c:\work\Jor\vol741_1 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 1-9

Corneal Endothelial Cells Changes after Phacoemulsification in Diabetic

Emad Abdel Aal Saliem
Ophthalmology Department, Al-Azher Faculty of Medicine, Assuit
E Mail: emadophtha@yahoo.com.


Background: To assess endothelial cells changes following cataract extraction by phacoemulsification
and posterior chamber IOL implantation in type II diabetic patients.
Patients and Methods: The study included 40 eyes of 40 patients scheduled for cataract surgery by
phacoemulsification at Al-Azhar University Hospitals. The patients were assigned to 2 groups. Group
Twenty patients without diabetes were used as a control group. Group 2: Twenty patients diagnosed
with diabetes based on medical history and all were on medical treatment. In this prospective
randomized study, preoperative specular microscopy and serial postoperative specular microscopy
(Topcon SP- 1P, Topcon Medical Inc., Japa) were performed to evaluate endothelial cell count changes
over 6 months. The main outcome measures were central corneal thickness (CCT), cell density (CD),
coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). Results:
In term of CCT, BCVA, HEX and CD, the differences between preoperative and postoperative values
are statistically significant in both groups. On the other hand, in term of CV, the difference between
preoperative and postoperative CV is statistically insignificant in both groups. Conclusion: The
endothelium in diabetic subjects is more vulnerable to surgical trauma and has a lower capability in the
process of repair.
Keywords: phacoemulsification, endothelial cell loss, central corneal thickness.

Cataract has been documented to be the most
consists of approximately 4000 cells per square
significant cause of bilateral blindness.
millimeter, whereas the number is reduced to
Worldwide more than 285 million people are
about 2500 cells per square millimeter at age of
50 years [4]. There are 2 important parameters,
Phacoemulsification is nowadays the preferred
age and the presence of diabetes compromise
technique for most types of cataract due to less
the status of the endothelium, which may have
astigmatism, less postoperative inflammation
a negative impact on the final visual outcome in
and rapid visual recovery [1]. The hexagonal
case of surgery [5]. The corneal endothelium is
cells of the endothelium are responsible for
evaluated by central corneal thickness, corneal
maintaining the clarity of the cornea by actively
endothelial cell density, and morphology
removing the water, these cells have limited
mitotic capacity, and any disturbance in the
Descemet's endothelium complex (DEC)
endothelial homeostasis might therefore have a
showed edematous thickening and different
profound effect on the clarity of the cornea [2].
degrees of morphological changes after
Several studies have indicated an increased
phacoemulsification. The DEC deformation
corneal vulnerability in diabetic subjects to
and corneal edema recovered by one week after
intraocular surgical stress. It is likely that this
surgery, which indicated recovery of
phenomenon occurs because of chronic
endothelial function. Pre-operative DEC
metabolic changes on the cellular level that
thickness may indicate the integrity of the
primarily seems to affect the monolayer of
endothelium and could be used for predicting
endothelial cell loss after phacoemulsification
Phacoemulsification with intraocular lens
implantation is one of the most common
phacoemulsification machines were efficient,
surgical procedures performed. The patients are
with similar endothelial cell loss. This
usually elderly, and this might have a negative
endothelial cell loss was related to the increased
impact on the surgical outcome because
nuclear sclerosis grade and increased
increasing age is associated with loss of
phacoemulsification power [8].
endothelial cells. In childhood, the endothelium

Received: 15/09/2018
Accepted: 30/09/2018

Full Paper (vol.741 paper# 1)

EMBRYOLOGY The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 10-16

Role of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of
Patients with Salivary Glands Tumors

Abdallah Mohammed AL-kheshen, Mohammed Salah EL-Feshawy, Mohammed Essmat Abd-
ElGhani, Mahmoud Mohammed Abomosalam Ali

Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
Corresponding author: Mahmoud Mohammed Abomosalam Ali, Mobile: 002001140268464, EMail:

The diffusion weighted imaging and ADC value give appreciable information about
tumor cellularity with tissue contrast between the active and necrotic areas within the tumor. This would
be valuable and could direct the beneficial site for interventional procedure and biopsy to be taken from
the viable tumoral tissue especially in case with non-enhanced studies due to renal impairment.
Objective: The aim of this study was to investigate the capacity of Diffusion MRI to predict the benign
and malignant Salivary gland tumors, using ADC value and DWI.
Patients and Methods: This study included 40 patients (24 male and 16 female). Sixteen patients had
malignant lesions and twenty-four had benign ones. The DWI was obtained with b values including 0
and 800mm2/second. The Apparent Diffusion Coefficient (ADC) generated by measuring identical
images at different b-values and represented as ADC map, from which the ADC value was calculated.
Results: The absolute ADC value of lesions was significantly different between benign and malignant
salivary gland tumors (p<0.001). The sensitivity of ADC in differentiating benign from malignant
lesions in our study was 93.7% indicating a high true positive rate. Hence, if the average ADC is below
0.85 x 10 -3 mm2/sec, there is high probability that the mass will be malignant with high specificity of
95.8 %. Results revealed that the mean ADC value of benign and malignant salivary gland tumors were
1.33±0.46x 10-3 mm2/s and 0.65±0.21 x 10-3 mm2/s, respectively. The mean ADC value of benign was
significantly higher than that of malignant lesions.
The use of DWI and ADC values can provide better assessment of salivary gland tumors
and predict the benign and malignant lesions.
ADC, MRI, DWI, Malignant Salivary Gland Tumors


The major salivary glands are the parotid
Surgical approach to parotid tumors is
glands, submandibular glands and sublingual
different for benign and malignant neoplasms,
glands. There are also a large number (600-
but the clinical symptoms do not correlate well
1,000) of minor salivary glands widely
with histology and only few symptoms, as
distributed throughout the oral mucosa, palate,
facial palsy, allow the diagnosis of malignancy.
uvula, floor of the mouth, posterior tongue,
Therefore, preoperative imaging has assumed a
retro molar and per tonsillar area, pharynx,
major role in surgical planning for assessing the
larynx and paranasal sinuses. Tumors affecting
location and malignancy of the tumor (4).
salivary glands may be benign or malignant and
Pre-operative diagnosis of the type of
are diverse in their pathology. About 80% of
salivary gland mass can help the surgeon
salivary gland tumors occur in the parotid gland
determine the most suitable surgical procedure.
MR imaging (MRI) is the method of choice for
The majority of salivary neoplasms are
the characterization of salivary gland tumors.
benign (65-70%). Nearly 8o% of parotid gland
MRI is a non-invasive technique that can
tumours is benign. Malignant tumours are rare,
provide morphological information of the mass,
Malignancy typically presents after age 6o,
allow correct diagnosis and proper staging. It
whilst benign lesions usually occur after age 40
can accurately determine the deep or superficial
(2). Only 5% of all salivary gland tumours occur
location of the mass, extension, contour and
in childhood (3).
signal pattern (5).
Received: 15/09/2018
Accepted: 30/09/2018

Full Paper (vol.741 paper# 2)

Full Paper (vol.741 paper# 3)

Full Paper (vol.741 paper# 4)

c:\work\Jor\vol741_5 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 31-35

Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

Elmenawy M., Elsherief O. , Abd Elaliem M.
Orthopedic Surgery Department, Faculty of Medicine (Damietta), Al-Azhar University

Corresponding Author: Wael Tantawy, Email: tantawy_wael@yahoo.com

: ulnar impaction syndrome (UIS) is a common cause of ulnar-sided wrist pain. The
differential diagnosis of ulnar-sided wrist pain is diverse due to the complex nature of the bony and soft
tissue anatomy UIS may lead to degenerative lesions of the triquetrum, lunate, ulnar head cartilage or
of the TFCC. Concomitantly the triquetrolunate ligaments may be disrupted. Associated factors of ulno-
carpal joint space narrowing may include previous fracture (e.g. of the distal radius), premature physeal
arrest of the distal radius or congenital ulna positive variance.
Aim of the work:
this study aimed to evaluate the outcome of treating ulnar impaction syndrome with
ulnar shortening osteotomy upon clinical and radiological.
Materials and Methods
: in this study ten adult patients with ulnar impaction syndrome were selected
from Orthopedic Outpatient Clinic of Faculty of Medicine (Damietta), Al-Azhar University Hospital
from January 2018 to October 2018 and they were operated by ulnar shortening osteotomy and fixed
by plating. Description of technique alongitudinal incision over the subcutaneous border of the ulna
issued to expose the ulna between the distal and middle third of the ulna from the ulna styloid.
Preoperative posteroanterior (PA) X-rays were reviewed to determine the amount of shortening
required, with a goal of creating -2 mm variance postoperatively. A 6-hole dynamic compression plate
was predrilled distally prior to performing two oblique osteotomies separated by the desired shortening
length. The fragments were reduced and plated by using compression. Results: the mean disabilities of
the arm, shoulder and hand (DASH) score was 9 postoperatively. Flexion, extension and supination
were reduced compared to the contralateral unaffected extremity (84.6%, 85.3%, and 86.9% of normal).
Patients received worker's compensation 5 of 10 patients required hardware removal for plate irritation
and 2 of 10 patients had a nonunion. Conclusion: we preferred our surgical technique ulnar shortening
osteotomy for all cases of UIS. Pain was significantly improved in our Cases; however smokers had
less improvement in pain and higher disability scores.
Keywords: ulnar shortening osteotomy, ulnar impaction syndrome


Ulnar impaction syndrome (UIS) is a
syndrome is defined by a shortened ulna
common cause of ulnar-sided wrist pain. The
impinging on the distal radius (1) . UIS may
differential diagnosis of ulnar-sided wrist pain
lead to degenerative lesions of the triquetrum,
is diverse due to the complex nature of the
lunate, ulnar head cartilage, or of the TFCC.
bony and soft tissue anatomy .The clinical
Concomitantly the triquetrolunate ligaments
scenario of UIS may include pain that
may be disrupted. Associated factors of ulno-
localizes to the region of the ulno-carpal
carpal joint space narrowing may include
articulation and is exacerbated with a pronated
previous fracture (e.g. of the distal radius),
grip and/or ulnar deviation. Decreased joint
premature physeal arrest of the distal radius,
space between the ulnar-carpal bones and the
or congenital ulna positive variance (2).
ulnar head is present, either due to positive
Treatment is initially non-operative. If non-
ulnar variance (UV) or less commonly, in
operative management fails, surgery to
ulnar-neutral or negative UV wrists with a
decompress the ulno-carpal joint is indicated.
thickened triangular fibrocartilage complex(1).
Joint decompression may be achieved by
UIS is synonymous with ulno-carpal
either ulnar shortening osteotomy (USO) or by
wafer procedure. Wafer procedure may be
abutment, but is a distinct entity from ulnar
either arthroscopic (AWP) or open (OWP).
styloid impaction and ulnar impingement
Various techniques for performing USo have
syndrome. Ulnar styloid impaction is caused
been described (3). The choice of surgical
by impaction between the ulnar styloid and the
treatment for refractory UIS is largely based
proximal triquetrum; ulnar impingement
on surgeon preference. Each surgery has
Received: 15/09/2018
Accepted: 30/09/2018

Full Paper (vol.741 paper# 5)

Full Paper (vol.741 paper# 6)

Full Paper (vol.741 paper# 7)

c:\work\Jor\vol741_8 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 55-62

Prevalence of female sexual dysfunction in Damietta governorate

Hassan Abou Khodair1, Hany Othman Abo Al-Wafa1, Salwa Mohamed Mostafa Rotab2

1 Dermatology, Venereology and Andrology Department, Faculty of Medicine, Al-Azhar University,
Damietta, Egypt, 2 Dermatology Hospital, Damietta, Egypt

Corresponding Author: Salwa Mohamed Mostafa Rotab, Mobile: 01000690887, E Mail: msalwa788@gmail.com

to assess the prevalence of female sexual dysfunction among women of Damietta governorate
Patients and methods: 500 randomly selected sexually active non-pregnant married women at age 18
­ 45 years from outpatient clinics of Al-Azhar University Hospital were subjected to filling out the
Arabic validated FSFI.
Results: The frequency of female sexual dysfunction among women of Damietta Governorate was 62%
of participants. There was a statistically significant difference between women with female sexual
dysfunction (FSD) and women without FSD in age, age of marriage and education level (P<.0001).
Also, women not working were at higher risk to get FSD (P<.001) with the significant impact of
socioeconomic level on having FSD.
Also, we reported a statistically significant difference between women with FSD and women without
FSD in the mode of delivery and women used IUD &72.6% had a history of circumcision. There was
a statistically significant difference between women with FSD vs women without in mean score of
desire, arousal, lubrication, orgasm, satisfaction, and pain as women with FSD showed less score in all
domains compared to women without the disease.
Conclusion: FSD was a significant health problem in Damietta that needs to be investigated more
deeply and assessing associated risk factors. Low rate of overt complaints regarding sexual problems
among Egyptian women does not indicate lack of sexual interest but reflects cultural factors such as
shyness, embarrassment, reluctances of the women and lack of physicians' awareness which lead to
inadequate identification and management of such problems.
Keywords: Circumcision, Damietta Governorate, Sexuality, Sexual Dysfunction

Human sexuality is a process that
more prevalent in women (43%) than in men
involves the integration of different organ
(31%) (5).
systems and requires neurologic, vascular and
An analysis of collected data in Egypt
endocrine coordination (1).
revealed a high prevalence of FSD (52%) with
Female sexual functioning is a state of
sexual desire disorders as the commonest type
ability to achieve sexual arousal, lubrication,
of sexual dysfunction. The prevalence of desire,
orgasm, and satisfaction and results in
orgasm, arousal, pain, and sexual satisfaction
wellbeing and state of wellness, with good
disorders were (35%), (29%), (21%), (20%),
quality of life (2).
(15%) respectively (2).
Female sexual dysfunction (FSD) is
This study aimed to assess the
defined as a disorder of sexual desire, arousal,
prevalence of female sexual dysfunction among
orgasm, and sexual pain that lead to personal
women of Damietta Governorate.
distress or interpersonal difficulties. It is a

multifactorial, age-related, progressive problem
Patients and Methods
This study included 500 randomly
Several factors have been found to
selected non-pregnant married women at
affect FSD. These include anatomical,
sexually active age (18 ­ 45 years old) from
physiological, medical, psychological and
outpatient clinics of Al-Azhar University
social factors (4).
Hospital. Informed consent was taken from
Epidemiological data on sexual
every patient. The study was approved by the
dysfunction are relatively scanty and vary
Ethics Board of Al-Azhar University.
widely (3). In analysis of data in United States
Female in the childbearing period,
(US) from the national health and social life
female married with the regular marital
survey; it was found that sexual dysfunction is
relationship, and can read and understand the
Received: 15/09/2018
Accepted: 30/09/2018

Full Paper (vol.741 paper# 8)

c:\work\Jor\vol741_9 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 63-69

Effect of Metformin Only versus Effect of Metformin and Corticosteroids
after Laparoscopic Ovarian Drilling on Ovulation in Women with
Clomiphene Citrate Resistant Polycystic Ovary Syndrome

Ismail Talaat El-Garhi, Fahd Abdel Aal El-Omda, Gamal Zakaria El-Khatib, Ahmed
Mohamed Fathy Awad
*Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Corresponding author: Ahmed Mohamed Fathy Awad, Mobile: 02001222676432

the syndrome of polycystic ovary syndrome (PCOS) is clinically and biochemically
heterogeneous. Medical treatment of PCOS is tailored to the patient's goals. Broadly, these may be
considered fewer than four categories: lowering of insulin levels, restoration of fertility, treatment of
hirsutism acne and restoration of regular menstruation. Objective: this study aimed to study the effect of
Metformin alone after laparoscopic ovarian drilling on ovulation in women with clomiphene citrate resistant
polycystic ovary syndrome in comparison with studying the effect of Metformin with Dexamethasone after
laparoscopic ovarian drilling on ovulation in women with clomiphene citrate resistant polycystic ovary
syndrome. Methodology: in the present study, 60 patients with PCO were resistant to clomiphene citrate
therapy had undergone ovarian drilling. Those patients had been classified into 2 groups according to
the selected therapy. Two trails had been compared; group A received metformin (850 mg twice daily)
plus dexamethasone (2mg daily from day 5 to day 14 monthly) for 3 months while group B had received
metformin only (850 mg twice daily).Results: our study showed no significant correlation between
serum progesterone level after therapy and different parameters in both study groups. Conclusion: we
concluded that there was a good value of administration of Dexamethasone with Metformin after
laparoscopic ovarian drilling in patients with clomiphene resistant polycystic ovarian disease especially
those patients with normal DHEAS levels.
Keywords: metformin, corticosteroids, PCOS.

Polycystic ovary syndrome (PCOS) is the
Hyperandrogenism is a central feature
most common cause of infertility in women,
for most forms (phenotypes) of PCOS. The
frequently becomes manifest during adolescence
androgens are secreted primarily by the ovaries
and it is primarily characterized by ovulatory
and secondarily by the adrenals. Although
syndrome is hetero-geneous clinically and
hyperandrogenism in PCOS, insulin resistance
biochemically (1).The diagnosis of PCOS has
alone is not sufficient for the development of
lifelong implications with increased risk for
PCOS, suggesting that an underlying (genetic)
metabolic syndrome, type 2 diabetes mellitus
predisposition to hyperandrogenism must also be
and possibly cardiovascular disease and
present (4).Women with polycystic ovary
endometrial carcinoma. PCOS should be
syndrome (PCOS) have multiple abnormalities
considered in any adolescent girl with a chief
complaint of hirsutism, treatment-resistant
acne, menstrual irregularity, or obesity (2).
anovulatory infertility, and metabolic risk
Functional ovarian hyperandrogenism was
factors such as obesity, insulin resistance,
usually the major source of the androgen excess
dyslipidemia, and impaired glucose tolerance.
and can account for the major features of the
Weight loss, which can restore ovulatory cycles
syndrome, ie, hirsutism, anovulation and
and improve metabolic risk, is the first-line
polycystic ovaries. This ovarian dysfunction was
intervention for most women. our overall
unique: it appeared to be intrinsic and was
approach is similar to that described by the
2o13 Endocrine Society Clinical Guidelines (5).
steroidogenesis and folliculogenesis that were
Legro et al. stated that clomiphene
manifested clinically by androgen excess and
citrate was the first-line therapy for ovulation
anovulation (3).
induction in non-obese women with PCOS (BMI
<3o kg/m2); approximately 8o percent of women
Received: 02/10/2018
Accepted: 21/10/2018

Full Paper (vol.741 paper# 9)

c:\work\Jor\vol741_10 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 70-73

Accuracy of Two-Dimensional Speckle Tracking Echocardiography in
Detection of Myocardial viability in Patients with Ischaemic

Mamdouh H. Altahhan 1, Attia M. Shokr 2, Mahmoud M. Gebali 3
Department of Cardiovascular Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mahmoud M. Gebali, Mobile: 01002432386, Email:drmahmoud07@gmail.com

ischaemic cardiomyopathy is one of the common causes of high mortality and increasing
prevalence of heart failure. Because of the need to treat the cause of ischemic cardiomyopathy, testing
of patients and detection of myocardial viability is much important and can help to identify viable
segments of myocardium that have great chance of improving after revascularization. Noninvasive
imaging are used for detection of viability and 2 dimensional speckle tracking echocardiography is
under research for this.
Aim of the work: Detection of myocardial viability in ischemic cardiomyopathy using 2D speckle
tracking Echocardiography versus myocardial perfusion imaging.
Patients and Methods:
The ethical approval was obtained from the hospital ethical research committee and
each patient entering the study signed an informed consent. Fifty patients included in this study with known
ischemic cardiomyopathy. They were recruited from outpatient clinic at Al-Hussien Hospital during the
period from October 2017 to July 2018. Myocardial perfusion imaging and 2D speckle tracking
echocardiography with segmental longitudinal strain and global longitudinal strain were done to the fifty
Results: 2D speckle tracking echocardiography with segmental longitudinal strain and global longitudinal
strain when compared with myocardial perfusion imaging predicted cutoff point for viable segment from
nonviable with detected sensitivity and specificity.
Conclusion: The new echocardiographically-derived myocardial deformation indices, which reflect
structural changes assessed by transthoracic echocardiography can be used to detect myocardial viability.
Keywords: echocardiography, myocardial viability, myocardial perfusion imaging, ischemic
cardiomyopathy, speckle tracking.

Because of increased mortality and increased
myocardial perfusion imaging and detection of
incidence of heart failure and the great need to
cutoff point for myocardial viability.
treat the etiology, testing of patients with heart
Patients and Methods
failure will increase obviously1. SPECT is one
of the non-invasive nuclear imaging techniques,
We included 50 patients with diagnosis of
which is frequently used to detect viable
ischemic cardiomyopathy who came to
myocardium. Viable myocardium can be
cardiology outpatient clinic at Al-Hussin
elicited by detecting the myocyte membrane
Hospital from October 2017 to July 2018. The
integrity through the amount of myocardial
study was approved by the Ethics Board of
uptake of the radioactive tracers. The
Al-Azhar University.
radioactive tracers used in daily practice

included Thallium-201 or Technetium (Tc)-99
Inclusion criteria:
m or Tc-99 m tetrofosmin, with Tc-99 m
Patients with cardiomyopathy due to
sestamibi being the most available and used
ischaemic origin who have EF<40%.
tracer in daily practice 2.
Exclusion criteria:
Aim of the study:
Patients with cardiomyopathy due to
The aim of this work is to identify viable
non-ischaemic cause.
segments from non-viable segments in patients
Patients with AF.
with ischemic cardiomyopathy using two
Patients with poor echo window.
1. Informed consent was taken from all
patients for the study participation.
Received: 01/10/2018
Accepted: 20/10/2018

Full Paper (vol.741 paper# 10)

c:\work\Jor\vol741_11 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 74-79

Prospective Study to Evaluate Effect of Autologus Plasma Injection in the
Wound Site immediately after Primary Wound Closure

Fawzy Ahmed Hamza, Ahmed Taha Sayed,
Mohamed Mustafa Mohamed Mohamed Saeed*

Plastic surgery Department, Al-Azhar University

* Corresponding author: Mohamed Mustafa Mohamed Mohamed Saeed, E-mail: mhmd.saeed1988@gmail.com


Background: Healing of wounds is considered as a complex and dynamic process, Platelets play an
important role in the process of wound healing because it releases many growth factors that may be
valuable in improving the results of the healing process.
Aim of the Work: The purpose of this study was to evaluate the effect of autologus plasma injection
in the wound site immediately after wound closure on the process of wound healing.
Patients and Methods: The study was conducted on 60 patients having wounds at different sites of
the body either post-traumatic or post-operative. They were grouped into two groups: Group A received
autologus plasma injection in the wound site immediately after primary wound closure together with
the usual wound care while the other group B received only the usual wound care without plasma
injection. We have evaluated the wound healing process parameters as vascularity, pigmentation,
pliability, pain, stiffness, the cosmetic results and development of complications using the Patient And
Observer Scar Assessment Scale (POSAS) Score.
Results: We have found that the results of the wound healing process have improved much in group A
which received autologus plasma injection than that was found in group B that didn't receive plasma
injection regarding vascularity, pigmentation, pliability, pain, wound healing complications, cosmetic
results and patients' satisfaction.
Conclusion: Autologus plasma injection in the wound site immediately after wound closure has
enhanced the wound healing process, gave better cosmetic results and led to more patients' satisfacion
because it contains abundant growth factors, cytokines and biologically active substances.
Keywords: Wound healing, Autologus Plasma, Platelet-rich Plasma, Platelet-Poor Plasma, Cosmetic,
Growth factors, growth mediators.

Healing of wounds is considered as a
mechanism of action of platelet rich plasma is
complex process because as when a wound
thought to be the molecular and cellular
starts healing, the process resolves with
induction of normal wound healing responses
complete wound cessation. Healing of acute
and chronic wounds can be affected by patient
The wide popularity of PRP came from
factors and/or wound factors. Restarting a
its promise as a safe and natural alternative to
wound with impaired healing is difficult
surgery. Using PRP has promoted the wound
because good standard wound care does not
healing process being an organically based
always provide an improved healing results (1).
therapy derived from patient's own blood. PRP
Platelets play important roles in wound
has been shown to be effective in tissue healing
healing because of their hemostatic function
because PRP is known to be effective in many
and concentrated levels of biologically active
aspects of tissue regeneration (4).
substances as cytokines and growth factors (2).
Many studies proposed that platelets
Platelet rich plasma (PRP) is
contain an abundance of growth factors and
considered to be advanced wound therapy for
cytokines that can affect inflammation,
wounds. PRP is a highly concentrated
autologous solution of plasma obtained from a
osteogenesis, wound, muscle tear, and soft
patient's own blood. PRP contains platelets that
tissue healing. Research nowadays shows that
release many growth factors that may be
platelets also release many bioactive proteins
that attract macrophages, mesenchymal stem
applications. Autologous PRP contains
cells, and osteoblasts that not only promote
cytokines, growth factors, chemokines and
removal of degenerated and necrotic tissue but
fibrin derived from the patient's blood. The
also enhance tissue regeneration and healing (5).
Received: 01/10/2018
Accepted: 20/10/2018

Full Paper (vol.741 paper# 11)

c:\work\Jor\vol741_12 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 80-86

Clinical audit on Management of Acute poststreptococcal
glomerulonephritis in children admitted to Assiut University Children

Marwa A.M. Abuzeid*, AhlamBadawy Ali, Faida M.M. Mostafa

Department of Pediatrics, Faculty of Medicine, AssiutUniversity, Assiut, Egypt
*Corresponding author: Marwa A.M. Abuzeid, E-mail: Dmarwaa@yahoo.com

acute poststreptococcal glomerulonephritis (APSGN) is the most common
glomerulopathy among children in our community. Aim: to assess degree of adherence of medical
physicians to Assiut University Children Hospital protocol for management of acute poststreptococcal
glomerulonephritis. Patients and Methods: fifty eight patients with APSGN admitted to Assiut
University Children Hospital were included in this study. The unit´s protocol was followed for the
management of these cases. Results: evaluation of the studied patients were done perfectly except for
12%of patients not asked about symptoms suggestive of hypertension (HTN) and 14% not checked for
oliguria and some laboratory investigations with less importance in diagnosis. Management was
perfectly done except for general and supportive measures including daily weighting, calculating fluid
input and output, which showed some defect. Putting patients on blood pressure percentiles was not
done at all. Conclusion: evaluation of the APSGN patients includes taking proper history of nephritic
symptoms and careful clinical examination. Main treatment includes monitoring fluid status and HTN,
and proper management to avoid complications. Recommendation: stress on general and supportive
measures including weighting patients daily, calculating fluid input and output, checking patients for
oliguria, and follow up proper dietary measures especially for hypertensive and hyperkalemic patients.
Stress in putting patients on blood pressure levels according to age and height percentiles for accurate
detection of HTN.
Keywords: Acute poststreptococcal glomerulonehpritis, Assiut University Children Hospital, Audit.


of clinical cases have at least 2 manifestations,
glomerulonephritis (APSGN) is the most
and 40% have the full picture of acute nephritic
common glomerulopathy among children in our
syndrome. Subclinical cases are 4­10 times
community. Typical features of the disease are
more common than symptomatic patients (5).
acute onset of haematuria, edema, facial
General symptoms like malaise,
puffiness and hypertension (1).
weakness, and anorexia may occur in about half
Incidence rate for APSGN in
of the patients and less complains of nausea and
developing countries is 24.3 per 100,000 and
vomiting within a week or so from onset of
2.0 per 100,000indeveloped countries. The
symptoms (6). APSGN occurs predominantly in
long-term prognosis of the disease is excellent.
males. The clinical course is usually mild, but
The bad prognosis of the disease is due to early
severe acute renal failure with crescentic
mortality and a rapidly progressive clinical
formation may occur (7).
course. The overall mortality from APSGN is
Hypertension (HTN) is observed in
less than 0.5%. Less than 2% are complicated
more than 80% of patients. The increased
by end stage renal diseases (2).
peripheral vascular resistance, plasma volume
The median age at presentation for
and cardiac output are possible causes of HTN.
APSGN in childhood is between 6 and 8 years
Some patients present with hypertensive
old. It rarely occurs before age 2 (3). It occurs 2­
emergency, heart failure or pulmonary edema
4 weeks following upper respiratory infection
and 2­4 weeks following skin infection (4).
The pathogenesis of APSGN is due to
Acute nephritic syndrome presenting
multi streptococcal antigens and a patient
as edema, hematuria, and hypertension with or
antibody response with the formation of soluble
without oliguria is the most frequent
complexes, which cannot be removed by the
presentation of APSGN. Approximately 95%
glomeruli and activate the complement system.
Received:3/10/2018 Accepted:22/10/2018

Full Paper (vol.741 paper# 12)

c:\work\Jor\vol741_13 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 87-93
Comparison between taans cerebellar diameter, biparietal diameter and
femur length for gestational age measurement accuracy in the 3rd
Alsaied Abdelmaksod Askr, Mahmoud Salah Mahmoud, Asmaa Ahmed Mahmoud Salloum*
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Asmaa Ahmed Mahmoud Salloum, Mobile: 00201005854475, E-Mail: drasmaa822@gmail.com

the provision of obstetric and neonatal care, as well as the public health monitoring of
pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational
age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery
and perinatal mortality and independent of maternal characteristics. Many patients in Egypt due to
socio-economic reasons come for their first antenatal visit in the third trimester. Most of them are
uneducated and come from remote areas. Also, many being lactating mothers are unsure of their LMP
or have irregular cycles. Because of non-availability of any dating scans or earlier ultrasound and
uncertainty in LMP, it becomes very difficult to calculate their due dates, so many pregnancies
considered to be preterm or posterm were wrongly classified. The use of ultrasonography has
significantly improved evaluation of fetal growth and development and had permitted prenatal diagnosis
of a variety of congenital malformations. Ultrasonographic fetal biometry is highly reliable in the first
and second trimester of pregnancy, but reliability of any ultrasound method greatly diminishes as
gestational age advances, in the third trimester, reliability of any single ultrasound parameter alone is
poor without correlation with other parameters. Objective: in our study, TCD was compared to FL and
BPD in accuracy of assessment of gestational age in the third trimester of pregnancy. We correlated
between the three parameters, Transcerebellar (TCD) and Biparietal diameter (BPD) and Femur length
(FL), for accurate determination of gestational age in third trimester of pregnancy. Methods: a total of
200 pregnant women in the third trimester pregnancy were assessed in this observational study in
Department of Obstetrics and Gynecology, Damietta Hospital, Al-Azhar University (Outpatient) by
two-dimensional ultrasound to assess the accurate method for assessment of gestational age in the third
trimester of pregnancy. Examinations were performed after a verbal consent from the patient with the
patient lying in the dorsal supine position. Two dimensional ultrasounds were carried out. Fetal
biometry and amniotic fluid volume were assessed. All women included in this study were subjected to
history taking and clinical examination. Results: we found that out of 200 patients, TCD gave correct
assessment of gestational age within 3 days in 118 patients (59%) and within 1 week in 180 patients
(90%). While, FL gave correct assessment of gestational age within 3 days in 92 patients (46%) and
within 1 week in 160 patients (80%). The least accurate was BPD that gave correct assessment of
gestational age within 3 days in 59 patients (29.5%) and within 1 week in 120 patients (60%).
Conclusion: from this study, we concluded that TCD was the most accurate method for assessment of
gestational age in the third trimester followed by FL and the least accurate was the BPD. Also, by
combining accuracy of TCD (90%) and that of FL (80%) we can be near certain of gestational age in
most of our patients even if they are unsure of their dates.
Recommendations: measuring TCD as routine in the third trimester as it has the same accuracy as the
current fetal biometry (BPD and FL).
Keywords: TCD, LMP, BPD, FL, GA

The pregnancy date estimation is
the most beneficial assessments in pregnancy ,
mandatory for the pregnant ladies in order to
which is dependent on determination whether
have the expect time of delivery in which
the patient in gestation or not .In order to
various tests will be taken to achieve the
decrease the biologic variability among fetuses
estimated time. There are methods that used to
traditional biometry, ancillary biometric also
determine the gestational age including
non biometric measurements will be used in
menstrual history, clinical examination and the
addition those measurements can also be used
ultra sonography (1). Accurate determination of
for the assessment of the gestational age and
the gestational dating is considered to be one of
maturity of the fetal lung and some specific
Received: 03/10/2018
Accepted: 22108/2018

Full Paper (vol.741 paper# 13)

c:\work\Jor\vol741_14 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 94-102
Relationship between Adenoidal Hypertrophy and Allergic Rhinitis in
Mohamed Abdel Monem Yonis 1, Marwan Ahmed Ibrahim 1, Farag Khalil Farag 2 and Ahmed
Mohamed El Shennawy *1

1Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University (Cairo), 2Internal
Medicine Department, Faculty of Medicine, Al-Azhar University (Cairo), Egypt
*Corresponding author: Ahmed Mohamed El Shennawy, E-mail: ahmed_mohmad_ahmed2012@yahoo.com

as a consequence of antigenic stimulation associated with chronic inflammation, the
adenoids may enlarge so that they may almost fill the nasopharynx. Moreover, adenoid hypertrophy
and allergic rhinitis can co-exist in the same patient and treating allergy may relieve patient's symptoms
and thus avoid unnecessary surgery. Objective: this study aimed to determine the relationship between
adenoid hypertrophy and allergic rhinitis in children based on clinical examination, nasal endoscopy
and skin prick test. Methods: this was a prospective study included 50 children who were selected from
many patients attended Otolaryngology Outpatient Clinic in Al-Azhar University Hospitals during the
period from February 2018 to June 2018. All patients were signed an approved informed consent form
before study enrollment. Results: the results of this study showed that there was no significant
association between allergy and nasal obstruction neither measured by endoscopy, nor FRS.
Furthermore, there was a significant negative correlation between allergy and adenoid volume measured
only by endoscopy not by lateral X-ray nasopharynx. Supplementary, among all tested allergens, house
dust and cotton dust allergy showed a significant negative association with the volume of adenoid.
Moreover, all types of food and perennial allergens did not show significant correlations. Conclusion:
this study showed that large adenoid may be associated with absence of allergy, whereas large turbinates
may be associated with small adenoid. These findings may be helpful in clinical management of a child
with nasal obstruction, so a detailed evaluation of the nose and nasopharynx is mandatory in each child
with this complaint and it should be performed by nasal endoscopy. Consequently, the treatment should
be geared toward the specific findings in that individual.
Keywords: adenoid hypertrophy, allergic rhinitis, relationship, skin prick test

The adenoid is aggregate of lymphatic tissues,
(6). It is well known that children with allergic
located at the junction of the roof and the
rhinitis usually have lymphoid hypertrophy of
posterior wall of the nasopharynx(1). The
upper airway, mainly concerning the adenoids
adenoid is part of the ring that encircles the
(7). Furthermore, AH and AR in children have
pharynx collectively defined as the Waldeyer's
very similar clinical manifestations, mainly as
ring that includes the adenoid, the lingual
nasal obstruction and snoring and are associated
tonsils, the two palatine tonsils and the
with impaired quality of life, failure to thrive
lymphoid tissue situated on posterior wall of the
and poor school performance (8). AH and AR
pharynx (2). The adenoid physiologically serves
can co-exist in the same patient and treating
as a defense against respiratory antigens
allergy may relieve patient's symptoms and thus
(microbes, allergens, etc) at the entry of upper
avoid unnecessary surgery (9). It is mandatory
aero-digestive tract having a significant role in
to determine the cause of nasal obstruction
the adaptive immune response (3). As a
before starting any treatment as it is a non-
specific symptom associated with variety of
associated with chronic inflammation, the
disorders. Because of the location of adenoids
adenoid may enlarge so that it may almost fill
in the posterior wall of nasopharynx, the
the nasopharynx (4)Adenoidal hypertrophy
measurement of both adenoid pad and airflow
(AH) is detected in most of general pediatric
obstruction represents a challenge issue.
population and constitutes one of the most
Several modalities have been proposed such as
frequent otorhinolaryngological indications for
acoustic rhinomanometry, endoscopy, intra-
surgical intervention (5). On the other hand,
operative mirror rhinopharyngoscopy and
Allergic rhinitis (AR) is frequent in children,
radiographic assessments (10). However, the
affecting up to 30% of the general population
most commonly used preoperative modality in
Received: 03/10/2018
Accepted: 24/10/2018

Full Paper (vol.741 paper# 14)

c:\work\Jor\vol741_15 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 103-109

Evaluation of Gastro-Esophageal Reflux Disease after Sleeve Gastrectomy
in Morbid Obese Patients
1Mohammed Elsayed Radwan, 1Mohammed Arafat Abdel-Maksoud, 2Ashraf Abdo-Almonem
Sayed Ahmad Abotaleb, 1Sobhy Rezk Ahmed Teama
1Department of General Surgery, 2Department of Clinical Pathology, Faculty of Medicine, Al-Azhar
Corresponding author: Sobhy Rezk Ahmed Teama, Mobile: 01061757521 Email: sobhyteama2007@gmail.com

obesity is one of the major problems in the world and is associated with several
comorbidities and disabling diseases e.g. cardiovascular disease, metabolic syndrome, type 2 diabetes
mellitus (T2DM), infertility, certain tumor types, and GERD. Management consisted of conservative
and surgical measures, conservative measures such as diet modifications physical exercise and
pharmacological therapy. There was considerable evidence in the literature on the long-term positive
impact of bariatric surgery as a primary therapy for the treatment of obesity and its co-morbidities.
this study aimed to conclude that if gastroesophageal reflux disease develops after sleeve
gastrectomy in morbidly obese patients or not. Patients and Methods: this prospective non-comparative
study was conducted in Surgery Department, Al-Azhar University Hospitals in the period between
October 2016 and October 2018. Study included 30 cases of morbidly obese patients (with BMI 40
Kg/m˛ or 35 Kg/m˛ associated with comorbidities) and they were submitted for laparoscopic sleeve
gastrectomy and all of them had failed in trials of conservative management including dietary control
and they are bulky eater but non-sweet eater. Results: the prevalence of gastroesophageal reflux disease
(GERD) was markedly increased in morbid obese patients compared to the incidence in normal
individuals, with a percentage of up to 70% of patients undergoing bariatric surgery. SG is associated
with an increase in GERD prevalence. The measured increase in GERD prevalence ranged from 2.1%
to 34.9% in the analyzed literature. There was marked heterogeneity between the studies in regard to a
number of factors including preoperative BMI, method of evaluating GERD, exclusion criteria, length
of follow-up and operative technique. Conclusion: only in a very special group of patients with BMI
between 30 and 35 and comorbidities, SG plus other antireflux procedure or hiatal hernia repair is
Keywords: central nervous system, gastro-esophageal reflux disease, laparoscopic sleeve gastrectomy


Obesity is a chronic medical condition
increase incidence of different tumors (3). An
in which excess body fat has accumulated to
additional common weight-related comorbidity
extend that it may has an adverse effect on
is gastroesophageal reflux disease (GERD),
health, leading to reduction of life expectancy
with an increase in both reflux symptoms and
or increasing health hazards. Obesity and its
esophageal adenocarcinoma associated with a
related co-morbidities are increasing to
body mass index above 30 (4). The Montreal
epidemic proportions at an alarming rate
Classification defines GERD as a condition that
worldwide. It is estimated that more than 300
develops when reflux of stomach contents in
million adults worldwide are obese (Body Mass
the esophagus causes troublesome symptoms or
Index [BMI] >30 kg/m2) and 20% of them are
complications. Symptoms associated with
morbidly obese (BMI >35 kg/m2) (1). In Taiwan,
the incidence of morbidly obese patients (BMI
regurgitation laryngitis, and chronic cough.
>35 kg/m2) had doubled the incidence in the
Prolonged acid exposure within the esophagus
past decade and consisted of 1.5% of the
can lead to histopathologic and structural
population in a recent survey (2).
changes as peptic stricture and Barrett's
Obesity prevalence is increasing
esophagus (5). Bariatric surgery is the most
rapidly worldwide, in both developed and
effective treatment for morbid obesity and the
developing countries, a number of serious
long-term results regarding weight loss and
comorbidities are associated with morbid
improvement of obesity related co-morbidities
obesity, apnea, gastroesophageal reflux disease
(6). Sleeve gastrectomy (SG) was seen just as a
(GERD), nonalcoholic fatty liver disease and
part of the biliopancreatic diversion with
Received: 03/10/2018
Accepted: 22/10/2018

Full Paper (vol.741 paper# 15)

c:\work\Jor\vol741_16 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 110-116

Diagnostic Value of Electrocardiographic ST-T Wave Changes in Lead
aVL in Patients with Chronic Stable Angina

Mohamad Osama Kayed, Aly Aly Ramzy, Ibrahim Yassin,
Eslam Ismail Zakria Kotb

Department of Cardiology, Faculty of Medicine, Alazhar University

Corresponding Author: Eslam Ismail Zakria Kotb,Phone: 01003334493,email:Dreslamkotb222@gmail.com


Background: coronary artery diseases affect millions of patients in the world which cause a lot of
complications up to death. by very simple non-invasive method like ECG we can predict and early
diagnose and even localize very serious lesion in coronary angiograghy in patient with chronic stable
angina and this is the target of our research. Aim of Work: this study aimed to detect the diagnostic
value of ST segment and T wave changes in lead AVL in patient with chronic stable angina. Methods:
this was a prospective observation study that was done from June 2017 to July 2018 and it included 200
patients presented to Alhussin University Hospital or referred to us from other secondary hospitals with
chronic stable angina. All patients were subjected to full history, clinical examination, ECG and
coronary angiograms with focusing on ST segment and T wave changes and analyses and localized the
lesions in coronary angiograms and their relationship to previous ECG changes. Results: mean age in
patients in our study was 55.89 years old with 77% males and 23% females. Most common risk factor
was HTN. There was a relationship between ST-T wave changes in lead AVL in patient with chronic
stable angina with moderate agreement to mid LAD lesion 78% and to lesser degree LCX then RCA
and LM. Conclusion: according to the previous results of our research, inverted T wave in lead AVL
in chronic stable angina corresponds angiographically to tight mid left anterior descending coronary
artery lesion.
Keywords: ECG,aVI,t wave,St segment chronic stable angina.


Coronary heart disease also called
years vs <50 years (11% vs 5%) (3-5).As we know
coronary artery diseases affect millions of
there are three main coronary arteries that supply
people around the world which cause a lot of
complications up to death(1) . About 71 million
descending artery) and (RCA >> right coronary
in USA are suffering from cardiovascular
artery) and (LCX >> left circumflex
complications that represented 1 in every 2.5
artery).LAD supplies 60 % to 70% of the left
adult including 15 million with coronary artery
ventricular myocardium and early management
disease and about 10 million are suffering from
of its proximal obstruction is mandatory to
angina. In the age group of 60 to 79 years old
prevent major myocardium ischemic damage (6).
about 25 % of men and 17 % of women had a
So, early diagnosis and treatment of LAD
very serious IHD and these numbers rise to 35
obstructive lesion is very important to prevent
% for men and 24% for women in the age group
serious damage of the main pump power of the
above 80 years old (2). In additional to data
heart (the left ventricle).ECG is an important
obtained from the World Health Organization
fast, non invasive, safe, bedside and cheap
(WHO) there was a national project (the
method to diagnosis acute or chronic heart
Egyptian National Hypertension Project) that
disease which provides important diagnostic and
provided us by important information on the
prognostic information about the patient with
epidemiology of the coronary heart disease in
chest pain. Inverted T wave and ST segment
Egypt. The data base that obtained from this
depression are a very important sign of ischemia
project which represented survey of 6733
in patient with chest pain and is always
subjects 50% male and 50 % was females; 8.5
associated with CAD (7). Localization of
of this survey were suffering from coronary
coronary heart disease narrowing or obstructive
heart disease. It was noticed that females were
lesion and localization of the anatomic site of
more affected 8.9% and males 8.3%, but it was
myocardiaL infarction are dependent on the
clearly associated with an urban versus rural
localization of T wave or ST segment changes
location (8.8% versus 7% ) and age group 50
Received: 03/10/2018
Accepted: 22/10/2018

Full Paper (vol.741 paper# 16)

c:\work\Jor\vol741_17 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 117-119

Fournier gangrene as an atypical presentation of seminal vesicle abscess: a
case report
Mohammed Alfozan
College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia
Corresponding author: Mohammed Alfozan,Email: dr.masf@gmail.com

seminal vesicle abscesses are usually misdiagnosed due to the rarity of this pathology
and can be mistakenly diagnosed as an inguinal hernia or scrotal abscess even with the aid of
computerized tomography of the abdomen and pelvis. We report a case where a pre-operative diagnosis
was difficult owing to the atypical presentation with Fournier gangrene.
Aim of the work: To the best of our knowledge, our case is the first to report a seminal vesicle abscess
presenting as Fournier's gangrene. We believe it can add to the scarce literature and help increase the
index of suspicion for such rare urological condition.
Results: For our patient, the transurethral approach was successful without any complications and he
was asymptomatic and able to void on the third day postoperative.
the transurethral drainage is a good alternative to transrectal drainage with comparable
hospitalization period and symptoms relief. Also, it ensures complete drainage of the abscess cavity.
Keywords: seminal vesicles, abscess, atypical presentation

Seminal vesicle abscess is a rare entity with
had a fever of 39.5C, pulse rate of 112 and
only 28 cases reported in the English literature
blood pressure of 103/65. He appeared fatigued
[1­3]. The first case of seminal vesicle abscess
and dehydrated. Abdominal examination
was reported by Raijfer et al. in which the
revealed generalized abdominal distention and
patient presented with fever and prostatic mass
tender swelling over the left inguinal area.
[3]. A review was done by Pandey et al.
Genital examination showed swollen scrotum
documented the clinical presentations of
with gangrenous scrotal skin (Figure 1).
reported cases with 74% presenting with fever,
58% with dysuria and 32% with a tender
prostate or ongoing epididymo-orchitis [1].
Although the a literature recommended the use
of transrectal ultrasound (TRUS) in diagnosing
seminal vesicle abscess, CT scan is the most
frequently described diagnostic tool [2]. TRUS
has the advantage of a real-time image that can
show the extent of the abscess cavity and the
extension of physical diagnosis yet without
radiation exposure. In addition, it has the ability
to be used for diagnostic, therapeutic and
follow-up purposes. Surgical drainage has been
the mainstay for treatment, which can be

achieved by the transrectal, transperineal or
Figure 1: picture of the scrotum that shows
transurethral approach [2].
marked swelling with a large area of
gangrenous skin

Case report
This was a 66-year-old male who was known to
have hypertension and type II diabetes mellitus.
hemoglobin was 68 gm/l, white cells count was
20,000× 109/L and hematocrit was 22%. His
He presented to the Emergency Department
serum sodium, random glucose, blood urea
with a 30-day history of scrotal and left groin
swelling with a history of fever and no history
nitrogen, creatinine, and serum CO2 levels
were 125 mEq/L, 23.8 mmol/l, 10 mmol/L, 111
of dysuria or hematuria. He had a history of not
passing bowel motion for six days with
mol/L and 70 mEq/L respectively. Urinalysis
was positive for bacteria, negative for nitrate
abdominal pain. On physical exam, the patient
with WBC 35 per high power field (HPF).
Received: 02/10/2018
Accepted: 21/10/2018

Full Paper (vol.741 paper# 17)

c:\work\Jor\vol741_18 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 120-125
The Comparative Preemptive Analgesic Efficacy of Addition of vitamin B
Complex to Gabapentin versus Gabapentin alone in Orthopedic Surgery
under Spinal Anesthesia

Ismael Abdel-Latif Shabayek, Saeed Mostafa Abdel-Hamid, Mohamed Mohsen Abdellatif

Anesthesia and Intensive Care Department, Faculty of Medicine, Al-
Azhar University
Corresponding author: mohamed mohsen, email:dr.m_elbanna@yahoo.com

development of new multimodal analgesic regimens have led to substantial improvement
in postoperative pain relief. Aim of the work: we designed this study to compare the effect of combined
vitamin B complex-gabapentin versus gabapentin alone on postoperative pain in orthopedic surgery
under spinal anesthesia. Methods: 80 patients who underwent elective orthopedic surgery under spinal
anesthesia were randomized to receive orally 300mg gabapentin (Group G) or 300mg of gabapentin
plus 2 vitamin B complex (Group GB) tablets 30minutes before surgery. Postoperative pain intensity
and total analgesic consumption during 12 hours after surgery, vomiting, and drowsiness during
recovery were assessed. Results: the pain intensity in the gabapentin plus vitamin B complex group
was lower than gabapentin group during 12hours after surgery (p-value <0.001). Meanwhile, the total
analgesic consumption in this group was less than gabapentin alone (p-value <0.05). The incidence of
vomiting in patients who received combined gabapentin--vitamin B complex group was similar to
gabapentin alone (p-value >0.05). Conclusion: combination of vitamin B complex to gabapentin
reduced intensity of postoperative pain and also the total amount of analgesic consumption within the
first 12hours postoperative following orthopedic surgery under spinal anesthesia.
orthopedic surgery, gabapentin, pain, vitamin B complex

Pain is defined by International Association for
postoperative pain hyperalgesia and chronic
Study of Pain (IASP) as an unpleasant sensory
pain after surgery [3,4]. Furthermore, pain control
and emotional experience associated with
after cesarean delivery improved the general
actual or potential tissue damage. The relief of
condition of the patient and infant rooming in
postoperative pain is a subject, which has been
times breastfeeding [5]. Nowadays, opioids are
receiving an increasing amount of attention in
widely used for pain relief but, they often
the past few years. Postoperative pain due to
provide suboptimal analgesia with occasional
surgical trauma and tissue injury is associated
serious side effects [5]. Furthermore, it is
reported that a single administration of an
catecholamine and inflammatory mediator
opioid may induce a long lasting increase of
release, and the central sensitization, which is
threshold pain sensitivity, leading to delayed
considered to be one of the mechanisms
hyperalgesia [5,6]. Therefore, the search for a
responsible for the persistence of postoperative
new drug to decrease the severity of
pain [1].The noxious stimuli may cause the
postoperative pain with minimal side effects is
expression of new genes (Which are
necessary. Some clinical trials for using
resp0nsible for neuronal sensitization) in the
gabapentin as preemptive analgesia, given
dorsal horn of the spinal cord within 1hour after
before a variety of surgical intervention
tissue injury due to surgical trauma. Hence, the
producing visceral and somatic injury, have
traditional separation between the acute and
found significant reduction in postoperative
chronic pain is unproven because the acute pain
analgesic requirements and others have found a
may quickly turn into chronic pain. Also, the
reduction in early and late postoperative pain [7­
intensity of acute postoperative pain is a
10]. Furthermore it is reported that pretreatment
significant predictor of chronic postoperative
with gabapentin prevents the occurrence of
[2,3] . Prevention of central sensitization with
hyperalgesia[11] with no effect on platelets,
multimodal analgesic interventions could
gastric mucosa, renal function and renal
reduce the intensity or even eliminate acute
function respiratory system [12]. The analgesic
Received: 15/09/2018
Accepted: 30/09/2018

Full Paper (vol.741 paper# 18)

c:\work\Jor\vol741_19 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 126-134

Posterior Lumbar Interbody Fusion in Degenerative Spondylolisthesis
Mohammed Bisar, Ahmed Akar, Ashraf Albasiony*
Orthopedic Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Ashraf Albasiony, Mobile: 01156561034, Email: basiony5527@gmail.com

Background: degenerative spondylolisthesis is one of causes of low back pain in older patients and it's
referring to a forward slippage of a lumbar, with an intact neural arch. Uncommon before the age of 50
years, it is more common in women and particularly in blacks, with a male: female ratio of 1:6. Posterior
lumbar interbody fusion surgery is one of an effective surgery in treatment of patients with degenerative
spondylolisthesis and can make significant relief in low back pain and disability. It has amore advantages
more than other type of back surgery through restoring of vertebral height and restricts motion of the
vertebral segment.
Objective: this study aimed to evaluate the surgical treatment of degenerative spondylolisthesis by
Posterior Lumber Interbody Fusion.
Patients and Methods: this was a prospective study carried out at Al-Azhar University Hospitals on 15
patients with degenerative spondylolithesis operated by posterior lumber interbody fusion and assessment
pre-operative, one day, three months and six months post-operative by oswestry disability index .also
according to visual analogue scale pre and post-operative then assessment of the fusion according to lenke
Results: the mean preoperative ODI was (70.2%±5.5) one day Postoperative ODI was (10.93%±4.76), after
3 months was (10.67±7.97) and 6 months the mean post-operative was (12.76±14.25). According to VAS
for back pain pre-operative was (6.9± 0.9) preoperative and show marked improvement and the main
postoperative value according to VAS is (1.53±1.126) for leg pain The mean value Pre-operative according
to VAS was :(9.06±0.7) and the mean value Post operativeis (2.0±1.41) the mean outcome was 87.24 %
ranged from 38% to 94% the main complication noted the adjacent segment degenerative disease and Dural
Conclusion: posterior lumber interbody fusion in degenerative spondylolisthesis is a very good option.
Key word: degenerative spondylolisthesis, interbody fusion

Degenerative spondylolisthesis refers to
results. Farfan believes that in addition to
a forward slippage of a lumbar, with an intact
degeneration of the disc there are multiple small
neural arch. Uncommon before the age of 50
stress compression fractures of the inferior
years, it is more common in women and
articular processes of the olisthetic vertebra. As
particularly in blacks, with a male: female ratio of
the slip progresses, the articular processes change
1:6 (1). L4-L5 is the most commonly affected level
directions and become more horizontal. One side
and rarely exceeds 30% of the vertebral width.
nearly always rotates more than the other. This is
Degenerative spondylolisthesis is usually
an integral characteristic of this disease.Farfan
asymptomatic but may be associated with
believes that the typical hour-glass deformity
symptomatic stenosis of the lumbar spinal canal.
seen on the myelogram is due to rotation of the
The canal stenosis is the most common cause of
upper vertebra with displacement of the pedicle
back surgery in adults over 55 years when
decompression and stabilization in degenerative
asymptomatic. Therefore, clinical radiological
correlation is essential for making decisions (2).
conservative treatment fails (4). The surgical
The lesion is due to longstanding
treatment of degenerative spondylolisthesis is
intersegmental instability. Remodeling of the
indicated for cases of neurogenic claudication,
articular processes at the level of involvement
intractable radicular pain, severe low back pain,
Received: 10/09/2018
Accepted: 29/09/2018

Full Paper (vol.741 paper# 19)

c:\work\Jor\vol741_20 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 135-141

A Comparative Study between Bedside Chest Ultrasound and Traditional Chest
Radiography in Critically Ill Patients

Omar M. Abo Shahba, Mohamed F. Agag, Badr I. Allah, Shadi M. Yousef

Department of Anesthesia and ICU, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Shadi M. Yousef; Mobile: 01095266156; Email: shadi_magdi_1990@hotmail.com
Bedside chest ultrasound emerge a sensitive tool with much higher sensitivity than plain chest x-ray.
It avoids the cost, risk of transportation to perform the CT chest and that of radiation exposure. Aim of the Study:
was to evaluate the sensitivity and the specificity of bedside ultrasound in the detection and the evaluation of chest
conditions of critically ill patients in comparison of CT chest as the gold standard tool. Patients and Methods: This
prospective study was conducted on a registry of 80 patients with different chest pathology admitted to the Medical-
Surgical Intensive Care Unit of Bab Al Shaeria Hospital between March and November 2018. Results: bedside
chest ultrasound sensitivity in detection and evaluation of pneumothorax, pleural effusion, and consolidation and
Interstitial lung disease in comparison to CT chest showed sensitivity around 93 % with little cost, without risk of
radiation exposure and transportation of critically ill patients. Conclusion: Bedside chest ultrasound is a highly
sensitive and specific tool in the detection and evaluation of many chest conditions that eliminates the risk of
transportation of unstable patients and that of radiation exposure and is easily accessible in resource limited areas.
Key words: bedside chest ultrasound, traditional chest radiography, critically ill patients

Traditionally chest imaging in critically ill
Patients and Methods:
patients is performed either by bedside chest
This prospective study included a total of 80
radiography (CXR) or thoracic computed
patients with different chest pathology admitted to
tomography (CT), both techniques have limitations
the Medical-Surgical Intensive Care Unit of Bab Al-
which constrain their usefulness (1).
Shaeria Hospital. Approval of the ethical
Although thoracic CT is the gold standard
committee and a written informed consent from
for chest imaging, it is expensive and cannot be
all the subjects were obtained. This study was
performed on a routine basis. In addition to the
conducted between March and November 2018.
transportation of critically ill patients to the
Patients were assigned into four groups. The
radiology department combined with the radiation
groups are categorized after the results of
exposure carries a measurable risk (2).
radiological investigations and allocated randomly
On the other hand, limitations of bedside
as the following:
CXR have been well described and lead to poor-
20 patients
quality X-ray films with low sensitivity. Indeed, it
has been shown that even under carefully
b) Group B, 20 patients with pleural
controlled exposure conditions more than 30% of
the X-ray films are considered suboptimal (3).
c) Group C, 20 patients with consolidation.
Finally, there is poor correlation between
d) Group D, 20 patients with interstitial
CXR findings and those of CT. Nevertheless, despite
chest syndrome.
these limitations bedside CXR remains the daily
Patients age was ranging from 22-85 years,
reference for chest imaging, Nowadays bedside chest
74 % of them were males. 46% of patients were
ultrasound is increasingly used in patients managed
diabetic while 42% were chronic hypertensive. The
in intensive care units (ICUs) (4).
demographic data for the included patients is
It has been shown in patients with acute
demonstrated in table (1).
respiratory distress syndrome (ARDS) that

compared to bedside chest X-ray, chest ultrasound
Inclusion criteria:
has a higher diagnostic accuracy for pleural
This study included any patient with
effusion, consolidation, and interstitial syndrome
different chest pathology regardless the age of
adult ICU patient or gender. Chest lesions included
The aim of the current study was to
consolidation, pnemothorax, pleural effusion and
compare the diagnostic performance of chest
interstitial chest syndrome.
ultrasound versus bedside chest CXR and thoracic

C.T for the detection of several pathologic

abnormalities in unselected critically ill patients.
Exclusion criteria:

Received: 01/10/2018
Accepted: 20/10/2018

Full Paper (vol.741 paper# 20)

c:\work\Jor\vol741_21 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 142-146

A prospective Study of the Risk of Depression in Acne Patients Treated
with Oral Isotretinoin
Rabie Bedir Atallahb 1, Hany Othman Abo Alwafa 1, Mohamed Abdel Fattah El Mahdy 2,
Asmaa Elsayed Mahmoud 3
1Dermatology, Venereology and Andrology Department,2Psychatric Department, Faculty of
Medicine, Al-Azhar University, Damietta, Egypt, 3 Dermatology Department, Damanhour National
Medical Institute
Corresponding author: Asmaa Elsayed Mahmoud, Mobile: 01003407130; Email:dr_snowwhite1234@yahoo.com

depression showed up as potential side effect of isotretinoin in the summary of product
characteristics. There have been numerous studies treating this issue yet as a rule not distinguishing any
significant depression or suicide risk.
Aim of the Work: this study aimed to evaluate the risk of depression in acne patients treated with oral
isotretinoin therapy. Methods: one hundred patients with moderate to severe acne were enrolled in non-
controlled prospective study. The psychological condition was evaluated at the baseline and fourth
month by the Hamilton Depression Rating Scale (HDRS) for all patients. Statistical analysis of HDRS
scores was performed. Results: all patients completed the study. Before the treatment 18% of the
patients had suffered from mild depressive symptoms. at end of 4 months The patient's scores remained
below the subclinical level for depression except only 2 patients one was mildly depressed turned to
moderately depressed after four months treatment with isotretinoin other was mildly depressed and still
mildly depressed after four months treatment with isotretinoin. The incidence of depression was 1%.
Symptoms of depression which occurred in two patients, in which case coexisting situational factors
were found to be the cause. Conclusion: our results showed that the oral isotretinoin treatment for acne
at the typical therapeutic dose caused significant reduction in depression scores with a depression
incidence only 1%. These changes might be related to clinical effect of isotretinoin. Moreover, the
treatment of acne improved symptoms of depression for most patients.
Acne valgaris, systemic isotretinoin, depression.


Due to its brilliant anti-acne effect,
Before the oral administration of
isotretinoin is the first choice of treatment for
isotretinoin (at baseline), the severity of acne
severe acne or moderate acne not responding to
was assessed by grading, clinical photographs,
topical and or oral antibiotic (1). The
and physical dermatological examination.
relationship between isotretinoin treatment for
Grading was performed according to Global
acne and depression stays controversial both
Acne Grading scale. Details of any psychiatric
clinically and experimentally (2).
history (Psychiatric diagnoses and/or treatment
AIM of the WORK
by a psychiatrist or psychologist) were
The aim of the study was to evaluate
recorded. The psychiatric status of patients was
the risk of depression in acne patients treated
determined by using questions about
with oral isotretinoin therapy.
Materials and Methods:
responses to acne. Participants completed the
The participants in the study were
Hamilton Depression Rating Scale (HDRS).
recruited between September 2017 and
All questionnaires were checked by a
September 2018 among attendants of
psychiatrist. HDRS gave a rating of depression
Department of Dermatology and Venereology
and changes in violent behavior of the patient.
Scoring was based on the 17-item scale and
University Hospital. Male and female patients
scores of 0­7 were considered as being normal,
aged 12 years who were suffering from
8­13 suggested mild depression, 14­18
moderate to severe acne was eligible to
moderate depression and scores over 19-23 are
participate. At the screening assessment,
indicative of severe depression 23 indicative
patients completed medical histories were
for very severe depression. Although the HRDS
recorded, and routine physical and laboratory
form lists 21 items the scoring was based on the
examinations were performed.
first 17 to assess severity of depression.
Received: 03/10/2018
Accepted: 24/10/2018

Full Paper (vol.741 paper# 21)

c:\work\Jor\vol741_22 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 147-155

Assessment of Routine Drainage in Elective Thyroid Surgery. A Prospective
Randomized Study
Ayman Helmy Ibrahim
Department of General Surgery, Faculty of Medicine, Al-Azhar University
E-mail: dr.aymanhelmy10@gmail.com

At the end of thyroidectomy surgery, there was an area of some debate about insertion
of closed suction drain before closure. The decision of routine use of drain depends on the surgeon's
training, experience, and personal preference. Many surgeons prefer to place drain to minimize dead
space collection and to prevent or reduce the post-operative hematoma that may be life-threatening so,
the insertion of drains was generally accepted, although there are many studies that show no difference
in the rate of complication with or without drain insertion. Moreover drain insertion may be
accompanied by many hazards such as more hospital stay and post-operative pain. So, the concept of
routine use of drain should be revised in the light of recent reports that test the real need for its use.
Aim of the study: this study aimed to assess if there was actual benefit from the use of drain in thyroid
surgery and to evaluate the necessity of its use in thyroid surgery and to detect hazards of its use.
Patients and methods: between June 2015 and July 2018, a prospective randomized study included 87
patients from those had elective thyroid surgery in Al-Hussien University Hospital for different
indications. Patients had been categorized into 2 groups; group A (93 patients) for thyroidectomy
without insertion of drain and group B (93 patients) for thyroidectomy with insertion of suction drain.
In the study, results including: post-operative pain, hospital stay and complications (including wound
infection, seromas, post-operative bleeding, hematoma, recurrent laryngeal nerve (RLN) palsy or hypo-
parathyroidism) were documented. Follow up after patient discharge was done until healing of wounds
to detect post-operative complications. Results: the overall postoperative complications rate in the
study was low (13 patients) in the two groups. In the non-drained group, there were one case of
hematoma ( 2.5 %), 2 cases of seroma ( 5.1 %), one case of RNL palsy ( 2.5 %), one case of transient
hypoparathyroidism (2.5 %) and no cases of wound infection, whereas in the other group, there were 2
cases of hematoma ( 5.1 %), 3 cases of seroma ( 7.6 %), 2 case of RNL palsy ( 5.1 %), 2 case of transient
hypoparathyroidism ( 5.1 %) and no cases of wound infection. There was no statistical significance
between both groups as regard incidence of complications. In the non- drained group, 37 patients (94.8
%) were discharged at the next day after surgery while in the drained group 2 patients (5.1%) only were
discharged in the next day and the remaining patients were discharged after removal of drain after 48
hours. The mean hospital stay for the non- drained group was 1.2±1 days and the mean hospital stay for
the drained group was 2.1±1 days. Conclusion: in the study, use of drain in thyroid surgery did not
have significant effect on the rate of incidence or prevention of postoperative complications. In serious
postoperative bleeding, the drain which usually has small pores often become blocked be blood clots
and become useless. On contrary, insertion of drain prolongs patient hospital stay and increases
postoperative pain. So, routine use of drain in elective thyroid surgery should be prohibited.
Key words:
drain, thyroidectomy, post-oprative complications.
In most thyroidectomies, drainage is
draining post-operative hematoma or lymphatic
very low and in the case of incomplete drainage
fluid collection and to alert the surgeon to early
of large volume of collection, seroma or
post-operative bleeding [3]. Surgeons adopting
hematoma is unavoidable. Also we should
the concept of routine drainage noted that some
notice the fact that adequate haemostasis could
thyroidectomies with a dry surgical dissection
never be replaced by insertion of drains [1]. In
have still developed significant post-operative
spite of these facts, drains are still routinely
collection and drainage. They keep all patients
inserted by most surgeons in thyroidectomy [2].
overnight with a drain for two purposes: 1) to
The use of drain is a tradition and belief on
drain excess collections; 2) to detect active
surgeons rather than evidence based trials and it
bleeding in those who may develop a post-
depends on the surgeon's experiences and
operative hematoma 4. It might be accepted that
practice. The main purpose of drain use is to
the use of drain in the past decades was to some
prevent post-operative complications by
extent needed due to high rate of post-operative
Received: 01/09/2018
Accepted: 25/09/2018

Full Paper (vol.741 paper# 22)

c:\work\Jor\vol741_23 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page
156 61

Correlation between Serum Interleukin-31 Level and the Severity of Atopic
Dermatitis in Children

Rabie Bedir Atallah1, Ahmed Wahhed-Allah Amer1, Hesham Samir Abd El-Samee2, Reham
Mahmoud Ibraheem3

Departmentsof 1Dermatology, Venereology &Andrology and 2 Clinical pathology, New Damietta
Faculty of Medicine, Al-Azhar University, Damietta, 3 Departments of Dermatology, Desouk General
Hospital, Egypt
Corresponding author: Reham Mahmoud Ibraheem, Mobile: 01005156262; Email: reham19885@gmail.com

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease, characterized by intense
itch, typical localization and a specific image of skin lesions. Pathogenesis of pruritus in AD is not fully
understood, but recent studies emphasize the role of interleukin-31 (IL-31). This relatively recently
described cytokine is considered to be a potential mediator inducing pruritus in AD.
Aim of the Work: was to assess the correlation of serum IL-31 level and the disease severity in children
with AD.
Patients and Methods: a case control study. Sera were obtained from 50 AD children and 30 healthy
volunteers. IL-31 levels were measured using ELISA with standard kits from EIAab R&D Systems.
Serum IL-31 levels were correlated with AD disease activity. Disease severity in children with AD was
assessed using the SCORAD (Severity scoringof atopic dermatitis) index.
Results: Serum IL-31 level was significantly higher in AD children (Mean ± SD 99.73 ± 75.93) than
in healthy children (Mean ± SD 54.01 ± 57.36), (p-value = 0.019). Serum IL-31 levels correlated
positively with the calculated severity score (SCORAD index), (rs = 0.480, p- value <0.001)
Conclusion: The results of this study confirm the importance of IL-31 in AD pathophysiology. Serum
IL-31 level is an objective reliable marker of AD severity in children. It may represent a novel target
for antipruritic drug development.
Keywords: atopic dermatitis, interleukin-31, severity SCORAD, pruritus, children.

Atopic dermatitis (AD) is a chronic, relapsing
relatively newly described cytokine is
and pruritic inflammatory skin disease,
preferentially produced by activated T cells
characterized by typical localization and a
skewed towards Th2 [6]. Interleukin-31 is
specific image of skin lesions, with coexistence
related to the IL-6 cytokine family [7]. It signals
of other atopic diseases. Diagnostic criteria for
through a heterodimeric receptor composed of
AD elaborated by Hanifinand Rajka have been
IL-31 receptor (IL-31RA) also known as
universally accepted, due to a large variety of
gp130-like receptor (GPL) and oncostatin M
the clinical picture [1]. Pruritus is one of the most
receptor (OSMR) [6,8,9]. Other studies revealed
common symptoms in AD, practically
that IL-31 serum levels are higher in patients
occurring in each patient. Therefore, it has been
with AD comparing to healthy controls [10].
included as one of the four major diagnostic
Moreover, serum IL-31 levels correlate with the
criteria [1,2]. Scoring the intensity of pruritus is
disease activity in atopic patients [11].
an integral part of the SCORAD (Severity
Evidence of the importance of IL-31 in the
SCORing of Atopic Dermatitis) index, which is
pathogenesis of pruritus is also present in
commonly used to determine the severity of the
studies on IL-31 inhibitors relevant to the
disease [3]. The etiology of pruritus in AD is not
treatment of AD [12, 13].
fully explained, however the participation of
The aim of the study was to assess the
some endogenous mediators, neurotransmitters,
correlation between serum IL-31 levels and
arachidonic derivatives and cytokines has been
severity of AD in children.
pathophysiology [4]. Recently, in numerous
This study included a total of 80 subjects,
studies, interleukin-31 (IL-31) has been
divided into two groups; group I: 50 patients
associated with the pathogenesis of pruritus in
with atopic dermatitis and group II: 30 Healthy
chronic inflammatory skin diseases [5]. This
volunteers served as control group. They were
Received: 15/09/2018
Accepted: 30/09/2018

Full Paper (vol.741 paper# 23)

Summary The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 162-169

Detection of Subclinical Left Ventricular Systolic dysfunction by 2D Speckle Tracking
Echocardiography in Patients with Peripheral Artery Disease

Mohammad S. Al-Baz1, Wael Mohammad Attia1, Hany A. Abd El-Fattah2, Islam F. Abd Al-
Gawad1 *
1 Department of Cardiovascular Medicine, 3 Vascular Surgery, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
*Corresponding author: Islam F. Abd Al-Gawad; Mobile: 01024330323; Email: dr.abonasab@gmail.com
peripheral arterial disease (PAD) is estimated to affect 202 million people worldwide, with
prevalence that is increasing over time. PAD represents a local manifestation of systemic atherosclerosis
and portends a 2-6 fold increase in both cardiovascular and cerebrovascular events with an annual
mortality rate of 4-6%(1,2).
Aim of the Work: the aim of this work was to detect left ventricular subclinical dysfunction using 2-
dimensional speckle-tracking echocardiography (2D-STE) in patients with peripheral arterial disease.
Patients and Methods: the ethical approval was obtained from the hospital Ethical Research Committee
and each patient entering the study signed an informed consent. In a case-control study, 30 patients included
was diagnosed with peripheral arterial disease and 20 control. They were recruited from Vascular department
at Al-Hussein and Bab El-She'riya University Hospitals during the period from June 2018 to November
Results: there was moderately strong significant correlation between ABI and left ventricle 2d speckle
tracking echocardiography (2D-STE) (GLS% (p=0.003, r=0.52), AP4% (p=0.001, r=0.57), AP3% (p=
0.004, r=0.51) and AP2% (p=0.005, r=0.50)). This correlation was obvious according to limb affection (one
limb vs. both limbs, GLS% p=0.025, AP4% p=0.038, AP3%=0.013 and AP2%=0.046) and severity (severe
arterial disease vs. moderate arterial disease vs. some arterial disease subgroups GLS% p=0.003, AP4%
p=0.001, AP3%=0.002 and AP2%=0.015). Also, there was moderately strong significant correlation of ABI
with left ventricle systolic function (p=0.011, r=0.46) while other conventional echo parameters were of no
significance with decline in ABI.
Conclusion: peripheral arterial disease patients had lower global and segmental longitudinal strain than the
healthy subjects and this was more prominent either with severity or limb affection. This study showed that
even there is correlation between decline ABI and left ventricular systolic function EF% but LV GLS offer
a better economic way to detect subclinical dysfunction in asymptomatic patient.
Keywords: echocardiography, peripheral arterial disease, ankle brachial index and speckle tracking,
global longitudinal strain.
Peripheral arterial disease (PAD)
artery disease, improved prediction of acute
represents a local manifestation of systemic
coronary events, higher prevalence of
atherosclerosis(2) and portends a 2-6 fold increase
in both cardiovascular and cerebrovascular
Approximately 202 million people are
events. The diagnosis is also associated with an
affected with PAD worldwide, of whom almost
annual mortality rate of 4-6%. In addition to
40 million are living in Europe. Eight to ten
million Americans suffer from PAD with an
symptoms, uncontrolled disease can progress on
overall prevalence 12% in the adult population(4).
to critical limb ischemia the end stage of PAD(1).
Regarding the natural history, in a recent meta-
The ankle-brachial index has been used as an
analysis, most patients with Intermittent
important indicator for diagnosis of peripheral
arterial disease, particularly in studies of elderly
cumulative CV-related morbidity of 13% vs. 5%
populations with a high incidence of clinically
in the reference population. Regarding the limb
significant atherosclerotic disease. A low ABI is
risk, at 5 years, 21% progress to Critical Limb
Ischemia, of whom 4­27% have amputations(5).
cerebrovascular disease, more severe coronary
Leg amputation due to atherosclerotic PAD
Received: 04/10/2018
Accepted: 23/10/2018

Full Paper (vol.741 paper# 24)

c:\work\Jor\vol741_25 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 170-176

Assessment of the effects of frequent ventricular extra systoles on the left
ventricle function using two-dimensional speckle tracking
echocardiography in apparently normal hearts

Sameh R. Allam, Mohamed Sami, Muhammad I. Azzam*
Department of Cardiovascular, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

*Corresponding author: Muhammad I. Azzam; Mobile: 01004363095; Email: muhamedazzam02@gmail.com

premature ventricular contractions are commonly seen within the general population and
frequently observed during clinical practice. In recent years studies have shown that athough PVCs was
considered as mostly benign, frequent PVCs without structural heart disease might lead to cardiac
dysfunction and even cardiomyopathy, more recent work has revealed that PVCs can contribute to
cardiomyopathy and heart failure and treating PVCs could lead to improved cardiac function.
Aim of the Work: the aim of this work was to assess the effect of ventricular extrasystoles (VESs) on
LV function by using 2D-STE for early detection of subtle LV dysfunction in patients with apparently
normal hearts and assess correlation between frequency of extrasystole and degree of impairment of
LV dysfunction. Patients and Methods: the ethical approval was obtained from the hospital ethical
research committee and each patient entering the study was signed an informed consent. Fifty patients were
included in this study with asymptomatic frequent PVCs. All were without structural heart disease. Detailed
history, physical examination, full labs, resting ECG, Holter monitoring for 24 hours, conventional ECHO
assessment and finally strain imaging with measurement of LV-GLS were done. They were recruited from
Cardiovascular Department at Sayed Galal University Hospitals during the period from December 2017 to
November 2018. In this study we assessed speckle tracking of LV in apparently normal patients with
frequent PVCs.
Results: early detection of subtle LV dysfunction was done by speckle tracking echocardiographic
modalities other than conventional echocardiographic and showed a significant correlation with PVCs
burden, focality, interpolated PVCs and duration of the complex of ectopic beat.Conclusion: frequent
PVCs may produce LV dysfunction and cardiomyopathy independently of any pre-existing underlying
cardiac disease and early detection of subtle LV dysfunction can be done by speckle tracking
echocardiographic modalities even in asymptomatic patient.
Keywords: echocardiography, premature ventricular contraction, interpolated PVCs, PVCs burden,
speckle tracking echocardiography.
PVCs were found in a healthy population
potentially reversible condition in which left
in only 0.6% of those <20 years of age and 2.7%
ventricular dysfunction is induced by frequent
of those >50 years of age on 12-lead ECGs,
PVCs and function improves on suppressing
about 50% of all people with or without heart
PVCs(3). The concept of PVC-induced
disease in longer term monitoring (1).Although
cardiomyopathy was first proposed by Duffee
PVCs was used considered as mostly benign,
and co-workers(4) who noticed a small group
long-term frequent PVCs may lead to several
of patients with cardiomyopathy recover
cardiac complication such as cardiomegaly,
normal left ventricular (LV) function after
cardiac hypofunction, and even PVC-induced
pharmacological suppression of frequent PVCs
cardiomyopathy in some patients, via
(5) . However, traditional echocardiographic
pathogenic mechanisms possibly involving
methods may not effectively evaluate subtle
ventricular systole desynchrony during PVCs,
and early forms of PVC-induced ventricular
shortened coupling intervals and post extra
systolic potentiation(2). Another work had
dimensional (2D) STE provided a new
revealed that PVCs can contribute to
convenient and non-invasive method for
cardiomyopathy and heart failure and treating
quantitative evaluation of cardiac function by
PVCs could lead to improved cardiac function.
allowing to measure strain values (6). Premature
ventricular complex-induced cardiomyopathy
Received: 05/10/2018
Accepted: 24/10/2018

Full Paper (vol.741 paper# 25)

c:\work\Jor\vol741_26 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 177-183
Prediction of Ipsilateral and Contralateral Cervical Lymph Node
Metastasis in Unilateral Papillary Thyroid Carcinoma

El Sayed R. Ahmed*, Said H. Bendary, Mohamed Esmat, Ibrahim M. Hasan

Department of General Surgery, Faculty of Medicine, Al Azhar University
*Corresponding author:El Sayed R. Ahmed ,Email: gogoseka1@gmail.com

Surgical therapy is the cornerstone of treatment in patients with papillary thyroid
cancer (PTC). Surgical therapy in PTC includes hemithyroidectomy or total thyroidectomy
(TT) and, in cases of lymph node metastases, cervical lymph node dissection (CLND). The
inclusion of prophylactic central compartment neck dissection (pCCND) as a new approach in
the management of patients with PTC with clinically negative cervical lymph nodes raised
controversies among the endocrine surgeons and predictive factors for central lymph node
(CLN) metastasis in unilateral PTC cases not well defined.
To investigate the risk factors associated with CLNM in clinical lateral cervical
lymph node-negative (cN0) and analyze the rate of ipsilateral and contralateral CLN metastasis
in unilateral PTC cases in Al Azhar University Hospitals in the period from May 2016 till June
Patients and Methods:
A prospective case-control descriptive study was performed to
investigate the research questions during the period from the 1st of May 2016 till the end of
June 2018 in Al-Azhar University Hospitals. A total of 04 selected patients suffering from
papillary thyroid with clinically negative cervical lymph nodes who have received total
thyroidectomy with bilateral CLND. The clinicopathological features of PTC patients with
respect to sex, age, observation, tumor diameter, multifocality, extrathyroidal invasion,
lymphovascular invasion and capsular invasion. The risk factors of CLNM were analyzed by
Chi-squared test and multivariate logistic regression model.
Ipsilateral CLN metastasis were present in 47.5% (19/40).Results analysis showed
that males patients with tumor size (>1 cm) (P=0.027; OR, 2.153), age <45 years old (P=0.017;
OR, 2.009) and capsular invasion (P= 0.018; OR= 0.730) were the predictors of ipsilateral CLN
metastasis.Contralateral CLN metastasis were present in 17.5% (7/40) and prelaryngeal lymph
node (LN) metastasis (P=0.008; OR, 13.333) and ipsilateral CLN metastasis (P=0.051; OR,
9.231), pretracheal lymph nodes (P=0.051; OR, 9.231), lymphovascular invasion (P=0.043;
OR, 5.113) and ETE (P=0.05; OR, 4.901) independently predicted contralateral CLN
Conclusion: For the high-risk PTC patients with CLNM, prophylactic CLND may be
beneficial. Nevertheless, the present data was a single center prospective analysis, and the long-
term prognostic factors including recurrence rate and mortality rate were lacking. Therefore,
the results of this research may only serve as a tool in predicting CLNM.
Keywords: central lymph node, central lymph node metastasis, thyroid papillary carcinoma

Papillary thyroid cancer (PTC) accounted
biopsy using fine-needle aspiration
for >90% of all the new thyroid cancers (1).
(FNAB) can be considered the first-line
PTC appears as an irregular solid or cystic
diagnostic procedure for detecting thyroid
mass or nodule in a normal thyroid
nodule. Surgery is the gold slandered
parenchyma. Although its differentiated
treatment of papillary thyroid cancer.
characteristics, papillary carcinoma may be
Approximately 4-6 weeks after surgical
overtly or minimally invasive. Papillary
thyroid removal, patients may have
tumors have a propensity to lymphatic
radioiodine therapy to detect and destroy
spread but are less likely to invade blood
any metastasis and residual tissue in the
vessels (2). The most common presentation
thyroid (4). The lymphatic drainage of the
of PTC is an asymptomatic thyroid nodule
thyroid and its pattern is relatively
or a palpable cervical lymph node (3). The
consistent, and the spread of lymph node
Received: 01/09/2018
Accepted: 25/09/2018

Full Paper (vol.741 paper# 26)

c:\work\Jor\vol741_27 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 184-192
Effect of Intramuscular Administration of Dexamethasone on Labour
Outcome in Induction of Primigravida at Late-Term Pregnancy

Eslam Elsayed Shehata, Mostafa Mohamed Zaitoun, Mohamed Naguib Azzam, Mohamed
Elhussiney Radwan
Obstetrics & Gynecology department, Faculty of Medicine ­Zagazig University, Egypt
Corresponding author: Eslam Elsayed Shehata,email:eslamshehata65@yahoo.com

Induction of labour is common in clinical practice and is usually troublesome in
primigravidas. Obestatricians are always in search of the best method of induction to ensure the best
maternal and fetal outcome.
Objectives: to evaluate the effect of dexamethasone on labor outcome and to establish whether
dexamethasone plays a role in shorting of the duration interval between initiation of labor induction and
beginning of the active phase of labor in primigravida late-term pregnancy.
Patients and methods: Case control study included 120 primigravidae with late-term pregnancy
classified into two groups: group I (cases) included 60 women assigned to receive a single 8-mg dose
of dexamethasone intra-muscular and group II (control) included 60 women will not receive
dexamethasone or any other cervical ripening agent.
Results: The interval between initiation of labor induction and beginning of active phase of labor was
shorter in the dexamethasone group than in the control group (2.54 ± 0.94 hours vs. 3.59 ± 0.86 hours;
p=0.001). Dexamethasone group showed shorter duration of active phase of labor than control group
(4.82 ± 0.56 hrs. vs. 5.12 ± 0.58 hrs.). Dexamethasone group showed shorter duration of first stage of
labor than control group (7.35 ± 1.15 hrs. vs. 8.69 ± 1.09 hrs.). Dexamethasone group showed faster
rate of cervical dilatation than control group (1.37 ± 0.18 cm/hr. vs. 1.28 ± 0.17 cm/hr.). Dexamethasone
group showed shorter duration of second stage of labor than control group (25.09 ± 12.99 minutes vs.
30.73 ± 12.96 minutes).
Conclusions: The administration of dexamethasone shortened labor duration with no significant
difference between the two groups involving the duration of the third stage of labour, the neonatal
outcome (meconium stained liquor, Apgar score at 1 minute and 5 minute birth weight, neonatal
admission to neonatal intensive care unit and number of cases with fetal heart rate disturbance) and
maternal complication.
Keywords: Dexamethasone, late-term pregnancy, induction of labor.


Induction of labour refers to the process of
The American College of Obstetricians and
artificially initiating uterine contractions prior
Gynecologists and the Society for Maternal-
to their spontaneous onset to affect progressive
Fetal Medicine (SMFM) are discouraging use
effacement and dilatation of the cervix and
of the general label `term pregnancy' and
ultimately, delivery of the baby (1). Induction of
replacing it with a series of more specific labels:
labour is one of the most common interventions
`early-term,' `full-term,' `late-term,' and `post-
practiced in modern obstetrics. In the developed
world, the ability to induce labor has
The following represent the four new
contributed to the reduction in maternal and
definitions of `term' deliveries:
perinatal morbidity and mortality (2). The goal
Early-Term: Between 370/7 weeks and 386/7
of labor induction is to stimulate uterine
contractions before the spontaneous onset of
Full-Term: Between 390/7 weeks and 406/7
labor, resulting in vaginal delivery. The benefits
of labor induction must be weighed against the
Late-Term: Between 410/7 weeks and 416/7
potential maternal and fetal risks associated
with this procedure. When the benefits of
Post-Term: Between 420/7 weeks and
expeditious delivery are greater than the risks of
beyond (4)
continuing the pregnancy, inducing labor can
be justified as a therapeutic intervention (3).
Received: 01/10/2018
Accepted: 20/10/2018

Full Paper (vol.741 paper# 27)

c:\work\Jor\vol741_28 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 193-207

Adjuvant Chemotherapy Treatment after Radical Cystectomy in Patients
with Muscle Invasive Bladder Cancer
Hassan Khaled Hamdy 1, Mohsen Salah El-Din Zekry 1, Sabri Mahmoud Khaled 2 and Sherif
Mohammed Mustafa Azzam 1*
1Clinical Oncology and Nuclear Medicine, and 2 Urology and Andrology Departments,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding Author: Sherif Mohammed Mustafa Azzam, E-mail: sherifazzam24@yahoo.com

about 25% of patients newly diagnosed with bladder cancer have muscle-invasive
bladder cancer (MIBC). Patients with MIBC have a worse prognosis than those with non-MIBC.
Radical cystectomy with pelvic lymphadenectomy has been shown to be effective against MIBC. The
pathologic stage of the primary tumor and regional lymph nodes status has been shown to be the most
accurate predictors of disease recurrence after radical cystectomy.
Aim of the Work: to evaluate the toxicity profile related to the adjuvant chemotherapy cisplatin,
gemcitabine when added to radical cystectomy as primary treatment, and to estimate disease free survival
(DFS) and overall survival (OS).
Patients and Methods: during the period between December 2013 and October, 2017, a total number
of 42 patients were included in this study at Clinical Oncology and Nuclear Medicine Department, Al-
Hussein University Hospital with a provisional diagnosis of invasive type bladder cancer. The cutoff
date for the analysis of overall survival was 31st April, 2018 corresponding to 6 months of follow-up
for the last patient enrolled in the study. All patients were subjected to radical cystectomy and pelvic
lymphadenectomy and received four cycles of adjuvant chemotherapy cisplatin 70mg/m2 D1,
gemcitabine 1000mg/m2 D1,8, every three weeks.
Results: the most common grade 3 and 4 adverse events of hematological and non-hematological toxicities
recorded during adjuvant chemotherapy were neutropenia (18.8%), grade 3 anemia (9.5%), grade 3
thrombocytopenia (2.3%), grade 3 nausea (28.5%), grade 3 and 4 vomiting (9.4%), grade 3 diarrhea (9.4%)
while grade 3 renal toxicities observed in two patients (4.7%). As regard the survival analysis, the median
disease-free survival (DFS) rate was not reached due to a relatively short follow up period and DFS was 82.9%
at 1 year, 74% at 2 years, and 70.1% at 3 years. Concerning overall survival analysis, the median overall
survival in our study was not reached due to a relatively short follow up period. Overall Survival rate at 1 year
was 90.4%; at 2 years was 77.3% and 73.4% at 3 years.
Conclusion: for patients with bladder cancer who were not treated with neoadjuvant chemotherapy, we suggest
not routinely administering chemotherapy following cystectomy. However, for patients with high-risk (T3 or
higher, pathologic node involvement) urothelial carcinomas who are candidates for cisplatin -based
combination chemotherapy and are willing to accept the risk for treatment-related toxicities in the absence of
high level of evidence, adjuvant chemotherapy is a reasonable option. If administered, we prefer to use a
cisplatin-based combination.
Keywords: Chemotherapy - Radical Cystectomy - Muscle Invasive Bladder


Radical cystectomy is the standard
anesthetic methods have reduced the morbidity
treatment for patients with muscle invasive
and mortality associated with surgery. Radical
bladder cancer. Five-year survival for patients
cystectomy provides an accurate evaluation of
with pT3-pT4a pN0 M0 bladder cancer after
both the primary bladder tumor and the regional
radical cystectomy is 35%-40%. In pN+
lymph nodes, allowing for adjuvant treatment
patients, five year survival is no more than 10%
strategies based on clear pathologic rather than
clinical staging (2).
Surgical approaches, including en bloc
Invasive bladder cancer is generally a
cystectomy, bilateral pelvic iliac lymph node
lethal disease requiring aggressive therapy,
dissection, and various forms of lower urinary
with fewer than 15% of untreated patients
tract reconstruction, have been developed to
surviving to 2 yr after diagnosis. The optimal
enhance survival in patients with MIBC.
goals of treatment for any invasive bladder
Improvements in medical, surgical, and
cancer include long-term survival, prevention
Received: 06/10/2018
Accepted: 25/10/2018

Full Paper (vol.741 paper# 28)

c:\work\Jor\vol741_29 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 208-214

Clinical Outcome of Cervical Key-Hole Foraminotomy for Monolevel
Cervical Radiculopathy

Samy Moussa Selim

Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

Corresponding auther: Samy Moussa Selim, E-mail: samy_seliem@yahoo.com, phone: 00966509776812, 00201113319187

Cervical degenerative disc disease is the most common cause of acquired disability in
patients over the age of 50. C6-C7 and C5-C6 are the most common levels involved in it. Radiculopathy
can be unilateral or bilateral and single level or multiple levels.
Objective: To know about the clinical outcome of cervical key-hole foraminotomy for monolevel
Materials and methods: This cross sectional study was conducted in neurosurgery department, Al
Qunfudah General Hospital, Saudi Arabia from January 2017 to December 2017. All admitted patients
with mono level cervical radiculopathy due to posterolateral prolapsed intervertebral disc (PIVD) or
bone spur who undergone key hole foraminotomy were included in this study, while patients with severe
cervical degenerative diseases, myelopathy, instability, trauma, infection, tumors of cervical spine were
excluded. Patients age, gender, level of cervical spine radiculopathy, pre-operative signs and
symptoms, Pre and post-operative complications with post-operative variation in clinical status were
recorded on a designed proforma. Minimum 1 month follow up was done.
Results: Total 20 patients were included in which there were 12 (60%) male and 8 (40 %) female with
mean age 45 years (32-65 yrs.). The mean duration of complaint was 11 months (6-17 months). In all
of these cases C6, C7 level involvement was the most common with total 8 (40%) patients. Complete
recovery was found in 18 (90%) patients and partial in 2 (10%) patients while there was unintended
durotomy in 1 (5%).
Minimally invasive posterior cervical foraminotomy for cervical radiculopathy is an
effective option in well selected patients in postero-lateral foraminal stenosis due to prolapsed
intervertebral disc and osteophytes formation.
Keywords: Cervical foraminotomy, Clinical outcome, Monolevel cervical radiculopathy.


Cervical radiculopathy is a condition
getting up in the morning without any
which is caused by compression or irritation of
identifiable stress or trauma (3,4).
cervical nerve root by soft cervical disc or bone
History and physical examination are
spurring from spondylosis. When the size of the
considered the main pillars while making the
cervical neural which formina reduces then it
diagnosis of cervical radiculopathy. Spurling
causes the inflammation of cervical nerve root.
test, upper limb tension test, cervical distraction
Clinically it presents in the form of neck pain,
test and ipsilateral cervical rotation reduction
upper limb pain, motor or sensory loss in upper
more than 60 degrees increases the likelihood
limbs depending upon the level of cervical root
of cervical radiculopathy if these test are
effected. The population which most
positive. If all tests are positive, then the
commonly effect from it is middle and old age
positive likelihood ratio (LR+) for diagnosis of
(1,2). Cervical degenerative disc disease is the
cervical radiculopathy will 30. It decreases to
most common cause of acquired disability in
6 when 3 of 4 tests are positive. Based on these
patients over the age of 50(3). C6-C7 and C5-C6
values a LR+ superior to 10 is considered large,
are the most common levels involved in it.
and between 5 and 10 moderate; thus, it
Radiculopathy can be unilateral or bilateral and
increases the possibility that the impairment in
single level or multiple levels. Since cervical
question is present. If we combine these clinical
disc herniation is more common than the spur
tests with history of patients then the diagnosis
compressing upon the cervical root therefore in
of cervical radiculopathy can be made more
clinical practice most of the patients gives the
accurately (5,6). Along with clinical diagnosis
scenario that there are symptoms to me on
many diagnostic tests are available to confirm
Received: 04/10/2018
Accepted: 23/10/2018

Full Paper (vol.741 paper# 29)

c:\work\Jor\vol741_30 The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 215-218

Detection of -Human Chorionic Gonadotrophin in Vaginal Fluid
For The Diagnosis of Preterm Premature Rupture of Membranes

* Ahmed Hamza Awad, ** Mohamed Ibrahim El-Mohandes,** Mahmoud Nahedd mushtaha
*Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, **Department
of Obstetrics and Gynecology, El-Galaa Maternity Teaching Hospital, Cairo.

The purpose of the present study is to evaluate -hCG in vaginal washing fluid for the
diagnosis of preterm premature rupture of membranes (PROM).
Methods: This clinical trial was carried out at El-Galaa Maternity Teaching Hospital. The study
included 100 women who were in their 3rd trimester of pregnancy. They were divided into 2 groups;
group (case group):
Pregnant women with definite history of premature rupture of membranes
confirmed by speculum examination as patients' (PROM) group. (n =50) and group (control group):
Pregnant women with no history of rupture of membranes as control group. (n = 50)
There was significant statistical difference in the prediction of PROM between the case group
and the control group.
Conclusion: The presence of vaginal HCG is highly predictive of membranes rupture and is a more
accurate diagnostic test than the amniotic fluid index (AFI) assessment in the diagnosis of ROM.
Keywords: -hCG, Premature Rupture of Membranes.


Premature rupture of the fetal membranes
Patient and methods:
(PROM) is defined as rupture of amniotic
This study was designed for pregnant women
membranes and amniotic fluid leakage, 1 h or
attending Al-Galaa Maternity Teaching
more prior to the onset of labor. PROM is
Hospital in their 3rd trimester of pregnancy
divided into two categories including term
with gestational age between 28 and 40 weeks
PROM (PROM after 37 weeks of gestation) and
from March 2018 to November 2018. The
preterm PROM (PPROM) (before 37 weeks of
study was approved by Al-Azhar University
gestation) (1 ).
Ethics Board.
PROM occurs in approximately 10% of all
This study included 100 pregnant women who
pregnancies after 37 weeks gestation and in 2-
were admitted to the hospital. They were
3.5% of pregnancies before 37 weeks gestation.
divided into 2 groups. Group (case group):
The diagnosis of rupture of the membranes
Pregnant women with definite history of
(ROM) may be made by clinical history and
premature rupture of membranes confirmed by
some simple diagnostic tests. Patient history is
speculum examination as patients' (PROM)
accurate for about 90% for the diagnosis and
group. (n =50). Group (control group):
should not be ignored (2).
Pregnant women with no history of rupture of
Regarding the necessity for accurate diagnosis
membranes as control group. (n = 50)
of preterm premature rupture of membranes

(PPROM), several diagnostic tests have been
Study Procedures:
suggested. Nitrazine test, fern test, and
- Informed consent for study procedure and
ultrasound have been considered as very useful
patient counseling
tests (3).
- History taking for last menstrual period, leak
Biochemical tests have also been suggested, but
of vaginal fluid and labor pain, take sure dates
should only be performed in cases of very
and early ultrasound document if unsure of
suspicious ROM, which other simple tests may
not diagnose accurately. One of biochemical
- General examination for blood pressure,
materials (substances) which have high
concentrations in amniotic fluid is -human
chorionic gonadotropin (-hCG), which is
- Sterile Cusco speculum examination.
secreted solely by syncytiotrophoblasts and can
be found in mother's blood or urine and has
gestational age and amniotic fluid index (AFI)
been studied for the evaluation of ROM (4).
calculation for correlation with the diagnosis
Received: 03/10/2018
Accepted: 22/10/2018

Full Paper (vol.741 paper# 30)