c:\work\Jor\vol733_1 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6182- 6188

Study of Iron profile Level in Lupus Nephritis
Mohamed Nabil Raafat) (1, Mamdouh Attia Mohamed) (2, Ismail Mohamed Elmancy) (1 and Eslam
Abdelhaleem Abd Allah Elnemr) (1
1-Internal Medicine Department, 2-Clinical Pathology Department, Faculty of Medicine, Al-Azhar
University (cairo), Egypt.
Corresponding author: Eslam Abdelhaleem Abd Allah Elnemr. Email:dreslamelnemr98@yahoo.com
ABSTRACT
Background: Systemic lupus erythematosus (SLE) is a multi-factorial, chronic autoimmune disorder,
characterized by dysfunction of T and B lymphocytes. It affects various vital organ systems, and 70% to
90% of SLE patients are females. Lupus nephritis (LN) is one of the common complications in patients
with SLE and influences overall outcome of these patients. About two-thirds of patients with SLE have
renal disease at some stage which is a leading cause of mortality in these patient .Iron is critical in nearly
all cell functions and the ability of a cell, tissue and organism to procure this metal is obligatory for
survival. Iron is necessary for normal immune function, and relative iron deficiency is associated with
mild immunosuppression. Concentrations of this metal in excess of those required for function can
present both an oxidative stress and elevate risks for infection. As a result, the human has evolved to have
a complex mechanism of regulating iron and limiting its availability. Ferritin levels correlate with disease
activity in patients with SLE and developing of lupus nephritis. Objective: To correlate between Iron
profile and SLE activity and developing lupus nephritis. Materials and Methods: A prospective study
was conducted on 75 adult persons: 25 Patients with SLE with proteinuria, patients with SLE without
proteinuria, 25person have no SLE (control group).These person were Admitted at internal medicine
department and outpatient clinic of Al-Hussein university hospital, Cairo, Egypt. SLE patients were
diagnosed according to the American College of Rheumatology (ACR) criteria, Lupus Activity
assessment by C3&C4, Lupus nephritis assessment using Albumin /creatinine ratio. Iron profile was
measured and included: serum iron, serum TIBC, transferrin saturation and Serum ferritin levels were
tested by ELISA. Results: There were no significant statistical difference between groups as regard age
or sex however, There were significant difference between groups as regard S.iron, S. ferritin, TIBC and
TSAT, Between group analysis results showed significantly lower s.iron and TSAT level of SLE
patients with and without proteinuria in comparison with control group. While S. ferritin is significantly
high in SLE patients with proteinuria in comparison with SLE patients without proteinuria and control
group. And this data go with activity markers of SLE. Conclusions: 1) Hyperferritinemia is a useful
marker in assessment of disease activity and severity of Albuminuria in SLE patients complicated by
lupus nephritis, treatment of hyperferritinemia can result in decreased Albuminuria and delayed renal
damage. 2) Iron homoeostasis is important in normal immune function and Iron disturbance can
result in mild immunosuppression.
Keywords:
Iron,Inflammation ,Systemic lupus erythematosus.
Introduction
sufficiently sensitive and specific for monitoring
Systemic lupus erythematosus (SLE) is a
of disease activity, particularly in certain
multi-factorial, chronic autoimmune disorder
systems like the central nervous system and the
characterized by dysfunction of T and B
gastrointestinal tract. Even for more common
lymphocytes. It affects various vital organ
manifestations such as lupus nephritis, these
systems, and 70% to 90% of SLE patients are
conventional markers also lack sensitivity and
females. It is believed that environmental, host
specificity in gauging residual inflammation and
genetic and hormonal factors play crucial roles
predicting flares of renal disease. Thus, novel
in the pathogenesis of SLE, but the etiology of
biomarkers for SLE activity have to be
the disease has not been clearly understood (1).
developed. Ideal biomarkers for SLE should
SLE is characterized by an unpredictable
have high specificity for the disease (or specific
disease course, interspersed with periods of
end-organ involvement) to aid early diagnosis
remission and flares. Conventional serological
have good correlation with disease activity and
markers of SLE such as anti-dsDNA and
be sensitive to change in disease status to allow
complement levels are not ideal as they are not
for serial monitoring, and be able to detect flares
6182
Received: 15/7/2018
Accepted: 23/7/2018

Full Paper (vol.733 paper# 1)


ABSTRACT The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6189-6197

Comparison of the Duo of Insulin-Like Growth Factor Binding Protein-1/Alpha
Fetoprotein (Amnioquick Duo+®) and Nitrazine Test for Diagnosing Query
Rupture of Fetal Membranes
Sherif Fekry Abd Allah Hendawy*, Sherif Hanafi Hussain*, **Jamila Ahmed Elmabrouk
* Department of Obstetrics and Gynaecology, Faculty of Medicine - Ain Shams University, ** Tripoli University
Corresponding author: Jamila Ahmed Elmabrouk, Mobile: 002010666866572, E-Mail: tantawy_wael@yahoo.com
ABSTRACT
Background:
premature rupture of membranes (PROM) constitutes one of the most important dilemmas in the
obstetric practice. It could be defined as rupture of membranes before the onset of labour, irrespective of the
gestational age. It is associated with infectious morbidity in mother and fetus, cord accidents, imminent term or
preterm labour. For these reasons, its correct diagnosis is very important. A novel test used for diagnosing
rupture of membranes (ROM) is Amnioquick duo+® (Biosynex, Strasbourg Cedex, France). Amnioquick
duo+® is a rapid strip test with immunoassay that is simple, easy to perform, quick and noninvasive. It is an
immunochromatographic test that identifies even trace amounts of both alpha fetoprotein (AFP) and insulin-
like growth factor binding protein-1 (IGFBP-1). On other hand the traditional methods for diagnosis of PROM
are through the patient's history, leakage, ferning test and nitrazine test. Aim of the Work: the aim of this
study is to compare the accuracy of the duo of insulin-like growth factor binding protein-1/alpha fetoprotein
(Amnioquick duo+®) and nitrazine test for diagnosing query rupture of fetal membranes in pregnant women
with query PROM. Patients and Methods: this comparative cross sectional study was carried out at Ain
Shams University Maternity Hospital between November 2017 to June 2018. Results: a total of one hundred
and thirteen pregnant women > 24 weeks of gestation were included in the study with age ranging between 18
and 42 years (mean ± SD, 27 ± 6 years). Thirty eight (33.6%) women were primigravidae and 75 (66.4%) were
multigravidae. Forty (35.4%) women were primiparas while 63 (64.6%) were multiparas. Twenty five (22.1%)
women experienced one or more previous abortion. The Amnioquick duo+® test was more specific and
accuracy in diagnosing rupture of membranes than Nitrazine test. The sensitivity and the specificity of
Amnioquick duo+® test in diagnosing PROM was 100% and 97.3% respectively as compared to Nitrazine test
which was 100% and 83%. The PPV and NPV of Amnioquick duo+® test were 98.7% and 100% as compared
to Nitrazine test which were 92.7% and 100%. Conclusion: this study concluded that IGFBP-1/AFP
(AmnioQuick® Duo+) test is rapid reliable non-invasive, easy and accurate bedside immunoassay test, better than
nitrazine test and can used as complementary test to improve the management of women with women premature
fetal membranes rupture.
Keywords: Amnioquick duo+®, Nitrazine, PROM, IGFBP-1/AFP

INTRODUCTION
diagnosing rupture of membranes (ROM) is
Premature (prelabor) rupture of membranes
Amnioquick duo+® (Biosynex, Strasbourg Cedex,
(PROM) is defined as rupture of the fetal membranes
France). Amnioquick duo+® is a rapid strip test with
spontaneously prior to the onset of uterine
immunoassay that is simple, easy to perform, quick and
contractions(1). It is a relatively frequent obstetric
noninvasive. It is an immunochromatographic test that
phenomenon occurring in 2­18% of pregnancies(2).
identifies even trace amounts of both alpha fetoprotein
When it is preterm, it is often associated with
(AFP) and insulin-like growth factor binding protein-1
prematurity-related complications including premature
(IGFBP-1). The protein markers, though abundant in
birth, pulmonary hypoplasia, fetal deformities and
amniotic fluid, are present in far lower concentrations or
infectious materno-fetal morbidity (3). The diagnosis of
undetectable in the maternal blood or in cervicovaginal
PROM is straight forward in the presence of obvious
secretions in the genuine absence of rupture of
rupture of membranes. However, several factors such as
membranes(5). Thus, such a differential concentration
urine, vaginal discharge or semen may interfere with
between amniotic fluid and cervicovaginal secretions of
traditional clinical assessment (TCA), leading to high
the biomarkers makes Amnioquick duo+® an excellent
levels of false negative and positive results. Such results
marker for PROM. The test can be performed even
may lead to inappropriate interventions such as
when fluid is not obvious in the vagina and its execution
hospitalization and stimulation of labor(3). On the other
does not require laboratory specialized equipment or
hand, misdiagnosis of PROM may cause providers to
specially trained personnel(3, 5). On other hand the
withhold appropriate therapy(4). A novel test used for
traditional methods for diagnosis of PROM are through
6189
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.733 paper# 2)


c:\work\Jor\vol733_3 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6198-6205

Association between Vitamin D Deficiency and Preterm: A Case Control
Study
Shereif Mohammed Abd El Hameed 1, Dina Yahia Mansour 1, Heba Mohamed Adel Abou Zaghla 2,
Seham Hasan Rishi 1*
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University
2 Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University
*Corresponding Author: Seham Hasan Rishi, Phone No.: (+2) 01014176642,E-mail: seham.rishi77@gmail.com

ABSTRACT
Background: Preterm labor refers to the delivery before 37th week of pregnancy. The World Health
Organization (WHO) reported that about 15 million neonates are born preterm with about 1 million
deaths occur during infancy. PTB infants who survive frequently suffer from chronic pulmonary
diseases and learning deficits, causing heavy burdens for society and family. Preterm birth is one of
the most serious medical complications of pregnancy.
Purpose: to compare serum 25 hydroxy vitamin D levels among patients with preterm delivery and
women who have full term birth.
Patients and Methods: a case-control study was conducted at Ain Shams University Maternity
Hospital from December 2017 to May 2018. It was carried out on 138 women post delivery recruited,
they were divided into group of patients with preterm babies and other group with full term babies, 69
women in each.
Results: Mean level of 25 hydroxy vitamin D between preterm birth group was 4.4 ±2.5 ng/ml and
between full term birth group was24.9±13.74ng/ml. Therefore, according to student T test and chi-
square test, the current study found that there is significant difference in serum 25 hydroxy vitamin D
levels between women with preterm birth and women with full term birth preterm birth.
Conclusion: from this study it can be concluded that vitamin D assay can be used for prediction of
preterm birth and vitamin D supplementation can be used routinely in prevention of preterm birth.
Keywords: Preterm Labor - Preterm Birth - Tansvaginal Ultrasound
mellitus (GDM), preeclampsia and small for
Introduction
gestational age (2).
Preterm birth (PTB) is the birth of a
Prematurity is not only a huge medical
baby before completed 37 weeks of gestation.
problem but also a social and economic one.
Every year, 15 million neonates worldwide are
born preterm preterm birth (PTB), as the
There have been some studies
largest cause of neonatal deaths worldwide
describing the association between maternal
puts surviving children at risk for cerebral
vitamin D levels and preterm birth; however
palsy,
behavioral
problems,
their results are conflicting. According to some
bronchopulmonary dysplasia, retinopathy of
studies, vitamin D deficiency during
prematurity, hearing impairments, increased
pregnancy is associated with an increasing risk
hospital
admissions
and
academic
of preterm birth. Wagner et al. (3) reported that
underachievement (1).
pregnant women with serum concentrations of
vitamin D less than 20ng/mL had 3.81times
Vitamin D is a fat-soluble metabolite
the odds of a preterm birth compared to those
required for the proper regulation of many
with serum concentrations of vitamin D
body systems, as well as normal human
greater than 40ng/ mL. Bodnar et al. (4)
growth and development. Vitamin D
reported that the risk of preterm birth
efficiency is considered as a common and
decreased
significantly
as
serum
thorny public health problem around the
concentrations of 25-hydroxyvitamin D
world, especially for pregnant women (2).
increased to approximately 36 ng/mL and then
Maternal vitamin D deficiency, or
plateaued. As reported by Shibata et al. (5)
insufficiency, has been demonstrated to be
lower levels of vitamin D among pregnant
related to variety of adverse maternal and fetal
women are associated with premature delivery
outcomes, including gestational diabetes
in Japan. In contrast Zhou et al. (6) reported
that vitamin D deficiency was associated with
a reduced risk of preterm birth. They found
6198
Received: 13/7/2018
Accepted: 23/7/2018

Full Paper (vol.733 paper# 3)


c:\work\Jor\vol733_4 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6206-6412

Nonopioid versus Opioid Based General Anesthesia Technique for
Laparoscopic Cholecystectomy

Mostafa Shalaby, Mofeed Abdalla, Amr Samir Mahmoud

Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
Corresponding author: Amr Samir Mahmoud, Mobile: 01061981288; Email: moori.more@gmail.com

ABSTRACT
Background:
The choices of premedication and anesthetic techniques are able to influence the
neurohormonal stress response by modulating the pathophysiological pathways. Various
pharmacological agents like nitroglycerine, beta blocker, and opioids were used to decrease surgical
stress of laparoscopic procedures to improve outcome, with their own limitations.
Objective: It was to compare the effect of opioid-free (using dexmedetomidine and propofol) and
opioid-based (using fentanyl and propofol) TIVA techniques on hemodynamic stability, sedation
postoperative pain intensity and the incidence of side effects in patients scheduled for LC.
Patients and Methods: Eighty patients who were scheduled for elective laparoscopic
cholecystectomy were included in this study. Before induction of anesthesia, patients were randomly
divided into two equal groups: (40 each). Dexmedetomidine group (Non-opioid group) received
dexmedetomidine (1 µg/kg) over 10 minutes before induction of anesthesia followed by continuous
infusion of 0.5 µg/kg/hr. till the end of surgery and Fentanyl group (Opioid group) received fentanyl
(1.0 µg/kg) over 10 minutes before induction of anesthesia followed by continuous infusion of 0.4
µg/kg/hr. till the end of surgery.
Results: The results of the present study showed that there were no significant differences between
the two groups regarding HR and MAP except after loading dose of the studied drugs, after
intubation, after pneumoperitoneum, 15 min, 30 min, 45 min, and 60 min after induction where it was
lower in dexmedetomidine group than fentanyl group. There were no significant differences between
two groups regarding intraoperative SPO2, postoperative SPO2 and blood glucose level (mg/dl).
Conclusion:
This study concluded that dexmedetomidine is better than fentanyl for patients who
undergo elective laparoscopic cholecystectomy due to perioperative maintaining of hemodynamic
stability, decrease dosages of postoperative analgesics, prolong the duration of postoperative analgesia
and decrease postoperative nausea and vomiting.
Keywords: Pure laparoscopic surgery, open surgery

INTRODUCTION
involved in the somatic nociception:
Pure laparoscopic surgery (PLS) has
transduction, transmission, modulation and
been adopted in various fields. Compared with
perception. Somatic pain is characterized as
open surgery (OS), PLS has substantial
being
well
localized
topographically,
advantages in terms of less blood loss, less
intermittent or constant and is described as
pain, a lower morbidity rate, a shorter time to a
aching, stabbing, or throbbing (4).
postoperative diet, and a shorter hospital stay
Visceral pain: it is not evoked from
(1).
all visceral organs, such as liver, kidney. Most
Laparoscopic surgery has a different
solid viscera and lung parenchyma are not
pain profile than normal open surgery. Pain
sensitive to pain. It is not always linked to
during laparoscopic surgery is a result of both
visceral injury (cutting the intestine causes no
somatic and visceral afferents (2).
pain, whereas stretching of the bladder causes
Somatic and visceral pain can be
pain). It is diffuse and poorly localized. It is
distinguished by the quality of the pain and
referred to other locations. It is accompanied
associated clinical features (3).
by motor and autonomic reflexes, such as
Somatic pain: results from excitation
nausea and vomiting. It is often described as
and sensitization of nociceptors in tissues such
dull, colicky, or squeezing (5).
as bone, periarticular soft tissue, joints, and
The use of opioids can add to the side
muscles. Four physiologic processes are
effect profile of patients undergoing robotic
6206
Accepted: 28/7/2018
Received: 20/7/2018

Full Paper (vol.733 paper# 4)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (11), Page 6213-6218

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave
Lithotripsy in Management of Ureteric Stones in Pediatric Age Group
Mohamed Esmat Abo Gareeb, Ahmed Tawfick Hassan, Waleed Fawzy Abdelsami *
Urology Department, Faculty of Medicine, Ain Shams University
*Corresponding Author: Waleed Fawzy Abdelsami, E-mail: waleedfawzy950@gmail.com
ABSTRACT
Background:
pediatric stone disease is one of the most common urological issues in pediatric urology
practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work:
determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne
laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in
management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients
in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL
or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital
and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A:
Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible
ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the
two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically
significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and
there was highly statistically significant difference between the two groups regarding duration of the procedure
which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe,
highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less
postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric
calculi in children after failure of ESWL.
Keywords: Flexible Ureteroscopy, Laser Lithotripsy, Extracorporeal Shock Wave Lithotripsy, Ureteric
Stones.

INTRODUCTION
children, success rates with ESWL are lower for
In recent decades, the incidence of pediatric
distal ureteric stones (3). Extracorporeal shock wave
stone disease has increased markedly. The disease
lithotripsy in the pediatric population has higher
incidence has raised 6­10 % annually over the last
success rate due to number of reasons including
two decades also Population-based observational
smaller body volumes and increased ureteral
studies have estimated contemporary incidence to
compliance allowing passage of stone fragments.
range from 36 to 145 per 100,000 children (1). Also
Also, Dimercaptosuccinic acid (DMSA) scanning
the increase in incidence in both sexes, indicated
post-ESWL did not identify any evidence of renal
that girls showed a greater increase more than boys
scarring (2). The advantage of flexible ureteroscopy
(2). In pediatric patients a predisposing factor for
in children includes high stone-free condition rates,
stones can be found in more than 75% of children.
low complication rates, minimal radiation exposure
The majority of cases have a metabolic disorder (2).
and short hospitalization periods (3). The indication
Children are regarded as high-risk recurrent stone
of flexible ureteroscopy has been extending,
formers rates range from 19 to 34 % at a mean
including intrarenal stones, ESWL failure, morbid
follow-up of 2­3 years (1). The three main treatment
obesity, musculoskeletal deformities and bleeding
options available for pediatric stones treatment are
diathesis (4). Initial concerns were raised regarding
Extracorporeal shock wave lithotripsy (ESWL),
the traumatic sequelae to the pediatric ureter like
ureteroscopy (rigid and flexible), Percutaneous
Perforation, ischemia, stricture and reflux were
nephrolithotomy (PCNL) and open surgery has been
expected following URS in children (5). URS was
reserved for complex stones associated with
found to be superior to ESWL in a prospective
abnormal anatomy (2). ESWL was used in pediatric
randomized study, rendering 94% stone free after
stones in 1986, which showed safety, efficacy and
one session compared with 43% stone free
complications equivalent to adult and its efficacy for
following SWL (5).
upper tract stones has been reported as ranging from
AIM OF THE WORK
68% to 84% (2). Due to technical problems that arise
To assess the safety, efficacy and outcome
with localization and focusing of ureteric stones in
of flexible ureteroscopy using holmium Yttrium
6213
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.733 paper# 5)


c:\work\Jor\vol733_6 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (3), Page 6219- 6229

Sofosbuvir/ledipasvir in treatment of HCV infected Egyptian patients
with decompensated liver cirrhosis Child Pugh class (B)
Amr Mohamed Abbass; Ahmed Ghalwash; Mohamed Salaheldin Abdelhamid;
Hassan Salaheldin Hamdy
Faculty of Medicine - Ain Shams University in Tropical Medicine department
Corresponding: Amr Mohamed Abbass,email: amrabassgafer@gmail.com, Tel: +202 01007373971
Abstract:
Background: The main goal of anti-HCV therapy in patients with decompensated (Child-
Pugh B) cirrhosis, not on a transplant waiting list is to achieve improvement in liver function
and survival. Several studies have demonstrated acceptably high sustained virological
response (SVR) rates, equivalent in Child-Pugh B patients, in individuals with decompensated
cirrhosis, together with an effect of therapeutic viral clearance on liver function, with
significant improvements in bilirubin, albumin and international normalized ratio values and,
as a result, in model for end stage liver disease (MELD) and Child-Pugh scores in one-third to
half of patients. Similar results were reported in real-world studies.
Aim of the work: Assessment of the safety and efficacy of sofosbuvir/ ledipasvir in infected
naļve and experienced HCV Egyptian patients with decompensated liver disease.
Patients and Method: This study was conducted on 100 patients with HCV related
decompensated liver disease who presented to the hepatology outpatient clinic in El Agouza
Police hospital and were evaluated according to the inclusion and exclusion criteria.
Results: Among the 100 enrolled patients; there was male predominance being 72 males
(72%) and 28 females (28%). Their age ranged between 34 and 65 years (mean 52.7 ±8.2
years). Age was significantly higher in patients who did not achieve SVR. Among the 100
studied cases 6 patients stopped treatment; 3 of them developed HCC, 1 developed precoma,
1 died and 1 lost follow up. SGOT, SGPT, ALP, total and direct bilirubin, serum urea and
creatinine and AFP showed significant improvement at the end of treatment and 3 months
after end of treatment. As regards Child and MELD scores among the studied cases, Child
and MELD significantly decreased in the whole sample.
Conclusion: Ledipasvir/sofosbuvir is effective and safe in the treatment of HCV
decompensated patients Child Pugh B. MELD and Child scores significantly improved with
HCV treatment in decompensated patients
Recommendations: Longer follow up with assessment of the need for liver transplantation or
HCC development is important. Larger number of patients is required.
Keywords: Ledipasvir/sofosbuvir, Child score, decompensated liver disease, Hepatitis C
virus, naļve.
each year from hepatitis C-related liver
Introduction:
diseases(1).
Hepatitis C virus (HCV) can
cause both acute and chronic hepatitis
HCV becomes chronic when the
infection, ranging in severity from a
virus remains in the blood over six months
mild illness lasting a few weeks to a
after the acute infection period. Unless
serious, lifelong illness. About 130­
treated with medication, the infection is
150 million people globally have
lifelong. After a 25-30 year period, this
chronic hepatitis C infection. A
chronic infection may result in significant
significant number of those who are
fibrosis of the liver, which can progress to
chronically infected will develop liver
cirrhosis (complete fibrosis), liver failure,
cirrhosis
or
liver
cancer.
and possibly hepatocellular carcinoma(2).
Approximately 500,000 people die
Signs of decompensation include ascites,
jaundice, encephalopathy and variceal
9126
Received: 4/7/2018
Accepted: 13/7/2018

Full Paper (vol.733 paper# 6)


c:\work\Jor\vol733_7
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6230-6237

Evaluation of Carpal Tunnel Diagnosis, Management, and Outcome in
Primary Health Care Center

Sahar Salem A Albalawi1, Ruwaynah Waleed Aziz Alrahman2, Abdulrahman Mohsen
Althagafi2, Abdulaziz Saud Alrahili2, Saad Saeed Alqahtani3, Salman Mohammed Almutairi3,
Dhafer Mubarak Alajmi3, Zeyad Saad Aljohani4, Fahad Abdullah Abualnassr5, Ammar
Mohammed Sabah5
1- Tabuk university, 2- Umm Al-Qura University, 3- Prince Sattam Bin Abdulaziz University,
4- University of Jeddah, 5- Taibah University
Abstract
Background:
Carpal tunnel syndrome (CTS) is one of the commonest conditions encountered in
primary care centers as mentioned earlier. CTS of mild to moderate severity can often be effectively
treated in a primary care environment. However, many patients being referred immediately to hospital
for consideration of surgical decompression.
Objective:
In this study, we aim to evaluate the available primary care options and their efficacy in
dealing with CTS.
Methods: PubMed database was used for articles selection, and the following keys used in the mesh
(("Carpal tunnel syndrome"[Mesh]) AND ("Carpal tunnel syndrome/Management"[Mesh] OR
"Carpal tunnel syndrome/Diagnosis"[Mesh] OR "Carpal tunnel syndrome/ Primary Health Care
Center)). 5 studies were enrolled according to our inclusion, and exclusion criteria.
Results: Patients successfully treated with wrist splinting alone reported a higher level of satisfaction
with their treatment compared to patients who failed wrist splint treatment or had surgical
decompressionMechanical traction is associated with fewer surgical interventions compared to care as
usual in CTS patients. Reductions in patient-reported symptoms at 6 months' follow-up was similar in
both groups.Steroid injection combined with splinting resulted in modestly greater reduction of
symptoms, functional recovery, and improvement of nerve function at 12-week follow-up compared
to steroid injection alone.
Conclusion: CTS is commonly encountered in primary care. So, a trial of conservative treatment can
be done before referral for surgical decompression. Conservative treatment of CTS had shown a clear
reduction in hand surgery waitlists, thus reduction in expenditures and costs. Wrist splinting is
recommended as first line treatment for patients with symptoms of CTS. Other methods of non-
surgical treatment include steroid injection, osteopathic manipulative therapy, mechanical wrist
traction and combining wrist splinting with steroid injection or with NSAIDs use. Referral for surgical
decompression may be a more appropriate option when the level of numbness and other symptoms are
getting worse, or when conservative management has failed and is likely to lead to dissatisfaction.

Keywords: Carpal Tunnel, Diagnosis, Management, Outcome, Primary Health Care Center

INTRODUCTION

moderate, and severe. Also, most of the time
Carpal tunnel syndrome (CTS) is a neuropathy
symptoms worse at night (2). CTS can occur in
occur as a result of median nerve compression
one or both hands, and is either idiopathic
at the level of the wrist characterized by hand
(spontaneous) or dynamic (only during certain
pain, numbness, and tingling in the distribution
movements). CTS most of time occur between
of the median nerve (thumb, index, middle
40 to 60 years, but also can occur at any age
finger, and the radial side of the ring
especially in women (1). In USA the prevalence
finger) and a reduction in grip strength and
of CTS as estimated to be 4% of general
hand function (1-2). The severity of the
population and up to 10% in working
symptoms can vary between patients into mild,
population(3). CTS can occur as a result of
6230
Received: 15/7/2018
Accepted: 25/7/2018

Full Paper (vol.733 paper# 7)


c:\work\Jor\vol733_8
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6238-6242

Fetal Renal Volume and Renal Artery Doppler in Normal and
Intrauterine Growth Restricted Fetuses

Hani Maged Abd El-Aal, Khaled Zakaria El-Sheikha and Ahmed Mohammed Abd-Elrazek
Ragab

Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University
Corresponding author: Ahmed M. Ragab; Mobile: 01066498927; Email: docahmedragab@hotmail.com

Abstract
Objective
: To evaluate the difference between fetal renal artery Doppler and fetal kidney volume in
normal and intrauterine growth restricted fetuses
Design: A prospective cross sectional study.
Setting: Obstetrics and Gynecology department, Al-Azhar University.
Sample: One hundred pregnant women, 50 with normal fetal growth parameter, and 50 with
restricted fetal growth.
Methods: Fetal renal volume was measured using 3-dimensional ultrasound. Umbilical artery and
fetal renal artery Doppler indices were examined.
Main outcome measures: Correlation of Doppler parameter to fetal kidney volume, and association
of fetal biometric indices to combined fetal kidney volume.
Results: Combined fetal renal volume was significantly reduced in growth restricted fetuses than in
normally grown fetuses as the Mean of combined renal volume in IUGR was (21.0 ± 0.1) while in
normal fetuses was (31.24±2.31). All fetal biometric indices were positively associated with
combined kidney volume. Concerning the umbilical artery Doppler and fetal renal artery Doppler
there was significantly difference between the two groups as the intrauterine growth restricted fetuses
have a high Doppler.
Conclusion: Intrauterine growth restriction appears to be associated with a statistically significant
decrease in the renal volume than the normally growth fetuses. The renal artery Doppler shows also
significant difference between the two groups, which matches with other studies. This study supports
the hypothesis that intrauterine growth restriction may be linked to renal disease and hypertension in
late life and renal volume can be used as a parameter for diagnosis of IUGR.

Keywords:
Fetal kidney volume; fetal renal artery Doppler; Intrauterine growth restriction

Introduction
The human kidney develops through three
Studies of kidney size in human fetuses of
successive embryonic stages. Transient
known gestational age have shown that
development and regression of the primary
intrauterine growth restriction is accompanied
(pronephros) and secondary (mesonephros)
by decreased kidney volume compared to
fetal kidneys occurs between day 23 and day
fetuses with appropriate weight for gestational
112. These primitive fetal kidneys have no
age (2).
impact on fetal renal function. The definitive,
Fetuses that fail to meet their growth potential
tertiary fetal kidney is the metanephros and
in utero are at risk for adverse antenatal and
this is the permanent functional kidney. It
postnatal events such as stillbirth, preterm
begins developing on day 30 leading to the
birth, and adverse neonatal and long-term
formation of nephrons - the functional units
health
outcomes.
Therefore,
antenatal
within the kidney. Fetal kidneys are unlike
recognition and monitoring of intrauterine
most other organs in that the maximum cell
growth restriction (IUGR) is an important
proliferation occurs in the third trimester.
component of prenatal care. In its simplest
Nephrogenesis continues up until 34­36 weeks
form, IUGR is defined as a sonographic
gestation with approximately 60% of nephrons
estimation of fetal weight below the tenth
formed in the third trimester (1).
percentile for a given gestational age (3).
Assessment of the fetal kidneys is an essential
part of an obstetric ultrasound. Accurate
6238
Accepted: 14/7/2018
Received: 5/7/2018

Full Paper (vol.733 paper# 8)


c:\work\Jor\vol733_9 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (3), Page 6243-6251
Fasting Insulin Level Changes after Large Volume Liposuction
Hanna Habib, Sarah Abd Alazeem, Nermin Abd Alazeem
Department of General Surgery, Faculty of Medicine - Ain Shams University
Corresponding author: Nermin A. Abdelaziz; Mobile: 01013613439; Email: nerminabdelaziem@gmail.com
Abstract
Background: Obesity is a disabling disease which has gained greater attention worldwide. It
significantly increases the risk for other diseases such as insulin independent diabetes mellitus also
known as diabetes type 2. The most common surgical procedure for obesity is liposuction. It is
traditionally performed either as small-volume liposuction or large-volume liposuction. Aim of the
Work:
to spot the light on the effect of large volume liposuction on fasting insulin level changes after
3 months postoperative and to find if LVL may obtain any improvement in metabolic variables. This
study will provide the clinician with a more valid basis on which to advise patients undergoing body-
contouring procedures, particularly to ensure realistic expectations regarding the effects of body-
reshaping procedures on general health. Patients and Mehtods: This is prospective study was
conducted on a total of 15 overweight and obese (BMI 26­35 kg/m2) premenopausal women (age 21­
40years). All subjects were at their maximum body weight and weight stable for at least 3 months.
The study took place at Ain Shams University Hospitals and other authorized hospitals under
supervision of thesis supervisors studying fasting insulin changes after 3 months following large
volume liposuction. Results: The present study demonstrates that large-volume abdominal liposuction
should, by itself, be considered a clinical therapy for obesity and its metabolic sequelae. Aspiration of
large amounts of subcutaneous abdominal fat in women with abdominal obesity, besides having
cosmetic benefits, does significantly improve fasting insulin levels. Therefore, the procedure is safe
and could successfully help obese subjects to reduce their potential metabolic risks. Conclusion: The
analysis of the study suggests that plastic surgery could play a role in metabolism. The surgical
removal of fat is not detrimental with regard to variation of metabolic indices.
Key words: Fasting insulin, large volume liposuction, body contouring, obesity.
Introduction
ultrasonic
liposuction,
power-assisted
Obesity is increasingly frequent in our
liposuction, and, more recently, laser-assisted
society and is associated closely with
liposuction) (4).
cardiovascular risk factors and metabolic
Liposuction classified into two types
disorders (1).
according to the volume of solution aspirated:
Liposuction has become one of the
High volume or low volume (<4,000 ml
most popular cosmetic procedures performed.
aspirated) (5).
The vast number of potential candidates, the
The definition of "large volume
relative ease of performance, the safety, and
liposuction" varies in the plastic surgery
the high patient satisfaction rate with suction
literature. In fact, no strict definition exists. The
lipectomy are the primary reasons for its
most common definitions refer to either total fat
popularity.The goal of the liposuction surgeon
removed during the procedure (eg, 4 L of fat
is to remove "target" fat, leaving the desired
removal) or total volume removed during the
body contour and smooth transitions between
procedure (fat plus wetting solution, eg, 5 L of
suctioned and nonsuctioned areas (2).
total volume removal (fat plus wetting solution)
Given that the procedure is traditionally
(6).
performed for cosmetic reasons, there are no
Recently, it has been suggested large
specific recommendations with respect to
volume liposuction is a potential treatment for
appropriate degree of obesity for the procedure,
reducing metabolic complications due to obesity
and suction lipectomy is often performed on
(7).
individuals with a BMI in the normal or
Insulin is an anabolic hormone that
overweight categories (3).
regulates plasma glucose by promoting
Liposuction is done by several
glucose uptake, glycogenesis, lipogenesis, and
techniques including introduction of tumescent,
protein synthesis of skeletal muscle and fat
3426
Received: 9/7/2018
Accepted: 18/7/2018

Full Paper (vol.733 paper# 9)


c:\work\Jor\vol733_10 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6252-6258

The Diagnostic accuracy of Ultrasound Guided Fine Needle Aspiration
Biopsy for Dominant Nodules in Multinodular Goiter
Abd Elrahman Mohamed Elmaraghy, Mahmoud Saad Farahat, Mohamed Mahmoud Elsayed,
Ahmed Mohamed Rushdi*
Department of General and Endocrine Surgery, Faculty of Medicine, Ain Shams University
*Corresponding author: Ahmed Mohamed Rushdi, Mobile: 01000503563; Email: dr.ahmed.rushdi.shemy@gmail.com

ABSTRACT
Background:
FNAC is useful tool to evaluate dominant thyroid nodule in patients with multi nodular
goiter however, because the diagnostic performance of US-based FNAC criteria varies according to
the individual international society guidelines, clinicians should be aware of the strengths and
weaknesses of US-based FNAC criteria in the management of dominsnt nodules in patients with
multinodular goiter. FNAC is an office procedure, done with or without local anesthesia with 23 to 27
gauge needle, to obtain cells samples for cytological examination. It is a safe, accurate and cost-
effective way for evaluating dominant thyroid nodules. Objective: the aim of this study was to
discuss the accuracy of Ultrasound guided FNAC technique in diagnosis of pathological types of
dominant nodule in multinodular goiter. Patients and Methods: this was a prospective study to
evaluate the accuracy of FNAC in diagnosis of pathological type of dominant nodule in 20 patients with
multinodular goiters who referred to the endocrine surgery unit at El-Demerdash Hospital, Ain Shams
University from March 2017 to December 2017. Results: in our study the FNAC results indicated
malignancy in 1 patients (5%), benign in 13 patients (65%) and intermediate in 6 patients (35%). The
final histopathological diagnosis was malignancy in 3 of the patients (15%); one case had follicular
thyroid carcinoma while two of the patients had malignant papillary thyroid tumor. Among the rest,
17 patients (85%) had benign lesion or tumor. Out of the 13 cases identified to be benign lesion by
thyroid FNAC 7.7% of the group subjects were found to be malignant follicular carcinoma by biopsy
(N=1). Conclusion: the main problem among the clinical features is false negatives, as it implies the
presence of undetected carcinomas. Although FNAC is useful test, our decision making should not be
depend on the basis of its results and sometimes clinical and U/S criteria are preferred to cytological
data.
Keywords:
Fluorodeoxyglucose, Fine-needle aspiration cytology, Ultrasonography, Magnetic
resonance imaging
Multinodular goiter (MNG) is defined
INTRODUCTION
as the palpation of multiple discrete nodules in
Thyroid nodule is a discrete lesion in
the enlarged thyroid gland. Etiology and
the thyroid gland that is radiologically distinct
pathogenesis of MNG is not very clear. A mild
from the surrounding thyroid parenchyma (1).
dietary deficiency of iodine, slight impairment
of hormones synthesis, increased iodide
Thyroid nodules are common; their
clearance from the kidney and presence of
prevalence in the general population is high, the
thyroid stimulating immunoglobulins have
percentages vary depending on the mode of
been suggested as the various causes (4).
discovery:
2­6 %
(palpation),
19­35 %
(ultrasound) and 8­65 % (autopsy data) (2).
MNG
is
a
risk
factor
for
epidemiologically
ascertained
thyroid
They are discovered either clinically on
malignancy. Epidemiologically studies have
self-palpation by a patient, or during a physical
demonstrated the incidence of malignancy in
examination by the clinician or incidentally
patient with MNG was higher than the incidence
during a radiologic procedure such as
of general population (5).
ultrasonography (US) imaging, computed
tomography (CT) or magnetic resonance
Traditionally patients with MNG have
imaging
(MRI)
of
the
neck,
or
been considered less at risk of malignancy
fluorodeoxyglucose (FDG) positron emission
than those with single nodule. However,
tomography. With the increased use of sensitive
published reports show that the incidence of
imaging techniques, thyroid nodules are being
malignancy in patients with single nodule dose
diagnosed incidentally with increasing frequency
not differs from those with MNG (6).
in the recent years (3).
6252
Received: 21/6/2018
Accepted: 30/6/2018

Full Paper (vol.733 paper# 10)


c:\work\Jor\vol733_11 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6259-6262

Non-Invasive Markers for Liver Fibrosis in Chronic HCV Patients

Mohamad Abd-Elrasheed1*,Mahmoud Abd-Elrasheed2

1Department of Tropical Medicine, 2Internal Medicine , Faculty of Medicine, Al-Azhar University,
Cairo, Egypt

* Mohamad Abd-Elrasheed,email: m-allam74@azhar.edu.eg, mobile:01005104342
Abstract
Background: liver biopsy for years was the only trustable tool for liver cirrhosis evaluation, it is an
invasive and painful procedure with considerable rate of complications. Looking for non-invasive
markers was mandatory.
Aim: we aimed to evaluate the use of non-invasive markers for fibrosis staging in HCV-infected
patients.
Patient and methods: from HCV patients subjected to antiviral therapy within 2015, 42 patients were
evaluated with histopathological staging (metavir-staging) after liver biopsy. According to
pathological stages, our patients were divided into two groups; group (I) of 18 patients with
significant liver fibrosis and group (II) of 24 patients of non-significant liver fibrosis. For all patient
age, ALT, AST, GGT, cholesterol, platelets count, bilirubin, prothrombin time and albumin were
evaluated and statistically correlated with fibrosis stage.
Results: patients with significant liver fibrosis had higher AST and GGT levels and lower S. Albumin
and prothrombin time than patient without significant liver fibrosis. Patients with significant liver
fibrosis had positive correlation between AST and GGT level and stage of fibrosis, also had negative
correlation between S. Albumin, platelet count and prothrombin time and stage of fibrosis.
Conclusion: non-invasive markers as AST, GGT, serum albumin, platelet count and prothrombin
time could be used as markers for diseases severity in cirrhotic patients of HCV.
Recommendation: recent studies must be done for evaluating these markers before and after HCV
therapy is highly recommended.

Keywords:
HCV; Hepatitis C virus, Liver biopsy and Liver Fibrosis

Introduction
(AST), alanine aminotransferase (ALT) ratio
Chronic HCV is the most prevalent
>1, from a clinical standpoint had been used
disease in hepatology clinics. Generally, it was
for diagnosis of liver fibrosis (6). Forns and
accepted that the diagnostic protocol of HCV
colleagues reported a fibrosis index based on
includes a liver biopsy (1). Liver biopsy is an
Age, Platelet count, Gamma ­GT, and
invasive and painful procedures which has rare
Cholesterol levels (4).
but potentially life- threatening complication
Aim: We aimed to evaluate the use of non-
(2,3).
invasive markers for fibrosis staging in HCV-
The prognosis and management of
infected patients.
chronic liver disease greatly depends on the

degree and progression of liver fibrosis. Liver
Patients and Methods
fibrosis
staging
provides
prognostic
This study included 42 patients with
information (3,4,5).
chronic HCV subjected to liver biopsy
The accuracy of liver biopsy in assessing
between January 2014 and December 2015
liver fibrosis has also been questioned, up to a
before INF-based antiviral therapy. This study
20% error rate in disease staging has been
was performed at Al-Hussein university
reported (4).
hospital. For all patients' written consent, full
Other testes like serum hyaluronate,
clinical
assessment,
laboratory
and
procollagen III, N-peptide, laminin, type IV
sonographic findings were recorded.
collagen matrix, metalloproteinase tissue
The examined patients were divided after
inhibitory metalloproteinase -1, transforming
liver biopsy into 2 groups, group (I) of 18
growth factor ­ beta, prothrombin index,
patients with significant liver fibrosis and
platelets count and aspartate aminotransferase
6259
Received: 21/6/2018
Accepted: 30/6/2018

Full Paper (vol.733 paper# 11)


c:\work\Jor\vol733_12 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6263-6267

Role of Medical Imaging in Cases of Stress Urinary Incontinence
Abdel Karim M. ElHemaly 1, Ibrahim Mahrous Kandil 1, Mohammed Salah Elden Hassanen 1,
Amr Mahmoud Zaied Mahmoud 2, Attia Mohammad Attia Ibrahim 1 *
1 Obstetrics and Gynecology Department, Faculty of Medicine for Boys, Al-Azhar University
2 Radiology Department, Faculty of Medicine for Boys, Al-Azhar University
* Corresponding Author: Attia Mohammad Attia Ibrahim, E-mail: atiabayoumy122@gmail.com
ABSTRACT
Background: traditional methods for evaluation of women with urinary incontinence include
urodynamic studies with measuring the pressure in the abdomen, the bladder, and the urethra and
urine flow analysis. In addition, cysto-urethroscopy, cysto-urethrography are used for visualization of
the bladder and the urethra.
Aim of the Study: urinary continence depends on a closed and empty urethra with high urethral pressure.
High urethral pressure (Pura) depends on two factors; one is structural which is defined as damage and
lacerations in the collagen chassis of the internal urethral sphincter (IUS), the second factor is acquired
functional factor is having and maintaining high sympathetic tone at the IUS from toilet training.
Patients and Methods: 40 women who from SUI are examined clinically and investigated with sonar
scanning 3DUS. 20 cases control by 3DUS. Patients with primary infertility those who had no vaginal
deliveries, did not suffer cognitive behavioral therapy. This study is done at Bab El-Sharia Maternity
University Hospital during the period from January 2017 to June 2018.
Result: the IUS, as it is a cylinder, the level and extent of the rupture along the cylinder will
determine the type and the degree of urinary incontinence as well as the configurational shape seen on
imaging (case with primary infertility two years ago).
Conclusion: we conclude that damage of the IUS leads low pura and stress urinary incontinence
(SUI). Childbirth trauma causes damage to the collagen layer (the frame) of the vagina that leads to
redundancy of the vagina and vaginal prolapse.
Keywords: Stress Urinary Incontinence, cysto-urethroscopy, Three Dimensional Ultrasound
INTRODUCTION
Urinary continence depends on a
The female pelvis contains three major
closed and empty urethra with high urethral
tracts that lie on and traverse the pelvic floor.
pressure (Pura) which depends upon two
These are the urinary bladder (UB) and the
factors: One inherent and one acquired.
urethra anteriorly, the female genital tract in
The inherent factor is the tough strong
the middle, and the rectum and anal canal
collagen layer constituent of the internal
posterior. The pelvic floor consists of the
urethral sphincter (IUS), that creates the high
pelvic floor muscles, mainly the levator ani
wall tension necessary for keeping high
muscles, and connective tissues and ligaments.
urethral pressure (Pura). The IUS is a
The relative contributions to the structural
collagen-muscle tissue cylinder that extends
support of the pelvic floor and its functions
from the bladder neck to the perineal
have been the subject of controversy (1).
membrane in both sexes (2).
With increasing age, women can
The acquired factor, which is high
develop voiding troubles as urgency,
alpha-sympathetic tone at the IUS gained from
overactive bladder, frequency, nocturia and
learning and training in early childhood, keeps
stress urinary incontinence (SUI). Other
it contracted and the urethra closes all the time
concomitant troubles, which occur, are genital
until there is a need or a desire to void as
prolapse, fecal incontinence (FI) and pelvic
social circumstances allow. Injury to one or
pain. All of these symptoms can be associated,
both factors leads to urinary incontinence.
to a greater or lesser extent, with pelvic floor
Imaging with 3DUS and MRI can
defects (1).
demonstrate the rupture in the IUS clearly. The
level of the rupture along the cylinder of the
2626
Received: 18/7/2018
Accepted: 28/7/2018

Full Paper (vol.733 paper# 12)


ABSTRACT The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6268-6271

Serum Beta 2-Microglobulin as a Biomarker of Activity in Ulcerative Colitis
Ihab Hassan Nashaat, Maha Mohsen Mohamed, Tari Magdy Aziz, Mina Wagdy Nakhla
Internal medicine and Gastroenterology, Ain Shams University
Corresponding Author: Mina Wagdy Nakhla, E-mail: Mina.wagdy1991@yahoo.com, Tel: 01206891272
ABSTRACT
Background:
ulcerative colitis (UC) is a chronic, idiopathic, inflammatory bowel disease that causes
inflammation and ulcers in the innermost layers of the large intestine (colon) and rectum. Assessment of
intestinal inflammation in UC is crucial and still remains a difficult challenge for the clinician. Although
endoscopic modalities with biopsy sampling seem to be the most reliable method for estimating disease
severity, they are invasive and costly. Apart from endoscopic interventions, disease severity can be assessed
using both laboratory studies and non-invasive imaging tests. C-reactive protein (CRP), erythrocyte
sedimentation rate (ESR), white blood cells (WBCs), acid glycoprotein, platelet count and albumin are in
common use but have only modest accuracy in reflecting UC disease activity. Therefore, adjunctive use of
additional serum markers that will be more sensitive and specific for determination of disease activity and
achieving diagnostic accuracy is strongly needed in daily clinical practice. Aim of the Work: to investigate
the diagnostic utility of beta 2 microglobulin (B2-M) levels and analyze this correlation with the activity of
ulcerative colitis disease. Patients and Methods: a case control study that was conducted at the
Gastroenterology Clinic, Internal Medicine Department, Ain Shams University during the period of January to
July 2018. 60 patients were recruited for the study. They were divided as follows; Group "A": 40 patients
newly diagnosed as ulcerative colitis based on colonoscopy and biopsy, subdivided as follows; 20 patients with
active ulcerative colitis and 20 patients with inactive ulcerative colitis. Group "B": 20 healthy individuals free
from any systemic diseases serving as a control group. Results: in this study, the serum levels of serum B2-
microglobulins were highest in patients with active ulcerative colitis compared to those with inactive ulcerative
colitis and the control groups. Also B2-microglobulins values become higher with higher number of presenting
symptoms and endoscopic activity, which becomes higher in severe disease. Conclusion: our results revealed
that serum B2-microglobulin was simple and non-invasive marker that could be helpful for differentiating active
UC from inactive disease. Moreover, it was more helpful when used together with serum laboratory inflammatory
indices (ESR and CRP).
Keywords: Serum Bet2-Microglobulins, Ulcerative Colitis, ESR, CRP, Endoscopy.

INTRODUCTION
difficult to assess objectively because of several
Ulcerative colitis is characterized by
subjective components. Serum B2-M levels are
idiopathic and chronic inflammation of the intestinal
elevated in diseases associated with increased cell
tract. Disease activity of ulcerative colitis is
turnover, and they are elevated in several benign
determined using both direct and non-invasive
condition such as chronic inflammation.
laboratory
markers.
However,
endoscopic
AIM OF THE WORK
examination is still the gold-standard diagnostic test,
To investigate the diagnostic utility of beta
even though it is invasive and expensive (1).
2 microglobulin (B2-M) levels and analyze this
Laboratory markers such as C reactive protein
correlation with the activity of ulcerative colitis
(CRP), erythrocyte sedimentation rate (ESR), white
disease.
blood count (WBC) and platelet count have been
investigated in IBD with different aims including
PATIENTS AND METHODS
diagnosis, disease activity, response to therapy, and
1-Patients: A case control study that was
estimate of relapse with a wide range of sensitivity
conducted at the Gastroenterology Clinic, Internal
and specificity (2). Beta 2 microglobulin (B2-M) is a
Medicine Department, Ain Shams University
low-molecular-weight protein released by activated
during the period of January to July 2018. The
T and B lymphocytes. The estimated half-lifetime is
study was approved by the Ethics Board of Ain
short. B2-M has been shown to increase in several
Shams University and an informed written
inflammatory and hematologic disorders, such as
consent was taken from each participant in the
systemic lupus erythematosus (SLE), acquired
study. 60 patients were recruited for the study.
immunodeficiency syndrome, multiple myeloma,
They were divided as follows; Group A: 40
lymphoma and leukemia (3) . Clinical IBD activity is
patients newly diagnosed as ulcerative colitis based
6268
Received:21/6/2018
Accepted:30/6/2018




Full Paper (vol.733 paper# 13)


c:\work\Jor\vol733_14 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6272-6282

Retrospective and statistical study of pattern of acute poisoning among
cases presented to emergency department of Kafr El - sheikh Governorate
hospitals
Mohamed A. El Gendy, Nagy Alfadaly, Ibrahim N. Mohamed
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Al -Azhar University,
Cairo, Egypt
Corresponding author: Mohamed A. El Gendy,email:yzezogindy@gmail.com
Abstract
Background:
Acute poisoning is a common situation in emergency departments all over the world. It
may cause severe complications and death. Treatment of these cases requires great medical care and
significant costs. There are many differences with respect to the pattern and cause of acute poisoning
between geographical regions, even within the same country.
Objective: This study was carried out to assess the pattern of acute poisoning with drugs, chemicals
and natural toxins in both adults and children in Kafr El - Sheikh Governorate hospitals.
Methods: The study was conducted onacutely intoxicated cases admitted to some of Kafr El - Sheikh
Governorate hospitals. The medical records of cases who were admitted due to acute poisoning from
January 2015 to January 2017 were reviewed retrospectively.
Results: This study included 1046 acute poisoned cases presented to ED. There were 85% less than 6
years old and 15 % more than 12 years old. .Number of males with toxic exposure was 421 while that
of females was 625. Pharmacological agents, constituted the highest percentage of the poisoning
(28.92%), followed by Insecticides (24.4 %), household products (20.45 %), food poisoning (12.5 %)
and animal poisoning (8.03%).The majority of cases of acute poisoning were accidental (78.01%),
followed by attempted suicide (21.98%).The majority of cases stayed at the hospital (51.9 %), while
(40.8 %) Discharged from ED and about (7.2%) referred to nearest poison centers. 1027 patients
(98.18%) recovered, only 1.3% developed complications.
Conclusion: Accidental poisoning is still a significant cause of morbidity. Regarding the high
prevalenceofpharmaceuticaldrugandhouseholdproductspoisoninginchildren,
implementation
of
legislations to ban over the counter selling of medications and to sell potentially dangerous chemicals
in childproof containers is recommended. Improving proper and complete medical record-keeping is
also suggested for a better information access.
Keywords: Acute Poisoning, Drugs, Household Products, Animal Envenomation
the uptake of natural human hormones by fish
Introduction
found downstream of sewage treatment plant

outfalls, or the chemical defenses produced by
Poisoning is the occurrence of harmful effects
some organisms as protection against predators.
due to exposure to a foreign chemical or a
Xenobiotic can produce harm to the biological
xenobiotic (1). Xenobiotic is a chemical
organism(4).
compound foreign to a given biological system.
The developed world has accurate information on
With respect to animals and humans, xenobiotic
incidence and changing trends of causative agents
include
drugs,
drug
metabolites,
and
as a result of rigorous population census and
environmental compounds such as pollutants that
mortality data and the development of Poison
are not produced by the body. In the
Control Center (PCC) (5). To the best of our
environment, xenobiotic include synthetic
knowledge, till date, no study on acute
pesticides, herbicides and industrial pollutants
poisoning in Kafr El Sheikh Governorate
that would not be found in nature(2).
region has been published. Kafr El Sheikh is a
Poisoning cases are increasing day by day
governorate that has an area of 3,437 km2. It
due to changes in the life style and social
islocated in the northern part ofEgypt, along
behavior. Advances in technology and social
the western branch of the Nile in the Delta. The
development have resulted in the availability of
population of the governorate as a whole is
most drugs and chemical substances in the
approximately 3,172,753.
community(3).

Natural compounds can also become xenobiotic

if they are taken up by another organism, such as

6272
Received: 13/7/2018
Accepted: 23/7/2018

Full Paper (vol.733 paper# 14)


c:\work\Jor\vol733_15 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6283-6290

Outcome of Endovascular Treatment of Cerebral Arteriovenous
Malformations with Ethylene Vinyl Alcohol Coploymer
Husein El Sayed Mohram, Mohamed Alaa EL Dein Habib, Sherif Hashem Mourad, Ahmed
Hassan Abo Zeid, Abd Allah Mouhammed Maher Salem
Department of Neurosurgery, Faculty of Medicine ­ Ain Shams University
Corresponding author: Abd Allah Mouhammed Maher Salem, Mobile: 01095635930, email:abdallahmaher1985@gmail.com
ABSTRACT
Background:
Cerebral AVMs are very rare lesions, and this rarity contributes to the difficulty of
treating them. There is no consensus concerning the method of treatment to be chosen among
neurosurgery, radiosurgery or embolization.
Onyx embolization could serve as a curative option with accepted morbidity and mortality. The
introduction of Onyx and of catheters with detachable tips has no doubt increased the rate of
endovascular occlusion, and decreased the risks associated with treatment in our experience.
Objective: The aim of the study was to assess the outcome of the use of Onyx in the treatment of
intracranial AVMs as curative embolization or before neuro- or radiosurgery
Patients and Methods: This analytical prospective study was conducted on 25 patients who were
diagnosed with cerebral arteriovenous malformations and underwent endovascular embolization with
EVOH copolymer with curative intent during the study period. Interventional procedures were done
in the neuro ­endovascular unit, neurosurgery department Ain Shams University Hospitals and
associate neuroendovascular unit in El Matarya Teaching Hospital in the period between September
2014 and April 2017.
Results: Actually comparing these results especially concerning the cure rate along with other studies
was somewhat confusing and problematic owing to the diversity in results between studies across the
last 15 years.
Conclusion: For the cases that are not fulfilling these criteria, embolization should be offered as
preparing step for other modality of treatment. In our experience, for curative embolization, the AVM
should be small sized (< 3 cm), supplied by one vascular territory, with feeders that can tolerate reflux
up to 2­3 cm, with clear proximal parts of the draining veins, and not located in deep structures.
Keywords: arteriovenous malformations - dimethyl-sulfoxide.
dissolved in dimethyl-sulfoxide (DMSO) with
INTRODUCTION
tantalum powder added for radio-opacity (2).
Despite advances in neurosurgical and
Its slow solidification allows for a
endovascular
techniques,
treatment
of
more prolonged and controlled injection which
intracranial
arteriovenous
malformations
permits theoretically slower filling, better
(AVMs) remains challenging, often requiring a
penetration, and obliteration of the nidus. The
multidisciplinary approach. Nidus reduction
introduction of Onyx into our AVM
before surgery or radiosurgery, curative
embolization practice has brought a different
embolization, and palliative embolization of
endovascular treatment philosophy in which a
AVMs are the different goals of endovascular
"cure" is intended in all brain AVMs, rather
treatment (1).
than this being a presurgical procedure.
Since the first report in the early1960s
The aim of the embolization became,
about transcatheter embolization of cerebral
primarily, to cure all small- to medium-sized
AVMs,
a
considerable
evolution
of
AVMs by embolization alone, and secondly, to
microcatheter tools, embolization materials,
reduce the size of the larger AVMs (2).
and techniques has improved the success of
embolization. Onyx (ev3, Irvine, California)
AIM OF THE WORK
was introduced a few years ago as a new
The overall aim of the study was to
embolic material for the endovascular
assess the outcome of the use of Onyx in the
treatment of brain AVMs. It consists of an
treatment of intracranial AVMs as curative
ethyl-vinyl alcohol (EVOH) copolymer
embolization or before neuro- or radiosurgery
6283
Received: 13/7/2018
Accepted: 23/7/2018

Full Paper (vol.733 paper# 15)


c:\work\Jor\vol733_16 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6291-6296

Pre-operative Prediction of Difficulties in Laparoscopic Cholecystectomy
Mahmoud Mohamed Ibrahim, Mohammed Hassan Elshafey, Ibrahim Ismail Elshaikh
Department Of General Surgery, El Hussin Hospital, Al Azhar University
Corresponding author: Ibrahim Ismail Elshaikh, Mobile: 01093226167, Email: himaelshaikh@gmail.com

ABSTRACT
Background:
Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic
procedures being performed by general surgeons all over the world. Preoperative prediction of the risk
of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. The
purpose of our prospective study was to analyze various risk factors and to predict difficulty and
degree of difficulty preoperatively by the use of a scoring system.
Objective: The objective of this study is to evaluate a Scoring system to predict difficult
laparoscopic Cholecystectomy.
Patients and Methods:
Laparoscopic cholecystectomy was done in the department of surgery, EL
Hussin University Hospital. The parameters considered in the preoperative scoring method were old
age, male sex, history of hospitalization, obesity, previous abdominal surgery scar, and palpable gall
bladder, wall thickness of gall bladder, pericholecystic collection and impacted stone. A total of 50
patients were included in the study.
Results: We found that history of hospitalization; palpable gall bladder, impacted stone and gall
bladder wall thickness were statistically significant factors for prediction of difficult laparoscopic
cholecystectomy. Conversion rate from laparoscopic to open cholecystectomy was found to be 4%.
Conclusion:
High risk patient may be informed beforehand regarding the probability of conversion
and hence they may have a chance to make arrangements. Surgeons can also be aware about the
possible complications that may arise in high risk patients.
Keywords: Laparoscopic cholecystectomy, Difficult, Prediction.

informed consent. This study was commenced
INTRODUCTION
after obtaining approval from the ethical
Laparoscopic
cholecystectomy
is
committee of the institution. Technique:
considered as the gold standard treatment for
laparoscopic cholecystectomy.
most gallbladder diseases(1). Preoperative
Study design: None randomized
assessment of complexity factors is needed
prospective study.
for frequent procedures such as (LC) in
order to avoid complications and delays
Inclusion criteria: Acute calcular
and to guarantee an efficient course of
cholecystitis, chronic calcular cholecystitis and
surgery(2).
Although
laparoscopic
Acute non-calcular cholecystitis
cholecystectomy has generally a low incidence
Exclusion criteria: Known cases of
of morbidity and mortality and of conversion
Carcinoma of gall bladder, late month's
rate to open surgery, its outcome is particularly
pregnancy,
affected by the presence and severity of
Bleeding diathesis and Presence of
inflammation, advancing patient's age, male
complications caused by migration of stones
sex and greater body mass index(3).
(jaundice, cholangitis, dilated common bile
duct, common bile duct stones).
Patients and Methods
RESULTS
This study was conducted in
A total of 50 patients were included in
department of general surgery, El hussin
this study. Majority of the patients were
university hospital within the period from
females (84.00%). Following variable risk
December 2017 to June 2018. A total 50
factors were analyzed (Table 1).Mean
patients were included in the study after prior
intraoperative time was 30 min (range 20-60
6291
Received: 17/7/2018
Accepted: 25/7/2018

Full Paper (vol.733 paper# 16)


c:\work\Jor\vol733_17
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6297-6303

Overview of Risk factors of diabetic macular edema treatment prognosis

Abdulrhman Ali Hassan Hassan, Ahmed Abdullah Yahya Ojaem, Mohammed Nasser Ahmed
Asiri, Sarah Hassan Asiri

Faculty of medicine, King Khalid University, Abha, Saudi Arabia

Abstract:
Background:
Diabetes mellitus (DM) is just one of the world's fastest growing chronic conditions as
well as a leading cause of acquired vision loss, diabetic macular edema (DME) is a disease linked to
diabetes. Some individuals with diabetes will certainly get a kind of retinopathy-a problem of the
retina in the eye. Diabetic retinopathy could progress as well as result in DME (additionally referred
to as retinal swelling) that might impact your vision, and is among the most usual reasons for
blindness.
Objective:
In this review we discuss about the most dangerous risk factors during treatment and in
daily life, which can worsen the treatment prognosis.
Methods:
PubMed and Embase database were searched up to July, 2018 for relevant studies that
discussing the risk factors of glaucoma.
Result:
It is clear that the variety of people affected by DM is expanding greatly, as is the variety of
patients with problems from DM. Fortunately; the eye symptoms of DME can be identified and
managed prior to considerable vision loss happens if patients with DM undergo routine eye tests and
much better manage their systemic condition.
Conclusion: Close collaboration in between doctors and also ophthalmologists is important in the
managing of patients with diabetic retinopathy and also DME. To make certain very early medical
diagnosis as well as treatment all diabetic person patients should be screened for diabetic person
retinopathy. Control of blood pressure, serum lipids, and also renal function are very important
treatments focused on prevention of visual impairment associated with diabetic retinopathy and DME.
Keywords:
Risk factors, diabetic macular edema, treatment, prognosis.

Introduction:

person macular edema (DME), left neglected,
Diabetes mellitus (DM) is just one of the
is a common cause of vision loss [3]. DME
world's fastest growing chronic conditions as
influences central vision as well as can cause
well as a leading cause of acquired vision loss
decrease in vision ranging from minor visual
[1]. According to the World Health
obscuring to blindness, substantially impacting
Organization, it is estimated that the total
self-reliance as well as quality of life [5]. At
variety of people with diabetes will double
least given that the 1980s and until 2010,
from 171 million in 2000 to 366 million by
focal/grid laser photocoagulation was the
2030 [2]. Diabetic retinopathy (DR), a details
standard of care to treat macular edema,
microvascular difficulty of DM, continues to
minimize the danger of vision loss, and also
be the leading root cause of obtained vision
enhance the opportunity of vision gain
loss worldwide in middle-aged as well as
compared with no therapy [6]. More just
therefore economically active individuals
recently, in phase II and also III tests with
[1].With the enhancing number of individuals
ranibizumab as well as aflibercept and phase II
with diabetes mellitus, the variety of DR and
trials with bevacizumab, intravitreal shots of
vision-threatening DR (VTDR), that includes
anti-vascular endothelial development variable
serious non-proliferative DR, proliferative DR
representatives have actually been shown to be
(PDR) as well as diabetic person macular
superior to focal/grid laser relative to reducing
edema (DME), has been approximated to rise
the risk of vision loss as well as raising the
to 191.0 million and also 56.3 million,
possibility of vision gain[7]. In intending the
respectively by 2030 [3].
demands and also estimating the prices
Diabetic eye disease is a leading cause of
associated with these additional resources, it is
vision loss in individuals aged 20 to 74 years
important to ascertain a precise estimate of the
[4]. Of the visually disabling problems in
magnitude of and take the chance of aspects
individuals with diabetic eye illness, diabetic
for DME.
6297
Received: 14/7/2018
Accepted: 24/7/2018

Full Paper (vol.733 paper# 17)


ROLE OF PET/CT IN DIAGNOSIS, STAGING AND FOLLOW UP OF COLORECTAL CANCER
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6304-6309
Cable Tie Seton in Surgical Treatment of High Perianal Fistula
El-Sayed Ahmed Mohammed Awad Ammar, Adel Mohammad Abdulhaleim Lasheen, Ahmed Shawki Abd-El-Aziz
General Surgery department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding Author: El-Sayed Ahmed Mohammed Awad Ammar, Email: ammargermany85@gmail.com.,
Tel.01030244881
ABSTRACT:
Background: Seton is any string-like material which when tied through the fistula tract causes an
inflammatory reaction which stimulates fibrosis that fixes and prevents retraction of the sphincter continuity
when it is divided. In this way, it maintains sphincter continuity during cutting process. Aim of work: was to
evaluate the
cable tie seton technique in surgical treatment of high perianal fistula, regarding the rate of
fecal incontinences and recurrence. Patients and Methods: This prospective study included a total of 20
cases having single tract, high perianal fistula, primary or recurrent and who were managed by cable tie seton
from October 2016 till September 2017. Patients were enrolled from General Surgery Department, Al-
Hussein Hospital. Patients were instructed to follow up weekly for 10 weeks with continuous tightening of
the seton. Results: All the patients were followed up for the state of incontinence for flatus, liquid and solid
stool and follow up for recurrence, slippage of cable: Incontinence: There is 3 cases noticed in early 2 weeks
incontinent for flatus. Incontinence for liquid stool noticed in 2 cases in early 1 week. Incontinence for solid
stool not noticed in our study. In all cases, the cable tie seton was kept in its position and didn't dislodged or
slipped. Conclusion: It could be concluded that cable tie seton is safe, low cost, ubiquitous, pragmatic,
precise, and accost effective option for the treatment of high perianal fistula. We there for recommended it
for treating fistula in ano requiring the placement of aseton. It does not carry the disadvantages of repeated
anesthesia and visits to the operating theater and reduce the morbidity, inconvenience, and cost to the patient.
Keywords: ACPGBI: Association of Coloproctology of Great Britain and Ireland; AFP: Anal fistula plug;
EAS: External anal sphincter; IAS: Internal anal sphincter
been conventionally treated by either fistulotomy,
INTRODUCTION:
or fistulectomy, which have been proven to be
Fistula-in-ano is one of the commonly
effective(4).Seton have been used to manage anal
encountered surgical problems with prevalence of
fistula from hundreds of years; however, in the
1.2 to 2.8/10,000. The classification of fistula-in-
literature, setons were commonly used only for
ano, as described by Parks et al. is based on the
high or complex anal fistula in order to avoid
location of its tract in relation to anal sphincter
fecal incontinence and recurrence(5). Seton is any
muscle: intersphincteric, transsphincteric, supra-
string-like material which when tied through the
sphincteric, or extrasphincteric (1). The term
fistula tract causes an inflammatory reaction
complex fistula is modification of the Park's
which stimulates fibrosis that fixes and prevents
classification, which falls in any one of these
retraction of the sphincter continuity when it is
conditions, that is, the track crosses >30% to 50%
divided. In this way, it maintains sphincter
of the external sphincter, anterior in females,
continuity during cutting process(6). Different
multiple tracks, recurrent, or the patient has
types of setons are used for this purpose like
preexisting incontinence, local irradiation, or
silastic tube, silk, linen, braided silk, rubber band,
Crohn's disease. Due to the involvement of the
braided polyester, vascular loop, polypropylene,
anal sphincter, the treatment of complex fistula
nylon, cable tie, and so forth(6). The reported
poses a high risk for impairment of continence (2).
incontinence and recurrence rate ranges from 0%
Due to the lack of a single appropriate technique
to 25%. Ritchie et al. (6).and from 0% to 16%(7).
for the treatment of fistula-in-ano, treatment must
respectively, with different materials used as
be navigated by the surgeon's experience and
seton. The cable tie is very cheap, easily inserted,
judgment. The surgeon has to keep in mind the
and provides convenient tightening in a clinic
tradeoff between the extent of sphincter division,
setting without need of analgesia which even can
postoperative healing rate, and functional loss(3).
be done by the attendants if they are trained onc.
Whatever the type and the extent of fistula are, the
principles of anal fistula surgery are to get rid of
The aim of the current work was to evaluate the
the fistula, prevent recurrence, and preserve
cable tie seton technique in surgical treatment of
sphincter function. Most of the fistula-in-ano has
high perianal fistula, regarding the rate of fecal
incontinences and recurrence.
6304
Received:21/6/2018
Accepted:30/6/2018

Full Paper (vol.733 paper# 18)


c:\work\Jor\vol733_19 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6310-6

315

Incidence of Placenta Accreta and its Complications in Cases of Previous
Cesearean Sections with Placenta Previa Anterior at Al Hussein University
Hospital
Abd Al Fattah Mohamed El sayed Al Senitty, Ashraf Hamdy Mohamed,
Ibrahim Mohammed Mohammed Ahmed*
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University
* Corresponding author: Ibrahim Mohammed Mohammed Ahmed, E-mail: himakamar67@gmail.com
ABSTRACT
Objective: Incidence of placenta accreta and its complications in cases of previous cesarean sections
with placenta previa anterior at Al Hussein University Hospital.
Materials and Methods: Ultrasound is the recommended first step in the diagnosis of placenta previa
accreta. Color Doppler ultrasound has been suggested to aid in the diagnosis of placenta previa
accreta. Magnetic Resonance Imaging also was used.
Results: Cesarean Hysterectomy performed in all cases of accretion, bladder injury in 19 (47.5%)
cases, bowel injury in 1 (2.5%) case, all cases received intraoperative blood transfusion, postoperative
blood transfusion in 38 (95%) cases and ICU admission in 25 (62.5%) cases.
Conclusion: The incidences of placenta accreta in cases of previous cesarean section with placenta
previa anterior were 63%. Incidence, risk factors and Feto-maternal outcome of management of
Patients with placenta accreta at Al Hussein University Maternity Hospital are comparable with those
presented in several literatures.
Keywords: Placenta Accreta, Cesearean Sections, Placenta Previa Anterior.
INTRODUCTION
Morbid Adherent Placenta (M.A.P)
the usefulness of ultrasonography in making
occurs when the chorionic villi invade the
this diagnosis, particularly at more than 20
myometrium abnormally. It is divided into
weeks' gestation (5). Unfortunately, some cases
three grades based on histopathology: placenta
of placenta accreta are diagnosed at the time of
accreta where the chorionic villi are in contact
delivery when the mother experiences
with the myometrium, placenta increta where
continued vaginal bleeding, or heavy vaginal
the chorionic villi invade the myometrium, and
bleeding when an attempt is In Egypt,
placenta percreta where the chorionic villi
Placenta accreta became prevalent mainly due
penetrate the uterine serosa (1).
to increased number of cesarean sections and
The exact pathogenesis of placenta
multiparity (National Institutes of Health
accreta is unknown. A proposed hypothesis
Consensus
Development
Conference
includes a maldevelopment of decidua,
Statement).As regard Al Hussein University
excessive trophoblastic invasion, or a
Hospital number of cases of placenta accreta
combination
of
both
(2).
Defective
increased in the last few years. Patients with
decidualization, abnormal maternal vascular
placenta accreta discovered at antenatal care
remodeling, excessive trophoblastic invasion,
visits diagnosed by ultrasonography, color
or combinations are considered to be the
Doppler or MRI and admitted in the maternal
consequences of previous instrumentation (3).
department for observation and to prevent the
expected
complications
(Al
Hussein
Placenta accreta is considered a severe
university Hospital document centre).
pregnancy complication that may be
associated with massive and potentially life-
AIM OF THE WORK
threatening intrapartum and postpartum
This work aims at determining the
hemorrhage (4). Placenta accreta is diagnosed
incidence of placenta accreta and its
ideally in the antenatal period by either
complications in cases of previous cesarean
sonographic or magnetic resonance imaging
sections with placenta previa anterior and
techniques. Several studies have demonstrated
outcome
of
management
of
these
97:6
Received: 19/7/2018
Accepted: 27/7/2018

Full Paper (vol.733 paper# 19)


c:\work\Jor\vol733_20 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6316-6323
Prevalence and Risk Factors of Diabetic Septic Foot among Attendees of
Diabetes Center of Arar City, Northern Saudi Arabia

Najah Dhaher Y Alanzi 1, Rehab Thayib R Alanazi 1, Hadeel Saud D Alanazi1, Fadih Nada M
Alenezi 2, Rehab Mohammed A Alanazi 2, Itizaz Hatim R Alanazi 2, Malak Sayah S
Alkuwaykibi 2, Marwah Motlaq A Alanazi 2, Banan Khalid M Alotaibi 2, Huda Owaid H
Alanazi 2, Rehab Zaid M Alayyashi 2, Reem Meshal T Almjlad 2, Rahmah Subhi H Alanazi 2,
Amer Ahmed Balla 3

1 Medical Intern, Northern Border University, Arar, KSA,2 Medical student, Northern Border
University, Arar, KSA,3 Assistant Professor and Endocrine specialist, Faculty of medicine, Northern
Border University, Arar, KSA

Abstract
Background:
Diabetic septic foot contributes significantly to morbidity and mortality of patients with
diabetes leading to substantial physical, physiological and financial burden for the patients and
community at large. Objective: to determine the prevalence, patterns and risk factors of diabetic foot
ulcers amongst patients with diabetes mellitus who were attending the diabetes center of Arar city in
the period of the study. Methods: This was a retrospective study in the patients of the diabetes center
of Arar city, Northern Saudi Arabia. The study was carried out during the period from 1 April to 31
May, 2018. All the patients attended the diabetes center in the period of the study were included in
our data. The data were collected using a predesigned questionnaire. The questionnaire covered all the
necessary items in the research. Data were collected through personal interviews with the participants
and filling the questionnaires. Results: The prevalence of diabetic foot among the included diabetic
patients was 52.8%. 77.8% had type II and 22.2% had type I, 83.3% had glucometer and 38.9%
monitor their blood glucose level daily, 41.7% were obese, 77.8% had hypertension, 52.8% had
hyperlipidemia. Only 11.1% examined the pulse and sensation the foot of the population. For diabetes
control, 58.3% of them use oral tablets, 27.8% use insulin injection and 13.9% use both tablets and
insulin but 52.8 of them have complication with treatment. Conclusion: The prevalence of diabetic
foot among the included diabetic patients was high (52.8%). This emphasizes the importance of the
more health education and better management of the diabetic patients in order to reduce the burden of
health care costs of diabetic foot.
Key words: Diabetes, ulcers, septic, complications.

Introduction:
diabetes leading to substantial physical,
physiological and financial burden for the
Diabetes, considered as a disease of developed
patients and community at large (3).
countries, is one of the endocrine disorders
Epidemiologic studies suggest that 2.5% of
that reached epidemic proportions worldwide
diabetic patients develop diabetic foot (DF)
(1). Therevalence of diabetes worldwide was
ulcers each year and 15% develop DF ulcers
estimated to be 2.8% in 2000 and is projected
during their lifetime (4). It is a common
to be 4.4% in the year 2030, with the total
complication of diabetes which may require
number of people with diabetes expected to
long hospitalization or frequently leads to
rise from 171 million in 2000 to 366 million in
amputation of the extremities (5). It is
2030 (1). Lots of complications are associated
estimated that approximately 2.5% of all
with DM. Those complications arise chiefly
diabetic patients will develop foot problems
from the disruption of the vascular system
yearly (6). Individuals with diabetes are at a 30-
which can result in inadequate circulation to
times higher risk for lower extremity
the peripheral body. This places the foot at
amputation compared with those without
higher risk of ulceration and infection which is
diabetes (5). Globally, it is estimated that every
mainly the cause of diabetic septic foot (2).
30 seconds a lower limb is lost somewhere in
Diabetic septic foot contributes significantly to
the world as a consequence of diabetic septic
morbidity and mortality of patients with
foot (DSF) (7). The risk of ulceration and
6136
Received: 12/7/2018
Accepted: 22/7/2018

Full Paper (vol.733 paper# 20)


c:\work\Jor\vol733_21 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6324-6330


Lower Respiratory Tract Infection in Pediatrics, Treatment Approaches:
Review Article

Mohammed Hundur Alasmari, Abdulaziz Abdullah Alhazmi, Abdullah Salem Al Haider,
Yaqoub Mubarak Ali Alhamami, Nasser Naji Mohsen Al harthi, Mana Ali Mueidh Al hajlan

Medical school, Najran University, Najran, KSA

Abstract:
This article outlines the etiology and epidemiology of childhood acute lower respiratory tract
infections (ALRI), preventative measures, and management of the most common and important cause
of ALRI, pneumonia.
Method: We conducted a review to determine the proper treatment of Lower respiratory tract
infection in pediatrics. In May 2018 we searched PubMed, Medline, and EMBASE databases
Conclusion: Viral lower respiratory system infections in newborns and children are important clinical
and socioeconomic problems worldwide. Viral lower respiratory system infections are mild and self-
restricting in many cases. Specific patient groups are at risk of a severe program of illness, although
formerly healthy infants with a viral lower respiratory tract infection may additionally develop
extreme illness.
Keywords: Respiratory Tract Infection, Pediatrics, pneumonia, Treatment Approaches.

Introduction:
appropriate
anti-bacterial
therapy
and
According to world health organization
precautionary treatments against the leading
(WHO) estimates, even more than 150 million
reasons for youth mortality [5]. This strategy
episodes of community-acquired pneumonia
has been effective in reducing ARI- related
and 2 million pneumonia-related deaths took
mortality in kids below 5 years in developing
place in the year 2008 amongst children under
nations [6]. Over time, to increase the
five years of age in creating countries. Of all
specificity of the guidelines, the programs
pneumonia instances, 7-13% were sever
have advanced [7]. Our goals in this narrative
enough to be life-threatening and necessary
review are: to define and diagnose pneumonia
hospitalization [1] . To decrease the morbidity
and its subtypes based on the WHO standards,
and mortality caused by pneumonia in
to define the most ideal antibacterial agent for
youngsters below 5 years in resource-poor
different settings of diseases "simple versus
countries the WHO has developed a basic
sever and really sever pneumonia", to diagnose
situation-management approach of acute
and discuss one of the most suitable
respiratory infection (ARI) in the 1980s with
approaches to cases with treatment failing, and
early diagnosis of pneumonia and empirical
lastly to define patients that have benefited
antibacterial treatment [2]. The basis for the
from other treatments.
case-management program was that nearly all
This article outlines the etiology and
ARI-related death was caused by bacterial
epidemiology
of
childhood
ALRIs,
pneumonia. According to the protocol,
preventative measures, and management of the
pneumonia can be differentiated from other
most common and important cause of ALRI,
respiratory diseases by trained paramedical
pneumonia.
healthcare providers using basic medical signs
Methodology:
in primary health facilities [3]. The WHO
We conducted a review to determine the
integrated the ARI instance- management
proper treatment of Lower respiratory tract
standards right into the medical protocols of
infection in pediatrics. In May 2018 we
"The Integrated Management of Childhood
searched PubMed, Medline, and EMBASE
Illnesses (IMCI)" and the program had been
databases using the search terms: LRTI in
taken on by many establishing nations [4].
pediatrics, including acute lower respiratory
These guidelines consisted of referrals for the
illness and bronchiolitis. Search results were
instance- management of acute childhood
restricted to English language with human
illnesses and guidance when referral to greater
subjects.
levels of care is needed. They specify

6324
Received: 16/7/2018
Accepted: 26/7/2018

Full Paper (vol.733 paper# 21)


c:\work\Jor\vol733_22
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6331-6336

Risk factors associated with glaucoma disease progression
Ahmed, Ali Yasen A, Althomali, Ibrahim Hassan M, Althobaiti, Omar Mohammed A, Assery,
Mohannad Solaiman Faia, Alsini, Abdullah Abdulwahab N
Medical school Taif University, KSA
Abstract:
Background: Glaucoma is a disease which damage the eye's optic nerve. That so many instances of
glaucoma can be undiscovered ways that research studies based in hospitals or specialist clinics, as an
example, can be biased to specific classes of referred patients and so not representative of the Glaucoma
associate. Objective: In this review we discuss risk factors that lead to onset of glaucoma and focus on
risk factors affecting the progression of this disease, to give information to prevent and start early
treatment. Method: PubMed and Embase database were searched up to July, 2018 for relevant studies
that discussing the risk factors of glaucoma. Conclusion: The most consistent factors are older age and
also higher baseline IOP. Currently, there is very little we can do about age, due to the fact that it is
probably a surrogate threat factor for various other potentially more important elements, for example,
mitochondrial performance. Because IOP can be lowered either medically or operatively, it is a flexible
threat or prognostic element for open-angle glaucoma.
Key words: review, risk factors, glaucoma, old age, progression.

Introduction:
The variety of individuals with visual
diagnosed [4]. That so many instances of
impairment in 2002 was greater than 161 million
glaucoma can be undiscovered ways that
around the world, of which about 37 million
research studies based in hospitals or specialist
were bilaterally blind [1]. After cataract glaucoma
clinics, as an example, can be biased to specific
is found to be the 2nd leading root cause of loss
classes of referred patients and so not
of sight [2]. The effect of glaucoma on health-care
representative of the Glaucoma associate [5],
systems is presently enhancing with aging
which should preferably consist of all the
population. In the Western world chronic open-
undiagnosed cases. Identification of the risk
angle glaucoma (OAG) is without a doubt the
variables for glaucoma advancement requires
most typical form of the illness. Glaucoma
population-based studies [5].
entails a progressive loss of retinal ganglion cells
Rate of progression is a scientifically vital yet
(RGC) as well as characteristic changes in
difficult to measure criterion in glaucoma
neuroretinal rim tissue in the optic nerve head
disease management. An exact sign of rate of
(ONH) which are accompanied by visual field
development of glaucomatous illness would
(VF) restriction [1]. There are numerous sorts of
enable clinicians to determine patients who are
glaucoma comprising a team of eye illness
at the majority of threat of enduring a substantial
which are the leading reason for permanent
decrease in their quality of life from the
blindness around the world [2]. Besides the threat
condition. In spite of numerous studies
of developing glaucoma there is the risk that it is
examining the methods of measuring condition
not spotted and also permanent loss of vision
progression, there is still currently little
follows [1]. In an example of 5000 city Greek
consensus with major randomised regulated
individuals over 59 years of age, 57.1% of
trials using various approaches [6]. A major
glaucoma situations were located to be
concern that avoids the precise measurement of
undiagnosed
[3]. A research of 3654
glaucoma condition development is that it is
predominantly white Australians (90.2% over 60
concealed by the brief and also long-term
years of age and 24% over 80 years of age)
irregularity that is inherent in visual field
discovered that the occurrence of POAG was
screening [7]. Trend based evaluation, although
3.0% with 51% not having been previously
incomplete, enables medical professionals to
6331
Received: 14/7/2018
Accepted: 24/7/2018

Full Paper (vol.733 paper# 22)


c:\work\Jor\vol733_23
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6337-6341

The Use of CT and MRI in Evaluation of Primary Brain Tumors in Saudi
Arabia

Saad Mohammed Alhaqbani1*, Dalal Aayed Al-Harbi2, Abdulaziz Musaad Mutiran Aljohani3,
Talal Ahmad Ali Alomari4, Mohammed Mousa Alghamdi5, Fawaz Abdulrahman Alsaleh6,
Eman Mohammad Alfaraj7, Abdulrahman Nasser Alakeel8

1Prince Sattam Bin Abdulaziz University, Al-Kharj, 2Batterjee Medical College, Jeddah,
3King Khalid University, Abha, 4Al-Baha University, Saudi Arabia5Almaarefa Colleges, Riyadh, 6Al
Imam Mohammed Ibn Saud Islamic University, Riyadh, 7ImamAbdulrahman Bin Faisal University,
Dammam, 8King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

*Corresponding Author: Saad Mohammed Alhaqbani, E-mail: S3dm92@hotmail.com

ABSTRACT
Background:
Imaging plays a crucial function in the management of patients with brain tumors. The
technical improvement of computed tomography (CT) and magnetic resonance imaging (MRI) with
the advancement of, brand-new imaging techniques highly enhanced the detection and
characterization of brain tumors. This comprehensive review of literature is aimed to discuss the roles
of MRI & CT in the diagnosis and evaluation of primary brain tumors, we attempted to discuss the
advantage and disadvantage of each modality and which is more effective in this matter.
Objective: to find a relevant article to our study, this is discussing the roles of MRI and CT in
evaluation of Primary brain tumors. Several terms were used in the search through the databases;
(MRI, CT, and Imaging), combined with (Brain cancer, primary brain tumors, glioblastomas).
Method:
We performed a comprehensive search of literatures among main medical databases;
PubMed (MIDLINE), Embase, and science direct, up to November 2017, We limited our search to
English language studies, and only to Human trails.
Results: Computed tomography (CT) might be the very first modality employed in a patient
presenting with a brain tumor but for one of the most part MRI is the primary imaging modality in
brain tumor patients. The function of CT is mostly relegated to emerging imaging in the detection of
hemorrhage, herniation, and hydrocephalus but mass effect from brain tumors and calcification within
brain tumors such as oligodendrogliomas or meningiomas can potentially be discovered.
Conclusion: The main use of MRI-based medical image analysis for brain tumor studies remains in
medical diagnosis, patient tracking and treatment preparation, however it could also be useful in
clinical trials.

INTRODUCTION

Imaging plays a crucial function in the
technical enhancement of CT and MRI, the
management of patients with brain tumors.
energy of contrast material in the imaging of
The technical improvement of computed
brain tumors along with the introduction of
tomography (CT) and magnetic resonance
new imaging strategies, enhanced substantially
(MRI) with the advancement of, brand-new
the detection and the evaluation of brain
imaging techniques highly enhanced the
neoplasms. As soon as a brain tumor is
detection and characterization of brain tumors.
scientifically
presumed,
radiologic
For the ideal therapeutic management of the
examination is required to figure out the
oncologic patient not only the recognition of
location, the level of the tumor and its
the lesion is needed, however likewise the
relationship to the surrounding structures (3,4).
exemption of other diseases that can mimic
Brain tumors share some functions and
brain tumors (1,2). Imaging plays an essential
obstacles for medical diagnosis and treatment
role in the assessment of patients with brain
with tumors elsewhere in the body, but they
tumors. CT and MRI represent the two crucial
also posture specific problems that relate to the
and frequently used imaging modalities. They
distinct homes of the organ they being in (5).
have a significant impact on patient care. The
Most of the brain is separated from the blood
6337
Received: 21/7/2018
Accepted: 1/8/2018

Full Paper (vol.733 paper# 23)


c:\work\Jor\vol733_24
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6342-6347

Management of Abdominal Trauma with Liver Injuries among
Patients in Riyadh, Saudi Arabia

Khaled Abdullah Alshareef1*, Amirah Mohammed Alosaimi1, Luay Mohammed
Sahyun2, Hashem Mohammed Justaniah2, Mahmoud Talat Khodary2, Faisal Khalid
Alhothali3, Yasir Mohammed Alsagoor4, Yaser Abbas Alnajrani5

1Almaarefa Colleges, Riyadh, 2IbnSina National College for Medical Studies, Jeddah,
3University of Jeddah, Saudi Arabia,4University of Groningen, Netherlands,5University of
Najran, Saudi Arabia
*Corresponding Author: Khaled Abdullah Alshareef, E-mail: Khaled.alshareef@hotmail.com

ABSTRACT
Background:
recently, there was a shift in the management plan for liver blunt trauma from
operative to non-operative treatment, as there were advances in critical care and sensitivity of
diagnostic tools for detection of liver injury such as CT scan. Objectives: To estimate the
prevalence and correlates of non-operative management of liver injury among abdominal
trauma patients admitted under surgical team care. Patients and Methods: this is a
retrospective cohort study carried out in Riyadh, Saudi Arabia from May 2017 to June 2018.
All patients admitted to general surgery departments with abdominal trauma and liver injuries
were included. Variables were obtained through file review. Results: the study included 54
patients with liver trauma. Their age ranged from 7 to 60 years with mean age of 29.2±11.3.
Male was the dominant gender; with male to female ratio were 8 to 1. Regarding mechanism
of injury, all cases of fall down and 88.9% of road traffic accidents compared to none of
penetrating injury were treated non-operatively, p=0.011. Concerning CT grading, all cases
of grade I compared to 75% of grade IV and 70% of grade III were treated non-operatively,
p=0.016. Majority of patients treated non-operatively (45/48; 93.8%) compared to one third
of those treated operatively (2/6; 33.3%) were improved on discharge, p<0.001. Conclusion:
the prevalence of non-operative management of liver injury in Riyadh hospitals is currently
very high, ever for high-grade injuries. Most of them were improved on discharge compared
to those managed operatively.
Keywords: Liver Injury, Non-Operative, Operative, Retrospective Cohort.

INTRODUCTION
Operative management of liver trauma was
Therefore, surgeons should understand the
considered the golden standard of
indications for operative intervention well
treatment before two decades (1). Recently,
(6). Non-operative management of liver
there was a shift in the management plan
trauma should be carried out if possible in
from operative to non-operative treatment,
every patient provided he is hemo-
as there were advances in critical care and
dynamicaly stable. Riyadh hospitals in
sensitivity of diagnostic tools for detection
receive huge number of MVA (motor
of liver injury such as CT scan (2). Non-
vehicle accident), and Saudi Arabia
operative
management
started
by
considered having one of the highest rates
conserving low-grade liver injury and it's
of RTA in the world (7).
proved to be a good tool, higher grades of
Abdominal trauma and liver injury is one
liver injuries also treated non-operatively
of the commonest presentations in Riyadh
and
it
decreased
the
morbidity
hospitals. This study carried out because of
complication rate of operative treatment (3).
limited studies addressing this issue in the
Patients with hepatic trauma associated
kingdom of Saudi Arabia to estimate the
with hemodynamic instability and co-
prevalence and correlates of non-operative
morbid organ injuries need surgery as they
management of liver injury among
are subjected to higher mortality (4,5).
abdominal trauma patients admitted under
6342
Received: 22/7/2018
Accepted: 2/8/2018

Full Paper (vol.733 paper# 24)


c:\work\Jor\vol733_25
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6342-6347

Management of Abdominal Trauma with Liver Injuries among
Patients in Riyadh, Saudi Arabia

Khaled Abdullah Alshareef1*, Amirah Mohammed Alosaimi1, Luay Mohammed
Sahyun2, Hashem Mohammed Justaniah2, Mahmoud Talat Khodary2, Faisal Khalid
Alhothali3, Yasir Mohammed Alsagoor4, Yaser Abbas Alnajrani5

1Almaarefa Colleges, Riyadh, 2IbnSina National College for Medical Studies, Jeddah,
3University of Jeddah, Saudi Arabia,4University of Groningen, Netherlands,5University of
Najran, Saudi Arabia
*Corresponding Author: Khaled Abdullah Alshareef, E-mail: Khaled.alshareef@hotmail.com

ABSTRACT
Background:
recently, there was a shift in the management plan for liver blunt trauma from
operative to non-operative treatment, as there were advances in critical care and sensitivity of
diagnostic tools for detection of liver injury such as CT scan. Objectives: To estimate the
prevalence and correlates of non-operative management of liver injury among abdominal
trauma patients admitted under surgical team care. Patients and Methods: this is a
retrospective cohort study carried out in Riyadh, Saudi Arabia from May 2017 to June 2018.
All patients admitted to general surgery departments with abdominal trauma and liver injuries
were included. Variables were obtained through file review. Results: the study included 54
patients with liver trauma. Their age ranged from 7 to 60 years with mean age of 29.2±11.3.
Male was the dominant gender; with male to female ratio were 8 to 1. Regarding mechanism
of injury, all cases of fall down and 88.9% of road traffic accidents compared to none of
penetrating injury were treated non-operatively, p=0.011. Concerning CT grading, all cases
of grade I compared to 75% of grade IV and 70% of grade III were treated non-operatively,
p=0.016. Majority of patients treated non-operatively (45/48; 93.8%) compared to one third
of those treated operatively (2/6; 33.3%) were improved on discharge, p<0.001. Conclusion:
the prevalence of non-operative management of liver injury in Riyadh hospitals is currently
very high, ever for high-grade injuries. Most of them were improved on discharge compared
to those managed operatively.
Keywords: Liver Injury, Non-Operative, Operative, Retrospective Cohort.

INTRODUCTION
Operative management of liver trauma was
Therefore, surgeons should understand the
considered the golden standard of
indications for operative intervention well
treatment before two decades (1). Recently,
(6). Non-operative management of liver
there was a shift in the management plan
trauma should be carried out if possible in
from operative to non-operative treatment,
every patient provided he is hemo-
as there were advances in critical care and
dynamicaly stable. Riyadh hospitals in
sensitivity of diagnostic tools for detection
receive huge number of MVA (motor
of liver injury such as CT scan (2). Non-
vehicle accident), and Saudi Arabia
operative
management
started
by
considered having one of the highest rates
conserving low-grade liver injury and it's
of RTA in the world (7).
proved to be a good tool, higher grades of
Abdominal trauma and liver injury is one
liver injuries also treated non-operatively
of the commonest presentations in Riyadh
and
it
decreased
the
morbidity
hospitals. This study carried out because of
complication rate of operative treatment (3).
limited studies addressing this issue in the
Patients with hepatic trauma associated
kingdom of Saudi Arabia to estimate the
with hemodynamic instability and co-
prevalence and correlates of non-operative
morbid organ injuries need surgery as they
management of liver injury among
are subjected to higher mortality (4,5).
abdominal trauma patients admitted under
6342
Received: 22/7/2018
Accepted: 2/8/2018

Full Paper (vol.733 paper# 25)


c:\work\Jor\vol733_26
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6354-6358

A simple index to predict myocardial infarction size and adverse clinical
outcome in patients with acute STEMI undergoing primary PCI

Osama Amin Abd- Elhamid, Wael Samy , Akram Abdelbary , Tarek Elgohary , Alia Abd-El-
Fattah.
Critical Care Department, Faculty of Medicine, Cairo University
Corresponding author: email: Osama Amin Abd- Elhamid,email: osamaamin130@yahoo.com

Abstract

Background: Early improvement of perfusion after acute MI will improve left ventricle function and
decrease the infarction area, thus decreasing mortality.
Methodology: 52 patients presented with acute ST segment elevation MI Who underwent primary
PCI within 24 hours of presentation. All patients were subjected to full history taking, physical
examination, serial ECG, cardiac enzymes, calculation of relative importance index (RII) by dividing
culprit segment diameter by left anterior descending , circumflex and right coronary arteries at their
proximal segments and myocardial perfusion image to detect infarction size.
Results: There is significant correlation between RII and left ventricular dysfunction
(p: 0.028). Significant correlation between RII and mortality are present.
Conclusion: RII is significantly correlated with adverse clinical outcome in patients with acute
STEMI.
Key words: Simple index, STEMI, Primary PCI.

Introduction
Acute myocardial infarction (MI)
mortality(6).The
efficacy
of
reperfusion
indicates irreversible myocardial injury
treatment may be shown indirectly with
resulting in necrosis of a significant portion of
electrocardiography (ECG), by regression of
the myocardium secondary to occlusion of an
ST elevation, but there is a need for methods
epicardial artery. The area of infarct occurs in
to demonstrate left ventricle and microvascular
the distribution of the occluded artery, which
function
improvement
(7)
.Primary
typically starts at the subendocardium and
percutaneous coronary intervention (PCI) is
progresses towards the epicardium in a wave-
regarded as the best reperfusion model in
front fashion(1). Clinical outcome after acute
STEMI.
MI depends largely on final infarct size and is
Over the last 20 years, nuclear
improved with early reperfusion. The major
cardiology has become a mainstay in the
determinant of final infarct size for a given
evaluation of ischemic heart disease. In the
coronary occlusion is the size of the
setting of acute coronary syndromes
myocardial area-at-risk (AAR)(2,3). Therefore,
(myocardial infarction or unstable angina),
deter- mination of both initial AAR and final
myocardial perfusion imaging has emerged as
infarct size after acute MI has major clinical
an important tool in assessing the functional
implications since it permits an accurate
significance of angiographic coronary stenosis,
assessment of myocardial salvage provided by
evaluating the efficacy of therapeutic
reperfusion therapies. Final infarct size is
intervention and risk-stratifying patients in the
always less than the initial AAR.
post infarction period (8) .
Successful rescue PCI within 3­24
Myocardial
perfusion
imaging
hours of the onset of chest pain has been
possesses not only diagnostic but also
associated with improved LV systolic function
prognostic
value,
because
it
permits
at a mean follow-up period of 22 months (4). In
stratification of patients into categories of risk
this
study,
baseline
and
repeated
for future cardiac events (9-10).
Echocardiography were used to assess LV
Patients and methods:
systolic function. Other studies of primary PCI
52
patients
were
prospectively
have also reported improved LV systolic
enrolled in our study presented with their first
function compared to thrombolysis (5).
STEMI event and were undergone primary
Early improvement of perfusion after
PCI within the first 24 hours of presentation.
MI will improve left ventricle function and
The study was approved by the Ethics
decrease the infarction area, thus decreasing
Board of Cairo University.
6354
Received: 28/7/2018
Accepted: 8/8/2018

Full Paper (vol.733 paper# 26)


c:\work\Jor\vol733_27 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6359-6366

The Influence of Stress on Body Mass Index among Female University
Students

Nada Fahad M Alsultan1, Malik Dham Alanazi1, Ayat Abdulnasser Boholigah2, Daham Obaid
Alshammari1, Kawthar Ali Alnahwi2, Zahrah Ali Alsayafi1, Yahya Mohammed Alzahrani1,
Lama Zaki Nasserullah2, Lina Zaki Nasserullah2

1- Student, King Faisal University, 2-Student, Arabian Gulf University

Abstract:
Background:
The interrelatedness between obesity and psychological problems seems to be twofold,
in that clinically meaningful psychological distress might foster weight gain and obesity may lead to
psychosocial problems. Stress may contribute to changes in dietary behaviors that lead to weight
change, with various effects related to sex baseline body mass index, or cortisol reactivity in response
to stress. Objective: To describe the relationship between stress, weight-related health behaviors (e.g.,
eating behaviors, physical activity, sedentary behavior, sleep, cigarette smoking and binge drinking),
and weight status using cross-sectional data from community college students. Methods: This was a
community-based cross-sectional study. Data were collected from representative sample of
undergraduate female students in Kingdom of Saudi Arabia. A total of 208 undergraduate female
students were included in this study. The study period was from October 2017 to December 2017.
Data were collected by means of personal interview with the participants using a predesigned
questionnaire which was distributed among students and filled by personal interviewing after a brief
introduction or explanation of the idea of the research to the participants . Results: There was a high
significant correlation between stress and BW (P= 0.004). We found no relation between BW and
academic year, fast food consumption, main meal content, muscular exercise and cause of stress.
There was a high significant correlation between BW and number of meals per day (P= 0.000), stress
level (P=0.000) and dealing with stress (P=0.017). Conclusion and Recommendations: Factors
which were significantly associated with BMI and stress should be further studied to include number
of meals per day, stress level and dealing with stress). Interventions among university students should
relate actual measured BMI to stress perception of the students in order to target students at risk.
Universities should offer individual counselling for at risk students in order to prevent eating
disorders, and should offer psychological and stress related counselling, but should also counteract
unrealistic body image concerns of students by broad health communication campaigns.
Keywords: University students, BMI, Stress, Influence, Dietary behaviors, Muscular exercise

Introduction:
Obesity is one of the major non-communicable
overweight or obesity: type II diabetes,
diseases in recent decades leading to huge
coronary heart disease, high blood pressure
morbidity, mortality & economic losses.
(hypertension),
High
cholesterol
level
Obesity is perhaps the most prevalent form of
(dyslipidemia) [6]. Young adults enrolled in
malnutrition. Overweight and obesity are the
university or college are subjected to high
fifth leading risk of global deaths [1].
levels of stress from a number of factors that
Prevalence of obesity and an overweight status
can lead to maladaptive coping mechanisms
within the college student populace has
such as convenience eating in the form of
become a rapidly increasing occurrence. The
eating out at fast food establishments and
population with the most dramatic rise in rates
ordering food for delivery. This form of
of overweight and obesity appear to be within
convenience eating offers calorie dense, high
the 18 to 29 age range, with those participating
in saturated fat, and processed options that
in a college education representing the most
promote an increase in weight status along
prominent increase [2]. Weight disorders are
with other deleterious health outcomes. It is
responsible for a number of health problems
usually observed that college students undergo
some of which include; for underweight:
tremendous stress during various stages of the
increased risk of anemia [3], osteoporosis [4], `in
education. It characterized many psychological
women it can lead to amenorrhea [5], and for
changes in students [7]. High levels of stress
8576
Received: 29/7/2018
Accepted: 09/7/2018

Full Paper (vol.733 paper# 27)


c:\work\Jor\vol733_28 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6367-6371
Assessment of knowledge and attitude and practice towards malignant
hypertension among interns in Saudi Arabia, 2018
Majed Meshal H Almutairi1, Muhammad Abdullah M Almalki2, Abdulrahman Bader A Alaql3
1-Imam Mohammad Bin Saud University 2-Northen Border University
3-Prince Sattam Bin Abdulaziz University
Abstract
Background:
Malignant hypertension (MHT) is the most severe form of arterial hypertension.
Objectives: Assessing the knowledge, attitude and practice (KAP) regarding the malignant
hypertension in Kingdom of Saudi Arabia (KSA). Methods: A cross-sectional questionnaire based
study was conducted at 26 different hospitals in Saudi Arabia, Ministry of Health, from March to July
2018 among 260 interns. Results: This study showed a high level of knowledge and awareness among
the respondent's regarding the malignant hypertension definition, cut off values, diagnosis, symptoms
and treatment. The prompt knowledge was reflected by good attitude and practice among most of the
interns. Most of the interns knew the definition of malignant hypertension, and the blood pressure
values of hypertensive subjects without comorbidities, the difficulty in diagnosis of malignant
hypertension and the importance of monitoring the blood pressure if suspecting malignant
hypertension. Also, most of them showed good awareness of the targeted BP that would like to be
achieved in hypertensive patients with diabetes mellitus and/or chronic kidney disease without
proteinuria (87.5%). Conclusion: The level of knowledge was sufficient among interns in KSA.
Interns' knowledge about malignant hypertension is reflected in their attitude and practice.
Keywords: Knowledge, Attitude, Practice, Interns, Malignant Hypertension, KSA

Background

Hypertension
is
a
major
retrospective diagnosis is difficult. Another
cardiovascular
risk
factor.
Malignant
obstacle for MHT diagnosis is that the
hypertension (MHT) is defined as extreme
retinopathy
associated
with
malignant
elevation of blood pressure (diastolic above
hypertensive can gradually resolve during a
130 mm Hg) that could be associated with
short period thus it is hard to be diagnosed(9).
either hemorrhage or exudates from the retina
that may be accompanied by papilledema or
Although being more worldwide
not. It is also known as accelerated
prevalent, the prognosis of MHT was
hypertension and is considered as the most
improved during the last decades especially in
severe form of hypertension or emergency
developed countries. The poor prognosis could
hypertension(1, 2).
occur if no treatment or management resulting
in persistent target organ damage and other
About 26.4% of adults around the
coronary complications(10, 11).
world were diagnosed to suffer from
hypertension in 2000, however in 2025 it is
Methods:
expected to reach to 60% of the globe adults
Study design: A cross-sectional questionnaire
(3). The actual prevalence of malignant
based study was conducted at Saudi Arabia,
hypertension is still a debate however the in
from March to July 2018.
UK one or two new cases per 100 thousand
Study population and sample size:
subjects are diagnosed with MHT every year (4,
In the first stage of selection, a stratified
5). Also, the number of new cases hasn't been
random sampling was used to select Saudi
changed for long time and its prevalence is
females randomly out of thirteen governorates
still low (6). There are a vast range of available
in Saudi Arabia according to their population
antihypertensive drugs that can be used for
density in the different regions. The second
management of hypertension, although MHT
stage of selection included random selection of
is still a major obstacle for physicians to
2 hospitals from each governorate and then 10
diagnose and manage (7, 8).
interns were randomly selected from each
hospital. Thus the final sample size included
The diagnosis of MHT is challenging
260 interns from different 26 hospitals
as the symptoms can only be established after
randomly selected in KSA.
occurrence
of
organ
damage
hence

3636
Received: 27/7/2018
Accepted: 7/8/2018

Full Paper (vol.733 paper# 28)


c:\work\Jor\vol733_29
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6372-6376

Gender Differences in Characteristics of Colorectal Cancer Patients: Eight
Years' Experience in Tertiary Care Center.

Futun Aljoufi 1, Adel Yasky 1, Sara Qubaiban 1, Roaa Amer 1, Abdullah Alasaad 1, Husam
Altahan 1, Thekra AlGholaiqa 1, Hala AlMarzoug 1, Emad Masuadi 1 Ashwaq Al Olayan 2

1 King Saud bin AbdulAziz University for Health Sciences,2 King AbdulAziz Medical City Riyadh,
KSA
Corresponding author: Futun Abdulrahman M. Aljoufi, Email: Futunaljoufi@gmail.com
Abstract
Introduction and Objectives:
Colorectal cancer (CRC) has become a very common researched topic
in Saudi Arabia. Significance of the disease lay as the third most common cancer in the Kingdom plus
the various risk factors it may be connected to. Smoking, obesity, age, and gender should be further
investigated in our community to focus our screening and minimize the burden of this disease. We
tried to determine the differences between males and females in term of demographic, clinical and
treatment characteristics. Methodology: A retrospective cohort study was performed in all cases of
CRC from 2006-2014 in King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia (KSA).
Categorical data were presented as frequencies and percentages to summarize patients' demographic
data. Chi-square was used to compare between sex and the site of metastasis. Moreover, Cox
regression was used to assess the risk factors on mortality. Results: Out of 581 patients diagnosed
with colorectal cancer, 326 (56.51%) were males. The mean age of colorectal patients at the time of
diagnosis was 59.7. Majority of the BMI was overweight 183 (37.0%) smoking history was found in
only 18 (3.5%) patients. Most of the patients were stage IV. The bio marker (K-RAS) was done for
189 colorectal cancer patients, of which male and female patients had mostly wild type. Tumor
marker Carcinoembryonic Antigen (CEA) showed that most of the patients were in the high range for
male patients 140(48.8%) and for females 115(53.2%). Conclusion: No difference was found in
regards to K-RAS mutation distribution by gender. High CEA was not associated to any age or
gender. There was no statistical significance in relation to gender and response to treatment.
Keywords:
Colorectal, cancer, gender, characteristics, K-RAS, CEA, cancer treatment.
KEY MESSAGE
We evaluate the differences in clinical characteristics and survival outcomes of patients with
colorectal cancer who were treated at a single institution in Saudi Arabia between 2006 and 2014.
INTRODUCTION
Cancer is a term that refers to the pathology in
divided into modifiable (e.g., smoking,
which abnormal cells grow and divide
obesity, and dietary habits) and non-
uncontrollably, and due to their abnormal
modifiable (e.g., genetics, age, and sex)
structure, they can invade nearby tissues and
factors3,5. Therefore, many studies have begun
organs1. Colorectal cancer (CRC; pertaining to
to evaluate the differences in risk factors for
the colon and rectum) has become a common
CRC and their impact on the incidence and
research topic in Saudi Arabia. It has gained
mortality rates.
attention due to its significance as the third
most common cancer and the fourth most
Another consideration is the screening process
frequent cancer-related cause of death
for CRC, with statistics having shown
worldwide2,3. However, since 2010, CRC has
reductions in the incidence and mortality rates
represented the most common type of cancer
in the United States over the last 15 years,
in men and the third most common type of
which has developed a well-structured
cancer in women in Saudi Arabia4. CRC has
screening program6. Nevertheless, such
also been a hot topic for research due to its
programs have not yet been established in
numerous risk factors, which are usually
Saudi Arabia, which could play a role in the
6372
Received: 15/7/2018
Accepted: 25/7/2018

Full Paper (vol.733 paper# 29)


c:\work\Jor\vol733_30 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (3), Page 6377-6381

Assessment of Knowledge, Attitude and Practice of Parents about
Immunization in Hail City, 2018

Tamam Murdi Alshammari1*, Yazeed Saad R Alsubaie2, Someili, Suleman Ali3, Najla Mohammed
Alajmi4, Alanazi Khalid Khalaf M5, Mohammed Abdulkareem M Abdrab Alamir6, Zayed Ahmad
Eisa Albenawi7, Ahmed Mohammed Alsahli8, Noor Sayed Saleh Darwish Alsharkhat9, Abdulaziz
Jazza Almejlad10, Mohammad Nasser Almatrafi11, Almotasem Bllah Ali Alhazmi12

1University of Hail, Saudi Arabia, 2Majmma University, Saudi Arabia, 3Princess Basma Teaching Hospital, Jordan,
4Almaarefa University for Science and Technology, Riyadh, Saudi Arabia, 5Tabuk University, Saudi Arabia, 6Imam
Abdulrahman Bin Faisal University, Saudi Arabia,7King Khalid University, Abha, Saudi Arabia, 8General
practitioner, University Of Science &Technology in Sana'a, Yemen, 9Jordan University of Science and Technology-
Irbid, Jordan, 10King Abdulaziz University, Jeddah, Saudi Arabia

Corresponding author: Tamam Murdi Alshammari, Email: itamam35@gmail.com

ABSTRACT
Background:
Immunization has shown major preventive aspects of infectious diseases, disability and
death. Objectives: Assessing the knowledge, attitude and practice (KAP) of Saudi parents in Hail City
regarding the immunization programs for children, Saudi Arabia (KSA), 2018. Methods: It is a cross
sectional survey study that was carried out upon 420 parents that were randomly selected as the team
focused on collection from public areas to get the appropriate knowledge level from the community for 3
months from May to the end of July, 2018. Parents and were asked to complete a questionnaire. The
questionnaire contained 4 different parts about the demographics, knowledge, attitude and practice of
parents toward immunization. Results: The included parents have shown a high level of awareness about
vaccination regarding the preventive measures and importance of vaccination which resulted in positive
attitudes and practice pattern among most of them. The overall KAP was good among most of parents.
The higher KAP level wasn't significantly associated with gender, educational degree and number of
children. Conclusion: Most of Saudi parents in Hail City had good KAP toward immunization which
wasn't associated with gender and educational degrees. However, educational programs are still in need
to increase the parents' knowledge and practice especially among illiterate and less educated parents
living in rural areas.

Keywords: Knowledge, Attitude, Practice (KAP), Immunization, Vaccination, Parents, Children, KSA,
2018.

INTRODUCTION
Despite the major efforts of health authorities to
Vaccines have thrived as one of the most
keep KSA free of diphtheria, pertussis, tetanus,
successful health interventions that have
polio, and measles, many physicians face major
diminished the occurrence of infectious diseases
obstacles from the parents about the safety,
and improved quality of life in the population[1].
efficiency and the necessity of regular childhood
During the last few decades, the burden of the
vaccines. Giving the child the appropriate
infectious diseases has been reduced through
vaccine would significantly decrease the costs of
immunization. It is a safe and effective method
disease treatment and rates of disease thus
of preventing many severe infectious diseases.
enhance a good quality of life for children[4]
The most common vaccine-preventable diseases
.Most of the parents in KSA believed that
are rubella, measles, diphtheria, tetanus,
vaccines can cause autism and disabilities[5].
pertussis, and polio[2,3]. The WHO estimated a
Also, in a global report issued by the CDC, it
reduction in the death rate from infectious
was stated that the general attitude of parents
diseases between 2 and 3 million each year.
was negative among most of them toward
6377
Received: 18/7/2018
Accepted: 28/7/2018

Full Paper (vol.733 paper# 30)