c:\work\Jor\vol722_1 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3861-3866

Sonomammography versus MRI in Evaluation of BI-RADS III Breast Lesion
Hanan Mohammed Eisa, Eman Ahmed Shawki Genedi, Ayman Mohamed Ibrahim, Fatma Mohammed Helmy*
Department of Radio-Diagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Fatma Mohamed Helmy, Email: fatmahelmy2010@yahoo.com, Tel: 01114394769

Breast cancer is sometimes found after symptoms appear, but many women with breast cancer
have no symptoms. This is why regular breast cancer screening is so important, early detection and treatment are
the most important strategies to prevent deaths from breast cancer. Breast cancer that's found early, when it's
small and has not spread, is easier to treat successfully, regular screening tests are the most reliable way for early
detection. Objective: to high light the role of sonomammography versus Magnetic Resonance Imaging (MRI) in
evaluation of BI-RADS III (Breast Imaging Reporting and Data System) breast lesion.
Patients and Methods: in this retrospective study, 28 patients with BI-RADS III breast lesion were assessed by
Digital mammography (DM), Ultrasound (US) and MRI. The resultant images were correlated with reports of the
pathology specimens. Results: histopathological analysis was done for each lesion with 13 lesions (46.43%) proved
to be benign, 15 lesions (53.57%) proved to be malignant. The sensitivity, specificity, Positive predictive value (PPV)
and Negative predictive value (NPV) of mammography (MG), ultrasonography and MRI in BI-RADS III breast
lesions were calculated. Conclusion: BI-RADS III lesions group is a very critical group to deal with as it exhibits
characters of both malignant and benign lesions. According to our study Dynamic contrast enhanced - Magnetic
Resonance Imaging. (DCE-MRI) should go hand by hand with sonomammogaphy especially in BI-RADS III
patients group, patients with benign looking lesion six months follow up is recommended and those with malignant
looking lesion biopsy should be done.
Keywords: Breast lesion, BI-RADS, Mammography, Ultrasound, Magnetic resonance imaging.

image both breasts at once and works well even with
Breast cancer is the most common cancer in women
dense breast tissue. It is good at finding invasive breast
worldwide, this represents about 12% of all new cancer
cancer, imaging around breast implants, and detecting
cases and 27% of all female cancers (1). The BI-
possible spread of cancer beyond the primary tumour (8).
RADS stands for Breast Imaging Reporting and Data
The purpose of this study is to assess the role of
System which is a widely accepted risk assessment and
sonomammography versus MRI in evaluation of BI-
quality assurance tool in MG, US or MRI. It is
RADS III breast lesion.
classified into six categories: BI-RADS 0, I and II are

toward benign lesions, BI-RADS III: suspicious
abnormality, BI-RADS IV, V and VI are toward
The current study was performed on 28 patients
malignancy (2).
with suspicious breast lesion, their age ranges between
BI-RADS III is an intermediate category in the
35-55 years. The study was conducted in private
breast imaging reporting and data system, category 3
Hospitals during the period from 2015 to 2017. The
lesions are common at screening work up and despite
patients underwent full history taking and clinical
their low malignancy rate, they require additional 3-6
examination, MG, US and MRI examination.
months follow-up and in some scenarios a percutaneous
Inclusion criteria included patients diagnosed as
biopsy might be considered (3). The BI-RADS III is the
only group exhibiting similar likelihood for both
sonomammography or MRI while exclusion criteria are
malignant and benign lesions. The probability of a BI-
other BI-RADS categories.MG was conducted for all
RADS 3 lesion to be malignant and considered to be
patients using digital MG, both mediolateral oblique
less than 2%. Therefore, the work-up of a BI-RADS 3
and craniocaudal views with spot compression
lesion can be a biopsy or follow-up MG after 6 months
magnification view when necessary, images were
(4). One should be careful of using BI-RADS III in the
analysed regarding the presence of masses, architectural
postmenopausal breast or a breast that had a previous
distortion, asymmetrical density and calcification. The
cancer as fat necrosis, radiation changes and post
detected masses were described as regard size, site,
surgical scarring can change with time (5).
number, margin and density, also micro calcification
MG is low-energy X-ray to detect the breast
was described according to their shape and distribution.
cancer, typically through detection of characteristic
The breast lesion was classified according to the BI-
masses and/or microcalcifications (6). Adding breast US
RADS. Then US was done for all patients using a high
to screening mammogram (sonomammography) in
frequency probe (7.5 MHZ), scanning was done in two
women with dense breast helps to decrease the
planes (longitudinal and transverse). The lesions were
relatively high false negative diagnosis of breast cancer
classified into mass or non-mass like lesions, masses
(7). MRI is a non-invasive imaging technique that can
were evaluated according to their shape, orientation,
Received20: /3 /2018
Accepted:30 / 3 /2018

Full Paper (vol.722 paper# 1)

c:\work\Jor\vol722_2 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3867-3872
Incidence of Malignancy in Egyptian Patients with Cold Thyroid
Nodule(S): Retrospective Study
Mohamed Atta Hassanain Swelam, Seleim Saeed Abd Elrahman Elnemr,
Ahmed Mohamed EL-Sayed
Department of General Surgery, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohamed Atta Hassanain Swelam , E-Mail: dr.moodyatta@gmail.com , Mobile: 01110077875

: this study was to evaluate the incidence of malignancy in Egyptian patients with cold thyroid
nodule(s) after total thyroidectomy and histopathlogical analysis and the final result in our study was the
incidence of malignancy in Egyptian patients with cold thyroid nodule(s) was (20%).
Aim: the aim of the work was to evaluate the incidence of malignancy in Egyptian patients with cold thyroid
nodule either solitary thyroid nodule or dominant cold nodule in multi-nodular goiter through retrospective
study. Materials and Methods: the study was carried out on 30 Egyptian patients suffering from cold
nodule(s) in the thyroid gland. Patients were managed at Al- Azhar University hospital; Cairo; Egypt. The
study was controlled retrospectively. Ethical approval from the local Ethics Committee of Surgery
Department was obtained.
Results: according to the descriptive statistics of our study, the total number of cases was thirty patients,
twenty-six of them were females and four were males, also the mean age of studied group was (37.87). The
final results of post-operative histopathological examination were twenty-four cases diagnosed as benign and
six malignant cases.
Conclusion: in this retrospective study the final results of histopathological examination were 24 benign
cases (80%) and 6 cases were malignant (20%). So in our study the incidence of malignancy in Egyptian
patients with cold thyroid nodule(s) was (20%).
Keywords: Incidence of malignancy, cold, thyroid, nodule(s), retrospective study.

Cold nodule is a scintigraphy evidence
Thyroid nodules are often found on the
(hypo functional district node) on the thyroid.
gland, with a prevalence of 4-7%. The majority of
Cold nodes produce little or no hormones
nodules does not cause any symptoms and are
triiodothyronine (T3) and thyroxine (T4). To put it
non-cancerous. Non-cancerous cases include
differently, cold node is a part of thyroid nodule,
simple cysts, colloid
and thyroid
not representing in scintigraphy(4).
adenoma. Malignant nodules which only occur in
The most common neoplasm affecting the
thyroid gland is a benign adenoma, usually
follicular, papillary, medullary carcinoma and
presenting as a painless mass in the
metastases from other sites (1).
neck. Malignant thyroid cancers are most
Nodules are more likely in females, those
often carcinomas, although cancer can occur in
who are exposed to radiation, and in those who are
any tissue that the thyroid consists of including C-
iodine deficient. When a nodule is present, thyroid
cells and lymphomas. Cancers from other sites
function tests are performed and reveal whether a
also rarely lodge in the thyroid. Radiation of the
person has a normal amount of thyroid hormones
head and neck presents a risk factor for thyroid
"euthyroid" or an excess of hormones, usually
cancer, and cancer is more common in women
secreted by the nodule, causing hyperthyroidism
than men, occurring at a rate of about 2:1(5).
In most cases, thyroid cancer presents as a
When thyroid function tests are normal,
painless mass in the neck. It is very unusual for
an ultrasound is often used to investigate the
thyroid cancers to present with other symptoms.
nodule, and provide information such as whether
Most malignant thyroid cancers are papillary,
the nodule is fluid-filled or a solid mass, and
followed by follicular, medullary, and thyroid
whether the appearance is suggestive of a benign
lymphoma (6).
or malignant cancer. A needle aspiration biopsy
Because of the prominence of the thyroid
may then be performed, and the sample
gland, cancer is often detected earlier in the course
undergoes cytology, in which the appearance of
of disease as the cause of a nodule. A radioactive
cells is viewed to determine whether they
iodine uptake test can help reveal the activity and
resemble normal or cancerous cells (3).
location of the cancer and metastases.
Received:7 / 4 /2018
Accepted:16 / 4 /2018

Full Paper (vol.722 paper# 2)

c:\work\Jor\vol722_3 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3873-3878

Diaphragmatic Excursion Assessment by Ultrasound versus Volume Associated
Weaning Parameters as A Prediction in Extubation in Critically Ill Patients
Mohamed Ahmed Abdel Hamid Shaalan, Gamal Ali Badr ,Atef Abou Elfotouh Ibrahim , Amr Ahmed Mostafa .
The Department of Internal Medicine, Faculty of Medicine, Al-Azhar University,Cairo, Egypt

Background: Liberating a patient from ventilator is a continuous process as with any disease condition which
starts with recognition of patient being ready to be weaned from ventilator by letting the patient breathe on T-piece
and, if successful proceeding to SBT followed by extubation, if it is tolerated well (simple weaning). Otherwise
letting patient on ventilator till next such trial being successful. Difficulty in weaning from mechanical ventilation
is one of the most frequently encountered problems in MICU. An estimated 20% of mechanically ventilated
patients face failed extuabtion (requiring reintubation within 48 h of extuabtion).
Aim of the study: This study was designed to assess the value of the excursion of diaphragm tested by
ultrasonography to predict weaning from mechanical ventilation versus volume associated weaning
parameters in medical intensive unit's patients.
Patients and Methods: A prospective study was carried out on 30 patients
All patients were divided into two equal groups.Group A (successful weaning group) and Group B (failed
weaning group).
Results: Of the entire group of 30 patients, 21 patients (70%) had succeeded extubation and 9 patients (30%)
failed. By applying cut-off level 1cm determined in our study the sensitivity and specificity of mean liver and
spleen displacement were 95.2% and 88.9% respectively, which is higher than Pi max (85.7% and 77.8%) by
cut-off level 20 cm H2o, /VT (85.7% and 66.7%) by cut-off level 105 breath/min/l.
Conclusions: The present study concluded that ultrasonographic measurement of liver and spleen displacement
during SBT before extubation is a good method for predicting extubation outcome.Key messages
Keywords: Bedside ultrasonography , Critically ill , Diaphragmatic dysfunction.

key messages
What is the key question?
1. Can ultrasound measurements of diaphragmtic excursion during inspiration provide a
measure of extubation success or failure?
2.What is the bottom line?
We found that measurements of diaphragmic excursion outperform standard measures of extubation outcome.
3.Why read on?
Learn the rationale for using ultrasound measures of diaphragmtic excursion to predict extubation outcomes, how these
measures compares with other measures used to predict extubation success or failure.


Bedside ultrasonography has become a valuable
abdominal or cardiac surgery (2) and in critically ill
tool in the management of intensive care unit patients.
patients under mechanical ventilation (3).
This is especially true in emergency situations where
Since diaphragmatic motion plays a prominent
an adequate imaging technique is frequently limited by
role in spontaneous respiration, observation of the
a variety of factors, including difficulty of patient
diaphragm kinetics seems essential. The use of tools
transportation to the radiology department due to
previously available for this purpose is limited due to
illness severity. Ultrasonography is a noninvasive
the associated risks of ionizing radiation (fluoroscopy
technique, which has proved to be an accurate, safe,
or computed tomography) or due to their complex
easy to use bedside modality, overcoming many of the
and/or highly specialized nature, requiring a skilled
standard limitations of imaging techniques (1).
operator (trans diaphragmatic pressure measurement,
The diaphragm is the principal respiratory muscle,
diaphragmatic electromyography, phrenic nerve
and its dysfunction predisposes to respiratory
stimulation and magnetic resonance imaging) (4).
complications and can prolong the duration of
Sonography receives increasing recognition as a
mechanical ventilation. Sonographic evaluation of the
fast, easy and accurate method of noninvasively
diaphragm has recently started to gain popularity in the
evaluating diaphragmatic function at the bedside. In
ICU as specific needs for assessing diaphragmatic
the ICU population, it can quantify normal and
function arise in many clinical situations. Abnormal
abnormal movements in a variety of clinical conditions
diaphragmatic motion is observed in conditions such
as phrenic nerve injury, neuromuscular diseases after

Received:8 / 4 /2018
Accepted:17 / 4 /2018

Full Paper (vol.722 paper# 3)

c:\work\Jor\vol722_4 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3879-3885

Role of MRCP in The Assessment of Patients Undergoing Cholecystectomy
Marmar Essam Mahmoud Salama, Hossam Abd Elkader, Ahmed Mohamed Hussein
Radiology Department, Ain Shams Hospitals
Corresponding author: Marmar Salama, email: docmarmarsalama@gmail.com
Aim of the work: this study aimed to assess if the Magnetic Resonance Cholangiopancreatography (MRCP) in
patients undergoing cholecystectomy, changed the treatment plan or changed the operation method. Patients and
: this study was carried out in the Radiology Departments of Ain Shams University Hospitals. A total of
30 patients undergoing cholecystectomy were referred for preoperative MRCP. They were 20 (66.7%) females
and 10 (33.3%) males. Their age was ranged from 20-60 years old. Results: Among the 30 cases, 21 cases had
dilated common bile duct (CBD), 11 patients had CBD stones, 2 of which were silent, one case had silent CHD
stone, one case had Mirizzi type I syndrome, 3 cases had trifurcation of the CHD, 4 cases had cystic duct
anatomic variants and one case had duplicated GB. Conclusion: In candidate patients for cholecystectomy,
routine preoperative MRCP is mandatory for confirmation of the already known pathologies, detection of other
missed pathologies by US as well as detection of anatomical variants of biliary tract, these will help the surgeon
for replanning and adjusting the surgical approach to preventing or at least decreasing the probability of post
operative complications.
Keywords: MRCP, GB, Stones, cholecystectomy.


dimensional (2D) and three-dimensional (3D)
cholangiopancreatography (MRCP) is well known
projection images provide excellent detailed
to be a unique noninvasive technique for the
anatomy which is comparable to ERCP and
diagnosis of biliary obstruction. It is well suited to
provide the information required to plan the optimal
Choledocholithiasis also may be asymptomatic; or
therapeutic approach for these patients (1).
symptomatic with potential complications including
A preoperative diagnostic imaging procedure is
post-operative biliary leakage, recurrent biliary
essential for therapy in cholecystolithiasis.
colics, cholangitis, and pancreatitis adding further to
According to the S3-Guidelines of the German
the burden of management in gallstone disease.
Society for General and Visceral Surgery only an
Several studies were done to assess the importance
ultrasound scan is needed before a cholecystectomy.
of preoperative MRCP in reducing postoperative
But an anatomic variant of the bile ducts or
complications. However the role of routine use of
choledocholithiasis is poorly shown by an
pre-operative MRCP is still a matter of debate. So
ultrasound (2).
this randomized study was conducted to evaluate
Biliary anatomy and its common and
this role (4).
uncommon variations are of considerable clinical

interventions in hepatobiliary system, and
From January 2015 to January 2018, 30 randomized
laparoscopic cholecystectomy. Intrahepatic and
cases diagnosed as having acute or chronic
extrahepatic bile duct variations are commonly
cholecystitis and preparing for cholecystectomy,
seen. Normal biliary anatomy is seen in only 58% of
were referred from Tropical Medicine, General
the population. There are various techniques
Surgery, and Clinical Oncology departments to the
available for the visualization of biliary tree. In-
MRI unit at Diagnostic Radiology Department in the
travenous cholangiography often does not opacify
Ain Shams University Hospitals, for MRCP
the intra- and extrahepatic biliary tree and rarely
examination. The study was approved by the
allows a detailed visualization of the duct
Ethics Board of Ain Shams University.

cholangiopancreatography (ERCP), although very
Inclusion criteria
accurate, is an invasive method for imaging the
Both sexes were included
biliary tree. Intraoperative cholangiography is also
All patients ranging from 20 to 60 years old
highly accurate; however, it is an invasive
Exclusion criteria
procedure and its routine use remains controversial.
Patients known to have contraindications for
Magnetic resonance cholangiopancreatography
MRI, e.g. an implanted magnetic device,
(MRCP) is an excellent non-invasive imaging
pacemakers or claustrophobia.
technique for visualization of detailed biliary anat-
Any patient with symptoms suggesting
omy. High-resolution cross-sectional, two-
pancreatitis or cholangitis
Received: 3/ 4/2018
Accepted:12 / 4 /2018

Full Paper (vol.722 paper# 4)

c:\work\Jor\vol722_5 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72(1), Page 3886-3899

Effect of Buspirone on Fetuses of the Pregnant Rats
Nadia G. Zaki and Magdy H. Abouel-Magd
Narcotic Research Department, the National Center for Social and Criminological Research, Cairo, Egypt

Aim of the work
: the purpose of this study was to detect effect of buspirone hydrochloride (Buspar) on the
structure of cerebellum cortex of the fetuses of the pregnant rats. Material and methods: buspirone
hydrochloride tablets are an antianxiety. Buspirone hydrochloride (buspar) tablets were obtained from
SmithKline Beecham-Haram-Giza- Egypt. Thirty pregnant female rats were randomly categorized into
three groups (Ten pregnant female rats in each group). Group I (control group) pregnant rats were
administered oral doses of distilled water, group II: in this group pregnant rats were treated with buspirone
hydrochloride, they were administered oral doses of drug in the distilled water equivalent to 0.27 mg/100g.
body weight/day respectively for 15 days from the 6th day to the 20th day of gestation. , group III: pregnant
rats were treated with to oral doses of buspirone hydrochloride in the distilled water equivalent to 0.41
mg/100g. body weight/day respectively for 15 days from the 6th day to the 20th day of gestation. Pregnat rats
of all groups were sacrificed on the 20th day of gestation and their fetuses were obtained for the
histopathological and histochemical studies. Results: treatment of pregnant rats with buspirone
hydrochloride (buspar) showed many dystrophic changes in brain of their fetuses; these changes were more
obvious in case of the toxic dose of buspirone which resulted in some sorts of neurotoxic structural changes
in the cerebellum of fetuses of pregnant rats as evident by deformity in the cerebellar layers and
degeneration of Purkinje cells. Conclusions: buspirone hydrochloride (buspar) has many adverse effects on
the fetal cerebellum tissue.
Keywords: fetal rats, buspirone drug, cerebellum cortex, histopathology and histochemistry.


Anxiety is an emotion characterized by an
benzodiazepines, barbiturates or other sedative /
unpleasant state of inner feelings, often
anxiolytic drugs but it has an efficacy comparable
accompanied by nervous behavior, such as pacing
to diazepam in treating generalized anxiety
back and forth, somatic complaints and rumination
disorder(1-3). It is also effective against depression,
(1). Anxiety can be appropriate, but when
obsessive compulsive disorder, attention deficit
experienced regularly the individual may suffer
hyperactivity disorder. Buspirone hydrochloride
from a disorder. Anxiety disorder refers to specific
(molecular formula C21H32ClN5O2, molecular
psychiatric disorders that involve extreme fear or
weight 421.97 g/mol-1) is supplied as tablets for
worry, and includes generalized anxiety disorder
oral administration containing 5,7.5, 10 or15mg (4) .
, panic
This work aimed to study the structure of
agoraphobia, social anxiety disorder, selective
cerebellar cortex tissue of fetuses of pregnant rats
mutism, separation anxiety, and specific phobias(2).
treated with buspirone hydrochloride.
A number of psychoactive agents are

currently availablefor the treatment of anxiety. As
a class the benzodiazepineshave been most
frequently used, although some are associated with
-Drug used
sedative side effectsincluding impairment of
Buspirone hydrochloride (buspar) was
psychomotor and cognitivefunction. Consequently,
obtained as tablets from SmithKline Beecham-
therapeutic efficacy needsto be balanced against
Haram-Giza- Egypt. The drug was dissolved in
unwanted behavioral effects(3).
distilled water and given orally by a gastric tube.
Buspirone, an anxiolytic drug with selective
The daily single oral dose was 0.27 mg and 0.41
affinity for the 5-hydroxytryptamine receptor
mg/100g body weight/day respectively. The dose
(5-HT1A) subtype of serotonin receptor, Buspirone
for rats was calculated according to the method
hydrochloride 8-[4-(4-pyrimidin-2-ylpiperazin-1-
Paget and Barnes (5) formula on the basis of the
human dose.
hydrochloride , is an anti anxiety agent, a partial
- Experimental animals
agonist of serotonin receptor (5-HT1A) and a mixed
The present study was carried out on thirty
agonist/antagonist on dopamine receptors that is
Sprague dawley pregnant adult rats with average
not chemically or pharmacologically related to the
weight 150-200g. They were taken from the
Received : 17/5/2018

Accepted : 27/5/2018

Full Paper (vol.722 paper# 5)

EVALUATION OF RHOMBOIDAL FLAP IN RECURRENT PILONIDAL SINUS The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72(2), Page 3900-3903

Evaluation of Rhomboidal Flap in Recurrent Pilonidal Sinus
Magdy Mahmoud Mostafa, Mohamed Hassan Al-Kaseer, Ahmed Mohamed Said Hassan
General Surgery Department, Faculty of Medicine, Al-Azhar University

A pilonidal sinus (PNS) is a small cyst or abscess that occurs in the cleft at the top of the
buttocks. A PNS usually contains hair, dirt, and debris. It can cause severe pain and can often become infected.
If it becomes infected, it may ooze pus and blood and have a foul odor. The exact cause of pilonidal sinuses is
unclear. It is generally thought they are caused by loose hairs pushing into the skin. They could also be caused
by deep layers of skin being stretched and moved, leading to a hair follicle rupturing.
Aim of the Work:
The prospective study aimed at evaluating the outcomes of management of recurrent
pilonidal sinuses by rhomboid flap. Patients and Methods: A prospective study of cases with recurrent
pilonidal sinus, was done at the department of general surgery at In Al-Azhar University hospitals over the
period from July 2017 with medium follow up period of three months.
Results: Age: ranged between 17 to 36 years with mean = 24.7±5.57. Sex: included 12 male and 8 female.
Based on this study, it seems to us that the rhomboid flap is a good alternative for recurrent
sacrococcygeal pilonidal sinus, especially for complex sinuses, and it could be appropriate for cases where
simpler techniques have failed. It permits early return to complete activity, does not require prolonged
postoperative attention, and has very low recurrence rate and postoperative morbidity which may compensate
the inconveniences related to an unfavorable cosmetic look.
Keywords: Rhomboidal Flap, Recurrent Pilonidal Sinus, Sacrococcygeal Pilonidal Sinus.

Microscopically, the sinus where the hair
A pilonidal sinus (PNS) is a small cyst or
enters is lined with stratified squamous epithelium
abscess that occurs in the cleft at the top of the
with slight cornification. Additional sinuses are
buttocks. A PNS usually contains hair, dirt, and
frequent. Cyst cavities are lined with chronic
debris. It can cause severe pain and can often
granulation tissue and may contain hair, epithelial
become infected. If it becomes infected, it may
debris, and young granulation tissue. Cutaneous
ooze pus and blood and have a foul odor (1).
appendages are not seen in the wall of cysts,
The exact cause of pilonidal sinuses is
meaning the cysts lack epithelial lining, unlike the
unclear. It is generally thought that they are caused
sinus. Cellular infiltration consists of polymorpho
by loose hairs pushing into the skin. They could
neuclear lymphocytes (PMNs), lymphocytes, and
also be caused by deep layers of skin being
plasma cells in varying proportions. Foreign body
stretched and moved, leading to a hair follicle
giant cells in association with dead hairs are a
rupturing (2).
frequent finding (4).
It has been postulated that hair penetrates
In summary, 3 pieces are instrumental in
into the subcutaneous tissues through dilated hair
this process: (1) the invader, hair; (2) the force,
follicles, which is thought to occur particularly in
causing hair penetration; and (3) the vulnerability
late adolescence, though follicles are not found in
of the skin. This process has been well
the walls of cysts. Upon sitting or bending, hair
characterized by Patey and Scarff as well as a
follicles can break and open a pit. Debris may
number of other authors from the second half of the
collect in this pit, followed by development of a
20th century through today (5).
sinus with a short tract, with a not clearly
We used a full thickness rhomboid-shaped
understood suction mechanism involving local
flap which extends down to the gluteal fascia. This
anatomy, eventually leading to further penetration
was then rotated into the defect created by excising
of the hair into the subcutaneous tissue.
the diseased tissue down to the presacral fascia.
This sinus tends to extend cephaled, likely
These flaps were renowned for their robust
owing to mechanical forces involved in sitting or
vascularity and therefore flap necrosis was not a
bending. A foreign body-type reaction may then
major issue. Rather, the common complications are
lead to formation of an abscess. If given the
seroma or wound separation. These are variations
opportunity to drain spontaneously, this may act as
of the rhomboid flap including the limberg and
a portal of further invasion and eventually
dufourmental flaps. The limberg flap has been
modified and has successfully decreased the wound
of a foreign body granuloma. Infection may result
infection and separation rates even further. The
in abscess formation (3).
modified limberg flap involved lateralizing the

distal part of the midline suture line (6).

Received: 14/04 /2018
Accepted: 23/04/2018

Full Paper (vol.722 paper# 6)

A The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72(2), Page 3904-3908

Comparative Study between Alvarado Score and Appendicitis Inflammatory
Response Score in Diagnosis of Acute Appendicitis
Hesham Wefky Anwar, Ahmed Mohammed Elsayed,
Hesham Sayed Ahmed Ahmed
General Surgery Department, Faculty of Medicine, Al-Azhar University

The appendix is a worm like extension of caecum and for this reason has been called "vermiform
appendix". Appendicitis may occur due to several reasons, such as an infection of the appendix, but the most
important is the obstruction of appendiceal lumen. Acute appendicitis has remained the most common acute surgical
condition of the abdomen in all ages and of course, a common disease in surgical practice. The usual picture of
appendicitis is often not classical, leaving in many cases a diagnostic problem. In patients with questionable
findings, the aggressive surgical approach has been "when in doubt, take it out, "and the price paid is the frequent
removal of normal appendix. Aim of the Work: The aim of the work is to evaluate the appendicitis inflammatory
response (AIR) score and compare its performance in predicting the risk of appendicitis to the Alvarado score.
Patients and Methods:
In this randomized prospective study, 100 patients with acute pain in right lower quadrant
of abdomen were admitted to the surgical department of Al-Hussain University Hospital in the period from June
2017 to October 2017. All the patients had indications for appendectomy. The present study was carried out among
patients suffering from acute pain in right lower quadrant of abdomen. Results: This randomized prospective study
comprised 100 patients, of whom 52 were females (52%) and 48 were males (48%). Their ages ranged from 16 to 42
years old with a mean age of 21 years. These 100 patients were presented with acute pain in right lower quadrant of
abdomen. All female cases proved to be pregnant were excluded from the study. Recurrent sub-acute appendicitis
were also excluded from the study. Patients with known abdominal malignancies or previous abdominal surgery
were also excluded from the study. Conclusion: This prospective study comprised 100 patients with acute right iliac
fossa pain for evaluation and comparing between Alvarado score and AIR score in diagnosis of acute appendicitis.
The present study showed that the AIR score has a good statistical discrimination for patients with acute appendicitis
and outperforms the Alvarado score.
Keywords: Alvarado Score, Appendicitis Inflammatory Response Score, Acute Appendicitis.


The appendix is a worm like extension of
have appendicitis and the scenario continues to pose
caecum and for this reason has been called
a diagnostic challenge [6].
"vermiform appendix". Appendicitis may occur due
The Alvarado score is the best known
to several reasons, such as an infection of the
clinical predicting rule for estimating risk of
appendix, but the most important is the obstruction
appendicitis. It is based on a combination of
of appendiceal lumen [1].
symptoms, signs and basic laboratory results and
Acute appendicitis has remained the most
has been the subject of many validation studies [7].
common acute surgical condition of the abdomen in
It's use in routine clinical practice is varied
all ages and of course, a common disease in surgical
and limitations included overestimating the risk of
practice [2]. The usual picture of appendicitis is often
appendicitis in women and children have been
not classical, leaving in many cases a diagnostic
noted [8].The appendicitis inflammatory response
problem. In patients with questionable findings, the
score (AIR) is based along the same principles of
aggressive surgical approach has been "when in
the Alvarado score, assigning patients to low,
doubt, take it out, "and the price paid is the frequent
medium or high probability of acute appendicitis. It
removal of normal appendix [3].
incorporates CRP as a variable in the score, a
widely available laboratory test that has not shown
commonest cause of acute abdomen that is
sufficient sensitivity or specificity to be used as a
responsible for over 40,000 hospital admissions per
stand-alone test to predict the risk of appendicitis [9].
year in England, and more than 200,000 operations

per year in the United States [4].
The lifetime risk of having appendicitis is
The aim of the work is to evaluate the AIR
8.6% for males and 6.7% for females, while the
score and compare its performance in predicting the
lifetime risk of appendicectomy is 12 % for males
risk of appendicitis to the Alvarado score.
and 23.1 % for females [5].
The study was approved by the Ethics
Despite this, the majority of patients who
present with acute right iliac fossa (RIF) pain do not

Received: 14/04 /2018
Accepted: 23/04/2018

Full Paper (vol.722 paper# 7)

c:\work\Jor\vol722_8 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72(2), Page 3909-3913

Overview of Allopurinol Decisions in Primary Care: A Narrative Review
1Multag Jaual Alqahtani, 2Abdullah Mohammad Alshamrani
1Primary Care Unit, Jubail General Hospital, 2Health Care Center, Ministry of Health, Khobar, KSA
Corresponding author: Mutlaq Alqahtani ,E-mail: mutlaq.j@gmail.com, Tel no: +966536565683

Allopurinol is a type of drug called a xanthine oxidase inhibitor. It functions by lowering the
production of uric acid in the body. It can be found in the kind of an oral tablet. Generalist physicians, specifically
general internists and primary care physicians, are usually the first to see individuals with gout and for that reason
play an essential role in the diagnosis and management of these patients. Gout is mostly managed in primary care and
lasting treatment aims to reduce serum uric acid degrees with using allopurinol. Urate lowering therapy is indicated in
patients who have had an acute gout attack and whose uric acid level remains high, increasing the risk of a subsequent
attack. The effect of allopurinol on uric acid level is dose dependent and variable. Aim of the Study: In the present
review, we aimed at discussing the indications of Allopurinol in primary care along with its benefits and side effects
which should be considered by patients and physicians before prescribing it. Methods: Narrative review was
conducted using electronic database such as; PubMed/Medline, Embase, Google scholar, for relevant articles related
to our concerned topic which is about the usage of allopurinol in primary care and methods that family doctors use to
make a decision about the usage, published up to 2018. Conclusion: The benefit-risk balance of allopurinol should
be carefully assessed with respect to the patients' condition and medical profile before prescription in the PCU.
Keywords: Allopurinol, Primary Healthcare, xanthine oxidase inhibitors.

be concerned by patient and doctor before prescribing
Allopurinol, a xanthine oxidase inhibitor, is one of
the most frequently utilized hypouricemic agents. It is

generally utilized for lasting control of gout, prevention
of tumor lysis syndrome, and the control of
The present narrative review was conducted using
hyperuricemia in chronic kidney illness. Moreover, its
electronic database such as; PubMed/Medline, Embase,
valuable duty as an antioxidant suggests a potentially
Google scholar, for relevant articles related to our
novel use for this drug [1]. In spite of its reliable
concerned topic which is about the usage of allopurinol
hypouricemic result, allopurinol can create adverse
in primary care and methods that family doctors use to
responses in 2% to 8% of users, ranging from cutaneous
make a decision about the usage, published up to 2018.
hypersensitivity responses to the possibly serious
Restriction were applying to only English language
allopurinol hypersensitivity syndrome (AHS), which
articles with human subject.
causes fatality in up to 27% of cases[2]. Allopurinol is

reported to be a typical source of Stevens-Johnson
Allopurinol Decisions in Primary Care
syndrome and complex renal failure[3].Allopurinol-
The Relationship between Uric acid, Gout and
induced unfavorable reactions have been reported to
develop in organization with inappropriately high
dosage, renal insufficiency, concurrent use diuretics,
internists and primary care physicians, are frequently
and the existence of the HLA-B * 5801 allele [4].
the very first to see patients with gout and consequently
Accumulation of oxipurinol, a major metabolite of
play a critical function in the diagnosis and
allopurinol, was suggested as a feasible reason for the
management of these patients. Gout is a major concern
negative responses, and a guideline of dosage
globally and is the most common kind of inflammatory
adjustment according to creatinine clearance has been
arthritis. The threat of both an initial gout attack and
suggested [5]. However, many researches on the risk
reoccurring gouty arthritis increases with uric acid
elements for allopurinol generated unfavorable
levels. Hyperuricaemia, a prerequisite for gout, is
occasions have concentrated on a minimal set of threat
related to the metabolic syndrome and is an
variables, and several recent research studies could not
independent danger factor for chronic kidney illness,
validate these previous threat elements.
stroke and perhaps ischaemic heart disease .It is
In this review we discuss the usage of allopurinol in
connected with multiple damaging health results,
primary care, it benefits and side effects which should
including hypertension, heart disease and is involved as
Received: 13/04 /2018
Accepted: 22/04/2018

Full Paper (vol.722 paper# 8)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3914-3917
Ultrasound Guided Therapeutic Excisional Vacuum Assisted Biopsy in
Fibroadenoma (BIRAD3 Lesions)
Ahmed Mohamed Monib, Ahmed Hassan Soliman, Haneen Ahmed Najeeb
Department of Radiology, Ain -Shams University
Corresponding author: Haneen A. Najeeb, Mobile: 01008550975; Email: Iphoneiraq93@yahoo.com

Our study showed that ultrasound-guided, vacuum-assisted excision can play an efficient role in
the diagnosis of benign breast lesions and is a safe and successful alternative treatment of fibroadenomas.
Although the breast fibroadenoma is a common benign breast tumor, the treatment and follow-up of these
lesions is still debatable. We suggest that UGVAB, which has a well-documented role in the diagnosis of breast
lesions, may provide an option for the definitive treatment of breast fibroadenomas.
The objective of our work was to evaluate ultrasound-guided, vacuum-assisted excision (UGVAE)
as an alternative approach in the diagnosis of radiologically benign breast lesions.
Patients and Methods:
We prospectively evaluated breast lesions excised using VAB between April -October
2017 at Ain-Shams University /interventionl radiology unit at radiology department, which had a proven
diagnosis of fibroadenoma. An informed consent form was obtained from each patient of a total of 25 cases
ultrasound-guided VABB using biopsy system. All patients have been subjected to breast ultrasound
Results: Thirteen patients developed hematomas during UGVAE but none needed surgical intervention, while
twelve patients pass with no significant hematomas, with 100% cure rate. None of the patients experienced
significant enough pain to require the cessation of the procedure, although 22 (88%) patients reported mild pain
and moderate pain (12%) during procedure. At the two week control, 3(12%) patients reported taking
paracetamol for mild pain. In ten of them (40%) the pain was strong enough to interfere with sleep.
Vacuum assisted Ultrasound-guided biopsy allows real-time imaging, could be performed without
breast compression, and is the preferred method if the lesion is detectable with ultrasound.
Breast fibroadenomas - Vacuum assisted excisional biopsy - ultrasound-guided, vacuum-assisted


Breast fibroadenomas (FA) are a common
costly, since it requires an operating room and
cause of a benign discrete palpable lump in females
sometimes hospitalization. Because it can extract large
(1). They are relatively more common in patients aged
volumes of tissue, VAB can also be used for the
between 15 and 35 years. They often present as a
excision of benign breast lesions (5).
painless mobile breast lump which are discovered
Cost-effectiveness has been proved, and
incidentally in the majority of cases by the patients
this procedure is currently approved for the
themselves. They can also be discovered during
resection of breast fibroadenomas and other types
investigations for other breast conditions or during
of benign breast lesions which usually are
routine screening imaging or examination. They may
removed in the operating room. With US-VAB,
either remain static, continue to grow or decrease in
these patients may avoid going into surgery if the
size. (2).
lesion is confirmed to be benign.
Sixty nine percent of breast lesions
As it is a procedure performed under
undergoing open surgical biopsy were found to be
image guiding, the radiologist is professional to
benign (3) and fibroadenomas (FA) constitute about
deal with this technique (6).
50% of those lesions (4).

Vacuum assisted excisional biopsy (VAB)
utilizes large bore needles and can extract larger tissue
The objective of our work was to evaluate
samples compared to fine needle biopsy and core
biopsy. This method leads to a decrease in the rate of
(UGVAE) as an alternative approach in the
negative biopsies as well as a decrease in discordance
diagnosis of radiologically benign breast lesions.
between the biopsy material and surgical specimen.

VAB is also recommended for lesions located close to
the thoracic wall or nipple, since it does not employ a
We prospectively evaluated breast lesions
forward moving needle. Benign lesions may need to be
excised using VAB during the period between
removed if they grow, or symptomatic or produce
April -October 2017 at Ain-Shams University
anxiety to the patient. However, surgical excision is
/interventionl radiology unit which belong to
Received: 17/04 /2018
Accepted: 26/04/2018

Full Paper (vol.722 paper# 9)

c:\work\Jor\vol722_10 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3918-3923
Risk Factors for Post-Operative Thyroid Related Complications in Patient
Undergoing Thyroidectomy: A Single Center Study
Fatemah Saleh AlTheyab1, Renad Nasser AlOnazi1, Ibtehaj Mohammed AlHarbi1,
Hessa Mohammed AlHarbi1, Sultan AlSaigh2
1.Collage of Medicine, Qassim University, Saudi Arabia, 2. General Surgery Consultant, Head of General
Surgery Department King Fahad Specialist Hospital-Buraidah.
Corresponding Author: Fatemah Saleh AlTheyab, Tel: 00966 565472636, Email: fatimah.saleh23394@gmail.com

Thyroid diseases are one of the most prevalent endocrinopathies globally (1). Most of the thyroid
diseases treated surgically. The operation duration is under multiple factors can be predicted preoperatively (2).
Hypocalcaemia and nerve injury are serious complication after thyroid surgery and we hypothesized it could be
prevented by simple measures to avoid such complications.
Objective: Was to assess the correlation between thyroidectomy operating time, histo-pathological diagnosis of
thyroid disease and pre-operative vitamin D supplementation with post thyroidectomy complications mainly
hypocalcaemia and nerve injury. Method: An observational retrospective cohort study with a total of 187
patients who underwent thyroidectomy from October 7th 2013 to January 4th 2018 were included in this study.
Data were analyzed for demographic information including age, sex, nationality, height and weight. Information
about the use of vitamin D supplementation before or after the operation, the clinical and the histological
diagnosis of thyroid diseases, the name of the procedure (partial or total thyroidectomy), and the presence of
any complications. Result: The mean age of the patients was 39.7±12.71 years. 81.8%(153) were females and
18.2%(34) were males. 53.5%(100) were given Vitamin-D supplements before or after the surgery.
Histopathology showed that the most prevalent type was papillary Carcinoma accounting for 68 (36.4%). No
significant association between histological diagnosis and complication of hypocalcaemia and nerve injury.
Mean duration of surgery performed was 135.61±47.668. 83 of our patients suffered from hypocalcaemia and
6 suffered from nerve injury. When correlating between duration of surgery with hypocalcaemia and nerve
injury, The independent t-test was associated with statistically insignificant effect t(182)= -1.85 , p= 0.066
(>0.05) for hypocalcaemia and t(185)= -0.075 , p= 0.940 (>0.05) for nerve injury.
Conclusion: Our study suggested that there was no significant correlation between the duration of surgery as
well as histo-pathological diagnosis and the development of post-operative hypocalcaemia and nerve injury.
Keywords: Thyroidectomy, Post-operative hypocalcaemia, Post-operative nerve injury, Complications,
Vitamin D.

factor for postoperative hypocalcaemia is vitamin D
Thyroid diseases are one of the most prevalent
preoperative and postoperative supplements. A
endocrinopathies globally, however, the importance
randomized controlled trial of alfacalcidol
of thyroid diseases is recently identified and now is
supplementation. The results showed that
considered as one of the non-communicable diseases
preoperative and postoperative supplementation
that affect the community. In Saudi Arabia thyroid
decreased transient hypocalcaemia (5). Another
ranked as fourth in male and second in female as
randomized controlled trial was conducted to assess
most prevalent cancer and it represents 6.1% of
the efficiency of preoperative and postoperative
newly diagnosed cancers, thyroid cancer is the most
calcium and vitamin D supplementation to prevent
common endocrine malignancy and it accounts 87%
postoperative hypocalcaemia. The results confirmed
of all endocrine gland cancers (1). Most of the thyroid
decreased postoperative hypocalcaemia (6). A
diseases treated surgically especially when medical
systematic review and meta-analysis reported a
treatment fails, cosmetic purposes or when thyroid
significant decrease in postoperative hypocalcaemia
cancer extensively invading the surrounding
in patients who received oral calcium or vitamin D
structures. The operation duration is under multiple
supplementation (7). Hypocalcaemia and nerve injury
factors can be predicted preoperatively (2). A study
were serious complication after thyroid surgery and
was conducted in tertiary referral center state that
we hypothesized it could be prevented by simple
operation duration more than 120 min will lead to
measures to avoid such complications. Our aim of
hypocalcaemia (3). Where was another study stated
this study was to estimate the relationship between
that there was no correlation between long operation
thyroidectomy operating time and postoperative
duration and postoperative complications (4).
complications mainly hypocalcaemia and nerve
injury and assess the correlation between

Received: 15/04 /2018
Accepted: 24/04/2018

Full Paper (vol.722 paper# 10)


Full Paper (vol.722 paper# 11)

c:\work\Jor\vol722_12 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3930-3934
Prevalence and Risk Factors of Dyspnea among General Population of
Arar City, Kingdom Saudi Arabia
Abdulelah Aziz Eissa Alenzi1, Osama Alsallum Alanazi1, Tariq Hulayyil Alanazi1, Abdulwahab
Mabkhoot Ali Meqbel2, Nasser Theeb Alqahtani3, Munirah Abdullah Almakhayitah4, Wejdan jumyaan
alharbi5, Israa Abed Alfadhli5, Wijdan Salem Almatrafi5, Asma Salem Almatrafi5
1Faculty of Medicine, Northern Border University, 2Faculty of medicine, King Khalid University,
3Faculty of Medicine, King Saud University, 4 Faculty of Medicine, King Faisal University,
5 Faculty of Medicine Umm-Alqura University

Dyspnea is defined as the subjective experience of breathing discomfort. It is increasing by age
and it is a common problem affecting up to half of patients admitted to acute, tertiary care hospitals and also
affecting one quarter of ambulatory patients.Study objective: to determine the prevalence and risk factors of
dyspnea among general population of Arar city, Northern Border Province, Saudi Arabia. Methods: This was a
cross-sectional, community-based study. It was conducted on the general population of Arar city during the
period from 1st October, 2015 to 30th June 2016.Data were collected using a predesigned online self-
administered questionnaire covering all the needed items. Results: Dyspnea was reported in 35.2% of the study
population. Causes of dyspnea reported in our study were mainly of unknown causes (38.6%), bronchial asthma
(23.9%), allergy (22.7%), psychological causes (12.5%), cardiac causes (1.1%), and COPD (1.1%).It was more
common among females as 44.8% of females reported dyspnea while it was reported in only 31.7% of males.
Our study has also shown that dyspnea was most prevalent among the < 20 age group by ratio as 52.6% of them
reported dyspnea. However, 36.1% of subjects aged between 20 and 40 have reported dyspnea. Precipitating
causes of dyspnea were found to be mostly due to dust (30.7%), smoking (22.7%), climate changes (14.7%),
nervousness (13.6%), specific food/ingested material (11.4%), and excess physical activities (6.8%). It was also
founded in our study that 56.5% of participants with family history of dyspnea suffered from dyspnea. While
72.9% of those who did not have a family history of dyspnea did not suffer any dyspnea. Conclusion: Dyspnea
was reported in 35.2% of Arar population. Our study showed that dyspnea was more common among females
than males. large scale study with detailed investigations about causes and precipitating factors are required.
Dyspnea, hard breathing, Prevalence, chronic disease.


Chronic respiratory diseases represent a group of
having less oxygen available, you may also
diseases characterized by abnormal condition of the
experience temporary dyspnea. At extremely high
respiratory system such as inflammation of the
elevations, such as mountaintops, the air can be a real
airways, airflow obstruction, chest pain, dyspnea,
health hazard[4]. Also dyspnea may occur due to
hemoptysis, and sputum production[1]. It became a
medical condition and it appear in a sudden
predominant cause of morbidity and mortality,
breathlessness, as in heart failure, low blood
especially in the resource-poor countries such as
pressure, pneumonia, pulmonary embolism, carbon
South and Southeast Asia and Africa[2].
monoxide poisoning, stress or anxiety or may also
Dyspnea is a normal symptom of heavy exertion
experience sudden dyspnea if a piece of food or some
but becomes pathological if it occurs in unexpected
other object blocks your airway[5].
situations[3] or light exertion. In 85% of cases it was
An injury that harms a lung or causes a rapid loss
due to asthma, pneumonia, cardiac ischemia,
of blood will also make breathing more difficult, and
interstitial lung disease, congestive heart failure,
all this cases are considered as acute dyspnea but
when shortness of breath isn't a sudden emergency,
psychogenic causes[4] such as panic disorder and
but is instead a problem that lingers for at least four
anxiety. Dyspnea is known as a subjective experience
weeks, it's considered chronic cases as in chronic
of breathing discomfort that consists of qualitatively
obstructive pulmonary disease (COPD), interstitial
distinct sensations that vary in intensity" or as the
lung disease (scarring of lung tissue), poor physical
experience of breathlessness which may be either
conditioning, obesity, heart disease[6].
acute or chronic[3]. There are many causes of
The symptoms of chronic dyspnea appear in
dyspnea, it may occur in normal condition such as,
sensation of just not getting quite enough air into
exercise is usually a trigger for short-term dyspnea or
lungs all the time. In serious cases, you may feel as
when you at a higher elevation and you're not used to
though you're suffocating. Bouts of dyspnea may also
Received: 17/04 /2018
Accepted: 26/04/2018

Full Paper (vol.722 paper# 12)

c:\work\Jor\vol722_13 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3935-3940
Hyper- and Hypoglycemic Coma among Diabetic Patients in Arar,
Northern Saudi Arabia
Nada Kareem S Alruwaili1, Yasamiyan Mohammed A Alanazi1, Seham Mohammed Alanazi2,
Wafaa Kareem S Alruwaili1, Almaha Ahmad Abdulaziz Alali1, Zaynab Hussain M Almukalaf1,
Noof Saud J Alenezi1, Shouq Saud J Alanazi1, Razan Mohammed G Aldahmashi1
1 Faculty of Medicine, Northern Border University, Arar, 2 Almaarefa Colleges for Science and Technology,
College of Medicine, Riyadh, KSA

Diabetic coma is a reversible form of coma found in people with diabetes mellitus. It is a medical
emergency. Three different types of diabetic coma are identified; Severe low blood sugar in a diabetic person,
diabetic ketoacidosis (usually type 1) advanced enough to result in unconsciousness from a combination of a
severely increased blood sugar level, dehydration and shock and exhaustion, hyperosmolar non ketotic
coma (usually type 2) in which an extremely high blood sugar level and dehydration alone are sufficient to
cause unconsciousness. The aim of this study was to determine the prevalence of diabetic coma among the
studied diabetic patients and to illustrate the relationship between type of diabetic coma and type of DM, period
of diabetes and place of management of coma. Methods: A cross-sectional study was carried out on 113
diabetic patients (both type I and II DM) in Arar city, Northern Saudi Arabia, KSA, during the period from 1
December to 30 June 2017. Data collected by a pre-designed online self-administered questionnaire.
Results: The mean age of participants was 35.62 (±21.62) years and 67.3% were females. The prevalence of
diabetic coma among the studied diabetic patients was 57.5% and the type of coma was hypoglycemic in 70.7%
and hyperglycemic in 29.3%. 42.1% of hyperglycemic coma patients had type I diabetes and 57.9% had type II.
While, 50% of hypoglycemic coma patients had type I diabetes. On the hand, 21.1% of hyperglycemic coma
patients treated in the emergency department, 10.5% admitted to the hospital and 68.4% treated at home. While
34.8% of hypoglycemic coma patients treated in the emergency department, 6.5% admitted to the hospital and
58.7% treated at home. There was no significant relation between type of DM and type of diabetic coma (P=
0.562) or between period of diabetes and type of diabetic coma (P= 0.060). Conclusion: The prevalence of
diabetic coma among the studied diabetic patients was 57.5% and the type of coma was hypoglycemic in 70.7%
and hyperglycemic in 29.3%. We recommend to spread awareness of the diabetic patients about causes and
manifestations of diabetic coma to guard against it. Also we recommend a large scale and more detailed
Keywords: Hyper and Hypoglycemic Coma; Type I and Type II diabetes; Diabetes emergency; Arar, Northern
Saudi Arabia


The complications of diabetes mellitus are far less
diabetic patients and to illustrate the relationship
common and less severe in people who have well-
between type of diabetic coma and type of DM,
controlled blood sugar levels. They represent the
period of diabetes and place of management of coma.
major causes of morbidity and mortality that are

associated with this chronic metabolic disorder [1].
The term diabetic coma refers to the diagnostical
A cross-sectional study was carried out on 113
dilemma posed when a physician is confronted with
diabetic patients (both type I and II DM) in Arar city,
an unconscious patient about whom nothing is
Northern Saudi Arabia, KSA. This study was
known except that they have diabetes [2].
conducted during the period from 1 December 2017
At the present time three main types and one
to 30 June 2017, on general population in Arar, KSA.
'mixed' type of diabetic coma are recognized known
Data collection: by a pre-designed online
as hypoglycemia, ketoacidosis and hyperosmolar
questionnaire which was distributed among the
hyperglycemic state [3].
population. It was self-administered by participants
Easily the most common variety of diabetic coma
after a brief introduction or explanation of the idea of
is that associated with gross and excessive over-
the research. The questionnaire included the relevant
production of 'ketone bodies' which-because they are
questions to collect data about:
also strongly acidic lead to the characteristic Socio-demographic characteristics of the participants
syndrome of 'ketoacidosis' [4].
including age, marital status and educational status
The aim of this study was to determine the If the patient has DM or previous diabetic coma or
prevalence of diabetic coma among the studied
Received: 18/04 /2018
Accepted: 27/04/2018

Full Paper (vol.722 paper# 13)

c:\work\Jor\vol722_14 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3941-3945

Evaluation of the Association of Bariatric Surgery with
Development of Cholelithiasis
Sultan Abdullah Bin Jerais1, Rana Mohammed Ahmad 1, Mohammad Ibrhim Taleb2, Raad Jamaan
Al-Ghamdi3, Fahad Obaid Al-Namshah4, Sarah Mohamed Sayed5, Wejdan Abdulmoniem Alsumaien6,
Marram Jaber Al Haider6, Ahmed Tabaan Alenezi7, Ashwaq Musaed AL-Mutairi8
1- Al-Maarefa Colleges, 2- Sulaiman Al-Rajhi Colleges, 3- Al-Baha University, 4- King Khalid University,
5-Ibn Sina National College, 6-Najran University, 7- King Faisal Specialized Hospital & Research Center,
8- Unaizah College of Medicine

Significant research papers have been published to assess the relation between rapid weight loss
and the development of cholelithiasis, and the risk factors behind it. Assessment of cholelithiasis development
after rapid weight loss as a result in most of bariatric surgery will help in reducing the admission rate to hospitals
because of colic pain, and the complication related to stones formation.
This study aimed at measuring the association of rapid weight loss with the development of
gallbladder stones and identifying the role of prophylactic cholecystectomy.
PubMed database was used for articles selection. All relevant articles to our review with the following
topics: Bariatric Surgery, Gallbladder stones, bariatric surgery complication were included. We excluded other
articles which are not related to this field. The data were extracted according to specific form in which it is going
to be reviewed by group members to assess the relation between bariatric surgery and the development of stones,
and weight loss as well as the benefits of prophylactic cholecystectomy against gallbladder stones.
Bariatric surgery can lead to gallstone formation because of the rapid excess weight loss. Small
percentage may become symptomatic and rarely cholecystectomy becomes needed during the first year of the
bariatric surgery. So, it is not evidently recommended to be done as prophylaxis. However, Prophylactic
medicinal therapy (Ursodeoxycholic acid) in the first 6 months can be used instead.
Bariatric Surgery, cholelithiasis, gallstone, rapid weight loss, medicinal therapy, prophylactic


The incidence of obesity has been increasing
risk factors for gallstone formation are known to
day after day, worldwide. Hence, bariatric surgery
increase with age with a cut-off of 40 years, female
has recently become one of the most common
gender, obesity, and rapid weight loss as the most
treatment modality in maintaining long-term
important contributors1-5.
weight reduction and improving obesity-related
Gallstones and bariatric surgery is an important
conditions. There are different procedures for
issue because both obesity and bariatric surgery
bariatric surgeries such as, Laparoscopic Rouxen-Y
resulting with rapid weight loss are risk factors
Gastric Bypass (LRYGB), Laparoscopic Sleeve
for the formation of gallstones6-8. The incidence of
Gastrectomy (LSG), and Laparoscopic Adjustable
cholelithiasis after Roux-en-Y gastric bypass is
Gastric Banding (LAGB). Every procedure has its
reported to be as high as 71%7-9. Because of this high
own pros and cons in relation to total weight loss,
rate, some surgeons suggest a prophylactic routine
post-operative hospital stay, and the complication
cholecystectomy at the time of laparoscopic Roux-
that might occur1,2.
en-Y gastric bypass (LRYGB)10. Also, some prefer
Gallstones are hardened deposits of the digestive
performing concomitant cholecystectomy only with
fluid bile that can form within the gallbladder. They
patients with positive preoperative ultrasound
vary in size and shape from as small as a grain of
findings10-16. The percentage mentioned included
sand to as large as a golf ball. Gallstones occur when
both symptomatic and a symptomatic cholelithiasis.
there is an imbalance in the chemical constituents of
Few researchers stated that the asymptomatic
bile that result in precipitation of one or more of the
gallstones in the bariatric patient can be effectively
components. Gallstone formation itself depends on
managed similar to non-obese population.
several risk factors. In the general population, several
Received: 20/04 /2018
Accepted: 29/04/2018

Full Paper (vol.722 paper# 14)

c:\work\Jor\vol722_15 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3946-3950
Evaluation of the Risk Factors and Emergency Management Plan of Status
Asthmatics in Children: A Simple Literature Review
Khaled Abdullaziz Alasous 1, Khalil Ibrahim Kariri 2, Sultan Mousa Bakri 3, Sultan Masoud Almasoud 4,
Nawaf Fahad Alshuraym 4, Abdulrahman Nabih Aljaber 5, Wed Mohammed Alluhaibi 6, Samia Zaben
Almurshadi 7, Zainab Ibrahim Albahouth 7, Haidar Taher Aldulaim
1- Prince Sattam Bin Abdullaziz University, 2- Jazan University, 3- Prince Mohammed Ibn Nasser Hospital,
4- Imam Mohammed Ibn Saud Islamic University, 5- Qassim University, 6- Ibn Sina National College,
7- Riyadh Elm University

Significant research papers were published to assess different risk factors associated with
development of status asthmaticus (SA) in children and prevention. Understanding the different risk factors
associated with SA development in children will help in the early prediction of the cases that might develop SA
in future which may cause death in few cases.
In this study, we aimed at evaluating the various risk factors, etiologies that stand behind of status
asthmaticus development and Assessment of SA management in emergency department.
PubMed database were used for articles selection. All relevant articles related to our review were
chosen to cover the following topics: Asthma, SA management, SA in children risk factors. We excluded other
articles, which are not related tour objectives . The data have been extracted according to specific form to be
reviewed by the group members to assess the different risk factors, and management modalities of SA.
Delay in seeking medical help, poor compliance to the treatment, multiple previous admissions,
frequent chest infections, and obesity are major risk factors of complicating asthma in children leading to life
threatening attacks (SA). Preventing the risk factors is major task of the management and it is as important as
the treatment of asthmatic attacks.
Risk Factors, Emergency, Management Plan, Status Asthmatics, Children


Asthma is a disease characterized by reversible
undertaken lots of investigations to explore
airflow obstruction. Airway inflammation consisting
etiologies behind it, and to assess the precautions
with airway infiltration by eosinophils and activated
that can be done to avoid the development of this
T-lymphocytes is now recognized as central to the
condition. We therefore, reviewed the literatures
pathophysiology of asthma, in conjunction with
cover this filed to assess the various etiologies, risk
smooth muscle bronchoconstriction and intraluminal
factors, management modalities, and prevention
mucus accumulation1,2. The incidence and severity
methods that could be achieved as well as providing
of asthma have increased in recent years, which
a review paper that summarizes the recent advances
escalate the number of the patients who will develop
in this research field .
acute respiratory failure (ARF), also called status

asthmaticus (SA)3. Status asthmaticus is considered
a major cause of acute illness in children and one of
the top indications for admission to a pediatric
PubMed was chosen as the search database for the
intensive care unit (ICU)4, 5, 6, 7.
articles selection, because it is one of the major
research databases within the suite of resources that
inflammation, and increased mucous production are
have been developed by the National Center for
the key components of acute asthma4, 5, 6. This
Biotechnology Information (NCBI). The following
pathophysiology results in increased pulmonary
topics were used: Asthma, SA management, SA in
resistance, small airway collapse, and dynamic
children risk factors. Restriction to the last 5 years,
hyperinflation. Unlike during normal breathing, in
children under 18 years, and English language due to
status asthmaticus a child's inspiratory muscle
unavailable resources for translation were used. The
activity can persist through exhalation, significantly
chosen articles were screened by titles, and
increasing respiratory muscle workload and fatigue 4,
reviewing the abstracts yielded 4 articles which were
5, 6. Additionally, because of heterogeneous areas of
enrolled. Inclusion criteria: the selected articles
premature closure and obstruction, there can be
were those relevant to the topic of study which
significant ventilation-perfusion mismatching and
should include one of the following topics
{asthma in children, SA risk factors in children,
As a result of the escalating number in the incidence
management of SA in children}. Exclusion criteria:
of status asthmaticus during recent years, and the
all other articles which did not have one of these
morbidity associated with it, the researchers
Received: 19/04 /2018
Accepted: 28/04/2018

Full Paper (vol.722 paper# 15)

c:\work\Jor\vol722_16 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3951-3960
Evaluation of the Most Common Complications of Sickle Cell Anemia and
Management in Children: Simple Literature Review
Ghadeer Awad Alenazy1, Asma Mutni Almutairi2, Lamia Aiad Al-Onazi2, Ghaid Mohammed H
Alkharaz3, Shuruq Hassan Alsulami4, Manal Nasser Alotaibi4, Eyman Abdulmajeed Alfaraj5,
Afnan Hussain Alshaikhali5, Mahabbat Nadin Anam A6, Ammar Mohammad M Bahati7
1- Hail University, 2- Qassim University, 3- Unaizah College of Medicine, 4- Ibn Sina Medical College,
5- Imam Abdulrahman University, 6- King Saud bin Abdulaziz University for Health Sciences, 7- Umm Al-Qura

Sickle cell anemia is an autosomal structural defect that affect the hemoglobin. It is associated
with reduction in the RBC life span especially under stress. As a result of this structural defect the RBCs takes a
sickle shape which is associated with a lot of complications that significantly have an effect on the patient's life.
In this study, we aim at evaluating the most common complication of sickle cell anemia. Also, the
assessment of the various management plans to prevent it if occurred. Methods: PubMed database were used for
articles selection as well as all relevant articles to our research interest with the following topics: Sickle cell
anemia, Complications, Mortality, Prevention and Management. We excluded other articles, which are not
related to this field. The data were extracted according to specific form in which it is going to be reviewed by the
group members. Conclusion: Sickle cell anemia have various complications that have impact on quality of life
and arise from effect of three main pathophysiological mechanisms i.e. Vasooclussive, hyper-haemolytic and
infective complications. Hydroxyurea, chronic blood transfusion, and routine Transcranial Doppler Ultrasound
are still the most useful preventive measures of SCA complications.
Sickle cell anemia, complications, quality of life, children.


RBCs are less deformable, therefore, they obstruct
Sickle cell anemia (SCA) is considered as one of the
the microcirculation.
commonest gene disorder of human beings. In Africa,
Complications of sickle cell anemia is a growing
more than 200000 infants are born yearly with SCA
research area. As a result, we will revise the
(1). In United States, mortality in SCA patients
commonest complications of sickle cell anemia and
dramatically decreased with newborn screening and
evaluate the best measures to reduce it is occurrence.
better comprehensive care. Powars et al. (2) found

that the median age of sickle cell anemia patients is
53 years for men and 58 years for women2. Despite
all of the progress that has been achieved in the
PubMed was chosen as the search database for the
medical management and care, still SCA patients are
articles selection, because it is one of the major
hospitalized frequently and by the fifth decade of life,
research databases within the suite of resources that
48% of surviving patients have documented
have been developed by the National Center for
irreversible organ damage (2). SCA in Saudi Arabia
Biotechnology Information (NCBI). The following
was first reported in the Eastern province in the 1960s
topics were used: Sickle cell anemia, management,
(3). Since that time, a lot of studies have been done as
complications. The chosen articles were screened by
for screening of SCA in Saudi Arabia regions. The
titles, and reviewing the abstracts yielded 4 articles
Saudi Premarital Screening Program estimated the
which were enrolled. Inclusion criteria: The articles
prevalence of the sickle cell gene in the adult
were selected based on the relevance to the research
population at 4.2% for sickle-cell trait and 0.26% for
project which should include one of the
SCA, with the highest prevalence noted in the Eastern
following topics {Sickle cell anemia, complications,
province (approximately 17% for sickle-cell trait and
mortality, prevention and control}. Exclusion
1.2% for SCA (4).
criteria: all other articles which did not suit with
Sickle cell anemia (SCA) is genetically inherited
these topics as their primary end, or repeated studies,
disease, in which there is a structural defect in the
and reviews studies.
hemoglobin, associated with an amino acid
substitution of valine for glutamic acid. As a result of
No software was used to analyze the data. The data
this genetic defect the RBC life span will be shorter
extracted was based on specific form that contain
under stress and become sickle shape cells. The sickle
(Title of the study, name of the author, Objective,
shape RBC is the responsible for most of SCA
Summary, Results, and Outcomes), these data were
complication. This happen because sickle shape
reviewed by the group. Double revision of each
Received: 21/04 /2018
Accepted: 30/04/2018

Full Paper (vol.722 paper# 16)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3961-3967

Audiological Profile in Children with Autism Spectrum Disorders
1Ali Abdel Dayem Ali, 2Shoura Youssef Darwish, 1Ahmed Mohammed Ahmed Mahmoud,
1Mohammed Moneer Mohammed Hassanain
1E.N.T Department, Faculty of Medicine, 2Neurology Department, Faculty of Medicine, Al-Azhar University
Corresponding author: Mohammed M.M. Hassanain, Mobile: 01005027660; Email: audiology_now2003@yahoo.com

Autism spectrum disorder is defined by the Diagnostic Statistical Manual of Mental Disorders
V (DSM V) as a neurobehavioral disorder manifested by persistent deficits in social and communication
interaction, deficits in developing, understanding and maintaining relationships, as well as abnormal and fixed
interests and repetitive behavior. Symptoms must be present at early childhood and interfere with daily
function. The majority of individuals with ASD demonstrate some degree of auditory dysfunction. The level
and expression of this dysfunction ranges from deafness and increased thresholds to hyperacusis and
difficulty listening with background noise.
The purpose of this study was to characterize the findings of audiological and electrophysiological
hearing assessment in individuals with autism and to compare these findings to those obtained in typically
developing individuals. Subjects, Materials & Method: Forty one Autistic children are divided into two
groups:- group (1) Mild to moderate autism were seventeen children & group (2) Severe autism were twenty
four children) were enrolled in this study (Whose ages were 2-6.5 years old) compared with ten typically
developing matching peers. All Autistic children in the study had a definite medical diagnosis of Autism
according to DSM-5 and based on the severity of symptomatology, ASD children were assessed and divided
using CARS score (Childhood autism rating scale). Audiologic evaluation consisted of a case history,
otoscopic examinatioin, behavioral free field evaluation, acoustic immittance measures (Tympanogram and
Acoustic reflexes), speech audiometry, measurement of distortion product otoacoustic emissions and auditory
brain stem response.
Results: Our results support an association between ASD and higher DPOAEs S/N ratios at only 500 & 750
Hz. Moreover, ABR in ASD children showed a significant increase in waves III & V absolute latencies and I-
III & I-V inert peak latencies (In both groups of ASD), with inter aural asymmetry as shortened right ear III-V
& I-V inter peak latencies reflecting a more right ear advantage (mild to moderate group), in addition to a
significant decrease in waves V/I amplitude ratio (Both ASD groups).
The OAE responses of children with ASD were highly significantly only at 500 Hz (Both
groups) 750 Hz (Mild to moderate group). ASD children (either mild to moderate or severe) had a significant
increase in ABR waves III & V peak absolute latencies and I-III & I-V inter peak latencies. Asymmetrical
ABR findings also noted in children with ASD (mild to moderate group) as shortened right ear III-V & I-V
inter peak latencies (more prominent right ear advantage). In ABR also the amplitude of peak I in response to
90 dB nHL click stimulation was greater than the amplitude of peak V significantly in both groups of ASD
children than controls.
Auditory Brainstem Response - Autism Spectrum Disorders - Acoustic Stapaedial Reflex ­
Otoacoustic emissions - Cytosine, Guanine, Guanine.


Autism spectrum disorders (ASD) represent a
has an incidence of 1 in 110 (1:70 in males and
heterogeneous group of specific and non-specific
1:315 in females, although there is significant
symptoms characterized by pervasive manifestation
geographical variability (4).
of partial indicators and cardinal differences in the
development of the child with ASD in comparison
with the intact individual (1). Autism spectrum
including differences in neuronal packing density,
disorders (ASD) are highly heritable neuro-
soma size and number and attenuated dendritic
developmental disorders characterized by reduced
arbors (5). The majority of individuals with ASD
social interactions, language impairment and
demonstrate some degree of auditory dysfunction
repetitive or restricted interests and behaviors (2).
(6). The level and expression of this dysfunction
Despite strong genetic etiology, diagnosis is based
ranges from deafness and increased thresholds to
purely on behavioral criteria. However, individuals
with ASD display marked phenotypic heterogeneity
background noise (7).
and frequent medical comorbidities, which have
It is known that children with autism and
hindered advances in diagnosis and treatment
Asperger syndrome can have perception, attention
development (3). A recent survey indicated that ASD
and memory disorders and often times the presence
Received: 22/04 /2018
Accepted: 1/05/2018

Full Paper (vol.722 paper# 17)

Review The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3968-3978

Risk Factors of Delayed Milestones Among Children Attending
Sohag General Hospital
1Ekram M. Abdel khalek, 1Sabra M. Ahmed, 2Ramadan A. Ahmed, 3Gamal E. Soliman
1Public Health and Community Medicine Department, Faculty of Medicine, Assiut
University,2Pediatrics Department, Faculty of Medicine, Sohag University,3Public Health and
Community Medicine Department, Faculty of Medicine, Assiut branch, Al-Azhr University
Corresponding author: Gamal E. Soliman, E-Mail: gmalhurgad210@yahoo.com

developmental delay occurs when a child exhibits a significant delay in the
acquisition of milestones or skills, in one or more domains of development (i.e., gross motor, fine
motor, speech/language, cognitive, personal/social, or activities of daily living). Aim of the work:
the present study aimed to investigate the most common risk factors of delayed development in
children under four years attending Sohag General Hospital. Subjects and Methods: a case
control study was conducted in Sohag General Hospital during the period from January 2015 to
June 2016 on children attending Pediatric, Physiotherapy and Phoniatric clinics in Sohag General
Hospital, Sohag Governorate. The sample size was 150 cases and 150 controls. One hundred and
fifty children (aged 1.5 month to 48 months) diagnosed with developmental delay by a specialist
or/and a developmental pediatrician were recruited as cases.
Results: in the logistic regression model, the odds of developing delayed milestones is
significantly higher among children with cyanosis (OR=16.391), low birth weight (OR=6.147),
parental consanguinity (OR=5.489), 1st birth order (OR=4.048), urban residence (OR=3.702) and
history of neonatal jaundice (OR=2.518).
Conclusion: the urban children, first children and from few number of family members were more
frequently at risk for developmental delay.
Keywords: Developmental delay, Risk factors, Children, Sohag General Hospital


Developmental delay occurs when a child
In Egypt, a retrospective chart review was
exhibits a significant delay in the acquisition
carried out on all children referred for
of milestones or skills, in one or more
developmental assessment in the child
domains of development (i.e., gross motor,
development center in the National Institute
fine motor, speech/language, cognitive,
for Neuro-Motor System (NINMS) from
personal/social, or activities of daily living).
July 2001 to April 2002. A total of 1261
A significant delay has been traditionally
defined as discrepancy of 25 percent or
Neurodevelopmental assessment did not
more from the expected rate, or a
confirm developmental delay in 165 cases
discrepancy of 1.5 to 2 standard deviations
(13.8%). While 350 (28.23%) cases showed
mild DD, 398 (31.56%) were moderately
According to the World Health Organization
delayed and 342 (27.12%) were severely
(WHO), about 5% of the world's children
who were below 14 years of age suffered
reported in 43% of cases (3).
from moderate to severe developmental
In a study of risk factors and etiology on
delay (DD) associated disability most of
developmental delay of 18-month-old
which would have been either prevented or
children in Beijing, China, Zhou and other
managed, if detected early (2).
researchers (4) found that the prevalence rate

Full Paper (vol.722 paper# 18)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3979-3985
The Use of Levonorgestrel-Releasing System (Metraplant-E) in the Treatment of Abnormal
Uterine Bleeding
Mohamed Ezz-Eldin A. Azzam*, Magd Eldin M. Mohamed, Laila A. Farid, Alshaimaa AA Mahmoud,
Reem Abdelazeem Hussein, Alaa Rashid
Department of Obstetrics and Gynecology and Early Cancer Detection Unit, Ain Shams University, Cairo, Egypt.
Corresponding author: * Mohamed Ezz-Eldin A. Azzam,E-mail: prof_m.azzam@outlook.com,Mobile Number: 01003465651
Dysfunctional uterine bleeding (DUB) is one of the commonest condition for which patient seeks
out medical consultation. The prevalence increases with the increase of age peaking before menopause.
Objective: The aim of this work is to evaluate the effect of this new form of levonorgestrel-releasing IUD on
the treatment of patients with abnormal uterine bleeding.
Subjects and methods: A prospective age-specific comparative analysis of 61 peri-menopausal women presented
with dysfunctional uterine bleeding who constituted the study group. They underwent hysteroscopy and endometrial
sampling during an 18 months period from June 2014 to January 2016 at Ain Shams University Materity Hospital.
Prior to metraplant-E application, all the patients in this study were in the age of 25-58 years old.
Results: The role of Metraplant-E in the treatment of abnormal uterine bleeding (AUB) was evaluated. Sixty-one
women with failed attempt(s) of medical treatment unwilling or unfit for hysterectomy were treated with Metaplant-
E. Menstrual blood loss was assessed by pictoral bleeding assessment chart (PBAC), bleeding index (B.I) and total
bleeding score (T.B.S/month). The bleeding patterns in the form of the mean menstrual blood loss estimated by
bleeding index and the mean menstrual loss estimated by the total bleeding score/month and PBAC decreased
significantly (p = 0.001). The quality of life scale (Likert scale) improved significantly (p = 0.001). All 15 cases who
had endometrial sampling demonstrated progestational effect on histo-pathological examination.
Conclusion: Metraplant-E was found to be effective in managing dysfunctional menorrhagia on both clinical
and histopathological levels.
Keywords: Metraplant-E, LNG-IUS, Menorrhagia, Contraceptives

hyperplasia. Therefore, it is mandatory to do
Dysfunctional uterine bleeding (DUB) is one
endometrial sampling in cases of peri-menopausal
of the commonest condition for which patient seeks
age with irregular menstruation with or without
out medical consultation. The prevalence increases
hypertension [2].
with the increase of age peaking before menopause.
Progesterone intra-uterine devices were
The peri-menopausal women who have anovulatory
originally introduced as contraceptives. However, the
cycle resulting in DUB. The normal menstrual cycle
addition of levonorgestrel, which induces profound
is defined as having a mean interval of 28 ± 7 days
remodeling and differentiation of the oestradiol-primed
with a men duration of 4 ± 3 days. The upper limit of
endometrium, leads to decreased menstrual bleeding [3].
normal menstruation is 80 ml per menstruation. Any
Its action (levonorgestrel) proved to be particularly
deviation from the normal cycle and the amount of
useful in the treatment of the following conditions:
loss is regarded as abnormal uterine bleeding.
dysmenorrhea associated with endometriosis [4, 5, 6],
Dysfunctional uterine bleeding (DUB) is one of the
idiopathic menorrhagia [7,8,9,10,11], adenomyosis and
commonest causes of abnormal uterine bleeding. It is
anomalous bleeding [12,13,14,15]. Moreover, it has been
defined as heavy and/or irregular menstruation in the
proposed for use in the treatment of endometrial
absence of detectable pelvic pathology, pregnancy or
carcinoma or as an alternative to surgical treatment in
general bleeding disorder. It affects 20 to 30 % of
women affected by menorrhagia [16].
women and accounts for 12 % of gynecological
Metraplant-E, which is a new levonorgestrel-
referrals. DUB can be ovulatory or anovulatory.
releasing intra-uterine system used in this study is
Anovulatory DUB occurs at extreme reproductive age
developed by Azzam in 2013. Metraplant-E design
(adolescence and peri-menopausal age) [1].
has a T-shaped frame containing levonorgestrel and
Hyperplastic endometrium is abnormal
ethinyl vinyl acetate (EVA) as well as barium
histology finding found in DUB. DUB is more
sulphate to make it radio-opaque. The whole system
frequent in peri-menopausal age, multiparity and
is containing levonorgestrel, which is different from
those patients who had undergone tubal ligation.
other forms of LNG-IUS like mirena or metraplant. It
Commonest normal histology of DUB is proliferative
consists of Levonorgestrel hormone (60 mg), EVA
endometrium. One third of the patients had initial
(120 mg) and barium sulphate (20 mg) and 20 mg
abnormal histology report which is found more in
polyethylene. It is designed with a release rate of
peri-menopausal age. Peri-menopausal age, irregular
more than 20 µg/24 h, which allowed it to be used as
menstruation and hypertension are risk factors for
a contraceptive for more than 5 years. The higher

Full Paper (vol.722 paper# 19)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3986-3989
Evaluation of Graded Transcutaneous Levator Muscle Recession with Mullerectomy for
Treatment of Upper Eyelid Retraction in Dysthyroid Patients
Ahmad H. and Abd Elmagid M. Tag Eldin
Ophthalmic Department, Faculty of Medicine, Al-Azhar University
To evaluate the efficacy, advantages and disadvantages of graded transcutaneous levator muscle
recession with mullerectomy for treatment of dysthyroid upper eyelid retraction.
Design: Randomized, prospective and interventional case series.
This prospective interventional case series comprised 20 eyes of ten patients. Inclusion criteria
included patients with bilateral upper eyelid retraction, with or without other manifestations of thyroid
orbitopathy, without diplopia and with stable thyroid state for at least 6 months. All patients were subjected to
graded transcutaneous levator muscle recession with mullerectomy after full ophthalmological assessment.
All patients included in the study have signed a written consent and the study has been approved by the ethical
committee of AL-AZHAR faculty of medicine.
Results: Postoperatively the mean decrease of MRD1 was 2.87 mm. Mean improvement of lagophthalmos was 0.78
mm. Mean increase of upper lid crease height was 0.65mm. Good lid contour achieved in 85.9%. Temporal flare
persisted in one lid (5%) and nasal ptosis was reported in two eye lids (10%).
Conclusion: According to this study graded transcutaneous mullerectomy with levator muscle recession is a
good and a reliable surgical technique for correction of dysthyroid upper lid retraction and is successful as a
lengthening procedure for retracted upper eyelid regardless the severity of retraction with significant
symptomatic and cosmetic improvement.
Keywords: Mullerectomy, Upper eyelid retraction, Dysthyroid, Graded transcutaneous levator muscle
recession, Levator lengthening.

sensation, discomfort, epiphora, keratitis, formation
Lid retraction is a disorder of eyelid
of erosive corneal ulcers, burning sensation, reactive
malposition characterized by appearance of a band of
epiphora, photophobia, blurred vision, conjunctival
white sclera between the limbus and the eyelid
irritation, and decreased visual acuity due to the
margin, when the eye in the primary position [1].
chronic exposure of the cornea and conjunctiva and
Eyelid retraction is the most common
cosmetic concerns with the related emotional stress.
ophthalmic feature of thyroid-related orbitopathy,
In thyroid-related orbitopathy, upper eyelid retraction
occurring unilaterally or bilaterally in more than 90%
present in primary gaze is called Dalrymple sign, and
of patients at some point in their clinical course [2].
an abnormally high upper eyelid in down gaze is
The exact cause of lid retraction in Graves
called the Von Graefe sign or lid lag [6].
ophthalmopathy is not completely understood, but
The surgical treatment of eyelid retraction
several factors seems to be contributory. In upper lid
presents challenging management problems to the
these factors include: muscle contraction due to
surgeon. Although patients frequently attained
adrenergic stimulation; involvement of Muller-
postoperative reduction in their eyelid retraction with
levator complex by Graves disease process;
many prior techniques, occasional contour defects
overaction of levator-superior rectus complex in
and the occasional residual lid retraction more
response to hypophoria produced by inferior rectus
prominent temporally led to the search for new or
fibrosis; and adhesion of the levator to the orbital
modified techniques for the correction of upper eyelid
septum and neighboring subcutaneous tissues. In the
retraction. The large number of surgical procedures
lower lid: stimulation of sympathetic muscle plays a
described for the correction of upper eyelid retraction
role; fibrosis of inferior rectus exerts a retracting
attests to the difficulty of reliably correcting this
action; proptosis if present plays a role; and adhesion
disease process. In thyroid-related orbitopathy, results
of inferior retractors to neighboring subcutaneous
are often unpredictable with inconsistent eyelid
tissues [3,4,5].
position and contour abnormalities. Recurrent

Retraction of the upper eyelid may
retraction, overcorrection, and undercorrection are
cause decreased excursion of the eyelid and
recognized complications of eyelid retraction surgery
lagophthalmos, which may result in exposure
secondary to thyroid-related orbitopathy. Several
keratopathy. The effect of these conditions resulting
operations may be necessary to achieve complete
from eyelid involvement range from minor ocular
success [7].
irritation and discomfort to vision-threatening corneal
Mullers muscle surgery alone corrects
decompensation, potentially resulting in severe vision
approximately 2 mm of upper lid retraction, while
loss. Exposure keratopathy may lead to foreign body

Full Paper (vol.722 paper# 20)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3990-3995
The Effect of Aflibercept and Ranibizumab in Patients with Diabetic Macular Edema: A
comparative Study
Abdallah H. Hamed, Ahmad E. Hudieb, Mohamed A. Eid*
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohamed A. Eid; Mobile: 01005748110; Email: drmohamedeidopth@gmail.com
Diabetic macular edema is one of the most significant causes of blindness and severe visual
impairment in patients with diabetes, which can result in reduced quality of life. Three commonly used intravitreous
VEGF inhibitors aflibercept, bevacizumab and ranibizumab have been shown to be beneficial and relatively safe for
the treatment of diabetic macular edema, but only aflibercept and ranibizumab are approved by the Food and Drug
Administration (FDA) for this indication. Aim of the Work: To compare between the effect of ranibizumab and
aflibercept in patients with diabetic macular edema as a diabetic retinopathy complication that leads to visual
impairment. Patients and Methods: A prospective study of 20 patients (20 eyes) was conducted in Al-Mouneer
diabetic eye center with three times injection one month apart. The patients were divided into two groups, Group A
was consisted of 10 patients who received ranibizumab as 0.5 mg (0.05ml of 10mg/ml solution) an intra vitreal
injection. Group B was consisted of 10 patients who received aflibercept 2 mg (0.05mL of 40mg/ml solution) as an
intra vitreal injection with follow up for three months. Results: A statistically significant difference over the time
through BCVA and central macular thickness with ranibizumab. There was also a statistically significant difference
over the time through BCVA, central macular thickness and IOP with aflibercept. Conclusion: There was more
improvement in BCVA which was significant and more reduction in central macular thickness with ranibizumab
than with aflibercept. Recommendations: Larger group studies to confirm our results; longer term study for the
effect of ranibizumab and aflibercept injection on the central macular thickness and IOP and comparing the effect of
single injection versus multiple injections. Searching for the causes of resistance or delayed response to the
intravitreal injections in some patients.
Key words:
Diabetic macular edema, Aflibercept, Ranibizumab

caliber changes consisting of alternating areas of venous
The alarming rise in diabetes prevalence is a
dilation and constriction), intraretinal-microvascular
global public health and economic problem. Diabetic
abnormalities, hard exudates (lipid deposits), cotton-
retinopathy is the most common complication of
wool spots (ischemic retina leading to accumulations of
diabetes and the leading cause of blindness among
axoplasmic debris within adjacent bundles of ganglion
working-age populations in the developed world (1).
cell axons), and retinal neovascularization. These
The worldwide prevalence of DM is
findings can be utilized to classify eyes as having one of
predicted to grow to 430 million patients by 2030,
two phases of DR (6):
and every one of them will be at risk of developing

diabetic retinopathy (2).
1. Non proliferative Diabetic Retinopathy (NPDR)
The prevalence of diabetic retinopathy (DR)
Eyes progress from having no DR through a
remains high at 40% of diabetic patients. Globally, there
spectrum of DR severity that includes mild, moderate
are approximately 93 million people with DR, 70
and severe NPDR. Correct identification of the DR
million with proliferative diabetic retinopathy (PDR), 21
severity level of an eye allows a prediction of risk of
million with diabetic macular edema (DME) and 28
DR progression, visual loss, and determination of
million with a sight- threatening retinopathy as
appropriate treatment recommendations including
proliferative diabetic retinopathy (PDR) (3).
follow-up interval (7).
2. Proliferative Diabetic Retinopathy (PDR)
microangiopathy characterized by microaneurysms
Proliferative diabetic retinopathy (PDR) is
(Mas), capillary nonperfusion, and ischemia within
the most advanced stage of DR and represents an
the retina. It may cause several complications, such as
angiogenic response of the retina to extensive
diabetic macular edema (DME) and diabetic macular
ischemia (DMI). In particular, capillary non perfusion
neovascularization is typically characterized as being
impairs the nutrition of the neuroglial tissues in the
new vessels on the disc (NVD) or new vessels
retinal parenchyma, and the resultant hypoxia
elsewhere (NVE) along the vascular arcades (7).
increases the expression of vascular endothelial
Diabetic macular edema, a manifestation of
growth factor (VEGF), which promotes both
diabetic retinopathy that impairs central vision,
angiogenic responses and vascular permeability (5).
affects approximately 750,000 people in the United
The classic retinal lesions of DR include
States and is a leading cause of vision loss. The costs
microaneurysms, hemorrhages, venous beading (venous
associated with visual disability and treatment of

Full Paper (vol.722 paper# 21)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3996-3999
Evaluation of Capillary Network Abnormalities in Branch Retinal Vein Occlusion by Optical
Coherence Tomography Angiography
Khaled Mohamed Selim, Ahmed El-Sayed Hudieb, Mahmoud Salah Aldin Aldemardach
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mahmoud Salah, Tel:00201014896146, Email: msalahbaza@gmail.com
Objectives: Is to detect the vascular morphological changes in the two intra retinal; layers superficial network
layer and deep network layer by optical coherence tomography angiography (OCT-A) in cases with acute
onset branch retinal vein occlusion (BRVO).
Study Design: An observational cross-sectional study in new Kafer El-Sheikh Ophthalmology Hospital.
Population: This study included ten patients with (BRVO) of recent onset within the last three months.
Methods: Demographic data such as age, gender, sex and hypertensive history were obtained. A detailed
evaluation of cases including complete anterior segment evaluation and posterior segment evaluation was
done. OCT-A and fluorescein angiography (FA) were used to study the vascular morphological changes in the
(BRVO) area.
Results: As regarding 5 disc area of retinal ischemia FA detected ischemia in 2 cases (20%), detected no
ischemia in one case (10%) and was not able to evaluate ischemia in 7 cases (70%) compared to OCT-A, that
detected the ischemia in the superficial capillary plexus (SCP)in 4 cases (40%), and detected no ischemia in 6
cases (60%), but it detected the ischemia in the deep capillary plexus (DCP) in 6 cases (60%) and detected no
ischemia in 4 cases (40%).
Conclusion: Our study demonstrated that OCT-A was superior to FA in detection of macular ischemia in
cases with acute onset branch retinal vein occlusion (BRVO), macular ischemia detected in the DCP by OCT-
A had stronger negative relation with V.A. than that of SCP. By OCT-A macular edema (ME) was present
mainly in the DCP compared to SCP.
Keywords: Branch retinal vein occlusion (BRVO), fluorescein angiography (FA) capillary non-perfusion,
foveal avascular zone(FAZ), macular ischemia, macular edema(ME), optical coherence tomography
angiography(OCT-A), superficial capillary plexus (SCP), deep capillary plexus (DCP).

Each case was subjected to a detailed
Retinal vein occlusion (RVO) is the second
ocular examination. this assessment included
most common retinal vascular disorder after
uncorrected visual acuity (UCVA), refraction
diabetic retinopathy1. RVO is anatomically
(automated) and then best corrected visual acuity
classified into three main groups based on the
(BCVA), intraocular pressure (IOP) measurement
location of venous occlusion (branch, central, and
using applanation tonometer, anterior segment slit-
lamp examination, posterior segment slit-lamp
FA is a very important tool for evaluating
examination by +78 lens an, color photography
neovascularization in ischemic (RVO)3. However,
angiography (FFA) and OCT-A was performed
the ability to detect microvasculature alterations
using (Topcon OCT Triton), 6x6 mm scan was
has been limited by the superposition of the
taken centered on the fovea in all cases.
capillary networks and leakage4.
Statistical methods
OCT-A allows separating the superficial
Statistical presentation and analysis of the
and deep vascular network, whereas the deep
present study was conducted, using the mean,
capillary network is barely visible on fluorescein
standard deviation and chi-square test by SPSS V.20.

Patients and Methods
This study was conducted on 10 eyes of 10
This study was designed to be cross
patients (3 males 30% and 7 females 70%)
observational study including ten eyes to detect the
vascular morphological changes in the branch
Table (1): Sociodemographic data of included
retinal vein occlusion area in both the superficial
and the deep retinal network layers by OCT-A in
cases of acute onset BRVO. The study was
approved by the Ethics Board of Al-Azhar

Full Paper (vol.722 paper# 22)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 4000-4004
Evaluation of Polymorphnuclear Leucocyte Elastase as Diagnostic Tool in Neonatal Sepsis
1Bothina Mohamed Abdel-Aziz El-Nagar, 1Soheir Ibrahim Mohamed,
2Sabah Ibrahim Abdelrahim, 1Mohamed Abdel-Gawad Morsy
1Department of Pediatrics, 2Department of Clinical Pathology, Faculty of Medicine for Girls - Al Azhar University
Corresponding author: Mohamed Abdel-Gawad Morsy, Mobile: 01002228083; Email: Basmahamdy1710@gmail.com
Objectives: Neonatal sepsis is clinical syndrome of bacteremia with systemic signs and symptoms. Neonatal
sepsis is still a leading cause of mortality in neonatal intensive care units all over the world. Early diagnosis
and treatment of the newborn infant with suspected sepsis are essential to prevent severe and life threatening
Objective: The aim of this study was to evaluate polymorph nuclear (PMN) leucocyte elastase as a diagnostic
tool in neonatal sepsis.
Subjects and Methods: This study was conducted on 45 full term and preterm neonates suspected as neonatal
sepsis compared to 45 apparently healthy neonate with matched age and sex, as a control group.
Results: 55.6% of our patients group were full-term patients and 44.4% were preterm. All the patients were
subjected to full history taking, full clinical examination, lab investigation including CBC, CRP, blood culture
and sensitivity, and measurement of serum polymorph nuclear leucocyte elastase enzyme.
Conclusion: Significant elevation of serum polymorph nuclear leucocyte elastase level in neonatal sepsis with
high specificity.
Keywords: Polymorphonuclear leucocyte - Escherichia coli - Early onset sepsis - Late onset sepsis

This cross sectional comparative study was
Neonatal sepsis is the cause of substantial
conduced on ninety (90) neonates of both sexes
morbidity and mortality. The clinical manifestation
from neonatal intensive care units, and from the
range from subclinical infection to severe
well-baby department in Al­Zahraa University
manifestation of focal or systemic disease. The
Hospital after approval of ethical committee of Al-
source of pathogen might be attributed to an utero-
Zahraa Hospital University for girls from June
infection, acquisition from maternal flora, or
2017 till December 2017.
postnatal acquisition from the hospital or community.
Group I: Included forty five (45) full term
The timing of exposure, the immune status, and
and preterm neonates who were selected from the
virulence of the causative agent influence the clinical
neonatal intensive care units, they were (15) females
expression of neonatal sepsis (1).
and (30) males, with early and late onset neonatal sepsis.
The neonate immune response to sepsis is
Group II: Included forty five (45)
driven by increased expression of neutrophil and
apparently healthy neonates, they were (23)
monocytes. By contrast there is net suppression of
females and (22) males as control group.
the adaptive immune response as characterized by
Inclusion criteria: Age: neonates; preterm
a decrease in expression level by T and B cells (2).
or full-term from 0-28 days of both sexes. Neonates
Polymorphonuclear leucocyte elastase is
with early and late onset suspected sepsis. The
major serine proteinase in man, which is secreted
clinical signs for diagnosis of neonatal sepsis include
any of the following signs: respiratory rate > 60
inflammation. It plays a role in degenerative and
breath/min., grunting, lethargic or unconscious,
inflammatory disease by its proteolysis of collagen
tachycardia, and convulsions (1).
IV and elastin of the extracellular matrix (3).
Exclusion criteria: Neonates with major
Early diagnosis before obvious clinical signs
congenital anomalies or associated syndromes. All
of neonatal sepsis is an important goal, as delay in
cases with different clinical presentation
commencing antibiotics will result in serious
resembling neonatal sepsis (hypoxic ischemic
consequences. On the other hand over treatment of
encephalopathy necrotizing enterocolitis).
neonates with antibiotics based on false positive
Methods: The study groups were
result will promote the presence of multiresistant
subjected to the following: Full history taking,
bacteria in neonatal intensive care unit (3).
prenatal, natal and postnatal includes: Intrapartum
fever > 38C, premature rupture of membrane,
mode of delivery, and invasive procedures as
The aim of the work is the evaluation of the
mechanical ventilation. Full clinical examination
blood polymorphonuclear elastase as diagnostic tool
includes: Determination of gestational age using
in neonatal sepsis.
Ballard score (4), assessment of body weight,
length and head circumference, clinical evidence of
neonatal sepsis as: Lethargy, temperature

Full Paper (vol.722 paper# 23)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 4005-4011
Role Of Insulin Like Growth Factor in Polycystic Ovary Syndrome
Magdi A. Laban1, Tarek A. Shemais2, Ehab Mohamed Elhelw3 and Ahmed R. El-Hassanin2
1Department of Medical Biochemistry, Faculty of Medicine, Cairo, 2Department of Medical Biochemistry, Faculty of
Medicine, Damietta, 3Department of Obstetrics and Gynecology, Faculty of Medicine, Damietta, Al-Azhar university, Egypt.
Corresponding author: Ahmed Ramadan el-Hassanin, Tel: 00201001574914, E-mail address: Medodoc2017@ azhar.edu.eg.
Objectives: The polycystic ovary syndrome (PCOS) is conventionally defined as a combination of
hyperandrogenism and anovulation with polycystic ovaries. Insulin-like growth factor I (IGF-I) is a 70 aa
polypeptide hormone with endocrine, paracrine, and autocrine effects. it is now established that the ovary is a
site of IGF-I gene expression and reception. However, this huge amount of data could be somehow distractive
since different species may produce distinct IGFs (or their relative binding proteins and receptors) at different
stages of follicular development.
Objective: The aim of this work was to determine the serum level of IGF-I to evaluate its role in PCOS.
Subjects and Methods: Twenty-five infertile women with PCOS diagnosed by ultrasound examination and a
history of oligomenorrhea, hirsutism and obesity were studied. Serum levels of insulin-like growth factor-1
(IGF-1) and hormonal profile were measured. Fifteen healthy and fertile women with regular menstrual cycles
served as a comparison group.
Results: The serum levels of IGF-I were significantly elevated in women with PCOS compared with control
and there was positive correlation between IGF-I from one side and each of BMI, W/H ratio, LH, LH/FSH
ratio, TSN, T/SHBG ratio, right and left ovarian volumes. On the other side, IGF-I was inversely correlated
with SHBG, right and left uterine artery PI and RI.
Conclusion: The significant finding of this study is that PCOS patients have increased circulating IGF-I levels
than healthy controls and it can be used as a biochemical marker for PCOS.
Keywords: Insulin-like growth factor; Polycystic ovary syndrome, Hormonal profile.

insulin receptor. The involvement of the IGF system
PCOS is a diagnosis of exclusion and the
as intraovarian regulators of folliculogenesis has been
conditions which are similar to PCOS either
intensively studied in a variety of mammalian
biochemically or clinically should be excluded such
species, and it is now established that the ovary is a
site of IGF-I gene expression and reception [8]. In
Cushing's syndrome and virializing tumors. Until
brief, GH enhances the development of small antral
now insulin resistance and cardiometabolic features
follicles to the gonadotrophin-dependent stages and
are not actually part of PCOS diagnostic criteria and
stimulates oocyte maturation, whereas IGFs increase
this is due to deficiency of the accurate methods for
granulose cell proliferation, steroidogenesis and
measurement of insulin resistance [1]. PCOS is the
oocyte growth in most mammalian species [9].
most common endocrinopathy in women of the
reproductive age and it can be detected in early
The aim of this work was to determine the
adolescence. The prevalence of PCOS ranging from
serum level of IGF-I to evaluate its role in PCOS.
4% to 8% previously [2] but later the prevalence
increased due to the use of different diagnostic
criteria and might reach to 18% [3]. Insulin resistance
This study included a total of 25 women
represents about 50% to 80% in the pathophysiology
with polycystic ovary and 15 women as a control
in women with PCOS especially in those with severe
with normal ovaries, attending at Obstetrics and
PCOS who are overweight [4]. Insulin-like growth
Gynecology Department, New Damietta Faculty of
factor I (IGF-I) is a 70 aa polypeptide hormone with
Medicine -Al Azhar University. Approval of the
endocrine, paracrine and autocrine effects. It shares
ethical committee and a written informed consent
>60% homology with IGF-II and by 50% homology
from all the subjects were obtained. This study was
with proinsulin structures [5]. Most of IGF-I actions
conducted between July 2017 to January 2018.
are mediated through the union of IGF-I to its
The study subjects were divided into two
putative receptor, IGF-IR, a tyrosine kinase that is
one of the most potent natural activators of Akt
Group : Twenty-five women with PCOS,
pathway [6]. However, IGF-I can also bind to the
having PCO on ultrasound examination and a
insulin receptor (with a lower affinity), as a
history of anovulatory menstrual cycles and/or
secondary effect through which this hormone
oligomenorrhea, with or without hirsutism, acne
mediates some of its metabolic functions [7] due to
and obesity and/or elevated serum LH and/or
their high homology. Complementarily, insulin can
elevated serum androgen concentrations, who did
also bind to IGF-IR with a lower specificity than
not receive any treatment for at least 3 months.

Full Paper (vol.722 paper# 24)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 4012-4016
Awareness of Risk Factors of Hernia among Adults in Al-jouf region, Saudi
Yazeed A. Al judaya, Abdullah L. Al Hassan, Ahmed F.H Al Sabi, Ahmed M. Alruwaili, Sultan M.
Alshalan, Hassan A. Al Judia
Al-jouf University, Collage of Medicine, Department of Surgery
Corresponding author: Yazeed Ahmed Al judaya, E-mail: Yazeed94@outlook.com, Tel.: +966 55 622 1948
Background: A hernia is characterized as the distension of an organ or tissue through an abdominal muscle
ordinary opening, it happens when an organ or greasy tissue presses through a feeble spot in an encompassing
muscle or connective tissue called fascia (1).
Objective: This study aimed at assessing the awareness of the risk factors of abdominal hernias among adults
in Al-jouf, Saudi Arabia.
Material and Methods: This is a cross-sectional community-based study of a qualitative approach. The
present study enrolled 105 candidates (aged 18 to 45), males 63, 42 Female. Moreover, candidates were
subjected to structured self- administered close-ended study questionnaire during the period between January
and February 2018 and one month for data analysis
Results: The present study enrolled 105 candidates, from both gender male (63, %60) and female (42, %40).
Age groups were (18-25) %62, (26-35) %35, (36-45) %3 Ages were varied according to the level of education
(high school, college, graduated). Evaluation of the knowledge about Hernia: the highest proportion goes to
%38 for Very Good then, %36 for Good, and the less %26 for Excellent.
Recommendation and Conclusion: The present study revealed that the study group of Saudis, both gender have
knowledge on the risk factors for hernia regardless to the age, gender and level of education. In the face of, 59%
related Hernia with asthma, 81% constipation, 40% smoking, 41% enlarged prostate, 88.5% pregnancy, 89.5%
heavy lifting, and 86% surgery. Unlike, participants have no knowledge about relating DM to hernia with
proportion of 44%, This indicates that further studies are needed to clarify these conclusions. We recommend
establishment of an awareness campaign for hernia risk factors among Saudi adults such as social media.
Keywords: Adults, hernia, inguinal, risk factors, KSA.

men the frequency ascends from 11 for each 10,000-
A hernia is characterized as the distension of
person years matured 16 - 24 years to 200 for each
an organ or tissue through an abdominal muscle
10,000; aged 75 years or above (6).
ordinary opening, it happens when an organ or greasy
To illustrate, other study demonstrated that
tissue presses through a feeble spot in an
budgetary imperatives and absence of awareness were
encompassing muscle or connective tissue called
accounted for as the most widely recognized reasons
fascia (1). One of the abdominal wall hernia's forms
behind late appearance of hernia. Certainty, human
called inguinal hernia, a well-known surgical
beings living with inguinal hernia have suf-fered
pathology (2). Furthermore, the risk of inguinal hernia
different sorts of disgrace and differentiation, it was
renovation is assessed to be 27% for men and 3% for
uncovered that individuals living with a state of huge
women (3).
hydrocele and inguinal hernia either experienced issues
Additional risk factors occur for the progress
to marry or stay unmarried forever (7).
of inguinal hernias informed to be related with
Accordingly, casualties of inguinal hernia
improved risk for sexes and smoking, which leads to
and hydrocele are viewed as fruitless and useless.
a heavy lifting, defective connective tissue
Supplementary, this makes individuals living with
metabolism and chronic obstructive pulmonary
inguinal hernia to veil their positive status until the
illness (4). Moreover, it was stated that factors such as
point when they ended up gangrenous and immense
peritoneal dialysis, lower body-mass index, collagen
bringing about crisis medicines or passing (7).
vascular disease, thoracic or abdominal aortic
aneurysm, high intra-abdominal pressure, patent
processes vaginalis, and history of open
This study aimed at assessing the awareness
appendectomy, are considered to be risk factors for
of the risk factors of abdominal hernias among adults
inguinal hernia (5).
in Al-jouf, Saudi Arabia.
In 2001-2 around 70,000 inguinal hernia
repairs (62969 essential, 4939 intermittent) were
done in England, requiring in excess of 100,000
This is a cross-sectional community-based
doctor's facility bed days. 95 for every penny of
study of a qualitative approach. The present study
patients pre-senting to essential care are male, and in
enrolled 105 candidates (aged 18 to 45), males 63,

Full Paper (vol.722 paper# 25)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 4017-4020
Knowledge, attitude and practice of dental students, practitioners and
specialist on composite shade matching in Al-jouf, KSA
Mazen N. Alruwaili, Abdulkarim O. Alanazi, Rakan M. Albilasi, Yunus K. Alruwaili, Adel H. Alanazi,
Faisal F. Almusieb
Department of Endodontics, College of Dentistry, Al-jouf University
Corresponding author: Mazen nafa alruwaili, E-mail: Mzmilan8@gmail.com, Tel. +966 50 179 5407
Background: Shade selection is an essential system to give patients an aesthetics renovation that
correspondently merges to the patient's current dentition. Moreover, natural teeth are acknowledged to have
various shades in their surfaces.
Objective: The aim of the study was to evaluate the awareness of knowledge, attitude and practice about the
complications in shade selection and to utilize for improving the quality of training being imparted in the
dental school and general practitioners.
Methods and Material: Participants were divided into six Groups: operative dentist and endodontist, 3rd
Year students, 4th Year students, 5th Year students, Intern and VI-General practitioners; 20 Questionnaire
survey forms were distributed to fill among all the groups.
Results: The results that the highest proportion was 41% for skill factor, knowledge was the second with 26%.
Whilst, individual observer was 13.5% and 12.6% for the factor talent. 4.5% for (All) the factors. The lowest
proportion was for more than two answers.
Conclusion and Recommendation: The need of flourishing of cosmetic dentistry required to keep with up-to-
date information considering all conceivable factors which influence shade selection.
Keywords: Shade selection, Factors, Knowledge


Nowadays, aesthetics has turned into an
essential issue, as it appears to characterize one's
character. Before, practical needs were the primary
This is a cross-sectional of a qualitative
thought in dental treatment. Today, with the declining
approach. Participants were divided into six
in caries pervasiveness, the concentration has moved
toward dental Aesthetics (1).
I- Operative dentist and pedodontist,
Furthermore, shade selection is an essential
II- 3rd Year students,
system to give patients an aesthetics renovation
III-4th Year students,
that correspondently merges to the patient's current
IV-5th Year students,
acknowledged to have various shades in their
VI-General Practioners
surfaces (2).
20 Questionnaire survey forms were
The determination of teeth with an
distributed to fill among all the groups.
appropriate shade has been appeared to decidedly
Furthermore, data were collected for two months
impact the patient's aesthetics observation and
and one month for statistical analysis. It was done
enhanced prosthesis acceptance (3).
using ANOVA testand results were evaluated
The determination of fake teeth shading
can be extremely entrusting and denture aesthetics
has been characterized as the cosmetic impact
created by a dental prosthesis which influences the
The present study enrolled 105 candidates,
alluring magnificence, character, attractiveness and
from both gender male (63, %60) and female (42,
self-confidence of the person (4).
%40). Age groups were (18-25) %62, (26-35) %35,
(36-45) %3 Ages were varied according to the
level of education (high school, college,
The aim of the study was to evaluate the
graduated). Table1 illustrates all the information
awareness of knowledge, attitude and practice
collected of the socio-demographic characteristics
about the problems in shade selection and to utilize
of the candidates.
for improving the quality of training being

imparted in the dental school and general




Full Paper (vol.722 paper# 26)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 4021-4025
Harmful effects of water pollution on some physiological responses of the Nile tilapia (Oreochromis
niloticus) in both Qarun and Burullus Lakes
1Eman, G.E. Helal; 2Abd El-Atti, M. S. and3Yasmina, M.Ekraim
1,3 Zoology Department, Faculty of science (Girls), Al-Azhar University, Cairo Egypt
2 Zoology Department, Faculty of Science, Zagazig University, Egypt
Corresponding author: Eman Helal, email: emanhelal@hotmail.com, Mobile: 00201001025364,orcid.org/0000-0003-0527-7028
Background: Qarun and Burullus Lakes suffer from serious pollution problems owing to the enormous input
of untreated agricultural, domestic and industrial effluents. This study was conducted to explain the effect of
water pollution of these lakes on some physiological parameters of O. niloticus. Results: Showed clearly that
water collected from both Qarun and Burullus Lakes were contaminated with high levels of lead and cadmium.
The concentration of Pb and Cd in Lake Qarun (0.074 and 0.006 ppm respectively) were much lower than that
of Burullus Lake (0.112 and 0.011ppm respectively). The study showed that the rates of Pb bioaccumulations
were increased significantly in the muscles of O. niloticus collected from Brurllues Lake than that of Qarun
Lake. It can be seen also that there are insignificant differences of Cd concentrations in muscles of tilapians
collected from both Lakes. Analysis of liver functions shwoed a highly significant increase in the level of ALT
in O. niloticus liver collected from Brurllues Lake than tilapia'sb liver from Qarun Lake. Both AST and GGT
levels were insignificantly changed in fishes collected from both Lakes (no change in the table). Investigation
of kidney functions of tilapias collected from Qarun and Burullus Lakes showed that urea concentration was
significantly increased in kidney of Tilapia gathered from Burullus Lake (32.40 ± 0.93 mg/dl) than those
collected from Qarun Lake (28.80 ± 0.73 mg/dl). Creatinine concentrations were significantly increased in
kidney of tilapias gathered from Burullus Lake than Qarun Lake. Cholesterol, Triglycerides, high density
lipoproteins (HDL), low density lipoproteins (LDL), and very low density lipoproteins (VLDL) in the muscles
of tilapians collected from Burllues Lake were highly significant increase while total proteins were
significantly decreased in comparison with tilapians of Qaron Lake.
Key words: Oreochromis niloticus - Physiology- Qarun and Burullus Lakes -Water pollution.

refining, electroplating processes, applications of
Qarun Lake is found at the lowest part of
fertilizers and pesticides contribute to Cd pollution
El-Faiyoum depression. Although this Lake
in environment (5). Cadmium binds strongly to
designated as protected area since 1989, it has
organic matter where it is immobilized in soil and
hardly been protected from various polluting
taken up by agricultural crops. A long-lasting
elements and suffers from serious pollution
exposure to lead and cadmium may cause changes
problems due to uncontrolled solid and liquid
in the immune response (6).
domestic and industrial waste disposal practice(1).
Lead exposure is a global issue since lead
Burullus Lake is a brackish water Lake in the Nile
Delta in Egypt and located in Kafr El-Sheikh
manufacturing/disposal/recycling, are common in
Governorate. Burullus Lake is the second largest
many countries. Lead enters the body via
Lake along the Mediterranean Sea and represents
inhalation, ingestion, or skin absorption. Almost all
one of the most subjected Lakes to pollution at the
inhaled lead is absorbed into the body; for
delta's coastline. This Lake serves as reservoirs for
ingestion, the rate is 20­70%, with children
drainage waters, which are contaminated, with
absorbing a higher percentage than adults (7). Acute
anthropogenic materials (2).
exposures often manifest as central nervous system
Heavy metals are commonly found in
(CNS) and gastrointestinal symptoms. Pb targets
natural waters and some are essential to living
the proximal tubules of the kidneys and is capable
organisms, yet they may become highly toxic when
of inducing nephrotoxicity (8).
present in high concentrations(3). Aquatic
Usage of biomarkers has become a valuable
organisms take up metals from water and their diet.
tool during monitoring the environmental quality and
Recent evidence suggests that dietary metal
the health of fish inhabiting polluted ecosystems (9).
exposure is the predominant source for metal
At present, the direct immunotoxicity of heavy metals
accumulation in some aquatic organisms(4).
is the subject of extensive studies, especially on in
Cadmium (Cd) has been considered as one of the
vitro models like fishes.
most toxic heavy metals in the environment. Cd
Therefore, this research was carried out to
coexists with zinc in the zinc ore in nature.
measure the levels of Cd and Pb in the water of
Weathering of rock is the major natural source of
both Qarun and Burullus Lakes and their
Cd in the environment. Industrial and agricultural
bioaccumulation in the muscles of the Nile tilapia
activities such as mining, smelting and ore
Oreochromis niloticus fish collected from the two

Full Paper (vol.722 paper# 27)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 4026-4033
Expression of micro RNA-9 in Patients with Acute Myeloid Leukemia and its Impact on Treatment
1Mona A. Ismail, 2Hanaa R.M. Attia, 1Mona H.I. Farag, 1Dalia A.D. El Dine Salem, 1Mysra S.
1Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, 2Department of Clinical Pathology, Medical
Research Division, National Research Centre
Corresponding author: Mysra S. Youssef, Mobile: 01229650631; Email: mysara.samy.yousef@gmail.com
Background: Acute myeloid leukemia (AML) is a malignant disorder of hematopoietic tissue. It is one of the
most common malignancies in adults. It is characterized by its heterogeneous and complex nature that includes
chromosomal, genetic and epigenetic abnormalities. MicroRNAs have been described to be one of the
epigenetic regulators in AML.
Objective: The present study focused on measuring expression levels of miR-9 in de novo AML patients. 30
bone marrow samples were collected from patients attending at Hematology and Oncology Unit of
Aldemerdash Hospitals.MiR-9 expression levels were measured using real time PCR. These expression levels
were compared to 30 adult healthy volunteers.
Patients and Methods: The present study was carried out in medical oncology and Clinical Pathology
Departments of Ain Shams University and National Research Centre, Egypt during the period between
September 2017 and April 2018.
Results: Statistical analysis of the results showed that miR-9 was significantly down regulated in AML
patients in comparison to controls. It is also significantly correlated to platelet count. Regarding diagnostic
performance, this study showed that miR-9 has weak diagnostic performance but regarding screening function,
it has perfect sensitivity but weak specificity so it can be used as an excluding test.
Conclusion: This study showed reduction of miR-9 in bone marrow of AML patients and opened the horizon
for future studies on diagnostic and screening performance of miR-9 to be performed on larger scale and
different ethnic groups.
Keywords: Leukemia, myeloid, acute,miR-9,treatment outcome.

harbor distinct sets of microRNA signatures. This
Acute myeloid leukemia (AML) is a
may play a part in the pathogenesis and prognosis
malignant clonal disorder of immature cells in the
in AML (3).
hemopoietic hierarchical system. These cells have
Evidence is emerging that micro RNA-9 is
abnormal function characterized by a failure to
an important regulator of normal development and
progress through the expected differentiation
diseases. Its aberrant expression levels have been
program and / or to die by the process of apoptosis.
reported in many types of cancers, having opposing
This leads to the accumulation of a clone of cells
effects on proliferation through regulation of
which dominates bone marrow activity and leads to
various mRNA targets. It is over expressed in
marrow failure (1).
Hodgkin lymphoma, primary brain tumors as
MicroRNAs are a class of small, noncoding
Neuroblastoma and Medulloblastoma. In contrast,
RNAs. They are epigenetic regulators that regulate gene
it is down regulated in ovarian tumor (4).
expression by either degradation of mRNA or inhibition
Regarding hematological malignancies,
of translation. Their physiological roles start from
miR-9 is an important player in scope of AML
development, differentiation, cell cycle regulation and
prognosis. It is overexpressed in MLL rearranged
end by aging and metabolism. Consequently, they are
AML, causing a significant increase in cell viability
frequently deregulated in human's cancers. The Roles of
and a decrease in apoptosis. On the other hand, miR-
microRNAs in carcinogenesis are very complex.
9 repress the oncogenic LIN28B/HMGA2 axis,
Numerous microRNAs promote tumorigenesis and
thus, acting as a tumor suppressor-miRNA which
cancer progression by enhancing tumor growth,
acts in a stringent cell context (5).
angiogenesis, invasion and immune evasion, while
others have tumor suppressive effects. As a result, the
expression profile of cancer microRNAs can define
Measure miR-9 expression levels in AML
tumor type, susceptibility, prognosis and response to
patients group and to correlate different expression
treatment (2).
levels of miR-9 to clinical and laboratory data to
Different microRNA expression profiles
evaluate its role on treatment strategy in AML cases.
are seen in various cytogenetic groups of AML.

Moreover, AMLs with specific gene mutations also


Full Paper (vol.722 paper# 28)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 4034-4038
Role of Anti-Hepatitis C Virus (HCV) Signal to Cut-off Ratio (S/CO) in Following-
up Patients Received Anti-HCV Therapy in Egypt
Ahmed M. Saba; Sayed A.M. Mahmoud; Shaheen A.M.
*Medical Biochemistry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Background: Hepatitis C Virus (HCV) infection is diagnosed by antibody and RNA based methods. Anti
HCV-RNA testing based methods are introduced to confirm viremia in seropositive samples. This study aimed
to evaluate the relationship between quantitative anti-HCV (S/CO ratio) and HCV-RNA by PCR as a
diagnostic test to identify viremic from non-viremic HCV patients received anti-HCV therapy in Egypt.
Subjects and Methods:
Patients serum samples used in this study were collected from Al Hussein University
hospitals after they had completed their anti-HCV therapy. A total of 172 patients were included in this study
82 were positive RNA, 90 of them were negative RNA their serum samples were assessed for the presence of
antibodies to HCV using ELISA method. Results: The results were expressed as the ratio between the signal
detected on the sample and the cutoff value of the run (S/CO). Patients with HCV-positive RNA were
considered viremic. Receiver operator characteristic (ROC) curve was constructed by plotting sensitivity
versus 1 - specificity, using HCV RNA and the S/CO ratio results respectively. Of the 172 patients with HCV
infection the mean age was 51.9 ± 7.2 years ranging 35-67 years, 111 (64.5%) were males while 61(35.5%)
were females. In the present study there was significant difference in S/CO ratio between viremic and non-
viremic subjects. The sensitivity, specificity, negative predictive value, and positive predictive value were
98.78%, 71.11%, 98.46%, and 75.70%, respectively in the S/CO ratio of 8. Area under ROC curve was
estimated to be 0.982 (95% confidence interval 0.967 ­ 0.997). Conclusion: by establishing 8 as cutoff value
of the S/CO, it is possible to distinguish between viremic and non-viremic patients without need to use Anti
HCV-RNA testing as a confirmatory test.
Key Words:
Hepatitis C, Hepatitis C antibody. Enzyme Linked Immunosorbent Assay. Signal-to-cut-off ratio.

based on the detection of anti-HCV antibodies in
HCV is a roughly spherical, enveloped,
serum by means of enzyme-linked immunosorbent
positive-strand RNA virus approximately 55 nm in
assays (ELISA). Anti-HCV positive result might
diameter. It is a member of the family Flaviviridae,
be one of three possible conditions: Current active
yet it is sufficiently distinct from the type genus
infection, past infection and false positive result.
Flavivirus (e.g., yellow fever virus and dengue
Detection of HCV-RNA by polymerase chain
virus) to merit classification within a separate
reaction (PCR) is considered the gold standard to
genus, Hepacivirus, which also include Pestivirus
confirm the diagnosis of HCV infection and for
(e.g., bovine viral diarrhea virus and classical
assessing viremia in patients during and following
swine fever virus) and Pegivirus (1). It is estimated
antiviral therapy (5). The Centers for Disease
that more than 80 million people are chronically
Control and Prevention (CDC) published
infected worldwide, with 3­4 million new
recommendations for laboratory testing and
infections and 350 000 deaths occurring each year
reporting of anti-HCV results, with the option to
because of HCV-related complications (2). Egypt is
classify the positive antibodies as low or high, and
the country with the highest HCV prevalence in the
then choose supplementary testing based on the
world; in 2015, a national Egyptian health issue
signal-to-cut-off (S/CO) ratio. The CDC guide also
survey was conducted to describe the prevalence of
proposed that cases which could be classified as
HCV infection. The prevalence of HCV antibody
having true positive results with a high level of
in Egyptian population was found to be 10.0% (3).
Anti-HCV should be confirmed by (Immunoblot)
Transmission is mainly associated with infected
IMB (6). Recently, the CDC guidelines were
blood products, intravenous drug abuse, accidental
updated to use a second anti-HCV antibody assay
needle sticks or perinatal infection although other
to distinguish between true positive and false
less common routes such as vertical or sexual
positive HCV antibody (7). The decision to use a
transmission are reported. Laboratory assays that
specific supplemental testing strategy has
are available for the diagnosis and management of
economic implications for society. In health care
HCV infection include: serologic tests to detect
systems with limited budgets, the recommendation
HCV antibodies, molecular tests to detect and
always to use Anti HCV-RNA testing might not be
quantitate HCV-RNA and genotyping techniques
feasible and requires a sophisticated molecular
in addition to assays to detect and quantify HCV
laboratory. The aim of this study is to evaluate the
core antigen (4). The diagnosis of HCV infection is
relationship between quantitative anti-HCV (S/CO


Full Paper (vol.722 paper# 29)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 4039-4044
Survey of Awareness of Thyroid Disorders among the Riyadh Population, Central
Region of Saudi Arabia
Atheer Mohammed D Alotaibi1, Abdulrahman Ibrahim S Almousa2
1Almaarefa Colleges for science and Technology, College of Medicine, Riyadh, 2Prince Sattam bin Abdulaziz
University, Akharj, Saudi Arabia
Background: Thyroid diseases are among the commonest endocrine disorders worldwide and attention to
physical examination findings, combined with selected laboratory and radiologic tools and aids in the early
diagnosis and treatment of thyroid endocrine disorders is fundamental. Health education is considered an
essential component to improve knowledge and change behavior. People affected by thyroid diseases often
have inadequate knowledge about the nature of thyroid diseases, its risk factors and associated complication.
The aim of this study was to assess the awareness of the Riyadh population with various aspects
of thyroid diseases. Methods: A cross-sectional study was carried out in Riyadh city, the capital of the
Kingdom of Saudi Arabia. The study was carried out on Saudi nationals from different age groups that were
selected by systematic random sampling. Data were collected by means of personal interview with the
participants using a pre-designed questionnaire which was administered by the medical students for each
participant. Data were analyzed by SPSS version 16, using descriptive statistics. Results: The total number of
participants was 870 among which 297 (34.1%) were males and 573 (65.9%) were females. The participants
were classified into 4 age groups, most of them were in the 31-50 years old group, counting 492 (56.5%). Only
6.6% among the participants did not know what the thyroid gland is, while 93.4% have chosen specific
answers that are facts regarding the thyroid on different levels of knowledge. Among participants, 17% related
thyroid disorders to disturbances in the menstrual cycle, recurrent miscarriage, and birth of dead fetuses, while
30.3% related that to psychological factors as depression, confusion, lack of concentration, mood swings, and
anxiety, 27.4% to neck and joint pain with fatigue and weight loss, and 25.3% constipation and/or diarrhea,
voice changes and swelling of the neck. Among our participants, 16.8% reported suffering from
hypothyroidism. Regarding hypothyroidism, 30.9% answered yes to the question regarding whether or not
ionized salt has a role in the treatment of hypothyroidism, when 22.2% responded with `No' and the majority
(46.9%) responded `I do not know'. The majority (39.0%) answered `Yes' to whether the treatment can be
stopped when investigations become normal in hypothyroidism, and (43.6%) answered `I do not know,' in
hyperthyroidism. Moreover, 26.6% thought that herbal remedy can cure hypothyroidism as well as (26.0%) in
hyperthyroidism. Conclusion: This study recommended that health policy makers must conduct more
effective health education sessions to increase knowledge of the population and their caregivers about various
aspects of thyroid diseases and the importance of compliance with its treatment.
Awareness, thyroid diseases, Knowledge, Riyadh City, Saudi Arabia

Thyroid gland is an endocrine organ located
hyperthyroidism. Hypothyroidism is the most
in the anterior aspect of the neck in front of the
prevalent type affecting 4-5% in the developed
trachea. The function of this gland is to produce
countries. While it's is more common in areas with
sufficient amount of thyroid hormones which will
iodine deficiency [2].
primarily influence the metabolic rate and protein
The pattern of the disorders distribution
synthesis. Thyroid hormones also have other effects
depends on age, ethnicity and geographic factors
such as development of tissues and organs. The
especially in iodine deficient areas. Despite being
production of thyroid hormone is regulated by
one the most prevalent medical condition, thyroid
hypothalamic pituitary axis through thyroid
disorders are the most underdiagnosed and
stimulating hormone from anterior pituitary gland and
neglected chronic health conditions globally [3,4].
thyroid releasing hormone from the hypothalamus.
During clinical assessment of thyroid
Prevalence of thyroid disorders is a very
disorders patient may present with variety of
common medical condition. Symptoms of thyroid
manifestations involving major systems of the
disorders depending on the condition of thyroid gland
body like endocrine, cardiovascular, central
functions [1]. The function of the thyroid can be
nervous system, musculoskeletal, hematological,
primarily affected from the gland itself (most
reproductive, gastrointestinal and dermatological
common) or secondarily affected from higher centers
[5]. These manifestations can be confused with
signal in the brain (hypothalamic pituitary axis). This
other medical conditions because; they are not
effect on the gland function will result in one of two
specific to thyroid disorders only.


Full Paper (vol.722 paper# 30)