The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4582-4585
Knowledge and Attitude Practice (KAP) of Rickets Disease
among Mothers in KSA
1Fahad Saleh Alsuwat, 1Nouf Jafer Alzahrani, 1Mohammed Ateih Awwad Alsofyani, 2Reem
Mohammed Alshamrani, 3Nadia Abaidullah Ahmed, 1Abdulrahman Talal Qasim, 4Samia
Mohammad Babi,1Emad Ruddah M. Alsofyani
1Taif University, 2King Abdulaziz University, 3Imam Abdulrahman Bin Faisal University, 4National Ribat University
Background: Rickets is one of the emerging diseases around the world and its records have been frequently
increased among Saudi children.
Objective: Our aim of the study was to discuss and improve the knowledge and the awareness of mothers in
the Kingdom of Saudi Arabia about rickets disease and its environmental and nutritional risk factors.
Methods: We conducted this cross-sectional retrospective Study at the maternal Children Hospital in Taif,
Saudi Arabia. Data were collected using a pre-specified questionnaire after obtaining the patients consent.
SPSS software was used to analyze the data.
Results: We included 150 mothers with their children. There were 146 (97.3%) of the children with vitamin D
Conclusion: In Saudi Arabia, there is a need for campaigns that spread awareness among mothers and young
adult females about the importance of vitamin D, diets containing adequate levels of it as well the risk factors
that cause its deficiency.
Keywords: Vitamin D, rickets, mothers, awareness, knowledge, children, Saudi Arabia.
inadequacy was the confinement to daylight
Vitamin D insufficiency can come about
because of insufficient presentation to daylight;
Nutritional rickets is as yet predominant in
malabsorption; quickened catabolism from specific
Saudi Arabia with the essential etiology being
medicines; and, in newborn children, the negligible
vitamin D lack. The majority of our patients were
measure of vitamin D found in bosom drain. In
below the age of 14 months and none was more
youngsters, vitamin D lack can bring about rickets,
youthful than a half year of age. Male newborn
which exhibits as bowing of the legs; in grown-ups,
children dwarfed the females 2:1. There is no
it brings about osteomalacia, which introduces as
obvious clarification for this finding however this
an ineffectively mineralized skeletal framework(1).
has been additionally seen in a few reports(5).
Researches in Saudi Arabia have studied
The consciousness of vitamin D and daylight
Osteomalacia and Rickets in different ages and
in youngsters should be enhanced by the arrangement
both sexes5, 6 . Significantly more women than
of prepared doctors and teachers. Making more
men suffered from vitamin D deficiency this was
regions where young ladies can reveal uninhibitedly
explained by the fact that men are more exposed to
amid routine works and open air exercises will help
sunlight than women(2).
expand their vitamin D levels(6).
Living in the Eastern area in Saudi Arabia ,
females, 16-19 years old, low financial class, large
and absence of omega 3 supplements were hazard
factors in understudies. Representatives living in
This study is a retrospective, descriptive
the Eastern locale, females, center wage class,
and comparative study with systemic randomized
carbonated soda pop buyers, and absence of
selection among all mothers in mother-children
multivitamin supplements were at higher hazard(3).
hospital at Taif city.
Around 96.7% and 78.2% of females and
We included Saudi mothers in KSA of all
guys were insufficient in vitamin D, individually.
age groups who have children younger than or at
No adequate vitamin D female subject was
age 6 months and mothers who were willing to
perceived. The predominance of vitamin D
participate in this study; we excluded as well as
insufficiency in kids school from Makkah was high
mothers who did not have children and mothers
and the inadequacy was higher in females than
who declined to participate in this study Data was
guys. The principle explanation behind vitamin D
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4586-4592
Vaginal Misoprostol for Cervical Priming Before Outpatient Hysteroscopy:
A Randomized Controlled Trial
Mohamed Ibrahim Amer, and Malames Faisal, Anis Mansour Nagib Younis
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain shams University, Cairo, Egypt
Corresponding author: Anis M.N Younis, Mobile: 01128181509; Email: firstname.lastname@example.org
Background: Misoprostol has generally shown good efficacy in promoting cervical softness and facilitating
Objective: To evaluate the efficacy and safety of vaginal misoprostol for cervical priming before diagnostic
outpatient hysteroscopy (OH) without anesthesia.
Patients and Methods: Design: Double-blind randomized controlled trial. Setting: University teaching
hospital. Patient(s): Ninety patients requiring diagnostic OH for investigation of infertility or abnormal uterine
bleeding in the reproductive age. Intervention(s): Patients were randomly allocated into two equal groups (n=
45). In group I, 200 mcg misoprostol was inserted into the posterior vaginal fornix 3 hours before OH; in group
II (control), 250 mg metronidazole as placebo was inserted into the posterior vaginal fornix by investigator. A
rigid 30 4-mm hysteroscope was used in the vaginoscopic technique. Main Outcome Measure(s): Ease of
cervical entry (Likert scale), procedural time, patient acceptability (Likert scale), and pain scoring (visual
Result(s): Vaginal misoprostol significantly facilitated the procedure; cervical entry was easier, procedural
time was shorter, patient acceptability was higher, and pain scoring was lower in group I compared with group
II. Side effects of misoprostol were infrequent, minor, and transient. No complications were reported.
Conclusion(s): The regimen of 200 mcg vaginal misoprostol administered 3 hours before diagnostic OH is a
simple, effective, and safe method of cervical priming to facilitate the procedure without anesthesia.
Keywords: Misoprostol, cervical priming, outpatient hysteroscopy
Traditional methods of cervical dilatation
pre-procedure include the use of hegar's dilators or
Hysteroscopy is considered the ``gold
luminaria tents, which could cause significant
standard'' for diagnosing intrauterine pathology. With
patient discomfort, and at the same time potentially
the invention of the miniature hysteroscope, it is
induce bleeding and hamper views obtained at
possible to perform hysteroscopy in an office setting
hysteroscopy. The efficacy of misoprostol as a
(outpatient hysteroscopy [OH]) without anesthesia for
cervical ripening agent in the pregnant uterus is well
diagnostic indications and certain operative procedures
established. However, there are varying reports
(1). However, the experience of pain related to the
regarding efficacy and incidence of side effects
procedure can be a major limitation for OH as a
when misoprostol is used prior to hysteroscopy (5).
standard of care. This is often caused by the diameter
of the hysteroscope and/or cervical resistance (2).
Misoprostol (prostaglandin E1 analog) is a
drug of choice for cervical ripening, labor induction,
Several alternatives have been proposed to
post-partum hemorrhage and pregnancy termination (6).
perform the procedure with an acceptable patient
compliance. Local anesthetic reduces the pain
There is evidence supporting the use of
experienced by women during OH. This occurs with
misoprostol as a cervical priming agent before
paracervical and intracervical injections of anesthetic
some gynecologic procedures, such as intrauterine
but not with transcervical and topical application;
device insertion and hysteroscopy (7).
paracervical injection seems to be the most effective
The most common side effects with use of
method of administering local anesthetic for the
misoprostol in non-pregnant women are mild
procedure. Nevertheless, the injection of paracervical
abdominal cramps, vaginal bleeding, febrile
anesthetic may cause pain and bleeding (3).
episodes, nausea and diarrhea (8).
Although hysteroscopy has been considered
This study aims at evaluation the efficacy
as a safe and less invasive procedure, some
and safety of vaginal misoprostol for cervical
complications such as cervical tear, bleeding, uterine
priming to facilitate the procedure of diagnostic
perforation, pain and discomfort may occur during
OH without the use of anesthesia, in patients with
the process (4). Many women need dilatation prior to
infertility or abnormal uterine bleeding (AUB).
hysteroscopy to make the procedure simpler.
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4593-4595
Primary Parotid Gland Sarcoidosis - Case Report
Kholood S Assiri and Mohammad S. Al-Ahmari
The Department of ORL-HNS, Khamis Mushayt General Hospital, Aseer, Kingdom of Saudi Arabia
Correspondence author: Kholood S Assiri, E-mail: email@example.com
Background: Sarcoidosisis rare disorder worldwide and in Saudi Arabia. Extrapulmonary involvement are
noticed as primary presentation seen in patients with sarcoidosis and can present at the same time as
pulmonary sarcoidosis. Methods: A notolaryngology view of case report following a 44-year-old female
presented with right painless parotid swelling for four months who was managed in Otolaryngology-Head and
Neck Surgery (ORL-HNS) Clinic of Khamis Mushayt General Hospital and referred to rheumatology for
evaluation and management and follow up for one year who completely cured. Conclusion: Primary parotid
sarcoidosis is an uncommon disease. The diagnosis has been obtained from the surgical excision of the lesion.
Keywords: Otolaryngology-Head and Neck Surgery -
dryness. However, this result doesn't give
Sarcoidosis is a systemic disease of
definitive diagnosis and need biopsy.
unknown origin that is characterized by non-
The decision was made to treat the patient
otolaryngology manifestations of sarcoidosis are
performed for right parotid mass. Under general
not commonly remarkable. The documented
anesthesia preauricular incision was made near the
incidence of parotid gland involvement (either
crease of the ear. We were very conscious not to
primary or secondary) is only 6%. Extra pulmonary
distort the anatomy of the ear. A flap was made on
involvement can be present in up to 30% of
the surface of the parotid gland to help expose the
patients with sarcoidosis and can present at the
gland and tissue to be removed. Veins and nerve
same time as pulmonary sarcoidosis(1).
branches were identified. Facial nerve monitoring
had been found to reduce nerve associated
Parotid gland involvement is a well-
morbidities. Dissection of the nerves took place in
recognized extra-thoracic feature of sarcoidosis.
order to avoid any stimulation while operating.
However, the data on epidemiology and clinical
Parotid tissue was removed (Fig 2,) and sent for
characteristics of parotid gland disease in
histopathology examination, which revealed non-
sarcoidosis are limited (2). This article aimed at
caseating epithelioid granuloma suggestive for
reporting an uncommon case of parotid lesion.
sarcoidosis Fig 3.
Patient referred to rheumatology consultant
and he ask for Antinuclear antibodies and
A 44-year-old female presented on February
Rheumatoid factors which showed negative result.
17th, 2017, at the Otolaryngology-Head and Neck
CT lung done revealed unremarkable indication.
Surgery (ORL-HNS), Clinic of Khamis Mushayt
Follow up of the case after one year revealed
General Hospital, complaining of right parotid swelling
complete disappearance of her symptoms.
for Four months. The patient complaint was painless
with no facial weakness or skin changes. Symptoms
were progressive with no aggravating or relieving
factors. No history of cervical lymphadenopathy, fever,
loss of appetite or weight loss.
On examination, the patient was generally
stable, but she had right firm parotid swelling,
about two by two cm, not tender with facial nerve
intact. No lymphadenopathy.
Basic laboratory investigations were
Fig. (1): (A,B) ill defined, heterogenous enhanced mass
normal. CT scan revealed ill defined, heterogenous
from right parotid gland
enhanced mass from right parotid gland, no sizable
cervical lymphadenopathy Fig 1.
Fine needle aspiration (FNA) done showed
lymphoid aspirate with low cellularity and air
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4596-4601
Fetomaternal Outcome in Severe Preeclamptic Women Undergoing
Emergency Cesarean Section with Spinal or General Anesthesia
Tarek Mohamed Ramadan, Adel Aly Elboghdady, Mohamed Anwar Mohamed Oreef
Department of Obstetrics & Gynecology, Faculty of Medicine, Al- Azhar University
Corresponding author: Mohamed A.M. Oreef, Mobile: 01010437268; Email: firstname.lastname@example.org
Background: Preeclampsia (PE) is a hypertensive disease specific to pregnancy and it complicates 510 % of
all pregnancies and it is a major cause of maternal, fetal, and neonatal morbidity and mortality worldwide.
Preeclampsia is defined as new-onset hypertension (systolic blood pressure 140 mm Hg or diastolic blood
pressure 90 mm Hg) and new-onset proteinuria after 20 weeks of gestation in previously normotensive
Objective: The aim of this work is to show the fetomaternal outcome of severe preeclampsia in women
undergoing emergency cesarean section with either spinal or general anesthesia. Which better?
Patients and Methods: This study was conducted at El Sayed Galal and El Hussein University Hospitals. 180
pregnant women with severe preeclampsia admitted to the operating room for emergency cesarean section
were included and divided into 2 groups: Group I: 150 patients underwent cesarean section under spinal
anesthesia. Group II: 30 patients underwent cesarean section under general anesthesia. This study was
prospective observational study. The patients fulfilled our inclusion criteria and signed a well informed consent
to declare their agreement to be in this study as agreed upon by the ethical committee.
Results: The mean values of DBP were significantly higher in group II than in group I (p <0.05). The
incidence of maternal complications was significantly higher in group II more than group I, especially in
vomiting, high blood pressure and convulsion (p <0.05). There was a significant increase in neonatal weight in
group I more than group II (p <0.05). Regarding preterm, there was a significant increase in preterm cases in
group II (60%) more than group I (38%) (p <0.05). Regarding APGAR score at 1 and 5 min, it was found that
there was a significant increase in APGAR score in group I more than group II at both 1 minute and 5 minutes
(p <0.05). The mean values of neonatal heart rate were significantly higher in group II than in group I (p
<0.05). The mean values of neonatal respiratory rate were significantly higher in group I than in group II (p
<0.05). Regarding breast feeding after cesarean section (hrs.), there was a significant increase in the duration
after cesarean section till the breast feeding in group II more than group I (p < 0.05). Regarding neonatal
mortality, there was a significant increase in mortality in group II (16.7%) more than group I (2.7%), (p <0.05).
Conclusion: This means that spinal anesthesia is a safer alternative to general anesthesia in severe
preeclampsia with less postoperative morbidity and mortality regarding both mothers and babies. These
findings agreed with many previous studies worldwide.
Keywords: Acute renal failure - blood pressure - cesarean section
multisystem involvement (thrombocytopenia, liver
Preeclampsia (PE) is a hypertensive disease
dysfunction, renal insufficiency, pulmonary edema,
specific to pregnancy .It complicates 28 % of all
cerebral or visual disturbances) (4).
pregnancies and it is a major cause of maternal, fetal,
In severe preeclampsia systolic blood pressure
and neonatal morbidity and mortality worldwide (1).
greater than or equal to 160 mm Hg or diastolic blood
Preeclampsia is defined as new-onset
pressure greater than or equal to 110mmHg on two
hypertension (systolic blood pressure 140 mm Hg
occasions at least four hours apart while the patient is on
or diastolic blood pressure 90 mm Hg) and new-
bed rest, thrombocytopenia (<100,000 platelets/mL),
onset proteinuria after 20 weeks of gestation in
impaired liver function (liver enzymes levels increased
previously normotensive patients (2).
twice to normal) or persistent right upper
Hypertension should be documented to be
quadrant/epigastric pain unresponsive to medication),
persistent over two determinations at least four hours apart,
progressive renal insufficiency (serum creatinine >1.1
unless it is greater than or equal to 160 mm Hg systolic or
mg/dL , without other renal disease), pulmonary edema,
greater than or equal to 110 mm Hg diastolic (3).
cerebral or visual disturbances (5).
Proteinuria is defined as 300 mg of protein per
Most of preeclampsia cases occur in
24 hours or a urine protein/creatinine ratio of 0.3 mg/dL.
primigravida, there is no specific recognizable etiologic
In the absence of proteinuria, preeclampsia may also be
defined as new-onset hypertension with other signs of
For the mother, the complications can be life
threatening. It includes abruptio placenta, DIC/HELLP
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4602-4609
Prevalence of Access Recirculation in Prevalent Arterio-Venous (A-V) Fistula
Hemodialysis Patients and Its Effect on Hemodialysis Adequacy
Michael Mamdouh Fakhry, Essam Nour El Din, Lina Khedr
Internal Medicine Department, Ain Shams University
Corresponding author: Michael Mamdouh Fakhry; Mobile: 0127007720; Email: email@example.com
Background: Assessment of access recirculation (AR) is crucial to dialysis efficiency and there is thus a need
for a method yielding a highly accurate, fast, easy and economical measurement that can be applied in any
dialysis clinic. Non-urea based dilutional methods are more accurate than urea based methods and avoid
problems with cardiopulmonary recirculation, but they require expensive specialized devices, which limit their
applicability. Patients and Methods: We used simple dilutional method of AR based on the determination of
serum potassium [K+] in two samples. A prospective study was performed in a Dialysis Unit at El Sahel
Teaching hospital, Cairo, on End stage kidney disease patients on regular Hemodialysis through a functioning
Arterio-venous fistula. Results: Access recirculation was found in 42% of studied patients. There were Highly
Significant positive correlation between access recirculation, pre / post dialysis blood urea, basal k, and
parathyroid hormone level. In addition, there were highly significant negative correlation between AR, Urea
reduction ratio and KT/V. Conclusion and Recommendations: Potassium dilution method is one of the most
simple, specific, and economical way to measure access recirculation and can easily be performed in any
dialysis unit. We recommend more research should be done about hemodialysis adequacy, access recirculation
and how to improve it.
Keywords: Access, Recirculation, Hemodialysis, Potassium, Dilutional
the dilution of serum potassium (K), glucose,
End stage renal disease (ESRD) is one of
hematocrit (Hct) and hemoglobin (Hb) have been
the most common life-threatening diseases. The
recently described (5).
number of patients accepted for renal replacement
Assessment of access recirculation (AR) is
therapy including hemodialysis (HD), peritoneal
crucial to dialysis efficiency and there is thus a
dialysis, and kidney transplantation in developed
need for a method yielding a highly accurate, fast,
and developing countries is increasing every year
easy and economical measurement that can be
and imposes a major social and economic burden
applied in any busy dialysis clinic. So the Non urea
on these communities (1).
based methods are good method & avoid problems
Some factors that affect the survival of
with cardiopulmonary recirculation, but they
ESRD patients including inadequate dialysis, method
require expensive specialized devices, which limit
of renal replacement therapy, etiology of renal failure
and the presence of comorbid disease (2).
In Dilutional-based method, the degree of
It is well established that one of causes of
access recirculation is measured by comparing the
inadequate dialysis in HD patients is arterio-venous
basal and arterial k concentration from the
(A-V) fistula access recirculation (AR). In addition,
following formula: Percent recirculation = 100 x [1
screening for recirculation may be used as a
- arterial K+/basal K+].
surveillance technique for the early detection of
Potassium-based dilutional method, similar
fistula stenosis, the correction of which may
to other dilutional methods, is not influenced by
prevent thrombosis (3).
cardiopulmonary recirculation or veno-venous
disequilibrium and is fast and accurate. Moreover it
diagnosed when dialyzed blood returning through the
is very simple, economical, and can easily be
venous side reenters the dialyzer through the arterial
performed in any dialysis unit (6).
needle, rather than returning to the systemic
The potassium-based method showed:
circulation and as a result, the efficiency of HD is
sensitivity (100 %); specificity (95%); predictive
value, positive (91%); predictive value, negative
The Diagnosis of arterio-venous (A-V)
(100%). In addition, the potassium-based method
fistula access recirculation (AR) could be done
appears to be more reliable than the two-needle
through two methods Non Urea based method
urea based method (6).
(Ultrasound dilution Transonic Hemodialysis
Monitor--USM) or Dilution techniques, utilizing
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4610-4619
Effect of Psidium guajava leaf extract, glibenclamide and their combination on
rat model of diabetes induced by streptozotocin
Shadia Ali Radwan1; Yasser A. Khadrawy2; Gamal Abdel-Aty Hafez3 and Omnia Nasr
1Department of Biological and Geological Sciences, Faculty of Education, Ain Shams University.
2Department of Medical Physiology, Medical Division, National Research Center.
3Department of pathology, Faculty of medicine- Suez Canal University.
Aim: The present aim is to evaluate the anti-diabetic effect of aqueous extract of guava (Psidium guajava) leaf
using rat model of diabetes induced by streptozotocin. In addition, the effect of this extract on liver and kidney
functions induced in rat model of diabetes were investigated.
Material and Methods: Rats were divided randomly into: control group, rat model of diabetes induced by
streptozotocin, rat model of diabetes treated with aqueous extract of guava leaf, rat model of diabetes treated
with glibenclamide and rat model of diabetes treated with aqueous extract of guava leaf plus glibenclamide.
Result: In the present rat model of diabetes a significant decrease in the serum insulin level and a significant
increase in glucose level were detected. Streptozotocin induced a significant increase in the activities of AST,
ALT, ALP and a significant increase in the levels of bilirubin, urea, creatinine and uric acid. In addition
histopathological and immunological changes were detected in the pancreatic tissue. The present data revealed
that aqueous extract of guava leaf improved the reduced insulin level and the high glucose level induced by
streptozotocin. This was associated with an improvement in the changes in the liver and kidney functions. Loss
of body weight gain induced by streptozotocin was alleviated by guava leaf extract, glibenclamide or both.
Conclusion: According to the present findings it could be concluded that the aqueous extract of guava leaf has
a potent anti-hyperglycemic effect on rat model of diabetes induced by streptozotocin with hepatic and renal
Key words: Hypoglycemic, Streptozotocin, Psidium guajava, liver functions, kidney functions, Rats
activation of protein kinase C isoforms; and over
Diabetes mellitus (DM) is a disease
activity of the hexosamine pathway. All these five
characterized by high blood sugar (glucose) levels that
mechanisms are activated by a single upstream event
result from defects in insulin secretion, insulin action, or
which is mitochondrial overproduction of reactive
both. The chronic metabolic imbalance associated with
oxygen species (3).
this disease puts patients at high risk for long-term
Oxidative stress plays a key role in the
macro- and micro-vascular complications. These
pathogenesis of micro- and macro-vascular diabetic
vascular changes may lead to development of clinical
complications. The increased oxidative stress in diabetic
complications characteristically affecting the eye, the
patients is a consequence of several abnormalities
kidney and the nervous system (1).
including hyperglycemia and insulin resistance(4).
It has been estimated that world-wide
Diabetes mellitus is a chronic disease that
prevalence of diabetes mellitus in 2008 was more
can be controlled by life styles such as monitoring
than 347 million with varying prevalence among
ones weight, diet, exercise to long term use of oral
different ethnic groups, and it is expected to rise to
hypoglycemia drugs. Treatment can also be achieved
500 million by 2025 (2).
by the use of synthetic drugs such as sulphonylureas.
Complications of diabetes typically take five
Herbs and vegetables have contributed significantly
to ten years to manifest themselves. They are
in improvement of human health in terms of
generally irreversible and are predominantly related
prevention and/or treatment of diseases. Thousands of
to sustained high levels of blood glucose. These
wild plant species grow in Africa and have both
complications lead eventually to death or disability
nutritional and therapeutic purposes (5).
and can be mostly avoided by adequate glycemic
Psidium guajava, is an important food crop
control. Tissue damage associating diabetes occurs
and medicinal plant in tropical and subtropical
through five major mechanisms: increased flux of
countries which is widely used in medicine around of
glucose and other sugars through the polyol pathway;
the world. P. guajava is mainly known for its
increased intracellular formation of advanced
antispasmodic and antimicrobial properties in the
glycation end products (AGEs); increased expression
treatment of diarrhea and dysentery (6). It has also
of the receptor for AGEs and its activating ligands;
been used extensively as a hypoglycemic agent.
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4620-4624
Comparative Study between Cervical Laminectomy and Cervical
Laminectomy with Fixation on Clinical Outcome and Spine Stability in
Patients with Degenerative Cervical Myelopathy
Adel Nabeeh Mohamed Abdalla, Mohamed Wael Sameer, Amr Mohamed Nageeb El-Shehaby,
Mohamed Abdalla El-Werdany, Mohammed Abdelaty Mohamed Abdalla
Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Background: Degenerative Cervical Myelopathy (DCM) is an age-related disease of the cervical spine and
represents one of the most common causes of spinal cord dysfunction. Surgical intervention is the cornerstone
of management in symptomatic cases,but the approach of choice is always debatable.
Purpose: Was to compare between mutltilevel cervical laminectomy,and multilevel cervical laminectomy with
lateral mass fixation in patients with cervical spondylotic myelopathy regarding the functional clinical outcome
and cervical spine normal sagittal alignment.
Patients and Methods: This work is a prospective study of two groups of randomly selected patients. The first
group (n= 20) underwent cervical laminectomy while the second group (n=18) underwent cervical
laminectomy with lateral mass fixation. Patients were followed up for 12 months duration using functional
modified Japanese orthopedic association (mJAO)score, andmeasurement of C2-C7 cobb`s angle to evaluate
post-operative cervical sagittal alignment.
Results: Results revealed that both approaches have better post-operative functional outcome with no
significant changes on the normal cervical lordosis. Results alsoshowed no statistically significant difference in
clinical outcome between the 2 groups after one year follow up.
Conclusion: Both simple multilevel posterior cervical laminectomy and posterior cervical laminectomy with
lateral mass fixation are associated with improvement in the functional outcome in CSM patients with no
changes in normal cervical lordotic sagittal alignment in at least 12 months follow up duration.
Key words: Degenerative cervical myelopathy, Laminectomy, Lateral mass fixation, Modified Japanese
orthopedic score, Cobb`s angle.
with lateral mass fixation in patients with cervical
Cervical spondylotic myelopathy (CSM) is
spondylotic myelopathy regarding the functional
a progressive degenerative disease and is the most
clinical outcome and cervical spine normal sagittal
common cause of cervical spinal cord dysfunction.
CSM can be due to direct compression of the spinal
cord, or surrounding blood vessels, resulting in
PATIENTS AND METHODS
varied clinical symptoms. Spondylosis has been
This prospective study included a total of
shown as the most common etiology for cervical
40 patients with multiple level cervical spondylotic
myelopathy in people aged 55 years or older(1). The
myelopathy attending at Ain Shams University
surgical procedures include anterior and posterior
Hospitals. Approval of the ethical committee and a
approaches, the choice of which depend on the
written informed consent from all the subjects were
cervical alignment and the levels and sources of
obtained. This study was conducted between
compression. In patients exhibiting preserved
January 2014 till January 2017.
cervical lordosis and >3-level canal stenosis
Patients were randomly assigned into two
laminoplasty or laminectomy with or without
groups (20 patients each), the first group underwent
fixation was performed. In the case of significant
cervical laminectomy and the second group
compression on the posterior side, posterior
underwent cervical laminectomy with lateral mass
approach was also selected, even if the patients
exhibited <3-level compression (2).However,
although the effectiveness of cervical laminectomy
Inclusion Criteria: Age: 18 Years and
was documented repeatedly, there were still
over. Genders: Both. Symptomatic cervical
concerns over postoperative kyphotic deformity,
myelopathy At least three level Cervical canal
cervical instability, and late deterioration(3).
The aim of the current work was to
Exclusion Criteria: Patients with pre-
operative cervical kyphosis or cervical sublaxation.
laminectomy, and multilevel cervical laminectomy
Previous cervical intervention due to any cause.
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4625-4629
The Prevalence of Iron Deficiency Anemia and its Associated Risk Factors
among a Sample of Females in Riyadh, Saudi Arabia
Abdullah Mansour Alswailem, Sulaiman Mohammed Alahmad, Muath Ali Alshehri
Corresponding author: Abdullah Mansour Alswailem, Email: Abdullah.firstname.lastname@example.org, mobile no: 0544435539
Objectives: To assess the prevalence of iron deficient anemia (IDA) within Saudi Arabian females and to
examine the risk factors leading to the IDA.
Methods: A cross-sectional study on 683 healthy females aged between 18 and 40 years was performed within
April 2016. Data on the participants' socio-demographics, diet, health, anthropometry, and hematological and
biochemical iron status indices were gathered. Univariate and multivariate logistic regression analysis were
used in order to reveal the IDA risk factors.
Results: A total of 683 non-pregnant women aged between 18-40 years were included in the analysis. The
prevalence of IDA was 41.6%. In the multivariate regression analysis; inadequate iron and vitamin C intakes,
infrequent (2 times per week) consumption of red meat and fish, menstruation disorder eg: (Twice or more
per month), (more than 8 days), (blood clotting and heavy blood flow),blood disorder and previous blood
transfusion, past personal history of IDA and familial history of IDA were significantly associated with
increased odds of IDA.
Conclusion: To reduce IDA in Saudi Arabian women, the country needs a multifaceted approach that
incorporates iron supplementation, food fortification, rich dietary iron sources and by raising awareness of the
food and drinks which facilitate or hinder the bioavailability of iron.
Keywords: Iron deficiency anemia, women, prevalence, food, risk factors.
other nutrients such as vitamins A, C, B2, B12 and
Anemia is recognized as the world's most
folic acid may also cause anemia(13). Other identified
widespread nutritional disorder, affecting 1.6 billion
non-nutritional causes of anemia include malaria,
people that constitute about 25% of the global
hemodialysis patients, hookworm infestation, chronic
population(1). Iron deficiency (ID) is a state in which
infection and inflammation, and hemoglobin opathies
there is insufficient iron to maintain the normal
such as thalassemia (13-17).
physiological function of tissues(2). IDA is the most
Our study aimed at exploring the risk
frequent cause of anemia world-wide and is a very
factors of ID in Saudi Arabian females, to design
common disorder in daily medical practice(3). Iron
an effective intervention program that can target
deficiency anemia is the most common nutritional
the underlying causes and prevent or treat anemia
disorder seen all over the world, more in the developing
in this population group. It is of paramount
countries, particularly, affecting young children of 6-24
importance to identify the potential risk factors for
months of age, adolescents, women of reproductive age
anemia and ID. Therefore, the present study was
group and pregnant/ lactating women (4, 5).
designed to identify the potential risk factors
Anemia is associated with adverse
associated with iron deficiency anemia among
physiological and psychological outcomes in
females in kingdom of Saudi Arabia.
women especially pregnant and nursing mothers
which affect also the babies. For the mother, these
PATIENTS AND METHODS
include cardiovascular problems, reduced physical
activity and cognitive performance, reduced
This cross-sectional observational study
immune function, tiredness, and increased
was performed during April 2018 with a sample of
depressive episodes, while, for the infant, these
683 healthy women aged between 18 and 40years,
include preterm birth, fetal growth restriction,
who were from Riyadh city, Saudi Arabia.
intrauterine fetal death, and neonatal infection(6-9).
The main cause of deficiency is consumption
of cereal-based diets, which provide non-haem iron of
The study sample excluded females who
poor bioavailability(10), prolonged negative imbalance
were currently pregnant or breastfeeding, those who
between a person's dietary intake of iron and their
were taking medication or nutritional supplement. All
body's physiological demand(11, 12) and Deficiency of
the participants provided written informed consent
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4630-4636
Prognostic Impact of Factor V Leiden in Systemic Lupus Erythematosus
1Sahar S. Abd Elmaksoud, 1Doaa A.G. Eissa, 2Hanan M. Abd El Lateef,
1Noha S.A. Abdelhalim
1Department of Clinical Pathology, 2Department of Pediatric Immunology, Ain Shams University
Corresponding author: Noha S.A. Abdelhalim, Mobile: 01091275975, E-mail: email@example.com
Objective: This research aimed to study the presence of factor V gene G1691A mutation (Factor V Leiden) in
SLE pediatric patients with and without complications and to investigate the association between the presence
of Factor V Leiden and lupus complications mainly lupus nephiritis in these patients.
Subjects and Methods: This study was conducted on 50 Egyptian pediatric patients (48 females and 2 males)
who were all diagnosed as SLE according to the American College of Rheumatology criteria. They were
enrolled from the Immunological Clinics at Ain shams University Pediatric Hospital and were divided into two
groups: Group 1 (control group) of matched age and sex: Including 25 newly diagnosed uncomplicated SLE
patients e.g.: arthritis, musculoskeletal and cutaneous lupus. Group 2 (patients group): Including 25 SLE
complicated patient e.g.: nephritis, neurolupus, thrombotic manifestation, cardities and antiphospholipid
antibody syndrome. The complications observed in patient group was further classified into lupus nephritis
alone or lupus nephritis with other complications (21 patients) or patients with complications other than lupus
nephritis (4 patients).
Results: All patients included in this study were subjected after taking their parents' consent to full history
taking laying stress on history of complications mainly lupus nephritis. In addition, laboratory investigations
which include CBC, tests for confirmation of SLE as ANA, anti dsDNA, C3, lupus anticoagulant,
anticardiolipin IgG and IgM and renal function tests as serum creatinine and 24hrs urinary proteinsm were
done. The Factor V gene mutation was determined by the method of PCR-based DNA analysis in both control
and patient groups. In control group, there was 1 out of 25 patients having the Factor V Leiden mutation; who
had a heterozygous pattern. The prevalence of Factor V Leiden in patients group showed 2 out of 25 patients,
both of them had a heterozygous pattern of the gene mutation.
Conclusion: This study couldn't demonstrate any correlation between the presence of Factor V Leiden
mutation and the presence of complications in SLE patients as there was no statistical significant difference (P
Keywords: Systemic Lupus Erythematosus - Factor V Leiden - Activated Protein C resistance
pulmonary manifestations, gastrointestinal manifestations
Systemic Lupus Erythematosus (SLE) is a
and cardiac manifestations. Thrombotic complications are
chronic autoimmune inflammatory disease that has a
frequently observed in SLE especially during active lupus
highly variable course of relapsing and remitting,
with vasculitis (6).
resulting in damage to essentially any organ system.
According to some authors, thrombotic and
Ninety percent of SLE cases occur in females,
cardiovascular are the first complications of SLE after
frequently starting at child bearing age (1). They are
flares of the disease (7). SLE has been widely described
affected about nine times more than men (2).
as independent risk factor itself for developing arterial
The diagnosis of SLE is often complex
and venous thrombosis with a prevalence >10%. This
combining between both clinical and laboratory
prevalence may even exceed 50% in high-risk patients
criteria. It's based on the presence of 4 out of 11 of the
. The incidence of thrombosis increased in the first
American College of Rheumatology (ACR) criteria for
year. Possible reasons for this early higher incidence of
the classification of SLE (3). These criteria include
thrombosis could be the high levels of disease activity
serositis, oral ulcers, arthritis, photosensitivity, blood
and circulating immune complexes, cytotoxic
disorders, renal involvement, antinuclear antibodies,
antibodies, or a higher inflammatory state (9).
immunological phenomena, neurological disorders,
Thrombotic risk also increases in the presence of
malar rash and discoid rash (4,5).
inherited or acquired prothrombotic abnormalities or of
triggering events such as infections (10).
Children diagnosed with SLE may be
complicated with infections, hematological abnormalities,
Factor V Leiden (FVL) is considered as the
renal manifestations, neurological manifestations,
most common cause for venous thrombosis in SLE
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4637-4643
Molecular Detection of Human Herpes Viruses 1, 2, 3 and 6 in the
Cerebrospinal Fluid of Patients with Central Nervous System Infections
Magda Salah El Dine Gabr, Nevine Nabil Kassem, Samia Abdou Girgis, Rania Mohamed Abd-
El Halim, Yasmeen Mohammad Mahmood Ali
Clinical Pathology Department Faculty of medicine Ain Shams University
Background: Infections of central nervous system (CNS), such as encephalitis, meningitis, and
meningoencephalitis are potentially life-threatening syndromes. They are caused by a diverse array of
infectious causes. Despite being relatively uncommon, the morbidity, mortality, and costs are substantial. Of
major importance are the herpes simplex virus (HSV)-2 and varicella zoster virus (VZV) in meningitis, and
HSV-1 in encephalitis. Human herpes virus 6 (HHV-6) infection can induce severe encephalitis cases,
particularly in immunocompromised. Human herpes viruses (HHVs) can cause CNS disease following primary
infection, reactivation or recurrence.
Purpose: To estimate the frequency of four common neurotropic herpes viruses: HHV-1 (HSV-1), HHV-2
(HSV-2), HHV-3 (VZV) and HHV-6 as causative agents for viral encephalitis and aseptic meningitis.
Patients and Methods: The study was conducted on sixty five (65) CSF samples selected from the CSF of
patients clinically diagnosed with acute encephalitis or meningitis. The samples belonged to 39(60.0%) males
and 26(40.0%) females. Their ages ranged from 12 days to 62 years old. All CSF samples included in the study
were subjected to white cell count, estimation of the level of protein and glucose, direct macroscopic and
microscopic examination and culture on blood, chocolate and MacConkey agar plates. All samples had a CSF
leukocytic count 5 cells/ mm3 and all were negative for bacterial culture. Real time PCR for the following
viruses: HHV-1 (HSV-1), HHV-2 (HSV-2), HHV-3 (VZV) and HHV-6 was done for each sample.
Results: The results of the PCR showed that twenty six (40%) were positive: twenty two (34%) were positive
for a single infection; HSV-1 was positive in seven (10.8%), HSV-2 in eight (12.3%), VZV in one (1.5%) and
HHV-6 in six (9.2%) of the cases. Four (6.2%) samples showed co-infection with two viruses. VZV was
common in all cases of co-infection, together with HSV-2 in two (3%), HSV-1 in one (1.5%) and HHV-6 in
one (1.5%). Thirty nine cases (60.0%) were negative for the four viruses.
Conclusion: The four herpes viruses (HSV-1, HSV-2, VZV and HHV-6) tested by PCR are causative agents in
40% of the tested cases of CNS infections. The most frequently detected virus by PCR was HSV-2 followed by
HSV-1. In case of encephalitis, the most frequently detected virus was HSV-1, while HSV-2 was the most
frequent in case of aseptic meningitis. VZV was common in all cases of co-infections.
Keywords: Meningitis, encephalitis, CNS infections, Herpes viruses, PCR.
meningeal involvement, such as fever, headache,
Infections of central nervous system
photophobia, stiff neck, irritability, nausea, vomiting,
(CNS), such as encephalitis, meningitis, and
and rash. Negative bacterial culture of the
meningoencephalitis, remain a major global cause
cerebrospinal fluid (CSF) is suggestive of aseptic
of morbidity and mortality (1). In the United States,
meningitis. Although the etiologic agent is not
each year, there are approximately 7.3
identified for most cases, viral infection has been
hospitalizations per 100,000 population due to
reported as a major cause (2).
encephalitis. However, the syndromes encephalitis
Herpes simplex virus-1 (HSV-1) and
and meningitis are not nationally notifiable
varicella-zoster virus (VZV) are the first and second
infectious conditions and therefore the incidence of
most common causes of viral encephalitis,
these diseases is not well documented (1).
respectively. These viruses are associated with
Acute encephalitis is characterized by a triad
mortality and morbidity, especially when treatment is
of fever, headache, and altered mental status. Diffuse
delayed (3). HSV-1 is responsible for approximately
or focal neurologic signs such as cranial nerve
10% of all cases of encephalitis and is the most
dysfunction, hemiparesis, or seizures are commonly
common cause of fatal sporadic viral encephalitis
encountered. Capillary and endothelial inflammation
worldwide. The mortality rate of HSV encephalitis
of cortical vessels is a striking pathologic finding,
(HSVE) may be more than 70% if untreated, and more
occurring primarily in the gray matter or the gray
than 95% of untreated survivors will suffer lifelong
white junction. Aseptic meningitis refers to a disease
sequelae. Varicella-zoster encephalitis affects 0.1 to
with acute onset of symptoms and obvious signs of
0.2% of persons with primary varicella. Before the use
of varicella vaccine, it was the most common cause of
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4644-4649
Randomized controlled trial comparing pregnancy outcome using artificial
versus letrozole stimulated cycle in cryo preserved embryo transfer
Mohammed K. Mustafa, Hassan A. Abdrabo, Ahmed S. Tahoon
Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University
Corresponding author: Ahmed S Tahoon; Mobile: 01010111841; Email: firstname.lastname@example.org
Background: Intracytoplasmic sperm injection (ICSI) is a procedure performed in the IVF embryo laboratory
after the eggs have been retrieved from the ovaries and involves placing a single sperm directly inside the egg.
It is indicated for cases which involve very low sperm counts or motility. Aim of the Work: To compare the
outcome of pregnancy using artificial and letrozol stimulated cycle in cryo preserved embryo transfer. Patients
and Methods: This randomized controlled trial was conducted on 190 patients attending the clinic submitted
for embryo transfer of cryo embryos. All cycles were performed at international Islamic Center for population
Studies and Research Assisted Reproduction Unit (ART unit IICPSR) at Al-Azhar University and evidence
based centers. Results: Pregnancy rate was significantly higher in letrozole (53.2%) compared to the artificial
group (40.6%). Furthermore, first trimester abortion rate was non-significantly lower in letrozole group.
Conclusion: ovulation induction with letrozole during endometrial preparation for cryopreserved ET has a
significantly higher ongoing pregnancy rate than artificial cycle. The reported ongoing pregnancy rate in
letrozole arm was encouraging and may provide an alternative mean to artificial cycles in endometrial
preparation in FET.
Key words: Pregnancy outcome, letrozole, cryopreserved embryo transfer
Stimulated cycle is where fertility drugs such
Intracytoplasmic Sperm Injection (ICSI) is a
as gonadotropin injection is usually recommended for
procedure performed in the IVF embryo laboratory after
women who do not ovulate regularly and did not
the eggs have been retrieved from the ovaries and
respond to hormone replacement treatment in a
involves placing a single sperm directly inside the egg. It
previous cycle. There are insufficient evidences to
was indicated in cases with very low sperm counts or
recommend any one particular protocol for
motility (1).It may also be considered for cases of
endometrial preparation over another with regard to
previous failed fertilization cycles by conventional IVF,
pregnancy rates after embryo(8).
or in eggs of women of late maternal age (2).
This study designed to determine whether there
Frozenthawed embryo transfer (FET) enables
is a difference in pregnancy outcome between artificial
the excess embryos generated by IVF andICSI to be
cycle FET and using letrozole.
stored and utilized later. This can increase the
In artificial cycle FET (AC-FET), estrogen and
cumulative pregnancy rate of IVF/ICSI treatment(3).In
progesterone were administered in a sequential regimen
contrast to the complex stimulation protocols employed
which aimed to mimic the endocrine exposure of the
to stimulate multiple follicular growth for IVF, FET are
endometrium in the normal cycle. Initially, estradiol was
protocols simpler, with the primary aim limited to
given in order to cause proliferation of the endometrium,
adequate preparation of the endometrium to receive the
during the development of the dominant follicle (9).
thawed transferred embryo(4).
The timing of embryo thawing and transfer
Furthermore, FET results in similar live
was planned according to the moment of progesterone
birth rates to fresh cycles when frozen top quality
embryos are transferred (5).
Letrozole, a selective aromatase inhibitor,
Hormone replacement cycle with or
prevents the conversion of androgens to estrogen in the
without GnRh agonists is usually recommended for
granulosa cells, thus, releasing the hypothalamo-
older women, woman without ovaries or non-
pituitary axis from the negative feedback of estrogen,
functioning ovaries, women with irregular
resulting in an increase of FSH secretion from the
infrequent menstrual cycles or ovulation(6).
anterior pituitary. In addition, the accumulated
Different IVF clinics have different
androgens in the ovary further increase follicular
protocols for giving these medications and in some
sensitivity to FSH (11).
women GnRh agonists may be given in addition to
Letrozole has a relatively short half-life (±2
hormonereplacement to suppress any hormone
days) compared with CC (±2 weeks), so estrogen
production by the ovaries which may interfere with
target tissues (e.g., endometrium and cervix) spared
anti-estrogenic adverse effects. Because of these
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4650-4653
Role of Automated Breast Ultrasound System (ABUS) as Screening Tool in
Comparison To Mammogram in Detect of Different Breast Lesions
Hanan M. Arafa, Ahmed M. Bassiouny, Marwan A. Mohammed
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
Corresponding author: Marwan A. Mohammed, E-mail: Marwan_figo@hotmail.com, Mobile: +201008463441
Background: Mammography is an effective randomized controlled trial-proven method for reducing mortality
due to breast cancer. However, the sensitivity of mammography depends on breast density. The current
supplemental screening options include breast ultrasonography (US) and magnetic resonance imaging (MRI).
Automated breast ultrasound system (ABUS) is an option proposed to overcome the time-consuming and
costly nature of handheld, physician-performed whole-breast US (WBUS).
Objectives: To evaluate the utility of automated breast ultrasound system (ABUS) in detection of different
breast lesions especially in dense breast in comparison to mammogram.
Patients and Method: It is prospective study included 25 women outreached for digital mammography or
handheld ultrasound examination at the general Egyptian hospitals. Women have no specific age group.
Results: The use of ABUS with the mammogram shows significant increased frequency of detection of
positive benign lesions in ACR class C and D in comparison to class A and B and insignificance malignant
Conclusion: ABUS reflects a promising modality in breast imaging however appears to be on a par with
mammogram in terms of diagnostic quality.
Keywords: Thin Film Transistors - Terminal Ductal Lobular Unit - Triple Negative Ultrasound.
anxiety. For this reason recently, research and
Mammography is an effective randomized
development in ultrasound are demonstrating that it is a
controlled trial-proven method for reducing mortality due
technology that can lend itself to breast diagnostic
to breast cancer. A recent study showed 43% reduction
imaging. Automated Breast Ultrasound an alternative to
among women participating in a national screening
traditional hand-held ultrasounds for supplemental use.
program. However, the sensitivity of mammography
Like traditional ultrasound, ABUS uses high-frequency
depends on breast density. Studies on women with dense
sound waves targeted at the breast, but the scans provide
breasts have demonstrated a sensitivity of less than
physicians with a 3-D volumetric image of the entire
50%. More recently, more than 50% of women younger
breast. These 3-D images are more beneficial to women
than 50 years and at least one-third aged over 50 years
within the dense breast population because they allow
have been found to have dense breast tissue. The current
radiologists the ability to check the breast from a variety
supplemental screening options include breast
of angles and offer a better interpretation. ABUS exams
ultrasonography (US) and magnetic resonance imaging
are also much shorter than traditional ultrasound, with
(MRI). US-based screening technologies may offer lower
some systems taking as little as seven minutes to
cost and wider availability than MRI. However, bilateral
perform a bilateral exam -- less than half the time of
whole-breast screening using handheld US (HHUS) is
some traditional ultrasounds. Because the transducer
used in ABUS automatically scans the breast, the
reproducibility, and time required by the radiologist to
operator dependency is greatly reduced (3)
perform the exams. ABUS screening is an option
proposed to overcome the time-consuming and costly
AIM OF THE WORK
nature of handheld, physician-performed whole-breast
The aim of this study to evaluate the
US (WBUS) (1)
ABUS machine as non X-ray hazardous tool in
Both ABUS and handheld ultrasound exhibited
early detection of different breast lesion.
high sensitivity (both 100%) and high specificity
(95.0%, and 85.0%, respectively). In addition, ABUS
PATIENTS AND METHODS
had a higher diagnostic accuracy (97.1%) than handheld
Type of study: This study is a prospective
ultrasound (91.4%) for breast neoplasms (2)
Dense breast tissue obscures tumors on
Ethical and approval statements: Ethics
mammograms, making it difficult for radiologists to
committee of faculty of medicine, Ain shams
read and interpret the exams. This inaccuracy has
university has approved the study protocol.
resulted in an increased number of false positives and
biopsies, and has increased healthcare costs and patient
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4654-4659
Orthopedic Injuries in Poly- Traumatized Patients in
Age Group of 15-45 Years
Muddather AA. Mohammed, Omar MS. Younus, Ahmad Saladdin Sultan
Emergency Medicine, Scientific Council of Emergency Medicine
Corresponding author: Ahmad Saladdin Sultan; Email: email@example.com
Background: Orthopedic injuries in polytraumatised patient are common and affect the management in such
patients. Aim of the Work: The purpose of this study was to assess the pattern and nature of orthopedic
injuries in polytraumatised patient who sustain different mechanism of injury and to analyze the management
of these injuries in the E.D. It is a descriptive study carried out at E.D. of Al-Jamhory teaching hospital.
Patients and Methods: The study included all polytraumatised patient aged 15-45 years admitted to the E.D.
OF Al-Jamhory teaching hospital after being injured in different mechanism of injury (MCV, FFH, Bullet
injury, ... etc). Management carried out according to ATLS and to specific patient needs, 64 patient included
in this study by using a special form for the study, patients ages were ranging from 15-45 years with
subdivided to subgroups (15-25), (26-35), (36-45) and studied separately from the mechanism of injury and
injured part of the body point of view. Results: Total number of causalities was 64 their mean age was 20
years, out of them 59 were male and 5 females, the most mechanism of injury were MVC 32(50%),
transportation time was with average of 30 minutes, upper limbs affected equally to lower limbs, closed
orthopedic injuries were common than open injuries, head injuries were noted to be the bulk associated injuries
with the most serious and fatal outcome. Conclusions: Orthopedic injuries have a major impact on the
management of polytraumatized patients. Males were the active sex group in our society and had much more
affected in polytrauma than females with the main mechanism of injury of MVC.
Key words: Motor vehicle collision, polytrauma patient, orthopedic injury
have all contributed to better treatment of the
Damage control orthopedic: Damage control
patient in physiological crisis after trauma, who is
in general trauma surgery includes packing the major
at risk for the multiple-organ dysfunction syndrome
sources of haemorrhage rather than performing
and is battling for survival(1).
immediate, lengthy, definitive procedures of the
The implementation of advanced trauma life
visceral organs. As part of the damage control
support training was probably the greatest stimuli
philosophy, immediate life-saving interventions,
affecting the philosophy in the treatment of patients
directed at stopping bleeding are applied, after which
resuscitation and further stabilization are performed
development in molecular medicine and genetics
in the ICU. Only after the overall physiology has
have influenced our perception of management
improved definitive interventions are performed. This
leading to the concept of "damage control
change in trauma practice resulted in improved
procedures" (1). While the basic concept of 'save life-
survival rates. Initial surgery was done with the goal
limit disability' has not changed, the type and timing
of achieving rapid skeletal stabilization of major
of interventions have been gradually modified (1).
orthopaedic injuries to stop the cycle of ongoing
The vast majority of patients sustaining
musculoskeletal injury and to control haemorrhage.
polytrauma have some form of musclo-skeletal
This approach was termed "Damage Control
injury, these injuries often cause significant pain &
may distract from other more life-threatening
The Advanced Trauma Life Support
injuries, even though extremity injuries can threat
(ATLS) course teaches a systematic, concise
in the long term function or even survival of a limb
approach to the early care of the trauma patient.
they rarely constitute an acute life threat(2).
This course is vital to guiding care for the injured
Wound management is of great important
patient in emergency department trauma rooms.
in proper healing of penetrating and crush injuries,
ATLS course training provides a common language
careful treatment is, however, just one important
that can save lives in critical situations (2).
factor in decreasing the rate of wound infection,
The management of the multiply-injured
bacterial inoculums, tissue devitalization, blood
patient has been revolutionized during the past
supply, time to presentation and treatment,
presence of foreign bodies and host immune status,
resuscitation, implants and intensive-care medicine
all play a role in final outcome.3
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4660-4665
Association between Potentially Inappropriate Prescription (PIP) and Health
Outcome Among Geriatric Home Residents
Moatassem S. Amer, Rania M. Elakkad, Alaa I. Saeed
Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University
Corresponding author: Alaa I. Saeed, E-mail: firstname.lastname@example.org, Mobile: 01005115675.
Background: Appropriate prescribing of medications in elderly especially with advancing age is a major
clinical and economic issue. Therefore, health care and appropriate use of medications with advancing age is
one of the major challenges facing health care systems. Potentially inappropriate prescriptions (PIP) are
defined by the presence of a risk of prescribed drugs that overweighs their benefit. Especially, when there are
safer alternatives and include misuse of medications, prescription of drugs with significant drugdrug or drug
disease interactions and the negligence of beneficial medications.
Aim of the Study: To assess the association between potentially inappropriate prescription and health outcome
among a sample of Egyptian elderly patients in geriatric homes in Cairo.
Methods: A cross-sectional study. A random sample of 120 geriatric home residents in Cairo. Demographic
data were collected and comprehensive geriatric assessment was done for each participant including history
taking, clinical examination, psychological, mental, functional, risk of falls and nutritional assessment.
Assessment of potentially inappropriate prescription using STOPP criteria.
Results: The present study showed that among the 120 participants; the prevalence of PIP using STOPP
criteria was 27(22.5%) of them were taking one or more PIP, 24 (20%) were taking one PIP and 3 (2.5%) were
taking 2 PIP, 12 (44.4%) of the studied participants having visual impairment were using PIP regarding
STOPP criteria; 7 (25.9%) of the studied participants having hearing impairment were using PIP as detected by
STOPP criteria, so there was significant relation between PIP and patients who had visual and hearing
impairments, there was a significant relation between PIP among the studied group using STOPP criteria
regarding functional assessment (Instrumental activity of daily living (IADL) with p-value equal (0.031), and
there was no significant relation with cognitive, psychological, risk of falls and nutritional assessment and
there was no significant relation with other health outcome.
Conclusion: Potentially inappropriate prescription using STOPP criteria was found to be statistically
significant with hearing, visual impairment and regarding functional assessment (IADL) only. No significant
association with other health outcome.
Keywords: Potentially Inappropriate Prescription (PIP), Health outcome, Elderly, Geriatric homes.
become one of the major issues for family physicians
Elderly persons are more susceptible to the
who manage most of the chronic diseases. Nursing
adverse medication outcomes because of the age
home residents are particularly vulnerable to
related changes in drug pharmacokinetics and
potentially inappropriate prescribing (PIP) as they are
pharmacodynamics and their complex drug
more fragile, receive therapy from multiple health
regimens. The risk of polypharmacy and complex
care workers and are often prescribed a high number
medication regimens rise especially with the
of medications. It makes prescribing in this setting a
increased prevalence of chronic multimorbidity and
challenging task and very complex issue (2).
symptoms in elderly (1).
For geriatric population, there is strong
Potentially inappropriate prescriptions (PIP)
evidence of a sizable and consistent negative effect of
are defined by the presence of a risk of prescribed
inappropriate drug use on patients' health status. And an
drugs that overweighs their benefit, especially, when
associated increase in use of outpatient services and
there are safer alternatives. PIP includes misuse of
more rapid hospitalization. Prescribing for older people
medications, prescription of drugs with significant
is especially daunting because they require complex
drugdrug or drugdisease interactions and the
regimens for multiple chronic conditions. Moreover, to
negligence of beneficial medications. Potentially
minimize adverse drug reactions, practitioners must
inappropriate prescribing is a major health care
consider age-related changes in drug pharmacokinetics
concern and is associated with polypharmacy,
and pharmacodynamics when selecting from the
adverse drug events, morbidity, mortality, functional
thousands of chemical entities available. Prevalence of
decline and substantial economic costs. Inappropriate
PIP is higher in nursing home settings. A study
medication prescribing for elderly patients has
conducted in South Africa, reported that the prevalence
of PIP using Beers criteria was significantly higher
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4666-4672
The Effect Of Eicosapentanoic Acid Administration On Clinical Outcome Of
Patients With Major Depression: A Pilot Study
El Baz A.H.1, El Wakeel L.M. 2, El-Shafie T. M, PhD3, Zaki M.A1
1Department of Clinical Pharmacy, Faculty of pharmacy,Ahram Canadian University,
2Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University,
3Department of Psychiatry, Faculty of Medicine, Al Azhar University
Corresponding author:Alaa Hassan El Sayed El Baz, Email: email@example.com,Phone: +201020553399
Background: Major depressive disorder (MDD) is a common brain disorder that affects approximately 10% of
the world population and leads to significant disability. The current study was aimed to evaluate the impact of
Omega3 PUFAs administration on the clinical outcome of patients with depression.
Patients and Methods: This prospective, randomized controlled study included a total of Forty-two patients
who diagnosed with depression according to a strict inclusion and exclusion criteria, attending at the outpatient
clinics of the Department of Psychiatry, Al-Zahraa University Hospital, Cairo, Egypt. Approval of the Ethical
Research Committee of Faculty of Pharmacy, Ain Shams University (registration number 61), and a written
informed consent from all the subjects were obtained. This study was conducted between February 2015 till
August 2016. patients were randomly assigned to either; Group1; (intervention n=21); received the prescribed
antidepressant + omega3 (2100mg) for 8 weeks, or Group 2; (control, n=21); received the prescribed
antidepressant only for 8 weeks. Baseline evaluation and 8-week assessment included; patient demographic-
data collection, history taking and clinical assessment of DSM-5 criteria & HAM-D score. Laboratory
assessment included; complete blood picture (CBC), prothrombin time (PT), activated partial thromboplastin
time (aPTT). Patients were followed up regularly every 2 weeks for 8 weeks for the occurrence of side effects
due to antidepressants/ Omega 3 and compliance with medications.
Results: The 2 groups were comparable at baseline. The test group showed a significant improvement in the
HAMD score from baseline values and versus the control. There was no significant difference in the reported
side effects between the 2 groups.
Conclusion: Omega -3 PUFAs administration at a dose of 2100 (EPA1350 mg/ , DHA 600 mg/ 150 mg other
omega 3 FA) for 8 weeks, improved depression symptoms and was well tolerated.
Keywords: Omega-3 PUFAs, depression, HAMD, EPA/DHA.
do not effectively treat all depressed patients. In
Major depressive disorder (MDD) is a
addition, many drugs have side effects that can affect
common brain disorder that affects approximately
compliance and morbidity. So patients are increasingly
10% of the world population. According to the
using complementary and alternative medicine (CAM)
Diagnostic and Statistical Manual of Mental
therapies to treat depression (4). One such possibility is
Disorder, Fifth Edition (DSM-5, 2013), MDD is
the use of n-3 omega polyunsaturated fatty acids
characterized by the loss of interest in pleasure, low
(PUFAs) for the treatment of depression. A link
self-esteem, disturbed sleep or appetite, fatigue, and
between omega-3 fatty acids and mood disorders has
diminished ability to think or concentrate. These
been suggested by some studies showing a lower
problems often become chronic and recurrent, and at
incidence of depression among populations with a diet
the worst, can lead to suicide (1).
rich in omega-3 fatty acids (5).
Major depression is a commonly occurring,
Omega-3 PUFA have been proposed, for
serious, recurrent disorder linked to diminished role
treatment of Major depressive disorder. The
functioning and quality of life, medical morbidity,
positive effects of omega-3 PUFA on depression
and mortality. The World Health Organization
may depend on their physiological abundant
(WHO) has ranked depression as the fourth leading
content in the human nervous system and their
cause of disability worldwide and projects that, by
involvement in neurogenesis and neuroplasticity (6)
2020, it will be the second leading cause (2) .
.Moreover, their anti-inflammatory capacity may
counteract inflammatory processes occurring in
The lifetime prevalence of depression in
depression (7). Also lower concentrations of omega
urban and rural Egyptian populations found to be
3 PUFA in plasma or red blood cells may
11.4 and 19.7% (3).
contribute to depression. Administration of omega
New-generation antidepressants appear more
3 PUFAs significantly improved depressive
effective than older drugs in treatment of major
symptoms in patients with major depression (8).
depression, with response rates of up to 50%, but they
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4673-4680
A Study of Endometrial Perfusion in Unexplained Infertility
Ahmad Mohammed Nour-Eldin Hashad, Ibrahim Mohamed Ibrahim1, Mohamed Kamal
Etman2, Heba Abdel Naby Kamal Elkholy3
1Obstetrics & Gynecology Department, Ain Shams University,2Ultrasound Special Care Unit for the Fetus,
Corresponding author: Heba Abdel Naby Kamal Elkholy, email: firstname.lastname@example.org, Tele: 01006539415
Background: Infertility in itself represents a wide spectrum of disorders explaining the inability to conceive.
Series of investigations are required to depict the potential cause of infertility, yet there exist a small
percentage (10 -25%) of couples in which no obvious cause is delineated. these groups of patients are
classified as `unexplained infertility. The endometrium has dynamic features: cyclical growth, desquamation
and regeneration. Its main function is to provide the possibility of the time-limited support of implantation of
the embryo for further development. Most part of the menstrual cycle, the endometrium is resistant to the
embryo but acquires special receptive properties in a limited space and time interval of the luteal phase, known
as the ``implantation window''.
Aim: The aim of this study was to evaluate the uterine perfusion, particularly the endometrial blood flow in
women with unexplained infertility.
Methodology: The patients recruited from women presenting to the outpatient clinic at Ain Shams University
Maternity Hospital seeking fertility compared to other fertile group coming to hospital with non specific
gynecological problems or for routine checkup at the same period. The study conducted on two groups of
women: Group1(study group) 40 women with unexplained infertility, Group 2 (control group) 20 fertile
women who had normal physical and pelvic examination, regular menstrual cycles, didn't have intrauterine
device or oral contraceptive, and gave a birth year ago.
Results: As regard the mean, the resistance index in the study group was 0.69 ranged from 0.39 to 0.96, while
the resistance index in the control group was 0.61 ranged from 0.58 to 0. 73 and the difference between both
groups was statistically significant pulsatility index in the study group was 1.3 ranged from 0.51 to 1.99 while
the pulsatility index in the control group was 1.16 ranged from 0.88 to 1.7 and this difference between both
groups was statistically significant. From the results of our study we could say that uterine perfusion,
particularly the endometrial blood flow in women with unexplained infertility different from that in fertile
Recommendation: We recommend further study on large numbers of women and the possible role of
perfusion enhancer's drugs in improving utero-ovarian circulation as a treatment of unexplained infertility.
Keywords: Endometrial perfusion, unexplained infertility
Ultrasonography has an increasingly
Infertility in itself represents a wide spectrum
important role in the evaluation and treatment of
of disorders explaining the inability to conceive.
infertility patients, being an efficient and cost-
Series of investigations are required to depict the
effective modality for studying the female
potential cause of infertility, yet there exist a small
reproductive organs and for monitoring functional
percentage (10 -25%) of couples in which no obvious
changes during spontaneous and induced cycles(3).
cause is delineated. these groups of patients are
During spontaneous menstrual cycles
classified as `unexplained infertility (1).
endometrial volume increased significantly during
A number of studies showed that poor
the follicular phase, reaching a plateau around the
uterine and ovarian blood flow can be an important
time of ovulation and remaining relatively stable
- often undiagnosed factor - in infertility,
throughout the luteal phase.(1)
miscarriage and IVF failure; research shows that
Uterine arterial resistance changes might
poor blood flow may be at the root of 'unexplained
reflect receptivity of endometrium, so color
infertility' too. However, most women with a
Doppler signals are measured at the uterine arteries
diagnosis of 'unexplained' would never be offered
and their ascending branches located in the outer
the diagnostic test for uterine blood flow
third of the myometrium (4).
impairment and would never be offered treatment,
Uterine spiral artery perfusion has been
instead they would retain their frustrating non-
found to improve during the luteal phase, which
specific diagnosis of `unexplained'(2).
coincides with the implantation window (5).
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4681-4685
Measurement of knee cartilage thickness in young adults by musculoskeletal
ultrasound in relation to serum vitamin D level
Ashraf I. Khalifa1, Mohamed M. Abdelkreem1, Mohamed A. Hashesh2, Khaled O. Zaiton3
1Department of Physical medicine & Rheumatology and Rehabilitation,
2Department of clinical pathology, Faculty of Medicine, Al-Azhar University, Cairo,
3Department of Physical medicine & Rheumatology and Rehabilitation, AL-Ahrar educational hospital, Zagazig, Egypt
Corresponding author: Khaled O. Zaiton; Mobile: 01000089394; Email: email@example.com
Background: Osteoarthritis (OA) is a degenerative joint disease involving the cartilage and many of it's
surrounding tissues. In addition to damage and loss of articular cartilage, there is remodeling of subarticular
bone, osteophyte formation, ligamentous laxity, weakening of periarticular muscles and in some cases,
synovial inflammation.Musculoskeletal Ultrasound (MSUS) is a newer imaging technique in musculoskeletal
system for diagnosis and monitoring of treatment. A potential association between serum vitamin D levels and
knee OA symptoms may occur through effect on cartilage metabolism, bone metabolism or both.
Aim of the Work: This study was done tomeasure of knee cartilage thickness in young adults by
musculoskeletal ultrasound in relation to serum 25(OH) vitamin D level.
Patients and Methods: This study was carried on 75 individuals chosen from out-patient's clinics of physical
medicine and rheumatology department at AL-Hussein hospitals of AL-Azhar University after their agreement
to inform a consent for this research. They are divided into 2 groups: Group (1) includes 50 patients suffering
of knee pain, their age ranged from 20-35 years with a mean of 29.5± 4.4, 43 females and 7 males. Group (2)
includes 25 apparent healthy volunteers matched for age and sex as group 1.
Results: Musculoskeletal Ultrasonography is a very important tool in detection of early OA in patients with
vitamin D deficiency and Comparison between MRI and musculoskeletal ultrasound showed high concordance
in the findings of cartilage changes of early OA patients.
Conclusion: Vitamin D deficiency and insufficiency is correlated with thinning of femoral cartilage thickness
and higher risk of early knee OA.
Keywords: knee cartilage thickness, musculoskeletal ultrasound, vitamin D, Magnetic Resonance Imaging.
dynamic evaluations are big advantages of this
The concepts regarding OA have
dramatically changed in the past decade by
A potential association between serum
development of the new imaging techniques as
vitamin D levels and knee OA symptoms may
musculoskeletal ultrasound and MRI these
occur through effect on cartilage metabolism, bone
techniques allow detection of early detection of
metabolism or both(5).
pre-radiographic structural damages and not only
MRI became popular technique that is
the periarticular bone but also in synovial
more sensitive than to the OA changes including
membrane, ligaments, cartilage and menisci (1).
abnormalities in cartilage, subchondral bone,
Knee OA is one of the clinical forms of
menisci, ligaments and synovium(6).
OA with clinical manifestations and functional
disorders which can be visualized by X-ray,
AIM OF THE WORK
Computed Tomography (CT), or Magnetic
This study was done to measure of knee
Resonance Imaging (MRI) (2).
These imaging techniques help to evaluate
musculoskeletal ultrasound in relation to serum
and classify degenerative changes of OA, X-ray is
25(OH) vitamin D level.
widely used for knee OA classification but does not
evaluate soft tissue of the knee(3).
PATIENTS AND METHODS
Musculoskeletal Ultrasound (MSUS) is a
This study was carried on 75 individuals
newer imaging technique in musculoskeletal
chosen from out-patient's clinics of physical medicine
system for diagnosis and monitoring of treatment.
and rheumatology department at AL-Hussein
High-frequency and high-resolution US of joints
hospitals of AL-Azhar University after their
does not assess only morphologic changes but also
agreement to inform a consent for this research. They
functional changes in the knee joint. Static and
are divided into 2 groups: Group (1) includes 50
patients suffering of knee pain, their age ranged from
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4686-4692
Clinical Significance of Lymphoid Enhancer-Binding Factor 1 (LEF-1)
Expression in Acute Myeloid Leukemia
Nahela Ahmed Shalaby, Doaa Ahmed Gamal Eissa, Botheina Ahmed Thabet Farweez, Shaimaa
Abdelmalik Pessar, Raghda El Sayed Abdel Monem Galal
Department of Clinical Pathology Faculty of Medicine, Ain Shams University, Cairo, Egypt
Background: Lymphoid enhancer-binding factor-1 (LEF1) is a member of the LEF/T-cell factor family of
transcription factors and a key mediator of the Wingless-type (Wnt) pathway. It mediates Wnt signals through
recruiting -catenin and its co-activators to Wnt response elements of target genes. It plays crucial roles in
normal hematopoiesis, not only in the development of B and T lymphocytes but also in granulopoiesis.
Objectives: The aim of this study was to evaluate of LEF1 expression levels in patients with AML and
correlate this expression with clinical data.
Methodology: The present study was conducted on 30 de novo adult AML patients and 10 age and sex-matched
controls with non-malignant hematological disorders (e.g.: hypersplenism, megaloblastic anemia, immune
thrombocytopenic purpura) who attended Hematology/Oncology unit of Ain-Shams University Hospitals during the
period from May 2017 till January 2018, after taking the approval of the Scientific and Ethical Committee of Ain-
Shams University. LEF1 expression levels were measured by quantitative real-time PCR.
Results: The present study showed that there was highly statistically significant association between patients
and control group in LEF1 expression level. There was positive significant correlation between LEF1
expression level and Hb level and PLT count. While negative significant correlation was found with age, TLC
count and peripheral blood blast %. No correlation was found with bone marrow blasts %. There was
statistically significant difference between LEF1 expression level and both hepatosplenomegaly. No
statistically significant difference was found between LEF1 expression level and Sex or lymphadenopathy.
Conclusion: Our study has shown that Lymphoid Enhancer-Binding Factor 1 (LEF-1) is over expressed in
AML patients. LEF1 expression might be involved in the process of disease progression, and possibly can
serve as a molecular parameter for risk assessment and/or monitoring of treatment in AML patients. Thus,
molecular assessment of LEF1 expression at diagnosis may be of value to add to the prognostic work of AML
Keywords: LEF1, Wnt, AML
signals through recruiting -catenin and its co-
Acute myeloblastic leukemia (AML) is a
activators to Wnt response elements of target genes. It
clonal hematopoietic disorder characterized by
plays crucial roles in normal hematopoiesis, not only
uncontrolled self-renewal of hematopoietic stem
in the development of B and T lymphocytes but also
cells, maturation arrest at myeloblast level, peripheral
in granulopoiesis (4).
blood and bone marrow infiltration of blast cells(1).
The AML is classified according to the
granulopoiesis through direct activation of its target
World Health Organization (WHO) classification
genes CCND1, MYC and BIRC5, encoding cyclin
of tumors of hematopoietic and lymphoid tissues,
D1, c-myc and survivin, respectively. Reduced LEF1
which was last updated in 2008. The major
expression plays a critical role in the defective
categories of the current classification include
maturation program of myeloid progenitors in
AML with recurrent genetic abnormalities, AML
individuals with severe congenital neutropenia (5).
with myelodysplasia-related changes, therapy-
The Wnt pathway has been implicated in
related AML, and AML not otherwise specified (2).
leukemic transformation and was shown to promote
Researches are directed to describe the
proliferation and survival of leukemic cells in vitro (6).
advances in the disease classification, understanding
The LEF-1 was found to be highly expressed in
of the genomic landscape, identification of prognostic
different hematologic malignancies, including
factors, current treatment, and new therapies under
lymphomas, chronic lymphocytic leukemia, acute
investigation in types of adult AML(3).
lymphocytic leukemia and AML (7).
Lymphoid enhancer-binding factor-1 (LEF1)
Increased expression of LEF1 affects
is a member of the LEF/T-cell factor family of
normal expression of cell cycle and growth-
transcription factors and a key mediator of the
promoting genes, such as cyclin D1 and c-myc and
Wingless-type (Wnt) pathway. It mediates Wnt
disturbs differentiation in hematopoiesis. Aberrant
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4693-4696
Assessment of Awareness of Medical Students Toward Paralytic Ileus After
Abrar Saad Alshareef, Anwar Mohammed Omer Basri, Bashaer Ibrahim Ahmed, Areen
Ibn Sina National College-Jeddah-kingdom of Saudi Arabia
Background: Protocols for bowel management have been used adequately among postoperative patients to
maintain the normal GIT function and prevention of ileus among critically ill patients.
Objectives: Evaluating the knowledge, attitude and practice (KAP) of medical students about paralytic ileus
after colon surgery at Kingdom of Saudi Arabia (KSA).
Methods: It is a randomized cross sectional study that was conducted during the period from March 2018 to
June 2018, at Saudi Arabia among 320 medical students at the 5 thacademicyear.The study was based on a
questionnaire sheet with an interview that included questions about knowledge, attitude and practice pattern of
the students about paralytic ileus after surgery.
Results: The study included 320 medical students from different universities at the stage of fifth academic
year. All of the included subjects had good knowledge about the definition of ileus, its symptoms and the
initial treatment with intravenous fluids. Most of them have adequate knowledge about effect of epidural
anesthesia on the duration of ileus (82.5%), the complications of ileus (67.5%), the paralysis of the bowel
(86.3%) and the diagnostic importance of CT (87.8%). The attitude of most of the participants was good
toward the importance of good nursing and efficient doctors to overcome the risks of postoperative ileus, the
efficiency of bowel protocols and increasing the knowledge of the staff is adequate for prevention of ileus. The
practice pattern was found to be adequate among the majority of participants as 81 % would take care while
using analgesics and sedatives and 90% would encourage movement of patient when possible. All of the
subjects had adequate practice toward managing dietary nutrition, constipation and diarrhea.
Conclusion: The level of knowledge was adequate among most of the students which resulted in proper
attitude and practicing pattern that encourage educating the health staff about ileus and how to be efficient in
managing the bowel protocols.
Keywords: Awareness, paralytic ileus, colon surgery, medical students, KSA, 2018.
This study hypothesized that good knowledge
Ileus is defined as a paralysis or closure of
among medical students would result in good
the bowel that delay and prevent the intestinal
attitude and practice which in turn would decrease
content passage whichmay result in accumulation
the risk of postoperative ileus or even prevent it.
of the content at the blocking site. It can be divided
into two types either functional or mechanical (1).
AIM OF THE STUDY
The signs of ileus include nausea, cramps,
The present study aimed at evaluatingthe
retention of stool and flatus as well as vomiting.
knowledge, attitude and practice (KAP) of medical
After longstanding ileus, the symptoms are
students about paralytic ileus after colon surgery.
increased to major illness, constipation and long
hospital stay (2).
As for postoperative ileus, many protocols
have been established to prevent it however it is
It is a randomized cross sectional study
one of the most common types after abdominal
that was conducted in Saudi Arabia during the
surgery. It could result in long hospital stay, more
period from March 2018 to June 2018.
medications and costs (3).
All surgeons, physicians, nurses and
Study population and sample size:
medical staff should have good knowledge, attitude
The study included 320 medical students at
and practice about the bowel protocols that could
5th year who were chosen from different 3
result in decreasing the number of cases after
universities using multiple stratified random
surgery and preventing its initiation. Also, the
emergent management of bowel is a multimodality
interviewed at the balls of their college and they
care plan which includes using analgesia,
gave a written consent for their approval to
enhancing feeding, chewing, movement and
participate in the present study.
ambulation, are the gold standards of bowel care(4).
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4697-4701
Decline of Tobacco Smoking Among Medical Specialists at A Spanish
Alberto Molina Cabildo1, Carmen Díaz Molina1, Mohamed Farouk Allam1,2
1Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Cordoba, Cordoba, Spain
2Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Correspondence: Mohamed Farouk Allam, Department of Community, Environmental and Occupational Medicine, Faculty of
Medicine, Ain Shams University. 11566 Abbasia, Cairo, Egypt; E-mail: firstname.lastname@example.org and
email@example.com; Phone/Fax: +(202) 24346888; Mobile: + (2) 011 43559946
Background: Several epidemiological studies have shown that the prevalence of tobacco smoking in the
Spanish healthcare centres is relatively high. Objective: to assess the current situation of tobacco smoking
among medical specialists of Reina Sofia University Hospital (Cordoba, Spain). As a secondary objective we
intended to calculate the indirect costs of smoking among medical specialists during the working hours.
Materials and Methods: Descriptive cross-sectional study of the medical specialists of Reina Sofia University
Hospital. Our survey was conducted using an interview questionnaire that included the following variables:
age, sex, medical specialty, smoking habits, tobacco smoking during work hours, time spent on each cigarette,
intention to quit smoking and the possibility to participate in a smoking cessation program. Results: A total of
143 medical specialists; 64 women and 79 men were interviewed. About 14% of participants were former
smokers and 10.5% were current smokers, of whom 67% wanted to quit smoking. About 73% of smokers
consumed tobacco during the working hours. Most of smokers consumed 2 cigarettes during the working
hours. About 60% of smokers would use a permanent aid program to quit smoking. The hours lost by the
smoking habits of medical specialists cause an annual loss of 143.512,96 euros. Conclusions: The study
results show that currently there is an increasing awareness of health professionals about the harmful effects of
smoking: former smokers have increased, and most of smokers want to quit. Also, they would use a permanent
aid program to quit smoking.
Keywords: Prevalence, Tobacco, Medical specialist, Reina Sofia University Hospital, Cordoba, quit smoking.
from the World Health Organization (WHO)
According to several epidemiological
emphasized on the importance to facilitate treatments
studies, the prevalence of tobacco smoking in the
for tobacco dishabituation for smokers considering
Spanish healthcare centres is relatively high. In a
them patients, taking into consideration that tobacco
cross-sectional study, conducted in Valencia, about
smoking causes a high worldwide morbidities and
smoking habits among healthcare workers (HCWs)
mortalities, on short and mid-terms (5).
the prevalence rate of smoking reached 37%, and
The principal objective of our study is to
about 57.1% of smokers had no intention to quit
know the current situation of tobacco smoking
smoking (1). In Teruel, the prevalence of tobacco
among medical specialists of Reina Sofia
smoking among HCWs was 29.1% and only 41% of
University Hospital of Cordoba, Spain, with the
smokers accepted to participate in a medical and
characteristics of smoking habits and practices of
psychological programme to quit smoking (2). All
smokers. As a secondary objective we plan to
these studies were published before the Law 28/2005,
calculate the indirect costs of tobacco smoking of
which prohibited smoking in any work place (3).
medical specialists during the working hours.
In a recent pilot study conducted at Reina
Sofia University Hospital of Cordoba, we
MATERIAL AND METHODS
interviewed 30 medical specialist and 30 nurses.
Type of study: Cross-sectional study.
About 13.4% of the participants were current
Study population: 611 medical specialists
smokers and only 1.7% had no intention to quit
of Reina Sofia University Hospital of Cordoba,
smoking. All interviewed HCWs knew the current
law, which prohibits tobacco smoking in work
Inclusion criteria: Being a medical
complicated its application. About 87.5% of
specialist working at Reina Sofia University Hospital
smokers reported getting out the hospital to smoke
of Cordoba. Accept to participate in the study.
during the working hours (4).
Exclusion criteria: House officers and
It is very important to facilitate treatments for
Residents or any other category of HCWs. Medical
tobacco dishabituation: In 1996, an official report
specialists, who are not involved in clinical
practices, like management and directors.
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4702-4706
Role of Duplex Ultrasonography in Correlation With CT Angiography In
Assessment Of Vascular Complications In Recipients Post Liver
1Sherif Abu Gamrah, 2Marwa Adel Shabaan, 1Ahmed Hassan Soliman, 1Hala Mohamed Abdel
Radio-Diagnosis Department, Faculty of Medicine, 1Ain Shams University and 2Misr University for Science and Technology
Correspondence: Hala Mohamed Abdel Hamid Badawy; E-mail: firstname.lastname@example.org ,Mobile: 01118890580
Background: Liver transplantation is currently accepted as a first line treatment for patients with end-stage
acute or chronic liver diseases. Graft survival and overall patient survival have steadily improved since the first
transplants were performed in the early 1960s, but a significant percentage of transplants develop
complications related to vascular and biliary insufficiency. Graft ischemia after liver transplantation is
associated with a high incidence of morbidity and mortality. Aim of the Work: to evaluate the sensitivity and
specificity of Duplex ultrasound in detection most of vascular complication after liver transplantation in
correlation with CTA. Patients and Methods: The study was done from Aug. 2017 until Aug. 2018, where
50-55 cases who underwent living donor liver transplantation with post-operative complications. The cases
were done at Ain Shams University Hospital and other private hospitals. All cases where admitted to post-
transplanting intensive care unit in the postoperative period where a routine full laboratory and radiological
assessment were done. The laboratory assessment included full liver function tests, kidney function tests,
complete blood picture, and C-Reactive Protein. Immunosuppressant level and bilirubin level in drains had
also done. Results: The patient age ranges from 36 to 53 years with the mean age of 45 years. Most cases have
cases had hepatitis C related cirrhosis (90%). One case had veno-occlusive disease related cirrhosis (Budd
Chiari syndrome). About 95% of cases were suffering from end stage liver disease. The results we have
reached are that Doppler U/S sensitivity in diagnosis of these complications is 83.8% and CTA sensitivity is
about 100%. Conclusion: It could be concluded that colour duplex is the investigations of choice in
postoperative liver transplantation. They can be used as routine steps in the assessment of liver transplant graft
postoperatively in recipient patient as early as possible within the first 3 days after operation and used as a late
follow up, as they are noninvasive, safe, cheap, and accurate. Routine use of gray-scale US and color duplex
showed to minimize the impact of postoperative complications and maximize both graft and recipient patient
survival and if any complications suspected, it can be confirmed by CTA
Keywords: Duplex Study, CTA, Recipient Patient, Post Liver Transplantation
and thrombosis, caval and hepatic veins obstruction,
Liver transplantation is currently accepted
arterial pseudo aneurysm. Biliary complications
as a first line treatment for patients with end-stage
include; biliary leakage, stricture and obstruction (4).
acute or chronic liver diseases (1).
Graft survival and overall patient survival
ultrasonography and cross-sectional imaging studies
have steadily improved since the first transplants
often is most effective for diagnosis. Each imaging
were performed in the early 1960s, but a significant
modality has specific strengths and weaknesses, and
percentage of transplants develop complications
the diagnostic usefulness of a modality depends
related to vascular and biliary insufficiency. Graft
mainly on the patient's characteristics, the clinical
ischemia after liver transplantation is associated
purpose of the imaging evaluation, and the expertise
with a high incidence of morbidity and mortality (2).
of imaging professionals (1).
Biliary and vascular complications and
Ultrasound is the initial imaging modality of
rejection of the transplanted liver are the main
choice for detection and follow-up of early and
causes of malfunction and loss of the hepatic graft.
delayed complications from all types of liver
Advances in medical therapy over the last few
transplantation. Knowledge of the surgical technique
years have led to a more efficient diagnosis and
of liver transplantation permits early detection of
treatment of postoperative complications after
complications and prevents misdiagnosis (5).
orthotopic liver transplantation, thereby increasing
Duplex US is used to evaluate vessel
the survival rate after liver transplantation (3).
patancy, and are frequently used to distinguish
Vascular complications include; hepatic
dilated bile ducts and blood vessels and also can
artery stenosis and thrombosis, portal vein stenosis
evaluate the extrahepatic portal venous system (6).
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4707-4711
Comparative Study Between Sublingual and Vaginal Misoprostol for
Induction of Labor in Post Term Pregnant Patients with Unfavourable Cervix
Hossam Sobhy Mohamad Bayomi, Ismail M. El-Garhy, Ashraf Hamdy Mohamad
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Hossam Sobhy Mohamad Bayomi, email: email@example.com
Background: Pharmacological studies suggest that sublingual route might be the optimal route of
administration for PGE1 analogue misoprostol because the avoidance of the first pass hepatic circulation
would yield bioavailability like that achieved with the vaginal route along with an earlier onset of action and a
Objective: The aim of this study was to compare the efficacy and the safety of vaginal misoprostol with
sublingual misoprostol for induction of labor in post-term pregnancy.
Subjects and Methods: This study included 50 cases, each with a singleton post-term pregnancy and a live
fetus requiring induction of labor were allocated to sublingual and vaginal administration of misoprostol.
Outcome measures related to labor and maternal and fetal side effects were compared between the 2 groups
and evaluated using Chi square test.
Results: The sublingual route of misoprostol was associated with a reduced risk of failed induction, reduced
time from initiation to induction, reduced induction to delivery interval and a higher incidence of maternal and
fetal side effects. However, the differences were not statistically significant.
Conclusion: The sublingual route of administration of misoprostol is comparable in efficacy and safety to the
vaginal route for induction.
Key words: Induction of labor, Misoprostol, Sublingual.
SUBJECTS AND METHODS
Amongst the plethora of techniques
available for induction of labor, Prostaglandins
This study included a total of 100 pregnant
remain the single most effective means of
women whose gestational ages were beyond 42
achieving cervical ripening and inducing labor and
weeks attending at Department of Obstetrics and
have been administered through various routes.
Gynecology, In Al-Azhar University Hospitals.
Pharmacological studies suggest that sublingual
Approval of the ethical committee and a written
route might be the optimal route of administration
informed consent from all the subjects were
for PGE1 analogue misoprostol because the
obtained. This study was conducted between
avoidance of the first pass hepatic circulation
September 2017 and May 2018. Subjects were
would yield bioavailability similar to that achieved
divided into two groups as follows:
with the vaginal route along with an earlier onset of
I- Group I: This group included 50
action and a prolonged activity (1).
pregnant women who received vaginal misoprostol
This has generated an interest in the
in a dose of 25 µg to be repeated every 4 hours if
sublingual route for labor induction. An additional
no response was achieved with a maximum of 6
possible advantage is that avoidance of direct
doses. This dose was placed in the posterior fornix
cervical effects might reduce the risk of uterine
of the vagina. (1 tablet of Vagiprost, Adwia,
hyperstimulation. Sublingual dosing for labor
induction is attractive also because of ease of
II- Group II: This group included 50
administration, less frequent need for vaginal
pregnant women who received sublingual
examination, greater freedom of position and the
misoprostol in a dose of 50 µg to be repeated every
possibility of its convenient use despite vaginal
4 hours if no response was achieved with a
bleeding or ruptured membranes (2).
maximum of 6 doses. This dose was placed under
A few studies have found that sublingual
the tongue till completely dissolved. (1/4 of
administration of misoprostol is also effective for
Misotac tablet, Sigma, Egypt). In both groups
induction of labour (3).
gestational age was determined by reliable history
The aim of this study was to compare the
of dating of the last menstrual period with regular
efficacy and the safety of vaginal misoprostol with
cycles and / or sonography at first trimester.
sublingual misoprostol for induction of labor in
Unification of the baseline characteristics between
both groups was attempted. This study was
approved by Al-Azhar University hospitals and
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4712-4714
Effect of Alienation on Academic Achievement Performance of Medical
Students of King Faisal University
Abdullah Ibrahim Alamoudi., Abdullatif Waleed Al Arfaj., Abdullah Habib Almeshari., Abdulatif Alom.,
Azam Abdulwahab ALQuraini., Qussi Jaffer Al-Rebh. Essam Abdelbary
College of Medicine, King Faisal University
Background: Alienation is a term used to describe student estrangement in the learning process. It is also
defined as a state or experience of being isolated from a group or an activity to which one should belong, or in
which one should be involved. The aim of this research is to find out if there is a real effect on alienated
students in their academic achievement through biostatical correlation
Materials and Methods: This study was conducted at the college of medicine of King Faisal University in Al-
hasa throughout the period between March and May 2015. The study included 79 students, 59 of them were
male, and 20 were female. The alienated students were 20 out of 79 with a percentage of 25.3%. Four of which
were females while 16 were males with a ratio of 1:4.
Results and Discussion: After the analysis of the results of the study, it's turn out that there is no statistical
relationship between alienation & academic achievement. That was an unexpected result, and opposite to old
stereotypes about alienation,which believed that academic achievement is affected or influenced by alienation.
Summary and Conclusion: This study is about alienation and its effects on the medical student's academic
achievements and performance. It argues whether alienation has good or bad consequences on the medical
student's academic achievements. The results are impressive, because many people think that alienated
students are performing academically better than the other students. However, that is false. Both alienated and
non-alienated students are performing at the same level and have the same caliber of academic achievements.
Keywords: Alienation, academic achievements, medical students, King Faisal University
questions that are going to be on the form about
Alienation is a term used to describe student
alienation, in relation to academic achievements.
estrangement in the learning process. It is also
These questionnaires were distributed
defined as a state or experience of being isolated from
among the students of the college of medicine
a group or an activity to which one should belong, or
during their work time intervals and were collected
in which one should be involved (1).
after the students completed them.
The concept of alienation is deeply
Statistical Package for the Social Sciences
embedded in all the great religions and social and
(SPSS-IBM), software program application version
political theories of the civilized epoch, namely,
21, was used for the analysis of the obtained results.
the idea that sometime in the past people lived in
harmony, and then there was rupture which left
people feeling like foreigners in the world, but
Seventy nine students shared in this study, 59
sometime in the future this alienation would be
males and 20 females. The alienated students' number
overcome, and humanity would again live in
was 20 out 79 with a percentage of 25.3%. Four were
harmony with itself and nature (2).
females and 16 were males with a ratio of 1:4.
The medical student's achievements are very
The age of students ranged between 19 and
crucial at every stage of his life, it affects him
22. With a mean value of 19.8 years and SD 0.662.
individually, his family members, and the world(3).
Alienation has three factors that affect a student's life,
which are curricular, institutional, and socio-cultural(4).
MATERIALS AND METHODS
This study was conducted at the college of
medicine of King Faisal University in Al-hasa
throughout the period between March and May 2015.
This study included 79 male and female students.
A well-prepared form of questionnaire,
hard and soft copies were prepared by the team of
Figure (1): Number of males and females included in the study.
this research. and after consulting the psychology
department of the college about the types of
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4715-4724
Incisional Hernia Repair with Abdominoplasty
Hesham H Wagdi, Mostafa A Mohamed, Mohamed A Aboul Naga, Ahmed R Nassem
Department of General Surgery, Faculty of Medicine, Ain Shams University
Corresponding author: Ahmed R Nassem; Mobile: 01002760066; Email: firstname.lastname@example.org
Background: Abdominoplasty is considered by many general surgeons as only an aesthetic technique. It has
shown to provide great benefits for patients: (1) removal of excessive skin, which promotes better local
hygiene and reduces incidence of skin infections; (2) strengthening of muscular bending (better muscular tone,
corporal position, and then de-ambulation); (3) stabilization of the lumbar spine level (by changing the angle of
lumbar lordosis and sacral inclination, improving the chronic low back pain), scar removal and, finally, a better
perception of their bodies (higher selfesteem, satisfaction and quality of life), less anxiety and better personal
relationships. All these changes are always desirable for all patients. Aim of the Work: The main objective of
our study is to assess the outcome of the combined procedure of abdominoplasty and incisional hernioplasty,
compared to incisional hernioplasty alone. Patients and Methods: This randomized comparative study was
carried out on fourty patients having incisional hernias in General Surgery and Plastic Surgery Departments in
Ain Shams University and AL Salam Specialized Hospital. Hernias are included in this study and divided into
two groups, each group formed of 20 patients. First group (group A) with patients underwent hernioplasty
alone and the other group (group B) with patients underwent combined hernioplasty with abdominoplasty.
Patients are explained that they have the right to refuse joining to the research or withdraw at any time without
affecting their chances to receive the optimal treatment at any time. Patients are explained the significant risks
and the problems specific to them as well as the likely outcome if complications occurred and the relevant
treatment options as well as the risks of not having the procedure. Results: According to size of hernia
hernioplastywas 4.20 and abdominoplasty was 5.45. According to type of suture PDS loop hernioplasty
was15.0%, abdominoplasty was 75.0% and Prolene hernioplasty was 85% abdominoplasty was 25%.
Conclusion: Abdominoplasty can be performed in combination with hernia repair in patients with incisional
hernias, especially when associated with large sized defects or divercation of recti. Simultaneous techniques
can be safely performed with the same morbidity and recurrences, but with major quality of life improvement
and superiority over hernioplasty alone.
Key words: Hernia, Incisional Hernioplasty, Abdominoplasty
with a body mass index greater than 31 kg/m2 are
Incisional hernias are often associated with
prone to develop incisional hernia (3).
an excess of skin and fat, laxity or muscle
relaxation and abdominal shape deformity with
asymptomatic and rarely leading to obstruction or
hernia bulge and scars. This set of changes has an
strangulation, can remain troublesome and
impact on physical and mental health of patients
unsightly to patients. This is representing
such as back pain, digestive disorders, eating
significant burden upon healthcare resources, such
disorders, urinary incontinence, increased tendency
as radiological imaging, outpatient review and
to depression and stress (1).
surgical correction (2).
The development of incisional hernias
The most frequent complications of
represents one of the commonest late complications
incisional hernia repair are seroma, hematoma,
following open abdominal surgery. Literature
abscess formation and abdominal wall pseudocyst.
searches reveal post-laparotomy incisional hernia
Abdominal CT scanning is useful to differentiate
rates of 4-18%, in series with follow-up of 1-5
the pseudocyst from recurrent incarcerated
years, with over 75% of these occurring within two
incisional hernia (4).
years of the initial surgery. Following laparoscopic
The ideal reconstruction would be one that
resection, hernias may develop in the port-sites or
corrects and prevents visceral eventration, provides
the specimen removal site (2).
dynamic muscle support and allows for tension-
Risk factors of incisional hernia includes
free repair during a one stage procedure (5).
Transverse rather than vertical incisions
emergency surgery, history of smoking, anaemia,
and the use of monofilament, slowly-absorbable or
prostate hypertrophy, cough, chronic obstructive
pulmonary disease and significant post-operative
abdominal fascial closure have been associated
wound problems or infection. Furthermore, patients
with decreased development of incisional hernias.
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4725-4731
Misunderstanding of Parents about using of Anti-Biotic in Upper Respiratory
Tract Infection in Riyadh, Saudi Arabia
Fatimah Adam Alaswad1, Faisal Mubarak AlZahrani2, Faisal Abdullah Alomani2, Nawaf Mohammed
Alwohaibi2, Ali Ahmed Almaimouni2, Abdullah Abdulrahman Almannaa2, Abdullah Abdulrahman Bin
Saeed2, Abdulaziz Abdullah Alzwaid2, Rakan Abdulrahman Aladwanie2
1Ras Tanura General Hospital, Ras Tanura, 2Almaarefa Colleges, Riyadh, Saudi Arabia
Corresponding Author: Fatimah Adam Alaswad, E-mail; email@example.com
Background: Misuse of antibiotics has become a global public health issue for several reasons, one of which
is the rapid development of antibiotic resistance that leads to high morbidity and mortality.
Objectives: Objective of this study was to study the misconceptions of parents of primary school children in
Riyadh about the use of antibiotics for upper respiratory tract (URT) symptoms; and also study perceptions,
attitudes, and behavior toward antibiotic use and identifies the factors affecting this.
Methods: Analytic cross sectional study of parents in one large city: Riyadh, Saudi Arabia. Study population
were parents of children studying in these schools, and were selected multistage sampling and proportional to
population size (PPS).
Results: The questionnaire was distributed to 1306 parents. The response rate was 78.9%, 56.6% respondents
were mothers with a mean age of 40 ± 7. Sixty seven percent of the parents admitted to self-prescription once
or more, and the most common reason for self-prescribing, was because they thought the child was not ill
enough to be taken to hospital (41.8%). This was followed by 37.7% who used "leftovers". Regarding the
attitude toward antibiotic prescription, 62.5% agreed that children should not be given an antibiotic when they
have fever and nasal congestion. In addition, 63.5% agreed that they should give their child antibiotic for ear or
throat pain. Around two thirds agreed that upper respiratory tract infection (URTI) was caused by a virus.
Those who obtained their information from primary health care centers and general practitioners had the lowest
median of total knowledge score, and the highest knowledge was for those who obtained information from
websites and the social media. Multiple linear regressions revealed that parents whose incomes were high, had
high education, had children in private schools were more likely to have good knowledge and highly favorable
attitudes and practices toward antibiotic use.
Conclusion: Thirteen percent had an excellent knowledge, and 52.7% had an intermediate level of knowledge.
Of those with excellent knowledge, 58.6% still expected to get antibiotic prescription from a physician for
Keywords: Antibiotics, misuse, Saudi Arabia, upper respiratory tract infection
without a prescription (9). Although there has
The World Health Organization (WHO)
been a law since 1978 forbidding the purchase of
defines self-medication as treating one's own
antibiotics without prescription, this law is not
symptoms or those of other family members,
enforced by pharmacists (11). Finally, information
especially children (1). Antibiotics misuse has
regarding the antibiotic consumption in Saudi
become a global health problem that has led to
Arabia is very limited, and there are no reports
many serious health issues such as antibiotic
on the trends of antibiotic use by Saudi children,
resistance. Many authorities consider such
especially those with upper respiratory tract
practices as incomplete antibiotic course,
infections (URTIs). Consequently, the study of
suboptimal dose, self-prescription, re-use of
parents' knowledge, practice, and attitude toward
leftover antibiotics, and inappropriate attitude as
this global problem becomes even more
the leading causes of the development of
important (12). To the best of our knowledge, there
antibiotic resistance (2-8). Antibiotics are some of
is very little data in Saudi Arabia on antibiotic
the important medications that are misused for
misuse and parents' knowledge, beliefs, and
viral respiratory tract infections, to the extent
practice. In addition, no studies have been done
that parents expect antibiotic prescriptions from
on parents in the Central Province (9). The current
physicians on the assumption that they will
study was conducted to assess parents'
reduce the severity of the symptoms although
knowledge and awareness of antibiotic use for
they really would have no effect on the time
the upper respiratory tract symptoms (URTI) in
course of the disease (9,10). In Saudi Arabia,
the Central Province, Saudi Arabia.
antibiotics can be purchased from the pharmacy
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4732-4736
Visual Outcomes after Topography-Guided Femtosecond LASIK in Virgin
Ahmed Hassan Assaf, Sameh Hany Abd El Rahman, Mahmoud Abd El Meguid Abd El Latif, Mai
Mohammad Zaki Afifi
Ophthalmology Department, Faculty of Medicine, Ain Shams University
Corresponding author: Mai Mohammad Zaki Afifi, Email: firstname.lastname@example.org
Background: Laser vision correction has been established over the last 2 decades as a safe and
effective intervention, with Laser-assisted in situ keratomileusis (LASIK), being one of the main
techniques practiced globally. Femtosecond laser-assisted LASIK has become a popularized
modification over the last decade and over the standard LASIK technique utilizing mechanical
microkeratomes. A spherical ablation profiles performed by "wave front optimized" have been
employed to reduce spherical aberration associated with myopic corrections.
Aim of the Work: To evaluate the quality and efficacy of topography-guided femtosecond lasik in virgin eyes
with myopia, hypermetropia and astigmatism.
Patients and Methods: This comparative prospective study was conducted on 60 eyes of 30 Egyptian patients
with comparing preoperative and postoperative outcomes. Eyes with myopia (-1.0 up to -8.0 diopters) or
hypermetropia (+1.0 up to +5.0 diopters) or astigmatism (up to 5.0 diopters) or less. Eyes with central corneal
thickness (CCT) of 500 microns or more. Eyes at risk for developing post-refractive corneal ectasia, such as
keratoconus, keratoconus suspect, previous refractive surgery, corneal dystrophy, corneal guttae or opacities,
any previous eye surgery e.g.:pseudophakic patients, retinal detachment surgery, all eyes were normal for
example no cataract, no glaucoma, no retinal pathology and no previous trauma.
Results: Our study was performed on sixty eyes of thirty Egyptian patients. Sixty eyes of thirty patients
underwent LASIK using T-CAT. Seventeen patients were females and thirteen were males. The average age of
the patients was 24.8 year ±5.45 standard deviation (SD). The average spherical error was -3.09 D ±2.33 SD.
The average cylinder error was -1.02 D ±1.02 SD.
Conclusion: The results showed that there was statistically significant differences between preoperative
BCVA and postoperative UCVA with a good safety and efficiacy profile with T-CAT lasik as no patient loss
even one line and 80% of cases gaining at least one line postoperative. The surgery was associated with higher
values of high order aberrations after surgery than before surgery.
Keywords: Visual Outcomes, Guided Femtosecond LASIK, Virgin Eyes
reduce spherical aberration associated with myopic
established over the last 2 decades as a safe and
Further customization of the ablation
effective intervention, with Laser-assisted in situ
pattern has been practiced by pairing wave front
keratomileusis (LASIK), being one of the main
eye data to the refractive data chosen to be
techniques practiced globally (1, 2).
corrected, as wave front-guided treatments in
Femtosecond laser-assisted LASIK has
pursue of improving visual function in aberrated
become a popularized modification over the last
eyes, or pre-empting aberrations created by the
decade and over the standard LASIK technique
standard procedures (8, 9).
utilizing mechanical microkeratomes (3, 4).
Since most inherent and acquired eye
Excimer lasers, used in the second step of a
aberrations lie in the cornea the premiere
LASIK procedure to correct refractive error (RE),
refractive medium of the eye topography-guided
have been evolving as well, with most platforms
treatments have been additionally employed as a
currently utilizing flying spot technology of very
means of ablation customization in pursue of
high repetition rates and advanced tracking
additionally correcting corneal irregularities
mechanisms to track intra-operatively the pupillary
affecting visual function (10).
aperture and some even to provide cyclorotation
LASIK outcomes appear to have improved
adjustment (5, 6).
in safety and efficacy with the evolutions described
A spherical ablation profiles performed by
earlier Zheng and Song (11) in both refractive
"wave front optimized" have been employed to
outcomes and induced high-order aberrations (12, 13).
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4737-4745
Predictors of admission in patients with acute Bronchiolitis
1Muddather A. Mohammed, 2Mazen H. Khalid, Faraj A. Faraj, Ahmad Saladdin Sultan
1Lecturer, Senior specialist, Mosul Teaching Hospital, 2Senior Specialist, Alkhansaa Teaching Hospital Mosul, Iraq
Background: Acute viral bronchiolitis represents the most common lower respiratory tract infection in infants
and young children less than 24 months and is associated with substantial morbidity and mortality. Respiratory
syncytial virus is the most frequently identified virus, but many other viruses may also cause acute
bronchiolitis. Most children with bronchiolitis have a self-limiting mild disease and can be safely managed at
home with careful attention to feeding and respiratory status. Criteria for referral and admission vary between
hospitals as do clinical practice in the management of acute viral bronchiolitis, Supportive care, including
administration of oxygen and fluids, is the cornerstone of current treatment. Aim: To identify the
epidemiological profile of babies less than 2 years with bronchiolitis, clinical characteristics of babies with
bronchiolitis in respect to the main symptoms, signs and clinical presentations and the factors that affect
disposition of the patient with acute bronchiolitis. Patient and Method: Design: A prospective observational
case series study. Setting: Emergency unit in Al-Khansaa Teaching Hospital. Study period: one year
(1/October/ 2012 30/September/ 2013) Sample size: 84 patients were enrolled in this study. Inclusion
criteria: 1-first attack of acute wheeze due to bronchiolitis.2-age 2years or younger. Exclusion criteria: 1.
patients with more than one attack wheezes.2.wheezes due to other cause (pneumonia).3.age more than 2
years. Result: A Total of 84 patients with 1st attack wheeze in less than 2 years identified. The main age was
8.2±5.77months, and the peak age was 6 months.53 (63.1%) male, and 31(36.9%) female and ratio of 1.7:1.and
the majority were mature babies, came from urban area more than rural area. The comparison done
concentrated on symptoms, signs, and radiological findings between babies younger and older than 6months
age, and studied either to hospital or not and concentrated these findings had role as an indicator for admission
on heart rate, respiratory rate and SPO2, The results indicated that poor feeding, irritability, runny nose, cough
and shortness of breath all of these symptoms consider a good indicators for admission in both age groups.
Severe retraction, rhonchi, and temperature more than 38.1 C, all of these physical findings consider good
indicators of admission in both age groups. While fine rales and cyanosis are good indicators in babies younger
than 6 months only. Radiological findings had no role in assessing admission of the patients to hospital.
Respiratory rate (tachypnea)>60 bpm, and SPO2<94 are consider a significant indicators in both age groups,
while heart rate >160 BPM consider significant indicator only in babies older than 6 months of age. Of all 84
patients admitted to emergency unit, only 63(75%) of them were admitted to hospital and the remaining were
discharged. Conclusion: Indications of admission can be assessed by many symptoms (poor feeding,
irritability, runny nose, cough, and SOB) and physical signs (Rhonchi, severe retraction, temperature >38.1 c,
RR>60bpm, and SPO2<94), so We recommended carrying out serial checking SPO2 by pulse oximetry, and to
conduct arterial or capillary blood gas analysis for the severely ill patients to assess the severity of the disease
and its complications and treatment procedures.
Keywords: Airway Obstruction, Admission to Hospital, Viral Bronchiolitis.
Acute bronchiolitis is characterized by
Bronchiolitis is the term used for first-time
bronchiolar obstruction with edema, mucus, and
wheezing with a viral respiratory infection in
cellular debris. Even minor bronchiolar wall
children less than 2years age. The distinctive
thickening significantly affects airflow because
element of acute bronchiolitis is lower respiratory
resistance is inversely proportional to the 4th power
tract inflammation with airway obstruction
of the radius of the bronchiolar passage. Resistance in
resulting from swelling of small bronchioles
the small air passages is increased during both
leading to inadequate expiratory airflow (1).
inspiration and exhalation, but because the radius of
an airway is smaller during expiration, the resultant
Most severe cases of bronchiolitis occur
respiratory obstruction leads to early air trapping and
among infants, probably as a consequence of
over inflation (3).
smaller airways and an immature immune system.
Viruses penetrate the terminal bronchiolar
Bronchiolitis is the most common disease of the
epithelial cells, causing direct damage and
lower respiratory tract in infants, resulting from
inflammation in the small bronchi and bronchioles.
inflammatory obstruction of the airways (2).
Limited information are available on the pathology
of typical cases because most affected infants
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4746-4752
Expression of CD73 and CD39 on Peripheral Blood Leukocytes in Type II
Soha Ezz El-Arab Abdel Wahab1, Deena Samir Eissa1, Mona Mohamed Abdelsalam2,
Christine Atef Habib1
Departments of 1Clinical Pathology and 2Endocrinology & Metabolism, Faculty of Medicine, Ain Shams University
Corresponding author: Soha Ezz El-Arab Abdel Wahab, Phone: 01006619021
Background: Type II diabetes mellitus (T2D) is one of the most common chronic metabolic diseases. It is
associated with a state of chronic inflammation resulting in both microvascular and macrovascular
complications. The adinosinergic axis plays an important anti-inflammatory protective role through conversion
of ATP (produced as a result of inflammation) into adenosine (a potent anti-inflammatory mediator) through
CD39 and CD73. Various peripheral blood leucocytes hold CD39 and CD73 with different degrees.
Objective: To determine the expression of CD73 and CD39 on different peripheral blood leukocytes including
Treg cells to uncover their inflammatory modulation role in T2D subjects in comparison to normal control
ones. The level of their expression will be correlated with various anthropometric and biochemical parameters
in diabetic patients.
Materials and Methods: Venous blood was collected on EDTA anticoagulated tubes from 45 T2D patients;
15 with early T2D and 30 with complicated T2D with both microvascular and macrovascular complications.
Twenty-five normal subjects, with no family history of T2D, were included. Immunophenotyping of the
samples were performed on Navios Flow cytometer (Coulter Electronics, USA), using phycoerythrin (PE)-
labelled CD39 antibodies, fluorescein isothiocyanate (FITC)-labelled CD4 antibodies, peridinin-chlorophyll-
protein complex: CY5.5 conjugate (PerCP-CY5.5)-labelled CD73 and allophycocyanin conjugate (APC)-
Results: CD39 expression was highest in early cases of T2D in comparison to least expression in complicated
T2D on peripheral blood total lymphocytes, CD4+ lymphocytes and CD4+CD25+ lymphocytes.
Conclusions: The increased expression of CD39 in early non-complicated cases of T2D indicates a state of
low-level chronic inflammation owing to their role in production of adenosine; a potent anti-inflammatory
mediator. This is reversed when CD39 expression in peripheral blood leucocytes is assessed in complicated
T2D patients, which emphasise their role in protecting the patients from diabetic complications.
Keywords: Adenosine, CD39, CD73, diabetes, inflammation.
the pathogenesis of obesity-induced insulin
Diabetes mellitus is a disorder of glucose
resistance, the metabolic syndrome and T2D. In
metabolism characterized by a state of chronic
fact, in T2D there is infiltration of the liver,
hyperglycemia. It is caused by deficiency in insulin
muscle, pancreas and adipose tissue by
secretion, abnormal insulin action or both. It is a
macrophages and other immune cells with switch
systemic disorder causing damage and dysfunction
of the profiles of these cells from an anti-
of multiple organs (1).
inflammatory phenotype to a pro-inflammatory
phenotype. The pro-inflammatory phenotype
There are two
contributes to the pathogenesis of T2D by
abnormalities in these patients. First, the insulin
producing cytokines that causes inhibition of
resistance which is a decline in the effect of insulin
insulin signalling in the peripheral tissues and
on the peripheral tissue, which is believed to be the
induction of -cell dysfunction (4).
primarily defect in T2D. Second, beta cell
dysfunction which is a decrease in insulin synthesis
Diabetes mellitus is complicated by both
in the pancrease making it unable to overcome the
acute and chronic complications. Chronic
peripheral insulin resistance, thus there is a relative
complications of diabetes can be both
deficiency of insulin early in the disease and
microvascular (retinopathy, nephropathy and
absolute insulin deficiency later on (2). T2D is a
neuropathy) and macrovascular (atherosclerosis,
multifactorial disorder in which both insulin
coronary artery disease, diabetic foot and stroke)
resistance and beta cell dysfunction are influenced
by multiple environmental and genetic factors (3).
Extracellular nucleotides, such as ATP, are
Chronic low-grade inflammation and
important signalling molecules involved in many
activation of the immune cells are main factors in
biological processes. Under basal conditions
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4753-4760
Analgesic Efficacy and Outcome of Lumber Epidural Analgesia versus ultrasound
guided Trasversus Abdominis Plane block In Laparoscopic Sleeve Gastrectomy
Mohamed S. Abd-El Aziz, Sherif S. Wahba, Sanaa F. Mahmoud,
Moustafa M. Sery, Marwa M. Salem
Department of Anesthesia, Intensive care and Pain Management, Faculty of Medicine Ain Shams University
Corresponding author: Marwa M. Salem, Phone number: +201003591259, Email: email@example.com
Background: The transversus abdominis plane (TAP) block provide effective postoperative analgesia in lower
abdominal surgery. Subcostal TAP block as a new technique to provide analgesia for the supraumbilical
abdomen. Traditionally, pain relief for these patients is provided by epidural analgesia or IV opioid analgesia.
Although epidural analgesia is currently the "gold standard" for postoperative pain treatment, associated
complications and contraindications may limit its use. IV opioid analgesia may cause opioid-related side
effects and be associated with inadequate analgesia. Aim of the Work: This study aimed at clinically
evaluating and statistically comparing between lumber epidural versus transversus abdominus plane block as
postoperative Analgesia for laparoscopic sleeve gastrectomy. Also, our goal was to figure out the most
possible effective technique for this kind of procedure with most benefits and least side effects. Patients and
Methods: This single blinded randomized clinical trial was carried out at Ain Shams University hospitals on
60 adult Bariatric patients undergoing elective Laparoscopic sleeve Gastrectomy, aged 20 to 50 years, ASA I-
II, BMI equal or less than 45 Kg/m2. Results: Patients in the Lumber Epidural group had significantly less pain
score when compared to the other TAP group (p-value < 0.001). And, they had longer time to first request
rescue analgesia (nalbuphin) (P = 0.0013). Also, total dose of nalbuphin consumption was less in Lumber
Epidural group than TAP group (P < 0.001). Conclusion: This study concluded that TAP block was effective
in pain relief after Laparoscopic sleeve gastrectomy, however, Lumber Epidural was superior in pain relief,
less narcotic consumption and overall more patient satisfaction.
Keywords: Lumber Epidural Analgesia, Trasversus Abdominis Plane block, Laparoscopic Sleeve Gastrectomy
block is a regional anesthetic technique used to block
The recent adoption of pain assessment and
myocutaneous sensation of anterior abdominal wall.
management standards follows a growing recognition
This block has a number of advantages which include
of the benefits of acute pain control on short-term
technical simplicity, high analgesic effectiveness,
outcomes, patient satisfaction, quality of life, and in
opioid sparing, long duration of effect (~30 - 36
the prevention of development of chronic pain
hour), minimal side effects in comparison to that
syndromes (1).postoperative pain seems to remain a
very important factor that can deteriorate the overall
hypotension, motor blockade) and opioid analgesia.
quality of recovery after laparoscopic procedures
TAP block may be posterior or subcostal TAP block
.Opioids continue to play a major role in the
.Valid and reliable pain assessment tools are
pharmacologic management of acute postoperative
essential for both clinical trials and effective pain
pain but are less efficacious in treating inflammatory
management. Acute postoperative pain can be
or neuropathic pain. Moreover, the use of opioids
reliably assessed using physiologic data (heart and
often leads to undesirable side effects (respiratory
respiratory rates) and behavioral responses. Other
depression, central nervous system depression,
diagnostic tools are used to assist in assessing the
sedation, circulatory depression, nausea, vomiting,
severity and quality of pain experienced by the
pruritus, urinary retention, impairment of bowel
patients such as Numeric Rating Scales(NRS) or
function, and sleep disruption) that can hamper or
Visual Analogue Scales (VAS). Both these are more
delay recovery from surgery.Treatment with other
powerful in detecting changes in pain intensity than a
non-opioid modalities (neuroaxial analgesia and
Verbal Categorical Rating scale (VRS) (6).Rapid and
peripheral nerve block techniques) has the potential
uneventful postoperative recovery following general
advantage of providing improved analgesia and early
anesthesia in morbidly obese patients undergoing
mobilization while reducing opioid side effects
bariatric surgery may offer challenges to
(3).Epidural anesthesia and analgesia have the
anesthesiologists. With improved surgical techniques
potential to reduce or eliminate the perioperative
and shorter pneumoperitoneum, regional anesthesia
physiologic stress responses to surgery and thereby
may be considered for this laparoscopic procedure in
decrease surgical complications and improve
selected cases (7).
outcomes (4).Transversus abdominis plane (TAP)
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4761-4764
Differential Incidence of Eyelid Margin Cysts in ASU Outpatients
Mayar Mohammad Salaheldin Faheem, Sherif Elwan, Azza Mohamed Ahmed Said, Ossama Tarek
Department of Ophthalmology, Faculty of Medicine, Ain Shams University
Corresponding author: Mayar Mohammad Salaheldin Faheem, E-Mail: Mayar.firstname.lastname@example.org, Mobile: +2 01097316366
Background: Wide varieties of lesions affecting the eyelid are encountered within routine Ophthalmology
practice. These lesions are numerous due to the unique anatomical features of the eyelid as the whole skin
structures, appendages, muscle, modified glands, and conjunctival mucous membrane are represented in the
eyelid. The eyelid comprises different types of glands that clinically correlate with the development of eyelid
cysts; Sebaceous glands (Meibomian glands and glands of Zeis), aporcine glands (glands of Moll) and eccrine
Objectives: To report the incidence of the different etiologies of eyelid margin cysts in Ain Shams University
(ASU) Hospital, General Ophthalmology Outpatients Clinic.
Patients and Methods: It included all patients who presented to the General Ophthalmology Outpatient
Clinic, 6 days per week for one month (November 2017) complaining of eyelid margin lesions, found cystic on
slit lamp examination, of all ages.
Results: The total number of patients recorded was 45 patients presenting with eyelid margin cysts, out of
1920 patients visiting the General Ophthalmology Outpatient Clinic during the month of November 2017 with
an incidence of 2.34%. Seven types of cysts were found namely; External Hordeolum (8.9%), Internal
Hordeolum (15.6%), Chalazion (28.9%), Sebaceous Cyst (11.1%), Cyst of Zeis Gland (13.3%), Apocrine
Hidrocystoma (11.1%) and Eccrine Hidrocystoma (11.1%).
Conclusion: Eyelid margin cysts should be studied and categorized as a separate entity from eyelid lesion due
to the unique anatomy of the eyelid margin. The incidence was calculated to be 2.34% during this study that
was relatively short lived. Chalazion was the most common lesion encountered but that was solely by clinical
Recommendations: It is recommended to continue this study for a longer duration to be more comparable
with the other studies and it should be enriched by histopathological diagnosis aside the clinical one.
Keywords: Eyelid, Margin, Cysts
muscle layer and the hard posterior tarso-conjunctival
Wide varieties of lesions affecting the
layer by a knife (3).
eyelid are encountered within routine Ophthalmology
The eyelid comprises different types of
practice. These lesions are numerous due to the
glands that clinically correlate with the development
unique anatomical features of the eyelid as the whole
of eyelid cysts; Sebaceous glands (Meibomian glands
skin structures, appendages, muscle, modified glands,
and glands of Zeis), aporcine glands (glands of Moll)
and conjunctival mucous membrane are represented
and eccrine sweat glands (4).
in the eyelid (1).
The tarsal glands of Meibom (glandulae
The eyelid is composed of two lamellae:
tarsales) are large sebaceous glands located in the
the anterior lamella, composed of skin and
eyelids and, unlike those of the skin, are
orbicularis oculi muscle, and the posterior lamella,
unassociated with hairs. These separate glands are
composed of the tarsal plate and conjunctiva (2).
arranged in parallel in a single row throughout the
The lid margin is about 2 mm thick,
length of the tarsal plates in the upper and lower
horizontally placed, and has a sharp posterior border
lids, and they presumably act in a coordinated
and a round anterior border. The round anterior
fashion that is influenced by hormonal and neural
border has hair follicles of the eyelashes, into which
regulation and by the mechanical forces of muscle
the sebaceous gland of Zeis and the sweat gland of
contraction during the eye blink (5). They produce
Moll open. Just anterior to the sharp posterior border
the lipid that lines the layer of tear film (6).
of the lid margin is the opening of the tarsal
The human glands of Moll are specialized
Meibomian gland. Just anterior to the opening of the
apocrine sweat glands located at the margin of the
Meibomian gland is a gray line along which the lid
eyelids near the lash follicles. The nature and function
can be vertically split into its anterior soft skin
of the secretions of the glands of Moll is unknown (7),
however, it likely includes the production and