussein A. A. Sultan 1, and Ibrahim O. Ali 2&4
1.Department of Zoology, Faculty of Science, Al-Azhar University (Assiut ­ Egypt), 2.Chemistry Department, Faculty of Science,
Al-Azhar University (Cairo­ Egypt), 3. Department of biology, Jazan University, Jazan, Kingdom Saudi Arabia,
4. Department of Biology, Jouf University, Sakaka, Kingdom Saudi Arabia.
Correspondence: Mohamed M.A. Shahat, Email: shahat_egy@yahoo.com
ABSTRACT
Background:
the release of heavy metals into the environment through industrial effluents is a major concern,
worldwide and removal of such pollutants has been a great concern during the last decades. Heavy metals are
not biodegradable and tend to be accumulated in organisms and cause numerous diseases and disorders. Aim
of the Work:
this study evaluated the protective role of synthetic zeolite against cadmium toxicity of
freshwater crayfish (Procambarus clarkii). Patients and Methods: the crayfish was divided into six groups
(36 individual in each group), the first group was used as a control group, the second group was exposed to a
dose of (50 g/L) cadmium chloride for 45 days, the third group exposed to a dose of (50 g/L) cadmium
chloride for 45 days and then added zeolite (1 mg/L) for 45 days. The fourth group was exposed to a dose of
(50 g/L) cadmium chloride for 45 days and then added zeolite (5 mg / L) for 45 days, the fifth group was
exposed to a dose of (50 g/L) cadmium chloride plus (1 mg/L) zeolite for 45 days. The sixth group was
exposed to a dose of (50 g/L) cadmium chloride plus (5 mg/L) zeolite for 45 days. After the experimental
periods, the crayfish were weighted and hemolymph was collected to measure the biochemical parameters
(Glucose, total protein, albumin, globulin, A/G ratio, cholesterol, triglyceride, LDL, HDL, Na+, K+, Cu+2,
Ca+2and Mg+2). Results: in G2 the concentration of total protein, albumin, globulin, HDL, Na+, K+, Cu+2
and Ca+2 were significantly decreased (p< 0.05) compared with the control group, while glucose, A/G ratio,
cholesterol, triglyceride, LDL and Mg+2 were significantly increased (p< 0.05) compared with the control
group. The addition of the ion-exchanging agent, zeolite (1 mg/L and 5 mg/L) to cadmium exposed group (G2)
caused improvement in weight and all hemolymph biochemical parameters in G3, G4, G5 and G6.
Conclusion:
the synthetic zeolite was able to protect crayfish against cadmium toxicity by reducing the transfer of
cadmium from polluted water into crayfish tissue and reducing the chance for metal uptake by interacting in the
experimental medium which in evidently improves the physiological and biochemical functions.
Keywords: Cadmium, Synthetic Zeolite, Crayfish (Procambarus Clarkii).

INTRODUCTION
The persistence and ubiquitous nature of Cd is
Pollution of the aquatic environments with
coupled with their tendency to accumulate in
heavy metals has become a serious concern during
organisms ultimately produce toxic reactions in
the recent years. With the rapid development of
aquatic biota, especially in fish. Thus, the
various industries, wastes containing metals directly
deleterious effects of metals on aquatic ecosystems
or indirectly discharged into the environment,
necessitate the continuous monitoring of their
especially in developing countries and these wastes
accumulation in key species, since it affords
having brought serious environmental pollution and
indication of temporal and spatial extent of the
threatened bio life (1). Furthermore, the impetuous
process and impact on organism's health (4).
economic and social development of human
Removing heavy metals from the aquatic pollution
communities
has
induced
an
accelerated
required high energy or special operational
environmental change deeply disturbing the natural
requirements. Several techniques such as adsorption,
balance of the compensatory processes in the
extraction, disambiguation, clotting, ion-exchange,
biosphere (2). The problems of protecting and
and membrane processes are supposed for the
improving the environment on a planetary scale is
handling of wastewater pollution (3). Adsorption
one of the most acute and complex contemporary
method forms an appropriate method for wastewater
problems. Interrelations of the environment with the
handling because of its cost effectiveness and
economic fields and all sides of social life lead to a
simplicity among all these methods (5). Zeolites are
mutual conditioning (3). Cadmium (Cd) is considered
important minerals of hydrated aluminotectosilicates
as one of the most toxic heavy metals and an
of alkali and alkaline-earth cations with three-
environmental pollutant toxic to a number of tissues (1).
dimensional structures of interconnecting channels
and large pores, capable of trapping molecules in
5517
Received:3/1/2018
Accepted:15/1/2018




Full Paper (vol.7211 paper# 1)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5527-5533

Effect of Different Lung Ventilatory Patterns during and After Cardiopulmonary
Bypass on Oxygenation Parameters after Cardiac Surgery in Adults:
A Comparative Study
Eslam Reda Abdelhay Hassan, Samia Ibrahim Sharaf, Eman Mohamed Kamal Aboseif,
Marwa Mostafa Mohamed
Faculty of Medicine - Ain Shams University in Anesthesia Department
Corresponding: eslamr1888@gmail.com, Tel: +202 01274554841
ABSTRACT
Background:
pulmonary complications after cardiac surgery recorded incidence of 25% of all cardiac
surgeries. Ventilation strategies before and after CPB also cause problems. Alveolar over-distention and
reduced lung recruitment are involved in lung injury during general anesthesia in cardiac surgeries. Protective
lung ventilation is a common practice during general anesthesia and includes positive end expiratory pressure
(PEEP), recruitment maneuvers and the use of FiO2 levels not greater than 80%. Aim of the Work: the aim of
the study was to compare the effect of application of continuous positive airway pressure (C-PAP) ventilation
during cardiopulmonary bypass and application of positive end expiratory pressure (PEEP) after
cardiopulmonary bypass (CPB) per se or followed by lung recruitment (RM) in the intensive care unit (ICU)
on arterial oxygenation after cardiopulmonary bypass. Patients and Methods: after obtaining approval from
the medical ethical committee, this study was conducted at Cardiothoracic Academy of Ain Shams University
and Ain Shams University specialized hospitals. The study included 66 patients divided into three equal
groups. Conclusion: the application of alveolar recruitment strategy showed short term improvement in the arterial
oxygenation and ventilation perfusion mismatch in patients undergoing CABG using CPB. Further studies are
needed to determine if this beneficial effect of recruitment maneuvers could be further prolonged and produce more
lasting clinical effects.
Keywords: PEEP: Positive end expiratory pressure; PaO2/FiO2: Ratio between partial pressure of arterial
oxygen and fraction of inspired oxygen; RMs: Recruitment maneuvers

INTRODUCTION
anesthesia in cardiac surgeries. Protective lung
Pulmonary complications are common after
ventilation is a common practice during general
cardiac surgery. They prolong the duration of hospital
anesthesia and includes positive end expiratory
stay, contribute to postoperative morbidity, and
pressure (PEEP), recruitment maneuvers and the use
increase mortality. Pulmonary complications after
of FiO2 levels not greater than 80%(4). Recruitment
cardiac surgery recorded incidence of 25% of all
maneuvers (RMs) have been proposed as an adjunct
cardiac surgeries (1). These problems range from
to mechanical ventilation to reverse alveolar
postoperative pulmonary complications such as
derecruitment and improve pulmonary gas exchange.
atelectasis, pneumonia, pleural effusion and
There are different methods to perform RM when
diaphragm dysfunction to severe forms of acute
using the conventional ICU ventilator. The three RM
respiratory distress syndrome which cause great
methods that are mostly used and investigated are
effect of morbidity and mortality. Also these
sighs, sustained inflation, and extended sigh. There is
problems affect the pulmonary vascular bed and gas
no standardization of any of the above RM (5).
exchange mainly postoperative causing deterioration
AIM OF THE WORK
in arterial oxygenation (2). Impairment of gas
The aim of the study was to compare the
exchange is reflected by reduction in oxygenation and
effect of application of continuous positive airway
ratio between partial pressure of arterial oxygen and
pressure (C-PAP) ventilation during cardio-
fraction of inspired oxygen (PaO2/FiO2) which called
pulmonary bypass and application of positive end
"hypoxic index" after cardiac surgery associated with
expiratory pressure (PEEP) after cardiopulmonary
poor hospital outcome.PaO2/FiO2 (hypoxic index)
bypass (CPB) per se or followed by lung recruitment
value of 300 or less indicates reduced efficiency in
(RM) in the intensive care unit (ICU) on arterial
alveolar-capillary membrane performance(3). CPB is
oxygenation after cardiopulmonary bypass.
not the only stage in which lung injury might occur.
Ventilation strategies before and after CPB also cause
PATIENTS AND METHODS
problems. Alveolar over-distention and reduced lung
Type of Study: A controlled randomized
recruitment are involved in lung injury during general
clinical study. Study Setting: After obtaining
5527
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 2)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5534-5539

Study of Hand Hygiene Awareness among Doctors and Nurses in King Abdulaziz
Specialist Hospital
Wijdan Abdulmohsen Alzahrani 1*, Malak Khalid Alkuwaykibi 1, Athir Athallah Alruwili 1, Abeer Zaid
Almaziad 1, Shaimaa Mohamed Abd Elfattah Hasn 1
1 College of Medicine, Aljouf University, Sakaka, Saudi Arabia
*Corresponding author: Wijdan Abdulmohsen Alzahrani, E-mail: waz74649@gmail.com, Mobile No: +966 55 105 2142
ABSTRACT
Background:
hand hygiene is now regarded as one of the most important element of infection control
activities. It is an effective strategy to prevent health care-associated infections (HCAIs). It is a required
practice for all health care providers. It is done by using manually antibiotics jelly or washing hands by soap
and tap water. Hand hygiene before and after examination of the patient is the first line of protection against
infection as hand is considered the primary carrier of infections. Aim of the Work: was to assess the
knowledge, attitudes and practice of doctors and nurses in King Abdulaziz Specialist Hospital. Patients and
Methods:
this descriptive cross-sectional study was conducted on the 110 of doctors and nurses in King
Abdulaziz Specialist Hospital, who were interviewed between 3rd March 2017 and 9thApril 2017. Data were
collected and analyzed using SPSS version 16. Results: out of 110 respondents, 57.3% were female and the
nurses constituted the highest cadre (61.8%). Hand hygiene knowledge was highest in the Emergency Room
(29.1%) and lowest among diabetes center staff (3.6%). Conclusion: hand hygiene is crucial for doctors and
nurses and hence the need to improve their attitude, practice and knowledge. The presence of significant differences
between doctors and nurses in our study indicated the need for qualified doctors who have enough information and
knowledge about the importance of hand hygiene to assure control of infections as well as all hygienic affairs during
working with patients enrolled in hospitals.
Keywords: Hand hygiene, Infection control, Health care associated infection, Health care-associated infections.

INTRODUCTION
from client/patient/resident-to-client/patient/resident
Hand hygiene is a general term that applied
carrying out a number of tasks and procedures. There
to routine hand washing with soap and water or by
are many indications for hand hygiene during the
hand rubs with gel to disinfect it. It is the single most
delivery of health care and in the activities of daily
effective and cheap means for preventing hospital
living outside of the health care setting. However,
acquired infection (1-3). Hand hygiene reduces
health workers wash hands too seldom, not always at
potential pathogens on the hands. It is considered a
the most appropriate times and technique is
primary measure for reducing the risk of transmitting
suboptimal(4). Hand hygiene is the responsibility of all
organisms to patients including Antibiotic-Resistant
individuals working in health care. It is the most
Organisms (ARO).Although the action of hand
effective means of reducing infections. It is practice
hygiene is simple, the lack of compliance among
for protection of patients from intervention of many
health-care workers continues to be a problem
microorganisms. It is done by using manually
throughout the world(1). There are many indications
antibiotics gelly or washing hands by soap and tap
for hand hygiene which include the following: Before
water as hand is primary carriers of infections. So, the
and after treating each patient (e.g., before glove
first line defend is hand hygiene before and after
placement and after glove removal), after barehanded
examination of patients(5). There are many causes and
touching of inanimate objects likely to be
means for the spread of infection among health care
contaminated by blood, saliva, or respiratory
organization. These elements include the following :
secretions, before leaving the dental operatory, when
immune compromised patients , more antibiotic­
hands are visibly soiled, before re-gloving, after
resistant strains of several types of bacteria due to the
removing gloves that are torn, cut, or punctured, for
misuse of antibiotics, improper satisfied hand
oral surgical procedures, perform surgical hand
hygiene, inefficient as well as sufficient cleanness
antisepsis before donning sterile surgical gloves(1).
and sterilization of equipment's due to lack of
Hand hygiene is now regarded as one of the most
nursing staffs which lead to less attention to infection
important element of infection control activities. It is
prevention practice(6, 7). According to the
an effective strategy to prevent health care-associated
abovementioned information it is recognized that
infections (HCAIs). It is a required practice for all
hand hygiene is considered the most effective
health care providers, as health care providers move
intervention for avoiding hospital acquired infections,
5534
Received:30/5/2018
Accepted:9/6/2018




Full Paper (vol.7211 paper# 3)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5540-5546

Effect of Intramuscular Administration of Dexamethasone on the Duration of
Labor Induction
Mohammed Abd-Allah Elmaraghy, Tamer El Refaie, Kareem Mohamed Labib,
Marwa Gamal Mohamed*
Department of Obstetrics and Gynaecology, Faculty of Medicine - Ain Shams University
*Corresponding author: Marwa Gamal Mohamed, Mobile: 00201099543064, E-Mail: marwa_prof_med@yahoo.com
ABSTRACT
Background:
induction of labor is a common obstetric procedure which is performed for a variety of medical
and non-medical indications. If the cervix is unfavourable, prior ripening of the cervix makes induction of
labor easier and more succeful. There are different methods for ripening of the cervix and making it ready for
induction. These methods included medical methods such as the administration of prostaglandins, and
mechanical methods such as extra amniotic saline infusion, traction on the cervix with Foley catheter and
laminaria. Aim of the Work: the aim of the study is to evaluate the efficacy of intramuscular dexamethazone
injection prior to induction in improving progression and duration of labour phases. Patients and Methods:
this study started with 100 Nulliparous Pregnant women who were conducted at the labor wards of Ain Shams
Maternity Hospital. The studied subjects were randomized into two groups: Dexamethasone group: This group
included 50 Nulliparous women (N=50), called A group. Control group: This group included 50 Nulliparous
woman (N=50), called B group. Results: in this study the duration of active and second stages was decreased
without change on mode of delivery. The study no significant statistical differences between the two studied
groups as regards fetal heart rate. The duration of second stage in dexamethasone group was shorter than in the
control group. Dexamethasone intramuscularly prior to induction significantly shortens duration of normal
labor in normal parturants with minimal complications. Conclusion: an intramuscular injection of
dexamethasone before labor induction is found to shorten the duration of labor induction by decreasing the interval
between the initiation of induction and the beginning of the active phase, duration of active phase and duration of
second stage of labor with no observed maternal or neonatal complications.
Keywords: Dexamethazone injection, Duration of labour phases.

INTRODUCTION
it produces a lot of (Corticotropinreleasing
Induction of labor is a common obstetric
hormone). The adrenal glands of the fetus do not
procedure which is performed for a variety of
produce a considerable amount of cortisol until the
medical and non-medical indications(1). If the cervix
third trimester. During the last weeks of pregnancy,
is unfavourable, prior ripening of the cervix makes
the cortisol and (Dehydroepiandrosterone sulfate)
induction of labour easier and more successful.
contents of the fetus rise. Placental Corticotropin
There are different methods for ripening of the
releasing hormone is not under the influence of
cervix and making it ready for induction. These
negative feedback from cortisol (3). The
methods included medical methods such as the
concentration of Corticotropin releasing Hormone in
administration of prostaglandins, and mechanical
the fetus rises during the last 12 weeks of
methods such as extra amniotic saline infusion
pregnancy. This results in modification of the
(EASI), traction on the cervix with Foley catheter
contractility of the uterus, stimulation of the
and laminaria. One of the methods proposed for the
membranes to produce more prostaglandins,
speeding up of the labor process (labor induction) is
stimulation to produce Cortico steroids from
use of corticosteroids(2). We use in our study medical
placental adrenaline, and increase in the estrogen
induction via oxytocin, but prior to it we use intra
content. This will disturb the ratio of estrogen to
muscular Dexamethasone to potentiate the effect.
progesterone and will cause expression of
The process of childbirth starts from the axis of the
contractile proteins. In fact, the increase in
hypothalamus, the pituitary gland, and the uterus.
Corticotropine Releasing Hormone near the end of
Other axices share in this process like adrenal gland
pregnancy confirms the presence of a placental-fetal
steroid hormones. Steroid substances produced in
clock(3). One of the methods proposed for the
the adrenal glands of the human fetus affect the
strengthening and speeding up of the labor process
placenta and the membranes and transform the
(labor induction) is use of corticosteroids, although
myometrium from the static to the contractile state.
the effects of using these substances in the labor
The placenta may play a role in this process because
process is not well ­ understood studies conducted
5540
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 4)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5547-5551

The Role of Dynamic MRI with Diffusion Weighted Images in Evaluation of
Portal Vein Thrombosis in Hepatic Patients
1 Suzan Bahig Ali, 1 Asmaa Magdy Salama, 2 Mostafa Farag Elshafie, 1* Martina Fares Fayez Shogry
Department of Radiology, Faculty of Medicine, 1 Ain Shams University
Department of Radiology, 2 Theodore Bilharz Research Institute
*Corresponding author: Martina F.F Shogry, Mobile: 01285352072, Email: martinafares9@gmail.com
ABSTRACT
Background:
hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide and its incidence is
increasing especially in western nations. HCC may be associated with portal vein thrombosis which could be
either benign or malignant. Aim of the Work: to detect the role of diffusion MR imaging in the differentiation
between benign and malignant portal vein thrombosis in patients with HCC. Materials and Methods:
prospective study carried on 30 patients with liver cirrhosis with pathological or radiological proof of HCC,
associated with visible portal vein thrombosis. Dynamic MRI examination and diffusion weighted imaging
were performed for all patients. ADC values and ratios were calculated for both HCC and thrombus. Definite
accepted radiological criteria were used as a standard of reference to detect the nature of the thrombus and
discriminate between bland ones and neoplastic ones. Results: we found that the ratio between the ADC of the
thrombus and ADC of the HCC was significantly different between the malignant and bland cohorts and a
cutoff value of 1.25 for the ADC ratio helped in differentiation between malignant and benign portal vein
thrombi with 85% sensitivity and 81% specificity. There was also obvious statistical significant difference
between the ADC values of the bland and neoplastic thrombi. Conclusion: diffusion weighted MR imaging has a
great role in differentiation between the benign and malignant portal vein thrombosis by measuring the ADC ratio
between the thrombus and HCC.
Keywords: Portal vein thrombosis, Liver cirrhosis, HCC, Diffusion weighted imaging, ADC value, ADC ratio.

INTRODUCTION
of bleeding especially in these patients with
Hepatocellular carcinoma (HCC) is the fifth
coexistent coagulation defects. On the other hand,
most common tumor worldwide and its incidence is
demonstration of arterial flow within the thrombus
increasing especially in western nations. HCC may
by using spectral Doppler US is 100% specific for
be associated with portal vein thrombosis which
tumor thrombus. Also, contrast-enhanced US has
could be either benign or malignant (1). Neoplastic
been demonstrated to be 88% sensitive and 100%
portal vein thrombi in patients with HCC gravely
specific in the diagnosis of malignant portal vein
affect prognosis and subsequent treatment options.
thrombosis (3). These figures are similar to those
These patients are considered unsuitable for most
obtained at contrast-enhanced CT, with a sensitivity
therapeutic options, including thermal or chemical
of 86% and a specificity of 100 % (4). Therefore, in
ablation, trans-arterial chemoembolization, liver
practice, diagnosis is often done with a combination
resection, and even orthotopic liver transplantation.
of laboratory and imaging findings. MRI have a role
Five year survival after surgical resection is 12%­
in differentiating malignant from bland thrombosis,
39% in patients with neoplastic vascular invasion
malignant thrombus is characterized at imaging by
and 59% in those without. Such patients usually
expansile dilatation of the portal vein and
undergo palliative or experimental treatment (1,2).
intermediate to high signal intensity on T2 images in
Although the reference standard in the diagnosis of
comparison to the normal portal vein caliber and
the malignant portal vein thrombosis is the
low T2 signal seen in bland thrombosis "attributed
pathologic examination, in clinical practice,
to hemosiderin within the thrombus". A malignant
diagnostic imaging plays a pivotal role (3). Biopsy of
thrombus also shows arterial neovascularity with
portal vein has many drawbacks; it relies on the
enhancement similar to the primary tumor and often
skills of the radiologist and the size of the affected
is contiguous with the primary tumor (5). Diffusion
vein and if performed improperly, the tumor cells
imaging is an MR technology that helps more in
could be obtained from adjacent HCC rather than
tissue characterization. In malignant tissue, the
from the thrombus, leading to misdiagnosis, or the
diffusion of water molecule is more restricted due to
amount of the biopsy material could be insufficient
higher lesion cellularity, so lower ADC values are
for evaluation. Moreover, portal vein thrombus
noted as compared to benign lesions. Also, DW
biopsy is an invasive procedure with associated risks
imaging does not require contrast medium
5547
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 5)


ABSTRACT Naglaa Mohamed El Khayat et al.


1


Full Paper (vol.7211 paper# 6)


The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5561-5570

Role of Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) in
Assessment of Urinary Bladder Carcinoma
Hanaa Abdel Qader Abdel Hameed*, Mona Ali Mohamed Ali Nagi*, Dhurgham Hayder Wali**
*Diagnostic Radiology Department; Faculty of Medicine, Ain Shams University, ** Dhi-Qar University - College of Medicine ­ Iraq
*Corresponding Author: Dhurgham Hayder Wali, E-mail: durghamhaider7@gmail.com
ABSTRACT
Background:
bladder cancer is the fourth most common cancer in males and the tenth most common cancer in
females. Urinary bladder cancer occurs three to four times more frequently in men than in women and has a
high recurrence rate, necessitating long-term surveillance after initial therapy. Patients with bladder cancer
survive longer than those with most other common cancers. For the radiological evaluation of the urinary
bladder and prostate gland, magnetic resonance imaging (MRI) is a valuable imaging modality due to high
tissue contrast, multiplanar imaging capabilities, and the possibility of tissue characterization. Diffusion-
weighted imaging (DWI) has emerged as a diagnostic technique in the evaluation of various abdominal
lesions. Aim of the Work: to evaluate the role of diffusion weighted magnetic resonance imaging (MRI-DWI)
in the diagnosis of urinary bladder carcinoma, with pathological diagnosis was taken as the reference. Patients
and Methods:
this is a retrospective study that included 20 patients in whom bladder cancer had been
suspected either clinically or by U/S and confirmed by biopsy and 20 patients in whom bladder cancer had
been not suspected and MRI was done because of other pelvic diseases as a control group. The study was
conducted in El-Demerdash hospital. The patients will be referred to the radiology department from the
urology department for further MRI evaluation with DWIs. Results: in this study, 20 patients suspected to
have bladder cancer were scheduled for MR imaging. All patients were scheduled for different MR sequences
including T2WIs, DWIs and post contrast T1WIs. Regarding the detection of urinary bladder carcinoma the
sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using T2 images alone
and combined use of T2 and DW images were 62.5%, 66.7%, 63.2% and 100%, 100%, 100% respectively.
The sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using post
contrast MR images alone and combined use of post contrast MR images and DW images were 92.3%, 100%,
93.3% and 100%, 100%, 100% respectively. Conclusion: we assume that DW-MRI is a safe and confident
method in detection and local staging of urinary bladder carcinoma. In addition, DW images may predict the
histological grade of the tumor. Hence DWI may be added to routine imaging protocols of urinary bladder tumors.
Keywords: Diffusion Weighted Imaging, Magnetic Resonance Imaging, Urinary Bladder Carcinoma

INTRODUCTION
technique in the evaluation of various abdominal
Bladder cancer is the fourth most common
lesions. DWI reveals micro-molecular diffusion,
cancer in males and the tenth most common cancer in
which is the Brownian motion of the spins in biologic
females. Urinary bladder cancer occurs three to four
tissues. This technique can delineate pathologic
times more frequently in men than in women and has
lesions with high tissue contrast against generally
a high recurrence rate, necessitating long-term
suppressed background signal(3). The utilization of
surveillance after initial therapy. Patients with bladder
diffusion-weighted (DW) magnetic resonance (MR)
cancer survive longer than those with most other
imaging in the abdomen was attractive in the
common cancers(1). In Egypt, the condition is worse
detection of the malignant tumors, such as malignant
as a result of Bilharziasis. Bilharziasis is not only
hepatic, renal, prostatic, colonic and uterine cervical
endemic in Egypt but also considered to be a
tumors. However, its application to the abdomen has
historical disease as it has been discovered in the
been hindered by the presence of bulky physiologic
urinary bladder of pharaoh ancestors' mummies. The
motions such as respiration, peristalsis, and blood
uncommon aggressive squamous cell carcinoma is
flow(4). To resolve those problems, in 2017, Barsoum
frequently associated with Bilharzial bladder (2). For
et al. (3) reported a procedure of body DW MR
the radiological evaluation of the urinary bladder and
imaging under free breathing which enables longer
prostate gland, magnetic resonance imaging (MRI) is
scan times. This technique gives more, thin-slice
a valuable imaging modality due to high tissue
images, with multiple signal averaging, and provides
contrast, multiplanar imaging capabilities, and the
high quality multiplanar display. In this study, the
possibility of tissue characterization (3). Diffusion-
feasibility of DW MR imaging under free breathing
weighted imaging (DWI) has emerged as a diagnostic
for the detection of a urinary bladder carcinoma was
5561
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 7)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5571-5574

Effect of Sildenafil Citrate on Fetal Color Doppler Study and Biophysical Profile
in Cases of Intrauterine Growth Restriction (IUGR) in Third Trimester
Mohamed Hesham Hasan Anwar, Morad Kamel Hasanin, Bassem Ragab Abdelaziz,
Omar Abd El Mageed Ismail Hamd *
Obstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar University
*Corresponding Author: Omar Abd El Mageed Ismail Hamd, E-mail: omardoda24@yahoo.com
ABSTRACT
Background:
fetal growth restriction is an important cause of perinatal morbidity and mortality. The accurate
assessment of fetal growth during pregnancy is difficult, but recent advances have improved this important
aspect of obstetric care with positive implications for antenatal patients and their babies. Aim of the Work: to
assess the effect of sildenafil citrate on color Doppler flow parameters in umbilical artery, Middle cerebral
artery and Biophysical Profile in case of fetal growth restriction. Patients and Methods: this is a prospective
cohort study of 100 pregnant females presenting for routine antenatal care at 28 + 0 weeks till delivery. A
cohort of 100 pregnant females attending the antenatal care clinics at Al-Hussein university hospital and Bab
El-Sharia university hospital during a period of 2 years from May 2016 to May 2018. Results: this study
excluded the patients with undetermined gestational age, intrauterine infection, high risk for aneuploidy
(e.g. maternal age >40 years, detected congenital fetal anomalies in the current or previous pregnancies). All
cases were followed regularly twice monthly during the seventh and eighth month and then once weekly till
delivery, after the administration of 20mg of sildenafil citrate every 12 hourly starting from the 28 weeks of
gestation until delivery. Conclusion: the current study conclude that, administration of Sildenafil 20 mg every 12
hourly in pregnant females with fetal growth restriction (FGR) improved the feto-placental Doppler indices
(pulsatility index and resistance index) of umbilical artery, middle cerebral artery.
Keywords: Sildenafil Citrate, Fetal Color Doppler, Intrauterine Growth Restriction, Biophysical Profile.

INTRODUCTION
demise are greater than the risks of prematurity (4).
Fetal Growth Restriction (FGR) represents a
Abdominal circumference (AC) measurement is the
pathophysiological condition in which a foetus is
most sensitive parameter for detecting FGR (5). EFW
restricted from reaching its genetically determined
is determined from the average of three readings for
size. This distinguishes a FGR foetus from another
each of the following: Femur length (FL), abdominal
who is simply small for gestational age (SGA) based
circumference (AC) and Biparietal diameter (BPD)
(6)
on its genetic make-up (1). According to (the
. Reduced flow and increased resistance in uterine
American
College
of
Obstetricians
and
and umbilical arteries, indicative of reduced
Gynecologists), FGR is "one of the Most common
uteroplacental flow in pregnancies with foetal growth
and complex problems in Modern obstetrics
restriction, have been documented by non-invasive
comprising about one-third of low birth weight
Doppler ultrasound velocimetry (7). A salient feature
babies. In developed countries, its overall incidence is
observed in FGR is the reduction of amniotic fluid
about 2­8%. The incidence among the term babies is
volume. Amniotic fluid volume is estimated by a
about 5% and that among the post-term babies is
simple subjective assessment or calculation of the
about 15 % (2). FGR foetuses have significantly
amniotic fluid index (AFI) (8). Sildenafil citrate is a
elevated risks of intrauterine foetal demise, neonatal
potent and selective inhibitor of cyclic guanosine
mortality, and short and long term complications (3).
monophosphate (cGMP) specific phosphodiesterase
The fetus is affected from the noxious effect very
type 5 (PDE5) (9). Sildenafil citrate and uteroplacental
early in the phase of cellular hyperplasia most often
perfusion in fetal growth restriction: In a normal
caused by structural or Chromosomal abnormalities
pregnancy, the trophoblast produces nitric oxide
or congenital infection TORCH (Toxoplasma, others,
(NO) which plays an important role in vasodilatation
rubella,
cytomegalovirus,
and
herpes).The
in the fetoplacental circulation to improve oxygen and
pathological process is intrinsic to the fetus and
nutritional supply to the fetus (10). Furthermore,
involves all the organs including Head. Current
Sildenafil citrate can improve fetoplacental perfusion
clinical management consists of close monitoring of
in pregnancies complicated by intrauterine growth
foetal growth rates and well-being. Preterm delivery
restriction. It could be a potential therapeutic strategy
was indicated when foetal growth or well-being
to improve uteroplacental blood flow in pregnancies
become so poor that the risks of intrauterine foetal
with FGR (11).
5571
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 8)


The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5575-5577

Role of PET/CT in Assessment of Colorectal Carcinoma
Waleed Mohamed Abd-Elhamid Hetta, Ahmed Hassan Soliman, Ahmed Mohamed Rabie*
Department of Radiology, Faculty of Medicine, Ain Shams University
* Corresponding author: Ahmed Mohamed Rabie, Tel: 01142313632, Email: Ahmedrabie67107@gmail.com
ABSTRACT
Background:
colorectal cancer is the second most common cause of cancer in women (9.2% of diagnoses)
and the third most common in men (10.0%), it is the fourth most common cause of cancer death after lung,
stomach, and liver cancer. Aim of the Work: the goal of this study was to elucidate the role of 18F-FDG PET-
CT in evaluation of colorectal cancer. Patients and Methods: twenty five patients with histopathologically
proven colorectal primary malignancy were evaluated for suspected local recurrence and metastasis. No age
predilection and both sexes were included, clinical history, image follow-up, tumor markers, and pathological
reports were reviewed for gold standard. Results: the final diagnosis of distant metastasis and/or local
recurrence in post-therapeutic cancer colon was evident in 70% of our patient population with PET/CT
sensitivity of 95.6%, specificity of 91.4%, (NPV) of 88.9%, (PPV) of 96.7%, and diagnostic efficacy of 94.4%
and CT sensitivity of 62.6%, specificity of 48.6, (NPV) of 33.3% (PPV) of 76.0%, and diagnostic efficacy of
58%. Conclusion: PET/CT is a better method to evaluate post-therapeutic colorectal cancer patients.
Keywords: Post therapeutic colorectal cancer18F-FDGPET/CTCECT.

INTRODUCTION
performed on an integrated scanner (Philips 128 slice
Colorectal cancer is a major cause of
CT) that combines both CT and PET capabilities in
morbidity and mortality throughout the world. It
two sequential gantries, avoiding the need for patient
accounts for over 9% of all cancer incidences. It is the
motion between the CT and PET components of the
third most common cancer worldwide and the fourth
study giving accurate co-registration of the CT and
most common cause of death. It affects men and
PET data. Patients fasted for at least 6 hours before
women almost equally(1). Early detection of
the examination, except for water and glucose free
recurrence is clinically important and can improve the
fluid. Blood glucose levels measured less than
prognosis and survival of patients with cancer. CT is
200mg/dL. Patient's weight was measured. A dose of
considered the primary method of investigation
(0.18­0.21mCi/kg, 5-14 mCi) FDG was injected
because of its low cost, widespread availability, and
intravenously. The patients rested in aquietroom.
high-resolution of anatomic details, but may under-
After the 45­60-minute uptake period, the patients
estimate the actual tumor burden by overlooking
were asked to void just before entering the
small tumor clusters in areas of distorted anatomy
examination room. No oral or intravenous contrast
after treatment (2). Accurate imaging of patients with
agent was used for the PET-CT examination. Multi-
possible recurrent colorectal cancer (CRC) is vital, as
detector CT examination from the base of the skull to
it is now clear that curative surgery is still possible for
the upper thighs (120 mA, 140 kVp, table speed =
a proportion of patients with metastatic disease.
13.5 mm per rotation and thickness of 4 mm) was
Follow-up
is
usually
performed
with
planned. After CT acquisition, PET acquisition of the
carcinoembryonic antigen (CEA) level, computerized
same axial range started with the patient in the same
tomography (CT) and other conventional imaging
position on the table for 2­3 minutes per bed position.
techniques, but in the last few years, functional
PET data were acquired by using a matrix of 128x128
imaging
using
integrated
positron
emission
pixels. CT-based attenuation correction of the
tomography and CT (PET/CT) is being used
emission images was used. After PET data
increasingly to identify recurrent disease (3).
acquisition was completed, the reconstructed
attenuation corrected PET images. Exclusion
AIM OF THE WORK
criteria: Patients with the following conditions were
The goal of this study was to elucidate the
excluded from the study: Strong history of atopic
role of 18F-FDG PET-CT in evaluation of colorectal
disorders, Serum creatinine level above 2mg/dl,
cancer.
recent surgery less than 6 weeks, radiotherapy within
less than 3months, and chemotherapy within less than
PATIENTS AND METHODS
3weeks. Interpretation and image analysis: Images
Methods: PET/CT study was performed for
were interpreted by experienced nuclear medicine
each patient as follows: Procedures of Whole-Body
physicians and radiologist. Qualitative assessment for
PET/CT Imaging with 18F-FDG:PET/CT was
the presence of hyper-metabolic lesions was
5575
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 9)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5578-5583

Role of Transarterial Chemoembolization (TACE) in Down Staging of
Hepatocellular Carcinoma (HCC) before Liver Transplantation
Abdallah Lutfy Farouk Ahmed, Haytham Mohamed Nasser, Mohamed El-Gharieb Abo-Elmaaty,
Iman Fawzy Montasser
Radiology Departments, Faculty of Medicine, Ain Shams University
*Corresponding author: Abdallah Lutfy Farouk Ahmed, Email: dr.abdallahlutfy@hotmail.com.
ABSTRACT
Background:
liver transplantation (LT) has emerged as the optimal treatment for cirrhotic patients with
Hepatocellular carcinoma (HCC) because it cures both tumor and underlying cirrhosis. HCC could be
downstaged or controlled by various anticancer therapies, which might bring them chance of undergoing a
curative treatment such as LT. Aim of the Work: it was to evaluate the outcomes of HCC downstaged patients
using transarterial hepatic chemoembolization (TACE) therapy to allow eligibility for liver transplantation.
Patients and Methods:
the study included all the cirrhotic patients who underwent TACE for downstaging of
HCC to become eligible for liver transplantation at the period from 2008 to 2017 in Ain Shams Specialized
Hospital. Al the patients underwent TACE to meet the Milan criteria for liver transplantation. Results: the
etiology of cirrhosis and HCC in our patients was primarily Hepatitis C virus which is endemic in our country.
All the cases were not eligible for liver transplantation because they were out of Milan criteria, therefore all the
cases underwent TACE for downstaging of the tumor to be within the Milan criteria to become fit for liver
transplantation. After undergoing TACE for downstaging, Patients underwent living donor liver
transplantation, then they were followed up for detection of recurrence on the transplanted liver. Four of the
twenty seven patients had recurrent HCC (14.8 %). Conclusion: successful down-staging of HCC by TACE
can be achieved in the majority of carefully selected patients and is associated with excellent
posttransplantation outcome.
Keywords: LT, HCC, TACE.

INTRODUCTION
have since been known as the Milan criteria (MC),
Hepatitis C virus (HCV) infection is a major
and have been adopted worldwide to select HCC
public health burden in Egypt, where it bears the
patients for LT(4). Patients, who suffered from HCC
highest prevalence rate in the world. Estimates for
with or without poor liver function, who were out of
prevalence are based upon data reported from the
the transplant criteria, remained the most difficult
2008 and 2015 Egypt Demographic Health Surveys.
group to be treated. Disease could be downstaged or
Chronic infection with HCV is the leading cause of
controlled by various anticancer therapies, which
end-stage liver disease, hepatocellular carcinoma
might bring them chance of undergoing a curative
(HCC) and liver-related death in Egypt. HCV causes
treatment such as LT (5). HCC downstaging using
chronic hepatitis in 60%­80% of the patients, and
exclusively transarterial chemoemolization (TACE)
10%­20% of those patients develop cirrhosis over
or multimodal sequential therapies to meet the
20­30 years of HCV infection. About 1%­5% of the
conventional criteria for LT among carefully
patients with liver cirrhosis may develop liver
selected patients yields promising results in terms of
cancer(1). Liver transplantation (LT) has emerged as
overall and disease-free survival. In particular, some
the optimal treatment for cirrhotic patients with
recent papers have demonstrated that patients
HCC because it cures both tumor and underlying
successfully downstaged within the MC criteria can
cirrhosis. Poor patient selection (excessive tumor
achieve a 5-year survival rate comparable to that of
burden, unknown tumor biology) made initial results
patients meeting the abovementioned criteria
of LT for HCC quite dismal(2). It wasn't until 1996,
without requiring downstaging(6). TACE has been
when Mazzaferroet al.(3) defined tumor criteria for
proven to improve survival and control symptom. It
patient selection (single lesion 5 cm, or up to 3
has the advantage of instillation of the
lesions 3 cm each in the absence of tumor vascular
chemotherapeutic agent directly into the liver tumor,
invasion or evidence of extra-hepatic metastases)
which was carried by the lipidol, as well as ischemic
associated with comparable outcome to patients
necrosis induced by arterial embolization. It has
undergoing LT without HCC. Also, they revealed 4
been used for unresectable HCC in patients who are
year post-LT survival > 75% and post-LT
awaiting LT as well as those who are not transplant
recurrence rate in the order of 8%. These criteria
candidates opted for palliative care. Adequate tumor
5578
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 10)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5584-5588

Correlation between Peptidyl Arginine Deiminase Type 4 Polymorphism and
Disease Activity in Polyarticular Juvenile Idiopathic Arthritis in Egyptian Patients
Mohsen M. Ali 1, Ahmed A. Abdel-Aziz 2, Kamel S. Hammad 3, Mohamed A. Hanafy 4
1,2,4 Department of Physical Medicine & Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
3 Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding Author: Mohamed A. Hanafy; Mobile: 01115181806; Email: Hanafy_2016@yahoo.com
ABSTRACT
Background:
juvenile idiopathic arthritis (JIA) is a broad term that describes a clinically heterogeneous group
of arthritides of unknown cause, which begin before 16 years of age affecting one or more joints, lasting for at
least 6 weeks. PADI4 is one member of PADI gene family. The PADI gene region is located at chromosome
1p36. It codes for enzymes responsible for the posttranslational conversion of arginine residues into citrulline.
There are likely to be different genetic risk factors for JIA in different ethnic groups. Therefore, here we
sought an influence of HLA-SE and PADI4 on JIA susceptibility in Japanese, because both HLA-SE and
PADI4 were reported as significant genetic risk factors for RA independent of ethnicity. Recently, association
of PADI4 gene polymorphisms with ACPA positivity and disease activity in polyarticular JIA. Aim of the
Work:
the aim of this work is to investigate PADI polymorphism rs2240340 to determine whether this
polymorphism could be a marker of susceptibility to JIA in Egyptian children and adolescents and whether this
single nucleotide polymorphism (SNP) is correlated with clinical parameters in JIA. Patients and Methods:
the ethical approval was obtained from the hospital ethical research committee and each patient entering the
study will sign an informed consent. Thirty patients included in this study with polyarticular types of juvenile
idiopathic arthritis and all of them fulfilled ILAR classification criteria (2004). All were under the age of
sixteen at time of diagnosis. They were recruited from Physical Medicine, Rheumatology and Rehabilitation
Department at Al-Hussein and Sayed Galal University Hospitals during the period from January 2018 to June
2018. In this study we measure PADI4 polymorphism and correlate with disease activity in polyarticular JIA
in Egyptian patients. Results: association of PADI4 gene polymorphisms with ACPA positivity and disease
activity in polyarticular JIA and PADI4 gene polymorphism can be used as a marker of susceptibility to
polyarticular JIA. Conclusion: PADI4 gene polymorphism became a marker of susceptibility to polyarticular JIA
and gene polymorphism correlated with disease activity in ACPA positivity in polyarticular positive JIA.
Keywords: Juvenile idiopathic arthritis, Peptidyl Arginine Deiminase type 4 polymorphism.

INTRODUCTION
polyarthritis, psoriatic arthritis, enthesitis-related
Juvenile idiopathic arthritis (JIA) is a broad
arthritis, and undifferentiated arthritis(3). The major
term that describes a clinically heterogeneous group
pathology of oligoarthritis and polyarthritis is
of arthritides of unknown cause, which begin before
articular inflammation and joint destruction. RF-
16 years of age affecting one or more joints, lasting
positive polyarthritis is considered to be a
for at least 6 weeks. This term encompasses several
counterpart of adult rheumatoid arthritis. In contrast
disease categories, each of which has distinct
to the above forms of JIA, the major pathology of
methods of presentation, clinical signs, and
systemic JIA is systemic inflammation, which is
symptoms, and, in some cases, genetic background.
considered similar to adult Still's disease (4). PADI4
The cause of disease is still poorly understood but
is one member of PADI gene family. The PADI
seems to be related to both genetic and
gene region is located at chromosome 1p36. It codes
environmental factors, which result in the
for enzymes responsible for the posttranslational
heterogeneity of the illness (1). Juvenile idiopathic
conversion of arginine residues into citrulline. It was
arthritis is the most common autoimmune
indicated that an RA susceptibility haplotype in
inflammatory joint disease in childhood, with
PADI4 was associated with increased stability of
prevalence of 3.43 per 100,000. Prevalence in boys
PADI4 mRNA (5). And it could lead to accumulation
was 2.58 per 100,000 and in girls 4.33 per 100,000
of PADI4 protein, with subsequent increases in
(2). JIA is subdivided into seven clinically more
citrullinated proteins and enhanced production of
homogeneous subtypes, using the International
autoantibodies against these citrullinated peptides (6).
League of Associations for Rheumatology (ILAR)
PADI4 mRNA is detected in hematological cells
classification
system:
systemic
arthritis,
and pathological synovial tissues and it was reported
oligoarthritis, RF negative polyarthritis, RF-positive
that PADI4 significantly overexpressed in the blood
cells of RA patients (7). There are likely to be
5584
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 11)


The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5589-5594

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave
Lithotripsy in Management of Ureteric Stones in Pediatric Age Group
Mohamed Esmat Abo Gareeb, Ahmed Tawfick Hassan, Waleed Fawzy Abdelsami *
Urology Department, Faculty of Medicine, Ain Shams University
*Corresponding Author: Waleed Fawzy Abdelsami, E-mail: waleedfawzy950@gmail.com
ABSTRACT
Background:
pediatric stone disease is one of the most common urological issues in pediatric urology
practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work:
determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne
laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in
management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients
in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL
or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital
and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A:
Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible
ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the
two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically
significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and
there was highly statistically significant difference between the two groups regarding duration of the procedure
which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe,
highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less
postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric
calculi in children after failure of ESWL.
Keywords: Flexible Ureteroscopy, Laser Lithotripsy, Extracorporeal Shock Wave Lithotripsy, Ureteric
Stones.

INTRODUCTION
children, success rates with ESWL are lower for
In recent decades, the incidence of pediatric
distal ureteric stones (3). Extracorporeal shock wave
stone disease has increased markedly. The disease
lithotripsy in the pediatric population has higher
incidence has raised 6­10 % annually over the last
success rate due to number of reasons including
two decades also Population-based observational
smaller body volumes and increased ureteral
studies have estimated contemporary incidence to
compliance allowing passage of stone fragments.
range from 36 to 145 per 100,000 children (1). Also
Also, Dimercaptosuccinic acid (DMSA) scanning
the increase in incidence in both sexes, indicated
post-ESWL did not identify any evidence of renal
that girls showed a greater increase more than boys
scarring (2). The advantage of flexible ureteroscopy
(2). In pediatric patients a predisposing factor for
in children includes high stone-free condition rates,
stones can be found in more than 75% of children.
low complication rates, minimal radiation exposure
The majority of cases have a metabolic disorder (2).
and short hospitalization periods (3). The indication
Children are regarded as high-risk recurrent stone
of flexible ureteroscopy has been extending,
formers rates range from 19 to 34 % at a mean
including intrarenal stones, ESWL failure, morbid
follow-up of 2­3 years (1). The three main treatment
obesity, musculoskeletal deformities and bleeding
options available for pediatric stones treatment are
diathesis (4). Initial concerns were raised regarding
Extracorporeal shock wave lithotripsy (ESWL),
the traumatic sequelae to the pediatric ureter like
ureteroscopy (rigid and flexible), Percutaneous
Perforation, ischemia, stricture and reflux were
nephrolithotomy (PCNL) and open surgery has been
expected following URS in children (5). URS was
reserved for complex stones associated with
found to be superior to ESWL in a prospective
abnormal anatomy (2). ESWL was used in pediatric
randomized study, rendering 94% stone free after
stones in 1986, which showed safety, efficacy and
one session compared with 43% stone free
complications equivalent to adult and its efficacy for
following SWL (5).
upper tract stones has been reported as ranging from
AIM OF THE WORK
68% to 84% (2). Due to technical problems that arise
To assess the safety, efficacy and outcome
with localization and focusing of ureteric stones in
of flexible ureteroscopy using holmium Yttrium
5589
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 12)


The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5595-5599

Cognitive Functions in Recipients of Liver Transplantation: Prospective
Comparative Study
1 Ahmad Saad Mohamed, 2 Mahmoud Ahmed Elmeteini, 1 Ghada Abd Elrazek Mohamed, 1 Doha
Mostafa Elserafy, 1 Reem Elsayed Hashem, 1 Alaa Adel Elmadani
Department of Neuropsychiatry, Faculty of Medicine-Ain Shams University
2 Dean of Faculty of Medicine, Director of Ain Shams Center for Organ Transplant, Professor of Surgery-Ain Shams University
Corresponding author: Alaa Adel Elmadani, Mobile: 01005400566; Email: alaa.aelmadani@gmail.com
ABSTRACT
Background:
cognitive control refers to the ability to regulate, coordinate, and sequence thoughts/actions in
accordance with the current task goals. It comprises a set of components including task switching, updating
and response inhibition and coordinating multiple simultaneous operations. The fronto parietal network has
been suggested as a neural basis for cognitive control. Liver transplantation is one of the most dynamic fields
in modern medicine and is a lifesaving option for patients with end stage liver disease. Since the first
successful transplantation in 1967, liver transplantation has been performed in many centers worldwide saving
thousands of liver failure patients. Aim of the Work: based on that, our study aimed to assess cognitive
functions, depression, and anxiety in patients with end stage liver disease before and after liver transplantation,
then compare between both. Patients and Methods: the study involved convenience sample of 44 recipients
with ESLD prepared for liver transplant, 30 of which completed the study and 14 cases dropped out. Results:
all data were recorded and statistical analysis was done using the Statistical Package for Social Science SPSS-
20th version. The results were tabulated, grouped and statistically analyzed using the suitable statistical
parameters. For description analysis. Conclusion: more liver impairment as estimated by Child Pugh score and
MELD score associated with more impairment in cognitive tasks. In the current study the presence or absence of
hepatic encephalopathy had no relation to cognitive function.
Keywords: Cognitive Functions; Executive Functions; Liver Transplant; Working Memory; Fronto Parietal
Network.

INTRODUCTION
HE (MHE) to different grades of overt HE, it is
The liver is a vital organ that detoxifies most
believed that cerebral edema is the common
endogenous and exogenous toxic compounds, thus
pathogenic mechanism for cognitive impairment in
when the liver fails these processes do not proceed
MHE and overt HE(4). Patients with clinical HE show
properly and toxic compounds may reach the brain
various
neuropsychiatric
symptoms
including
and affect cerebral function (1). Prolonged ingestion of
impairment in the sleep wake cycle, cognitive and
alcohol as well as presence of chronic viral toxins like
intellectual function and motor activity and
hepatitis B and C, both usually cause severe
coordination as well as alteration in personality and
complications and lead to hyperdynamic system
consciousness. MHE may present by mild cognitive
circulation as well as neuropsychiatric dysfunction
impairment, attention deficits, psychomotor slowing
and the severity of cognitive impairment is linked to
and impaired visuo-motor and bimanual coordination
the degree of hepatic dysfunction (2). The CNS is
that can progress to clinical HE and reduces quality of
usually involved during the development of chronic
life (1). It is unclear whether minimal HE is fully
liver disease depending on its degree of severity. This
reversible or persists to some degree after LT. Some
involvement can cause limited mental capacity,
prospective
studies
have
shown
that
brain
changes in psychomotility and/or hepatic coma
abnormalities detected in MRI normalize within one
associated with irreversible brain damage (2). Clinical
year after LT(5). Liver transplantation (LT) can correct
presentation and pathophysiologic mechanisms of
liver function resulting in an improvement in
brain injury are dependent on the type of liver failure
symptoms of MHE, however some cognitive deficits
(fulminant or chronic). Recently evidence that
seem to persist to some degree. The MHE patients
hepatitis C virus can be found in the central nervous
can experience persistent cognitive deficits after LT,
system and may have a role in a subcortical pattern of
in addition permanent brain injury has been found in
neuropsychological impairment in patients similar to
those with previous episode of overt HE (4). HE
that seen in HIV/AIDS dementia (3). HE is frequently
occurring before LT can have a substantial negative
associated with a wide range of neuropsychiatric
impact on post-transplant outcomes, and preoperative
abnormalities and has been classified from minimal
history of HE may be a predictor of posttransplant
neurologic complications. Even with resolution of
5595
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 13)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5600-5603

Evaluation of Knowledge regarding Shaken Baby Syndrome among Parents
in Tabuk City
Abdullah Nasser Alshahrani 1, Mohammed Nasser Alshahrani 2,
Ali Bani Ahmed 2
1 Faculty of Medicine Tabuk University, 2 Faculty of Applied Medical Sciences, Tabuk University
*Corresponding Author: , E-mail:
ABSTRACT
Background:
abusive head trauma (AHT) or shaken baby syndrome (or SBS), is an injury to a child's brain as
a result of abuse. SBS can be caused by direct blows to the head, dropping, throwing or shaking a child. The
prevalence of SBS has been reported to be 14­33.8/100 000 in children aged below one year. With a mortality
rate of approximately 25%, a great portion of the survivors continue their lives with functional disorders
including learning difficulty, behavior problems, advanced cognitive and developmental retardation, stroke and
blindness. Shaking frequently occurs as a result of getting angry of a caregiver of a baby who cries in an
unspecifiable way. Therefore, caregivers of babies should be aware of their level of stress and learn how to
cope with stress. Shaken baby syndrome is a preventable problem. However, we have limited knowledge about
how educated of caregivers about SBS especially in less urbanized regions such as Northern Borders including
Tabuk city. Aim of the Work: to evaluate parents' knowledge regarding shaking baby syndrome in Tabuk
city. Patients and Methods: The target population of this research are parents who have children up to one
year old in Tabuk city. A questionnaire was administered to parents who have children from birth up to one
year old. The participants were consented and then the questionnaires were distributed to them. The
questionnaires involved questions regarding some demographics including age, educational level, nationality,
how many children. Questions regarding Level of knowledge about SBS included: incidents of shaking their
baby during the first year of life, awareness about the risk of shaking your child in first year, knowledge
about the term shaking baby syndrome. All data obtained with questionnaire were analyzed using the
Statistical Package for the Social Sciences (SPSS) version 23. The chi square statistics were used to test our
hypotheses and the distributions of categorical variables. Results: The total sample size was 92 participants.
Descriptive statistics showed that 88% were Saudi, 60% were below the age of 40. Regarding education, 12%
were illiterate. Regarding the knowledge about SBS, 57.61 % reported shaking the baby to make them quite
within the 1st year of life. 67.39 % reported said they had no idea about the risks of shaken the baby during the
1st year of life. Moreover, about 70% reported they have never heard about what is called SBS. Conclusion:
Majority of parents have never heard about SBS. Only 32% of the surveyed understood the connection of
shaking with risks on the child's life during the 1st year and thereafter. Perception, knowledge of and attitudes
towards SBS must be addressed by applying Shaken Baby Syndrome educational and Prevention Programs
especially in less urbanized regions such as Northern Borders including Tabuk city.
Keywords: Shaken Baby Syndrome, childhood head injury, craniocerebral trauma, inflicted traumatic brain
injury.

INTRODUCTION
behavior problems, advanced cognitive and
Abusive head trauma (AHT) is an injury to
developmental retardation, stroke and blindness. No
a child's brain.as a result of child abuse. It can be
dysfunction is found in only less than 35% of all
caused by direct blows to the head, dropping or
cases 4. Shaking frequently occurs as a result of
throwing a child, or shaking a child. AHT is also
getting angry of a caregiver of a baby who cries in
called shaken baby syndrome (or SBS), inflicted
an unpacifiable way. Therefore, caregivers of babies
traumatic brain injury, and shaken impact syndrome
should be aware of their level of stress and learn
1. In a few epidemiological studies, the prevalence of
how to cope with stress 5. Shaken baby syndrome is
SBS has been reported to be 14 ­33.8/100 000 in
a preventable problem. Prevention has become
children aged below one year. It is thought that these
important, because it is late when the child is shaken
figures are lower than the actual ones because of
and abused 6. Education is given to prevent this
problems in reporting 2, 3. Approximately 25% of the
syndrome in the world especially in developed
subjects are lost in a few days after injury. A great
countries 7. During this education, it is important to
portion of the survivors continue their lives with
explain to everybody who takes care of babies that
functional disorders including learning difficulty,
crying is a normal part of the baby's development,
5600
Received:7/6/2018
Accepted:16/6/2018




Full Paper (vol.7211 paper# 14)


The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5604-5608

Cortical Lesions in a Sample of Egyptian Multiple Sclerosis Patients
Ismail A. Montaser 1, Mohamed H.Rashad 2, Mohamed A. Abd El-Aziz 3, Alaa G. Mashaal 4
1,2,4 Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
3 Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Corresponding author: Alaa Gamal Mousa Mashaal; Mobile: 01061695793; Email: Alaamash3al@gmail.com
ABSTRACT
Background:
multiple sclerosis is an inflammatory demyelinating disease with a neurodegenerative
component mainly characterized by progressive accumulation of focal white matter (WM) lesions. The degree
of cortical damage at baseline was associated with the progression of disability. Cognitive deficits could be
better explained by cortical lesions (CLs) than by WM lesions. Fatigue in MS could be due to damage to the
cortico striato thalamo cortical circuit. Aim of the Work: to detect (CLs) in MS patients and correlate these
lesions with physical disability, cognitive dysfunction and fatigue. Subjects and Methods: a case-control
study on 64 subjects including 44 known multiple sclerosis patients diagnosed according to revised
McDonald's criteria 2017. Results: we observed a statistically significant difference between MS patients and
healthy controls as regard number of (CLs), Symbol Digit Modality Test (SDMT), Fatigue Severity Scale
(FSS) and P300 wave latencies and amplitudes. Secondary progressive (SPMS) subgroup was affected more
than relapsing remitting (RRMS) subgroup. (CLs) were located mainly in temporal lobes. Conclusion: This
study suggested that cortical affection is directly associated with physical and cognitive disability progression.
Keywords: Cortical Lesions, Multiple Sclerosis.

INTRODUCTION
SUBJECTS AND METHODS
Cognitive Impairment affects a large
This study was carried out on 64 subjects
proportion of patients with MS and has a profound
during the period from February 2018 to August
impact on their life activities. Although cognitive
2018. The study was approved by the Ethics
deficits have been observed from the early stages of
Board of Al-Azhar University. They were
the disease, they are more frequent in chronic
divided into two main groups: Group I: included
progressive MS and tend to be worse over time[1]. It is
20 healthy volunteers (15 females and 5 males).
recognized that fatigue, one of the most common and
Their ages ranged between 23 and 43 years (with a
debilitating complaints associated with the disease.
mean age of 30.500 + 7.55 SD). All subjects were
Fatigue may not impact upon any one particular
matched for age, sex, educational level with group
domain of cognitive functioning, but rather acting to
II and free from any physical, neurologic,
limit the overall capacity of individuals with MS to
psychiatric or cognitive impairments. Group II:
sustain mental activity[2]. MRI studies have shown
included 44 patients fulfilled the Revised
that focal damage (i.e. cortical lesions) and diffuse
McDonald's criteria for diagnosis of multiple
damage (i.e. neuronal loss, widespread cortical
sclerosis 2017[9] and this group included 32 females
thinning and damage to normal-appearing gray matter
and 12 males. Their ages ranged between 21 and 45
(NAGM)) occurs in all MS phenotypes and can be
years (with a mean of 28.568 ± 5.695 SD). A
present early in the disease[3]. Despite its good
written informed consent was taken from patients
sensitivity in detecting white matter lesions,
and healthy controls before the start of the study.
conventional MRI (proton density, T2-weighted,
The study protocol was approved by the ethics
FLAIR and pre- and post- gadolinium [Gd] T1-
committee of faculty of medicine El- Azhar
weighted sequences) is not adequate for the detection
University. Inclusion criteria: Age more than 18
of(CLs), because such lesions are typically small,
years old, known cases of MS diagnosed according
have poor contrast with the surrounding normal gray
to revised McDonald's criteria 2017. Exclusion
matter, and because of partial volume effects from the
criteria: systemic diseases affecting cognition such
cerebrospinal fluid (CSF)[4]. Double inversion
as
thyroid
dysfunction,
hepatic
or
renal
recovery (DIR) sequences markedly improved the
impairment, history of diabetes or hypertension,
sensitivity of MRI to detect (CLs)[5].
history of drugs or alcohol abuse.
AIM OF THE WORK
Methods:
To detect (CLs) in MS patients and
All patients were subjected to: A-clinical
correlate these lesions with physical disability,
assessment:
Full
history
and
neurological
cognitive dysfunction and fatigue.
examination. B-Assessment of disability: using
5604
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 15)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5609-5615

Systemic Versus Intratympanic Corticosteroid Therapy for Idiopathic Sudden
Sensorineural Hearing Loss; A Meta-analytical Study
Ossama Ibrahim Mansour, Waleed Farag Abd El Aziz Ezzat, Tarek Abd El Hamid Hamdy, Beshoy
Nadhy Habib Shehata
Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine - Ain Shams University
Corresponding author: Beshoy Nadhy Habib Shehata, Mobile: 01112532386; Email: dr.beshoynadhy@gmail.com
ABSTRACT
Background:
idiopathic sudden sensorineural hearing loss (ISSHL) is one of the most controversial issues in
otology. There have been countless publications and debates concerning ISSHL over the last decades. ISSHL
can be defined as a sensorineural hearing loss of sudden onset or one that happens in minutes, hours or even in
a few days. The hearing impairment varies as far as intensity and sound frequency are concerned, some
specifically say it is a 30dB hearing loss minimum, in at least three continuous frequencies with all known
causes have to be ruled out previously. Aim of the Work: the aim of this study was to evaluate the treatment
outcomes of ITS treatment and SST based on meta-analysis, and to provide an alternative modality for clinical
practice. Materials and Methods: the current meta-analysis assessed the therapeutic effectiveness of intra-
tympanic (IT) steroid protocol as first and single drug method compared to a systemic steroid protocol. In the
current meta-analysis study we applied 2 parameters to compare between ITS group and SST group which
were : recovery rate and hearing improvement. Results: the results of this study showed that regarding both;
recovery rate and hearing improvement, there was no significant difference between intra-tympanic steroid
(ITS) and systemic steroid therapy (SST). Second both SST and ITS alone were an effective treatment in
ISSNHL patients as they significantly improved PTA and also the recovery rate. Third, if patient has any
systemic condition that make the use of systemic steroid risky or lead to side effect, then the option of intra-
tympanic steroid was, not only justified but mandatory. Conclusion: the conclusion from our meta-analysis was
shown as follows: first, according to the current study, ITS treatment produced no significant difference in both
aspects PTA improvements and recovery rate than SST in ISSHL patients. Second both SST and ITS alone were an
effective treatments in ISSNHL patients as they significantly improved PTA and also the recovery rate.
Keywords: Idiopathic sudden sensorineural hearing loss ­ Intra-tympanic ­ Intra-tympanic steroids

INTRODUCTION
Hearing loss may be accompanied by other
Idiopathic sudden sensorineural hearing
symptoms such as tinnitus (in 70% of the cases)
loss (ISSHL) is one of the most controversial issues
and dizziness may be sometimes present (up to
in otology. There have been countless publications
40% of the cases). There may also be ear fullness,
and debates concerning ISSHL over the last
headache and viral infection symptoms of the
decades. Uncertainty regarding its pathophysiology
upper airways (6). Because ISSHL physiopathology
and high rates of spontaneous recovery question
is still unclear, there are arguments about its true
the validity of the various recommended
cause. According to Nakamura et al. (7), over 45%
treatments, as well as the significance of reported
of ISHL cases bear unknown causes. Vascular
results (1). ISSHL may, sometimes, accompanied
causes also compete with autoimmune diseases and
by tinnitus and/or vertigo, represents, not only the
the rupture of the labyrinthine membrane, and also
loss of inner ear function, but also the impairment
viral infections. There still are psychosomatic
to the patient's psychological status. It has no
disorders (8). Many treatments for ISSHL have been
established cause or physiopathology and,
tested and found ineffective. These include
therefore, without established treatment. Thus, it is
hyperbaric oxygen, agents that decrease blood
a problem that places the physician in a difficult
viscosity
(osmotic
diuretics,
pentoxifylline,
clinical situation (2). ISSHL can be defined as a
procaine, and heparin), vasodilator drugs
sensorineural hearing loss of sudden onset or one
(histamine, papaverine, verapamil, and carbogen),
that happens in minutes, hours or even in a few
free radical scavenging vitamins, gingko biloba (9).
days. The hearing impairment varies as far as
However, ever since the 1980s when two double-
intensity and sound frequency are concerned, some
blind trials showed efficacy of corticosteroids in
specifically say it is a 30dB hearing loss minimum,
the treatment of this condition, they have become
in at least three continuous frequencies with all
the most commonly used agents in most centers
known causes have to be ruled out previously (3).
worldwide (10).
5609
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 16)


The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5616-5622

Prevalence of Rheumatic Heart Disease and its Risk Factors among Cardiac
Patients in Taif City, KSA.
Abdulelah S Algethami (1), Althobaiti, Omar mohammed A (1), Ibrahim H Althomali (1), Gamal M
Elnemr (1,2), Mashael A Alzahrani (3), Sultan M Althobaiti (4)
1. Department of Internal Medicine, Faculty of Medicine, Taif University, 2. Department of Medical and Radiological Researches,
Nuclear Materials Authority, Egypt, 3. Department of Internal Medicine, King Faisal Hospital , KSA,
4. 1. Department of Pharmacology, Taif University, KSA .
*Corresponding Author: Abdulelah S Algethami, E-mail: Dr.abdulelah94@hotmail.com
ABSTRACT
Background:
exposure of the body's connective tissue to group A -hemolytic streptococci, after an infection,
causes an inflammatory response called Rheumatic fever (RF). When the heart's connective tissue is affected, the
condition is called Rheumatic heart disease (RDH). Aim of the Work: we aimed at discovering the prevalence of
RDH among cardiac patients and to determine factors that played a role in its development. Also, the study was
conducted to find out the causal relationship between early treatment of RF and the occurrence of RHD. Patients
and Methods:
faisal Hospital's cardiac outpatient clinics, in Taif, KSA, who filled a designed questionnaire after
training. To screen the population for the prevalence of RDH among cardiac patients and to determine factors that
played a role in its development. Also, it was conducted to find the causal relationship between early treatment of
RF and the occurrence of RHD. The ages were from 18 to 70 years old. Results: the overall prevalence of RHD
among cardiac patients was 8%. The difference in prevalence of RHD was statistically significant (p=0.021)
between patients whose family sizes exceeded 10 individuals (37.5%) compared to those whose family sizes was 10
individuals or less (62.5%). Also, the difference in prevalence of RHD was statistically significant (p=0.044)
between patients who had little (37.5%) or no knowledge (37.5%) about symptoms of RHD compared to those who
had moderate (25%) or good knowledge (0%) about symptoms of RHD. The effect of RF management on RHD
was studies and it was found that irregular and incomplete antibiotic therapy in case of tonsillitis (p=0.006) and
irregular oral hygiene (p=0.027) were associated with higher prevalence rates of the disease. Conclusion: The that
efficient management of rheumatic fever and acute tonsillitis in terms of adequate antibiotic therapy, good oral
hygiene and awareness about the symptoms of RHD are very import aspects to protect against RHD.
Keywords: Rheumatic heart disease, Rheumatic fever, Antibiotics, Oral hygiene, Cardiac patients.

INTRODUCTION
three weeks after the onset of an untreated
Rheumatic heart disease (RHD) is a
streptococcal throat infection. Apart from the sore
condition in which all the three layers of the heart i.e.,
throat caused by the streptococcal infection, children
pericardium,
myocardium,
and
endocardium
have a fever and feel ill. Commonly, the children will
(including valves), may be permanently damaged (1).
have a very painful, swollen, and red joint (usually
RHD is caused by rheumatic fever (RF), an
large joints like knee, ankle, elbow, or shoulder are
inflammatory complication due to the exposure to
affected) that goes away after a day or two to be
group A -hemolytic streptococci (1). As the infection
replaced by the same problem in another joint so it is
becomes recurrent, further damage is inflicted on the
called migratory arthritis. Short-lived skin rashes may
heart tissues. The heart valves damage caused by RF
also occur, but they are uncommon. If the heart is
forces the heart to work harder to pump blood and,
affected, it is usually not severe enough to cause
over time, heart-related problems develop such as
symptoms, although occasionally the child may
such as arrhythmias and heart failure(1) . RF can occur
complain of dyspnea(1). It is also suggested that poor
at any age, but usually occurs in children aging 5 to
oral hygiene can lead to dental caries which are
14 years old(1). It is more common in developing than
correlated with RF and RHD(1).We aimed to assess
developed countries since it is associated with
the prevalence of RDH among cardiac patients and to
overcrowding, poor sanitation, and other social
determine socioeconomic demographic factors that
indicators of poor health(1) . RHD related symptoms
played a role in its development.
may vary between one person and another and
PATIENTS AND METHODS
accordingly, damage to the heart is not usually
noticeable. When symptoms appear, they depend on
Study design: This was a cross sectional
the
extent
and
location
of
the
heart
study that was done on 100 cardiac cases who were
damage. Typically, symptoms of RF appear about
visiting the cardiac outpatient clinic of King Faisal
hospital (KFH), Taif City, KSA to screen the
5616
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 17)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5623-5627

A Study of Sexual Dysfunction in a Sample of Medicated and non Medicated
Egyptian Female Patients with Schizophrenia
Ahmed Saad Ali, Gihan Medhat El Nahas, Mona Mahmoud El Sheikh, Mahmoud Mamdouh El
Habiby, Hussein Ahmed Elkholy, Phoebe Fayez Ghobrial
Department of Neuropsychiatry, Faculty of Medicine- Ain Shams University
Corresponding author: Phoebe Fayez Ghobrial, Mobile: 01223309014; Email: dr.fibyfayez@gmail.com
ABSTRACT
Background:
the relationship between sexuality and schizophrenia is complex. It may be related to both the
psychopathology and the pharmacotherapy, as the sexual functions may be affected by symptoms itself, living
with a severe chronic mental health illness, and the adverse effects of antipsychotics or other medications.
Systematic studies have revealed that sexual dysfunction is highly prevalent in both untreated and treated
schizophrenia patients, affecting 30­80% of women and 45­80% of men. The prevalence of sexual dysfunction
may be higher in patients with schizophrenia than in patients treated for other mental disorders. Aim of the
Work:
to compare a group of females with Schizophrenia to healthy female control group regarding frequency
and type of sexual dysfunction. Patients and Methods: this study was sought to extend our knowledge about the
association of schizophrenia and its treatment with sexuality problems. It was done at Institute of Psychiatry,
Faculty of Medicine, Ain Shams University to determine the rate of occurrence of sexual dysfunctions in married
females with schizophrenia in comparison to control group. It included 90 females diagnosed as schizophrenia
(divided into 3 groups of 30s 1-untreated patients 2-patients treated with typical anti psychotics 3- patients treated
with Atypical antipsychotics) and 30 females as a control group. Results: the study revealed high prevalence of
sexual dysfunction among all patients group yet it was highest among the drug naive group as 100% of them had
sexual dysfunction. Conclusion: the relation between schizophrenia and female sexuality is complex it could be
the result of side effect of antipsychotic medications yet the high prevalence of sexual dysfunction among drug
naļve patients, suggest that sexual dysfunction is an integral part of the disease.
Keywords: Female Sexual Function Index - type of sexual dysfunction - Schizophrenia

INTRODUCTION
sexual dysfunction may be higher in patients with
Satisfying sexual life is essential for wellbeing
schizophrenia than in patients treated for other mental
and quality of life for all people especially middle-aged
disorders (6). Symptoms of schizophrenia can affect
women (1). Women's sexuality is multifactorial, with
female sexual functions in many ways. Negative
biological, psychosexual, and context-related factors
symptoms of schizophrenia can limit the capability for
involved (2). The latter include couples dynamics,
interpersonal and sexual relationships; and their sexual
family, sociocultural issues and developmental factors.
responsiveness and capacity to enjoy close
Sexuality in women also involves multisystem, a
relationships is impaired (7). Moreover, positive
physiologic response requires the integrity of the
symptoms can affect women sexuality as they may
hormonal, vascular, nervous, muscular, and immune
experience tactile or auditory hallucinations of a sexual
systems (3). Schizophrenia is a severe and chronic
nature, erotomaniac delusions, delusions related to
mental illness, associated with high prevalence as (1%)
sexual identity, infidelity against partner, and delusions
of the population suffers from this condition.
about the shape, size or function of genital organs and
Symptoms of schizophrenia typically emerge during
hypersexualism which may lead to high risk behaviors,
adolescence or early adulthood. They are usually
self harm or sexual abuse to or from the patient (8). Also
classified as either positive, negative or cognitive
Due to the lack of insight, poor judgment and defective
symptoms (4). The relationship between sexuality and
cognitive function, patients could be involved in risky
schizophrenia is complex. It may be related to both the
behavior, unplanned pregnancies, exposure to sexually
psychopathology and the pharmacotherapy, as the
transmitted disease (9).
sexual functions may be affected by symptoms itself,
AIM OF THE WORK
living with a severe chronic mental health illness, and
To investigate if there was a significant relation
the adverse effects of antipsychotics or other
between schizophrenia and sexual dysfunctions. To
medications (5). Systematic studies have revealed that
compare between females with schizophrenia on
sexual dysfunction is highly prevalent in both untreated
medication and their counterparts who are neuroleptic
and treated schizophrenia patients, affecting 30­80%
naive or off medications for at least 3-6 months
of women and 45­80% of men, the prevalence of
regarding sexual dysfunctions.
5623
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 18)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5628-5633

Relationship between Oxytocin Level and Major Depressive Disorder
Abd El Nasr M. Omar, Heba H. Alshahawy, Doaa H. Hewedi, Reem E. Hashem, Fairouz A. Tawfik
Institute of Psychiatry, Faculty of Medicine ­ Ain Shams University
Corresponding: Fairouz A. Tawifk; Mobile: 01001377645; Email: fairouz.tawfik8587@gmail.com
ABSTRACT
Background:
major depressive disorder is one of the most common medical disorders worldwide, having
huge impact on physical and mental health in the society and is considered an extended life-threatening
psychiatric disorder. Abnormalities in the neurohypophyseal system, neuroendocrine, and immune systems
have been reported in depression. Aim of the Work: this study was carried out to identify the relationship
between plasma oxytocin level and the severity of major depressive disorder. Patients and Methods: this case
control observational study was started from July 2016 till March 2018. The subjects were selected from
inpatient and outpatient clinics of Institute of Psychiatry, Faculty of medicine, Ain Shams University. Twenty
two female patients were enrolled and fourteen female healthy subjects were considered as controls. Both
groups were subjected to Arabic version of Structured Clinical Interview for DSM-IV-TR Axis I Disorders and
sampling of serum Oxytocin. Moreover the female patients were subjected to Hamilton rating scale for
depression and state trait anxiety inventory to assess the presence of anxiety symptoms. Results: our study
revealed reduced serum oxytocin levels in depressed female patients with cutoff point 25.6 denoting that
below this level shows probability for major depressive disorder in females. Conclusion: our study revealed
reduced serum oxytocin levels in depressed female patients. Consistently with the hypothesis of dysregulated OXT
biology may serve as a biomarker for major depression.
Keywords: Oxytocin, major depressive disorder, Hamilton Rating Scale for Depression, state trait anxiety
inventory.

INTRODUCTION
OXT levels and major depressive disorders in both
Major depressive disorder (MDD), is
humans and animals. An increased concentration of
associated with substantial deficits in quality of life,
OXT in plasma is negatively correlated with
considered to be the leading cause of disability
symptoms of depression (8). There has been
globally as it affects nearly 350 million people
unprecedented interest in the prosocial effects of the
worldwide (1,2). Importantly, the quality of life
neuropeptide oxytocin in humans over the last
deficits revealed to persist beyond the clinical
decade. A range of studies have shown correlations
resolution of symptoms. Placing patients at an
between basal oxytocin levels and the strength of
increased risk for relapse and rising direct and
social and bonding behaviors in both healthy
indirect costs (3). In the last decades several
individuals and in those suffering from psychiatric
neuropeptide families were discovered having
disorders(9). It was found that plasma OXT levels are
modulatory roles on neurotransmission in synapses.
reduced in patients suffering from major depression.
This in turn evoked the interest of psychoneuro-
In animal models of depression, OXT has been
endocrinologists predicting potential significant
shown to act as a potent antidepressant. It has been
clinical relevance in the treatment of stress-related
suggested that one of the mode of actions of
mood disorders (4). Oxytocin (OXT) is a
selective serotonin reuptake inhibitors (SSRIs) is
neuropeptide produced in the hypothalamus,
through increased OXT release(10). Clinical reports
involved in a broad range of physiological and
suggest OXT to be a promising drug for psychiatric
behavioral processes (5). A few data suggest a link
diseases such as depression, anxiety disorders,
between Oxytocin and neuropsychiatric disorders,
schizophrenia, and autism. OXT may also have
especially obsessive-compulsive disorder, addiction,
therapeutic potential in the treatment of major
post-traumatic stress disorder, anxiety, depression,
depressive disorders (11).
schizophernia and autism which elevates the need
AIM OF THE WORK
for further research (6). A recent perspective added
To measure plasma oxytocin level in major
the possible role for oxytocin in depressive
depressive disorder patients. To identify the
disorders. Oxytocin is involved in prosocial
relationship between plasma oxytocin level and the
behaviors such as attachment, affiliation, trust, and
severity of major depressive disorder by Hamilton
social support (7). Moreover, several studies have
Rating Scale for Depression (HRSD). To compare
reported a significant association between plasma
between plasma oxytocin level in major depressive
5628
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 19)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5634-5639

Clinical Patterns of Facial Aging among Egyptian Females
Hanan Mohamed El Kahky, Heba Mahmoud Diab, Amany Abdelaziz Ali
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University
*Corresponding author: Amany Abdelaziz Ali, E-Mail: dramanyabdelaziz@gmail.com, Mobile: 0100847885.
ABSTRACT
Background:
the skin displays the most visible manifestations of aging. Research interest in aging process has
grown and people are becoming obsessed with looking young. The face has received most of the attention and
generated most of the studies related to beauty and aging because it is the most expressive part of human
body. Aim of the Work: to assess the different clinical patterns of facial wrinkles and signs of skin aging
among different age categories of Egyptian females. Subjects and Methods: this cross-sectional study was
carried out in the Dermatology, Venereology and Andrology department of Ain Shams University Hospitals
after Institutional Review Board approval. The study included included 100 adult females ranged from 20-60
years old. Results: the mean age was (38.570±11.634) with a range of 20-60 years. Skin phototype was
Fitzpatrick Type III in 8 patients (8%), IV in 55 females (55%) and V in 37 females (37%). Glogau
classification for severity of skin aging signs was type I in 39 cases (39%), Type II in 20 (20%), Type III in 26
(26%) and type VI in 15 (15%). All patients reported history of excessive sun exposure for extended hours; 32
cases reported sunscreen use but not regular, while 68 cases didn't use sunscreen. Conclusion: skin Type IV
showed more wrinkles indentation index, roughness, melanin concentration, melanin heterogeneity and HGB
heterogeneity. There was a significant correlation between the sunscreen use and average melanin concentration,
where cases that used sunscreen showed lower average melanin concentration. The relation between sun screen use
and severity of wrinkles (Indentation index) was non-significant.
Keywords: Facial Aging, facial wrinkles.

INTRODUCTION
tissue by single or repeated exposure to UV light.
The skin is a portal of knowledge on aging.
Sunlight is believed to account for the vast majority
From its softness and smoothness in infancy,
of not only aesthetic effects of skin ageing, but also
through its suppleness in youth, to its wrinkled
clinical problems as well (4). Skin Aging is a
texture in elders, the skin displays the most visible
complex phenomenon clinically described by
and accessible manifestations of aging. As the
numerous features (wrinkles, sunspots, uneven skin
proportion of the aging population in industrialized
color, telangiectasia, skin loosening, etc...) that often
countries continue to increase, Research interest in
depend on ethnic origin. In addition to genetic
the process of aging has grown and people are
inheritance, numerous factors can interfere and
becoming obsessed with looking and staying young
modify skin color and/or skin color heterogeneity
(1). The face has received most of the attention and
including climatic changes, social and cultural
generated most of the studies related to beauty and
conditions and hormonal status. The different
aging because it is the most expressive part of the
patterns of aging may result from different
human body, responsible for visual evaluation,
environmental and constitutional factors which
recognition and social interaction (2). Aging is a
could be explored by an epidemiological approach
(5)
process in which both intrinsic and extrinsic factors
. Aging process differs among different ethnic
lead progressively to loss of structural integrity and
groups. Many studies were done to investigate signs
physiological function. Intrinsic aging of the skin
of face aging among different populations. To the
occurs inevitably as a natural consequence of
best of our knowledge, no previous studies were
physiological changes that are genetically
done about face aging in Egypt.
determined. Extrinsic factors include smoking,
AIM OF THE WORK
exposure to sunlight and pollution. The synergistic
The aim of this study is to assess the
effects of intrinsic and extrinsic aging factors
different clinical patterns of facial wrinkles and
produce deterioration of the cutaneous barrier with
signs of skin aging among different age categories
significant associated morbidity (3). Cumulative sun
of Egyptian females.
exposure (photoaging) is the most important
extrinsic factor in aging skin. Photoaging is the
PATIENTS AND METHODS
superposition of solar damage on the normal aging
The present study included 100 adult
process, defined specifically by damage produced in
female patients ranged from 20-60 years old. This
5634
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 20)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5640-5646

Abnormal Ocular Findings in Chronic Renal Failure Patients on Hemodialysis
Dina E. Mansour, Ahmed M. El-Bayomi, Aml M. El-Azab *
Department of Ophthalmology, Faculty of Medicine, Ain-Shams University
* Corresponding author: Aml M. El-Azab; Mobile: 01019635327. Email: amlnoor87@yahoo.com
ABSTRACT
Background:
chronic kidney disease (CKD) is a global public health problem and diabetes is a leading cause
for it. Those patients with end-stage renal disease (ESRD) are generally treated using hemodialysis (HD). HD
causes numerous metabolic changes which in turn induce osmotic changes in blood and extracellular fluids
including the aqueous and vitreous humor, so there are many ocular abnormalities in ESRD patients either due
to common pathophysiological mechanisms and risk factors between eye and kidney diseases or due to
hemodialysis itself. Aim of the Work: the aim of this study is to evaluate ocular findings in CKD patients on
hemodialysis, including the best-corrected visual acuity (BCVA), measurement of intraocular pressure (IOP),
corneal, conjunctival, tear film changes, lens and fundus changes. Patients and Methods: this cross sectional
observational study was carried out on twenty three patients (6 males and 17 females) with 44 eyes, with
chronic kidney disease on chronic hemodialysis for 2-10 years in the Dialysis Unit at Agouza Specialized
Hospital in the period from November 2017 to April 2018. The hemodialysis duration was approximately four
hours three times per week. Results: forty three percent of total 44 eyes had BCVA > 6/18. As regard anterior
segment, we found yellow sclera was the commonest finding (75%), cataract (61.4%), lid edema (56.8%), dry
eye (43.2%), conjunctival congestion (47.7%), and pterygium (13.6%). As regard posterior segment; Diabetic
retinopathy was the commonest finding (38.6%), hypertensive retinopathy (4.5%), AMD (2.3%), macular
hemorrhage (2.3%). Regarding OCT findings, there was statistically significant difference between eyes of
diabetic, hypertensive and other patients as regard central foveal thickness. Conclusion: our results
demonstrate high prevalence of abnormal ocular findings in chronic renal failure patients on hemodialysis. So
those patients should be evaluated regularly by the ophthalmologist.
Keywords: Chronic Renal Failure, Hemodialysis, Ocular Findings, Central Foveal Thickness, OCT.

INTRODUCTION
fluids and is concerned with the change in plasma
Chronic kidney disease (CKD) is a slow
colloid osmotic pressure during haemodialysis (5).
progressive loss of kidney function over a period of
During hemodialysis, numerous metabolic parameters
several years, which also is the presence of either
including blood urea, sodium, potassium and sugar will
reduced renal function as evaluated by estimated
be changed (6), which also induce osmotic changes in
glomerular
filtration
rate
(eGFR
<60
blood and extracellular fluids. This includes the
ml/minute/1.73 m2) or albuminuria evaluated by
aqueous and vitreous humor, any change in osmotic
urinary albumin to creatinine ratio (ACR 30
pressure of these fluids could affect the refractive status
(7)
mg/g) (1). Chronic kidney disease has become a
. The relationship between chronic hemodialysis and
major public health problem worldwide and has
intra-ocular pressure (IOP) has been widely
been associated with premature morbidity and
investigated in the past. There are several studies,
mortality (2). Chronic kidney disease has numerous
which demonstrate a significantly increased IOP and
causes. The most common causes of CKD
decreased OPP occur during HD, bringing both to
are diabetes
mellitus
and
long-term
levels that increase the risk of glaucoma development
uncontrolled hypertension (3). Chronic renal failure
and progression (8). In contrast, other studies have
patients have had a wide range of findings,
demonstrated the opposite effect (9), while some studies
including refractive changes, dry eye, increased
reported no IOP change during HD (10). Ocular
tear osmolarity, conjunctival calcium deposits,
posterior segment changes such as, retinopathy
band keratopathy, corneal endothelium changes
secondary to diabetes mellitus, hypertension, anemia,
and lenticular opacity (4). Patients with chronic
and uremia, are also observed frequently in CRF
kidney disease are generally treated using a blood
patients (11). Pahor et al. found that central foveal
filtration mechanism such as hemodialysis. The
thickness was significantly thinner in hemodialysis
primary objective of hemodialysis is to correct the
patients than normal healthy subjects (12).
composition and volume of body fluids. Correction
AIM OF THE WORK
of body fluid aims to resolve the excessive
The aim of this study is to evaluate ocular
accumulation and abnormal distribution of body
findings in CKD patients on hemodialysis, including
5640
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 21)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5647-5651

3-Nitro-Tyrosine as a Biomarker of Minimal Hepatic Encephalopathy in Patients
with Liver Cirrhosis
Emad Ahmed Awad, Mansour Nassef Mohammed, Moataz Mohammed Sayyed, Ahmed El-Saady El-
Khayal, Mohamed Ahmed Saad Ahmed*
Department of Internal Medicine and Gastroenterology and Hepatology, Faculty of Medicine, Ain Shams University
*Corresponding author: Mohamed Ahmed Saad Ahmed, Mobile: 01003381735, Email: just_human_86@hotmail.com
ABSTRACT
Background:
hepatic encephalopathy (HE) is a common complication in patient with liver cirrhosis. It comprises of a
broad spectrum of neuropsychiatric abnormalities of varying severity, and affected patients usually suffer from
psychomotor, cognitive, emotional, behavioural, and motor coordination dysfunctions. Patients with minimal HE (MHE),
a subclinical form of HE, usually have a normal mental and neurological status upon routine clinical examination. The
subtle deficits in patients with MHE can only be elicited by specialized neuropsychological tests. Aim of the Work: the
aim of this study was to evaluate the role of 3-Nitro-Tyrosine as a biomarker of Minimal Hepatic Encephalopathy in
patients with liver cirrhosis. Patients and Methods: our conducted study was a prospective case control study carried on
60 adult patients and 30 age matched controls. All were recruited from Internal Medicine and Hepatology and
Gastroenterology Department at Ain Shams University Hospitals in the period between September 2016 and June 2018.
All patients enrolled in the study were subjected to detailed history taking, full physical examination, laboratory
investigations, psychometric tests for detection of MHE using specially digit symbol test (DST), Trail making test A
(TMT A), Trail making test B (TMT B), serial dotting test (SDT) and 3-Nitro-Tyrosine level (3NT). Results: our study
found that the serum levels of 3-nitro-tyrosine are a good predictor of the presence of MHE in patients with liver cirrhosis,
with good sensitivity (90%) and specificity (93.33%) and positive and negative predictive values were 93.1% and 90.3%
respectively at a cutoff of 14.8 ng. Conclusion: determination of 3-nitro-tyrosine in serum is easy and is not time
consuming. It only requires taking a serum sample from the patient and determining 3-nitro-tyrosine concentration. This
procedure can be therefore easily added to the routine clinical determinations in patients with liver cirrhosis. This would
also allow extending the diagnosis of MHE to most clinical settings, helping to identify patients with MHE.
Keywords: 3-Nitro-Tyrosine, Hepatic Encephalopathy, Liver Cirrhosis

INTRODUCTION
clinical studies and standardized definitions. Clinical
Liver disease is a major cause of mortality and
management tends to be dependent on local standards
morbidity worldwide. In most cases, liver-related
and personal views. This is an unfavorable situation for
mortality results from complications of chronic liver
patients and contrasts with the severity of the condition
disease (CLD) including advanced cirrhosis and
and the high level of standardization in other
hepatocellular carcinoma (HCC) (1). Chronic Liver
complications of cirrhosis (4). Between 30 and 50 % of
Disease and complications of cirrhosis including ascites,
the patients with liver cirrhosis who do not show evident
bleeding tendency, Hepatocellular Carcinoma, minimal
symptoms of clinical hepatic encephalopathy (HE) have
and overt hepatic encephalopathy also are associated
minimal HE (MHE). MHE cannot be detected in
with severe impairments in health-related quality of life
routine analysis but can be unveiled using psychometric
(2). The burden of liver disease in Egypt is exceptionally
tests or neurophysiological assessment (4,5). MHE has a
high, maintaining the highest prevalence of hepatitis C
negative impact on daily life activities and working
virus (HCV) worldwide (3). Hepatic encephalopathy
capacity, affects health-related quality of life (HR-QoL)
(HE) is a frequent complication and one of the most
impairs fitness to drive (4). Currently, the "gold standard"
debilitating manifestations of liver disease, severely
for diagnosis of MHE is the psychometric hepatic
affecting the lives of patients and their caregivers.
encephalopathy score (PHES), a battery of five
Furthermore, cognitive impairment associated with
psychometric tests. However, PHES is time consuming
cirrhosis results in utilization of more health care
and needs adjusting for age and educational level. As a
resources in adults than other manifestations of liver
consequence, MHE is not routinely diagnosed in most
disease. Progress in the area has been hindered by the
clinical settings because of lack of simple procedures,
complex pathogenesis that is not yet fully elucidated (4).
and most patients with MHE remain undiagnosed and
Apart from such biological factors, there remains the
untreated. Hence, there is a need for a simple diagnostic
larger obstacle that there are no universally accepted
test that can be performed routinely in the laboratory to
standards for the definition, diagnosis, classification, or
detect MHE in patients with liver cirrhosis (5). It would
treatment of HE, mostly as a result of insufficient
be very useful in clinical practice to have some
5647
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 22)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5652-5657

A Comparative Study of the Diagnostic and Prognostic Value of Squamous Cell
Carcinoma Antigen and Alfa-foeto Protien in Hepatocellular Carcinoma Before
and After Therapeutic Intervention
Tarek Maged Al Sakty 1, Hesham Hamdy Radwan 1, Mohamed El Gharib Abou El Maaty 2, Ahmed
Samir Allam 1, Ramy Samir Abd El Hamid, Mohamed Gamal Yousef 1 *
1 Internal Medicine Department, Faculty of Medicine, Ain Shams University,
2 Radiology Department, Faculty of Medicine, Ain Shams University
* Corresponding Author: Mohamed Gamal Yousef, E-mail: m.gamal.yousef@gmail.com
ABSTRACT
Background:
hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and it is
one of the major causes of death, because of its high frequency and poor prognosis. Hepatocellular carcinoma
is now a common malignancy in Egypt which usually develops on top of liver cirrhosis secondary to viral
infection, as hepatitis C viruses increased the risk of HCC in the Egyptian patients. Aim of the Work: was to
verify the possibility of using the plasma squamous cell carcinoma antigen level as a tumor marker for
hepatocellular carcinoma and to evaluate its prognostic value in management of HCC. Patients and Methods:
the study included 60 subjects divided into three groups: group I was 30 patients with hepatocellular
carcinomas, group II was 15 patients with liver cirrhosis and group III was 15 normal subjects serving as a
control group. Results: the plasma SCCA level was significantly higher in group I patients (with HCC), than
in the group II patients (cirrhosis) and control group. SCCA showed direct significant correlation with the most
of laboratory data specially AST, INR, number and size of lesion. Conclusion: plasma SCCA is a sensitive
and specific serum marker for the diagnosis of HCC and combination of AFP and SCCA in screening and
diagnosis of HCC yielded a better sensitivity in diagnosis of HCC.
Keywords: Squamous Cell Antigen, Alfa-foeto Protien, Hepatocellular Carcinoma, Therapeutic Intervention

INTRODUCTION
[abdominal ultrasonography, contrast-enhanced
Hepatocellular carcinoma (HCC) is the
computed tomography (CT) and magnetic resonance
seventh most common malignancy and the second
imaging (MRI)] and laboratory biomarker analysis
leading cause of cancer-related deaths worldwide.
[serum alpha-fetoprotein (AFP) levels, However, the
Globally, there are approximately 750000 new cases
diagnostic performance of imaging technologies is
and 700000 deaths of HCC reported per annum (1).
unsatisfactory, particularly for the diagnosis of small
Two well-known risk factors for HCC are chronic
lesions and early-stage HCC (3). AFP is the most
viral hepatitis B (HBV) and C (HCV), which
commonly used tumor marker for HCC diagnosis
account for 80%-90% of all HCC cases worldwide.
and prognosis prediction, but the false negative rate
Other risks for HCC include obesity, diabetes,
using AFP level alone is as high as 40% for patients
vitamin D deficiency, aflatoxin B1 exposure,
with early-stage HCC. AFP levels remain normal in
alcoholic and non-alcoholic liver cirrhosis.
15%-30% of all the patients, even patients with
However, the underlying mechanism of HCC has
advanced HCC (2). Studies have identified Squamous
not been entirely elucidated. Surgical resection and
Cell Carcinoma Antigen (SCCA), as a potential
orthotopic liver transplantation are the best curative
novel HCC serum marker. Two genes, which share
tools for the long-term survival of HCC patients.
a high degree of homology (up to 98%), encode for
However, surgical resection is not feasible in more
two 45 kDa, 390 amino acid-long proteins of the
than 80% of HCC patients because of tumor
same name, which are 92% identical at the amino
location, tumor size or severity of the underlying
acid level. The first isoform, SCCA1, is neutral
liver disease. Only 5%-15% of HCC patients are
while the second isoform, SCCA2, is acidic.
potentially resectable (2). The overall five-year
Importantly, a Third genetic variant of SCCA has
survival rate in patients with HCC is very low,
also been identified in a minority of HCC cases,
ranging from 5% to 9%. The cumulative five-year
which is characterized by a G351A polymorphism
recurrence rate is approximately 70% to 80% even
in the Reactive core of the protein (4). Of
after curative surgical resection. Recurrence after
significance is that serum (SCCA) is dramatically
resection generally results in a high rate of mortality.
elevated in patients with HCC, and the sensitivity
Current methods for HCC diagnosis are classified
and specificity of GP73 for HCC might be superior
into the following main categories: imaging
to those of AFP (5). Trans arterial chemo
5652
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 23)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5658-5665

Discontinuation Rates among Copper Intrauterine Device Users in Primary
Healthcare Unit and University Clinic. Is There a Difference?
Noha Mohamed Abd El Hafeez Ahmed, Rania Hassan Mostafa, Wessam Abuelghar, Gasser Elbishry
Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University
*Corresponding Author: Noha Mohamed Abd El Hafeez Ahmed, E-mail: nohaelzaydy@gmail.com, Tel: +202 01008309518
ABSTRACT
Background:
in Egypt, despite the high percentage of women using IUD according to Demographic and
Health Surveys (DHS) 2014 (52.9%) of total women using contraceptive methods, the discontinuation rates
among Cu-IUD users (within 12 months of use) reaches 14.3% in 2014. Aim of the Work: the aim of the
study was to compare between primary health care unit and university family planning clinic in
discontinuation rate among copper IUD users. Patients and Method: study design: prospective analytical
observational study. Study setting: This study was conducted at Family planning Outpatient clinic of Ain
Shams Maternity Hospital and El-Zahraa primary health care unit for a year. This study included 260 women
whom attending family planning clinic for Cu- IUD insertion. Total 100 subjects was enrolled from each
clinic. Rest of subjects was lost on follow up either after 6 months or 12 months. Some others refused to
participate or gave wrong personal contacts. Results: preliminary results of the study revealed that there is no
statistically significant difference between discontinuation rate among Copper IUD users in university clinic
and primary healthcare clinic (p-value = 0.095). Conclusion: in our Study, analysis of data revealed that age,
parity and previous usage of IUD may affect discontinuation rate after 12 months of IUD use. The mean cause
of IUD discontinuation was bleeding and Anemia was present in 66.6% of patients complaining from bleeding.
Keywords: CU-IUD: Copper containing intrauterine device, DHS: Demographic and Health Surveys, PID:
Pelvic inflammatory disease

INTRODUCTION
unintended pregnancies in Egypt(3). A sizable share
The intrauterine device (IUD) is one of the
(30%) of unintended pregnancies in developing
most widely used, reversible contraceptive methods
countries is due to contraceptive failure(7).
in the world(1). IUD is convenient, safe and highly
Unintended pregnancies can have many undesirable
efficacious. It is recommended as a first-line long-
physical, emotional and social consequences for
term contraceptive option for women of all
individuals. In 2012, 38% of all unintended
reproductive ages, including adolescent and
pregnancies worldwide ended in an unplanned birth,
nulliparous women(2). IUD is globally used by 15%
13% in miscarriage, and 50% in unsafe abortion
of women aged 15­49 years. In Egypt, the
(which is the third major cause of maternal mortality
percentage of women using IUD according to
worldwide)(7). The majority of cases of
Demographic and Health Surveys (DHS) 2014 is
contraceptive discontinuation are not due to the
52.9%(3). These high rates of IUD usage are due to
desire to get pregnant(9). Causes include both
its advantages such as reversible fertility
method-related failures (i.e., failure of a method to
immediately after removal, no need to daily
work as expected leading to accidental pregnancy)
reminder, no effect on breastfeeding, lack of
and user-related failures (i.e., failure stemming from
hormonal effects, no interference with sexual
incorrect of use or dissatisfaction with the method
activities and medications. But despite all of these
including side-effects and health concerns or no
advantages; it doesn't always succeed(4). Analyses of
further need (i.e. menopause) or method-
DHS data indicated that 38% of women with an
switching(1). In study held within 14 countries, the
unmet need for modern contraception have used a
median probability of discontinuing an IUD (within
modern method of contraception in the past but have
12 months of use) ranged from 9.6 % to 37.3%(1). In
chosen to discontinue use. This phenomenon, called
Egypt the discontinuation rate of IUD (within 12
contraceptive discontinuation, is defined as starting
months of use) was 14.3% in 2014(10). There is
contraceptive use and then stopping for any reason
evidence suggesting that the quality of services
while still at risk of an unintended pregnancy(5).
influences contraception discontinuation rates. IUD
Unintended pregnancy is common worldwide:
use was positively associated with the quality of
Eighty-five million pregnancies, representing 40 %
public family planning services in Egypt, which
of all pregnancies, were unintended in 2012(6). In
stresses the need to improve service quality,
2016, according to DHS there were 952, 000
particularly counselling, so that women are
5658
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 24)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5666-5672

Role of Surgery in Management of Discitis
Amr Hasan Yousef, Ahmed M El-Sherif, Yousef. A. Barakat
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University
Corresponding author: Amr Hasan Yousef, Mobile: 01060925550, Email: amrhasanyousef@gmail.com
ABSTRACT
Background:
discitis is an inflammation of the vertebral disc space which may spontaneous or post spinal
surgery; that is often diagnosed late. With good response to conservative treatment and in some condition the
plan of management is surgical. Aim of the Work: to assess the role of surgery in management of discitis and
which approach is appropriate, with comparison between conservative and surgical management and the
relationship between risk factors and outcome. Patients and Methods: this prospective and retrospective
study was conducted on 25 patients of specific criteria confirmed to have discitis by clinical presentation,
radiological findings and laboratory investigations. Results: discitis is more common in old age that occurred
in lumbar more that dorsal or cervical disc space with risk factors such as failed spinal surgery (40%), DM
(36%), HCV +ve (8%), TB (8%), Brucella (4%) and addiction (4%) of past history with affect the outcome.
There was a statistically significant relation between location of discitis and pre modified ranking scale, while
modified ranking scale pre and post management were statistically highly significant in each cervical, dorsal
and lumbar. Conclusion: both conservative and surgical management have good outcome. But we observed that
the risk factors like DM and addiction worsened the prognosis. We also observed that the shorter surgical maneuver
the better is the outcome.
Keywords: Discitis, failed spinal surgery, conservative and surgical management.

INTRODUCTION
symptoms. Over 90% of patients with bacterial
Discitis is an inflammation of the vertebral
discitis complain of back pain that is not relieved by
disc space often related to infection. The lumbar
rest or common analgesics. Localized tenderness to
region is most commonly affected, followed by the
palpation, muscle spasm, and worsening of
cervical spine and, lastly, the thoracic spine (1).
symptoms with movement are common. A
Discitis exhibits a bimodal age distribution, with
neurologic deficit is uncommon. Epidural abscess is
peaks in early childhood and after age of 50. A male
more common in chronically ill patients who are
predominance is seen. Risk factors for discitis
unfortunately unlikely to exhibit constitutional
include diabetes, old age, immunosuppression, IV
symptoms usually associated with abscess, such as
drug use, alcoholism, and renal failure. Although
fever and chills (4). Different modalities of imaging
rare, there is an increased risk of discitis following
are available for diagnosis as plain x ray, computed
invasive spinal procedures, estimated at 0.5% for
tomography, nuclear medicine studies, and magnetic
anterior cervical discectomy and 0.25% for lumbar
resonance imaging with specific criteria for each (4).
discectomy, with an overall rate of 0.1 to 4% of all
The most common laboratory abnormalities in
invasive spinal procedures. Postoperative discitis
patients with discitis are an elevated erythrocyte
accounts for approximately 20-30% of cases of
sedimentation rate (ESR) and elevated levels of C-
discitis (2). There is debate as to the cause, although
reactive protein (CRP), seen in over 90% of patients
(1)
hematogenous seeding of the offending organism is
. Non-operative treatment is effective in the
favored as well as direct spread. It is important to
majority of patients (up to 90%) and consists of 4-8
differentiate between spontaneous discitis which is
weeks of parenteral antibiotics and immobilization.
usually from hematologic spread from a
Percutaneous CT-guided drainage of paraspinous
genitourinary or respiratory infection versus that
abscesses larger than 2 cm may also be performed.
from a post-operative complication which usually
Surgery is indicated in cases of spinal cord
involves skin flora such as staph aureus. It can be
compression, instability, correction of mechanical
caused due to spinal tuberculosis and spread along
deformity, abscess, or severe persistent pain. In
spinal ligament to involve the adjacent anterior
cases where instability is present, the placement of
vertebral bodies,causing angulation of the vertebrae
fixation devices has not been shown to impede
with subsequent kyphosis. The cause may be aseptic
healing (2).
(3). The signs and symptoms of discitis are
AIM OF THE WORK
nonspecific, commonly leading to a delay in
This work aimed to assess the role of
diagnosis of 2 to 6 months on average after onset of
surgery in management of discitis and which
5666
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 25)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5673-5678

Comparison of Smoking Cessation Practices among Smoker and Non-smoker
Health Care Providers: A KAP Study in Northern Saudi Arabia
Abdullah Saud Alsaqry, Umer Farooq Dar, Altaf Hussain banday, Talal Mohammed Alsharari, Ayman
Khalil Alrushaydan
Al-Jouf University
Corresponding author: Abdullah Saud Alsaqry, E-mail: AbdullahAlsaqry@outlook.com, Mobile number: +966548448333
ABSTRACT
Background and objectives:
health care Providers (HCPs) are epicenters for counseling the smokers to quit
smoking and adopt healthy lifestyle based on informed decisions. The effects of smoking status of HCPs on
cessation practices are contradictory in published literature. The northern Saudi Arabia has high smoking
prevalence so is the need for cessation interventions. We carried out the KAP study to determine the difference
in knowledge, attitude and practices between smoker and non-smoker HCPs. Materials and Methods: using
non-probability consecutive sampling, 268 HCPs including physicians, dentists, pharmacists, nurses, and
paramedical staff were included from governmental Hospitals and primary health centers of Aljouf region. A
self-administered questionnaire containing Global Adult Tobacco Survey and standard practice guidelines for
smoking cessation intervention in Hospitals and primary care centers was used for data collection. Results: we
found that HCPs (14.92%) were current smokers, 2.6% were former smokers. Among female HCPs, there was
no reported active smoking but 48.94% reported passive smoking. Knowledge of hazards of smoking among
HCPs was up to standard. In addition, there was obvious misbelieve that Certain Types of Cigarettes Can Be
Less Harmful Than Other among all HCPs (Smokers and non-smoker HCPs significantly differed in advising
smoking cessation (p value < 0.01). Among other variables, increasing taxes on tobacco sale (p value < 0.01)
and applying standard guidelines for smoking cessation intervention (p value < 0.01) were significantly
different between groups. Lacking skills and facilities e.g. medical supply were the most frequency reasons for
not starting smoking cessation intervention. Conclusion: because of high prevalence of smoking among HCPs
and its negative effects on patient counseling, we suggested that there should be systematic and quality mechanism
intact for quitting smoking independent of personal attitude of health care providers and initiate training center
along with providing pharmacological supply for smoking cessation intervention in Aljouf region.
Keywords: Smoking, KAP, Hazards, Aljouf.

INTRODUCTION
Among HCPs, primary care physicians part is vital
Worldwide, all forms of tobacco use are an
for helping smokers quit starting from screening to
important and a preventable risk factor for a number
referral. In hospital-based studies highlighted an
of diseases such as cardiovascular disease,
absence of training and false convictions about
complications of pregnancy, stroke and a variety of
tobacco smoke and smoking cessation that turns off
cancers such as lung cancer (1,2). Simply smoking
clinicians from offering pharmacologic and mental
cessation may reduce and lessen the danger of death
support (13, 14) . United States (U.S.) Public Health
related to smoking by around 90%. The individuals
Service Guidelines known as ,,5 As (Ask, Advise,
who quit smoking may enjoy ten years increase in
Assess, Assist and Arrange) is recommended and
life expectancy and better quality of life in contrast
easier guidelines for the HCPs for helping the
to the individuals who proceeded with smoking (3,7).
patients who smoke to quit for life (3). This five A's
Primary Health Care Centers (PHCCs) and
framework has been developed to allow physicians
hospitals are places to implement smoking cessation
to incorporate smoking cessation counseling into
interventions. The start of smoking cessation
busy clinical practices (3). Smoking is much
intervention at primary health care level was found
prevalent among healthcare providers as compared
more powerful and successful than community-
to general population (13-15). The impact of smoking
based cessation programs (3-6, 8-12). At institutional
habits of the HCPs on smoking cessation activities is
level, the health care providers (HCPs) play a
not well documented. Some argue that HCPs could
pivotal role in controlling tobacco smoking by
better convince patients to quit smoking in the event
educating the general population about the risks of
that they themselves are not smokers. In the
tobacco. The smoking habits of the HCPs may or
previous study, the northern region has shown a
may not affect their abilities to use different
higher prevalence of smoking than other regions of
behavioral models for smoking cessation (4, 8-10).
Saudi Arabia (16). So studies focusing on northern
5673
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 26)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5679-5687

Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus
Local Wound Infiltration for Post Operative Analgesia in Patients Undergoing
Inguinal Hernia or Infra Umbilical Incisional Hernia
Zakria Abdel-Aziz Moustafa Sanad, Adel Mohamed Meselhi El-Ansary, Mohamed Mourad Mohsen
Mohamed Ali, Mohamed Sabry Abdel-Badei Ismael
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University
Corresponding author: Mohamed Sabry Abdel-Badei Ismael, Mobile: 01091757431, Email: drm7md.sabry@gmail.com
ABSTRACT
Background:
since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists
are trying their best to provide adequate post operative analgesia. The proper management of post operative
pain ensures early ambulation of patients and obviates many postoperative complications. Aim of the Work:
to compare the efficacy of transversus abdominis plane (TAP) block versus wound infiltration with local
anesthetic agent as regarding postoperative analgesia, its effect on hemodynamic changes (HR, BP) during
rest, opioid (pethidine) consumption. The patients included in this study were either of inguinal hernia or infra
umbilical incisional hernia. Patients and Methods: after obtaining approval from the medical ethical
committee in Ain Shams University, this prospective randomized clinical trial study was conducted in Ain
Shams University Hospital. It included fifty adult undergoing inguinal hernia or infra umbilical incisional
hernia repair. Results: patients were assigned randomly into two equal groups: Group A: (n = 25) TAP Block:
patients received general anesthesia followed by Tap block at the end of the operation. Group B: (n=25) Local
Wound Infiltration: patients received general anesthesia followed by local wound infiltration at the end of the
operation. Conclusion: bilateral TAP block was effective in reducing postoperative pain scores at rest and
movement for 8-12 hours and lower total 24-h postoperative opioid and analgesic consumption after inguinal
hernia or infra umbilical incisional hernia repair under general anesthesia, compared to local wound
infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter
insertion is contraindicated.
Keywords: Arterial Blood Pressure - Bronchial Asthma - Central Nervous System

INTRODUCTION
approach to enhance recovery after lower abdominal
The
most
common
modality
for
surgeries (4). Transversus abdominis plane (TAP)
postoperative pain management has remained the
block is a regional anesthetic technique which
parenteral use of non-steroidal anti-inflammatory
blocks neural afferents from the anterolateral
drugs (NSAIDs) and opioids. The infiltration of
abdominal wall. With the aid of ultrasound or
surgical wound with long acting local anesthetic
anatomical landmark guidance, local anesthetic is
agents has also remained a popular method to take
injected into the transverses abdominis fascial plane,
care of immediate post operative pain. This
where the nerves from T6 to L1 are located. The
technique is virtually cost free, rapid and hardly
initial clinical trials assessing the analgesic effect of
requires any special technical experience or
TAP blockade showed an effect for up to 24 h
equipment for its use. But as there are advances in
postoperatively (5).
anesthetic techniques, more and more regional
AIM OF THE WORK
blocks are being tried to take care of post operative
To compare the efficacy of transversus
pain. The choice of anesthetic block technique
abdominis plane (TAP) block versus wound
depends upon the site of surgical incision proposed.
infiltration with local anesthetic agent as regarding
Transversus abdominis plane (TAP) block is a novel
postoperative analgesia, its effect on hemodynamic
approach in which local anesthetic agent is injected
changes (HR, BP) during rest, opioid (pethidine)
into the plane between the internal oblique and
consumption. The patients included in this study
transverses abdominis muscles (1). This technique
were either of inguinal hernia or infra umbilical
was described by Kuppuvelumani et al.(2) in 1993
incisional hernia.
and was formally documented in 2001 by Rafi(3).
The technique of TAP block has been found to be a
PATIENTS AND METHODS
safe and effective tool in a variety of general,
After obtaining approval from the medical
gynecological, and urological surgery, and it is
ethical committee in Ain Shams University, this
suggested as part of the multimodal anesthetic
prospective randomized clinical trial study was
5679
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 27)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5688-5694

Study of the Bronchoreversibility and Outcomes in Patients with Chronic
Obstructive Pulmonary Disease (COPD)
Emam Abdelkader Mahmoud Al-Shareif, Khaled Mohamad Ibrahim Halema, Mohamad Al-Sayed
Abdulatif Nasr *
Pulmonary Diseases Department, Faculty of Medicine, Al-Azhar University
* Corresponding Author: Mohamad Al-Sayed Abdulatif Nasr: E-mail: abo.omar.noor89@gmail.com
ABSTRACT
Background:
acute bronchial reversibility after inhalation of short acting Beta2 agonists (SABA) has been
traditionally used to differentiate asthma from chronic obstructive pulmonary disease. However, it is clear that
a positive reversibility test does not exclude the diagnosis of chronic obstructive pulmonary disease. About
24% of patients with COPD met the criteria for reversibility. Aim of the Work: assessment of airflow
reversibility & outcomes in patients with COPD. Patients and Methods: this study was conducted at Chest
Department, Al-Hussein Hospital, Al-Azhar University and the Chest Hospital in Addakahliah Governorate in
the period between January & December 2017. The study included 30 patients with COPD; diagnosed and
classified according to [Global initiative for chronic Obstructive Lung Disease (GOLD), 2017]. Results: mean
PFT (FEV1, FEV1 / Pred. FVC % and PEFR) showed no statistically difference pre and post BDT. There was
highly statistically significant difference in PFTs (FEV1, FEV1 / Pred. FVC % and PEFR) at 4, 6 and 8 weeks
compared to Pre BDT. A highly statistically significant improvement in ABG (PaO2, PaCO2 and pH) was
found through weeks of study compared to baseline ABG. CAT test results showed highly significant
improvement after 8 weeks compared to 0 week. Conclusion: bronchoreversibility is not determined from the
first session of nebulizer. Moreover, mostly there is no difference in pulmonary functions mainly forced expiratory
volume in the first second between pre and post bronchodilator inhalation. To judge if there is airflow reversibility
or not, we must give the patient complete course of treatment for at least one month. Therefore, the lack of acute
response to short acting Beta2 agonists does not preclude the beneficial long-term response maintenance
bronchodilator treatment.
Keywords: Bronchoreversibility, Outcomes and Chronic Obstructive Pulmonary Disease.

INTRODUCTION
AIM OF THE WORK
COPD is a common, preventable and
This work was designed to assess the
treatable disease that is characterized by persistent
airflow reversibility & outcomes in patients with
respiratory symptoms and airflow limitation that is
COPD after two months of follow up with regular
due to airway and/or alveolar abnormalities usually
course of treatment mainly by bronchodilators,
caused by significant exposure to noxious particles
muscarinic antagonists & corticosteroids.
or gases (1,2). COPD is a debilitating disease
PATIENTS AND METHODS
associated with repeated respiratory events
(exacerbation, emergency room visit, hospital or
This study was conducted at Chest
ICU admission) or death (3). Acute bronchial
Department, Al-Hussein Hospital, Al-Azhar
reversibility after inhalation of SABA has been
University and the Chest Hospital in Dekerness,
traditionally used to differentiate asthma from
Addakahliah Governorate in the period between
COPD. However, it is clear that a positive
January & June 2017. The study included thirty
reversibility test does not exclude the diagnosis of
(30) patients with COPD; diagnosed and classified
COPD. About 24% of patients with COPD met the
according to (GOLD, 2017) (2). Ethical approval:
criteria for reversibility. Also, the bronchodilator
Informed consent was obtained from all patients
status (positive or negative) varied temporally and
enrolled in the study after explanation of the aim
did not differentiate clinically relevant outcomes (4).
and method of the research. Ethics Committee in
Bronchodilators and anti-inflammatory agents are
Al-Azhar University approved the study. All
used to reverse the bronchoconstriction, improve
patients are in stable or after exacerbation state
lung function, improve quality of life, improve
without significant co-morbidity. There were no
exercise capacity and prevent exacerbation (5). There
risks on patients. Target population: Smokers or
is a little information about bronchoreversibility of
ex-smokers (considering the smoking is a risk
COPD and its roles in diagnosis in Egypt. Therefore,
factor), those having COPD > 2 years and co-
further researches are required.
operative patients were included in the study.
5688
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 28)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5695-5704

Comparative Study between Intravenous and Intraperitoneal Magnesium
Sulphate as Adjuvant to General Anesthesia for Pain Management in
Laparoscopic Cholecystectomy
Mohamed Ahmed Mohamed Elfiky, Alsayed Mostafa Stohy, Wael Mohmed El Mahdy Ibrahim &
Ahmed Khedr Tolba Ibrahim*
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
*Corresponding Author: Ahmed Khedr Tolba Ibrahim, Email: dr.ahmedkhedr91@gmail.com
ABSTRACT
Background:
numerous researches have proved the benefits of laparoscopic cholecystectomy compared to the
open method, mainly because of less metabolic response to stress, maintenance of diaphragm and pulmonary
function, less postoperative complications, lower incidence of postoperative ileus, early mobilization, shorter
hospital stay, and a more cosmetic. The main presentation of postoperative pain is somatic, whereas visceral
pain is less present, and thus the pain is less in the patients operated by laparoscopic method. Aim of the
Work:
to compare intravenous Magnesium Sulphate with intra peritoneal Magnesium Sulphate as adjuvant to
general anesthesia for pain management in laparoscopic cholecystectomy. Patients and Methods: this
prospective randomized double blind clinical study using closed envelopes method was carried out on 100
adult patients, Undergoing laparoscopic cholecyctectomy in Bab-Alshaeria University Hospital, faculty of
medicine, Al-Azhar University. After approval by the Institutional Ethical Committee, and informed written
consent obtained from the patients, we randomly divided the patients into two groups 50 patients each.
Results:
the pain scores of group II (intra-peritoneal group) were significantly lower than group I (intravenous
group), the total opioid consumption postoperatively in group II(intra-peritoneal group) was highly significant
lower than group I (intravenous group). Also there was a significant reduction in opioid-related side effects
such as postoperative nausea and vomiting. Conclusion: the intraperitoneal administration of magnesium sulphate
is a safe and effective method in the management of acute postoperative pain after laparoscopic cholecystectomy
more than intravenous administration of magnesium sulphate.
Keywords: Intravenous and Intraperitoneal Magnesium Sulphate ­ Anaestesia - Laparoscopic
Cholecystectomy

INTRODUCTION
responses are likely to be due to increased release of
Laparoscopy has changed the surgical
catecholamines, vasopressin, or both. On the other
approach to symptomatic gallstone disease. The first
hand, magnesium sulphate (MgSO4) blocks the
laparoscopic cholecystectomy was performed in
release of catecholamines from both adrenergic
Europe in 1987 using a pneumoperitoneum. Many
nerve terminals and the adrenal gland, and
studies have shown the preference of laparoscopic
intravenous (IV) magnesium sulphate inhibits
cholecystectomy over open cholecystectomy, and
catecholamine release associated with tracheal
laparoscopic cholecystectomy has become the
intubation.
Moreover,
magnesium
produces
standard procedure for gallstone disease and was
vasodilatation by acting directly on blood vessels,
first called the `gold standard' in 1989 (1). However,
and high-dose magnesium attenuates vasopressin-
pain is the most frequent complaint after LC in 17­
stimulated
vasoconstriction
and
normalizes
41% of the patients and it is the main reason for
sensitivity to vasopressin (3). In addition, carbon
staying overnight in the hospital on the day of the
dioxide reacts with the tissue and activates the
operation (1). Consquently, Postoperative pain should
emergence of sour products, which put local
be effectively treated. Effective treatment serves to
pressure on the nerve endings of the peritoneum and
blunt autonomic, somatic and endocrine reflexes
the right phrenic nerve (4). Noxious stimulation leads
with a resultant potential decrease in perioperative
to the release of glutamate and aspartate, which bind
morbidity. The most common treatment practice is a
to various subclasses of excitatory amino acid
poly pharmacological approach (2). Pneumoperitoneum
receptors, including the N-methyl D-aspartate
with carbon dioxide (CO2) insufflation for
(NMDA) receptor. Activation of NMDA receptors
laparoscopic surgery induces a cardiovascular
leads to calcium and sodium influx into the cell,
response characterized by elevations of arterial
with an efflux of potassium and initiation of central
pressure and systemic vascular resistance with no
sensitization and windup. Magnesium blocks
significant change in heart rate. These vasopressor
NMDA channels in a voltage-dependent way, and
5695
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 29)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 5705-5708

Impact of Increased Maternal Body Mass Index on Pregnancy Outcomes
Ismail Talaat El Garhy, Ashraf Hamdy Mohamed 1, Hazem Sayed Shabban,
El-Hussien Mohamed Abdo 2 *
Obstetrics & Gynecology, 1 Faculty of Medicine, Alazhar University, 2 Police Authority hospitals
* Corresponding Author: El-hussien Mohamed Abdo, E-mail: drmetaphysics@yahoo.com, Tel: 01220114242
ABSTRACT
Background:
in the last decade, the prevalence of obesity has significantly increased in populations
worldwide and becomes epidemic. Obesity has been documented by World Health Organization (WHO) as "a
pandemic nutritional disorder. Egypt had the highest average Body Mass Index (BMI) and obesity in the
world. Aim of the Work: evaluation of the possible effects of increased body mass index on pregnancy and
measure its maternal, fetal and neonatal outcomes. Patients and Methods: the present study was approved
from alazhar research ethical committee. The present study was carried out in Obstetrics and gynecology out-
patient, Nasr city police hospital and El-hussien university hospital. Three hundred (300) pregnant women
were included in the study; they were divided into3 groups: Group I 150 pregnant women with normal weight
(BMI = 18.5 ­ 24.9 kg/m2). Group II: 75 pregnant women who are overweight (BMI = 25 ­ 29.9 kg/m2).
Group III: 75 pregnant women who are obese (BMI >= 30 kg/m2). Groups were subjected to full history
taking, clinical examination, obstetric palpation, ultrasound, investigations, antenatal care, post natal care and
neonatal assessment. Results: statistical significant relationship between increased BMI and incidence of
gestational hypertension, diabetes, postpartum hemorrhage and macrosomia. No Statistical significant
relationship was found between increased BMI and incidence of cesarean rate, wound infection and intra
uterine fetal retardation (IUGR). Conclusion: maternal obesity carries significant risks for the mother and fetus,
including maternal outcomes as increased incidence of hypertension, gestational diabetes, cesarean rates, and
postpartum hemorrhage. Fetal outcomes as macrosomia.
Keywords: Maternal Body Mass Index, Pregnancy Outcomes

INTRODUCTION
police hospital and El-hussien university hospital.
Egypt had the highest average Body Mass
The study was approved by the Ethics Board of
Index (BMI) and obesity in the world Obesity has been
Al-Azhar University. Three hundred (300)
documented by World Health Organization (WHO) as
pregnant women were included in the study; they
"a pandemic nutritional disorder" (1). Obesity is an
were divided into3 groups: Group I about 150
increased body fats accumulation to an extent that
pregnant women with normal weight (BMI = 18.5
affects the health negatively. It is defined as body mass
­ 24.9 kg/m2). Group II: 75 pregnant women who
index (BMI) equal or more than 30 kg/m2 BMI is
are overweight (BMI = 25 ­ 29.9 kg/m2). Group
calculated as weight in kilograms divided by height in
III: 75 pregnant women who are obese (BMI >= 30
meters squared. 25-30kg/m2 are considered overweight
kg/m2). Patients: Inclusion criteria: Pregnant
and those with BMI 30 are considered obese (2). All
women up to 40 weeks, Age ranged between 20 ­
the complications that occur in pregnancy are more
40 years, primigravidas. Their weights prior to 8
likely with obese gravid when compared to women
weeks gestation was estimated; either through her
with normal body mass indices (3). Maternal obesity
weight previously documented in her follow up
has many health implications with increased morbidity
card or from the patient's own words and recall
and mortality for both mother and fetus (4). According
with their pregestational BMI, Pregnancy of single
to the Confidential Enquiry into Maternal and Child
viable fetus and Patients with no medical disorders
Death obesity is associated with over half of the total
as Diabetes, Hypertension, chronic heart diseases,
maternal deaths (5).
thyroid dysfunction, chronic liver disease, adrenal
dysfunction and renal failure. Exclusion criteria:
AIM OF THE WORK
Diabetes, Hypertension, chronic heart diseases,
Evaluation of the possible effects of
thyroid dysfunction, chronic liver disease, adrenal
increased body mass index on pregnancy and
dysfunction and renal failure, Multiple pregnancy
measure its maternal, fetal and neonatal outcomes.
Multipara women, Cesarean section due to fetal
PATIENTS AND METHODS
distress or malpresentation, Pregnant women more
than 40 weeks gestation, BMIs were not within the
The present study was carried out in
previously mentioned parameters or didn't know
Obstetrics and gynecology out-patient, Nasr city
their pregestational weight and Age under 20 years
5705
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.7211 paper# 30)