c:\work\Jor\vol737_1 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 6987-6994

Ameliorative Effect of Borage Seeds Oil against Radiation-
Induced Hepatotoxicity in Rats
Mohamed M. Rezk1, Hazem, K.A. Sarhan2 and Amal A. A. Ammar2
1Geological Isotopes Dept., Nuclear Materials Authority
2Medical and Radiation Research Dept., Nuclear Material Authority, Cairo, Egypt

Oxidative stress is known to be a key factor in several diseases and was reported as
a result of radiation exposure in human and experimental animals. Borage (Borago officinal L.) oil
contains a high percentage of -linolenic acid, which reported as a preventive treatment of a wide
range of disorders. Aim: The present study was designed to determine the possible protective
effects of borage seeds oil against gamma (-) radiation induced oxidative stress in male
rats.Materials and Methods: Thirty rats were divided into five groups (6 rats each): Control,
irradiated; rats were exposed to (6.5 Gy) of whole body -radiation, borage seeds (50 mg/kg b.wt),
irradiated borage treated pre-irradiated and borage treated post-irradiated. Serum aspartate
aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT)
levels, as well as serum and hepatic reduced glutathione (GSH), superoxide dismutase (SOD) and
lipid peroxide (malondialdehyde) (MDA) levels were assessed.
The results showed that, activities of GSH were highly significant decrease, while marked
highly significant increase in MDA due to irradiation. Supplementation with BO before or treated
after irradiation, exerted marked amelioration of irradiation induced disturbances in all the
investigated parameters. Therefore, borage could have a beneficial role in modulating oxidative
stress by improving the natural antioxidant mechanism.
Conclusion: borage has a beneficial role in reducing hepatotoxicity and oxidative stress induced
by radiation exposure.
Keywords: Borage seeds oil; -irradiation; Antioxidant; Hepatotoxicity.

classes of these components act as
Radio-therapy is one of the most common
antioxidants(3). Borage seeds oil is the richest
treatment modalities for human cancer and it
plant source of -linolenic acid (GLA) which
affects not only malignant tumors but also
is used as dietary supplement for prevention
surrounding normal tissues. Because liver is a
and/or treatment of various degenerative
highly radiosensitive organ (1), irradiation of
pathologies illnesses(2). GLA has also been
the non-tumor compartment of the liver may
reported to suppress tumor growth in vitro,
cause cell damage.
improve oxygenation status, exert anti-
Antioxidants have the capacity to reduce
inflammatory activity and display beneficial
harmful effects of radiation on normal tissues.
effects in the early stages of sepsis(4). In view
of these considerations, the objective of the
treatment-related adverse effects, which occur
present study was to evaluate the efficacy of
during radiation therapy by overcome the
borage in the modulation of oxidative stress,
oxidative damage to normal cells. The use of
biochemical and histopathological disorders
traditional plant-based preparations in
in the liver of irradiated rats.
Materials and Methods
medicines has been developed. Borage
Plant Material
(Borago officinalis L.) from Boraginaceae
Borage seeds (Borago officinalis L.) were
family is an annual herbaceous plant with
obtained from Faculty of Sci., Ain Shams
nutritional value used in traditional medicine
University, Cairo, Egypt.
and culinary uses in some countries(2). Borage
Extraction of oil from Borage Seeds
seeds oil contains mainly triacylglycerol
Dry borage seeds (750 g) were crushed using
(95%) consisting of C16-C20 fatty acids,
a commercial blender and then subjected to
while 5% presents minor components
cold pressing. In this method, oil was
composed of tocopherols, flavonoids,
extracted by continuous screw-pressers
phospholipids, sterols, free fatty acids and
(Carver Press, USA) without any chemicals
also mono-and diacylglycerols. Several
for 20 min at a pressure of 49.0 MPa.
Received: 17/9/2018
Accepted: 27/9/2018

Full Paper (vol.737 paper# 1)

c:\work\Jor\vol737_2 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 6995-7005

Comparative Study between Hysterosalpingography, Saline Infusion Transvaginal
Ultrasound and Doppler Studies in Assessment of Uterine Factor of Infertility
Mohammed Hesham Hassan Anwar, Osama Elsaeid Ali, Bassem Ragab Abdelaziz and Mohammed
Abdalla Hassanin *
Obstetrics and Gynaecology Department, Faculty of Medicine, Al Azhar University
*Corresponding Author: Mohammed Abdalla Hassanin,Phone No.: (+2) 01156669577,E-mail:
One of the basic steps of an infertility workup is to evaluate the shape and regularity of
the uterine cavity. Acquired uterine lesions, such as uterine fibroids, endometrial polyps, intrauterine
adhesions, or all of these, may cause infertility by interfering with proper embryo implantation and
Aim of the Work: to compare the findings of hysterosalpingography, saline infusion transvaginal
sonohysterography and Doppler studies in patients with suspected uterine causes of infertility. Patients
and Methods:
This is a comparative observational cross sectional study, which was conducted in the
Obstetrics and Gynecology Department at Al Hussein and Sayed Galal University Hospitals, Al Azhar
University in Cairo during the period from April 2017 to the end of September 2018. Sixty patients
were included at the study who were recruited from the infertility outpatient clinics, with suspected
uterine factors of infertility clinically, by hysterosalpingography (HSG) or by ultrasound. Results: HSG
showed the highest sensitivity in the diagnosis of bicornuate uterus, septate uterus and intrauterine
synechia (100%) followed by endometrial polyp (70%) then submucous myomas (62.5%). High
specificity (100%) was in the diagnosis of endometrial polyp and submucous myoma. Also it showed
high false negative values as it missed the diagnosis of 7 cases.
Conclusion: SIS is the gold standard of our study in assessment of uterine factor of infertility. Doppler
studies showed high false negative results compared to HSG and saline infusion sonohysterography
(SIS). Some lesions were missed from HSG and diagnosed by SIS and these missed lesions may play a
role in infertility, so SIS is very important modality in diagnosis and assessment of uterine factor of
Keywords: Hysterosalpingography - Saline Infusion Transvaginal Ultrasound ­ Doppler

In fact, infertility related to uterine
an expanding agent. So, saline infusion
cavity abnormalities has been estimated to be
sonohysterography can help to triage patients to
the causal factor in as many as 10% to 15% of
(1) no anatomic pathology, (2) globally
couples seeking treatment. Moreover, abnormal
thickened anatomic pathology that may be
uterine findings have been found in 34% to 62%
evaluated with blind endometrial sampling, or
of infertile women (1).
(3) focal abnormalities that must be evaluated
under direct vision (3).
(HSG) has been the most commonly used
Transvaginal pulsed wave (PW)
technique in the evaluation of infertility. It gives
Doppler ultrasound is an important tool for
reliable information about the patency and
examining the female reproductive system and
morphology of the fallopian tubes. It is also
is a noninvasive method to assess the uterine
helpful in evaluating uterine cavity abnormalities
perfusion. However blood flow characteristics
(2). Sonohysterography (SHG) is considered a
within the uterine artery may not be
simple, effective and well tolerated technique
representative of endometrial perfusion (3).
for enhanced transvaginal sonographic imaging
PW Doppler may be used to examine the
of the endometrial cavity. The instillation of
smaller downstream radial and spiral arteries; it
sterile saline into the uterine cavity via a fine
reveals information from single vessels rather
catheter provides both a contrast medium and
than from the endometrium as a whole.
Received: 17/9/2018
Accepted: 27/9/2018

Full Paper (vol.737 paper# 2)

c:\work\Jor\vol737_3 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7006-7010

Knowledge about Waiting Time Spent in the Emergency Department for
Patients in Saudi Arabia and Overall Patient Satisfaction
Abdulrahman Saeed Saad Alharbi 1, Adnan Meteb Mohamed Almezani 1, Ayman Mamdouh
Alrashdi 1, Hisham Mohammed Almomen 2
College of Medicine University of Hail 1, Gulf Medical University Ajman, UAE 2
Corresponding author: Abdulrahman Saeed Saad Alharbi, E-mail: abdulrahmansaeed64@yahoo.com,
Phone no: +966540956098

: Despite the modern society and medical services, waiting in emergency department is
taking too long time for patients in Saudi Arabia. Time spent in the emergency department is crucial
and can affect the overall health outcomes. Knowing the time spent in the emergency department and
overall patient's satisfaction can provide an important information of health care that is provided in
Saudi Arabia. Comparing the time spent in the emergency department in Saudi Arabia to other
countries will help us know the quality of health care provided.
Objectives: Waiting in the emergency department is a global issue not only in the developing
countries but also in modern countries. This study aimed at assessing how long is the waiting time
spent by patients in the emergency department before receiving the medical care and the overall
patients' satisfaction. Methods: A cross-sectional study on the time spent in the emergency
department before getting help for patients in Saudi Arabia and overall patients' satisfaction was
carried out on 528 participants during the period from February to March 2018. Results: 42% of the
participants, indicated that the main complain that brought them to the emergency department was in
the abdominal area and 29.5% of the patients spent more than one hour before getting helped from
healthcare providers. 18.8% of the participants evaluated the emergency department service by 1 out
of 10. Conclusion: Our results showed that large number of patients was suffering from waiting too
long time in the emergency department before receiving the required medical care.
Keywords: Emergency department, waiting time, Evaluation.

A hospital is a combination of a social and
maximum time of 15 minutes (4). Patients who
medical organization which functions to
go to the emergency departments often
provide complete healthcare in a professional
experience a long waiting time. Waiting is
way to the patients through both curative and
usually due to the triage process which is
preventive means. Hospitals are an important
requested for hospital admission, waiting for a
facility in the community and an essential
bed for the patients, a shortage of the on-call
center for training the health care workers (5).
physicians and an overcrowded emergency
An emergency department (ED) should offer a
department due to a disaster accidents. Because
fast care for the acutely ill or injured persons
of emergency waiting time can lead to a delay
that require the attention of specialized nurses
in treating and handling patients who need an
and physicians. Emergency department (ED)
immediate medical care. Hospitals spend more
crowding in the Saudi Arabia has increased
efforts on reducing the waiting time for patients
significantly these years the same as other
who spend long time in the waiting areas (6).
countries around the world. Across the United
Patients either their medical condition may
States of America, an ambulance is diverted
deteriorate, or they could get anxious and
away from an overcrowded ED approximately
worried once they wait too long time to receive
once every minute (1). Patients who do arrive in
medical care (7, 8). Frustration and eventually
the ED have faced increasingly long average
anger then happen among patients; a condition
wait times and ED visit increased over the past
which is a difficult task for the medical staff
decade (2,3). Most importantly, this increase has
members to deal with (9, 10).
been obvious for patients with the most acute
illnesses that need to receive care of their illness
A cross-sectional study involving 528
(2,3,4). In 2006, the average wait time for
participants from all over Saudi Arabia was
emergent patients to acquire an ED provider
done during the period from February to March
was 37 minutes, which is above recommended
2018. The selected sample size for this study
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 3)

c:\work\Jor\vol737_4 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7011-7017

Role of cluster of differentiation 39 (CD39) in the immunosuppressive
status associated Acute myeloid leukemia (AML)
Karima A. Mahfouz, Ibraheem M. Bayomi, Lamis M. El-toukhy*
Clinical Pathology Department, Al-Azhar University Egypt
*Corresponding author: Lamis M. El-toukhy, Clinical pathology department, Al-Azhar University Egypt,
Tel 00225398650, E-mail: Lucie.eltokhy@hotmail.com.
CD39 is an integral membrane protein (ectoenzyeme) that phosphohydrolyzes ATP in a Ca2+-
and Mg2+-dependent fashion to yield AMP, Can be viewed as immunological switch, and is expressed in
spleen, thymus, lung, and placenta, and in these organs it is associated primarily with endothelial cells and
immune cell populations, such as B cells, NK cells, dendritic cells, Langerhans cells, monocytes,
macrophages, mesangial cells, neutrophils, and regulatory T cells. Aim of the study is to assess the expression
of CD39 on CD4+ CD25high T-reg cells in patients with acute myeloid leukemia to identify its role in
immunosuppressive status of AML patients. Methods: Flow cytometric analysis of T-reg cells using CD4
CD25 and CD39 in 60 AML patients and 15 apparently healthy controls with matched age and sex was done.
Results: There was a significant difference between cases and controls as regards expression of CD39 on T-
helper cells. A highly significant elevation of expression of CD39 has been obtained on T-reg cells in AML
patients compared with Controls with increased expression of CD39 on T-reg cells than on helper T cells.
Conclusion: CD39 plays a significant role in immunosuppressive status of AML patients particularly with
expressing the receptor of chain of IL-2 (CD25)
Key words: Acute Myeloid Leukemia, CD39, Regulatory T Cells

Acute myeloid leukemia is a complex and
heterogeneous hematopoietic tissue neoplasm
pathogen clearance and promote chronic infection.
characterized by rapid expansion of immature
In addition to controlling autoimmunity, T-reg
myeloid cells in bone marrow and other organs (1)
cells have been ascribed to have a role as mediators
The affected cells undergo an uncontrolled
of cancer-related immunosuppression (4).
proliferation and impaired differentiation program.
T-reg cells suppress effector cells and
Typically, the cells are blocked at various
antigen presenting cells either in a contact-
maturation steps and are resistant to cell death (2).
dependent or -independent manner whereas nTregs
can use both mechanisms, iTregs induce
Foxp3+CD25highCD4+ T cells that constitutively
immunosuppression through cytokines, including
express the receptor of chain of IL-2 (CD25) with
IL-4, IL-10, or TGF-. Cell-to-cell interactions can
diverse immunosuppressive functions. Subsets of
occur between T-reg cells and T-effs with or
T-reg cells include natural T-reg cells (nT
without APCs. T-reg-to-Teff contact results in the
regs) that
are thymus-derived but undergo further expansion
suppression or apoptosis of T- effector cells. On
in peripheral tissues, and induced T-reg
contact, formation of gap junctions occurs between
cells (iT
these 2 T cells. cAMP transferred through the gap
regs) that are converted from conventional
T cells (T
from T-reg cells to T-effs suppresses the
cons) in the periphery (3).
proliferation of T-effector cells by decreasing IL-2
Both subsets have been shown to suppress
production and phosphodiesterase 3 inhibitors,
autoreactive lymphocytes and thus to limit the
which increase cAMP, also increase T-reg cells (5).
magnitude of innate and adaptive immune
responses. Accordingly, impaired T-reg function
In patients with AML, T-reg cells were
aggravates autoimmune diseases while T-reg
found to more efficiently hydrolyze adenosine
Received: 13/8/2018
Accepted: 29/8/2018

Full Paper (vol.737 paper# 4)

Full Paper (vol.737 paper# 5)

REVIEW OF LITERATURE The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7025-7031
Effects of Intravitreal Injection of Ranibizumab on Intraocular Pressure
Abdel Kader S. Abdel Kader, Ahmed A. Ghalwash, Ahmed N. El-Sayed,
Abdul Rahman E. Refaee*
Ophthalmology Department, Faculty of Medicine, Al-Azhar University
*Corresponding author: Abdul Rahman E. Refaee,email:drabdourefaee@gmail.com

the administration of anti-vascular endothelial growth factor (anti-VEGF) agents has become
an application of IVIs to treat a variety of retinal and choroidal neovascular diseases including neovascular
age-related macular degeneration, vein occlusion with macular edema, and diabetic maculopathy. ranibizumab
is the most commonly used anti-VEGF treatments for retinal disease. While Intravitreal ranibizumab appears
to be safe and effective but it can cause adverse effects as intraocular inflammation, cataract, vitreous
haemorrhage, and increased intraocular pressure.
Aim of the work: this study aimed to Evaluation of Iop changes after intravitreal injection of Ranibizumab
retinal and choroidal neovascular diseases as neovascular age-related macular degeneration (AMD), central
vein or branch vein occlusion with macular edema, and diabetic maculopathy
Patients and Methods: this prospective study was carried out from March 2018 to September 2018 on 35
eyes of patients attending outpatient clinic of Al-Azhar University Hospitals and Ophthalmology Department
of Research Institute of Ophthalmology in Giza.
All participant names were hidden and were replaced by code numbers to maintain privacy of the patients. IOP
was measured Using Applanation tonometer and Perkins tonometer before IVI of ranibizumab immediately
after injection, 30 minutes, 1ST day, 1st week, and 1st month after injection.
Results: IOP was highly increased immediately after injection of ranibizumab, preoperative mean IOP
15.31±3.70, immediate after injection mean IOP 24.62±11.38, then it started to decrease till reaching normal
values in the first 24h after injection, 1st 24hours mean IOP 16.31±3.60. The mean IOP for patients who were
previously injected was 16.47±3.74 pre injection, and it was 30.88±12.55 immediately after injection, it still
decreasing till reaching 20.24±2.77 after 30 minutes, we follow the patients after 1 day it was 18.41±3.12, then
it became 18.29±3.62 after 1 week, and 17.88±3.33 after 1 month. The mean IOP for patients who were the
first time to be injected was 14.22±3.41 pre injection, Immediate after injection the mean IOP was 18.72±5.92,
after 30 minutes of injection the mean IOP was 15.44±3.99 mm Hg, after 1 day of injection the mean IOP was
14.33±2.87 mm Hg, We followed up the patients to one week after injection and we checked the IOP. The
mean IOP after one week was 13.72±2.93mm Hg, We continue following the patients for one month and
checked IOP, The mean IOP was 14.06±3.21 mm Hg.
IOP tends to increase after intravitreal injection of Ranibizumab 0.05ml (0.5 mg). It causes
mainly a transient immediate increase in intraocular pressure especially in patients who exposed to repeated
intravitreal injection. This elevation of IOP tends to normalize after one day.
Recommendations: this study recommend monitoring of IOP after intravitreal injection of ranibizumab and
Care should be taken for cases with multiple injections and predisposing risk factors like glaucoma and
glaucomatous patients
Intravitreal injection, Ranibizumab, intraocular pressure.

development of blood vessels. VEGF production is
Intravitreal injection (IVI) therapy is getting more
increased by hypoxia (a lack of oxygen). So, if a
and more popular, The administration of anti-
tissue is not getting enough oxygen, it will produce
vascular endothelial growth factor (anti-VEGF)
more VEGF, which will stimulate the growth of
agents has become an application of IVIs to treat a
additional blood vessels to provide more oxygen. In
variety of retinal and choroidal neovascular
the presence of excessive VEGF, the capillaries
diseases including neovascular age-related macular
start to leak and large molecules form exudates and
degeneration ,central vein or branch vein occlusion
escape into the retina
with macular edema, and diabetic maculopathy (1).
causing oedema in the surrounding tissues. If this
All of these conditions are caused partly by over-
affects the macula, then the central vision will be
production of a protein called vascular endothelial
reduced, excessive VEGF also causes the growth of
growth factor (VEGF). This protein was discovered
new, abnormal retinal blood vessels and capillaries.
in the 1980s and is important in the growth and
The new vessels are fragile and prone to tearing.
Received: 13/8/2018
Accepted: 29/8/2018

Full Paper (vol.737 paper# 6)

c:\work\Jor\vol737_7 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7032-7036
Extended Letrozole Therapy for Ovulation Induction in clomiphene
resistant Women with Polycystic Ovary Syndrome
Mohammad Salah El-Dein Hassanein, Mostafa Hussein Hegab, Attia Mohammad Attia,
Mostafa Ahmed Abd El-Maksoud Zayed 1
Department Of Obstetrics and Gynecology, Al-Azhar Faculty of Medicine, Cairo, 1Obstetrics and
Gynecology at Manshiet El-Bakry General Hospital.
Corresponding author: Mostafa Ahmed Abd EL -Maksoud Zayed, Tel: +201001394433, E-mail:
Objective: This study aimed to evaluate the efficacy of short and extended long course of letrozole
therapy for ovulation induction in clomiphene resistant women with polycystic ovary syndrome.
One hundred infertile women were selected from the patients attending the outpatient clinic
of Manshiet El-Bakry general hospital. All patients were diagnosed as having anovulation due to
polycystic ovary syndrome (PCOS).
Patients were randomly allocated to treatment with either long letrozole group took 2.5
mg of letrozole daily starting day 1 of spontaneous or progesterone inducing menstrual bleeding for 10
days (50 patients, up to 3 cycles) or short letrozole group took 5 mg of letrozole daily starting day 1 of
spontaneous or progesterone inducing menstrual bleeding for 5 days (50 patients, up to 3 cycles).
The number of ovulating patients was greater in the long letrozole group (74% vs. 56%), but
without statistical differences. The total number of follicles during stimulation was insignificantly
greater in the long letrozole group (8.2 vs. 8.17). The numbers of follicles 18 mm were significantly
greater in the long letrozole group. Pregnancy occurred in 7 in the short group (14%) and 12 of (24%)
in the long letrozole group, and the difference was statistically insignificant.
The long letrozole protocol (10 days) can produce more mature follicles and subsequently
more pregnancies than the short letrozole therapy (5 days).
Key Words:
Extended Letrozole, Ovulation induction, clomiphene resistance, PCOS.

The polycystic ovary syndrome accounts
drugs that were introduced for ovulation
for approximately 80% of women with
induction in 2001 by (5). Over the last ten years
anovulatory infertility (1). Various factors
data from many clinical trials have been
influence ovarian function and fertility is
collected and there is evidence that the AI
adversely affected by an individual being
letrozole might be as effective as CC, but the
overweight, the degree of hyperandrogenism
outcome data vary. AIs are like CC
and having elevated serum concentrations of
administered orally, but due to their short half-
LH (2). Polycystic ovary syndrome (PCOS) is
life elimination time of 48 hours there are fewer
the most common cause of infrequent periods
adverse effects on estrogen target tissues such
(oligomenorrhea) and absence of periods
as endometrium and cervix compared to CC (6).
(amenorrhea), affecting about 4-8% of women
The aim of this prospective randomized study
worldwide in their fertile years (3).
was to evaluate the efficacy of short and long
Aromatase inhibitors:
course of letrozole therapy in induction of
Aromatase inhibitors have been proposed
ovulation in clomiphene resistant women with
as an alternative treatment to Clomiphene
Citrate (CC) therapy as the discrepancy

between ovulation and pregnancy rates with CC
Patients and methods
has been attributed to its anti-estrogenic action
and estrogen receptor depletion. Inhibition of
One hundred infertile women were
selected from the patients attending the
aromatization of androgens to estrogens that in
outpatient clinic of Manshiet El-Bakry General
turn releases the hypothalamic­pituitary axis
Hospital. Written consent was obtained from
from negative feedback of estrogen. There are
patients. All patients were diagnosed as having
reports of good pregnancy rates with a lower
anovulation due to polycystic ovary syndrome
incidence of multiple pregnancies (4).
(PCOS). The diagnosis of PCOS based on the
Aromatase inhibitors (AIs) are a newer class of
revised 2003 consensus on diagnostic criteria
Received: 18/8/2018
Accepted: 28/8/2018

Full Paper (vol.737 paper# 7)

c:\work\Jor\vol737_8 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7037-7041

Characterization of Respiratory Manifestations of Chronic Hepatitis C
Virus Infected Patients
Refaat Abo-Elfetouh Abo-Elsaad1, Ezzat Atwa Ali Rezk2, Kamel Abd-Elghafar Hassan2,
Fathiya Mostafa EL-Raey3, *Ebrahim Fathi Abo-Elfetouh Hasanin2
1Chest Department, Al-Azhar Univeristy, Cairo
2Chest Department, Al-Azhar Univeristy, Damietta
3Tropical Medicine Department, Al-Azhar Univeristy, Damietta
*Corresponding author: Ebrahim Fathi Abo-Elfetouh Hasanin2, E-Mail: ebrahimfathi85@yahoo.com, Mobile:
chronic hepatitis C virus (HCV) infection has been reported in association with several
extrahepatic manifestations. Chronic HCV infection is also associated with both direct and indirect
effects on pulmonary tissue.
Purpose: to evaluate phenotypes of respiratory manifestations of chronic hepatitis C virus.
Patients and Methods
: 1-this study was conducted on 150 Egyptian patients with chronic hepatitis C.
Patients were selected from those attending the in patients and out patients clinic of the Tropical
Medicine and Chest Departments, Al-Azhar University Hospital-Damietta from September 2016 to
Septamber 2018.
2-also ,50 healthy subjects matched for age and sex were included as volunteer.
3-consent was informed by all patients and volunteer shared in this study.
Results: C.O.P.D: documented in 32 patients (21.3%).
documented in 15 patients (10%) of all patients.
Air way hyperreactivity:
documented in 15patients (10%) of all patients.
Idiopathic pulmonary fibrosis (IPF):
is presented in 37 patients (24.6%).
documented in 10 patients (6%) of all patients.
Transudative pleural effusion: documented in 10 patients (6%) of all patients.
Adenocarcinoma: documented in 5 patients (3.3%) of all patients.
documented in 1 patient (0.006%) of all patients.
Lung abscess: documented
in 10 patient (6%) of all patients.
Pulmonary embolism: documented in 5 patients (3.3%) of all patients.
Hepatopulmonary syndrom:
documented in 10 patients (6%) of all patients.
Conclusion: Chronic hepatitis C virus infection is related to the development of several pulmonary
abnormalities. These pulmonary manifestations of HCV infection are frequently underdiagnosed.
Recommendations: Any patient with chronic HCV infection should be evaluated with HRCT chest
and pulmonary function tests for early diagnosis of pulmonary abnormalities to prevent further
Keywords: Hepatitis C virus, Pulmonary manifestations of Hepatitis C virus.
Type of study design: descriptive study.


Hepatitis C virus (HCV) is the most
frequently seen in association with chronic
important cause of liver disease in Egypt (1,2),
HCV infection(8).
with the latest anti-HCV antibody prevalence of
Aim of the work: to evaluate phenotypes of
14.7% (3). It is a progressive disease that can
respiratory manifestations of chronic hepatitis
lead to cirrhosis, liver failure, hepatocellular
C virus.
carcinoma and death (4).
Patients and Methods:
Over the last decade, emerging clinical
1- This study was conducted on 150 Egyptian
data suggest that chronic HCV infection can
patients with chronic hepatitis C. Patients were
lead to multiple direct and indirect pulmonary
selected from those attending the in patients and
complications (7). Secondary effects of HCV
out patients clinic of the Tropical Medicine and
infection on pulmonary disease are either
Chest Departments, Al-Azhar University
related to liver cirrhosis and portal hypertension
Hospital-Damietta from Septamber 2016 to
or to the autoimmune disorders that are
Septamber 2018.
Received: 13/8/2018
Accepted: 29/8/2018

Full Paper (vol.737 paper# 8)

c:\work\Jor\vol737_9 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7042-7047

Sleep Quality and Internet Addiction Level among University Students
Maie Abdulrhman Khayat2, Prof. Mohamad Hasan Qari1, Basmah Salman Almutairi2,
Bashayer hassan Shuaib2, Marwah Ziyad Rambo2, Manal Jobran Alrogi2, Sulaf Zaki
Alkhattabi2, Dalya Abdulrahman Alqarni2
1 Professor, Department of Hematology, , Faculty of Medicine, King Abdulaziz University, 2
Medical Student, Faculty of Medicine, King Abdulaziz University, Saudi Arabia
Sleep is an essential need of humankind; it is necessary for quality of life and health
at all ages. Poor sleep quality is closely associated with lifestyle habits including Internet use. This
study aimed to evaluate the relationship between sleep quality and the level of Internet addiction
among students at King Abdulaziz University (KAU). Methodology: This was a cross-sectional
study carried out on July 2017 among 511 students aged 18-25 years enrolled at KAU in Jeddah,
Saudi Arabia. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality and
habits, and Young's Internet Addiction Test was used to assess Internet addiction among students.
Frequencies, chi-square, Pearson's correlation coefficient and multivariate analysis were used in
data analysis. Results: A total of 511 students participated; 350 (68.5%) were women. Poor sleep
quality was found in 54.4% of the participants, whereas Internet addiction was found to be mild in
42.3 %, moderate in 29.9%, and severe in 1.8%. A significant correlation was found between sleep
quality and Internet addiction (p = .00). Other significant associations linked the quality of sleep to
smoking and caffeine consumption. Conclusion: Sleep problems and poor sleep quality among
KAU students were related to high Internet use. Further studies are needed to fully understand the
factors that affect sleep behavior and Internet addiction among university students in Jeddah.
Sleep, Internet, addiction, quality Sleep quality, internet addiction, university
students, sleep disturbance, sleep medications, sleep behavior, internet use, poor sleep, sleep
Sleep is an essential need of humankind,
academic performance, and increased risk of
important for quality of life and health at all
motor vehicle accidents (8).
ages. Quality sleep has been associated with
Today, the Internet has become an important
multiple factors including environmental
element in people's lives. It is used for
factors, social life, and general health status
(1,2). Guidelines advocate 8.5 ­ 9.5 hours of
education. Despite its advantages, the side
sleep per night for adolescents 10 to 17 years
effects of Internet overuse have been
old, while young adults, over 18 years, need
emerging progressively (9). Heavy internet
7 ­ 9 hours of sleep (3). Sleep has been found
use has many associations, with depression,
to be fundamental for memory consolidation,
(10) poor sleep quality, mood changes, and
learning, critical thinking and decision
poor health outcomes such as obesity and low
making (4,5). Furthermore, it is necessary for
self-esteem (11). Internet addiction (IA) is
cognitive functions related to academic
described as excessive or poorly controlled
performance in higher education. As students
preoccupations or behaviors regarding
approach the college stage, they will be in an
Internet access, which lead to distress or
entirely different atmosphere. They will
impairment (12). A multinational meta-
experience greater responsibilities with
analysis showed that 6% of people worldwide
increasing pressure and more chaotic
have an IA, ranking the Middle East in first
schedules affecting their sleep quality (6).
place with 11%, while northern and western
Studies have shown that most university
Europe were ranked the lowest with 3% (13).
students do not meet their sleep requirements,
Internet Addiction has been considered as a
as 71% sleep less than 8 hours (7). Sleep
new type of addiction and mental disorder;
deprivation can result in serious outcomes
like other already established addictions such
including reduced coping mechanisms, poor
as compulsive gambling and alcoholism (3).
Received: 14/8/2018
Accepted: 24/8/2018

Full Paper (vol.737 paper# 9)

c:\work\Jor\vol737_10 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7048-7054

Knowledge and Attitude of Breastfeeding among Women in Al-Madina Al-
Munawwarah, Saudi Arabia, 2017
*Shireen Albouq , Raghad Alsubhi, Manal Othman , Rawabi Almutiri and AlaaAlraheili
College of Medicine, Taibah University, Al-Madina Al-Munawwarah, Kingdom of Saudi Arabia.
Corresponding author: Shireen Ghazi Albouq,mobile:+966530723334-E-mail: shireen.albouq@gmail.com

: breastfeeding is considered to be beneficial for both babies and mothers. Objective: this
study aimed to assess the knowledge and attitude of breastfeeding among women in Al-Madina Al-
Munawwarah, Saudi Arabia. Methods: this was an analyticalcross-sectional study and it was carried
out in Al- Madina, Kingdom of Saudi Arabia during the year 2017. Data were collected by electronic
self-administered semi-structured questionnaire. Results: data were collected from 388 female. The
majority of the respondents were above 36 years old (48.2%). More than half of our respondents 225
(58.0%) were unemployed and 277 (71.4%) had a college-level education or higher. 138 (35.6%) of the
women were exclusively feeding their baby by breastfeeding, while the majority of the respondents 220
(56.7%) chose a mix of both breast and formula feeding. The percentage of women who received
hospital education regarding breastfeeding was equal to the women who had not received the hospital
education 194 (50.0%). 175 (45.1%) of the respondents reported that health problem is the most reason
that preventing them from breastfeeding their babies. Mothers believed that breastfeeding helped them
by preventing breast and ovarian cancer 308 (79.4%) and the majority of the respondents 334 (86.1%)
believed that breastfeeding improved the immunity and protect from different illness. Conclusion: in
spite of the low percentage of exclusive breastfeeding, all the mothers were certain about the importance
of breastfeeding to them and to their babies. There is a significant opportunity to improve awareness
among women regarding the importance of exclusive breastfeeding.
Keywords: breastfeeding, alternative feeding, maternity.

Breastfeeding is considered to be beneficial for
in Al-Madina Al-Munawwarah, regardless of
both infants and mother(1). Despite many
nationality and age with excluding the women
benefits of breastfeeding for mothers and
who did not have children and who live in
infants, rates of the initiation of breastfeeding
another city in Saudi Arabia. Data were
vary in many countries. Initiation in Europe,
collected by electronic self-administered semi-
Australia and Saudi Arabia was higher than
structured questionnaire, which included socio-
New Zealand, Canada and the USA with 74-99
demographic data, the knowledge and attitude
% in Europe , 91-97% in Australia(2), 91.6% in
of the women regarding breastfeeding and
Saudi Arabia (1) , compared to approximately
using alternatives.
80% in New Zealand (Maori and Pacific people
Statistical Analysis:
hada lower rate), 69-83% in Canada , and 27-
Data were tabulated by using Microsoft Office
69% in the USA (2) . Exclusive breastfeeding
-- Excel sheet entered and analyzed by using
(The infant received only breast milk for the
SPSS, version 20.0. Ethical Committee
first 6 months of life) in the Arab region has a
approval was obtained before starting the study.
pattern similar to western countries; where it
was less than 35%. Educating the mothers
Data were collected from 388 female by using
during their antenatal visits can improve their
questionnaires which were filled electronically.
attitude and practice of breastfeeding
The majority of the respondents were above 36
afterward(3). Therefore, this study aimed to
years old (48.2%). 348 (89.7%) were Saudi and
assess the knowledge and attitude of
40 (10.3%) were non-Saudi. Regarding parity,
breastfeeding among women in Al-Madina Al-
312 (80.4%) were multiparous, while 76
Munawwarah, Saudi Arabia.
(19.6%) were primiparous. Most of the
Material and Methodology:
participants 237 (61.1%) had 3 or more
This analytical cross-sectional study carried out
children. More than half of our respondents 225
in Al- MadinaAl-munawarah, Kingdom of
(58.0%) were unemployed and 277 (71.4%) had
Saudi Arabia during the year 2017. Subjects of
a college-level education or higher (Table 1).
this study were women who had children living
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 10)

c:\work\Jor\vol737_11 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7055-7063

Pharmacological Study on the Effect of the Aqueous Extract of Mangifera
Indicaa Leaves on Vascular Activity of Diabetic Albino Rats

Hassan Helaly Abu Rahma1, Haredy Hassan Haredy1*, Hoda khalifa Abd-Elhady2, Saleh
Mohamed Hussein3 and Ahmed Abdelnaser Ahmed1
1Pharmacology Department, Faculty of Medicine, Al-Azhar University, Assuit
2Physiology Department, Faculty of Medicine, Al-Azhar University, Assuit
3Food Science and Technology Department, Faculty of Agriculture, Al-Azhar University, Assuit

*Corresponding author: Haredy Hassan Haredy, E-Mail: dr_haredy74@yahoo.com

Background: diabetes mellitus is the most common endocrine disease, which is considered one of the
most important causes of morbidity and mortality worldwide. Diabetes can affect many different organ
systems in the body and can lead to serious complications. These complications can be classified as
microvascular or macrovascular. Microvascular complications include nervous system damage, renal
system damage and eye damage. Macrovascular complications include cardiovascular disease, stroke
and peripheral vascular disease. Objective: it aimed to assess effects of aqueous mango leaves extract
on diabetes mellitus. Materials and Methods: aqueous mango leaves extract were assessed for their
effects on blood glucose, blood pressure, lipid profiles and body weight in diabetic rats. Also, check
out photochemical agents including total phenolics, flavonoids, tannins and antioxidant activity in the
aqueous mango leaves extract. Results: aqueous mango leaves extract are rich in total phenols,
flavonoides and tannins content, so the antioxidant activity is high. Random blood glucose level and
systolic blood pressure were decreased in diabetic rats treated with either aqueous extract of mango
leaves or glibenclamide, while, body weight was increased in diabetic rats treated with either
glibenclamide or aqueous extract of mango leaves. The contractile responses to norepinephrine were
decreased and the relaxant effect of acetylcholine were increased significantly in diabetic rats treated
with either glibenclamide or aqueous extract of mango leaves. The treatment of glibenclamide with
aqueous mango leaves extract gave the best results with diabetic rats compared to other treatments.
Conclusion: aqueous mango leaves extract produced a significant hypoglycemic effect in diabetic rats
and improved the diabetes mellitus induced changes in the vascular reactivity, so possibility of its using
as dietary supplements have healthy and therapeutic properties.
Keywords: Aqueous mango leaves extract, Diabetes mellitus, Vascular reactivity.

radicals, as determined by cell damage markers.
combination of heterogeneous disorders
Increased oxidative stress has been implicates
commonly presenting with episodes of
in the pathogenesis of diabetic complications
hyperglycaemia and glucose intolerance, as a
and reduced levels of antioxidants are found in
result of lack of insulin , defective insulin
blood and tissue in both human and
action, or both(1). DM leads to many
experiments diabetes(4). Herbal medicines and
complications like Peripheral vascular disease
their preparations have been widely used
which may lead to bruises or injuries that do not
traditionally, for the thousands of years in
heal, gangrene gangrene and ultimately
developing and developed countries owing to
amputation(2). Other complications include
its natural origin and lesser side effects or
dental disease, reduced resistance to infections
dissatisfaction with the results of synthetic
such as influenza and pneumonia, and
drugs. One of the characteristics of oriental
macrosomia and other birth complications
herbal medicine preparations is that all the
among pregnant women with diabetes.
herbal medicines, either presenting as single
Although types of complications are similar for
herbs or as collections of herbs in composite
type 1 and type 2 diabetic patients, the
formulae(5). The traditional preparations
frequency or timing of occurrence can vary(3).
comprise medicinal plants, minerals and
On the other hand, high glucose level
organic matter. Herbal drugs constitute mainly
was found to increase the production of free
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 11)

c:\work\Jor\vol737_12 T
he Egyptian J
ournal of
Hospital Me

dicine (
October 2
018) V
ol. 73

7), Page 64

Evaluation of knowledge, attitudes and practice of coronary artery disease
risk factors among general population in Tabuk City, Saudi Arabia

Abdulrahman abdulaziz alwakeel, Raid Awad Alshehri, Radhi Ali Alshehri, Tarig Merghani
Faculty of Medicine, University of Tabuk, Saudi Arabia

The prevalence of the coronary artery disease (CAD) is increasing in the developing
countries, including Saudi Arabia. The aim of this study was to evaluate knowledge of CAD risk factors
and to appraise the related attitude and practice among the general population of Tabuk city, Saudi
Arabia. Methods: A cross-sectional descriptive study was conducted on a random sample of Tabuk city
population. Each participant responded to a questionnaire paper requesting information about his
personal details, knowledge about the CAD risk factors, his attitude, and his actual practice towards the
risk factors. Study permission was obtained from the Research Committee (Faculty of Medicine/
University of Tabuk). Informed consents were obtained from the participants before entry into the study.
The collected data were analyzed using the Statistical Package for the Social Sciences (SPSS Inc.,
Chicago, IL), version 20. Statistical significance was accepted when P value is less than 0.05. Results:
A total of 126 adult subjects (69.84% males) participated in this study. Of the participants, 71.42%
received university education, 2.4% had a past history of heart attack, 3.2% were known cases of
diabetes mellitus, and 6.3% were known cases of hypertension. The commonest risk factors identified
by the participants were smoking (81%). Those who could identify hypertension, obesity, smoking and
diabetes mellitus were 65.9%, 77.8%, 81.0%, and 37.3% respectively. Less than two thirds (64.3%) of
individuals could identify stress as a risk factor, and less than half (44.4%) could identify the genetic
tendency as a risk factor of CAD. The majority of participants (72.2%) know that lack of exercise or
the sedentary life style is a risk factor for CAD; however, only 8.16% were fully aware of the principal
five modifiable risk factors of heart disease. Conclusion: The study showed critical deficiencies in
CAD risk factors knowledge and perception that could result in underestimation of the disease severity.
Educational health programs are highly recommended to increase awareness about the modifiable risk
factors of the CAD.
Key words:
Coronary Artery Disease, Risk Factors, Knowledge, Attitude, Practice

Cardiovascular diseases (CVD), including
factors, including unhealthy diet, sedentary
coronary artery disease (CAD), constitute
lifestyle, cigarettes or shisha smoking, and
major public health problems worldwide. Each
obesity, are reaching dangerous levels in our
year, mortality due to heart diseases exceeds
community. The interaction of these risk factors
that of cancer around the world. Most countries
face high and increasing rates of CVD. It is one
environmental factors plays a major role in the
of the principal causes of death and disability in
underlying cause of coronary artery disease
the United States and most European countries
(CAD). Healthy diet, exercise and avoidance of
(1) . A recent survey showed that the vast
smoking are invaluable measures in preventing
majority of killer diseases in the Kingdom of
atherosclerosis. A national prevention program
Saudi Arabia (KSA) are non-communicable,
at the community level as well as high risk
chronic diseases (2) .The worldwide increase in
groups is highly recommended to prevent the
CVDs, especially in the developing countries,
rapid rise in CAD morbidity and mortality.
is caused by the rapid urbanization and its
Therefore, the assessment of knowledge,
related reduction in physical activity and
attitude and practice of CAD and the
unhealthy diet.
association of these three components with the
By the time heart problems are detected, their
educational level of the general population
underlying pathology (atherosclerosis) is
could be one of the most important factors in
usually well established, and had been
planning how to prevent CAD that is fatal even
developing for long time. A recent study
in those patients who are without a history of
reported a high prevalence of cardiovascular
coronary heart disease.
disease risk factors among young adults (3) Risk
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 12)

c:\work\Jor\vol737_13 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7069-7076
Evaluation of Diagnosis and Management Plan of Diabetes Mellitus Related
Cystic Fibrosis in Children
Eyman Abdulmajeed Alfaraj1, Fatimah Mohammed AlOmran1, Hassan Abdullah Alashwan1,
Abdullah Jameel Almajed1, Redha Ali Alsaleh1, Hassan Abdulmohsen Alhumrran1, Rawan
Abdulqawi Bobakr2, Seham Matar Alotaibi2, Nouf ghazi S. Abuhekmah3, Nasser Subeeh
1- Imam Abdulrahman bin Faisal University, 2- Umm Al-Qura University, 3- King Khaled
university, 4- Jordan University of Sciences and Technology

Cystic fibrosis (CF) is a disease that occurs as a result of genetic mutations in cystic fibrosis
transmembrane conductance regulator gene (CFTR). CFTR can be found in airways epithelial cells,
intestine and cells with exocrine and exocrine function. CF is associated with variant complications, Cystic
Fibrosis-Related Diabetes (CFRD) is considered as one of the most common complications of CF.
Objective: In this review, we discussed the recent updates about Cystic Fibrosis-Related Diabetes (CFRD)
diagnosis and management plan. Methods: PubMed database were used for articles selection. All relevant
articles related to our review were chosen to cover the following topics: Cystic Fibrosis, Cystic Fibrosis
Related Diabetes management, Cystic Fibrosis Related Diabetes diagnosis. We excluded other articles,
which are not related to our objectives. Conclusion: CFRD can significantly worse the health condition of
CF patients. However, with the recent advancement of management plans of CFRD, previous sex
differences in mortality have disappeared and that the gap in mortality between CF patients with diabetes
and CF patients without diabetes has considerably narrowed. Early diagnosis and early intervention also
helped in improving the quality of CFRD patients and preventing the complications. This can be obtained
by annual screening for DM among CF patients since 10 years of age using OGTT as recommended by
ADA. The primary pathologic feature of CFRD is insulin insufficiency. It leads to increased breakdown of
protein and fat. So, insulin replacement is the only recommended medical treatment and it has been shown
to improve clinical outcomes. Oral diabetes agents are usually not recommended in CFRD.
Keywords: evaluation, management plan, diabetes mellitus, cystic fibrosis, children.


Cystic fibrosis (CF) is an inflammatory disease
amount of intestinal fluid is lower than normal;
occurs as a result of mutations in the CF
hence, after a dehydration of the stool, patient
transmembrane conductance regulator (CFTR)
will suffer from bowel obstruction (7). The
gene (1). CFTR is a chloride bicarbonate channel
pancreatic duct also secretes less fluid than
responsible for correction of epithelial cell
normal, causing ductal blockage and eventually
secretions. In case of CFTR dysfunction, there
pancreatic degeneration. As a result, loss of
will be ionic imbalance in the secretions which
pancreatic enzymes causes steatorrhea that may
will lead to accumulation of mucus in exocrine-
offset the tendency for intestinal block.
associated organs (2, 3, 4). The main symptoms

include a persistent cough that produces mucus,
CF has been generally well defined throughout
recurrent lung infection, intestinal obstruction,
the world although its prevalence is very difficult
malabsorption, nasal polyps, rectal prolapse,
to ascertain for a number of reasons, including the
pancreatitis, increase of blood sugar level, and
fact that the medical/scientific literature and
growth hormones disorders (2, 5). Therefore, the
patient registries vary in quality in different
main affected organs in CF diseases are
countries. According to the recent literatures, the
respiratory, digestive, and reproductive tracts.
higher frequency of registered CF patients was in
Lungs in CF diseases lose their ability to maintain
the European Union. This could be due to strong
a sterile surface. That is, these organs will be
clinical awareness and greater health facilities. In
damaged by bacterial infections gradually (6). The
contrast, we found a very irregular report from
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 13)

c:\work\Jor\vol737_14 retracted.


Full Paper (vol.737 paper# 14)

c:\work\Jor\vol737_15 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7085-7089

Motives and Knowledge towards Bariatric Surgeries among Adults in Al-
Madinah, Saudi Arabia, 2018
*Shireen G. Albouq, Yousef M. Alturk
College of Medicine, Taibah University, Al-Madinah, Kingdom of Saudi Arabia

Corresponding author: Shireen G. Albouq, E-mail: shireen.albouq@gmail.com. ,Phone: +966530723334

: recent studies have shown the effectiveness of bariatric surgery in improving severe
obesity, it's associated with co-morbidities and the level of mortality. Objective: this study aimed to
determine the motives of bariatric surgeries among Saudi adults in Al-Madinah and to assess their
beliefs and knowledge toward surgical intervention in treating obesity. Methods: this was an
observational analytical cross-sectional study and it was carried out in Al- Madinah, Kingdom of Saudi
Arabia during 2018. Results: the data were collected from 406 participants. 61.8% of them were female.
The mean age was 33.5 ± 9.12 and the mean of BMI of the participants was 29.89 ±8.22. The majority
of the participants were married (62.6%). More than half of our respondents (80.3%) had a college-
level education or higher. 51.5% were employed. 79.6% of participants tried to lose weight by
traditional methods. The majority of the participants (77.6%) did not undergo weight loss surgery. 75%
of the respondents who did the surgery reported that health problem was the most reason motivated
them to do the surgery. 364 (90.8%) of the participants believed that bariatric surgeries were effective
in treating of obesity. However, 67.8% of the participants didn't prefer the surgery over traditional
methods to lose weight. The majority of the respondents (77.6%) believed that bariatric surgery was
not the best choice to lose weight and 95% of the participants believed that bariatric surgeries had
complications. Conclusion: health problem is the major motive for our population to do bariatric
Keywords: bariatric surgery,obesity, motives, beliefs.


Obesity is a physiological state that occurs
premature mortality (1,5,6).The traditional
through a chronic imbalance in whole-body
treatment of obesity focus on a diet, exercise,
energy metabolism in which caloric intake
behavioral therapy program that has been
exceeds energy expenditure(1). It is defined by a
individualized according to patient's needs.
body-mass index (BMI)(The weight in
These methods had not been effective in long-
kilograms divided by the square of the height in
meters) of 30.0 or more according world health
approaches had also little success in the
organization (WHO) (2). Obesity is considered a
maintenance of long-term weight loss (9) .
worldwide epidemic and associated with an
Recent studies XXX have
increased risk of death (3).Globally, more than
shown the effectiveness of bariatric surgery in
1.9 billion adults aged 18 years were
improving severe obesity, it was associated co-
overweight in2014, over 600 million of them
morbidities and the level of mortality (3,5,6).
were obese. (2). A study (4) reported that Saudi
Another study (11) showed that bariatric surgery
Arabia had a fast-growing obesity rate in which
was an appropriate option in the treatment of
70-75% of adults were overweight and about a
severe obesity. Gastric bypass was established
third were obese. There were numbers of
as an effective and safe therapy for morbid
modifiable factors played a role in increasing
obesity and it was associated morbidities
the proportion of obesity and the risk of pre-
according to some studies (10,5,6).On the other
mortality such as poor food quality, physical
hand, there were only a few studies reported the
inactivity, hormonal problem...etc. And some
effect of noncompliance with post-surgical
were nonmodifiable such as genetics and race
instructions on post-surgical weight loss(5-7).In
(1). Several recent documents had outlined the
our study, we aimed to determine motives of
health risks associated with obesity, which
bariatric surgeries among Saudi adults and to
included an increased risk of type 2 diabetes,
assess their beliefs and knowledge toward
surgical intervention in treating obesity.
dyslipidemia, some types of cancers and
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 15)

Full Paper (vol.737 paper# 16)

c:\work\Jor\vol737_17 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7104-7111

Effect of Pravastatin on the Incidence of Preeclampsia
Mohamed S. Hassanain, Bassem R. Abdel-Aziz, Mohamed A. Elsayed
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Corresponding author: Mohamed A. Elsayed; Mobile: 01140407230; Email: m_atef_dr@yahoo.com
Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that
occurs after 20 weeks' gestation and can present as late as 4-6 weeks post-partum. It is clinically defined by
hypertension and proteinuria, with or without pathologic edema. Aim of the Work: is to study the effect of
pravastatin given for primigravidae from 13th week to 16th week of gestation on the incidence of preeclampsia
compared to a control group in Egyptian women. Subjects and methods: This prospective case control study
included 400 pregnant women presenting for routine antenatal care at 13th to 16th weeks' gestation at EL Sayed
Galal Obstetric outpatient clinic, Al-Azhar University. Results: In our study, 16 cases developed preeclampsia
in the control group (11 cases were severe and the remaining 5 were mild) with a percentage of 8% instead of
6 cases in the study group (4 cases were severe and 2 were mild) with a percentage of 3%.
Conclusion: Pravastatin can be used as an effective agent in the prevention of preeclampsia in newborns within
neonatal period including fetal weight, gestational age at time of delivery and NICU admission. However,
extended follow up is needed till the age of 5 years to assess cognitive functions and school performance
among children born for women who received pravastatin for prevention of preeclampsia.
Keywords: pravastatin, preeclampsia, primigravida, gestation

Preeclampsia is a pregnancy-specific
maternal and fetal monitoring in such patients
disorder that affects 2 to 8% of all pregnancies and
would lead to an earlier diagnosis of the clinical
remains a leading cause of maternal and perinatal
signs of the disease and the associated fetal growth
morbidity and mortality worldwide. Diagnosis is
restriction and avoid the development of serious
based on new onset of hypertension and
complications through such interventions as the
proteinuria. Multiple organ systems can be affected
administration of antihypertensive medication and
with severe disease. The wide range of risk factors
early delivery. Early identification of the high-risk
reflects the heterogeneity of preeclampsia. Obesity,
group for the development of PE is also important
which is increasing at an alarming rate, is also a
for future studies investigating the potential role of
risk factor for preeclampsia as well as for later life
pharmacological interventions starting from the
cardiovascular disease. Exploring common
first trimester to improve placentation and reduce
insight into
the prevalence of the disease(3).
Pravastatin is one of the leading and most
preeclampsia (1).
effective statins derived from the natural product
Hypertension developing in the second
compactin. Statins are successful widely used
half of pregnancy is subdivided according to the
drugs that decrease the risk of coronary heart
presence or absence of co-existing significant
diseases and strokes by lowering cholesterol levels.
proteinuria into preeclampsia and gestational
They selectively inhibit the key regulatory enzyme
hypertension. An evidence suggests that
of the cholesterol synthesis pathway, thus lowering
preeclampsia can be further subdivided into early
level of plasma LDL (bad) cholesterol(4).
preeclampsia and late preeclampsia with the
Pravastatin is a competitive inhibitor of 3-
former being associated with a higher incidence of
hydroxy-3-methyl-glutaryl-coenzyme A reductase,
fetal growth restriction and both short-term and
the enzyme that catalyzes the rate-limiting step in
long-term maternal mortality and morbidity (2).
cholesterol synthesis. It is the most hydrophilic
There is no proven effective method for the
polar compound among the current statins, and
prevention of preeclampsia (PE), nevertheless,
thus thought to have limited ability to cross the
routine prenatal care in the last 50 years has
placenta. In addition it is the least potent sterol
evolved with the aim of early identification of
synthesis inhibitor (5).
women at high-risk for preeclampsia, which could
The Medical Genetics branch of the
potentially improve pregnancy outcome. Intensive
National Institutes of Health reviewed 214
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 17)

Role of Right Liver Lobe Diameter/Serum Albumin Ratio in Esophageal Varices Assessment in Cirrhotic Patients The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7112-7118
Role of Right Liver Lobe Diameter/Serum Albumin Ratio in Esophageal
Varices Assessment in Cirrhotic Patients
Mohamed Negm Eldin Salem*, Mostafa Abdel Aziz Elhawary*, Mohamed Ghareb Mohamed
Shekh roho*, Mohamed Abdel Hamid Bassyoni Khedr**, Sobhi Ramadan Abdallah*
Department of Tropical Medicine* and Department of Clinical Pathology**, Faculty of Medicine Al-
Azhar University, Cairo, Egypt
Corresponding author: Sobhi Ramadan Abdallah, E-mail: sobhi.rmadan@gmail.com
Background: Liver cirrhosis is a pathologic condition characterized by fibrosis of the liver parenchyma
and evidence of regenerative activity, resulting in portal hypertension. Portal hypertension plays a
crucial role in the transition from the pre-clinical to the clinical phase of the disease. Bleeding from
ruptured esophagogastric varices is the most severe complication of cirrhosis and is the cause of death
in about one third of cirrhotic patients. Cirrhotic patients frequently undergo screening endoscopy for
the presence of varices. These recommendations imply a considerable burden of endoscopies and
related costs. Objective: the aim of the study was to determine the predictive value of noninvasive
parameters (Rt. lobe diameter/ serum albumin ratio) in the prediction of esophageal varices. Subjects
Methods: This study was done on 120 patients divided into four groups: Group A: includes 30
cirrhotic patients with esophageal varices (OVs) grade I to II. Group B: includes 30 cirrhotic patients
with OVs grade III to IV. Group C: includes 30 cirrhotic patients without OVs. Group D: includes 30
none cirrhotic patients presented for esophagogastroduodenoscopy (EGD) screening because of other
etiologic factors that are not associated with liver cirrhosis. All participants were subjected to clinical
examination; laboratory investigations (CBC, Liver function tests including serum albumin
concentration, prothrombin time and concentration, modified Child-Pugh score and abdominal
ultrasonography (studying the right lobe and left lobe diameter, the presence of periportal thickening,
the splenic longest axis and the presence of ascites and Portal vein diameter, Right liver lobe
diameter/albumin ratio were calculated for all patients). Upper endoscopy was done for detection and
grading of esophageal varices. Results: This study revealed that The predictors that showed statistically
significantly associated with the presence of varices were increased right lobe diameter/Albumin ratio,
shrunken Rt. hepatic lobe, splenomegaly, thrombocytopenia, and the more advanced liver disease
(according to child class scoring of the patients), the more likely the presence of varices. Conclusion:
Right lobe diameter/Albumin ratio is good predictor for the presence and grading of esophageal varices.
Keywords: Right Liver Lobe Diameter/Serum Albumin Ratio, Esophageal Varices, Cirrhotic Patients,
Cirrhosis is a pathologic condition characterized 50% mortality within a week of the first bleeding
by fibrosis of the liver parenchyma and evidence episode (3).
of regenerative activity, resulting in portal The current recommendations are that all cirrhotic
hypertension (1).
patients should be screened for the presence of
Esophageal varices are related to portal varices at the time of initial diagnosis of cirrhosis.
hypertension which commonly accompanies the Follow-up endoscopy should be performed at 2-3
presence of liver cirrhosis, with a prevalence that years intervals in compensated patients with no
can range from 40 to 80% in patients with varices, and at 1-2 years intervals in compensated
cirrhosis (2). The yearly rate of development of patients with small varices (4). Although all
``new" varices is about 5­10% per year in patients patients with cirrhosis will eventually develop
with cirrhosis, and the progression from small to esophagogastric varices at a given point in time, a
large varices occur in 10% to 20% of cases after 1 variable proportion of un selected cirrhotic
year. In the 2 years following the first detection of patients will not have varices. Therefore,
esophageal varices, the risk of variceal bleeding performing endoscopy in all patients to detect
ranges between 20% to 30% and results in 25% to varices implies a number of unnecessary
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 18)

c:\work\Jor\vol737_19 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7119-7126

Comparative Study of Local Injection of Platelet Rich Plasma versus
Corticosteroids in the Treatment of Lateral Epicondylitis (Tennis Elbow)

Hesham D. Abd El Wahhab 1, Tarek M. Emran 2, Ashraf Abd S. Ahmed 1, El Sayed M. Abd El
Hami 1, Mai M. Khalifa 3

1Department of Physical Medicine, Rheumatology and Rehabilitation, and 2Department of
clinical pathology, Damietta Faculty of Medicine, Al-Azhar University, 3 Department of
Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University,
Corresponding author: Mai Khalifa Mobile: 01002777146; Email: dr. maikhalifa1012@gmail.com

Lateral epicondylitis, also known as 'tennis elbow', is a very common condition affecting
mainly middle-aged patients that is associated with local tendon pathology, alteration in pain
perception and motor impairment. Several approaches to treatment have been proposed, the most
frequently used is PRP. Platelet-rich plasma (PRP) is a growing modality for tissue healing,
regeneration and has more pain relief lasting effect.
Aim of the work:
was to estimate the clinical efficacy of local injection of Platelet Rich Plasma
compared to local injection of corticosteroids in cases of lateral epicondylitis.
Patients and Methods: This study was a prospective clinical trial study in which 80 patients with
lateral epicondylitis of both sexes between 2l - 60 years of age were recruited for the study. The
included patients were divided into two groups: 1- Platelet Rich Plasma group (40 patients) were
received a two injections of 1 ml of PRP with one month interval between the two injections, with
absolute platelet count of 1 million platelets/ mm3 as confirmed by automated cell counter. . PRP were
prepared under complete aseptic conditions. 2- Corticosteroids group (40 patients) were received a
two injections of corticosteroid (methyl-prednisolone, 40mg in l ml) with one month interval between
the two injections. The site of injection and the technique used was same in both the groups.
Results: Affected side was higher in right hand than left hand in both studied groups. In PRP group,
there were 92.5 % right hand and 7.5 % left handed patients. Whereas, in corticosteroid group, there
were 95.0 % right handed and 5.0 % left handed patients; and there was no significant difference
between the studied groups. Visual Analog Scale (VAS) was significantly improved at 1 and 3 months
in PRP patients compared to only significant improvement at 3 months in corticosteroid group. Both
studied groups showed significant improvement of grip strength at 1 and 3 months. qDASH at 1 and
3 months was significantly better in the PRP group, but it statically not reached. On the other hand,
significant improvement of US edema was estimated in the corticosteroid group at 3 months when
compared with PRP group. In addition, slight improvement of US tears was appeared in both groups
after 3 months.
Conclusion: It could be concluded that both PRP and corticosteroids showed better improvement of
pain, grip strength and qDASH at 3 months. However, PRP is suggested to be an effective treatment
for lateral epicondylitis. PRP provides better improvement in all parameters with nearly durable effect
when compared to corticosteroids. On the other hand, corticosteroids treatment resulted in better
improvement of US detected edema.
Keywords: Lateral epicondylitis, PRP, Corticosteroids.
Lateral epicondylitis (also known as tennis
lasting from 6 months to 2 years. Most of
elbow) is a painful degenerative condition
patients could respond to conservative
affecting the proximal enthesis of the extensor
therapy; whereas, others could need surgical
carpi radialis brevis tendon (1). It is
intervention. A new treatment strategy has
characterized as an overuse injury of the
been developed for use with ultrasound
forearm and the wrist extensors that typically
guidance in the ultrasonic microresection of
presents as progressive pain over the lateral
tendinopathic tissue (3). The annual incidence
aspect of the elbow (2). Tennis elbow is a
of LE and rate of surgical intervention have
common musculoskeletal condition affecting
remained constant from 2007 to 2014. The
middle-aged patients with symptoms usually
proportion of patients over >65 years
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 19)

c:\work\Jor\vol737_20 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7127-7132

Assessment of Practice of screening, Knowledge about Risk Factors, Perceived Barriers
and Attitude of Colorectal Cancer among Tabuk Population, Saudi Arabia-2018

Abdulelah Mohammed Alqarni1, Abdulrahman Abdulaziz Alwakeel2

1 General Practitioner, Tabuk, 2 Medical Intern, University of Tabuk, Tabuk, Saudi Arabia
In Tabuk region, colorectal cancer (CRC) ranked the first among male and the third
among female. Therefore, the current study was carried out to investigate the extent of both knowledge
and attitude toward CRC risk factor and screening among specific age group (31 and above) from both
males and females through conducting self-administrated questionnaire. In addition, the study aimed at
identifying the practice of CRC screening tests through fecal occult blood testing (FOBT), flexible
sigmoidoscopy (FS) and colonoscopy, which are the main tests in cancer screening programme in Saudi
Arabia. The study also identified perceived barrier of CRC screening of those who aged 51 year and
above. Methods: We have conducted a descriptive cross-sectional study in Tabuk city population,
Saudi Arabia. A self-administered questionnaire, about colorectal cancer was filled by participants. A
33-item instrument was developed based on an earlier studies and instruments used in other prior
studies. Results: Participants were classified to three categories according to age. Male and female
groups contributed to (26.3%) and (73.6%) respectively. Mostly noticed perceived barriers for doing
FOBT were: because of no symptoms and because I do not know if I have to do it, and the similar
results documented for doing flexible sigmoidoscopy and colonoscopy. Participants were more likely
not to be familiar with CRC screening. Conclusion: Many misconceptions regarding cancer and its
development were evident in the discussions. Collective efforts are needed to broadcast this knowledge
through media and public schools, with a hope that it will alter the current aggressive disease
presentation in Saudi Arabia.
Colorectal Cancer, Screening, Risk Factors, Perceived Barriers, Attitude.

The second most popular type of cancer among
proportion of people at risk have not been
all ages from both females and males in the
screened or are not screened regularly, as
kingdom of Saudi Arabia is colorectal cancer
recommended by national guidelines. When
(CRC) according to the most recent report by
detected in early stages, CRC is highly treatable
cancer registry in Saudi Arabia 2013. In Tabuk
with 5-year survival rates as high as 90%;
region ranked the first among male and the third
however, many cases are not diagnosed until
among female (1). In Saudi Arabia, recently,
later stages, when survival rates decline sharply
clinical practice guidelines for CRC has been
(4). Empirical evidence suggests that both
published (2) . which is undoubtedly an excellent
primary (e.g., diet and physical activity) and
step in controlling CRC. The guideline presents
secondary (e.g., screening and early detection)
recommendations on the age of initiating and
prevention strategies are effective means of
stopping screening for CRC in average-risk
reducing CRC incidence and mortality (5).
individuals. It also contrasts different screening
modalities (fecal occult blood testing (FOBT),
screening is valuable because CRC can have a
flexible sigmoidoscopy, colonoscopy, or
lag period during which the disease is
barium enema), which is an important issue at
detectable but asymptomatic (6). Therefore, the
this stage in which a nationwide CRC screening
current study was carried out to investigate the
program is being considered. FOBT is a self-
extent of both knowledge and attitude toward
administered test that examines fecal matter for
CRC risk factor and screening among specific
blood, while FS screening involves an
age group (31 and above) from both males and
examination of the distal colon and rectum to
females through conducting self-administrated
detect and remove polyps at the pre-cancerous
questionnaire. In addition, the study aimed at
stage (3). Despite the national recommendations
identifying the practice of CRC screening test
and positive evidence, CRC screening has not
through Fecal Occult Blood tests (FOBT),
been widely adopted by the Saudi public, and a
flexible sigmoidoscopy (FS) and colonoscopy,
majority of people are not adherent to the
which are the main tests in cancer screening
guidelines. Screening can be effective at
programme in Saudi Arabia. The study also
detecting cancer at treatable stages, but a large
identified perceived barrier of CRC screening

Full Paper (vol.737 paper# 20)

c:\work\Jor\vol737_21 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7133-7140

A comparative study between sinotomy with or without marsupialization
versus sinotomy and primary closure with or without drain in the
management of pilonidal sinus
Mahmoud Mohamed Mahran*, Mahmoud Salah Shehata, Akram Mohamed Mohamed Abd-
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo,
Corresponding author: Akram Mohamed Mohamed Abd-Elwahab, email: hero3starss@gmail.com
: pilonidal sinus (PNS) is a common condition. Although many methods for treatment are
available, there is no consensus on the optimal treatment.
Aim of the study: The aim of the work was to compare the outcome of sinotomy procedure with or
without marsupialization versus sinectomy and primary closure with or without drain in the
management of pilonidal sinus as regards operative times, postoperative complications, and time of
healing and return of work.
Patients and Methods: This is a comparative randomized comparative study. Sixteen patients
undergoing surgery for primary PNS were enrolled. The patients were randomized into four groups.
Each group included 15 patients. Group A underwent sinotomy without marsupialization; group B
underwent sinotomy with marsupialization; group C underwent limited excision and primary closure
with a drain and group D underwent the same procedure as group C but without drain. Each patient was
followed up for 6 months.
Results: Significantly short operative time was recorded in group B. Postoperative wound complications
occurred in 3.2% of patients in group A, in 1.7% of patients in B, in 7.4% of patients in group C and in
4.2% of patients in group D. Recurrence rate was a slightly higher in group C but with no statistical
Conclusion: The sinotomy with marsupialization for treatment of PNS is superior to excision with
primary closure either with or without a drain and sinotomy without marsupialization.
Keywords: sinectomy, pilonidal sinus, primary closure, sinotomy
Pilonidal sinus [PNS] is a common
simple suturing to the numerous complex
infectious process which occurs in buttocks and
methods for coverage.
sacral area, involves a wide range of symptoms
However, recurrence is still an important
ranges from an asymptomatic sinus to acute and
problem and its optimal management remains
chronic sinus track (1).
controversial (4).
The etiology of this disease is not fully
The quality of life of patients who underwent
understood, some are believed to be congenital
sinotomy with marsupialization was much
in origin and some considered being an
better than sinotomy without marsupialization
acquired disease. The reason of this condition
and sinectomy with primary closure either with
can be seen in folds between the fingers of
drain or not in terms of time to comfortable
hairdressers, shepherds and dog trainers which
walking, sitting on the toilet and healing time to
can be due to penetration of the hair as a foreign
return to work on the first and fifth day
body and cause reactions in the subcutaneous
postoperatively. This was in accordance with
tissue (2).
many studies that showed that the sinotomy
Risk factors include adiposity, sedentary
technique minimized the time away from work,
lifestyle, local irritation, trauma, insufficient
deviation from normal activities and costs (5).
body hygiene, excessive hair and perspiration
The ideal approach for the management of PNS
should be simple, cause minimal pain, have best
Many techniques have been advocated for the
chance for success and least recurrence rate
surgical management of PNS. They are
with low risk for complications, avoid general
classified basically into two groups, total
anesthesia, require minimal wound care and
excision of the sinus, followed by either leaving
ensure minimal inconvenience for the patient
the wound open for secondary healing or its
with rapid return to normal activity(6).
primary closure with techniques ranging from
Aim of the study:

Full Paper (vol.737 paper# 21)

c:\work\Jor\vol737_22 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7141-7145

Prophylactic Use of Intraumbilical Vein Oxytocin in the Management of
Third Stage of Labor

Mohamed Ahmed Mohamed*, Hassan I. Mohamed, Osama Ali, Ahmed Shabaan

Obstetrics and Gynecology department, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohamed Ahmed Mohamed, E-Mail:dr.osman89@gmail.com, Mobile: 01111211623

the third stage of labor is defined as the period of time between delivery of the fetus and
delivery of the placenta. The most common complication accompanying this stage is postpartum
hemorrhage (PPH) and prolonged third stage of labor owing to placenta retention and uterine atony are
among the underlying cause of most cases of PPH. The duration of the third stage of labor is 5-15 min.
Aim: to assess the efficacy of intraumbilical vein oxytocin in reducing duration of third stage of labour
and the amount of blood loss.
Patients and Methods:
this study included 150 women attending the delivery room of Department of
Obstetrics and Gynecology which was divided according to the inclusion and exclusion criteria into
two groups:
Group A (study group): include 75 cases which received 10 IU (1ml) of oxytocin in umbilical
Group B (control group): include 75 cases which received 1ml of saline in umbilical vein.
Results: the time of third stage took seconds in each group with no statistically significant difference
detected (p>0.05).
Conclusion: intra-umbilical oxytocin is a useful alternative in patients where methylergometrine is
contraindicated or in cases where intravenous fluids need to be restricted. For optimum effect, rapid
injection immediately after clamping of the cord is essential.
Keywords: intraumblical oxytocin, third stage of labour, postpartum hemorrhage

The third stage of labor is defined as the
efficient contracting of myometrium, can
period of time between delivery of the fetus and
disrupt hemostasis in the placental site (5).
delivery of the placenta. The most common

complication accompanying this stage is
Aim of the Work
postpartum hemorrhage (PPH) and prolonged
This is a randomized control study aims
third stage of labor owing to placenta retention
to assess the efficacy of intraumbilical vein
and uterine atony are among the underlying
oxytocin in reducing duration of third stage of
cause of most cases of PPH. The duration of the
labor and the amount of blood loss.
third stage of labor is 5-15 min (1).
Patients and Methods
Postpartum hemorrhage is a major
Type of Study: Randomized controlled study.
cause of maternal death worldwide. It is the
Study Settings: Al-Galaa Teaching Maternity
cause of approximately half of all maternal
deaths in developing countries (2). and even in
Study Duration: 6 months (from April 2017 ­
many developed countries. It is one of the major
September 2017).
causes of admission of mothers to intensive
Study Population:
care units (3).
This study included 150 women
The common causes of postpartum
attending the delivery room of Department
hemorrhage including bleeding from the site of
of Obstetrics and Gynecology which was
implantation of the placenta, genital and nearby
divided according to the inclusion and
organs trauma or both of them (4).
exclusion criteria into two groups:
Hemostasis of placental site is first
Group A (study group: include 75 cases
which received 10 IU (1ml) of oxytocin
myometrium and thrombosis of the vessel
in umbilical vein).
lumens. As a result, parts attached to the
placenta or large blood clots which impede

Full Paper (vol.737 paper# 22)

c:\work\Jor\vol737_23 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7146-7152

Accuracy of ultrasound in diagnosis of cholecystitis
Ali Omar Alshargi 1, Swedi Essa Al-sallami 2, Hamed Arif Mohammad Hejazi 1, Abdulmaajid
Ibrahim O Alahdal1

1Ibn Sina National College for Medical Studies, 2 King Khalid University
Acute cholecystitis- inflammation of the gall bladder- is most usually brought on by gall
stones. Gall stones are one of the most typical problems of the gastrointestinal system, impacting
regarding 10% of individuals in Western world.
Aim of the study: In this review we discussed background of cholecystitis, symptoms and possible
complications. As well we highlighted importance and use of ultrasound in diagnosis of cholecystitis
and other diagnoses possibilities and their efficiency.
Articles search was performed in MEDLINE, EMBASE, and CINAHL databases up to
May 2018 to identify studies about evaluation ultrasound in diagnosis of cholecystitis and other
diagnoses possibilities and their efficiency.
Conclusion: CT is debatably the most effective technique for imaging of challenging gallbladder
condition, especially for straight imaging of emphysematous cholecystitis, gallstone ileus, and
verification of presumed gallbladder perforation. Cholescintigraphy may assist ultrasound and CT for
differentiating acute from chronic cholecystitis and for the diagnosis of acalculous cholecystitis.
Keywords: ultrasound, diagnosis, cholecystitis.

Acute cholecystitis- inflammation of the gall
first diagnostic imaging methods that must be
bladder- is most usually brought on by gall
used [6]. Just when ultrasound and scintigraphic
stones. Gall stones are one of the most typical
indications are unsatisfactory or equivocal
problems of the gastrointestinal system,
would it be required to perform computed
impacting regarding 10% of individuals in
tomography (CT) [7]. Real-time scanners permit
Western world [1]. Greater than 80% of people
fast and very easy visualization of the
with gall stones are asymptomatic. In 1-3% of
gallbladder most of patients. Calculi
people with symptomatic gall stones acute
approximately 1 mm in diameter could be
cholecystitis develops [2].
imaged under suitable conditions [8]. As a result
In developing countries of Asia, southerly
of blockage of the gallbladder neck acute
Africa, and Latin America helminthic infection
cholecystitisusually develops, with subsequent
(ascariasis) is a significant root cause of biliary
infection. The gallbladder as a result appears
disease [2]. An inflammatory starts as a result of
abnormally distended and round fit and the
obstruction of the cystic, which causes acute
gallbladder wall surface is edematous and thick
cholecystitis. Perforation or gangrene of the
[9]. All these attributes, consisting of the
gall bladder may developed if the
blocking calculus, could be imaged by US and
might be very valuable in correctly establishing
With its diverse ethnic and geographical
the diagnosis.
distribution, cholecystolithiasis is among the
In this review we discussed background of
most common conditions worldwide, with an
approximated occurrence of 10-15 % [3]. Acute
complications. As well we highlighted
cholecystitis and pancreatitis are one of the
importance and use of ultrasound in diagnosis
most usual acute types of cholecystolithiasis [4].
Acute cholecystitis is triggered by sudden
possibilities and their efficiency.
impaction of a calculus in the vesicular
infundibulum [4].
Articles search was performed in MEDLINE,
Modern ultrasound (US) exam of the
EMBASE, and CINAHL databases up to May
gallbladder is a reliable device in the medical
2018 to identify studies about evaluation
diagnosis of acute cholecystitis (AC),
ultrasound in diagnosis of cholecystitis and
particularly when made use of on patients
other diagnoses possibilities and their
confessed for emergency situation surgery [5].
efficiency. We restricted our search to only
Cholescintigraphy (CS) and US are the very
English published articles with human subjects.
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 23)

c:\work\Jor\vol737_24 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7153-7159

HCV Infection And Erythropoietin In Haemodialysis Patients
Safwat F. Ahmed, Al -Sayed M. Rashed, Mohammed S. El Shorbagy, Mohammed I. Abd El
Internal Medicine (Nephrology Division) and Clinical Pathology departments, Faculty of Medicine,
AL Azhar University, Cairo, Egypt
Corresponding author: Al-Sayed M. Rashed, MD, Lecturer of internal medicine (Nephrology Division), AL Azhar
University, Email: drsayedaswad@ gmail.com
Background: Renal anemia is associated with increased cardio vascular morbidity and mortality and
decreased quality of life. It may worsen the preexisting heart disease and consequently may accelerate the
progression of renal dysfunction in a vicious circle. Renal anemia related mainly to decreased production
of erythropoietin (EPO) by the kidney, decreased it's response by bone marrow and disturbed iron status.
Aim of the Study:
Was to evaluate the relationship between HCV infection and erythrropoietin in patients
on regular HD. Patients and Methods: This study included 50 hemodialysis patients (25 patients +ve
HCV and 25 -ve HCV), 16 were male and 34 were female, and their ages ranged from 20 to 67 years,
with a mean ± SD of 50.5 ± 12.7 years, 15 apparently healthy individuals with normal kidney function
and not anemic were included in the study as a control Group. Results: The patients were divided into
two groups as the following: Group I consisted of 25 hemodialysis patients were positive for HCV
antibody, which was confirmed by PCR, and their ages ranged from 27 to 67 years, with a mean of 47.28
± 11.91 years. Group II consisted of 25 hemodialysis patients were negative for HCV antibody; their
ages ranged from 20 to 65 years, with a mean age of 46.32 ± 11.50 years. In contrast, 15 patients served
as age-matched and gender-matched; their ages ranged from 20 to 55 years, with a mean age of 44.13 ±
10.76 years, and were used as controls. Conclusion: Serum levels of erythropoietin correlate with chronic
hepatitis C infection, which was associated with an increased number of RBCs and higher values of
hemoglobin and hematocrit, which Result in lowering of the necessary erythropoietin dose and iron
Keywords: HCV Infection, Erythropoietin, Regular Hemodialysis
Chronic kidney disease (CKD) is a
of erythropoietin with rHuEpo results in an
public health problem and one of the most
increase in red blood cell mass and reduced the
important cause of death worldwide (1).
need for blood transfusion (4).
Anemia is an almost constant
Considerable percentage of patients on
complication of advanced renal failure, and
regular HD is already infected with hepatitis C
progress as the CKD progress. Renal anemia is
virus and is HCV antibody positive. Incidence
associated with increased cardio vascular
of HCV infection increased as the duration of
morbidity and mortality and decreased quality
dialysis increased. The risk of acquiring HCV
of life. It may worsen the preexisting heart
infection on HD is approximately 10% per year
disease and consequently may accelerate the
progression of renal dysfunction in a vicious
The level of hemoglobin is higher in
circle (2).
infected patients than in non-infected group (6).
Renal anemia related mainly to
The proposal was that this association may be
decreased production of erythropoietin (EPO)
due to secretion of erythropoietin from
by the kidney, decreased its response by bone
regenerating liver cells or due to alteration in
marrow and disturbed iron status (3).
iron metabolism (4). Several case report have
Erythropoietin is a glycoprotein
linked hepatic regeneration secondary to viral
hormone that regulates erythropoiesis and is
or toxic injury with increased red cell
mainly produced by the kidney. Epo deficiency
production in patients with and without CKD.
is the predominant factor in renal anemia. With
Intrestingly, patients with HCV antibodies
the development of recombinant human
positive had higher erythropoietin levels.
erythropoietin (rHuEpo) in 1989 new era of
treatment of renal anemia started. Replacement
Received: 20/8/2018
Accepted: 30/8/2018

Full Paper (vol.737 paper# 24)

Full Paper (vol.737 paper# 25)


Full Paper (vol.737 paper# 26)

c:\work\Jor\vol737_27 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7168-7176
Comparison of the Modified Lateral Position and Prone Position
Techniques in Percutaneous Nephrolithotomy
Ahmad Gomaa, Abul-fotouh Abdel-maguid, Abdullah Mohamed,
Ahmed Mohamed Soliman
Urology Department, Al-Azhar University, Cairo, Egypt
Corresponding author: Ahmed Mohamed Soliman, Mobile: 01060522677;
Email: the.only.way333@gmail.com

To evaluate the feasibility, operative time, efficacy and safety of the modified lateral
position in percutaneous nephrolithotomy (PCNL) for renal calculi, comparing it with the standard
prone position PCNL. Material and Method: The patient is placed with the thorax in the lateral
position and the pelvis in an oblique position. Then the lower limbs are split and bent in the lowest
position. Initial placement of a retrograde ureteral catheter, tract formation, stone fragmentation and
retrieval, and optional extra procedures were accomplished with the patient in the same position.
The study comprised 82 patients; 29 in split-leg modified lateral position (SL-MLP) group and
53in conventional prone position (PP) group. Three patients (all in PP group) underwent sequential
bilateral percutaneous nephrolithotomy (PNL) during the study period and each procedure was
considered as an independent case. So, the studied cases, according to the number of PNL procedures,
were 85; 29 in SL-MLP group and 56 in PP group. Conclusions: split-leg modified lateral position in
percutaneous nephrolithotomy (SL-MLP PNL) has significantly lower operative time compared with
conventional PP PNL. The stone free rate, need for ancillary procedures and complication rate were
equal in both groups.
Keywords: Prone position, modified lateral position, percutaneous nephrolithotomy.

With the introduction of new
procedure to perform carefully and has a certain
technologies in endourology, the indications for
potential for complications, because of the risk
open surgery for urolithiasis have decreased
of neck or limb injury or dislodgement of the
considerably. Minimal invasive treatment or
endotracheal tube. Moreover, simultaneous
surgery has become increasingly popular since
antegrade and retrograde access to the upper
its reduction in patient's morbidity and period
urinary tract is difficult or even impossible
of convalescence (1).
without changing position (4, 6).
Following the first description of
The rising number of PNL procedures
percutaneous renal access with a patient in the
combined with increasing confidence and
prone position (PP) by Goodwin et al. (2);
experience has caused researchers to modify the
Fernstrom and Johansson (3) reported the first
prone technique in an effort to improve success
case of stone extraction through a nephrostomy
rate and overcome some limitations. Some
tract in 1976. Since then, percutaneous
positions have been reported, aiming to
nephrolithotomy (PNL) has been widely
overcome the drawbacks of PP, such as supine
accepted and its indications well codified.
and modified supine positions, and lateral and
Variations of the PNL technique,
modified lateral positions (MLP) (4-6, 9-11).
including mini-PNL, ultra-mini-PNL and
To date, several randomized controlled
tubeless-PNL, have been described with the
trials have been performed to compare the
aim of reducing patients' morbidity.
prone and supine position techniques during
There is still controversy over the
PNL and most of published data have not
optimal position and technique to perform PNL,
shown significant superiority of either approach
and an overall consensus has yet to be reached.
Since it was initially described, the PP has been
Some investigators evaluated the split-
the most commonly used position for PNL (4-6).
leg MLP technique during PNL and concluded
However, this position does have some
that this position has several advantages for the
drawbacks; it might be risky for patients with
patient and the urologist, with greater versatility
cardiopulmonary ailments and markedly obese
of stone manipulation along the entire urinary
patients (7, 8). In addition, the change of position
tract. However, there are no prospective
from supine to prone is really a time-consuming
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 27)

c:\work\Jor\vol737_28 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7177-7181

The Effect of General and Spinal Anesthesia on Maternal Blood Loss in
Elective Cesarean Section: a prospective Study
* Ahmed Altaf Abbas, * Tarek Ramadan Abbas, **Ahmed Shawkey Dewidar
*Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo
**Department of Obstetrics and Gynecology, El-Galaa Maternity Teaching Hospital, Cairo

This study aims to compare between general and spinal anesthesia regarding to the
amount of maternal blood loss in cesarean section.
This is a randomized controlled study conducted at Bab El Shaaria Hospital to compare
maternal blood loss by general and spinal anesthesia.
Results: The results showed that the group which had a cesarean section under spinal anesthesia has a
statistically significant 2nd day postoperative higher level of hemoglobin (P< 0.001), when compared
with general anesthesia, with a mean difference of 0.660g/dL and also a statistically significant 3rd day
postoperative hematocrit percentage higher with the spinal anesthesia group with a mean difference of
1.507% (P= 0.002).
The spinal anesthesia showed definite advantages over general anesthesia; being higher
postoperative hemoglobin level and hematocrit value, less intraoperative blood loss, less need for blood
transfusion, less postoperative pain and need for postoperative analgesia, and earlier ambulation. In
addition; mothers were faster in starting breast feeding their babies
Spinal anesthesia, General anesthesia, Cesarean section, Maternal blood loss

Delivery by cesarean section is by far one of
in two groups. The first group (G) which
the most commonly performed obstetric
undergone "General anesthesia" and consists of
operations all over the world (1). Cesarean
80 patients while the second group (S) which
section refers to the procedure where a baby is
undergone "Spinal anesthesia" and consists of
delivered through an incision on the abdominal
80 patients.
wall and uterus of the mother (2,3).
All patients were subjected to the following
General anesthesia refers to the loss of
after taking a written consent from each patient:
ability to perceive pain associated with loss of
Personal history:
conscious produced by intravenous or
o Name, age, occupation, residence,
inhalation anesthetic agents, the risks include
the aspiration of stomach content, failed
intubation and respiratory problem for both
mother and baby (4).
Obstetric history:
Spinal anesthesia refers to the use of
o First day of last menstrual
local anesthetic solutions to produce
period, estimated gestational
circumscribed area of loss of sensation. With
age by date and first trimester
spinal anesthesia, the drug is injected directly
through a catheter that has been introduced into
Past medical history:
the subarachnoid space. Spinal anesthesia
o History of diabetes mellitus,
causes substantial drop in maternal blood
hypertensive disorders, cardiac
pressure, which may affect both mother and
problems, chest diseases, renal
fetus (5).
diseases, blood diseases or
Patient and methods:
bleeding tendency.
This is a randomized controlled study
Past surgical history:
conducted from November 2017 till August
o Previous uterine scars and
2018 at Bab El Shaaria Hospital to compare
previous laparotomies.
maternal blood loss by general and spinal
History of the present pregnancy:
anesthesia. It included 160 pregnant women.
o Medical or surgical conditions
One hundred and sixty pregnant
to define high risk factors.
women undergoing elective cesarean section

were included in this study, randomly allocated
Examination of the patients:
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 28)

c:\work\Jor\vol737_29 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (7), Page 7182-7188

Management of Isolated Lateral Malleolar Fracture
Ismail A. Yassin, Mohammed A. Hassan, Mohammed A. Sultan*
Department of Orthopedic Surgery,Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohammed A. Sultan; Mobile: 01000799386; Email: sultan_28@yahoo.com

fractures of the lateral malleolus are the most common type of fracture. Various methods of
lateral malleolar fixation have been utilized, all with acceptable results. Aim of the Work: to focus light on
important modalities in management of isolated lateral malleolar fracture considering the advantages, the
disadvantages and determine different protocol of management regarding the most recent guidelines for this
group of patients. Patients and Methods: this study was conducted on twenty patients with fresh isolated
lateral malleolar fracture. No or only minimal pain on the medial side was also a prerequisite, safeguarding
against a ligamentous SE IV injury of the deltoid ligament. The patients were 4 men and 16 women with a
mean age of 36 (22-50) years old. Results: all fractures united within an average time to union of 8.2 weeks.
in all patients the average time to full weight bearing was 7.2 weeks. Most of complications were minor and
resolved within 21 days. Conclusion: good anatomical reduction is essential for good clinical outcome
irrespective of the type of fracture. Nevertheless, if an acceptable reduction cannot be achieved using closed
techniques, one should proceed with open reduction and internal fixation without hesitation.
isolated lateral malleolar fracture, management modalities
Determining how to proceed with treatment
There are many types of ankle fractures, and
depends on where the injury has occurred. There are
treatments vary significantly depending on the location
many types of ankle fractures. Lateral malleolus
and severity of the injury. Understanding what to do
fractures (fibula only) are the most common type of
about a broken ankle requires some information about
ankle fracture. Medial malleolus fractures (tibia
how these injuries occur. The ankle is a complex joint
only) are relatively uncommon. In general, a
that forms where three bones come together. The bones
displaced (out of position) medial malleolus fracture
of the lower leg, the tibia, and the fibula are above the
is treated with surgery. Bimalleolar ankle fractures
joint, and the talus is below the joint (1).
(both tibia and fibula) occur when there is an injury
to both the inner and the outer side of the ankle.
The tibia is the larger, weight-bearing bone
These injuries always result in an unstable ankle
of the lower leg. Of the weight transferred through
joint, and in most active patients, surgery will be
the leg, about 90% is carried by the tibia. The fibula
recommended. Fractures of the posterior malleolus
is the smaller bone on the outside of the leg. It only
are generally found in association with bimalleolar
carries about 10% of your body weight. Both the
ankle fractures in which case the injury is called a
tibia and the fibula wrap around the talus to form the
trimalleolar ankle fracture(1).
ankle joint. The bony prominences at the ankle are
called the medial malleolus (the end of the tibia) and
In this study we focused on isolated fracture
the lateral malleolus (the end of the fibula) (1).
of the lateral malleolus. The lateral malleolus is the
name given to the bone on the outside of the ankle
The ends of these bones form a cup-shape that
joint. Fractures of the lateral malleolus are the most
the talus bone sits within. The most important aspect of
common type of fracture. These injuries typically
ankle fracture treatment is understanding how the talus
occur when the ankle is either twisted or rolled, often
moves in relation to the ends of the tibia and fibula.
with an awkward or uneven step. The good news is
Fractures of the ankle are either stable (the movement
that most lateral malleolus fractures are considered
of the talus is unchanged) or unstable (the talus does not
stable ankle fractures and can be treated without
move in a normal manner). This means that the joint is
surgery (2).
not held in a symmetric position--when the ankle
fracture is unstable, more invasive treatment is needed
Lateral malleolus fractures cause pain,
swelling, and bruising around the ankle. Pain in other
areas of the foot and ankle should be reason to
When a broken ankle occurs, the injury may
suspect a more serious ankle injury than an isolated
be to the end of the tibia (the medial malleolus) or to
lateral malleolus fracture. Pain and swelling on the
the fibula (the lateral malleolus), or both (1).
inner side of the ankle (along with a lateral malleolus
fracture) may indicate the possibility of an injury
Received: 22/8/2018
Accepted: 2/9/2018

Full Paper (vol.737 paper# 29)


The gyptian J


al Me

dicine (O



), P
age 7189


Comparative study between preoperative and operative staging in endometrial
cancer patients
Said Hosny Bendary, Elsayed Ragab Mostafa, and Mohamed Esmat *
Surgical Oncology Unit, Faculty of Medicine, Al-Azhar University, Cairo
*Corresponding author: Mohamed Esmat, E-mail: drmesmat67@hotmail.com --------

endometrial cancer is the most common gynecological cancer in developed countries and
is primarily treated surgically. This study aimed to compare between preoperative findings by Vaginal
U/S & MRI with postoperative pathological data regarding Endometrial thickening, Myometrial
Invasion Depth and Lymph Node Metastasis.
Methods: It is a prospective cohort study of 20 consecutive patients with endometrial cancer, in the
Department of General Surgery at Al-Azhar University Hospitals. To assess the depth of myometrial
invasion, we performed a pelvic MR. Subsequently; myometrial invasion was detected with MRI by
the recognition of the disruption, whilst transvaginal sonography was performed by experienced
sonographers who used a 5.0- to 7.5-MHz curvilinear-array transducer probe.
Results: Our results showed that the employment of magnetic resonance imaging to detect the
myocardial invasion established that the sensitivity, specificity, positive and negative predicted values
of MRI was 92.3%, 76.5%, 60.0% and 96.3% subsets, respectively. US was accurate in 12 of 20 cases
and overestimated the depth of invasion in 2 cases. In comparison with histopathological findings; the
results of MRI images were accurate in 13 patients whilst TVUS images were accurate in 12 patients
(60%) with 3 patients underestimated and two patients over estimated.
Conclusion: MRI and TVUS detect myocardial invasion with accurate results that help the surgeon to
make the appropriate decision. Brings to light that, MRI and TVUS perform best in the pretreatment
evaluation of endometrial cancer and differentiating deep from superficial myometrial invasion.
Keywords: Endometrial cancer, MRI, TVUS, Myometrial invasion.

Endometrial cancer is the most common
recognized as an important prognostic factor
gynecological cancer in developed countries
closely correlated with lymph node metastases
and is primarily treated surgically (1). It
and 5-year survival rate(6). Therefore, correct
predominantly occurs in postmenopausal
preoperative evaluation of myometrial invasion
women, often with serious co-morbidities. The
is important in optimizing treatment planning.
clinical challenge is the optimal selection of
Recent reports suggest that MR imaging, and
high-resolution transvaginalsonography may be
lymphadenectomy, if there is a high risk of
the techniques of choice for evaluating
advanced disease and relapse, and avoidance of
overtreatment if there is not (2). The extent of
Transabdominalsonography and unenhanced
surgery needed is based upon cell type, tumor
mid-field MR imaging were compared and
stage and, in apparent stage I cancers,
found to be equally accurate for assessing depth
myometrial or cervical invasion (3). The degree
of myometrial invasion(8). However, a
of myometrial and cervical invasion can be
comparison of transvaginalsonography and MR
assessed perioperatively, but preoperative
imaging in the same patients is limited in
knowledge of these parameters is advantageous
for optimal planning of extent and type of
The aim of the study is to compare between
surgery (4). There is no consensus about the
preoperative findings by Vaginal U/S & MRI
optimal imaging technique for evaluation of
with postoperative pathological data regarding
myometrial and cervical invasion. Two-
Endometrial thickening, Myometrial Invasion
dimensional transvaginal ultrasonography (2D-
Depth and Lymph Node Metastasis.
TVS) and magnetic resonance imaging (MRI)

have demonstrated accuracies of 69­74% and

66­90%, respectively (5).
The depth of myometrial invasion in patients

with endometrial carcinoma is widely
Patients and Methods
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.737 paper# 30)