Review of literature The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7404-7411

Comparison Between the Use of a Genexpert Device and Conventional
Diagnostic Methods in the Detection of Mycobacterial Tuberculosis and
Its Resistance to Drugs
Ahmed E. Elsayed (1), Mostafa Y. El-Mishad (1), Mahmoud A. Mohamed (1),
Ibrahim M. El-hosiny (1),Ahmed Abdel Tawab (1), Ghanem A. Mohamed (2)
(1) Department of Medical Microbiology and Immunology and (2) Department of chest diseases, Faculty of
Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Ahmed E. Elsayed; Mobile: 01003967843; Email:,
Orchid id: 0000-0002-9721-3584
Mycobacterium tuberculosis (MTB) is the causative agent of tuberculosis (TB), which remains
the leading cause of morbidity and mortality worldwide. The emergence of drug-resistant strains of MTB has
put status of TB to threatening levels. Aim of the Work: was to detect MTB along with rifampicin (RIF)
resistance using Genexpert (MTB/RIF). Its diagnostic, sensitivity and specificity were evaluated by comparing
with conventional technique. Patients, Materials and Methods: This prospective study was conducted on
two hundred and seven Egyptian patients at Abbasia Chest Diseases Hospital, from November 2016 to
December 2017, and comprised clinically and radiologically diagnosed TB suspected cases. This study was
approved by the Ethical Committee of faculty of medicine, Alazhar University and the Ethical Committee of
Ministry of Health and after Verbal consents from the patients or their parents were taken. Pulmonary
specimens (sputum and bronchial lavage) and pleural effusion as an extra-pulmonary specimen were included.
All samples collected were sent to TB laboratory of Abbasia Chest Diseases Hospital for further analysis.
Result: Out of the 26 Genexpert (MTB/RIF) positive samples for MTBC, 3 (11.54%) showed RIF resistance
and diagnosed as MDR-TB. Using LJ and MGIT cultures for drug sensitivity test (DST) on 31 and 34 positive
TB samples; respectively, the same three specimens showed resistance to rifampicin (RIF). Four positive
specimens were also resistant to streptomycin (STR) using the previously mentioned cultures. Moreover,
resistant to INH was reported in five positive TB samples using the same cultures. Finally, it was found that
all positive specimens were sensitive to Ethambutol (ETH). Conclusion: Although the conventional methods
remain the gold standard for diagnosing pulmonary TB, delayed diagnostic times demand for more rapid and
sensitive nucleic acid amplification techniques. Genexpert (MTB/RIF) assay is simple, rapid and accurate
method for detecting mycobacterial tuberculosis.
Keywords: genexpert device, mycobacterial tuberculosis, MDR.


dyes they cannot be decolorized by alcohol,
The mycobacteria are rod-shaped, aerobic
regardless of treatment with iodine. True tubercle
bacteria that do not form spores. Although they do
bacilli are characterized by "acid-fastness" 95%
not stain readily, once stained they resist
ethyl alcohol containing 3% hydrochloric acid
decolorization by acid or alcohol and therefore
(acid-alcohol) quickly decolorizes all bacteria
except the mycobacteria. Acid-fastness depends on
tuberculosis causes tuberculosis and is a very
the integrity of the waxy envelope (1).
important pathogen of humans. Mycobacterium
The term tuberculosis (TB) broad ranges of
leprae causes leprosy. Mycobacterium avium-
clinical illness caused by Mycobacterium
intracellulare (M. avium complex, or MAC) and
tuberculosis or less commonly Mycobacterium
other non-tuberculous mycobacteria frequently
bovis and other types of mycobacteria (2).
infect patients with acquired immunodeficiency
Mycobacterium tuberculosis which usually attacks
syndrome "AIDS" are opportunistic pathogens in
the lungs, it can attack any part of the body such as
the kidney, spine, and brain. Not everyone infected
occasionally cause disease in patients with normal
with tubercle bacilli becomes sick. That explains
immune systems. There are more than 125
the presence of two TB-related conditions: latent
Mycobacterium species (1).
TB infection (LTBI) and TB disease. If not treated
Mycobacterium Tuberculosis in tissue,
properly, TB disease can be fatal (3).
tubercle bacilli are thin straight rods measuring
about 0.4 x 3 µm. On artificial media, coccid and
Organization (4) there were 7974 newly discovered
filamentous forms are seen with variable
tuberculosis cases in Egypt in 2016 (4545
morphology from one species to another.
pulmonary cases and 3429 are extra pulmonary),
Mycobacteria cannot be classified as either gram-
174 of them confirmed as multidrug resistant
positive or gram-negative. Once stained by basic
organisms by the conventional culture method.

Full Paper (vol.739 paper# 1)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7412-7417

Outcome of Unilateral Intraocular Retinoblastoma
Mohammad Ahmad Wahdan 1, Abd Allah El Hussainy Shaleel1,
Hossam El Dein Ahmed El Zomor2, Hossam El Din Hassan El Sayed El Baz1*
Ophthalmology Department, Faculty of Medicine, Al Azhar University,Pediatric Oncology National Cancer
*Corresponding author: Hossam El Din Hassan El Sayed El Baz, E-mail:


Background: retinoblastoma is the most common primary, malignant intraocular tumor of childhood, the aim
of the study is to evaluate the outcome of management of 50 consecutive cases of unilateral retinoblastoma.
Aims of the Work: to evaluate the outcome of management of unilateral retinoblastoma and to assess the risk
of recurrence.
Patients and Methods: prospective study of 50 consecutive cases with unilateral intraocular retinoblastoma.
The management of cases was performed in the National eye center (Rod El Farag). Fundus examination was
done under general anesthesia with RetCam 3. Management of cases according to the staging was group A:
Focal treatment, TTT or cryotherapy, group B & C: chemotherapy with focal treatment, group D: If the patient
has good visual potential (according to macular affection) Chemotherapy with focal treatment, if the patient has
poor visual potential Enucleation, group E Enucleation.
Results: as regard cases that managed with chemotherapy, there was 23 cases, 13 out of them treated with
chemotherapy and transpupillary thermotherapy and showed complete regression, 10 cases showed initial
regression with further new tumor recurrence after finishing chemotherapy, 5 cases was well managed by focal
therapy, and another 5 cases failed to be controlled by focal therapy and Intra vitreal melphalan and ended by
enucleation. As regard cases that was managed by enucleation, there was 32 cases, 27 out of them managed by
primary enucleation, and 5 cases managed by secondary enucleation after failure of chemotherapy and focal
therapy, 17 cases out of the enucleated eyes revealed presence of high risk pathological features, none of the
cases developed local or metastatic tumors in the follow up period.
Conclusion: retinal seeding, vitreous seeding are major predictive factors for tumor recurrence,
Keywords: Unilateral Intraocular Retinoblastoma, leukocoria


Retinoblastoma is the most common

primary, malignant intraocular tumor of childhood
applicators, cryotherapy, photocoagulation, and,
with an incidence of 1:17000 to 1:34000 new births
more recently, systemic chemotherapy (6).
in USA (1). Some unilaterally diagnosed cases go
Although such 'conservative' approaches to
on to develop tumors in the fellow eye and become
managing unilateral retinoblastoma have enabled
bilateral (2). Children with unilateral retinoblastoma
physicians to salvage eyes and vision without
are usually diagnosed at a later age than bilateral
sacrificing survival, it has been emphasized that the
retinoblastoma (3). Unilateral retinoblastoma most
decision to manage unilateral retinoblastoma
commonly presents with advanced intraocular
without enucleation requires careful analysis of the
disease (4) and is treated with enucleation. Survival
risks and benefits of such an approach (6).
rates of over 90% are now widely reported for

unilaterally affected patients treated with simple
enucleation (5).
To evaluate the outcome of management of
It has been recognized that some cases of
unilateral retinoblastoma, to assess the risk of
unilateral retinoblastoma can be managed without
recurrence, extra ocular extension and to assess the
primary enucleation. The diagnosis may be made at
prevalence of high risk pathological features in the
an earlier age and stage in children with a family
enucleated eyes.

retinoblastomas affect the macula of one eye,
causing strabismus, or when the eye is examined
Patient Selection
for other reasons in the first few months of life.
Prospective study of 50 consecutive cases
Modalities used for primary therapy include
with unilateral intraocular retinoblastoma was
external beam radiotherapy, localized radioactive
recruited. The management of cases was performed

Full Paper (vol.739 paper# 2)

Yolk sac size and shape, gestational sac diameter & embryonic heart rate as prognostic factors for first trimesteric outcome The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7418-7428

3Yolk Sac Size and Shape, Gestational Sac Diameter and Embryonic
Heart Rate as Prognostic Factors for First Trimesteric Outcome
Emad Maarof Abd Ellatif, Abdalla Khalil Ahmad, Mohamed Ali Ali Halawa
Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University
*Corresponding author: Mohamed Ali Ali Halawa, Mobile: 002001008277407, E-Mail: dr_halawa_42

it is estimated that approximately 30% to 40% of implanted pregnancies resulted in spontaneous
abortion during the first trimester, most of which occur in very early stage. Significant number of losses
predominantly occurs very early in gestation, but once the embryonic heart activity appears the rate of
spontaneous abortion gradually decreases to 2-5%. Aim of the work: this work aimed to evaluate the correlation
between the ultrasound parameters that were assessed in the first trimester (the gestational sac size, yolk sac size
and shape and embryonic heart rate) to early pregnancy loss and the correlation between different ultrasound
parameter to each other. Methodology: this study involved 100 pregnant women attending Al Hussein
University Hospital. They were examined by using 2D ultrasonography starting early in the first trimester with a
first scan between 6 and 8 weeks. A follow up scan was conducted at 9 and 12 weeks. During follow up, 7
women did not return for follow up and accordingly, the results (gestional sac diameter,embryonic heart rate and
yolk sac size and shape ) of the remaining 93 women were shown. All patients were evaluated by transvaginal
ultrasound using equipped with a real-time, 5-MHz sector electronic array endovaginal probe. The fetal heart rate
was measured by M-mode in all cases and the yolk sac diameter (YSD) was determined by placing the calipers
on the inner limits of the longer diameter. Results: in this study, there was a significant increase in age in fetal
loss group more than complete pregnancy group. Regarding the relation between gestational sac diameter at
different gestational age period and its relation to the outcome of pregnancy, the gestational sac diameter showed
a significant decreasing in the fetal loss group at 6, 9 and 12 weeks, so the GS diameter was a good predictor to
fetal loss (p < 0.05). Conclusion: first trimester ultrasound measurement of these parameters (FHR,YS diameter
and shape and GS diameter) proved to be an important, helpful and noninvasive tool in the investigation,
diagnosis as well as the follow up of pregnant females in their early pregnancy. Measurement of gestational sac
diameter, CRL and fetal heart rate in combination provided better prediction of the prognosis of the first
trimester than when either parameter used alone.
Keywords: yolk sac diameter, gestational sac diameter, embryonic heart rate


inner diameter of a yolk sac measures 3 to 5 mm (6).
It was estimated that approximately 30% to
In fact, the yolk sac size progressively increases
40% of implanted pregnancies resulted in
from the beginning of the 5th gestational week to the
spontaneous abortion during the first trimester, most
end of the 10th gestational week. Afterward, the yolk
of which occurred in very early stage (1).
sac size decreases gradually. When the 10th or 11th
Significant number of losses predominantly
weeks of gestation is completed, the yolk sac begins
occurred very early in gestation, but once the
to shrink rapidly and eventually disappears (6).
embryonic heart activity appeared the rate of
A study investigated the size, structure and function
spontaneous abortion gradually decreases to 2-5 %
of the yolk sac in addition to embryonic heart rate in
(2). However intrauterine gestational sac is the first
evaluation and prognosis of first trimester
one to appear sonographically, followed by the yolk
pregnancy loss. By transvaginal sonogram, EHR
sac and the foetal pole with cardiac activity
(Embryonic heart rate) can accurately demonstrate
(3).Within the gestational sac, yolk sac is the first
and assess the pregnancy outcome in those with
evident embryonic structure. It is usually visible
bradycardia (7). The embryonic heart beat can
between the fifth and twelfth week of pregnancy as
usually be identified at prenatal ultrasonography by
a round anechoic area; after which it undergoes
6 weeks gestation in M-mode (8). Another study
degeneration (4).
showed that a slow embryonic heart rate at 6.0­7.0
A yolk sac can be detected easily by
weeks gestation was associated with a high rate of
transvaginal sonography when the mean gestational
first trimester fetal demise, and the demise often
sac diameter was 5 to 6mm. It is generally accepted
occurs soon after the slow heart beat is detected (9).
that the yolk sac should be observed when a

gestational sac measures greater than 8mm (5).The
yolk sac is connected to the embryo by the vitelline
The aim of this work was to evaluate the
duct. Normally, the yolk sac appears as a circular
correlation between each of the ultrasound
structure with an anechoic center surrounded by a
parameters that were assessed in the first trimester
uniform well-defined echogenic wall. Usually the
(the gestational sac size, yolk sac size and shape and

Full Paper (vol.739 paper# 3)

c:\work\Jor\vol739_4 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7429-7434

Prospective Study of Changes in Anti-HCV Immunoglobulin G Antibody
Titers after Treatment with Direct Acting Antiviral Agents
Diaa Mohammad Eltebi, Islam Abdel-Mawla Ammar, Mohammad Abu Elsoud Mohammad
* Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo.

Corresponding author: Mohammad Abu Elsoud Mohammad, email:

worldwide, approximately 180 million people are living with CHC, which corresponds
to a global prevalence of 1.1% and millions more are newly infected each year. Annually, 700.000
people die from HCV-related complications, including cirrhosis and hepatocellular carcinoma (HCC).
Aim of the work: the present study investigated the dynamics of change in various HCV antibodies in
patients with CHC who achieved SVR after DAAs. Methodology: this was a prospective case-control
study that was conducted on 150 patients. They were categorized into three main groups:
Group I: included 100 patients with chronic HCV infection as diagnosed by SRT-PCR. They were
submitted to treatment with DAAs for 12 weeks.
Group II (positive control group): Included 25 patients who presented with CHC infection as
diagnosed by positive anti-HCV IgG antibodies and positive HCV SRT-PCR, but either refuse or
postpone HCV therapy or the treatment of HCV itself was contraindicated.
Group III (negative control group): included 25 patients, apparently healthy individuals who test
positive for anti-HCV IgG antibodies, but negative HCV SRT-PCR.
HCV IgG Ab titers was assessed by commercially available third-generation enzyme-linked
immunosorbent assay (ELISA) at base line, end of treatment and then at the 24th week (i.e. 12 weeks
after the end of treatment). Results: as regard HCVAb, it showed a significant statistical difference (p-
value < 0.001)
between titer results at baselin12th week and 24th week in patients group I; as HCV Ab
titers were 3.3 ± 0.2 mg/dl at baseline and declined to 2.7 ±0.2 at 12th week and 2.4± 0.3 at 24th week.
But, there was no statistical significant difference (p-value > 0.05) between HCV Ab titer results at
baseline, 12th week and 24th week in the studied positive control patients group II as HCV Ab titers
were 3.1 ± 0.2 at baseline, 3.2 ±0.2 at 12th week and (3.2± 0.1) at 24th week week. Also, there was no
statistical significant difference (p-value > 0.05) between HCV Ab titer results at baseline, 12th week
and24th week in studied negative control patients group III as HCV Ab titers were 1.22 ± 08 at baseline,
(1.23±0.08) at 12th week and 1.24± 0.07 at 24th week.
Conclusion: HCV antibody titer appeared to continue to decrease after eradication of HCV by DAAs
Keywords: CHC: chronic hepatitis c virus, DAAs ( Direct acting antiviral agents), HCC
(Hepatocellular carcinoma),HCV (Hepatitis C virus), SVR (sustained virological response), SRT PCR
(Serum real time polymerase chain reaction ) .

(HCV) is a major cause of liver related
prevalence was as high as 22% (3). Even higher
morbidity and mortality worldwide and
HCV infection rates, up to 60%, have been
represents a major public health problem (1).
reported in older individuals, in rural areas such
Worldwide, approximately 180 million people
as the Nile Delta and in lower social classes.
are living with chronic HCV, which
The prevalence of antibodies to HCV in Egypt
corresponds to a global prevalence of 1.1%, and
was 10-fold greater than in the United States
millions more are newly infected each year.
and Europe(4).The purpose of diagnosis of viral
Annually, 700 000 people die from HCV-
infection is to allow the infected persons to be
related complications, including cirrhosis and
identified and treated. Thus, diagnosis of viral
HCC (2).
infection is important to prevent disease

progression and viral spread. Majority of
Egypt has the highest prevalence of HCV
in the world (Predominantly genotype 4), which
asymptomatic; thus symptoms could not be
has been attributed to previous public health
used as specific indicators for HCV infection.
eradication schemes for schistosomiasis. The
HCV viremia could still exist despite a normal

Full Paper (vol.739 paper# 4)

c:\work\Jor\vol739_5 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7435-7443

Immunohistochemical Study of Epithelial Mesenchymal Transition Markers Slug
and E-Cadherin in Laryngeal Squamous Cell Carcinoma

Laila Abd El-Samea Moussa, Marwa Abd Al Moniem Al Kholy, Azza Kamal Taha

Department of Pathology, Faculty of Medicine, Al-Azhar University, Egypt

Corresponding author: Azza Kamal Taha, Email:

: laryngeal carcinoma is the most common head and neck cancer, with a high rate of metastasis and
poor prognosis. It has a global incidence of 3.2 cases per 100,000 and a death rate of 1.1 per 100,000 per annum.
Squamous cell carcinomas constitute more than 95% of primary cancer larynx. Despite of the recent advances in
the treatment modalities for laryngeal carcinoma, the survival rate of patients with this malignancy has not
improved significantly. Therefore, there is an urgent need to identify novel biomarkers for the prediction of
tumour progression and metastasis. Epithelial-mesenchymal transition (EMT) process promotes the aggressive
behaviour of cancer through downregulation of epithelial markers and upregulation of mesenchymal markers of
cancer cells in order to become motile and invasive. Several transcription factors are key regulators of EMT,
including the Snail/Slug family, Twist, ZEB1 and ZEB2.
Aim of the work: this study aimed to evaluate the immunohistochemical (IHC) expression of the transcription
factor Slug as an inducer of EMT and E-cadherin as an epithelial protein in 50 Egyptian cases of laryngeal
squamous cell carcinoma (LSCC) and investigation of the relationship between both markers and the
clinicopathologic parameters. Material and Method: the material of this study included 50 specimens of LSCC.
All specimens were embedded in paraffin and stained with Hematoxilin and Eosin (H & E) for histopathological
evaluation. Other Sections were immunostained with antibodies to Slug and E-Cadherin. The results were tabled,
statistically analyzed and discussed. Results: high tumor grade and high TNM stage were positively correlated
with Slug IHC expression (P-value= 0.02 and 0.001) but inversely correlated with E-cadherin IHC expression (p-
value= 0.006 and 0.03) respectively. Conclusion: LSCC patients with Slug IHC overexpression and reduced E-
cadherin IHC expression are at higher risk of metastatic carcinoma and might benefit from more aggressive
treatment after surgery.
Keywords: LSCC, EMT, Slug, E-cadherin.


Laryngeal cancer is the most common head and neck
metastasis occurred [5]. Approximately 90% of
cancer in the world with a high mortality rate and
cancer deaths are caused by metastasis, yet it
poor prognosis [1]. More than 95% of all malignant
remains the most poorly understood component of
tumors in the larynx are squamous cell carcinoma [2].
cancer pathogenesis because of its complexity.
It accounts for 5.7% to 7.6% of systemic malignant
Emerging evidence suggests that epithelial-
cancers. The morbidity of laryngeal cancer has
mesenchymal transition (EMT), which is an
increased significantly in recent years. Although
essential phenotypic conversion during embryonic
major progress has been achieved in the treatment of
development, tissue remodeling, and wound healing,
laryngeal cancer, the long-term survival rate of
plays an important role in cancer metastasis. During
patients with laryngeal cancer still not increased
EMT, epithelial cells acquire fibroblast-like
significantly. [3] There are currently no markers for
properties, exhibit reduced intercellular adhesion and
assessing prognosis or tumor behavior in LSCC.
show increased motility. Several transcription
Therefore, it is worthwhile to investigate biomarkers
factors are key regulators of EMT, including the
for understanding tumor behavior and for guidance
Snail/Slug family, Twist, ZEB1 and ZEB2 [6].Slug,
to optimal treatment [1].Invasion and metastasis are
also known as Snail2, is one of the key transcription
the main factors affecting a patient's overall survival
factors that activate EMT process in cancer
and quality of life [4]. Once occurring the lymph node
progression. It contributes to repression of the
metastasis, the 5-year survival rate of laryngeal
epithelial phonotype by binding to E-box DNA
cancer patients may be less than 50%, and the 5-year
sequences in the proximal promoter region of the E-
survival rate may be less than 20% when distant
cadherin gene. This role as a strong E-cadherin

Full Paper (vol.739 paper# 5)

c:\work\Jor\vol739_6 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7444-7447
Prevalence of Asymptomatic Bacteriuria in Patients with Preterm Labor
Hossam Aldin Hussein Kamel, Mostafa Hussein Mohammed Hegab,
Ahmad Al-saeed Al-sehrawey, Hassan Mohammed Hassan
Department of Obstetrics and Gyencology, Faculty of Medicnie ­ Al-Azhar University

asymptomatic bacteriuria (ASB) during pregnancy is the primary cause of acute pyelonephritis,
preterm labor, low birth weight fetus, etc., if left untreated. Adequate and early treatment reduces the prevalence of
these obstetric complications.
this study aimed to determine the prevalence of ASB during pregnancy and determine the association
between asymptomatic bacteriuria and spontaneous preterm birth.
Patients Methods:
this was a case control study of 120 preterm pregnancies and 40 term pregnancies among those
attending El-Galaa Teaching Hospital, Obstetric Emergency Unit to evaluate the incidence of ASB and determine
the association between asymptomatic bacteriuria and spontaneous preterm birth from March 2016 to
March2017.Urine analysis and culture with antibiotic sensitivity were performed .
Results: out of the 160 patients studied, ASB was observed in 7 patients (6 cases in preterm group (5%) and 1 case
in full term group (2.5%) with no significant difference between the two groups (p-value 0.05), the incidence of
ASB in preterm labor was quite lower 5%. E. coli was the most common pathogen (55.14%) followed by proteus
28.57 followed by klebsiella (14.28%).
: all pregnant women should be screened by urine culture to detect asymptomatic bacteriuria at their first
visit to prevent overt urinary tract infections (UTI) and other complications in both mother and fetus.
preterm labor, urinary tract infections, asymptomatic bacteriuria


occurs commonly in pregnancy, typically during early
Asymptomatic bacteriuria in pregnancy is defined
pregnancy.Without treatment, as many as 30 to 40
as the presence of

1,00,000 organisms per milliliter (ml) of urine
percent of pregnant women with asymptomatic
taken from a clean catch mid-stream urine specimen
bacteriuria will develop symptomatic urinary tract
with no symptoms referable to the genito-urinary tract
infection (UTI). The smooth muscle relaxation and
However ASB often is the primary cause of
subsequent ureteral dilatation that occurs in pregnancy
complications such as pyelonephritis, preterm labor,
are thought to facilitate the ascent of bacteria from the
low birth weight fetus, maternal Sepsis , anemia and
bladder to the kidney, accounting for the greater risk
prenatal death [1].
of pyelonephritis. Additionally, untreated bacteriuria
Treatment of ASB has been shown to reduce the
may be associated with an increased risk of preterm
rate of pyelonephritis in later part of pregnancy and
birth, low birth weight, and perinatal mortality [6].
therefore regular screening for and appropriate

treatment of ABU has become a standard of obstetrical
care [2].
This was a case control study in 120 preterm
Urinary Tract Infections (UTI) is the microbial
pregnancies and 40 term pregnancies among those
invasion and subsequent multiplication on part or
attending El-Galaa Teaching Hospital, Obstetric
entire urinary tract[3].
Emergency Unit to evaluate the incidence of ASB
Pregnancy causes numerous changes in the
from March 2016 to March2017.
physiology of a woman's system. Various anatomic
- Urine samples were collected employing the clean-
and physiological changes which include dilatation of
catch, mid-streamtechnique after aproper local
the renal pelvis and ureters in as early as the eighth
hygiene procedure.
week of pregnancy[4] and displacement of the bladder
- Samples were transported to the laboratory and
itself superiorly and anteriorly are responsible for
processed within ONE hour of collection.
- All urine samples were subjected to the standard
Also, smooth muscle relaxation induced by
complete urine analysis procedure.
progesterone may also play a role. As a consequence

of smooth muscle relaxation peristalsis of the ureters
- While, physical examination was carried out on the
are decreased, bladder capacity is increased which in
whole sample, after centrifugation the supernatant
turn lead to urinary stasis [5]. Henceforth, screening
portion was subjected to chemical testing and the
and treatment of ASB prerequisite to be incorporated
sediment part was re suspended and examined
as routine antenatal care for an integrated approach to
safe motherhood and newborn health. Bacteriuria

Full Paper (vol.739 paper# 6)

Introduction The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7448-7453

Evaluation of Diagnostic Cerebral Angiography at Al-Hussein
Neuro-Intervention Unit
Sayed Ahmed Fathy El-Zayat1, Mohamed Fouad Abd El-Moaty2,
Khaled Mohamed Sobh1, Hamada Abd-Eltwab Salama Mohamed1*
Departments of Neurology1 and Radiology2, Faculty of Medicine, Al-Azhar University
*Corresponding author: Hamada Abd-Eltwab Salama Mohamed, E-mail:

digital subtraction angiography (DSA) is important diagnostic tool for evaluation of cerebral
vasculature and provides essential information regarding hemodynamic status and collateral circulation in patients
with stroke and vascular malformations, so it is ideal imaging method of choice for diagnosis of cerebrovascular
Aim of the Work: to register all cases undergoing diagnostic cerebral angiography in Al-Hussein University
hospital, neuro-intervention unit performed by a neuro-interventional team and evaluate the results, and outcome of
this procedure.
Materials and Methods: the present study is single-center study included all patients subjected to diagnostic
cerebral angiography during period from 2006 to 2018. The study protocol was approved by the local Ethics
Committee in Al-Azhar University. The patients had been recruited from Al-Hussein and Sayed Galal Hospital
outpatient's clinics, internal departments and stroke units, which indicated for diagnostic cerebral angiography.
Results: in the present study the mean age of patients with arterial stenosis was (55.47 ±8.80), 1049(51%) of them
were males, 1009(49%) were females. In our study, mild stenosis was present in 254 (12.3%), moderate stenosis in
525 (25.5%), severe stenosis in 567 (27.6 %), subtotal occlusion in 315 (15.3%) and total occlusion in 397 (19.3%)
of the patients which detected by DSA.
Conclusion: arterial stenosis is more common than cerebral aneurysms and AVM in the patients who subjected to
DSA. The presence of hypertension and diabetes mellitus were found to be significantly more prevalent among
patients with arterial stenosis. However, the prevalence of hypertension and smoking were more prevalent in
cerebral aneurysms.
Keywords: Diagnostic Cerebral Angiography, Doppler ultrasonography.


Digital subtraction angiography (DSA) is
provides information about collateral circulation
important diagnostic tool for the evaluation of
and perfusion (4).
cerebral vasculatures and provides essential
In addition catheter angiography is
information regarding hemodynamic status and
frequently reserved for cases in which noninvasive
collateral circulation in patients with stroke. It is an
imaging results are not diagnostic or consistent (5).
ideal imaging method of choice for diagnosis of
DSA has been preferred follow up imaging
cerebrovascular disorders (1).
modality for detecting in-stent re-stenosis after
DSA is important in spontaneous
intracranial stenting (6).
intracranial haemorrhage if surgery is indicated,
Although, less invasive techniques for
and to find the aetiology of the bleeding,
follow up investigations would be described
(particularly in patient at high risk for instent
arteriovenous malformation (AVM) are present, in
restenosis), non invasive imaging as TCD, CTA,
which surgical or endovascular intervention
MRA is potentially affected by artifact and
significantly reduce the re-bleeding risk (2).
hemodynamic changes (6). DSA has a risk of peri
Noninvasive imaging such as Doppler
and post procedural complications (e.g., embolism,
ultrasonography CTA and MRA, have gained
dissection, retroperitoneal hematoma, allergic
increasing importance in the diagnosis of
reaction to contrast medium, nephropathy),
particularly in older patient with polyvascular
circumstances, the accuracy of noninvasive
atherosclerosis, resulting in a morbidity and
angiographic data may be sufficient to supplement
mortality from 1 to 4 % (7).
catheter angiography (3).

However, DSA remains the gold standard
for evaluating the cerebral vessels with regard to
To register all cases undergoing diagnostic
determining the degree of arterial stenosis and the
cerebral angiography in Al-Hussein University
presence of dissection, vasculopathy, vasculitis or
hospital, neuro-intervention unit performed by a
occult lesion such as vascular malformation and
neuro-interventional team and evaluate the results,

and outcome of this procedure.

Full Paper (vol.739 paper# 7)

c:\work\Jor\vol739_8 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7454-7457

Incidence of Miss Targeting in Frame-based Stereotactic Brain Surgery
Mohamed Hasan Mansour
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University
Corresponding author: Mohamed Hasan Mansour, email:

accurate localization of a lesion is the ultimate goal of stereotactic surgery. Frame-based systems
have the advantage of proven clinical utility and instrument carriage with a high degree of mechanical stability
and accuracy. Aim of the work: this study aimed to investigate the incidence of miss targeting in frame based
stereotactic brain surgery. Patient and methods: this was a retrospective study and included non-comparative,
consecutive case series of 200 cases of different intracranial lesions, using CT imaged Leksell G stereotactic brain
surgery, for diagnostic 180 cases or therapeutic 20 cases purposes and they performed at Sayed Galal University
Hospital and other neurosurgical centers at Egypt between Jan 2015 and Jan 2018.
Results: there were 120 males and 80 females. The procedures were performed under local anesthesia. Diagnostic
purposes were the most encountered procedures for 180 cases, while therapeutic were 20 cases. The incidence of
miss targeting was 2% of the studied group, which was noticed among the diagnostic group (2/180 = 0.011%)
more than the therapeutic group (2/20=10%). Conclusion: the incidence of miss targeting in frame based
stereotactic brain surgery is a concern and must be suspected.
Recommendations: stereotactic surgical team must evaluate every surgery steps very carefully.
Key words: stereotactic surgery, frame based surgery, miss targeting, sliding phenomena.


In clinical practice, brain imaging can now be
of inaccuracy( some due to human factors and others
divided in two parts: the diagnostic neuroradiology
are due to tissue factors or instrument factor).
and the preoperative stereotactic localization
The aim of the study: the purpose of this study was
procedure. The latter is a part of the therapeutic
to investigate the incidence of Miss targeting in
procedure. It is the surgeon's responsibility and
frame based stereotactic brain surgery.
should be closely integrated with the operation (1).
Methods and patients : this was a retrospective
The purpose of incorporating stereotactic
study and included a retrospective, non-comparative,
methodology into neurosurgical operations is to
consecutive case series of 200 cases of different
achieve a consistently high degree of accuracy in
intracranial lesions , using CT imaged Leksell G
localizing intracranial targets (2). Stereotactic surgery
stereotactic brain surgery , for diagnostic 180 cases
is currently undergoing great changes with a large
or therapeutic 20 cases purposes performed at Sayed
number of frameless methodologies being developed
Galal University Hospital and other neurosurgeical
alongside traditional frame-based systems (3). Frame-
centers at Egypt between Jan 2015 and Jan 2018.
based systems have the advantage of proven clinical
Results: A total of 200 patients who underwent a
utility and instrument carriage with a high degree of
frame-based stereotactic surgery using the Leksell G
mechanical stability and accuracy (3). It is concluded
frame system were operated. The mean ± standard
that conventional frame-based stereotaxic has higher
deviation of age at time of the procedure was 39.4
accuracy/precision for hitting a small brain target
years ± 20.3 years and range from 12-72 years. There
than the frameless technique. However, the
were 120 males and 80 females. The procedures
difference is relatively small (4). In this study: I am
were performed under local anesthesia to avoid
recording major miss targeting not just small errors
complications of general anesthesia; diagnostic

purposes were the most encountered procedures for

180cases, while therapeutic were 20 cases.

Aim of the procedure
Miss targeting
Diagnostic - 180 cases
2 ( one is surgeon's miscalculation and the other is lesion displacement) =
2/180 = 0.011% of diagnostic due to human factor and the
other due to pathology instrument that the true miss
targeting is one.
Therapeutic- 20 cases
2(one surgeon overpassing and the other pathology instrument relationship
flexible= stylet displacement by the thick capsule of the lesion) = 2/20
=10% of therapeutic group. So that the true miss targeting is one.
Total number of cases were 200 4/200= 2% of the total number of cases

2/200= 1% of the total after exclusion cases of malpractice.

Full Paper (vol.739 paper# 8)

c:\work\Jor\vol739_9 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7458-7468

Evaluation of Safety and Efficacy of Radiofrequency Lesioning of Thoracic
Dorsal Root Ganglion in Chest Cancer Pain Patients
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,

since cancer-associated pain is a common occurrence in malignancies involving the chest. In these
cases, pain is complex and may have visceral, somatic or neuropathic components. It has been noticed that the
number of cancer patients with refractory chest pain is increasing with more cancer prevalence, also with the
advances in therapy and prolonged life expectancy. The demand for interventional procedures to control pain for
these patients also increases. Interventional pain procedures are indicated for refractory pain when analgesic drugs
are ineffective or associated with intolerable side effects. In controlling cancer pain it is commonly inadequately
managed for these patients leading to suffer form of physical disabilities, psychological disturbance and avoiding
treatment. Aim of the work: this study was designed 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.
Methodology: this prospective randomized study was conducted in the National Cancer Institute, Cairo
University and Aswan University after board approval from October 2016 to March 2018. Sixty-five patients with
Refractory Chronic Chest Cancer Pain were selected randomly and prospectively from the pain clinic of both the
National Cancer Institute of Cairo University and Aswan University, after taken an informed written consent from
the patient. 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. 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.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. It also requires a
minimal hospital stay or can even be performed on an outpatient basis.
Keywords: Radiofrequency, Thoracic dorsal root, Chest cancer pain.


anorexia, insomnia, prolonged fatigue, reduced
The prevalence of pain in cancer patients in
cognition and an overall reduction in their vital
recent reviews reported to be 51% regardless the type
capacity. Cancer patients with unrelieved pain tend
and stage of cancer (1).Cancer associated pain
to withdraw themselves from both social and family
commonly occurs in malignancies involving the
interactions, which lead to isolation and
chest. It has been noted that about 5% of patients of
pain clinics are of thoracic pain sufferers (2).Thoracic
advances allowed an increase in the survival rate of
pain may arise from a variety of structures such as
cancer patients; therefore making lung cancer a
the thoracic spine, referred from chest or upper
chronic condition (7). With the increase in cancer
abdomen, thoracic pain syndromes, or iatrogenic
prevalence, plus the increase in number of cancer
chronic chest pain following thoracic surgical
patients with refractory chest pain and also
procedures (3). Chest wall pain is a severe and
prolonged life expectancy there is a demand for
disabling symptom; over half of lung cancer patients
interventional procedures to control their pain (5).
are suffering from chest pain at diagnosis (4).Chest
Interventional pain procedures are indicated
pain in cancer patients can be multifactorial, making
for refractory pain when analgesic drugs become
it complex; visceral, nociceptive, neuropathic or
ineffective or are associated with intolerable side-
somatic. Thoracic pain of chronic nature may be
effects. These interventions vary from simple
intercostal nerve blockade up to percutanous cervical
radiotherapy, physiotherapy, occupational therapy or
cordotomy (PCC) and rhizotomy (5).Radiofrequency
interventional therapy (5).Untreated cancer pain is
ablation is of use due to its efficacy, safety and ease
associated with both physical and psychological
of use. It also requires only minimal hospital stay or
problems which cause suffering. Patients with
can be even done as an outpatient procedure (8).
uncontrolled pain have physical symptoms such as:
Aim of the Study:

Full Paper (vol.739 paper# 9)

c:\work\Jor\vol739_10 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7469-7474

Surgical Release of Trigger Thumb in Pediatrics
Mohamed S. Abdelhafiz, Amro A. Fouaad, Mostafa M. Abdelatif*
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mostafa M. Abdelatif; Mobile: 01004781515; Email:

trigger thumbs in children predominantly present with flexion deformity and a nodule at the MCP joint.
Surgical release with a transverse incision and splitting of the A1 pulley achieves good cosmoses and attains a
satisfactory range of motion with minimal complications.
Aim of the Work: to analyze the results of treatment of congenital trigger thumb by open surgical release.
Patients and Methods: this study was carried out on 12 patients with congenital trigger thumb treated by surgical
release of A1 pulley after obtaining the hospital's Research Ethics Committee approval and written informed consents
from the patients.
Results: twelve patients were followed up for a mean of 10 (range 4­16) weeks, by which time they were all free of
pain and had normal strength subjectively. Of the 12 patients evaluated postoperatively, all were able to fully extend
the interphalangeal joint of the involved thumb. Conclusion: Surgical management is the most common treatment,
and this is done effectively and safely in the hands of experienced surgeons with pediatric anesthesiologists.
Keywords: trigger thumb, surgical release, children.


Trigger finger is relatively a common problem

among hand disorders. The primary pathology is the
characteristics of flexion attitude of thumb. This
discordance between the diameter of the flexor tendons
flexion posturing is normal until the age of 3 months
of the finger and the fibro-osseous canals in which
when the child begins to hold the thumb out of the
those tendons lie, which will lead to limitation of the
palm. The frequent omission of routine thumb
tendon function necessary for hand movement. When
examination in the neonates may delay the detection of
the finger is flexed, catching or locking occurs. Left
this deformity (4).
untreated, this may cause flexion contracture of the
The differential diagnosis of congenital trigger
proximal interphalangeal joints (1).
thumb in childhood may include congenital clasped
Trigger thumb of childhood is known as a
thumb, spastic thumb in palm, arthrogryposis, and
pathology of the flexor tendon system.The pathology
other clutched thumb abnormalities (5).
presenting in childhood is referred to as a congenital

Despite its frequent occurrence, there still
entity by numerous authors. While the thumb seems
remains controversy over the optimal method of
normal, the interphalangeal (IP) joint is held in
treatment (4). Most authors recommend open or
fixedflexion. A nodule at the base of the
percutaneous surgery to release the A1 pulley (5).
metacarpophalangeal (MCP) joint, known as Notta's
Trigger thumb release is quick, relatively easy to
node, can be palpated. The incidence is reported as less
perform, and reliable (6).
than 0.3% in childhood (1).
There are various conservative and surgical
Etiology is not clear. The pathology can be
methods for the treatment of trigger finger. Steroid and
detected soon after birth or in childhood. Bilateral
local anesthetic injection, and splint application are
involvement is reportedbetween 25% to 50%.
recommended in the acute stage.
Treatment can be either conservative or surgical (2).
In case of failure of the conservative approach,
The incidence of trigger thumb in children is 1-
or in chronic cases, surgical intervention is required.
3:3000. It is ten times more common than trigger
Nonetheless, percutaneous surgery is currently being
finger. The "Notta nodule", first described by Notta(2)
used as an alternative method, currently being used as
in 1850, can be present on the volar aspect of the
an alternative method. This study aims to evaluate the
metacarpophalangeal joint.
advantages of open surgery for trigger finger in
Triggering, snapping, or pain is not common
pediatric cases (7).
during childhood. Fixed-flexion deformities and Notta

nodules are reported as the most frequent symptoms in
pediatric cases. Therefore, various reports have stated
Aim of the work is to analyse the results of
that fixed-flexion deformity is a rule for trigger thumb
treatment of congenital trigger thumb by open surgical
in childhood (3).
The diagnosis of congenital trigger thumb in a

newborn infant may be delayed because of the

Full Paper (vol.739 paper# 10)

Radiofrequency management of trigeminal neuralgia The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7475-7480

Radiofrequency Management of Trigeminal Neuralgia
El sayed almor, Maamoun Abo Shosha, Mohammed Hassan,
Mohamed Ellabbad Alaa Rashad, Mostafa Elmaghraby, Moustafa Ramzy
Department of Neurosurgery, Al-Azhar University
Corresponding author: Moustafa Ramzy, Mobile: 01068898655, Email:


Background: Trigeminal neuralgia (TN) is a unique disease. The first line of management in TN is medical treatment
using antiepileptic drugs, when drugs failed to control the pain or when there is intolerability to them, surgical
interventions are then indicated. Percutaneous Trigeminal rhizotomy (PTR) is recommended for elderly patients with
higher operative risk factors. Objective: The aim of this work is to review the literature regarding the pathology, methods
of investigations, operative techniques, complications of management of trigeminal neuralgia and eventually prognosis,
also evaluation of the effectiveness of the radiofrequency percutaneous radiofrequency rhizotomy - for management of
trigeminal neuralgia. Patients and Methods: This study included a total of 15 patients with trigeminal neuralgia presented
predominantly in females. Female: male 1.7:1 and the mean age was 53 years. They were admitted and managed at the
Neurosurgical Department of at Al-Azhar University Hospitals and other private centers between June 2017 and October
2018. Clinical follow-up was obtained in 15 (100%) patients. Results: follow up revealed that 11 patient (73.4 %) had
favorable outcome and 4 patient (26.6%) had unfavorable outcome. The mean preoperative visual analogue scale(VAS)
was 7.83 (range 7-10). It dropped immediately postoperative to 2.33 (range 1- 4).), intraoperative complication was noted
in 3 cases (18%).Conclusion: Radiofrequency rhizotomy is the procedure of choice for most patients undergoing first
surgical treatments and patients at high risk from general anesthesia (although not necessarily the elderly).
: Trigeminal neuralgia, radiofrequency, percutaneous trigeminal rhizotomy.


Trigeminal Neuralgia (TN): is defined as
neuropathic pain syndrome characterized by sudden and
management of cases of trigeminal neuralgia as regard
usually unilateral severe brief stabbing recurrent pain in
the distribution of one or more branches of the fifth
radiofrequency rhizotomy is considered a minimally
cranial nerve. It is an excruciating, short-lasting (<2
invasive procedures and performed as outpatient
minutes), unilateral facial pain that may be spontaneous
surgery with minimal anesthetic risk. In the 11th
or triggered by gentle, innocuous stimuli and separated
century an Arab physician, Jurjani, described a type of
by pain free intervals of varying durations (1). The
facial pain believed to be TN.
patient usually describes it as the worst pain in his
This entity was "a type of pain which affects the teeth
life(2). It is a very peculiar disease, which is also known
on one side and the whole of the jaw on the side which
as "tic douloureux". It is limited to the facial
is painful. The first clear description of TN was
distribution of the trigeminal nerve and precipitated by
provided in 1671. The patient was a well-known
stimuli to sensory endings in the trigeminal receptive
physician, Johannes Laurentis Bausch of Germany
area. The pathophysiology is unclear. Based on clinical
(1605­1665), founder and first president of the Imperial
observations, compression of the trigeminal nerve near
Leopoldian Academy of Natural Sciences, who suffered
the origin from the brain stem (root entry zone) by
from severe TN for 4 years. The pain prevented him
blood vessels or tumor, may cause trigeminal neuralgia.
from eating any solid food and he was almost unable to
Local pressure causes demyelination that leads to
speak. Emaciation gradually occurred and led to death
abnormal depolarization resulting in ectopic impulses(3).
from a stroke in 1665.Bausch's illness was detailed in
In the latest classification of the International
his eulogy published in the Academy volume covering
Headache Society, 2 main types were defined:
the year 1671 (6). The well-known philosopher and

physician John Locke (1632­1704) provided the first
full description of TN and its treatment performed by a
Primary: or idiopathic including those with
physician. While in Paris in 1677, Locke was called to
potential vascular compression of the trigeminal nerve
see the wife of the English Ambassador, the countess of
Secondary: which may be due to intrinsic
Northumberland, who was suffering an excruciating
brainstem pathology e.g. multiple sclerosis or lacunar
pain in the face and lower jaw. Two teeth had been
infarction) extrinsic cerebellopontine angle pathology
removed without relief. Locke has applied sulphuric
(e.g., neoplasms or vascular lesions) (4).
acid to the face of the Duchess of Northumberland in an
Since the first scientific publication on TN a
attempt to treat her facial pain. In letters to his friend
variety of treatments have been advocated and practiced
Mapletoft, he described her suffering in detail and
by surgeons throughout the world. Some controversy
outlined his treatment, which included a thorough
still exists regarding which surgical modality is the one
purging of the lady (7). In the 1930s, while performing
of choice (5(.In this study, we evaluated the
partial sectioning of the trigeminal root for typical TN

Full Paper (vol.739 paper# 11)

c:\work\Jor\vol739_12 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7481-7491

Monitor of Water Quality Using The Grey Mullet (Mugil Cephalus) as
Bioindicator in Two Egyptian Lakes
1Eman, G.E. Helal, 2Abd El-Atti, M. S., 3Shaymaa Hussein and 4Yasmina, M. Ekraim
1&4 Zoology Department, Faculty of science (Girls), Al-Azhar University, Cairo, Egypt.
2 Zoology Department, Faculty of Science, Zagazig University, Egypt.
3 Department of Cytology and Histology, Fac. Vet. Med. Cairo University, Egypt.
Corresponding author: Eman Helal, email: , Mobile:00201001025364,

Background-Burullus Lake has brackish water and agricultural, industrial and sewage drainage water represent the
major inflows and it represents one of the most subjected lakes to serious pollutants at the delta's coastline. Mugil
is one of the most important food fish species for the Egyptian people. This study was conducted to explain
the effect of water pollution of both Qarun and Burullus Lakes on some biochemical and histological characteristics
of mullet collected from both Lakes. Our results showed that water collected from Burullus Lake has higher levels of
lead and cadmium than Qarun Lake. The liver function analysis showed that there were no significant differences
between levels of GGT in M. cephalus livers collected from both Lakes. ALT and AST were significantly increased in
livers of fishes collected from Qarun Lake than Burullus Lake, cholesterol, triglycerides, RF1, RF2, high density
lipoproteins (HDL), low density lipoproteins (LDL) and very low density lipoproteins (VLDL) in muscles of the
mullet collected from Burullus Lake were highly significant increase, while total proteins were significantly decreased
in comparison with mullet of Qarun Lake. Histopathological investigations revealed that livers of mullet cached from
both Lakes were suffered from marked area of hemorrhage, aggregates of hemosiderin granules and vacuolated
hepatocytes. Ultrastructural observation showed degenerated and swelled cylindrical mitochondria in liver obtained
from Burullus Lake with accumulation of lipid droplets and degenerated cytoplasmic organoids. Hepatocyte from
Qarun Lake showed apoptotic nuclei, degenerated, swelled and cylindrical mitochondria, lipid droplets and dilated
rough endoplasmic reticulum. Von Kupffer cells in liver of both lakes contained abundant lysosomes with corrugated
walls and numerous cytoplasmic vacuoles. The kidney sections of mullet of both Lakes showed necrosis in the tubular
epithelial lining with scattered apoptotic cells and interstitial inflammatory infiltrate.
Keywords: Bioindicator, Monitor, Mugil cephalus, Water quality, Histology, Transmission Electron Microscope,
Hepatocytes, Kidney.

predominant source for metal accumulation in some
Qarun Lake has an average area of about 226 km2; the
aquatic organisms (5). High concentrations of heavy
lake is shallow, with average depth of 4 m and
metals have potential genotoxic effects and
receives annually about 470 million cubic meters of
genotoxicty is possibly related to agricultural and
drainage water (Agricultural and sewage) through 12
domestic activities (6). A long-lasting exposure to lead
drains (1). Burullus Lake is a brackish water Lake in the
and cadmium may cause changes in the immune
Nile Delta in Egypt and located in Kafr El-Sheikh
response (7). Pb targets the proximal tubules of the
Governorate. Burullus Lake is the second largest Lake
kidneys and is capable of inducing nephrotoxicity (8).
along the Mediterranean Sea and represents one of the
There has been a widespread world-wide use of
most subjected Lakes to pollution at the delta's
flathead mullet, Mugil cephalus, in fish biomonitor
coastline. This Lake serves as reservoirs for drainage
studies within the coastal zone (9). At present, the
waters contaminated with anthropogenic materials (2).
direct immunotoxicity of heavy metals is the subject of
Heavy metals are a serious hazard for aquatic
extensive studies. The grey mullet normally feed on
ecosystems and human health and they negatively
algae in fresh water and can acclimate to different
affect aquatic life functioning through accumulation
levels of salinity (10). The genotoxic effects of metal
resulting physiological/growth disturbances in aquatic
pollution in Oreochromis niloticus and Mugil cephalus
life forms (3). Heavy metals are commonly found in
in Lake Qarun were studied and the results showed
natural waters and may become highly toxic when
that high concentrations of heavy metals had a
present in high concentrations (4). Aquatic organisms
potential genotoxic effects and genotoxicty was related
take up metals from water and their diet. A study
to agricultural and domestic activities (11).This research
suggested that dietary metal exposure is the
was carried out to measure levels of Cd and Pb in the

Full Paper (vol.739 paper# 12)

c:\work\Jor\vol739_13 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7492-7497

Knowledge and Beliefs of Early Childhood Caries and Late Night
Bottle Feeding among Mothers in Saudi Arabia
Abdulrahman Sulaiman Aldakhili, Anas Abdulrahman Alsoqeer, Abdulrahman Khaled Alothaim,
Abdulaziz Sulaiman Alkhodair, Saleh Musaad Alsaykhan
Dentist, Faculty of Dentistry, Al-Qassim University, Al-Qassim , Saudi Arabia

Early Childhood Caries is a public health problem that continues to affect babies and preschool children
worldwide. A comprehensive review of the epidemiology of ECC showed that its prevalence varies from population
to population, however, disadvantaged children, regardless of race, ethnicity or culture, are most vulnerable.It is
considered one of the most prevalent diseases in childhood, affecting 60% to 90% of children globally.It is considered
one of the most prevalent diseases in childhood, affecting 60% to 90% of children globally. ECC is still highly
prevalent among children in communities in both developing and developed countries.
Aim of the work:
To assess and evaluate Saudi mothers' knowledge and believes of early childhood caries.
Methods:Descriptivecross sectional studywas conducted during the period between 1st of November 2017 to the 4th
of January 2018among Saudi mothers. Datawere collected through an online questionnaire distributed to all regions
of Saudi Arabia. Results: Among the 1477 Saudis' mothers, the majority of participants were from the Middle region
1178 (79.8%).Less than half of mothers 637 (43.1%) have 1-3 children, 434 (29.4%) of them have 4-5 children, 348
(23.5%) have more than 5 children, and only 59 (4%) have no children.Nearly three fourths 1117 (75.6%) of the
mothers thought deciduous teeth are important and 654 (44.2%) think bottle feeding of children at late night is not
harmful to child's teeth. Conclusion: Better knowledge of the cause of early childhood caries and effective strategies
to reduce its risk should produce enormous reductions in initial and long-term dental treatment costs
Knowledge, Dental, Caries, Childhood.


Dental caries is the most common chronic oral
feeding behavior during sleep intensifies the risk of
disease worldwide, affecting 2.4 billion people.On
caries, as oral clearance and salivary flow rate are
average, 2.11 billion people have decayed, missing, or
decreased during sleep. In addition, caries-promoting
filled teeth worldwide. Untreated dental caries affects
feeding behaviors result in an increase in the magnitude
the quality of social, psychological and economical life
of dental reservoirs of S. mutans (8).
of people (1). Dental caries is not always painful, it is
The condition, when associated with the bottle
expensive to treat, and it can affect nutrition and overall
habit, has been characterized as first affecting the
health negatively (2). Earlychildhood caries (ECC) is the
primary maxillary anterior teeth, followed by
term used to describe the presence of decayed, missing
involvement of the primary molars. Mandibular incisors
or restored teeth in the primary dentition of children
generally are not affected, reportedly due to the child's
younger than six years old (3). ECC is a public health
tongue in the suckling position protecting these teeth
problem that continues to affect babies and preschool
from the cariogenic challenge(4, 9). Prolonged and night-
children worldwide.
time bottle-feeding practices in infants and toddlers
A comprehensive review of the epidemiology of
generally are thought to provide the carbohydrate source
ECC showed that its prevalence varies from population
that promotes high acid production by mutans
to population; however, disadvantaged children,
streptococci. Yet evidence suggests that blaming
regardless of race, ethnicity or culture, are most
sleeping with a bottle of milk may over simplify the
vulnerable (4).Although fluoridated toothpaste and the
cause of rampant caries(10).
continued use of fluoride in various forms are effective
Treatment of ECC is expensive, often requiring
in caries prevention (5,6), ECC is still highly prevalent
extensive restorative treatment and extraction of teeth
among children in communities in both developing and
atan early age. Estimates of the cost of restoring the teeth
developed countries (7). It is known that ignorance of
alone may exceed $1,000 per child(11). Accordingly, our
ECC and malpractice of breastfeeding may lead to
aim in this study is toassess and evaluate Saudi mothers'
laziness, obesity and unhealthy child's health(7).In many
knowledge and believes of early childhood caries.
cases, ECC is thought to be initiated and exacerbated by

inappropriate feeding with a nursing bottle.
The use of nursing bottles and "Sippy cups"
We conducted a descriptive cross sectional study
enhances the frequency of exposure. This type of
among 1477 Saudi mothers. The study conducted

Full Paper (vol.739 paper# 13)

Introduction The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7498-7506

Magnetic Resonance Cholangiopancreatography versus Endosonography in
Diagnosing Biliary Ducts Obstruction
El-Sayed Gaber Abd-Elhamid Ammar1, Gamal Mohammad Mohammad Soliman1,
Mokhtar Ragab Ramadan2, Mahmoud Ismail Bastawy3, Mahmoud Mohammad Ghoname1*
1-Tropical Medicine Department, 2-Radiology Department, 3-Clinical Pathology Department,
Faculty of Medicine-Al Azhar University.
*Corresponding Author: Mahmoud Mohammad Ghoname, Tel: +201003802445,

biliary obstruction or cholestasis is a common medical or surgical problem. Broadly speaking, the
causes can be divided into intrahepatic and extrahepatic. The diagnosis of biliary tree can be done by different
imaging modalities starting from transabdominal ultrasonography, to magnetic resonance cholangeopancreatograpy
(MRCP) to endoscopic ultrasonography (EUS) and endoscopic cholangeopancreatography (ERCP) for diagnosis
and treatment. Aim of the present work: this study aimed to evaluate the accuracy of these different modalities
when compared to ERCP as diagnostic methods for diagnosis of different biliary tree abnormalities.
Patients and methods: eighty-four patients with obstructive jaundice were included and categorized into two
groups group I: 56 patients with calcular obstructive jaundice, group II: 28 patients with non-calcular obstruction.
Patients underwent history taking, clinical examination and routine laboratory investigations as well as tumor
markers. Patients were examined by US, MRCP, EUS, ERCP and the findings of each modality were compared to
ERCP. Results: the sensitivity and specificity of US in diagnosis of intrahepatic biliary dilatation (IHBRD) and
common bile duct (CBD) dilatation were 81% , 100% and 33% and 100% for diagnosis of pancreatic tumors
respectively. The sensitivity and specificity of MRCP in diagnosis of IHBRD was 97% and 100% successively and
for CBD dilatation 79% and 100% successively and for diagnosis of pancreatic tumors 100% and 96% successively.
The sensitivity and specificity of EUS in diagnosis of IHBRD were 100% and 100% successively and for CBD
dilatation were 100% and 100% successively but in diagnosis of pancreatic tumors were 100% and 94%
Conclusion: Both MRCP and EUS were good diagnostic modalities for biliary obstruction and pancreatic tumors
with sensitivity and specificity of >90% when compared to ERCP.
Keywords: biliary obstruction, jaundice, MRCP, ERCP, EUS


and less expensive than other imaging studies.
Jaundice is yellowish discoloration of skin and
Disadvantages include dependence on the skill of the
mucous membranes due elevation of serum bilirubin.
operator for the procedure and potential technical
One of the causes of jaundice is obstruction of the
difficulty in obese patients or patients with excessive
lumen of the biliary tree which is the way of excretion
bowel gas that overlies some organs like the
of bilirubin after conjugation either due to something
pancreas(4). MRCP techniques have greatly evolved
and providing high radiology. Section resolution
(choledocolithiasis), parasites like fasciola or tumors
images of the biliary tree with short exam duration.
fungating inside the lumen (cholangiocarcinoma)(1).
The major disadvantages of MRCP compared with
The obstruction of the biliary tree can be caused also
ERCP are lower resolution, unit availability, lack of
by something in the wall of the biliary vessels like
any immediate therapy for duct obstruction,
strictures due to injuries or accidental ligation during
claustrophobia, and the inability to evaluate patients
cholecystectomy, malignancy invading the wall or
with pacemakers or ferromagnetic implants & It is
congenital anomalies of the biliary tree (2).The
more expensive than US or CT(5) .
obstruction can also be due to some mass
EUS can detect obstruction of the bile duct and
compressing the ducts from outside like pancreatic
major intrahepatic bile ducts. EUS has the potential
tumors, portahepatis lymph nodes, duodenal
advantage of permitting biopsy of suspected
carcinoma or severe spasm in the sphincter of Oddi(3)
.Abdominal US is usually the initial imaging test in
circumstances, the operator can proceed directly to
jaundiced patients with suspected hepatobiliary
ERCP for definitive biliary decompression(6).ERCP
disease. US can also demonstrate cholelithiasis and
permits direct visualization of the biliary tract. ERCP
intrahepatic lesions more than 1 cm in diameter. US
is more invasive than US, CT, and MRCP and
have the advantages of being noninvasive, portable
comparable in cost to MRCP(7) .After endoscopic

Full Paper (vol.739 paper# 14)

c:\work\Jor\vol739_15 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7507-7511
Clinical, and Biochemical Profile of Pediatric Diabetic Ketoacidosis
Patients in Al-zahraa Hospital Pediatric ICU
RagaaAbd EL Salam Mohammed, NaglaaAbd El MonemAbdalla,
FatmaAbdelghaffar Mohamed Mahran
Department of Pediatric, Faculty of Medicine, Medicine (for Girls),Al-Azhar University

Diabetic ketoacidosis (DKA) is an acute and life-threatening situation that accounts for themajority
of diabetes-related morbidity and mortality in children and adolescents who suffer from type 1 diabetes mellitus
Objective: To assess pediatric patients presented with DKA regarding aspects of presentation, findings, and
management and probable risk factors associated with DKA.
Methods: a retrospective descriptive hospital-based study of 43 pediatric patients. Categorized into two groups,
Group A: n=18, previously diagnosed T1DM children and Group B: n=25, newly diagnosed cases of T1DM
admitted into Pediatric ICU at Alzahraa Hospital,during the period 2013 to 2017.The following data were
analyzed: age, sex, weight loss, basic signs & symptoms, severity on admission, blood gas, blood glucose,
glycated hemoglobin,risk factors, length of stay, and complications such as electrolyte disturbances were
compared between the two groups.
Results: Newly diagnosed diabetics accounted for 25 (58.1%) of the patients. Patients in group B had longer
hospital stay of 5.88±2.55 days.This study reported more nausea, vomiting, polydipsia, and polyuria, and showed
more weight loss (p =.017)in group B. There was a significant relationship between hypokalemia and clinical
severity (P = 0.012), and between lower bicarbonate,acidosis and severity of DKA (P <.001). No deaths occurred.
Conclusion: DKA was most prevalent in newly diagnosed T1DM cases. Significant differences in severity
between groups were observed.Infections was the most common precipitating factors. No lethal complications
were reported.
Keywords: Diabetes Mellitus Type 1, Diabetic ketoacidosis, children.

Mild diabetic ketoacidosis - pH level of less than
Diabetic ketoacidosis (DKA) is a relatively
7.3, bicarbonate level of less than 15 mmol/L
common pediatric emergency. It's a major cause of
Moderate diabetic ketoacidosis - pH level of less
morbidity and mortality in children with type I
than 7.2, bicarbonate level of less than 10 mmol/L
diabetes mellitus. DKA is commonly encountred
Severe diabetic ketoacidosis - pH level of less
clinicaly as the first presentation of newly diagnosed
than 7.1, bicarbonate level of less than 5
cases of typeI diabetes mellitus(1).
DKA at diagnosis of diabetes is common in
children and adolescents. The worldwide incidence
varies from approximately 13 to 80% (2).During the
This was a retrospective hospital-based study of 43
management of DKA, acid-base status, glycemia, and
pediatric patients. Categorized into two groups,
serum electrolytes are measured frequently to
Group A: n=18, previously diagnosed T1DM
monitor the efficacy of treatment, detect
children and Group B: n=25, newly diagnosed cases
complications of DKA and its treatment, and to
of T1DM admitted in Pediatric ICU at ALzahraa
determine resolution of DKA. Although there is some
Hospital,during the periodfrom 2013 to 2017. All
variation in the specific details of treatment
patients gave informed consent to take part in this
research. Patients with inflammatory or infectious
DKA is an acute life-threatening disease, which
diseases, autoimmune and rheumatic diseases,
may be associated with acute and chronic
cancer, haematological diseases, as well as those who
complications. Acute complications can include
were under treatment with anti-inflammatory drugs,
hypokalaemia, deep vein thrombosis (DVT), cerebral
were excluded.
oedema and death (1).Cerebraloedema is a rare
Exclusion criteria included patients with incomplete
complication, with an incidence of 0.5% to 0.9% (4).
documentation of DKA.Briefly, The data were
It can result in medium- and longterm morbidity
collected by reviewing the medical records of the
such as neurological dysfunction (5).In addition, the
patients. We recorded the age, sex, presenting
mortality rate of children in cerebral oedema with
symptoms and signs at admission, precipitating
DKA is 40% (6). The severity of diabetic ketoacidosis
factors like intercurrent illnesses, number of DKA
can be defined by blood gas results, as follows:
admissions with reasons in children with established

diabetes and investigations like complete blood

Full Paper (vol.739 paper# 15)

c:\work\Jor\vol739_16 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7512-7516

Neurophysiological Assessment of Peripheral Nerve Functions in a Sample
of Egyptian Patients with Liver Cirrhosis
Kamel Hewedi1, Yasser M. M. El-Dessouky2, Hossam Mohammed Emam1, Ahmed Essmat1 and
Abdelsalam Abdalla Ali Abd Elkader1*
Departments of 1Neurology and 2Tropical Medicine, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Abd Elsalam Abd Allah Ali Abd Elkader, E-mail:
Background: peripheral neuropathy is damage to or disease affecting nerves which may impair
sensation, movement, gland or organs function or other aspects of health depending on the type of nerve
affected. Peripheral neuropathy is a common complication of liver cirrhosis either due to viral (mostly
HCV), NASH, Alcoholic or mixed.
Objectives: the aim of this study was to define the prevalence of peripheral neuropathy in a sample of
Egyptian patients with liver cirrhosis and to determine any etiologic correlation.
Patients and Methods: this descriptive study was conducted on 47 Egyptian liver cirrhotic patients.
Patients were subjected to history taking, detailed neurological examination and clinical and
neurophysiological assessment.
Results: viral hepatitis was the commonest cause of liver cirrhosis 59.6% while non viral causes 25.5%
e.g. NASH, the main duration of liver cirrhosis was 10 + 3.98 yrs ranging from 3-23 yrs. The majority
of patients were asymptomatic, 48.9%, while the most presenting symptoms were sensory symptoms
25.5%, the prevalence of PN among a sample of Egyptian patients with liver cirrhosis according to
neurophysiological assessment was 72.3% mostly of mixed sensory and motor polyneuropathic pattern,
not related to the cause of liver cirrhosis but affected by the duration and severity of liver cirrhosis
determined by Child Pugh classification.
Conclusion: peripheral neuropathy is a common complication of liver cirrhosis related mainly to the
duration and severity of liver cirrhosis, but not affected by the causes of liver cirrhosis.
Keywords: Peripheral Nerve Functions, Liver Cirrhosis


Cirrhosis of liver is a major health problem and
However, neuropathy was seen irrespective of
leads to several complications. Cirrhosis is the
the cause of liver disease, and there was a
final pathway for a wide variety of chronic liver
significant correlation of the severity of
diseases characterized by diffuse hepatic
neuropathy to the severity of liver disease.
fibrosis with replacement of normal liver
These observations suggest that metabolic
architecture by nodules. Etiology of cirrhosis
dysfunction caused by the liver disease rather
can be usually identified by patient's history
than the etiology of liver disease is the primary
combined with laboratory, imaging and
determinant of polyneuropathy (4).
histologic evaluation. Hepatitis C, B, NASH
Although the majority of patients were
and Alcoholic related cirrhosis are the leading
causes of cirrhosis with varying prevalence in
showed distal sensory loss to pain or vibration
different geographic areas (7).
or distal loss of reflexes. Sensory neuropathy
Peripheral neuropathy (PN) has been reported
was seen more commonly than motor axonal
in association with chronic liver disease (CLD)
polyneuropathy on nerve conduction studies (4).
including liver cirrhosis and chronic hepatitis.
This study was carried out to find the
However, the reports have varied regarding the
prevalence and pattern of peripheral neuropathy
and their etiological correlation in a sample of
neuropathy. Some authors have been reluctant
Egyptian patients with liver cirrhosis.
to accept the existence of this neuropathy. The
causal relationship of the liver disease with
The aim of this study is to define the prevalence
neuropathy has also been questioned (12).
of peripheral neuropathy in a sample of
A cause and effect relationship between liver
Egyptian patients with liver cirrhosis and to
disease and neuropathy has been questioned
determine any etiologic correlation.
because some of the systemic illnesses that
cause liver dysfunction also are independent
Study design and patients
causes of peripheral nerve dysfunction.
This descriptive study was conducted on 47
Received: 5/9/2018
Accepted: 24/9/2018

Full Paper (vol.739 paper# 16)

c:\work\Jor\vol739_17 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7517-7525

Role of folic acid deficiency as a possible risk factor for erectile
Attia Abdallah Attia, Mohamed Abdelmawgoud Amer, Nagah Mohamed A.Mohamed, Ahmed
Mahmoud Mohamed Alhabashi
Department of Dermatology and Venerology Department, Faculty of Medicine, Al Azhar University
Corresponding author: Ahmed Mahmoud Mohamed Alhabashi, Mobile: 00201023296171, E-Mail:
erectile dysfunction (ED) is the persistent inability to attain or maintain an erection. ED
affects millions of men worldwide. The pathophysiology of ED includes vasculogenic, neurogenic,
hormonal, anatomical, drug-induced and psychogenic causes. Endothelial dysfunction (EDys) is an
important pathophysiologic factor underlying vasculogenic erectile dysfunction. The pathogenesis of
both EDys and ED are linked through decreased expression and activation of endothelial nitric oxide
synthase (NOS) which is responsible for formation of Nitric Oxide (NO). NO is a relaxing factor which
plays a major role in activation and maintenance of the erection process.
Aim of the work: this study aimed to detect the possible relationship between serum folic acid and
erectile dysfunction by measuring serum FA concentration in patients with erectile dysfunction and
comparing them with the healthy controls. Methodology: our study has been carried out on 90
individuals who were categorized into two groups. Group 1: 60 married males complained of ED. Group
2: 30 married potent males as a control.All participants were subjected to : personal history, past history
of medical diseases and operations, sexual history, general examination, genital examination and
evaluation of erectile function according to the International Index of Erectile Function (IIEF-5)
Questionnaire). Fasting serum samples were collected from all participants and assayed for serum total
testosterone, serum prolactin, serum cholesterol, serum triglycerides (TG), HbA1c and serum folic
acid.Results: results of the current study showed a significant relation between folic acid and ED. FA
level was declined as ED severity increased. It is thought that ED severity was related to HHcy which
was related to the severity of FA deficiency.Conclusion: a significant association between serum FA
level and ED severity was detected in the current study. Serum FA level decreased as the severity of
ED increased. These results suggest that FA deficiency might reflect the severity of ED.
Recommendations: serum folic acid assessment as a part of the routine investigations for patients
complaining with erectile dysfunction. Additional experimental and clinical studies are needed to
determine whether FA supplementation may be beneficial for patients having ED.
Keywords: folic acid, erectile dysfunction


Erectile dysfunction (ED) is defined as
role in activation and maintenance of the
the persistent inability to attain or maintain an
erection process (4).Homocysteine is a potent
erection sufficient to permit satisfactory sexual
NOS inhibitor as it promotes NOS uncoupling
performance (1).Erectile dysfunction is the
reducing the production of the endothelial
major component of male sexual dysfunction
(NO). Hyperhomocysteinemia was recently
which negatively affects the quality of life for
reported to be a novel ED risk factor (5).Folic
acid play an important role in metabolism of
pathophysiology of ED included vasculogenic,
NO and homocysteine as it promotes the
neurogenic, hormonal, anatomical, drug-
remethylation of homocysteine (Hcy) to
induced and psychogenic causes (3).Penile
methionin (Met) and inverts NOS uncoupling.
erection is a vascular event that requires an
FA deficiency prevents remethylation of
intact endothelium and vascular smooth
homocysteine and permits its accumulation,
muscles of the corpus cavernosum. The
pathogenesis of both endothelial dysfunction
(EDys))6). According to Hamidi et al. (7), FA
and ED are linked through decreased
supplementation improved ED. They found FA
expression and activation of endothelial nitric
supplementation therapy to be clinically useful,
oxide synthase (NOS) which is responsible for
and the IIEF scores were three times higher in
formation of Nitric Oxide (NO). Nitric oxide
the diabetic patients with ED taking tadalafil
(NO) is a relaxing factor which plays a major
and FA in combination than in those taking
Received: 6/9/2018
Accepted: 25/9/2018

Full Paper (vol.739 paper# 17)

c:\work\Jor\vol739_18 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7526-7530

Predictive value of Cerebroplacental blood flow ratio for fetal heart rate
disturbances and perinatal outcome
Alsaeed Elsayed Ahmed Askar*, Mahmoud Salah Mahmoud* & Ramadan Sheta Ibrahim
*Obstetrics and Gynecology Department, Faculty of Medicine, Al Azhar University Damietta
Corresponding author: Ramadan Sheta Ibrahim Ibrahim*, E-mail:, Phone: 01015227576

Doppler ultrasound velocimetry foetal vessels have become established method of
antenatal monitoring, allowing non-invasive assessment of foetal circulation. Aims: To determine the
usefulness of Doppler velocimetry, based on cerebroplacental ratio (C/U) evaluation, in predicting
intrapartum fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies
from 36 to 40 weeks. Subjects and Methods: this is prospective study include 300 uncomplicated
pregnant women, age ranged from 17 to 45 years, with gestational age 36 to 40 weeks. Results: there
was significant relation between CPR and adverse neonatal outcome p-value <0.001 with sensitivity,
specificity and PPV, NPPV of CPR in detecting neonatal adverse outcome 100%. Conclusion: better
prediction of neonatal outcome can be done by C/U ratio.
Keywords: Cerebroplacental ratio, Doppler Ultrasound, Middle cerebral artery Umbilical artery.


uncomplicated pregnancies from 36 to 40
Fetal hypoxia is one of the major causes
of high perinatal morbidity and mortality rates.
Subjects and Methods:
It may lead to various neurodevelopment
This is prospective study include 300
disabilities, ranging from difficulties in school
uncomplicated pregnant women, age ranged
to dyslexia, attention deficit hyperactivity
from 17 to 45 years, with gestational age 36 to
disorder (ADHD), vision or hearing
40 weeks from march 2018 to October 2018 at
impairment, and mental disorders, including
AL Azhar university hospital Damietta.
cerebral palsy (1).
Doppler velocimetry is the best method
The study was approved from the ethical
of surveillance for fetal hypoxemia during
committee of the department of obstetrics and
pregnancy. Doppler ultrasound velocimetry of
gynecology, faculty of medicine, AL Azhar
uteroplacental umbilical and fetal vessels has
university Damietta.
become an established method of antenatal
The patients submitted to the study were
counseled about the procedure; its value and
assessment of fetal circulation. Its indices
hazards and the aim of the study. Thereafter, a
provide important information on the
written consent was obtained from each
hemodynamics of the vascularity of fetal
vessels. Umbilical arteries are the common
Inclusion criteria:
vessels assessed, but recent studies confirm the
Patient's age ranged from 17 to 45
efficacy of middle cerebral artery (MCA)
Gestational age ranged between 36 and
measurement is a well-known modality for
40 weeks.
detecting fetal compromise (2).
Exclusion criteria:
Doppler ultrasound indices such as
Patients age before 17 and after 45
cerebroplacental ratio (CPR) evaluation are
commonly used nowadays. It enables to assess
Diabetic and hypertensive patients.
the fetal response to hypoxia by detecting
Patients with coexisting chronic
blood flow distribution pattern in placento-
umbilical and feto-cerebral circulations (3).
Gestational age before 36 and after 40
Aims: To determine the usefulness of
All patients were subjected to:
cerebroplacental ratio (C/U) evaluation, in
A. Full medical, obstetric history and
predicting intrapartum fetal heart rate
abnormalities and adverse neonatal outcome in
B. Laboratory investigation includes
Received: 17/9/2018
Accepted: 30/9/2018

Full Paper (vol.739 paper# 18)

c:\work\Jor\vol739_19 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7531-7541

Percutaneous Fixation of Split Fracture Tibial Plateau
Ali Mohammed Mahmoud El- Gyoshi, Faisal Hassan Youssef Zayed, Mahmoud Hamouda
Taha Massoud
Department of Orthopedic Surgery, Faculty of Medicine, Al Azhar University
Corresponding author: Mahmoud Hamouda Taha Massoud, Mobile: 00201023296171, E-Mail:
tibial plateau fractures represented only 1% of all fractures. If not appropriately treated,
the consequences may be severe and have a great social impact. The management of the fracture depends
on several factors such as fracture configuration, concomitant soft tissue injury, the patient's age, activity
level and bone quality. Tibial plateau fractures may be divided into low energy or high energy fractures.
Low energy fractures are common in older patients due to osteoporotic bone and are typically depressed
fractures. High energy fractures are commonly the result of motor vehicle accidents, falls or sports-
related injuries. Split tibial plateau fractures may be treated by closed reduction and percutaneous
fixation using cancellous screws and washers, with very good results as recommended by many
authors.Objective: the aim of this study was to evaluate the results of closed reduction under fluoroscopic
control and percutaneous fixation with cancellous screws 6.5 mm and washers of split type of tibial plateau
fractures. Methodology: twenty patients were included in this study; they were admitted to the Department
of Orthopedic Surgery, Sayed Galal Hospital and luxor International Hospital, from October 2016 to April
2018. On admission all patients were assessed by history taking, clinical examination and radiological
assessment. The mean age of patients in this study was 37.15 ± 11.4 years. Age was ranged from 20 to 55
years. There were 13 males (65 %) and 7 females (35 %). 11 patients (55 %) had right side tibial plateau
fracture, while only 9 patients had left side tibial plateau fractures. Results: 12 (60 %) patients had traffic
accidents as a mechanism of injury, 4 (20 %) were falling from height, 4 (20 %) had direct trauma.
Associated fractures of the head of fibulae was present in two patients (10 %), other associated fractures were
Colles' fracture (5%), femoral shaft fracture (5 %) and fracture tibia (5 %).The time till operation varied from
two days to five days, but the majority of the cases were done within the first two to three days after
admission. The mean duration of follow up was 6.5 ± 2.86 months, ranging from six to eight months. After
follow up period the result were assessed according to Rasmussen's grading system, eighteen patients (90%)
had excellent results, and two patients (10 %) had good results. Conclusion: tibial plateau fractures
represented only 1% of all fractures. If not appropriately treated, the consequences may be severe and
have a great social impact. Early mobilization is an important factor in treatment of intra articular
fracture, as immobilization result in death of chondrocyte. Percutaneous reduction and fixation
technique is a simple procedure if facilitates, equipment and experience are available.
split fracture, tibial plateau


Tibial plateau fractures are one of the
Each increasing numeric category specifies
commonest intra-articular fractures resulting
increased level of energy directed to the bone
from indirect coronal or direct axial
thereby increasing severity of fracture. First
compressive forces. Fractures of tibial plateau
four are unicondylar and type V and VI are
constitute 1% of all fractures and 8% fractures
bicondylar(3). The Lateral tibial plateau split-
in the elderly. These fractures included many
depression fracture (Schatzker type II) was the
and varied configurations that involved the
most common fracture type encountered
medial plateau (10-23%), lateral plateau (55-
clinically, and accounts for 25­33 % of all tibial
70%) or both (11-30%) with various degrees of
plateau fractures. The location, the size of the
articular depression and displacement(1). In case
split fragment and the degree of articular
of improper restoration of the plateau surface
compression vary greatly and may be
these fractures could lead to development of
accompanied by fibular head or neck fractures
premature osteoarthritis, lifelong pain and
(4).Conservative treatment was reserved for very
disability(2).For assessment of the initial injury,
simple undisplaced fractures that represent a
planning for management and prediction of
small minority of the overall tibial plateau
prognosis, orthopedic surgeons widely use the
fracture population or for very low demand
Schatzker's classification system, which
patients with severe co-morbidities. Open or
divided tibial plateau fractures into six types.
closed reduction and internal or percutaneous
Received: 7/9/2018
Accepted: 26/9/2018

Full Paper (vol.739 paper# 19)


Uses of Ultrasound and Doppler in Assessment of Endometrial Receptivity
in Patients of Unexplained Infertility
Emad Abd El-Rahman El-Tamamy, Mofeed Fawzy Mohamed and Badawy Ezzat Hamza*
Obstetrics and Gynecology Department, Faculty of Medicine, Al Azhar University
*Corresponding Author: Badawy Ezzat Hamza,Phone No.: (+2) 01100399809, email:

although the majority of infertile couples was found to have an identifiable male or
female factor, 15­30% was categorized as having ``unexplained infertility''. The endometrium is
considered to be a key determinant in successful implantation. Endometrial receptivity is regulated by
many factors including endometrial perfusion. Aim of the Work: this study aimed to detect the role of the
two dimensional ultrasound and Doppler ultrasonographic uterine markers of implantation in patients of
unexplained infertility compared to fertile participants. Patients and Methods: the study was performed on
50 patients presented to the outpatient clinic in Al-Hussein, Bab El-Shearia (Sayed Galal) Hospitals,
Al-Azhar University from October 2017 to August 2018 and they were categorized into two groups:
Group A (Patients group): it was included 30 participants presented with unexplained infertility.
Group B) (Control group) who included 20 fertile women coming for contraception.
Results: there was a significant statistical difference as regard the endometrial thickness between
cases and controls, and the controls had a thicker endometrium. Lower pulsatility index (PI) in
uterine artery in the controls compared to the infertile group. Increased sub endometrial
vascularization in the controls compared to the infertile group. Conclusion: ultrasound as well as
Doppler studies of the endometrial and subendometrial vascularization had a role in predicting
endometrial receptivity. Uterine artery Doppler study and the endometrial thickness measurement
had a role in detection of uterine receptivity.
Keywords: endometrial receptivity, unexplained infertility, ultrasound, doppler


revolution in the non-invasive monitoring of
endometrium is a commonly used non-invasive
follicular development. Owing to the presence
method of assessing endometrial receptivity
of the third dimension (coronal plane), three
during infertility treatment. Assessment of the
dimensional ultrasound can perform a precise
endometrium, however, is usually limited to
measurement of the area and volume of each
measurement of its thickness and description of
follicle and the endometrium (4).There is a
its appearance, and these parameters may not be
reasonable certainty that women with
specific indicators of implantation (1).
heterogenous endometrial lining of less than 6
Doppler ultrasound assessment of
mm will rarely conceive and lack of
uterine blood flow appears to be more
endometrial contraction plays a role in the
informative, but Doppler study of uterine
establishment of pregnancy, so these
arteries does not reflect the actual blood flow to
ultrasonographic imaging techniques are used
the endometrium. Endometrial and sub
as predictors of uterine receptivity. Also
endometrial blood flows can be more
different utero-ovarian blood flow changes
objectively and reliably measured with three-
during the peri-implantation period occur in
dimensional (3D) power Doppler ultrasound
(2).Ultrasound imaging technology brings a new
(5).Doppler assessment of uterine arterial
insight to the cyclic changes in the endometrium
resistance can help to determine a time interval
and offers the potential to assess the probability of
within the menstrual cycle that is of optimal
embryo transfer in natural and artificial
endometrial status for embryo transfer in
reproductive cycle, however the data are diverse
assisted conception programs. Delay in
and frequently conflict in their analysis and
achieving adequate uterine perfusion during the
conclusions. Ultrasound technology provides a
temporal window of implantation may have an
rapid, noninvasive endometrial evaluation (3).
impact on endometrial receptivity (6).Presence
Current practice depends on two dimensional
of both endometrial and sub-endometrial flow
trans-vaginal ultrasound for monitoring
is indicative of good endometrial receptivity,
ovulation.Three dimensional ultrasound is a
whereas the absence of both represents a poor
Received: 6/9/2018
Accepted: 25/9/2018

Full Paper (vol.739 paper# 20)

c:\work\Jor\vol739_21 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7551-7556

Assessment of Wet Age-Related Macular degeneration by Optical Coherence
Tomography Angiography
Sayed A. Sayed, Hossam Eldin A. Ziada, Mahmoud S. Mohammad*
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Mahmoud S. Mohammad, E-mail:, Telephone No.: +2001005750332


Background: to date, fundus fluorescein angiography (FFA), remains the gold standard for the diagnosis
of choroidal neovascular membrane (CNV). Optical coherence tomography angiography (OCTA) is a new
imaging modality that allows a clear, depth-resolved visualization of the retinal vascular structures.
Aim of the Work: to evaluate the role of OCTA in diagnosis of CNV in patients with age-related macular
degeneration (AMD).
Patients and Methods: this study enrolled 32 patients (40 eyes), including 20 patients (20 eyes) with wet
AMD and 12 patients (20 eyes) with dry AMD. All patients underwent swept-source optical coherence
tomography (SS-OCT), swept-source OCTA, and fundus fluorescein angiography (FFA). OCTA was used
to evaluate neovascular networks in terms of their type, location and extent of visualization. Sensitivity
and specificity of the method were assessed separately in a group of 20 CNV eyes and 20 dry AMD based
on FFA diagnosis as the gold standard.
Results: sensitivity and specificity of en face OCTA were 95% and 100% respectively. Both Sensitivity
and specificity of structural OCT were 100%.
OCTA enables diagnosis of both classic and occult choroidal neovascularization in patients
with AMD. The method has high sensitivity and specificity.
Keywords: optical coherence tomography angiography, age-related macular degeneration, choroidal

the potential risks which can result in rare adverse
Age-related macular degeneration (AMD) is
events (10).
the term applied to ageing changes without any
other obvious precipitating cause that occur in
The aim of this work is to evaluate the role
macula in people aged 50 years and above (1).
of OCTA in the diagnosis of choroidal
Aging is the strongest risk factor for AMD, but, of
neovascularization (CNV) in patients with
course, it is not modifiable. Age-related changes in
Bruch's membrane and age-related formation of

the components of drusen play the strongest role in
AMD (2). AMD ranks third among the causes of
In this prospective case series, consecutive
blindness, following cataract and glaucoma.
subjects were recruited from the retina clinic at
However, it is the primary cause of blindness in
Kafr EL Sheikh Ophthalmic center (Kafr El
industrialized nations (3). AMD has been classified
Sheikh, Egypt) from March 2017 to March 2018.
depending on whether there is a presence of
The study protocol was adhered to the tenets of
abnormal neovascularization into wet (exudative or
the declaration of Helsinki (11) and was approved
neovascular) and dry AMD (4). Fundus fluorescein
by the Ethics Board of Al Azhar University. An
angiography (FFA) is an important tool in
informed written consent was taken from each
diagnosing and following the treatment of retinal
participant in the study.
diseases (5). FFA is not without problems; some
Clinical and instrumental assessments were
patients have contraindications to the dye such as
performed in 32 patients (40 eyes), of whom 20
those with hypersensitivity to fluorescein (6). FFA
patients (20 eyes) were diagnosed as wet AMD
modality is not depth resolved(7). Optical coherence
and 12 patients (20 eyes) with dry AMD.
tomography angiography (OCTA) is capable of
All patients underwent FFA, swept source
visualizing the choriocapillaries blood flow, and
OCT (SS-OCT) and swept source OCTA (SS-
therefore, may have use in the evaluation of
OCTA) using Topcon OCT Triton .The three
neovascular AMD (8). OCTA is based on repeated
imaging modalities were performed within 7
consecutive optical coherence tomography (OCT)
days of each other. The angioretina of the
B-scans at the same section to generate a contrast
Topcon OCT Triton utilizes OCTARA
(decorrelation signal) between static and non-static
algorithm. OCTA acquisition protocol in the
tissue (9). OCTA does not require administration of
macular region consisted of a 6×6 mm area
intravenous dye such as fluorescein thus avoiding
centered onto the fovea. En face OCTA images
were segmented into four layers, namely the
Received:4/9/208 accepted:23/9/2018

Full Paper (vol.739 paper# 21)

c:\work\Jor\vol739_22 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7557-7565

Effect of gonadotrophin dose on oocytes yield and quality and embryonic
development in Super ovulated mice
Samir A. M. Zaahkouk1, Ahmed S. Abdon2, Ahmed M. Al-Atrash3, Omaima M. Kandil2,
Amal A. A. Ammar4, Asmaa A. M. Yones4
1Faculty of science, Al-Azhar University.
2 Reproduction and Artificial Insemination, Veterinary Research Division, National Research Center.
3Medical Administration, Nuclear Materials Authority.
4Medical and Radiation Research Dept., Nuclear Materials Authority, Cairo, Egypt

Hormonal control for multiple follicular growths in IVF program was directed toward
maximizing the yield of fertilizable oocytes, enhance successful implantation and improve early embryonic
The effect of different doses of urinary human menopausal gonadotropin (U-hMG) in superovulation
regimen was studied.
Materials and Methods: Four groups of immature female mouse were sequentially injected by 5 IU, 10
IU, 15 IU and 20 IU of U-hMG followed by injection of 15 IU human chorionic gonadotropin (hCG) for
all groups. Mature cumulus oocytes complexes (COCs) were collected 12 hours later then the grading of
cumulus cell expansion and oocytes maturity was determined. In vitro fertilization for mature oocytes was
done by using epididymal sperm, the embryonic development was followed up till the blastocyst stage.
Results demonstrated that the super ovulatory response in immature mice increased with
increasing dose of hMG. 15 IU U-hMG was the optimal dose that gave maximum number oocytes with
higher maturation rate,minimum degeneration rate and support embryonic development.
: 15 IU is the optimal dose for induction of superovulation and support in vitro embryo
developmentin immature female mice.
Keywords: Immature mice, HMG dose, Maturation rate, Cleavage rate, Embryo development.
years an increasing interest in animal care and
Superovulation is a technique used to produce a
rights has arisen, limiting the use of laboratory
large number of embryos developmentally
animals in experimental procedures. Therefore,
synchronized[1]. It is employed for protocols such
different superovulation with gonadotrophins
as embryo transfer [2],embryonic stem (ES) cell
regimen are widely performed to reduce the
production[3], transgenic animals[4[, and to
number of mice used in experiments, without
develop animal models of human diseases [5].
reducing the accuracy of results. In mice, 8 to 10
Superovulation protocols based on gonadotrophic
ova are extruded by copulation-induced
hormones have been standardized in species such
spontaneous ovulation [12]. This number can be
like mouse[3], pig [6],cattle [7], sheep [2] and goat [8],
substantially increased to 40 to 60 ova by using
and the quality of the embryos produced appears
superovulation protocols [13]. However, the
to be satisfactory.
efficacy of exogenous stimulation varies with the
Mouse is the most commonly used animal model
strain, age, nutritional status and health,
in reproductive research for obtaining mature
breeding-housing conditions of a female mouse,
oocytes or for investigating pre implantation
and the dose of administered gonadotrophins
embryo development. In such experiments, it is
[14,15]. Therefore these factors that influence the
possible to test different reproductive techniques
number and quality of super ovulated eggs must
and infertility treatment programs[9] and to
be optimized for any given strain of mouse. The
determine the effects of potentially toxic
program for superovulation using human
materials on the oocytes or embryos [10,11]. In this
respect a great number of ova/embryos is needed
standardized. According to our knowledge there
and therefore the number of mice required for a
are no literatures on the effect of dose of human
given experiment increases. However, in recent
chorionic gonadotropin on development of
Received: 16/10/2018
Accepted: 26/10/2018

Full Paper (vol.739 paper# 22)


Comparative Study of Transvaginal Sonography and Hysteroscopy for
Detection of Pathological Endometrial Lesions in Women with
Perimenopausal Bleeding
Emad Abd El-Rahman El-Tamamy, Mofeed Fawzy Mohamed and Gamal Kamel El-Sayed *
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University
*Corresponding Author: Gamal Kamel El-Sayed, Phone No.: (+2) 01064604025, E-mail:

: abnormal uterine bleeding is a frequent condition in gynecology. It may impact physical,
emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases
of acute and severe bleeding, women may need urgent treatment with volumetric replacement and
prescription of haemostatic substances. In some specific cases with more intense and prolonged
bleeding surgical treatment may be necessary. Aim of the Work: this study aimed to estimate the
diagnostic accuracy of two dimensional transvaginal ultrasound and hysteroscopy compared to the
histopathology in evaluation of uterine cavity lesions in peri menopausal women with abnormal uterine
bleeding. Patients and Methods: this was a prospective cohort study and it included 50 patients from
Obstetrics and Gynecology Outpatient Clinic at Al-Hussein and Bab El-Shearia (Sayed Galal)
Hospitals, Al-Azhar University during the period from October 2017 to May 2018. Results: 2D TVS
were more sensitive and a little more accurate than hysteroscopy in detecting endometrial hyperplasia,
while hysteroscopy showed higher specificity. Hysteroscopy showed highest accuracy for diagnosis of
the endometrial polyp and was more sensitive, specific and accurate than 2D TVS in this diagnosis. 2D
TVS were more sensitive and accurate than hysteroscopy in the diagnosis of adenomyosis, but both
showed same specificity. For differentiating normal from abnormal endometrial cavity both 2D TVS
and hysteroscopy showed high accuracy, but U/S was more sensitive and a little more accurate than
hysteroscopy, while the last was more specific. Both 2D TVS and hysteroscopy ignore the diagnoses of
one lesion when endometrial hyperplasia, endometrial polyp or adenomyosis were found in one case.
Conclusion: endometrial hyperplasia was the commonest observed endometrial abnormality in our
patient sample and the second most common pathology was the endometrial polyp.
transvaginal sonography, perimenopausal bleeding, pathological endometrial lesions


Abnormal uterine bleeding (AUB) is
and dysmenorrhea (4). Anovulatory bleeding
the main reason for women to go to
occurs more frequently at the extremes of
gynecologists and accounts for two thirds of all
reproductive age and in obese women. It is
hysterectomies (1). AUB is responsible for as
usually irregular and often heavy. It poses a
many as one-third of all outpatient gynecologic
higher risk of endometrial hyperplasia (5).
visits and this proportion rise to 69 % in a the
Fibroids or polyps are the most common cause
perimenopausal group (2). In perimenopausal
of anatomic AUB twenty to forty percent of
women, AUB is diagnosed when there is a
women had fibroids. These women might
substantial change in frequency, duration, or
present with abnormal bleeding, anemia, pain
amount of bleeding during or between periods.
In postmenopausal women, any vaginal
examination included looking for evidence of
bleeding 1 year after cessation of menses is
systemic diseases. Pelvic and bimanual
considered abnormal and requires evaluation
examinations were done to detect diseases in
(3).The cause of AUB in perimenopausal
the genital tract. Cervical cytology analysis
women was found in 50% to 60% of cases. The
should be current and normal and cervical and
remaining cases, where no organic cause was
vaginal swabs should be assessed to rule out
found, were classified as DUB (1).History
infection (7).Investigations can include pregnancy
focused on identifying the type of AUB as
testing if indicated and a CBC with ferritin. A
ovulatory, anovulatory or anatomic in order to
serum ferritin level may be useful if there is any
guide treatment. Ovulatory bleeding is more
doubt about iron deficiency, but should not be a
common, usually cyclic and can be associated
routine investigation. Other investigations might
with midcycle pain, premenstrual symptoms
be done on the basis of clinical suspicion
Received: 08/9/2018
Accepted: 27/9/2018

Full Paper (vol.739 paper# 23)

c:\work\Jor\vol739_24 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7574-7579

Biomechanical Corneal Changes Post LASIK with Mechanical
Microkeratome Flap versus Femtosecond Flap
Mohamed Elmoddather and Asaad Nooredin
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assuit

Back ground:
The biomechanical impact of flap creation may be important in explaining changes in the
curvature of the residual stroma after flap creation which plays a critical role in the development of
To evaluate the impact of the creation of corneal flaps with mechanical microkeratome
versus femtosecond laser on the biomechanical properties of the corneas.
This study included 100 eyes of 50 patients (Microkeratome Group) Compared with 100
eyes of 52 patients (Femtosecond Group) with myopia with or without astigmatism. Corneal hysteresis
(CH) and corneal resistance factor (CRF) were measured with Ocular Response Analyzer before and1,
3,6and 12 months after surgery. We also investigated the relationship between these biomechanical
changes and the amount of myopic correction.
Corneal resistance factor and hysteresis was changed significantly after flap creation in both
groups. In Moria2 group, they decreased significantly from 11.55 ± 1.29 mm Hg and 11.68±1.40 mm Hg
to 9.47 ± 1.29 mm Hg and 8.49 ± 1.54 mm Hg, respectively) (P <.0001). In femtosecond group, they
decreased from11.51 ± 1.25 mm Hg and 11.66±1.41 mm Hg to 9.49 ± 1.30 mm Hg and 8.5 ± 1.53 mm
Hg, respectively (P <.0001). The ablation depth (P=0.650), residual corneal thickness (P=0.442), and
postoperative corneal curvature (P=0.354) were not significantly different between femtosecond group
and Moria2 group after surgery.
CONCLUSION: Both femtosecond LASIK and Moria2 LASIK can affect the biomechanical strength
of the cornea depending on the amount of myopic correction. The amount of biomechanical changes is
larger after LASIK with mechanical microkeratome than after femtosecond from a biomechanical
LASIK, Femtosecond, Microkeratome, Flaps.

Refractive surgery alters the biomechanical
some mechanical microkeratomes, with standard
properties of the cornea, which may play an
deviations of 30 µm having been reported
important role in affecting treatment outcome in
depending on the microkeratome used(7). The
terms of postsurgical complications(1,2). Advances
predictability of this process has a potential for
in techniques and instruments have reduced the
compromising corneal stability in the long term as
incidence and severity of flap abnormalities and
thicker flaps could more significantly modify the
other potentially severe complications(3). During
biomechanical integrity of the cornea(8).
LASIK, an immediate near-circumferential
In this study, we used the femtosecond laser to
severing of corneal lamellae results in a
create flaps at same depths of microkeratome
redistribution of stress and unprogrammed
Moria2 and measured the impact of programmed
biomechanical shape changes (4,5). Although some
flap thickness on the biomechanical properties of
changes in the shape of the residual stroma during
the underlying residual stroma.
and after surgery may be precursors of an ectatic
condition, others may represent non-progressive
This study included 100 eyes of 50 patients
changes associated with the establishment of a
(Moria2 Group) Compared with 100 eyes of 52
new postoperative structural state (6).
patients (Femtosecond Group) with myopia with
The biomechanical impact of flap creation on the
or without astigmatism. Inclusion criteria were no
residual stroma likely plays a critical role in the
symptoms or signs of dry eye before LASIK, no
development of ectasia. Biomechanical effects
previous eye surgery, no topical ocular
may also be important in explaining changes in the
medications before surgery, and no other ocular
curvature of the residual stroma after flap creation
conditions, such as ocular rosacea or chronic
and photoablation that do not represent ectasia but
blepharitis. The preoperative evaluation consisted
nonetheless affect refractive outcome. It is known
of a complete ophthalmic examination comprising
that flap thickness can vary significantly with
uncorrected distance visual acuity (UDVA),
Received: 28/8/2018
Accepted: 18/9/2018

Full Paper (vol.739 paper# 24)

c:\work\Jor\vol739_25 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7580-7586

Outcome of PRK in Management of Post LISIK Residual Myopia and Myopic
Mohamed Elmoddather
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assuit

Different retreatment options are available for management of post LASIK residual myopia
and myopic astigmatism, however PRK reduces the risk of ectasia by preserving the corneal stroma as
much as possible and avoids the flap-related complications.
Purpose: To evaluate the outcome as regards the safety, efficacy, and predictability of photorefractive
keratectomy (PRK) for correction of residual myopia and myopic astigmatism after laser in situ
keratomileusis (LASIK).
Patients and Methods:
The study included 30 eyes of 15 patients retreated by PRK for residual myopia
and myopic astigmatism after laser in situ keratomileusis (LASIK). Data included uncorrected and best
corrected visual acuity (UCVA and BCVA), spherical equivalent (SE), central pachymetry, corneal higher
order aberrations (HOAs), corneal hysteresis (CH), corneal resistance factor (CRF), and corneal haze.
Results: This study was performed on 30 eyes of 15patients. The mean age was 25.27±3.70 SD years old
(9 women and 6 men). The average interval between procedures was 13.35 ± 5.51 months. The mean
follow-up was 16.58 ± 3.06 months. Before PRK, the mean UCVA and BCVA were 0.35 ± 0.18 and 0.91
± 0.07, respectively. The mean central pachymetry was 400.21 ± 7.8m, the mean SE was -1.74 ± 0.51D.
12 months postoperatively. The mean UCVA and BCVA were 0.78 ± 0.14 (P = 0.01) and 0.92 ± 0.13 (P >
0.5), respectively. The mean central corneal thickness was 382.41 ± 2.61m, the mean SE was -0.18 ±
0.32D (P < 0.01). Two eyes gained 1 line of best spectacle-corrected visual acuity; one eye lost 1 line
because of corneal ectasia. No other sight-threatening complications was occurred postoperatively.
Conclusions. Photorefractive keratectomy and mitomycin C was an effective, predictable, and safe
procedure for correcting residual myopia and myopic astigmatism less than 3D after LASIK. This decrease
postoperative ectasia and avoids the flap related complications but has no significant effect on HOAs.
Key words:
PRK, LASIK, Myopia and Myopic astigmatism.

Laser in situ keratomileusis (LASIK) is the most
creation. Furthermore, corneal wavefront-guided
PRK can reduce flap-induced higher order
procedure. Despite technological improvements,
aberrations, resulting in better outcomes (7,8).
residual postoperative refractive errors are still an
Febbraro (9) and Agarwal (10) described the
issue that needs to be dealt with, especially when
disadvantages of PRK retreatment such as
they interfere with the patient's quality of life (1-3).
haze/corneal scarring, more frequent regression,
Retreatment, which is typically performed on 10
tissue melting, irregular astigmatism and
to 20% of patients who underwent laser in situ
keratomileusis (LASIK), is considered by the
The aim of this study was to evaluate outcome of
patients to reflect failure of the original
the safety, efficacy, and predictability of PRK for
procedure; therefore retreatment should be
correction of residual myopia following LASIK.
precise to address patient satisfaction and
maintain safety (4).
This study included 30 eyes of 15 patients with a
Different retreatment options are available such
residual myopia and/or myopic astigmatism after
LASIK procedure. The inclusion criteria included
subepithelial keratectomy (LASEK), and trans-
residual mean spherical equivalent between
or subepithelial photorefractive keratectomy
-1.00D and-3.00D, stable refraction for at
(PRK) (5,6). However, LASIK may not be safe as
least 6 months before PRK, and calculated
a retreatment, as an increased number of eyes
postoperative corneal thickness < 380m (which
with ectasia were reported following LASIK
is not safe for LASIK retreatment). Exclusion
enhancement. PRK reduces the risk of ectasia by
criteria included eyes with post-LASIK
preserving the corneal stroma as much as possible
complication other than mayopia or myopic
and avoids the flap-related complications caused
astigmatism as corneal ectasia, flap striae, and
by either original flap manipulation or new flap
central islands. All PRK procedures were
Received: 28/8/2018
Accepted: 18/9/2018

Full Paper (vol.739 paper# 25)

c:\work\Jor\vol739_26 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7587-7596

Evaluation of Glycated Albumin to Glycated Hemoglobin Ratio as a
Predictor for Esophageal varices and its Risk of Bleeding

Ahmed Mohammed Osama, EL-Sayd Mohammed Mohie EL-Dien,
Mohammed Abd El-Hamid Bsyoni, Mostafa Shehata EL-said

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

Corresponding author: Mostafa Shehata EL-said, E-mail:

Background: Variceal hemorrhaging due to portal hypertension is a severe complication of liver
cirrhosis. Although several biomarkers have been reported as predictors of the presence of varices, it is
still difficult to assess the risk of variceal bleeding without esophagogastroduodenoscopy (EGD). The
ratio of glycated albumin (GA) to glycated hemoglobin (HbA1c) was reported to increase with the
progression of liver fibrosis. The aim of the study was to investigate whether the GA/HbA1c ratio is
related to the severity and bleeding risk of the varices. Aim of the work: goal of our study was to assess
the value of Glycated albumin to Glycated hemoglobin ratio in the prediction of esophageal varices and
assessing its risk of bleeding. Methods: We measured the GA/HbA1c ratio of HCV-related cirrhotic
patients and analyzed its relationship with the presence and bleeding risk of varices. Results: The
GA/HbA1c ratio was higher in the patients who had the varices with a high risk of hemorrhage than in
the patients with a low risk of bleeding. In addition, the GA/HbA1c ratio was higher in patients with
varices than that in patients without varices. Furthermore, the GA/HbA1c ratio was the most
significantly different parameter of all the factors examined, including the platelet count, prothrombin
activity and albumin level. Conclusion: The GA/HbA1c ratio is increased in patients with varices and
with the bleeding risk of the varices.
Keywords: Liver cirrhosis; Portal hypertension; Esophageal varices; Glycated albumin; Glycated


Portal hypertension is a major complication of
varices and those with a low risk of hemorrhage
liver cirrhosis and can be a direct cause of
have not yet been clarified. Glycated proteins
variceal hemorrhage and of bleeding-related
are known to reflect the plasma glucose level
and glycated hemoglobin (HbA1c), is
commonly used as an index of glycemic control
(EGD) is considered to be necessary for all
in patients with diabetes mellitus (9, 10). Since the
cirrhotic patients to evaluate the risk of variceal
lifespan of erythrocytes is about 4 months, the
bleeding (1, 3) .Three factors identify patients at
HbA1c level is correlated with the level of
a high risk of bleeding from varices: a large
glycemia for the past few months (11). Another
variceal size, red signs on the varices and
glycated protein, glycated albumin (GA),
advanced liver disease (Child-Pugh class B or
reflects the plasma glucose level during the past
C) (4). Several biochemical parameters have
few weeks, because the turnover of albumin is
been reported as predictors of the presence of
about 3 weeks (12, 13). Although the ratio of
varices, such as a low platelet count, an
GA/HbA1c is usually close to 3, patients with
advanced Child-Pugh class, hypoalbuminemia
chronic liver disease (CLD) have a shortened
and low prothrombin activity (5, 8). However, it
lifespan of erythrocytes due to the
is still difficult to predict the presence of varices
hypersplenism, thus resulting in lower HbA1c
without EGD. In addition, with regard to
levels relative to the plasma glucose level.
compensated cirrhotic patients with well-
Conversely, the turn-over period of serum
maintained liver function (Child-Pugh class A),
albumin in CLD patients is increased to
the differences in the biochemical data between
compensate for the reduced albumin
the patients with treatment requiring high-risk
production. Therefore, the GA levels in CLD

Full Paper (vol.739 paper# 26)

c:\work\Jor\vol739_27 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7597-7603
The Relationship between Helicobacter Pylori Virulence
Factors and Gastric Carcinoma
Mohamed Shees Ahmed*, Mohamed Amer Afifi*, Hany Mostafa Abu-Shukka*,
Ragaae Mohamede Fath-Elbab**, Raafat Zaher Abdel Rahman**, Ahmed Fkirin**
* Microbiology and Immunology Department, Faculty of Medicine, AL-Azhar University,
Cairo, Egypt. **, Military Medical Academy, Cairo, Egypt.
Corresponding author: Ahmed Fkirin, E-mail:

Helicobacter pylori is a gram-negative microaerophilic bacterium found usually in the stomach and
use several mechanisms to survive in the stomach lumen. The presence of these bacteria in the stomach can lead to
gastritis and reduction in stomach acid production. Aim of the work: this study aimed to investigate the
seroprevalence of six highly immunogenic virulence factors (Cag A, Vac A, Gro EL, gGT, Hcp C and Ure A) in
patients with different gastric histology in a high-risk population of gastric cancer and explore the relationship
between H. pylori virulence factors and gastric carcinoma. Methods: this study included 100 patients: 25 patients
were diagnosed histopathologically as gastric cancer (Group I) and 75 patients were diagnosed endoscopically as
mild gastritis (Group II). Their samples were collected from Military Armed Hospitals. Noninvasive serologic test
was performed to detect immune responses to H. pylori by stool antigen test, ELISA and by Recomoline H. pylori
Results: on comparing results of gastric carcinoma and chronic gastritis by Recomoline H. pylori test, it was found
that Cag A was detected in 88% (22/25) in group I. While, in group II it was 57.33% (43/75) of cases and Vac A
was detected in 80% (20/25) in group I while, it was in group II in 44% (33/75) of cases. Gro EL was detected in
72% (18/25) in group I while; it was 49.33% (37/75) group II and Urea A was 52% (13/25) in group I while, it was
52% (39/75) in group II. Hcp c was 56% (14/25) in group I while, it was 40% (30/75) in group II and gGT was
48% (12/25) in group I while, it was 34.67% (26/75) in group II.
Conclusion: in this study, a statistically significant association was found between Cag A, Vac A and Gro EL antigen
in the studied groups of patients. However, no such statistically significant association was found between Urea A,
Hcp c and gGT antigen. (P value > 0.05). Thus, Cag A, Vac A and Gro EL antigen proved to be virulence markers
for gastric carcinoma group.
Keywords: Helicobacter pylori; Recomoline H. pylori test.


immune suppression [5]. Many testing methods are
In 1994, H. pylori was recognized as a type I
available for detection of H. pylori. Invasive methods
carcinogen and it was considered as the most common
use endoscopy as the vehicle to obtain tissue for
etiologic agent of infection-related cancers, which
histology, noninvasive tests are recommended for
represented 5.5% of the global cancer burden. In
first-line assessment of H. pylori infection. Here, the
2005, Marshall and Warren were awarded the Nobel
[13C] urea breaths test (UBT), serology and the stool
Prize of Medicine for their discovery of this bacterium
antigen test offer high accuracy at relatively low cost.
and its role in peptic ulcer disease [1]. In areas with high
Culture is no longer considered necessary for
incidence of gastric cancer, population-based
confirmation of H. pylori infection, but cultured
screening and treatment measures were discussed to
organisms can be tested for antibiotic resistance.
reduce the incidence of gastric cancer [2]. Japan has
Biopsies are also required for PCR analysis [6].
recently revised its guidelines and now recommends

screening for H. pylori infection and treatment of all
the infected individuals [3].
This study aimed to investigate the seroprevalence of
The most well-known H. pylori risk marker was
six highly immunogenic virulence factors (Cag A, Vac
the cytotoxin-associated antigen (Cag A), a
A, Gro EL, gGT, Hcp C and Ure A) in patients with
component of the pathogenicity island, which was
different gastric histology in a high-risk population of
present in approximately 60% of H. pylori strains in
gastric cancer and explores the relationship between
the United States [4]. Cag A contributes to alteration of
H. pylori virulence factors and gastric carcinoma.
myriad signaling transduction, which affects host cell

physiology with disruption of intercellular junctions,
loss of cell polarity, promotion of inflammation,
Study design:
dysregulation of cellular apoptosis and proliferation.
This study was conducted between January 2015 and
Vac A inducts cytoplasmic vacuolation, apoptosis and
November 2016. Specimens were obtained from the
Endoscopy Unit and Surgical Oncology Department,

Full Paper (vol.739 paper# 27)

Role of MRI in Detection of Repaired Cleft Palate Muscles and Correlation to Speech The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7604-7609

Role of MRI in Detection of Repaired Cleft Palate Muscles and
Correlation to Speech
Amro Mahmoud Abdelrahman Ali, Mahmoud Ibrahim El Shamy, Ahmed Ali AbdElmonem,
Fawzy Ahmed Hamza, Tarek Mahmoud El Banoby.
Department of plastic Surgery, Faculty of Medicine, Al-Azhar University
Corresponding author: Amro Mahmoud Abdelrahman Ali, Mobile: 01096849308,

: Cleft palate is a birth defect when the roof of the mouth contains an opening into the nose. It occurs
in about 1:2 per 1000 births. These disorders can result in speech disorders, feeding problems and frequent ear
infections. It is the result of tissues of the face not joining properly during development. Speech therapy and dental
care may also be needed. Approximately 30 percent of patients having undergone cleft palate repair require
secondary surgery for velopharyngeal dysfunction. Magnetic resonance imaging (MRI) is one of the common used
tests in variable fields of medicine and surgery. Now trials are done for use of MRI in the postpalatoplasty
velopharyngeal dysfunction patients. Objective: This study aims to detect static craniofacial and velopharyngeal
measures of repaired cleft palate patients specially repaired muscle state (levator veli palatini muscle) by using MRI
and correlate these data to speech state.
Patients and Methods
: this prospective study conducted in AlAzhar and Beni-suef University Hospitals in the
period of February 2018 till November 2018. It is conducted on twenty children who complained of post-
palatoplasty velopharyngeal dysfunction and examined by nasendoscopy and speech analysis then MRI palate was
done using 1.5 T MRI; to correlate MRI data to speech data. Results: our statistical results revealed significant
decrease in the velopharyngeal variants than normal ranges. That prove that static MRI is a valid procedure for
diagnosis of anatomical abnormality. But after correlation with speech data it showed that it should be accompanied
with dynamic procedure (e.g. Nasendoscopy) especially in patients with normal ranged anatomy.
Conclusion: this study was done in variant range of children who suffer from post-palatoplasty speech abnormality,
scanned by MRI palate and correlate these data by speech data. Static MRI is efficient technique to demonstrate
structural defects in these patients.
Keywords: - MRI, Speech, Velopharyngeal Dysfunction, Cleft Palate.


Cleft palate is a birth defect when the roof of
Normal speech is dependent upon the
the mouth contains an opening into the nose. It occurs
functional and structural integrity of the velopharynx.
in about 1:2 per 1000 births. These disorders can
Normal velopharyngeal closure is accomplished by
result in speech disorders, feeding problems and
the coordinated action of the velum, the lateral
frequent ear infections (1). It is the result of tissues of
pharyngeal walls, and the posterior pharyngeal wall.
the face not joining properly during development.
These structures function as a valve that serves to
Speech therapy and dental care may also be needed.
close off the nasal cavity from the oral cavity during
Approximately 30 percent of patients having
undergone cleft palate repair require secondary
velopharyngeal valve regulates and directs the
surgery for velopharyngeal dysfunction (2, 3).
transmission of sound energy and airflow in the oral
The basic morphology of the face is
and nasal cavities. The valve opens for nasal
established between the 4th and 10th weeks of human
breathing and production of nasal sounds.
development. The face is formed as a result of fusion
Dysfunction of the velopharyngeal valve may lead to
of the midline frontonasal prominence and three
hypernasality, nasal air emission and compensatory
paired prominences; the maxillary, lateral nasal, and
articulation errors (5).
mandibular prominences. Each of these prominences
The normal palate serves several important
is filled with cranial neural crest cells that originated
functions, the main aim for palate repair is normal
at different positions along the neural tube.
speech and consideration of cleft palate surgery must
Disruptions in the rate, the timing, or the extent of
balance developmental, dentofacial growth and
outgrowth of the facial prominences can all result in
otologic issues as well (6). The primary goal of
facial clefting (4).
surgical management of VPI cases is to produce a

Full Paper (vol.739 paper# 28)

c:\work\Jor\vol739_29 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7610-7614

Mini-Open Reconstruction of Rotator Cuff of The Shoulder
Ibrahim Hussein, Emad Mohamed Zayed, Mohamed Ahmed Mahmoud Abd-Allah*
Orthopedic Surgery Department, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohamed Ahmed Mahmoud Abd-Allah, E-Mail:, Mobile:01001936562

: shoulder pain is one of the most common musculoskeletal (MSK) disorder affecting a large portion of
the population. It is estimated that one in three persons will have at least only one episode of shoulder pain within
their lifetime. Rotator cuff tears are very common in the general population. Radiographic studies have shown the
prevalence of rotator cuff tears to be 4-13% in the population aged between 40-60 years and 20% in population
whom age between 60-70 years and 30-50% in population above 70 years. Rotator cuff tears are a common
pathology associated with degenerative changes in the shoulder joint. They cause significant disability, pain,
dysfunction and poor health status and their prevalence is currently increasing within an aging population.
Aim of the Work: the aim of this work was to study the results of mini open rotator cuff repair of the shoulder
joint. Patients and Methods: this study was conducted on ten patients presented to Al-Azhar University Hospital
with rotator cuff tear of the shoulder. They are treated with mini-open repair technique. All our patients completed
a period of at least one year of follow up. Results: a clinical success rate was found in ten patients treated by mini
open technique, 70% had excellent and good results according to Constant and Murly score after one year of follow
up. Conclusion: repair of rotator cuff tears by mini-open technique is one of the good viable options providing
improvement in pain and function of the shoulder joint. Also it is more economic than arthroscopic repair and it
does not need high learning curve as arthroscopic repair.
Keywords: Rotator Cuff, Mini-Open.

shoulder moves. They stiffen the capsule and decrease
Shoulder pain is one of the most common
glenohumeral translation. These functions make them
musculoskeletal disorders affecting a large portion of the
susceptible to injury and tearing with time and age (7).
population (1) .It is estimated that one in three persons
Etiology of rotator cuff tears is multifactorial.
will have at least only one episode of shoulder pain
Acromial morphology is implicated as contributing
within their lifetime (2).
factor ; four types of acromion morphology are
Rotator cuff tears are very common in the
present: flat, curved, hooked and convex. An increase
general population. Radiographic studies have shown
in rotator cuff tears was noted more with the hooked
that the prevalence of rotator cuff tears to be 4-13% in
acromion type (8).
the population aged between 40-60 years and 20% in
Although impingement may play a role, the
population whom age between 60-70 years and 30-
pathologic effects of overuse appears to play more
50% in population above 70 years (3).
significant role in the development of rotator cuff tear.
Rotator cuff tears are one of the most common
Overuse can cause imbalance between tendon
pathologies that is associated with degenerative
degeneration and tendon regeneration leading to
changes in the shoulder joint. They cause significant
increased apoptosis of tenocytes and conversion of the
disability, pain, dysfunction and poor health status and
tendons to the biomechanically inferior fibrocartilage.
their prevalence is now increasing within an aging
This can lead to attritional tears of the rotator cuff and
population(4) .
mechanical failure. Also the aging process appears to
The risk of rotator cuff tear is much more higher
increase the pathologic effects of overuse(9).
on the dominant side. Established factors which affect
Most patients with rotator cuff tears have
the outcome following rotator cuff repair include the
gradual onset of progressive pain and weakness, with
tear size, age and time from the tear to surgery(5).
associated loss of active motion. Pain is usually
The rotator cuff muscles are a group of four
present at night and is usually referred to the insertion
muscles including subscapularis in front, supraspinatus
of deltoid muscle so patient may be not able to sleep
above and infraspinatus and teres minor from behind
on the affected side. Other complaints include
that fuse together to form a tendon which encompasses
instability and weak abduction and external
the head of the humerus.(6)
The rotator cuff muscles are part of the intrinsic
The diagnosis of rotator cuff tears depends on
muscles in the shoulder joint. Their function is to
impingement tests and the cuff muscles tests, namely
control the glenohumeral joint to provide the stability
Jobe test, lift-off test and external rotation stress test.
by dynamically positioning the scapula to place the
Then the patient is initially evaluated radiographically
glenoid properly opposite the humeral head as the
by plain X-ray which may show the type of acromion,

calcific deposits, glenohumeral arthritis,

Full Paper (vol.739 paper# 29)

c:\work\Jor\vol739_30 The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (9), Page 7615-7621

Use of Drain in Laparoscopic Cholecystectomy
Ayman Helmy Ibrahim, Abdel Wahab M. Abdel Wahab, Karim A. Abdel Rahman Ali
Department of General Surgery, Faculty of Medicine, Al Azhar University
Corresponding author: Ayman Helmy Ibrahim ,email:

laparoscopic cholecystectomy has become the procedure of choice for treatment of patients with
gall stones. The routine placement of drains becomes a part of this operation for a long period of time.
However, controversy has surrounded this practice in elective conventional cholecystectomies, with most
surgeons departing from this approach. Aim of the Work: this study aimed to assess the value of the drain in
uncomplicated laparoscopic cholecystectomy and if the insertion of a drain should be routinely done or not.
Patients and Methods:
this study was conducted at AL-Azhar University Hospitals in Cairo (Al Hussien and
Bab Al Shaaria Hospitals), Kafr Al-Sheikh General Hospital and Biala Central Hospital on 180 patiants
presented to general surgery clinic with gall stone disease. Patients were randomized into two groups and both
groups underwent laparoscopic cholecystectomy, group A (90 patients) received a drain in gall bladder bed
and group B (90 patients) receivd no drain. Postoperative mortalities and morbidities shuch as pain, nausea,
vomiting, fever, abdominal collection, wound infection, need for analgesics and time of discharge from
hospital were assessed. Statistical analysis was performed. Mean and standard deviation were estimated for
each continuous variable. Results: there was no mortality in either groups and no statistically significant
difference in postoperative pain, nausea, vomiting, wound infection or abdominal collection between the two
groups. However, hospital stay was longer in the drain group than in group without drain. Conclusion: our
study suggested that insertion of drain should not be routinely done in elective laproscopic cholecystectomy
as it has no significant effect on postoperative morbidity, moreover, it delays hospital discharge.
Keywords: drain, laparoscopic cholecystectomy.

surgeons to use or not use drains seems to be a
Laparoscopic cholecystectomy (LC), after
matter of habit and experience (6).
its advent in 1987, was rapidly established itself as

the gold standard treatment of gallstones.
Arguments of drainage from open era continue into
This study aimed to assess the value of the
the laparoscopic era, with another factor, that is,
cholecystectomy and if insertion of adrain should
Laparoscopic cholecystectomy provides a safe and
be routinely done or not.
effective treatment for patients with gallstones as it

reduces post operative pain with almost inadvisable
scar, short hospital stay and earlier return to work
This work was conducted at AL ­Azhar
(2).On the other side, patiants complain of
University Hospitals in Cairo (Al Hussien and Bab
abdominal pain, shoulder tip pain and
Al Shaaria Hospitals), Kafr Al-Sheikh General
nausea/vomiting post-opetatively (3).High pressure
Hospital and Biala Central Hospital.
pneumoperitoneum using carbon dioxide gas was
The study included 180 patiants presented
accused for those complications, thus a drain tube
to general surgery clinic with gall stone disease
is inserted (4).The value of surgical drainage in open
from May 2015 to July 2018.
cholecystectomy is an issue that is not resolved till
Type of study: this study was a prospective
now (5). The same occurs in laparoscopic
clinical study.
cholecystectomy, where the lack of evidence on
Inclusion criteria:
usefulness of drain is present. Again surgeons keep
1. Patients who would not had acute
being divided among those placing a drain
cholecystitis, cholangitis or pancreatitis.
selectively and those who never place a drain,
2. Patients who would not had any
based on their personal experience, beliefs or bias
cholecystectomy is still debatable. The main
3. Patients who would not required common
indication for drain use after laparoscopic
bile duct exploration or any other
cholecystectomy is to prevent a biloma or
additional procedure.
hematoma. According to the Cochrane Database
Exclusion criteria:
Systemic Review, randomized clinical studies
1. Patients who refused to enter the study.
show no benefit of a drain. Some studies even
2. Patients who have chronic liver diseases or
claim that drains are harmful. The tendency of
bleeding tendency

Full Paper (vol.739 paper# 30)