ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4230-4235
Role of Diffusion Weighted MRI in Grading of Endometrial Carcinoma
Lobna A. Habib, Nourhan A. Gaber, Rasha S. Hussein
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Nourhan A. Gaber, Mobile: +201150189304, E-mail: dr.nourhangaber@gmail.com
ABSTRACT
Background: Recent developments in diagnostic imaging techniques have magnified the role and potential of
MRI in female pelvic imaging. Functional imaging by means of diffusion weighted magnetic resonance
imaging (DW-MRI) is now part of the standard imaging protocols for evaluation of the female pelvis.
Objective: This study aimed to highlight the role of Diffusion Weighted MRI in tumor grading noninvasively
prior to surgery.
Methodology: This study carried out in Radiology Department of Ain Shams University Hospitals. This study
included 20 patients. All patients were subjected to careful history taking, Histologic diagnosis of endometrial
carcinoma and pelvic MRI was done.
Result: The difference between the mean ADC values of high grade and low grade endometrial carcinoma
was significant.
Conclusion: MRI is accurate in assessing the depth of myometrial invasion and cervical extension, allowing
for selective lymphadenectomy, with higher accuracy measures for Diffusion Weighted MRI than for Dynamic
Contrast Enhanced MRI in both lesion characterization and staging.
Keywords: Endometrial carcinoma, DW MRI.
INTRODUCTION
predicting tumor grade noninvasively prior to
Endometrial carcinoma is the leading
surgery (6).
malignant tumor of the female genital tract in
Diffusion weighted -MRI may help to
industrialized countries. Over the last decade the
differentiate endometrial cancer from normal
annual incidence has remained stable with an
endometrium, however this has limited clinical
estimated 25.1 cases per 100. 000 women (1).
utility at the diagnosis of endometrial cancer which
The vast majority of endometrial cancer is
is made by endometrial biopsy and the role of
diagnosed at an early stage with atypical uterine
contrast enhanced MRI is to stage a known
bleeding in postmenopausal age. The 5-year overall
endometrial carcinoma (7).
survival is 81.7 %, but it varies broadly from 20 to
AIM OF THE WORK
91 % for different tumor histologies and stages (2).
The aim of this study was to highlight the
Advances in magnetic resonance imaging
role of DW-MRI in tumor grading noninvasively
(MRI) technology provide excellent soft tissue
prior to surgery.
contrast resolution with multiplanar capabilities
when evaluating the female pelvis (3).
PATIENTS AND METHODS
There has been a growing interest in
Patients: The study was conducted in the period
functional imaging modalities. Diffusion-weighted
between October 2017 and May 2018 in Radiology
imaging (DWI) with the aid of quantitative
Department at Ain Shams University Hospitals. The
apparent diffusion coefficient (ADC) measurement
patients underwent MR examination using a 1.5 T
is a unique, noninvasive modality that was shown
machine (Achieva, Philips medical system, Eindhoven,
to improve the radiological diagnosis of malignant
Netherlands) using phased array coil.
tumors (4).
Inclusion criteria: Patients presented with
Diffusion weighted MR imaging is a
a histologic diagnosis of endometrial carcinoma.
functional imaging technique that displays
Exclusion criteria: Patients known to
information about water mobility, tissue cellularity,
have contraindications for MRI, e.g. an implanted
and the integrity of the cell membranes. It carries
magnetizable device, pacemakers or claustrophobia
the potential to improve tissue characterization
and patients having allergy to contrast.
when findings are interpreted together with
Ethical Considerations: All participants
conventional MR imaging sequences (5).
signed an informed consent after explaining to them
High grade endometrial carcinomas have
the objective of the study. The study was approved by
high cellular density and are expected to have
the Ethics Board of Ain Shams University.
lower ADC values compared to low grade ones.
MR-imaging protocol: Localizer images
Thus, the expected clinical significance of ADC
in both axial and sagittal planes: 1- Sagittal T2WI.
measurement in endometrial cancer would be in
2- Axial oblique T2WI. 3- Coronal oblique T2WI.
4230
Received:30/4/2018
Accepted:9/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4236-4240
An Ultrasound Guided Technique of Central Venous Catheterization versus
Anatomical Landmark Guided Technique in Medical Intensive Care Patients
Ayman A. Yousef1, Gamal A. Badr1, Atef A.E. Ibrahim1 and
Ahmad M. Aboul Fotouh2
1Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
2Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Ayman A. Youssef, E-Mail: ayman123930@gmail.com, Phone: 0201220236951
ABSTRACT
Background: Central venous catheterization (CVC) is an important procedure in the practice of emergency
medicine. Insertion of CVC is amongst the most frequently performed invasive procedures in ICU. In severely
ill and long-stay patients, inserted CVCs enable relatively safe and painless application of parenteral nutrition,
long-term antibiotics, chemotherapy, intravenous fluids, and blood components and are also used for repetitive
blood sampling. Furthermore, CVCs are used for invasive hemodynamic monitoring, hemodialysis,
plasmapheresis and in case of shortage of a peripheral access. With the increasing availability of bedside
ultrasound, emergency physicians have begun to incorporate this new technology to reduce error and improve
patient care. Objective: To compare the outcome of an ultrasound guided technique versus an anatomical
landmark guided technique for central venous catheterization. Patients and methods: The present study was
performed on one hundred patients of both sexes; the study was conducted at El-Hussein University Hospital.
They were scheduled for insertion of central venous line for various purposes. The patients were assigned into
two groups each group formed of fifty patients (n=50). Group (A): Anatomical guided technique for insertion
of CVC, Group (B): Ultrasound guided technique for insertion of CVC. Patients with local infection, known
vascular abnormalities, untreated coagulopathy (INR more than 1.5, platelets less than 50000/mm3) and age
less than 16 years old were excluded from the study. Results: A total of 100 patients were included. The
outcome of each group was recorded regarding success rate, number of attempts and access time in seconds.
The use of ultrasound guided central venous catheterization has better outcome and higher-safety in
comparison to anatomical landmark-based technique. Ultrasound guidance elevated significantly the success
rate of central venous catheterization than anatomical landmark-based technique. In addition, the access time
was reduced in a significant trend by using ultrasound guidance. In the same manner the average number of
attempts needed for accessing the vein was limited significantly when Ultrasound guidance was applied. The
incidence of hematoma formation, arterial puncture and malposition was reduced in a significant trend by
using ultrasound guidance in comparison to landmark-based techniques. When comparing ultrasound guidance
to anatomical landmark-based guidance we found that all mechanical complications were significantly lower
when central venous catheterization was carried out by means of ultrasound guidance. Conclusion: Ultrasound
examination of the region of interest offers some additional information compared to clinical examination as
Position of the vessel, Patency of the vessel, Size of the vessel and Stenosis or hematoma. The implementation
of ultrasound guidance improves success and reduces complication rate during central venous catheterization.
Keywords: Central, Venous, Catheterization, Ultrasound, Anatomical, Landmark, Guided, Technique.
INTRODUCTION
practice and with improvement importability and cost-
Central venous catheters (CVCs) have now
effectiveness its use has further expanded. In many
become indispensable in intensive care units and
facilities, the use of ultrasound when placing central
operating rooms. Insertion of CVC is amongst the most
venous catheters has become increasingly popular.
frequently performed invasive procedures. In severely
Ultrasound guidance of CVC insertion improves
ill and long-stay patients, inserted CVCs enable
success rates and reduces complications (2).
relatively safe and painless application of parenteral
Ultrasonography was introduced into clinical practice in
nutrition, long-term antibiotics,
chemotherapy,
the early 1970 and is currently used for a variety of
intravenous fluids, blood components and are also used
clinical indications (3). In this study we aim to compare
for repetitive blood sampling. Furthermore, CVCs are
the outcome of an ultrasound guided technique versus
used for invasive hemodynamic monitoring,
an anatomical landmark guided technique for central
hemodialysis, and plasmapheresis and in case of
venous catheterization.
shortage of a peripheral access (1). By definition, these
PATIENTS AND METHODS
devices involve placement of a large-bore catheter into
The present study was performed on one
one of the body's main central veins either by
hundred patients of both sexes; they were scheduled for
conventional method or Ultrasound guided. Ultrasound
insertion of central venous line for various purposes.
(U/S) technology has many uses in clinical medical
They were assigned into two groups each group formed
4236
Received:30/4/2018
Accepted:9/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4241-4245
Left Ventricular Diastolic Function in Patients with Heart Failure with Preserved
Ejection Fraction
Mohsen A.M. Salama, Islam S. Abd El-Aziz, Ayman S. Elsaeid, Ahmed E. Abd Elhameed
Cardiology Department, Faculty of Medicine, Al-Azhar University
waela0486@gmail.com
ABSTRACT
Background: Left ventricular heart failure in sitting of preserved left ventricular ejection fraction constitutes
up to 50% of heart failure. It increases with age and is correlated with the presence of systemic hypertension
and left ventricular hypertrophy. It has significant morbidity, approaching that of systolic heart failure. Heart
failure preserved ejection fraction (HFpEF) is a clinical syndrome resulting from increased resistance in the
filling of the left ventricle (LV) leading to symptoms of congestion although the exact cause continues to be
unknown and the identification of markers that predict HFpEF risk have not been proven.
Aim of the Work: Assessment of left ventricular diastolic function in patients with heart failure and preserved
ejection fraction.
Patients and Methods: This study included 90 patients with ages ranging from 30 to 70 years old referred to
Al Hussein University Hospital, Bab Al Shearia University Hospital, Cardiology Outpatient Clinic suffering
from low functional capacity, exertional dyspnea and even exertional chest discomfort. Over a period from
November 2015 to May 2018. The study population was divided into two groups according to incidence of
positive stress ECG. Group A (patient group): Patients with positive stress ECG. Group B (control group):
Patients with negative stress ECG.
Results: This study included (90) patients with their ages ranging from 30 to 70 years referred to (Al Hussein
University Hospital), (Bab Al Shearia University Hospital) cardiology outpatient clinic from November 2015
to September 2017, with low functional capacity, exertional dyspnea and even exertional chest discomfort and
are evaluated to rule out coronary artery disease (CAD). Those patients were evaluated by stress ECG and
Transthoracic Echodoppler and Tissue Doppler imaging. The study population was divided into two groups
according incidence of positive stress ECG into: Groups according incidence of positive stress ECG. Group I
patients group: Included 60 patients presented by chest pain with dyspnea NYHA class 1 (12 patients), class II
(37 patients), or class III (11 patients) with mean age 54.05±7.9 years, this group included 19 females (31.7%)
and 41 males (68.3%), Group II control group: Included 30 patients with mean age 52.7±5.11 years. Female
number was 13(43%) and males were 17(60%).
Conclusion: The assessment of diastolic function is now essential on routine testing for HF. The noninvasive
nature of echocardiography has allowed an increase in diagnosis and awareness of diastolic dysfunction.
Keywords: Left Ventricular Diastolic Function, Heart Failure, Preserved Ejection Fraction
INTRODUCTION
However, biomarkers that enable prevention,
Left ventricular heart failure in sitting of
diagnostic and treatment guidelines and population-
preserved left ventricular ejection fraction constitutes
specific characteristics are not evident in the
up to 50% of heart failure that increases with age and
literature. The pathophysiologic understanding of HF
is correlated with the presence of systemic
has changed notably over the last 25 years (5).
hypertension and left ventricular hypertrophy. In
Terminology has evolved to include HF
addition, it has significant morbidity, approaching
syndromes with ejection fraction (EF) < 50 %
that of systolic heart failure (1).
described as diastolic heart failure (DHF), and as
Heart failure preserved ejection fraction
the pathophysiological mechanisms of HF became
(HFpEF) is a clinical syndrome resulting from
clearer, the terms were changed to HFpEF and
increased resistance in the filling of the left
heart failure reduced ejection fraction (HFrEF)
ventricle (LV) leading to symptoms of congestion
which are currently used (6).
(2) although the exact cause continues to be
Although the understanding of HFpEF
unknown and the identification of markers that
pathophysiology
has
progressed,
definitive
predict HFpEF risk have not been proven (3).
research on population specific pathophysiology,
Data from the National Health and
consistent use of biomarkers and guidelines for
Nutrition Examination Survey (NHANES) suggest
diagnosis and treatment are not yet established (5).
an estimated 5.7 million Americans have HF and
Heart failure is a clinical syndrome
HFpEF accounting for at least 50 % of all HF
resulting from impairment of ventricular filling or
hospital admissions and forecasts a 46 % increase
ejection of blood, consequently limiting cardiac
in HFpEF prevalence by 2030 (4).
output (CO) to the body at rest or with exertion, or
4241
Received:8/5/2018
Accepted:17/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4246-4251
Mutiparametric Magnetic Resonance Imaging in Assessing Ovarian Cysts
Arwa T.M. Ali, Rasha S.E. Hussein, Sherine G. Moftah
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Arwa T.M. Ali, Mobile: +201003505714, E-mail address: doctor.arwa@hotmail.com
ABSTRACT
Objective: Is to study the role of multi-parametric MRI including the novel sequences, diffusion weighted
images (DWI) in the characterization of ovarian cystic lesions.
Methodology: This study carried out in MRI unit, Radiology Department of Ain Shams University Hospitals.
20 patients with pathologically proven nature of ovarian cyst underwent pelvic MRI examination including
diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC)
Result: Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) to detect nature of
ovarian cysts can't be carried alone but need to be combined by conventional and DCE MRI.
Keywords: Multi-parametric MRI (Mp-MRI), Adnexal, Ovarian, Cysts, Apparent diffusion coefficient (ADC)
INTRODUCTION
AIM OF THE WORK
Ovarian cancer remains the leading cause
The objective of this study is to study the
of death amongst gynecological malignancies. The
role of multiparametric magnetic resonance
degree of suspicion for malignancy in a given
imaging (Mp-MRI) including the novel sequences,
ovarian cystic lesion is largely based on diagnostic
namely diffusion weighted images (DWI) in the
imaging (1).
characterization of ovarian cystic lesions.
Differentiating a benign from a malignant
adnexal cystic lesion would provide a base for
PATIENTS AND METHODS
optimal preoperative planning and may also reduce
Patients: During a period of 6 months
the number of unnecessary laparotomies patients
duration from December 2017, twenty patients were
undergoing treatment for benign disease (2).
enrolled in the study. All patients with
MRI provides additional information on
sonographically detected ovarian cystic lesion where
the composition of cystic lesions using differences
histopathological report of the nature of cyst or strict
in MR relaxation properties seen in various types
follow up was done. MRI examination was done
of tissue. More recently developed MRI sequences,
prior to any intervention. The study was approved
like diffusion weighted, susceptibility weighted,
by the Ethics Board of Ain Shams University.
and dynamic contrast enhancement sequences
Inclusion criteria: Female patients with
provided additional capacities for adnexal lesion
sonographic findings of ovarian cysts. No age
tissue characterization (3).
predilection.
It was reported that Mp-MRI limits
Exclusion criteria: Patients known to
additional expense and invasive diagnostic and
have contraindications for MRI, e.g. an implanted
surgical applications and has advantages in terms
magnetic device, pacemakers or claustrophobia.
of cost-effectiveness contrary to general belief (4).
Patients with bad general condition needing life
Diffusion-weighted imaging (DWI) has
support and those with severe hepato-renal disease.
some utility for characterization of adnexal cystic
Purely solid ovarian masses. Histopathological
lesions, and is especially useful in the detection of
Analysis The histology was reviewed by an
metastases and peritoneal implants (5).
experienced pathologist.
Fibrous lesions with very low ADC values
MRI imaging: Conventional MRI and
usually also show low signal on DWI, suggesting
DWIs were performed using PHILIPS Achieva 1.5
benignity. Further, lesions with benign features on
Tesla, Netherlands, using a torso XL 16 channels
both ADC maps and DWI are most often benign, and
phased array coil.
demonstration of low DWI signal within a mass may
Diffusion study: DW images were
augment diagnostic confidence when features on
acquired in the axial plane using the single-shot
other sequences favor a benign process (5).
echo-planar
imaging
technique.
Diffusion-
Quantitative dynamic contrast enhanced
encoding gradients were applied using three b
MRI (DCEMRI) provides an accurate method for
values of 0,600 and 800 s/mm2 along the three
the prediction of malignancy, particularly in
orthogonal directions of motion-probing gradients.
preoperative indeterminate cases (2). The early
ADC maps were automatically constructed on a
enhancement patterns of ovarian epithelial tumors on
pixel by-pixel basis.
DCE MR images can help distinguish between
MRI data analysis: When the ROI was
benign, borderline, and invasive epithelial tumors (6).
drawn, attention was paid to the exclusion of the
4246
Received:7/4/2018
Accepted:16/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4252-4258
Natural Honey Bee venom Manipulates Human Immune Response
Fayez M. Shaldoum, Mostafa I. Hassan, Mohammed S. Hassan
Department of Zoology, Faculty of Science, Al-Azhar University, Madinat Nasr, Cairo, Egypt.
Correspondence: Fayez Muhammad Shaldoum, Email: fshaldoum@azhar.edu.eg
ABSTRACT
Background: Honey bee venom is an important toxin which has various useful properties. Bee venom
possesses various peptides including melittin, apamin, adolapamin and mast cell degranulating peptide. It
appears to stimulate cortisone secretion, enhances antibody production, and affects cytokine production.
Aim: The aim of the work is to study changes in levels of complement system proteins, C3 and C4, together
with C-reactive proteins and rheumatoid factors (CRP and RF) in response to bee venom in subjects exposed
naturally to sting with honey bee workers. Subjects and Methods: Subjects (12) were randomly selected from
patients visiting El-Mostafa bee house, Elmarg, cairo, Egypt; to get natural bee venom therapy for various
diseases. Blood samples (24) were collected from these volunteers, before and after honey bee sting, at the
laboratory of Egypt Air Hospital, Cairo, Egypt following the standard protocol. Serum levels of C3 and C4
were measured by radial immunodiffusion technique. CRP was quantitatively measured by in vitro diagnostic
test using auto analyzer (Dimension® EXEL) clinical chemistry system. Serum RF was measured by Rapid
latex agglutination test for qualitative screening. Result: After exposure of patients to bee sting: all abnormal
levels of C3 returned to normal values while abnormal C4 levels did not change; Half of cases that were
showing abnormal high CRP levels have dropped to normal levels and All RF positive cases have become
negative. Conclusion: The complement system has been activated, in patients, by both classical and
alternative pathways before treatment with bee venom where it became only classically activated after
treatment. Improved values of both CRP and RF indicate reduction in the inflammatory immune response after
exposure of patients to honey bee venom.
Key words: Honey bee, Venom, Human, C3, C4, CRP, RF, Egypt
INTRODUCTION
complement system. Activation of C3 results in a
Apitherapy is nowadays practiced all over
variety of immunologic reactions such as immune
the world. Use of honey and other bee products can
adherence, phagocytosis, antibody response,
also be traced back thousands of years. Apitherapy
cytolysis, inflammation, and killing of pathogenic
has been practiced in: ancient Egypt, Greece and
microorganisms(3,4).
China for as old as 3-5000 years ago(1). Holy Quran
Complement protein 4 (C4) plays a central
has paid our attention to the importance of bees in
role in classical and lectin pathways of
life more than 1400 years ago by including a
complement. A C4 deficiency is often seen in
separate complete chapter 16, Surat An-Nahl,
association with infectious diseases (5,6).
entitled by the name of bees where you find two
C-reactive protein (CRP) is a well-known
verses; 68 and 69 talking about the life of bees and
inflammatory marker which is able to activate
healing properties of its secretions.
complement component (7).
Bee venom is a natural toxin produced by
Human studies have shown bee venom to
the honey bee and it has a prime role of defense for
be immensely beneficial in rheumatoid arthritis
the bee colony. It has an efficient and complex
(RA, positive RF auto antibodies) patients and
mixture of substances designed to protect bees
possess anti-inflammatory and antioxidant activity
against a broad diversity of predators. Bee venom
(8). Bee venom has also been used in oriental
possesses various peptides including melittin,
medicine to relieve pain and to treat chronic
apamin, adolapamin and mast cell degranulating
inflammatory diseases (9). Bee venom therapy has
peptide. It also contains enzymes, biologically
also been used as the therapeutic method in treating
activity amines and non-peptide components.
rheumatoid arthritis, amyotrophic lateral sclerosis,
Enzymes are composed of phospholipase A2
Parkinson's disease, Alzheimer's disease, liver
(PLA2), hyaluronidase, acid phosphomonesterase,
fibrosis, atherosclerosis, pain and others(10).
-D-glucosidase and lysophospholipase, as well as
The aim of the present work is to Study
non-peptides such as histamine, dopamine and
changes in levels of C3 and C4 together with CRP
norepinephrine (2).
and RF in response to bee venom in patients
The role of the complement as a system
exposed naturally to sting by honey bee workers.
merging early-phase innate immunity with later-
PATIENTS AND METHODS
phase acquired immunity has been established.
Complement protein 3 (C3) is a key protein of the
Patients: Patients (12) were randomly
selected from subjects visiting El-Mostafa bee
4252
Received:7/4/2018
Accepted:16/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4259-4263
A Comparative Study of Primary Colonic Repair versus Stoma in Emergency Cases
Mohamed Hafez Mahmoud, Mahmoud Abd El Hady Abd El Aziz, Mohamed Magdy Ahmed Ali
General Surgery Department, Faculty of Medicine, Al Azhar University
ABSTRACT
Background: In emergency surgery, management of an enterotomy, either spontaneous or following resection of a
bowel segment can be by approximation of cut edges, referred to as primary repair or by exteriorization of the
involved segment, referred to as ostomy. Indication of this operation can be a perforated bowel segment (produced
as a result of trauma or secondary to an inflammatory process of gut) or a devitalized/redundant segment of bowel
requiring resection. Penetrating colon injury or blunt abdominal trauma carries a high risk of a high-risk rate of
infectious morbidity. The development of infectious complications is related to the injury severity and
haemodynamic status of the patient, not the type of operation performed. Aim of the Work: Comparing the
outcome of primary repair versus colon diversion in emergency cases regarding efficacy, safety and usefulness.
Patients and Methods: A prospective study on 40 patient undergoing either primary repair of bowel or intestinal
stoma formation following emergency laparotomies in the Department of Surgery in El-Hussien and El-Haram
Hospitals, which is a big emergency and trauma center and cover large geographic area. All persons will give their
informed consent. The people who have the decision in performing and choosing the type of the operation are
specialists and consultants (they have the license as decision makers). All patients presented in ER department with
colorectal emergencies, included trauma (penetrating, gunshot & blunt), obstruction (malignant & non-malignant)
and acute abdomen due to perforation, and need emergent laparotomy confirmed by history, clinical examination
and investigations. Results: It included 40 patients divided into three age groups with main age of 31.2 ± 20.1 years
old. There were 26 males and 14 females. Etiological causes were trauma 30 patients (75%), benign obstruction 2
patients (5%), malignant obstruction 4 patients (10%) and the acute abdomen 4 patients (10%). Time between
injury and admission was less than 8 hours in 28 patients and it was between 9 to 24 hours in 12 patients (30%) and
more than 24 hours in 4 patients (10%). Shock defined by systolic blood pressure less than 90 mmHg was present in
7 (17.5 %) patients and non-shocked patients were 33 patients (82.5%). Conclusion: After reviewing many
literatures and studies, after this work. We recommend primary repair of the colon in colorectal emergent
conditions. Especially injuries and benign obstruction and care must be taken when performing primary repair in
cases of malignant obstruction and peritonitis due to non-traumatic colonic perforation (PNTCP). First of all the
main indicator for the primary repair is the patient's general condition. Over all the main determine to do primarily
repair or to divert is the general condition of the patient.
Keywords: Primary Colonic Repair, Stoma IN Emergency Cases
INTRODUCTION
its own complications and the need for subsequent
In emergency surgery, management of an
surgery (4). It seems, however that there is a limited
enterotomy, either spontaneous or following
role for colostomy, particularly in high-risk patient
resection of a bowel segment can be by
with destructive injuries of the left colon (5).
approximation of cut edges, referred to as primary
The decision regarding the type of surgery
repair or by exteriorization of the involved
needs to balance the risks of anastomotic
segment, referred to as ostomy.
dehiscence to the of bowel exteriorization.
Indication of this operation can be a
Although numerous studies have concluded a
perforated bowel segment (produced as a result of
trauma primary advantage of repair over stoma
trauma or secondary to an inflammatory process of
formation in emergency trauma surgeries (6).
gut) or a devitalized/redundant segment of bowel
There are different strategies to avoid
requiring resection (1).
colostomy and its associated problems with
Penetrating colon injury or blunt
improved facilities in patient care and proper use of
abdominal trauma carries a high risk of a high-risk
antibiotics, the surgeons today are more included to
rate of infectious morbidity. The development of
primary repair of colon (7).
infectious complications is related to the injury
AIM OF THE WORK
severity and haemodynamic status of the patient,
Comparing the outcome of primary repair
not the type of operation performed (2).
versus colon diversion in emergency cases
Latrogenic abdominal colonic perforation is a
regarding efficacy, safety and usefulness.
rare but very dangerous complication of colonoscopy (3).
PATIENTS AND METHODS
During the world war II, diversion was the
A prospective study on 40 patient
dictum, current trends favor the primary repair.
undergoing either primary repair of bowel or
Colostomy is no longer a standard option because of
intestinal stoma formation following emergency
4259
Received:14/4/2018
Accepted:23/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4264-4269
Role of PET/CT in Differentiating Bronchogenic Carcinoma from Inseparable
Pseudo-Neoplastic Lesions
Mounir S. Girguis, Mohamed G., Ahmed M. Osman, Maged M. Sabry
Radiodiagnosis Department, Ain Shams University, Cairo, Egypt
Corresponding Author: Maged M.S. Abdel-Aziz, Email: drmagedsabry@live.com, Tel.: 01006264155
ABSTRACT
Background: Bronchogenic carcinoma is the single most important cause of cancer-related deaths with
approximately 1.5 million cases worldwide every year. Computed tomography (CT) scanning can only estimate the
proximal extent "with difficulty in visualization the real borders" of a tumor. The role of MRI in local staging of
bronchogenic carcinoma is limited by the signal loss secondary to respiratory motion and heterogeneity of the
magnetic field caused by the tissue/air interfaces. Positron Emission tomography combined with CT (PET/CT can
accurately delineate the viable tumor from surrounding atelectasis and collapse/consolidation, This information
cannot only demarcate the size and extent of the tumor for accurate T staging, but also provide guidance for
biopsies if histological confirmation is required
Purpose: It was to emphasize the role of PET/CT in differentiation the bronchogenic carcinoma from its
inseparable pseudo-neoplastic lesions for better staging and increase the accuracy of follow up by ruling out the
pseudo progression as well as pseudo regression.
Patients and Methods: The study involved 32 patients proved histo-pathologically to have bronchogenic
carcinoma and referred for PET/CT scanning. Each patient included in the study was subjected to full history
taking, reviewing medical sheet and PET/CT examination. The study was done in private center (Techno-scan
holding center, Heliopolis branch using PET-CT machine (GE Discovery VCT 64 PET/CT, USA); in which PET-
CT examination was followed by diagnostic contrast enhanced CT examination and processed at Ain Shams
University, Radiology department.
Results: In this study we found presence of inseparable pseudo neoplastic lesions among 20 patients out of 32
patients and the mean diameter of the bronchogenic mass lesion was 6.89 +/- 3.65 SD as measured by CT, while it
was 5.77 +/-3.38 SD as measured by PET/CT in centimeters.
Conclusion: The combined PET/CT using 18F-FDG is the best oncologic imaging modality with valuable role in
local staging and follows up in patients of bronchogenic carcinoma.
Keywords: Bronchogenic carcinomaPET/CT Pseudoneoplastic lesions.
INTRODUCTION
biopsies if histological confirmation is required or
Bronchogenic carcinoma is the single most
prior biopsy attempts have led to inconclusive
important cause of cancer-related deaths with
pathological results (4).
approximately 1.5 million cases occurring
AIM OF THE WORK
worldwide every year (1).
To emphasize the role of PET/CT in
A number of imaging modalities have been
differentiation the bronchogenic carcinoma from
used in staging lung cancer. These include (CT),
its inseparable pseudo-neoplastic lesions for better
magnetic resonance imaging (MRI) and fluorine-
staging and increase the accuracy of follow up by
18-dexy-D-glucose positron emission tomography
ruling out the pseudo progression as well as pseudo
(FDG/PET) (2).
regression.
CT scanning can only estimate the
PATIENTS AND METHODS
proximal extent "with difficulty in visualization the
A cohort study involved 32 patients with
real borders" of a tumor. It also has difficulty in
histopathologically
proved
bronchogenic
differentiation between pleura-pericardial or chest
carcinoma and referred for PET/CT scanning. This
wall invasion and anatomic contiguity or
study carried out in the period from March 2016 to
desmoplastic reaction (3).
July 2017. All patients were histopathologically
The use of FDG tracer made PET
proven to have bronchogenic carcinoma either by
contribution to oncological imaging matchless by
endoscopic transbronchial or CT guided biopsies.
any other functional imaging modality (3).
The study was done in private center (Techonscan
PET/CT can accurately delineate the viable
holding center, Heliopolis branch) using PET-CT
tumor from surrounding atelectasis and collapse/
machine (GE Discovery VCT 64 PET/CT, USA);
consolidation. This information cannot only
in which PET-CT examination was followed by
demarcate the size and extent of the tumor for
diagnostic contrast enhanced CT examination and
accurate T staging, but also provide guidance for
processed at Ain Shams University, Radiology
department.
4264
Received:20/4/2018
Accepted:29/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4270-4277
Role of MDCT Angiography in Diagnosis and Evaluation of Anatomical Variations
and Anomalies of the Coronary Arteries
Mostafa M.G. Eldin, Wessam S Shokry, Aws R Al-Isawi
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Aws R Al-Isawi; Mobile: 01009791336; Email: aws.alisawi@yahoo.com
ABSTRACT
Background: Coronary anomalies are often asymptomatic and may be accidentally discovered. With the
increase of interventional coronary procedures, the detection of coronary anomalies is becoming of major
clinical importance, the coronary anomalies cannot be considered just rare aspects because they may often lead
to relevant clinical consequences. That is reason why the diagnosis of coronary anomalies should be a
healthcare priority. Aim of the Study: This study was designed to identify the MDCTA appearance of the
anatomic variations and anomalies of the coronary arteries and determine their prevalence. Patients and
Methods: This study was conducted as a cross-sectional study in Radio-Diagnosis Department, Faculty of
Medicine, Ain Shams University and other specialized private radiology centers, during the period between
December 2017 and June 2018. All patients gave their written informed consent for taking part in this study.
Patients inclusive of 70 males and 50 females with their ages ranged between 4-82 years. The study was
approved by Ethical Committee of Faculty of medicine, Ain Shams University. It included 120 patients that
were referred for MDCTA for coronary arteries study, Patients were referred for coronary CTA because of
known or suspected coronary artery disease (CAD). Results: The total number of studies population were 100.
60 (60%) were males ages ranging 4-82 years and 49.5± 11.3 years mean age, and 40 (40%) were females with
25-77 age group and 52.75 years mean age. In 79 patient out of 100 (79%), the RCA was dominant giving off
PDA and PLB, in 11 patient (11%) the left coronary artery were dominant and in the remaining patients 10
(10%) were Co-dominant. in 2% the LMCA originated from right sinus of valsalva with interarterial course. In
23.46 % the LMCA trifurcated to LAD, LCx and an intermediate ramus artery. The LAD showed myocardial
bridging 16% more than other coronary arteries. One coronary aneurysm seen in the LAD. The LCx had
abnormal origin from Rt. coronary sinus in two patients (2%) with retro aortic course. The myocardial
bridging is very rare in LCX, present in 1% only. LCx fistula also rare detected in 1 patient (1%), no aneurysm
was detected in the LCx. The origin of RCA was from right sinus of valsalva in 99 patients (99%) while one
patient had abnormal origin from left coronary sinus (1%), in this case the RCA course was inter-arterial. In
general, the normal variations and anomalies of coronary arteries were more common in LMCA 27%, in LAD
19%, LCx was 9 % and least 3% in RCA. Conclusion: Complex anatomy of the coronary artery system can
accurately be depicted by MDCTA because of the improved isotropic spatial resolution and flexible post-
processing tool. This noninvasive modality is useful in detecting coronary artery variants and anomalies and is
a valid alternative to conventional coronary angiography in their diagnosis. Recommendations: Further studies
are needed with large sample volume and correlate clinical presentation of patients with coronary anomalies &
variant.
Keywords: Coronary artery, Anatomical variant, Multi detector cardiac Computed Tomography.
INTRODUCTION
desirable for acquisition of nearly motion free images.
In
1998,
multi-detector
computed
This was achieved by administering beta blocker agent
tomography (MDCT) was introduced and since
2 hrs before the examination(3). The occurrence of
then, cardiac CT has played a major role in the
coronary artery abnormalities in the general population
evaluation of the coronary arteries (1).
is reported to be approximately 0.2% to 1.3% based on
In MDCT, the coronary anatomy is shown in
the adult population(4). These anomalies are usually not
axial slices, as in all other radiological studies. But
symptomatic and have no clinical significance.
besides these axial slices, coronary anatomy can also be
However, certain types of coronary artery abnormalities
evaluated using a three-dimensional visualization
were related to sudden death, particularly in young
derived from these axial slices. With current software,
athletes. According to the report of the Sudden Death
oblique multiplanar reconstructions, curved multiplanar
Committee of the American Heart Association,
reconstructions, three- and four-dimensional volume
approximately 19% of sudden death in athletes may be
rendering can be achieved without extensive manual
related to these anomalies(5).
manipulation necessary (2). Excellent image acquisition
Other studies also report that sudden
required a normal resting sinus rhythm with a targeted
cardiac death due to coronary anomalies, especially
rate of less than 65 beats per minute during the scan.
those which courses between the root of the aorta
Cardiac motion with higher diastolic interval was
and the pulmonary artery (range from 19% to 33%
4270
Received:26/4/2018
Accepted:5/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4278-4282
Sonographic Evaluation of Synovium of Wrist Joint in Rheumatoid Arthritis
Patients during Activity
Ayman M. Ibrahim, Haytham M. Nasser, Nesma A.H Mohammed Saleh
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
Corresponding author: Nesma A.H. Mohammed Saleh, Mobile: +201274656552, E-mail: Nesmasaleh@hotmail.com
ABSTRACT
Background: Rheumatoid arthritis (RA) is an inflammatory rheumatic disease with progressive course
affecting articular and extra-articular structures resulting in pain, disability and mortality. Persistent
inflammation leads to erosive joint damage and functional impairment in the vast majority of patients. The
onset of disease is not similar in all patients but varies in regard to type, number, and the pattern of joint
involvement. The course of disease may be also different according to the presence or absence of several
variables including genetic background, frequency of swollen joints, autoantibody in the serum and the
severity of inflammatory process.
Objective: The aim of this study was to demonstrate the role of Ultrasonography and Power Doppler in
diagnosis of activity of rheumatoid arthritis in the hands and wrist joints among different aged population,
compared with the laboratory investigations.
Patients and Methods: This study was carried out in Radiology department of Ain Shams university
hospitals. Twenty five patients known patients with rheumatoid arthritis suspecting activity will underwent
assessment by ultrasonography and power Doppler of both wrist and hand joints.
Result: US & PD are highly sensitive and specific in detection of activity of the Rheumatoid Arthritis in
correlation to laboratory investigations. So, they can be used as non invasive methods in detection of RA
activity changes in wrist and hand joints.
Conclusion: Both ultrasonography and power doppler are good predicators for activity in rheumatoid arthritis
patients
Keywords: Ultrasonography (US), Power Doppler (PD), rheumatoid arthritis (RA).
INTRODUCTION
AIM OF THE WORK
Rheumatoid arthritis (RA) is a chronic
Our goal in this study is to demonstrate the
inflammatory disease associated with significant
role of Ultra-sonography and Power Doppler in
functional limitations and disability (1).
diagnosis of activity in rheumatoid arthritis in the
The wrist joint is one of the joints that are
hands and wrist joints among different ages
affected early in the course of the rheumatoid
population and correlate it with the laboratory
arthritis. It shows the rheumatic changes such as bone
investigation.
erosions, joint effusion and tendinopathy. So, the
PATIENTS AND METHODS
wrist joint changes with rheumatoid arthritis could be
Patients: During a period of 7 months
used for diagnosis of the diseaseactivity (2).
duration from Decemeber 2017 to June 2018, twenty-
The use of Doppler techniques, including
five patients were enrolled in the study. All patients
power, color and spectral Doppler, has greatly
proved rheumatoid patients for suspicion of activity,
increased in rheumatology in recent years. This is
US& PD examination were done. The study was
due to the ability of Doppler US to detect
approved by the Ethics Board of Ain Shams
pathological vascularization within joints and
University.
periarticular soft tissues, thereby demonstrating the
Inclusion criteria: All patients with clinical
presence of active inflammation (3).
suspicion of active Rheumatoid Arthritis. No age or
US & PD are commonly used to assess soft
sex predilection.
tissue pathology, detect fluid collection and
Exclusion criteria: No Exclusion criteria.
measure synovial vascularity due its capability to
US imaging: Each MCP and wrist joints will
provide data that can be used to evaluate the level
be scanned longitudinally and transversely from the
of joint inflammation and assess rheumatoid
dorsal view, with the joint in 20° of palmar flexion
arthritis. It can also be used to visualize cartilage
and will be documented in the longitudinal and
and bone surfaces. The real-time capability of
transverse view in B mode and colourmode. All data
ultrasonography allows dynamic assessment of
was saved in a digital archiving computer system. For
joint and tendon movements to visualize the
adjustment, we chose constant parameters that are a
structural abnormalities (4).
pulse repetition frequency of 551 Hz, a B mode
frequency of 12.0 MHz, a colour mode frequency of
4278
Received:19/4/2018
Accepted:1284/2018
c:\work\Jor\vol724_10
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4283-4291
Stents Technique for Endovascular Management of Intracranial Aneurysms
Abdulkafy Sharafeldin, Mohammad Hasan, Magdy El-Hawwary, Ahmed El-Shrif,
Mohammed El-Shandawily , Mohammad Al-Bialy
Department of Neurosurgery, Al-Azhar University
Corresponding author: Mohammad Al-Bialy, mohammadelbialy@gmail.com
ABSTRACT
Background: Endovascular detachable coil embolization has become an important method in the management
of intracranial aneurysms. However, coil embolization alone may fail to treat some wide-neck aneurysms and
other complex anatomy configuration. Herein, we report our experience with and outcome of stent techniques
of intracranial aneurysms. Objective: The aim of the study was to evaluate the feasibility safety and efficacy
of stent usages either conventional or flow diverting stents in endovascular management of intracranial
aneurysms. Patients and Methods: Between October 2011 to May 2018 a prospective study was done on a
series of 17 consecutive patients harboring 17 intracranial aneurysms approached with endovascular
therapeutic stent techniques, These 17 aneurysms (5 have history of rupture, 29 % and 12 unruptured, 71%),
Angiographic and clinical follow-up was obtained in 17 (100%) patients (mean 21 months, range 0.5 to 84).
Results: In late follow up 16 patient (94%) had favorable outcome and 1 patient (6%) had unfavorable
outcome, over all Complete occlusion Grade 0 with stent technique was achieved in 10 patients (59%), Grade I
in 3 patient (17%), Grade II in 1 patients(6%), Grade III in 1 patient(6%), Grade IV in 1 patient(6%) and
Grade V in 1 patient(6%), intraoperative complication was noted in 3 cases (18%) with favorable outcome.
Conclusion: Endovascular stent-assisted coiling was an feasible, effective and relatively safe technique for the
treatment of broad neck and complex configuration intracranial aneurysms.
Key Words: Intracranial aneurysms, Coiling, endovascular treatment, Intracranial stent, Flow diverter
INTRODUCTION
with guglielmi detachable coils to treat a fusiform
In early endovascular revolution and
aneurysm of the vertebrobasilar junction(8).
technological limitations of endovascular devices,
The first stent specifically designed for the
Parent artery preservation, coil herniation and
intracranial area to obtain food and drug administration
migration, arterial branch occlusion, and higher rates
(FDA) approval was the neuroform TM (boston
of recanalization have all plagued safe and effective
scientific corporation, natick, usa) in 2002. Outside the
exclusion of wide necked aneurysms(>4 mm neck or
USA, especially in Europe the leoTM stent (balt,
dome-to-neck ratio <2)and other geometrically
montmorency, france), the first self-expanding closed
unfavourable anatomy via endovascular means. This
cell design stent released in Europe in 2003(9).
make surgical repair the "gold standard" for the
Intracranial stents work as a barrier support
treatment of wide-necked cerebral aneurysms(1).
the coil mass and enhance dense backing of the
Although use of the balloon remodeling
aneurysm also serve as scaffolding for neo-
technique(2) and use of two- or three dimensional
endothelization, providing additional reduction of
shaped(3) and bioactive coils or double-catheter
the flow into the aneurysm. Consequently, their use
technique(4) may help to obtain better morphologic
improves intravascular thrombosis and decreases
results in the treatment of wide-neck aneurysms,
the risk of recanalization(9).
insufficient coil packing and/or recurrence is still a
Although stent-assisted coiling has expanded the
major problem(3-5).
treatment possibilities, the technique carries the risk of
Since the advent of the intracranial stent,
stent misplacement, thromboembolic events and in-stent
stent-assisted coil embolization(SACE) of an
stenosis or thrombosis. Furthermore long-term
aneurysm has the capability to facilitate the
antiplatelet medication is necessary in this subgroup of
management of intracranial wide-neck aneurysms
patients(10).
to prevent coil protrusion into the parent vessel,
The aim of the study was to evaluate the
which may allow for the safer and denser packing
feasibility safety and efficacy of stent usages either
of the aneurysm sac(5-7). However, the mid- or long-
conventional or flow diverting stents in endovascular
term effects of SACE of wide neck aneurysms
management of intracranial aneurysms.
have not been well-evaluated.
PATIENTS AND METHODS
The first case of intracranial stenting for
Patient population: A prospective study
treating a brain aneurysm was reported in 1997 by
was done during the period from October 201 to
Higashida et al. In that occasion, the authors used
May 2018 on a series of 17 consecutive patients
a balloon expandable cardiac stent in combination
harboring 17 intracranial aneurysms approached
4283
Received:9/5/2018
Accepted:18/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4292-4299
Dexmedetomedine versus Standard Sedatives in Weaning from Mechanical
Ventilation
Nabila M. Fahmy, Hatem S. Abdel Hamid, Amal H. Rabie, Hany M. Salib,
Ayman E. Abdellatif
Department of Anesthesiology & Intensive Care Medicine, Faculty of Medicine Ain Shams University
Corresponding author: Ayman E. Abdellatif; Mobile: 01060498594, Email: aymanelsaid2312@gmail.com
ABSTRACT
Background: Sedation in the intensive care unit Patients is assumed to reduce discomfort from care
interventions, increase tolerance of mechanical ventilation, prevent accidental removal of instrumentation, and
reduce metabolic demands during cardiovascular and respiratory instability. Aim of the Work: The aim of the
work was to evaluate the use of dexmedetomedine as a sedative to facilitate weaning from mechanical
ventilation and extubation, so decrease the incidence of reintubation, ventilator complications and decrease the
ICU cost and stay. Patients and Methods: This was a controlled randomized prospective clinical trial carried
out at Ain-Shams University Hospitals. After approval of institutional ethical committee, the study included 90
adult postoperative patients and requiring postoperative mechanical ventilation in the surgical ICU for
maximum duration of 48 hours postoperatively. Results: As regard to time to extubation, results of the current
study showed a highly statistically significant difference between three groups regarding time to extubation
(hr) when p-value was < 0.001. Conclusion: dexmedetomidine has clinically relevant benefits compared to
midazolam and propofol in facilitating extubation because of its shorter time to extubation, more
hemodynamic stability, easy arousability and lack of respiratory depression; hence, it can be used as an
effective, and safe sedative agent to facilitate extubation in ICUs and decreasing ICU length of stay.
Key words: Dexmedetomedine, Standard Sedatives, Mechanical Ventilation, Weaning
INTRODUCTION
delirium, ventilator-associated pneumonia (VAP),
Pain, agitation and delirium commonly
and prolonged mechanical ventilation (4).
occur in critically ill patients, with potential
The process of weaning from mechanical
consequences that necessitate treatment with
ventilation is central to the management of
analgesic, sedative and antipsychotic medications.
critically ill patients. It is a very complex and
Over the last 15 years, considerable evidence has
difficult task. Attention should be paid to wean off
accumulated demonstrating that both choice of
the ventilator as quickly as possible after the
agent and how we use these drugs can significantly
conditions that warranted placing the patient on the
impact clinically relevant patient outcomes. This,
ventilator begin to resolve and stabilize (5). Delayed
in turn, has influenced recent pain, agitation and
or unnecessarily prolonged weaning increases
delirium guidelines (1).
length of intensive care unit (ICU) stay, health-care
Patients requiring mechanical ventilation are
cost, decreases the ICU bed availability and
typically having significant anxiety and pain (2). These
adversely affects patient outcome (6).
patients require sedation to tolerate the tracheal tube
Dexmedetomidine is a selective alpha-2-
and the ventilator, to suppress cough, to prevent
adrenoceptor agonist. It exerts both sedative and
respiratory fighting during intensive care procedures
analgesic effects via mechanisms different from other
and to prevent psychological complications
sedatives such as midazolam and propofol, and
associated with pain and anxiety. An ideal sedative
provides sedation characterized by prompt response
agent should allow for rapid modification of the
to stimuli with no respiratory depression (7). Therefore
sedation level by titration of doses, no depressant
does not interfere with weaning from mechanical
effects on the cardiovascular or respiratory systems,
ventilation. Because of this characteristic, infusions
cheap, have short duration without cumulative
of dexmedetomidine can be continued after
effects, and allow rapid recovery of effective
extubation without the risk of respiratory failure, a
spontaneous respiration after stopping the infusion (3).
complication that can occur with propofol,
The pharmacologic control of analgesia
lorazepam, and midazolam (8).
and sedation is nearly a routine in everyday
practice in intensive care units (ICUs) worldwide,
AIM OF THE WORK
especially in the management of symptoms of
The aim of the work was to evaluate the use
mechanically ventilated patients (1).
of dexmedetomedine as a sedative to facilitate
Sedative medications are often provided for
weaning from mechanical ventilation and extubation,
comfort in mechanically ventilated patient but have
so decrease the incidence of reintubation, ventilator
been associated with harm, including occurrence of
complications and decrease the ICU cost and stay.
4292
Received:7/5/2018
Accepted:16/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4300-4307
Comparative Study of Vitamin D Level between Psoriatic Patients and Psoriatic
Arthritis Patients
Abd Elmegeed A. El-Ashmawy 1, Abd Alshafy A. Haseeb2, Hatem G. Abd_Allah3, Hesham S.
Abd-Alsamie 4,Mostafa A. Elhelaly5
1,2,3 Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, 4Department of clinical
pathology, Damietta Faculty of Medicine, Al-Azhar University, 5 Department of Physical Medicine, Rheumatology and
Rehabilitation, Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
Corresponding author: Mostafa A. Elhelaly; Mobile: 01008828261; Email: dr.mostafa9192@yahoo.com
ABSTRACT
Background Psoriatic arthritis (PsA) is a seronegative (rheumatoid factor-negative) usually Cyclic
Citrullinated Peptide (CCP) antibody negative, immunologically triggered, chronic inflammatory joint disease
within the framework of psoriasis. Psoriasis affects 24% of the general population. It is a common, chronic,
relapsing/remitting, immune-mediated systemic disease characterized by skin lesions including red, scaly
patches, papules and plaques, which usually itch.Vitamin D is actually a fat-soluble steroid prohormone that
has endocrine, paracrine and autocrine functions.
Aim of the Work: To investigate the level of serum vitamin D in patients with psoriatic arthritis and compare
it with patients with psoriasis to show if there is a role of vitamin D in development of arthritis in psoriatic
patients or not.
Patients and Methods: This study is a cross sectional study in which fifty patients with psoriatic arthritis and
psoriasis age range 16-50 years selected from those attending the outpatient clinic and inpatients of
rheumatology, physical medicine &rehabilitation department, Al-Azhar university hospitals from 2017 to 2018
and divided into two groups: Group (A): (25) patients with psoriatic arthritis were diagnosed according to the
criteria for psoriatic arthritis classification "CASPAR criteria". Group (B): (25) patients with skin psoriasis. In
this study we measured of 25 hydroxy vitamin D3 using commercial ELISA kits,ESR,CRP,CBC, Blood urea ,
serum creatinine , Liver enzymes (SGOT & SGPT), Serum uric acid , Fasting blood glucose,RF,urine
analysis,ANA,HCV Ab and HIV Ab. Plain x-ray on both hands postero-anterior view,Plain x-ray on
lumbosacral spine antero- posterior and lateral views and Plain x-ray on both sacroiliac joints "cone" view.
Results: There was female sex predicliction in psoriatic arthritis group. Otherwise, both groups were
comparable regarding age, BMI, residence, co-morbid diseases, disease charateristics, and laboratory
investigations, except signficant increase of WBCs and inflammatory markers (ESR and CRP) in psoriatic
arthritis group. Diseases severity was mild in 72%, moderate in 22% and severe in 6.0%; and there was
statistically significant increase of moderate and severe disease in PA when compared to psoriasis
group.vitamin D was sufficient in 32.0%, insufficient in 34.0% and deficient in 34.0%; and there was no
significant difference between psoriasis and PA groups. In addition, vitamin D levels were increased in
psoriasis when compared to PA groups. However, the difference was statistically non-significant.No signficant
relation was found between vitmain D from one side and each of patient characteristics, laboratory
investigations (except signficant positive correlation with hemoglobin and RBCs), disease characteristics
(excpet signficant inverse (negative) correlation with disease duration and disease severity), X-ray findigns,
and psoriatic arthritis disease activity indices.
Conclusion: Vitamin D deficiency/insufficiency was common among psoriasis and psoriatic arthritis patients
and the dificnecy was signficnatly and inversly correlated with disease severity (PASI) and disease duration.
Thus, is though to play a role in development (or a consequence) of psoriasis. On the other hand, there was no
corrlation with PA disease activity and severity indices. Thus, the association seems to be linked to psoriais
proper.Vitamin D supplementation thought to have a potential therapeutic role in treatment of psoriasis.
Keywords: Psoriatic Arthritis, Psoriasis, Vitamin D.
INTRODUCTION
design
and
population
studied)
develop
Psoriatic arthritis (PsA) is a seronegative
musculoskeletal involvement typical for this disease.
(rheumatoid
factor-negative)
usually
Cyclic
In about 20 % of patients inflammatory joint disease
Citrullinated Peptide (CCP) antibody negative,
appears usually many years after the manifestation of
immunologically triggered, chronic inflammatory
skin disease. PsA can appear without or before the
joint disease within the framework of psoriasis. PsA
manifestation of cutaneous signs and symptoms. The
has many similarities to rheumatoid arthritis and
male:female ratio is about 1:1.3 (1).
other inflammatory joint diseases making the
Psoriasis affects 24% of the general
diagnosis more difficult. About one-fourth to one-
population. It is a common, chronic, relapsing/
third of all psoriasis patients (depending on study
remitting, immune-mediated systemic disease
4300
Received:7/4/2018
Accepted:16/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4308-4312
Magnesium sulphate versus Dexmedetomidine as adjuvants for local anasthetics in
peribulbar block for eye surgeries: Clinical comparative study
Osama A.H. Kassem, Ahmed M.M. ELgarhy, Mahmoud G. Salim
Anesthesiology and Intensive Care Faculty of Medicine-Al-Azhar University
ABSTRACT
Background: Regional anesthesia is a preferred technique for ophthalmic surgery. It is safe, inexpensive and
provides efficient ocular anesthesia for ophthalmic surgery. It is associated with less hemodynamic instability,
less respiratory depression, better postoperative pain relief, and less nausea and vomiting compared to general
anesthesia. Among regional blocks, peribulbar block is safer in comparison with retrobulbar block due to a
lesser incidence of serious complications such as brain stem anesthesia, globe perforation, and retrobulbar
hemorrhage.
Objective: The aim of the study was to compare the safety and efficacy of the use of Magnesium sulfate
versus that of Dexmedetomidine as an adjuvant to the local anesthetic in peribulbar anesthesiaas for inducing
optimal operating conditions for eye surgery in terms of akinesia (as a primary end point), analgesia, incidence
of complications, as well as patient and surgeon satisfaction (as secondary end points).
Patients and Methods: The present study included 50 patients (females and males)aged 20-80 years.
Materials: Anesthetic drugs, Needles size: 25 gauge, Intravenous cannula 22 G, Drugs for premedications:
intravenous midazolam (5mg/ml, Mediathetic, Amoun, Egypt) (0.01mg/kg) and Fentanyl Citrate (50µg/ml,
Fentanyl- Janssen, Belgium) (25 µg)was administrated 5minutes before the block, Monitors for vital signs
registration were done for each of the following: Electrocardiograph (ECG), non-invasive blood pressure
(NIBP), heart rate (HR) and oxygen saturation (SpO2), respiratory rate (RR), Anesthetic machine,
resuscitation equipment and drugs.
Results: The current study was carried on 75 patients divided into Three equal groups: first group (control
group), second group (dexmedtomedine group) and third group (magnesium sulphate group). All patients were
scheduled for surgery.
Conclusion: Addition of 50 mg of magnesium 10% or 15 mic of dexmedetomidine to local anesthetic mixture
for peribulbar anesthesia in the operations of phacoemulsification of cataract and intraocular lens implantation
accelerated onset of globe anesthesia, akinesia of the globe and the lid, prolonged the duration of globe
akinesia, lid akinesia, time to 1st analgesic request, and enhanced the satisfaction of the patients and quality of
the operative conditions.
Key Words: Magnesium sulphate, Dexmedetomidine, local anasthetics, peribulbar block, eye surgeries
INTRODUCTION
adrenaline, sodium bicarbonate, and hyaluronidase
Regional anesthesia is a preferred technique
have been added to the local anesthetic mixture
for ophthalmic surgery. It is safe, inexpensive and
used for peribulbar block to augment its efficacy
provides efficient ocular anesthesia for ophthalmic
and hasten its speed of onset. However, their
surgery. It is associated with less hemodynamic
effects were variable (2).
instability, less respiratory depression, better
These agents are also not devoid of side-
postoperative pain relief, and less nausea and
effects like allergic reaction, bradycardia, sedation
vomiting than general anesthesia (1).
and dryness of mouth, etc. Until date, no one
Among regional blocks, peribulbar block is
adjuvant is ideal for peribulbar block (4).
safer in comparison with retrobulbar block due to a
Magnesium sulfate has been used for many
lesser incidence of serious complications such as
years on an empirical basis to control convulsions in
brain stem anesthesia, globe perforation, and
patients with pre eclamptic toxemia. Magnesium ions
retrobulbar hemorrhage (2).
are essential for many biochemical reactions, and a
Peribulbar block is a much simpler, rapid,
deficiency may produce clinically important
and safe technique; especially in elderly patients
consequences. Many of its pharmacological
who have multiple systemic diseases such as
properties have only recently been appreciated (like
diabetes or cardiovascular disease that may limit
its action as bronchodilator and its sedative effect) (5).
the use of general anesthesia (3).
Magnesium is a physiological calcium
Peribulbar anesthesia is widely used for
channel blocker and noncompetitive antagonist of
cataract surgery.However, it has the disadvantages
N-methyl-D-aspartate (NMDA) receptors.
of a slow onset of orbital akinesia and the frequent
Magnesium has been used with a local
need for block supplementation.To overcome these
anesthetic solution in different regional anesthesia
limitations, many adjuvant drugs such as
4308
Received:17/5/2018
Accepted:26/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4313-4319
Evaluation of the clinical efficacy of Fractional CO2 laser combined with topical
antifungal in the treatment of onychomycosis using SCIO (Score clinical index of
onychomycosis)
Norhan K.M. Ali Al-Meligi; Maha A. Shaheen; Mohammed T. Mahmoud; Rania M. Al
Husseiny
Dermatology, Venerology and Andrology Department, Faculty of Medicine - Ain Shams University
Corresponding: Norhan K.M. Ali Al-Meligi, norhankhaledderma@gmail.com, Tel: +202 01099978172
ABSTRACT
Background: Onychomycosis, a fungal infection of the nail, is considered one of the most prevalent disorders
of the nail. Score clinical index of onychomycosis (SCIO) enable comparison of the severity of
onychomycosis between nails despite differences in the clinical presentation. Recently fractional CO2 laser
and topical antifungal were found to be effective in treating onychomycosis.
Aim of the Work: To evaluate the clinical efficacy of fractional carbon dioxide laser combined with topical
antifungal in treatment of onychomycosis.
Patients and Methods: The present study included 20 patients with toenail and fingernail onychomycosis of
all age groups. The affected nails received 3 sessions of laser therapy (Fractional CO2 laser) at 4 weeks
intervals and once daily application of topical antifungal (Oxiconazole) available at the market under the name
tinox cream.
Conclusion: We concluded that fractional carbon-dioxide laser therapy, combined with a topical antifungal
agent, is effective in the treatment of onychomycosis. It can treat different types of onychomycosis safely and
effectively, and is especially suitable for older patients with low immunity or liver and renal dysfunction who
are not appropriate candidates for systemic antifungal agents. Thus, it could be considered as an alternative
treatment modality.
Keywords: CO2: Carbon dioxide; DLSO: Distal-lateral subungual onychomycosis; SCIO: Score clinical
index of onychomycosis
INTRODUCTION
Clinical pattern component based on (1)
Onychomycosis, a fungal infection of the
clinical form, (2) depth of nail involvement and,
nail, is considered one of the most prevalent disorders
(3) thickness of subungual hyperkeratosis.
of the nail. It occurs after primary infection of the nail
Growth pattern component based on
bed, which may lead to subungual hyperkeratosis (1).
location of the onychomycosis, digit number and
Primary caused by dermatophytes such as
age of the patient.
Trichophyton
rubrum
and
Trichophyton
Photodynamic therapy is considered to be
mentagrophytes (2). Other causative organisms are
a new non-traditional method for treatment of
non-dermatophyte molds (3). Candida albicans
onychomycosis (8). Photodynamic therapy offers a
accounts for approximately 70% of onychomycosis
number
of
advantages
over
traditional
caused by yeasts. Direct microscopic examination
antimicrobial therapies as it has a broad spectrum
after (KOH) preparation and fungal culture are
action and is effective independent of patterns of
commonly used to confirm the diagnosis (4).
antimicrobial resistance (9). Laser-based treatments
The classical treatment modalities for
have been explored as a possible alternative
onychomycosis include oral as well as topical
treatment for onychomycosis. Long pulse 1064-nm
antifungal, however, the cure rate is considered to
neodymium: yttrium-aluminiumgarnet (Nd:YAG)
be low and regression rate is found to be high
laser, diode laser and Q-switched Nd:YAG laser
(5).Topical antifungals are often ineffective because
have all been studied and found to be safe and
of their inability to penetrate via nail plate.
effective for treating onychomycosis.
Systemic treatments, although effective, have
The fractional CO2 laser systems were
limited application because of adverse effects such
developed to maximize the effect of ablative laser
as hepatotoxicity, potential drug interactions (6).
therapies and minimize side effects (10). Recently
Score clinical index of onychomycosis
fractional CO2 laser and topical antifungal were found
(SCIO) enable comparison of the severity of
to be effective in treating toenail onychomycosis (4).
onychomycosis between nails despite differences
in the clinical presentation, The SCIO may prove
AIM OF THE WORK
to be an accurate indicator of therapeutic
effectiveness (7). It has:
To evaluate the clinical efficacy of fractional
carbon dioxide laser combined with topical antifungal in
treatment of onychomycosis.
4313
Received:7/4/2018
Accepted:16/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4320-4326
The effect of intraarticular glucocorticoid injection on the serum level of resistin in
Osteoarthritis of the knees. Correlation of the level of resisitin to ultrasonographic
findings
Sameh A. El-Zayat1, Hany M. Aly2, Abdullah M Gaafar3, Abdelrahman M. Labib4
1,2,4 Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University,
Cairo, Egypt. 3Department of Clinical Pathology, Faculty of medicine, Al-Azhar University, Cairo, Egypt.
Corresponding author: Abdelrahman M. Labib; Mobile: 01092098744; Email: abdelrahmanlabib1990@gmail.com
ABSTRACT
Background: Osteoarthritis (OA) is one of the ten disabling diseases affecting 9.6% of men and 18 % of
women aged over 60 worldwide. OA characterized by articular cartilage loss, subchondral bone remodeling,
soft tissue damage and low grade synovitis It is the most common form of arthritis and major cause of
disability in the adult population. The main source of resistin in humans is mononuclear cells. Evidence has
shown that higher serum levels of resistin in patients with severe OA compared to controls with no OA and
resistin are detected in both serum and synovial fluid, proving its systematical and local involvement in
inflammatory changes of OA.
Aim of the Work: The aim of this work is to study the effect of local GC intra articular injection on the level
of serum resistin in OA knees. Also, to study the relation between different serum levels of resistin and US
findings of the knee.
Patients and Methods: The ethical approval was obtained from the hospital ethical research committee and
each patient entering the study will sign an informed consent. Thirty patients with primary knee OA will be
recruited for the study from the Physical medicine, 'Rheumatology and Rehabilitation Outpatient Clinic of Al-
Azhar University Hospitals starting from November 2017 till may 2018. In this study we measure Serum
Resistin level and Musculoskeletal ultrasound examination of the knee before and three months after steroid
injection
Results: Serum resistin level is markedly decreased after intra articular steroid injection into OA knee joint.
Conclusion: Our study revealed that: Resistin could be considered as an important severity marker of knee
OA. Serum resistin level is markedly decreased after intra articular steroid injection into OA knee joint. The
longer the duration of illness the higher the resistin level. The older the age the higher the resistin level. The
longer the duration of illness, the higher the radiological grade. Serum resistin level should be equal to or
higher than 2.8 ng / ml to diagnose a case of primary knee OA
Keywords: Osteoarthritis, Resistin.
INTRODUCTION
OA is one of the rheumatic disorders in
Osteoarthritis (OA) is one of the ten
which advances in high resolution Ultrasound (US)
disabling diseases affecting 9.6% of men and 18 %
have greatly enhanced our ability to observe the
of women aged over 60 worldwide (1). OA
detailed changes in the pathological joint
characterized
by
articular
cartilage
loss,
potentially providing insight into the causes of
subchondral bone remodeling, soft tissue damage
pain, the role of inflammation and the progression
and low-grade synovitis. It is the most common
of the disease process such as joint effusions and
form of arthritis and major cause of disability in
popliteal cysts are common findings in OA.
the adult population(2).
Synovitis has been confirmed in knee OA
There
are
proinflammatory
agents
especially in patients with early disease (6).
including classical cytokines (interleukin-6 (IL-6),
Intra-articular (IA) Glucocorticoid (GC)
interleukin- 1 beta (IL-1), and tumor necrosis
injections are frequently used to treat acute and
factor-alpha (TNF-) as well as adipokines such as
chronic inflammatory conditions. Especially during
leptin, visfatin, resistin which play a critical role in
the OA flare, when there is evidence of inflammation
immune and inflammatory responses (3).
and joint effusion, GC injections decrease acute
The main source of resistin in humans is
episodes of pain and increase joint mobility (7).
mononuclear cells (4). Evidence has shown that
higher serum levels of resistin in patients with
AIM OF THE WORK
severe OA compared to controls with no OA and
The aim of this work is to study the effect of
resistin are detected in both serum and synovial
local GC intra articular injection on the level of serum
fluid, proving its systematical and local
resistin in OA knees. Also, to study the relation between
involvement in inflammatory changes of OA (5).
different serum levels of resistin and US findings of the
knee.
4320
Received:19/5/2018
Accepted:28/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4327-4332
Detection of Urinary CD4TCell in Patients with Lupus Nephritis during Activity
and Treatment period
Mohsen M. El-Said1, Ashraf I. Mostafa2, Mohamed A. Ali3
1,2,3DepartmentofPhysical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Corresponding author: Mohamed A. Ali; Mobile: 01006602307; Email: Dr.mo.Adl2012@gmail.com
ABSTRACT
Background: Renal involvement is common in Systemic Lupus Erythromatosis (SLE) and is a significant
cause of morbidity and mortality. It is estimated that as many as 90% of patients with SLE will have pathologic
evidence of renal involvement on biopsy, but clinically significant nephritis will develop in only 50%. The
clinical presentation of lupus nephritis is highly variable, ranging from asymptomatic hematuria and/or
proteinuria, to frank nephrotic syndrome, to rapidly progressive glomerulonephritis with loss of renal function.
Lupus nephritis typically develops within the first 36 months of the disease, although there are exceptions.
Aim of the Work: The aim of this work was to study the level of urinary CD4 T cell and monitor the
treatment in lupus nephritis patients.
Patients and Methods: The ethical approval was obtained from the hospital ethical research committee and
each patient participated in the study signed an informed consent. The present study was conducted on
seventy-five female subjects, their age ranged from 20 to 40 years. They were divided into 3 groups a- 25
patients knowns as SLE with lupus nephritis, b- 25 SLE patients without lupus nephritis, c-25 normal control
subjects. They were recruited from Physical Medicine, Rheumatology and Rehabilitation department of Sayed
Jalal and Al-Hussein Al-Azhar University Hospitals, during the period from October 2013 to October 2017.
Results: Urinary CD4 markedly decreased after treatment of lupus nephritis.
Conclusion: Urinary CD4 T-cells marker has a valuable role in detecting LN in SLE patients and has a
significant correlation with disease activity index. Significant Positive correlation was found between Cd4 t-
cell and SLEDAI in before and after treatment. Significant positive correlation was detected with 24hr urine
protein, SLEDAI, PGA, while Platelet, ESR and C3 significant and negative correlation in post treatment.
Monitoring urinary CD4 T-cells may help to identify treatment responders and treatment failure and enable
patient-tailored therapy in the future.
Keywords: Lupus nephritis, CD4
INTRODUCTION
PATIENTS AND METHODS
Renal involvement is common in Systemic
The present study was conducted on
Lupus Erythromatosis (SLE) and is a significant cause of
seventy-five female subjects, their age ranged from
morbidity and mortality. It is estimated that as many as
20 to 40 years. They were divided into 3 groups a-
90% of patients with SLE will have pathologic evidence
25 patients knowns as SLE with lupus nephritis, b-
of renal involvement on biopsy, but clinically significant
25 SLE patients without lupus nephritis, c-25
nephritis will develop in only 50%. The clinical
normal control subjects. They were recruited from
presentation of lupus nephritis is highly variable, ranging
Physical
Medicine,
Rheumatology
and
from asymptomatic hematuria and/or proteinuria, to frank
Rehabilitation department of Sayed Jalal and Al-
nephrotic
syndrome,
to
rapidly
progressive
Hussein Al-Azhar University Hospitals, during the
glomerulonephritis with loss of renal function. Lupus
period from October 2013 to October 2017.
nephritis typically develops within the first 36 months of
An approval was obtained from the
the disease, although there are exceptions (1,2).
medical ethics committee of Al-Azhar University
In lupus nephritis, the infiltrates in the
before starting this study. All the patients were
nephritic kidneys consist mainly of CD4 T cells
informed about the study procedures and a written
and, to a lesser extent, CD8 T cells, macrophages
consent was obtained from all of them.
cells, and plasma cells (3).
The subjects were divided into three
In severe lupus nephritis, as in other forms
groups: Group A: 25 SLE patients with lupus
of rapidly progressive glomerulonephritis, CD4 + T
nephritis. Group B: 25 SLE patients without lupus
cells are present within glomeruli (4).
nephritis. Group C: 25 healthy control subjects
Patient's selection
AIM OF THE WORK
A) Inclusion criteria for group A &B:
The aim of this work was to study the level
of urinary CD4 T cell and monitor the treatment in
Patients were fulfilled the revised ACR and
lupus nephritis patients.
the SLICC classification criteria for SLE (2015).
4327
Received:19/5/2018
Accepted:28/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4333-4338
Delayed Enhancement Cardiac MRI In Ischemic and Non-Ischemic Heart Failure
Hussein M.S. Mohamed Saad, Ahmed A.F. Abashed, Mahmoud I. Alshamy
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
Corresponding Author: Hussein M.S. Mohamed Saad; Email: husseinsamy17@gmail.com,mobile:01061800220
ABSTRACT
Background: In patients with left ventricular systolic dysfunction, the primary diagnostic issue is to
differentiate the underlying cause whether related to coronary artery disease or dilated cardiomyopathy, for
which coronary angiography was often used.
Aim of the Work: Using Delayed enhancement-magnetic resonance imaging (DE-MRI) to identify
myocardial tissue characteristics through retention of gadolinium in areas with reduced density of viable
myocytes so appear enhancing (bright). So, we can differentiate dilated from ischemic cardiomyopathy.
Patient and Method: Our study included 34 patients with left ventricular systolic dysfunction (ejection
fraction less than 40% by echocardiography). All of them were submitted to DE-MRI using achieva 1.5 Tesla
MRI machine.
Results: 15 patients (44%) showed infarct pattern of DE (presumed ischemic cardiomyopathy) while 19
patients (56%) showed no DE or non-infarct pattern of DE (presumed dilated cardiomyopathy).
Conclusion: DE-MRI could be considered as an effective non-invasive tool to differentiate ischemic from
non-ischemic cardiomyopathy.
Key words: Delayed enhancement- MRI- Heart failure- Coronary artery disease- Dilated cardiomyopathy.
INTRODUCTION
well as the evaluation of pericardial diseases and
Cardiovascular
magnetic
resonance
cardiac masses. In some centers, CV MRI is
imaging (CV MRI) has recently emerged as a new
emerging as the test of choice for the detection of
non-invasive imaging modality capable of
ischemic heart disease, as well as for the initial work-
providing high resolution images in any desired
up of patients presenting with heart failure (6).
plane (1). It has evolved from an effective research
The treatment of patients with left
tool into a clinically proven, safe and
ventricular systolic dysfunction is determined in
comprehensive imaging modality providing
part by the identification of the underlying disease
anatomic and functional information in acquired
process. The primary diagnostic issue centers on
and congenital heart diseases (2).
differentiating an underlying cause of the left
Over the last several years, CV MRI has
ventricular dysfunction that is related to dilated
undergone rapid evolution and tremendous
cardiomyopathy or coronary artery disease (7).
advances in pulse sequence design, scanner
This differentiation is clinically important as
hardware, and coil technology resulting in
ischemic cardiomyopathy is associated with shorter
progressive expansion of the clinical applications
mean survival than nonischemic cardiomyopathy. In
(3). For imaging cardiac structure and function,
addition, the patient management is altered as patients
pulse sequence and hardware development has
with ischemic heart disease may benefit from
resulted in improvement in image quality with
revascularization,
and
secondary
preventive
simultaneous acceleration of image acquisition,
pharmacotherapy, whereas patients with nonischemic
resulting in shorter but better examinations.
cardiomyopathy may have better response to beta-
Improved coil design now allows the use of parallel
blockade (1). In many centers, coronary angiography is
imaging technology, resulting in further reduction
routinely performed for this task (7).
in acquisition time (4).
Contrast-enhanced CV MRI can play a role
In particular, new pulse sequences have
in the differentiation between primary dilated
enriched the inherently superior soft tissue contrast
cardiomyopathy and ischemic cardiomyopathy
provided by MRI so that it now provides the
through the identification of myocardial scarring or
reference standard for in vivo viability imaging (5).
fibrosis as presence of delayed enhancement (8).
Additionally, the pattern and distribution of scar as
This would reduce the costs and inherent risk
demonstrated by CV MRI often provide useful
associated with invasive cardiac catheterization on
information regarding the specific etiology of various
which the diagnosis of dilated cardiomyopathy is
cardiac disorders (1).
still dependent (7). In addition, CV MRI in non-
This improvement has led to the recognition
ischemic cardiomypathy patients strongly predicts
of CV MRI as the reference standard for the
adverse cardiac outcomes (9).
assessment of regional and global systolic function,
the detection of myocardial infarction and viability as
4333
Received:16/5/2018
Accepted:25/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4339-4342
MRI In Achilles Tendon Injuries
Ahmed M. Monib, M.D.; Essam M Abd Elhafez M.D.; Ibrahim A Sobhy M.Sc.;
Department of Radiodiagnosis, Faculty of Medicine, Ain shams University
Corresponding Author: Ibrahim A Sobhy.; Email: iprahima@yahoo.com.01061800220
ABSTRACT
Background: The prevalence of Achilles tendon injuries is a common musculoskeletal disorder affecting the
foot in athletic and non-athletic population. The Achilles tendon is the thickest and strongest tendon in the
human body. It is the major plantar flexor of the foot and contributes to the maintenance of the upright
position. MRI is an excellent imaging modality for suspected Achilles tendon lesions due to its accuracy,
efficiency, multiplanar imaging capabilities and excellent soft tissue characterization.
Objective: The aim of this study is to evaluate the role of MR imaging in clinically diagnosed Achilles tendon
rupture and how MRI influences the management.
Patients and Methods: This study was conducted at the radiology department, Faculty of medicine, Ain
shams University. 20 patients with clinically diagnosed partial and full thickness tear of the Achilles tendon
underwent MRI evaluation after four clinical tests.
Results: The results of our study revealed many limitations in clinical tests that revealed defective details
which were essentially significant for the way of management being operative or conservative.
Conclusion: MRI is the method of choice and superior to clinical tests when evaluating Achilles tendon
lesions, facilitating the choice of treatment being operative or non-operative, evaluating intra-tendinous
changes in all types of AT tear and follow up during the healing period.
Keywords: Achilles tendon lesions, MRI, clinical Tests.
INTRODUCTION
AIM OF THE WORK
The Achilles tendon is the thickest and
The aim of this study is to compare the
strongest tendon in the human body. It is the thickest
value of MR imaging in clinically diagnosed
and strongest tendon in the human body. It is the
Achilles tendon rupture and to investigate
major plantar flexor of the foot and contributes to the
reliability of these clinical examination tests.
maintenance of the upright position. It originates from
the aponeuroses of the medial, lateral gastrocnemius
PATIENTS AND METHODS
and soleus muscles (triceps surae) and is inserted into
This study was conducted at the radiology
the posterior calcaneal tuberosity (1).
department, Faculty of medicine; Ain shams
The Achilles tendon is the most frequently
University between October 2016 and June 2018
injured ankle tendon. It lacks a tendon sheath;
following the approval by the scientific and ethics
however it has a peritenon whose vascular system
committee
extends both within and outside the tendon. Achilles
Patients: This study performed on 20
tendon injuries frequently occur in athletes, as well in
patients with clinical diagnosis of partial or
the general population (2). Its injuries may be
complete Achilles tendon tear and at least 2
classified as non-insertional or insertional. The
positive clinical tests are needed (score 2/4)
former group includes partial or complete thickness
(Tiptoes test, Matles test, Palpable gap test,
tear. Achilles tendon tear is usually 26 cm above the
Thompson test), then all patients had been
insertion of the tendon on the calcaneus (3).
submitted for ankle MRI at the radiology
MRI has been widely used in confirming the
department, Ain Shams University.
diagnosis of Achilles tendon injuries. It is an excellent
Clinical Tests: The Achilles tendon is the most
technique for those cases where the diagnosis is uncertain;
frequent site of injury in the foot. Its superficial location
it is the most suitable investigation for assessment of soft
leads to excellent evaluation by clinical examination
tissue for persistent foot and ankle pain following injury,
especially in a complete tear injury type (1, 5).
Owing to its multiplanar imaging capabilities and
The diagnosis of acute Achilles tendon
excellent soft tissue contrast characteristics (3).
ruptures is usually diagnosed with appropriate patient
However; in this study, clinical diagnosis of
history taking and clinical examination. Most of the
Achilles tendon Tear could be primary based on
patients present with pain and swelling in the
specific clinical tests followed by MRI examinations
posterior ankle and describe a traumatic event or a
as a reference that allow a global evaluation of the
feeling of being kicked at the back of the heel.
bones, tendons, ligaments, and other structures with a
On examination: There is loss of Achilles
single examination that exceeds the capabilities of all
tendon congruity or palpable gap, weakness of ankle
other available clinical tests (4).
joint plantar flexion, and inability to do heel raises (6).
4339
Received:18/5/2018
Accepted:27/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4343-4348
Radiological Assessment of Surgical Treatment of Distal Radius Fractures among
Patients at an Academic Center in Jeddah
Orjwan Anas Abulaban1, Abdulrahman Ihsan Alrifai1, Salma Ayman Almosallam1, Aseel Anas
Abulaban1, Amre Sami Hamdi1
1College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Corresponding author: Orjwan Abulaban, Phone number: 00966553739474, E-mail: orjwan.abulaban@gmail.com
ABSTRACT
Background: Distal radius fractures (DRFs) are mainly treated by surgery; however, there is no strong
evidence to establish the superiority of one modality over another.
Aim: To determine the most efficient surgical procedure in terms of restoring anatomical angles in DRFs.
Methods: This retrospective study was conducted at King Abdulaziz University Hospital, Jeddah between 2010 and
2016. It involved 31 patients with DRF treated surgically. All patients were assessed pre-and post-operatively to
measure radial height (RH), radial inclination(RI),ulnar variance (UV) and volar tilt (VT) on posteroanterior and
lateral radiographs. The Shapiro-Wilk test was performed to determine the normality of measurements.
Results: Pre-operative variables, including (RH), (RI), (VT), and (UV), were not significantly different among
patients in all treatment groups. In group 1 (closed reduction with K-wire, external fixation, or both), all the
pre- and post-treatment variables were significantly different (p < 0.05), except (UV) (p = 0.867). Conversely,
the difference between pre- and post-measurement variables in group 2 (open reduction with plate and screw)
was significantly high (p < 0.05). Further, group 3 (open reduction with K-wire plus plate and screws) and
group 4 (open reduction with K-wire plus plate and screws in combination with external fixation) showed no
significant difference (p > 0.05).
Conclusion: Open reduction with plate and screws was highly effective in the management of DRFs.
However, additional studies are needed to establish an effective management for these fractures.
Keywords: Distal radial fracture, open reduction, closed reduction, radial inclination.
INTRODUCTION
have been many significant complications reported
Distal radius fractures (DRFs) are the most
with ORIF, such as tendon rupture, carpal tunnel
common fracture among all age groups, particularly in
syndrome, and high rates of infections (7,10).
pediatric and elderly populations(1) due to the high rate
While many studies have shown acceptable
of falls and prevalence of osteoporosis in these age
anatomical and functional results with EF, this surgical
groups (2). DRFs account for more than 640,000 of all
modality increases the risk of displacements in up to
fractures reported annually in the United States (3).
50% of patients, and it is associated with multiple
It is well-known that DRFs need steady reduction
complications, such as pin tract infection, cosmetic
and internal or external fixation (4). If not properly aligned
deformity, and nerve injury (8,10,14). On the other hand,
and fixed, fractures lead mostly to post-traumatic arthritis 1.
some investigators suggested that EF had remarkably
Although DRFs are among the most common injuries
refined the radiological measurements (radial length and
treated by orthopedics, the treatment options are variable
dorsal tilt) in correlation to casting 15. Although IF
and remain a topic of debate (5,6).
(using K-wire) has the advantage of being reasonable,
In addition to cast immobilization for
easy to perform, and minimally invasive, (7) the
minimal displacement, (4) there are several treatment
introduction of variable angle locking plates has led to a
modalities for unstable DRF restoration, including
decrease in the use of this fixation method (12).
closed reduction with either internal fixation (IF) or
Most authors report the relationship between
external fixation (EF) and open reduction with
radiographic variables and their influence on the final
internal fixation (ORIF) (7,8). For several years, cast
outcome in patients with DRFs (16). Several studies
immobilization has been the mainstay of treatment (9).
proved that in patients with DRFs, it was possible to
Nevertheless, an unsystematic trial showed that ORIF
restore function more effectively with anatomical
was superior to casting regarding the prompt ability to
restoration than other solutions (16). Further, the
move the wrist. Additionally, ORIF minimized the
restoration of volar angulation, radial length, and
period needed to regain proper range of motion
radial inclination were reported to be essential for
(ROM) and enabled better anatomical reassembling
good functional outcomes at the wrist (12).
of the fragments and articular surface than superior
There is no consensus on the management of
casting (7,1013). This finding was reported by other
DRFs among orthopedic and hand surgeons9.
investigators who found that ORIF was associated
However, the main goal of treatment is to reduce the
with a better radiological outcome when volar
DRF anatomically and restore the patient's level of
locking plate fixation was used (9). However, there
functioning (9). Despite the importance of radiological
4343
Received:28/4/2018
Accepted:7/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4349-4354
The Prevalence of Infection in RA Patients using Biological DMARDs in King
Abdul-Aziz University Hospital Jeddah, Saudi Arabia: A cross sectional study
Badreyah Ahmad Aldauig1, Khalid A. Alshehri1, Ahmed A. Alharbi1, Rana M. Bajaba1, Sarah
Alghamdi1, Suzan Attar2
1 College of Medicine, King Abdulaziz University, Jeddah, 2 Department of Internal Medicine (Rheumatology), King
Abdulaziz University, Jeddah, Saudi arabia
Correspondence: Badreyah Ahmad Aldauig, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
PO Box-21411 Jeddah-456 district, Saudi Arabia.
E-mail: Bdaryahmad12@gmail.com
ABSTRACT
Background: Rheumatoid Arthritis is one of the most common autoimmune disorders. Drugs used are only to
slow the progression and to enhance the quality of life. These therapies have several disadvantages as lack of
selectivity and it can cause loss of patient compliance.
Aim: To identify the most common type of infection, rheumatoid arthritis patients in our region encountered,
while using biologics and/or traditional DMARDs.
Method: Cross-sectional study was carried out in Rheumatology clinics at King Abdulaziz University
Hospital, included Rheumatic patients who visit the clinics from 2013 to 2017. Data sheet was including
demographic, using drug and American College of Rheumatology classification criteria for RA were added.
Result: Total of 164 patients were included in this study, 18 (11%) males, and 146 (89%) females. Trends
among the target sample showed that 40 (24.4%) had diabetes and 51(31.1%) had hypertension. Patients who
had been taking both DMARDs and Biologics, DRMADs only, biologics only were 49 (29.9%), 74(45.1%)
and 15(9.1%) respectively. The total number of the infections was 180, among them 62.78% were taking
DMARDs only and the most common infection was lower urinary tract infections (UTI) 28(37.38%).
Conclusion: UTI have the highest rate of infection in patients using traditional DMARDs and patient using
both drug groups. And we recommend conducting a cohort study to identify these infections. It can help in
assessing their outcomes.
Keywords: Rheumatoid Arthritis, biological drugs, DMARDs, infection
INTRODUCTION
DMARDs act non-specifically and have effects on
Rheumatoid Arthritis (RA) is considered
different inflammation processes (4).
one of the most common human systemic
There are ten biologics therapies approved
autoimmune disorders. Therapies used now for RA
for the treatment of RA, and they are usually used
patient are only to slow the progression of the
when treatment with DMARDs alone have failed.
disease and try to enhance the quality of life.
Half of these are anti-tumor necrosis factor (anti-
However,
these
therapies
have
several
TNF)
therapies:
infliximab,
adalimumab,
disadvantages because of their lack of selectivity,
golimumab, etanercept and certolizumab pegol.
and it can cause loss of patient compliance due to
The first classes of biological therapies to be
its frequent and long-term dosing (1). The choice of
licensed for the treatment of RA were Anti-TNF
treatment depends upon the disease state such as
therapies: Anakinra which works by blocking the
activity, prognosis regarding joint destruction, and
interleukin-1 (IL-1) receptor. Abatacept which is a
complications (2). Disease Modifying Anti-
selective co-stimulator of T-cell activity, followed
Rheumatic Drugs (DMARDs) are used as the
by rituximab which is an anti-B-cell therapy used
initial treatment they are effective by slowing down
in the management of nonHodgkin's lymphoma.
the progression and easing the symptoms. There
More recently, tocilizumab and Sarilumab were
are many different types of DMARDs including:
added which are considered as anti-IL-6 receptor
methotrexate, leflunomide, hydroxychloroquine,
antibodies, and, finally, tofacitinib which is a Janus
and sulfasalazine. Methotrexate usually is the first
kinase (JAK) inhibitor and this drug is the first
medicine given, with another DMARD and a short
orally administered biological agent (4).
course of corticosteroids to relieve any pain; or
Due to the presence of different treatment
combined with biologics (3). Biologics are made of
options, clinicians need to compare between them
proteins. They are potent and specific therapies; it
and assess their efficacy and side effect. Infections
works by antagonizing the mechanism of action of
are noted to be one of the most important risks in
a particular chemical or cell involved in the
biological therapy, either serious or non-serious.
occurrence of inflammation that results in joint
Serious infection (SI) is defined by the FDA as the
swelling and other symptoms. While Traditional
one that result in either death, hospitalization or the
use of parenteral therapy. A meta-analysis state that
4349
Received:28/4/2018
Accepted:7/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4355-4361
Prognostic Factors of Non-Small Cell Lung Cancer and Their Relation to the
Clinical Outcomes
Tarek H Kamel, Dalia A AbelAal, Khaled R Kamal El-Din, Eslam H Mahdy
Department of Clinical Oncology and Nuclear Medicine, Ain Shams University
Corresponding author: Eslam H Mahdy; Mobile: 01226644399; Email: Eslam_mahdi@hotmail.com
ABSTRACT
Background: Lung cancer is the main cause of cancer deaths worldwide. Around 1.8 million people are
diagnosed worldwide with lung cancer each year. This accounts for about 13% of total cancer diagnoses
making it the most common cancer disease. Lung cancer is also the type of cancer that has the highest
mortality, killing approximately 1.6 million people annually. The highest incidence rates among men are in the
United States and Eastern Europe, whereas the highest among women are in North America and Northern
Europe.
Aim of the Work: The aim of this study is to analyze the importance of clinicopathological parameters and
treatment modality as prognostic factors affecting survival of patients diagnosed as Non small cell lung cancer
(NSCLC) and the quality of life.
Methods: We retrospectively reviewed the clinical records of patients with inoperable stage III/IV NSCLC,
who were treated at the department of Clinical Oncology, Ain Shams University Hospital and the International
Medical center between 2009 and 2017. The association between the demographic and clinical characteristics
and survival of these patients was analyzed.
Results: A total of 69 patients (32 stage III& 39 stage IV) were identified and included in this study. Sex
(males vs. females, p=0.04), Eastern cooperative Oncology group performance status (0 vs. 1 vs. 2, p=0.001),
smoking habit (never vs. current vs. former, p=0.001), stage (IIIA vs. IIIB vs. IV, p=0.008) and the initial
treatment (no vs. chemotherapy vs. concurrent chemoradiotherapy, p=0.001) were found to be factors affecting
survival in univariate analyses. Sex and histological subtype did not affect survival. Performance status, stage
and initial treatment were determined as the independent prognostic factors affecting survival in multivariate
analyses.
Conclusion: Performance status, stage and initial treatment with concurrent chemoradiotherapy in eligible
patients were prognostic factors affecting overall survival of patients with advanced NSCLC.
Keywords: non-small cell lung cancer, prognostic factors, survival
INTRODUCTION
lung cancer patients are sex, age, stage,
Lung cancer is the most common type of
performance status, weight loss, smoking history,
cancer worldwide and it is the leading cause of
quality of life, and genetic mutations (6).
cancer-related mortality in the United States (1).
Treatment modality is an additional
Lung cancer was divides into small cell
important prognostic factor in patients with stage
carcinomas and non-small cell carcinomas. Non-
III disease. Radiotherapy dose and treatment
small cell lung cancer (NSCLC) accounts for about
modality (chemoradiotherapy, radiotherapy or
80% of all lung cancers (2).
chemotherapy alone) may be indicators influencing
The 5-year relative survival rate of patients
treatment outcomes and survival (7). Investigation
with lung cancer varies markedly depending on the
of the additional prognostic factors of stage III
stage at diagnosis, from 49% to 16% to 2% for
patients may play an important role in evaluation of
patients with local, regional, and distant-stage
optimal treatment options and increasing survival
disease, respectively (3).
of these patients.
Thirty percent of patients with NSCLC
The aim of this study was to analyze the
diagnosed with stage III disease. The survival of
importance of clincopathological parameters and
clinical stage III NSCLC patients is poor and most
treatment modality as a prognostic factors affecting
patients are not eligible for surgical resection (4).
survival of patients with advanced non-small cell
The usual treatment is radical radiotherapy (RT) or
lung cancer.
concurrent chemotherapy (5).
PATIENTS AND METHODS
It is important to understand the
Study design: Retrospective analysis.
progression of this disease which leads to low
survival times despite the advancing treatment
Site of the study: Patients diagnosed with
modalities. For this reason, many prognostic
primary unresectable stage III/IV non-small cell
factors have been investigated in several studies.
lung cancer (NSCLC) recruited from the Clinical
The most common prognostic factors studied for
Oncology Department, Ain Shams University and
4355
Received:2/5/2018
Accepted:11/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4362-4367
Neuromuscular Ultrasound Versus Electrophysiological Studies in Assessment of
Posterior Tibial Nerve Neuropathy in Rheumatoid Arthritis Patient
Mostafa A. Al-Dahan1, Hegazy M. Al-Tamimy2, Ahmed M. Fahmy3, Mahmoud I. Risha4
1,2,3,4 Department of Physical medicine & Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University,
Cairo, Egypt
Corresponding author: Mahmoud I. Risha; Mobile: 01200021223; Email: dr.m_risha@yahoo.com
ABSTRACT
Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive
and deforming polyarthritis. Extra-articular manifestations occur in 1020% of patients, especially those with
high titers of rheumatoid factor. Neuromuscular ultrasound is useful for the work up of posterior tibial nerve
neuropathy. Diagnosis of posterior tibial neuropathy is based on a combination of characteristic symptoms and
electrophysiological abnormalities. Recently, neuromuscular ultrasound has become an attractive complement
to electrodiagnostic (EDX) studies in the evaluation of peripheral nerves.
Aim of the Work: To evaluate neuromuscular ultrasound versus electrophysiological studies in assessment of
posterior tibial nerve neuropathy in rheumatoid arthritis patients.
Patients and Methods: The subjects included in our study functionally were divided into two groups. Group
(A): Thirty Egyptian patients with Rheumatoid Arthritis (RA), all fulfilled the American College of
Rheumatology (ACR) 2010 criteria for diagnosis of RA and ACR criteria for classification of rheumatoid
arthritis (1987). All were over the age of sixteen at time of diagnosis. They were recruited from Physical
Medicine, Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals
during the period from November 2017 to April 2018. They were complaining of burning pain or paresthesia
on the plantar aspect of the foot and toes. Group (B): Thirty healthy individuals, age and sex matched, were
used as a control group after an informed consent from all subjects.
Results: Neuromuscular ultrasound had a complementary role in the diagnosis of posterior tibial nerve
neuropathy. The combined use of electrophysiology with neuromuscular ultrasonography further confirmed the
diagnosis of posterior tibial nerve neuropathy.
Conclusion: Neuromuscular ultrasound became an attractive complement to electrodiagnostic (EDX) studies
in the evaluation of posterior tibial nerve neuropathy.
Keywords: Rheumatoid arthritis, neuromuscular ultrasound, nerve conduction studies.
INTRODUCTION
The posterior tibial nerve is a branch of the
Rheumatoid arthritis is a systemic rheumatic
sciatic nerve with a nerve root supply of L4, L5, S1, S2
disease characterized by symmetrical, often erosive and
and S3. The nerve enters the leg between the two heads of
deforming polyarthritis. Extra-articular manifestations
the gastrocnemius muscle and the nerve lies deep to the
occur in 1020% of patients, especially those with high
soleus muscle in the posterior compartment of the leg. In
titers of rheumatoid factor. Extra articular pathology
the lower leg the nerve travels between the flexor
includes bursitis, tendonitis, neuritis, and vasculitis (1).
digitorum longus and the flexor hallucis longus. It then
Vasculitic neuropathy in rheumatoid arthritis
travels behind the medial malleolus through the proximal
is a sequential process of inflammation, thrombosis
tarsal tunnel where it divides into its terminal branches,
and ischemic injury to vasa nervosum, especially
the medial plantar nerve and the lateral plantar nerve (5).
involving epineural arteritis of nerve (2).
Evaluation mainstays of the rheumatoid foot
Clinical presentations include entrapment
include both electrophysiological studies and imaging
neuropathy that is one of the commonest types of
techniques. Electrophysiological studies are used to
carpal tunnel syndrome, tarsal tunnel syndrome
assess the peripheral electrophysiological changes in
(TTS), ulnar neuropathy at the elbow (cubital tunnel
the rheumatoid feet (6).
syndrome), femoral neuropathy, peroneal neuropathy,
Neuromuscular ultrasound is useful for the
combined
sensorimotor
polyneuropathy
and
work up of posterior tibial nerve neuropathy. It can
mononeuritis multiplex (3).
often locate the exact site of nerve entrapment and
The symptoms of posterior tibial nerve
can provide useful information on the cause of nerve
neuropathy include pain and numbness in the sole of the
damage in the tunnel and address the pathology of
foot, cramping pain, tingling, sensation of tightness,
tarsal tunnel syndrome, such as perineural tissue
worsening of symptoms with prolonged standing and
vascularity and concomitant tendon pathology (7).
walking and signs of entrapment include hyperthesia,
AIM OF THE WORK
weakness, hypoesthesia and Tinel's sign (4).
The aim of the work was to evaluate
neuromuscular ultrasound versus electrophysiological
4362
Received:19/5/2018
Accepted:29/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4368-4373
Factors Associated with Fistula Secondary Failure in Patients on Hemodialysis
Safwat Farrag1, Ahmed El Ashkar1, Ahmed Aboul Fotouh2, Mohamed El Shorbagy3, Ahmed
Ibrahim1
Internal Medicine & Nephrology1, Radiology2 and Clinical Pathology3 Departments, Faculty of Medicine Al-Azhar
University.
Corresponding author: Ahmed Ibrahim, email:drahmedibrahim14@yahoo.com
ABSTRACT
Background: Native arteriovenous (AV) fistulas, which are the most commonly used access line, enable
sufficient and repeated hemodialysis (HD) applications and improves the rate of survival and quality of life in
patients with end-stage renal disease (ESRD) when performed timely in an appropriate anatomic location using
a fine technique. Objectives: We aimed to assess factors responsible for fistula secondary failure in patients on
hemodialysis. Patients and Methods: Thirty patients with end stage renal disease (ESRD) on regular HD were
included. All patients underwent history taking, clinical examination and ultrasound examination was carried
out for all patients to assess AVF and factors associated with its patency and failure. Results: There was no
statistically significant differences between group I and group II as regards to age, BMI, HD duration and AVF
age (p-value >0.05). There was statistically high significant difference between patients with well functioning
AVF (group I) and patients with malfunctioning (secondary failed) AVF (group II) as regarding SVP and mean
arterial blood pressure (P-value < 0.01) and there was statistically significant difference between group I and
group II as regarding DVP (p-value < 0.05). There was statistically high significant difference between group I
and group II as regarding venous diameter and FV (P-value < 0.01), while there was no statistically significant
difference between group I and group II as regarding arterial diameter (P-value > 0.05). There was statistically
high significant difference between group I and group II as regarding hemoglobin & dialysis adequacy (Kt/V)
(P-value < 0.01). Conclusion: The native AVF is the vascular access of choice for patients who require
hemodialysis: it lasts longer and is associated with fewer complications than other types of vascular access; for
hemodialysis patients, these benefits translate into better quality of life and longer survival. The result of this
study showed a significant positive correlation between access blood flow (Qa) and Kt/V. This confirm the
importance of well-functioning non stenotic AVF in delivering adequate dialysis.
Key words: HD: Hemodialysis, AVF: Arteriovenous fistula, ESRD: End stage renal disease, Qa: Access blood
flow, Kt/V: Dialysis adequacy.
INTRODUCTION
non-invasive technique, suitable for the study of
End-stage renal disease is a chronic disease
superficial structures, it does not use contrast
requiring treatment with dialysis or renal
agents and it is becoming a tool directly used by
transplantation. Patients require an adequate
nephrologists. In fact Doppler ultrasound is an
vascular access for hemodialysis (HD). Autologous
excellent and sensitive modality for hemodialysis
arteriovenous fistula (AVF) is gold standard to
access evaluation and important not only as a
maintain vascular access for HD (1). Vascular
preoperative tool, but also in post-operative
accessrelated complications can lead to patient
monitoring of AVF maturation. The current
morbidity and reduction of patient quality of life (2).
guidelines recommend AVF surveillance by access
The complication rate related to permanent HD
blood flow measurement and the correction of
vascular access remains relatively high and access
hemodynamic stenosis if present in order to
related problems are responsible for 50% of the
prolong access survival. In conclusion Doppler
hospitalization of dialysis patients (3). Secondary
ultrasound is readily available, easily used by
failures are not rare and in need of adequate
nephrologists, non-invasive, safe, inexpensive,
attention and care. Once the AVF has been placed.
reproducible, although it requires more clinical
It is recommended that serial monitoring of the
skill and time to perform and proper equipment.
AVF should be done for long term effective
Furthermore,
ultrasonography
imaging
can
function. Delays in preventing complications may
substantially reduce the number of subsequent
lead to AVF dysfunction. However, little is known
invasive angiographic procedures (5).
about the factors determining long term prognosis
of an AVF (4). The fistulae were then followed-up
PATIENTS AND METHODS
by means of non-invasive measurement of diameter
A thirty patients with end stage renal
and blood flow using an ultrasonic colour flow
disease (ESRD), on regular HD in Dialysis Unit,
scanner. The echo color Doppler ultrasound (CD-
Internal
Medicine
Department,
Al-Hussein
US) allows a detailed morphological and functional
Hospital, Faculty of Medicine, Al-Azhar
vascular access (VA) assessment; it is a cheap and
University-Egypt, were recruited to participate in
4368
Received:18/5/2018
Accepted:27/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4374-4377
A comparative study of the discrepancy in the horizontal white-to-white
measurement using Calipers vs Pentacam
Tamer El-Mekkawi, Moamen Mostafa, Ashraf Soliman, Yahya Abdulla Hamed Khedr
Department of Ophthalmology, Faculty of Medicine, Ain Shams University
Corresponding author: Yahya A.H. Khedr, Mobile: 01001614870; Email: yahya_khedr@hotmail.com
ABSTRACT
Background: The accurate measurement of the horizontal corneal white-to-white (WTW) diameter is essential
and has multiple applications in the field of ophthalmology whether medical or surgical. There are many
means of measuring the horizontal white-to-white, which includes the Pentacam, the IOL Master and Manual
Calipers. Both the Pentacam and Manual Calipers measure the external white-to-white diameter, whereas the
IOL Master measures the internal white-to-white diameter.
Objective: The aim of this study is to measure the accuracy of the Pentacam white-to-white camera in
measuring the horizontal corneal WTW diameter in comparison to the Manual Calipers, which is considered to
be the basic standard.
Patients and Methods: The study was a cross sectional one, conducted at Maghrabi Eye Hospital, Cairo,
Egypt. It was conducted in accordance with the ethical standards stated by the Ethical Committee of Ain
Shams University. Informed consent was obtained from each participant following the explanation of the
academic nature of the study.
Results: Our study compared the accuracy of the Pentacam HR to the Manual Calipers and found a strong
correlation between both methods regarding all parameters. A difference of 0.44 ± 0.17 mm was found
between the manual calipers and the Pentacam (HVID Automated) measurements and a lesser difference of
0.24 ± 0.27 mm when comparing the manual calipers with the Pentacam manual digital calipers. On the other
hand, the difference between the 2 methods of the Pentacam measurement used was 0.19 ± 0.13 mm. All of
which, showed a highly significant correlation.
Conclusion: The Pentacam gives larger WTW measurements than the manual calipers as it relies on the gray
scale analysis of the HVID in the iris image display.
Keywords: White to White - Manual Calipers - Pentacam
INTRODUCTION
The IOL Master is considered to be the gold
The horizontal corneal white-to-white
standard in optical biometry. It uses the principle of
(WTW) diameter measurement is an essential value
partial coherence interferometry (PCI) to obtain the
and has multiple applications in the field of
axial length of the eye with high precision and hence
ophthalmology. It is defined as the distance between
calculating the intraocular lens (IOL) power. The IOL
the two corneal limbal areas horizontally (1).
Master also automatically measures the horizontal
There are many means of measuring the
white-to-white diameter of the cornea (3).
horizontal WTW, which includes the Pentacam, the
As for the manual calipers, we used the
IOL Master and Manual Calipers. Both the Pentacam
Bausch and Lomb Storz Ophthalmics E-2404
and Manual Calipers measure the external white-to-
Castroviejo Caliper, which measures from 0 to 20
white diameter, whereas the IOL Master measures the
mm in 0.5 mm increments, with a scale reading on
internal white-to-white diameter.
both sides. The measurement will be performed
The current accepted standards of normal
under the slit lamp biomicroscope.
horizontal WTW diameter, is greater than 11.0 mm
There are many clinical uses of the
and less than 13.0 mm (1).
horizontal
WTW
measurement,
including
The Pentacam HR (OCULUS, Germany) is
identification of: microphthalmia, relative anterior
a device that combines a rotating Scheimpflug
microphthalmia, microcornea, macrophthalmia,
camera with a static camera to acquire multiple
megalocornea, and congenital glaucoma (1).
photographs of the anterior eye segment. The
As from the surgical point of view,
Scheimpflug camera rotates along with a
surgeons have relied on the horizontal WTW
monochromatic slit light source around the optical
measurement for sizing of some types of
axis to obtain the slit images. This rotating system
intraocular lenses like implantable collamer lenses
performs a corneal scan from zero to 180 degrees
(ICL) and angle supported phakic IOLs (1).
and each of the photographs is an image of the
cornea at a specific angle. It also has a WTW
AIM OF THE WORK
camera, to automatically measure the horizontal
The aim of this study was to measure the
WTW diameter of the cornea (2).
accuracy of the Pentacam white-to-white camera in
4374
Received:24/5/2018
Accepted:3/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4378-4381
Epidemiological Study of Seborrheic Keratosis among Egyptians in Great Cairo
Mohamed Abdel Moneim Abdel Aal, Ahmed Rashad Mohamed El-Shahed, Maydaa Mohamed
Fawzy
Department of Dermatology and Venereology, El-Hussin University Hospitals, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
Corresponding author: Name: Maydaa Mohamed Fawzy, E-Mail: maydaa.mohammed@gmail.com, Mobile: 01003797353
ABSTRACT
Background: Seborrheic keratosis is one of the most common benign epidermal tumors. Seborrheickeratoses
are hyperkeratotic lesions of the epidermis, which often appear to be "stuck on" the surface of the skin. Cherry
angiomas are very common acquired vascular skin lesions.
Objective: To find any relation between seborrheic keratosis and cherry angioma.
Patients and Methods: A total of one hundred male and female patients, presented with Seborrheic keratosis
with or without associated cherry angioma (62% present CA & 38% absent CA), were included in the study.
Full history taking and full examination was done between December 2015 and May 2017. Twelve biopsies
were taken from 6 patients.
Results: The age of the patients ranged from 18 to 88 years old. The male patients were (63%) and the female
patients were (37%). 17% of patients complained of itching, 20% had positive family history of Seborrheic
Keratosis, 75% had skin photo type III. Flat Seborrheic Keratosis was 49% of the cases. The most common site
of SK was face (76%). The most common site of cherry angioma was abdomen (88.7%). The examination of
the biopsies revealed no histopathological correlation between seborrheic keratosis and cherry angioma.
Conclusion: The patient with seborrheic keratosis sometimes may have cherry angioma in adjacent to it or in a
different site which didn't necessarily means that they have the same pathological origin.
Keywords: Seborrheic keratosis, cherry angioma, biopsy, tumer, histopathology.
INTRODUCTION
patients, presented with Seborrheic keratosis with
Seborrheic keratoses (SK) are common,
or without associated cherry angioma were
benign, pigmented epidermal tumors. These
included in this study from Al-Azhar University
usually develop after the age of 50 years although
Hospitals, Al-Waraa Central Hospital and Al-Houd
occasionally, seen in young adulthood without any
Al-Marsoud Hospital. Patients were subjected to:
sexual predilection (1).
Full history taking: 1-Personal history
The common site of involvement includes
that includes name, age, sex, marriage, occupation,
the trunk, particularly the interscapular area, sides
special habits of medical importance, address. 2-
of the neck, the face and the arms. The tumors are
Present history: presence of pain, discharge,
not, however, seen on the mucous membranes.
bleeding, ulceration, itching at the site of the
Lesions appear as coin-like, sharply demarcated,
lesion. 3- Family history of Seborrrheic Keratosis.
exophytic lesions and are "stuck on the skin" with
Examination: 1-General examination:
a verrucous, rough, dull or punched-out surface (2).
Height, body weight, body mass index, span, and
SK is found in a significant portion of
general build. 2-Dermatological examination: To
elderly individuals, ranging from 11% to 60% of
determine patient's skin type; site, color and
older adults in different populations, because this
number of Seborrheic Keratosis, associated Cherry
tumor is benign and its treatment is not mandatory.
Angioma; their site, color and number.
However, the lesions are often removed especially
Ethical Issues: Informed consents were
for cosmetic reasons (3).
taken from all of the patients included in our study.
Cherry angiomas (CAs) are the most common
form of acquired vascular proliferation of the skin (4).
Skin Biopsy: Six patients who have
CAs usually appears in the third or fourth
seborrhiec keratosis with associated cherry angioma
decade of life and tends to increase in number and
were collected from Al Houd Al Marsoud hospital,
size with increasing age (5).
with biopsy samples from 12 skin lesions. Every
patient was subjected to two biopsies procedures. The
The aim of this study is to consider any relation
biopsy of half of the patients was taken from two
between seborrheic keratosis and cherry angioma.
cherry angiomas different in color and shape. The
other three patient's biopsies were taken from
PATIENTS AND METHODS
seborrheic keratosis and cherry angioma. All of the
Type of the study: epidemiological study.
biopsy's patients were males, their age ranges from 56
This epidemiological study was carried on100 patie
to 7o years old. The biopsies were taken from: chest,
nt.The study was approved by the Ethics Board of
Al-Azhar University. A total of one hundred
4378
Received:12/4/2018
Accepted:21/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4382-4388
A Randomized Trial of Combined Letrozole with Metformin Versus Clomiphene
Citrate with Metformin in Polycystic Ovary (PCOS) patients
Fahd A El Omda, Ahmed T Abd El Fattah, Mahmoud A Hashish, Mahmoud A Khalil
Department of Obstetrics and Gynecology, Faculty of Medicine Al Azhar University
ABSTRACT
Background: Polycystic Ovary Syndrome (PCOS) is one of the most common causes of anovulatory
infertility. Currently, clomiphene citrate (CC) is considered the first-line therapy for ovulation induction for
women with PCOS and infertility. Aromatase inhibitors (AIs) have been introduced as a new treatment option
that could challenge CC for ovulation induction. Aim of the Work: The present study was designed to
compare the efficacy of combined aromatase inhibitor (Letrozole) with metformin versus CC with metformin
in PCOS patients. Patients and Methods: This study was done on 100 documented PCOS cases. They were
divided into two groups, The 1st group received CC 50 mg twice daily from the 3rd day of cycle for 5 days and
repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with CC and continued for 3 cycles.
The 2nd group received aromatase inhibitor (Letrozole) 2.5 mg twice daily from 3rd day of cycle for 5 days
and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with letrozole and continued for 3
cycles. These cases were followed up for three cycles by transvaginal ultrasound folliculometry to document
ovulation (size and number of follicles). Results: The results of the present study revealed both lines of
treatment were effective in treatment of PCOS patients, with slight favorability in letrozole group but without
statistically significant difference founded between CC group and letrozole group as regard ovulation rate,
number of follicles at the end of first, second or third cycles, or as regard the diameter of follicles, i.e., both
regimens showed efficacy to the same extent. Conclusion: both CC and letrozole are equally effective in
treatment of infertility in PCOS patients, when combined with metformin treatment.
Key Words: PCOS, clomiphene citrate, letrozole, metformin
INTRODUCTION
conversion of androstenedione and testosterone via
Infertility has been attributed to various
three hydroxylation steps to estrone and estradiol.
factors, amongst which anovulation is the cause in
Aromatase activity is present in many
about 40% of all female infertility. Polycystic Ovary
tissues such as the ovaries, adipose tissue, muscle,
Syndrome (PCOS) is one of the most common causes
liver, breast tissue, and in malignant breast tumors.
of anovulatory infertility, affects 4-7% of women (1).
The main sources of circulating estrogens are the
Criteria used for diagnosing Polycystic Ovary
ovaries in premenopausal women and adipose
Syndrome (PCOS) are the Rotterdam Criteria of which
tissue in postmenopausal women (3).
a woman must have two out of the followings: 1:
AIs can be applied for ovarian stimulation as
Oligo- or anovulation. 2: Clinical and / or biochemical
its administration early in the follicular phase can
signs of hyperandrogenism 3: Polycystic ovaries (with
induce ovulation by releasing the hypothalamus or
the exclusion of related disorders).
pituitary from estrogen negative feedback on GnRH
With exclusion of other conditions with
and gonadotropin secretion, leading to an increase in
similar signs such as androgen-secreting tumors or
gonadotropin production which would stimulate
Cushing's syndrome and thyroid dysfunction and
ovarian follicular development (4). AIs prevent the
hyperprolactinemia.
Androgen-Estrogen
conversion
and
therefore
Anti estrogenic drug, such as Clomiphene
interfere with the negative feedback at the level of the
citrate (CC) is considered the first line treatment
hypothalamus-pituitary. The increased pituitary
for induction of ovulation in women with
gonadotropin output will in turn stimulate the ovaries
Polycystic Ovary Syndrome (PCOS). CC is given
(5). In addition, they act locally in the ovary to increase
orally at a dose of 50-100 mg/day from 3rd day of
follicular sensitivity to FSH. This may result from
cycle for 5 days. If patients fail to respond to 150
accumulation of intraovarian androgens, since
mg/day, they are considered as CC resistant.
conversion of androgen substrate to estrogen is
Aromatase inhibitors (AIs) have been
blocked. Recent data support a stimulatory role for
introduced as a new treatment option that could
androgens in early follicular growth (6).
challenge CC for ovulation induction (2).
In some studies, letrozole in contrast to CC
Aromatase is a cytochrome P-450 hem
is better as it increases endometrial thickness by
protein containing enzyme complex (the product of
upregulation of estrogen receptors. So, it increases
the CYP19 gene) that catalyzes the rate-limiting
pregnancy rate and also it decreases incidence of
step in the production of estrogens which is the
multiple pregnancy (5,7).
4382
Received:24/5/2018
Accepted:3/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4389-4391
Effect of Silver nanoParticles on Carbapenem Resistant Gram-negative Bacteria
Naglaa Gamal Abo Al-Azaim, Ahmad Al-Saeed Al-Sehrawey, Abd el aleem Abd el aleem Aly
Elgendy, Mohamed Nashaat Mohamed Ahmed
Departments of Clinical Pathology, Al-Houssien University Hospital, Al-Azhar Faculty of Medicine
Corresponding author: Mohamed Nashaat Mohamed Ahmed, E-Mail: dr.mohamed.nashaat2014@ gmail.com, Mobile: 01099062240
ABSTRACT
Background: Gram-negative bacteria are common causes of both community-acquired and hospital-acquired
infections. -Lactam drugs are often the primary therapeutic option for serious infections, and carbapenems in
particular are often considered agents of last resort. Thus, the emergence and spread of carbapenem-resistant
(CR) bacteria are a significant public health concern. Infections with these resistant bacteria are associated with
higher mortality rates than those for infections caused by carbapenem susceptible organisms. There have been
considerable efforts to develop new antimicrobials drug against this type of resistant bacteria. Silver
Nanoparticles (AgNPs) have emerged as promising weapons in the anti-microbial arsenal. Their anti-microbial
efficacy is attributable to multiple mechanism of action.
Objective: The aim of this study was to evaluate effect of AgNPs on CR Gram-negative bacteria.
Materials and Methods: Effect of AgNPs on CR Gram-negative bacteria alone and in combination with
carbapenems. 50 CR Gram-negative bacterial samples were included in this study. They were divided into 4
types; Acinetobacter, E. coli, klebseilla and P. aeruginosa. Each type was divided into (subtypes) metalo and
non metalo carbapenemase producers.
Results: There was statistically significant difference between all types of CR Gram-negative bacteria with AgNPs
alone and some of them with AgNPs plus antibiotic (P-value < 0.05). A comparison of the effect of AgNPs alone
between different types of detected CR Gram-negative bacteria showed different levels of response. Lowest
response was observed with klebsiella (metalo), while highest was remarked with P. aeruginosa (metalo). Highest
synergy with highly statistically significant difference (P-value < 0.001) occurred with Meropenem in P. aeruginosa
Conclusion: AgNPs showed anti-microbial effect against CR Gram-negative bacteria alone and synergistic
effect against some of detected CR Gram-negative bacteria with certain antibiotics.
Keywords: AgNPs, CR Gram-negative bacteria, synergistic effect
INTRODUCTION
functionalized with small molecule ligands exhibit
Gram-negative bacteria are common causes
broad-spectrum activity against bacteria (5).
of both community-acquired and hospital-acquired
However, an alternative strategy is to use
infections, including urinary tract, bloodstream, and
NPs in combination with existing antibiotics to
lower respiratory tract infections (1).
combat MDR bacterial infections (6).
-Lactam drugs are often the primary
This study was performed to evaluate
therapeutic option for serious infections, and
effect of AgNPs on CR Gram-negative bacteria
carbapenems in particular are often considered
alone and in combination with carbapenems.
agents of last resort. Thus, the emergence and
spread of carbapenem resistant bacteria (CRB) are
MATERIALS AND METHODS
of significant clinical and public health concern (2).
Materials:
Infections with these resistant bacteria are
1. 50 bacterial isolates; They were divided
associated with higher mortality rates than those
into 4 types; Acinetobacter, E. coli, klebseilla and
for infections caused by carbapenem susceptible
P. aeruginosa. Each type was divided into
organisms (3).
(subtypes) metalo and non metalo carbapenemase
There have been considerable efforts to
producers. This study was conducted in
develop new antimicrobials by screening natural
collaboration between the Clinical Pathology
products, modifying existing antibiotics and
department and other clinical departments Al-
synthesizing antimicrobial peptides. Synthetic macro
Houssien University Hospital, Faculty of Medicine,
molecules such as polymers that mimic host defense
Al-Azhar University. The study was approved by
peptides are frequently used as biomedical agents (4).
the Ethics Board of Al-Azhar University.
Nanoparticles (NPs) have emerged as
All isolates were collected from Al-
promising weapons in the anti-microbial agents.
Houssien University Hospital over the period from
Their anti-microbial efficacy is attributable to
22 th December 2017 to 15th May 2018. Appropriate
multiple mechanism of action. For example, their
consent was obtained from the patient participating
large surface area enabling high synergy arising
in this study after explaining the sampling
from multivalent
interactions. Also,
NPs
procedure as well as the aim of our work to them.
4389
Received:18/5/2018
Accepted:27/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4392-4402
Effect of Trans Cranial Magnetic Stimulation in Management of Dysphasia, A
Systematic Review
Amira A. Hashim, Mariam S. Shadi and Nirvana G. Hafez
ENT Department, Phoniatric Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Amira A. Hashim, Tel: +201285328198, e-mail: ginnyaharry@hotmail.com
ABSTRACT
Background: Aphasia is the most disabling functional defect after ischemic stroke. It affects more than a third
of all stroke victims. Effective therapeutic strategies are needed to treat aphasic patients. Novel techniques,
such as methods of delivering cortical brain stimulation to modulate cortical excitability, such as transcranial
magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), are just beginning to be
explored. The purpose of repetitive transcranial magnetic stimulation (rTMS) application in the neuro-
rehabilitation of aphasic patients is to act on specific networks involved in the pathophysiology of language
processing and to promote adaptive cortical reorganization after stroke. TMS was shown to have lasting effects
on cortical excitability that persisted beyond the actual stimulus delivery. Given the ability of this treatment to
modulate cortical activity in a focal way, focus was soon placed on the use of this technique in various
neurological and psychiatric diseases such as aphasia.
Aim of the work: The aim of this work is to evaluate the effect of Transcranial Magnetic Stimulation as a
therapy for dysphasia in order to promote an evidence-based practice. This will be made by conducting a
systematic review of literature in this topic area.
Materials and Methods: This was a systematic review. Seven electronic databases (Medline, Google scholar,
CINHAL, Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials,
Database of Abstracts of Reviews of Effects and Embase) were searched for articles. Relevant studies were
further evaluated and studies that met inclusion criteria were reviewed.
Results: The literature search yielded 5097 studies. Twenty-six articles were further evaluated to be included.
Eleven studies met all inclusion criteria and were chosen for review. The studies provided moderate to strong
evidence that rTMS may be an effective treatment for non-fluent stroke aphasia. We have found significantly
higher scores on the language assessment scales of patients after the rTMS treatment than those with sham
TMS treatment, in most of the included studies. The studies reviewed here established the beneficial effect of
rTMS in multiple language domains. The domain of naming is the most affected, with almost all studies
demonstrating improvement in naming after stimulation.
Conclusion: The current systematic review suggests that inhibitory low frequency rTMS with 90% resting
motor threshold (rMT) targeting pars triangularis of the right inferior frontal gyrus can improve multiple
language domains in right-handed post-ischemic stroke patients.
Keywords: Dysphasia, TMS, language assessment, treatment.
INTRODUCTION
Types of TMS, depending on the mode of
Aphasia is the most disabling functional
stimulation, includes single or paired pulse TMS,
defect after ischemic stroke. It affects more than a
Repetitive TMS (rTMS) {slow rTMS (1Hz) and fast
third of all stroke victims. Effective therapeutic
rTMS (5, 10, or 20 Hz)} (3) and Intermittent Theta
strategies are needed to treat aphasic patients,
burst stimulation which is a patterned form of rTMS
treatments, which can benefit people with aphasia
(4). The rationale of using inhibitory (1Hz) TMS as a
include: intensive speech and language therapy
complementary therapy in neuro-rehabilitation was
(SLT), medications, stem cell transplantation and
mainly to decrease the cortical excitability in regions
Transcranial
Magnetic
Stimulation.
Novel
that are presumed to hinder optimal recovery (5).
techniques, such as methods of delivering cortical
Several studies used inhibitory rTMS over the right
brain stimulation to modulate cortical excitability,
hemisphere homologue of the Broca area in the right
such as transcranial magnetic stimulation (TMS)
inferior frontal gyrus (IFG) to facilitate naming and
and transcranial direct current stimulation (tDCS),
other language abilities in people with dysphasia (6).
are just beginning to be explored (1). TMS was
Many studies (7) support this approach by
shown to have lasting effects on cortical
interhemispheric inhibition hypothesis. It assumes
excitability that persisted beyond the actual
that damage to the left hemisphere releases the right
stimulus delivery (2). Given the ability of this
hemisphere from transcallosal inhibitory input,
treatment to modulate cortical activity in a focal
resulting in increased right hemisphere activation
way, focus was soon placed on the use of this
and,
consequently,
increased
behaviorally
technique in various neurological and psychiatric
deleterious transcallosal inhibition of the already
diseases such as aphasia (1).
damaged left hemisphere (8).
4392
Received:5/4/2018
Accepted:4/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4403-4406
Assessment of Interleukin (8) in Type 2 Diabetes Mellitus
Ilham Aly Motawa, Mekky Abd El Monem Aly, Mahmoud Mohammed Mohammed Metwally,
Ihab Nehad Farhan Mohammed
Department of Clinical Pathology, Al-Hussein University Hospital, Al-Azhar Faculty of Medicine
Corresponding author: Ihab Nehad Farhan Mohammed, E-Mail: ihabnehad1690@gmail.com, Mobile: 01128987774
ABSTRACT
Background: Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects
in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-
term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood
vessels. Type 2 diabetes (T2D) is characterized by a condition of systemic low-grade inflammation. IL-8 is an
important member of the chemokine family of proinflammatory chemotactic cytokines. IL-8 was initially
characterized as a potent chemoattractant of neutrophils and was later shown to also activate neutrophils. IL-8
is also known to be a potent promoter of angiogenesis.
Objective: It was the Assessment of Interleukin (8) in Type 2 Diabetes Mellitus.
Patients and Methods: Serum IL 8 level in Type 2 Diabetes Mellitus. 30 patients compared to 30 normal
individuals were included in this study.
Results: There was a highly statistical significant difference between all patients and control groups as regard
serum IL 8 level (mean of serum IL 8 in patients and control groups were 69.9 ± 20.5 and 5.4 ± 3.3
respectively, p= < 0.001).
Conclusion: Type 2 diabetes mellitus patients showed marked elevation of circulating IL-8 levels which
identify subjects with worse inflammatory state and metabolic control and therefore it may be used as a marker
for the rate of development of diabeteic complications.
Keywords: Type 2 Diabetes Mellitus, Interleukin-8, CXC chemokine
INTRODUCTION
Several cross-sectional studies showed that
Diabetes is the most common endocrine
insulin resistance and T2D are associated with higher
disorder, affecting in the year 2013, about 382 million
circulating levels of C-reactive protein (CRP), IL-6
people worldwide and it is estimated that in 2035, over
and TNF-, in addition, the chemokine system, in
592 million cases of diabetes will be registered (1).
particular interleukin-8 (IL-8), came more recently
Type 2 diabetes (T2D) is characterized by
into the focus of metabolic inflammation research (6).
a condition of systemic low-grade inflammation
This study was performed to evaluate
which represents a key factor for the development
circulating plasma IL-8 levels in adult patients with
of insulin resistance and associated comorbidities,
type 2 diabetes mellitus in comparison with non-
such as non-alcoholic fatty liver disease (NAFLD)
diabetic subjects.
and atherosclerosis. Insulin resistance is defined as
SUBJECTS AND METHODS
the impaired ability of target tissues of fat, liver,
Subjects:
and muscle to show various metabolic effects of
This study was conducted in collaboration
insulin, including glucose uptake (2).
between the Clinical Pathology and Internal
Interleuken-8
is
a
pro-inflammatory
Medicine department at Al-Hussein University
polypeptide belonging to the CXC chemokine
Hospital, Faculty of Medicine, Al-Azhar
superfamily, characterized by the presence of two
University. The study was approved by the
cysteine residues separated by an intervening aminoacid
Ethics Board of Al-Azhar University.
in the first three positions, and is secreted by several cell
All patients were collected from the
types, including adipocytes, monocytes / macrophages,
outpatient clinic and Internal Medicine department
T-lymphocytes, endothelial and epidermal cell (3).
at Al-Hussein University Hospital over a period
As
a
multifunctional
chemokine,
from 15th January 2018 to 5th April 2018, with
interleukin-8 has chemoattractant and mitogenic
appropriate consent to participate in this study after
effects on neutrophils as well as on T-cells,
explanation to the patients how much it is helpful
vascular smooth muscle cells, vascular endothelial
in diagnosis and treatment and also explaining to
cells and monocytes (4).
them that it is just a blood sample collection. Those
Among its multiple actions, IL-8 also
subjects were divided into 2 groups: (patients
promotes macrophages infiltration in adipose tissue
group) and (control group).
(AT) inducing local and systemic inflammation and
Patients group (B) including 30 patients
representing, in turn, a potential Link between AT
suffering from type 2 diabetes mellitus.
dysfunction and insulin resistance-related conditions (5).
4403
Received:17/5/2018
Accepted:26/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (4), Page 4407-4412
A comparative study between anterior lamellar repositioning and anterior lamellar
repositioning with blepharoplasty in management of upper eyelid entropion
trichiasis
Saad M. Rashad, Mahmoud A. Abd Elhamid, Mahmoud A. El Samkary, and Samah H. El-
nenaey
Department of Ophthalmology, Faculty of Medicine, Ain Shams University
Corresponding author: Mahmoud A. El Samkary, E-Mail: elsamkary76@gmail.com, Phone: 01006282215
ABSTRACT
Background: Entropion is the inward turning of the lid margin that brings both lashes and external keratinized
skin into contact with the globe.
Aim of the study: It was to compare the surgical outcome and aesthetic appearance between anterior lamellar
repositioning only and anterior lamellar repositioning with blepharoplasty in management of upper eye lid
entropion trichiasis.
Patients and Methods: This was prospective interventional study includes 20 lids of 13 patients with upper
eyelid cicatricial entropion selected from the ophthalmology outpatient clinic of "Ain Shams University"
Hospitals. Patients were randomly divided in 2 groups: group A: Ten lids had an anterior lamellar reposition
technique (ALR) with grey line split (GLS) technique. Group B: Ten lids had an anterior lamellar reposition
with GLS technique and blepharoplasty. All surgeries were performed by one surgeon (third author) in Ain
Shams University hospital.
Results: Our study showed that after 3 month follow up, success rate of first group was 70 %, patient
satisfaction was 60% and final aesthetic outcome was 30% excellent, 30% fair and 40% poor results. The
second group success rate was 100%, patient satisfaction was 100% and final aesthetic outcome was 100%
excellent results.
Conclusion: Combining the procedure of ALR with GLS technique with blepharoplasty in surgical correction
of upper eye lid cicatricial entropion has excellent both functional and aesthetic outcome and a higher success
rate with minimal complication than anterior lamellar reposition only.
Keywords: Cicatricial, upper lid, trachoma, anterior lamellar reposition, blepharoplasty, Lid malposition
INTRODUCTION
addition the irritated spastic orbicularis muscle
Entropion is inward rotation of the eyelid
combined with redundant skin and dermatochalasis
margin. It is one of the most common lid
further pushes the rubbing lashes downwards
malpositions encountered in clinical practice. There
making the symptoms more serious and putting the
are four types of entropion: congenital, cicatrecial,
eyelid into a viscous cycle (3).
ivolutional and acute spastic. The pathophysiology
Anterior lamellar repositioning (ALR) with
of each of these types is different, and so is the
grey line split technique(GLS) is an effective
treatment (1).
surgical technique but the excess anterior lamella
Cicatricial entropion results from a
and dermatochalasis remains a bulk and may slide
differential horizontal shortening of the posterior
on the bare tarsus back toward the eyelid margin(4).
lamella of the eyelid in relation to the anterior
Therefore, this procedure can be improved
lamella.
Chronic
inflammation
such
as
by combining ALR with GLS surgery and
meibomianitis,
blepharo-conjunctivitis
and
blepharplasty, to create a completely penetrating
trachoma can lead to lid margin keratinization,
anterior lamellar flap so as to fully shift the anterior
trichiasis, or dis-tichiasis (1).
lid margin upwards, preventing downward migration
Upper cicatricial entropion is usually seen
of the anterior lamella, improve the surgical outcome
in middle and old aged patients, who may also
and the aesthetic appearance of the procedure with
present with other lid problems, such as
less bulky eyelid appearance (5). Although removal of
dermatochalasis, herniated orbital fat and skin
skin is typically a part of upper lid blepharoblasty but
laxity (2).
the underlying orbicularis and orbital fat all will play
In Egypt, trachoma is still the most
a role in determining the contour of the upper eyelid
common cause of cicatricial entropion and
esthetic unit (6).
trichiasis in upper eyelid. The rubbing lashes can
AIM OF THE WORK
cause keratitis, corneal abrasion, ulceration, and
The aim is to compare the surgical outcome
even conjunctival metaplasia that can end in
and aesthetic appearance between anterior lamellar
blindness and vision loss if left untreated. In
repositioning only and anterior lamellar repositioning
4407
Received:22/5/2018
Accepted:1/6/2018