ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4765-4771
Role of diagnostic hysteroscopy and histopathology in evaluation of abnormal
uterine bleeding
Hatem H. El-Gamal, Magda M. Abd-El-Salam, Reda M. Ghanem, Shaymaa I. Al-Ani
Department of Obstetrics and Gynecology, Faculty of Medicine Ain Shams University
Corresponding author: Shaymaa I. Al-Ani; Mobile: 01068019982; Email: shaimaa.alani@yahoo.com
ABSTRACT
Background: Abnormal uterine bleeding is a bleeding from uterine compose that is abnormal in volume,
regularity and/or timing that has been present for the majority of the last 6 months. Evaluation of women with
abnormal uterine bleeding should comprise history taking, systemic and local examination, laboratory
investigations, imaging and different diagnostic procedures including hysteroscopy. Aim of the Work: to
assess the accuracy of hysteroscopy in the diagnosis of the cause of bleeding in women with abnormal uterine
bleeding. Patients and Methods: This prospective observational study was conducted on 114 patients
attended the Early Cancer Detection Unit, Faculty of Medicine, Ain Shams University between July 2017 and
April 2018, to assess the role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine
bleeding. Results: Hysteroscopy had a sensitivity of 91.9%, specificity of 86.5%, positive predictive value of
93.2%, and negative predictive value of 84.2% and diagnostic accuracy of 90.1% for diagnosing the etiology
of abnormal uterine bleeding. Conclusion: Hysteroscopy has a definitive role in evaluating patients with
abnormal uterine bleeding especially with patient with thick endometrium, in any age group. Hysteroscopy is a
safe and reliable procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity,
specificity, positive predictive value and negative predictive value and the results of hysteroscopy are
immediately available. Hysteroscopy and histopathology complement each other in evaluating patients with
abnormal uterine bleeding for accurate diagnosis and further treatment.
Key words: Hysteroscopy, Histopathology, Uterine Bleeding
INTRODUCTION
system as a description of the disorder (e.g. abnormal
Abnormal uterine bleeding is a bleeding from
uterine bleeding caused by ovulatory disorders is
uterine compose that is abnormal in volume, regularity
referred to as AUB-O). The term dysfunctional uterine
and/or timing that has been present for the majority of
bleeding, used in the past to describe abnormal
the last 6 months. It may be excessively heavy or light
bleeding, is being replaced by these terms. Differential
and may be prolonged, frequent, or random (1).
diagnosis will vary based on symptomatology as well
as age. Pregnancy is a possible cause of any type of
Abnormal vaginal bleeding is a common
abnormal bleeding in any woman of reproductive age
complaint in primary care. The prevalence of some
(ie, after menarche and before menopause). Many
type of abnormal bleeding is up to 30% among
systemic illnesses and medications can affect
women of reproductive age (2).
menstrual bleeding and should be included in a broad
Over 18% of all gynecology outpatient visits
differential diagnosis of a presenting woman (6).
in the United States are for menorrhagia alone (3).
Until recent times, usual method of
Because most cases are associated with
evaluating this symptom was dilatation and
anovulatory menstrual cycles, adolescents and
curettage. But this detects the cause in less than
perimenopausal women (4) are particularly vulnerable.
50% of the cases. Hysteroscopy offers a valuable
About 20% of affected individuals are in the
extension of the gynecologist's armamentarium. It
adolescent age group, and 50% of affected
can improve the diagnostic accuracy and can
individuals are aged 40-50 years.
permit better treatment of uterine diseases. After
In 2011, the International Federation of
hysteroscopy, the elective surgery of the patient
Gynecology and Obstetrics (FIGO) published a
can be planned better (7).
new classification system and the American
Hysteroscopy allows direct visualization of
College of Obstetrician-Gynecologists has also
the endometrial cavity and importantly, directed
endorsed this new classification system (5).
endometrial sampling of any suspicious areas (8).
This system divides the etiology of abnormal
Use of hysteroscopy in abnormal uterine
uterine bleeding into structural and non-structural
bleeding is almost replacing blind curettage, as it
causes and follows the acronym PALMCOEIN. New
"sees" and "decides" the cause. This is because the
nomenclature uses the acronym of AUB (abnormal
uterine cavity can be observed and the area in question
uterine bleeding) with the initial from the classification
can be curetted. In fact, it is an eye in the uterus (9).
4765
Received:12/6/2018
Accepted:21/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4772-4779
Role of diffusion weighted MRI in assessment of hypervascular hepatic tumors
Amany M. Abd El-Aziz, Walid R. Abdelaziz, Tarek W. Hemada, Mariam E. Mosaad
Department of Radiodiagnosis,Faculty of Medicine - Ain Shams University
Corresponding author: Mariam E Mosaad; Mobile: 01006228978; Email:mariam.elsaid10@gmail.com
ABSTRACT
Background: Hypervascular hepatic focal lesions may be benign or malignant. Therapy requires an accurate
diagnosis, which in turn relies primarily on appropriate imaging and image-guided biopsy. MRI having many
sequences, markedly helps in the detection of small lesions and in reaching the diagnosis easily even without
contrast injection or the need for biopsy as in hemangiomas. Aim of the Work: To assess the role of diffusion
weighted MRI imaging in differentiation between various types of hypervascular hepatic tumors. Patients &
Methods: This study included (24) patients, 12 males & 12 females, their ages ranges from 28 to 66 years with
a mean age of 49.5 years. The study was performed in Radiology department at Ain Shams University
Hospitals and some private clinics in addition to National Cancer institute. Results: Highly statistically
significant difference between benign and malignant according to ADC value. Benign lesions have higher
mean ADC value compared to malignant lesions. Conclusion: Diffusion-weighted MRI sequence with
quantitative ADC measurements can be useful in the differentiation of benign and malignant hypervascular
hepatic focal lesions. Recommendations: Further studies on a larger scale of patients are needed to confirm the
results obtain by this study.
Key words: DW MRI, hypervascular hepatic tumors
INTRODUCTION
It allows the mapping of the free diffusion of water
Hypervascular
hepatocellular
lesions
molecules (Brownian motions) which reflects the
include both benign and malignant etiologies. In
structural differences in disease by restricting
the benign category, focal nodular hyperplasia and
diffusion (7). Diffusion is expressed in an apparent
adenoma are typically hypervascular. Malignant
diffusion coefficient (ADC), which reflects the
hypervascular primary hepatocellular lesions
diffusion properties unique to each type of tissue (5).
include hepatocellular carcinoma. Also certain
DWI can be added to the routine
cancers such as metastatic neuroendocrine tumors
examination easily using recently available
tend to produce hypervascular metastases due to
machines. This imaging method has a good ability
the greater recruitment of arterial blood supply (1).
to detect liver lesions, and quantitative evaluation
Hepatocellular carcinoma (HCC) is the
can be achieved without contrast media (7).
second leading cause of cancer-related death
The clinical uses of liver DW-MRI
worldwide (2) with an estimated 500,000 to 1
include improved: 1. detection of focal liver
million deaths per year (3).
lesions, 2. contribution to tissue characterization
Ultrasound is frequently the first-line
for both diffuse disease and focal lesions, 3.
imaging modality for the study of the liver because
monitoring of tumor response after chemotherapy
of a combination of high spatial resolution and
or radiotherapy, 4.detection of recurrent disease, 5.
inherent soft tissue contrast, lack of ionizing
differentiating recurrence from post-therapeutic
radiation, low cost, and wide availability. Operator
change, and 6.potentially predicting treatment
dependency, substantial image degradation in
outcome (8).
obese patients, and limited field of view, however,
represent major limitations of this modality
AIM OF THE WORK
compared with other cross-sectional imaging
The aim of the current study was to assess
techniques (4).
the role of diffusion weighted MRI imaging in
MRI proved to be superior to CT in the
differentiation
between
various
types
of
detection of HCC and for the characterization of
hypervascular hepatic tumors.
nodules in patients with liver cirrhosis because of
the high tissue contrast provided by MRI (5).
PATIENTS AND METHODS
Nowadays, it plays a key role in management of
Patients:
liver lesions, using a radiation-free technique and a
This study included 24 patients, 12 males
safe contrast agent profile(6).
& 12 females, their ages ranged from 28 to 66
Diffusion-weighted imaging (DWI) is a
years with a mean age of 49.5 years.
relatively recent technological improvement of MRI.
4772
Received:29/5/2018
Accepted:8/6/2018
ABSTRACT
Transverse Supraumbilical versus Pfannenstiel Incision for Cesarean Section ...
deleted
1
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4786-4791
Management of postoperative Complications after posterior lumber spinal fixation
Mohamed Abd-Elbary Abd-Elaziz Al Saadwy, Yousof Barakat, Mohamed Fouad, Abd-Elaleem Abd-
Elaleem Elgendy, Sayed Roshdy
Neurosurgery Department, Faculty of Medicine, Al-Azhar University
ABSTRACT
Background: For increasing safety and reducing complications that may occur with Trans-Pedicular Scre
Placement, different ways have been reported including application of C-arm X-ray view, application of axial
computed tomography scan (CTS), frameless stereotactically guided screw placement and different guidance
devices. However, the application of all these devices and techniques are not so easy and even in many operating
rooms such kinds of instruments are not available. A posterior approach to anterior and middle column
reconstruction is often preferred in the lumbar spine for two reasons, the first is that the morbidity associated with an
anterior approach is significant and delays recovery, the second is that pedicle screws and rods or plates can be
placed before dural retraction and dissection of the intervertebral disk. Aim of the Work: The aim of this work was
to evaluate the postoperative Complications. In posterior lumber transpedicular fixation and their management.
Patients and Methods: Retrospective and prospective study for evaluating the history, clinical state, laboratory
investigations, radiological findings and way of management in 25 cases of postoperative Complications after
posterior lumber spinal fixation. Results: 25 patients operated upon for posterior lumbar fixation were included in
the present work, In the current work we divided complications of posterior lumbar fixation into intraoperative
complications and postoperative complications, Among the 25 patients of our work we had 5 cases of intraoperative
complications (20 %) and 20 cases of postoperative complications (80%), Dural tear was the most common
intraoperative complications (8%), instrument failure was the most common postoperative complications 12 cases
(48%). Conclusion: According to medical history smoking was statistically significant risk factor for intraoperative
complications; significant epidural bleeding and dural tear. Hypertension was statistically significant risk factor for
intraoperative complications; inappropriate screw insertion and fracture pedicle. Also, smoking was Statistically
significant risk factor for development of postoperative complications; infection, C.S.F leak, infection, nerve root
injury and pseudoarthrosis.
Keywords: Complications of posterior lumber spinal fixation, Management of complications of lumber fixation
INTRODUCTION
those that address how they are inserted and those
Since the 1940's, pedicle screw fixation has
that deal with augmentation techniques (2).
evolved and become increasingly popular among
For increasing safety and reducing
spine surgeons. It designed to provide immediate
complications that may occur with trans-Pedicular
stability and rigid immobilization of the spine without
Screw Placement, different ways have been reported
sacrificing additional motion segments required by
including application of C-arm X-ray view,
other forms of conventional instrumentation. The
application of axial computed tomography scan
design of the pedicle screw continues to be modified
(CTS), frameless stereotactically guided screw
and updated for improved strength and purchase,
placement and different guidance devices. However,
New systems and techniques are continuously
the application of all these devices and techniques are
becoming available, and old systems are being
not so easy and even in many operating rooms such
modified and up-dated (1).
kinds of instruments are not available (3). Pedicle
There are three basic concepts that are
screw systems provide significant and in many cases,
important to the biomechanics of pedicle screw
improved and previously unattainable spinal fixation.
based on instrumentation. First, the outer diameter
However, pedicle screw systems represent difficult
of the screw determines pullout strength, while the
surgical techniques involving several potential
inner diameter determines fatigue strength.
problems and complications. Several different sizes
Secondly, when inserting a pedicle screw, the
and shapes of pedicle screws are available (4).
dorsal cortex of the spine should not be violated
A posterior approach to anterior and
and the screws on each side should converge and
middle column reconstruction is often preferred in
be of good length. Thirdly, fixation can be
the lumbar spine for two reasons, the first is that
augmented in cases of severe osteoporosis or
the morbidity associated with an anterior approach
revision. Studies on the biomechanics of the
is significant and delays recovery, the second is
pedicle screw can be divided into three types: those
that pedicle screws and rods or plates can be placed
that concern the characteristics of the screw itself,
before Dural retraction and dissection of the
intervertebral disk (5).
4786
Received:21/4/2018
Accepted:30/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4792-4799
Role of diffusion weighted MRI in assessment of hypervascular hepatic tumors
Amany M. Abd El-Aziz, Walid R. Abdelaziz, Tarek W. Hemada, Mariam E. Mosaad
Department of Radiodiagnosis, Faculty of Medicine - Ain Shams University
Corresponding author: Mariam E Mosaad; Email: mariam.elsaid10@gmail.com
ABSTRACT
Background: Hypervascular hepatic focal lesions may be benign or malignant. Therapy requires an accurate
diagnosis, which in turn relies primarily on appropriate imaging and image-guided biopsy. MRI having many
sequences, markedly helps in the detection of small lesions and in reaching the diagnosis easily even without
contrast injection or the need for biopsy as in hemangiomas. Aim of the Work: To assess the role of diffusion
weighted MRI imaging in differentiation between various types of hypervascular hepatic tumors. Patients &
Methods: This study included (24) patients, 12 males & 12 females, their ages ranges from 28 to 66 years with a
mean age of 49.5 years. The study was performed in Radiology department at Ain Shams University Hospitals and
some private clinics in addition to National Cancer institute. Results: Highly statistically significant difference
between benign and malignant according to ADC value. Benign lesions have higher mean ADC value compared to
malignant lesions. Conclusion: Diffusion-weighted MRI sequence with quantitative ADC measurements can be
useful in the differentiation of benign and malignant hypervascular hepatic focal lesions. Recommendations: Further
studies on a larger scale of patients are needed to confirm the results obtain by this study.
Key words: DW MRI, hypervascular hepatic tumors
INTRODUCTION
molecules (Brownian motions) which reflects the
Hypervascular
hepatocellular
lesions
structural differences in disease by restricting
include both benign and malignant etiologies. In
diffusion (7). Diffusion is expressed in an apparent
the benign category, focal nodular hyperplasia and
diffusion coefficient (ADC), which reflects the
adenoma are typically hypervascular. Malignant
diffusion properties unique to each type of tissue (5).
hypervascular primary hepatocellular lesions
DWI can be added to the routine
include hepatocellular carcinoma. Also certain
examination easily using recently available
cancers such as metastatic neuroendocrine tumors
machines. This imaging method has a good ability
tend to produce hypervascular metastases due to
to detect liver lesions, and quantitative evaluation
the greater recruitment of arterial blood supply (1).
can be achieved without contrast media (7).
Hepatocellular carcinoma (HCC) is the
The clinical uses of liver DW-MRI include
second leading cause of cancer-related death
improved: 1. detection of focal liver lesions, 2.
worldwide (2) with an estimated 500,000 to 1
contribution to tissue characterization for both diffuse
million deaths per year (3).
disease and focal lesions, 3. monitoring of tumor
Ultrasound is frequently the first-line
response after chemotherapy or radiotherapy,
imaging modality for the study of the liver because
4.detection of recurrent disease, 5. differentiating
of a combination of high spatial resolution and
recurrence from post-therapeutic change, and
inherent soft tissue contrast, lack of ionizing
6.potentially predicting treatment outcome (8).
radiation, low cost, and wide availability. Operator
dependency, substantial image degradation in
AIM OF THE WORK
obese patients, and limited field of view, however,
The aim of the current study was to assess
represent major limitations of this modality
the role of diffusion weighted MRI imaging in
compared with other cross-sectional imaging
differentiation
between
various
types
of
techniques (4).
hypervascular hepatic tumors.
MRI proved to be superior to CT in the
detection of HCC and for the characterization of
PATIENTS AND METHODS
nodules in patients with liver cirrhosis because of
Patients:
the high tissue contrast provided by MRI (5).
This study included 24 patients, 12 males
Nowadays, it plays a key role in management of
& 12 females, their ages ranged from 28 to 66
liver lesions, using a radiation-free technique and a
years with a mean age of 49.5 years.
safe contrast agent profile(6).
The study was performed in Radiology
Diffusion-weighted imaging (DWI) is a
department at Ain Shams University Hospitals and some
relatively recent technological improvement of MRI.
private clinics in addition to National Cancer institute.
It allows the mapping of the free diffusion of water
4792
Received:20/5/2018
Accepted:8/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4800-4807
Study of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as a
predictor inflammatory marker for diabetic nephropathy in type 2 diabetic patients
Ahmed Ateia Abdelaziz1; El-Sayed El-Meghawry El-Sayed2; Tarek Mustafa Emran3 and
Ali Ibrahim Abdallah2
1DepartmentofInternal Medicine; Faculty of Medicine, Al-Azhar University (Cairo), 2Department of Internal Medicine;
3 Department of Clinical Pathology; Damietta Faculty of Medicine, Al-Azhar University
Corresponding author: Ali Ibrahim Abdallah, E-Mail: alilonly6@gmail.com, Mobile: 01012466203
ABSTRACT
Background: Diabetes mellitus (DM) is a systemic disease having serious microvascular and macrovascular
complications. DN in T2DM has an inflammatory pathology. Many inflammatory markers have been found to be related
to DN, such as interleukin1 (IL1), IL6, IL8, transforming growth factor beta 1(TGF-1) and tumor necrosis factor alpha
(TNF ). However, their measurement is not used routinely as it is not easy to do it, in this respect. Search for
inflammatory markers for the disease is a continuous process to enhance the diagnostic and treatment process.
Aim of the Work: To assess neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as a predictor
inflammatory markers for diabetic nephropathy in type 2 diabetic patients.
Patients and Methods: This study is a prospective one that was carried out on one hundred (100) type 2 Diabetes
mellitus (T2DM) patients attending to internal medicine outpatient clinic and inpatient department of internal
medicine at Al-Azhar university hospital, Damietta and twenty five (25) apparently healthy volunteers as a control.
The populations of the study were classified into three groups according to their level of albuminuria. All were
subjected tofull history and Clinical examination, Laboratory tests include Fasting mid-stream urine samples were
obtained and examined for complete urine analysis and albumin/creatinine ratio (UACR),Complete blood count
(CBC), HbA1c,Fasting blood sugar, Renal Function Tests,eGFR and Abdominal ultrasonography, Fundus
examination and ECG and Assessment of NLR &PLR.
Results: Our study showed that there was high statistically significant increased NLR, PLR and UACR in group IB
when compared to group IA, II and III. Also there was statistically significant increased NLR,PLR and UACR in
group IA in comparison to group II and also there was statistically significant increased NLR,PLR and UACR in
group II in comparison to group III.
Conclusion: Neutrophil lymphocyte ratio (NLR) & Platelet lymphocyte ratio (PLR) was significantly associated
with diabetic nephropathy (DN) and high Neutrophil lymphocyte ratio (NLR) & Platelet lymphocyte ratio (PLR)
values may be considered as a predictor and a prognostic risk markers of diabetic nephropathy (DN).
Keywords: Albuminuria; diabetic nephropathy; inflammation; neutrophil/lymphocyte ratio; platets/lymphocyte ratio
INTRODUCTION
Rudiger et al.(5) showed that the relationship
Diabetes mellitus (DM) is a systemic disease
between systemic inflammation and vascular disease
having serious microvascular and macrovascular
indicated that chronic inflammation promotes the
complications. Microvascular complications include
development and acceleration of micro and macro
diabetic nephropathy (DN), diabetic retinopathy, and
angiopathic complications in patients with diabetes.
diabetic
neuropathy
while
macrovascular
Also Rudiger et al.(5) confirmed that Total white
complications include stroke, cardiovascular diseases
blood cell (TWBC) count is a crude but sensitive
(CVDs), and peripheral vascular diseases (1).Diabetic
indicator of inflammation which can be done easily in
nephropathy (DN) is a clinical syndrome
laboratory routinely, being also a cost effective
characterized by persistent albuminuria (>300 mg/24
investigation and showing increase in the neutrophil
hr, or 300 mg/g creatinine), a progressive decline in
count in thrombus formation and ischemic diseases.
glomerular
filtration
rate
(GFR),
arterial
The neutrophil lymphocyte ratio (NLR) in complete
hypertension, increased cardiovascular morbidity and
blood count is studied in many cardiac and non-
mortality and eventually end stage renal disease
cardiac diseases as an inflammatory marker and is
(ESRD) (2). The degree of albuminuria is not
used to predict the prognosis of diseases.
necessarily linked to disease progression in patients
White blood cell and differential count can
with DN associated with either type 1 or type 2
be done as a part of routine automated hematology
diabetes mellitus (T2DM)(3).
analyzer. Recently, neutrophil lymphocyte ratio
Diabetic nephropathy affects approximately
(NLR) has been evaluated and used as inflammatory
25% of patients with T2DM and represents the
marker in malignancies, infection and coronary artery
leading cause of ESRD (4).
diseases (6). In addition Celikbilek et al.(7) observed
that Neutrophil/lymphocyte ratio (NLR) possesses a
4800
Received:17/6/2018
Accepted:26/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4808-4814
Electrosurgical Unipolar Vessel Sealing Versus Purohit Technique in Vaginal
Hysterectomy (A Pilot Randomized Clinical Trial)
Ihab H Abdel Fattah, AmrA Nadim, Ahmed A Tharwat, Amr H Yehia,
Alaa M El-din
Department of Obstetrics and Gynecology,Faculty of Medicine Ain Shams University
Corresponding author: Alaa M El-din; Mobile: 01001886343; Email: dralaamatef@gmail.com
ABSTRACT
Background: Vaginal hysterectomy should be performed in preference to abdominal hysterectomy, where
possible as it has benefits; quicker return to normal activities, fewer complications, shorter operative time, less
blood loss, and a shorter stay in hospital. Also, it is preferred to laparoscopic-assisted vaginal hysterectomy
because of fewer bladder or ureteric damage as well as a shorter operating time and learning curve. Aim of the
Work: To compare the between using unipolar electrocautery versus Purohit technique in vaginal
hysterectomy as regards operative time. Patients and Methods: This pilot prospective randomized clinical
trial was conducted at Ain Shams University Maternity and Womens Hospital during the period from June
2016 to February 2018. This study included patients presenting to the outpatient gynecologic clinic of Ain
Shams University Maternity and Womens Hospital and planned to have vaginal hysterectomy for benign
cause. Results: both total operative time and pedicle securing time were significantly longer in the Purohit
technique group compared to the unipolar electrocautery group (P <0.001). Conclusion: using unipolar
electrocautery significantly reduces total operative time than using bipolar electrocautery without increasing
rate of complications nor does it cause specific type of complications provided that special precautions are
taken to avoid thermal effect on nearby structures. Recommendations: using unipolar electrocautery is
recommended by well trained hands in suitable patient and should be offered for training by other surgeons of
different levels to judge learning curve. Further studies with inclusion of patients having larger sizes of uteri
using the same technique. Further settings with higher cautery up to 50W were found to be safe for further
analysis.
Key words: Unipolar electrocautery, Purohit technique, vaginal hysterectomy
INTRODUCTION
activities, fewer complications, shorter operative time,
Hysterectomy is the most frequently performed
less blood loss, and a shorter stay in hospital compared
major gynecological operation in the world. For benign
to abdominal hysterectomy (5,6,7).This is endorsed in the
situations, hysterectomy is most usually done using
National Institute of Clinical Excellence (NICE)
either the abdominal or vaginal method. Nevertheless, a
guidelines on heavy menstrual bleeding and in a meta-
small proportion of women with benign conditions
analysis review of the Cochrane database. Also, vaginal
undergo laparoscopic hysterectomy, which was
hysterectomy was preferred to laparoscopic-assisted
introduced in the 1980s in the United States (1).
vaginal hysterectomy because of fewer bladder or
ureteric damage as well as a shorter operating time and
The American Col ege of Obstetrics and
learning curve (8).
Gynecology recommended the vaginal route in case of uteri
weighing 280gm or less which is about 12 weeks size (2).
The American Association of Gynecologic
Laparo-scopists
(AAGL)(9)
highlight
that
The experience of the surgeon and the
hysterectomy for benign uterine disease should be
knowledge of using surgical techniques as morcellation,
performed either vaginally or laparoscopically. This
bisection and myomectomy can overcome difficulties in
affirms the American College of Obstetricians and
dealing with large uteri vaginally (3).
Gynaecologists (ACOG) statement that the vaginal
Vaginal hysterectomy is the method of choice
approach should be primary whenever feasible due to
for gynecologists who carry out hysterectomies.
better patient outcomes and fewer complications than
Undertaking this procedure regularly will enhance the
laparoscopic or abdominal surgery.
gynecologists level of skill and enable conditions such
The overall incidence of major complications
as ovarian cysts, broad ligament fibroids and other
in vaginal hysterectomy is 4%, improvements can be
adnexal pathology to be dealt with vaginally during
done to reduce the complication rate in vaginal
hysterectomy surgery without abdominal invasion (4).
hysterectomy specially by carrying out careful patient
Vaginal hysterectomy should be performed in
selection, proper and thorough pre-operative
preference to abdominal hysterectomy, where possible.
assessment, expert surgical techniques and vigilant
Vaginal hysterectomy means quicker return to normal
post-operative care (1).
4808
Received:12/6/2018
Accepted:21/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4815-4820
Breastfeeding of mothers attending the outpatient clinic of Reina Sofia University
Hospital (Cordoba, Spain)
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: fm2faahm@gmail.com and farouk.allam@med.asu.edu.eg; Phone/Fax: +(202) 24346888; Mobile: + (2) 011 43559946
ABSTRACT
Background: Although the beneficial effects of breastfeeding are well-known, the prevalence of breastfeeding
in many developed countries is quite low. Objective: The objective of this study was to estimate the
prevalence of breastfeeding in the catchment area of Reina Sofia University Hospital of Cordoba (Spain).
Materials and Methods: A cross sectional study was conducted for mothers attending the outpatient clinic of
Reina Sofia University Hospital of Cordoba, for follow-up after 6 weeks of delivery. All mothers attending the
outpatient clinic over 3 months accepted to participate in the study. Finally, we had a sample of 91 mothers.
Study variables were age, educational level, gestational weeks, type of delivery, gender and weight of the new
born, type of feeding for the baby over the first 6 weeks of his/her life, motives for abandoning breastfeeding,
and motives for selecting the artificial formula. The information was collected through a previously validated
interview questionnaire. Results: The mean age of the mothers was 31.8 (SD 3.13) years old. About 67% of
mothers selected exclusive breastfeeding and 4.39% selected the combination of breastfeeding with the
artificial formula. More than 28% of mothers selected the artificial formula. The reasons for selecting the
artificial formula were own decision (46.15%), medical recommendation (11.53%), lack of breast milk
(3.84%). The remaining 23.1% of mothers who selected the artificial formula refused to answer this question.
Conclusions: Our results show that only two-third of mothers adopted breastfeeding in the first 6 weeks after
delivery. Health education and promotion programmes for breastfeeding are urgently needed.
Keywords: Breastfeeding, Artificial Formula, Cross sectional, Cordoba, Spain.
INTRODUCTION
conducted at 151 primary care trusts in England
The World Health Organization (WHO)
2010-2011 (14).
recommends exclusive breastfeeding in the first 6
In the United States of America (USA),
months of life (1,2).
about 81.1% of infants born in 2013 had
Several studies showed short and long
breastfeeding in the first 4 weeks of their lives.
terms beneficial effects on health of new-borns and
This prevalence decreased to 51.8% at 6 months
mothers (2). Early beneficial effects include
and to 30.7% at 12 months (12).
lowering mortalities in premature new-borns (2,3)
In a recent study conducted in Cyprus,
and lowering infantile morbidities due to
about 84.3% of mothers initiated breastfeeding
gastrointestinal tract, respiratory and urinary tract
after delivery and before hospital discharge. This
infections, together with atopic skin diseases (4,5,6,7).
prevalence deceased at the sixth month to 32.4%,
Also, many investigations showed that
with the highest decrease reported between the first
exclusive breastfeeding is associated with low rates
and fourth months (15).
of communicable disease in the first 6 months of
Many mothers agree to breastfeed their
life (8,9,10).
new-borns during only a limited period of time and
The
beneficial
health
effects
of
others do not even initiate breastfeeding. There are
breastfeeding for new-borns explain the national
many reported factors which could influences in
and international supports to initiate and continue
the early of cessation of breastfeeding. However,
breastfeeding for all new-borns (1,3,11,12,13).
many studies showed that many mothers feel
disappointed because they did not continue
Although the beneficial effects of
breastfeeding for longer periods (16,17,18,19).
breastfeeding are well-known, the prevalence of
breastfeeding in many developed countries is quite
Based on the results of the previous
low. In England, breastfeeding initiation was 72%
studies, it is clear that it is necessary to evaluate the
and exclusive breastfeeding at 6-8 weeks decreased
current situation of the breastfeeding in Andalusia
to 32%. These results were obtained from a study
in general and in Cordoba in particular. So, the
objective of this study is to estimate the prevalence
4815
Received:5/5/2018
Accepted:14/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4821-4825
Multiple Myeloma: A retrospective Analysis of the Patients Treated at Ain Shams
University Clinical Oncology Department with a Review of the Literature
Khaled Abdel Karim, Mohamed Yassin Mostafa, Khaled Kamal El-Din Elghoniemy, Moushira Esmail
Hassan El-Sakka
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine - Ain Shams University
Corresponding author: Moushira E.H. El-Sakka, Mobile: 01015134301; Email: moushiraesmail@yahoo.com
ABSTRACT
Background: multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone
marrow leading to bone destruction and marrow failure. Multiple myeloma accounts for about 1.8% of all
cancers and slightly over 17% of all the hematologic malignancies in the United States. It is more common in
men and for unknown reasons.
Objective: this study aims at analysis the epidemiological data of the patients treated from multiple myeloma
at Ain Shams University together with reviewing the different lines of management according to recent
recommendations.
Patients and Methods: this retrospective analysis of 62 patients with multiple myloma data recorded at their
files with follow up and reviews of the recent advances in the management of multiple myeloma.
Results: we found that 96.8% of patients showing clinical improvement after treatment on other hand only
3.2% deteriorated, 61.35 of patients were alive, 9.7% died and 29% lost follow up, the mean time to DFS was
22.55 months, mean OS was 63.2 months with 87.8% of patients survived at the end of the study, as regard
mean PFS was 54.9 months with PFS at end of study was 74.9% of patients, there was insignificant differences
between OS and demographic data, laboratory studies, there was insignificant differences between PFS and
demographic data, laboratory studies.
Conclusion: Multiple myeloma (MM) is a heterogeneous hematologic malignancy involving the proliferation
of plasma cells derived by different genetic events contributing to the development, progression, and prognosis
of this disease.
Key words: Multiple myeloma, Kahler's disease, Egyptian patients, prognostic factors.
INTRODUCTION
AIM OF THE WORK
Multiple myeloma (MM) is a malignant
neoplasm of plasma cells that accumulate in bone
This study aims at analysing the
marrow leading to bone destruction and marrow
epidemiological data of the patients treated from
failure (1).
multiple myeloma at Ain Shams University
together with reviewing the different lines of
Most cases of multiple myeloma also
management according to recent recommendations.
feature the production of a para protein (an
abnormal antibody) which can cause kidney
PATIENTS AND METHODS
problems. Bone lesions and hypercalcemia are also
often encountered (2).
After approval of the local ethics
committee, no need for informed consent forms
Multiple myeloma accounts for about 1.8%
from the patients as the study has no risk of harm
of all cancers and slightly over 17% of all the
to any of the study subjects.
hematologic malignancies in the United States.
Myeloma is most frequently diagnosed among
We retrospectively reviewed the records
people aged from 65 to 74 years with median age
of 62 consecutive patients with MM who treated at
69 years. About 30,280 new myeloma cases have
Ain
Shams
University
clinical
oncology
been estimated in the United States in 2017 with an
department during the period from January 2011 to
estimated 12,590 deaths (1).
December 2015 . The data recorded at their files
with follow up and reviews of the recent advances
It is more common in men and for
in the management of multiple myeloma.
unknown reasons, is twice as common in African
Americans as it is in White Americans. With
The patients were analyzed with respect to
conventional treatment, median survival is 34
the demographic profile, staging system, diagnosis,
years, which may be extended to 57 years or
treatment
details
and
survival
outcome.
longer with advanced treatments (3).
Cytogenetic analysis was not performed routinely
in our institution.
4821
Received:15/6/2018
Accepted:24/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4826-4830
Efficacy and safety of Thulium Laser for Treatment of short segment
bulbomembranous Urethral Stricture
Efficacy and safety of Thulium Laser for Treatment of short segment bulbomembranous Urethral
Stricture
Urology Department, Faculty of Medicine, Al_Azhar University, Damietta, Egypt
Corresponding author: Mohamed Farid Ali Ebrahim, E-mail: kokmfa3@gmail.com, Tel: 00201004063660
ABSTRACT
Background: Evaluation of outcome of thulium laser urethrotomy for patients with urethral strictureas a
minimally invasive treatment for urethral stricture. Objective: The purpose of this study was to evaluate
Efficacy and safety of Thulium Laser for treatment of short segment bulbomembranous Urethral Stricture.
Patient and methods: A prospective non controlled study conducted on twenty patients with urethral stricture
selected from outpatient clinic of Al-Azhar-university hospital New Damietta in duration between June 2017
and July 2018. Evaluated by retrograde urethrography, uroflowmetry, International Prostate SymptomScore
(IPSS), Sexual function assessment: International Index of Erectile Function (IIEF), Male Sexual Health
Questionnaire (M.S.H.Q)] and quality of life preoperatively. All patients were treated with thulium laser
urethrotomy. All patients were followed up for 6 months postoperatively by uroflowmetry and by retrograde
urethrography after 6 months. And all patients were followed up by mailed questionnaire, including IPSS
(International prostate symptom score), (IIEF), (M.S.H.Q) and quality of life. Result: Thulium laser
urethrotomy was performed in all 20 cases. The mean operative time was 23.7±4.5 minutes range (1530
minutes). No intraoperative complications were encountered. Despite perioperative antibiotics, 15% of the
patients developed urinary tract infection postoperatively that was managed with antibiotics accordingto urine
culture sensitivity. Stricture treatment was successful in 17 patients (85%). three patient developed recurrent
stricture treated with urethral dilation. In 17 patient the postoperative mean Qave (average urine flow) >
12.3±3.6 ml /second (P <0.05) and adequate caliber urethra in retrograde urethrogram (RUG) 6 months after
operation.Three patients (15%) showed narrow stream of urine )Qave) average urine flow <8.0 ml/second) and
performed urethral dilation 1 time every month for 4 months. The average postoperative Qmax (the maximum
flow rate) was 21.7±2.1 ml/second (P <0.05) with insignificant PVR urine. The mean postoperative IPSS was
2.6±1.2 (P <0.05). Conclusion: We demonstrated that thulium laser endourethrotomy was a reliable and safe
therapy with minimal invasive therapeutic modality for urethral strictures.
Keywords: urethral stricture; urethrotomy; laser surgery;thulium.
INTRODUCTION
sufficient hemostasis, a clear visual field, and fast
Urethral stricture is one of the most difficult
tissue incision with little thermal damage (9).
urological problems to cure adequately and is
Disadvantage of other type of laser. This laser energy
known to mankind since ages as it has been
is delivered most commonly in a pulsatile manner,
documented in ancient literature of the Hindus,
using athermomechanical mechanism of action. It
Egyptians and Greeks (1,2). Different techniques used
superheats water, which heavily absorbs light energy at
for the treatment of urethral strictures, depending on
this wavelength. This creates a vaporization bubbleat
the stricture length, location, and depth of scar,
the tip of a lowwater density quartz or silica fiber
which include: simple dilatation, visual urethrotomy,
used for delivery. This vapor bubble expands rapidly
uroLume stent placement urethroplasty, perineal
and destabilizes the molecules it contacts. This is ideal
urethrostomy and laser endourethrotomy (3,4). The
for lithotripsy of all stone types better than tissue (10).
types of lasers that have been used for urethrotomy
include: carbon dioxide, Nd: YAG, the KTP, the
PATIENTS AND METHODS
Argon, and the Ho: YAG and excimer laser (4,5).
There were 20 male patients with urethral
Thulium LASER is a continuous laser with a
stricture disease treated with thulium laser
wave length of 2,013nm that achieves a shallow tissue
endourethrotomy at Al-Azhar university hospital,
penetration of less than 0.4 nm (6). Compared to
New Damietta in duration between June 2017 and
holmium there is less mechanical effect but a higher
July 2018. The average age of the patients was
production of continuous heat (7). The thulium laser has
45.2±11.14 years (range 2735 years). The average
several theoretical advantages over the holmium laser
course of disease was 10 years (range 1 month30
such as rapid and efficient vaporization and
years). The diagnosis of urethral stricture was
coagulation as well as tissue incision (8). Water
based on history of illness, symptom scores,
absorption peak in the tissue at 1.92 mm, result in
uroflowmetry, and retrograde urethrography.
4826
Received:16/6/2018
Accepted:25/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4831-4835
Diabetic ketoacidosis; Annual Incidence and Precipitating Factors at King
Abdulaziz Medical city, Jeddah
Shahd Alahmadi1, Aliya Ragaban2, Shahd Alblowi2, Entisar Aljumail3, Hawazen Zarif4
1Ibn Sina National College for Medical Studies,2King Abdulaziz University Hospital,3 Qassim University,4 King
Saud University for Health Science
ABSTRACT
Introduction: Diabetes is a recognizable and major health burden in Saudi Arabia. The incidence of Diabetes
Mellitus Type 1 (DM1) reached 109.5 per 100,000 child and adolescent. One of the major life-threatening
complications of DM1 is Diabetic Ketoacidosis (DKA). This study aims to estimate DKA incidence among
DM1 patients and possible risk factors.
Methods: Retrospective review for DM1 patients at King Abdul-Aziz Medical City, and who was presented
with DKA during the past six and half years.
Results: Three hundred and fifty DM1 patients were included and (72) experienced DKA during study period.
The average annual DKA onset was (6.2%). Mean age was (22.82 ± 5.567) years, and females constituted
(66.7%) of this group. Poor medication compliance was the commonest risk factor associated with DKA, and
this relationship was found significant (P-value 0.003). Out of the total DKA sufferers, (28) patients
experienced recurrent or multiple DKA episodes, and those had higher HbA1C levels (11.7 ± 2.9 Vs 12.4 ±
3.3). Patients who had multiple DKA episodes reported less visits to the diabetes educator when compared to
the single DKA group. (On average (9) Vs (11) per year).
Conclusion: DKA was found relatively uncommon among our DM1 patients, and usually seen in young
females with poor medication compliance. More comprehensive education on DKA is needed to protect
against life threatening complications.
Key-words: IDDM Diabetic Ketoacidosis (DKA) Diabetic Education
INTRODUCTION
massive elevation of glucose and ketones blood levels
(6)
Diabetes is a recognizable and major health
. Patients mostly present with polyuria, polydipsia,
burden in Saudi Arabia. In fact, more than 3.4
vomiting, and abdominal pain. The resultant
million citizens were diagnosed with diabetes in the
dehydration and metabolic acidosis can result in
year 2015 (1,2). Many factors have been implicated in
tachycardia, hyperventilation, confusion and in severe
the etiology of the disease, and all are directly
forms coma and death (6). DKA can be the first
related to disorders of insulin production, action or
presentation for non-diagnosed DM1patients, and one
both. The resulting failure of glucose uptake by
third of DM1 patients' admissions to the Intensive
human cells leading to hyperglycemia, can start a
Care Units are due to severe DKA, with a (13%) in-
series of serious metabolic changes and chronic
hospital mortality rate (8). Globally, researchers have
organ dysfunctions. Different categories of diabetes
studied factors attributed to recurrent DKA onsets,
were identified: Type (1), Type (2), gestational
such as: medication non-compliance, infections,
diabetes, plus forms resulting from other conditions
mental health issues and stress, and even other
such as pancreatitis or consumptions of large doses
demographic factors such as age and gender (7), and
of exogenous steroids. As one of the most prevalent
despite classifying Saudi Arabia among the top three
chronic conditions in our region, all these types of
countries with highest incidence of DKA presentations
diabetes are encountered in Saudi Arabia.
in the region, a limited number of studies focused on
The Insulin Dependent Diabetes Mellitus
describing and quantifying DKA occurrence. This
(IDDM) or Diabetes Mellitus type 1 (DM1) is an
study aims to estimate DKA incidence among DM1
autoimmune disease which targets insulin-
patients at King Abdulaziz Medical City (KAMC),
producing, pancreatic _cells, and although its
describe episodes' characteristics including recurrence,
incidence is variable across different populations, it
and identify possible risk factors.
is predominant among younger age groups (3,4). In
PATIENTS AND METHODS
Saudi Arabia, a research conducted between the
years 2001-2007 reported DM1 incidence to be
The study was a two months' retrospective
109.5 per 100,000 child and adolescent (5).
review, for DM1 patients registered and followed at
One
of
the
major
life-threatening
King Abdulaziz Medical City (KAMC) in Jeddah,
complications of DM1is Diabetic Ketoacidosis (DKA).
between the first of January 2010 and until the end
DKA is an acute metabolic state characterized by
of June 2016. We reviewed electronic files of all
patients admitted between the ages of 14-40, and
4831
Received:15/5/2018
Accepted:24/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4836-4842
Prevalence and possible risk factor of social phobia among male secondary and
intermediate school students in Al-Medinah, 2016
Basem Musllam Aljohani, 1Amani Mahrus
1Family Medicine resident (R4), Ministry of Health, Postgraduate program of Family Medicine, Al-Madinah,
2Family Medicine consultant, Family Medicine department, Prince Mohammed Bin Abdul Aziz hospital, Al-
Madinah, Saudi Arabia
Corresponding author: Basem Musllam Aljohani, Email: Dr.johanifm@gmail.com, mobile: 00966561040789
ABSTRACT
Background: When prevalence estimated was based on the examination of psychiatric clinic samples, social
anxiety disorder was thought to be a relatively rare disorder. The opposite was instead true; social anxiety was
common but may be were afraid to seek psychiatric help, leading to an underestimation of the problem.
Objectives: To determine the prevalence and possible risk factors of social phobia among intermediate and
secondary school male students in Almadinah city.
Subjects and methods: A cross-sectional study was conducted included a random representative sample of
male students enrolled in intermediate and secondary governmental schools in Al-Madinah city throughout the
scholastic year 1436-1437 H (2014-2015).The social phobia Inventory (SPIN) scale was utilized to diagnose
social phobia at a cut-off value of 19 whereas the Social Phobia Risk Factors Questionnaire (SPRFQ) was
applied to assess risk factors for social phobia.
Results: The study included 425 students; 258 were recruited from intermediate schools (60.7%) and the
remaining 167 (39.3%) from secondary schools. Their age ranged between 12 and 22 years with a mean of
15.75 and standard deviation of ±1.94 years. Social phobia was identified among 29.5% of intermediate school
students compared to 18.6% of secondary school students. The difference was statistically significant,
p=0.011.Multivariate logistic regression analysis revealed that intermediate school students who had close
friends with social phobia, those frequently experienced battering, bullying and humiliation, those experienced
withdrawal and fear when facing new situation or people at least in the past 6 months. Students who have
problems with their fathers and first born students were more significantly like to develop social phobia
compared to their counterparts whereas secondary school students who frequently experienced battering, those
experienced shyness when facing new situation or people at least in the past 6 months and first born students
were more significantly like to develop social phobia compared to their counterparts.
Conclusion: The prevalence of social anxiety disorder among the intermediate and secondary school students
in Al-Madinah city is high. Important significant risk factors for social phobia have been identified.
Keywords: Social phobia, male, school adolescents, prevalence, risk factors, Saudi Arabia
INTRODUCTION
humiliating or embarrassing. The DSM-IV(4) gave SP
The usual fear of "being stared at" is
alternative name "Social Anxiety Disorder"
common to most of us. The ordinary normal social
Patients with social phobia tend to interpret
talks usually involve being under the gaze of
neutral or ambiguous conversation with a negative
strangers, friends, people whom we do not know,
outlook although still inconclusive. Some studies
and colleagues. These interactions are usually
suggest that socially anxious individuals remember
navigated without our conscious thoughts (1). Most
more negative memories than those less distressed.
people express their social discomfort while being
An example of an instance may be that of an
under public scrutiny(2).
employee presenting to this co-works. During the
Social phobia (SP), however, is the
presentation, the person may stutter a word upon
excessive fear that a performance or social inter-
which he or she my worry that other people
action of a certain person would be inadequate,
significantly noticed and think that he or she is a
embarrassing, or humiliating. People with SP avert
terrible presenter. This cognitive thought propels
their gaze from their audience and often avoid a
further anxiety which nay lead to further stuttering,
feared social settings (3).
sweating and a possible panic attack (5).
According to diagnostic and statistical of
Social anxiety disorder is a persistent fear of
mental disorders(4), social phobia is a persistent fear of
one or more situation in which the person is exposed
one or more situations in which the person is exposed
to possible scrutiny by others and fear that he or she
to possible scrutiny by others and fears that he or she
may do something or act in a way that will be
may do something or act in a way that will be
humiliating or embarrassing. It exceeds normal
"shyness" as it lead to excessive social avoidance and
4836
Received:14/5/2018
Accepted:23/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4843-4852
Clinical Comparative Study Between Dexmedetomidine, Magnesium sulphate and
Ketofol versus Midazolam for Sedation During Awake Fiberoptic Nasotracheal
Intubation in Predicted Difficult Air ways Patients
Mostafa I. Shalaby, Maamoun M. Ismael, Ahmed S.A. Nasr, Mohammad H.M. Alqassas
Anathesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mohammad H.M. Alqassas, Mobile: 01129939569; Email: dr.qassas1984@gmail.com
ABSTRACT
Background and objectives: Awake fiber optic intubation (AFOI) is recommended technique in securing the
airway in predicted difficult airway patients with sedation. However, it is not easy to achieve a comfortable
sedation so conscious sedation is the key for a successful AFOI. The goal of the study to compare different
conscious sedation strategies aimed to improve comfort and safety in patients prepared for elective surgeries.
Subjects and Methods: Case control, randomized controlled study in predicted difficult airway patients
scheduled for elective surgery under GA carried out at AL-Azhar University Hospitals after approval by the
local ethical committee. 120 patients of age group 18-60 years old with ASA I and II prepared for nasal
(AFOI) under conscious sedation after giving their informed written consent to participate in our study. The
patients were randomly assigned into 4 groups: Group dexmedetomidine (DEX), group ketofol, group
magnesium sulfate and group midazolam. HR, MAP, Oxygen saturation and end tidal CO2 were monitored.
Sedation score, patient tolerance, patient satisfaction and intubation score (vocal cord movement and
coughing) were assessed.
Results: All patients were successfully intubated by fiber optic and none of them developed bradycardia or
reduced MAP more than 20% from the base line during intubation. Group DEX mild decrease in MAP and HR
(<10% fall when compared with the baseline value) after loading of drug and during intubation in contrast to
midazolam, ketofol and magnesium sulphate, which increase during intubation. There was no statistically
significant difference in the intubation scores, grimace score, time of intubation, number of attempts and
saturation in between the groups with one episode of desaturation in group ketofol and two in group
midazolam (P > 0.05). Group ketofol and midazolam patients were sedated deeper after the start of the study
drugs than group DEX and none of the patients were sedated to a score of < 2 (modified OAA/S score) in
either of the groups. Group magnesium showed lighter sedation level significantly different with other groups.
Conclusion: Study showed DEX provides optimum sedation without compromising airway or hemodynamic
stability with favorable intubation time and less intubation attempts during AFOI in comparison to magnesium
sulphate, ketofol and midazolam patients with better patient tolerance and satisfaction.
Keywords: (AFOI) Awake fiberoptic intubation, (DI) difficult intubation, (DEX) dexmedetomidine.
INTRODUCTION
especially
when
used
in
higher
doses.
Fiber optic intubation is a valuable
Dexmedetomidine, an 2-adrenoreceptor agonist, is a
technique in securing the airway in predicted
valuable drug for fiber optic intubation as it induces
difficult intubation scenario, compromised airway,
sedation and analgesia without depressing respiratory
lower airway pathology and when neck extension
function (2).
is to be avoided (1).
In addition, xerostomia is commonly
Awake fiber optic intubation (AFOI) is
reported by patients. These two effects make
used in patients with predicted difficult airway
dexmedetomidine highly desirable for awake
management. This study aimed to compare different
fiberoptic nasotracheal intubation (3).
conscious sedation strategies in order to improve
Conscious sedation is achieved by injection of
comfort and safety in patient prepared for elective
dexmedetomidine at 6 mcg/kg/hr. Sedation is assessed
surgeries. In awake fiber optic intubation under
with the Richmond agitation-sedation scale (RASS) (4).
intravenous (IV) sedation patient should remain calm,
After 10 minutes of dexmedetomidine infusion, the
fall asleep if undisturbed and follow verbal
RASS score was 0 to -1, and the dose of
commands. An ideal sedation regime should provide
dexmedetomidine was decreased to 0.4 mcg/kg/hr. The
patient comfort, cooperation, amnesia, hemodynamic
fiberoptic bronchoscope was inserted through the ET
stability, blunt airway reflexes and maintain a patent
tube or before ET tube insertion (the endotracheal tube
airway with spontaneous ventilation. Available
inserted over the endoscope with the objective of rail
conventional sedatives such as benzodiazepines,
roading it). The epiglottis and vocal cords were
opioids and propofol cause respiratory depression,
visualized, and an attempt was made to insert the ET
4843
Received:28/5/2018
Accepted:7/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4853-4855
Retropharyngeal calcific tendonitis complicated by retropharyngeal
abscess: Case report
Nawal Mohammed Alhulaimy1, Nadia Mohammed Albraheem2
1Aljabr hospital in KSA, 2King Faisal University.
Corresponding author: Nadia Mohammed Albraheem, E.mail: n.g.e.a.h.123@hotmail.com
ABSTRACT
Background: Retropharyngeal calcific tendonitis is defined as an uncommon and self-limiting inflammatory
process of the superior oblique tendons of the longus colli muscle. It is considered as one of the differential
diagnosis of retropharyngeal fluid collection. Furthermore, it causes neck pain resulting in limitation of the
range of motion due to calcification of longus colli muscle and accumulation of sterile effusions. It is very
important to have a definitive diagnosis by using computed tomography (CT) because the symptoms of
retropharyngeal calcific tendonitis can resemble other serious conditions such as retropharyngeal abscess, thus
it will affect the management plan. Retropharyngeal calcific tendonitis does not require surgical treatment; it is
treated medically using non-steroidal anti-inflammatory medications. On the other hand, retropharyngeal
abscess required incision and drainage. In this study, we discuss one case of retropharyngeal calcific tendonitis
complicated by retropharyngeal abscess, discussing key radiologic features, and treatment options.
Key-words: Retropharyngeal space, Calcific tendonitis, Longus colli muscle, Abscess
INTRODUCTION
palpable nor any lymph-adenopathy. Brudzenski's
We present this case which was initially
and kernig's signs were negative.
diagnosed as retropharyngeal abscess according to
Fibro-optic endoscopy findings: mild
the first presentations. After further investigations
bulging of the posterior pharyngeal walls seen,
the patient was found to have retropharyngeal
causing mild airway compression, laryngeal
calcific tendonitis (RCT) complicated by
structures appeared normal.
retropharyngeal abscess. The mean annual crude
Treatment course:
retropharyngeal calcific tendinitis incidence was
0.50 cases per 100,000 person/years, and the
Immediately Ceftazidime and Clindamycin
standardized incidence was 1.31 for the age-
were started and CT scan of head & neck was done
matched population [1]. The purpose of this case
(figure 1) and showed pre-vertebral fluid collection,
report is to highlight the diagnostic features that
big osteophyte and airway compression.
will help the surgeon to give a definitive diagnosis
On the next day, patient condition started
that will minimize the risk of unnecessary
to worsen, he complained of shortness of breath.
operative interventions and manage the patient
Under general anaesthesia: trans-oral incision and
medically according to the severity of the case.
drainage was done and a drain kept for 3 days. The
Finally, it is important to differentiate between
drained fluid appeared milky and we took swabs
retropharyngeal abscess and RCT in order to set the
for C/S, TB and cytology. The patient symptoms
suitable management plan as the RCT is not very
started to improve immediately after the surgery
rare and cases are rather under-diagnosed.
but after 4 days he started to deteriorate. Follow up
CT Images showed a clear retro-pharyngeal space
CASE HISTORY
but persistent mediastinal fluid (figure 2).
A 52-year-old male presented to our
Thoracic surgeon, neuro-surgeon and
Emergency Room complaining of severe dysphagia,
infectious disease specialties had involved in this
neck pain and restricted neck movement for 9 days,
case, they agreed to manage the case medically by
but no significant airway compromising symptoms.
changing the Ceftazidine to Tazocin. Culture result
He is a known case of diabetes and hypertension on
was negative for bacteria and AFB stain. Patient
medical treatment with poorly controlled blood sugar
remained in the hospital for 2 weeks on antibiotics
level. He denied any history of fever, upper
and he responded well clinically.
respiratory tract infection or dental problem.
On examination, his vital signs were
normal, positive neck rigidity and tender neck
muscle mainly at the right side associated with loss
of the laryngeal crepitus, but no definite mass
4853
Received:16/5/2018
Accepted:25/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4856-4865
Maternal and fetal outcomes in women undergoing caesarean section under
general and spinal anesthesia
Mohamed Ahmed Elkady1; Mohammed HussainMostafa1; Mahmoud Hasan Mohamed1; Hanan
Mohammed Ateeyah2
1Faculty of Medicine - Ain Shams University, Professor of Obstetrics & Gynecology department
2M.B.B.Ch, (2007)-AL-Mergeb University
Corresponding: Hanan Mohammed Ateeyah, email: hakeim1980@gmail.com, Tel: +202 01120222751
ABSTRACT
Background: Both spinal and general anaesthesia used for caesarean section have certain advantages and
disadvantages and there is no method which is completely ideal. The most important factors for choice of
anaesthesia are; pregnant systemic problems and wishes, the urgency of the operation, and the surgeon and the
anesthetists experience.
Aim of the Work: These studies aimed at comparing maternal and fetal outcomes in women undergoing
elective caesarean section and have spinal anaesthesia with those having general anaesthesia.
Subjects and Methods: This study was carried out at Ain Shams University Maternity Hospital during the
period from December 2017 to August 2018 after approval of the hospital health ethical committee. It included
186 patients who had C.S and were subdivided into 2 groups according to a randomization scale. On the day of
the operation, each randomly received a closed opaque envelope for the selection of the procedure (spinal
versus general).
Results: We noted that the mean haemoglobin and haematocrit values at the 24th hour were higher in the
spinal anaesthesia group. The estimated blood loss volume was significantly higher in the general anaesthesia
group. The median apgar score at the first and the fifth minutes were significantly higher, and the time that
elapsed until the first requirement for analgesia was significantly longer in the spinal anaesthesia group.
Conclusion and Recommendations: General anaesthesia could be thought the quickest anaesthesia method in
an emergency since it avoids the possibility of a failed regional block. Meanwhile, it is associated with higher
possibility of blood loss and low Apgar score. Thus, using spinal anaesthesia for elective caesarean section is
recommended provided that adequate maternal hydration is established and sparing general anaesthesia for
emergency caesarean sections or whenever spinal anaesthesia is contraindicated (e.g. coagulopathy, sever
thrombocytopenia, anticoagulation or sever degree of malformation of spine).
Keywords: Accidental awareness during general anesthesia; combined spinal and epidural; General anesthesia.
INTRODUCTION
When medically justified, caesarean
Delivery by caesarean section is by far
section can effectively prevent maternal and
one of the most commonly performed operations
perinatal mortality and morbidity. However, there
all over the world. Approximately 18.5 million
is no evidence showing the benefits of caesarean
caesarean sections are performed yearly
delivery for women or infants who do not require
worldwide (1).
the procedure. As with any surgery, caesarean
sections are associated with short and long term
About 40% of the countries have CS rates
risk which can extend many years beyond the
<10%, about 10% have CS rates between 10 and
current delivery and affect the health of the
15%, and approximately 50% have CS rates>15%.
woman, her child and future pregnancies. These
Countries with CS rates <10% account for only
risks are higher in woman with limited access to
25% (4.5 millions) of the global CS but for 60%
comprehensive obstetric care (3).
(77 millions) of the total number births worldwide.
On the other hand, 73% (13.5millions) of the total
This
operation
requires
effective
number of CS are performed in the countries with
anaesthesia which can be regional (epidural or
CS rates >15% where 37.5% (48.4 millions) of the
spinal) or a general anaesthesia. The type of
total number of births occur (1).
anaesthesia used and the care with which it is
administered is an important determine of the
In Egypt, more than one-half of deliveries
outcome of caesarean section (4).
in the five-year period before the 2014 were by
caesarean section. Caesarean deliveries were more
Both spinal and general anaesthesia used
common in the urban areas compared to in rural
for caesarean section have certain advantages and
areas (60% and 48% respectively) (2).
disadvantages and there is no method which is
completely ideal. The most important factors for
choice of anaesthesia are; pregnant systemic
4856
Received:15/6/2018
Accepted:24/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4866-4873
Construction of The Arabic Phonological Short Term Memory Test on Egyptian
Children
Hedia M. El Neshwey, Mohammed A. Baraka, Nahla A. Rifaie, Amal S. Saber, Sally A. Sarwat
ENT Department, Phoniatric Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Correspondence to Hedia M. El-Neshwey, Tel: 01003819318, Email: Hediaserry@med.asu.edu.eg.
ABSTRACT
Background: Phonological short-term memory is a part of working memory, as working memory consists of
four components: the central executive, the phonological loop, the visuo-spatial sketchpad and the episodic
buffer.
Aim of the work: To construct a valid and reliable test for assessment of phonological short-term memory,
which can be applied in language child disorders as on specific language impaired children. This might help to
clarify more points in their diagnosis and therefore to guide a better management.
Subjects and methods: The subjects of the study were 2 groups: The first group consisted of 102 normal
children between the ages of 4 to 8 years old, with average number of 25 children in each with 1 year age
range. The second group included 31 specific language impaired children that were selected to match the
control group as regard age and IQ level. The constructed test items were 17 in number. The test included the
following items: digit span, syllable repetition ( for 1,2,3,4 syllables ), non sense word repetition (NSWR) of
(1,2,3 and 4 syllables),dissimilar word set recall (short word set recall of 1 and 2 syllables, long word set recall
of 3 and 4 syllables) and lastly similar word set recall (of 1,2,3 and 4 syllables).
Results: Reliability of the test was measured by test re-test, alpha Cronbach and split half method. Validity of
the test was also measured using internal consistency, contrasted group validity and factorial validity.
Conclusion: The constructed test for measuring phonological short-term memory (PSTM) showed high
reliability and validity and could be used on Arabic speaking children from 4 years to 8 years of age.
Keywords: Phonological short-term memory, Working memory, Non word- repetition digit span, SLI.
INTRODUCTION
word repetition correlate significantly with
Phonological short term memory (PSTM)
phonological short-term memory (3).
is a part of working memory. Working memory
Non-word repetition tasks are interpreted as a
consists of four components: the central executive,
measure of PSTM because in order to accurately
the phonological loop, the visuo-spatial sketchpad
repeat the non-word several moments after it is
and the episodic buffer (1).
presented, one must temporarily maintain the novel
It is a system that is involved in several
sound sequence in the phonological loop(3). The
cognitive abilities, including reasoning, learning,
previous tests done to measure the PSTM used
and comprehension. Working memory is
mainly the Non-word Repetition Test (NWRT). The
important, because it provides a system for us to
studies of non-word repetition have employed a
attend to important incoming sensory information
variety of non-word stimuli. However, two sets of
and work on this incoming information by
non-word stimuli have been used most frequently.
associating it with prior knowledge (2).
The first is the set of 40 non-words developed by
Gathercole and Baddeley (4) and later revised to
Different synonyms for the phonological
form the Children's Test of Non-word Repetition (5).
short- term memory are present. Some researchers
The second is the set of 16 non-words developed by
call it "verbal short term memory", others call it
Dollaghan and Campbell (6), currently referred to as
"phonological
short-term
memory"
or
the
the Non-word Repetition Test (NWRT).
"phonological loop". PSTM is a limited capacity
storage system for the auditory or phonological
In addition, the tests were done for non-
information without manipulation. It has two distinct
Arabic speaking children except for the one that
subcomponents: A short-term store and an
measures PSTM as a part from a battery that
articulatory rehearsal component. The phonological
measures the whole working memory done by EL
short-term memory is affected by phonological
Desouky et al. (7). The aim of this study was to
similarity, the word length effect and lexicality effect.
develop a test for measuring PSTM, for Arabic
PSTM can be assessed using tasks such as digit span,
speaking children between the ages of 4 to 8 years
word span (word set recall) and non-word repetition
of age, in order to be used in related
(3). Specifically, measures such as digit span and non-
communicative disorders that show deficit in the
PSTM as SLI disorder.
4866
Received:14/6/2018
Accepted:23/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4874-4879
Evaluation of some available HCV antibody detection tests (ELISA,
Chemiluminescence, Immune Assay) and RT-PCR assay in the diagnosis of
Hepatitis C virus infection
Aida Mohamed Ibrahim, Naglaa Gamal Mady Abo-El-Azaem, Mamdouh Attia Mohamed, Amina Abd-
El Aziz Ghaith, Soha Hassan Hosny Ahmed*, Mohamed Mohamed Amer Zaki
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University
Corresponding author: Soha Hassan Hosny Ahmed, E-mail: sohahosny1987@gmail.com, Mobile: 01223407671
ABSTRACT
Background: The purpose of diagnosis of viral infection is to allow the infected persons to be identified &
treated and to prevent blood-transfusion infection. Majority of primary HCV-infected patients are
asymptomatic, thus, symptoms could not be used as specific indicators for HCV infection. HCV viremia could
still exist despite a normal serum alanine aminotransferase (ALT) level. Therefore, virological methods rather
than ALT levels are used to diagnose HCV infection. The diagnosis of HCV infection is mainly based on the
detection of anti-HCV antibodies by the enzyme immunoassay(EIA) or Chemiluminescence immunoassay
(CIA) of serum samples. These anti-HCV assays are used as a screening test, while PCR is essential for
detection of screening test falsity. The presence of HCV-RNA in the serum is a reliable marker of viremia.
Universal standardization for HCV-RNA titer is important for diagnosis and follow up.
Objective: This study aimed to evaluate the commercially available antibody tests for diagnosis of hepatitis c
virus infection in comparison to RT-PCR in Egyptian blood donors.
Materials and Methods: This study Included 456 serum samples from blood donor at Al-Hussien hospital
blood bank (Al-Azhar University, Cairo) from June 2016 to June 2018. Serum samples subjected to routine
laboratory tests (CBC, liver and renal function) to exclude organs affection. Also they are subjected to HCV
antibody detection by ELISA and Chemiluminescence tests and HCVRNA detection by RT-PCR assay.
Results: We considered PCR as a standard test to evaluate ELISA and Chemiluminescence. The detected
percentage of infectivity of donors in this study was 9% by ELISA, 13% by Chemiluminescence and 8 % by
PCR. The percentage of false negativity of HCV antibody by ELISA and CIA when compared with PCR assay
were 0.96% and 1.5% respectively. The false positivity of HCV Ab by ELISA and CIA as compared PCR
was 14-6% (6 out of 41) and 26.6% (16 out of 60).
Conclusion: Generally, ELISA is more sensitive and specific than Chemiluminescence for blood transfusion
screening. But, at gray zone results, PCR should be used as confirmatory method. And so it is very important
to screen blood donors using RTPCR to avoid false positive and false negative results.
Keywords: HCV, PCR, ELISA, Chemiluminescence.
INTRODUCTION
the risk of donated blood can be missed with
The safety of the blood products is one
negative serology tests (4, 2).
of the major issues in the area of transfusion
Using PCR for detection and quantitation
medicine. Screening of the blood donors plays
of HCV-RNA before seroconversion in blood
a major role to decrease the risk of transfusion
and detect viral load in antibody-positive chronic
of infected units. HCV affected around 3% of
cases is the best. PCR has the ability to detect
world population while it is > 10%for Egyptian
immune activation in patients with residual
population (1,2).
hepatitis C virus after treatment with IFN and
Diagnostic procedures of hepatitis C
ribavirin (5). Quantitative real-time PCR is the
infection in laboratory is based on detection of
gold standard test in diagnosis of HCV (6).
IgG antibodies against recombinant HCV-
polypeptides by two main methods; Enzyme
AIM OF WORK
Linked
Immunoassay
(ELISA)
and
The main objective of our study is to
Chemiluminescence immunoassay (CIA) (3).
compare the results of HCV-infection by serological
Immunoassay detects antibodies against virus
tests (ELISA and Chemiluminescence) with the
that takes an interval between donor's
gold standard test (till now) PCR. Also to select the
exposure to a virus and production of
most sensitive, specific and least cost test for
antibodies known as window period may last
screening blood donors in Egypt.
2-3 months after infection. During this period
4874
Received:17/6/2018
Accepted:26/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4880-4884
Role of Renal Arterial Embolization (Rae) In Treatment of Iatrogenic Renal
Arterial Injuries
Ahmed Fathy Abd EL Ghany, Marwa ElSayed Abd El Rahman, Dr.Karim Ahmed Abd El Tawab,
Zeinab Aly Moussa Aly
Radiology Department, Faculty of Medicine, Ain Shams University
zeinabalymoussa26@gmail.com
ABSTRACT
Background: Trans-catheter renal arterial embolization (RAE) has emerged as a possible alternative to
surgery in the management of iatrogenic renal arterial injuries. Objective: To discuss the role of renal arterial
embolization in patients with iatrogenically-induced renal arterial injuries.
Methodology: All cases were done at the Interventional Radiology Unit, Ain Shams University Hospital.
Results: Technical and Clinical success rates of the RAE reached 90% for each, with post procedural
complications that only amounted up to 30%, half of which was the post embolization syndrome that presents
as fever, leukocytosis and pain and is treated conservatively.
Conclusion: Renal artery embolization has proven to be a safe, minimally invasive option in the treatment of
iatrogenic renal arterial injuries achieving high technical and clinical success rates.
Keywords: Renal arterial injuries, Renal artery embolization (RAE), Renal Pseudo-aneurysm, Renal arterio-
venous fistula (AVF).
INTRODUCTION
and ability to spare other non-bleeding arteries for
Renal arterial injuries could develop following
the preservation of the normal renal parenchyma (8).
blunt trauma as in road traffic accidents, penetrating
Coils are used for proximal large bleeders
trauma as in stab wounds or iatrogenically post
embolization. Polyvinyl alcohol (PVA) particles
urological interventions: renal surgeries, percutaneous
are used for small distal bleeders. Glue is used for
nephrolithotomy (PCNL), renal trucut biopsy and
hemodynamically unstable patients with an
percutaneous nephrostomy tube application. Life
abnormal bleeding profile (9).
threatening hemorrhagic complications could occur in
Little is known about the side effects of the
up to 15% of those patients (1).
renal arterial embolization, which might result from over
Surgical corrections of bleeders could
devascularization of a large portion of renal parenchyma
exacerbate the condition by releasing the
or renin secretion by the ischemic renal parenchyma
tamponade effect of the perirenal hematoma, as
followed by hypertension development (10).
well as higher postoperative morbidity/mortality
and longer hospital stay (2).
AIM OF WORK
Trans-catheter arterial embolization is an
The aim of this study was to assess the
endovascular approach devised to control the post
success rates of the technical methodology and the
traumatic renal hemorrhage. It has recently
short term clinical outcome of RAE in patients with
emerged as an alternative to operative correction of
iatrogenic renal arterial injuries. Investigation and
renal arterial compromise since it is minimally
treatment of the cases were done at Ain Shams
invasive, with fewer postoperative complications
University Hospitals.
and shorter hospital stay (4).
The role of trans-catheter renal artery
PATIENTS AND METHODS
embolization has presently become more renouned
due to the great advancement in the development of
Patients
embolizing agents as : (vascular coils, particles and
During a period of 6 months (from January
endovascular glue) as well as the introduction of
2018 till June 2018), a single arm interventional study
the microcatheters enabling superselective bleeder
was conducted upon a convenience sample of 20 cases
localization and catheterization with minimal
(11 males and 9 females) at an age range of 18-60 years
parenchymal loss (6).
old post complicated iatrogenic renal procedures.
The choice of embolic agents depends upon:
The causative procedures were: renal biopsy in 9
the site of the bleeder whether proximal or distal,
cases (45%), nephrostomy tube application in 5 cases (25%),
size of the injured artery, hemodynamic status of
renal artery angioplasty in 2 cases (10%), extracorporeal
the patient, accessibility of the source of bleeding
shock wave lithotripsy (ESWL) in 2 cases (10%),
percutaneous nephrolithotomy (PCNL) in 2 cases (10%).
4880
Received:1/4/2018
Accepted:10/4/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4885-4893
Current Perspective of Laparoscopic Cholecystectomy for Acute Cholecystitis
Abdelghany Mahmoud AlShamy, Karim Fahmy Abd El Moaty, Yehia Khaled Said Mohamed Salem
Department of General Surgery, Faculty of Medicine, Ain Shams University
Corresponding author: Yehia Khaled Said Mohamed Salem; Mobile: 01000949404; Email: y_k_said@hotmail.com
ABSTRACT
Background: Acute cholecystitis is a potentially life-threatening condition, which affects >5 million Egyptian
yearly and causes high economic burden around the world. Gallstones are the major contributor to acute
cholecystitis. Laparoscopic cholecystectomy (LC) is an important approach for treating acute cholecystitis
nowadays. Issued data indicated that approximately 600,000 LCs and >30,000 LCs were annually performed to
treat acute cholecystitis in the Egypt. Although LCs have been extensively performed to manage acute
cholecystitis, the optimal timing of LC for this given condition is inconclusive.
Aim of the Study: To highlight the optimal time for LC in acute cholecystitis, comparing ELC or DLC is
better in terms of surgical complications as bile duct injury, bile leakage, cystic artery bleeding, conversion to
open surgery, duration of the surgery.
Patients and Methods: This study was done on 30 patients in Ain Shams University Hospitals in 12 months
duration starting from June 2017 to June 2018 reviewing reports on ELC vs. DLC with all patients received
medical treatment as antibiotics (3rd generation cephalosporins) and proper analgesia for 48-72 hours and if
the patient responded to medical treatment so he/she was go with DLC group and if no response, he/she was go
ELC group. This study was classified into two groups: Group (A) underwent laparoscopic cholecystectomy in
the first seventy two hours from the onset of symptoms. Group (B) underwent laparoscopic cholecystectomy
after delayed interval of six to eight weeks after initial period of conservative treatment.
Results: The mean operative time (100.3 ± 14.75 minutes) in the early group was more than the mean
operative time (80.3 ± 12.4 minutes) in the delayed group. The conversion rate to open cholecystectomy
(6.7%) in the early group was less than the conversion rate (13.3%) in the delayed group. The mean total
hospital stay (4.8 ± 0.91 days) in the early group was less than the mean total hospital stay (9.2 ± 1.61days) in
the delayed group. Finally, the overall complications in (53%) the early group were slightly more than
complications occurred (47%) in the delayed group.
Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis within 72 hours has been shown to be
superior to late or delayed cholecystectomy as regard the outcome and cost of treatment. Laparoscopic
cholecystectomy should be carried out as soon as the diagnosis of acute cholecystitis is established and
preferably before 3 days following the onset of symptoms. Early laparoscopic cholecystectomy can reduce
both the conversion rate and the total hospital stay as medical and economic benefits.
Keywords: Laparoscopy, Cholecystectomy, Acute Cholecystitis, Hepatobiliary surgery, Outcome assessment.
INTRODUCTION
LC (ELC) (within 7 days of the onset of
Acute cholecystitis is a potentially life-
symptoms) to treat acute cholecystitis (3). Although
threatening condition, which affects >5 million
some researchers investigated the optimal timing of
Egyptian yearly and causes high economic burden
LC for patients with acute cholecystitis previously,
around the world. Gallstones is the major
a consistent and conclusive conclusion has not yet
contributor to acute cholecystitis (1). Laparoscopic
been obtained from these researches. For instance,
cholecystectomy (LC) is an important approach for
2 researches qualitatively supported no difference
treating acute cholecystitis nowadays. Issued data
between ELC and DLC in terms of mortality, 1
indicated that approximately 600,000 LCs and
indicated no difference in both approaches for this
>30,000 LCs were annually performed to treat
outcome, and 2considered this given outcome, but
acute cholecystitis in the Egypt. Although LCs
the effects of both approaches in causing mortality
have been extensively performed to manage acute
were identified. Moreover, 4 researches indicated
cholecystitis, the optimal timing of LC for this
that DLC shortens the duration of operation;
given condition is inconclusive (2). Traditionally,
however, 2 identified no difference between DLC
given the higher rate of morbidity such as bile duct
and ELC in terms of this given outcome. Most
injury, leakage, and conversion to open surgery, the
importantly, these conflicting findings will confuse
delayed LC (DLC), which is defined as at least 1
the informed decision making. And thus, we
week after initial conservative treatment, is
performed this thesis research of discordant meta-
commonly adopted in treating acute cholecystitis.
analyses to further assess the effects of ELC for
However, several clinical studies supported early
acute cholecystitis compared with DLC (4).
4885
Received:7/6/2018
Accepted:16/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4894-4897
Osteoporosis: a Common Health Problem in Senior Adult Population of Arar
City, Saudi Arabia
Abdalla Mohamed Bakr Ali1, Amal Mahmoud R. Abdullah2, Mohammed Faleh M Alanazi3, Deema
Faleh M Alanazi3, Reema Faleh M Alanazi3, Ahmed Mahmoud R Abdullah3, Abdullah Mohammed M
Alsayed2, Rema Jamal Alotaibi2, Mays Nawaf F. Alharbi2, Luluah Maan R Abdullah3, Ghaida Abdullah
Rasheed Alshamlani3
1Faculty of Medicine, Sohag University, Egypt, 2Faculty of Medicine, Arabian Gulf University, Bahrain, 3Faculty of
Medicine, Northern Border University, KSA
apdo3332008@gmail.com
ABSTRACT
Background: Osteoporosis is characterized by compromised bone strength predisposing to an increased risk
of fracture, which has significant effects on human health, quality of life. Objective: To determine the
prevalence and determinant factors of osteoporosis among elderly in Arar, KSA. Methods: The present cross
sectional community based study was conducted in Arar city, the capital of Northern Borders Governorate on
229 adult people aged 60 years and more. Data were collected through personal interviews with the sampled
population and filling the questionnaire which guided us to the data of socio-demographic status, smoking,
chronic diseases, already previously diagnosed osteoporosis, after ensuring the diagnosis by reviewing the
accompanied health reports and/or prescriptions and asking the accompanied caregivers about the case.
Results: The mean age of the participants (± SD) was 70.5 (± 9.4) years. Males were 48% and females were
52%. The overall prevalence rate of osteoporosis found in this study was 24.5%. There was significant
relationship between osteoporosis and sex, presence of thyroid disease (P<0.05). While there was an
insignificant relationship between osteoporosis and age group, BMI group, presence of diabetes mellitus and
presence of hypertension (P>0.05). Conclusion: In conclusion, osteoporosis is a common health problem
(24.5%) in the elderly population in Arar city, KSA. Conclusion: Osteoporosis is significantly higher in
elderly females. Health education and preventive programs are highly recommended to protect and treat that
vulnerable group.
Keywords: Osteoporosis; Elderly; Saudi Arabia
INTRODUCTION
according to the WHO, 55% of the population in
Osteoporosis is a progressive systemic non-
the USA aged over 50 years suffer from
communicable skeletal disorder that is associated
osteoporosis [4]. Among women in Saudi Arabia,
with significant mortality, morbidity and costs of
the incidence of post-menopausal osteoporosis
management. It is characterized by decreased bone
(PMO) is higher in comparison with women in
mass due to an imbalance between bone formation
Western countries [5-7]. Among men, however, a
and resorption and increased risk of fracture. The
study found that 24.3% of Al-Khobar (city in Saudi
World Health Organization referred to osteoporosis
Arabia) subjects attending outpatient clinics at
as "an epidemic of the 21st century [1]." Osteoporosis
King Fahd Hospital University, aged 50-76 years
has a diagnostic criterion based on the measurement
were osteoporotic, based on hip scans, and 37.4%,
of bone mineral density (BMD)[2], as it is the only test
based on scans on the lumbar spine [8].
that can diagnose osteoporosis before a bone fracture
Early
diagnosis and management
of
occurs. Since the BMD distribution in young healthy
osteoporosis can prevent its complications, mainly,
individuals is normal and the bone loss occurs along
osteoporosis-related fractures (ORF), and decrease
with aging, the prevalence of osteoporosis increases
morbidity and mortality rates in those senile patients.
with age. Trends on the prevalence of osteoporosis
The aim of this prospective study was to
are published throughout time and are increasing as
assess the prevalence and determinant factors of
more focus and attention are paid towards such
osteoporosis in the senior adult population of Arar
common diseases.
city, Saudi Arabia, based on the physicians'
Since the world healthcare systems are
diagnoses and using a pre-designed questionnaire.
aiming to increase the life expectancy of
individuals, an increase in osteoporotic patients is
STUDY OBJECTIVE
expected. A study carried out in Sweden showing
The aim of this study was to determine the
the prevalence of osteoporosis in men and women
prevalence and determinant factors of osteoporosis
aged 50-84 using the WHO criterion to be 6.3%,
and 21.2% of population, respectively [3]. Also,
among elderly in Arar, KSA.
4894
Received:17/5/2018
Accepted:26/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4898-4902
Epidemiology and Risk Factors of Superficial Fungal Infections in Toukh
Primary Health Care Centre
1Nermeen Samy Abdel Fattah, 2Nayera Samy Mostafa, 1Ahmed Abdelfattah Afify, 3Aya Elsayed Husain
1Department of Dermatology, Venereology and Andrology, 2Department Community, Environmental and
Occupational Medicine, Faculty of Medicine, Ain Shams University, 3Toukh Primary Health Care Center, Menstrey
of Health
Corresponding author: Aya E. Husain, Mobile: 01092551501; Email: ayaelsayed1412@yahoo.com
ABSTRACT
Background: Fungal skin infection has become a significant problem. Therefore accurate diagnosis and
treatment of the active disease as well as the reduction of the re-infection by continued screening, follow up of
relatives, treating asymptomatic carriers and disinfecting their environment is mandatory.
Objective: The study was conducted to determine the frequency of superficial cutaneous fungal infections in
Toukh City and to identify the risk factors underlying superficial cutaneous fungal infections.
Patients and Methods: Our study investigated prevalence of fungus infections in Toukh Primary Health Care
Center, 420 study participants were examined for presence of fungus infection of glabrous skin, hair and nails.
All participants completed a questionnaire to estimate their knowledge about superficial fungal infections
(SFIs) and to record presence of risk factors for SFIs.
Results: The study showed more prevalence of fungal infection (18.6%). Dermatophyte infections were more
prevalent than non-dermatophyte (51.2% vs 37.2%) of infected cases. Onychomycosis had prevalence 1.2% of
our study participants and 6.4% of infected participants. Candidal infection was (5.2%), tinea (T.) pedis was
(3.6%), T. cruris was (2.1%), T. capitis was (1.7%), T. versicolor was (1.7%), T. circinata was (1.2%), T.
barbae was (0.5%) and T. corporis was (0.5%) of study participants. Females represent (62.8%) of cases, while
males represent (37.2%). Concerning with predisposing factor was contact with animals (70.5%). (57.1%) of
infected participants were diabetics, (71.4%) of infected participants were usually wearing synthetic clothes,
(64.1%) of infected participants shared towel between family members and (73.1%) shared hair brush.
Conclusion: Skin fungal infections are widely prevalent among the population and there is need to increase the
awareness of risk factors contributing to skin fungal infections. Awareness in relation to personal hygiene,
education status and occupation do play a part in genesis of SFIs.
Keywords: Superficial Fungal Infections Dermatophytes Yeasts.
INTRODUCTION
AIM OF THE WORK
Superficial fungal infections are caused by
heterogeneous group of fungi. As they involve stratum
To determine the frequency of superficial cutaneous
corneum, outermost layer of the skin, they are called
fungal infections in Toukh City. To identify the risk factors
superficial fungal infections. They can be classified as
underlying superficial cutaneous fungal infections.
dermatophytic and non dermatophytic. Dermatophytic
superficial fungal infections affect keratinized tissues
PATIENTS AND METHODS
and are also known as tinea. The non dermatophytic
Type of Study: Observational cross
superficial fungal infections include tinea versicolor,
sectional study.
tinea nigra, piedra and candidiasis. The fungal
Study Setting: The study was conducted
infections of the skin and its appendages are more
in Toukh Primary Health Care Centre.
common in tropical countries like India due to
environmental factors like heat and humidity. The risk
Study Period: From June to November 2017.
factors include socio-economic conditions like
The researcher visited the centre on alternating 4 days
overcrowding, poverty and poor personal hygiene (1).
weekly to cover the whole week (6 working days).
According to World Health Organization
Study Population:
(WHO), the prevalence rate of superficial mycotic
Inclusion criteria: Both genders (males and
infection worldwide has been found to be 20-25% (2).
females), all age groups who are seeking medical
Abdel-Hafez et al. (3) found that the
advice at Toukh Primary Health Care Centre were
prevalence of SFIs in rural areas of Assiut
eligible for inclusion in our study. The centre include
Governorate was 16.17%.
clinics for internal medicine, paediatrics, obstetric and
family planning clinics. Internal medicine clinic was
chosen to select adult participants and paediatrics
clinic was chosen to select children participants. Any
4898
Received:20/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4903-4912
Comparative Study Between Lumbar Epidural Versus Transversus Abdominis
Plane Block For Postoperative Analgesia After Lower Abdominal Surgeries
Ismail A. Shabayek, Ahmed M. El-Garhy, Walid N. Soliman
Department of Anesthesia and Intensive care
Corresponding author: Walid N. Soliman; Mobile: 01063268156; Email: walidnashaat744@gmail.com
ABSTRACT
Background: Postoperative pain is a potent cause of adverse effects in many organ systems thus anterior abdominal
wall analgesia after abdominal surgery may assist in improving postoperative outcome. The analgesic regimen
needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with
inhibition of trauma -induced nociceptive impulses. Aim of the work: to compare the analgesic efficacy of
transversus abdominis plane block with lumber epidural analgesia for postoperative pain relief following lower
abdominal surgeries. Patients and methods: The present study was carried out at Al-Azhar University Hospitals
(Al-Hussien and SayedGalal) after institutional ethics and informed consent. 90 adult patients were randomized into
three groups (30 patients in each group): Lumbar epidural group, Transversus abdominis plane block group and A
Control group. Results: As regards postoperative hemodynamic data, higher readings appeared within the control
group, while the epidural group and TAP group showed lower readings with no statically difference among the three
groups, except at the first 10 minutes and 20 minutes time periods after starting the epidural analgesia and
application of the TAP block. As regard pain scoring using the visual analog scale (VAS), the results showed no
statically difference among the three groups with (P>0.05), except at the first 10 minutes and 20 minutes time
periods after starting the epidural analgesia and application of the TAP block, highest readings were realized among
the control group at these two time periods in comparison with the other two groups with P<0.05. Patients of the
control group were the first to ask for rescue analgesia. Rate of administration of the rescue analgesia was seen to be
more frequent among patients of the control group rather than the other two groups with (P<0.05).Postoperative
complications as, (nausea and vomiting) which occurred due to systemic use of opioids were mostly seen among the
control group rather than the other two groups with (P<0.05) Conclusion: Use of the TAP block proved to be a
simple and safe procedure in providing effective reliable analgesia, together with reduction of postoperative pain
scores, both at rest and knee flexion, and postoperative opioid requirements thus avoided any of the systemic side
effect of opioid such as PONA as seen among the control group. Recommendations: The blind application of this
technique might have been associated with major complication although we didn't experienced any, yet performing
this block under ultrasound guidance facilitates identification of the needle tip in the TAP, and may result in reduced
risk, particularly in obese patient with BMI > 30 kg/m2.
Keywords: lumbar epidural, Transversus abdominis plane block, postoperative analgesia, analgesia, lower
abdominal surgery
INTRODUCTION
The TAP block provides analgesia to the
Pain continues to be a significant problem
parietal peritoneum as well as the skin and muscles
for many patients after surgery. In addition to
of the anterior abdominal wall. It has a high margin
improving patient satisfaction and decreasing pain
of safety and is technically simple to perform,
scores, enhanced perioperative pain control can
especially under ultrasound guidance(5).
improve clinical outcomes (1).
Lumbar Epidural Analgesia (LEA) remains
Abdominal field blocks have been used in
a main tool for anesthesiologists to use in acute
anesthesia for surgery involving the anterior
pain management. LEA is particularly useful for
abdominal wall for several decades. The Transversus
reducing pain after abdominal surgeries and likely
Abdominis Plane (TAP) block is a technique
permits major surgical procedures to be performed
involving multiple injections of local anesthetic in the
on patients with moderate to severe comorbid
abdominal wall was used in the 1980s (2).
diseases, who several years ago may have been
determined to be too high a risk for surgery (1).
This technique improved with a blind landmark
technique, via the `lumbar triangle of Petit' (3).
There is clear evidence that epidural
analgesia provides better postoperative analgesia
The clinical efficacy of the landmark
compared to parenteral opioids (6).
technique and, more recently, ultrasound-guided
procedures has been investigated in severalcenters
It also enhances functional exercise
around the world (4).
capacity, health-related quality of life, and reduces
hospital stay after abdominal surgery(7).
4903
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4913-4918
Red Blood Cell Alloantibodies in Healthy Egyptian Blood Donors
Azza Elsayed Abdelfattah Hashem, Gehan Mostafa Hamed Mostafa, Mariam Samy Mohamed El-
Faramawy
Department of Clinical Pathology, Faculty of Medicine Ain Shams University
Corresponding author: Mariam Samy Mohamed El-Faramawy, Mobile: 01004050341; Email: mariam.s.faramwy@gmail.com
ABSTRACT
Background: Alloantibodies are antibodies that are produced in response to foreign antigens, the main stimuli
responsible for erythrocyte alloantibodies in healthy adult donors are previous pregnancies and transfusions. Red
blood cell (RBC) alloantibodies, especially IgG class, are clinically significant because of the association with
hemolytic disease of newborns (HDN), hemolytic transfusion reaction (HTR) and a significant reduction in lifespan
of transfused red blood cells. It has been stated that hemolytic reactions due to erythrocyte alloantibodies in donor
blood is a relatively rare occurrence; however, they can occasionally cause severe transfusion reaction, particularly
if given to infants and in the setting of massive transfusion.
Objective: We aimed in this study to screen healthy Egyptian blood donors for the presence of red blood cells
alloantibodies in a trial to prevent complications of blood transfusion, other secondary possible outcomes are to
reveal the differential frequency of these alloantibodies among donors with previous blood transfusion, multiple
pregnancies, different age groups and gender.
Subjects and Methods: This study was carried out on 200 healthy Egyptian blood donors coming to Ain Shams
University Hospitals Blood Banks. Data was collected on: gender, age, frequent donor or first time to donate, history
of previous blood transfusion, number of pregnancies (in female donors), history of hepatitis or other viral infection,
history of diabetes mellitus, hypertension, and history of recent surgery.
Results: Sera from donors was subjected to alloantibody screening by manufacturer's antibody screening cells
(Grifols I+II+III), when positive screening test, alloantibodies identification was done by manufacturer's antibody
identification panel (Grifols), which consists of 11 panels. Out of the 200 donors, alloantibodies were detected in 8
donors (4%), a percent which is higher than other studies, may be due to the smaller sample size, alloantibodies
were: anti-Kell in 1 case (12.5%), anti-M in 1 case (12.5%), and anti-C in 1 case (12.5%), anti-c in 1 case (12.5%),
and anti P in 1 case (12.5%), and 3 (37.5%) cases were non-specific antibodies, 130(65%) of donors were males and
70 (35%) were females with a male to female ratio 1.8:1, their ages ranged from 19 years to 65 years with median of
32 years.
Conclusion: Relation between alloantibodies and gender, multipara, repeated blood transfusion and previous
surgeries was done showing statistically significance of previous surgeries and presence of allo-antibodies.
Keywords: Red Blood Cell, alloantibodies, blood transfusion, multipara
INTRODUCTION
stipulate that blood from donors with a history of prior
Alloantibodies are antibodies that are
transfusion or pregnancy be tested for RBC
produced in response to foreign antigens (1). The
alloantibodies. Identification of donors' antibodies helps
main
stimuli
responsible
for
erythrocyte
with the selection of suitable products for the
alloantibodies in healthy adult donors are previous
transfusion, so the risk of complications from
pregnancies and transfusions (2).
incompatible blood transfusions are greatly reduced (4).
Red blood cell (RBC) alloantibodies,
There is a paucity of literature on the
especially IgG class, are clinically significant
prevalence of RBC alloantibody in the general
because of the association with hemolytic disease
population probably due to difference in selected
of newborns (HDN), hemolytic transfusion reaction
population and laboratory test sensitivity (5).
(HTR) and a significant reduction in lifespan of
Reported incidence of RBC alloantibodies
transfused red blood cells (3).
in these literatures varied significantly from 0.5%
It has been stated that hemolytic reactions due to
to up to 60% (6).
erythrocyte alloantibodies in donor blood is a relatively rare
Antibody screening test is a simple and
occurrence; however, they can occasionally cause severe
inexpensive method for identification of large number
transfusion reaction, particularly if given to infants and in
of important antibodies; which are generally against
the setting of massive transfusion (2).
minor blood group antigens (3). Because of the
Screening of donated blood for the presence of
importance of these alloantibodies, paucity of literature
RBCs alloantibodies is significant. The American
and variability in their reported prevalence in normal
Association of Blood Banks (AABB) Standards
population, we decided to examine the frequency of
occurrence of alloantibodies in blood donors.
4913
Received:16/6/2018
Accepted:25/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4919-4926
A Study of the Prophylactic and Curative Effect of Melatonin on Postoperative
Delirium after Coronary Artery Bypass Grafting Surgery in Elderly Patients
Samia I. Sharaf, Dalia A. Nasr El-Din, Mostafa G. Mahran, Dalia F. Ali Nawar,
Dalia I. El-Naggar
Department of Anesthesia and Intensive care, Faculty of Medicine, Ain Shams University
Corresponding author: Dalia Ibrahim Mohamed El-Naggar; Mobile: 01006215850; Email: daliaibrahim555@gmail.com
ABSTRACT
Background: delirium is a common complication after cardiac surgical procedures and is associated with
increased morbidity and mortality. Postoperative delirium is associated with an increased length of stay in the
intensive care unit, long hospital stay and high hospital charges. Aim of the Work: to investigate the
effectiveness of melatonin as a preoperative sedative as well as the preventive and the curative effect of
melatonin supplementation in elderly patients undergoing coronary artery bypass surgery on postoperative
delirium. Patients and Methods: this prospective, randomized, controlled, double blind study was conducted
on a total of 50 patients allocated into 2 equal groups. It was conducted in Ain Shams University hospitals, in
the cardiothoracic surgery unit. Results: melatonin has superior sedative effect at 30 min preoperatively
compared with placebo (P=0.022). Melatonin succeeded to treat about 56% of delirious patients. The incidence
of delirium was 8% in the melatonin group vs. 28% in the control group (P= 0.046). In univariate analysis,
predictors of delirium in both groups were age (P= 0.049 in melatonin group, P=0.021 in control group), higher
fentanyl dose (P= 0.021 in melatonin group, P=0.047 in control group), lower ejection fraction (P= 0.018 in
melatonin group, P=0.008 in control group), longer cardiopulmonary bypass (CPB) times (P= 0.026 in
melatonin group, P=0.04 in control group) and longer aortic cross clamping (ACC) times (P= 0.04 in
melatonin group, P=0.019 in control group). Conclusion: administration of melatonin significantly decreased
the incidence of postoperative delirium (POD) after coronary artery bypass grafting in elderly patients and
significantly increased preoperative sedation. Advanced age, higher total intraoperative fentanyl dose, lower
ejection fraction and longer CPB and ACC times were independent predictors of POD with or without
melatonin supplementation.
Keywords: melatonin, postoperative delirium, coronary artery bypass grafting, elderly
INTRODUCTION
Anticholinergic medications, benzodiazepines, and
Delirium is an acute or subacute organic
narcotics in high doses are common causes of drug
mental syndrome characterized by disturbance of
induced delirium (4).
consciousness, global cognitive impairment,
Melatonin by virtue of its multiple
disorientation, the development of perceptual
functions has the potential to take a place in the
disturbance, attention deficits, decreased or
anesthetic drug armamentarium, because it can be
increased psychomotor activity, disordered sleep-
an attractive option for premedication as an
wake cycle, and fluctuation in presentation. The
anxiolytic and sedative, for the induction of general
term ,,,,delirium, from the Latin roots de (meaning
anesthesia as a hypnotic or as an induction adjuvant
,,,,away from) and lira (meaning ,,,,furrow in a
and perioperatively for analgesia. Melatonin can
field) and ium (Latin for singular), literally means
also be used postoperatively to store sleep rhythm
,,,,a going off the ploughed track, a madness (1).
and prevent delirium (5).
Delirium is a common complication in
elderly patients after cardiac surgery and is
AIM OF THE WORK
associated with adverse outcomes including
The aim of this work is to investigate the
prolonged hospital stay and increased mortality (2).
effectiveness of melatonin as a preoperative sedative
The incidence of postoperative delirium
as well as the preventive and the curative effect of
ranges from 10 to 46% in general surgical
melatonin supplementation in elderly patients
population and reaches 50 to 67% among the
undergoing coronary artery bypass surgery on
patients undergoing cardiac surgery (3).
postoperative delirium.
Drugs have been associated with the
PATIENTS AND METHODS
development of delirium in the elderly. Successful
treatment of delirium depends on identifying the
Study design and sampling
reversible contributing factors, and drugs are the
After approval of the Research Ethics
most common reversible cause of delirium.
Committee and written informed patient consent,
4919
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4927-4931
Surgical Repair of umbilical hernia in children
1Hosam El Den El Azazy, 2Mohammed Hesham Ahmed, 1Ahmed Nabil El Hofy, 1Taha Mohamed Talaat
El Diehy
1Department of general Surgery, 2Department of Pediatric Surgery, Ain Shams University, Faculty of Medicine
Corresponding author: Taha M.T. El Diehy, Mobile: 01000945458; Email: taha.el_diehy14@yahoo.com
ABSTRACT
Background: Elective repair of an umbilical hernia is one of the most common surgical operations performed
by pediatric surgeons, although most of them resolve spontaneously during the first 3 years of life. The exact
technique and steps involved in the repair differ widely among pediatric surgeons. Many pediatric surgeons
prefer the transverse interrupted suture technique in rectus sheath closure than the purse string or continuous
technique as it isolates the tension to each individual stitch, ensures correct suture placement and precise
coaptation of edges. It is less likely to devascularize the incision margin. Interrupted sutures also have the
advantage that they can be removed individually if infection or haematoma formed, while the purse string
suture or the continuous closure has the disadvantage of being a single suture line holding the fascia together
and most of wound dehiscence occurs because sutures cut through the fascia. In this study we give a chance to
assess the efficacy of the purse string technique.
Objective: The aim of our study is to compare between umbilical hernia repair of rectus sheath with closure by
interrupted sutures and purse string technique regarding operative time, intra operative complications
(bleeding, intestinal injury), and post-operative complications (edema, hematoma formation, seroma formation,
cosmetic appearance & recurrence).
Materials & Methods: A total of 30 umbilical hernias in children (17 females and 13 males) were operated in
Ain Shams University hospital and El Galaa teaching hospital from September 2017 till May 2018.
Results: In this prospective study, 30 cases of umbilical hernia in children aging from two years till the age of
ten years including 17 female and 13 male with a ratio of 1.3: 1 were randomly selected from the outpatient
clinic of Ain Shams University hospital and Al Galaa teaching hospital were divided into two equal groups,
group A underwent the repair of the rectal sheath with purse string suture technique while group B underwent
the repair with transverse interrupted suture technique.
Conclusion: Conclusively, there are no significant differences between both techniques regarding the intra
operative complications and post operative complications in short term follow up; however, transverse
interrupted suture technique appears to consume more time than the purse string technique.
Keywords: Umbilical granuloma - Umbilical hernia Hemoglobin - Congenital hernia of umbilical cord
INTRODUCTION
The majority of umbilical hernias close
Umbilical hernia is defined as a visible
spontaneously at 3 to 4 years of age. However,
protrusion on straining or crying which develops as
there are no good long-term prospective studies
a result of incomplete ring closure, it is very
that document spontaneous hernia closure rates
common in young children. The incidence ranges
with regard to various sized defects. Hernia straps
from 10% to 25% and is increased in girls, African
or buttresses, in addition to potentially irritating
American children, and low-birth-weight babies (1).
local skin, actually delay closure by alleviating the
local stress that is necessary for promoting
Umbilical hernias have been associated
muscular and fascial strengthening (4).
with multiple syndromes and conditions including
Hypothyroidism, mucopolysaccharidosis, Down
Bowel incarceration or strangulation is
syndrome, Beckwith-Wiedemann syndrome, and
extremely rare and is the only absolute indication for
exomphalos-macroglossia syndrome (2).
urgent surgical repair. Relative surgical indications
take into account the 2 factors most associated with a
The first umbilical hernia repair was
decreased likelihood of spontaneous closure: age
mentioned by Celsus in the early first century.
greater than 3 to 5 years and fascial defect size greater
However, the majority of cases up to the 18th century
than 1.5 to 2 cm & also when there is a need for
were managed with abdominal binders. In 1890, Nota
general anesthesia during concurrent minor
reported the first series of children undergoing hernia
otolaryngologic, orthopedic, or other procedures (5).
reduction and purse-string closure of the fascial
defect. Mayo recommended transverse fascial closure
If the child has a tender umbilical mass, the
in1901 and his technique remains most frequently
hernia may be reduced by milking the air out of the
utilized today (3).
incarcerated loop of intestine and applying firm,
steady pressure on the incarcerated mass. Admitting a
4927
Received:21/6/2018
Accepted:23/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4932-4937
Prenatal Diagnosis of Fetal Hypertrophic Cardiomyopathy in Diabetic Mothers
Using 5D Fetal Echocardiography
Mohammad AbdElhameed M. NasrAdDeen, Mohammed Salah Elsokkary, Mohamed Esmat Abbass
Shawky, Heba Ramadan Elsayed Abdel Fattah
Obstetrics and Gynaecology Department, Faculty of Medicine, Ain Shams University
ABSTRACT
Background: Diabetes mellitus is a common condition, affecting approximately 7% of pregnant women.
Appropriate management has reduced morbidity and mortality. Diabetes mellitus in pregnancy can cause many
problems for the fetus as significant congenital disorders, risk of premature delivery and increased prenatal
morbidity and mortality. In addition, it causes neonatal hypoglycemia, macrosomia and transient hypertrophic
cardiomyopathy HCM (observed in up to 35% of fetuses). Fetal Intelligent Navigation Echocardiography
(FINE) is a novel method for visualization of standard fetal echocardiography views from volume datasets
obtained with spatiotemporal image correlation (STIC).This method can simplify examination of the fetal heart
and reduce operator dependency.
Objectives: The aim of this study was to investigate the utility of 5D fetal echocardiography in the prenatal
diagnosis of fetal hypertrophic cardiomyopathy in healthy mothers, controlled diabetic mothers and
uncontrolled diabetic mothers.
Patients and Methods: Cross sectional observational study was conducted at Ain Shams University Maternity
Hospital at the ultrasound fetal special care unit, Study duration: September 2017- July 2018. This study was
conducted on healthy and diabetic pregnant women divided into 3 groups Sampling Method: This study
included 111 pregnant women between the 28th and 36th weeks of gestation. After approval of the Local
Institutional Review Board, the study was explained and an informed written consent was obtained from all
participants. This study included 3 groups of pregnant women which were: Group A: Control group which
consist of 37 healthy non-diabetic pregnant women, group B: Controlled group which consist of 37 diabetic
pregnant women with good glycemic control, group C: Uncontrolled group which consist of 37 diabetic
pregnant women with poor glycemic control.
Results: The current study showed that, as regards the thickness of the interventricular septum IVS, there were
significant differences between the three groups. The mean IVS thickness in Group A was 0.38±0.05 cm; in
Group B, it was 0.44±0.05cm and in Group C, it was 0.57±0.08cm. In a similar study, compared the IVS
thickness between GDM, DM type 2 and DM type 1,showed that the mean fetal IVS thickness was 3.73 + 0.84
mm in the DM type1 group; 4.08 + 0.75 mm in the GDM group; and 3.99 + 0.59 mm in the DM type 2 group
and found that there was a statistically significant difference between HbA1c and IVS thickness in the DM
type1 group only P=0.013.But in the GDM group (P=0.723) and the DM type2 group (P=0.380), there were no
significant differences.
Conclusion: Infants of diabetic mothers are prone to have multiple problems during the neonatal period which
makes them a very high risk infant. These neonates must be screened for any associated congenital anomalies
and metabolic abnormalities. Hypertrophic cardiomyopathy of IDM have good prognosis and this
cardiomyopathy is reversible in nature but these neonates requires close monitoring and regular follow-up and
early intrauterine detection.
Keywords: Prenatal Diagnosis, Fetal Hypertrophic Cardiomyopathy, Diabetic Mothers, 5D Fetal Echocardiography.
INTRODUCTION
Approximately 3-6% of infants of diabetic
Diabetes mellitus is a common condition,
mothers
(IDMs)
have
congenital
cardiac
affecting approximately 7% of pregnant women.
malformations. While 40% of infants of diabetic
Appropriate management has reduced morbidity
mothers have hypertrophic cardiomyopathy (HCM)
and mortality (1).
that may or may not be symptomatic. A major
finding is hypertrophy of the ventricular and sepal
Diabetes mellitus in pregnancy can cause
walls of the neonatal heart. In all, 5% of neonates
many problems for the fetus as significant congenital
born to diabetic mothers suffer from congestive
disorders, risk of premature delivery and increased
heart failure due to left ventricular outflow
prenatal morbidity and mortality. In addition, it
obstruction. Fortunately, in most cases, cardiac
causes neonatal hypoglycemia, macrosomia and
hypertrophy is transient with spontaneous
transient
hypertrophic
cardiomyopathy
HCM
echocardiographic resolution within the early
(observed in up to 35% of fetuses) (2).
months after birth, requiring no therapy (3).
4932
Received:4/6/2018
Accepted:13/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4938-4945
Comparison between Two Types of Copper Bearing Intrauterine Device Cu375
and Cu380Ag Regarding Bleeding Pattern:
(Randomized Controlled Trial)
1Mohamed Mahmoud ElSherbieny, 1Ahmed Mahmoud Hussein, 2Ragaa Galal Rafat Farag
1Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, 2Department of Obstetrics &
Gynecology, Faculty of Medicine, Tanta University
ABSTRACT
Background: The complications of IUDs are abnormal uterine bleeding, dysmenorrhea, expulsion of the IUD
or perforation of the uterus. Due to these complications, 5 to 15 percent of women will stop using the IUD
during one year. The most common complication of using IUDs is bleeding that is the cause of 15 to 30
percent of the rejection and exclusion of copper IUDs by the users. Except for progesterone IUDs, all IUDs can
lead 50-100 percent increase the amount of menstrual blood than before the insertion.
Purpose: To compare between two types of copper IUDs different in shape and size Cu375 & Cu380Ag
regarding bleeding pattern.
Patients and Methods: This is a randomized controlled clinical trial. The study was conducted at Family
Planning Outpatient Clinic at Department of Obstetrics & Gynecology at Ain Shams Maternity Hospital on
220 patients divided into two groups with insignificant differences between two groups as regard age (p-value
0.934).
Results: 110 participants recruited in each group. In group A, drop out after 1month was 6 women and only 70
women had subjective changes in bleeding pattern. After 1year, drop out was 8 women. In group B, drop out
after 1month was 4 women and only 79 women had subjective changes in bleeding pattern. After 1year, drop
out was 5 women.
Conclusion: One of the most common complications of IUD users is bleeding. These complications vary in
the different types of IUDs. The results of this study showed that the use of the IUD ML CU 375 causes a
significant decrease in the rate of bleeding.
Keywords: Bleeding Pattern, Copper Bearing, Intention-to-treat
INTRODUCTION
Some studies showed no differences of
Copper intrauterine devices are valuable
effects of the two IUD ML CU 375 and IUD
birth control resources (1). Because of the duration
Copper T 380A types (6). Other studies were
of high impact in contraception, low failure rate,
conducted have shown that the amount of bleeding
reversibility and low cost, copper IUD is used by
in IUD Copper T 380A was further (7).
over 130 million women around the world (2).
Another descriptive study showed that
The primary mechanism of action of the
bleeding and dysmenorrhea are the most common
copper IUD is the prevention of fertilization through a
complications for IUD ML CU 375 and IUD
cytotoxic inflammatory reaction that is spermicidal (3).
Copper T 380A, so that these two complications in
In copper IUD users, the copper concentration in
users of IUD ML CU 375 was significantly higher
cervical mucus is substantial and leads to an
than IUD Copper T 380A group (8).
inhibition of sperm motility (4). Because copper ions
also result in significant endometrial changes, sperm
PATIENTS AND METHODS
migration, quality, and viability at the level of the
Study design: Randomized controlled
endometrium is hindered. There is also, indirect
clinical trial.
clinical evidence that the copper IUD has post
Study setting: The study was conducted at
fertilization contraceptive effects. Placing a copper
Family Planning Outpatient Clinic at Department
IUD, even in the early luteal phase, is a highly
of Obstetrics & Gynecology at Ain Shams
effective emergency contraceptive (5).
Maternity Hospital. The study was approved by
There are two types of commonly used
the Ethics Board of Ain Shams University and
IUDs including the Multi Load CU 375 IUD and
an informed written consent was taken from
Copper T 380A IUD. IUD Copper T 380A is a T
each participant in the study.
shaped framework of polyethylene that contains
Patients Selection: Participants selected in
380 square millimeters of copper (2). The IUD ML
this study was women seeking a contraceptive
CU 375 is a tree-shaped device that contains 375
method and counceled to use IUD. Participants will
square millimeters copper woven around the body.
be distributed randomly into two groups: Group A:
4938
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4946-4950
Surgical Management of aseptic Femoral Shaft Non-union after Intramedullary
Fixation
Eissa Ragheb Refaie1, Ahmed Abd El hamidShamma, Abdullah Abu Senna1, Mohamed Negm1, Ahmed
Abd El sattar Eltarabany2
1Department of orthopedic, Faculty of Medicine, Al-Azhar University, Cairo,Egypt
5Department of orthopedic, Mashtoul-Elsouk general hospital Ministry of Health, Sharkia, Egypt
Corresponding author: Ahmed Abd El sattar, Tel: +01000955389, Email: ahmedeltarabany@gmail.com
ABSTRACT
Background: Several treatment modalities are available for handling of femoral nonunion after intramedullary
nailing. These alternatives include nail dynamisation, external fixation, exchange nailing and Plate
osteosynthesis. This treatment can be used as augmentation technique over a previous used intramedullary nail,
with or without bone grafting. Objective: To evaluate the outcome of femoral nonunion after intramedullary
fixation by locked nail and management of 30 cases of aseptic femoral nonunion with nail exchange or
augmentation with plate. Patients and Methods: We reviewed 30 patients with femoral fracture nonunion
after interlocking intramedullary nailing treated either with exchange nailing with or without bone graft or
plate augmentation and bone grafting with the nail in situ. The mean time from primary nailing to exchange
nailing or plate augmentation and bone grafting was 9.80±5.45 months for achieving stability of the fracture.
We did exchange nailing with larger diameter nail or applying DCP plate on the lateral aspect of the femur.
Results: 27 patients achieved solid union in time ranged from 6-12 months with mean of 7.54±2.18.
Conclusion: Exchange reamed intramedullary nailing has low morbidity, may obviate the need for additional
bone grafting, and allows full weight-bearing and active rehabilitation provides extremely rigid fixation, and
provides reason to allow patients to bear weight early in the postoperative period. Bone graft could be
precisely placed in the fracture site if necessary.
INTRODUCTION
the area of the nonunion or pain in the adjacent
Despite the advances in trauma care,
joints. The patient should also be examined in the
improved surgical techniques, newer implants and
weight bearing position. Antalgic gait and/or the
the evolution of new adjuvant to healing, biologic
presence of ambulatory assistive equipment may be
agents, nonunion still occur and are often a result
present. Static and dynamic functional alignment in
of a high energy initial trauma. Femoral nonunion
the frontal, horizontal and sagittal planes must
represents a serious socioeconomic problem for the
carefully be assessed, as well as range of motion of
patient, associated with prolonged patient
the adjacent joints. Neurovascular evaluation of the
morbidity, gait abnormality, inability to return to
lower extremity is essential. The evaluation should
work,
re-operations
and
psycho-emotional
include peripheral pulses and skin temperature (5).
impairment. It moreover stands for a treatment
The radiographic evaluation must include
challenge for the orthopedic surgeon.
anteroposterior and lateral views and with the beam
Union is considered delayed when healing
centered on the deformity. The diagnosis of a
has not advanced at the average rate for the
nonunion is based on the absence of bridging bone
location and type of fracture (usually 36 months).
at the fracture site and persistence of the fracture
Classification of nonunion is based on radiographic
line. Computerized tomography (CT) has replaced
and scintigraphic appearance of the fracture site (2).
plain tomography, and may be helpful in the exact
It is divided into, hypertrophic or viable and,
measurement of the anatomic and mechanical axis
atrophic or non-viable sub-types (3).
of the limb (5).
The diagnostic modalities are: patient
Infection should always be investigated in
history, including the date of injury, details of the
the presence of femoral nonunion. Laboratory tests
initial and subsequent treatment, patient's
include a complete blood test, erythrocyte
nutritional status and associated medical problems
sedimentation rate and C-reactive protein levels.
is essential before beginning the diagnostic
Inappropriate mechanical environment of the
workup. The patient's description of a painful and
fracture (inadequate fracture stability), insufficient
mobile fracture site may be the first sign in the
blood supply (avascularity), bone loss are the main
detection of the nonunion. Potential risk factors
reasons for the development of a nonunion. In
such as smoking, use of nonsteroidal anti-
some cases, despite the appropriate treatment, there
inflammatory drugs and the physical examination
is no evident reason (6).
must assess the presence of pain and/or motion in
4946
Received:11/6/2018
Accepted:20/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4951-4955
A prospective, Randomized Comparative Study Between Mini and Conventional
Laparoscopic Nephrectomy
Maher MA Mohamed; Ahmed GE Abd El Raouf; Nasr E; Ahmed Y Abo Alsaad
New Damietta University Hospital, Urology Department, Faculty of Medicine, Al-Azhar University, Egypt
Corresponding author: Maher MA Mohamed, Tel: 010681686
ABSTRACT
Background: Renal cancer is the commonest renal tumor and is usually treated by radical nephrectomy.
Development of laparoscopic surgery was associated with reduction of post-surgical complications and the
invent of mini-laparoscopic devices proposed to be associated with marked reduction of postoperative
complications. Objective: to compare between mini and conventional laparoscopic nephrectomy as regards
perioperative complications. Patient and Methods: Eligible patients underwent transperitoneal conventional
or minilaparoscopy (ML) or conventional laparoscopy depending on surgeon preference. Preoperatively,
patients were evaluated by history and clinical examination, with routine Lab and radiological investigations.
Both operative and postoperative data were collected and documented. Results: both groups were comparable
as patient demographics, associated medical diseases, preoperative data or the type of nephrectomy. However,
operative time was significantly shorter, while blood loss was significantly larger in conventional group. In
addition, postoperative pain was significantly higher and duration of hospital stay was significantly longer in
conventional group. Finally, total cosmoses score was statistically decreased in conventional group.
Conclusion: Compared with mini-laparoscopy, conventional laparoscopy showed better intraoperative
parameters as shorter operative time, blood loss and less need for conversion to open surgery. However, the
overall complications were comparable for both groups.
Keywords: Radical nephrectomy; end stage renal disease; laparoscopic nephrectomy; conventional; mini-
laparoscopy.
INTRODUCTION
reduction of morbidity and advance the cosmetic
Renal cell carcinoma represents the
consequences of laparoscopic surgery. These
commonest malignant disease of the kidney and
comprise use of mini-laparoscopic, 2 mm `needle-
accounts for 3% of malignancies of adult patients
ports' usage of normal orifices, and use of purpose-
and the surgical removal is still the most important
intended single port appliances (4). Mini-
procedure in the eradication of renal cell carcinoma
Laparoscopic Surgery," which uses 2-3 mm
(1). Simple nephrectomy is used in the treatment of
diameter devices, was announced and shaped in
most benign renal tumors associated with long-
1990s, but did not catch on due to early limitations
lasting loss of renal function. Indications include
of such devices, high costs and associated injuries.
chronic pyelonephritis, obstructive or reflux
But once new devices have found, the use of mini
nephropathy, renal tuberculosis, multicystic
laparoscopic maneuvers were settled (5).
dysplastic kidney, endovascular hypertension,
The aim of our study is to compare
attained renal cystic disorders among patients on
between mini and conventional laparoscopic
dialysis, nephrosclerosis, autosomal dominant
nephrectomy as regards operative as well as
polycystic kidney and hypertension developed after
postoperative incidents and complications.
kidney transplantation (2).
Clayman et al. (3) carried out the first
PATIENTS AND METHODS
laparoscopic nephrectomy to treat a 3 cm renal
A prospective randomized study protocol
mass in old patient. This achievement is one of the
was approved by the local research and ethical
milestones in minimally invasive surgery as it
committee of Faculty of Medicine, Al-Azhar
delivered the solution for laparoscopic removal of a
University. Between July 2017 and July 2018, all
large solid organ.
patients who were admitted to Urology Department
Conventional
laparoscopic
surgery
(Al-Azhar University Hospital, New Damietta) for
involves the use of several (three to six), large (5
nephrectomy were tested for eligibility for the
mm, 10/12 mm) ports inserted through
study. Patients who fulfilled the following criteria
commensurately sized skin incisions for retraction
were eligible for inclusion in the study: 1) age
of tissues, and the essential triangulation of the
older than 18 years, 2) patients' physical states
surgeon's right- and left hand instruments for the
ASA I and II, 3) those who prepared for
surgical dissection. Efforts are ongoing to further
nephrectomy (simple or radical). On the other
4951
Received:17/6/2018
Accepted:26/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4956-4963
Timing of Renal Replacement Therapy and its impact on the Outcome of Acute
Kidney Injury Patients
Fawzy Hamed Hasan, Haytham Sabry Abdul Hamed, Mohamed Ahmed Elsayed, Ahmed Mohammed
Owais Elhawy, Mohammed Zaher Sadaka
Department of Internal Medicine and Nephrology, Faculty of Medicine, Al-Azhar University
Correspondence: Ahmed M.O. Alhawy, E-mail: amo.alhawy@ymail.com, Mobile: 00201112746367.
ABSTRACT
Background: Previous studies using Acute Kidney Injury Network (AKIN)/RIFLE criteria to classify early
initiation of renal replacement therapy (RRT) have defined it as the therapy started in less severe AKIN/RIFLE
stages. Generally, these studies failed in demonstrating measurable benefits.
Aim: To evaluate RRT in critically ill patients and its timing and its impact on critically ill patients.
Methods: We compared RRT initiation in critically ill patients and defined early or late RRT in reference to
timing after stage 3 AKIN was met: patients beginning RRT within 24 hours after acute kidney injury (AKI)
stage 3 were considered early starters. AKIN criteria were evaluated by both urine output (UO) and serum
creatinine (sCr) and patients with acute-on-chronic kidney disease were excluded. A propensity score
methodology was used to control variables.
Results: A total of 358 critically ill patients were submitted to RRT. Only 150 patients with pure AKI at stage
3 were analyzed. Mortality was lower in the early RRT group (51.5 vs. 77.9%, P = 0.001). After achieving
balance between the groups using a propensity score, there was a significant 30.5 (95% confidence interval
[CI] 14.4 to 45.2%, P = 0.002) relative decrease of mortality in the early RRT group. Moreover, patients on the
early RRT group had lower duration of mechanical ventilation, time on RRT and a trend to lower intensive
care unit (ICU) length of stay.
Conclusions: For the first time, AKIN was used with UO criterion to evaluate early and late RRT. Using a
time based approach could be a better parameter to access the association between RRT initiation and
outcomes in patients with AKI.
Keywords: RRT, AKI, AKIN, RIFLE, Critically ill patients.
INTRODUCTION
start (n = 2) [17,18] have also been used to define
Acute Kidney Injury (AKI) is a common
early dialysis. RIFLE criteria have been used in
occurrence in critically ill patients, with incidence
three other studies to define early dialysis [19-21].
rates of occurrence varying from 5 to 60% and a
Although the RIFLE criteria were
trend towards higher rates (30 to 60%) when using
developed and validated for AKI diagnosis and
the risk, injury, failure, loss of kidney function, end
evaluation of severity, and not a parameter to guide
stage renal failure (RIFLE) or Network (AKIN)
RRT initiation, some observational studies [19-21]
classification [1,2]. AKI is an independent risk factor
have investigated whether initiating RRT in less
for increased morbidity and mortality [3,4]. Renal
severe renal injury (that is, RIFLE classification -0
replacement therapy (RRT) is necessary in about
or R) can be associated with a better survival rate.
6% of critically ill patients, according to a large
Although one study that analyzed AKI after major
multinational, multicenter survey [1]. Generally,
abdominal surgery demonstrated benefits [20], two
RRT is provided as supportive treatment to AKI
others studies evaluating mainly patients with
patients,
preventing
additional
disorders
sepsis demonstrated similar outcomes with either
(hypervolemia, metabolic acidosis, progressive
early or late RRT [19,21]. However, two problems
uremia, and hyperkalemia) [3]. Data from mainly
can make the analysis of survival benefits in early
observational studies have suggested that early
dialysis difficult when using this definition: (1)
RRT in critically ill patients with AKI may have a
patients at less severe AKI stages initiating RRT
beneficial impact on survival [5,6]. However, in
may have severe metabolic disorders (that is,
addition to the lack of large randomized clinical
metabolic acidosis, or hyperkalemia) in spite of
trials assessing early dialysis indication, there is a
limited renal injury, or even no AKI (RIFLE
broad variation in the criteria used to classify early
classification -0); (2) when using RIFLE/AKIN
or late RRT [6]. In a review of 16 studies comparing
criteria, patients with chronic kidney disease
early vs late dialysis, metabolic markers (serum
(CKD) must have significant metabolic disorders to
urea or hyperkalemia) were the most frequently
require RRT before classification with the
used parameters (n = 8) [7-13]. Reduced urine output
maximum severity grade, as opposed to those with
(n = 3) [14-16] or timing from ICU admission to RRT
previous normal previous renal function.
4956
Received:11/6/2018
Accepted:20/6/2018