ABSTRACT The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7622-7631

Thyroid Dysfunction in Non-segmental versus Segmental Vitiligo
Rabie Bedir Atallah, Mohamed Shokry Zaky, Amany Abdullrafea Mohamed Ghanem
Department of Dermatology, Venereology and Andrology, Faculty of Medicine,
Al-Azhar University (Damietta)
Corresponding author: Amany Abdullrafea Mohamed Ghanem; Number: 01001416512; Email:
vitiligo is the most common pigmentation related disorder. Vitiligo is a one of the disorders of melanin
pigmentation that affect approximately 0.5- 2% of the population. Both adults and children are affected with no
predilection for sex or ethnicity. Although the pathogenesis of this disease is not fully understood, the autoimmune
hypothesis is the most commonly accepted theory. The autoimmune thyroid abnormalities are the most common
associations with NSV. One common feature of autoimmune thyroid diseases is the frequent presence of autoantibodies
directed against thyroglobulin (TG) and thyroperoxidase (TPO). Associated thyroid dysfunction with NSV that may be
at the subclinical or the clinical level, includes Graves' disease, Hashimoto's thyroiditis, hyper-thyroidism or
hypothyroidism. Interestingly, vitiligo often precedes thyroid disease indicating a need for regular screening for thyroid
dysfunction and thyroid-related antibodies.
this study aimed to shed a light on the association between SV, NSV and the presence of TG Ab and
TPO Ab. This study included thirty SV patients, thirty NSV patients and thirty age and sex matched individuals
free from vitiligo as a comparative group. Estimation of serum anti-TPO, anti-TG, serum TSH and serum FT3
andFT4were done by using the ELISA kits.
Subjects and Methods: in our study, most of the patients were of Fitzpatrick skin type IV. Two cases only had
poliosis in NSV and five in SV patients. Koebner phenomenon was absent in SV patients while, there was 40% of
NSV group of patients. Results: mean TSH levels were normal in all the studied subjects. FT3 showed a
statistically significant difference between NSV patients and the comparative groups. There was a statistically
significant increase in the prevalence of anti TPO antibody in NSV patients compared to the SV group and vitiligo
free group. No statistically significant increase in the prevalence of anti TG among the comparative groups. The
levels of anti TG and anti TPO levels show significant increase with duration of the disease, VASI score and
female gender in NSV group.
Conclusion: the presence of higher mean levels of anti-TPO in the NSV group compared to the SV group and
vitiligo free group was in favor of the autoimmune pathogenesis hypothesis as they point to a disturbance in the
autoimmune system of the NSV patients and this supporting the view that the pathogenesis of SV and NSV is
Keywords: thyroperoxidase, thyroglobulin.


reported the presence of antithyroglobulin (Tg) or
characterized by the appearance of a chromic
antithyroperoxidase (TPO) in 20.8 % of vitiligo
macules due to the disappearance of functional
melanocytes from the epidermis (1).
autoantibodies, some are selectively directed
Vitiligo has been recently classified,
toward thyroid hormones (TH) thyroxine (T3) and
according to the clinical presentation of macules,
triiodothyronine (T4) (T3- and T4-Ab), which are
into three major forms, namely non-segmental
the less frequently detected class of thyroid
antibodies in human serum (8) with a prevalence of
undetermined/unclassified vitiligo (2).
0.07 % in the general population. Their
Although the pathophysiology of all forms
pathogenetic role is still unknown, but they have
of vitiligo likely involves autoimmune or
been found to be increased in individuals with ATD
inflammatory mechanisms, non-segmental and
and extrathyroid autoimmune diseases (9).Regarding
segmental vitiligo differ, in addition to their clinical
the triggering factors of ATD, it has been shown
presentation, for the pathophysiology, clinical
that alcohol, smoking, iodine, iodine-containing
course, prognosis, response to treatment, and
compounds and other chemical agents, grouped into
associated comorbidities (3).Namely, non-segmental
the category of the thyroid disruptors (10)that can
vitiligo patients have increased frequencies of
elicit the appearance of ATD (11).
associated autoimmune disorders (4).

AIM of the WORK
disorders (ATD) are the most frequently found co
This study aimed to evaluate the thyroid
morbidities (5).International guidelines on vitiligo
dysfunction in vitilligo patients by assessment of
management recommend periodic screening of
serum levels of TSH, T3, T4, Anti Thyroid Anti
thyroid function (6) because a recent meta-analysis has

Full Paper (vol.7310 paper# 1)

c:\work\Jor\vol7310_2 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7632-7637

Recent Therapeutic Alternative Methods for Burst Abdomen and its
Relation to Development of Incisional Hernia
Ahmed Abd El Aal Sultan1,HishamWefky Anwar1 and Islam Abd Elhaleem eldesoky2
1Department of Surgery, Faculty of Medicine, Al-Azhar University and 2Department of Surgery, Military
Production Hospital, Cairo, Egypt
*corresponding Authors: Ahmed Abd El Aal Sultan, E-mail: Dr.ahmedsultan@azhar.edu.eg and
Hisham Wefky Anwar, E-mail: Hisham.wefky@yahoo.com


Background: Burst abdomen is considered one of the most challenging obstacles that facing general surgery.
Studying the layers of the abdominal wall, and knowing the anatomy of the anterior abdominal wall, its arterial
and nerve supply is the corner stone in management of that surgical problem, and in finding the best way how
to close that defect.
The aims of the study were to evaluate and compare between recent therapeutic methods of burst
abdomen after elective and emergency laparotomy as regard technical, function and to prevent its complication
with its later development of incisional hernia.
Patients and Methods: This randomized prospective study was carried out at Al-Azhar University Hospitals
and Military production hospital on 20 patients with post-lapraotomy burst abdomen in the period from January
2016 to October 2017. The patients were randomly classified according to the method of abdomen closure into
5 groups; 4 patients each: Group A: Closure with TI, TIE, TIES incisions and component separation technique.
Group B: Simple mass closure with continuous sutures. Group C: Closure using a Pedicled Tensor Fascia
LataFlap. Group D: Vacuum assisted closure. Group E: Closure with gradual skin stretching by tension relief
By the use of TI, TIE, TIES incisions and component separation technique, complete fascial closure
was achieved in 3 patients (75%).By the use of mass closure, complete fascial closure was achieved in all
patients (100%).By the use of the vacuum assisted closure, complete fascial closure was achieved in all patients
(100%) but enterocutaneous fistula was encountered in one patient (25%).
By the use of the pedicled tensor fascia lata to close the abdomen, complete fascial closure was achieved in all
patients (100%) but recurrence occurred in one patient (25%).By the use of the TRS, complete fascial closure
was achieved in 2 patients (50%)
Conclusion: Mass closure with continous suture seems to be the best method as the abdominal wall defect is
not large as its simple ,easy and cost effective .
Keywords: Burst Abdomen, Incisional Hernia , Mass closure, component separation.


Burst abdomen is a serious postoperative
quite high in the case of an emergency
complication that concerns many surgeons. The
disruption of the wound tends to occur between the
The most frequent complications of burst
sixth and eighth day. Serosanguinous (pink)
abdomen include recurrence,mortality, and
discharge from the wound is the most
incisional hernia. Another complication is the
pathognomonic sign of impending wound
occurrence of enterocutaneous fistula(4).
disruption. Poor closure techniques, deep wound
It is important for the surgeon to knows
infections, increasing intra-abdominal pressure in
that wound healing demands oxygen consumption,
the early postoperative period and poor metabolic
normoglycemia and absence of toxic or septic
state of the patient are the most common
factors, which reduces collagen synthesis and
predisposing factors(1).
oxidative killing mechanisms of neutrophils(5).
It is described as partial or complete
Management of dehisced wounds may
disruption of an abdominal wound closure with or
include immediate re-operation if bowel is
without protrusion of abdominal contents. Partial
protruding from the wound. Mortality rates
wound dehiscence is defined by separation of facial
associated with dehiscence have been reported
edges without evisceration and occasionally, fibrin
between 14­50%(6).
covered intestinal loops. Complete wound
The aims of the study were to evaluate and
dehiscence is defined as full separation of fascia
compare between recent therapeutic methods of
and skin with evisceration of intestinal loops (2).
burst abdomen after elective and emergency
Despite a better understanding of wound
laparotomy as regard technical, function and to
healing and good suturing techniques, the incidence
prevent its complication with its later development
of various wound complications, including a burst
of incisional hernia.
abdomen and incisional hernia, in later stages is


Full Paper (vol.7310 paper# 2)

Assessment Of Optic Disc Perfusion In Open Angle Glaucoma (OAG) Using Optical Coherence Tomography Angiography (OCTA) The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7638-7643

Assessment of Optic Disc Perfusion in Open Angle Glaucoma (OAG) Using
Optical Coherence Tomography Angiography (OCTA)
Abu Bakr Mohammad Farid Abu Al Naga, Hassan Metwally Bayoumy,
Shady Abdel Mohsen Emam Ibrahim*
Ophthalmology Department, Faculty of Medicine, Al- Azhar University
* Corresponding author: Shady Abdel Mohsen Emam Ibrahim, E-mail: shady.abdelmohsen@gmail.com

glaucoma is a major disease that potentially results in irreversible blindness, some prospective
studies demonstrated that in primary open-angle glaucoma (POAG), blood flow is diminished in the ophthalmic,
retinal, choroid and retro-bulbar circulations. Aim of the Work: this study aimed to compare Optic disc perfusion
in normal healthy persons with that of Open Angle Glaucoma (OAG) patients by using Optical Coherence
Tomography Angiography (OCTA) and to see if a correlation exists between optic disc perfusion, visual field
changes and retinal nerve fiber layer thickness in normal healthy persons and in OAG patients. Patients and
we did an analysis of optic disc perfusion in two groups of normal healthy persons and primary open
angle glaucoma patients who were previously diagnosed and attended follow up in outpatient clinic in Sayed Galal
University Hospital located in Cairo. In our study we included 22 eyes of 12 people, (10 normal eyes and 12 Open
angle glaucoma patients eyes) aged between 20 and 78 years old.
Results: there was a statistically significant relationship between optic disc perfusion and glaucoma group in
comparison with normal group, thus in normal group the optic disc perfusion indicated good optic disc perfusion
which was significantly lower in glaucoma group. Also we discovered that there was a statistically significant
correlation between optic disc perfusion with (Visual field changes and RNFL thickness).
Conclusion: optic disc perfusion assessment by using OCT angiography could be beneficial in evaluation of
glaucoma and assessment of disease progression and it's follow up together with Visual Field assessment and
clinical examination.
Keywords: optic disc perfusion, open angle glaucoma, optical coherence tomography angiography.

normally dense peripapillary microvascular network
Glaucoma is a major disease that potentially
is attenuated in both the superficial disc vasculature
results in irreversible blindness. It is the second
and the deeper lamina cribosa (6).
leading cause of induced vision loss worldwide. For
Measurements of optic nerve head
a long period of time, elevated intraocular pressure
microcirculation with OCT angiography revealed a
(IOP) was recognized as the only cause of neural
significant reduction of blood flow in glaucomatous
tissue loss at the optic nerve head (ONH),
eyes and these measurements were also well
subsequently resulting in visual field loss (1).A
correlated with visual field function (7).There is a
prospective study demonstrated that in primary
general consensus that ocular blood flow is reduced
open-angle glaucoma (POAG), blood flow was
in glaucoma and that vascular factors might be more
diminished in the ophthalmic, retinal, choroidal, and
prominent in open-angle glaucoma (OAG). Despite
retrobulbar circulations (2).
this, the study of disc perfusion in patients with
Recently, a newly developed OCT
OAG has been rare. Additionally, the relationship
angiography using split- spectrum amplitude-
between the severity of damage of optic disc
perfusion and the functional and anatomical changes
demonstrated the ability to quantify retinal and disc
of glaucoma has not been established. To explore the
blood flow rapidly and accurately (3).
possible correlation between disc perfusion and
Optical coherence tomography angiography
visual field loss in OAG patients, this study will be
(OCTA) is a new non-invasive imaging technique
performed using OCT angiography (3).
that employs motion contrast imaging to high-

resolution volumetric blood flow information
generating angiographic images in a matter of
The aim of this study was to compare optic
seconds (4). Both the retinal and the choroidal
disc perfusion in normal healthy persons with that of
microvasculature can be visualized by using OCT
Open Angle Glaucoma (OAG) patients using Optical
angiography while, fluorescein angiography (FA) is
Coherence Tomography Angiography (OCTA) and
used for seeing the retinal vessels and Indocyanine
to see if a correlation exists between optic disc
green angiography (ICGA) is more ideal for imaging
perfusion, visual field changes and retinal nerve
the choroid (5).OCTA is a useful tool for evaluating
fiber layer thickness in normal healthy persons and
optic disc perfusion in glaucomatous eyes. The
in OAG patients.

Full Paper (vol.7310 paper# 3)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7644-7649

Ultrasonographic Assessment of Sternoclavicular Joint in
Patient with Rheumatoid Arthritis
Khaled A. Zaki, Hassan M. Bassiouni, Hany M. Aly, Ibrahim E. Elsakka
Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
Corresponding author: Ibrahim E. Elsakka; Mobile: 01095772459; Email: ielsakka9@gmail.com

the sternoclavicular (SC) joint is a real diarthrodial joint that can be affected during the route of RA;
but, its scientific implications appear to remain under estimated through the rheumatology network. In every day
clinical practice, traditional radiography is taken into consideration the usual imaging approach for assessing SC
joint involvement; unfortunately, it can constitute a problem inside the diagnostic evaluation because it provides
little data regarding gentle tissue involvement. Moreover, it's far much less sensitive than different imaging
techniques for assessment of bony abnormalities. Computed tomography (CT) is considered the gold widespread
for detection of bone erosions at different joint degrees, inclusive of the SC joint, its major disadvantage is
associated with ionizing radiation. The value of magnetic resonance imaging (MRI) is remarkable as it allows
identification of bone marrow edema, greater-articular abnormalities, disc and cartilage lesions, and synovial
membrane involvement. However, its use is regularly constrained due to its high price. Currently, ultrasound (US)
is right extensively common imaging approach in each clinical exercise and in rheumatology studies to visualize
joints and tender tissues. To date, there is a regular frame of evidence assisting its validity, reliability, and
feasibility inside the evaluation of persistent inflammatory arthritis and its higher sensitivity than scientific exam in
the analysis of synovitis, enthesitis, and tenosynovitis in these patients.Aim of the Work: this work aimed to
describe the prevalence of sternoclavicular (SC) joint involvement and the relationship between clinical and
ultrasound (US) findings in patients with rheumatoid arthritis. Patients and Methods: the ethical approval was
obtained from the hospital ethical research committee and each patient participated in this study signed in informed
consent. The present study was conducted on a hundred and twenty patients; their age ranged from 20 to 50 years.
They were categorized into 2 groups a- 60 patients knowns as RA, b-60 normal control subjects. They were
recruited from Physical Medicine, Rheumatology and Rehabilitation Department of Sayed Jalal and Al-Hussein,
Al-Azhar University Hospitals, during the period from April 2018 to October 2018.Results: ultrasound revealed a
high prevalence of sternoclavicular joint involvement in patients with rheumatoid arthritis than clinical findings.
Conclusion: the present study provided US evidence that reveals a higher prevalence of SC joint involvement in
patients with RA than in age- and sex-matched healthy controls. US was extra sensitive than medical examination
for detecting SC joint involvement in RA. The correlation amongst US synovitis, intraarticular PD and the DAS28
showed that SC joints actively participate within the systemic inflammatory manner of RA. The precise position of
US within the assessment of the SC joint in sufferers with RA is but to be mounted firmly in the rheumatologic
Keywords: ultrasonographic, sternoclavicular joint, rheumatoid arthritis.

technique for assessing SC joint involvement (3).
Rheumatoid arthritis is the prototype inflammatory arthritis,
Unfortunately, it could constitute a trouble in the diagnostic
affecting about 1% of the world's population. Its
assessment as it offers little records concerning tender tissue
pathogenesis has not been completely understood. However,
involvement. Moreover, it's far much less sensitive than
there's evidence that the sickness can also involve synovial
different imaging strategies for the evaluation of bony
joints, subchondral bone marrow in addition to intra and
abnormalities. Computed tomography (CT) is considered the
extra articular fat tissue, and might cause innovative joint
gold standard for detection of bone erosions at specific joint
ranges, including the SC joint, its major drawback is related
Over the remaining two decades, a large improvement in its
to ionizing radiation. Magnetic resonance imaging (MRI) is
prognosis has been completed thanks to new strategies for
high-quality as it allows identification of bone marrow
sickness management, the emergence of recent biologic
edema, more articular abnormalities, disc and cartilage
remedies and higher utilization of traditional disease-
lesions, and synovial membrane involvement. However, its
modifying anti-rheumatic drugs(1).The sternoclavicular
use is frequently restrained due to its high fee4. Currently,
(SC) joint is a real diarthrodial joint that can be
ultrasound (US) is an extensively regularly occurring
worried during the route of RA; but, its scientific
imaging technique in each scientific practice and in
implications appear to remain underestimated through
rheumatology studies to visualize joints and soft tissues. To
the rheumatology network(2).In daily clinical practice,
date, there is a consistent frame of evidence assisting its
conventional radiography is considered the standard imaging
validity, reliability, and feasibility in the evaluation of

Full Paper (vol.7310 paper# 4)

Introduction The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7650-7658

The Possible Protective Role of Vitamin C against Toxicity Induced by
Lead Acetate in Liver and Spleen of Adult Albino Rats
(Light and Electron Microscopic Study)
Mohamed Abdul Haye Autifi 1, Wahed Yousry Mohamed 2,
Wagih Mansour Abdul Haye 1 Kamal Rady Elbaz 1
1- Anatomy and Embryology Department, 2- Histology Departments, Faculty of Medicine, Al-Azhar University

lead toxicity has been recognized as a major environmental health hazard worldwide affecting both
humans and animals at all ages especially young children in humans. Lead does not have any beneficial biological
effects to humans and its presence at high concentrations produce very undesirable toxic consequences to humans
affecting all the body organs. Ascorbic acid is probably the most widely studied vitamin when it helps to prevent
lead induced oxidative stress. Its property of quenching ROS along with metal chelation makes it a potential
detoxifying agent for lead.
Aim of work: this study aimed to detect the possible protective effect of vitamin C against toxicity induced by
lead acetate in liver and spleen of adult albino rats by light and electron microscope.
Material and Methods: 40 adult male albino rats were used in this work. They were categorized into four groups
each group was consisted of ten rats as follows: group I (Control group): The rats received 1ml 0.9% sodium
chloride orally every day for 28 days. Group II: rats received vitamin C in a dose of 27 mg/day orally every day
for 28 days. Group III: rats received lead acetate in a dose of 10.8 mg/kg; orally every day for 28 days. C group
IV: rats received vitamin C in a dose of 27 mg of one hour prior to administration of 10.8 mg/kg of lead acetate
orally every day for 28 days. Finally, on the 29th day, the rats were anesthetized with ether and their abdomens
were opened and their livers and spleens were excised and divided to small slices and prepared for light and
electron microscopic examination.
Results: results of the present study revealed that administration lead acetate to rats produced harmful effects on
the rat's liver and spleen; showed distortion of liver architecture with marked vacuolar degeneration of the
swollen hepatocytes with cytoplasmic vaculations and condensed pyknotic nuclei. Central vein was dilated and
congested, some of blood sinusoids were obliterated and others showed congestion and hemorrhage. Portal tract
also showed congestion of the portal vein with mononuclear cellular infiltration in the portal tract area. Collagen
deposition was detected around the central vein, between the cords of hepatocytes and in the blood sinusoids.
Portal tracts expanded by thick collagen fibers also. And spleen showed distorted splenic architecture with
massive hemorrhagic areas in the red pulps and highly reduced white pulps (diffusion of white pulp into the red
pulp) and marked degeneration in the lymphocytes with necrotic foci with marked collagen deposition around the
splenic arterioles and in the red pulps.
and these effects relatively improved by administration of vitamin C. Sections were examined by light
microscopic examination.
Conclusion: lead acetate caused histological changes in liver and spleen of adult albino rats most probably
through oxidative stress. Vitamin C therapy could ameliorate these changes in liver and spleen and this may be
attributed to its antioxidant and free radicals scavenging properties. This may indicate the effectiveness of vitamin
C in prevention of lead acetate toxicity on liver and spleen
Keywords: lead acetate; vitamin C; liver; spleen.


Lead, a non-physiological heavy metal, is one
antioxidants, the condition is called oxidative stress
of the first metals used by man. Its wide application
was begun since over 8000 years ago (1). The
The present work aimed to evaluate the
absorbed lead is conjugated in the liver and passed
protective effect of vitamin C against toxicity
to the kidneys, where part of it is excreted in the
induced by lead acetate on liver and spleen of adult
urine and the rest of absorbed lead accumulates in
albino rats.
various body organs, affecting many biological

functions at the molecular, cellular and intercellular
levels (2). Ascorbic acid is well known for its
Forty adult male albino rats weighting 200-250 g
antioxidant activity, acting as a reducing agent to
were used. The rats were randomly categorized into
reverse oxidation in liquids. When there are more
four groups each group formed of ten rats:
free radicals (ROS) in the human body than
1- The control group (I): rats were received 1 ml

normal saline orally.

Full Paper (vol.7310 paper# 5)

Anatomy Of Spleen The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7659-7665

Conservative Versus Operative Management of Blunt Splenic Injuries
Abduh El-Said Mohammed, Mahmoud Abd El Hady Abd El Aziz, Ahmed Ramadan Abd El Rahim*
*Department of General Surgery, Faculty of Medicine, Al-Azhar University
Corresponding author: Ahmed Ramadan Abd El Rahim, Mobile: 002001019592522, E-Mail: midobs9090@gmail.com

The spleen is the most frequently injured organ in blunt abdominal trauma, mainly because of its
highly vascularized parenchyma and its anatomic location. In the past the management of blunt splenic injuries was
splenectomy, but high rate of operative complications caused paradigm shift from operative to non-operative
management (NOM) in hemodynamically stable blunt abdominal trauma patients. Now, nonoperative management
of hemodynamically stable patients with blunt splenic injuries is the standard of care and has been proven to be safe
and successful in the acute setting. The advent of newer imaging techniques with high resolution CT scanners has
enabled the clinicians to exactly diagnose the extent of intra-abdominal organ injury.
Objective: This work aim to compare between operative and conservative management of splenic trauma.
Total numbers of patients in this study were 20 patients classified in two groups, the first group
contained12 patients and the other group contained 8 patients. The First group was managed conservative and the
second was managed operative with splenectomy and splenoraphy. The first group of patients consisted of 9 males
(75%) and 3 female (25%). The second group of patients consisted of 6 males (75%) and 2 females (25%).
Results: In this study, bunt splenic injury was found to be more common in males because of their risky and hard
work. RTA and Falling from a height were found to be the most common causes of blunt abdominal injuries.
According to CT, grade one and two of splenic injury are more common than other grades of splenic injury. As
regard complication the operative management has more complication as postoperative wound infection and
postoperative chest infection. So, NOM of splenic injury is the management of choice in haemodynamically stable
The nonoperative management is considered the ideal management for blunt splenic injuries due to
less complication, less blood transfusion, less hospital stay and less mortality than operative management.
Keywords: Splenic, CT, Operative Management, Conservative Management.


The decision to operate on a patient with a
The spleen is the most commonly injured
splenic injury is best based on hemodynamic stability
organ in blunt abdominal trauma and is frequently
which is monitored by pulse, blood pressure,
injured in penetrating trauma to the left upper
respiratory rate, urine output and ongoing blood loss
quadrant, the management of penetrating splenic
as reflected on patient hemoglobin and hematocrit
injury is straightforward and primarily operative (1).
values, and responsiveness to non-operative methods

Splenic injury should be suspected in patients
rather than grade of injury (6).
with direct trauma to the left side, associated rib

fractures, and left upper quadrant tenderness (2).

CT scan is the standard imaging study to
This study aims to differentiate between
diagnose and grade splenic injuries. CT also guides
cases of blunt splenic injury that indicate operative
management of injuries, and a finding of high grade
management and others that need only conservative
of splenic injury on CT scan seems to increase the rate
of operation and correlate with hemodynamic

instability. However, even most of the patients with
blush still can be managed successfully with non-

This study carried out on 20 patients
operative management (3).
presented with blunt splenic trauma, admitted to

Splenic preservation should be achieved
Emergency Department in Etay El-Baroud Hospital
whenever possible to avoid post-splenectomy
in the duration from Mars 2018 to November 2018.
complication such as bleeding, abscess, adhesive
Inclusion criteria:
obstruction and the most serious over whelming post
Patients from10 to 50 years old.
splenectomy infection caused by encapsulated
Patients with blunt abdominal trauma.
bacteria, Streptococcus pneumonia, Haemophilus
Patients with isolated splenic injury.
influenza and Neisseria meningitidis, which are
Exclusion criteria:
resistant to antimicrobial treatment and have a high
Patients under 10 and over 50 years old.
mortality rate (4).

Non-operative management has become
Penetrating splenic injuries.
standard practice and achieves a high success rate (5).
Bleeding disorders.

Full Paper (vol.7310 paper# 6)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7666-7671

Assessment of Fertility Status among Multibacillary Leprotic Females in
Kafr El-Shiekh and Damietta Governerates
Rabie Bedir Attallah1, Osama Abdelazeem Hashem1,
Abdel Raouf Mohamad Oun2, Salwa Ibrahim Elsayed Abo-Elfetoh3
1Department of Dermatology, Venereology and Andrology, Faculty of medicine, Al-Azhar University(Damietta)
2Department of Gynacology and Obstatrics, Faculty of Medicine, Al-Azhar University(Damietta), 3MBBCH
Corresponding author: Osama Abdelazem Ibrahim Hashem, tel :01062227676 , email :osama.os129@gmail.com

Leprosy is a chronic infectious disease caused by obligate intra- cellular microorganism
mycobacterium leprae that tend to infect skin and the peripheral nerves. The disease manifested clinically by a
spectrum depending on the host immune response and finally leading to peripheral nerve damage and deformities.
Although leprosy rarely involves the female genital tract, a significantly larger number of female patients with MB
leprosy had irregular periods postdating the onset of leprosy also gonadotropic hormone levels were elevated in
significantly more patients with MB and that the mean levels of these hormones showed an increasing trend from
Objective: The objective of this study is to assess the fertility status among multibacillary leprotic females
Patients and Methods: This study was conducted on thirty multibacillary leprotic females who were selected
from Kafr-Elsheikh dermatology and leprosy hospital and Damietta dermatology and leprosy hospital and twinty
healthy females as a control group. Patients were subjected to history taking, general clinical examination and
dermatological examination, and were divided into groups according to WHO classification.
Results: Our study showed that a significantly large number of female patients with MB leprosy had irregular
period post dating to the onset of leprosy and the gonadotrophic hormone level is significantly elevated in patients
than in control in addition to fertility which is significantly affected in MB leprotic females.
Conclusion: the findings of this study are significant in view of the fact that it is generally believed that ovarian
dysfunction does not occur in leprosy. Even in the absence of confounding factors like anemia and tuberculosis,
leprosy may be associated with menstrual irregularities, infertility, and elevation of gonadotropin hormones.
Leprosy, fertility, follicle-stimulating hormone, luteinizing hormone.


Leprosy, known as Hansen's disease (HD),is
a chronic granulomatous infectious disease caused
characteristics between the two forms (6).
by the obligate intracellular microorganism
mycobacterium leprae that tend to infect skin and
preponderance has been reported in various
peripheral nerves. Nerve damage seen across the
epidemiological studies (7).
spectrum is the main cause of deformities and
Traditional beliefs, the low status assigned
morbidity in this disease (1).
to women, and women's limited mobility, illiteracy,
HD is still considered a major health
and poor knowledge of leprosy have been suggested
problem in some countries of Asia, Latin America
as important sociocultural factors responsible for
and Africa including Egypt. According to World
underreporting of cases of women affected with
Health Organization (WHO), 228,474 new leprosy
leprosy (8). A significant number of female patients
cases was detected worldwide during 2010 as
with MB leprosy had irregular periods postdating the
reported by 130 countries (2).
onset of leprosy than patients with PB leprosy. Also
The Ridley-Jopling classification of leprosy
gonadotropic hormone levels were elevated in
is based on clinical and histopathological criteria ,
significantly more patients with MB leprosy than
which suggest a disease spectrum with five clinical
patients with PB leprosy, and that the mean levels of
categories : tuberculoid (TT), borderline tuberculoid
these hormones showed an increasing trend from
(BT), borderline borderline (BB), borderline
controls to patients with PB to patients with MB
lepromatous (BL) and lepromatous leprosy (LL)(3).
leprosy (9).
At one pole, TT leprosy is characterized by few

(paucibacillary; PB) and vigorous cell-mediated
Evaluation of fertility status among
immunity (CMI) (4). At the other pole ,LL present
multibacillary leprotic females.
with many skin lesion with uncontrolled

proliferation of leprosy bacilli (multibacillary ;MB),
an inefficient CMI (5). Borderline leprosy manifests
The current study is a case control study

which was carried on 30 leprotic females (as a

Full Paper (vol.7310 paper# 7)

10.11648.j.ajcem.20140204.15 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7672-7682

Vaginal Probiotic Administration in The Management of
Preterm Premature Rupture of Membranes
Farag A. Ibrahim , Mohammed K. Mostafa, Mohammed M. Farahat
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Preterm premature rupture of membranes (PROM) , refers to rupture of membranes before the
onset of labour in women with a pregnancy <37 weeks gestation. It complicates 1-3% of all pregnancies and is
responsible for approximately 30% of preterm deliveries.
Objective: This study aimed at examining the efficacy of a vaginal probiotic formula in combination with standard
antibiotic prophylaxis on perinatal outcome in cases of PPROM before 34 weeks of gestation and comparing them
with those treated only with antibiotics.
Methods: This is a prospective randomized controlled study conducted at the department of obstetrics &
gynecology and its out-patient clinic, El- Hussein University Hospital from august 1 st 2017 to august 1 st 2018 .
Results: During the study period, 73 pregnant women diagnosed as PPROM were invited to participate. Two of
them denied, while the remaining 71 women accepted participation in our study ( 2 women of the study group were
excluded due to poor compliance to the study protocol and 1 of each group was also excluded due to delivery in the
first 48 h after the study entry). In total 67 women were included in the study. In our study the cases diagnosed as
PPROM were divided into 2 groups: Group 1 ( study group ) consisted of 33 cases and group 2 (control group)
consisted of 34 cases . There was no statistical significant difference between the two groups as regard
mean gestational age at admission , age, height, weight ,parity and gravidy (p value > 0.05). There was
statistical significant difference between the two groups as regard history of PROM with higher cases in control
group , gestational age at delivery (weeks) with higher percentage in study group and latency period with highly
period in study group (p- value <0.05). Also, in the present study as regard neonatal outcome there were significant
statistical differences between the two groups as regard 1 and 5-minute APGAR score after birth with highest low
score in control group .
: This study demonstrated that the efficacy of a vaginal probiotic formula in combination with standard
antibiotic prophylaxis on perinatal outcome in cases of PPROM before 34 weeks of gestation as compared to those
treated only with antibiotics.
Keywords: Preterm premature rupture of membrane (PPROM) , Probiotics , Bacterial vaginosis.


number of cases with chorioamnionitis, in
Preterm premature rupture of membranes
comparison with those who had labor induction (4).
PROM, refers to rupture of membranes before the
The standard care of PPROM cases before 34
onset of labour in women with a pregnancy <37
weeks involves the administration of glucocorticoids
weeks gestation. It complicates 1-3% of all
and antibiotics (5).
pregnancies and is responsible for approximately
30% of preterm deliveries (1).
chorioamnionitis and improve the perinatal oucome
It may result in devastating maternal, fetal,
by prolonging the latency period (6).
and neonatal outcome. The risk of severe perinatal
Probiotics are live microorganisms that exert
complications such as, chorioamnionitis, cord
various beneficial effects on human health (7). Several
compression, abruptio placenta, neonatal sepsis,
reports in the literature indicated that they could
respiratory distress syndrome, intraventricular
protect against genital infections and restore the
bleeding, and even neonatal death is also increased
normal vaginal flora in women (8).
following PPROM (2).
The actual mechanism of action of Probiotics in the
The etiology of this complication is not
vagina is probably multifactorial.
completely understood. However, infections seem to
The production of lactic acid, bacteriocin, and
play a major role, as in 36% of cases , there are
hydrogen peroxide seems to be important, and
positive amniotic fluid cultures (3). Moreover ,
modulation of immunity is another possible
bacteria that are normally found in the vagina may
mechanism (9).
enter the amniotic cavity following amniorrhexis and
The administration of these lactobacilli by mouth or
can cause ascending infection.
intravaginally, or both, has been shown to be safe and
Among women with PPROM who were managed
effective in reducing, or treating, urogenital infections
expectantly, there were a significantly increased


Full Paper (vol.7310 paper# 8)


Evaluation of Role of Laparoscopy in Diagnosis and Treatment of
Non-Traumatic Acute Abdomen
Esam El-Deen Abdel-Azeim Zayed, Abdel-Hafez Abdel-Aziz Selim,
Ahmed Mohamed Abd El-Hai El-Bastaweisi *
General Surgery Department, Faculty of Medicine, Al-Azhar University
*Corresponding Author: Ahmed Mohamed Abd El-Hai El-Bastaweisi, Phone No.: (+2) 01150019559,
E-mail: hokasbokas33@gmail.com

abdominal pain is a common complaint seen in emergency departments in United States. Abdominal
pain is the leading reason for visits to the emergency department (ED), accounting for 6.8% of all visits in 2006.
Aim of the Work: this study aimed to evaluate the diagnostic role of laparoscopy in acute abdominal conditions
and its therapeutic role in perforated peptic ulcer, acute cholecystits and acute appendicitis.
Patients and Methods: this study was conducted prospectively on 40 patients presented with acute abdomen to Al-
Azhar University hospitals from March 2018 till August 2018. 24 (60%) of patients were females and 16 (40%)
were males. The age ranged from 20 to 60.Results: we accomplished complete laparoscopic diagnosis in 90% of
cases, and avoided negative laparotomy in 5% of cases. We converted about 10% of laparoscopically diagnosed
cases to open surgery for therapeutic purposes with significant reduction in complications in laparoscopic cases and
mean hospital stay 2.6 days in laparoscopic cases vs. 5.3 days in open cases. Conclusion: laparoscopy was an
excellent diagnostic tool. It was a very good therapeutic tool in acute appendicitis, acute cholecystitis and perforated
peptic ulcer. It was also safe and satisfactory; also it saved more hospital beds.
Keywords: laparoscopy in diagnosis, non-traumatic acute abdomen, therapeutic.


The acute abdomen may be defined generally
laparoscopy to guide the subsequent surgery. Most
as an intra abdominal process causing severe pain and
were in female patient of fertile age and documented
often requiring surgical intervention. It is a condition
significant reductions in the numbers of negative
that requires a fairly immediate judgment or decision as
appendicectomies and rate of unestablished diagnosis.
to management (1).Nonspecific acute abdominal pain
The diagnostic advantages in men and children are less
(NSAP) is defined as acute abdominal pain that lasts
clear due to the relative ease of diagnosis in these
less than 7 days and for which the diagnosis remains
subgroups (3).
uncertain after baseline examination and diagnostic
In perforated peptic ulcer, laparoscopic patient
tests (1).Different strategies to assess these patients have
did however experience less post-operative pain in the
been used, including observation, imaging methods,
medium to long term, which may account for the
and early laparoscopy (EL). In the presence of
shorter hospital stay and earlier return to normal
uncertainty, the watchful waiting option is also
activities. Mortality may also be marginally lower in
considered when the physician is able to balance the
those treated laparoscopically (4).
current expected benefits of immediate treatment
The DL procedure can be performed safely in
against the risks (2).
ICU patients. Few complications include bradycardia,
The rationale for use of diagnostic laparoscopy
increased peak airway pressures and perforation of a
(DL) in this setting is to prevent treatment delay, with
the subsequent potential for poorer patients outcome,
manipulation (5).
and to avoid unnecessary laparotomy, which is
Laparoscopy can be performed safely for the
associated with relatively high morbidity rates (5-22%)
majority of patient of acute abdomen. The reported
(1).Emergency laparoscopy can be used for the diagnosis
morbidity rate was 24% and the rate for mortality
and/or management of a wide variety of diseases
ranged from 0% to 4.6% (3).Generally, there are 3 major
including acute cholecystitis, perforated duodenal ulcer,
iatrogenic perforations of the colon, intestinal
laparoscopic procedure: vascular injuries, visceral
obstruction, the acute abdomen in surgical intensive
injuries and abdominal wall injuries including port -site
care patients, as well as certain suspicion of mesenteric
infection, hematoma and acute herniation at trocar site
ischemia and peritonitis of all origins (2).
(5).There is insufficient evidence to recommend routine
Early laparoscopic cholecystectomy in the
use of early laparoscopy as the gold standard in patients
course of acute cholecystitis decreases overall hospital
stay and avoids increased complications, conversion to
Conversely, there is no evidence of harm. Further large
open procedures and mortality (2). Among the many
clinical trials are required to determine the role of
laparoscopy in this clinical situation (6).
appendectomy and open appendectomy, only a few
The limited quality of the available literature on
studies have used the findings of a diagnostic
DL make generalizations difficult and allow

Full Paper (vol.7310 paper# 9)

c:\work\Jor\vol7310_10 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7692-7698

The Impact of Laparoscopic Ovarian Cystectomy on Ovarian Reserve in
Cases of Endometrioma
Hany M. Abd El-Aal, Ismaiel M. Mira, Ehab M. Samy
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo,
Corresponding author: Ehab M. Samy, Mobile: 01008812575, Email: ehabsamy895@gmail.com

An endometrioma is one of the most common manifestations of endometriosis.
Laparoscopic cystectomy is the preferred approach to managing bengin ovarian cysts in adolescents
and adults, but unfortunately it affects the ovarian reserve.
Aim of the work:
This study was aimed to evaluate the effects of laparoscopic cystectomy on ovarian
reserve in patients with endometriomas.
Patients and methods:
This prospective study was conducted on 44 cases suffering from ovarian
endometriomas and subjected to laparoscopic cystectomy. The patients in the study were selected from
the Outpatient Clinic in Sayed Galal University Hospital and EL-Gala Maternity Teaching Hospital.
This study was conducted between April 2017and March 2018. Serum anti-mullerian hormone (AMH),
FSH and E2, as well as the antral follicle count (AFC) were measured preoperatively and 3 months
Main outcome measures: Ovarian reserve based on the comparison of AMH alterations. The
secondary end points are changes in FSH, E2 and AFC.
There was a statistically significant reduction in postoperative median, values of AFC, serum,
AMH, serum E2 and serum E2: FSH ratio, and a statistically significant rise in postoperative median
serum FSH, when compared to preoperative measurements in included women.
Conclusion: The AMH level decreased and the FSH level increased after laparoscopic cystectomy for
endometriomas, especially in older patients and those with bilateral cysts.
Keywords: Laparoscopic cystectomy, endometrioma, ovarian reserve.

Endometriosis is an estrogen-dependent,
agonists, and aromatase inhibitors. As there are
chronic, inflammatory disease prevalent
no data supporting one treatment or treatment
worldwide in 10­30% of women of
combination over another, the treatment choice
reproductive age and beyond. Characterized by
is based upon symptom severity, patient
the growth of endometrium-like tissue in
preferences, medication side effects, treatment
aberrant locations outside of the uterus, it is
efficacy, contraceptive needs, costs, and
responsible for symptoms including chronic
availability (4). Endometriomas usually present
pelvic pain, inflammation, dysmenorrhea,
as a pelvic mass arising from growth of ectopic
dyspareunia, and subfertility that degrade
endometrial tissue within the ovary (2).Ovarian
quality of life of women significantly (1).
reserve refers to the functional potential of the
Endometriosis lesions in the pelvis can be
ovary, reflected as the number and quality of
categorized as superficial peritoneal, ovarian,
the remaining primordial follicles at any given
and deeply infiltrating. Similar to eutopic
time. There are various tests and markers of
endometrial tissue, endometriosis lesions
ovarian reserve, none of which has as yet been
contain endometrial glands and stroma.
shown to be ideal. Static tests include age, FSH,
(2).Patients with minimal to mild endometriosis
LH, E2, FSH:LH ratio, antimullerian hormone
are likely to have normal tubal-ovarian
(AMH), inhibin B, and sonographic variables
anatomical relationships and no endometriotic
such as ovarian volume, antral follicle count
cysts involving their ovaries. Follow-up
(AFC), and stromal blood flow. Dynamic tests
without active intervention is termed `expectant
include clomiphene citrate (CC) challenge test,
management'. However, some of these couples
exogenous FSH ovarian reserve test, and GnRH
will conceive without any treatment (3).Medical
agonist stimulation test(5)(6).Recently, AMH has
been suggested as the most reliable and
reproducible marker, because it is menstrual
Received: 11/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 10)

c:\work\Jor\vol7310_11 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7699-7706
Arthroscopic Management of Triangular Fibrocartilage Complex
(TFCC) Injuries
Mohamed Amer Mohamed(1), Abd El Hakim Abd Allah Massoud(1), Alberto Lazzerini(2),
Rashed Emam Rashed(1)
1) Department of Orthopedic Surgery, Facu

lty of Medicine, Al

- zhar University, Cairo,
and Surgery Unit, Humanitas Research Hospital, Milan, Italy.
Correspondence: Mohamed Amer.Mobile:01004805183, Email: mohamedamerortho@yahoo.com

Triangular fibrocartilage complex (TFCC) injury is major cause of ulnar side
wrist pain. It can lead to distal radio ulnar joint instability.
Aim of the work: was to examine the efficacy of arthroscopic management of the TFCC
injuries, and assess the functional outcome of this procedure.
Patients and Methods: Twenty patients with torn TFCC underwent arthroscopic management.
Five patients had central TFCC tears to which arthroscopic debridement was done. Five patients
had superficial peripheral TFCC tears to which arthroscopic reattachment to the capsule was
done. Ten patients had deep foveal TFCC tears with DRUJ instability to which arthroscopic
assisted foveal reattachment by suture anchor was done. All patients were assessed before and
after surgery (at follow-up) by Visual Analogue Scale (VAS) for pain, the Disability of the
Arm, Shoulder and Hand (DASH) score, the Modified Mayo Wrist Score (MMWS), and the
incidence of complications.
Results: Twenty patients were available for follow-up at a mean of 12.9 months.
VAS improved from a mean of 6 to a mean of 1.3 (p<0.001). The DASH score improved from
a mean of 28.2 to a mean of 5.8 (P < 0.001). MMWS improved from a mean of 66.3 to a mean
of 88.5 (p<0.001).
Conclusion: Arthroscopic management of TFCC tears has shown to reach good results
according with different TFCC lesions and improvement in pain and function. However, the
current study is limited by absence of conservative or open control group for comparison and
the relatively short follow-up period.
Key words: Ulnar sided wrist pain, TFCC lesions, Arthroscopy of the wrist.


Palmar classified the TFCC lesions
fibrocartilage complex (TFCC) describes
to traumatic (type 1) and degenerative (type
the close anatomic and functional
2). Type 1 is further classified according to
relationships of the soft-tissue structures in
the tear location to 1A: central tear, 1B:
the ulnar side of the wrist (1).
Periphral ulnar tear, 1C: ulnocarpal
ligament tear, and 1D: radial side tear (1, 4, 5).
complex (TFCC) consists of six parts. The
Overlap can occur so both traumatic and
fibrocartilage articular disc; The dorsal and
degenerative tears can be seen during
palmar radioulnar ligaments: These
arthroscopy in the same wrist (6). Type 1B
ligaments tighten up during prono-
has been further sub classified by Atzei et
supination to prevent instability at the
al (7) to five classes: Atzei 1:distal
extremes of motion; The ulnolunate and
component tear, Atzei 2:proximal and
ulnotriquetral ligaments, the extensor carpi
distal components tear, Atzei 3: proximal
ulnaris (ECU) tendon subsheath, the ulnar
component tear, Atzei 4:Poor healing
collateral ligament and the meniscus
capacity, and Atzei 5:DRUJ arthritis .
homologue (2,3).
Patients with a TFCC injury
This complex allows smooth motion of
usually experience ulnar side wrist pain or
the wrist and forearm, distributes load
discomfort particularly during powerful
between the ulna and ulnar carpus, and
rotatory hand movement, like opening a
stabilizes the ulnocarpal joint as well as the
closed jar or pushing down a doorknob (4,8).
distal radioulnar joint (DRUJ) (2).
compression stress test and DRUJ stability
Received: 11/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 11)

Full Paper (vol.7310 paper# 12)

c:\work\Jor\vol7310_13 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7713-7719

Evaluation of Esophageal Varices Band Ligation Effects on Rectal Varices
and Hemorrhoids Development and Grading in Post-HCV Cirrhosis

Elsayed Gaber Ammar*, Gamal Mohammad Soliman*,
Islam Abdel-Mawla Ammar*, Mohammad Farag Abdel-Mageed Elbasyony*

*Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Corresponding author: Mohammad Farag Abdel-MageedElbasyony,
Background: Rectal varices and hemorrhoids are a gastrointestinal complication of portal
hypertension. There is a large discrepancy in previous studies regarding prevalence of rectal varices
and hemorrhoids and their correlation with other factors. Aim of the work: goal of our study was
evaluation of the effect of band ligation of oesophageal varices (OVs) on the evolution and/or
progression of rectal varices and haemorrhoids. Patients and Methods: This study conducted on 50 post-
HCV cirrhotic patients screened for esophageal varices. They were divided into two main groups; Group I:
It included 25 post-HCV cirrhotic patients, screened for OVs, band ligation was indicated in them, and they
were banded for OVs. Group II: It included 25 post-HCV cirrhotic patients, screened for OVs, and band
ligation was not indicated in them. All of them were submitted to oesophagogastrodudenoscopy (OGD) for
assessment of OVs and short colonoscopy for assessment of rectal varices & haemorrhoids at the baseline
and after 6 months. Results: Obliteration of esophageal varices by endoscopic variceal band ligation did
not affect the incidence of hemorrhoids (38% before and after) and anorectal varices (12% before and
after). Conclusion: It is concluded that esophageal variceal band ligation does not affect the incidence
of hemorrhoids, or anorectal va1rices inpatients with liver cirrhosis.
Liver cirrhosis, Portal hypertension, Oesophageal varices and Rectal varices.
Cirrhosis is a chronic condition with a high
per year in patients with cirrhosis, and the
mortality. It constitutes the fifth-leading cause
progression from small to large varices occur in
of adult deaths and ranks eighth in economic
10% to 20% of cases after 1 year. In the 2 years
cost among the major illnesses (1). Cirrhosis is
following the first detection of oesophageal
defined anatomically as a diffuse process with
varices, the risk of variceal bleeding ranges
fibrosis and nodule formation. It is the end
between 20% to 30% and results in 25% to 50%
result of the fibrogenesis that occurs with
mortality within a week of the first bleeding
chronic liver injury. Although the causes are
episode(4).The current recommendations are
many, without successful treatment or removal
that all cirrhotic patients at the time of diagnosis
of the agent responsible, the end result of
should be screened with upper endoscopy to
fibrogenesis is the same (2). Portal hypertension
look for gastroesophageal varices and to
(PH) -defined as the elevation of hepatic venous
eradicate them endoscopically by rubber band
pressure gradient (HVPG) above 5mmHg- is
ligation or injection sclerotherapy. Follow-up
the initial and main consequence of cirrhosis
endoscopy should be performed at 2-3 years
and is responsible for the majority of its
intervals in compensated patients with no
complications including variceal bleeding,
varices, and at 1-2 years intervals in
spontaneous bacterial peritonitis (SBP) and
compensated patients with small varices (5). The
hepatorenal syndrome (HRS), which represent
prevalence of colonic varices and rectal varices
the leading causes of death and of liver
has been found to be 34-46%, and 10-20%,
transplantation in patients with cirrhosis (3).
respectively, in patients with cirrhosis
Esophageal varices is related to portal
undergoing colonoscopy (6). Rectal varices are
hypertension which commonly accompanies
described and differentiated from hemorrhoids,
the presence of liver cirrhosis, with a
as rectal varices extend more than 4 cm above
prevalence that can range from 40 to 80% in
the anal verge, are dark blue in color, collapse
patients with cirrhosis (4). The yearly rate of
with digital pressure, and do not prolapse into
development of ``new" varices is about 5­10%
the proctoscope on examination, whereas
Received:11/9/2018 Accepted:30/9/2018

Full Paper (vol.7310 paper# 13)

c:\work\Jor\vol7310_14 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7720-7725

Tamoxifen versus Tamoxifen and Ovarian Suppression in Premenopausal
Hormone Positive early Breast Cancer (Retrospective study)
Ahmed Yosry El-Agamawi, Wael Helmy El-Shishtawy,
Ashraf Ibrahim Basiony Ali Al-Sharif*
Clinical Oncology and Nuclear Medicine Department,
Faculty of Medicine, Al-Azhar University
* Corresponding author: Ashraf Ibrahim Basiony Ali Al-Sharif, E-mail: Dr.Ashraf.Alsharif@gmail.com

breast cancer is the most frequently diagnosed cancer globally and is the leading cause of
cancer-related death in women. The American Cancer Society estimated that 249, 260 Americans were
diagnosed with invasive breast cancer and 40, 890 were died of the disease in the United States in 2016.Aim
of the Work:
this was a retrospective study aimed to evaluate the disease free survival, overall survival
and toxicity profile in premenopausal breast cancer patient who received tamoxifen versus tamoxifen with
ovarian suppression (LHRH) agonists as adjuvant hormonal treatment.Patients and Methods: this was
a retrospective cohort study. Premenopausal Female patients with Breast Cancer, who received Tamoxifen
with or without Ovarian Function Suppression (LHRH agonist for 2 years) as adjuvant hormonal treatment,
presented to clinical Oncology Department, Al-Hussein University Hospital in the period between January
2008 and January 2015 in Breast Cancer Unit, Clinical Oncology Department, Al-Hussein University
Hospital. Results: in our retrospective analysis there was no statistical significant difference in the primary
endpoint of DFS between group I who received tamoxifen and group II receiving tamoxifen plus ovarian
suppression (2-year DFS, 65.3% vs. 75.0%) with (P value=0.838 not significant).Conclusion: we
concluded that adding ovarian suppression to tamoxifen did not provide a significant benefit in the overall
population of premenopausal women in this study (P=0.15 not significant).
Keywords: tamoxifen, ovarian suppression, premenopausal hormone, breast cancer


Breast cancer is the most frequently
positive breast cancer during the past 15 years
diagnosed cancer globally and is the leading
(4).The American Society of Clinical Oncology
cause of cancer-related death in women. The
endorsed guidelines recommending that ovarian
American Cancer Society estimates that 249, 260
ablation or suppression not be added routinely to
Americans were diagnosed with invasive breast
adjuvant therapy in premenopausal women
cancer and 40, 890 were died of the disease in the
(5).International consensus guidelines for breast
United States in 2016 (1).Treatment of breast
cancer management in young women suggested
cancer included treatment of local disease with
that the addition of a gonadotropin-releasing
surgery, radiation therapy or both and systemic
hormone (GnRH) agonist to tamoxifen be
treatment with chemotherapy, endocrine therapy,
discussed on an individualized basis (6).
biologic therapy, or combinations of these. The
AIM of the WORK
need for and selection of various local or systemic
This retrospective study aimed to
therapies were based on several prognostic and
evaluate the disease free survival, overall survival
predictive factors. These factors included tumor
and toxicity profile in premenopausal breast
histology, clinical and pathologic characteristics
cancer patient receiving tamoxifen versus
of the primary tumor, ALN status, tumor
tamoxifen with ovarian suppression (LHRH)
hormone receptor (ERlPR) content, tumor HER2
agonists as adjuvant hormonal treatment.
status (2).Adjuvant endocrine therapy is an
integral component of care for endocrine-
Type of study:
dependent breast cancer (EDBC). The goal of this
A retrospective cohort study
type of therapy is to counteract the production
Study population:
and the action of estrogens (3).Adjuvant endocrine
Premenopausal female patients with
therapy with tamoxifen had been recommended
breast cancer, who received tamoxifen with or
for premenopausal women with hormone receptor
without ovarian function suppression (LHRH
Received: 08/9/2018
Accepted: 27/9/2018

Full Paper (vol.7310 paper# 14)

c:\work\Jor\vol7310_15 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7726-7729
Massive Transfusion Complications Following Cutaneous Hemangioma

Rafeef Alhajress1, Bader Muaykil AlQahtani2, Dhabiah AlQahtani3, Jaber Alenazi4

1- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 2- King Abdullah
Specialized Children's Hospital, National Guard Health Affairs, Riyadh, 3- King Saud Bin
Abdulaziz University For Health Sciences, Riyadh, 4- King Abdullah Bin Abdulaziz University

Aim of the work:
Describe the clinical events of a patient experiencing MT complications
following cutaneous hemangioma resection since there is still no clear evidence on how to approach
pediatric transfusion as the existing literature is lacking.
Patient information was obtained from medical records after taking permission.
Personal information that has been collected shall not be disclosed prior to consent. Patient's
clinical course was mentioned in a chronological order with literature review to show significance
of such cases in medical practice.
A seven-month-old male who was found to have cutaneous hemangioma that required
resection. Along to the clinical course, experienced several complications secondary to a massive
Massive transfusion management in patients with non-traumatic-related hemorrhage,
or surgery-related hemorrhage, is crucial for survival and better outcomes.
transfusion, pediatric, hemangioma.


The transfusion of blood and blood
hours after transfusion. In fact, some cases
products is commonly used in a variety of
experience delayed complications that may
clinical situations in an attempt to restore
take days or even years to develop [3]. Acute
normal blood hemostasis and ensure
complications can include fever, allergic
reactions, anaphylaxis, acute hemolysis,
transfusion (MT) involves the rapid
administration of balanced ratios of packed
red blood cells (RBCs), fresh frozen plasma
transfusion-related acute lung injury.
(FFP) and Platelets (PLT) in significant
Delayed complications that are related to
volumes within a short time period; this
transfusion can include iron overload, post-
practice is used to resuscitate critical patients
transfusion purpura, transfusion-associated
and the methods involved are referred to as
graft-versus-host disease and transfusion-
MT protocols (MTPs) [1,2].While ,many
related immunomodulation [3,4].The first case
definitions of MT have been established for
of pediatric MT to be reported in the literature
the adult population, these are not, however,
involved a male neonate diagnosed with Rh
applicable for pediatric patients. The optimal
hemolytic disease of the newborn (HDN).
approach to manage pediatric transfusion has
This case was managed with 400 ml of blood
not been adequately explored in the existing
in less than 24 hours and had an uneventful
literature, leading to the practice of pediatric
recovery thereafter [5].
transfusion becoming reliant upon expert

opinion and local institutional resources [1].In
Aim of the work: In the present case
general, the transfusion of blood and blood
report we described the clinical events of a
products has been associated with acute
patient experiencing MT complications
following cutaneous hemangioma resection.
immediately, within minutes or up to 24
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 15)

c:\work\Jor\vol7310_16 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7730-7736

Impact of Body Mass Index on Implantation Rate in ICSI Cycles
Osama Alsaied Ali, Bassem Ragab Abdel-Aziz,
Abdallah Mohammed Ahmed Alsenbawy
Obstetrics and Gynecology Department, Faculty of Medicine, Al Azhar University
* Corresponding author: Abdallah Mohammed Ahmed Alsenbawy, E-mail: Mido158015@gmail.com
obesity and overweight are recognized as a growing global health problem Worldwide,
prevalence of overweight or obesity, defined as an adult body mass index (BMI) of 25kgm² or greater.
Patterns of overweight and obesity differ between countries, regions and by country income, with
overweight or obesity more prevalent among men in developed countries and among women in
developing countries. Aim of the Work: this study aimed to evaluate the impact of female increased
body mass index (BMI) on implantation rate and clinical pregnancy in women undergoing ICSI cycle.
Patients and Methods: this is a retrospective study conducted on a total of 400 cycles of assisted
reproduction treatment has been evaluated from Orabi IVF Centre and Mit_Ghamr IVF Centre. Data
recruited from patient files from January 2016 to July 2018 who did ICSI trial during this period.
Patients who included in our study were sub divided into 2 groups according to BMI: 1st group: normal
weight with BMI between 18 and 24.9 kg/m2. (200 case), 2nd group: overweight and obese women
25 kg/m2 (200 case).Results: we showed that overweight and obese infertile women had a higher basal
serum FSH, LH and estradiol levels than normal weight women. In our study group the duration of
infertility was progressively higher as BMI increased. The two groups were comparable regarding
female age were not statistically different in both groups. The duration of infertility showed no
significant difference between the two groups. As in group (1) it range from 10-17 years with median
duration of 6 years, while in group (2) it range from 0.5-23 with median duration of 5 years this result
a significant difference with p value (0.057).Conclusion: female overweight and obesity appeared to
have deleterious effects on ovarian response to stimulation in women undergoing IVF and implantation
rate. Moreover, female obesity compromised IVF outcome.
Body Mass Index, ICSI Cycles
Obesity and overweight are recognized
BMI of an individual in the range of 20 and 24.9
as a growing global health problem Worldwide,
is considered normal whilst between 25 and
prevalence of overweight or obesity, defined as
29.9 was referred to as overweight. However,
an adult body mass index (BMI) of 25kgm²
in obese individuals the BMI was greater or
or greater, increased by 27.5% between 1980
equal to 30. Despite the fact that BMI was
and 2013. The proportion of overweight among
certainly not flawless in providing an accurate
adult women globally increased from 29.8% in
body fat measurement, it has been used and
1980 to 38.0% in 2013, notably in developing
proposed as a single indicator of body fat not
countries. Patterns of overweight and obesity
only in adults but also in children. However,
differ between countries, regions and by
BMI measurement does not provide the correct
country income, with overweight or obesity
estimate of body fat in certain cases such as
more prevalent among men in developed
body builders, high performance athletes and
countries and among women in developing
pregnant women. Nevertheless, it still serves as
countries (1).Measuring the amount of body fat
a signal of obesity for clinical and screening
was crucial in understanding the health of the
purposes and maintaining a healthy lifestyle.
individual along with the disease risk the
Hence, the precise measurement of weight and
individual is subjected to. One predictive
height must be performed prudently (2).Obesity
method being used extensively in measuring the
has a significant negative effect on Intra
body fat in large population was Body Mass
Cytoplasmic Sperm Injection (ICSI) outcomes.
Index (BMI), a noninvasive and easy to
Patients with BMI >30 have up to 68% lower
accomplish method providing a good
odds of having a live birth following their first
correlation with percentage body fat and level
ART cycle compared with women with BMI
of risk. Measurement of body fat using weight
<30 kg/m² (3).Concerning ovarian stimulation,
relative to height, determines the BMI in kg/m².
some authors had shown increased duration of
Received: 09/9/2018
Accepted: 28/9/2018

Full Paper (vol.7310 paper# 16)

c:\work\Jor\vol7310_17 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7737-7745

Minimally Invasive Strabismus Surgery for Horizontal Concomitant
Adel Abdel-Rahman Osman, Abdallah Hussein Hamed, Abdel-Mongy El-Sayed Ali, Abdel-Ghany
Ali Elgabbar*
Department of Ophthalmology, Faculty of Medicine ­ Al-Azhar University
*Corresponding author: Abdel-Ghany Ali Elgabbar, Mobile: 01006308790, E-Mail: abdelghanyali2008@gmail.com

strabismus is a condition in which the eyes are not properly aligned with each other. It
typically involves a lack of coordination between the extraocular muscles. Strabismus can present as
manifest (heterotropia), apparent, latent (heterophoria) varieties.
Objective: the present study aimed to compare the minimally invasive strabismus surgery (MISS) as
an alternative to limbal approach for horizontal concomitant strabismus.
Patients and Methods: the study included 50 patients of different ages and sexes, presented with
transverse strabismus, for elective surgical correction. They allocated into two equal groups; the first
group included 25 cases who were managed by MISS (patients group); the second group included the
other 25 cases who were managed by limbal approach (control group).
Results: the results were evaluated at one week, three week and six week as regards to visibility of
surgical wound, post-operative conjuntival redness, patient discomfort, surgical opening related
complications and post-operative correction at first week, third and six months. Few complications were
seen with the MISS technique and they were mostly related to the surgery not to the technique itself.
the minimally invasive strabismus surgery has the same effect as limbal approach as
obvious by the similar success rate. Its stability is as good as the stability of limbal incision. It has the
advantages of sparing perilimbal episcleral vessles which make it a good choice instead of limbal
approach whenever there is fear of anterior segment ischemia.
Extraocular muscle, Minimally invasive strabismus surgery, Exotropia.


Minimally invasive surgery has been one
reduce the risk for an anterior segment ischemia
of the most important revolutions in surgical
techniques since the early 1900s (1).
A nice alternative to a limbal opening,
In ophthalmology, many minimally
which can be used in patients with elastic
invasive procedures have been developed over
conjunctiva as in children, is Park's fornix
opening (7).
phacoemulsification for cataracts and 23-gague
Another alternative for rectus muscle
sutureless vitrectomy (2).
exposure, which further reduces anatomical
For rectus muscles, the majority of
disruption and can be used also in patients with
strabismus surgeons use Harms' limbal
inelastic conjunctiva, uses two keyhole
approach, which has been popularized by von
openings placed near to the muscle insertion (8).
Noorden (3). This is a limbal opening over a
Gobin (9) in 1994 was the first to
quadrant, allowing full visualization of the
describe the principle of access for rectus
operated muscle. Parks (4) in 1986 introduced and
muscles through two small radial openings one
popularized a fornix-based conjunctival incision
along the superior and the other along the
for rectus muscle access, which remains covered
inferior muscle margin .
by the lids after sugery.
A new access for horizontal rectus
In recuts muscle strabismus surgery,
muscle recession and plication has been used.
several varieties to reduce the conjunctival
Muscle exposure was performed through only
incision size have been published after Harms
two small radial cuts, one along the superior
published his widely used limbal approach (5).
and the other along the inferior margin of the
horizontal muscles, allowing to perform
especially if placed away from the limbus, will
minimally invasive strabismus surgery (MISS),
induce less tissue disruption and less
as the opening and tissue dissection are
postoperative discomfort. Probably, they also
minimized (10).
Received: 14/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 17)

Full Paper (vol.7310 paper# 18)

c:\work\Jor\vol7310_19 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7754-7760

Study of potential nephroprotective effects of Ramipril versus Alpha lipoic
acid against Gentamicin induced nephropathy in rats
*Mohamed Y.A. Darwish, **Abd El-Lateef S. Abd El-Lateef
*Pharmacology Department, Faculty of Dentistry, Sinai University, North Sinai, ** Pharmacology
Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mohamed Y.A. Darwish, Phone number: 01553910887, E-mail address:

: development of aminoglycosides antibiotics assisted in the cure of infective diseases,
Gentamicin (GM) is a well known example that has a wide antibacterial domain.This clinical effect is
restricted by the occurrence of kidney functions impairment . Aim of the work: we performed this
study to examine possible protective effects of Ramipril, Alpha lipoic acid (ALA) and their
combinations on kidney functions impairment caused by GM in rats. Materials and Methods: fifty
male albino rats were categorized into five groups of ten rats. The first group served as control, the
second group received GM, the third group received Ramipril and GM, the fourth group received ALA
and GM, the fifth group received Ramipril, ALA and GM. Serum biochemical parameters and kidney
homogenate oxidative stress parameters were utilized for evaluation of the nephrotoxicity. Results:
pretreating rats with Ramipril or ALA or their combination attenuated GM induced nephrotoxicity.
Conclusions: administration of Ramipril alone, ALA alone, or their combination possessed various
degrees of nephroprotection against Gentamicin induced nephrotoxicity in rats.
Key words: gentamicin nephrotoxicity, alpha lipoic acid, Ramipril-kidney functions, oxidative stress.

Usage of aminoglycosides antibiotics
(RNS) species and protect cells against a host
especially GM is basically hindered due to their
of insults where oxidative stress is part of the
nephrotoxicity [1]. GM induced nephropathy has
underlying etiolLipoic acid, and dihydrolipoic
been investigated in many experimental
acid are ROS scavengers; they could guard
animals as in rabbits, mice and rats [2]. Many
renal cells against variable insults where
approaches as drugs and herbals have been
oxidative stress is part of disease pathogenesis
utilized to diminish or reverse renal GM
[9] .
toxicity [3].This would be helpful to augment the
A significant number of studies now show that
safety of the drug and provided that the
LAand its reduced form, dihydrolipoic acid
pharmaceutical manufacturers are not financing
(DHLA), directly scavenge reactive oxygen
sufficiently the development of new antibiotics,
species (ROS) and reactive nitrogen species
with the increasingly arise of resistant strains of
(RNS) species and protect cells against a host
microbes, reuse of old antibiotics might be a
of insults where oxidative stress is part of the
feasible choice [4] .This particular effect of GM
underlying etiology
is attributed to its exceptional aggregation in the
proximal convoluted tubules of the kidney 50 to
oxidative injury in the kidney and is correlated
100 times more than serum [5] .One of the
with a significant improvement of renal
principal elements that intermediates GM-
function [10].
induced renal impairment is Reactive Oxygen
Gentamicin alters D-glucose movement
Species (ROS) [6]. ROS produce cellular
through the renal brush border membrane thus
injuries and tissue death via several
confounding energy system of the cells. Alpha
membrane lipids; protein denaturation and
transporting and increases glycolytic enzymes
Deoxyribonucleic acid (DNA) damage [7]. The
[11].Another mechanism that leads to GM
scavengers of ROS safeguard the kidney
nephrotoxicity is the reduction of glomerular
against GM induced nephropathy [8].
filtration rate resulting from aggregation of
A significant number of studies now show that
aminoglycosides in the proximal tubular cells
LA and its reduced form, dihydrolipoic acid
leading to inadequacy of renal concentrating
(DHLA), directly scavenge reactive oxygen
power. The utilization of angiotensin
species (ROS) and reactive nitrogen species
Received: 14/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 19)

c:\work\Jor\vol7310_20 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7761-7767
Tricusped Annular Plane Systolic Excursion in Children with ASD
Ramy Abdelfatah Fetouh*, Hassan Saad Abu Saif*, Ayda Kafafy Abdelghafar*
Mohamad Ibrahem Al-Deftar**
*Pediatric Department and **Cardiology Departement, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Ramy Abdelfatah; Mobile: 01114576155; Email: dr_ramyabdelfatah@yahoo.com>

Background: the complexity of estimating RV geometry and function was well documented and Tricusped
Annular Plane Systolic Excursion (TAPSE) is one of the assessment tools of right ventricle in adults. Aim Of
the work:
this study aimed to evaluate right ventricular (RV) function in children with atrial septal defect (ASD)
and to determine whether TAPSE is an accurate marker of right ventricular (RV) systolic function in patients
with atrial septal defect (ASD).
Patients and methods: this retrospective study was conducted on 30 Egyptian children with age ranged from 2
months to 18 years of both sexes and they were categorized into two groups, 20 patients group with ASD and 10
control group; they were referred to Cardiology Unit of Al-Azhar University Hospitals in the period from
December 2016 to December 2018. The ethics committee of Faculty of Medicine, Al-Azhar University approved
this study after verbal and written consents from the parents of these children. All children were subjected to the
clinical history, general examination, local examination, chest radiograph, electrocardiogram (ECG) and trans-
thorathic echocardiography examination. Results: there was statistical significant difference in TAPSE results
between ASD and non-ASD children, statistical significant difference in ECG finding between ASD and non-
ASD children, there was a statistical significant positive correlation between TAPSE and right ventricular
fractional area changes (RVFAC) in the control group and a statistical significant negative correlation between
TAPSE and left ventricle ejection fraction (LVEF). Conclusion: TAPSE is a good indicator for the right
ventricular function in children with ASD and a good predictor for development of complications.
Key words: Tricusped Annular Plane Systolic Excursion, atrial septal defects, right ventricular function.

AIM of the WORK:
The complexity of estimating RV geometry
The purposes of this study were to evaluate right
and function was well documented. The main
ventricular (RV) function in patients with atrial septal
problems were: complex, three-dimensional RV shape
defect (ASD) and to determine whether TAPSE is an
impossible to describe the known geometric figures,
accurate marker of right ventricular (RV) systolic
specific myocardial fibres orientation (different from
function in patients with atrial septal defect (ASD).
LV) and their various participation in RV contraction.
Both interventricular septum and RV free wall
This retrospective study was performed on 30
contribute approximately equally to the right
Egyptian children with age ranged from 2 months to
ventricular function (1). Tricuspid Annular Plane
18 years of both sexes; they were referred to
Systolic Excursion (TAPSE) and Tricuspid Annular
Cardiology Unit of Al-Azhar University Hospitals and
Peak Systolic Velocity (TAPSV) are from the recently
found to be normal by clinical examination and by
published indices for assessment of right ventricular
investigations in the period from December 2016 to
function (2).
December 2018.
The TAPSE is an indicator of ventricular contractile
The ethics committee of faculty of medicine Al-Azhar
function that correlates well with RVEF in adults and
University approved this study.
can also be used as a reference of systolic RV function
The children in this study were classified according to
in pediatrics (3).
the ASD to two groups:
Atrial Septal Defect (ASD) is one of the more
Group 1 patients with ASD.
common congenital cardiac anomalies presenting in
Group 2 healthy children as the control group
childhood. Atrial septal defect is characterized by a
- Inclusion criteria:
defect in the inter-atrial septum allowing left to right
The criteria for inclusion in this study were clinical
shunt. Depending on the size of the defect, size of the
and/or echocardiographic evidence of a significant
shunt and associated anomalies, this can result in a
left-to-right shunt through a ASD.
spectrum of disease affecting the right ventricular
- Exclusion criteria:
function ranging from no significant cardiac sequelae
1- Weight less than 5 kg.
to right ventricular dysfunction, pulmonary arterial
2- Other significant congenital cardiac anomalies.
hypertension, and even atrial arrhythmias (4).
Received: 15/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 20)

c:\work\Jor\vol7310_21 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7768-7777

Public Knowledge, Attitude, Practice, Antibiotics, Riyadh,KSA
Aman Swied*, Shatha Mahmoud Sharaf, Adalah Basel Al-Qalawah, Raghad Jamil Al-Haniny,
Douaa Maher Al-Dabee, Duaa Hassan Madoun, Hasna Sulaiman Al-Kahmous, Maymuna
Suleman Abdu, Raghdaa Moussa Al-Basha, Shahad Hussein Abu-Sheikha
College Of Medicine, Al-Maarefa Colleges for Science & Technology, Riyadh, Saudi Arabia
*Corresponding author: Aman Swied, Email: aman-swied@hotmail.com, Mobile number:


Background: Antibiotics are important drugs used against bacterial infections. Unfortunately,
overusing them resulted in the development of resistant bacteria. There are limited data concerning
antibiotic use so we worked on this study to provide more updated data.
Objective: The aim of this study was to assess public knowledge, attitude and practice regarding
antibiotics use and related factors in Riyadh ­ KSA.
Method: It was a cross-sectional online and manual survey involving 474 respondents and was
conducted in Riyadh, KSA in February 2016. The collected data were analyzed using SPSS version 20.
Results: Most of the respondents (86.5%) had used antibiotics for others (friends and family). Only 7%
of respondents had good knowledge and about 50% of them had negative attitudes. Respondents'
educational level was a predictor of negative attitude as those with a low level of education (below
secondary) 66.7% were more likely to show negative attitude compared to those with high educational
level (university and above; 40%). Poor level of knowledge was a predictor of negative attitude; as 65%
of respondents with poor knowledge showed negative attitude compared to only 24.2%;those with a
good level of knowledge.
Conclusion: This study concluded that females and married participants showed better practice toward
antibiotics use. Higher education level was strongly associated with better knowledge, attitude and
practice and was not associated with the increased risk of self-medication. Respondents with high
income and those with better knowledge exhibited better practice.
Public Knowledge, Attitude, Practice, Antibiotics, Riyadh, KSA.


Antibiotics are important drugs for the
between 14-43% of all courses of antibiotics
treatment of bacterial infections in both humans
were deemed unnecessary because there was no
and animals. They are effective drugs if used
evidence of infection (2). Furthermore, many
appropriately. It is important to use them in the
other people take wrong doses of antibiotics
right way, in the right dose and at the right time
which has contributed largely to the elimination
for the right duration, unfortunately, they are
of beneficial intestinal normal flora and most
losing their effectiveness at an increasing rate,
importantly to the emergence of new resistant
mainly due to the resistance that is developing
strains that can cause longer and more serious
against them which is driven by inappropriate
infections, prolonged recovery and more-
and excessive use. Resistance occurs when an
expensive treatments (3,4).
antibiotic loses its ability to effectively kill
Food and Drug Administration (FDA)
bacteria or control its growth; in other words,
data reported that the overuse of antibiotics is
the bacteria continue to multiply in the presence
the biggest cause of antibiotic-resistant
of therapeutic levels of the drug.
organisms(5) .Each year in the United States, at
least 2 million people become infected with
organizations and experts working in the field
these organisms and at least 23,000 people die
of infectious diseases have increased their
annually as a direct result of these infections.
efforts to control and limit the misuse and over-
As an example, the death rate for patients with
prescription of antibiotics when it is not
serious infections caused by common bacteria
required aiming to avoid the development of
treated in hospitals can be about twice that of
new resistance and to prevent the resistance that
patients with infections caused by the same
already exists from spreading (1).
non-resistant bacteria (6) .
Several studies demonstrated that
A cross-sectional survey was processed
antibiotics were often used inappropriately and
on a sample of 1,005 adults on 23 February
Received: 17/8/2018
Accepted: 27/8/2018

Full Paper (vol.7310 paper# 21)

c:\work\Jor\vol7310_22 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7778-7784

Prevalence of Stress among Female Medical Students at AL-Maarefa

Asil MHD Khalid Alhomsi, Abrar Ahmed Aldeera, Amjad Omar Alhussaini, Doaa Ali Al-
Laili, Fatima Saleh Ali, Hind Mustafa Mona, Kawthar Ali Almarhoon, Ola Abdullah
Khalaf, Shahd Abdullah Abdulwahab, Yossra Alaaddine Benhadi, Zainab Ali Alabbas*
College Of Medicine, Al-Maarefa Colleges for Science & Technology, Riyadh, Saudi Arabia
*Corresponding author: Zainab Ali Alabbas, Email: ehsas-z-@hotmail.com, Mobile number: +966565151929

Stress is a state of mental tension and worry. A study was conducted in Al Maarefa
Colleges, College of Medicine in a sample of 130 female medical students to assess the prevalence
of stress.
This study aimed at determining the prevalence and levels of stress in female medical
students. Association of stress with some factors was determined.
This was an observational, descriptive, cross-sectional study in which a sample of
randomly collected female medical students between 3rd and 8th level completed a self-
administrated questionnaire. SPPS was used to analyze data and Chi-square test to investigate the
association of the proposed variables.
students in level 7-8, 78% who were single, 82% of students who studied 2-4 hours/day,
77% of students who chosed their specialty based on their own desire, and 79% of students who
had a relationship with their family had low stress. There was a significant association between the
adaptation to frequent exams and the levels of stress. (p=0.048). Otherwise, there was no statistical
association between any of the other factors such as hours/day spent on studying, the method of
tuition payment or choice of specialty and stress.
Conclusion: It was found that the majority of the students had low levels of stress. The highest
proportion of low stress was in those who were in level 7-8 and those who were not adapted to
frequent examination. It was found that those who had good relations with their family, teachers
and colleagues had a low level of stress.
Keywords: Prevalence, Stress, Female, Medical Student.

It has been hypothesized that
many other problems. It can result in feelings
exposure to stress and negative life events is
of rejection, anger, and depression, leading to
related to poor health outcomes, and that
health problems such as headaches, upset
differential exposure to stress plays a role in
stomach rashes, insomnia, ulcers, high blood
socioeconomic disparities in health (1). One of
pressure, heart disease, and stroke (3). Medical
the major obstacles concerning stress is that
students are expected to learn and master a
the term "stress" is used by the public as an
huge amount of knowledge and skills. Stress
umbrella to describe anything including the
has serious consequences, which may lead to
usual blues that people all suffer from time to
the development of depression and anxiety.
time. It is partly due to this lack of knowledge
Studies on psychological problems such as
that many cases of stress go undiagnosed and
stress, depression and anxiety among medical
untreated. Medical students are faced with
students have found that these disorders are
demanding academic standards, deadlines,
under-diagnosed and undertreated. Failure to
career aspirations, and the need to compete
detect these disorders, unfortunately, leads to
for residency positions (2). Stress can lead to
increased psychological morbidity with
Received: 18/8/2018
Accepted: 28/8/2018

Full Paper (vol.7310 paper# 22)

c:\work\Jor\vol7310_23 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7785-7793

Role of Platelet-Rich Plasma injection during Modified Radical

Mahmoud Ibrahim, Abdel Fattah El Sheik, Abdelgaber Rabea
Department of General Surgery, Faculty of medicine, Al-Azhar University, Cairo, Egypt

*Corresponding author: Abdelgaber Rabea, E-mail: mostafa2712015@yahoo.com, Mobile No. : 01013223434
platelet-rich plasma (PRP) is a human plasma product enriched by platelets,
growth factors, and fibrinogen with high hemostatic and healing properties.
Objectives: The aim of this study was to evaluate the effect of autologous PRP on wound
healing in women undergoing modified radical mastectomy (MRM).
Patients and Methods: In this randomized and controlled trial, 100 females were admitted to
El Sayed Galal hospital, Egypt from October of 2017 to August of 2018 for MRM. The patients
were randomly assigned into two groups. The intervention group received PRP after surgery,
whereas the control group received the usual care. All patients were evaluated at baseline, five
days, and 2 weeks after surgery. The primary endpoint used the REEDA scale for assessing the
changes in wound healing. The secondary outcome measures used were the Vancouver scar
scale (VSS). All scale scores were analyzed using a repeated measures test for variance.
Results: At the end of study, the PRP group showed a greater reduction in the edema
ecchymosed discharge approximation (REEDA) score compared to the control group (85.5%
reduction in the PRP group; 72% in the control group) (P < 0.001). Furthermore, patients treated
with PRP experienced a 93% reduction in the VAS score at the end of follow-up, but the control
group only observed a 79% reduction (P < 0.001).
Conclusions: It seems that applying PRP is an effective therapeutic approach for wound
healing, and faster wound healing is expected due to the presence of more platelets and growth
Keywords: Platelet-Rich Plasma, Modified Radical Mastectomy, Wound Healing.

and mortality, prolonged hospital stay, and
Breast cancer is the second most common
increased cost. Therefore, reduction in the
cause of cancer-related death in women. In
incidence of these morbidities would cut
most patients, death resulting from either
down on medical expenses 4.
treatment, complications of treatment, or
Surgical wounds heal through an orderly
tumor recurrence or metastasis 1.
sequence of several distinct physiological
The modern approach to breast cancer
and biological events that include
management is multi-disciplinary. The
hemostasis, inflammation, proliferation,
different surgical treatment options include
simple mastectomy, modified radical
maturation 5, 6. This process is initiated
mastectomy and breast conservative
immediately upon injury. A platelet plaque
surgery 2.
develops which is composed of platelets
Radical mastectomy was first carried out in
and fibrin, and the platelets release granules
1882 and described in 1894 by William
containing multiple growth factors and
Stewart Halsted and for a number of
thromboxane A2, the latter of which acts as
decades it remained the standard operation
a potent vasoconstrictor. Transforming
for early breast cancer. Modified radical
growth factor beta (TGF-b) is the key
mastectomy combines the removal of all
growth factor that plays a central role in
breast tissue from the affected breast with
wound healing. In a wound site, following
lymph node removal from the armpit on the
affected side of the body 3.
mesenchymal stem cells release their
Surgical site complications such as
complex contents in the wound healing
infection, hematoma, seroma, dehiscence,
process. The maximum tensile strength of
and pain may occur. These complications
the tissue is reached approximately eight
are associated with substantial morbidity
weeks after injury 5.
Received:6/9/2018 Accepted:25/9/2018

Full Paper (vol.7310 paper# 23)

c:\work\Jor\vol7310_24 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7794-7805

Assessment of endoscopic sinus surgery in management of sinonasal

Sayed Attia Siam, Mohammed Kamel Elawady,
Omer Mohammed Elemery
Otorhinolaryngology and Head and Neck Surgery Department, Faculty of Medicine, Al-Azhar
Corresponding author: Omer Mohammed Elemery, email: omerelemery@gmail.com

functional endoscopic sinus surgery (FESS) has revolutionized surgical
care, opening new horizons in the management of chronic rhinosinusitis and other
paranasal sinus disorders Messerklinger established and reinterated the importance of
the sinus ventilation and pattern of mucociliary clearance. FESS was first described
independently by both Messerklinger in German literature and Wigand.
Aim of the work: this study aimed to assess the efficacy, safety and benefits of FESS
in cases of chronic recurrent rhinosinusitis with or without nasal polyposis, fungal
sinusitis,septal and turbinate pathology and CSF rhinorhea in terms of morbidity,
mortality and recurrent of disease. Patients and Methods: this study was conducted in
Bab Elshaerea University Hospital and Hearing and Speech Institute from July 2017 to
August 2018. A total of 50 patients with clinical evidence of sinonasal diseases were
categorized into 4 groups (Chronic recurrent rhinosinusitis with or without nasal
polyposis (20 patients) ,fungal sinusitis (10 patients),septal and turbinate pathology(10
patients) and CSF rhinorhea(10 patients)). Patients were evaluated with nasal
endoscopy and computed tomographic (CT) evaluation prior to FESS. Results: out of
50 patients, 26 were male and 24 were female in the present study. Male: female ratio
was 52:48. Depending on symptoms, endoscopic examination and CT scanning, three
patients only had recurrence (Two patients from group of chronic recurrent
rhinosinusitis with or without nasal polyposis and one patient from fungal sinusitis
group). Conclusion: FESS provided an excellent and safe method for treating sinonasal
disease. The success rates were encouraging, but because of the nature and chronicity
of the disease, longer follow-up was necessary to truly assess the surgical effectiveness
of the procedure.
Key words: surgery, sinonasal disease.


Functional endoscopic sinus surgery is
ophthalmopathy (3- 5). The first recorded
otorhinolaryngologists to treat a host of
instance of endoscopy being used for
nasal sinus pathologies (1). Functional
visualization of the nasal passage was in
endoscopic sinus surgery (FESS) is a
Berlin, Germany in 1901(6). Alfred
minimally invasive surgical treatment
Hirschmann, who designed and made
which uses nasal endoscopes to enlarge the
medical instruments, modified a cytoscope
nasal drainage pathways of the paranasal
to be used in the nasal cavity. Hirschmann
sinuses to improve sinus ventilation(2) .This
published Endoscopy of the nose and its
procedure is generally used to treat
accessory sinuses (7). Reichart performed
inflammatory and infectious sinus diseases,
the first endoscopic sinus surgery using a
including chronic rhinosinusitis that doesn't
7 mm endoscope. Maltz also encouraged
respond to drugs, nasal polyps, some
the use of endoscopes as a diagnostic tool
cancers, and decompression of eye
for nasal and sinus abnormalities (6).
Received: 10/9/2018
Accepted: 29/9/2018

Full Paper (vol.7310 paper# 24)

c:\work\Jor\vol7310_25 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7806-7813

Evaluation of Serum Interferon-gamma Level in Vitiligo Patients
Shaker Ezzedine *, Emad Mahmoud El Rewiny *, Ahmed Abdulhamied Abozied *, Ahmed
Shabaan Mahmoud Samna*
* Department of Dermatology, Venereology and Andrology, Faculty of Medicine ­ Al-Azhar University
Corresponding author: Ahmed Shabaan Mahmoud Samna, Mobile: 00201227470830, E-Mail: ahmed_sh14@yahoo.com


Background: Vitiligo is an acquired depigmentation disorder of the skin, resulting from a loss of
functioning epidermal melanocytes. Multiple pathogenetic factors have been proposed, including the
neural theory, genetic predisposition and impaired anti-oxidative defense. Cytokines are small immune-
regulatory molecules that can generate an inappropriate immune response when imbalanced. IFN- is a
pleiotropic cytokine that is a key regulator of the immune system. In addition to host defense, IFN-
also contributes to autoimmune pathology by inducing autoantibodies, activating autologous cytotoxic
T cells and inducing target cell apoptosis. It plays an important role to induce depigmentation in vitiligo.
Aim: In this study, we aimed to determine whether vitiligo is associated with alterations in serum level
of IFN- or not and to find out its association with disease course, severity, and duration.
Methods: This case control study included 40 patients presented with stable (N=22) and active (N=18)
vitiligo (non-segmental and segmental), diagnosed on the basis of typical clinical features, were selected
as patient group. Forty age and sex matched apparently healthy individuals were also included
representing the control group. Also patients with previous skin cancer or premalignant skin lesions, or
taking immunosuppressive drugs as methotrexate and patients with hepatitis viral infection and those
on INF therapy were excluded. They were 25 females (62.5%) and 15 males (37.5 %), their ages ranged
from 18 to 45 years old (mean of 33.53). The controls were 20 females (50%) and 20 males (50%),
their ages ranged from 18 to 46 years old (mean of 32.85).
Results: The distribution of vitiligo in patients, 60% was vitiligo vulgaris, 25% were segmental vitiligo
and 15% were acro-fascial vitiligo. The results showed no statistical significant difference (p-value >
0.05) between patients and control as regard age, sex and family history and showed statistical
significant difference (p-value < 0.001) between patients and control as regard serum concentration of
IFN-. Results also showed statistical significant (p-value < 0.001) positive (r = 0.63) correlation
between IFN- levels and VASI score in patients group and statistical significant difference (p-value <
0.001) between IFN- levels and duration, clinical types and activity of the disease in patients group.
Conclusion: This study proved high serum level of IFN- may be risk factor for vitiligo progression
suggesting that it could be used as a marker for assessing vitiligo activity and may open the way for
further therapeutic approaches for vitiligo. Serum IFN- is positively correlated with disease duration
and severity, although it does not seem to be influenced by age, sex and family history of the patient.
Keywords: Vitiligo, Serum IFN-


Vitiligo is an inflammatory autoimmune skin
responsible for the increase of pro-
disorder characterized by the progressive
inflammatory cytokines primarily observed on
appearance of depigmented skin lesions due to
the border of lesional and perilesional
loss of melanocytes at the cutaneous level (1).
vitiliginous patches (3).
Etiology of vitiligo is still unclear but a
IFN- is a pleiotropic cytokine that is a
growing number of observations have led the
key regulator of the immune system (4). In
researchers to consider altered cellular
addition to host defence, IFN- also contributes
immunity as a key factor of melanocyte loss (2),
to autoimmune pathology by inducing
a shift in the immune response, characterized by
autoantibodies, activating autologous cytotoxic
the prevalence of Th1/Th17-related cytokines
T cells and inducing target cell apoptosis (5).
(pro-inflammatory) instead of a Tregs/Th2-
The major IFN--secreting cells in
related one (anti-inflammatory), that is
humans are T helper 1 (Th1) cells, natural
killer (NK) cells and CD8+ cytotoxic T
To date, since the first description of type
lymphocytes (CTLs) (6).
II IFN activity more than 4 decades ago, a
Received: 14/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 25)

c:\work\Jor\vol7310_26 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7814-7820

Variations Occurring in Intraocular Pressure and Refraction
during Pregnancy
Hassan Elsayed El-Baz, Mostafa Mahmoud Mostafa,
Ahmed Abdel Moniem Abdel Karim*
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Egypt
* Corresponding author: Ahmed Abdel Moniem Abdel Karim, E-mail: Dr4a2014@gmail.com

pregnancy represents an important challenge in the female's life that she needs close
observation during it and also needs counseling by her physician about the changes that are going
through her body in this stressful period.
Aim of the Work: the purpose of our study was to detect the changes that occur in the women's eyes
during pregnancy and postpartum period regarding intraocular pressure and refraction.
Patients and Methods: we studied 40 pregnant healthy women whose ages ranged from 18 to 35 years
and we exclude any ocular diseases such as keratoconus, amblyopia or diabetic retinopathy. We
measured the intraocular pressure using a Goldmann applanation tonometer, best corrected visual acuity
using the Snellen's chart and k reading using autorefractor-keratometer.
Results: we found that the IOP decreases only in the 3rd trimester with more decrease in women with
multiple fetuses and multiple pregnancies. We found that the BCVA decreases only in the 2nd and 3rd
trimesters. We also found that the K reading increases only in the 2nd and 3rd trimesters. Intraocular
pressure, best corrected visual acuity and k reading returned to the normal values after delivery.
Conclusion: the physiologic changes that occur in the women's eyes during pregnancy and postpartum
period are usually marked in second and third trimester; this is because at this period, hormonal activity
is at its peak, and however these changes are transient because several weeks postpartum, all hormonal
activities return to their prenatal levels.
Keywords: Intraocular Pressure, Keratoconus, Amblyopia, Goldmann Applanation Tonometer,


represents a
have reported a statistically significant decrease
challenge to all body systems. The progressive
in IOP during pregnancy compared with non-
physiological changes that occur are important
pregnant women. IOP decrease as pregnancy
to support and protect the fetus and prepare the
progresses (5).
mother for delivery. These physiologic changes
Cornea may show changes in
involve cardiovascular, renal, pulmonary,
sensitivity, thickness or curvature. Corneal
sensitivity decreases with other changes
immunologic, and visual systems. If there is
occurring in pregnancy. An increase in corneal
clinical or sub-clinical pathology, these
thickness due to edema has been documented to
physiologic changes can lead to significant
occur in pregnancy. An increase in corneal
problem on already compromised systems (1).
curvature also has been documented during the
The ocular changes occurring during
second and third trimesters which returned to its
pregnancy could be physiologic, pathologic, or
normal value after delivery. Changes in
modification of a pre-existing disease, the most
thickness may affect the refractive index of the
common is the proliferative diabetic
cornea leading to changing refraction, many
retinopathy (2, 3).
women complain contact lens intolerance
Most of the physiologic changes that
during pregnant. This is could be due to the
occur because of pregnancy are marked in the
increase in corneal curvature and thickness. The
third trimester. This is because at this time,
pregnant women advised to wait until at least
hormonal activity is at its peak. However, these
several weeks after delivery to obtain a new
changes are temporary because several weeks
glasses prescription or new contact lens (6).
after delivery, all hormonal activities return to
Visual affection and other ocular
their normal level (4).
changes are rare during pregnancy. They
Intra ocular pressure (IOP) decreases
developed in 15% of pregnant women and
during pregnancy, studies in healthy women
mostly not harmful, but are a cause of anxiety
Received: 15/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 26)

c:\work\Jor\vol7310_27 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7821-7826

Evaluation of the effect of balance training in hemiplegic patients
Sabah Abd El Monem Hussein Ebeid, Mervat Abd El Sattar Al Sergany, Hanan Mohammed El
Sadany, Radwa Mostafa El Khouly
Physical Medicine, Rheumatology and Rehabilitation Department -Faculty Of Medicine -Tanta
Corresponding author: Sabah Abd El Monem Hussein Ebeid. Email: sabahebeid1@yahoo.com

Aim of the work: To
assess the postural instability in hemiplegic patient and evaluate the effect of balance
training by the biodex balance system (BBS-SD).
Patients and methods: Forty patients with hemiplegia (hemiplegic group) and 30 healthy volunteers
(control group). The hemiplegic group was subdivided randomly into two subgroupsnI and IInaccording to
the rehabilitation program .Group I received balance training by BSS-SD in addition to traditional
rehabilitation program for hemiplegia .Group II received traditional rehabilitation program for hemiplegia.
All patients were functionally assessed by Stroke Specific Quality of life scale (Ss-QOL) scale and balance
assessment by berg balance scale and by using BSS-SD.
Results: There was significant affection of overall stability index of postural stability test, fall risk test
and parameters of limits of stability (LOS)test in hemiplegic group in comparison to the apparently control
group (p 0.05 ). There was statistically significant improvement in both hemiplegic subgroups but more
significant in group I regarding postural stability test, fall risk test and limits of stability test. Also there was
improvement in Ss-QOL scale and BBS that was more significant in group I.
Stroke patients have postural instability and increased risk of falling. Balance training by
using BSS-SD in addition to the traditional rehabilitation program decreases the postural instability, also
improves the quality of life more than the traditional rehabilitation program only.
Keywords: Postural stability, Balance training, Biodex system, Hemiplegia.

Stroke is an acute onset of neurological
balance as well as treatment of balance disorders
dysfunction due to cerebrovascular affection
lasting more than 24 hours with resultant signs
The aim of this work was to assess the postural
and symptoms that correspond to involvement of
stability and balance disturbance in hemiplegic
focal areas of the brain(1).
patient, and to evaluate the effect of balance
Stroke is the third cause of death in Egypt and the
training in those patients.
Patients and methods:
disability.Approximately75% of stroke survivors
Forty patients with hemiplegia (Hemiplegic
are left with motor dysfunction (2).
group ) diagnosed clinically and radiologically
The important component for postural control are
.In addition to thirty healthy volunteers as control
movement strategies, cognitive processing,
group, both groups were matched in age and sex
sensory modalities (somatosensory, visual and
.Both groups were selected from the outpatient
vestibular), the sensory reintegration and
clinic of Physical Medicine, Rheumatology
reweighting in central nervous system, all of
and Rehabilitation Department, Faculty of
which can be impaired after stroke .Patients with
Medicine, Tanta University.
stroke exhibit uneven weight distribution as
Patients included in this study were
increasing weight bearing on the unaffected limb,
during the first 6 months of stroke onset, with
decreased weight-shifting ability in stance,
ability to stand with or without assistance and
increasing the risk of falling. Therefore, balance
able to understand and follow simple verbal
training cause's improvement in gait symmetry
instruction. Patients with severe spasticity,
and help recovery of activities of daily living (3).
flaccid stage of stroke, lower limb deformity or
The Biodex Stability System is an effective,
past history of any lower limb injury, peripheral
reliable and valid tool used for assessment of
neuropathy, dementia and cognitive deficit and
impaired vision were excluded.
Received: 15/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 27)

c:\work\Jor\vol7310_28 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7827-7833

Immunohistochemical Study of CDK5 and Ki-67 in Cervical
Precancerous Lesion and Carcinoma
Amira Nasr Elsokary*, Samah Mohamed Attiah, Bahaa Bedair Ghannam
Department of Pathology, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Amira Nasr Elsokary, Tel: 002-01003997007, Email: ameranasr.medg@azhar.edu.eg


Background: cervical carcinoma is one of the commonest female tumors worldwide arises from
cervical intraepithelial neoplasia. Cervical cancer is a multifactorial process and infection with some
types of human papilloma virus (HPV) has been suggested as the most important risk factor. The genesis
of cancer was correlated with abnormal regulation of DNA damage and repair. A research proved that
CDK5 was mandatory for the DNA damage response in cancer cells. Ki-67 is a nuclear protein that is
associated with RNA transcription and cell cycle progression.
Aim of the work: the purpose of this study was to evaluate the expression of CDK5 in cervical
precancerous lesions and carcinoma to clarify its role in carcinogenesis and progression of cervical
cancer, as well as the expression of Ki-67.
Material and Method:
specimens included (55 cases) consisted of precancerous lesions (15), SCC
(30), adenocarcinoma (10). All specimens were formalin-fixed and embedded in paraffin blocks.
Multiple serial 5-microne thick sections were cut from the paraffin blocks of the specimens; one was
stained by Hematoxylin and Eosin for histopathological examination, Other Sections were
immunostained with antibodies to CDK5 and K-i67.
Results: high tumor grade and high FIGO stage were positively correlated with CDK5 IHC expression
(P-value=0.012 and 0.042) and with Ki67 IHC expression (p-value= 0.01 7and 0.044) respectively.
Conclusion: there is a direct positive correlation of both CDK5 and Ki-67 expression with high tumor
grade and high FIGO stage of cervical carcinoma.
precancerous, SCC, adenocarcinoma, CDK5, Ki-67


Cervical cancer is usually associated with
papillary architecture versus solid areas) and its
human papilloma virus (HPV) (1). Cervical
nuclear features (6). The staging system for
intraepithelial neoplasia (CIN) is the precursor
tumors of the cervix is International
lesions of cervical squamous cell carcinoma (2).
CIN 1 Known as mild dysplasia; CIN 2 Known
Obstetricians (FIGO) (7).
as moderate dysplasia and CIN 3 known as
The genesis of cancer was related to
severe dysplasia. The grading of CIN depends
abnormal mechanism of DNA damage and
upon the proportion of the epithelium occupied
repair. Cyclin dependant kinase 5 (CDK5) is
by basaloid atypical cells reflecting a
important for the DNA damage response in
progressive loss of maturation and increasing
tumor cells (8). Ki-67 is a prognostic factor for
lesion severity (3).
the assessment of biopsies from precancerous
The World Health Organization (WHO)
and cervical cancer. Clinically; Ki-67 has been
(4) recognizes three basic types of invasive
shown to correlate with the stage of tumors (9).
carcinoma of the cervix: squamous cell
Aim of the work
The purpose of this study is to evaluate the
epithelial tumors.
expression of CDK5 in cervical precancerous
Histological grading divides Squamous
lesions and carcinoma to clarify its role in
cell carcinoma (SCC) into three subtypes,
carcinogenesis and progression of cervical
depends upon the proportion of the tumor
cancer, as well as the expression of Ki-67.
keratinization with the formation of keratin
CDK5 reactivity and proliferation rate as
pearls and mitoses, Well differentiated (grade
assessed by Ki-67 was correlated with the
1), Moderately differentiated (grade 2), Poorly
clinicopathological parameters
differentiated (grade 3)(5).
Materials and Methods
Grading of cervical adenocarcinoma
This study included total 55 cervical
depends upon gland architecture (glandular and
specimens (32 punch biopsy and 23 total
Received:14/9/2018 Accepted:30/9/208

Full Paper (vol.7310 paper# 28)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7834-7841

Role of Mean Platelet Volume in Prediction of Preeclampsia
Ismail M.T. El-garhey, Ashraf Hamdy Mohammed,
Al-Hussein Hamed Hassan Ismail
Department Obstetrics & Gynecology department, Faculty of Medicine, Al-Azhar University
Corresponding author: Al-Hussein Hamed Hassan Ismail, Mobile: 01007270751; Email:
preeclampsia (PE) is a pregnancy-specific multisystem disorder that is
characterized by development of hypertension and proteinuria with or without body edema after
twenty weeks of gestation, resolving by 6-12 weeks postpartum in previous normotensive
Objectives: comparing complete blood count (CBC) parameters especially Mean platelet
volume (MPV), in pre-eclamptic and normal pregnant women in the third trimester of
pregnancy and to evaluate whether this parameter have a prognostic significance in determining
the severity of preeclampsia.
: The study was conducted at alhussein university hospital. It included 150 pregnant
women. They were assigned to 2 groups: 1st group: 34 pregnant women with preeclampsia,
and 2nd group: 116 normal pregnant women free of any medical disorders
The current study showed no statistically significant difference between PE compred
to normal pregnancy (with p-value >0.05 NS).
we have found that MPV values do not have any determining effect on the
presence of preeclampsia.
The results of this study recommend that MPV has no prognostic
significance in determining preeclampsia, although large-scale clinical studies and longitudinal
study of platelet size changes through gestations are still awaited and fixing methods and
methods used for automated blood count.
Preeclampsia, Mean Platelet Volume.
Preeclampsia is a pregnancy-
hypertension; one should maintain a high
specific multisystem disorder that is
index of suspicion, and over diagnosis is
preferable and unavoidable (4).
hypertension and proteinuria with or
A good diagnostic test for
without body edema after twenty weeks of
preeclampsia would be especially useful in
gestation, resolving by 6-12 weeks
this setting. Conditions that make the
postpartum in previous normotensive
diagnosis of preeclampsia superimposed
women (1).
upon chronic hypertension highly likely are
It occurs in about 5% to 10% of all
as follows: New-onset proteinuria (0.3 g of
pregnancies and resulting substantial
protein in a 24-hour urine collection) after
maternal and fetal morbidity and mortality
20 weeks' gestation. Any of the following
in a woman with hypertension and
Many organs may be affected as,
protienuria before 20 weeks' gestation:
Sudden increase in proteinuria. Sudden
hematopoietic, and coagulation system (3).
increase in blood pressure in cases in which
preeclampsia increased in women with
controlled. Thrombocytopenia (platelet
chronic hypertension. The overlap of signs
count of less than 100,000 cells per cubic
makes it more difficult to diagnose
preeclampsia among women with chronic
aminotransferase (ALT) or aspartate
Received: 14/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 29)

c:\work\Jor\vol7310_30 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (10), Page 7842-7849

Comparison between clinical and biochemical versus interleukin 28B as a
predictive factor of virological response to direct antiviral drugs without
interferone in treatment of hepatitis C virus patients

Mahmoud Mohammad Moussa Bazeed, Anwar Gomaa Elsheety, Mohammad Saied Bakeer,
Mohamed Ali Saber & Essam Abdel Nabi Mohammady*
*Department of Internal Medicine, Faculty of Medicine, Al-Azhar University
Corresponding author: Essam Abdel Nabi Mohammady, wael tantawy, Email:

for SNP, the CC is associated with a higher SVR after DAAs/RBV therapy while, the
genotype TT is a risk factor for non-response.
Aim of the work: this study aimed to assess the value of SNP (rs8o99917) as a predictor of SVR.
Methodology: this study was a retrospective controlled study and was performed on a total number of
15o patients who were treated by DAAs/RBV for 12 weeks and SNP was done for the all the patients.
Results: CC genotype was more prevalent in SVR group than CT and TT genotypes. Conclusion:
determination of SNP before starting antiviral therapy may serve as a good response predictor.
Keywords: HCV-direct acting antiviral drugs, interleukin 28b SNP.

Hepatitis C virus infection gained
influence response to antiviral therapy in
increasing attention as a global health problem,
patients with chronic HCV infection and
with approximately 3% (~17o million) of the
whether reliable genetic markers predictive of
world's population infected persons. Egypt
SVR can be identified. As knowledge of the
reported the highest prevalence of HCV
human genome has expanded and our ability to
worldwide, ranging from 6% to more than 4o%
detect genomic differences among individuals
with an average of 13.8% (1). Unfortunately,
has become more advanced. A recent study had
HCV successfully evaded the host immune
identified single nucleotide polymorphisms
response in 55% to 85% of acutely infected
(SNPs) in proximity to the interleukin-28B (IL-
persons, thus leading to chronic infection. The
28B) gene as important predictors of treatment
natural history of hepatitis C varied greatly;
outcome. These findings have not only
reasons for this heterogeneity remain
new window
into host
incompletely understood but, are related to both
responsiveness to DAAs-based therapy but
viral, host and environmental factors. Chronic
have also yielded insights into genetic
HCV infection can lead to cirrhosis and
susceptibility to chronic HCV infection, the
hepatocellular carcinoma. The incidence of
molecular biology of host immunity against
these complications has risen dramatically in
HCVand the potential for discovery of new
the 2ooos (2).At past the introduction of
therapeutic agents(5).
Pegylated interferon alfa in combination with

ribavirin improved treatment outcome of
Aim of the Work
chronic hepatitis C, the rates for Sustained
This study aimed to assess the value of
Virologic Response (SVR) are heterogeneous
IL28B (SNP) as a predictor of virological
and vary significantly according to HCV
response to DAAs plus ribavirin in treatment of
genotype and baseline viral load, with a poor
the Egyptian patients with chronic hepatitis C
outcome in patients infected with GT1 or 4 and
virus infection.
with a high viral load at treatment initiation

(3).Besides these viral factors, host factors such
Patients and Methods
as age, body weight, insulin resistance, stage of
fibrosis, and compliance influence the outcome
This study was conducted on 15o
of antiviral treatment in patients with chronic
Egyptian patients who were infected with HCV.
Patients were selected from HCV patients that
A major unresolved question is the
attend National Hepatology and Tropical
extent to which host genetic factors may
Medicine Research Institute for receiving
Received: 15/9/2018
Accepted: 30/9/2018

Full Paper (vol.7310 paper# 30)