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The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7196-7203
Relationship between Type 2 Diabetes Mellitus and the occurrence of
Gastroesophageal varices in patients with chronic Hepatitis C Virus
Related Liver Cirrhosis
Fathy G. Abdel-Raziq, Mahmoud S. Berengy, Tarek M. Emran(*), Ahmed RA
Mohammed
Internal Medicine, and Clinical Pathology (*) Departments, Faculty of Medicine, Al-Azhar University (Damietta)
Abstract
Background: Hepatitis C virus (HCV) infection is a challenging health problem in Egypt. Esophageal
varices are a major complication of it which may bleed and endanger patient's life.
Aim of the work: to assess the relationship between type-2 DM and the development of
gastroesophageal varices and explore the role of insulin resistance as a predictor of gastroesophageal
varices.
Patients and methods: This study included 100 patients with Child A, HCV-induced cirrhosis. They
were divided into two main groups: Group A included 50 patients with type-2 DM, while Group B:
included 50 non-diabetic which were subdivided into: Group B1: patients without DM but, with
insulin resistance (IR) {32}, and Group B2: patients without DM or IR {18}. All patients were
subjected to full history taking, clinical examination, laboratory and imaging studies (abdominal
ultrasound) and upper GI endoscopy.
Results: The prevalence of esophageal varices in patients with Child A HCV-induced cirrhosis was
80%, elevated to 88% in patients with type-2 DM. Insulin resistance played the major role in
development of esophageal varices. There are statistically significant elevated HOMA-IR score, lower
platelet count/spleen diameter ratio and higher right liver lobe diameter/albumin ratio in patients with
varices.
Conclusion: Insulin resistance is a major contributor for development of esophageal varices in HCV
induced cirrhosis. Platelet count/spleen diameter ratio, right liver lobe diameter/albumin ratio and
insulin resistance measured by HOMA-IR are good predictors for the presence of esophageal varices.
Keywords: type-2 diabetes mellitus, insulin resistance, hepatitis C virus infection, gastroesophageal
varices.
Introduction
Hepatitis C virus (HCV) infection is a
suggested that non-invasive prediction of GEV
global health problem, which can lead to
is in great demand to prevent unnecessary
progressive hepatic injury with consequent
endoscopy and the unnecessary cost. This cost
cirrhosis and end stage liver disease[1].
is of concern in many African countries,
Worldwide, Egypt is an endemic country with
including Egypt, where liver cirrhosis is highly
the highest prevalence of HCV infection
prevalent. On the other side, Berzigotti et al.[7]
(15%)[2]. Gastroesophageal varices (GEV) are
proposed the criteria of ideal method for
serious complication of portal hypertension,
recognition of varices. It must be simple, non-
with variceal bleeding reported in up to 50% of
invasive, cheap, reproducible, precise, and
cirrhotic patients. The mortality of bleeding is
readily accessible; have high sensitivity and
up to 20% irrespective of improved diagnostic
specificity; follow the natural history; detect
and therapy modalities. Variceal bleeding is
the effect of the treatment correctly; and
the second most common cause of mortality in
indicate the prognosis and possibility of
patients with cirrhosis[3].
treatment.
About two thirds of patients with
Type-2 diabetes mellitus (type-2 DM)
decompensated cirrhosis and one third of
comprised patients with insulin resistance (IR)
patients with compensated cirrhosis have GEV
and relative insulin deficiency[8]. IR was linked
at the time of diagnosis. Thus, it is very
to HCV infection and usually developed early
important to recognize and treat patients at
in the course of the disease[9]. Thus, IR is
highest risk[4]. Cherian et al.[5] proposed that
proposed to have a possible usefulness in
screening of all cirrhotic patients with an
prediction of GEV in patients with early
endoscopy is mandatory to detect GEV and to
cirrhosis. It is simple, non-invasive, and easy-
initiate prophylactic maneuvers in patients
to-get test[10]. In addition, IR was reported as a
with large GEV. Abu El Makarem et al.[6]
major independent determinant of fibrosis and
6917
Received: 17/9/2018
Accepted: 30/9/2018
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The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7204-7210
Clinical comparative study between Magnesium sulphate versus
Rocuronium versus Dexmedetomidine as adjuvants for local anesthetic in
peribulbar block for eye surgeries
Sayed Ahmad AbdAlali, Gamal Farouk Mohamed, Amr Soliman AbdAlmagid, Mahmoud
Alsayed Hussin Desoki
Department of Anesthesiology and Intensive care,Faculty of medicine, Al-Azhar University
Corresponding author: Mahmoud Alsayed Hussin Desoki,email: mahmoudalsayed39@gmail.com
Abstract
Background: Regional anesthesia is a preferred technique for ophthalmic surgery. It is safe,
inexpensive and provides efficient ocular anesthesia for ophthalmic surgery. It is associated with less
hemodynamic instability, less respiratory depression, better postoperative pain relief, and less nausea
and vomiting compared to general anesthesia.
Objectives: The aim of the study was to compare the safety and efficacy of the use of Magnesium
sulfate versus that of Rocuronium versus Dexmedetomidine as an adjuvant to the local anesthetic in
peribulbar anesthesia. It is characterized by generating optimal operating conditions for eye surgery in
terms of akinesia, analgesia, incidence of complications, as well as induction of patient and surgeon
satisfaction.
Patients and Methods: The present study included100 patients of the American Society of
Anesthesiology (ASA), physical status I, II, III or IV of both sex, (20-80) years old and undergoing to
anterior and posterior segment surgeries. Informed written consent from all patients was taken after
approval of Al-Azhar University Ethical Committee.
Results: Evaluation of the globe akinesia was done at (2.5),(5),(7.5),and(10) min. after injection. The
onset of motor block showed a statistically significant difference between the four groups, the
rocrounium group showed more rapid onset of motor block then dexmedtomedine group then magnisum
sulphate group then lastly the control group.
Conclusion: The present study concluded that using Rocuronium as an additive to local anathestic
drugs in peribublar block it makes onset of block more rapid and dense but it has less effect on analgesic
aspect. On the other hand, when Dexmedetomidine or Magnesium sulfate were used as additive they
increased analgesic effect of local anathestic and decreased the need for early postoperative rescue
analgesia, as well as fastening the onset of block but to a lesser extent less than Rocuronium as an
additive to local anathestic.
Keywords: Magnesium sulphate, Rocuronium, Dexmedetomidine, local anesthetic, peribulbar block,
eye surgeries.
INTRODUCTION
Regional anesthesia is a preferred
Peribulbar anesthesia is widely used for
technique for ophthalmic surgery. It is safe,
cataract surgery .However, it has the
inexpensive and provides efficient ocular
disadvantages of slowing the onset of orbital
anesthesia for ophthalmic surgery. It is
akinesia and the frequent need for block
associated with less hemodynamic instability,
supplementation.
To
overcome
these
less respiratory depression, better postoperative
limitations, many adjuvant drugs such as
pain relief, and less nausea and vomiting than
adrenaline,
sodium
bicarbonate,
and
general anesthesia (1).
hyaluronidase have been added to the local
Among regional blocks, peribulbar
anesthetic mixture used for peribulbar block to
block is safer in comparison with retrobulbar
augment its efficacy and hasten its speed of
block due to the lesser incidence of serious
onset. However, their effects have been variable
complications such as brain stem anesthesia,
(2).
globe perforation, and retrobulbar hemorrhage
These agents are also not devoid of
(2).
side-effects like allergic reaction, bradycardia,
Peribulbar block is a much simpler,
sedation, dryness of mouth, systemic
rapid, and safe technique; especially in elderly
neuromuscular blockade, etc. Until date, no one
patients who have multiple systemic diseases
adjuvant is ideal for peribulbar block (4).
such as diabetes or cardiovascular disease that
Neuromuscular blocking drugs, such as
may limit the use of systemic analgesics (3).
vecuronium and atracurium, have also been
4027
Received: 23/8/2018
Accepted: 12/9/2018
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The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7211-7219
Comparison between the Effects of Insulin versus Corticosteroid Local
Injections in Diabetic Patients with Carpal Tunnel Syndrome
Ahmed Ismail Ali Shalaby1, Kalthom Mohamed Abd El Hamid1, Ibrahim Abd Alsamie Emam1,
Adel Ibrahim Azzam1, Mohamed Ahmed Zaki2
1 Department of Physical Medicine, Rheumatology and Rehabilitation, 2 Department of
Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Ahmed Ismail Ali Shalaby; Mobile: 01145513426; Email: dr.ahmedismail.
rheumatologist@gmail.com
ABSTRACT
Background: Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median
nerve as it travels through the wrist at the carpal tunnel. Carpal tunnel syndrome is the most commonly
diagnosed and treated entrapment neuropathy and is a significant cause of morbidity. It is estimated to
affect one out of ten people during their lifetime. Diabetic patients have a higher incidence with carpal
tunnel syndrome. It has been reported that insulin improves the nerve regeneration and myelination
through its role as neurotrophic factor.
Aim of the Work: was to compare the short-term effects of insulin and corticosteroid local injections
in the treatment of diabetic patients with carpal tunnel syndrome.
Patients and Methods: Fifty diabetic patients with clinical and electrophysiological evidence of mild
to moderate carpal tunnel syndrome were included in this study. All Patients had been sub-classified
into two equal groups:- Group (1): Twenty five patients have received local insulin injection of 10 IU
Neutral Protamine Hagedorn (NPH) {Insulinagypt N} into the affected carpal tunnel at the first visit
and the same dose of insulin after 2 weeks. Group (2): twenty five patients have received a single dose
of 40 mg triamcinolone acetonide {Epirelefan} local injection into the affected carpal tunnel. Nerve
conduction study (NCS), Boston Carpal Tunnel Questionnaire (BCTQ) and clinical evaluation were
carried out for both groups at baseline and four weeks after second dose of insulin injection and one
month after steroid injection.
Results: In steroid group, significant improvement in nerve conduction study as regard distal sensory
latency and sensory conduction velocity without significant improvement in distal motor latency and
motor conduction velocity and significant improvement in (BCTQ). In insulin group, a more significant
improvement in all parameters of nerve conduction study and also in (BCTQ) was observed with insulin
injection than steroid done. Also, there were significant differences between results of both groups for
insulin injection group.
Conclusion: Local insulin injection is an effective treatment for restoring median nerve function in
diabetic patients with mild to moderate carpal tunnel syndrome and produce significant improvement
in NCS and BCTQ.
Keywords: Carpal tunnel syndrome, diabetes, Insulin, steroid, local injection.
INTRODUCTION
Carpal tunnel syndrome (CTS) is a
The main symptoms are pain, numbness
medical condition due to compression of the
and tingling in the thumb, index finger, middle
median nerve as it travels through the wrist at
finger and the thumb side of the ring fingers [1],
the carpal tunnel [1] and it is the most commonly
which occurs following entrapment of the
diagnosed and treated entrapment neuropathy
median nerve within the carpal tunnel [5].
and is a significant cause of morbidity. The
Symptoms typically start gradually and during
estimated prevalence of CTS in general
the night, Pain may extend up the arm, on
population is 1 to 5 percent [2]. CTS is more
awakening, the patient usually gets relief by
frequent in women (0.7 to 9.2 percent) than in
shaking or rubbing the hands. Weak grip
men (0.4 to 2.1 percent) [3]. CTS is reported to
strength may occur and after a long period of
occur in 2.620% of all patients with diabetes
time the muscles at the base of the thumb may
[4].
waste away. In more than half of cases both
sides are affected [1]. Diagnosis is suspected
7211
Received: 17/9/2018
Accepted: 30/9/2018
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The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7220-7230
Comparative Study between Augmentation Skin Mastopexy versus
Augmentation Glandular mastopexy after Massive Weight Loss
Moustafa H. ELHelw 1, Ahmed M. ELMofty 2 , Magdy A. Abd Al Moktader 2 , Tarek M.
ELBanoby 2 , Amir A. Saedy 1 ,Ahmed A. ELDanaf 1
(1): Plastic & Reconstructive Surgery Department, Mataria Teaching Hospital
(2): Plastic & Reconstructive Surgery Department, AL Azhar University
*Corresponding author: Moustafa H. ELHelw, E-Mail: drmust.hassan@gemail.com, Mobile: 01122276012
Abstract
Background: an increase in the number of massive weight loss patients resulted in increase of body
contouring surgery including breast reshaping.
Aim of the study: it was to compare two procedures of augmentation skin mastopexy augmentation
skin glandular mastopexy with analysis and evaluation of the final aesthetic results.
Patients and Methods: forty female patients after massive weight loss patients were included in this
study, divided in to two groups. 20 patients underwent augmentation skin mastopexy (A) and the
other 20 patients underwent augmentation skin-glandular mastopexy (B). Augmentation was done
through implant. Breast measurements and aesthetic outcome were assessed.
Results: both groups showed well improvement in breast shape, volume, and projection with no
significant difference regards patient satisfaction and expectations and measurements.
Conclusion: augmentation mastopexy as a combined procedure is a good solution for breast ptosis
after massive weight loss. Skin glandular mastopexy is the same as skin mastopexy but it showed
fewer complications, no revision, and more satisfaction than skin mastopexy.
Keywords: augmentation mastopexy, massive weight loss, breast.
Introduction
The mammary gland forms one of the
regarding safety, complications, and aesthetic
most attractive areas of the female anatomy.
outcome.
As a beautiful, harmonious gland is essential
Patients and Methods
for sensuality a lot of surgical procedures for
This is a prospective study included 40
improving its look were introduced (1,2). More
female patients presented with breast ptosis
complex and challenging manipulations are
and atrophy after massive weight loss. We
needed in massive weight loss (MWL)
started surgery when patient weight is fixed
patients. The surgeon should understand each
for at least 6 months. The included criteria
deformity clearly to get an aesthetically
were age : 20-60 years, BMI: 20-30, healthy
pleasing result (3).
patients, no breast tumors, and no previous
Changes of the upper body after
breast surgery. The cases were divided
massive weight loss (MWL) include breast
randomly into two groups, 20 patients, skin
flaccidity and ptosis, loss projection,
mastopexy group A, the other 20 patients,
flattening, inframammary fold (IMF) and
skin-glandular mastopexy group B. The study
nipple descent, back rolls, and arms changes(4).
was done at Al-Azhar University Hospitals
The most important thing to obtain good and
and Mataria Teaching Hospital from February
log-term results with minimal complication
2016 till September 2018. Local examination
rate is the selection of the surgical technique of
to breast and axillae, degree of ptosis, and
augmentation mastopexy(5).
chest circumference were assessed.
The
safety
of
single-stage
Marking was done while the patients
augmentation-mastopexy is still controversial.
standing. While the patient in a supine
There are concerns about the technically
position, here arms were abducted 70-90
challenging nature of the procedure, expansion
degree, and under G.A surgery was started.
of breast volume and reduction of the skin
Creation of the subglandular pocket and
envelope(6).
insertion of the implant after proper
In this study we aim to clarify which is
haemostasis was done. Excess skin was
better of the two procedures, augmentation
tightened in a vertical fashion while the patient
skin mastopexy and augmentation glandular
in near semisetting position.
mastopexy in massive weight loss patients,
7220
Received: 16/8/2018
Accepted: 26/8/2018
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The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7231-7236
Evaluation of Oral Anti-HCV Therapy (OAT) Effects on Serum Lipids
Profile in Diabetic Patients
Abdou Mabrouk Al-Shafey*, Diaa Mohammad Eltebi*,
Islam Abdel-Mawla Ammar*, Mohamad Ali Alnadar*
*Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Corresponding author: Mohamad Ali Alnadar, E-mail: Mohamedali1990529@gmail.com
Abstract:
Background: hepatitis C Virus (HCV) has complex interactions with human lipid metabolism leading
to down regulation of cholesterol level. Interferon (INF) therapy has been shown to decrease cholesterol
even further during treatment .With the availability of direct acting antiviral agents (DAAs) the effect
of suppressing HCV on lipid metabolism warrantes re-evaluation. Aim of the work : goal of our study
was evaluation the changes in lipid profile after treatment of chronic HCV infection with oral
antiviral medications in diabetic patients. Methods: this prospective study conducted on 90 HCV
infected patients, all patients received Sofosbuvir (SOF) & Daclatasvir (DCV) as a dual therapy for 3
months. They were divided according to the presence or absence of diabetes mellitus (DM) and
hyperlipidemia into three main groups; Group I: included 30 diabetic hyperlipidemic patients, Group
II: included 30 non-diabetic hyperlipidemic patients, Group III: included 30 non-diabetic non-
dyslipidemia patients.Changes of lipid profile on treatment with DAAs were assessed by checking
fasting lipid profile at base line, then at end of treatment, and finally 3 months after treatment. Results:
there was a statistically significant increase in total cholesterol level (TCHOL) which was maintained after
the end of therapy. Changes in TCHOL were driven by changes in low-density lipo-protein (LDL)
cholesterol, whereas high-density lipo-protien (HDL) cholesterol and very low-density lipo-protein
(VLDL) cholesterol showed no significant changes. There were also no significant changes in
tryglyceride (TG) level on treatment. Conclusion: eliminating HCV with DAAs increased TCHOL but
had no effect on TG level.
Keywords: Hepatitis C Virus, Direct- acting antivirals
Introduction:
HCV infection is a major cause of chronic liver
transformed by the introduction of a new class
disease worldwide, ultimately leading to
of medicines called direct-acting antivirals
cirrhosis and hepatocellular carcinoma (HCC),
(DAAs). An 812-week course of these
Approximately, 130150 million people are
medicines can cure more than 90% of persons
infected with HCV each year, besides an
with chronic HCV infection,These new oral
estimated 399 000 people die from
treatments offer tremendous opportunities and
complications of HCV including cirrhosis,
hope to all those who are infected (6).
malignant neoplastic disease (HCC) and liver
failure (1).
Successful clearance of HCV viremia with
immunomodulatory therapy (Peg INF and
Unluckily, many people with HCV only know
ribavirin) has been associated with a decrease
about their infection when they experience
in TCHOL and LDL (7), But the impact of
symptoms of cirrhosis or liver cancer (1).
DAAs
on lipi
d met
aboli
sm is thus far
uncharacterized, so it's evaluated in our study.
Chronic HCV infection is associated with
AIM OF THE WORK:
hepatic steatosis and hypocholesterolemia (2),
HCV utilizes peripheral lipid metabolism
The aim of the current study was to evaluate the
pathways for viral assembly and requires
changes in lipid profile after treatment of
several apo- lipoproteins for production of
chronic HCV infection with oral antiviral
infective particles (3)(4), so patients with HCV
medications in diabetic patients.
infection show a reduction of serum TCHOL
and LDL and Apo-lipoprotein B (Apo-B) levels
Patients and Methods:
(5).
This prospective study was conducted at Al-
The field of HCV therapeutics has evolved
Azhar University Specialized hospital where 90
rapidly; in 2013, the treatment of HCV was
HCV patients related chronic liver disease
1327
Received: 25/8/2018
Accepted: 5/9/2018
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The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7237-7243
Relation of neutrophil-to-lymphocyte, platelet-to-lymphocyte ratio and
CRP level with coronary artery disease severity in patients undergoing
coronary angiography
Mamdouh Helmy Al Tahhan, Wael Refaat Hablas, Abdul Mohsen Mostafa, Mohammed
Sarhan1 & Mostafa Adel Mostafa*
Department of Cardiology and Clinical Pathology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mostafa Adel Mostafa, Mobile: 00201063033600, E-Mail: dr_mostafa_khamis@yahoo.com
Abstract
Background: coronary artery disease (CAD) is the leading cause of morbidity and mortality throughout
the world. It has a complex pathophysiology, and inflammation seems to play an important role in CAD.
Previous studies have shown that higher levels of inflammatory markers are associated with the severity
of CAD and worse cardiovascular outcome. Although endothelial damage has been known as the
triggering factor for the formation of atherosclerotic plagues, inflammatory process is responsible in the
initiation and progression of the atherosclerosis. The neutrophil-to-lymphocyte ratio (NLR) and platelet-
to-lymphocyte ratio (PLR) have recently been investigated as new predictors for worse cardiovascular
outcome. Previous studies have shown that NLR is associated with morbidity and mortality in many
cardiovascular diseases such as hypertension, heart failure, infective endocarditis, and acute coronary
syndromes (ACS).
Aims: The aim of this study was to explore the relation of NLR , PLR and CRP level with severity of
coronary artery disease (CAD) using the Syntax score (Sxscore).
Patients and Methods: This study was conducted to investigate the relationship between the severity
of coronary artery disease and inflammatory markers (lymphocyte ratio, lymphocyte platelet, CRP) by
sytax score in patients undergoing elective coronary angiography, the active number of 100 patients
with a chronic stable was taken Coronary angiography, different markers for coronary assessment, renal
function tests, INR, ECG and Echocardiography. A complete clinical evaluation was performed for each
of our patients
Results: Coronary lesions were evaluated by the result of camel synthesis and there was a strong
relationship between NLR, PLR, CRP level, and coronary heart disease r. 526 p 0.001, r 0.317 p 0.001,
r 0.699 p 0.001 However, when we divided the patient for a result Syntax The results show some
difference in determining who are drafting the sentence above 21, we found a negative relationship
between NLR, PLR and syntax points, while the CRP level was positively correlated at the level of the
structure below 31 a significant negative correlation was found with the construct conclusion above 31.
Conclusion: Our study concluded that the severity of coronary artery disease is associated with NLR,
PLR, CRP levels to some extent in the patient with angina for chronic stable chest.
Keywords: CAD, NLR, PLR, CRP, Syntax score
Introduction
Coronary artery disease (CAD) is the
prediction of cardiovascular events in
leading cause of morbidity and mortality
asymptomatic patients (3).
throughout the world. It has a complex
The neutrophil-to-lymphocyte ratio
pathophysiology, and inflammation seems to
(NLR) and platelet-to-lymphocyte ratio (PLR)
play an important role in CAD (1).
have recently been investigated as new
Previous studies have shown that
predictors for worse cardiovascular outcome(4).
higher levels of inflammatory markers are
Previous studies have shown that NLR
associated with the severity of CAD and worse
is associated with morbidity and mortality in
cardiovascular outcome(2).
many cardiovascular diseases such as
Although endothelial damage has been
hypertension,
heart
failure,
infective
known as the triggering factor for the formation
endocarditis, and acute coronary syndromes
of atherosclerotic plagues, inflammatory
(ACS) (5).
process is responsible in the initiation and
Although previous data have shown
progression of the atherosclerosis (1).
that NLR is associated with severity of CAD ,its
Inflammatory markers, including white
relation with PLR remains unclear.CRP which
blood cell (WBC), C-reactive protein (CRP),
is a hepatically derived pentraxin, composed of
and homocysteine, have been used for the
five 23kDa subunits, and has a critical role in
innate immune response(6). Hs-CRP has known
7237
RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7244-7250
Magnesium Sulfate Nebulizer versus Ketamine Nebulizer in Decreasing
Incidence and Severity of Post Operative Sore Throat with Endotracheal
Intubation in Adults
Essam Ali Mostafa, Ahmed Saied Abdel Rahman and Mahmoud Darwish Mahmoud*
Anesthesia and Intensive Care Medicine and Pain Management Department, Faculty of Medicine, Al-
Azhar University
*Corresponding Author: Mahmoud Darwish Mahmoud, Phone No.: (+2) 01002013816, E-mail:
mahmoud.darwish.med@gmail.com
ABSTRACT
Background: Endotracheal intubation is the prominent cause of airway mucosal injury which results in
postoperative sore throat (POST), with an incidence of 21%65%. Although this complication is minor,
if left unresolved, it produces significant agony and annoyance to the patient.
Aim of the Work: to compare efficacy of magnesium/ nebulizer versus ketamine nebulizer in decreasing
postoperative sore throat incidence, severity and duration with fixed endotracheal tube intra cuff
pressure at or below 20 cm H2O using handheld tracheal cuff pressure monitor in adults ASA (American
Society of Anesthesiologists) I-II in 20-60 years age group of either sex in operations less than 2 hours.
Methodology: our study included 90 adult patients, status I-II (ASA I-II) in the age group 20-60 years,
of either sex undergoing operation under general anesthesia (GA) scheduled for a day case surgery and
operation time less than 2 hours with fixation of endotracheal tube cuff at 20 cm H2O using hand held
tracheal cuff pressure monitor (Pressure Gauge) and checked every half hour till end of surgery and
maintained at or below 20 cm H2O.
Results: Our study showed reduction in POST incidence and severity after preoperative magnesium
sulfate nebulization in all time points 0, 2, 4, 8, 12 and 24 hours postoperative, so it was proved that
magnesium nebulizer has great role in reduction of incidence, severity and duration of POST.
Conclusion: we concluded that preoperative magnesium sulfate nebulization reduce incidence and
severity of POST and it is more effective than preoperative ketamine nebulization.
Keywords: Magnesium Sulfate Nebulizer - Ketamine Nebulizer - Post Operative Sore Throat
INTRODUCTION
Endotracheal
intubation
is
the
laryngoscopy trials for intubation, fixation of
prominent cause of airway mucosal injury
endo tracheal tube intra cuff pressure at or
which results in postoperative sore throat
below 20 cm H2O, gentle pharyngeal suctioning
(POST), with an incidence of 21%65%.
under vision and extubation when the tracheal
Although this complication is minor, if left
tube cuff is fully deflated to avoid coughing
unresolved, it produces significant agony and
during extubation [6].All these methods have
annoyance to the patient [1].
been reported to decrease the incidence of
It is considered an important
POST. [1, 2, 6]
complication as it may increase incidence of
It is known that N-methyl-D-aspartate
postoperative morbidity as hoarseness of voice
(NMDA) receptors have an important role in
and dysphagia that cause patient dissatisfaction
nociception and inflammation in human body.
and discomfort. It may be unresolved for few
NMDA receptors present in peripheral nerves
days postoperative and prolong hospital stay
and the central nervous system. [9].
especially in day-case surgeries. [2]
Ketamine is N-methyl-D-aspartate
Multiple pharmacological and non
(NMDA) receptor antagonist and has been used
pharmacological methods have been used to
as a gargle or nebulizer for reducing the
decrease the incidence of POST duration and
incidence and severity of POST due to its anti-
severity. [2] The pharmacological methods used
nociceptive and anti-inflammatory effects. [7, 8]
to reduce POST include use of beclomethasone
Ketamine nebulization is superior to
gel,
lidocaine
spray,
intravenous
ketamine gargle as the latter is used in larger
dexamethasone, ketamine gargle or nebulizer,
volume that may carry risk of aspiration if
oral magnesium lozenge or nebulizer [3-11].
accidentally swallowed in addition to its bitter
The non-pharmacological methods
taste. [10]
include smaller sizes of tracheal tubes, careful
Magnesium is also another NMDA
airway manipulation, intubation after complete
receptor antagonist that plays an important role
muscle relaxation, minimizing the number of
to decrease incidence of POST. It is used as oral
7244
Received: 27/8/2018
Accepted: 17/9/2018
c:\work\Jor\vol738_8
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7251-7257
Reducing risk of coronary heart disease in primary care, and roles of
family doctors
Alhussain Abdullah Jarullah Albudaydi, Nasser Naji Mohsen Al harthi, Abdullah
Salem Al Haider, Yaqoub Mubarak Ali Alhamami, Mana Ali Mueidh Al hajlan,Mohammed
Hundur Alasmari, Abdulaziz Abdullah Alhazmi
Najran University
Abstract:
Background: CVD is a long-term status with serious and often fatal results. In this review we discussed
the main areas targeted for primary prevention of CVD in primary care and recommendations to reduce
risk of CHD.
Method: We systematically searched electronic databases (MEDLINE, Embase, SCOPUS, CINAHL,)
for published articles discussing coronary artery disease management in primary care, and the roles of
family doctors in reducing the risk of CHD.
Conclusion: CVD is a major cause of disability as well as premature death throughout the globe. The
underlying pathology of atherosclerosis established over several years and is generally advanced by the
time the signs and symptoms occurrence, normally in midlife. The threat of creating CAD raises with
age, as well as consists of age > 45 years in men as well as > 55 years in women. A family history of
early heart disease is also considered a danger factor, such as cardiovascular disease in the father or a
brother detected before age 55 years as well as in the mother or a sister detected prior to age 65 years.
Key words: Cardiovascular disease, Risk, Coronary heart disease, Primary care, Family doctors.
Introduction:
Cardiovascular disease (CVD) is an umbrella
place a decline in death in current times,
term for a number of linked pathologies,
whereas in other countries it has boosted [2].
frequently specified as coronary heart disease
When unrefined death rates drop below 15 per
(CHD), cerebrovascular disease, peripheral
1000 persons as well as life span at birth boosts
arterial disease, rheumatic as well as congenital
to 55-60 years, the percentage of mortality as a
heart
diseases
as
well
as
venous
result of CVD approaches 20-25%, and non-
thromboembolism. Worldwide CVD accounts
communicable conditions become a major
for 31% of death, most of this through CHD and
public health problem [3]. This has become the
cerebrovascular accident [1]. Atherosclerosis is
instance in the Eastern Mediterranean Region
an older condition, which has been discovered
[3]. Taking into account the proportionately
in the mummies of Egyptian pharaohs. It is a
large part of the total condition problem, deadly
pathological entity as well as its professional
and also non-fatal, played by cardiovascular
equivalent is cardiovascular disease (CVD).
diseases it has actually come to be significantly
Only in recent times have its consequences got
essential to attempt to forestall that pattern.
to epidemic percentages, mainly in Western
affluent societies, although that epidemic is
CVD is a long-term status with serious and
appearing to other non-Western populations
often fatal results. In this review we discussed
today. The clinical symptoms of atherosclerosis
the main areas targeted for primary prevention
are manifold; however still make up only the tip
of CVD in primary care and recommendations
of the iceberg [2]. Somewhat atherosclerosis is
to reduce risk of CHD.
global; the pathogenesis is complex; however,
Methodology:
it is most likely that more than 90% of the facts
We
systematically
searched
electronic
about the processes included are currently
databases (MEDLINE, Embase, SCOPUS,
known, although how these truths fit into an
CINAHL,) for published articles discussing
overall understandable framework is less
coronary artery disease management in primary
understood [1].
care, and the roles of family doctors in reducing
In the industrialized world cardiovascular
the risk of CHD, all studies which were
disease (CVD) accounts for virtually half of all
published till June,2018. Furthermore we
fatalities. In a few of the places there has taken
7251
Received: 17/9/2018
Accepted: 30/9/2018
c:\work\Jor\vol738_9
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7258-7261
Effect of Indirect Biliary Cannulation on Endoscopic Retrograde
Cholangiopancreatography Outcome
Mohamed Abdelrasheed Allam, Mahmoud Abdelrasheed Allam, Emad Ads
Tropical Medicine Departments, Internal Medicine Departments, General surgery department, Al-Azhar
University
Abstract:
Background and aim: - Variable techniques could be used to raise the success rate and reduce complications of
endoscopic retrograde cholangiopancreatography (ERCP).
We aimed to evaluate the effect of indirect biliary cannulation techniques as double guide-wire technique (DGT),
trans-pancreatic sphincterotomy (TPS) and\or temporary pancreatic stenting on ERCP procedure outcome.
Patients and methods: - From 73 patients subjected to ERCP in our endoscopy unit, during the period between
January 2016 to December 2017, 47 patients were managed with standard free direct cannulation maneuver (group-
I), 21 patients managed with indirect maneuvers (DGT and\or TPS as group-II) and ERCP was failed in 5 cases;
in 3 of them temporary pancreatic stent was placed but with no value.
Results: - From 73 patients, standard free direct cannulation was done in 47 patients with success rate 64.4%, the
remaining 26 patients managed with indirect maneuvers with successful cannulation of CBD in 21 cases with
success rate 80.7% and total success rate of 94.4%.
Procedure duration was longer in patients of indirect maneuvers than patients of standard free direct cannulation
maneuver, with high significant difference (P value of 0.0036).
The post-ERCP complications were noticed in 21 patients with complications rate of 28.8 %. Complications were
significantly higher in patients of indirect maneuvers than patients of standard direct maneuver (47.6% vs. 23.4%).
Post-ERCP pancreatitis recorded in 7 patients (9.6%) with significant higher rate in patients of indirect maneuvers
than patients of direct maneuver (23.8% vs. 4.3%).
Conclusion: - Indirect biliary cannulation (DGT and/or TPS) solved the problem of failed cannulation but had a
higher rate of complications and took longer time.
Keyword: - ERCP; endoscopic retrograde cholangiopancreatography, Indirect ERCP maneuvers.
Introduction: -
could be explained as the cut either opens the BD or
Successful biliary cannulation is a crucial step for
exposes the duct's anatomy6.
endoscopic retrograde cholangiopancreatography
Double-guidewire technique and TPS might
(ERCP)1. Experienced endoscopists should achieve
facilitate biliary cannulation. However, with DGT
successful biliary cannulation rates more than 90% 2.
and TPS post-ERCP pancreatitis was reported in 0%
Some factors as altered anatomy, inflamed tissues
to 25% of patients 3.
and adenomatous papilla or periampullary
Objective: - We aimed to evaluate the effect of
diverticulum may increase the bile duct (BD)
indirect biliary cannulation techniques as double
cannulation difficulties3.
guide-wire technique (DGT), trans-pancreatic
Altered endoscopic techniques were developed in the
sphincterotomy (TPS) and\or temporary pancreatic
past few years to increase the success rate of
stenting regarding procedure duration, success and
cannulation 4.
complications.
Double-guidewire technique (DGT) is the use of a
Patients and methods: -
guidewire to occupy the pancreatic duct (PD) 5.
This prospective study was carried out at Al-Hussein
Double-guidewire technique has been used with
University Hospitals ERCP Unit, during the between
promising results in cases of failed cannulation5.
January 2016 to December 2017, on 89 cases of
Alternative techniques for difficult cannulation is
ERCP. The study was approved by the Ethics
transpancreatic sphincterotomy (TPS) in which
Board of Al-Azhar University.
sphincterotomy cut in the PD to help biliary
cannulation and\or temporary pancreatic stenting; it
7258
Received:24/8/2018
Accepted:14/9/2018
c:\work\Jor\vol738_10
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7262-7267
The Molecular Approach in Pain Management and Improve Aesthetics
Modules
1Khalid Mohammed Alqahtani, 2 Amal Radi Ayesh AlJuhani, 1 Abdulrahman Mohammed -
Aladhadhi , 1 Mohammad Saad Alshomrani , 3 Rasha Fahad AlShafi, 4 Saja Hussain Majed
Alsharif, 5 Rawan Mohammed Natto, 6Abdulaziz Badr Abualalaa
1King Khalid University, 2 King Abdulaziz University, 3AlMaarefa Colleges for Science & Technology,
4 Taibah University, 5 Umm Al-Qura University, 6Imam Mohamed Bin Saud Islamic University - IMSIU
Abstract:
In this review we discussed the developments in pain research and defined how the area is building on this
progress to understand how pain is recorded. We likewise speculated on how these insights could lead to
even more effective and specific analgesics. Methods: Computerized databases were searched for English-
language controlled studies assessing molecular approach in pain management and improve aesthetics
modules published to 2018. Our search was limited to only Human subject with English language.
Moreover, references of identified studies were manually searched for more relevant articles. Results: Pain
has been defined as an unpleasant sensory and emotional experience associated with actual or potential
damage, or described in terms of such damage. It is primarily a protective mechanism designed to avoid
tissue damage, is very subjective in nature with wide interpatient variability in pain sensitivity, and has been
described as "a conscious experience to which the outside observer is not privy". Despite the widespread
prevalence of pain, it is inadequately managed due to a lack of appropriate formal physician training that is
coupled with concerns regarding the addictive liabilities of the opioids, a global phenomenon described as
"opiophobia". On the other hand, patients may tolerate pain to an extent that can prevent effective treatment
and result in long-term nerve damage that is frequently irreversible.
Keywords: molecular approach, pain management, aesthetics modules.
Introduction:
In the past two decades, our understanding of how
Noxious stimulation always causes modifications
the brain acquires and processes aesthetic,
in gene expression within the main nervous
auditory, taste, olfactory and somatosensory
system, and different chronic pain states produce
information has been revolutionized. However, in
unique neurochemical signatures in the brain and
nothing else sensory modality has extra fast and
spinal cord. New insights right into exactly how
profound progression been made than in our
sensory info is processed as it relocates from the
comprehension of the mechanisms whereby
feeling organ to the cerebral cortex under the
nociceptive information is transmitted and
influence of a regularly transforming molecular
converted in both the normal and pathological
architecture will fundamentally change the way
state [1]. In big part, this rapid development has
that we come close to pain control and establish
actually been due to the multidisciplinary method,
new analgesics [3].
including the synchronized use of systems
neurobiology, behavioral analysis, genes, and cell
Pain is required for survival, however consistent
and molecular techniques that has actually been
pain can result in anxiousness, depression and a
taken. Pain is needed for survival and maintaining
reduction in the quality of life. In this review we
the integrity of the organism, however sustained
discussed the developments in pain research and
or chronic pain can result in second symptoms
defined how the area is building on this progress
such as anxiousness and depression and in a
to understand how pain is recorded. We likewise
significant reduction in the quality of life [2]. Pain
speculated on how these insights could lead to
pathways end in distinct brain areas that monitor
even more effective and specific analgesics.
the sensory and affective qualities of the starting
stimulus and reveal remarkable plasticity.
Methodology:
7262
Received: 17/9/2018
Accepted: 30/9/2018
c:\work\Jor\vol738_11
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7268-7273
Pediatrics Iron deficiency anemia from diagnosis to treatment
Abdulrahman Mohammed Aladhadhi 1, Saoud Tariq Etaiwi 2, Khalid Mohammed Alqahtani 1,
Ali Ahmed Bajafar 1, Ahela Faisal Nono 3, Sara Edrees Aldrees 4, Saleh Mohammed Almutawa
1, Shroq Abdulkreem alghraibi 5
1 King Khalid University, 2 Medical University of Gdansk, 3 Ibn Sina National College, 4 King
Faisal University, 5 Umm al-Qura University
Abstract:
Aim: the significant points in diagnosis and treatment of iron deficiency which is one of the most
common diseases observed in children have been compiled in terms of directing pediatricians, the recent
studies performed in this area have been reviewed and the experiences of our center have been
explained. Methods: Medline and PubMed database searches were performed for articles about acute
cholangitis published in English up to September 2018. Results: iron deficiency anemia continues to
be a considerable public health issue worldwide. The major concepts in treatment of iron deficiency
anemia consist of making the diagnosis, investigating the condition which triggers to iron deficiency
and removal of this problem, replacement of deficiency, enhancement of nutrition and education of
patients and families. Conclusion: The serum ferritin level is the best indicator of the iron stores in the
body and the first biochemical variable to change in ID.
Key words: Pediatrics, Iron deficiency anemia, diagnosis, treatment
Introduction:
Iron deficiency is the most usual dietary
anemia. Right now, only plasma ferritin level
deficiency worldwide and a vital public health
and plasma transferrin saturation are decreased.
issue especially in developing countries. There
Negative iron equilibrium which proceeds after
is no clear information regarding how many
iron stores are tired appears with decreased
individuals are affected by iron deficiency
hemoglobin. Conclusively, reduced body iron
worldwide, but it is estimated that ID is present
shops have been defined as ID and worsening
in a lot of the pre-school youngsters and
of this problem and growth of anemia is
expectant females in developing nations and in
specified as IDA.
at the very least 30- 40% in industrialized
In this article, the significant points in diagnosis
countries when anemia is made use of as an
and treatment of iron deficiency which is one of
indirect indicator of ID [1]. Inning accordance
the most common diseases observed in children
with the 2001 World health Organization
have been compiled in terms of directing
(WHO) data, 30% of the children matured in
pediatricians, the recent studies performed in
between 0 and 4 years and 48% of the children
this area have been reviewed and the
aged in between 5 and 14 years are anemic in
experiences of our center have been explained.
establishing countries [1]. In our nation, the
Methodology:
regularity of iron deficiency anemia (IDA) has
Medline and PubMed database searches were
been reported to array in between 15.2% and
performed for articles about acute cholangitis
62.5% in different studies performed with
published in English up to September 2018. The
youngsters [2-4].
keyword search headings included "Iron
Since anemia is the most crucial indicator of
deficiency anemia" and 'anemia', and a
iron shortage, the terms ID and IDA are
combination of these was used. References list
commonly utilized reciprocally. Nevertheless,
of each included study were searched for
iron deficiency might establish in the absence
further supportive data.
of anemia and the tissues could be impacted
from this problem. Iron deficiency appears in
Discussion:
different phases. If iron requirement is below
Clinical findings
intake, iron stores are reduced primarily. After
Since most of iron in the body is utilized for
the iron stores are minimized, hemoglobin
synthesis of hemoglobin, the most crucial
levels may stay typical for a while which means
searching for of iron shortage is anemia. In iron
that iron shortage is observed in the absence of
shortage anemia, clinical searchings for second
7268
Received: 17/9/2018
Accepted: 30/9/2018
Results
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (7), Page 7274-7287
Comparative Functional Analysis of the Anatomy of the
appendicular skeleton in two reptilian species
Ali G. Gadel-Rab1, Fatma A. Mahmoud2,Samy A. Saber3, Boshra A. ElSalkh4, Asmaa A.
El-Dahshan4, Doaa I. Gewily4
1-Department of Zoology, Faculty of Science, Al-Azhar University, Assiut, Egypt
2-Department of Zoology, Faculty of Science, Assuit University, Assiut, Egypt
3-Department of Zoology, Faculty of Science (Boys branch), Al-Azhar University, Cairo, Egypt
4-Department of Zoology, Faculty of Science (Girls branch), Al-Azhar University, Cairo, Egypt
Corresponding author: Ali Gamal,email: Aligamal200992@yahoo.com
Abstract:
Aim of the work: the present study aimed to illustrate the osteological characters of the
appendicular skeleton of two Egyptian lizard species, Acanthodactylus boskianus and
Ptyodactylus guttatus and clarify the relationship between characteristics of the appendicular
skeleton and mode of their locomotion of the two species. A. boskianus is diurnal
insectivorous lizard forage in open area and it is a generalized ground-dwelling species and
P. guttatus is a diurno-nocturnal omnivorous gecko which is a highly specialized climbing
on vertical substrates. Material and methods: in the present study we used Alizarin red and
Alcian blue as double skeletal staining to investigate the the bony and cartilaginous pattern
of limbs and girdles of A. boskianus and P. guttatus. Results: in P. guttatus, the pectoral
girdle was characterized by the presence of the interclavicles was dagger in shape and
partially fused with clavicles, while it was cruciform and completely fused with the clavicles
in A. boskianus. In P. guttatus, the epicoraoid was well developed, broad bony plates and
fused with the interclavicles, while in A. boskianus it was narrow cartilaginous, plates and
overlap in the mid-line. Moreover, in P. gutattus two fenestrae were appeared within
coracoid and scapula with un-fenestrated cartilaginous sternum, while one fenestra appeared
in both coracoid and sternum of A. boskianus. On other hand, the pelvic girdle of P. guttatus
had complete fusions between the pubis, ischium and ilium, while in A. boskianus the pubis
articulated poster-omedially with the ischium. In both P. gutattus and A. boskianus, the
forelimbs posture was in horizontal plane, while the hind limbs were in vertical plane. In P.
gutattus both the fore and hind limbs were relatively equal in length, while the fore limb in
A. boskianus was greatly shorter than the hind limb. Conclusion: the P. gutattus is
considered as a one of climbers species which have stout appendicular skeleton to support
the climbing process on the vertical surface with relatively short limbs, while A. Boskianus
is ground-dwellers and also good climbers and use their claws to walk and climbing on
rocky areas and these abilities of locomotion depend on the flexibility of skeletal elements of
its appendicular skeleton.
Keywords: girdles, limbs, double stain, reptiles
Introduction
interactions and predator avoidance [1].
Locomotion is considered as one
Many animals move through complex and
of the major functions within the ecology
heterogeneous physical environments at
of an animal because of its importance
varying speeds and using different modes
during activities such as feeding, social
of locomotion [2]. Among reptiles, lizards
- 7274 -
Received:1 / 8 /2018
Accepted:15 / 8 /2018
c:\work\Jor\vol738_13
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7288-7292
Free Thyroxine in Early Pregnancy and Risk of Developing Gestational Diabetes
Mohamed S. Fouad, Mohamed F. Ibrahim, Youssef M. Youssef*
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Youssef M, Youssef , E-Mail: dr.youssef.mohamed@gmail.com, Mobile: 002-01223291956
ABSTRACT
Background: Pregnancy has a considerable physiological impact on the thyroid gland and its metabolic unction and
to meet the increased demands during pregnancy. Thyroid disease is known to impact pregnancy outcomes, and
gestational diabetes is the most common obstetric metabolic disease. Both of these conditions can cause short- and
long-term harm to the mother and child, and an increasing number of scholars have therefore begun to investigate
whether there is a correlation between thyroid disease and GDM
Objective: evaluation of the relations between different thyroid hormone levels in early pregnancy and the incidence
of gestational diabetes mellitus (GDM).
Study design: This prospective observational cross-sectional study was conducted during the January 2018 to June
2018. The study comprised one hundred, euthyroid women with singleton pregnancy who provided early pregnancy
serum samples for analyses of thyroid function. GDM was diagnosed using a 2 hours, 75-g oral glucose tolerance
test, and the mothers were grouped and compared according to the results.
Results: The incidence of GDM in pregnant women tended to increase with age (P< .0001). The level of free T4
(FT4) in early pregnancy in GDM women was lower than that in non GDM women (P< .0001) also found that high
maternal weight was associated with a higher GDM rate in the first trimester (P< .0001).
Conclusion: Low thyroxine levels in early pregnancy could be a risk factor for GDM development.
Keywords: Gestational diabetes mellitus, free thyroxine, first trimester.
INTRODUCTION
during pregnancy, the thyroid gland increases up to
Gestational diabetes mellitus (GDM) is one of
40% in size, accompanied by an upsurge in the
the most common disorders complicating pregnancy,
production of thyroid hormones, thyroxine (T4) and
occurring in up to 14% of all pregnancies. The rise in
triiodothyronine (T3)(5). Abnormalities in thyroid
GDM can likely be attributed to improved screening
function are relatively prevalent among pregnant
and diagnostic tools, as well as to the climbing rate of
women, and have been linked to several obstetric
obesity. Excessive caloric intake and sedentary
complications including premature delivery and
lifestyles are the major causative factors contributing
pregnancy loss, as well as adverse health outcomes in
to obesity (1). The main pathophysiologic defects that
the offspring (5).
occur in GDM are the same as those observed with
Yet, the debate regarding the utility of routing
T2DM: marked insulin resistance and impairment of
screening and/or treatment of thyroid dysfunction
insulin secretion. The exact mechanisms responsible
during pregnancy is highly contentious, and remains
for these defects in GDM are not known (2).
to be resolved(5). Given the important role thyroid
All pregnancies are associated with an increase
hormones play in glucose metabolism and
in insulin resistance and increased pancreatic insulin
homeostasis, thyroid dysfunction has been suggested
secretion as the pregnancy progresses. Skeletal
to play a role in the etiology of gestational diabetes
muscle is the body's main site of glucose disposal and
mellitus (GDM), a common metabolic complication
becomes insulin resistant during pregnancy. This
in pregnancy. However, the existing evidence has
insulin resistance begins in mid pregnancy and
been conflicting and longitudinal data are sparse(6).Of
continues until the end of gestation. Pregnancies are
the two thyroid hormones T4 and T3, T4 is considered
also associated with a 200% to 250% increase in
as prohormone, serving as a substrate for the
insulin secretion to maintain euglycemia in the
biologically active form T3 where the conversion of
mother. These metabolic changes are normal and
peripheral T4 to T3, by two deiodinase enzymes,
provide adequate nourishment to the fetus. When
accounts for 80% of all the T3 produced; the rest is
maternal insulin secretion is unable to meet increased
produced directly by the thyroid gland(7).
demand secondary to marked resistance, GDM
In the present study, we investigated the
results(3).
associations of TSH and Free T4 levels as related
It is thought that the cumulative effects of
markers of thyroid function while accounting for
maternal and placental influences result in
thyroid autoimmunity status. Since thyroid levels can
abnormalities in insulin signaling pathways, which
change with the progression of pregnancy, we
lead to decreased glucose uptake and an increase in
assessed these associations separately for the first
insulin resistance. The exact molecular processes of
trimester.
such remain unclear (4). Pregnancy has a considerable
physiological impact on the thyroid gland and its
metabolic function to meet the increased demands
7288
Received:1/9/2018
Accepted:20/9/2018
c:\work\Jor\vol738_14
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7268-7273
The Molecular Approach in Pain Management and Improve Aesthetics
Modules
1Khalid Mohammed Alqahtani, 2 Amal Radi Ayesh AlJuhani, 1 Abdulrahman Mohammed -
Aladhadhi , 1 Mohammad Saad Alshomrani , 3 Rasha Fahad AlShafi, 4 Saja Hussain Majed
Alsharif, 5 Rawan Mohammed Natto, 6Abdulaziz Badr Abualalaa
1King Khalid University, 2 King Abdulaziz University, 3AlMaarefa Colleges for Science & Technology,
4 Taibah University, 5 Umm Al-Qura University, 6Imam Mohamed Bin Saud Islamic University - IMSIU
Abstract:
In this review we discussed the developments in pain research and defined how the area is building on this
progress to understand how pain is recorded. We likewise speculated on how these insights could lead to
even more effective and specific analgesics. Methods: Computerized databases were searched for English-
language controlled studies assessing molecular approach in pain management and improve aesthetics
modules published to 2018. Our search was limited to only Human subject with English language.
Moreover, references of identified studies were manually searched for more relevant articles. Results: Pain
has been defined as an unpleasant sensory and emotional experience associated with actual or potential
damage, or described in terms of such damage. It is primarily a protective mechanism designed to avoid
tissue damage, is very subjective in nature with wide interpatient variability in pain sensitivity, and has been
described as "a conscious experience to which the outside observer is not privy". Despite the widespread
prevalence of pain, it is inadequately managed due to a lack of appropriate formal physician training that is
coupled with concerns regarding the addictive liabilities of the opioids, a global phenomenon described as
"opiophobia". On the other hand, patients may tolerate pain to an extent that can prevent effective treatment
and result in long-term nerve damage that is frequently irreversible.
Keywords: molecular approach, pain management, aesthetics modules.
Introduction:
In the past two decades, our understanding of how
Noxious stimulation always causes modifications
the brain acquires and processes aesthetic,
in gene expression within the main nervous
auditory, taste, olfactory and somatosensory
system, and different chronic pain states produce
information has been revolutionized. However, in
unique neurochemical signatures in the brain and
nothing else sensory modality has extra fast and
spinal cord. New insights right into exactly how
profound progression been made than in our
sensory info is processed as it relocates from the
comprehension of the mechanisms whereby
feeling organ to the cerebral cortex under the
nociceptive information is transmitted and
influence of a regularly transforming molecular
converted in both the normal and pathological
architecture will fundamentally change the way
state [1]. In big part, this rapid development has
that we come close to pain control and establish
actually been due to the multidisciplinary method,
new analgesics [3].
including the synchronized use of systems
neurobiology, behavioral analysis, genes, and cell
Pain is required for survival, however consistent
and molecular techniques that has actually been
pain can result in anxiousness, depression and a
taken. Pain is needed for survival and maintaining
reduction in the quality of life. In this review we
the integrity of the organism, however sustained
discussed the developments in pain research and
or chronic pain can result in second symptoms
defined how the area is building on this progress
such as anxiousness and depression and in a
to understand how pain is recorded. We likewise
significant reduction in the quality of life [2]. Pain
speculated on how these insights could lead to
pathways end in distinct brain areas that monitor
even more effective and specific analgesics.
the sensory and affective qualities of the starting
stimulus and reveal remarkable plasticity.
Methodology:
7268
Received: 17/9/2018
Accepted: 30/9/2018
Anatomy of the lumbar spine and lumbosacral region
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7300-7305
Comparison between Taans Cerebellar Diameter, Biparietal Diameter and Femur
Length for Gestational Age Measurement Accuracy in The 3rd Trimester
Alsaied Abdelmaksod Askr, Mahmoud Salah Mahmoud, Asmaa Ahmed Mahmoud Salloum*
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Asmaa Ahmed Mahmoud Salloum, Mobile: 00201005854475, E-Mail: drasmaa822@gmail.com
ABSTRACT
Backgound: the provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy
outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been
associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal
mortality, independent of maternal characteristics. Many patients in Egypt due to socio-economic reasons come
for their first antenatal visit in the third trimester. Most of them are uneducated and come from remote areas.
Also, many being lactating mothers are unsure of their LMP or have irregular cycles. Because of non availability
of any dating scans or earlier ultrasound and uncertainty in LMP, it becomes very difficult to calculate their due
dates, so many pregnancies considered to be preterm or posterm were wrongly classified. The use of
ultrasonography has significantly improved evaluation of fetal growth and development and had permitted
prenatal diagnosis of a variety of congenital malformations. Ultrasonographic fetal biometry is highly reliable in
the first and second trimester of pregnancy, but reliability of any ultrasound method greatly diminishes as
gestational age advances, in the third trimester, reliability of any single ultrasound parameter alone is poor
without correlation with other parameters.Objective: in our study, TCD was compared to FL and BPD in
accuracy of assessment of gestational age in the third trimester of pregnancy. We correlated between the three
parameters, Transcerebellar (TCD) and Biparietal diameter (BPD) and Femur length (FL), for accurate
determination of gestational age in third trimester of pregnancy. Methods: a total of 200 pregnant women in the
third trimester pregnancy was assessed in this observational study in Department of Obstetrics and Gynecology,
Damietta Hospital, Al-Azhar University (Outpatient) by two-dimensional ultrasound to assess the accurate
method for assessment of gestational age in the third trimester of pregnancy. Examinations were performed after
a verbal consent from the patient with the patient lying in the dorsal supine position. Two dimensional
ultrasounds were carried out. Fetal biometry and amniotic fluid volume were assessed. All women included in
this study were subjected to history taking and clinical examination.Results: we found that out of 200 patients,
TCD gave correct assessment of gestational age within 3 days in 118 patients (59%) and within 1 week in 180
patients (90%). While, FL gave correct assessment of gestational age within 3 days in 92 patients (46%) and
within 1 week in 160 patients (80%). The least accurate was BPD that gave correct assessment of gestational age
within 3 days in 59 patients (29.5%) and within 1 week in 120 patients (60%).
Conclusion: from this study, we concluded that TCD was the most accurate method for assessment of
gestational age in the third trimester followed by FL and the least accurate was the BPD. Also, by combining
accuracy of TCD (90%) and that of FL (80%) we can be near certain of gestational age in most of our patients
even if they are unsure of their dates.
Recommendations: measuring TCD as routine in the third trimester as it has the same accuracy as the current
fetal biometry (BPD and FL).
Keywords: TCD, LMP, BPD, FL, GA.
INTRODUCTION
measurements can also be used for the assessment
The pregnancy date estimation is mandatory
of the gestational age and maturity of the fetal lung
for the pregnant ladies in order to have the expect
and some specific clinical situations as cases of
time of delivery in which various tests will be taken
oligohydramnios that manifested by fetal head and
to achieve the estimated time. There are methods
abdominal compression resulting in difficult
that used to determine the gestational age including
determination of accurate abdominal circumference
menstrual history, clinical examination and the ultra
and biparietal diameter (2).
sonography (1). Accurate determination of the
AIM OF THE WORK
gestational dating is considered to be one of the
This study aimed to assess the accuracy of
most beneficial assessments in pregnancy , which is
transcerebellar diameter (T.C.D.) measurement in
dependent on determination whether the patient in
estimation of the gestational age during the third
gestation or not .In order to decrease the biologic
trimester compared to the current fetal biometric
variability among fetuses traditional biometry,
measurements (Femur length and biparietal
ancillary
biometric
also
non
biometric
diameter) according to last menstrual period.
measurements will be used in addition those
7300
Received:29/8/2018
Accepted:19/9/2018
c:\work\Jor\vol738_16
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7306-7307
PostMortem Caesarean Section Performed 20 Minutes after
Maternal Cardiac Arrest: A Case Report
Majd Mryani, Maha Messawa, Ahmad Kadibalban and Nabawia Ali Eissa
Department of Obstetrics and Gynecology, Hera General Hospital, Makkah Al- Mukarramah, Kingdom of Saudi Arabia
ABSTRACT
Background: Postmortem caesarian section is defined as a low segment caesarian section that is performed to
deliver a fetus after the death of his mother. Objective: An approach of when and how to manage a post-mortem
pregnancy. Materials and method: in this report, we are discussing a case of 26 years old, primigravida, 39 weeks
pregnant Nigerian patient who was arrested, unconscious and unresponsive. Post-mortem caesarian section was
performed and a live fetus was delivered. Results: Duration between the mother cardiopulmonary arrest and
performing a Pfannenstiel incision was a total of 20 minutes. A live baby boy was delivered weighted 2.278 Kg
with an Umbilical cord pH: 6.7 and APGAR score of 0-0-3-4 at 1,3,5 and 10 minutes respectively, the baby was
comatose and cyanosed after the delivery but showed a slight respond 5 minutes later. Eventually, the baby was
admitted to the neonatal intensive care unit(NICU). The reason for the mother's cardiac arrest is unknown and her
medical condition was unrecorded. Conclusion: According to the information mentioned above. The only solution
to manage this case was performing a post-mortem caesarian section as quickly as possible.
Keywords: postmortem caesarian section, pregnancy, cardiac arrest.
INTRODUCTION
Delivering a live baby by cesarean section after the
Umbilical cord pH: 6.7 and an APGAR score of
death of the mother is a rare event that has always
0-0-3-4 at 1,3,5 and 10 minutes respectively. The
been a concern regarding its management and
baby was cyanosed and comatose with severe
outcomes [1,2].
bradycardia. He was resuscitated and intubated in the
The history of the past hundred years revealed a
ER then shifted to the neonatal intensive care unit
high fetal mortality rate. However, numbers of
(NICU) and connected to a mechanical ventilator.
reported cases are still not enough to find a plan to
Total time between announcing the patient
manage these cases in a definitive way [3].
unresponsiveness and getting the baby out was a total
Mother's health condition and sudden incident
of 20 minutes. Mother declared dead after 35 minutes
(trauma) that may occur at the third trimester of
of performing CPR. The Baby stayed at the neonatal
pregnancy are plenty, these risks may vary between
intensive care unit(NICU) under observation, but the
each patient and could change the plan of treatment
baby was arrested and died at the age of 35 days old.
[1,6]. As a way to find a solution, a 4 minutes role was
set which means that the baby should be out within 4
DISCUSSION
minutes of the mother first arrest started, but reports
As maternal cardiac arrest is a rare and uncommon
about similar cases showed a significant difference of
event, equipment and preparation to manage a similar
the duration time of delivering the baby and the baby
case are not always ready to handle the patient at the
status after the birth [4,5,6].
scene [7,8]. The fetus has a limited time to tolerate the
hypoxia that may lead to organ damage, so
CASE REPORT
management should be fast [9]. Doctors may hesitate
A 26 years old, primigravida, 39 weeks pregnant
in these kinds of cases because it's known for their
Nigerian patient was transferred by an ambulance to
lousy outcome and high mortality rate. As the 4
the ER department, according to paramedics reports
minutes role has been set, every minute counts so any
patient stopped responding in the ambulance at 3:14
delay could affect the fetus survival [10].
AM, code blue was announced immediately at the
A team of obstetrician and pediatrician should be
arrival to the hospital and the patient was
always ready to perform a caesarian section at the
unconscious, unresponsive with no pulse and her
scene which should be performed within 4-5 minutes
vitals were not able to be detected. Consultation for
rate in order to get the fetus out and start chest
Obstetrics and Gynecology department was ordered
compression sufficiently [4]. Even at a hospital that
then doctors performed an ultrasound that revealed a
does not have these departments, paramedics and
positive fetal heart. An emergency lower segment
emergency doctors should be trained and prepared as
cesarean section was performed at the CPR room in
well [11,12]. In conclusion, performing a caesarian
the Emergency Department. At 3:34 AM a baby boy
section as soon as possible may give the fetus a better
was delivered, baby weighted: 2.278 kg with an
chance to survive and avoid neurological
manifestation [13].
7306
Received:179/2018
Accepted:30/9/2018
c:\work\Jor\vol738_17
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7308-7316
Evaluation of Safety and Efficacy of Radiofrequency Lesioning of
Thoracic Dorsal Root Ganglion in Chest Cancer Pain Patients
Daily Activities and their Quality of Life
Ahmed El-Saeed Abdelrahman*, Rafaat Mahfouz Reyad*,
Ayman Mohamady El-Demerdosh*, Mahmoud Mohamed Hassan Mostafa*
*Department of Anesthesia & ICU Department, Faculty of Medicine, Aswan University
Corresponding author: Mahmoud Mohamed Hassan Mostafa, Mobile: 00201000553088, E-Mail:
dr_moody2001@yahoo.com
ABSTRACT
Background: in controlling cancer pain it is commonly inadequately managed for these patients leading to suffer
in the form of physical disabilities, psychological disturbance, avoiding treatment. Therefore pain that is caused
by cancer may directly affect the patient's quality of life; by having an effect on his/her daily activity, physical
state and also psychological and emotional status. Thus, making pain relief and control the patient's right; right for
a new life "pain free" or at least tolerable non-disabling pain.
Aim of the work: this study aimed to test both the efficacy and safety of thermo-coagulative ablation of the
thoracic dorsal root ganglia for pain control in cancer patients that have refractory chest pain And the impact on
quality of life for patients.
Patients and Methods: our prospective study was done on sixty-five patients selected from pain clinics of both
the National Institute of Cancer, Cairo University and Aswan University with refractory chronic chest cancer pain
according to the inclusion and exclusion criteria. The complete duration of the follow up lasted 3 months post-
interventional; with assessments after 1 week, 1 month and 3 months. At each follow up each patient was re-
assessed with the following assessments; VAS, ECOG performance status, QOLS, drug consumption, side-effects
(complications) and patient satisfaction. Results: we found that with effective pain relief there was a significant
reduction in the mean VAS values which means that there was functional improvement, in all the post-
interventional follow ups. Also, there was an improvement in the functional state of the patients throughout the
follow-up post-intervention with regards to the ECOG performance status from the results. In addition to the ECOG
improvement there was also a significant improvement in the QOL (Quality of Life) results, which was due to the
pain relief. Regarding drug consumption, it was recorded that all three drugs; pregabalin, oxycodone and
amitryptline, should maximum reduction after 1 month following the intervention, with a slight increase 3 months
post-interventional, which matched the degree of pain reduction based on the pain scaling scores. Only 11% of our
patients were found with numbness and neuritis, which were the only two complications reported. With regards to
our patients, 30.6% certainly would repeat the procedure, 54.8% probably would, and 12.9 % probably would not
while, only 1.6% certainly would not repeat it. With25.8% certainly would recommend the same procedure, 56.5%
probably would, 14.5% probably would not and only 3.2% certainly would not recommend it.
Conclusion: we concluded that thermal radiofrequency ablation is considered an alternative for treating refractory
chronic chest cancer pain of several types and causes. This is because of its efficacy, safety and ease of use,
patient's quality of life of was largely affected.
Keywords: QOL, Radiofrequency, Chest cancer.
INTRODUCTION
It has been postulated that 3-3.5% of the
thoracotomy pain syndrome is one of the most
visitors of pain clinics are thoracic pain sufferers (1).
challenging and refractory pain entities confronting
Pain of the thoracic region may arise from a variety
pain physicians. Its prevalence rate ranges from 22%-
of structures. Firstly, the thoracic spine (discs, spinal
67% (4). Even, the definition of being chronic pain is
dura, nerve roots, facet, costovertebral joints and
still a controversy; the delineation between acute and
myofascial structures) is a considerable source of
chronic post-surgical pain ranges from 2 months, 3
chronic chest pain. Secondly, pain may be referred to
months and up to one year (5). IASP defines it "pain
chest and upper abdomen from internal organs(2); this
that persists beyond the normal time of healing". The
referred pain may be due to inflammation, cancer or
reported incidence of post breast surgery pain varies
metastatic disease e.g. of the thoracic vertebrae. Third
greatly from less than 10% to up to 60% in some
quarter, thoracic neuropathic pain syndromes include
women (6). Regarding malignant chest pain, lung
primary intercostal neuralgia, postherpetic neuralgia,
cancer is the most common cancer in the world as
complex regional pain syndrome (CRPS). Finally
1.61 million of new cases are discovered annually(7).
iatrogenic chronic chest pain may follow thoracic
Pain was found to be the presenting symptom among
surgical procedures such as postmastectomy and
20% of these patients. Patients with lung cancer
postthoracotomy pain syndromes (3). Chronic post-
experience more distressing symptoms than other
7308
Received:28/8/2018
Accepted:18/9/2018
c:\work\Jor\vol738_18
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7317-7322
A Comparative Study between Appendicitis Inflammatory Response Score and
Alvarado Score in The Diagnosis of Acute Appendicitis
Mohamed Kamel El-Mezayen, Ali Ragab Mahmoud, Eslam Nouman Shehatah*
Department of General Surgery, Faculty of Medicine, Al-Azhar University
* Corresponding author: Eslam Nouman Shehatah, E-Mail: e.m.shehatah@outlook.com
ABSTRACT
Background: appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads
to its other parts. Despite diagnostic and therapeutic advancement in medicine, appendicitis remains a clinical
emergency and is one of the most common causes of acute abdominal pain and one of the most frequent surgical
complains in the emergency room.
Aim of the Work: the aim of this work was to compare the Appendicitis Inflammatory Response Score to the
traditional Alvarado score to determine which is more accurate in the diagnosis of acute appendicitis.
Patients and Methods: this descriptive prospective study was carried on 50 patients admitted to the surgical ER of
Rashid General Hospital from December 2017 to April 2018 complaining from right lower quadrant pain between
the age of 5 years old and 70 years old. All 50 patients had lower quadrant abdominal pain with suspicion of having
acute appendicitis, all of them were thoroughly examined and both Alvarado Score and Appendicitis Inflammatory
Response Score were applied to all of them, patients with moderate to high probability of having
appendicitis(Alvarado Score = 7 or higher, AIR = 8 or higher) underwent open appendectomy and then the resected
appendices were sent for histopathology to confirm the diagnosis.
Results: the total number of cases with confirmed diagnosis of acute appendicitis by means of post-operative
histopathology in our study was 46 out of 50 patients, the AIR score had sensitivity of 95.65% while the Alvarado
score had sensitivity of 91.3%.
Conclusion: this study demonstrates that the Appendicitis Inflammatory Response Score (AIR) appears to be more
accurate than the Alvarado score, easy-to-use and reliable when dealing with a case of right lower quadrant pain with
the suspicion of acute appendicitis and can help reduce the negative appendectomy rate.
Keywords: Acute Appendicitis, Appendicitis Inflammatory Response Score (AIR), Alvarado Score, C-Reactive
protein (CRP).
INTRODUCTION
Appendicitis is defined as an inflammation of
It is safe to assume that the negative
the inner lining of the vermiform appendix that
laparotomy rate declined to approximately 10% with
spreads to its other parts (1). Despite diagnostic and
that routine use of ultrasonography (US)(5).The higher
therapeutic advancement in medicine, appendicitis
sensitivity of computed tomography (CT) seems to
remains a clinical emergency and is one of the most
have had an even greater effect on the negative
common causes of acute abdominal pain and one of
laparotomy rate, which has decreased even further to
the most frequent surgical complains in the emergency
5-10%. In many European countries, most surgeons
room(2).
still consider acute appendicitis to be a clinical
In 1880, Robert Lawson Tait performed the
diagnosis and do not routinely perform imaging
first appendectomy for appendicitis in England. Now,
studies(6).
more than 130 years later, this most common of all
Scoring systems have been designed to aid in
surgical diseases can still be a diagnostic
the clinical assessment of patients with acute
problem(3).This is demonstrated by the high negative
appendicitis. The Alvarado score is the most well-
laparotomy rates documented in the literature. A study
known and best performing in validation studies, but
performed in 2005 in the Netherlands on 286 cases
it has some drawbacks(7).
found that approximately 15% of the patients
Its construction was based on a review of patients who
underwent a negative appendectomy, a number
had been operated with suspicion of appendicitis,
similar to another large Swedish study. The negative
whereas the score is supposed to be used on all
appendectomy rate was 13% in another large North
patients with suspicion of appendicitis. Furthermore,
American study(4).
the score does not incorporate C-reactive protein
(CRP) as a variable although many studies have
7317
Received:30/8/2018
Accepted:15/9/2018
c:\work\Jor\vol738_19
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7323-7328
Comparison between Upper Mini Sternotomy and
Full Sternotomy in Aortic Valve Replacement
Morsi Ameen Aly, Mohammed Ahmed Amr, El-Sayed Ahmed Fayad, Osama Elsayed Aly Mohammed*
Cardiothoracic Surgery Department, Faculty of Medicine, Suez Canal University
*Corrosponding author: Osama Elsayed Aly Mohammed, E-mail: ossamma_alex@yahoo.com
ABSTRACT
Background: aortic valve disease is common and its prevalence increases with age. For people over the age of 75
years, the prevalence of aortic stenosis (AS) is 5%. More than one in eight people over the age of 75 have moderate
or severe valve disease. Aim of the Work: the aim of this study was to compare the short term results of aortic
valve replacement through upper mini sternotomy and full sternotomy. Patients and Methods: This study was a
prospective randomized controlled clinical trial. The study was conducted at Suez Canal University Hospital in
the cardiothoracic operating rooms and inward after approval of Research and Ethics Committees. The study
included 50 patients having aortic valve disease presented to Suez Canal University Hospital, cardiothoracic
outpatient clinic for isolated aortic valve replacement. Results: The mean age of patients in Full Sternotomy in
Aortic Valve Replacement (FSAVR) group was 33.48 ± 17.74 while it was 32.03 ± 15.29 in Mini Sternotomy in
Aortic Valve Replacement (MSAVR) group which showed insignificance difference (p > 0.05). (20- 29y) was the
most frequent age group in both study groups (28% in FSAVR group and 32% in MSAVR group). No significance
different found (p > 0.05) according to gender in both group. Male gender was the most frequent in both group
(56% in FSAVR group and 64% in MSAVR group).
Conclusion: Mini Sternotomy (MS) can be considered as excellent option with favorable outcomes that should be
considered part of the routine practice of cardiac surgeons in the modern era.
Keywords: Upper Mini Sternotomy, Full Sternotomy, Aortic Valve Replacement.
INTRODUCTION
Aortic valve disease is common and its prevalence
The upper mini sternotomy limits the ability to
increases with age. For people over the age of 75
control left ventricular distention, and some surgeons
years, the prevalence of aortic stenosis (AS) is 5%.
do not use it for severe aortic insufficiency (7).
More than one in eight people over the age of 75 have
moderate or severe valve disease (1).
AIM OF THE WORK
The overall prevalence aortic regurgitation (AR)
The aim of this study is to compare the short term
in men was 13% and in women 8.5%. However, most
results of aortic valve replacement through upper
of the AR in this population was trace or mild in
mini sternotomy and full sternotomy.
severity; moderate or severe AR was rare. Multiple
logistic regression analysis revealed age and male
PATIENTS AND METHODS
gender to be predictors of AR (2).
aortic valve replacement (AVR) using upper mini
Type of study
sternotomy was first described in 1993, and
This study was a prospective randomized controlled
subsequently popularized in 1996 and 1997 as an
clinical trial.
alternative to conventional full sternotomy (FS) for
patients with isolated AVR(3).
Setting and timing:
Favorable results have led mini AVR to become a
The study was conducted at Suez Canal University
standard procedure in many high volume centers (4).
Hospital in the cardiothoracic operating rooms and
In addition to the smaller incision and improved
inward after approval of Research and Ethics
cosmetic outcome of cardiac surgery, numerous
Committees.
studies report a reduction in post-operative bleeding,
transfusion requirements, rates of atrial fibrillation,
Study population:
length of mechanical ventilation, length of intensive
The study included 50 patients having aortic valve
care unit (ICU) and hospital stay, as well as post-
disease presented to Suez Canal University Hospital
operative pain with no difference in mortality(5).
cardiothoracic outpatient clinic for isolated aortic
on the other side, The upper mini-sternotomy have
valve replacement.
a longer cardiopulmonary bypass and aortic cross-
To qualify for participation in this trial, the patients
clamp times, which in general tend to predict worse
have to meet the following inclusion and exclusion
outcomes in cardiac surgery(6).
criteria.
7323
Received:1/9/2018
Accepted:15/9/2018
c:\work\Jor\vol738_20
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7329-7333
Subjective Evaluation of Smell Dysfunctions before and after
Different Nasal Surgeries
Wafaie Abd El-Rasoul M. Mourad1, Atef Abd Allah El Maraghy 2, Tarek Mohamed
Abd El-Hamed El-Zyat3, Ayman Yehia Abbas4, Gamal Abd Al-Elah Abd Al-Samea Shaban5
Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University.
Corresponding author: Gamal Abd Al-Elah Abd Al-Samea Shaban, Mobile: 01099946326,
E-mail: gamshaban@gmail.com
ABSTRACT
Background: olfactory dysfunctions affect daily life activities. Nasal surgeries primarily aims at elimination of
nasal obstruction and removal of nasal polyps or inflamed mucosa. Improved olfactory function after these
surgeries may be a secondary benefit. Objectives: this study aimed to evaluate different types of smell
dysfunctions before and after different nasal surgeries and its liability to improve or not after surgery and to
discuss CT scan results in these cases in correlation to clinical and surgical results. Study Design: prospective
study. Methods: a total of 50 patients were included in this prospective study (32 men, 18 women; age range
was 2049 years, mean age 32 years, standard deviation =7.3years). Patients were suffered from different nasal
diseases requiring surgical interference and complaining of smell dysfunctions as one of the main nasal
symptoms. Patients were selected from those attending E.N.T Clinic in Bab EL-Sharia Hospital, Faculty of
Medicine, Al-Azhar University from February 2017 to April 2018. Prior to surgery, patients received a detailed
otorhinolaryngologic examination included nasal endoscopy. Olfactory function was evaluated subjectively. CT
scan nose and paranasal sinuses (coronal and axial) was done before the surgical interference and repeated after
complete healing of the operation. Questionnaire was directed to each patient to tell which type of smell
dysfunctions he was complaining of and the severity of this dysfunction, this questionnaire was repeated after
the complete post-operative period. The patients were followed up after the operation in scheduled sessions for
five months. Results: after different nasal surgeries no change of olfactory dysfunction was found in 26% and
improvement was seen in 74%. As regard patients underwent endoscopic sinus surgery no change of olfactory
dysfunction was found in 32% and improvement was seen in 68%; however in the septoplasty group no change
of olfactory dysfunction was found in 50% and improvement was seen in 50% and in septoplasty and inferior
turbinectomy group, no change of olfactory dysfunction was found in 14.3% and improvement was seen in
85.7%. in patients who had hyposmia no change of olfactory dysfunction was found in 17.9% and improvement
was seen in 82.1%, whereas in patients who had anosmia, no change of olfactory dysfunction was found in
42.9% and improvement was seen in 57.1%; patients who had cacosmia, no change of olfactory dysfunction was
found in 14.3% and improvement was seen in 85.7%. Free postoperative CT was found in 92% and recurrence
was seen in 8%.
Conclusion: the different nasal surgeries showed significant effect on olfactory function in Patients with
subjective olfactory dysfunction. However, considerable number of patients with olfactory dysfunctions did not
improve after surgery. CT scan is useful in the assessment of patients with olfactory dysfunction associated with
many sinonasal diseases.
Keywords: olfactory disorders, anosmia, hyposmia, cacosmia, nasal surgeries, CT scan.
INTRODUCTION
causes. On the other hand, the increased ability to
Olfaction plays a major role in food intake,
smell is called hyperosmia, it is the rare pathological
such that odors assist in food localization and indicate
situation and usually is linked with the exposure to
the food's edibility(1).The olfactory sense has also a
toxic vapors or neurologic disorders such as
protective role against environmental risks (such as
migraine(5).Cacosmia is the presence of an unpleasant
spoiled food, gas leaks and smoke) and helps with
and real odorant due to sinonasal or pharyngeal
gestation; thus it is an essential factor in determining
infections(6). Nasal surgery elimnates nasal obstuction
quality of life(2) .The most common etiologies of smell
and could therefore contribute to improvement in
loss are post viral upper respiratory infection (18
olfactory function postoperatively. Another reason
45% of the clinical population), nasal/sinus disease
why patient's olfactory function improves after nasal
(756%), head trauma (820%), exposure to
surgery might lie in the reduction of inflammatory
toxins/drugs (26%), and congenital anosmia (0
tissue
which
is
removed
by
surgery(7).
4%)(3).Smell loss can be partial, a condition called
hyposmia, or total, a condition called anosmia(4)
AIM of the WORK
.Quantitative olfactory disorders are usually acquired
This study aimed to evaluate different types of smell
dysfunction of the olfactory system with several
dysfunctions before and after different nasal surgeries
7329
Received:27/8/2018
Accepted:17/9/2018
c:\work\Jor\vol738_21
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7334-7342
Incidence of Placenta Accreta and Its Complications in Cases of Previous
Cesearean Sections with Placenta Praevia Anterior
at El-Sayed Galal Hospital
Mohammed A. Mohammed, Adel A. Al-Boghdady, Islam S. Ibraheem
Department of Obstetrics and Gynecology, Faculty of Medicine Al-Azhar University
Corresponding author: Islam S. Ibraheem; Mobile: 01127160615; Email: islamsaeed723@gmail.com
ABSTRACT
Background: due to the increasing rate of cesarean delivery, there has been a 10-fold rise in the incidence of
placenta accreta since the 1970. In a recent survey, placenta accreta was even found to become the leading
cause of emergency peripartum hysterectomy which represented 4060% of cases. Aim of the Work: the
purpose of this study was to determine the incidence of placenta accreta and its complications in cases of
previous cesarean sections with placenta praevia anterior at El-Sayed Galal Univerity Hospital.
Patients and Methods: this prospective study was done at El-Sayed Galal Maternal Unevirsity Hospital
during the period from March 2017 to March 2018 on 100 pregnant women diagnosed by ultrasound as
placenta praevia or low lying placenta anterior with previous cesarean section, they were selected from
Outpatient Clinic, Ultrasound Unit and women admitted in El-Sayed Galal Maternal University Hospital
Departments. Results: the incidence of placenta accreta in cases of previous cesarean section with placenta
praevia anterior were 63%. Risk factors of placenta accreta were: 1) Placenta praevia with prior cesarean
section. All cases had placenta praevia and had at least one previous CS, 2) Increased maternal age (the mean
age 32.60±5.018 years in cases of placenta accrete ), and 29.14±4.889 years in cases with normal placenta. 3)
Multiparity [the median parity was 3 (range: 1-6). The ultrasonography and Doppler was suggestive of morbid
adherence in 60 cases (95.2%)of cases approved with placenta accreta, with accuracy 96, sensiyivity 95.24,
specificity 97.3, +ve predictive value 98.36, and -ve predictive value 92.31. The intraoperative data were:, -
Cesarean hysterectomy performed in all cases of placenta accrete (63 cases), and 2 cases (5.4%) of normal
placenta due to severe bleeding from placental ped and uterine atony. , - Bladder injury occured in 31
cases(49.2%) all of them approved placenta accreta, all of them do C.S hystrectomy and performed bladder
repair. Bowel injury in 2 cases (3.2%) all of them have placenta accreta and C.S hysterectomy done. All cases
of placenta accreta received intra operative blood transfusion. Uterine preserving procedures (Bakry balloon)
done in one case after spontaneous separation of the placenta. The postoperative data were:, - ICU admission
occurred in 40 cases (63.5%) of cases with placenta accrete, and in 2 cases (5.4%) of cases with normal
placenta. 61 cases (96.8%) of cases with placenta accreta received postoperative blood transfusion. -No cases
complicated with DIC or death. Conclusion: from the above our results showed that the incidence, risk factors
and Feto-maternal outcome of management of Patients with placenta accreta at El-Sayed Galal University
Maternity Hospital are comparable with those in the previous literatures.
Keywords: placenta accrete, cesarean section, placenta previa anterior.
INTRODUCTION
incidence of 1: 533 births was reported for the
Placenta accreta occurs when the chorionic
period from 1982 to 2002, much greater than
villi invade the myometrium abnormally. It is
previous reports ranging from 1: 4027 to 1: 2510
divided into three grades based on histopathology:
births in the 1970s to 1980s (4), the incidence of
placenta accreta where the chorionicvilli are in
placenta accreta is likely to continue to increase (5).
contact with the myometrium, placenta increta
Placenta accreta is considered a severe pregnancy
where the chorionic villi invade the myometrium,
complication that may be associated with massive
and placenta percreta where the chorionic villi
and potentially life-threatening intrapartum and
penetrate the uterine serosa (1). The exact
postpartum hemorrhage. The severe uterine
pathogenesis of placenta accreta is unknown. A
hemorrhage may lead to the need of extensive life-
proposed hypothesis includes a maldevelopment of
saving surgical interventions such as Hysterectomy
decidua, excessive trophoblastic invasion, or a
and Ligation of major pelvic vessels, placenta
combination of both. Defective decidualization,
accreta has become the leading cause of emergency
abnormal maternal vascular remodeling, excessive
hysterectomy (6). Maternal morbidity had been
trophoblastic invasion, or combinations are considered
reported to occur in up to 60% and mortality in up
to be the consequences of previous instrumentation
to 7% of women with placenta accreta. In addition,
(2).The incidence of placenta accreta has been
the incidence of perinatal complications is also
steadily increasing, mirroring increased rates of
increased mainly due to preterm birth and small for
caesarean delivery over the past 50 years (3), an
gestational age fetuses (7). Several risk factors for
7334
Received:27/8/2018
Accepted:17/9/2018
c:\work\Jor\vol738_22
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7343-7349
The Effect Of Bipolar Radiofrequency Ablation (Novasure Endometrial
Ablation System) on Endometrial Thickness and Bleeding in
Patients with Premenopausal Bleeding
Ismael T. Elgarhy, Ashraf Hamdy, Sherif M. Elagamy
Department of Obstetrics and Gynecology, Faculty of Medicine-Al- Azhar University
Corresponding author: Sherif M. Elagamy; Mobile:01091133258; Email: mohamedgamalomr90@gmail.com
ABSTRACT
Background: Ablation of the endometrial lining of the uterus as an alternative to hysterectomy was
found to be a less invasive and aggressive method. A large number of clinical trials, as well as retrospective
analysis of clinical and financial data, has shown that endometrial ablation allows for a lower morbidity and
mortality rate and significantly lower procedure costs. Worldwide, endometrial ablation is increasingly being
adopted by the gynecological community. Aim of the Work: to study the effect of bipolar radiofrequency
ablation system on endometrial thickness and bleeding in patients with premenopausal bleeding. Patients and
Methods: This study was conducted on: 30 women with premenopausal bleeding not responding to medical
treatment. All subjects enrolled in the study were asked to give an informed written consent after explaining
the nature, steps and aim of the study. The approval of Medical Ethics Committee was obtained. Results: the
net results after treatment, the majority of the patients was improved (83.3%), 19 of them was complete
recovery (63.3%) while 6 cases (20.0%) had minor bleeding, 4 cases (13.3%) had bleeding less before
treatment, while only one case had no change.Conclusion: Bipolar radiofrequency ablation performed under
local anaesthetic in the postmenstrual phase is an effective and efficient method of treating the majority of
women who wish conservative surgical treatment for heavy menstrual loss.
Keywords: bipolar radiofrequency ablation, NovaSure endometrial ablation, endometrial thickness,
premenopausal bleeding.
INTRODUCTION
some women, problems that were present like
Menopause, also known as the climacteric,
endometriosis or painful periods will improve after
is the time in most women's lives when menstrual
menopause (1).
periods stop permanently, and they are no longer
Menopause is usually a natural change. It
able to bear children. Menopause typically occurs
can occur earlier in those who smoke tobacco. (5).
between 49 and 52 years of age (2). Medical
Other causes include surgery that removes both
professionals often define menopause as having
ovaries or some types of chemotherapy. At the
occurred when a woman has not had any vaginal
physiological level, menopause happens because of
bleeding for a year (1). It may also be defined by a
a decrease in the ovaries' production of the
decrease in hormone production by the ovaries. In
hormones estrogen and progesterone. While
those who have had surgery to remove their uterus
typically not needed, a diagnosis of menopause can
but still have ovaries, menopause may be viewed to
be confirmed by measuring hormone levels in the
have occurred at the time of the surgery or when
blood or urine (1). Menopause is the opposite of
their hormone levels fell (3). Following the removal
menarche, the time when a girl's periods start (6).
of the uterus, symptoms typically occur earlier, at
Specific treatment is not usually needed.
an average of 45 years of age (4).
Some symptoms, however, may be improved with
Before menopause, a woman's periods
treatment. With respect to hot flashes, avoiding
typically become irregular, which means that
smoking, caffeine, and alcohol is often
periods may be longer or shorter in duration or be
recommended. Sleeping in a cool room and using a
lighter or heavier in the amount of flow. During this
fan may help. The following medications may help:
time, women often experience hot flashes; these
menopausal hormone therapy (MHT), clonidine,
typically last from 30 seconds to ten minutes and
gabapentin, or selective serotonin reuptake
may be associated with shivering, sweating, and
inhibitors (1,7). Exercise may help with sleeping
reddening of the skin. Hot flashes often stop
problems. While MHT was once routinely
occurring after a year or two. Other symptoms may
prescribed, it is now only recommended in those
include vaginal dryness, trouble sleeping, and
with significant symptoms, as there are concerns
mood changes. The severity of symptoms varies
about side effects. High-quality evidence for the
between women. While menopause is often
effectiveness of alternative medicine has not been
thought to be linked to an increase in heart disease,
found. There is tentative evidence for
this primarily occurs due to increasing age and does
phytoestrogens (8).
not have a direct relationship with menopause. In
7343
Received:20/8/2018
Accepted:30/8/2018
c:\work\Jor\vol738_23
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7350-7357
Comparative Study between Three-Dimensional Transvaginal Ultrasonography
and Hysteroscopy in the Diagnosis of Uterine Cavity Abnormalities
Fahd AbdAlal Mohammad, Ahmed Taha Abdal Fattah, and Ahmed Maher Abd-Elrahman
Obstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar University
* Corresponding author: Ahmed Maher Abd-Elrahman, E-mail: aa_aa7282@yahoo.com
ABSTRACT
Objective: It was aimed at carrying out a comparative study between three dimensional transvaginal
ultrasonography and hysteroscopy in the accuracy of detecting intrauterine cavitary lesions.
Study design: Three dimensional transvaginal ultrasonography was done followed by hysteroscopy for all cases
(number=50). Data obtained were compared and analyzed to estimate the accuracy of 3D transvaginal
ultrasound.
Results: The comparison with using Hysteroscopy, the sensitivity, specificity, positive predictive value, negative
predictive values and total overall accuracy of Three dimensional transvaginal ultrasonography for total
abnormal findings were 89.13%, 100%, 100%, 44.44% and 90% respectively.
Conclusion: The three dimensional transvaginal ultrasound is a sensitive method to evaluate the endometrial
cavity lesions or abnormalities, before resorting to invasive procedures such as diagnostic hysteroscopy. But
hysteroscopy allows direct visualization of the uterine cavity so it can detect small intrauterine lesions which
could be missed by vaginal ultrasound.
Keywords: 3D ultrasound, hysteroscopy, uterine cavity abnormalities.
INTRODUCTION
Hysteroscopy allows for an accurate
Detection of uterine abnormalities has been
diagnosis in benign endometrial pathology.
the focus of research in gynaecology. Structural
Hysteroscopy also allows directed biopsies of
pathologies in the uterine cavity such as müllerian
suspicious lesions, which is useful in malignant
duct anomalies (MDAs) and intrauterine lesions
endometrial pathology (4).
(fibroids, polyps, synechiae) may have an important
Given their safety and efficacy, diagnostic
role in infertility, implantation failure and
and operative hysteroscopy have become standards
pregnancy outcome. As a result, screening for
in gynecologic practice (5).
uterine abnormalities is considered a part of routine
clinical investigations of women who have histories
AIM OF THE WORK
of infertility, recurrent miscarriages and early
The aim of the study was to compare
preterm labor(1).
between the diagnostic accuracy of the three
Transvaginal 3DUS is a non-invasive
dimensional transvaginal ultrasonography and
imaging technique with the ability to generate
hysteroscopy in the detection of intrauterine
accurate images of the endometrial cavity and of the
cavitary lesions.
external contour of the uterus. Three-dimensional
sonographic technology has become more widely
PATIENTS AND METHODS
available in clinical practice This technology entails
This comparative observational cross-
acquisition of a volume of data and rapid
sectional study was conducted on 50 females
reconstruction of images in the transverse, sagittal,
attending outpatient clinic at Al Hussin Hospital,
and coronal planes (2).
Faculty of Medicine, Al-Azhar University. All
Hysteroscopy is performed for the
patients presented with suspected intrauterine
evaluation, or for the treatment of the uterine cavity,
abnormality on 2D ultrasonography or on
tubal ostia and endocervical canal in women with
hysterosalpingography. The study was conducted
uterine bleeding disorders, Müllerian tract
between December, 2017 and June 2018. The study
anomalies, retained intrauterine contraceptives or
was approved by the Ethics Board of Al-Azhar
other foreign bodies, retained products of
University.
conception, desire for sterilisation, recurrent
Inclusion criteria: Any woman with
miscarriage and subfertility. If the procedure is done
suspected
intrauterine
abnormality
on
2D
for the purpose of evaluating the uterine cavity only,
ultrasonography or on hysterosalpingography with
it is called a diagnostic hysteroscopy. If the
complaints of abnormal uterine bleeding in
observed pathology requires further treatment, the
reproductive-
aged.,
peri&
postmenopausal
procedure is called an operative hysteroscopy (3).
bleeding, history of recurrent abortion, infertility,
lower abdominal pain, abnormal vaginal discharge
or for a routine gynecological examination.
7350
Received:20/8/2018
Accepted:30/8/2018
c:\work\Jor\vol738_24
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7358-7364
Evaluation of ALBI, MELD and Child-Pugh Scores as
non-Invasive Predictors of Esophageal Varices
Amer Abdel Hamid Gomaa *, Sayed Farouk Mohammed *, Waleed Mohamed Mousa *,
Nabil Fathy Esmael Hasan** , Mohamed Ahmed Mohamed Mhdy*
* Tropical Medicine Department, ** Clinical Pathology Department, Faculty of Medicine,
Al-Azhar University-Cairo, Egypt
Corresponding author: Mohamed Mhdy ,email: mhdy105@outlook.com
ABSTRACT
Background: the prevalence of esophageal varices (OV) in newly diagnosed cirrhotic patients is approximately
60-80% and the 1-year rate of first variceal bleeding is approximately 5% for small esophageal varices & 15%
for large esophageal varices. Non invasiveness has become a major goal in hepatology in the latter years,
several serum markers and imaging methods have been tried for the non invasive assessment of portal
hypertension or presence of esophageal varices. Aim of the work: this study aimed to compare ALBI, MELD and
Child-pugh scores in prediction of esophageal varices and for discrimination between risky and non risky
esophageal varices. Methods: in this Prospective study evaluation of of ALBI, MELD And Child-Pugh Scores
As non-Invasive Predictors of Esophageal Varices was done in 80 patients with liver cirrhosis. They were divided
into 2 groups, Group I: included 60 patients with liver cirrhosis & esophageal varices diagnosed by upper GIT
endoscopy and will be divided into 3 subgroups 20 patients each as described below: Small, Moderate and Large
esophageal varices. Group II: included 20 patients with liver cirrhosis with no esophageal varices as the control
groupg. Results: the current study showed that ALBI score could be used as a non invasive predictor of
esophageal varices with a cut-off value > - 2.2, with 96.7% sensitivity, 100% specificity, Child score could be
used with a cut-off value > 5.5, with 93.3% sensitivity, 100% specificity, and MELD score could be used with a
cut-off value > 8.5, with 90% sensitivity, 95% specificity. Conclusion: ALBI score is more accurate than Child
and MELD scores as non invasive predictor of esophageal varices and its grading.
Keywords: ALBI score, Child-Pugh score, MELD score, Esophageal varices.
INTRODUCTION
The formation of esophageal varices depends
normalized ratio (INR) and removing nutritional
on an elevation in portal pressure; a hepatic venous
status. ChildPugh score has been widely used to
pressure gradient (HVPG) greater than 10 mmHg is
assess the severity of liver dysfunction in clinical
necessary for the development of bleeding from
work [6]. Model for end stage liver disease (MELD)
esophageal varices [1]. The actual recommendation
has been a useful tool to predict mortality for patients
for surveillance in patients with compensated liver
awaiting liver transplantation. However, the role of
disease & small varices at the screening endoscopy is
the score in predicting complications after liver
a follow-up examination after 1-2 years [2].The
transplantation has yet to be evaluated [7].
prevalence of esophageal varices (OV) in newly
AIM of the WORK
diagnosed cirrhotic patients is approximately 60-80%
This study aimed to compare ALBI, MELD and
and the 1-year rate of first variceal bleeding is
Child-pugh scores in prediction of esophageal
approximately 5% for small esophageal varices and
varices and to use the interactive data of these scores
15% for large esophageal varices [3].Recently, the
to grade esophageal varices based upon EGD
albumin-bilirubin (ALBI) score has been established
procedure as a Gold Standard.
as a more convenient and evidence-based model to
assess the severity of liver dysfunction in patients
PATIENTS and METHODS
with hepatocellular carcinoma (HCC) [4].
This study was conducted in the period
The major advantage is that the prognostic value
between Sept 2017 and June 2018. Cases were
is comparable between the ALBI and Child-Pugh
selected from Gastrointestinal Endoscopy Unit,
scores, but two subjective variables [i.e., ascites and
Faculty of Medicine, Al Azhar University and
hepatic encephalopathy [HE] included in the Child-
enrolled in 80 patients with liver cirrhosis. They
Pugh score are excluded from the ALBI score. The
were divided into 2 groups. Group I: included 60
benefit of the ALBI score for assessing liver function
patients with liver cirrhosis and esophageal varices
has also been confirmed in advanced HCC patients
diagnosed by upper GIT endoscopy and they were
treated with sorafenib [5].ChildPugh score was
divided into 3 subgroups 20 patients each as the
firstly proposed by Child and Turcotte to predict the
following: small, moderate and large esophageal
operative risk in patients undergoing portosystemic
varices. Group II: included 20 patients with liver
shunt surgery for variceal bleeding. It was modified
cirrhosis with no esophageal varices as the control
by adding prothrombin time or international
group.
7358
Received:27/8/2018
Accepted:17/9/2018
INTRODUCTION
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7365-7375
Conservative Management versus Using of Bakri Balloon Catheter with
Intrauterine Washing with Misoprostol in Cases of Atonic Postpartum Hemorrhage
Ismaeal El-Garhy, Fahd A. Elmoda, Ahmed A. Dowy
Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University
Corresponding author: Ahmed A. Dowy; Mobile: 01123093083; Email: m.dowy2020@gmail.com
ABSTRACT
Background: post partum hemorrhage is an obstetrical emergency that can follow vaginal or cesarean
delivery. It is one of the bleeding causes of maternal mortality, especially in the developing countries. A
step-wise approach to management of post partum hemorrhage was recommended. Aim of the Work: this
study aimed to compare between conservative treatment and using Bakri balloon catheter in cases atonic
postpartum hemorrhage. Patients and methods: this prospective randomized study was conducted on 100
patients managed by conservative treatment or by using Bakri balloon catheter with intrauterine washing
with misoprostol at the Department of Obstetrics and Gynaecology, Aswan General Hospital in the period
from 1 October 2017 to 30 September 2018. Results: the descriptive of risk factor of all the studied cases
indicated that anemia was the major risk factor (34 cases, 34%). The causes of PPH showed that uterine
atony was the major cause of PPH (71 case which contributed 71% of the total cases) and the second cause
was placenta previa (29%) with 29 cases of the total. Bakri ballone catheter with intrauterine wash with
misoprostol decreased significantly (p<0.001) the number of patients who need blood transfusion from 50
cases (100%) in group 1which received conservative management only to 44 case (88%) in group 2. Also,
using Bakri ballone catheter with intrauterine wash with misoprostol decreased significantly (p<0.001) the
amount of blood units needed. Conclusion: postpartum hemorrhage (PPH) remains one of the top five
causes of maternal mortality worldwide in both the developed and developing countries. The use of
tamponade test in a tonic postpartum hemorrhage has a good predictive value in controlling of bleeding. Our
study showed that tamponade with Bakri ballone deserved a place in the treatment of post partum
hemorrhage. It is simple, readily available, effective and safe procedure. Bakri ballon tamponad (BBT) does
not exclude the use of other procedures if necessary. Even if BBT failed, it may provide temporary tamponad
and time to prepare for other intervention or transportation from local hospital to tertiary center.
Key words: conservative management, Bakri balloon catheter, intrauterine washing, misoprostol atonic
postpartum hemorrhage.
INTRODUCTION
nonoperative interventions. In acute postpartum
Postpartum hemorrhage (PPH) is a life-
hemorrhage refractory to medical and other
threatening complication of delivery.
conservative interventions, invasive therapies may
It occurs after vaginal or cesarean delivery
include arterial embolization, uterine compression
and is a major cause of maternal morbidity and
sutures, uterine artery ligation, and, ultimately,
mortality in both developing and developed
hysterectomy (4).
countries as well (1).
However, these measures are highly
The most common cause of PPH is uterine
invasive, require extensive resources, expertise,
atony; up to 80% of the cases resulted from
and are associated with significant morbidities
suboptimal contraction of the myometrium
Intrauterine balloon tamponade has been
following placental separation After excluding
suggested as an effective, easily administered
other etiologies of PPH such as retained placenta,
minimally invasive treatment option to control
uterine rupture, genital tract trauma, uterine
uterine bleeding while preserving the mother's
inversion, and coagulopathy, the management of
ability to bear additional children (5).
uterine atony should be timely and initiated to
The effectiveness of the intrauterine balloon
prevent hemorrhagic, hypovolemic shock, dilution
catheter can be assessed by the tamponade test
of coagulopathy, tissue hypoxia and acidosis (2).
first described by Condous et al.. This test is
The pituitary gland, the kidneys and the lungs
considered positive when control is achieved
are particularly susceptible organs to damage when
following inflation of the balloon patient with a
perfusion pressure decreases resulting in feared
negative (persistent bleeding despite the balloon
sequelae of postpartum hypovolemic shock such as
placement) should be proceed to more invasive
Sheehan syndrome (ie, postpartum hypopituitarism),
therapeutic approaches such as laparotomy or
renal failure, and acute respiratory distress syndrome
embolization depending on personnel and
(3).The repertoires of the management measures
facilities (6).
can be generally divided into operative and
So we used 200 mcg of misoprostol tablets
and intrauterine washing after insertion of Bakri
7365
Received:1/9/2018
Accepted:20/9/2018
c:\work\Jor\vol738_26
Parental Awareness and Management of Acute Otitis Media ...
retracted
1
c:\work\Jor\vol738_27
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7384-7387
Review on Omega-3-Supplementation in Eating Disorders
Yazed Mohammed Alashmali 1, Abdulrahman Sameer Basabrain 1, Abdulaziz Ibrahim Habadi 2,
Noura Ghaleb Alroweli3, Hamza Ahmed Bana4, Khaled Farouk Helmi Faisal5, Maryam Abdalhadi
Altayeb6, Luay Abdullah Alqurashi2, Sabei, Ali Ibrahim H.7, Elyas Mahmoud Alsa'ati 2
1- Royal College of Surgeons, Ireland, 2- Department of Psychiatry, Al-Amal Hospital, Ministry of Health,
Jeddah, Saudi Arabia,3- Ministry of Health, Jeddah, Saudi Arabia, 4- Faculty of Medicine, King Abdulaziz
University, 5- Imam Abdulrahman Alfaisal Hospital (Riyadh),6- Batterjee Medical College,7 -Salhaba and New
Sabya Primary Health Care Centre in Jazan
ABSTRACT
Background: Eating disorders are complex, potentially life-threatening conditions, characterised by disturbances
in eating behaviours and extreme fear of weight gain with significant morbidity and mortality rates. Individuals
avoid fattening foods. This avoidance of fattening foods may lead to the avoidance of foods which may include
those with omega 3 fatty acids. Aim of the work: Aim of the review is to explore the consequence of starvation on
the brain both in adolescence and in adults and particularly due to omega 3 deprivation. It also aims to explore the
role of the benefits and possible mechanisms of omega 3 supplementation on other mental health conditions and to
consider these implications for eating disorders. Methods: The search was undertaken by using PubMed and the
search terms , eating disorders, anorexia nervosa and Omega-3. Alternatively, search terms such as depression,
schizophrenia or other mental health conditions and omega-3 were used. References lists of identified reviews and
articles were also searched for relevant empirical studies. Results: According to a growing body of evidence, the
role and importance of omega-3 fatty acids in mental health is well-recognised and well-established to be beneficial.
Fatty acids are fundamental components of the brain and are necessary for normal body physiology. Since the body
cannot synthesize these fats, it has to be completely obtained from the diet. Brain tissue is rich in omega-3 fatty
acids. These acids have a major role within cell membranes and in connections between neurons.Omega-3 FAs
deprivation may be correlated with the happening of many psychiatric conditions, such as obsessive-compulsive
disorder, depression, bipolar disorder, and schizophrenia. Conclusion: The clinical research evidence on omega-3
supplements in eating disorders is preliminary and not definitive in comparison to other mental health disorders.
Thus, this will be an important area for future research, and may lead to the development of newer interventions.
Keywords: Omega-3 supplements, eating disorders, preliminary, mental health disorders.
INTRODUCTION
Eating disorders and fat deprivation
Omega-3 Fatty Acids
Eating disorders are serious psychological illnesses
Omega-3 fatty acids are polyunsaturated fatty acids that
marked by disturbances in eating behaviour and
are essential for human health and development. There
extreme fear of weight gain. They have a core
are three types involved in human physiology, namely:
psychopathology centred on food, eating habits and Alpha-Linolenic acid. (ALA): it is an 18 carbon chain
body image concerns. These habits eventually lead to
fatty acid with 3 double bonds. It is known as dietary
the deterioration of the individual's physical and mental
essential FAs, so called because it cannot be synthesised
health[1,2]. Eating disorders have one of the highest
de novo and it must be acquired from the diet. Dietary
death rates of all psychiatric diagnoses. The number of
resources includes walnut and flaxseed oil.
deaths in those with anorexia nervosa was 11.6 times Eicosapentaenoic acid. (EPA): It is a 20 carbon chain
higher in comparison with their healthy counterparts of
fatty acid with 5 double bonds. It could be acquired
the same age and sex. In those with bulimia, the rate is
through the conversion of ALA within the liver cells.
1.3 times [3]. Due to the core psychopathology and the
However, the conversion capacity in human is very
cognitive distortion associated with these disorders,
limited and inefficient. Thereby, it's mainly acquired
individuals restrict their dietary intake in order to
from dietary sources such as fish oil
prevent weight gain. This self-starvation may lead to Docosahexaenoic acid. (DHA): It is a 22 carbon chain
serious nutritional deficiencies. The impact of
fatty acid with 6 double bonds. It is the most abundant
nutritional self-deprivation ranged from general poor
fatty acid in the brain which makes up an average of
health to life-threatening conditions and could have
10% of fat in our brains. Its acquisition is similar to EPA
huge consequences on the body and mind. Patients with
in that it could be synthesised from ALA inefficiently
anorexia have the tendency to deprive fat during their
but the main source would be marine oils [5,6] .
self-induced starvation due to the fat phobic nature of
Role of Omega-3 in the Brain
this disorder. Thus, these patients are more likely to
These types of lipids play a key part in the body growth,
develop severe omega-3 deficiency which may have
development and metabolism as they are involved in
serious impact on the brain [4].
cell signalling and constitute an integral part of cell
7384
Received:17/9/2018
Accepted:30/9/2018
c:\work\Jor\vol738_28
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7388-7393
Study of Lipid Profile in Different grades of Non- Alcoholic Fatty Liver Disease
Farag Khalil, Mohamed Nabil Rafat, Mohamed Salah, Mamdouh Attia Mohamed, Wafeek Ibrahim*
Internal Medicine Department, *Radiology department, Faculty of Medicine Al-Azhar University Cairo Egypt.
Corresponding Author: Farag Khalil, Email: dr.farag7070@azhar.edu.eg
ABSTRACT
Background: The prevalence of NAFLD (non- alcoholic fatty liver disease) is increasing as it exceed (31.79%)
in Middle East and the metabolic syndrome prevalence in patients with NAFLD ranges from 18% to 67%,
according to the body weight. Imaging or histology is very important tools in diagnosis of NAFLD. Early detection
of NAFLD is very important especially if there is a non-invasive method. The clinicians in the primary, secondary
and tertiary care are in need for specific and sensitive diagnostic tool that can be used easily.
Aim: To study and analyze serum lipid changes in non-alcoholic fatty liver disease of different grades.
Patients and methods: 100 patients diagnosed by ultrasonography as NAFLD, whose age was more than 18 years,
were included in the study. History taking, full clinical examination and anthropometric measurement of weight,
height and body mass index (BMI) were done for all patients. Serum lipid profiles including total cholesterol,
HDL, LDL, triglycerides, ALT, AST. CBC, fasting and 2hpp blood glucose and TSH were measured.
Results: The largest group of patients (38%) was in the fifth decade of life. followed by 30% in the sixth decade
of life. As the grade of NAFLD increased, there was associated significant increase in levels of serum total
cholesterol (P-value 0.005), TG (P-value 0.002) LDL (P-value 0.001) and VLDL (P-value 0.003) and associated
significant decrease in HDL (P-value 0.001).
Conclusions: abdominal ultrasonography and increased lipid profile values can be used to detect NAFLD early.
Key words: NAFLD, Lipid Profile, Ultrasonographic grading of NAFLD
INTRODUCTION
cardiovascular disease are increased in the presence
NAFLD in developed countries is the most
of NAFLD (5).
prevalent chronic liver disease. The Middle East has
Most NAFLD cases have a benign course without
reported the highest prevalence of NAFLD (31.79%)
symptoms or signs of liver disease but some cases
and South America (30.45%) but Africa has the
can be progressive and develop fibrosis and cirrhosis
lowest prevalence rate (13.48%) (1).
or even liver failure and hepatocellular carcinoma(6).
NAFLD develops due to abnormal triglycerides
Ultrasound can detect the liver fatty infiltration
accumulation in the liver cells, leading to
but cannot differentiate between NAFLD and NASH.
histologically benign disease named simple steatosis
This differentiation needs a liver biopsy and is
but it can progress to histologically aggressive form
essential because of the much higher risk of liver
characterized by inflammation and liver cell injury
fibrosis and cirrhosis with NASH than NAFLD.
with or without fibrosis called steatohepatitis
However, liver biopsy is clinically impractical
(NASH) (2).
because of the large numbers of patients with
Non-alcoholic fatty liver disease diagnosis needs
NAFLD and that most patients are asymptomatic and
(1) exclusion of history of heavy alcohol
its high cost and sampling errors (7). Also it is a
consumption and steatogenic drug use (2) detection
painful procedure with dangerous complication like
of steatosis by histology or imaging (3).
bleeding (8).
By definition, NAFLD is the presence of more
The ultrasound has moderate accuracy and is
than 5% hepatic steatosis in the absence of
widely available so it is the primary tool to diagnose
hepatocellular injury but in NASH there is more than
NAFLD in routine practice (9).
5% hepatic steatosis with presence of inflammation
and hepatocellular injury with or without fibrosis (3).
PATIENTS AND METHODS
Visceral obesity, dyslipidemia, type 2 diabetes
This is a cross sectional prospective study. Total 100
mellitus and metabolic syndrome are the most
patients older than 18 years were enrolled in this
important risk factors for NAFLD. In lipid
study. They were diagnosed by ultrasound as non-
metabolism, thyroid hormones play an essential role.
alcoholic fatty liver disease. An informed consent
Hypercholesterolemia caused by decreased thyroid
was taken from all patients. The American
hormone levels has a fundamental role in the
Gastroenterology Association criteria were used for
development of NAFLD (4).
classification of the patients (10).
NAFLD and cardiovascular diseases share the
All the ultrasound examinations were performed on
similar risk factors. The mortality and morbidity of
Voluson E6 US Scanners using 3-5 MHz.
7388
Received:20/8/2018
Accepted:30/8/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7394-7399
Minimally Invasive Spinous Process Splitting Approach for
Management of Lumbar Canal Stenosis
Ali Mohammad AlGioushy, Mohammad Abd Almonem Negm, Mohammad Abd ElBaset Abd ElHakim
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Corresponding author: Mohammad Abd ElBaset Abd ElHakim, Mobile: 01147458147,
Email: dr.m.abdelbaset89@gmail.com
ABSTRACT
Background: for years, the gold standard treatment of symptomatic lumbar canal stenosis refractory to
conservative management is a facet preserving laminectomy. However, it has been suggested that extensive
resection of the posterior bone, posterior ligaments and muscular structures led to increase postoperative pain,
perioperative blood loss, complications and length of hospital stay. More recently, various authors have
recommended surgical techniques that preserve posterior midline structures (i.e. spinous processes, vertebral
arches, interspinous and supraspinous ligaments), as removal of these structures may contribute to instability
after surgery. Objective: the purpose of our prospective study is to evaluate the surgical outcome of minimally invasive
spinus process splitting approach in the treatment of lumbar canal stenosis.
Patients and Methods: this prospective study included 20 patients that were operated in Al Azhar
University Hospitals in the period between January 2017 and March 2018 via minimally invasive spinus
process splitting approach in the lumbar canal senosis. Pre- and postoperatively disability and pain scores
were measured by using the Oswestry Disability Index (ODI) and Visual Analog Score (VAS). Results: our
statistical results revealed that there was a statistically significant difference in the outcome between pre and
postoperative after follow up period of 12 months regarding VAS for back pain and leg pain, postoperative
ODI changes were significantly better. There was a significant decrease regarding operation time and
postoperative hospital stay, blood loss and postoperative pain. Conclusion: so, the relevance of preservation
of the posterior midline structures should be clarified in further studies.
Keywords: lumbar canal stenosis, decompression surgery, minimally invasive spinus process splitting
approach.
INTRODUCTION
performed by Lane. It is one of the most commonly
One of the most useful definitions of lumbar
performed procedures which can be done alone or
canal stenosis since its description is being a
along with a variety of other procedures such as
disproportion in the spinal canal between the size of
foraminotomies for affected roots and partial or
the neural elements and the space available.
complete
facetectomies. The
extent
of
Compression of the thecal sac and its neural contents
decompression should be determined according to
can cause pain and neural symptoms (1).Degenerative
each affected anatomical site (4). Despite affording a
spinal stenosis is part of the aging process, and
wide decompression, laminectomy or "unroofing" of
predicting who will be affected is not possible. No
the spinal canal, open decompression can cause
clear correlation is noted between the symptoms of
destruction or impairment, insufficiency of the pars
stenosis and race, occupation, sex, or body type. The
interarticularis or facet joints and the posterior midline
degenerative process can be managed, but it cannot
ligaments such as the supra- and interspinous ligaments
be prevented by diet, exercise, or lifestyle (2).Lumbar
lose their original attachments when the spinus
stenosis is the result of lumbar spine degeneration
processes are removed. Such intraoperative damage to
and loss of disc elasticity as well as disc herniation,
these posterior lumbar supporting structures can lead to
facet hypertrophy, spur formation, spondylosis,
atrophy of paraspinal muscles which caused trunk
thickening of yellow ligament and spondylolisthesis,
extensor weakness and possibly failedback surgery
all impinging on the spinal canal and intervertebral
syndrome and segmental instability (5). In particular,
foramen. It can be categorized according to the
spinal instability has been implicated as a cause of
anatomic area of the spine affected into central or
surgical failures, because wide decompression
lateral stenosis.
significantly alters spinal anatomy and biomechanics,
The surgical aim of treatment for
thus prompting many surgeons to perform fusion
symptomatic lumbar canal stenosis is relief of
procedures as an adjuvant treatment for lumbar
symptoms by adequate neural decompression while,
stenosis. The frequency of fusion surgery has been
preserving much of the anatomy and the
steadily increasing in the treatment of degenerative
biomechanical function of the lumbar spine(3).The
lumbar stenosis despite numerous concerns (6).In recent
concept of classic open decompressive lumbar
years limited opening in the spinal canal had
laminectomy for the treatment of spinal stenosis
increased in popularity. Single level or multilevel
dates back to 1893 when the procedure was
bilateral fenestration procedures constitute the major
7394
Received:2/9/2018
Accepted:21/9/2018
c:\work\Jor\vol738_30
The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (8), Page 7400-7403
Osteoid Osteoma; Surgical Resection and Per-Cutaneous Radiofrequency
Thermo-Ablation Outcome Comparison
Abdullah I. Qashgry 1*, Abdullah H. Alnemari 2, Abdulaziz R. Alshehri 2,
Alwaleed A. Alyami 1, Ammar F. Qutub 3, Ali H. Alyami 1,2
1 King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), 2 King Abdulaziz Medical City,
National Guard Health Affairs, 3 King Abdulaziz University.
* Corresponding Author: Abdullah Ibraheem Qashgry, Mobile No.:+966563663338, Email: Qashgry.abdullah@gmail.com
ABSTRACT
Background: Oteoid osteoma is a benign bone tumor that affects mainly children and adolescents. Most patients
complain of pain as the main symptom, which is usually managed by analgesia. Less commonly, the lesion can lead
to bone deformity or restricted mobility. Ultimate treatment of this disease is to remove the lesion surgically, or by
the recently adopted, less invasive, per-cutaneous radiofrequency thermo-ablation.
Objective of the study: To evaluate the outcome of patients diagnosed with osteoid osteoma treated with either
surgical resection or per-cutaneous radiofrequency thermo-ablation (PRT).
Methods: Our data were collected during the period from January 2000 to December 2016. A total number of 28
patients who underwent either surgical resection or PRT therapy were included. We evaluated the presence of
residuals after treatment, symptomatic relief, recurrence rate, and length of stay at hospital following treatment.
Results: Mean age of diagnosis in our patients was 14.7 years (±7.63), and 13 patients (46%) underwent surgical
treatment, and 15 had PRT therapy (54%). The presence of post-therapy residuals, symptoms relief, and recurrence
rate were not significantly different between the two treatment groups, while median length of stay post-op (surgical
= 4 days, PRT = 1 day) was significantly different and favored PRT treatment group (p-value=< 0.001).
Conclusion: PRT therapy was shown to be less invasive, safer, and significantly reduced the lengths of stay, which
could be a determinant factor in fast recovery to patients and a cost-effective option.
Keywords :Osteoid osteoma , per-cutaneous radiofrequency thermo-ablation (PRT), surgical resection,surgery,
ablation.
INTRODUCTION
the outcome and complications of treating osteoid
Osteoid Osteoma is a benign tumor that occurs
osteoma with either surgical resection or
mainly in childhood and adolescence. However, it is
radiofrequency ablation at our center.
not exclusive to these age groups as it may affect
adults (1). It accounts for about 11% of benign bone
METHODS
tumors (2). The affected individuals mostly present
This is a retrospective cohort study. The data were
with severe pain, usually dull aching in nature, that
collected by reviewing the charts in the medical
sometimes worsens at night and could affect sleep (1,
record department at King Abdulaziz Medical City
2). This tumour is usually identified by radiological
(KAMC) in Jeddah. All the cases of osteoid osteoma
means showing signs of centrally radio-transparent
were managed during the period between January
ossifying lesions with a diameter less than 12-15 mm,
2000 to December 2016. The privacy at the time of
surrounded by a zone of reactive ossification (1). The
data collection was assured. All the information and
pain is traditionally managed conservatively by non-
the data were anonymous, and the confidentiality was
steroidal anti-inflammatory drugs (NSAIDs).
guaranteed. All data were analyzed using SPSS. Chi
However, in order to achieve absolute relief, removal
Square or exact Fisher test was performed for
of this troublesome tumor is indicated. The options
comparison of categorical variables.
are mainly either surgical excision or percutaneous
A total number of 28 patients was enrolled in this
radiofrequency thermo-ablation (PRT) (2).
study. Both genders of all ages who were diagnosed
In surgical resection, precise identification of the
with osteoid osteoma by Computed Tomography scan
lesion is considered a difficulty, which usually
(CT) were included.
requires wider margins resected to ensure adequate
In our 28 patients, 13 underwent surgical
therapy. Such invasive nature, has led to higher
resection, and 15 were treated with Radiofrequency
morbidity and complications (3). The introduction of
ablation.
PRT has made it the most commonly used method
because of its less invasive nature, morbidity,
Data were analyzed using SPSS version 22.
mortality, hospital cost and stay (3,4). Up to our
Continuous variables were analyzed using mean ±
knowledge, no study has compared the outcome of
Standard Deviation (SD), and categorical variables
these two methods, therefore, our aim was to evaluate
were analyzed using frequency and percentages.
7400
Received://2018
Accepted://2018