ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 4964-4968
Neuraxial versus Peripheral Nerve Block for Postoperative Pain Management in
Drug Abusers Undergoing Orthopedic Surgeries
Alaa Eid Mohammad, Ahmed Ali El-Shebiny, Michael Naser Saba Tomas
Anesthesiology and Intensive Care Department, Faculty of Medicine, Ain Shams University
ABSTRACT
Background: While all surgical procedures are associated with some degree of pain, it is a well-accepted fact that
orthopedic surgeries are some of the most painful. Despite the increasing interest and continuous advancement in
postoperative pain management, more than half of the patients who undergo orthopedic surgeries experience
inappropriate level of postoperative pain. Poorly treated pain can have negative impact on recovery especially
owing to disruption in physiotherapy resulting in stiffness of joints and slow progress in mobility. In order to
achieve good quality of postoperative analgesia, careful history should be taken from the patients about any
coexisting medical conditions such as substance abuse or withdrawal, anxiety disorder, affective disorder, hepatic or
renal impairment and any past history of poor pain management. Aim of the Work: The purpose of this study was
to compare efficacy, side effects, opiate consumption and hemodynamic effects of neuraxial blocks versus
peripheral nerves blocks placed under ultrasound guidance, for postoperative pain management in drug abusers
undergoing orthopedic surgeries. Patients and Methods: Sixty patients presenting to Ain Shams University
hospitals for orthopedic surgeries were enrolled in this prospective randomized controlled study after providing
written consents. Participants were instructed about the study protocol and visual analogue scale (VAS). Approval
was obtained from the research ethics committee of anesthesia and intensive care department, at Ain Shams
University. In this study, all patients were preoperatively assessed for evaluation of their medical status, mode of
trauma, post-traumatic critical symptoms or signs, hemodynamic stability, evidence of coagulopathy and any
previous history or concurrent drug abuse. Results: This study included 60 drug-abuser patients, undergoing
orthopaedic surgeries, starting from January 2018 till May 2018 at Ain Shams University Hospitals and randomly
distributed within 2 groups, 30 patients each: Group A: EPI group, Group B: PNB group. As regard to age, gender,
body weight, height, ASA and duration of surgery, there were no statistically significant differences between both
groups (P-value>0.05). Regarding effects on hemodynamics and intraoperative ephedrine administration, the
present study found statistically significant difference in the mean arterial blood pressure measured intra operatively
with more drop in group A (EPI) than group B (PNB) with a (P value < 0.001). Also there was significant increase
in heart rate from baseline readings in group A compared to group B (P value < 0.001). Statistically significant more
incidence of intraoperative ephedrine administration was found in group A compared to group B with a (P value <
0.001). Regarding incidence of postoperative side effects such as sedation, dizziness, nausea, vomiting and urine
retention, there was statistically significant more incidence in group A (EPI) than group B (PNB) with a (P value <
0.001). Regarding postoperative pain assessment using VAS, opioids consumption, fulfillment of rehabilitation
programs and hospital stay, there were no statistically significant differences between both groups (P value > 0.05).
Conclusion: The choice of continuous femoral and sciatic block technique placed under ultra-sound guidance for
postoperative pain control provides equivalent analgesia, opioid consumption, postoperative rehabilitation and
hospital stay with a lower incidence of hemodynamic side effects when compared to continuous epidural analgesia
in drug-abuser patients undergoing orthopedic surgeries. It was also associated with decreased risk of postoperative
side effects as sedation, dizziness, nausea and\or vomiting and urinary retention.
Keywords: Neuraxial, Peripheral Nerve Block, Drug Abusers, Orthopedic Surgeries
INTRODUCTION
In order to achieve good quality of postoperative
While all surgical procedures are associated
analgesia, careful history should be taken from the
with some degree of pain, it is a well-accepted fact that
patients about any coexisting medical conditions such as
orthopedic surgeries are some of the most painful.
substance abuse or withdrawal, anxiety disorder, affective
Despite the increasing interest and continuous
disorder, hepatic or renal impairment and any past history
advancement in postoperative pain management, more
of poor pain management. In addition, preoperative
than half of the patients who undergo orthopedic
patient awareness should be done to improve
surgeries
experience
inappropriate
level
of
expectations, compliance and ability to effectively interact
postoperative pain. Poorly treated pain can have
with pain management techniques (2).
negative impact on recovery especially owing to
A common problem in managing postoperative
disruption in physiotherapy resulting in stiffness of
pain in patients with active or former substance abuse
joints and slow progress in mobility (1).
disorders is under-treatment of pain due to fear of creating
further addiction problems. Patients subsequently end up
4964
Received:11/6/2018
Accepted:20/6/2018
ABSTRACT
retracted
1
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 4973-4976
Role of Magnetic Resonance Imaging in evaluation of postoperative knee surgery
Mahmoud Mohamed Ahmed Ali1, Mohamed Ali Aboud1, Mohamed Salah El-Feshawy1,
Ali Mohamed El-Gyoshy2
Department of 1Radiodiagnosis and 2Orthopedic Surgery, Faculty of medicine Al-Azhar University
Corresponding author: Mahmoud Mohamed Ahmed Ali, E-Mail: mahmouddr75@gmail.com, Mobile: -01020881293
ABSTRACT
Background: MRI has high sensitivity and specificity regarding the assessment of the post-operative knee
joint. Purpose: to assess the role of MRI in evaluation of the post-operative knee joint and assessment of the
post complications after ACL, meniscal and cartilage surgical repair procedures. Patients and Methods: this
study included 20 patients, their age range between 14-50 years, all presented postoperative knee were referred
to Radiology Department at El-Hussien University Hospital and private centers for MRI exam for post-
operative assessment, complication or follow up after orthopedic examination from Orthopedic Department at
El-Hussien Hospitals and Outpatient Clinic. Patients had MRI imaging of the affected knee joint using high
field strength scanners (1.5 T) MRI unit (Achieva, Philips medical system) MRI was performed by Knee coil
in all cases. Results: this study included 15(75%) males and 5 females (5%)(A) Due to different types of
operations 10(50%) had ACL reconstruction,6(30%) had menisectomy,4(20%) had cartilage repair. (B) Due to
causes16(80%) trumatic,4(20%)non trumatic. (C) Due to types of complications: 3(15%) had no
complications,12(60%)had swelling, 2(10%) had limitation of movement,2(10%) had pain and
limitation,1(5%)had pain and swelling. Conclusion: MRI proved as an accurate method for evaluation of the
knee joint after ACL, meniscus and cartilage repair that can help predict post-operative complications.
Keywords: MRI postoperative knee, Postoperative knee complications.
INTRODUCTION
has greatly increased, resulting in a higher number
The knee is a frequently injured joint and,
of knee injuries(4).
thus, a common focus of operative intervention. As
Anterior cruciate ligament is considered
operative techniques and imaging modalities evolve,
the most common ligament that can be
radiologist must be aware of the expected
reconstructed. Clinical evaluation of ACL
postoperative appearance after knee surgeries that are
reconstructions can be difficult, and MRI plays an
performed commonly, and also must be comfortable
important role in evaluating the integrity of the
recognizing complications encountered in the
ACL graft, as well as diagnosis of complications
immediate or delayed postoperative period(1)
associated with ACL reconstruction(5)
.
.
Magnetic resonance imaging (MRI) is
Posterior cruciate ligament (PCL) is
often the method of choice to evaluate soft tissue
considered the second ligament that exposes to
injuries in acute knee trauma, and has widely
injuries. The accuracy of MRI in the evaluation of PCL
replaced diagnostic arthroscopy. MRI is a non-
injuries (near 100% sensitivity and specificity) has
invasive examination that allows excellent soft
been described(6).
tissue contrast without ionizing radiation(2).
Articular cartilage injury is very common,
MRI of the knee after surgical repair is
being present in up to 63% of arthroscopic
becoming more common because of the increasing
procedures. With the advent of new cartilage repair
number
of
therapeutic
knee
arthroscopic
procedures that have the potential to either form
procedures being performed. It is important to
hyaline-like repair tissue or transplant hyaline
understand the surgical procedure performed as
cartilage to the damaged area, there is an increased
well as the normal postoperative MR appearance to
need for an accurate noninvasive method to evaluate
make it possible to diagnose complications
the results of such repair procedures. MR imaging is
following such procedures(3).
currently the best method for such evaluation(7).
The most common arthroscopic repair
procedures include partial meniscectomy and
AIM OF THE WORK
meniscal repair, anterior cruciate ligament (ACL)
The aim of our study is to find out the role
reconstruction, and cartilage repair procedures(3).
of MRI in evaluation of postoperative knee.
Meniscal tears are the most frequent injury
to the knee joint. Such injuries are especially
PATIENT AND METHODS
prevalent among competitive athletes. In the last 25
This study included 20 patients, their age range
years, the number of people participating in sports
between 14-50 years, all presented postoperative knee
4973
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 4977-4983
Accuracy of Lung Ultrasonography in Diagnosis of Community Acquired
Pneumonia as Compared to Chest X-Ray in Pediatric Age Group
Abeer El-Sayed Metwally Mohamed, Omar Farouk Kamel, Mohamed Shaker Ghazy
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Abeer El-Sayed Metwally Mohamed, Mobile: +201117630373, E-mail address: top_girls.2110@hotmail.com
ABSTRACT
Objective: It was aimed at investigating the role of lung ultrasonography in assessment of pneumonia as
compared to chest x-ray in pediateric age group.
Purpose: to evaluate the ultrasound efficiency in the assessment of pneumonia in pediatric age group as
compared to chest x-ray.
Methodology: This study was carried out at the general pediatric wards and PICUs of El-Demrdash hospital,
Ain Shams University.40 patients were clinically diagnosed with pneumonia. For every child included in the
study, a chest x-ray and a chest US were performed.
Result: the detection rate of consolidative patches was higher in ultrasound compared to the x-ray technique.
Conclusion: Lung ultrasound is safe and accurate for the diagnosis suspected cases of community acquired
pneumonia and it is more sensitive than chest X-ray and allows a radiation free technique for detection of
consolidations in children, thus reducing radiation exposure in this population.
Keywords: Lung Ultrasonography (LUS), Chest x-ray (CXR), Radiation, Imaging tool, Consolidation.
INTRODUCTION
AIM OF THE WORK
Pneumonia is the single largest infectious
cause of death in children worldwide. Pneumonia
The aim of this study was to evaluate the
killed 920 136 children under the age of 5 in 2015,
ultrasound efficiency in the assessment of
accounting for 16% of all deaths of children under
pneumonia in pediatric age group compared to
five years old (1).
using chest x-ray technique.
Diagnosis
of
community
acquired
PATIENT AND METHODS
pneumonia CAP) is done clinically but with poor
diagnostic specificity (2, 3).
The study was performed on 40 Egyptian
children (males and females), admitted during the
Chest X-ray (CXR) is considered as the
period from June 2017 to June 2018 in the general
first imaging step for further evaluation. Even
pediatric wards and PICUs of El-Demrdash
though plain radiographs have small amounts of
Hospital, Ain Shams University. The study was
radiation dose exposure of about 0.01-1.5 mSv,
approved by the Ethics Board of Ain Shams
children are more susceptible to nondeterministic
University.
stochastic effects of radiation than adults (4, 5).
Children presenting with clinical picture of
In addition, the interpretation of CXR
pneumonia were enrolled in the study. This
findings is dependent on the quality of the film and
symptoms included fever, cough, lethargy, chest pain
the expertise of the reader (6, 7).
and an acute onset of symptoms and signs of
The use of ultrasound for the evaluation of
respiratory distress including tachypnea, retractions,
the lung is relatively recent. Lung ultrasound
grunting and cyanosis in addition to auscultatory
(LUS) is inexpensive, portable and non-ionizing
findings associated with diminished air entry, fine
imaging tool. It is relatively easy to teach (8).
rales and bronchial breath sounds.
The various studies had shown that LUS
Inclusion criteria: Clinical signs and symptoms
performs well in adults (9, 10).
of pneumonia (cough associated with abnormal lung
Lung
ultrasound
(LUS)
is
being
auscultation or percussion and fever of unknown origin
increasingly used with children and neonates under
lasting longer than 5 days). Children aged from 0 to 16
various thoracic conditions (11, 12). It is therefore,
years. Presence of clinical driven x-ray. Availability of a
and due to the accumulation of information and
pediatric sonographer expert in LUS.
knowledges about radiation exposure hazards of
Exclusion
Criteria:
Unwilling
using CXR with children, LUS technique was
parents/guardians. Contraindications with radiological
introduced and examined as a possible, useful, and
exposure (chromosomal breaking syndromes, e.g.
safe tool instead of using CRX.
(ataxia Telangectasia, fragile X syndrome and Wiskott
Aldrich syndrome).
4977
Received:3/5/2018
Accepted:12/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 4984-4989
Comparative Study between Effects of Addition of Fentanyl versus Dexmedetomidine
to Local Anesthetic Mixture for Peribulbar Block for Cataract Surgery
Said Mohamed Fayed, Mostafa Mohamed Mahdy, Abdallah Mohamed Ahmed, Amr Mohamed Ahmed
Hefny
Department of Anaesthesia and ICU, Faculty of Medicine- Al-Azhar University
Corresponding author: Amr Mohammed Ahmed Hefny, E-Mail: Amrhefny10@gmail.com, Mobile: 01113385644
ABSTRACT
Background: regional anesthesia is currently more preferable than general anesthesia in ophthalmic surgery
and include many types as; peribulbar (extraconal) and retrobulbar (intraconal) anesthesia. Peribulbar block is
commonly used because there is reduced risk of globe perforation and optic nerve damage in different to
retrobulbar block, but it needs sometimes block supplementations to improve the quality of the block such as
clonidine and hyaluronidase. Also, fentanyl and dexmedetomidine was added in this study as an adjuvant to
local anesthetics in peribulbar block for cataract surgery.
Objective: the aim of this study was to evaluate and compare the effect of adding fentanyl and
dexmedetomidine as adjuvants to local anaesthetic mixture in peribulbar block as regards duration (anesthesia
and akinesia), efficacy and pain relief.
Patients and Methods: in this study sixty patients of ASA I-III of both gender, aged 30-60 years arranged into
three equal groups (group S, group F and group D) received peribulbar block for phacoemulsification with
intraocular lens implantation operation. Group F and group D received fentanyl and dexmedetomidine respectivly
with local anaethetics (LA) solution and showed statistically significant difference in onset and duration of globe
akinesia respectively compared to group C which received local anaethetics (LA) solution only.
Results: the onset of globe analgesia was significant in group F and group D compared to Group S.
Postoperative pain was assessed by using a 5-points verbal rating score and recorded data showed significant
difference between the three groups with better postoperative pain control in group F and group D. There was
no statistical significant difference between the two groups as regarding the hemodynamics (MBP, HR and
SPO2) and the incidence of complications.
Conclusion: the current study concluded that adding fentanyl or Dexmedetomidine to local anaethetics (LA)
in peribulbar block significantly reduced the time of onset of globe akinesia and analgesia and reduced the
need for second injection. Also, it increased the duration of globe akinesia and analgesia with better
postoperative pain control.
Keywords: Myocardial infarction, Oxygen saturation - Intravenous
INTRODUCTION
bicarbonate and adrenaline, dexmedetomidine were
Regional anesthesia is more preferable
added to local anesthetics(4,5).
than general anesthesia in ophthalmic surgery as
Fentanyl
(N-phenyl-N-(1-Phenethyl-4-
most patients are elderly and have chronic diseases
piperi-dinyl) propanamide) is an opioid analgesic
as diabetes, hypertention, cardiac and chest
with potency eighty times that of morphine (4).
problems. Regional anesthesia for eye surgery
Fentanyl is extensively used for anaesthesia
includes peribulbar and retrobulbar blocks,
and analgesia in the operating room and intensive
Peribulbar block is commonly used for ophthalmic
care unit. It is frequently given intrathecally as a part
surgery in adults (1).
of spinal anaesthesia or epidurally as a part of
In peribulbar (extraconal) there is reduced
epidural anaesthesia and analgesia, it is also used as a
risk for globe perforation and optic nerve damage
sedative (6).Addition of small amount of local
in different to retrobulbar (intraconal) block,
anaestheics augments the effect of intrathecal opioids
However greater volume of anaesthetic solution
by increasing the duration of the block and speeding
must be used (2).
the onset of analgesia(7).
Using local anesthetics for peribulbar
Dexmedetomidine was used before in
anesthesia is associated with delayed onset of globe
neuroaxial blocks and regional blocks and proved
akinesia and corneal anesthesia, short duration of
to decrease the onset of anesthesia and akinesia and
analgesia and sometimes need of block
increase the duration of analgesia and akinesia in
supplementation(3). To decrease the time of onset of
all these blocks(8).
action and increase the duration of analgesia, many
This study is designed to examine the effect
additives such as clonidine, hyluronidase, sodium
of adding fentanyl versus dexmedetomidine to local
4984
Received:17/6/2018
Accepted:22/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 4990-4994
Predictors, complications and outcome of coronary artery bypass surgery in
patients attending the cardiac center of Arar City, Northern Saudi Arabia
Bader Arar Shadad Alruwaili1, Malik Azhar Hussain2, Thamer Arar Shadad Alruwaili1, Taghreed Arar
Shadad Alruwaili1, Osama Mazha Mutkhan Alanazi1, Adel Turki D Alenezi1, Mohammed Khalil Al
Shakarah1, Saud Rteamy R Alanazi1, Anwar Khulaif B Alshammari1, Khawlah Hameed Alanazi1,
Abdulaziz Salamah Alanazi1, Ahmed Saud A Aldaghmi1, Abdullah Saad A Alanazi1, Munif Saleh
Alenezi1
1Faculty of Medicine, Northern Border University, 2Surgery Department,College of Medicine. Northern Border
University.Arar Saudi Arabia
ABSTRACT
Background: The increased incidence of cardiovascular disease between patients nowadays led to upsurge in the
number of cardiac operations. After coronary artery bypass surgery, most patients remain free of symptoms for up
to 15 years. The surgery also reduces the risk of heart attack and improves survival. Objective: to determine the
predictors and outcome of coronary artery bypass surgery in patients attending the cardiac center in Arar, KSA all
over the study period. Methods: The current study is a cross sectional study conducted during the period from
September 2017 to March 2018. The current study included 72 individuals attending the cardiac center in Arar City.
Collecting patients' data was conducted through interviewing the patients included in the study and reviewing their
medical files. A predesigned questionnaire was used for data collection. Results: We found that 81.9% of cases
were males, 61.1% aged from 30 to 39 years old, 34.4% of cases have a myocardial infraction as a clinical diagnosis
before the operation, 25% had angina pain, and 50.0% were smokers. Hyperlipidemia, chronic kidney disease, and
chronic obstructive lung disease were found in 59.7%, 83.3% and 77.8% respectively. There were 41.6% who had
postoperative arrhythmia, 13.9% had bacterial infection in the site of operation and another 13.9% had hypotension,
11.1% re-operated due to bleeding, and 6.9% got postoperative acute myocardial infarction. After 6 month of the
operation, 69.4% of cases were quite good while recurrence of chest pain found in12.5%, heart failure in 2.8% and
8.3% died. There was significant association between outcome of cases after 6 months of operation and patients age
(P<0.05) and all the dead cases were males. Conclusion: Our findings indicated that, among cardiac patients
attending the cardiac center in Arar, KSA, the preoperative characteristics are suggestive of 30 to 39 years old males
with myocardial infraction, angina pain, smokers, have hyperlipidemia, chronic kidney disease, and chronic
obstructive lung disease is undergoing coronary artery bypass surgery. The death rate was low and 69.4% of cases
were quite good.
Key words: Coronary artery bypass surgery, Indications, Complications, Outcome, Cardiac center of Arar
City, Northern Saudi Arabia.
INTRODUCTION
years following surgery. The surgery also reduces
As a result of continually improving
the risk of heart attack and improves survival [4].
surgical strategy and the technology which
As with any type of surgery, coronary artery
supports it, cardiac surgery is now possible in an
bypass grafting (CABG) has risks in both short and
increasingly high-risk population [1] . Crude
long-term results. The risks of CABG include wound
mortality rates have often been used as an indicator
infection and bleeding, reactions to anesthesia, fever,
of quality of care, but their value is limited without
pain, stroke, heart attack, or even death [5].
knowledge of the risk profile of the patients [2].
Coronary artery surgery is now safer than
Coronary artery bypass grafting (CABG)
ever before, owing to modern surgical techniques
surgery performed for "Heart Attack", is the most
and pharmacological breakthroughs. Elderly
common open-heart operation [3] . CABG is a
patients, compared with patients of a younger age
technique that involves using an artery or vein from
group, present for surgery with a greater burden of
elsewhere in the body to bypass the blocked
risk factors and reduced functional levels [6].
vessels, restoring adequate blood flow to the heart.
In a study carried out by Weisel et al. [7] to
The artery or vein is attached around the blockage,
identify the predictors of outcomes in patients
so that there is a new pathway for oxygenated
undergoing CABG. It was found that the preoperative
blood to reach the heart muscle [4].
risk factors were history of heart failure, increasing
The outcomes of CABG are excellent.
age, history of peripheral vascular disease and
Most patients remain free of symptoms for up to 15
receiving aspirin before coronary artery bypass
grafting; which was protective.
4990
Received:18/5/2018
Accepted:27/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5001-5004
Correlation between T Stage of the Tumor and Tumor Behavior in Locally
Advanced Head and Neck Squamous Cell Carcinoma
Zeinab Mohammed Abdel-Hafeez Elsayed1, Mohammad Sabry Elkady1, Waleed Abd Elmmonem
Biomy1, Mai Mohamed Ali Ezz El Din1, Lamiaa Moustafa Abdel Megied Mohamed Ahmed1, Nashwa El-
khazragy2
Department of 1Clinical Oncology and Nuclear Medicine and Department of 2Clinical Pathology Faculty of Medicine,
Ain Shams University
Corresponding author: Lamiaa M.Abdel Megied Mohamed Ahmed, E-mail: lamiaa.ahmed@med.asu.edu.eg, Telephone: (+2) 01001460726
ABSTRACT
Background: Head and neck cancer (HNC) represents more than 550,000 cases annually. It accounts for
380,000 deaths every year. Despite aggressive treatment, only 35% to 55% of patients who present with
locally advanced HNC remain alive and free of disease 3 years after standard curative treatment. Thirty
percent to 40% of patients develop locoregional recurrences, and distant metastases occur in 20% to 30%.
Most recurrences appear quickly within 2 years of initial treatment and an additional 10% of patients will have
evidence of distant metastases at the time of first presentation.
Purpose: To retrospectively determine the prognostic effect of T stage in locally advanced head and neck
cancer.
Patients and Methods: This study retrospectively analyzed 40 patients diagnosed with locally advanced head
and neck cancer. Patients were diagnosed by a tissue biopsy and they were staged by endoscope and CT neck
or MRI neck with contrast. They received their treatment and were followed up every 3 months by CTs.
Results: We found a statistically significant correlation between T stage and both PFS and OS in HNC (95%,
CI 1.00 3.10, p=0.04 and 95% CI 1.01 2.65, p=0.05 respectively). We did not find any other statistically
significant correlation between other patients' sub-groups such as age, gender, smoking, affected site, stage,
lymph node infiltration, receiving induction chemotherapy, receiving radiotherapy with or without
chemotherapy, and response to treatment and between PFS and OS.
Conclusion: This study confirmed that the T stage of the tumor is an important prognostic factor in locally
advanced head and neck cancer.
Keywords: Locally advanced head and neck cancer, T stage, Prognosis.
INTRODUCTION
factor for local recurrence, disease free survival
Incidence if head and neck cancer
and overall survival(6).
represents more than 550,000 cases and 380,000
Aim: Determination of the prognostic
deaths every year (1). It represents 3 percent of
effect of T stage in locally advanced head and neck
malignancies in the United States with
cancer.
approximately 63,000 new cases annually and
13,000 deaths (2). In Europe, it approximately
PATIENT AND METHODS
represents 4 percent of cancer incidence with
Data were retrospectively collected from
250,000 cases an and 63,500 deaths in 2012 (3) .
forty patients with locally advanced HNSCC (stage
In Egypt a hospital based epidemiology
III- IVb) treated at the department of Clinical
retrospective study done in Kasr-AlAini
Oncology, Ain Shams University, Cairo, Egypt
Hospital during the period from Jan 2009 till
from May 2009 till December 2015. Of these
Dec 2011. It was done on cases of laryngeal
patients; 21 had laryngeal cancer, 9 patients had
cancers revealed the mean age was 57.6 + 10.5
oropharyngeal cancer and 10 had hypopharyngeal
ranging from 22 to 87 years old. Males were
cancer. Patients with laryngeal and oropharyngeal
93.9% while females were 6.1% and 62.4%
carcinoma received CCRT 66-70 Gy to the primary
were affected in the glottic and supraglottic
site, involved lymph nodes were to receive 60 to 70
regions, 20.7% transglottic regions(4) .
Gy & 50 Gy for areas of suspected subclinical
spread
2Gy/fraction,
5
fractions/week.
Squamous cell carcinomas represent
nearly 90% of all head and neck cancers, arising
Concurrently with Cisplatin every 3 weeks
mainly in the oral cavity but also occurring in
(100mg/m2) or weekly Carboplatin AUC 1.5,
the nasal cavity, pharynx and larynx (5) .T stage
according to patient's performance ECOG states
was found to be an independent prognostic
and medical history of any other comorbidities.
Induction TPF was allowed in locally advanced
5001
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5005-5008
Effect of Chest Physical Therapy Modalities on Oxygen Saturation and Partial
Pressure of Arterial Oxygen in Mechanically Ventilated Patients
Maged A. Meawad1, Akram Abd El Aziz1, Hany E. Obaya1, Sabah A. Mohamed2, and Khaled Mohamed
Mounir3
Departments of 1Physical Therapy for Cardiovascular/Respiratory Disorder & Geriatrics and 2Chest Medicine, Cairo
University, Department of 3Physical Therapy for Cardiopulmonary& Geriatrics Disorders, Egyptian Chinese
University, Egypt
Correspondence: Maged A. Meawad, E-mail: magedptdr@gmail.com, Mobile: 00201007977226
ABSTRACT
Background: Chest physical therapy plays an important role in increasing Pao2 and SaO2 among ICU
patients which is considered as a good indicator for the general improvement of the patient besides decreasing
ICU staying and costs.
Purpose: To figure out the effect of chest physical therapy on oxygen saturation and partial pressure of arterial oxygen.
Patients and Method: Thirty patients post MV, their age ranged from 50 to 60 years old were recruited in this
study. The patients were selected from ICUs of Kasr al Ainy hospital, Faculty of Medicine, Cairo University.
The patients received chest physiotherapy (percussion, vibration, manual hyperinflation), positioning and
upper and lower limbs exercises.
Results: Increase in Pao2 and SaO2 in addition to decreased incidence of chest infection and decreased ICU stay.
Conclusion: The results of this study support the importance of chest physiotherapy on increasing SaO2 and
Pao2, decrease ICU duration and decrease health care costs.
Keywords: chest physiotherapy, partial pressure of arterial oxygen (Pao2), oxygen saturation (SaO2) and
Mechanical ventilation (MV).
INTRODUCTION
Chest wall percussion and vibration were
Intensive Care Units (ICUs) are special
used by up to 80% of physiotherapists, often in
units used to provide care for critically ill patients.
combination with manual hyperinflation.This
ICU is expensive to operate; consuming 15- 40%
technique involves the production of large and
of total hospital costs (1).
small oscillatory movements performed during
expiration that aim to increase expiratory flow and
MV is always a lifesaving intervention,
subsequent pulmonary secretion clearance (6).
but carries many potential complications including
pneumothorax, lunginjury, alveolar damage, and
Mobilization refers to physical activity sufficient
ventilator-associated pneumonia(2).
to elicit acute physiological effects that improve
ventilation, central and peripheral perfusion, circulation,
Chest physiotherapy is one such common
muscle metabolism and alertness and countermeasures
preventive strategy where chest physiotherapists
for venous stasis and deep vein thrombosis (7).
routinely treat most of the ICU patients with various
chest physiotherapy techniques such as Manual
Positioning can be used to increase
hyperinflation, suctioning, patient positioning, chest
gravitational stress and associated fluid shifts, through
vibrations, chest percussions, various coughing
head tilt and other positions that approximate the
techniques in combination or individually to prevent
upright position, That increases lung volumes and gas
pulmonary complications in the ICUs(3).
exchange, stimulates autonomic activity, and can
reduce cardiac stress from compression(8).
Chest physiotherapy procedure help to
reinflate the collapsed lobe of a lung, Positioning
Passive movement has been shown to
combined with chest percussion, as well as lung
enhance ventilation in neurological patients in
hyperinflation plus suction, are the best ways to
high-dependency units (9).
quickly solve lung lobe atelectasis (4).
Is one of a number of techniques which provides
Percussion and vibration and shaking
a greater than baseline tidal volume to the lungs. It is
methods are based on the assumption that applying an
frequently used by physiotherapists in the treatment of
external force to the chest wall to loosen the mucus
intubated mechanical y ventilated patients with the aim of
facilitates airway mobilization and clearance, it
increasing alveolar oxygenation, recruiting atelectasis or
involves rhythmical beating with properly shaped
mobilizing pulmonary secretions (6).
hands on the chest wall over specific regions of the
Aim of the study: was to evaluate the
lungs and removing the mucus (5).
efficacy of chest physical therapy modalities on
SaO2 and Pao2.
5005
Received:9/6/2018
Accepted:18/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5009-5013
Comparative Study between Effect of Clomiphene Citrate, Tamoxifen and
Letrozole on Endometrial Thickness in Induction of Ovulation in Patient with
Polycystic Ovarian Syndrome
Abd El Monaem Mohamed Zakaria1, Mohamed Elsayed Hammour1, Mekky Abd El Monaem Aly2,
Ahmed Hussein Abd El Hamed Holla1
1Obstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar University
2Clinical Pathology Department, Faculty of Medicine, Al-Azhar University
Corresponding Author: Ahmed Hussein Abd El Hamed Holla, E-mail: ahmedhussein89@outlook.com, Phone: 01005252333
ABSTRACT
Background: Infertility is the inability of a married couple to conceive within one year in spite of regular marital
life. Globally 10-15% of the married couples are experiencing this problem. CC is non-steroidal selective estrogen
receptor modulator (SERM), has both estrogen agonist and antagonist properties. It binds to estrogen receptors
primarily in the hypothalamus, which interrupts the negative feedback of the increasing estrogen level and results in
continued production of FSH, which stimulates follicular growth and maturation. Its anti-estrogenic effect causes
long standing estrogen receptor depletion due to its long half life (2 weeks), so it has adverse effects on the quality
and quantity of cervical mucus and negative impact on endometrial development causing its thinning, implantation
failure and decreased blood flow during the peri-implantation stage.
Objectives: The aim of the study is to compare the effect of the following 3 drugs during induction of
ovulation: 1- Clomiphene citrate, 2- Tamoxifen, 3- Letrozole.
Patients and Methods: This study was carried out in El Entag El Harby Hospital. The patients were recruited
from the Infertility outpatient clinic between December 2017 and June 2018. This prospective study included
150 infertile women who were diagnosed as anovulatory infertility and meet the inclusion criteria. This study
followed the ethical committee rules of Obstetrics & Gynecology department, Al Azhar University. For all
women with anovulatory infertility in this study; explanation of the study procedures was done to all women
sharing in the study and informed written consents were obtained. In the current study, patients were divided
into three groups, each group formed of 50 patients: Group 1 (CC), Group 2 (letrozole), Group 3 (TMX). First
of all, the groups in our study were matched as regard to age, BMI, type and duration of infertility.
Results: The current study shows a statistically significant difference between the three groups regarding the
endometrial thickness, which was significantly thinner in group 1 (CC) than the other two groups; group 2
(letrozole) and group 3.
Conclusion: Clomiphene citrate has a negative effect on endometrial thickness which is mostly attributed to
its antiestrogenic effect. A triple layered endometrium (trilaminar pattern) is associated with higher pregnancy
rates; therefore, patients receiving CC with non trilaminar pattern have reduced pregnancy rates.
Keywords: Clomiphene Citrate, Tamoxifen, Letrozole, Endometrial Thickness, Polycystic Ovarian Syndrome.
INTRODUCTION
by polycystic ovarian syndrome (PCO), WHO type 3
Infertility is the inability of a married
(hypergonadotropic hypogonadism): usually is an
couple to conceive within one year in spite of
indication of ovarian failure (1).
regular marital life. Globally 10-15% of the
Polycystic Ovarian Syndrome (PCO) is the
married couples are experiencing this problem (1).
most common endocrinal disorder in women of
Anovulation accounts for about 20-25% of
reproductive age and is the primary cause of
causes of infertility as ovulation is a core event for
anovulatory infertility. Its prevalence range from 6-
reproduction. Anovulation may be due to problems
10% in general population. Its diagnostic criteria at
affecting the ovary, pituitary or hypothalamus. These
least two of the following (Rotterdam criteria): 1)
causes have been organized by the world health
Oligo or anovulation, 2) Hyperandrogenism
organization (WHO) into three main categories based
(laboratory confirm or by clinical symptoms), 3)
on the site of the lesion and as reflected by
Polycystic ovaries on ultrasound (2).
gonadotropin
production:
WHO
type
1
Ovulation induction involves the use of
(hypogonadotropic hypogonadism): caused by any
medication to stimulate development of one or
lesion affecting pituitary or hypothalamus and
more mature follicles in the ovaries of women who
affecting gonadotropin production, WHO type 2
have anovulation and infertility. These women
(normogonadotropic hypogonadism): the commonest
don't regularly develop mature follicles without
cause of anovulation and is most commonly caused
help from ovulation enhancing drugs as Selective
5009
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5014-5020
Effect of protective lung ventilation on oxygenation & hemodynamics in obese
patients
Ahmed Elsaied Abdulrahman1, Nagwa Mohamed Gamaleldeen2, Shazly Boghdady Ali3, Mohamed
Kamel Ahmed4
1
Department of Anesthesia and ICU, Sohag University, 2Department of Anesthesia and ICU,
3
Department of chest and RICU, 4Department of Anesthesia and ICU, Aswan University
ABSTRACT
Background: The number of obese patients undergoing surgery, either bariatric or non-bariatric, is steadily
increasing. These patients are more labile to the perioperative complications, such as hypoxemia, hypercapnia, and
atelectasis. Intraoperative protective ventilation consisting of low tidal volume, high PEEP and recruitment
maneuvers resulted in alveolar recruitment and optimization of intraoperative respiratory mechanics.
Objective: This study tested two strategies of mechanical ventilation in obese patients during pneumoperitoneum to
conclude which is better as regard gas exchange optimization and hemodynamic stability.
Methods: Study was a randomized prospective comparative control study which was carried out on 50 obese
patients with BMI 30-50 kg/m2. Patients were prepared for laparoscopic cholecystectomy. Patient's selection
according to attendees at time of operation as a single numbers were protective ventilation (group A) and a double
numbers were conventional ventilation (group B).
Results: Study showed significance between oxygenation in both groups. Post-operative oxygenation in protective
ventilation (group A). Mean Post P (A-a) O2 in group A was 27.93 (±7.76) mmHg, while in group B was 35.82 (±11.98)
mmHg, p value (0.022). Hemodynamic instability observed in 24% in group A, but only occurred in 8% in group B.
Conclusion: Study found that protective ventilation was superior to conventional ventilation as it was associated
with better oxygenation in the post-operative in obese laparoscopic cholecystectomy. In spite of it was very
effective in optimizing gas exchange, but associated with more hemodynamic affection.
Keywords: Obese; Laparoscopy; Protective; Lung ventilation; Conventional; Recruitment; Pulmonary function tests
INTRODUCTION
Therefore, the prevention of atelectasis is of utmost
Obesity is defined as having a body mass index
importance in this population because atelectasis
(BMI [calculated as weight in kilograms divided by
affects respiratory mechanics, the volume of airway
height in meters squared]) of 30 or greater, and it can be
closure, and the oxygenation index (PaO2/FiO2) }5{.
further subdivided: class I obesity is defined as a BMI of
Laparoscopy is a well-established procedure
30 to less than 35; class II obesity is defined as a BMI of
for laparoscopic cholecystectomy surgery often
35 to less than 40; and class III obesity is defined as a
performed in reversed trendelenburg position. To
BMI of 40 or greater }1{.
facilitate laparoscopic surgical manipulation, a
Obesity is characterized by several
pneumoperitoneum is usually induced through carbon
alterations in the mechanics of the respiratory
dioxide inflation. The increase in abdominal pressure as
system that tend to further exaggerate impairment
a result of carbon dioxide inflation has been shown to
of gas exchange. It has been demonstrated that in
impair the respiratory function during the procedure,
anaesthetized patients, arterial partial pressure of
mainly inducing atelectasis formation in the dependent
oxygen (PaO
2{
lung regions. The resulting decrease in functional
2) is inversely related to BMI } .
residual capacity poses patients at risk of perioperative
Postoperative lung atelectasis develops with
complications, particularly if they are obese and/or
both IV and inhaled anesthesia and whether the
submitted to intricate surgical procedures }6{. For
patient is breathing spontaneously or is paralyzed and
decades, it has been known that general anesthesia can
ventilated mechanically. The adverse effects of
impair oxygenation, even in patients with healthy lungs
atelectasis persist into the postoperative period and
and it is possible that the application of mechanical
can affect patient recovery }3 .{Up to 15% of the entire
ventilation is a contributing factor.
lung may be atelectatic during anesthesia, particularly
in the basal region, resulting in a true pulmonary
A strategy of protective ventilation,
shunt of approximately 5%10% of cardiac output }4{.
consisting of low tidal volumes and plateau
During general anesthesia and the immediate
pressures and application of positive end expiratory
postoperative period, obese patients are more likely to
pressure (PEEP) has gained widespread acceptance
develop postoperative pulmonary complications such
in intensive care units after large studies showed an
as atelectasis and exhibit impaired pulmonary
associated reduction in morbidity and mortality in
function compared to non-obese individuals.
patients with acute lung injury. Information about
5014
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5021-5025
Overweight and obesity in association with factors related to breastfeeding in
Arar, Northern Saudi Arabia
Ohud Falah M Alanazi 1, Sawsan Hassan Abdullah Hashim2, Nagah Mohamed Abo El-Fetoh3, Manal
Hajea Eid Alenazy1, Ayashah Moulfi A Alhazmi1, Reham Aref Alenezi1, Ibtisam Matan Alanazi1, Fai
Mulfi S Alanzi1, Raghad Khalid R Alruwaili1, Ahlam Sultan Alanazi1, Aliah Saad M Alruwaili1, Noof
Saad M Alruwaili1
1Faculty of Medicine, Northern Border University, 2Paediatrics department, Faculty of Medicine, Northern Border
University, Arar, KSA. 3Associate Prof. of Public Health and Community Medicine, Faculty of Medicine, Sohag
University, Egypt
ABSTRACT
Background: There is evidence that breastfeeding (BF) may have protective effect against obesity. In some
studies, a time-dependent association between duration of BF and obesity has also been shown.
Objectives: This community-based study was conducted aimed to evaluate the prevalence of overweight and
obesity in children 2-12 years in association with factors related to breastfeeding in Arar City, Northern Saudi
Arabia.
Participants and methods: A cross-sectional study was carried out in Arar City, mothers were selected from
the attendees of the female side of 5 randomly selected primary health care centres in the city. They were
interviewed and filled a questionnaire which included the needed questions.
Results: Among the 562 studied children, 54.8% were females and the estimated proportion of obese and
overweight children are 39.9% and 13.9%, respectively. The BMI group proportions were significantly
affected by the period of breastfeeding, father's obesity, and type of feeding; whether it was artificial or breast-
feeding, or both (P<0.05). We found that 43% of those who were underfed; breastfed for less than 4 months
only, were obese and 8.8% were overweight. Among those who were breast-fed for 4 to 6 months, 31.2% were
obese and 20.8% were overweight and for those that had a 6 months to a year breastfeeding, 19.4% and 12.9%
were obese and overweight, respectively.
Conclusion: In Arar City, Northern Saudi Arabia, the BMI of children 2-12 years is significantly affected by
the period of breastfeeding, father's obesity, and type of feeding; whether it is artificial or breast-feeding, or
both (P<0.05). So policy makers must condense their efforts to increase the awareness of the mothers about the
protective effect of breastfeeding from obesity and its comorbidities.
Key words: Breastfeeding, Childhood, Artificial feeding, BMI, Obesity, Arar City, Northern Saudi Arabia.
INTRODUCTION
than the breastfed ones. This increases the fat
Prevalence of childhood obesity has
storage when high protein is present [6,7].
increased markedly worldwide in the last three
In a study conducted to examine the
decades and become a major public health crisis
relationship between breastfeeding (BF) and odds
around the world [1]. Since obesity and overweight
of childhood obesity in Hispanic children, it was
are correlated with life-threatening diseases
reported that, infants exclusively formula fed at
including diabetes, high cholesterol levels,
birth were significantly more likely than fully
hypertension, cardiovascular diseases, stroke, and
breastfed infants to be obese at early childhood
certain types of cancers, the number of deaths
(P <0.001). For every additional month of any BF,
related to obesity is estimated at 2.8 million per
obesity risk at early childhood decreased by 1%.
year [2]. There is evidence that breastfeeding may
Every additional month of full BF conferred a 3%
have protective effect against obesity [3]. In some
decrease in obesity risk [8].
studies, a time-dependent association between
Another study was conducted in Iran to
duration of BF and obesity has also been shown
investigate the weight status and its relationship to
[4].The link between childhood obesity and
infant-feeding and BMI in Iranian children, it was
breastfeeding can be explained that breast milk
concluded that total time of BF and duration of
contains less calories and nutrients as well as
exclusive BF were not associated with childhood
bioactive substances, including leptin and ghrelin.
BMI and the timing of introduction of
However, the higher protein and fat levels in
complementary feeding was inversely related to
formula milk have been associated with higher
childhood BMI. Children with an early
adiposity levels [5]. Some research attributed the
introduction of complementary feeding had
association to higher levels of insulin hormone and
significantly higher mean BMI [9].
a longer response to insulin in formulae-fed infants
5021
Received:19/5/2018
Accepted:28/5/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5026-5033
Assessment of IL-10 Polymorphism and TGF beta 1 Polymorphism in Egyptian
Patients with Chronic Liver Disease
Magda H. Osman1, Radwa S. Shahin1, Wafaa M. Elzefzafy2, Maha R.Ghazzawi1
1Department of Clinical and Chemical Pathology, 2Department of Tropical Medicine, Faculty of Medicine (for Girls),
Al-Azhar University
Corresponding author: Maha R. Ghazzawi; Mobile: 01122996448; Email: mahaghazzawi@hotmail.com
ABSTRACT
Aim of the work: to determine the role of Interleukin-10 (IL-10) polymorphism (rs 1800896) and
Transforming Growth Factor-Beta-1(TGF-1) polymorphism (509 CT) as markers for cirrhosis in Egyptian
patients with chronic liver disease. Subjects and Methods: This case-control study was carried out on selected
patients admitted to Tropical medicine department, Al Zahraa University Hospital during the period from
March 2016 to April 2017. Genotyping of IL-10 (rs 1800896) and TGF-1 (509 CT) polymorphisms were
performed using real-time polymerase chain reaction (PCR) technique. Results: There was significant increase
in IL10 and TGF 1 509 gene polymorphisms in compensated and de-compensated groups as compared to
control group. Conclusion: Interleukin 10 rs 1800896 gene polymorphism and TGF 1 509 gene
polymorphism are associated with risk of liver cirrhosis in patients with chronic hepatitis C virus infection.
These findings could be useful for future screening for early detection of liver cirrhosis.
Key words: IL-10, polymorphism, TGF Beta, chronic liver disease
INTRODUCTION
Liver cel failure is the end stage of cirrhosis and is
Chronic liver disease (CLD) and its end
presented by hepatic encephalopathy (HE). Signs include
stages, cirrhosis and hepatocellular carcinoma
hepatic fetor, asterixis, mental confusion, stupor and coma(3).
(HCC), are leading causes of morbidity and
Up till now, liver biopsy is essential in
mortality worldwide with numerous socio-
establishing the diagnosis of liver fibrosis. Beside
economic costs. Patients with liver cirrhosis are at
invasiveness, liver biopsy has many complications
high risk of deadly hepatic failure and well over
like sampling error and cost (3).
80% of HCC develop on a cirrhotic background (1).
This situation strengthens the need for
Chronic liver diseases (CLDs) are defined as
harmless, alternative and complementary non
the continuity of clinical and biochemical evidence of
invasive serum biomarkers , that are safe,
hepatic dysfunction for longer than six months. Hepatitis
inexpensive and reliable (3).
B and C (HBV, HCV) are, and will remain for some
Interleukin 10 (IL-10) is a potent anti-
time, major health problems in Egypt. Both infections
inflammatory cytokine that plays a crucial, and
can lead to an acute or silent course of liver disease (1).
often essential, role in preventing inflammatory
Hepatic fibrosis, which represents the wound
and autoimmune pathologies(4).
healing response of the liver, is a common sequel of
Serum IL-10 concentration has been reported
liver injury characterized by excess deposition and
to be significantly elevated in patients with chronic
altered composition of extra-cellular matrix (ECM) (2).
HCV and IL-10 may be related to hepatocarcinogenesis
Cirrhosis means scar tissue in the liver which
with suppression of immune surveillance (5).
restricts the flow of blood and leads to portal
In consistence with Othman et al. (6) IL-10
hypertension, resulting in complications such as ascites,
concentration was elevated in patients with HCV, cirrhosis,
spontaneous bacterial peritonitis, esophageal varices and
and HCC and the concentrations are associated with
other potentially life-threatening complications (2).
disease progression indicating that IL-10 reflects the degree
Compensated cirrhosis means that the liver is
of inflammation in the liver and may be related to the
heavily scarred, but can still perform many important
development of HCC. However, increased circulating IL-
bodily functions. Many people with compensated
10 has been reported in patients with different types of
cirrhosis experience few or no symptoms and can live
tumors including resectable HCC(6).
for many years without serious complications, where
These results may be explained on the
de-compensated cirrhosis indicates that the liver is
basis that the high serum IL-10 levels in patients
extensively scarred and unable to function properly.
with HCC result from the secretion of IL-10 by
People with de-compensated cirrhosis eventually
tumor cells, in addition to the production at the site
develop many symptoms and complications that can
of inflammatory changes with activated infiltrating
be life threatening (2).
mononuclear cells in the liver(7).
5026
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5034-5038
Endoscopic Assisted Microscopic Skull Base Surgery
Walid Ali, Islam Alaghory, Osama El-Ghannam
Neurosurgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
ABSTRACT
Background: Over the last decade skull base surgery has been significantly progressed because of the
obvious improvements in imaging, anesthetic, surgical techniques as well as the advancement of
microsurgical instruments. However, the anatomical complexity of skull base makes dealing with lesions
in such area a "surgical challenge". Thats why looking for alternative methods is always needed.
Meanwhile there have been significant advances in the field of cranial base surgery with the help of
endoscopic techniques to manage such lesions.
Objective: To demonstrate the value of endoscope-assisted microsurgical technique for resection of skull base
tumors.
Patients and Methods: Twenty patients had skull base tumors were operated through Endoscopic-assisted
microscopic skull base surgery technique at Al-Azhar University & Mansoura International Hospital between
2015 to 2017 using a rigid endoscope for inspection of tumor boundaries and neighboring vascularity in
addition to confirm the extent of resection. Tumor resection was tried in all cases. Intra-operative resection rate
and post-operative radiological outcomes were assessed.
Results: Total resection was done in 10 patients (50%). Subtotal resection was done in the other 10 cases due
to excessive bleeding and adhesions of the tumors with vascular structures.
Conclusion: Endoscopic-assisted microsurgical approach is a reliable, safe and effective option for adequate
surgical resection of skull base tumors. The technique allowed proper inspection of the tumor relations and
vascularity, detection of any residual portions, providing better chance for gross total resection with minimal
tissue damage or vascular injury as well as convenient clinical outcome.
Keyword: Endoscopic neurosurgery, Endoscopic-controlled micro neurosurgery, Endoscopic inspection,
Endoscopic assisted micro neurosurgery.
INTRODUCTION
(EN) uses the endoscope as the only mean
The word "Endoscopy" originates from
of visualisation with the surgical instruments
two Greek words endon (inside) and scopein (to
introduced inside the working channel through a
watch carefully) (1).
single cranial hole as an entry site. (ECM) uses the
Angled mirrors were used in the past to
endoscope as the only mean of visualisation also
view the hidden areas during surgery. Later on the
however; the surgical instruments do not pass
endoscope was applied as an adjunct tool to the
through the working channel but alongside the
microscope in micro-neurosurgical procedures in
scope. (EAM) is a micro neurosurgical procedure
order to expose these hidden areas (2).
visually-assisted by the endoscope to visualize and
Endoscopic systems have been evolved
explore hidden corners. (EI) is a technique in
and improved to provide currently detailed
which the endoscope may be used in any surgical
visualisation of variety of the deep structures. The
procedure to inspect only (5).
aid of angled scopes in transcranial microscopic
dissection is very important to access regions
PATIENTS AND METHODS
beyond the width of the operative corridor and to
offer a substantial advantage for the approaches of
Patients
the posterior fossa (3).
Twenty patients admitted in neurosurgery ward of
Endoscopic assistance is particularly of
Al-Azhar University & Mansoura International Hospital
great value in order to inspect blind corners, which
from 2015 to 2017. Patients evaluated by taking detailed
cannot be visualised with the straight line of vision
history and clinical examination. Diagnosis of surgical
of the microscope specially when skull base lesions
skull base lesion was confirmed by radiological
are going to be removed via small craniotomies (4).
investigations. The study was approved by the Ethics
Endoscopic procedures are classified into:
Board of Al-Azhar University.
Pure endoscopic neurosurgery (EN), Endoscopic
Inclusion criteria
controlled
micro
neurosurgery
(ECM),
Endoscopic-assisted micro neurosurgery (EAM),
All patients with surgical skull base lesion.
Endoscopic inspection (EI).
A prospective chart review was conducted to
identify all patients who underwent microscopic
5034
Received:8/6/2018
Accepted:17/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5039-5043
Caudal Bupivacaine versus Systemic Nalbuphine for Post-Operative Pain
Management in Children undergoing Inguinal Hernia Repair
Mostafa Kamel Reyad, Ahmed Mohamed Elhennawy, Wael Sayed Ahmed Abdelghafar, Mohamed
Fathy Abdelmotagly
Anesthesia, Intensive Care & Pain Management Department, Faculty of Medicine, Ain Shams University
Corresponding Author: Mohamed Fathy Abdelmotagly, E-mail: dr.mohamed_fathy90@yahoo.com, Phone: 01114560525
ABSTRACT
Background: it's considered that post-operative pain management in children is essential as it reduce the
pain as well as anxiety of the parents regarding post-operative pain. There are some options which are
found and being used currently by pediatric anesthetists. However there is no consensus over a single best
method. Post- operative pain management had always been a major concern of parents as well as pediatric
anesthetists. Contrary to the ancient notion that children don't feel pain, many studies have f ocused on the
importance of good pain management in children. According to the studies, children in surgical ward feel
more pain than children in medical ward and prevalence was found to be 44% and 13% respectively and it
was found that about 64% of pediatric patients after surgery experience moderate to severe pain while
29% experience mild pain.
Objectives: the aim of this study was to compare pain scores in patients undergoing inguinal herniotomy
after caudal block and intravenous nalbuphine.
Patients and Methods: this comparative double blind study was conducted at Paediatric Surgery
Department. We included patients with age range of 3-12 years. The children were randomly divided into
two groups. Group C included Caudal Block; and Group N included patients who received Nalbuphine. In
group C patients, after herniotomy and before extubating the patient, caudal block was introduced by
giving Bupivacaine 0.25% according to body weight. In patients in group N, immediately after
herniotomy, nalbuphine was given intravenously 0.18 mg/kg according to body weight. Patients were
shifted to post-operative ICU where pain scores were measured at 0,1,2,4 and 8 hours. Also any side
effect of the drugs was noted and taken care of. For pain measurement Faces Pain scale wa s used. If any
patient developed pain score 8 or more, patient was given paracetamol10 mg/kg.
Results: we have used FACES pain scale in our study which is a verified scale for pain assessment in
children with the age range of 3-12 years. There was no significant difference between the two study
groups as regard side effects, as 14.8% of group 2 (Caudal Group) cases had side effects compared to
3.6% for group 1 (Nalbuphine cases(p=0.052). As regard the need for rescue analgesia, no significant
difference was found between the two study groups. Regarding our study, there was no significant
difference between the two study groups as regard pain scale at 1 hour. However, a highly significant
difference was found between the two study groups as regard pain score at 2, 4, and 8 hours with higher
pain among caudal block group.
Conclusion: nalbuphine is better than caudal block for post-operative pain management after inguinal
herniotomy in children.
Keywords: Caudal Bupivacaine, Systemic Nalbuphine, Inguinal Hernia Repair, Inguinal Herniotomy
INTRODUCTION
According to the studies, children in
It's considered that post-operative pain
surgical ward feel more pain than children in
management in children is essential as it reduce the
medical ward and prevalence was found to be 44%
pain as well as anxiety of the parents regarding
and 13% respectively (1). And it was found that
post-operative pain. There are some options which
about 64% of pediatric patients after surgery
are found and being used currently by pediatric
experience moderate to severe pain while 29%
anesthetists. However there is no consensus over a
experience mild pain (2).
single best method (1).
Studies have suggested that painful
Post-operative pain management had
experiences and events during childhood even
always been a major concern of parents as well as
during infancy, may lead to long term
pediatric anesthetists. Contrary to the ancient
psychological effects (3). Therefore pediatric
notion that children don't feel pain, many studies
anesthetists, surgeons and pharmacologists had
have focused on the importance of good pain
been in a continuous search to locate a safe and
management in children (2).
effective analgesic for children.
5039
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5044-5049
Ratio between Low Serum Maternal 25-Hydroxy vitamin D Concentration and
the Risk of Preeclampsia
Samir Abdalla Ali, Tamer Faris, Ahmed Fathy Abd Elaziz, Ahmed Abdelshafy Abdelhafiz
Department of Obstetrics and Gynecology, Faculty of Medicine-al-Azhar University
Corresponding Author: Ahmed Abdelshafy Abdelhafiz, E-mail: ahmed_aty29@yahoo.com
ABSTRACT
Background: Vitamin D may play a role in the etiology of preeclampsia by regulating the transcription
and function of genes associated with placental function, including placental invasion, normal
implantation, and angiogenesis. Vitamin D also, modulates immune function and inflammatory response.
Maternal vitamin D concentration may be influenced by several factors, including diet, supplementation,
sun exposure, skin pigmentation, and genetics. Therefore, vitamin D deficiency is a potentially modifiable
risk factor for preeclampsia.
Objective: To find out if lower levels of vitamin D is more prevalent in preeclamptic women.
Patients and Methods: This study carried out on 50 pregnant women recruited at pre labour room. They
divided into preeclamptic group and non-preeclamptic group, 25 cases in each group. Current study was
conducted as a case-control study to compare vitamin D level between preeclamptic and non-preeclamptic
women at Al-Hussein University Hospital as current study recruited 50 primigravida. Women after 36
weeks of gestation without any other medical disorders. They were classified into preeclamptic case group
and normotensive control group.
Results: The current study found that vitamin D levels were lower in preeclamptic group than
normotensive control group but these differences were not statistically significant.
Keywords: Pregnancy, Preeclampsia, Hypertension, Vitamin D deficiency, 25-Hydroxyvitamin D
INTRODUCTION
ultraviolet light and to a lesser extent can be
Preeclampsia is a multisystem pregnancy
ingested in the diet. It undergoes hydroxylation in
disorder defined by new-onset hypertension and
the liver to produce an inactive supply form of 25-
proteinuria after 20 weeks of gestation.
hydroxyvitamin D, 25(OH)D. Circulating 25(OH)D
Preeclampsia affects 2%8% of all pregnancies and
gets converted by renal 1-alpha-hydroxylase to the
remains a leading cause of maternal and perinatal
active form 1,25-dihydroxyvitamin (vitamin D3)
mortality and morbidity, including preterm birth
which is the hormonally active form of vitamin D (5).
and small for gestation age (1,2).
Vitamin D plays pivotal role in bone and
Multiple factors, such as maternal
mineral metabolism. During pregnancy, vitamin D
constitutional
factors,
angiogenetic
factors,
plays important role in implantation and placental
endothelial dysfunction, syncytio trophoblastic
function due to angiogenic, immunomodulatory,
microparticles (STMP) and inflammatory activation,
and anti-inflammatory effects. While, the
play a role in the development and progression of
pathophysiology of hypertensive disorders in
preeclampsia. The maternal diet is among the factors
pregnancy (HDP) involving abnormal placentation
related to the etiology of preeclampsia; an
and angiogenesis still incompletely understood.
insufficient diet, especially in terms of calcium,
Several studies have demonstrated an association
magnesium, selenium and vitamin A and C, is a
between higher 25(OH) D levels and reduced risk
contributing factor to preeclampsia (3).
of HDP especially in preeclampsia (6).
The etiology of preeclampsia is poorly
AIM OF THE WORK
understood a leading theory is insufficient spiral
artery remodeling in the placenta may result in a
To find out if lower levels of vitamin D is
hypoxic environment with reperfusion injury and
more prevalent in preeclamptic women.
upregulation of oxidative stress. The pre-
eclamptic placenta secrete factors such as
PATIENTS AND METHODS
inflammatory cytokines and reactive oxygen
Study Settings: After obtaining approval
species into maternal circulation to induce
from the Research Ethical Committee of AL-Azhar
hypertension through local production of
University. This study was conducted pre labour
vasoconstriction, notably endothelin -1(4).
room Al-Hussein University Hospital. Study
Vitamin D as a fat-soluble steroid hormone
Design: Case control study.
is mainly synthesized by the skin on exposure to
5044
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5050-5055
Role of CT in the Diagnosis and Follow up of Pediatric Oncology Patients with
Fungal Infection
Khaled Aboualfotouh Ahmad1, Mohamed Mamdouh Mohamed1, Iman Ahmed Ragab2,
Engy Kameel Shokry1
Departments of 1Radiology and 2Pediatrics, Faculty of Medicine, Ain Shams University
Corresponding Author: Engy Kameel Shokry, E-mail: dr.aojo@live.com, Telephone: +2 01201263105
ABSTRACT
Background: invasive fungal infections are rare in pediatric population, but have a high morbidity and
mortality rates despite the development of antifungal treatment. It ranges from superficial, mucosal to
invasive infection.
Aim of the Work: to assess the value of CT in the diagnosis of invasive fungal infection and
differentiating it from other causes of infection or metastatic deposits in patients with childhood cancer
and persistent fever in spite of antibacterial treatment and to assess the radiological response after
treatment with antifungal drugs.
Patients and Methods: our study was done over one year period from October 2017 to October 2018,
included 22 immunocompromised pediatric patients from El -Demerdash tertiary hospital, included (8
male, and 14 female) with age range (14m- 16 yrs.). We identified immunocompromised patient of having
underlying malignancy or auto-immune deficiency. We included all patients with fever, neutropenia and
high CRP, in whom we suspected chest or paranasal sinus infection.
Results: in our case group; the most common underlying disease was ALL-B cell (n=6, 40%), followed
by ALL-T cell (n=2, 13.3%), AML (n=2, 13.3%), aplastic (n=3, 20%), hepatobalstoma (n=1, 6.7%) and
auto-immunodeficiency (n=1, 6.7%). Analysis of the radiological data showed that macronodules was the
most significant finding to suggest fungal rather than bacterial infection (53.3% vs. 0% respectively,
p=0.015), followed by consolidation (40% vs. 57.1%, p=0.45) and ground glassing (26.7% vs. 14.3%.
Cavitary lesions, pleural effusion and lung abscess were associated only with fungal disease, yet it is not
considered significant enough in our study as a reliable sign to suggest fungal infection
Conclusion: increase number of hospitalized pediatric patients with fungal infection is a rising problem,
with no specific criteria for early diagnosis among this population causing delay of the proper treatment.
In our study hematological malignancy was the most common underlying disease with macronodules
being the most specific finding to suggest fungal infection in pediatrics.
Keywords: Pediatric Oncology Patients - Fungal Infection Candida - Aspergillus
INTRODUCTION
In haemato-oncological patients, the chest
In the past few decades, there has been a
x-ray is false negative in 4550%. Therefore, the
considerable increase in the frequency of invasive
use of thin-slice chest CT (<3 mm) is indicated in
fungal infection (IFI). This increase is directly related
immune -compromised patients when searching for
to the increased number of immunocompromised
a focus of infection (5).
patients, due to the use of chemotherapy,
CT is not useful in acute fungal sinusitis
immunosuppressive drugs, stem cell transplantation,
but in a chronic stage where it can evaluate
and solid organ transplantation (1).
changes in the bone. In case of bone destruction,
The most common fungi responsible for
intraorbital extension, intracranial extension, or
invasive fungal infections are Candida and Aspergillus,
both occur rapidly, with soft tissue inflammation
The incidence of invasive candidiasis is higher in the
and abscess formation. As a result, a low dose CT
pediatric age group, with the highest risk in neonates.
scan should be adopted for repeated imaging as
Candida infections in older children are more similar to
bone destruction can be subtle. MRI with
those in adults. In contrast, Invasive aspergillosis is rare in
gadolinium enhancement is better than CT to
neonates, but occurs more frequently in older children (2).
assess intracranial and intraorbital extension in
The most affected organs in order of frequency,
three planes (axial, sagittal, and coronal) (6).
are: lungs (70%), skin (20%), central nervous system
PATIENTS AND METHODS
(brain, spinal cord), and sinuses (18%) (3).
Early detection of Invasive fungal infection
Our study was done over one year period
is of high importance, as the prognosis depends
from October 2017 to October 2018, included 22
strongly on the appropriate use of antifungal early (4).
immunocompromised pediatric patients from El -
5050
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5056-5061
Evaluation of Efficacy of Ultrasound Guided Paravertebral Nerve Block as
Postoperative Analgesia in Abdominal Surgeries
Samia Abd El Mohsen Abd El Latief, Sanaa Mohamed El Fawal, Sabah Naguib Barsom, Mohamed
Mohsen Mohamed Ali
Anesthesiology and Intensive Care Medicine Department, Faculty of Medicine, Ain Shams University
Corresponding Author: Mohamed Mohsen Mohamed Ali, E-mail: mohamed.mohsen.habashi@gmail.com, Phone: 01026626226
ABSTRACT
Background: abdominal surgeries requires either general or regional anesthesia. Normally, general anesthesia
needed for abdominal surgeries consists of a mixture of neuromuscular blockers, opioids and inhalation
anesthetics. Airway control can be achieved by either endotracheal intubation or laryngeal mask. Regional
anesthesia can be used alone in abdominal surgeries or in combination with general anesthesia. If regional
anesthesia is used alone then effective sedation is required. Pulmonary functions impairment has a higher
incidence of happening in upper abdominal surgeries than non-abdominal and non-thoracic surgeries.
Intraoperative patient's ventilation is closely related to the amount of the analgesics received give that
depression of ventilation and excessive sedation should be avoided. The postoperative length of hospital stay
prolongs after major gastro-intestinal surgeries due to immobility, pain and gastric immobility and that's why
postoperative pain control is essential to speed up mobility and gastro-intestinal functions.
Objectives: the aim of this study was to evaluate the efficacy of ultrasound-guided paravertebral nerve
block as postoperative analgesia in abdominal surgeries.
Patients and Methods: a total of 64 patients were assessed for eligibility to our study, but two patients
not meeting inclusion criteria and other two patients were declined to participate so four patients were
excluded from the study. Sixty ASA physical status I and II patients of both sex, 18 -60 years old,
undergoing abdominal surgery in surgical operating theater of El-Sheikh Zayed Specialized hospital and
Ain-Shams Surgery hospital, who fulfilled the inclusion criteria, had been enrolled in the study. All
enrolled patients have already completed the study. Those patients were randomly allocated into two
groups, 30 patients each.
Results: demographic data including (age, gender and type of operation) did not show any statistically
significant difference between the two studied groups with P=0.176 for the age and P =1.0 for the gend er
and the type of operation. Patients' characteristics included age, sex, ASA score and type of operation.
There was no significant difference in the demographic data of the two groups of the study. The mean
age was 49.9 year in the Paravertebral block group, while the mean age was 47.6 year in the control
group. The females' count in group A and group B exceed the males' amount with 20% and 6.66%
respectively. According to the ASA classification, both groups have 60% classified as ASA -1 and 40% as
ASA-2. In this study, four types of operations are done, Lap-cholecystectomy, Umbilical Hernia,
Appendectomy and Inguinal Hernia.
Conclusion: this study proved that PVB provided better postoperative pain control, fewer opioids
consumption, less postoperative nausea and vomiting compared with other analgesic treatment strategies,
indicating that a postoperative PVB is a feasible and an effective method for an improved postoperative
pain treatment after abdominal surgery. The current study concluded that there was a significant
difference in post-operative period regarding morphine consumption between PVB group and control
group with the mean of total morphine consumption 0.9 and 6.9 respectively, with the P-value < 0.001.
Keywords: Ultrasound Guided Paravertebral Nerve Block, Postoperative Analgesia, Abdominal Surgeries
INTRODUCTION
Pulmonary functions impairment has a
Abdominal surgeries requires either general
higher incidence of happening in upper abdominal
or regional anesthesia. Normally, general anesthesia
surgeries than non-abdominal and non-thoracic
needed for abdominal surgeries consists of a mixture
surgeries. Intraoperative patient's ventilation is
of neuromuscular blockers, opioids and inhalation
closely related to the amount of the analgesics
anesthetics. Airway control can be achieved by
received give that depression of ventilation and
either endotracheal intubation or laryngeal mask.
excessive sedation should be avoided. The
Regional anesthesia can be used alone in abdominal
postoperative length of hospital stay prolongs after
surgeries or in combination with general anesthesia.
major gastro-intestinal surgeries due to immobility,
If regional anesthesia is used alone then effective
pain and gastric immobility and that's why
sedation is required (1).
postoperative pain control is essential to speed up
mobility and gastro-intestinal functions (2).
5056
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5062-5066
Comparison of the Accuracy of Three Algorithms in Predicting Accessory
Pathways among Adult Wolff-Parkinson-White (WPW) Syndrome Patients in
our Population
Mansour Mustafa, Mohamed Sarhan El Sayed Abo El Magd, Ahmed Ramadan Aly Farh
Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Ahmed Ramadan Aly Farh, E-mail: faredahamza707@gmail.com, Tel: 01099221480
ABSTRACT
Background: after the introduction of catheter ablation of atrioventricular accessory pathways (APs) in Wolff-
Parkinson-White (WPW) syndrome, to facilitate planned ablation and minimize catheter-related injury,
predicting the AP was required. Localization of APs can be anywhere around the atrioventricular (AV) annuli,
left- or right-sided, or within the septum or a rare possibility of Mahaim fibers.
Objective: to compare between three algorithms in their accuracy in predicting the exact site of accessory
pathway.
Patients and Methods: one hundred patients with manifest pre-excitation who underwent electrophysiological
study (EPS) and successful ablation of accessory pathway who were subjected to history taking, complete
physical examination stressing on 12-lead of pre-excited electrocardiogram (ECG).
Results: the distributions of the accessory pathway with left lateral accessory pathway being the most
prevalent (27%) while the postero-lateral being the least prevalent one (2%) and that Right-sided accessory
pathway was most frequently predicted by Arruda algorithm in 31% of patients and least frequently predicted
by D'Avila in 17% of patients while its actually present in 23% of patients according to the EP study, Left-
sided accessory pathway was most frequently predicted by D'Avila (61%) and least frequently predicted by
Arruda (49%) whereas it was truly present in 51% of patients according to EP study. Mid and antero-septal
accessory pathways were most frequently predicted by Chiang and least frequently predicted by Arruda while
it was present in 26% of cases proved by EP study. In all algorithms, 72 % of predictions were correct for
Chiang, 81 % for D'Avila, and 71 % for Arruda and the percentage of predictive accuracy of all algorithms did
not differ between the algorithms (p=1.000; p=0.076; p=0.064, respectively) The best algorithm for prediction
of right-sided and left-sided accessory pathways was D'Avila (p<0.001). The best algorithm that is particularly
useful in predicting antero-septal and mid-septal accessory pathways was Chiang (p<0.001).
Conclusion: prior knowledge of the AP location allows better planning, faster and safer procedure, as well as
decreased exposure to ionizing radiation and unnecessary punctures. In all algorithms, 72% of predictions were
correct for Chiang, 81% for D'Avila, and 71% for Arruda and the percentage of predictive accuracy of all
algorithms did not differ between the algorithms (p=1.000; p=0.076; p=0.064, respectively). The best algorithm for
prediction of right-sided and left-sided accessory pathways was D'Avila (p<0.001). The best algorithm that is
particularly useful in predicting anteroseptal and mid-septal accessory pathways was Chiang (p<0.001).
Keywords: WPW, Accessory pathway, electrophysiological study.
INTRODUCTION
practice and remember; in addition, delta wave
After the introduction of catheter ablation
polarity is difficult to assess (2).
of atrioventricular accessory pathways (APs) in
Wren et al.(3) compared the accuracy of
Wolff-Parkinson-White (WPW) syndrome, to
seven algorithms for predicting the accurate
facilitate planned ablation and minimize catheter-
location of AP in children with WPW syndrome
related injury, predicting the AP was required.
and reported that the power of all the tested
Localization of APs can be anywhere around the
algorithms in predicting APs was less accurate in
atrioventricular (AV) annuli, left- or right-sided, or
children than in adults (if only exact predictions
within the septum or a rare possibility of mahaim
were accepted, accuracy ranged from 30 to 49 %).
fibers (1). Several algorithms with varying degrees
In another study, 11 relevant algorithms were
of complexity and accuracy based on the analysis
tested in adult patients and it was reported that the
of QRS and delta wave morphology on the 12-lead
accuracy of the algorithms is dependent on the
electrocardiogram (ECG) have been proposed for
number of AP sites (AP sites >6, accuracy
accurate localization of APs. Although the 12-lead
40.6±10.9%; AP sites 6, accuracy 61.2±8.0%)
ECG is an easy, noninvasive tool to determine the
and also the algorithms that did not include delta
localization of APs and guide ablation procedures,
wave polarity had lower accuracy (delta wave
employed algorithms are complex to put into
polarity not included, accuracy 36.6±11.2 %; delta
wave polarity included, accuracy 52.3 ± 13.1%)(4).
5062
Received:20/6/2018
Accepted:29/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5067-5071
Role of Magnetic Resonance Imaging in diagnosis of Endometriosis
Sherif H. Abo-Gamra, Aliaa S. sheha, Alaa S. Abd-Elhafez, Marian A. Thabet
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Marian A. Thabet, Mobile: +20124471682, E-mail: marianayad95@gmail.com
ABSTRACT
Background: Endometriosis is defined as the presence of functional endometrial glands and stroma outside of
the uterine cavity. Although laparoscopy is the standard of reference for diagnosis of endometriosis, reliable
identification of the disease before laparoscopy would aid the gynecologist in choosing the preferred
therapeutic approach, medical or surgical. Ultrasound is performed initially, but MRI is increasingly being
used, particularly when sonographic findings are unclear, when deep pelvic endometriosis is suspected or when
surgery is planned. Objective: This study aimed to evaluate the accuracy of Magnetic Resonance Imaging in
diagnosis of Endometriosis. Patients and Methods: 30 Premenopausal female Patients with clinical and/or
sonographic suspicion of endometriosis underwent pelvic MRI. All our imaging results were finally compared
to the laparoscopic results with histopathologic verification which was our gold standard. The main outcome
parameters, The Sensitivity, Specificity, positive predictive value (PPV), negative predictive value (NPV) and
accuracy of MRI in diagnosing endometriosis were calculated. Results: The Sensitivity, Specificity, positive
predictive value (PPV), negative predictive value (NPV) and accuracy of MRI in diagnosing endometriosis
were 95.65%, 57.14%, 88%, 80%, 86.7% respectively. Conclusion: MRI is the best problem-solving tool as in
cases of indeterminate adnexal findings on sonography, when deep infiltrating endometriosis is suspected, or
for presurgical mapping.
Keywords: Endometriosis, MRI, Pelvis, Ultrasound, Laparoscopy
INTRODUCTION
MRI is being increasingly used for the
Endometriosis is a common gynaecological
evaluation of endometriosis, with reported
condition affecting women of reproductive age, it is
sensitivity and specificity values ranging from
defined as the presence of functional endometrial
69--92% and 75--98%, respectively (5).
glands and stroma outside of the uterine cavity. This
ectopic tissue responds to hormonal changes
The use of MRI offers the following
resulting in cyclical haemorrhage and pain, giving
advantages: Excellent at demonstrating the
the disease its clinical features (1).
haemorrhagic content (new and old) of
endometriomas. Used in identifying the
Its estimated prevalence varies between
presence of deeply-infiltrating endometriotic
2% and 10% within the general female
implants. Particularly useful in pre-operative
population, although it may be as high as 50% in
assessment of disease distribution and the
infertile women (2).
presence of adhesions, especially within the
Secondary
dysmenorrhea,
deep
posterior compartment and pouch of Douglas
dyspareunia, sacral backache with menses,
which helps guide subsequent laparoscopic
perimenstrual diarrhea, cramping and dyschezia,
surgery. Vital as a problem-solving tool when
dysuria, and hematuria are the most common and
assessing an ultrasound-indeterminate adnexal
relevant clinical manifestations (3).
mass, helping differentiate ovarian cystic and
Laparoscopy is the standard of
solid lesions from endometriomas and also in
reference for diagnosis of endometriosis
the detection of malignant transformation
followed by histologic confirmation (4).
within an endometrioma (6).
Currently, ultrasound is preferred for
PATIENTS AND METHODS
the initial assessment of both endometriomas
Patients: This is a retrospective study that
and deep pelvic endometriosis. However,
included 30 female patients referred from the
transvaginal ultrasound, even with adequate
Gynecology Department to the Radiology
bowel preparation and use of high-frequency
Department (Women's imaging unit) of Ain Shams
probes has important limitations, because of
University Hospitals in the period from November
the relatively small field-of-view and operator
2017 to June 2018. The study was approved by
dependency (5).
the Ethics Board of Ain Shams University and
5067
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5072-5078
Effect of immediate versus early oral hydration on caesarean section
postoperative outcomes: a randomized controlled trial
Heba A. Ahmed, Ahmed A. El-Shahawy, Hazem M. Sammour
Department of Obstetrics and Gynecology,Faculty of Medicine, Ain Shams University
Corresponding author: Heba A. Ahmed; Email: a.h_hoba@hotmail.com
ABSTRACT
Background: Caesarean sections are increasing in number dramatically all over the world. So, it became very
important to give more attention for their postoperative care. Objective: to evaluate the effect of immediate
oral hydration initiated within 2 hours after uncomplicated Caesarean Section on the following post-operative
outcomes: post-operative vomiting and abdominal distention, post-operative nausea and abdominal pain, the
return of intestinal movements, duration of intravenous fluid administration, duration of hospital stay and
participant satisfaction. Methods: this randomized controlled study was conducted at Ain Shams University
Maternity Hospital. It was carried during the period from July 2016 to July 2017. 140 women, all of them
underwent uncomplicated Cesarean Section under regional anesthesia were randomly assigned into two
groups. In the immediate group: oral hydration was received in the first 2 hours postoperatively, and in the
early group: oral hydration was received after 8 hours postoperatively. Results: all the results of the
postoperative outcomes of both groups had non-significant differences except for the psychological
satisfaction which was significantly higher in the immediate group with a (p<0.001). Conclusion: immediate
oral hydration group showed non-significant differences comparing with early oral hydration group regarding
most of the postoperative outcomes, but the results were relatively better towards the immediate group. Also,
immediate hydration is significantly better than early hydration regarding psychological satisfaction of women,
allowing them to be more able to breastfeed their kids and to spend a less stressful time in the hospital.
Key words: immediate/early oral hydration, cesarean section, postoperative outcomes, vomiting, nausea
INTRODUCTION
changed because the duration of surgery became
Caesarean sections performed every year
shorter, the regional anesthesia became more
are increasing in number dramatically all over the
available, and intestinal manipulation during
world. So, it became very important to give more
surgery became minimal. All these factors
attention for their postoperative care (1).
provided the chance for early oral intake before
bowel movements return (2).
Return of intestinal movement and passage
of flatus are considered important factors affecting
Several studies were done to compare
the duration of postoperative hospital stay in
between different regimens of postoperative
additional to other factors like the used anesthesia,
hydration and feeding (2). Many of which were
wound healing, and breastfeeding (2).
done on the effect of early hydration after
Caesarean section, but less studies were done on
The traditional approach of giving the
the effect of immediate hydration.
patient nothing orally postoperatively till bowel
function returns (in the form of bowel movement or
Therefore, early oral hydration especially
passage of flatus) followed by slow feeding is now
immediate supply of oral fluids after Caesarean
challenged and became controversial (3).
sections needs further studying. Also, its impact on
postoperative recovery and duration of stay in
The
importance
of
early
feeding
hospital needs to be studied widely as well. (2)
postoperatively depends on that food intake is able
to stimulate a reflex causing a coordinated
Moreover, early oral hydration after
propulsive activity and increasing the secretion of
caesarean section might be beneficial in many
gastrointestinal hormones. These effects cause an
ways, it may facilitate early return of intestinal
overall positive effect on intestinal movement
movements and reduces the risk of hospital
decreasing the duration of postoperative ileus (4).
infections, leading to early hospital discharge (2), it
also may decrease the cost of hospital stay as it
Early feeding also may be associated with reduced
decreases the duration of intravenous fluid
depletion of protein stores and improvement in
administration with less use of cannulae (3).
wound healing with a faster recovery (5).
There is
also a proof of its association with breastfeeding success
There was a belief that postoperative oral
and less suffering of the patient from thirst and hunger
intake without return of intestinal movements may
(6), early postoperative nutrition also leads to a better
cause nausea, vomiting, and abdominal distention
wound healing and a better muscle function with
leading to wound breakdown. However, this belief
decreased sepsis (7).
5072
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5079-5085
The Role of Fibroscan as a Non-Invasive Predictor for Oesophageal Varices in
Post HCV Cirrhotic Egyptian Patients With or Without Bilhariziasis
Mohamed Bastawy1, Anwar Gomaa El-Sheety1, Ahmed Abd El-Aleem1, Yasser M. M. El-Dessouky1,
Ayman Rabie 2 and Sherif Mohammad El-sayed Amine Hegab2
1Tropical Medicine Department, Faculty of Medicine, Al-Azhar University
2Hepatology Department, Ahmed Maher Teaching Hospital, Cairo, Egypt.
Corresponding author: Sherif Hegab, E-Mail: sherifhegab1@yahoo.com, Mobile: 01006502052
ABSTRACT
Background: Development of oesophageal varices is a major complication that may occur in up to 90% of
cirrhotic patients. The endoscopic screening is an invasive procedure. This is why the selection of patients with
large oesophageal varices at high risk for bleeding has become an issue of growing importance. In this respect,
several clinical, biochemical, ultrasonographic and elastrogarphic (transient elastography-TE) methods have
been proposed (and some of them validated) as noninvasive alternatives to endoscopy.
Objectives: It was to evaluate transient elastography by fibroscan in the prediction and determination of the
grade of esophageal varices in cirrhotic patients due to chronic hepatitis c virus (HCV) infection with or
without bilharziasis.
Patients and Methods: Sixty Egyptian patients with body mass index (BMI) <35, no history of: upper gastro-
intestinal tract (GIT) bleeding, hepatocellular carcinoma, moderate and tense ascites or any other cause of liver
cirrhosis. The patients were divided into two groups: Group I included thirty patients with liver cirrhosis due to
HCV infection only. Group II included thirty patients with liver cirrhosis due to HCV infection associated with
bilharziasis. The patients were subjected to: 1) Thorough history taking. 2) Detailed clinical examination. 3)
Laboratory tests. 4) Abdominal ultrasound. 5) Rectal snip for diagnosis of bilharziasis. 6) Upper
gastrointestinal endoscopy. 7) fibroscan.
Results: Regarding fibroscan in both groups, the mean values of fibroscan were lower in patients without
esophageal varices than patients with esophageal varices or with large esophageal varices with statistically
high significant differences (p<0.01). Regarding fibroscan in group I, the mean values of fibroscan were lower
in patients without esophageal varices than patients with small esophageal varices with statistically high
significant differences (p<0.01). But in group II, the mean values of fibroscan were lower in patients without
esophageal varices than patients with small esophageal varices with statistically non significant differences (p
> 0.05). In both groups, the mean values of fibroscan were lower in patients with small esophageal varices than
patients with large esophageal varices with statistically non significant differences (p > 0.05).
Conclusion: fibroscan is valuable in predicting the presence of esophageal varices and large esophageal
varices in patients with post HCV liver cirrhosis with or without bilharziasis but couldnot predict the grade of
esophageal varices.
Keywords: Fibroscan, Liver stiffness, Esophageal varices, Grading, Non-invasive methods, liver cirrhosis.
INTRODUCTION
(transient elastography- TE) methods have been
Cirrhosis is a condition prone to multiple
proposed (and some of them validated) as
complications because of portal hypertension.
noninvasive alternatives to endoscopy (3). Transient
Variceal bleeding is a life threatinig event that has
elastography is measured by Fibroscan (Echosens,
an incidence of 5% in Patients with small
Paris, France), equipped with a probe consisting of
oesophageal varices and up to 15% in those with
an ultrasonic transducer inducing vibration that
large oesophageal varices. Mortality per bleeding
cause an elastic shear wave that Propagates through
episode is around 10%-20% (1). Therefore, screening
the tissue. In the mean time, pulse-echo ultrasonic
for esophageal varices in cirrhotic patients is a
acquisitions are performed to follow the progression
strong recommendation in all consensus statement
of the shear wave and measure its velocity, which is
(2). The current screening method is endoscopy at 2-
directly related to tissue stiffness. TE was proved to
3 years in patients without oesophageal varices and
be useful in assessing the presence of significant
at 1-2 years in those with small varices but this
fibrosis in patients with chronic hepatitis and in
approach is invasive. This is why the selection of
suggesting the presence of cirrhosis (4). Many
patients with large oesophageal varices at high risk
studies showed that liver transient elastography
for bleeding has become an issue of growing
could predict the presence of oesophageal varices
importance. In this respect, several clinical,
with conflicts around detection of its size (5).
biochemical, ultrasonographic and elastrogarphic
5079
Received:8/5/2018
Accepted:17/5/2018
ABSTRACT
Outcome in Preterm Premature Rupture of Membranes (PPROM)....
deleted
1
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5093-5098
Leak after Laparoscopic Cholecystectomy; Incidence and Management
Alaa Abbas Sabry, Mohamed Gamal El Fouly, Mohamed Walaa El Dien Fawzy
Department of General Surgery, Faculty of Medicine, Ain Shams University
Corresponding author: Mohamed Walaa El Dien, E-Mail: mohamed_walaa7@hotmail.com, Mobile: 01062041513
ABSTRACT
Background: laparoscopic cholecystectomy is currently the procedure of choice for symptomatic gallstones. It has
evolved from an innovative, but time-consuming, novelty to a routine day-case procedure over the last 20 years.
Purpose: to estimate the incidence and management options of post laparoscopic cholecystectomy biliary
leaks. Also, it is a trial to advocate a minimally invasive structured management protocol to treat patients with
bile leak.
Patients and Methods: this study was a case series of 100 patients who underwent laparoscopic
cholecsystectomy. We didn't include patients who had: Biliary leak post Laparoscopic converted to open
cholecystectomy. Biliary leak due to other procedures. Biliary leaks managed by open surgery. Biliary injuries
discovered and definitively managed intra-operatively. The included patients presented to the General Surgery
Department at Manshyt El Bakry General Hospital. Patients' age ranged from 12 to 65 years and patients' sex
was distributed as 78 females and 22 males.
Results: in our cases there were two out of the 100 patients suffered from biliary leak ,one of the two cases
that were presented with biliary leak after surgery was due to direct injury to accessory duct of Luschka and
the other one was due to a slipped clips.
Conclusion: cholecystectomy is the most frequently performed abdominal operation in the United States, with
currently over 700,000 cases occurring per year. Bile leak as a result of cholecystectomy is uncommon. The
frequency in large series is less than 2% and in our study it was exactly 2%. And the treatment of that leak
varies from conservative treatment to ERCP and stent insertion like we did.
Keywords: Laparoscopic Cholecystectomy, Endoscopic Biliary Sphincterotomy, Endoscopic Retrograde
Cholangiopancreatography
INTRODUCTION
associated with significant morbidity and even
There have been several prospective,
mortality, particularly if it is not identified and
randomized trials comparing open cholecystectomy
treated at an early stage (4).
with laparoscopic cholecystectomy and results
In the early 1990s when both laparoscopic
have been mixed in demonstrating advantages of
cholecystectomy and minimally invasive techniques
laparoscopic
over
comparing
open
were in their infancy, bile leaks were managed
cholecystectomy in treating elective symptomatic
conservatively; if the patient did not improve, a
cholelithiasis. The largest study prospectively
laparotomy was often performed. Management was
randomized 310 patients to laparoscopic versus
anecdotal and based upon the experience of the
mini-laparotomy comparing open cholecystectomy
surgeon. However, with the advantage of improved
with 155 patients in each group. Conversion to
Radiological percutaneous drainage, therapeutic
large-incision cholecystectomy was significantly
endoscopic retrograde cholangiography (ERC), and
more common with laparoscopic (13% vs. 4%) and
increased confidence with laparoscopic techniques
complications were significantly more frequent
including suturing, it became clear that bile leaks
with laparoscopic (9% vs. 3%). When laparoscopic
could be managed in a minimally invasive manner,
was successful, there was no significant cost
potentially reducing morbidity and mortality. Prompt
difference between the two procedures (1).
access to the full range of techniques is important, as
Though bile leak after laparoscopic
is a structured approach (5).
cholecystectomy is uncommon but can occur in
0.32.7% of patients, it is defined as the persistent
AIM OF WORK
leakage of bile from the biliary tree. This can arise
Is to estimate the incidence and management
from an injury to the common bile or hepatic duct
options of post laparoscopic cholecystectomy biliary
but it is generally accepted that the vast majority
leaks. Also, it is a trial to advocate a minimally
arise from the cystic duct stump or a sub-vesical
invasive structured management protocol to treat
duct of Luschka (2, 3).
patients with bile leak.
A bile leak may result in a biliary fistula, a
subhepatic/ subphrenic collection and localized or
generalised peritonitis. Clearly, this can be
5093
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5099-5105
Value of Broncho-Alveolar Lavage in Diagnosis of Newly Developed Lung
Infiltrates in Mechanically Ventilated Patients
Yasser Mostafa1, Nevine Abd Elfattah1, Rehab M. Mohammed1, Lobna Roshdy2, Mahmoud Ibrahim2
1Chest Department, Faculty of Medicine, Ain Shams University, 2Chest Department, Egypt Air Hospital
Corresponding author: Mahmoud Ibrahim, Email: drmoudheet2@gmail.com
ABSTRACT
Background and Objectives: in a developing country, cost effectiveness is an important consideration. The
aim of this study was to investigate the efficiency and safety of mini broncho-alveolar lavage (mini BAL)
samples in the diagnosis of newly developed lung infiltrates in mechanically ventilated patients.
Methods: fifty mechanically ventilated patients with newly developed lung infiltrates were assessed by mini-
BAL and subsequent microbiological examination. An infant Ryle catheter FG-10 was used as the inner
catheter, a Nelaton catheter size 18 FG was used as the outer protective catheter and was blocked by sterile K-
Y gel instead of the pre-packaged catheters.
Results: eighty six percent of samples collected by Mini-BAL technique from mechanically ventilated patients
showed positive growth for culture and sensitivity. Thirty percent of patients had bi microbial infection while
fourteen had polymicrobial infection. Fungal infection (Candida) was the most frequent isolated pathogen
(32%) followed by Gram-negative bacteria (Klebsiella) (30%). Legionella was the commonest isolated
atypical bacteria.
Conclusion: this study highlighted the mini-BAL technique as a simple, safe, cheap, available and non-
invasive bedside procedure for acquiring uncontaminated lower respiratory secretions in patients with newly
developed pulmonary infiltrates.
Key words: Broncho-Alveolar Lavage, Newly Developed Lung Infiltrates, Mechanically Ventilated Patients.
INTRODUCTION
There are multiple ways to get sputum samples from
The complexity of patients in the intensive
intubated patients such as tracheal aspirate, blind
care unit (ICU), together with the recent advances
protected brushes and blind mini lavage (blind mini-
in radiographic images have led to new
BAL). Patients that have endotracheal tubes can
perspectives in the use of chest x-ray in the ICU.
undergo procedures besides BAL for diagnosis of
The American College of Radiology Consensus
VAP. Both blind protected brushes and blind mini-
Committee recommends and maintains that chest
lavage [blind mini-BAL] can be done in these
x-ray in patients with cardiopulmonary disease or
patients. These procedures are less expensive and
those receiving mechanical ventilation should be
more readily available. The results obtained from
performed daily (1).
these procedures have also been compared to lung
histology and cultures from patients with VAP, and
Nosocomial pneumonia, a common ICU
the data from blind mini-BAL has a sensitivity and
infection, affects 27% of all critically ill patients,
specificity of 80% when correlated with the
where 86% of it is associated with mechanical
sensitivity of the bronchoscopic BAL(6).
ventilation (2). According to the infectious diseases
society of America / American Thoracic Society
This study aimed to investigate the
(IDSA/ATS) (2) hospital acquired/nosocomial
efficiency and safety of mini broncho-alveolar
pneumonia (HAP) is pneumonia that occurs 48 h or
lavage (mini BAL) samples in the diagnosis of
more after admission and did not appear to be
newly developed lung infiltrates in mechanically
incubating at time of admission. On the other hand,
ventilated patients.
VAP is a type of HAP that develops more than 4872
h after endotracheal intubation (3). Moreover, VAP
PATIENTS AND METHODS
occurs in 28% of patients who receive mechanical
The
current
study
included
50
ventilation, where its rate of occurrence varies with
mechanically ventilated patients of different ages
the duration of mechanical ventilation. Estimated
and gender admitted to Respiratory Intensive Care
rates are 3% per day for the first 5 days, 2% per day
Unit at Egypt Air Hospital suffering from
for days 610, and 1% per day after day 10 (4). The
respiratory failure. The study period was two years.
diagnostic clinical Triad for VAP consists of
The study was approved by the Ethics Board of
pulmonary infection signs including fever, purulent
Ain Shams University.
secretions,
and
leucocytosis,
together
with
The enrolled patients were on mechanical
bacteriologic evidence of pulmonary infection, and
ventilation for more than 48 hours in whom chest
radiological suggestion of pulmonary infection (5).
x-ray showed newly developed pulmonary
5099
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5106-5109
Fixation of Lateral Humeral Condyle by Screw in Children
Abd Elhakim Abd Allah Farag, Galal Mohamed Mansour Hegazy, Islam Ahmed Mohamed El
Sharnoby
Department of Orthopedic, Faculty of Medicine, Al-Azhar University
ABSTRACT
Background: fractures of the lateral condyle of the humerus represent the second most common type of fracture of
the elbow in children. Although this injury is seen at all ages, it is predominately observed in children aged between
5 and 10 years. These injuries are typically the result of an avulsion of a portion of the humeral condyle by pull of
the extensor musculature due to a varus force on a supinated forearm or by the direct force of the radial head onto
the condyle in the setting of a fall and axial load through an extended elbow.
Objective: the purpose of this study was to evaluate the results of fixation of lateral humeral condyle by screw
in children by assessment of time to full union, range of motion, and percentage of complications according to
Hardacre criteria.
Patients and Methods: a randomized prospective interventional study aiming at evaluating of open reduction
and fixation of lateral humeral condyle by screw. Our series was conducted in Wadi El- Natroun hospital in
the period from February 2017 to December 2017; 15 patients with pediatric lateral condyle fractures cases
operated with open reduction internal fixation by partially serrated 4.0 o. Mean follow up was 6.8 months.
Results: we compared our results with the results of the studies in literature, which used screw fixation in
management of pediatric lateral condyle fracture.
Conclusion: the current follow-up is insufficient to determine whether growth disturbance may be
problematic. One other important consideration when screw fixation is utilized is the additional cost of a
secondary procedure for screw removal and the medulla of children is small which may lead to the screw
crosses the olecranon fossa.
Keywords: Fixation, Lateral, Humeral Condyle
INTRODUCTION
more stable fixation, resulting in a higher union rate,
Fractures of the lateral condyle of the
with decreased duration of casting (possibly leading
humerus represent the second most common type of
to an improved range of motion) (3).
fracture of the elbow in children. Although this injury
is seen at all ages, it is predominately observed in
AIM OF THE WORK
children aged between 5 and 10 years (1).
The purpose of this study is to evaluate the
These injuries are typically the result of an
results of fixation of lateral humeral condyle by
avulsion of a portion of the lateral humeral condyle
screw in children by assessment of time to full
by pull of the extensor musculature due to a Varus
union, range of motion, and percentage of
force on a supinated forearm (Milch type II) or by
complications according to Hardacre criteria.
the direct force of the radial head onto the lateral
condyle in the setting of a fall and axial load
PATIENTS AND METHODS
through an extended elbow (Milch type I) (2).
Study design: A randomized prospective
Multiple treatment options are available for
interventional study aiming at evaluating of open
these fractures, ranging from simple immobilization
reduction and fixation of lateral humeral condyle by
for nondisplaced or minimally displaced fracture
screw. Our series was conducted in Wadi El-Natroun
patterns, to Operative reduction and fixation with
hospital in the period from February 2017 to
Kirschner wires (K-wires) or screws for displaced
December 2017; 15 patients with pediatric lateral
fractures. Although some controversy exists with
condyle fractures cases operated with open reduction
regard to the acceptable amount of displacement,
internal fixation by partially serrated 4.0 o. Mean
fractures with displacement greater than 2mm or
follow up was 6.8 months. The study was approved
3mm are generally thought to require open reduction
by the Ethics Board of Al-Azhar University.
and fixation to facilitate union and prevent deformity
Patients' selection:
and articular incongruity. Because of concerns about
Inclusion criteria: Pediatrics and children
the possibility of loss of fixation with brief use of K-
up to 12 years with lateral condyle humerus
wires or occurrence of infection with their prolonged
fracture, and males and females.
use, authors have explored the use of screw fixation
for lateral condyle fractures. In theory, screws should
Exclusion criteria: 1. Children up to 8
be better suited for resisting load in tension, provide
years with supracondylar humerus fracture,
5106
Received:17/6/2018
Accepted:26/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5110-5115
Assessment of Non Coding RNA Expression as a Potential Stem Cell Biomarker
in Breast Cancer
Naglaa A. ELaidy1, Eman M. Elsalahy, Marwa M. Sayed1, Mahmoud A. Mahmoud2
1Medical Biochemistry and Molecular Biology Department, 2General Surgery department Faculty of Medicine, Ain
Shams University
Corresponding author: Naglaa A. ELaidy, Email: Najlaa.elaidy@gmail.com, Mobile: 01211041669
ABSTRACT
Background: worldwide, breast cancer is the most common malignancy among women and there is a deep need
for precise novel methodologies for breast cancer (BC) diagnosis. Major advances in cancer control will be
successfully achieved with early cancer detection. So, recent trends are going toward using circulating non-coding
RNA as diagnostic tool for their critical role in cancer detection.
Aim: retrieve non coding RNA that is mechanistically linked to breast cancer stem cell with validation of the results
in a group of breast cancer patients versus control groups to evaluate their usefulness as a potential biomarker in
breast cancer diagnosis.
Patients and Methods: we retrieved LncRNA that is linked to stem cell differentiation and specific to BC utilizing
bioinformatics tools. Then we validated this biomarker in serum of 30 patients with BC, 12 patients with benign
breast lesion and 12 healthy volunteers using RT-qPCR. We evaluate the power of diagnosis of the serum profiling
system using ROC curve analysis.
Results: hoxd antisense growth-associated long non coding RNA (HAGLR) had great sensitivity and specificity for
differentiating BC from patients with benign breast lesion and also from healthy controls.
Conclusion: the chosen circulatory RNA based biomarker can be used as a potential diagnostic biomarker for BC.
In addition it could be therapeutic target.
Keywords: breast cancer, long non coding RNA, bioinformatics, diagnosis.
INTRODUCTION
to stem cells, known as breast cancer stem cells
Breast cancer is the most frequent
(BCSCs)(6). Several markers have been reported for
malignancy among women worldwide. It can be
identification of BCSCs in many cancers, such as
treated when diagnosed at its earliest stage. Every 3
CD44, CD133, CD24, EpCAM, CD47and
minutes a female is diagnosed with BC globally,
ALDH1(7).
accounting to one million cases every year(1).
Stem cells undergo two types of cell division
In Africa, there is a limited data about
(symmetric and asymmetric), producing similar stem
breast cancer incidence. The incidence rates for
cell colony or more differentiated cells. Moreover,
breast cancer between African countries vary
stem cells remain in a state of quiescence in the tumor
considerably with the highest rates are in Gharbiah
environment, facilitating the so-called kinetic
governorate (Egypt) [6078 cases reported in Egypt
resistance, whereby these quiescent cells are
during the interval (1999-2007) and the lowest
unaffected by agents that can cause DNA damaging
rates are in Ghana(2).
or radiation in comparison with the more rapidly
proliferating cells(8). Also great drug resistance has
When taking a clinical decision on BC
been described for Cancer stem cells (CSCs) through
treatment, Oncologists face an exceptionally hard
different mechanisms such as drug effluxing(9).
task. Such hard task could be easier if there are
strong diagnostic and prognostic factors, which
In recent years, lncRNA is emerging as an
guide the choices of treatment options(3).Molecular
important player in the cancer paradigm. These non
technique, such non coding RNA (ncRNA)
coding RNAs are often apparently des-regulated in
expression profile, has been used to improve BC
many types of human cancers (10). Accumulating
diagnosis and to evaluate patient outcome and
evidences provide a mechanistic insight on how
response to treatment(4).
lncRNAs regulate important signaling pathways in
cancer cells at the transcriptional, post-transcriptional
Recent evidence suggests that small
and epigenetic levels(11).In addition to their effects on
populations of cancer stem cells can modify and
cancer cell growth, cell signaling and survival,
influence neoplastic cells aggressiveness and
lncRNA can modulate CSC behavior through the
behavior as well as response to therapy(5).Many
expression of pluripotency factors. The identification
observations prove that BC ability to divide,
of lncRNAs that are linked to cancer stem cells
progress and spread is based on this small
differentiation and self-renewal provides new
subpopulation of cells with characteristics similar
opportunities for cancer diagnosis and therapy(12).
5110
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5116-5121
Inflammatory Bowel Disease in Systemic Lupus Erythematosus Patients: A
Meta-analysis
Howaida El Sayed Mansour1, Mohamed Farouk Allam2, Sherin Mohamed Hosny1,
Amira Ibrahim Abdu1
1Departments of Internal Medicine and Rheumatology, and 2Department of Community, Environmental and
Occupational Medicine, Faculty of Medicine, Ain-shams University
Corresponding author: Amira Ibrahim Abdu; E-Mail: a_a22_1013@yahoo.com; Mobile: 01099498406
ABSTRACT
Background: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with features of
multisystem involvement, relapsing and remitting course. Gastrointestinal system affection is common in Lupus patients
but coexistence of the inflammatory bowel disease (IBD) and SLE is rare. The coexistence of signs and symptoms of
both diseases in the same patient represents a diagnostic challenge. Diagnoses of both diseases is difficult as both may
share the same gastrointestinal features. Some of the therapies used in IBD may induce lupus. Aim of the study: To
detect the presence of IBD in SLE patients. Methods: Only19 studies investigating the coexistence of IBD in SLE
patients were published from January 2000 to March 2017 searching the Medline, PubMed, Ovid, Trip and Cochrane
database. We excluded 16 studies (case reports) as they lacked the inclusion criteria for the meta-analysis. Only three
studies were included in this systematic review. The prevalence/frequency and its 95% CI are included or estimated
whenever possible. Results: Most of the studies that detected a statistical association between both diseases were case
series and case control study that revealed the presence of IBD in some lupus patients. Criteria for the diagnosis of SLE
cases and IBD cases were clearly explained in these studies, and same stratified results according to gender. The pooled
results of all cases with SLE were (total 6665) showed that, there were IBD cases (total 79) associated with lupus with a
frequency (95% CI) is 1.19% (0.96-1.48). Conclusion: The prevalence of IBD in SLE patients is rare however, the
coexistence of both diseases in the same patient could occur.
Keywords: Systemic lupus erythematosus, inflammatory bowel disease, Crohn's disease, Ulcerative colitis,
coexistence, gastrointestinal symptoms.
INTRODUCTION
(5). IBD and SLE are systemic diseases caused by
Autoimmune diseases tend to be viewed as
abnormal immune responses, in a genetically
distinct entities, however clustering, coexistences
susceptible individual due to environmental
and overlaps of autoimmune diseases can occur as
triggers (6). SLE association with IBD is considered
the association between Inflammatory bowel
mainly if GIT symptoms develop in a well-
disease (IBD) and Systemic lupus erythematosus
controlled SLE patient; in such cases a
(SLE). The coexistence of both diseases is rare and
colonoscopy with biopsy should be performed (7).
the presence of clinical features of both entities in a
Specific alleles can confer susceptibility to both
patient represents a diagnostic challenge (1). SLE is
diseases so, it is possible that SLE and IBD share
a systemic chronic autoimmune disease with
immunological or genetic defects. Three loci,
variable clinical presentations and immunological
the CARD15/NOD2 gene, the disc's large homolog
signs and symptoms. It mainly affects women
5 gene (DLG5) and the IBD5 locus on 5q31
during childbearing age (2). SLE has a highly
(IBD5), have been validated as giving
variable prognosis with benign to rapidly
susceptibility to IBD (8).
progressive and even fatal with remitting and
Crohn's disease and lupus:
relapsing course. The survival rate is higher, and
The occurrence of both diseases together is
the course is milder in persons with isolated skin
rare. Only few case reports are detected and
and musculoskeletal affection than those with renal
common genetic susceptibility between SLE and
and CNS affection (3). IBD is a chronic recurrent
CD is controversial as there is no evidence that the
disease that includes mainly two phenotypes,
Crohn's disease-associated mutations on CARD15
Crohn's disease (CD) and ulcerative colitis (UC)
contributed
to
SLE
susceptibility,
but
which lacks an autoimmune serological marker yet,
differentiation of CD from SLE gastrointestinal
they can be present with several examples of
symptoms is difficult, as CD may show clinical
autoimmunity (4). UC that causes ulcers in the
signs and symptoms similar to SLE. So, the correct
lining mucosa of colon and rectum, while CD
diagnosis has important treatment and prognostic
characterized by spreading inflammation deep into
implications (9).
the affected tissues. Both usually produce severe
diarrhea, abdominal pain, fatigue and weight loss
5116
Received:17/6/2018
Accepted:26/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5122-5129
Enhanced Recovery Program (ERP) versus Traditional care after Elective Left
Side Colorectal Cancer Surgery
Ahmad Aboelkassem Ibrahim2, Reda M. Moustafa 1, Ashraf Abdulmoghni Moustafa 1,
Saleem EL-Rabaa 2, Yahya Salama 2
1Department of General Surgery, Faculty of Medicine Ain Shams University Egypt
2Colorectal Department, Kettering General Hospital United Kingdom
Corresponding author: Ahmad M. Aboelkassem Ibrahim; Email: draboelkassem@hotmail.com
ABSTRACT
Aims: We aimed to study the effect of ERAS protocol after left side colorectal cancer surgery in comparison
with patients were subjected to traditional care. Methods: Retrospective study comparing 2 groups of patients
who underwent elective left side colorectal cancer surgery. Group A: 25 patients admitted between November
2014 and April 2015 subjected to ERAS, and Group B: 25 patients admitted between January 2008 and August
2008 received traditional care. Both groups were consecutive cases. The notes were examined to determine the
following outcome measures: Short-term morbidity, Length of stay, 30 days Readmission rate and Mortality.
Results: 25 patients with ERAS matched with 25 traditional recovery cases for baseline demographics. 96%
started oral fluids on D1 in group A compared to 8% in group B, 96% in group . A tolerated full diet on D6
compared to 72% in group B. Bowel movements by D5 was group A 92% compared to only 36% in group B.
Total LOS mean for group A was 7 days vs 12.48 in group B (p=0.005). Complications occurred less
frequently in group A compared to group B (anastomotic leak with 8% (n=2) in group A versus 16% (n=4) in
group B, prolonged ileus with 8% (n=2) in group A versus 16% (n=4) in group B (p = 0.663). Mobility on D1
40% (n=10) in group A was an independent factor which decreased LOS, as all stayed< 5 days (p=0.002) and
developed less complications (4% (p=0.027)). Conclusion: ERAS didn`t affect complications rate
significantly following left side colorectal surgery, however reduced LOS as it improved tolerating oral intake
and bowel movement. Mobility D1 can be independent pridector of reduced both complications and LOS and
should be encouraged for all patients.
Key words: inhanced recovery program, traditional care, colorectal cancer surgery
INTRODUCTION
Colorectal surgery has been associated
Colorectal cancer (CRC) continues to be a
with complication rates ranging from 10% to 20%
leading cause of cancer associated with significant
and mean postoperative hospital stays from 6 to 10
morbidity and mortality in the United States (US) and
days. The financial burden imposed on health care
throughout the world. Globally, CRC is the third most
systems due to prolonged hospital stay after
common cancer in men and the second in women (1).
colorectal surgery can be significant. In an effort to
improve postoperative outcomes in patients
Conventional colorectal operations for
undergoing colorectal surgery, enhanced recovery
malignant disease are usually associated with
after surgery (ERAS) programs has been designed
extensive preoperative preparation, significant
and evaluated (4).
surgical stress, and prolonged recovery of
gastrointestinal function and the body as a whole. An
Kehlet et al. (5) were the first to describe in
excessive stress response may predispose the patient
detail a specific protocol called fast-track or
to an increased risk of cardiovascular and
enhanced recovery after surgery protocol which
cerebrovascular
complications,
nutrient
had the potential to reduce hospital stay to a mean
malabsorption, and delayed convalescence (2).
of 4 days, largely as a result of better understanding
of postoperative physiology and advances in the
Many surgeons believe that left colectomy
field of health care in the last decade. The aim is to
(LC), which is often more technically challenging and
attenuate the surgical stress response, accelerate
requires a colo-colic or colorectal anastomosis, has a
recovery, decrease complications, minimize
significantly higher incidence of anastomotic leakage,
hospital stay, and ultimately reduce health costs
wound infection, overall complication rate, and
without compromising patients' safety (6).
longer length of hospital stay (LOS) compared to
right colectomy (RC), which utilizes an ileocolic
ERAS interventions focus on those key
anastomosis. Therefore, RC is generally believed to
factors that usually keep patients in hospital and make
be a simpler operation with better outcomes than LC.
them dependent on drugs and specialist assistance
Left
colectomy
had
higher
intraoperative
following uncomplicated surgery, namely the need
complications and total hospital stay than right
for parenteral analgesia, the administration of
colectomy (3).
intravenous fluids and confinement to bed. Pillars of
5122
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5130-5136
Effect of interictal epileptiform EEG discharges on cognitive functions in
epileptic children
Kamel M. Hewedi 1, Wael O. Mohamed1, Amr A. Mostafa2, Mohamed A. Zaki 1, Fathy M. Mansour1
1Department of Neurology, 2Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Corresponding author: Fathy M. Mansour; Mobile: 01096946464; Email: dr.fathy.mansour@gmail.com
ABSTRACT
Background: Epilepsy is a chronic disorder of the brain that affects people of all ages Neuropsychological
impairment is an important comorbidity of chronic epilepsy in the majority of children with epilepsy. interictal
epileptiform EEG discharges may present as a complicating factor in spite of being seizure free. In a group of
children with interictal EEG discharges there is sudden and unexpected decline of school performance as the
first symptom of epilepsy. Consequently, accumulating cognitive impairment, and even a decline in IQ scores,
is reported in epileptic children with frequent episodes with epileptiform EEG discharges.
Aim of the Work: To evaluate the possible relationship between interictal EEG discharge and cognitive
function in a sample of Egyptian epileptic children.
Patients and Methods: The ethical approval was obtained from the Hospital Ethical Research Committee.
Each patient and/or parents entering the study signed an informed consent. This study was conducted on 140
children selected from Epilepsy Outpatient Clinic of Al-Azhar University Hospitals during a period of two
years starting from June 2016 untill June 2018. A specialized pediatric neurology sheet was taken. EEG and
cognitive assessment of epileptic patients with and without epileptiform EEG discharges using Stanford-Binet
intelligence scale and P300 by ERP were performed to each patient two times 3 months in between.
Results: we found that patients with frequent IEDs had high mean P300 latency and low IQ when compared to
patients with infrequent and normal EEG examination. In addition, the mean p300 latency significantly
reduced with rising in IQ (more improvement in cognitive function) after disappearance of IED in some
patients.
Conclusion: Interictal epileptiform EEG discharge had an additional effect on cognitive function especially if
generalized and of high frequency. This effect might be often underestimated and might accumulate, and have
a severe cognitive impact. So, treatment of epileptic patients should put in concern reduction or even treatment
of IEDs as controlling of these IED lead to improvement of cognition.
Keywords: Epilepsy, interictal epileptiform discharge, cognition.
INTRODUCTION
In the majority of children with epilepsy,
Epilepsy is a chronic disorder of the brain
epileptiform interictal EEG discharges may present
that affects people of all ages. It is the most
as a complicating factor in spite of being seizure
common serious neurological condition in the
free (6).
world, and an important cause of mortality and
Interictal epileptiform activity is defined by
disability in developing countries (1).
spikes and sharp waves, with or without slow
Approximately
50
million
people
waves (7).
worldwide have epilepsy, making it one of the
Interictal epileptiform EEG discharges also
most common neurological diseases globally (2).
have cognitive effects, although these effects are
A long and rich history of research has
generally reported to be reversible when these
characterized relationships between cognitive
discharges are controlled, their impact on daily life
function and epilepsy (3).
may be greater than suspected, especially when the
effects are not recognized or when the discharges
Many of these cognitive deficits are
persist for years. In a group of children with
related directly to the brain disorder underlying the
interictal EEG discharges, there is sudden and
epilepsy syndrome. However, in other types of
unexpected decline of school performance as the
epilepsy, the epileptic seizures and/or epileptiform
first symptom of epilepsy (8).
activity can be the dominant factor (4).
Consequently, accumulating cognitive
Epilepsy, its underlying cause or treatment
impairment, and even a decline in IQ scores, is
may not stop all development. It may simply cause
reported in epileptic children with frequent
cognitive development to occur more slowly or less
episodes with epileptiform EEG discharges (9).
fully than it would have done without the epilepsy
(5).
5130
Received:21/6/2018
Accepted:30/6/2018